Descriptors: Bone neoplasms – diagnosis, surgery
Summary. Tumours of locomotors system regardless whether they are primary or secondary, malign or benign, are regarded as urgent conditions in orthopaedics. The goal is early identification, urgent processing and diagnosing within as short period of time as possible in order to start the appropriate treatment. Since such tumours are most common in childhood and with teenagers, when anamnesis and clinical data cannot be specific and they are various, it is an imperative to identify and diagnose them early.

Descriptors: Knee joint – surgery; Emergencies
Summary. Anatomy of the knee joint is one of the most complicated when compared to other joints in the human body. Due to high demands and strong forces acting on the knee joint, it is also one of the most injured joints. Every structure in the joint can be damaged and some of the damages demand earlier treatment. Except intraarticular fractures, stress fractures of the proximal tibia, as a result of lower extremity malalignment, need earlier treatment to prevent the dislocation of the fragments. Damage to the articular cartilage needs earlier treatment due to its tendency to involve wider area of the joint. Meniscus rupture is not an indication for earlier treatment, except a »bucket handle« rupture due to its potential to block the movements of the knee joint. Collateral ligament injury needs early treatment to prevent chronic laxity of the joint. Anterior cruciate ligament early recon- struction in top athletes results in their complete rehabilitation and return to the previous level performance. Total knee replace-ments may result in a number of complications, some of which need prompt treatment. Septic arthritis is a condition that requires prompt treatment, without any hesitation. Failure of earlier or prompt treatment of the conditions of the knee men- tioned in this chapter may result in permanent damage to the knee joint.

Descriptors: Emergencies; Forearm – surgery; Elbow – surgery; Hand – surgery
Summary. Functional ability of a hand determines person’s creative and social abilities. Thus any functional inability of upper limb causes huge unfavourable, practical and economic, consequences for both an affected person and the whole community. The goal of treating affected upper limbs is to restore their function. Subsequently, identification of urgent and relatively urgent pathology of an upper limb and early diagnostics and treatment are of great importance because belated, secondary and recon- structive surgical procedures achieve significantly poorer results. Identifying pathology of an upper limb requiring urgency, leading us towards early diagnostics and timely treatments, functional restoration of upper limbs and enable prevention of permanent consequences.

Descriptors: Emergencies; Orthopedics; Outpatient clinics, hospital
Summary. The aim was to analyse priority referrals from the general practitioner to the specialist in the orthopaedic outpatient clinic. The analysis was conducted during two weeks in 2005. Besides general data and procedures conducted by the ortho- paedic surgeons, the adequacy of the priority referral was acquired. 21.9 outpatients were daily examined and they suffered mostly from low-back pain (39%), followed by knee (20%), hip (12%), and shoulder (11%) problems. The priority referral was inadequate in 57% of cases. The X-ray imaging was conducted in 33% of cases, while an intake of oral analgesics was advised in 67% and physical therapy in 73% of the visits. The number of inadequate priority outpatients at the orthopaedic clinic was very high. They could either wait for a scheduled appointment or could be further treated by the general practitioner, as most of the conducted procedures are available at the primary health-care level.

Descriptors: Arthroplasty, replacement, knee – methods; Knee prosthesis
Summary. Development of mini invasive techniques for implantation of unicondylar knee prostheses has increased general interest in this type of surgery. Indications are single compartment arthrosis, patients over 50 years of age with total body weight of less then 80 kg with small axis deviations and ligaments preserved. Important contraindications are systemic diseases. Authors present mid term postoperative results for 25 patients and 26 knees after implantation of unicondylar knee prosthesis type Repicci. Average age at time of surgery was 64.3, predominantly women and in all patients varus deformity with medial compartment arthrosis was seen. According to the Ahlback classification patients were from type 1 to type 4. Average follow up was 31.8 months. We achieved good axial correction with femorotibial angle of 6.2 degrees postoperatively, with flexion of 118 degrees and only in 3 knees extension lag was seen of an average of 8.3 degrees. According to the Knee Society Questionnaire, knee score was 60 points preoperatively and 86.8 points postoperatively and functional score was 30.9 points preoperatively  and 71.1 points postoperatively. Pain level, according to the Visual Analogue Scale, was preoperatively 6.8 points and 2 points postoperatively (10 was max). We conclude that the unicondylar knee arthroplasty is a good solution for patients with early degenerative changes in one knee compartment. This type of operative procedure will be more used because of numerous advantages when compared to other treatment options.

