Šećerna bolest sa svojim komplikacijama uzrokuje 9 % ukupne smrtnosti diljem svijeta. Periferna arterijska bolest, uz kardiovaskularne bolesti, najčešća je komplikacija šećerne bolesti, čija ...prevalencija raste s dobi i duljinom trajanja dijabetesa. Specifičnost periferne arterijske bolesti u dijabetičara jest difuzno zahvaćanje arterijskog sustava, poglavito potkoljeničnih arterija. Posljedično tomu, dijabetes je i dalje glavni uzrok malih i velikih amputacija ekstremiteta, što, uz smanjenje kvalitete života, znatno utječe i na preživljenje bolesnika. Budući da razvijena aterosklerotska bolest uključuje niz komplikacija iz stručne domene različitih užih specijalnosti, poput dijabetičkog stopala, u dijagnostici i liječenju nužno je organizirati multidisciplinarne timove. U tu svrhu u Općoj bolnici „Dr. Josip Benčević“ u Slavonskom Brodu organiziran je multidisciplinarni tim sa svrhom ranog prepoznavanja periferne arterijske bolesti te pravodobnog liječenja. Dosadašnje iskustvo iz svakodnevne kliničke prakse pokazuje da je za pravilno funkcioniranje tima nužno imati precizan dijagnostičko-terapijski algoritam kako bi se izbjegle duge liste čekanja za slikovnu obradu koja uključuje dupleks ultrazvuk i višeslojnu kompjutoriziranu tomografiju. Dijagnostički algoritam temeljio se na vrijednostima gležanjskog indeksa, a njegova vrijednost i klinička slika usmjeruju i određuju stupanj hitnosti i tip slikovne obrade. Integriranjem algoritma u on-line registar baze podataka dobili smo mogućnost lakšeg praćenja stope učestalosti, uspješnosti liječenja i ovisnosti o unesenim varijablama. Nadamo se da će takav način rada rezultirati ranijim otkrivanjem simptomatske bolesti, a time i znatnim smanjenjem amputacija donjih ekstremiteta te naposljetku i smrtnosti.
Nodular fasciitis is a benign neoplasm occurring predominantly in the subcutaneous tissue. There have been nine intraneural occurrences described in the literature.
A 37-year-old woman presented ...with numbness and tenderness in her left shoulder and scapula and a slightly dropped left shoulder, without history of trauma. A magnetic resonance imaging (MRI) of the cervical spine showed a well-circumscribed oval mass deep to the levator scapula muscle. Due to persisting symptoms and an unknown nature of the process, surgical excision was performed, and histopathologic analysis confirmed diagnosis of a benign fibroblastic/myofibroblastic neoplasm, nodular fasciitis. The postoperative course was uneventful and the patient was without symptoms at 4 months of follow-up.
We reviewed the available literature (PubMed, Google Scholar), with nine published cases of intraneural nodular fasciitis. The reported clinical, radiologic, and histopathologic parameters were evaluated and compared.
Most of the cases reported in the literature were symptomatic, with tenderness and palpability being the main symptoms. Six of the reported cases occurred in the forearm, whereas three were in the leg. To the best of our knowledge, ours is the first reported case of nodular fasciitis occurring in the trunk. Ours is the only case to display desmin positivity, which supports the reactive hypothesis of nodular fasciitis.
Intraneural nodular fasciitis is an extremely rare diagnosis. Due to its benign natural course, a multidisciplinary approach with this extremely rare diagnosis in mind is needed to avoid overtreatment.
A decision support concept (DSC) for sustainable management of the bottom trawl fleet was created in line with ecosystem-based management. It is based on principles that integrate ecological, social ...and techno-economic aspects of trawl fisheries in a multicriteria analysis approach. For the sake of greater transparency and improved stakeholder participation, elements of the proposed multicriteria models were discussed, generated and evaluated in collaboration with designated experts from four stakeholder groups: fishers, environmentally focused non-governmental organizations, fisheries scientists and government representatives. The proposed DSC management could facilitate management and assist decision makers in adequately using data and scientific advice to shape management strategies and related policies for the bottom trawl fleet. It may also assist in finding compromise solutions based on deliverables from the multicriteria analysis, while taking stakeholder requirements into account by using the multicriteria Analytic Hierarchy Process (AHP) and Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE) methods. The final decision is then based on a vast amount of knowledge and relevant information collected from different sources. The proposed DSC represents a novel approach to fishery fleet management and assists in systematizing management processes and instruments to make it operational at the strategic level. The method was applied to the Adriatic bottom trawl fishery, and the obtained results confirmed its managerial potential in the strategic decision-making process, aimed at improving conventional management, while considering the specific requirements of an ecosystem-based approach and ensuring stakeholder participation.
