Descriptors: Blood pressure determination – instrumentation; Sphygmomanometers; Hypertension – diagnosis
Summary. Arterial blood pressure has been measured using mercury sphygmomanometer and auscultatory method for more than a hundred years. The results obtained by this measurement method make the basis of almost all conclusions related to pathogenesis, epidemiology and treatment of arterial hypertension. However, some deviations from ordinarily obtained data have been observed but are undoubtedly due to superficial approach to this simple method. A number of lesser faults can together result in an eventually inaccurate conclusion both regarding diagnosis and assessment of therapeutic effects. The aim of this short review article is to remind us of those little efforts needed to be done for improving the exactness of measurement in order to increase the accuracy of results. The ultimate consequence should be better care of patients with high blood pressure.

Descriptors: Endothelium, vascular – physiology, physiopathology; Hypertension – physiopathology; Atherosclerosis – physiopathology
Summary. Endothelium was »discovered« as a separate organ in the last decades of the previous century. For a long time endothelial cells were considered as a very passive monolayer of cells just covering the inner part of vascular walls. The role of these cells was thought to be only a mechanical barrier between circulating blood and vascular structures. Nowadays, after a series of biochemical and experimental studies, one can name endothelium as an organ, covering approximately 700 sqaure meters, weighing about 1.5 kilos in an average male with weight of 70 kg. Not only its quantity, but also its function is amazing. The most prominent and first well studied function of endothelial cells is vasodilatation and vasoconstriction. Normal cells, which are intact and in function produce regularly one of the most important protecting agent in circulation: NO. Normal endothelial cells produce NO as a result of higher blood pressure or growing demand for oxygen. It is produced from aminoacid L-arginine as a result of enzyme activity: endothelial NO synthetase (eNOS). Interleukins also can increase production of NO. NO has also antiinflammatory efects, helping in reparation and healing processes. Prostacyclins are the second most important vasodilating agent produced in endothelium. On the other hand, vasoconstriction is also mediated via endothelium. Endothelin 1, angiotensin II and thromboxan A are produced in vascular wall by endothelial cells, acting as op- ponent to NO. ACE system is very active inside those cells, with permanent local angiotensin II formation, that mostly act on vascular wall itself. Effects of such generated angiotensin II stimulate activation of VCAM molecules, starting adhesion of monocytes, their penetration in vascular wall and activation. Acivated macrophages get in contact with oxidized LDL particles already inside the vascular wall, producing foam cells. That is the very begining of atherosclerosis. All negative effects of excess of angiotensin II should be reduced by effective therapy with ACE inhibitors or AT antagonists. Today it seems more important to act on excess in endothelial AII in order to regulate not only blood pressure, but long-term devastat- ing effects on target organs, preventing atherosclerosis.

Descriptors: Obesity – complications, epidemiology; Hypertension – complications, physiopathology; Abdominal fat; Blood pressure
Summary. Obesity significantly increases the risk for the occurrence of cardiovascular disease in patients with essential hypertension. The aim of the study was to assess the frequency of obesity, measured by different methods, in patients with essential hypertension, its effect on arterial pressure, and to determine the best correlation between indicators of obesity and arterial pressure. The study included 88 patients with essential hypertension, 32 males, mean age 59.4 (±10.4) years, and 56 females, mean age 62.9 (±8.8) years. Body weight (BW) and height (BH), waist circumference (WC), and body mass index (BMI) were measured for each subject. Arterial pressure was determined using mercury sphygmomanometer. Overweight patients were defined as those with BMI 25–29.9 kg/m2, while obese as those with 330 kg/m2. Abdominal obesity was assessed by WC. WC values exceeding 102 cm for men and 88 cm for women indicated obesity. Body measures of male patients were higher than those for women (BW 92.5(±14.5) vs 76.7(±11.5) p<0.001; BH 175.4(±7.4) vs 163.4(±5.8) p<0.001), significantly higher waist circumference values (102.4(±12.2) vs 94.1(±13.9) p=0.006), with no differences in age, BMI, and arterial pressure values (p>0.05). Also, no differences were observed in the number of uncontrolled hyperten- sive patients or number of overweight or obese patients (p>0.05). The number of obese patients did not differ significantly with regard to the various measurement methods employed (BMI: M 50%, F 37%; waist measurement: M 51%, F 54%). A significant difference was noted in arterial pressure values only in the male patient group on comparing patients with normal BW and obese patients (systolic blood pressure (SBP) 156(±22.5) vs 142(±6.4) p=0.04; diastolic blood pressure (DBP) 94(±11.6) vs 82.5(±6.4) p=0.05). The correlation between obesity indicators and arterial pressure was significant for WC only in the male group (SBP r=0.33, DBP r=0.35, p<0.05). The frequency of obesity does not differ with regard to the deter- mined obesity indicators. Obese men have higher risk for increased arterial pressure values. WC values correlate better with arterial pressure values as it is a more accurate indicator of abdominal obesity.

Descriptors: Hypertension, renovascular – diagnosis, etiology; Arteriosclerosis – complications; Renal artery obstruction – complications, etiology; Fibromuscular dysplasia – complications; Hypertension – diagnosis
Summary. The aim of our study was to show the value of comparing clinical parameters in patients with renovascular hypertension (RVH) and essential hypertension (EH). We examined the differences between renovascular hypertension patients with atherosclerosis (ATH) and those with fibromuscular dysplasia (FMD). The diagnosis of renovascular hyper- tension was established on the basis of renal angiography finding, which also defined the type of stenosis (ATH or FMD). Our patient group included 108 patients with atherosclerotic RVH (46 male / 62 female, median age 53 yrs), 16 patients with FMD (3 male / 13 female, median age 49 yrs), and 106 patients with EH (61 male / 45 female, median age 38 yrs). In com- parison with patients with EH, patients with atherosclerotic RVH were found to be more frequently of female gender with lower body weight and height, older, and more frequently on therapy with antihypertensives. Their hypertension was of later onset and more severe stage. All those differences were statistically significant (P<0.05). When analysis by genders was performed, women were more frequently smokers and had higher serum cholesterol levels, which is an explanation for higher proportion of female gender in atherosclerotic RVH patients. In patients with fibromuscular dysplasia a higher proportion of female gender was also present, but in comparison with ATH patients their hypertension was more often of a less than 5 years duration and they had lower serum creatinine and triglyceride levels. Our results are in agreement with the results of other authors who showed clinical parameters to be useful in screening of patients for further diagnostic procedure. This stresses the importance of good history, physical examination and well-chosen laboratory tests. They can't clearly establish or exclude the diagnosis of renovascular hypertension, but this approach could more easily point out those hyper- tensive patients who require a thorough work-up. Clinical parameters could furthermore help in determining the type of treatment of RVH.