Descriptors: Antihypertensive agents – pharmacology; Anti-inflammatory agents – pharmacology; Drug interactions
Summary. Interactions between antihypertensive agents and nonsteroidal anti-inflammatory drugs (NSAIDs) are often seen in clinical practice. Inhibiting the renal synthesis of vasodilatory prostaglandins and enhancing salt and water retention, NSAIDs increase blood pressure, particularly in hypertensive subjects. Not all NSAIDs are equal in this respect: the highest elevations in mean arterial pressure are reported with indomethacin, naproxen, piroxicam and rofecoxib, while low-dosed aspirin, cele- coxib and ibuprofen, are less unwelcome in this respect. The same is true for the antihypertensive drugs: the most prone to the interaction (worsening of blood pressure control) are diuretics and ACE inhibitors, and the most resistant seem to be the calcium channel blockers. Although these claims must be corroborated by further clinical investigations, one of which is under way in Croatia, coprescription of antihypertensives and NSAIDs, particularly to the elderly, in addition to vigilance and care, requires operative knowledge of the therapeutic options.

Descriptors: Bone and bones – metabolism; Biological markers – analysis; Bone remodeling
Summary. Biochemical markers of bone turnover detect activity of bone cells, namely osteoblasts and osteoclasts. Osteoclasts resorb bone, and fragments of collagen type I (telopeptides, pyridinolines) are released into extracellular fluid and subsequently transported in blood and urine. Osteoblasts synthesise bone matrix proteins, among which are some of clinical significance: collagen type I propeptide, osteocalcin and bone alkaline phosphatase. Considerable scientific evidence has demonstrated that biochemical markers of bone turnover enable insight into dynamics of bone turnover, growth and repair. The most comprehen- sive data are available for the monitoring of osteoporosis treatment effects, for which use clinical guidelines have been defined. Measurement of biochemical markers of bone turnover in other metabolic bone disorders and malignant diseases with skeletal involvement is important in diagnostic assessment and therapy monitoring. Interpretation of results should take into considera- tion biological variations of these analytes.

Descriptors: HIV infections – complications, drug therapy; Eye diseases – etiology, drug therapy; Antiretroviral therapy, highly active
Summary. The aim of this study was to determine and compare the incidence of various ophthalmlogic changes before anfd after the initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients treated at the University Hospital for Infectious Diseases »Dr. Fran Mihaljevi}« in Zagreb. This retrospective longitudinal analysis included all adult patients with confirmed HIV-1 infection divided into two groups: period before HAART (1995–1997) and period after HAART (1998– 2000). Only those patients who underwent at least two ophthalmologic examinations in any of the two or in both periods were considered eligible. In total, 85 patients were enrolled in the study, 50 during the 1995–1997 period and 47 in the period 1998– 2000 (12 patients were monitored in both periods). The mortality rate was significantly lower in patients treated during the HAART era, with an average decrease in mortality rates of 59.3%. During the period of ophthalmologic monitoing from 1995 to 1997, only 9 (18%) patients received HAART, and 33 (70.2%) in the period 1998–2000. In total, 208 ophthalmic abnormali- ties were recorded, 132 (63.5%) in the first and 76 (36.5%) in the second period. Vascular changes were most frequently diagnosed (113/208 or 54.3% cases) of which cotton-wool exudates in 55 and microaneurysms in 54 cases. Cytomegalovirus (CMV) retinitis was most commonly diagnosed among infectious ocular complications (altogether 39 episodes). Changes in the anterior segment were observed in only 11/208 (5.3%) cases, while neuro-ophthalmic manifestations were sees in 39/208 patients (18.7%). The incidence of CMV-retinitis episodes in the first monitored period was 57.2 (95% CI, 38.5–86.6) per 100 years of follow-up and in the HAART era 7.6 (95% CI, 1.6–22.4; p<0.0001) per 100 years of follow-up. The visual acuity in patients from the HAART era was significantly more frequently preserved than in patients from the pre HAART era on follow- up examinations (p<0.001). Our study showed that the incidence of CMV-retinitis declined significantly in the period 1998– 2000, ehile the decrease in the incidence rates of other ocular manifestations was less profound. In contrast to the pre HAART era, there was no worsening of visual acuity in the HAART era.

