Irena Perić - Academia.edu (original) (raw)
Papers by Irena Perić
Acta medica Croatica, 2007
Statistika bibliografskih podataka o projektima, znanstvenicima i znantsvenim institucijama.
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, Sep 1, 2007
The study included 318 asbestos exposed workers. The aim was to investigate the symptomatology an... more The study included 318 asbestos exposed workers. The aim was to investigate the symptomatology and clinical findings over an average period of ten years. We took in cosideration quantitative data and analyzed them by statistical methodology of univariate and multivariate data analysis and chi2-test. Chest radiography, clinical and functional findings were used as a diagnostic tool. The most common finding was dyspnea, then cough and chest pain. Clinical symptoms were more common in workers exposed to crysotile asbestos than in those exposed to crocidolite asbestos. There is strong evidence for association between the symptoms and the duration of asbestos exposure. The symptoms were not specific for asbestosis. A significant positive correlation was found between physical examination and duration of asbestos exposure. Basal rales and pleural rub were recorded in 72% of exposed workers.
PubMed, Dec 1, 2009
Asbestos-related diseases are one of the burning public health issues worldwide. The incidence an... more Asbestos-related diseases are one of the burning public health issues worldwide. The incidence and the epidemiological patterns of malignant pleural mesothelioma in Split-Dalmatian County, where a large part of Croatian industry related to asbestos processing and use have been situated were assessed in this study. The history of asbestos-related issues and development of current legislation in Croatia was also discussed briefly. Data on the incidence were collected retrospectively from the medical records of patients with malignant pleural mesothelioma treated at Department of Pulmonary Diseases University Hospital Split during the 2000-2007 period. A total of 137 new cases was recorded with the mean incidence of 3.55/100,000 and the trend was increasing over years compared with 1992-1995 period in the same county when the mean incidence was 1.7/100,000. Men accounted for 85.4% of all cases. The mean age of patients was 64.9 +/- 15.4 years. The majority of patients were occupationally exposed to asbestos (85.4%), 8.8% had environmental exposure, and 2.2% had domestic exposure. The type of household exposition was in 5.8% of patients. More than half of the cases were exposed to asbestos 31-40 years. The mean length of exposure was 28.87 +/- 15.63 years. The incidence of malignant pleural mesothelioma in Split-Dalmatian County has been obviously increasing due to the predominantly occupational exposure and it is reasonable to assume that it will remain high in the next two-three decades and to be a reason for concern and fear among the general population.
Tussive syncope, or cough syncope, is most often found in middle-aged, moderately obese men, who ... more Tussive syncope, or cough syncope, is most often found in middle-aged, moderately obese men, who smoke or have stopped smoking. The reason why the male gender and obesity are predisposing factors for cough syncope is unknown. The majority of patients also suffer from chronic cough, episodes of severe cough, and clinical evidence of obstructive pulmonary disease. There are several proposed mechanisms. The first is that when a person coughs, intrathoracic pressure rises and obstructs venous outflow, which results in an acute decrease of cardiac output and blood pressure. As a result, the cerebral flow also decreases, which finally causes loss of consciousness. A second possible mechanism is the decrease of cerebral perfusion, as a consequence of increased pressure of the cerebrospinal liquor. Besides these mechanisms, tussive syncope is also found in patients with hypersensitive carotid sinus syndrome, gastroesophageal reflux, etc. Tussive syncope is considered as one of the situational syncopes, which take place after certain processes: e.g. defecation, micturition, swallowing and coughing. We will present the diagnostic guidelines through the case of a 45 year-old patient with tussive syncope, treated at the
PubMed, Oct 1, 2003
