A 36-year-old male patient arrived at the ENT Emergency Department (EED) with extreme pain in his... more A 36-year-old male patient arrived at the ENT Emergency Department (EED) with extreme pain in his left ear and a long history of left acute otitis media and noise exposure. The patient reported several weeks of persistent otalgia, left-sided hearing loss, and a sudden-onset left-sided facial weakness. Clinical findings and diagnostic assessments On examination, only erythema of the external auditory canal and a purulent effusion from the perforated left eardrum was detected. A mild peripheral left-sided facial palsy was detected and categorized as House-Brackmann (HB) grade 2/6. The function of other cranial nerves was normal. The initial neurological screening done before presentation in the EED was unremarkable. With the preliminary diagnosis of acute otitis media compli
Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u r... more Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u razdoblju 1997.-2006. i usporediti je s ucestaloscu u Republici Hrvatskoj. Retrospektivnim istraživanem prikupljeni su podaci iz arhiva bolnica i Zavoda za javno zdravstvo županije Splitsko-dalmatinske i Hrvatskog registra za rak. Dobno standardizirana stopa ucestalosti na 100.000 izracunata je iz broja bolesnika s karcinomom stitne žlijezde i broja stanovnika. U razdoblju 1997.-2006. na podrucju Splitsko-dalmatinske županije je bilo 503 bolesnika s novodijagnosticiranim karcinomom stitnjace(401 žena i 102 muskarca. Papilarni karcinom dijagnosticiran je u 86, 1%, folikularni u 9, 5%, medularni u 4, 2% i anaplasticni u 0, 2% slucajeva. Dobno standardizirana stopa ucestalosti za karcinom stitnjace na 100.000 stanovnika u Hrvatskoj bila je 8, 5 (žene 13, 5, muskarci 3, 5) u 2003. Stopa ucestalosti karcinoma stitnjace u Splitsko-dalmatinskoj županiji porasla je s 8, 2 (žene 13, 5, muskarci 2, 7) u 1997. na 11, 5 u 2006. godini (žene 15, 6 ; muskarci 7, 1). U razdoblju 1997.-2006. godine u Splitsko-dalmatinskoj županiji i cijeloj Hrvatskoj uocava se povecana ucestalost karcinoma stitnjace. Karcinom stitnjace cetiri puta je cesci u žena nego u muskaraca.
Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su pona... more Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su ponajprije otorinolaringolozima, specijalistima hitne medicine, liječnicima obiteljske medicine, te ostalim liječnicima u Republici Hrvatskoj koji skrbe o bolesnicima s vrtoglavicom i gubitkom ravnoteže, u primarnoj i bolničkoj zdravstvenoj zaštiti. U izradi smjernica sudjelovali su predstavnici Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata (HD ORL), te predstavnica Hrvatskog neurološkog društva. Prepoznati uzrok akutne vrtoglavice u praksi otežava činjenica da se simptomi oštećenja u različitim organskim sustavima preklapaju, nejasni su i djeluju dramatično. Cilj ovih smjernica je pomoć pri postavljanju dijagnoze kod bolesnika s izraženim simptomima vrtoglavice i pravodobno razlikovanje benigne od životno ugrožavajuće vrtoglavice koja zahtijeva hitno, bolničko liječenje. Smjernice sadrže i detaljne algoritme koji preporučuju postupanja s bolesnikom s napadajem akutne vrtoglavice i gubitkom ravnoteže.
Aim: To inestigate the incidence of thyroid cancer in the Split-Dalmatia County in the 1997-2006 ... more Aim: To inestigate the incidence of thyroid cancer in the Split-Dalmatia County in the 1997-2006 period, and compare it with the incidence in the Republic of Croatia. Methods: The study was retrospectively. The data were obtained using case records of all hospitals and Public Health Institute in the County and the Croatian Cancer Registry. Age-standardized incidence per 100.000 was calculated from the number of patients with thyroid cancer and the number of inhabitants. Results: There were 503 new cases of thyroid cancer (401 women and 102 men) in the Split-Dalmatia County during 1997-2006 period. Papillary carcinoma was diagnosed in 86, 1% cases, follicular adenocarcinoma in 9, 5% cases, medular carcinoma in 4, 2% cases, and anaplastic carcinoma in 0, 2%. Age-standardized incidence rate for thyroid cancer per 100.000 population in Croatia were 8.5 (women 13.3, men 2.7) in 2003. The thyroid cancer incidence rate in Split-Dalmatia County increased from 8.2 (women 13.5, men 2.7) in 1997 to 11.5 in 2006 (women 15.6, men 7.1). Conclusion: There was increase in the reported incidence of thyroid cancer in the Split-Dalmatia County and in whole Croatia in the 1997-2006 period. Thyroid cancer was more common in females than in males.
Granulomatosis with polyangiitis (GPA) is a chronic and systematic autoimmune condition character... more Granulomatosis with polyangiitis (GPA) is a chronic and systematic autoimmune condition characterized by granuloma formation and necrotizing vasculitis of small to medium-sized vessels. GPA initially presents itself as respiratory and renal symptoms. Although temporal bone involvement is not uncommon, an otologic disorder is rarely the initial symptom. We present a case of a 36-year-old man who presented with unilateral ear pain, hearing loss, and facial palsy. After a series of diagnostics and temporal bone and chest imaging, he was diagnosed with GPA with multiorgan involvement. Cyclophosphamide and methylprednisolone relieved the patient’s ear pain and partially improved his hearing, facial palsy, and overall clinical condition. Although uncommon, systemic GPA may cause initial otologic symptoms and should not be dismissed as a possible cause of an otologic disease resistant to standard therapy.