Descriptors: Adrenal gland neoplasms – surgery, pathology; Adrenalectomy – methods; Laparoscopy
Summary. Introduction: Laparoscopy is now a widely used method for removal of functioning and non-functioning adrenal tumors. This paper reports our experience in laparoscopic transperitoneal removal of functioning adrenal tumors including pheochromocytoma, Cushing's disease and aldosteronoma. Methods: Between May 2001 and April 2006, 29 patients under- went laparoscopic adrenalectomy for pheochromocytoma. In 37 patients (10 patients with bilateral adrenalectomy) adre- nalectomy was performed for Cushing's disease, while 28 patients had aldosteronoma. In 2 patients adrenalectomy was performed for virilizing adenoma. Results: All laparoscopic adrenalectomies were finished successfully, and no open surgery was necessary. Major postoperative complications were not observed. Mean hospital stay was 3 days. No patient required blood transfusion. Conclusions: Laparoscopic adrenalectomy for functioning adrenal tumors proved a safe and minimally invasive procedure. Laparoscopic adrenalectomy, in comparison with open surgery, has numerous advantages, including a shorter length of stay, shorter time to return to preoperative level of activity, better cosmetic effect, and decrease in postoperative pain.

Descriptors: Hypertension – etiology, physiopathology, drug therapy; Kidney failure, chronic – therapy, complications; Antihypertensive agents – therapeutic use; Renal dialysis – adverse effects
Summary. Arterial hypertension is one of the most frequent causes of chronic kidney failure but also one of most frequent complications in patients on long-term haemodialysis. The aim of this work is to investigate the prevalence of arterial hyper- tension in long-term haemodialysis patients, and methods for treating it. A total of 168 patients (86 women and 82 men aver- age age 62.9±12.9 years) from three dialysis centers were included in this study. Arterial hypertension was defined as blood pressure immediately before hemodialysis >140/90 mmHg or less if the patient has been on anti-hypertensive therapy. Before the beginning of a long-term hemodialysis program arterial hypertension was registered in 139 (81%) patients. The patients were on haemodialysis 52.5±45.17 months. All patients were dialyzed three times per week, an average of 11.7 hours per week (9 to 13.5 hours). Body weight of the patients was 68.4±15.8 kg, and weight gain between dialysis treatments was 2.9±1.1 kg. Arterial hypertension was recorded in 141 patients (84%), i.e. average blood pressure before haemodialysis in all patients was 157.3±17.3/85.2±8 mmHg. The average blood pressure of the remaining patients was 132.6±8.2/ 78.3±10.3 mmHg. The patients were treated with a variety of anti-hypertensive drugs. Thirty-seven patients were on monotherapy, while the others were on combined treatment (2–4 antihypertensive drugs). The most frequently used antihypertensive drugs were calcium channel blockers (95 patients, or 67%), ACE inhibitors (47 patients, or 33%), b-blockers (29 patients, or 20%), angiotensin II receptor blockers and a-blockers (25 patients, or 17%), diuretics (11 patients, or seven percent), and nine patients (6%) received central agents or drugs wich acted like an a+b blocker. Preven- tion and treatment of arterial hypertension is a special problem for haemodialysis patients. Unfortunately, there are still no guidelines for the optimal method of measuring blood pressure in these patients, or optimal values of arterial blood pressure, the first drug of choice or optimal combination of therapies. Perhaps because of this cardiovascular morbidity and mortality among these patients is high.

Descriptors: Kidney transplantation – adverse effects; Hypertension – etiology, drug therapy, epidemiology
Summary. Hypertension frequently occurs in patients with renal transplant. The aim of the present study was to determine the incidence, time of occurrence and hypertension severity following transplantation. A total of 78 patients (37 women and 41 men) mean age 49.9±12 years were included in the study. The post-transplant period amounted from 6 to 168 months. Prior to transplantation, hypertension was registered in14 patients (17.9%). Following transplantation hypertension was registered in 59 (75.6%). During the first post-transplant year hypertension occurred in 79% of patients, while in the period of one to three years in 13.5% and in 6.7% of patients with transplant performed three or more years earlier. Hypertension responsive to only one drug was found in 22%, and to two or more drugs in 25% of patients. The satisfactory blood pressure values were obtained in 78% of patients. The study reveals that hypertension in the majority of renal transplant patients develops during the first post-transplant year.

Descriptors: Hypertension – chemically induced, drug therapy; Immunosuppressive agents – adverse effects, therapeutic use; Kidney transplantation – adverse effects; Antihypertensive agents – therapeutic use; Postoperative complications – etiology
Summary. Cardiovascular disease (CVD) is the leading cause of death among renal transplant recipients. The prevalence and severity of CVD in renal transplant recipients are related to numerous factors, most shared with the general population and others specific to transplant recipients, including effects of kidney dysfunction and immunosuppressive drugs. Arterial hypertension is highly prevalent after renal transplantation and may contribute to the risk of cardiovascular disease and graft failure. Immunosuppressive drugs such as corticosteroids, cyclosporine and tacrolimus may be important contributing factors to post-transplant hypertension. Recent data suggest that renal transplant patients under tacrolimus-based therapy showed less arterial hypertension compared with cyclosporine treated patients. New immunosuppressive drugs, including mycophenolate mofetil and sirolimus, are not nephrotoxic, do not have any hypertensive effect and may permit several combinations that offer important alternatives to classical immunosuppressive regimens to reduce the incidence and clinical impact of arterial hypertension after renal transplantation. Other metabolic disorders, such as post-transplant dyslipidemia and diabetes have to be closely monitored and treated as soon as possible. Incidence of arterial hypertension after kidney transplantation may be reduced by early detection, proper adjustment of immunosuppressive protocols and aggressive treat- ment with lifestyle modification and potent antihypertensive drugs.

Descriptors: Hypertension – complications, drug therapy; Hypertensive encephalopathy – etiology, physiopathology, drug therapy; Cerebrovascular disorders – etiology, physiopathology, drug therapy; Antihypertensive agents – therapeutic use
Summary. Continuous brain blood supply in healthy individuals is warranted by brain autoregulation, the borders of which are not completely strict and can be changed as a part of dynamic physiological control. In acute neurological diseases like hypertensive encephalopathy, brain infarction, intracerebral hemorrhage and subarachnoid hemorrhage, a great attention should be paid to cerebral perfusion pressure preservation (which represents a difference between mean arterial pressure and intracranial pressure) when blood pressure is regulated. To preserve neurological function it is necessary to know anatomic and pathophysiological qualities of brain circulation and to approach the treatment of hypertension. In case of ishemic stroke hypertension should be reduced gradually, through several days, having in mind the distance of ischemic penumbra. The ideal antihypertensive for the reduction of hypertension in acute neurological diseases should have the following characteri- stics precise value and time control of blood pressure, not to have a rebound-phemonenon, not to cause the effect of exceed- ing with initially severe hypotension, not to have impact on heart muscle and not to worsen intracranial pressure. In everyday clinical work with these patients one should act according to the instructions for management of patients with stroke prepared by the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Society for the Prevention of Stroke.