Descriptors: Optic nerve injuries – etiology, diagnosis; Expert testimony
Summary. The optic nerve can be injured directly or indirectly. Direct injury occurs in association with orbital or cranio- cerebral injury with interruption of anatomical and functional optic nerve integrity. Indirect injuries occur when the force of impact is transmitted to the optic nerve. In the indirect injury group the mostly false diagnosed is traumatic opticoneuropathy – especially after whiplash injury. According to Quebec classification, after whiplash injury Ist to IIIrd degree, ophthalmologic examination or visual field testing is not necessary, because there is no possibility of optic nerve injury. The first signs of injured optic nerve are the loss of maximal visual acuity and the presence of pupillary defect. High doses of glucocorticoids or surgical decompression can be applied in the treatment of traumatic opticoneuropathy.

Descriptors: Glucose – metabolism; Peritoneal dialysis; Body weight; Kidney failure, chronic – therapy
Summary. A proportion of peritoneal dialysis (PD) patients experience substantial body weight (BW) gain with time. It is caused by fat tissue accumulation or fluid retention. It is believed that fat tissue accumulates due to caloric contribution of glucose absorbed from dialysis solution or to the mitochondrial fat regulatory uncoupling protein (UCP) gene polymorphism. This study examined BW fluctuations in 40 patients (24 females, 16 males), treated by PD at least 36 months (initial mean age 54.50±9.00 years, mean BW 68.00±8.50 kg and mean height 164.00±8.50 cm), relation of the BW fluctuation and caloric contribution of glucose absorbed from dialysis solution and characteristics of the patients with BW gain. Initial BW increased after 6, 12, 24 and 36 months by 5.90±3.50 kg, 7.90±4.90 kg, 9.50±5.00 and 11.00±5.00 kg, or for 8.68, 11.62, 13.97 and 16.18% of the initial value, respectively. After the first 6 and 12 months 38 patients gained weight, 39 after 24 and all 40 patients after 36 months. There was not significant correlation between BW gain and caloric contribution of glucose absorbed from dialysis solution. Female patients had initially lower BW, but for the first 12 months period significantly increased BW more than males, and not for the other observed periods. High transporters (patients with higher transport, higher transmission of glucose from peritoneal solution into the blood, and urea and creatinine in the opposite direction, with rapid decrement of osmolality gradient between dialysate and blood that is necessary for excessive fluid elimination), had lower initial BW and, although without statistical significance, only within the first period increased BW more than low transporters. In conclusion, with time BW gain was found in all the PD dialysis patients, it was not related to caloric contribution of glucose absorbed from dialysis solution, and women and high transporters increased BW weight more than men and low transporters in the first year of treatment. The BW gain is at least in part caused by fluid retention.

Descriptors: Myocardial ischemia – etiology, surgery; Diabetic complications; Myocardial revascularization – methods
Summary. In this restrospetive study, data on 272 coronary artery disease patients with concomitant diabetes mellitus treated between 12/1997 and 12/2002 were analyzed. Eighty patients inderwent complete arterial revascularization (DM-ART), whereas 192 patients underwent coronary revascularization using arterial-venous grafts (DN-NEART). The following preoperative data and risk factors were analyzed: arterial hypertension, hyperlipoproteinemia, number of vessels involved, left coronary artery stenosis, unstable angina, previous myocardial infarction (MI), previous cardiac surgery, EuroScore. During a 30-day postope- rative period, the following complications were analyzed: bleeding, perioperative MI, wound infection, sternal dehiscence, neurologic dysfunction, mortality. DM-ART patients had a higher rate of hyperlipoproteinemia (p=0.004). Difference was only found for the occurrence of perioperative MI in DM-NEART group (p<0.001). Total arterial revascularization without cardiopul- monary bypass is a reliable and safe choice in patients with concomitant diabetes mellitus irrespective of its type. Definitive conclusions can only be made after five- or ten-year evaluation of postoperative mirbidity and mortality.