Aim: To examine the presence of radiologically visible lung and pleural changes in patients who w... more Aim: To examine the presence of radiologically visible lung and pleural changes in patients who were exposed to the asbestos dust, and to correlate the progression of these changes with the duration and intensity of exposure and smoking. We also evaluated possible correlation between non-malignant asbestos-related pleural abnormalities and the occurrence of malignant pleural mesothelioma. Methods: Among 7,300 patients who visited our department between 1991 and 2000 due to non-specific respiratory symptoms, we selected 2,420 with chest X-rays indicating the possible existence of non-malignant asbestos-related diseases. The selected group was followed-up for progression of radiological changes and the development of malignant pleural mesothelioma, and the changes were correlated with the intensity and duration of exposure to asbestos dust and smoking. Results: Radiological changes characteristic for non-malignant asbestos-related pleural disease or lung asbestosis were identified in 340 (14%) out of 2,420 examined patients, of whom 77 (22.6%) developed malignant pleural mesothelioma, as compared with 13 patients out of 2,080 (0.6%) without radiological signs of asbestosis or pleural changes. Twenty-three (29.9%) patients who presented with a progression of pleural disease and lung asbestosis had a very significant incidence of malignant pleural mesothelioma (p<0.001). We also found that 55 (71.4%) patients with the highest asbestos exposure level (grade 3) developed malignant pleural mesothelioma more often (p=0.044). No correlation was found between malignant pleural mesothelioma development and duration of asbestos exposure (p=0.149) or smoking habit (p=0.617). Professionally exposed patients were at 3.3-times higher relative risk (95% confidence interval, 2.28-4.75) than those who were not exposed to develop malignant pleural mesothelioma. Conclusions: The risk of developing lung asbestosis increased with the level of exposure to asbestos dust and smoking. The risk of developing pleural disease correlated with the intensity and duration of exposure, but not with smoking. The patients with progressive pleural and parenchymal changes are at particularly high risk of developing malignant pleural mesothelioma and must be under special surveillance.
Arhiv Za Higijenu Rada I Toksikologiju, Mar 1, 2011
Pulmonary diseases are well documented and diverse in many patients with HIV in clinical stages 3... more Pulmonary diseases are well documented and diverse in many patients with HIV in clinical stages 3 and 4. It is not unusual that these patients, most of whom do not know that they are already HIV-infected, are fi rst examined and hospitalised by respiratory medicine specialists. While HIV-infection is relatively simple to diagnose if accompanied by advanced clinical manifestations and is regularly checked in patients with increased risk, this is not the case in low-risk patients, particularly in countries with low-level HIV epidemic and therefore low index of suspicion. Regular examination involves a series of tests, often including bronchoscopy with transbronchal lung biopsy in order to identify an interstitial lung disease and/or progressive dyspnoea. It is not uncommon that patients provide false or incomplete information about their lifestyle, which can mislead the clinician. At this point, HIV-infection is usually not suspected and healthcare workers may not strictly be following the safety principles which are otherwise applied when HIV-infection is known or suspect, although universal precautions are routine practice. At this point, the risk of exposure is the highest and HIV-transmission to healthcare workers is the most likely to occur. The cases presented here indicate that patients with progressive dyspnoea, which is typical of interstitial lung diseases, should undergo HIV-testing as a part of good clinical practice, even in a country with low-level HIV epidemic.
Journal of International Medical Research, Nov 29, 2018
Objectives: This study aimed to directly measure pH in the lungs, determine lactate dehydrogenase... more Objectives: This study aimed to directly measure pH in the lungs, determine lactate dehydrogenase (LDH), C-reactive protein (CRP), and glucose levels in serum and bronchoalveolar aspirate, and identify bacterial pathogens from bronchoalveolar fluid during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: We performed an observational, analytical case-control study from February 2015 to March 2017. We included 84 patients with AECOPD and 42 with stable chronic obstructive pulmonary disease (COPD). All participants underwent detailed medical anamnesis, a clinical examination, chest radiography, spirometry, an arterial blood gas test, bronchoscopy, bacterial culture, and serum/bronchiolar aspirate laboratory testing. Results: The mean pH of bronchoalveolar fluid was significantly higher in patients with AECOPD than in patients with stable COPD. The mean lung pH value, bronchoalveolar and serum LDH levels, and serum CRP levels in patients with isolated bacteria were higher than those in patients without isolated bacteria in the AECOPD patient group. Lung pH values in patients with AECOPD were significantly correlated with bronchoalveolar LDH and glucose levels.