Descriptors: Hypertension – complications, drug therapy; Arteriosclerosis – etiology, prevention and control; Antihypertensive agents – pharmacology, therapeutic use
Summary. Arterial hypertension is one of the leading causes of atherosclerosis. Many studies of antihypertensive drugs have been recently focused on prevention, stopping and if possible regression of atherosclerosis. Some antihypertensive drugs which are used in clinical practice have antiatherosclerotic effects besides their effects on the reduction of systemic blood pressure. Oxydative processes and oxygen free radicals participate in the pathogenesis of atherosclerosis. The concen- tration of oxygen free radicals is increased in patients with arterial hypertension. Antioxidant could neutralise oxygen free radicals. There are endogenous antioxidants like vitamin E, vitamin C etc. Some antihypertensive drugs have antioxidant properties and they could neutralise free oxygen radicals. These drugs are: calcium channel blockers, ACE-inhibitors, b-blocker carvedilol and blocker of a-receptors-doxazosine. Antiatherosclerotic effects of these drugs have been shown in experiments in vivo, in animals as well as in clinical studies. The results of the most important clinical studies will be presented in the following text.

Descriptors: Antihypertensive agents – therapeutic use, adverse effects, pharmacology; Diabetes mellitus,
type 2 – chemically induced, physiopathology, complications; Hypertension – drug therapy, complications; Blood glucose – metabolism, drug effects
Summary. Arterial hypertension is frequently associated with type 2 diabetes mellitus, and both of these diseases are the major risk factors for cardiovascular complications. During the past few years, a number of large randomized clinical trials examined the frequency of new onset diabetes mellitus during administration of antihypertensive drugs. Application of ACE inhibitors or angiotensin receptor blockers reduces the risk for the onset of diabetes mellitus by 20–27%, and calcium channel blockers by 16%. Despite some uncertainties, novel studies have demonstrated an increased risk for cardiovascular complications related to new onset diabetes mellitus. The duration of patient monitoring is also an important factor, as the onset of diabetes-related complications is closely associated with the duration of this disease. Considering all above, the aim of preventing the onset of diabetes is to recognize patients with an increased risk. The risk factors include basal glycemia, positive family history for diabetes mellitus, obesity, metabolic syndrome, and some ethnic groups (South Asia, the Caribbeans). Therefore, increased-risk patients should be subjected to therapy with ACE inhibitor, angiotensin receptor blocker, or calcium channel blocker as the first drug of choice. For these patients, application of thiazides and beta blockers or the combination of these two drugs is not advantageous. However, such a view poses a dilemma whether thiazide diuretics should be the first choice in the treatment of hypertension.

Descriptors: Hypertension – epidemiology, drug therapy, prevention and control; Croatia – epidemiology
Summary. Poor control of blood pressure (BP) is one of the main reasons for high cardiovascular mortality and morbidity. The aim of this study was to analyse control of BP in outpatient settings in four biggest towns in Croatia. The study included 412 medical doctors (GP) and 7031 middle-aged patients (62.9±11.5 years). Mean BP in treated patients was 162.9± 16.8/95.6±9.9 mmHg. There were no statistically significant differences in systolic (p=0.173) and diastolic (p=0.561) BP between men and women. In this group of patients only 8% achieved target BP values. In contrast, and surprisingly, 44.5% of medical doctors and 72% of patients were satisfied with obtained BP control. Higher percentage of male patients vs. female were satisfied with blood pressure control (81.9%:66.9%). BMI <25 was registered in 22.9% of hypertensive patients, and there was statistically significant difference in BMI between men and women (c2=56.769, p<0.001). In this study we found a statistically significant difference of hypertension in regard to BMI in both sexes (c2m=46.339, p<0.001; c2`=45.992, p=0.024). BMI was in correlation with severity of hypertension as well as with obtained treatment result. BMI was in correlation with the number of prescribed drugs. According to this, patients with BMI <25 were prescribed less drugs than those with BMI >30 (1.4:1,6 p=0.001). BP control in Croatia is, according to this study, very poor. The main reason for such situation is, beside obesity which determines the stage of hypertension and BP control in both sexes, insufficiently developed conscience in patients and doctors about the importance of stronger blood pressure control. The results indicate the necessity for the more intensive education of the population.

Descriptors: Anaphylaxis – chemically induced, diagnosis, therapy; Neuromuscular blocking agents – adverse effects; Anesthesia – adverse effects
Summary. The incidence of anaphylactic reactions during anesthesia is between 1:5000 and 1:25000 anesthetics. During the IgE-mediated anaphylactic reaction mast cells release proteases such as tryptase, histamine and vasoactive mediators. The release of mediators from the mast cells and basophils is responsible for the immediate clinical manifestations of anaphylaxis. Anaphylactoid reactions can be caused directly by a release of histamine and other mediators from mast cells and basophils and they don't depend on interaction of IgE antibodies with antigen. The most frequent agents that cause anaphylactic and anaphylactoid reactions during anesthesia are neuromuscular blocking agents (among them the highest percent refers to rocuronium and succinylcholine), some general anesthetics, antibiotics, blood and blood products, opioids and latex. Increased tryptase concentration in serum is a marker for systemic mast cell activation. Skin tests (in vivo) are used for verification of specific hypersensitivity to drugs in patients after anaphylactic reaction. In vitro tests prove the presence of specific IgE antibodies for drugs. The plan for the treatment of anaphylactic reactions must be established before the event. Airway maintenance, 100% oxygen administration, intravascular volume expansion and epinephrine are essential to treat the hypotension and hypoxia that result from vasodilatation, increased capillary permeability and bronchospasm. As soon as the diagnosis has been made the adrenalin should be given intravenously 1 to 3 ml of 1:10000 aqueous solution (0.1 mg/ml) over 10 minutes. Prevention is possible with methylprednisolone 125 mg i.v. 1 hour before administering of anesthetics and neuromuscular blocking agents with or without antihistaminic chlorpiramine-chloride 1 amp i.v. few minutes before anesthesia.

Descriptors: Multiple sclerosis – diagnosis, pathology; Magnetic resonance imaging – methods
Summary. Multiple sclerosis is an autoimmune disease characterized by demyelination and axonal loss. Conventional magnetic resonance imaging allows the demonstration of spatial and temporal dissemination of multiple sclerosis lesions earlier than is possible from clinical assessments. A variety of conventional magnetic resonance imaging protocols, in conjunction with clinical assessment, are now routinely used to increase the accuracy of diagnosis and long-term prognosis of multiple sclerosis. T2-weighted hyperintense lesions are related primarily to increased water content and thus cannot distinguish between inflammation, edema, demyelination, Wallerian degeneration, and axonal loss, whereas the contrast gadolinium-enhanced lesions on T1-weighted images reflect increased blood-brain barrier permeability associated with active inflammatory activity. Conventional magnetic resonance imaging metrics are not sufficiently sensitive to detect invisible brain damage in the normal appearing brain tissue, and they do not show a reliable correlation with clinical measures of disability. However, numerous studies showed that they can improve accuracy in the diagnosis and prognosis of multiple sclerosis. Recently, non-conventional magnetic resonance imaging techniques have been introduced to increase the accuracy of diagnosis and prognosis of multiple sclerosis. Several studies have used brain atrophy, T1-hypointense lesion volume, magnetization transfer imaging, diffusion-weighted imaging and magnetic resonance spectroscopy to test whether the extent and severity of tissue loss in lesions and in normal appearing gray and white matter at the time of clinically isolated syndrome may have diagnostic and prognostic value. These magnetic resonance imaging techniques represent a powerful tool to non-invasively study different pathological substrates of lesions and microscopic tissue changes. Additional short- and long-term prospective studies are requested to establish their value in the diagnosis and prognosis of multiple sclerosis.