Introduction: Malignant otitis externa (MOE) is commonly presented as invasive external otitis re... more Introduction: Malignant otitis externa (MOE) is commonly presented as invasive external otitis resistant to local treatment that classically affects elderly diabetic patients. Case presentation: We presented a 55-year-old man with a history of diabetes mellitus (DM) and ear scratching, initially manifesting with left-sided nocturnal otalgia, purulent otorrhea, and external auditory canal (EAC) edema. A diagnosis of MOE was made based on Levenson's criteria and radiological findings. Antibiotics were given intravenously based on bacterial cultures from ear swabs, with repeated cultures growing Escherichia coli (E. coli). The patient's MOE caused by E. coli improved after two months of ear toilets, DM management, parenteral and local antibiotics, and hyperbaric oxygen therapy (HBOT). We detected that the MOE was caused by self-inflicted local trauma to the EAC on the same side as the dominant hand. Conclusion: The isolation of E. coli from the EAC as the causative organism of ...
Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disorder characterized by necro... more Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disorder characterized by necrotizing vasculitis of small to medium-sized-vessels and granuloma formation. GPA is commonly initially presented with respiratory and renal symptoms. Although involvement of the temporal bone is not unusual, an otologic disorder is rarely the presenting symptom. We present a case of a 36-year-old patient complaining of severe ear pain, hearing loss and unilateral facial palsy. After comprehensive clinical diagnostics and temporal bone and chest imaging, a multiorgan involving form of GPA was diagnosed. The patient was treated with cyclophosphamide and methylprednisolone which resulted in amelioration of ear pain, improvement of hearing loss, partial resolution of facial palsy and altogether clinical improvement of the patient. Although infrequently, systemic GPA can initially present with otologic symptoms and should not be overlooked as a possible cause of an otologic disorder resilient ...
This is a unique presentation of an acute vestibular syndrome (AVS) caused by vestibular neuronit... more This is a unique presentation of an acute vestibular syndrome (AVS) caused by vestibular neuronitis (VN) of a vestibular nerve (CNVIII) already affected by vestibular schwannoma (VS). A 48-year-old patient, formerly diagnosed with an intracanalicular VS, presented with AVS. The patient underwent clinical and neurotological examination including video Head Impulse Test and a 4-hour delayed-enhanced 3D-FLAIR MRI using intravenous gadolinium. Clinical and neurotological findings were consistent with VN of the CNVIII formerly diagnosed with VS. A 4-hour delayed-enhanced 3D-FLAIR MRI showed significant enhancement of the labyrinth also indicating VN of the same nerve affected by VS. Pragmatic corticosteroid therapy and vestibular exercises were applied resulting in satisfactory recovery of the patient. As vestibular symptoms are common in VS patients, investigating another cause of dizziness and vertigo in VS patients can be marginalized. Nevertheless, VS presenting as AVS is very unusual. VN should not be overlooked as a possible cause of acute vertigo in a patient previously diagnosed with VS.
Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u r... more Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u razdoblju 1997.-2006. i usporediti je s ucestaloscu u Republici Hrvatskoj. Retrospektivnim istraživanem prikupljeni su podaci iz arhiva bolnica i Zavoda za javno zdravstvo županije Splitsko-dalmatinske i Hrvatskog registra za rak. Dobno standardizirana stopa ucestalosti na 100.000 izracunata je iz broja bolesnika s karcinomom stitne žlijezde i broja stanovnika. U razdoblju 1997.-2006. na podrucju Splitsko-dalmatinske županije je bilo 503 bolesnika s novodijagnosticiranim karcinomom stitnjace(401 žena i 102 muskarca. Papilarni karcinom dijagnosticiran je u 86, 1%, folikularni u 9, 5%, medularni u 4, 2% i anaplasticni u 0, 2% slucajeva. Dobno standardizirana stopa ucestalosti za karcinom stitnjace na 100.000 stanovnika u Hrvatskoj bila je 8, 5 (žene 13, 5, muskarci 3, 5) u 2003. Stopa ucestalosti karcinoma stitnjace u Splitsko-dalmatinskoj županiji porasla je s 8, 2 (žene 13, 5, muskarci 2,...
društva za vestibularnu rehabilitaciju Hrvatskoga liječničkog zbora Deskriptori VESTIBULARNI PORE... more društva za vestibularnu rehabilitaciju Hrvatskoga liječničkog zbora Deskriptori VESTIBULARNI POREMEĆAJI-dijagnoza, etiologija, rehabilitacija; VESTIBULARNI LABIRINT-patofiziologija; VRTOGLAVICA-etiologija, rehabilitacija; VESTIBULARNI FUNKCIJSKI TESTOVI; VESTIBULO-OKULARNI REFLEKS; TERAPIJSKE VJEŽBE-metode; SMJERNICE; HRVATSKA SAŽETAK. Vestibularna rehabilitacija jest planirani, individualno prilagođen sustav vježbi kojima se ubrzava proces središnje kompenzacije oštećenoga vestibularnog sustava. U medicinu ju uvode Cawthorne i Cooksey sredinom prošloga stoljeća. Godinama su postojali prijepori o značenju i učinkovitosti ovoga načina liječenja. Provedene su brojne randomizirane prospektivne kliničke studije, koje su dokazale važnost vestibularnih vježbi, kao i njihov povoljan učinak na brzinu i stupanj oporavka bolesnika, tako da one posljednjih desetljeća zauzimaju sve značajnije mjesto u liječenju vrtoglavica. Vestibularna hipofunkcija, bilo da je riječ o akutnome ili kroničnom poremećaju, ili pak o jednostranome ili obostranom oštećenju, predstavlja dosta čest problem za liječnika praktičara, osobito onoga koji se bavi problemima vrtoglavica. Premda je vestibularna rehabilitacija za većinu poremećaja ravnoteže metoda izbora u liječenju, ona je kod nas još uvijek podosta zapostavljena i neopravdano podcijenjena. Cilj ovih Smjernica za kliničku praksu jest pomoći liječnicima i fizioterapeutima pri ujednačavanju pristupa pacijentima s jednostranim i obostranim vestibularnim oštećenjima, izbjegavajući nepotrebne varijacije u primjeni vestibularnih vježbi. One nisu udžbenik niti jedini i neupitni izvor znanja, već pružaju okvir za strategiju kod donošenja odluka, ne zamjenjujući pritom značenje kliničke prosudbe. Vestibularnim vježbama značajno se ubrzava oporavak bolesnika s vestibularnom hipofunkcijom i njihov povratak uobičajenim životnim aktivnostima. Svrha ovih Smjernica jest utvrditi koga, kada, kako i koliko dugo liječiti, kao i kako otkloniti nepotrebne varijacije u pristupu rehabilitaciji pacijenata s vestibularnom hipofunkcijom. One se zasnivaju na dokazima dobivenim metaanalizom podataka iz dostupne medicinske literature, oslanjajući se pored toga i na naše dugogodišnje iskustvo u radu s vertiginoznim pacijentima.
Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su pona... more Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su ponajprije otorinolaringolozima, specijalistima hitne medicine, liječnicima obiteljske medicine, te ostalim liječnicima u Republici Hrvatskoj koji skrbe o bolesnicima s vrtoglavicom i gubitkom ravnoteže, u primarnoj i bolničkoj zdravstvenoj zaštiti. U izradi smjernica sudjelovali su predstavnici Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata (HD ORL), te predstavnica Hrvatskog neurološkog društva. Prepoznati uzrok akutne vrtoglavice u praksi otežava činjenica da se simptomi oštećenja u različitim organskim sustavima preklapaju, nejasni su i djeluju dramatično. Cilj ovih smjernica je pomoć pri postavljanju dijagnoze kod bolesnika s izraženim simptomima vrtoglavice i pravodobno razlikovanje benigne od životno ugrožavajuće vrtoglavice koja zahtijeva hitno, bolničko liječenje. Smjernice sadrže i detaljne algoritme koji preporučuju postupanja s bolesnikom s napadajem akutne vrtoglavice i gubitkom ravnoteže.
Hereditarni angioedem-dijagnoza, patofiziologija, farmakoterapija, prevencija; Protein inhibitor ... more Hereditarni angioedem-dijagnoza, patofiziologija, farmakoterapija, prevencija; Protein inhibitor C1-analiza, terapijska primjena; Komplement C1-antagonisti i inhibitori; Bradikininski B2 receptor-antagonisti i inhibitori; Bradikinin-analozi i derivati; Smjernice; Hrvatska Sa`etak. Hereditarni angioedem (HAE) rijetka je, ali potencijalno za `ivot opasna bolest zbog nepredvidivih napadaja bezbolnih, ograni~enih, recidiviraju}ih otoka supkutanog ili submukoznog, intersticijskog tkiva u trajanju od nekoliko sati do nekoliko dana. Oboljelih od HAE u RH ima oko 100 (ali vjerojatno ima vi{e nedijagnosticiranih). Poseban kvalitativni napredak u uskla|ivanju dogovora o lije~enju HAE jesu Smjernice Svjetske alergolo{ke organizacije koje su donesene 2012. Oslanjaju}i se na taj dokument, Radna grupa hrvatskih stru~njaka pripremila je prijedlog smjernica za lije~enje HAE u Hrvatskoj. Napadaji angioedema u HAE posljedica su mutacije gena za plazmatski protein inhibitor C 1. Zbog manjka inhibitora ili njegove disfunkcionalnosti dolazi do okida~em (trigerom) potaknute autoaktivacije C1 i cijele kaskade s kona~no pove}anom propusno{}u krvnih `ila i edemom tkiva. Postoje tri tipa hereditarnog angioedema: tip I uzrokovan sni`enom razinom C 1 inh proteina, tip II uzrokovan proizvodnjom nefunkcionalnog C 1 inh proteina te tip III karakteriziran normalnom funkcijom i razinom C 1 inh. U svih bolesnika sa sumnjom na HAE mora se odrediti nivo C4 i inhibitora C1, kao i funkcija inhibitora C1. Lije~enje akutne atake HAE: Svi napadaji angioedema koji onesposobe dijelove tijela i/ili zahva}aju lice, vrat, trbuh, a pogotovo gornje di{ne putove zahtijevaju lije~enje. Terapija mora biti odmah dostupna (On-Demand Treatment). U akutnoj ataci treba odmah primijeniti koncentrat inhibitora C1 (dobiven iz plazme ili rekombinantni), ikatibant ili ekalantid. Ako ovi lijekovi nisu dostupni, akutni napadaji edema mogu se lije~iti plazmom obra|enom detergentom. Ako se ovakva plazma ne mo`e dobiti, angioedemi se lije~e svje`e smrznutom plazmom. Intubacija ili traheotomija moraju se izvesti na vrijeme ako progredira edem gornjih di{nih putova. U napadaju angioedema bolesnik mo`e dobiti i adjuvantnu terapiju (analgetike, infuzije). Preporu~uje se da svi bolesnici uvijek nose sa sobom lijekove za samoprimjenu. Preporu~ljiva je kratkoro~na profilaksa edema prije kirur{kih zahvata (osobito stomatolo{kih zahvata), zahvata u kojima je potrebna endotrahealna intubacija, zahvata na gornjim di{nim putovima ili farinksu te prije bronhoskopije i endoskopije. Dugoro~na profilaksa indicirana je ako se javi jedna ili vi{e te`ih ataka angioedema na mjesec. Kao dugoro~na profilaksa mogu se rabiti koncentrat inhibitora C1 ili androgeni. Probir djece za HAE trebalo bi odgoditi do 12. mjeseca `ivota. Sve potomke bolesnika treba testirati. Descriptors: Angioedemas, hereditary-diagnosis, physiopathology, drug therapy, prevention and control; Complement C1 inhibitor protein-analysis, therapeutic use, administration and dosage; Complement C1-antagonists and inhibitors; Receptor, bradykinin B2-antagonists and inhibitors; Bradykinin-analogs and derivatives; Practice guidelines as topic; Croatia Summary. Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, nonerythematous, and not pruritic swelling which can affect the hands, feet, face, genitals and visceral mucosa. The type, frequency, and severity of the attacks vary between patients, and over the lifetime of an individual patient. Efforts in Croatian counties have identified approximately 100 patients (but there must be more undiagnosed patients). The first global guideline for the management of HAE was developed by the World Allergy Organization HAE International Alliance and published in 2012. Based on that document the Working group of Croatian experts was assigned to propose guideline for HAE management in * Odjel za klini~ku imunologiju, pulmologiju i reumatologiju Klinike za unutra{nje bolesti Medicinskog fakulteta Sveu~ili{ta u Zagrebu, KB »Sveti Duh«, Zagreb (prof. dr. sc. Asja Stipi} Markovi}, dr. med.), Klinika za pedijatriju Medicinskog fakulteta Sveu~ili{ta u Rijeci, KBC Rijeka (prof. dr. sc. Vojko Ro`mani}, dr. med.; Barbara Kveni}, dr. med.), Zavod za klini~ku imunologiju i reumatske bolesti Klinike za unutra{nje bolesti Medicinskog fakulteta Sveu~ili{ta u Zagrebu, KBC Zagreb, Zagreb (prof. dr. sc. Branimir Ani}, dr. med.; Boris Karanovi}, dr. med.), Pedijatrijski odjel OB »Josip Ben~evi}«, Slavonski Brod (prof. dr. sc. Neda Aberle, dr. med.), ORL klinika Medicinskog fakulteta u Splitu, KBC Split, Split (prof. dr. sc. Goran Ra~i}, dr. med.; Davor Sunara, dr. med.), Odjel za klini~ku imunologiju i reumatologiju Interne klinike Medicinskog fa kulteta Sveu~ili{ta u Rijeci, KBC Rijeka (prof. dr. sc. Sr|an Novak, dr. med.), ORL odjel OB Pula, Pula (Boris Grdini}, dr. med.), ORL odjel OB [ibenik, [ibenik (Ljerka Karad`a-Lapi}, dr. med.), Gastroenterolo{ki odjel Internog odjela, OB Zadar, Zadar (Melanija Ra`ov Radas, dr. med.
Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, non... more Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, nonerythematous, and not pruritic swelling which can affect the hands, feet, face, genitals and visceral mucosa. The type, frequency, and severity of the attacks vary between patients, and over the lifetime of an individual patient. Efforts in Croatian counties have identified approximately 100 patients (but there must be more undiagnosed patients). The first global guideline for the management of HAE was developed by the World Allergy Organization HAE International Alliance and published in 2012. Based on that document the Working group of Croatian experts was assigned to propose guideline for HAE management in Croatia. HAE is is most often related to decreased or dysfunctional C1 inh with autoactivation of C1 and bradykinin accumulation leading to localized dilatation and increased permeability of blood vessels resulting in tissue swelling. A diagnosis of HAE can be confirmed by measuring...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2011
To determine epidemiological characteristics of thyroid carcinoma in Dalmatia, and to compare the... more To determine epidemiological characteristics of thyroid carcinoma in Dalmatia, and to compare the incidence rate in Dalmatia with that in Croatia. Retrospective epidemiological study. Epidemiological indicators of thyroid carcinoma were compared between Dalmatia and Croatia as a whole, while some epidemiological indicators were compared with the characteristics of persons suffering from thyroid carcinoma in Croatia. The study included 651 persons suffering from and/or operated for thyroid carcinoma in Dalmatia between 1997 and 2006. Data were obtained from case histories, including the results of histopathologic analysis. The area of Dalmatia includes Zadar, Sibenik-Knin, Split-Dalmatia and Dubrovnik-Neretva counties (overall 861,060 inhabitants, surface 11,960 square kilometers). The incidence of thyroid carcinoma in Dalmatia ranged from 5.2 (1997) to 10.2 per 100,000 inhabitants (2006). The mean age adjusted incidence rate of thyroid cancer in the last 10 years was 8.1 in Croatia ...
A case of a three-year-old male child who was admitted to our hospital with the suspicion that he... more A case of a three-year-old male child who was admitted to our hospital with the suspicion that he had swallowed a battery approximately one hour before admittance. The parents believed that it was a button-shaped lithium battery approximately 12 mm in diameter. A chest X-ray was taken immediately, and a battery was identified in the esophagus at the fifth thoracic vertebra. By reviewing the child's medical history, we found that the child had had surgery the day after birth due to congenital atresia of the esophagus and a tracheoesophageal fistula type III b. An esophagoscopy was performed one hour after admittance, and the battery was found to be partially past the scar from the first surgery. Because of that, the battery was pushed further toward the stomach, out of fear that retrieving the battery through the scarred section of the child's esophagus could damage the stenotic wall. Upon the next X-ray of the abdomen, the battery was observed in the stomach. The child was m...