Descriptors: Cardiovascular diseases – rehabilitation, prevention and control
Summary. Atherosclerotic cardiovascular disease is the major cause of death in middle-aged and older adults in most developing countries in the world. Numerous strong evidences in professional and scientific literature showed that regular aerobic exercise training and cardiac rehabilitation programmes lead to significant reduction in the risk profile and mortality of cardiac patients. However, less than 1/3 of patients eligible for cardiac rehabilitation currently participate in formal rehabilitation programmes in most European countries. In this review, we present today’s »evidence-based« knowledge about many positive effects of cardiac rehabilitation with purpose to promote its greater use in daily clinical work.

Descriptors: Quinolines – therapeutic use; AZA compounds – therapeutic use; Anti-bacterial agents – therapeutic use; Respiratory tract infections – drug therapy; Product surveillance, postmarketing; Croatia
Summary. In this study, we investigated and analysed clinical efficacy and tolerability of moxifloxacin, a new quinolone antibiotic, for the outpatient treatment of bacterial respiratory infections – acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), pneumonia and acute sinusitis. The study was post-marketing and observational, and was conducted after the registration and listing of moxifloxacin in commercial distribution in Croatia. A total of 84 physicians throughout Croatia participated in this study that included 440 patients, 231 with clinically confirmed diagnosis of AE-COPD, 103 with pneumo- nia and 46 with acute sinusitis. According to physicians, evaluation, 96.8% of the patients were cured. The improvement was recorded on the average after 3.2 days and cure after 6.4 days from the beginning of treatment. Adverse events (48 side effects) were recorded in 40 patients, most commonly suffering from milder gastrointestinal symptoms (nausea, diarrhoea). Serious adverse events were not recorded (phototoxicity, severe hepatic impairment, cardiotoxicity). Moxifloxacin tolerability and patient compliance during treatment were rated as excellent in three-quarters of the patients. Physicians stated they would again prescribe moxifloxacin in 415 or 94.3% of the patients.

Descriptors: Endocarditis, bacterial – prevention and control; Antibiotic prophylaxis; Dentistry
Summary. According to epidemiological reports; 14–20% of infectious endocarditis (IE) are associated with previous stoma- tological procedures (oral surgery, procedures during periodontal and conservative endodontic therapy and intra-ligament anes- thesia) which cause transitory bacteriemia for 10–15 minutes. In patients at risk, such short lasting bacteriemia is sufficient for the development of infectious endocarditis. In everyday practice we encounter patients at risk for IE referred to oral surgery (most often tooth extraction) at the Oral Surgery Division, Department of Facial, Maxillary and Oral Surgery, Dubrava Univer- sity Hospital. Majority of these patients are given IE prophylaxis according to the latest AHA recommendations. For some patients we first consult a cardiologist due to the underlying disease, and as a rule these patients return with cardiologist’s advice on IE prophylaxis. We noticed that these recommendations differ between cardiologists. Some cardiologists have for years been recommending the same »prophylaxis« which is not in accord with AHA guidelines. From the available cardiac records we analyzed antibiotic IE prophylaxis before oral surgery in cardiac patients at risk recommended by cardiologists in four Zagreb hospitals in 2003. We collected in total 17 recommendations prescribed by 12 cardiologists. Regretfully, none was in accord with valid AHA guidelines from 1997. Only 6 out of 17 recommendations are in agreement with the outdated guide- lines from 1994, which also raises concern. Therefore, we thought it was worthwhile to present these cases, hoping this will stimulate discussion on common guidelines for the benefit of patients at risk for IE.

Descriptors: Myocardial infarction – therapy; Blood vessel prosthesis implantation – methods; Treatment outcome
Summary. We perform primary angioplasty in all acute myocardial infarction patients with ST elevation in the first 6 hours, with good results. In 30 selected patients (36.2% of all primary angioplasty patients in this period) we used the method od direct stenting with 100% primary success. In all patients we achieved TIMI 2-3 flow, and complete or partial ST elevation resolution. The early mortality rate was 3.3%, and no other complications arose. Direct stenting in primary coronary angioplasty is a safe and effective procedure, with high primary result in selected cases, and low complication rate during procedure and incidence of MACE (Mayor Adverse Cardiac Events) during hospital stay and after 6 month follow up. The results are comparable with standard interventional procedure in acute myocardial infarction, with the advantage of shorter procedure, lower radiation exposure and less material use.

