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.

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: 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: 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: 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: 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: 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: 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.