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: 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: 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: 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: 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: 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: 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.