Descriptors: CytochromeP-450 enzymesystem–antagonistsandinhibitors, administrationanddosage; Hydroxymethylglutaryl CoA reductases- administration and dosage; Drug interactions; Drug therapy, combination
Summary. It is known that coadministration of a statin and certain drugs that inhibit cytochrome P-450 may inhibit catabolism of statin, resulting in an increased concentration of statin in the blood and consequently, increased risk of certain side effects, e.g. myopathy. The aim of this study was to establish, for the first time, how many patients in Croatia concomitantly take statins with other drugs, and which drugs. Also, the aim was to determine how often statins are administered concomitantly with cytochrome P-450 inhibitors, and how many patients taking statin are therefore at increased risk of interactions and/or side effects. The data were collected from general practitioners’ health records all over Croatia during July and August 2004. The data for patients who were prescribed any statin between June 1, 2003 and June 1, 2004 were analysed. The records of 882 patients were analysed, 446 (50.6%) women, 422 (47.8%) men and 14 (1.6% ) of unidentified sex. The average age of women on statin was 65 years and of men 60 years. Of 882 patients, 772 patients (82%) were taking at least one more drug concurrently with statin. Of that number, 24% of patients concomitantly were taking one more drug, 20% two more drugs, 16 % three more drugs, 10% four more drugs, 8% five more drugs and 3% six more drugs. The average number of other drugs prescribed together with statin was 2.1±1.59 in men and 2.2±1.71 in women. The average age of patients who were taking another drug together with a statin did not significantly differ from that of patients receiving only statin. There were regional differences in the number of drugs prescribed together with a statin. In Osijek, the average number of drugs prescribed with a statin was 2.4±1.80, in Zagreb 2.2±1.64, in Rijeka 2.0±1.60, and in Split 1.8±1.44. The number of drugs prescribed with a statin in rural areas was 2.0±1.58, in urban areas 2.1±1.63 and in semi-urban areas 2.8±1.85. The therapeutic groups of drugs that are most frequently prescribed with a statin in Croatia are ACE inhibitors and their fixed combinations (32%), beta-receptor blockers and their fixed combinations (23%), selective calcium channel blockers (18%), anxiolytics (18%), vasodilators and organic nitrates (16%), antirheumatic drugs (11%), oral antidiabetics (11%), vitamin K antagonists, analgesics-antipyretics, diuretics (10%), antibiotics (8%), and angiotensin II antagonists and their fixed combinations (5%). All other drugs accounted for less than 5 %. Four percent of the patients take cytochrome P-450 inhibitors concomitantly with a statin. The most frequently used drug is verapamil, combination of verapamil and trandolapril, clarithromycin and diltiazem. Consequently, 3% of men and 5% of women are at increased risk of side effects. This sex difference is, however, not statistically significant. Patients between 70 and 74 years of age taking statins are in Croatia at the highest risk of interactions because 8% of them take concomitantly cytochrome P 450 inhibitors.

Descriptors: Water supply; Sanitation – methods; Water pollution – prevention and control; War
Summary. The aim of this article was to test the success of sanation of unsatisfactory individual water supply objects in the areas ravages of war. 198 individual water supply objects were consolidated in the area of Vo}in, with hyperchlorination and pumping out of water, after which desinfection with chlorine preparation was carried out. Samples of drinking water taken for bacteriological analysis were analyzed on total coliform bacteria, fecal coliform bacteria and fecal streptococci by method of membranous filtration, while the number of colonies of aerobic bacteria at 22°C and 37°C were determined on triptosis-glucosis-yeast agar. Good samples, considering the Regulations on health suitability of drinking water, were 152, or 77%. In unfit samples, which were 46, or 23%, the most common isolates were fecal streptococci, with frequency of 30%. Although public waterworks represent the best way to supply people with good drinking water, it is possible to achieve a satisfactory degree of water quality from individual water supply objects with implementation of public health activities, if we execute them periodi- cally and professionally.