Descriptors: Vertigo – diagnosis, physiopathology, therapy; Cervical vertebrae – physiopathology; Proprioception
Summary. Cervical proprioceptive system (CPS) consisting of mechanoreceptors of cervical intervertebral joints, mecha- noreceptors of neck muscles and ligament’s insertions, muscle spindles located in deep short muscles of cervical spine and sensitive fibers connecting neck’s proprioceptors with neurons of cornu posteriori of spinal cord, plays an essential part in maintaining bodily balance. CPS, via tractus spinovestibularis, is connected to vestibular nuclei. Clinical and neuro- physiological studies have shown that functional disorders and/or organic lesions of CPS cause identical symptoms as vestibular diseases: vertigo, nystagmus and balance disorders. Dysfunction (functional blockade) of craniocervical joints is the most frequent cause of cervicogenic proprioceptive vertigo (CPV). The constant tension of the capsule of a blocked joint irritates mechanoreceptors protecting the joint’s capsules. The increased activity of mechanoreceptors results in confusion of vestibular system. That is, the impulses from the blocked craniocervical joints do not correspond to the impulses from the vestibular organ and other sensory systems that take part in maintaining bodily balance. The disharmony of impulses results in an inadequate vestibulo-spinal and vestibulo-ocular reaction manifesting as vertigo and nystagmus. Hyperactivity of craniocervical mechanoreceptors also causes disturbances in reflex regulation of postural muscle tonus manifesting as »general instability«. Knowledge of CPV as a separate clinical entity is important from diagnostical and therapeutical aspect. As it concerns a peripheral vestibular disorder still unknown to a wider circle of physicians, the article describes etiopathogenesis, clinical manifestations, diagnosis and therapy of CPV with special emphasis on manual therapy.

Descriptors: Abdominal injuries – diagnosis, surgery; Laparoscopy; Spleen – injuries; Liver – injuries
Summary. In the past few years, laparoscopy has been increasingly used in patients with acute abdominal trauma. This metod in experienced hands enables direct eye visualisation of abdominal cavity, ensures accurate and early diagnosis and leads to prompt decision on the therapy. Reviewing the literature, laparoscopy in acute abdominal trauma is a safe and accurate procedure to yield diagnosis, enable laparoscopic interventions and help avoid unnecessary laparotomy. In acute abdominal trauma, laparoscopy is mostly used as a diagnostic method, not so often as a therapeutic method, but an expand- ing range of therapeutic interventions is available. We show our early results with diagnostic and therapeutic laparoscopy from January 1st 2003 to March 31st 2004, stressing therapeutic laparoscopy. We performed 79 laparoscopic explorations in patients with diagnosis of acute abdomen. 7 of them were explored because of acute abdominal trauma. In 3 patients there was no need for intervention after laparoscopic exploration, in 1 patient we electrocoagulates smaller bleeding from the spleen and in other 3 patients we made conversion to open surgery procedure, because of III–IV grade liver or spleen injury. In our group we didn’t have injuries of any other internal abdominal organs. Laparoscopic treatment of acute abdominal trauma with spleen or liver injury is applicable in I–III grade liver injury and I–II grade spleen injury, while in greater injuries it is necessary to make conversion to laparotomy.

Descriptors: Lymphoma – radiography, pathology; Bone neoplasms – radiography, pathology
Summary. The purpose of our study was to retrospectively review imaging appearances of primary bone lymphoma in 13 patients (six males, seven females; mean age 30.6 years) from 1994 to 2006 on plain radiography, computed tomography (CT), magnetic resonance (MR) and scintigraphy. Lytic-sclerotic pattern was noticed in 26 of 36 bone lesions on plain radiography and in 27 of 33 lesions on CT scanning. On MR, lesions were homogeneous and hypointense on T1 weighted images, and inhomogeneous and hypointense, isointense or hyperintense with respect to fat on T2 weighted images. Increased uptake on bone scintigraphy was noticed in six out of eight patients. The most common location of primary bone lymphoma was the pelvis. Pathologic type was non-Hodgkin's lymphoma in 11 patients and Hodgkin’s disease in two patients. Primary bone lymphoma presents as mixed lytic-sclerotic lesions that might cause the soft-tissue mass and bone marrow changes associated with little cortical destruction.

Descriptors: Cushing syndrome – etiology, genetics; Adrenal cortex diseases – complications, genetics; Pigmentation disorders – complications, genetics; Multiple endocrine neoplasia – genetics
Summary. We report a 11 year old girl and two 14 year old boys with Cushing's syndrome due to primary pigmented nodu- lar adrenocortical disease (PPNAD). In these patients, hypercortisolism is a consequence of autonomous cortisol secretion from adrenal glands and is ACTH-independent. Besides PPNAD, the girl had lentigines, spotty pigmentation on her bucal mucosa and lips and she also had schwannoma. One of the reported boys had prolactinoma. Considering this, those two patients fulfill the criteria for Carney complex which is a type of multiple endocrine neoplasia syndromes inherited in an autosomal dominant trait. The other boy had PPNAD but no other obvious signs of Carney complex were noticed. Family study didn't reveal any clinical or laboratory signs of Carney complex in our patients' first relatives. All of our patients under- went bilateral adrenalectomy (in one of the boys laparoscopic surgery was performed). Glucocorticoid and mineralo- corticoid substitution has been started. Adrenal glands were macroscopically normal but pathohistological analysis con- firmed the diagnosis of PPNAD.

Descriptors: Thyroid neoplasms – diagnosis, pathology; Carcinoma – diagnosis, pathology; Ki-67 antigen – analysis; Proto-oncogene proteins C-bcl-2 – analysis; Tumor suppressor protein p53 – analysis
Summary. The report covers the first case of insular thyroid cancer recorded in Croatian medical literature. A 71-year old female patient presented to our hospital with symptoms of inspiratory stridor. Clinical examination disclosed an expansive tumor mass. US guided FNA indicated anaplastic cancer and total thyroidectomy was accordingly indicated. Patho- histological analysis of H/E biopsies disclosed a tumor mass with a characteristic insular growth pattern of monomorphic tumor cells. Immunohistochemical analysis confirmed diagnosis by a diffuse positive reaction to thyreoglobulin, focally to TTF-1, and scant to cytokeratin, while calcitonin, FVIII, CD34 and LCA were clearly negative. P53 and bcl-2 were expressed in 35.9% and 85% of tumor cells, respectively. The proliferation index for Ki-67 was 4.19. According to our survey we suggest a panel of immunohistochemistry for diagnosing insular cancer. Even if partly present, insular cancer should be mentioned in the pathohistological description because of its prognostic meaning.

Descriptors: Hospitals – history; Croatia
Summary. »Brothers of Charity Hospital« or »Foundation Hospital« in Zagreb was the oldest hospital in continental part of Croatia. It was built in 1804 on Harmica Square (present Ban Jela~i} Square). The hospital building was demolished in 1931, and relocated to Sv. Duh Street where it is still located. On the 75th anniversary of the old hospital demolishion the author is showing its history (from 1804 to 1931) referring both to the particular departmens and wards development as well as to the important physicians, many of whom were the progenitors of many specialized medic professions in Croatia.