The aim of this population based neuroepidemiological study was to establish the real incidence rates of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the ...Republic of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.65, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100,000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.
The aim of the study was to assess the possible correlation between catecholamine and cortisol levels and changes in cerebral hemodynamics in patients with chronic posttraumatic stress disorder ...(PTSD). The study included 50 patients with chronic PTSD first ever hospitalized for psychiatric treatment and 50 healthy control subjects. All study subjects were aged 30-50. In PTSD patients, 24-h urine levels of the epinephrine and norepinephrine metabolites vanillylmandelic acid (VMA) and cortisol were determined and transcranial Doppler ultrasonography was performed on day 1 of hospital stay and repeated after 21-day psychiatric medicamentous treatment. On initial testing, increased level of 24-h VMA, decreased cortisol level and elevated mean blood flow velocity (MBFV) in the circle of Willis vessels were recorded in 25 (50.00%) patients. Repeat findings obtained after 21-day psychopharmaceutical therapy showed increased 24-h VMA, decreased cortisol and elevated MBFV in the circle of Willis vessels in seven (14.00%) patients (initial vs. repeat testing, P = 0.0002). Such parameters were not recorded in any of the control subjects (initial PTSD patient testing vs. control group, P = 0.0000). Study results pointed to a significant correlation between increased catecholamine levels, decreased cortisol level and elevated MBFV in the circle of Willis vessels caused by cerebral vasospasm. Psychiatric medicamentous therapy administered for three weeks significantly reduced the proportion of patients with concurrently altered cerebral hemodynamics, increased levels of catecholamine metabolites and decreased level of cortisol.
The aim of this population based neuroepidemiological study was to establish the real incidence rate of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the Republic ...of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.39, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100 000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.
Cilj ovoga rada bio je utvrditi moguću povezanost između razine kateholamina, kortizola i promjena cerebralne hemodinamike u bolesnika s kroničnim posttraumatskim stresnim poremećajem (PTSP). ...Ispitivanjem je obuhvaćeno 50 bolesnika s kroničnim PTSP koji su prvi put hospitalizirani i psihijatrijski liječeni te 50 zdravih ispitanika kontrolne skupine. Svi ispitanici bili su u dobi između 30 i 50 godina. U bolesnika s PTSP su prvoga dana boravka analizirane vrijednosti vanilmandelične kiseline (VMA), metabolita adrenalina i noradrenalina te kortizola u 24-satnoj mokraći i učinjena je transkranijska dopIer sonografija (TCD). Isti dijagnostički postupci ponovljeni su nakon 21-dnevnog medikamentnog psihijatrijskog liječenja. Prva analiza pokazala je istodobno povišenu razinu 24-satne VMA, sniženi kortizol i povišene srednje brzine strujanja krvi (SBSK) krvnih žila Willisova kruga u 25 (50,00010) bolesnika. Druga analiza koja je učinjena nakon 21-dnevnog psihijatrijskog liječenja pokazala je istodobno povišenu razinu 24-satne VMA, sniženi kortizol i povišene SBSK krvnih žila Willisova kruga u 7 (14,00%) bolesnika (odnos prve i druge analize P=0,0002), dok u kontrolnoj skupini nije pronađen niti jedan takav ispitanik s navedenim parametrima (odnos prve analize i kontrolne skupine P=0,0000). Istraživanje je pokazalo značajnu povezanost povišene razine kateholamina, sniženog kortizola i povišenih SBSK u krvnim žilama Willisova kruga koje su uzrokovane cerebralnim vazospazmom. Medikamentno psihijatrijsko liječenje PTSP u trajanju od tri tjedna dovelo je do značajnog smanjenja udjela bolesnika s istodobno promijenjenom cerebralnom hemodinamikom, povišenom razinom metabolita kateholamina i smanjenom razinom kortizola.
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