Respiratory medicine case reports, 2015
Benign thyroid disorders such as goiter, especially retrosternal, can cause tracheostenosis by ex... more Benign thyroid disorders such as goiter, especially retrosternal, can cause tracheostenosis by extrinsic tracheal compression, which is due to the lack of specific symptoms often misdiagnosed. Tracheomalatia develops as a result to long term tracheal compression and refers to weakness of the trachea characterized by softness of the tracheal cartilage arches and by loss of regular tracheal structure. Tracheomalatia is characterized by reduction of the endotracheal lumen and may affect the entire trachea or may be localized to one portion of it. We present the case of a 72-year old patient with distinct tracheostenosis and tracheomalatia, caused by long term pressure by the retrosternal goiter. We have been monitoring the patient for last 20 years after the second endotracheal stent had been placed. The first one was placed 34 years ago, in 1981. On both occasions granulation tissue and colonization of bacteria occurred. In the end the placed stents were rejected and migrated to the main carina. Despite the tracheal diameter narrower than 5 mm the patient has been living normally without the stent for 17 years, with the exception of no hard physical labor. He had a few short term antibiotic therapies and bronchial toilets during symptomatic deteriorations. Diagnosing retrosternal goiter and surgical treatment on time is of crucial importance in cases such as this one. Considering the complications caused by the stent, our opinion is that the majority of patients may require conservative treatment with closely monitoring during respiratory infections.
Arhiv Za Higijenu Rada I Toksikologiju, Jun 1, 2009
Inhalation of asbestos fi bres leads to asbestosis of the pleura and the lung, with possible prog... more Inhalation of asbestos fi bres leads to asbestosis of the pleura and the lung, with possible progression to lung cancer and malignant pleural or peritoneal mesothelioma. Asbestosis remains diffi cult to diagnose, especially in its early stages. The most important role in its diagnosis is that of chest radiographs. The aim of this cross-sectional study was to address interobserver variations in interpreting chest radiographs in asbestos workers, which remain to be an issue, despite improvements in the International Labour Offi ce (ILO) classifi cation system. In our ten-year study, we investigated 318 workers occupationally exposed to asbestos, and in 210 workers with diagnosed asbestos-related changes we compared interpretations of chest radiographs according to ILO by two independent radiologists. The apparent degree of interobserver variation in classifying lung fi brosis was 26.66 % for the diameter of changes and 42.2 % for the profusion of the changes. In cases with diffuse pleural thickening, the interobserver variation using ILO procedures was 34.93 %. This investigation raises the issue of standardisation and objectivity of interpretation of asbestosis according to the ILO classifi cation system. This study has revealed a signifi cant disagreement in the estimated degree of pleural and parenchymal asbestos pulmonary disease. This is why we believe highresolution computed tomography (HRCT) should also be used as a part of international classifi cation.
Rad obrađuje desetogodisnju retrospektivnu studiju progresije azbesne bolesti sagledanu kroz radi... more Rad obrađuje desetogodisnju retrospektivnu studiju progresije azbesne bolesti sagledanu kroz radiolosku sliku i funkcijske parametre pluca.
![Research paper thumbnail of [Lung function in children residentially exposed to asbestos]](https://attachments.academia-assets.com/112074901/thumbnails/1.jpg)
](PubMed, Nov 1, 2009
Impairment of respiratory function is one of the most sensitive indicators used in the evaluation... more Impairment of respiratory function is one of the most sensitive indicators used in the evaluation of the effects of air pollution on human health. We compared predicted values of flow-volume curve according to Knudson and the spirometry results in 81 healthy children; 40 girls and 41 boy, aged (10.69 +/- 2.24) years. We also measured the transfer factor of the lungs for carbon monoxide (TLCO) using the single-breath method and compared the results with reference values by Cotes. Patients were selected randomly among pre-school and elementary school children from the Split area, who were residentially exposed to asbestos. Children with atopic diseases, family history of atopy, history of severe respiratory diseases, and history of smoking were excluded from study. We found a statistically significant difference in FVC (p < 0.0001) from normal values according to Knudson, but when expressed in the percentage of the Knudson values, this difference was not significant (p > 0.05). No statistically significant difference was found for FEV1, FEF75, FEF50, FEF25, and FEV1/FVC. TLCO reached (107.37 +/- 20.50)% of normal values according to Cotes, and was not significantly different. At this point, it is hard to predict the consequences of exposure to low levels of asbestos in childhood, because it takes a long time for complications such as neoplasms, pulmonary fibrosis, or respiratory insufficiency to develop.