Descriptors: Urinary retention – drug therapy, etiology; Adrenergic alpha-antagonists – therapeutic use; Prostatic hyperplasia – complications
Summary. Catheterization remains the standard management of acute urinary retention (AUR), followed by a trial without catheter (TWOC) or prostatectomy in men who do not void spontaneously. If AUR is caused by increased sympathetic activity at the level of the prostatic smooth muscles, alpha-blockers (alpha-1 adrenoreceptor antagonists) should increase the likelihood of a successful trial without catheter (TWOC) following AUR. Alpha-blockers effectively reduce the symptoms associated with benign prostatic hyperplasia (BPH) and improve the urodynamic parameters of obstruction. They may diminish the incidence of AUR and the need for prostatectomy in symptomatic men. The adventage of tamsulosin and slow-release alfuzosin over doxazosin and terazosin in the management of AUR is that a therapeutic dose can be adminis- tered at the onset of AUR, thereby reducing the time for attempting catheter removal.

Descriptors: Lymphoma, follicular – radiotherapy; Antibodies, monoclonal – therapeutic use; Yttrium radioisotopes – therapeutic use; Radioimmunotherapy
Summary. Radioimmunotherapy is a new antineoplastic treatment modality combining the effects of irradiation and monoclonal antibodies. 90Y-ibritumomab tiuxetan is a monoclonal antibody directed against the CD20 antigen to which a radioactive isotope of yttrium is attached, used for treating follicular lymphomas (FL). Using this compound we treated 8 patients with FL relapsing or refractory to combinations of rituximab and chemotherapy. Severe neutropenia developed in 5, and severe thrombocytopenia and anemia in 3 patients. Serious infections developed in 2 patients, one died. Six patients responded to treatment, 4 are still in remission after a median follow-up of 15 months, 2 died of lymphoma. Best response was achieved in low-risk patients with a low tumor burden. 90Y-ibritumomab tiuxetan is an effective treatment for FL with significant hematological toxicity and a high price.

Descriptors: Digestive system diseases – ultrasonography, radiography, pathology; Endosonography; Tomography, X-ray computed
Summary. During the last 20 years endoscopic ultrasound (EUS) has been established as a highly accurate method in the diagnosis of digestive tract diseases. This method enables analysis of the lesions within the bowel wall, pancreas, and biliary system with utmost precision. Good results have also been achieved in evaluation of regional lymphadenopathy in staging of malignant diseases. Principal limitations of this method originate from its low accesibility and technical complexity which requires well trained sinologist and scientific evaluation of results in order to achieve adequate level of skill. Complications occur rarely with numbers comparable to other endoscopic procedures. With new software and hardware device introduced, computerized tomography (CT) (this refers in the first place to multidetector row CT) has been tremendously upgraded approaching the EUS in diagnostic accuracy in mentioned indications, and overcoming it in detection of distant metastases. Implementation of 3D reconstruction techniques allowed CT to enter the area of classic endoscopy, as in the case of virtual gastroscopy and/or colonoscopy. CT is a noninvasive method, very acceptable to majority of patients, and therefore popular and more prevalent compared to EUS. Although comparable in diagnostic accuracy in majority of indications, endo- sonography retains advance in evaluation of lesions within GI tract wall (including the early stages of carcinoma), detection of small biliary stones and small pancreatic tumors. Moreover, EUS is indespensable in therapeutic indications. Experiences with fine needle aspiration, punctions and drainage of cysts and abscesses, celiac plexus neurolysis and creation of digestive anastomosis confirm its place and value among the minimally invasive procedures which minimize the need for surgical intervention, patients’ trauma and treatment costs.

Descriptors: Intervertebral disk displacement – diagnosis, therapy; Lumbal vertebrae; Manipulation, orthopedic – methods
Summary. In a 38-year old patient affected by acute radicular syndrome magnetic resonance imaging (MRI), diagnosed a large dorso-medial herniation at L4/L5 segment. Upon application of the usual conservative therapy, during 3.5 months of conservative treatment, no clinical improvement was achieved. On the new MRI, made after the completion of physical therapy (the patient was treated for 30 days in a thermal resort), i.e. 40 days subsequent to the first MRI or 3.5 months after the onset of symptoms, no signs of natural regression of the herniation, i.e. changes in the size of herniation, were noted. After unsuccessful conservative treatment, neurosurgeon recommended a surgical procedure which was postponed by the patient for a definite period of time. In the meantime, the patient underwent a manipulative treatment. In the course of the manipulative treatment, a significant subjective and clinical improvement was reached. In the segment affected by the herniation, four rotational manipulations all together were carried out at the intervals of ten days. On the new MRI made upon the fourth manipulation, i.e. 40 days subsequent to the second MRI, an almost complete regression of the herniation was found which corresponded to the clinical outcome. A conclusion can be drawn that, by rotational manipulation, a reposi- tion effect has been achieved. The patient described in these papers does corroborate the viewpoint of several authors on effectiveness of rotational manipulation in patients suffering from lumbar disc herniation.

Descriptors: Mammaplasty – methods; Mastectomy, subcutaneous – adverse effects; Carcinoma, ductal,
breast – surgery; Breast neoplasms – surgery; Surgical flaps; Postoperative complications – etiology; Treatment failure; Reoperation
Summary. We present a patient who was operated due to bilateral breast carcinoma with immediate bilateral breast recon- struction with silicone implants after skin sparing mastectomy in a neighbouring country to Croatia. One year following the operation a severe bilateral capsular contracture was manifested. Due to a large umbilical hernia and lower laparotomy scar it was not possible to reconstruct the breasts with any abdominal free or pedicled flap. We performed bilateral secondary breast reconstruction with latissimus dorsi myocutaneous flap and silicone implants in two stages with good postoperative result

Descriptors: Streptococcal infections – microbiology, diagnosis, complications; Streptococcus bovis – isolation and purification; Colonic neoplasms – complications
Summary. Streptococcus bovis is relatively common cause of bacteremia and endocarditis, especially in older persons, or in patients that have some kind of chronic disease. These infections are frequently connected with malignant, potentially malignant, or benign colorectal neoplasia. Hematogenous dissemination of Streptococcus bovis could result with various clinical manifestations, namely purulent meningitis, brain abscess, osteomyelitis, spondylodiscitis, and many different kinds of infections in AIDS patients are reported. In this report, two patients hospitalized at the Departement of Infectious Diseases at the General Hospital »Dr. Josip Ben~evi}« in Slavonski Brod are presented. The first patient was addmited to the hospital  because of fever of unknown origin, and in his blood cultures, Streptococcus bovis was isolated. He was an older man, who had undergone prostatectomy due prostatic adenoma several years before. The other patient, previously completely healthy younger man, suffered purulent meningitis caused by the same microorganism. Colon endoscopy was performed in both patients and it revealed colon polyps. Histologically, in both cases, those were benign neoplasia. In Croatia, until this report, there have been no other reports about patients suffering systemic Streptococcus bovis infections. At the same time, this report describes Streptococcus bovis purulent meningitis in a previously healthy adult, which is also extremely rare in the medical literature. Since Streptococcus bovis infections are associated with colon carcinoma, it is imperative to perform colonoscopy in each patient suffering infection with this germ, and to consider him as a high risk patient for developing colon cancer.