A 36-year-old male patient arrived at the ENT Emergency Department (EED) with extreme pain in his... more A 36-year-old male patient arrived at the ENT Emergency Department (EED) with extreme pain in his left ear and a long history of left acute otitis media and noise exposure. The patient reported several weeks of persistent otalgia, left-sided hearing loss, and a sudden-onset left-sided facial weakness. Clinical findings and diagnostic assessments On examination, only erythema of the external auditory canal and a purulent effusion from the perforated left eardrum was detected. A mild peripheral left-sided facial palsy was detected and categorized as House-Brackmann (HB) grade 2/6. The function of other cranial nerves was normal. The initial neurological screening done before presentation in the EED was unremarkable. With the preliminary diagnosis of acute otitis media compli
Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u r... more Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u razdoblju 1997.-2006. i usporediti je s ucestaloscu u Republici Hrvatskoj. Retrospektivnim istraživanem prikupljeni su podaci iz arhiva bolnica i Zavoda za javno zdravstvo županije Splitsko-dalmatinske i Hrvatskog registra za rak. Dobno standardizirana stopa ucestalosti na 100.000 izracunata je iz broja bolesnika s karcinomom stitne žlijezde i broja stanovnika. U razdoblju 1997.-2006. na podrucju Splitsko-dalmatinske županije je bilo 503 bolesnika s novodijagnosticiranim karcinomom stitnjace(401 žena i 102 muskarca. Papilarni karcinom dijagnosticiran je u 86, 1%, folikularni u 9, 5%, medularni u 4, 2% i anaplasticni u 0, 2% slucajeva. Dobno standardizirana stopa ucestalosti za karcinom stitnjace na 100.000 stanovnika u Hrvatskoj bila je 8, 5 (žene 13, 5, muskarci 3, 5) u 2003. Stopa ucestalosti karcinoma stitnjace u Splitsko-dalmatinskoj županiji porasla je s 8, 2 (žene 13, 5, muskarci 2, 7) u 1997. na 11, 5 u 2006. godini (žene 15, 6 ; muskarci 7, 1). U razdoblju 1997.-2006. godine u Splitsko-dalmatinskoj županiji i cijeloj Hrvatskoj uocava se povecana ucestalost karcinoma stitnjace. Karcinom stitnjace cetiri puta je cesci u žena nego u muskaraca.
Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su pona... more Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su ponajprije otorinolaringolozima, specijalistima hitne medicine, liječnicima obiteljske medicine, te ostalim liječnicima u Republici Hrvatskoj koji skrbe o bolesnicima s vrtoglavicom i gubitkom ravnoteže, u primarnoj i bolničkoj zdravstvenoj zaštiti. U izradi smjernica sudjelovali su predstavnici Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata (HD ORL), te predstavnica Hrvatskog neurološkog društva. Prepoznati uzrok akutne vrtoglavice u praksi otežava činjenica da se simptomi oštećenja u različitim organskim sustavima preklapaju, nejasni su i djeluju dramatično. Cilj ovih smjernica je pomoć pri postavljanju dijagnoze kod bolesnika s izraženim simptomima vrtoglavice i pravodobno razlikovanje benigne od životno ugrožavajuće vrtoglavice koja zahtijeva hitno, bolničko liječenje. Smjernice sadrže i detaljne algoritme koji preporučuju postupanja s bolesnikom s napadajem akutne vrtoglavice i gubitkom ravnoteže.
Aim: To inestigate the incidence of thyroid cancer in the Split-Dalmatia County in the 1997-2006 ... more Aim: To inestigate the incidence of thyroid cancer in the Split-Dalmatia County in the 1997-2006 period, and compare it with the incidence in the Republic of Croatia. Methods: The study was retrospectively. The data were obtained using case records of all hospitals and Public Health Institute in the County and the Croatian Cancer Registry. Age-standardized incidence per 100.000 was calculated from the number of patients with thyroid cancer and the number of inhabitants. Results: There were 503 new cases of thyroid cancer (401 women and 102 men) in the Split-Dalmatia County during 1997-2006 period. Papillary carcinoma was diagnosed in 86, 1% cases, follicular adenocarcinoma in 9, 5% cases, medular carcinoma in 4, 2% cases, and anaplastic carcinoma in 0, 2%. Age-standardized incidence rate for thyroid cancer per 100.000 population in Croatia were 8.5 (women 13.3, men 2.7) in 2003. The thyroid cancer incidence rate in Split-Dalmatia County increased from 8.2 (women 13.5, men 2.7) in 1997 to 11.5 in 2006 (women 15.6, men 7.1). Conclusion: There was increase in the reported incidence of thyroid cancer in the Split-Dalmatia County and in whole Croatia in the 1997-2006 period. Thyroid cancer was more common in females than in males.
Granulomatosis with polyangiitis (GPA) is a chronic and systematic autoimmune condition character... more Granulomatosis with polyangiitis (GPA) is a chronic and systematic autoimmune condition characterized by granuloma formation and necrotizing vasculitis of small to medium-sized vessels. GPA initially presents itself as respiratory and renal symptoms. Although temporal bone involvement is not uncommon, an otologic disorder is rarely the initial symptom. We present a case of a 36-year-old man who presented with unilateral ear pain, hearing loss, and facial palsy. After a series of diagnostics and temporal bone and chest imaging, he was diagnosed with GPA with multiorgan involvement. Cyclophosphamide and methylprednisolone relieved the patient’s ear pain and partially improved his hearing, facial palsy, and overall clinical condition. Although uncommon, systemic GPA may cause initial otologic symptoms and should not be dismissed as a possible cause of an otologic disease resistant to standard therapy.