Descriptors: Stress disorders, post-traumatic – rehabilitation; Social adjustment; Self-help groups; Veterans; War; Croatia
Summary. For the period after the war patients with complex disorders are specific. Their increased need for psychiatric protection stimulates people to organize additional, outpatient activities in the mental health area. The authors present their experiences of working in the Club of Croatian War veterans treated for PTSD (the PTSD Club) and the positive therapeutic effect of systematic work upon the principles of sociotherapeutic community, systematic family approach, and self-help. The PTSD club is one of possible problem solutions, and the right choice of how to organize and conduct preventive and rehabili- tative programs for high-risk groups of patients.

Descriptors: Osteoporosis – chemically induced, prevention and control, drug therapy; Glucocorticoids – adverse effects
Summary. Glucocorticoids are the most frequent cause of secondary osteoporosis. They are responsible for both inadequate quantitative and qualitative effects on bone, primarily on osteoblasts (decreased activity and apoptosis). Studies have shown that patients taking glucocorticoids have decreased bone mineral density and increased risk for fractures, especially for post- menopausal women. Prevention of glucocorticoid-induced osteoporosis includes use of the lowest effective glucocorticoid dose possible, calcium and vitamin D supplementation, hormone replacement therapy and adequate physical activity. Prevention of fractures also includes all those factors that can influence the balance (e.g. muscle strenghtening, walking aids, architectonic barriers). Antiresorptive drugs should be started in all the patients with increased risk for osteoporosis, and among them bispho- sphonates are the first drugs of choice.

Descriptors: Sacroiliac joint; Joint diseases – diagnosis, therapy; Manipulation, orthopedic
Summary. Sacroiliac joint dysfunction is one of the proved causes of sacroiliac joint syndrome. We are talking about the restricted mobility of sacrum opposite to ilium the type of »reversible blockage of movement«. Main characteristics of dysfunc- tion are as follows: restricted »joint play«, referred pain, normal radiological finding, normal lab results and disappearance of clinical symptoms after deblocking of articular bodies. Pain from a blocked joint can be referred to lower back, buttocks, hip, groin, thigh, calf and lower part of abdomen. Dispersion of painful regions is a consequence of a complex and variable innerva- tion of articular capsule. Blocked position of articular bodies and protracted tension of articular capsule causes a stimulus of nociceptors by which a capsule is protected. Nociceptive activity is manifested with referred pains in innervational region of stimulated sensitive nerves. In the article, besides the clinical manifestations, there is described a diagnostics and manual therapy of dysfunction. Springing tests by means of which a passive mobility (»joint play«) is being tested, are most valuable in dysfunction diagnostics. Manual therapy (mobilization/manipulation) is indicated and efficacious with the patients suffering from dysfunction.

Descriptors: Tomography, spiral computed; Angiography; Vascular diseases – radiography
Summary. Incidence of vascular diseases and development of new radiologic techniques in the last three decades has given strong impuls for introduction of non-invasive vascular diagnostic methods. Thanks to the introduction of Doppler ultrasound, new types of computed tomography (CT) and magnetic resonance (MR) scanners, non-invasive vascular diagnostic methods are replacing conventional invasive (catheter) angiographic methods. Computed tomographic angiography (CTA) is a non- invasive vascular diagnostic method based on continuous scanning with CT scanner during intravenous application of contrast material. Performing of CTA is possible after introduction of spiral CT technique whose characteristics are short imaging time and volumetric data acquisition. The main goal of this article, based on our experiences, is to review the role of CTA, performed on single–slice CT scanner, in managment of patients with vascular pathology.

Descriptors: Beta-lactamases – classification, metabolism, antagonists and inhibitors; Beta-lactam resistance – genetics; Beta-lactams – pharmacology; Enzyme inhibitors – pharmacology; Gram-negative bacteria –enzymology, drug effects
Summary. Resistance to β-lactam antibiotics continues to increase, mostly due to the presence of various β-lakta mases. As a result of the ability of the plasmids to acquire additional resistance determinants, many of the β-lactamase producing pathogens became multidrug resistant.The most important β-lactamases which compomise the use of β-lactams nowdays are extended- spectrum β-lactamases, inhibitor-resistant TEM and SHV β-lactamases and carbapenemases. Carbapenemases are β-lactamases which hydrolyse carbapenems. They belong to molecular classes A, B, and D. Class A comprises carbapenemases sensitive to inhibition by clavulanic acid. Most of them are chromosomaly encoded, but some of them are plasmid-mediated such as KPC-1 in Klebsiella pneumoniae and GES-2 in Pseudomonas aeruginosa. The class B carbapenemases are metallo-β-lactamases of the IMP or VIM group. The class D carbapenemases are the most frequent in Acinetobacter baumannii but confer resistance to carbapenems only if other resistance mechanisms such as porin alterations, are present. Inhibitor resistant β-lactamases are one of the most important causes of resistance to β-lactam-inhibitor combinations. The resistance to these formulations can be also due to hyperproduction of TEM-1 β-lactamase, modifications of the outer membrane proteins or production of OXA-type enzymes. IRT enzymes are derived from parenthal TEM-1 or TEM-2 β-lactamases by point mutations in the β-lactamase gene. The frequent use of β-lactamase inhibitors in hospitals and general practice pose a selection pressure which favours spread of such strains in hospitals and community.