Descriptors: Laboratories – standards; Chemistry, clinical – standards, methods; Reference values; Quality control; Croatia
Summary. In order to harmonize laboratory results in the field of general medical biochemistry at the national level, analyti- cal methods and analytical quality goals based on biological criteria together with common reference intervals were recom- mended. The following parameters are included: general biochemical parameters (metabolites and substrates, enzymes, electrolytes, microelements, proteins, lipids), routine urine and stool analysis and laboratory haematology and coagulation. The main purpose of external quality control in medical biochemical laboratories is to ensure independent and objective evaluation of laboratory test results in order to promote harmonization and achieve a high degree of interlaboratory compara- bility. The recommended reference intervals were produced on a representative sample group of urban population in Croatia for school children, adolescents and adults. For pediatric population, reference intervals were recommended according to the literature data. The recommended laboratory methods and corresponding reference intervals in the field of general medical biochemistry have to be used in all medical biochemical laboratories in Croatia since January 1, 2005.

Descriptors: Osteoporosis, postmenopausal – drug therapy, complications; Thiophenes – therapeutic use, administration and dosage; Organometallic compounds – therapeutic use, administration and dosage; Fractures, bone – prevention and control, etiology; Bone densitiy – drug effects; Bone resorption – prevention and control
Summary. Osteoporosis has become a global public health issue due to the fact that the world population has gotten older. In the past ten years we have witnessed a great improvement in the treatment of postmenopausal osteoporosis. The anti- resorptive drugs are the most presribed ones. In the last couple of years osteoanabolic drug, a teriparatid, was introduced into the clinical use, and recently a strontium ranelate has occured as a drug with osteoanabolic and antiresorptive effect in bone formation. Clinical trials (phase III) have proved the efficiency of strontium ranelate in postmenopausal osteoporosis treat- ment. Strontium ranelate is a drug characterized by the new paradigm of action mechanism on bone, which has its place among the already well-proven drugs in postmenopausal osteoporosis treatment.

Descriptors: Glomerular filtration rate; Kidney diseases – diagnosis, blood, urine; Creatinine – blood, urine
Summary. In clinical practice, serum creatinine is most commonly used to estimate glomerular filtration rate (GF) although it is well known that serum creatinine may be influenced by GF and factors independent of GF (age, sex, race, body size, diet, certain drugs and analytical methods). Creatinine clearance is a more sensitive marker of GF, but it overestimates GF because of tubular secretion of creatinine, and it often involves errors in 24-hour urine collection. According to the NKF/ KDOQI (National Kidney Foundation Kidney Disease Outcome Quality Initiative) guidelines, the level of GF should be estimated from prediction equations taking into accout serum creatinine concentration and demographic characteristics. The aim of this work is to emphasize the clinical usefulness of these equations in estimating GF. Using prediction equations to estimate GF does not require timed urine collection susceptible to errors which are the most common underlying cause of unreliable estimation of GF done by creatinine clearance.

Descriptors: C-reactive protein – analysis; Coronary disease – diagnosis, blood; Coronary arteriosclerosis – blood; Biological markers – blood; Risk assessment
Summary. Inflammation plays a central role in the initiation, progression and destabilization of atheroma. In an attempt to improve global cardiovascular risk assessment considerable research has focused on inflammatory markers, particularly high sensitive C-reactive protein (hs-CRP). It has been reported that hs-CRP levels more than 3 mg/L identify increased risk of initial cardiovascular events in healthy individuals and also increased risk of adverse events in patients with stable and unstable angina, acute myocardial infarction, and in patients undergoing coronary revascularization procedures. Further- more, several pharmacologic (eg. aspirin, statins, tienopiridins) and lifestyle interventions (eg. weight loss, smoking cessation, regular exercise) known to reduce cardiovascular events rates have also been shown to lower levels of hs-CRP. Therefore, hs-CRP levels may also prove useful in targeting therapy for primary and secondary prevention. This review discusses the role of hs-CRP in the pathogenesis of atherosclerosis and its application in every day clinical practice, includ- ing the role of hs-CRP in identification of high-risk individuals, monitoring of the coronary artery disease activity, and assessment of therapeutic effect on the inflamatory component of the cardiovascular process.

Descriptors: Gastrointestinal stromal tumor – drug therapy; Pyrimidines – therapeutic use; Piperazines – therapeutic use; Protein kinase inhibitors – therapeutic use; Antineoplastic agents – therapeutic use
Summary. Gastrointestinal stromal tumours (GIST) may be defined as intraabdominal mesenchymal tumours that express KIT protein or have an activating mutation in class III receptor tyrosine kinase gene (KIT or PDGFRa). Most GISTs respond to imatinib mesylate, which selectively inhibits both KIT and PDGFRa, and is now considered standard systemic therapy for advanced GIST. We assessed the antitumour response of patients treated with imatinib mesylate who had advanced and/or metastatic (GIST). In the Department of Medical Oncology fourteen (14) patients with advanced GIST were treated in the period from year 2002 to 2004. Imatinib mesylate was applied at the dose of 400 mg daily. Only two patients required dose enlargement up to 800 mg. All tumours had positive immunohystochemical expression of KIT. Median age of patients was 56 years. 12 male patients and 2 female patient was treated. Considering primary site of tumour we had 6 small intestine, 4 mesenterium and 4 gastric tumours. Mean duration of the treatment was 14 months (5 to 30 months). Six patients had partial remission, six had stable disease and two progression. Complete remission has not been achieved in any patient. Side-effects were mild and no patient required dose reduction or treatment discontinuation. Our results show the effectivness of targeted antitumour therapy with imatinib mesylate in advanced and/or metastatic GIST, and correspond to those in literature.

Descriptors: Ventricular dysfunction, left – ultrasonography, physiopathology; Echocardiography, doppler; Heart failure, congestive – physiopathology
Summary. Approximately half of the patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (LVEF>50%). Diastolic dysfunction is an abnormality in left ventricular myocardial relaxation and/or compliance that alters the ease with which blood is accepted into the left ventricle during diastole. Elevated pressures in the left atrium are compensatory, ensuring adequate filling. All patients with systolic dysfunction have concomitant diastolic dysfunction. Indeed, in patients with CHF and reduced systolic function the level of diastolic dysfunction influ- ences the severity of symptoms. It is now clear that hypertension, coronary artery disease and other diseases and conditions commonly produce diastolic dysfunction in the absence of significant systolic dysfunction. Accurate noninvasive Dopp- ler-echocardiographic assessment of the presence and severity of diastolic impairment is crucial to the broad application and understanding of this common condition. This review discusses the clinical impact of classic and recent echocardiographic contributions to the field of diastology.

Descriptors: Ear, external – injuries, surgery; Reconstructive surgical procedures – methods
Summary. Replacement of defect of the upper third of the ear consequent to a traffic accident was successfully performed using modified Antia-Buch technique. Creation of wider and longer skin-cartilage flaps and their increased rotation allowed formation of the upper edge of the ear without tension and postoperative complications. Although the repaired ear is a bit smaller to attain adequate relief and matching color, the use of this method achieved a satisfactory esthetic result.