Introduction: Malignant otitis externa (MOE) is commonly presented as invasive external otitis re... more Introduction: Malignant otitis externa (MOE) is commonly presented as invasive external otitis resistant to local treatment that classically affects elderly diabetic patients. Case presentation: We presented a 55-year-old man with a history of diabetes mellitus (DM) and ear scratching, initially manifesting with left-sided nocturnal otalgia, purulent otorrhea, and external auditory canal (EAC) edema. A diagnosis of MOE was made based on Levenson's criteria and radiological findings. Antibiotics were given intravenously based on bacterial cultures from ear swabs, with repeated cultures growing Escherichia coli (E. coli). The patient's MOE caused by E. coli improved after two months of ear toilets, DM management, parenteral and local antibiotics, and hyperbaric oxygen therapy (HBOT). We detected that the MOE was caused by self-inflicted local trauma to the EAC on the same side as the dominant hand. Conclusion: The isolation of E. coli from the EAC as the causative organism of ...
Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disorder characterized by necro... more Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disorder characterized by necrotizing vasculitis of small to medium-sized-vessels and granuloma formation. GPA is commonly initially presented with respiratory and renal symptoms. Although involvement of the temporal bone is not unusual, an otologic disorder is rarely the presenting symptom. We present a case of a 36-year-old patient complaining of severe ear pain, hearing loss and unilateral facial palsy. After comprehensive clinical diagnostics and temporal bone and chest imaging, a multiorgan involving form of GPA was diagnosed. The patient was treated with cyclophosphamide and methylprednisolone which resulted in amelioration of ear pain, improvement of hearing loss, partial resolution of facial palsy and altogether clinical improvement of the patient. Although infrequently, systemic GPA can initially present with otologic symptoms and should not be overlooked as a possible cause of an otologic disorder resilient ...
This is a unique presentation of an acute vestibular syndrome (AVS) caused by vestibular neuronit... more This is a unique presentation of an acute vestibular syndrome (AVS) caused by vestibular neuronitis (VN) of a vestibular nerve (CNVIII) already affected by vestibular schwannoma (VS). A 48-year-old patient, formerly diagnosed with an intracanalicular VS, presented with AVS. The patient underwent clinical and neurotological examination including video Head Impulse Test and a 4-hour delayed-enhanced 3D-FLAIR MRI using intravenous gadolinium. Clinical and neurotological findings were consistent with VN of the CNVIII formerly diagnosed with VS. A 4-hour delayed-enhanced 3D-FLAIR MRI showed significant enhancement of the labyrinth also indicating VN of the same nerve affected by VS. Pragmatic corticosteroid therapy and vestibular exercises were applied resulting in satisfactory recovery of the patient. As vestibular symptoms are common in VS patients, investigating another cause of dizziness and vertigo in VS patients can be marginalized. Nevertheless, VS presenting as AVS is very unusual. VN should not be overlooked as a possible cause of acute vertigo in a patient previously diagnosed with VS.
Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u r... more Cilj studije bio je istražiti ucestalost karcinoma stitnjace u Splitsko-dalmatinskoj županiji u razdoblju 1997.-2006. i usporediti je s ucestaloscu u Republici Hrvatskoj. Retrospektivnim istraživanem prikupljeni su podaci iz arhiva bolnica i Zavoda za javno zdravstvo županije Splitsko-dalmatinske i Hrvatskog registra za rak. Dobno standardizirana stopa ucestalosti na 100.000 izracunata je iz broja bolesnika s karcinomom stitne žlijezde i broja stanovnika. U razdoblju 1997.-2006. na podrucju Splitsko-dalmatinske županije je bilo 503 bolesnika s novodijagnosticiranim karcinomom stitnjace(401 žena i 102 muskarca. Papilarni karcinom dijagnosticiran je u 86, 1%, folikularni u 9, 5%, medularni u 4, 2% i anaplasticni u 0, 2% slucajeva. Dobno standardizirana stopa ucestalosti za karcinom stitnjace na 100.000 stanovnika u Hrvatskoj bila je 8, 5 (žene 13, 5, muskarci 3, 5) u 2003. Stopa ucestalosti karcinoma stitnjace u Splitsko-dalmatinskoj županiji porasla je s 8, 2 (žene 13, 5, muskarci 2,...
društva za vestibularnu rehabilitaciju Hrvatskoga liječničkog zbora Deskriptori VESTIBULARNI PORE... more društva za vestibularnu rehabilitaciju Hrvatskoga liječničkog zbora Deskriptori VESTIBULARNI POREMEĆAJI-dijagnoza, etiologija, rehabilitacija; VESTIBULARNI LABIRINT-patofiziologija; VRTOGLAVICA-etiologija, rehabilitacija; VESTIBULARNI FUNKCIJSKI TESTOVI; VESTIBULO-OKULARNI REFLEKS; TERAPIJSKE VJEŽBE-metode; SMJERNICE; HRVATSKA SAŽETAK. Vestibularna rehabilitacija jest planirani, individualno prilagođen sustav vježbi kojima se ubrzava proces središnje kompenzacije oštećenoga vestibularnog sustava. U medicinu ju uvode Cawthorne i Cooksey sredinom prošloga stoljeća. Godinama su postojali prijepori o značenju i učinkovitosti ovoga načina liječenja. Provedene su brojne randomizirane prospektivne kliničke studije, koje su dokazale važnost vestibularnih vježbi, kao i njihov povoljan učinak na brzinu i stupanj oporavka bolesnika, tako da one posljednjih desetljeća zauzimaju sve značajnije mjesto u liječenju vrtoglavica. Vestibularna hipofunkcija, bilo da je riječ o akutnome ili kroničnom poremećaju, ili pak o jednostranome ili obostranom oštećenju, predstavlja dosta čest problem za liječnika praktičara, osobito onoga koji se bavi problemima vrtoglavica. Premda je vestibularna rehabilitacija za većinu poremećaja ravnoteže metoda izbora u liječenju, ona je kod nas još uvijek podosta zapostavljena i neopravdano podcijenjena. Cilj ovih Smjernica za kliničku praksu jest pomoći liječnicima i fizioterapeutima pri ujednačavanju pristupa pacijentima s jednostranim i obostranim vestibularnim oštećenjima, izbjegavajući nepotrebne varijacije u primjeni vestibularnih vježbi. One nisu udžbenik niti jedini i neupitni izvor znanja, već pružaju okvir za strategiju kod donošenja odluka, ne zamjenjujući pritom značenje kliničke prosudbe. Vestibularnim vježbama značajno se ubrzava oporavak bolesnika s vestibularnom hipofunkcijom i njihov povratak uobičajenim životnim aktivnostima. Svrha ovih Smjernica jest utvrditi koga, kada, kako i koliko dugo liječiti, kao i kako otkloniti nepotrebne varijacije u pristupu rehabilitaciji pacijenata s vestibularnom hipofunkcijom. One se zasnivaju na dokazima dobivenim metaanalizom podataka iz dostupne medicinske literature, oslanjajući se pored toga i na naše dugogodišnje iskustvo u radu s vertiginoznim pacijentima.
Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su pona... more Dijagnostičko-terapijske smjernice za akutnu vrtoglavicu i gubitak ravnoteže, namijenjene su ponajprije otorinolaringolozima, specijalistima hitne medicine, liječnicima obiteljske medicine, te ostalim liječnicima u Republici Hrvatskoj koji skrbe o bolesnicima s vrtoglavicom i gubitkom ravnoteže, u primarnoj i bolničkoj zdravstvenoj zaštiti. U izradi smjernica sudjelovali su predstavnici Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata (HD ORL), te predstavnica Hrvatskog neurološkog društva. Prepoznati uzrok akutne vrtoglavice u praksi otežava činjenica da se simptomi oštećenja u različitim organskim sustavima preklapaju, nejasni su i djeluju dramatično. Cilj ovih smjernica je pomoć pri postavljanju dijagnoze kod bolesnika s izraženim simptomima vrtoglavice i pravodobno razlikovanje benigne od životno ugrožavajuće vrtoglavice koja zahtijeva hitno, bolničko liječenje. Smjernice sadrže i detaljne algoritme koji preporučuju postupanja s bolesnikom s napadajem akutne vrtoglavice i gubitkom ravnoteže.
Hereditarni angioedem-dijagnoza, patofiziologija, farmakoterapija, prevencija; Protein inhibitor ... more Hereditarni angioedem-dijagnoza, patofiziologija, farmakoterapija, prevencija; Protein inhibitor C1-analiza, terapijska primjena; Komplement C1-antagonisti i inhibitori; Bradikininski B2 receptor-antagonisti i inhibitori; Bradikinin-analozi i derivati; Smjernice; Hrvatska Sa`etak. Hereditarni angioedem (HAE) rijetka je, ali potencijalno za `ivot opasna bolest zbog nepredvidivih napadaja bezbolnih, ograni~enih, recidiviraju}ih otoka supkutanog ili submukoznog, intersticijskog tkiva u trajanju od nekoliko sati do nekoliko dana. Oboljelih od HAE u RH ima oko 100 (ali vjerojatno ima vi{e nedijagnosticiranih). Poseban kvalitativni napredak u uskla|ivanju dogovora o lije~enju HAE jesu Smjernice Svjetske alergolo{ke organizacije koje su donesene 2012. Oslanjaju}i se na taj dokument, Radna grupa hrvatskih stru~njaka pripremila je prijedlog smjernica za lije~enje HAE u Hrvatskoj. Napadaji angioedema u HAE posljedica su mutacije gena za plazmatski protein inhibitor C 1. Zbog manjka inhibitora ili njegove disfunkcionalnosti dolazi do okida~em (trigerom) potaknute autoaktivacije C1 i cijele kaskade s kona~no pove}anom propusno{}u krvnih `ila i edemom tkiva. Postoje tri tipa hereditarnog angioedema: tip I uzrokovan sni`enom razinom C 1 inh proteina, tip II uzrokovan proizvodnjom nefunkcionalnog C 1 inh proteina te tip III karakteriziran normalnom funkcijom i razinom C 1 inh. U svih bolesnika sa sumnjom na HAE mora se odrediti nivo C4 i inhibitora C1, kao i funkcija inhibitora C1. Lije~enje akutne atake HAE: Svi napadaji angioedema koji onesposobe dijelove tijela i/ili zahva}aju lice, vrat, trbuh, a pogotovo gornje di{ne putove zahtijevaju lije~enje. Terapija mora biti odmah dostupna (On-Demand Treatment). U akutnoj ataci treba odmah primijeniti koncentrat inhibitora C1 (dobiven iz plazme ili rekombinantni), ikatibant ili ekalantid. Ako ovi lijekovi nisu dostupni, akutni napadaji edema mogu se lije~iti plazmom obra|enom detergentom. Ako se ovakva plazma ne mo`e dobiti, angioedemi se lije~e svje`e smrznutom plazmom. Intubacija ili traheotomija moraju se izvesti na vrijeme ako progredira edem gornjih di{nih putova. U napadaju angioedema bolesnik mo`e dobiti i adjuvantnu terapiju (analgetike, infuzije). Preporu~uje se da svi bolesnici uvijek nose sa sobom lijekove za samoprimjenu. Preporu~ljiva je kratkoro~na profilaksa edema prije kirur{kih zahvata (osobito stomatolo{kih zahvata), zahvata u kojima je potrebna endotrahealna intubacija, zahvata na gornjim di{nim putovima ili farinksu te prije bronhoskopije i endoskopije. Dugoro~na profilaksa indicirana je ako se javi jedna ili vi{e te`ih ataka angioedema na mjesec. Kao dugoro~na profilaksa mogu se rabiti koncentrat inhibitora C1 ili androgeni. Probir djece za HAE trebalo bi odgoditi do 12. mjeseca `ivota. Sve potomke bolesnika treba testirati. Descriptors: Angioedemas, hereditary-diagnosis, physiopathology, drug therapy, prevention and control; Complement C1 inhibitor protein-analysis, therapeutic use, administration and dosage; Complement C1-antagonists and inhibitors; Receptor, bradykinin B2-antagonists and inhibitors; Bradykinin-analogs and derivatives; Practice guidelines as topic; Croatia Summary. Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, nonerythematous, and not pruritic swelling which can affect the hands, feet, face, genitals and visceral mucosa. The type, frequency, and severity of the attacks vary between patients, and over the lifetime of an individual patient. Efforts in Croatian counties have identified approximately 100 patients (but there must be more undiagnosed patients). The first global guideline for the management of HAE was developed by the World Allergy Organization HAE International Alliance and published in 2012. Based on that document the Working group of Croatian experts was assigned to propose guideline for HAE management in * Odjel za klini~ku imunologiju, pulmologiju i reumatologiju Klinike za unutra{nje bolesti Medicinskog fakulteta Sveu~ili{ta u Zagrebu, KB »Sveti Duh«, Zagreb (prof. dr. sc. Asja Stipi} Markovi}, dr. med.), Klinika za pedijatriju Medicinskog fakulteta Sveu~ili{ta u Rijeci, KBC Rijeka (prof. dr. sc. Vojko Ro`mani}, dr. med.; Barbara Kveni}, dr. med.), Zavod za klini~ku imunologiju i reumatske bolesti Klinike za unutra{nje bolesti Medicinskog fakulteta Sveu~ili{ta u Zagrebu, KBC Zagreb, Zagreb (prof. dr. sc. Branimir Ani}, dr. med.; Boris Karanovi}, dr. med.), Pedijatrijski odjel OB »Josip Ben~evi}«, Slavonski Brod (prof. dr. sc. Neda Aberle, dr. med.), ORL klinika Medicinskog fakulteta u Splitu, KBC Split, Split (prof. dr. sc. Goran Ra~i}, dr. med.; Davor Sunara, dr. med.), Odjel za klini~ku imunologiju i reumatologiju Interne klinike Medicinskog fa kulteta Sveu~ili{ta u Rijeci, KBC Rijeka (prof. dr. sc. Sr|an Novak, dr. med.), ORL odjel OB Pula, Pula (Boris Grdini}, dr. med.), ORL odjel OB [ibenik, [ibenik (Ljerka Karad`a-Lapi}, dr. med.), Gastroenterolo{ki odjel Internog odjela, OB Zadar, Zadar (Melanija Ra`ov Radas, dr. med.
Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, non... more Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, nonerythematous, and not pruritic swelling which can affect the hands, feet, face, genitals and visceral mucosa. The type, frequency, and severity of the attacks vary between patients, and over the lifetime of an individual patient. Efforts in Croatian counties have identified approximately 100 patients (but there must be more undiagnosed patients). The first global guideline for the management of HAE was developed by the World Allergy Organization HAE International Alliance and published in 2012. Based on that document the Working group of Croatian experts was assigned to propose guideline for HAE management in Croatia. HAE is is most often related to decreased or dysfunctional C1 inh with autoactivation of C1 and bradykinin accumulation leading to localized dilatation and increased permeability of blood vessels resulting in tissue swelling. A diagnosis of HAE can be confirmed by measuring...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2011
To determine epidemiological characteristics of thyroid carcinoma in Dalmatia, and to compare the... more To determine epidemiological characteristics of thyroid carcinoma in Dalmatia, and to compare the incidence rate in Dalmatia with that in Croatia. Retrospective epidemiological study. Epidemiological indicators of thyroid carcinoma were compared between Dalmatia and Croatia as a whole, while some epidemiological indicators were compared with the characteristics of persons suffering from thyroid carcinoma in Croatia. The study included 651 persons suffering from and/or operated for thyroid carcinoma in Dalmatia between 1997 and 2006. Data were obtained from case histories, including the results of histopathologic analysis. The area of Dalmatia includes Zadar, Sibenik-Knin, Split-Dalmatia and Dubrovnik-Neretva counties (overall 861,060 inhabitants, surface 11,960 square kilometers). The incidence of thyroid carcinoma in Dalmatia ranged from 5.2 (1997) to 10.2 per 100,000 inhabitants (2006). The mean age adjusted incidence rate of thyroid cancer in the last 10 years was 8.1 in Croatia ...
A case of a three-year-old male child who was admitted to our hospital with the suspicion that he... more A case of a three-year-old male child who was admitted to our hospital with the suspicion that he had swallowed a battery approximately one hour before admittance. The parents believed that it was a button-shaped lithium battery approximately 12 mm in diameter. A chest X-ray was taken immediately, and a battery was identified in the esophagus at the fifth thoracic vertebra. By reviewing the child's medical history, we found that the child had had surgery the day after birth due to congenital atresia of the esophagus and a tracheoesophageal fistula type III b. An esophagoscopy was performed one hour after admittance, and the battery was found to be partially past the scar from the first surgery. Because of that, the battery was pushed further toward the stomach, out of fear that retrieving the battery through the scarred section of the child's esophagus could damage the stenotic wall. Upon the next X-ray of the abdomen, the battery was observed in the stomach. The child was m...
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