Descriptors: Pregnancy, multiple – statistics and numerical data; Twins – statistics and numerical data; Pregnancy outcome
Summary. The aim of this study was to examine perinatal outcome of twin pregnancies in maternity wards in Livno and Knin. The perinatal outcome in these two maternity wards was examined retrospectively during the period 1990–2002. The incidence of twin births, the month with the highest incidence of twin births, the age and parity of the women with twins and their gestational age were examined. Also, we compared the perinatal outcome of twins with singletons, distribution according to sex, lie and presentation at birth. During 13 years 10 856 newborns were delivered, and 127 (1.2%) of them were twins. The incidence of twins in maternity wards in Knin and Livno during the war and after the war was not significantly different (p=0.89). The month with the highest incidence of twin births was May (14.8%). The avarage age of women with twins was 28.9±9.7. Twins were born mostly by multiparas (2–4 deliveries). 94 (74%) twins were born on term and 33 (26%) twins before term. 74 newborns (7‰) from singletons and 11 (43‰) from twins died during perinatal period. Twins were delivered by cesarean section (27%) three times more often than singletons (8%). Hypertension in twin pregnancies (7%) was twice as frequent as in singletons (4%). 132 (51.6%) male and 122 (48.4%) female newborns were born. The distribution according to sex was: 58 pairs »male-female«, 37 »male-male« and 32 pairs »female-female«. The distribution according to presentation at birth was: 49% »cephalic-cephalic«, 29% »cephalic-breech«, 12% »cephalic-transverse«, 5% »breech-breech« and all other combinations got 5%. In conclusion, our results during the war and after the war were not different from other centers and studies thanks to good antenatal care and selection of twin pregnancies for transportation on time to the center with higher level of health care.

Descriptors: Breast neoplasms – pathology; Prognosis
Summary. One of prognostic factors known as Nottingham Prognostic Index (NPI), which is combination of known prognos- tic factors such as tumor size, grade and axillary node status, is recently in usage in some European countries in clinical practice in prediction of breast carcinoma patients’ survival. Therefore, the aim of this study was to verify, according to our experience, the prognostic significance of Nottingham Prognostic Index (NPI) in breast carcinoma patients in association with other new prognostic factors. In this study 148 consecutive specimens of breast carcinoma patients were analyzed. The following data for each patient were collected: age, tumor size, histological grade, axillary lymph node status, overall survival, estrogen (ER), progesterone (PR) receptor expression as well as expression of bcl-2, Ki-67, nm23, HER-2/neu, and p53. The Nottingham Prognostic Index (NPI) was calculated from the pathological information and patients were grouped according to the standard NPI index into: good prognostic group (GPG), moderate prognostic group (MPG), and poor prognostic group (PPG). The correlation of prognostic groups according to the NPI with other prognostic and predictive factors such as age, ER, PR, p53, bcl-2, Ki-67, nm23, Ki-67, Cathepsin D and HER-2/neu on overall survival was analyzed. The results of univariate analysis showed statistically significant correlation between patients’ age, NPI prognostic groups and stage of disease with patients survival. When other prognostic factors were correlated with NPI prognostic groups there was not additional prognostic dis- crimination in given prognostic groups. Only marginally statistically significant influence of p53 expression was found on patient survival between MPG and PPG. It seems that other prognostic factors in combination with NPI prognostic groups do not have in our group of patients practical clinical relevance for the management of patients with breast carcinoma.