Descriptors: Carpal tunnel syndrome – surgery, economics
Summary. Carpal tunnel syndrome (CTS) is a somewhat neglected medical and economic problem, and surgery is one of the therapeutic options. We analyze the outcomes of surgical treatment in 114 consecutive patients (154 hands). Before the surgery, physical therapy was implemented (96% cases) and the patients were frequently on a sick leave (42% cases). Imme- diately before the surgery, the patients suffered intensive pain (median 7 on a 0–10 scale), and had a reduced hand function (median 2 on a 0–10 scale). After the surgery (6–12 months), the pain was reduced (difference –5.0, 95% CL –5.5, –4.5, p<0.001), and the function improved (difference 4.5, 95% CLs 4.0, 5.0, p<0.001). Longer time interval between referral to a primary care physician and referral to an orthopeadic surgeon (>1 year in 48% of the cases) was an independent negative predictor for these outcomes. Total difference in costs for sick leaves and physical therapies between the pre- and postopera- tive periods was estimated at approximately 269.030,00 to over 375.315,00 euros. The time between the entrance into the healthcare system and recognition of the need for surgical treatment of CTS needs to be reduced in order to get better medical and economic results.

Descriptors: Physicians, women – history
Summary. By the Banal edict of 28 June 1903, while the country was part of the Austrian-Hungarian monarchy, women physicians in Croatia were granted permission to carry out medical practice. In the memory of that occasion a historical over- view of the women’s role in medical science and practice is presented. The evidence of women’s medical skills dates back to 2500 BC in Ancient Egypt. The 11th and 12th centuries saw first women gain access to medical schools in Europe. Women doctors practiced mainly gynaecology, obstetrics, cosmetics, skin and eye diseases. It took another seven centuries for them to be treated as men’s equals as far as medical training and permission to work were concerned. In the 18th and 19th centu- ries the number of female physicians greatly increased in Europe, USA, and Canada. In Croatia the first woman medical doctor was Milica [viglin ^avov, who graduated from the Medical School in Zürich in 1893, but was not allowed to work in the home country. The first woman to practice medicine in Croatia was Karola Maier Milobar in 1906. The first woman to have graduated from the Medical School in Zagreb, capital of Croatia, following its opening in 1917, was Kornelija Sertic The paper concludes with a view of the present-day role of women in medical practice, education and science.

Descriptors: Balneology; Mineral waters; Hydrogen sulfide; Croatia
Summary. The objective of this paper was to analyse the sodium levels in the spring water, surface and groundwater in Dalmatia during 2003. The sodium concentrations were computed from the difference between coefficient K (the ratio 1 between the chlorides and sulfates sum and the carbonate hardness) andK (the ratio between non-carbonate and carbonate 2hardness) and carbonate hardness. The average sodium concentrations have been expressed by a median and they ranged from 1.8 mg/L Na to 17.6 mg/L Na in the spring water, in the surface water they ranged from 1.0 to 502 mg/L Na and in the groundwater they ranged from 11.1 mg/L Na to 124.3 mg/L Na. In the spring water the sodium concentrations varied from 32% to 217%, in the surface water from 40% to 159% and in the groundwater from 77.3% to 180%. According to the corro-siveness coefficient K , 83% of the spring waters are classified as non-corrosive and 17% as water with a low degree of cor- 1 rosiveness; 84% of the surface waters are classified as non-corrosive water and 16% as very corrosive; all groundwater is classified as very corrosive water. Out of the total of 60 analyzed water resources 64% are classified as hypotensive, 20% as normotensive and 17% as hypertensive water.The drinking water has been defined as hypotensive (<10 mg/L Na), normotensive (from 11 to 20 mg/L Na) and hypertensive (>20 mg/L Na) by relating the sodium concentration projectively with the notion of arterial pressure knowing that an increased sodium concentration in blood increases the blood pressure.From the informatics standpoint the data related to health should be classified into data bases which can serve as a methodological starting point for studying the influence of sodium upon human health. Consequently, epidemiological studies should relate various sodium levels in drinking water to other factors which affect human health.

Descriptors: Postmenopause; Hormone replacement therapy – adverse effects; Complementary therapies
Summary. Despite the fact that hormonal combination used in huge Wpmen’s Health Initiative (WHI) is not common all over the world, and treated population is, because of age, in risk per se, study results have consternated not only lay users, but prescribers too. Namely, increased cancer, stroke and coronary heart disease risk associated with long term use of postmenopausal hormone therapy (HT) have rapidly declined the number of women treated with HT (either estrogen alone or estrogen plus progestogen). Considering recent position statements from leading organizations dealing with menopause, individualization of therapy and lower dosage HT becomes the state of the art. Not only WHI, but also results of other studies published during past few years, have induced curiosity for non-estrogen containing treatments in climacteric medicine. This review shows not only mandatory list of possibilities, but also emphasises which of the alternative and complementary treatments are evidence based regarding published randomized controlled trials.

Descriptors: Fetal diseases – diagnosis; Abnormalities – diagnosis; Fetus – pathology; Magnetic resonance imaging; Prenatal diagnosis
Summary. Fast magnetic resonance imaging (MRI) has revolutionized our ability to image the fetus by using fast scanning techniques. Individual images are obtained in 300–400 s allowing fetal imaging without sedation due to reduced fetal move- ment artifacts. MRI is most useful for evaluation of the anomalies of fetal nervous and urinary system which are not fully clarified by ultrasound. The influence of magnetic resonance depending on gestational age on perinatal management nowa- days is certain. This review discusses its current application and future developments.

Descriptors: Carcinoma, small cell – complications, Lung neoplasms – complications;
Lymphoma, T-cell – complications; Splenic neoplasms – complications; Liver neoplasms – complications; Antineoplastic combined chemotherapy protocols
Summary. Hepatosplenic T-cell lymphoma (HSTCL) is a rare form of extranodal non-Hodgkin lymphoma derived from cytotoxic T-cells, usually manifesting by sinusoidal infiltration of spleen, liver and bone marrow. In 1997 World Health Organization classified malignant lymphomas and placed HSTCL among peripheral T-cell neoplasms. The course of the diseases is usually very agressive with a median survival time of 8 to 16 moths despite multiagent chemotherapy. We present a case of a 48-year-old male patient whose initial symptoms were fatigue, weight loss and night sweats, which were followed by splenomegaly and pancytopenia. After clinical examination we suspected him to have HSTCL which was proved pathohistologically upon splenectomy and it is the first case of this lymphoma diagnosed in »Merkur« Clinical Hospital. As a first line of lymphoma therapy we decided to apply FED course (fludarabine, cyclophosphamide, prednisone), being aware of the published poor results the standard CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisolone) yields. As far as we know, the results of this chemotherapy course in the therapy of this tumor have never been published. The patient underwent 6 courses of FED therapy, which he tolerated well and was in good clinical condition. Upon the com- pletion of the 6th course of therapy he was diagnosed with lung anaplastic microcellular carcinoma and was treated with 3 course of PE therapy (cisplatin, etoposide).

Descriptors: Prostatic neoplasms – diagnosis, pathology, therapy; Adenocarcinoma – diagnosis, pathology, therapy
Summary. Prostate carcinoma is an important cause of morbidity and mortality in men of middle and older age. It is second diagnosed malignant tumor among men in USA and in Europe. Hereby, we’d like to show the number of treated patients at our hospital between January 2002 and January 2004. We made a retrospective analysis of patients’ histories, discharge letters and operation protocols. During that period 70 transrectal biopsies (12 cilindars) were made, finding prostate carcino- mas at 39 patients. Three patients with negative biopsies were incidentally diagnosed at TURP. Average age of treated patients was 72 years (51–90), with Gleason score 6.12 and PSA average 32.4 (5.2–159). Ten radical prostatectomies, 23 subcapsular orchidectomies and 6 chemical castrations by LH-RH agonists were made. Further palliative irradiation was performed in 7 patients with bone metastases and radical irradiation in 16 patients unable to undergone surgery. Only early detection of disease can lead to successful treatment, so we should search for prostate tumor in all male patients who come to see urologist and are older than 50 years.

Descriptors: Hepatitis B – epidemiology; Croatia – epidemiology
Summary. Epidemiologic characteristics of hepatitis B virus (HBV) infection in the Split-Dalmatia County and in Croatia as a whole from January 1, 1994 till December 31, 2003 were analyzed. The mean number of hepatitis B cases was 28 (mor- bidity rate 6.03‰) in the Split-Dalmatia County and 208 (morbidity rate 4.68‰) in Croatia. Over the last five years, there was a marked decrease in the incidence of hepatits B in the Split-Dalmatia County (morbidity rate 1.55‰), whereas its incidence at the national level showed a stable pattern (morbidity rate 4.49‰). In the Split-Dalmatia County, the majority of patients (57.51%) were aged 15–29, which could be attributed to risky sexual contacts and intravenous drug use. The male to female ratio was 2.1(188:93). There was no major incidence fluctuation according to months of year. The hepatitis B mortality rate was 0.24% (5/2079) in Croatia as a whole, whereas no case of HBV lethality was recorded in the Split-Dalmatia County. The significant decrease in the hepatitis B morbidity rate in the Split-Dalmatia County most probably resulted from the comprehensive measures of prevention, especially vaccination, the early introduction of the needle exchange program (1955–1996).

Descriptors: Professional competence; Problem solving; Decision making
Summary. The nature of expert knowledge is explored from two points of view. One of them questions the possibility of expert judgement making in practice and analyses the possible origins of bias of professional decision making. The second approach assumes that expertise manifests in different approaches in solving problems between beginners and experts who have proven high competence in the field. Shanteau’s analysis of particular fields of expertise which shows differences in validity and reliability of professional decision making was also described. These differences to large extent can be attrib- uted to different characteristics of problems specific to a particular field. In The last section of the paper gives an overview of the research results considering the origins of bias in medical expertise.

Descriptors: Lymphoma, Non-Hodgkin – drug therapy; Lymphoma, B-cell – drug therapy;
Antibodies, monoclonal – therapeutic use, administration and dosage;
Antineoplastic agents – therapeutic use, administration and dosage; Antigens, CD20 – immunology
Summary. Rituximab, a chimeric anti-CD20 monoclonal antibody, has become a part of standard treatment of B-cell non-Hodgkin lymphoma in the last several years. Depleting CD20+ cells by various mechanisms, it is active as a single agent and particularly when combined with chemotherapy. It is effective in »in vivo« elimination of neoplastic cells from the hematopoetic stem cell transplant. Side-effects are mostly infusion related, mild to moderate, mediated by cytokine release. Because of different mechanisms of action, adding rituximab to chemotherapy does not cause additional toxicity. Combination of rituximab and chemotherapy improves response rates in indolent lymphomas and survival in aggressive lymphomas.

Descriptors: Paraganglioma – surgery, physiopathology; Mediastinal neoplasms – surgery, physiopathology; Anesthesia, general; Intraoperative complications
Summary. A 70-year old female patient was admitted to the hospital because of scheduled thoracotomy and biopsy of poste- rior mediastinal retrocardiac tumor of unrecognized etiology. The patient had no complaints regarding the tumor. Routine anesthesiological preoperative examination revealed status ASA III. Induction in anesthesia was usually stable. At the moment when the surgeon intraoperatively touched the tumor, hemodinamic instability started and arterial blood pressure and heart rate dramatically increased. Our first reaction was to deepen the anesthesia. Very soon it was obvious that blood pressure increased by the surgeon’s manipulation of the tumor and we started to doubt on catecholamine-secreting tumor. During the course of the operation there were several hypertensive episodes and we managed them by alternately using atenolol, glyceroltrinitrate and anesthetic drug. The patient was extubated 5 hours after transfer to the intensive care unit. Postoperative period was hemodynamically stable. The level of catecholamines in 24-hour urine collection was significantly increased. Pathohistologic diagnosis was mediastinal paraganglioma.

Descriptors: Cardiopulmonary resuscitation – standards, methods; Electric countershock – standards, methods; Heart arrest – therapy; Advanced cardiac life support; Practice guidelines
Summary. European Resuscitation Council guidelines for resuscitation 2005 summary: Adult basic life support – The ratio of compressions to ventilations is 30:2 for all adult victims of cardiac arrest. Automated external defibrillation – A single defibrillatory shock is delivered, immediately followed by two minutes of uninterrupted CPR. Adult advanced life support – In out-of-hospital cardiac arrest attended, but unwitnessed, by healthcare professionals equipped with manual defibrillators, give CPR for 2 minutes before defibrillation. The recommended initial energy for biphasic defibrillators is 150–200 J, for second and subsequent shocks is 150–360 J. The recommended energy when using a monophasic defibrillator is 360 J for both the initial and subsequent shocks. Rhythm checks must be brief, and pulse cheks undertaken only if an or- ganised rhythm is observed. Adrenaline is given 1 mg i.v. as soon as intravenous access is obtained, and repeated every 3–5 min thereafter until return of spontaneous circulation is achieved. Consider thrombolytic therapy when cardiac arrest is thought to be due to proven or suspected pulmonary embolus. Unconscious adult patinets, with spontaneous circulation, after out-of-hospital VF cardiac arrest should be cooled to 32–34°C for 12–24 hours. Paediatric basic life support – Lay rescuers or lone rescuers witnessing paediatric cardiac arrest will start with 5 rescue breaths and continue with the 30:2 ratio as thaught in adult BLS. Two or more rescuers with a duty to respond will use the 15:2 ration in a child up to the onset of puberty. Paediatric advanced life support – When using a manual defibrillator, a dose of 4 J/kg (biphasic or monophasic waveform) should be used for the first and subsequent shocks. Adrenaline iv. or i.o. should be given at the dose of 10 μg/kg (0.01 mg/kg) and repeated every 3–5 minutes. Neonatal life support – Protect the newborn from heat loss. Standard resusci- tation in delivery room should be made with 100% oxygen. Suctioning meconium from the baby’s nose and mouth before delivery of the baby’s chest (intrapartum suctioning) is not useful and no longer recommended.