Arhiv Za Higijenu Rada I Toksikologiju, 2007
As a rule, asbestosis is a disease of workers who are occupationally exposed to inhalation of asb... more As a rule, asbestosis is a disease of workers who are occupationally exposed to inhalation of asbestos dust, leaving permanent alterations on the lung parenchyma or pleura. In our ten-year study, we investigated 318 workers with pleural asbestosis from whom we took medical history which included occupational exposure to asbestos, radiological examinations and lung function, which is mandatory for the diagnosis and the follow up of the disease. We analysed functional parameters such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1) and intermediate forced expiratory flow at 25 % to 75 % (FEF 25 %-75 %). In addition, we investigated the predicted values of functional parameters according to smoking and non-smoking habits. We found a significant reduction in vital capacity, particularly in smokers after 25 years of exposure to asbestos. During the first 15 years, values of vital capacity on the group basis remained inside the 80 % of the normal values and were not significant for assessing the dynamics of the lung function. To better assess the effects of occupational asbestos exposure, it is necessary to interpret lung function data not only on the group basis, but also for each subject individually.
Folia Microbiologica, Sep 14, 2017
Your article is protected by copyright and all rights are held exclusively by Institute of Microb... more Your article is protected by copyright and all rights are held exclusively by Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i.. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Hemoptiza je iskašljavanje krvi, odnosno pojava krvi u iskašljaju. Ishodište krvarenja može biti ... more Hemoptiza je iskašljavanje krvi, odnosno pojava krvi u iskašljaju. Ishodište krvarenja može biti larings, dušnik, bronhi, te parenhim pluća. Iskašljavanje krvi traži hitan pregled specijaliste pulmologa, te zbrinjavanje pacijenta. Tijekom 2010. godine na hitnom prijmu Klinike za plućne bolesti KBC-a Split su obrađena ukupno 123 pacijenta s krvi u iskašljaju. Analizirajući podatke koje smo prikupili iz povijesti bolesti, došli smo do određenih rezultata. Hemoptize su bile učestalije kod muškaraca u starijoj životnoj dobi i to u mjesecu svibnju. Kod 80% bolesnika je rađen standardni radiogram torakalnih organa. Kod 5 pacijenata su izmjerene vrijednosti arterijskoga tlaka više ili jednake 180 mmHg. Kod pacijenata kod kojih je rađena mikrobiološka obrada, u 83,3% slučajeva rezultati su bili uredni. Što se tiče bronhoskopskog nalaza, u 57% hospitaliziranih se vidio uzrok, odnosno mjesto krvarenja. Kao uzrok krvi u iskašljaju na prvom mjestu se nalazi upala pluća s udjelom od 31% u ukupno...
Sleep Medicine, 2017
Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation an... more Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation and increased risk of cardiovascular and chronic kidney disease. Cystatin C (Cyst C) is a novel biomarker of both latent renal damage and cardiovascular disease. Aim of the study was to measure serum levels of Cyst C, as well as IL-8 and CRP in otherwise healthy OSAS patients. Materials and methods: 84 individuals examined with polysomnography for OSAS symptoms without known comorbidities were prospectively recruited. Results: According to apnea hypopnea index (AHI) subjects were divided in two groups: OSAS group (AHI>5/hour, n¼64) and controls (AHI< 5/hour, n¼20), which were age-and BMI-matched. Cyst C levels were higher in OSAS patients vs. controls (1176.13±351.33 vs. 938.60±245.83 ng/ml respectively, p¼0.017) while serum IL-8 and CRP levels did not differ significantly. A positive correlation was found between Cyst C levels and respiratory disturbance index (RDI) (r¼0.240, p¼0.039), percentage of time with oxygen saturation < 90% (r¼0.290, p¼0.02) and a negative correlation with average oxygen saturation during sleep (r¼-0.291, p¼0.012). After adjustment for age and BMI, RDI was the only independent predictor of Cyst C (b¼0.256, p¼0.039).
Acta medica Croatica, 2007
Statistika bibliografskih podataka o projektima, znanstvenicima i znantsvenim institucijama.
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, Sep 1, 2007
The study included 318 asbestos exposed workers. The aim was to investigate the symptomatology an... more The study included 318 asbestos exposed workers. The aim was to investigate the symptomatology and clinical findings over an average period of ten years. We took in cosideration quantitative data and analyzed them by statistical methodology of univariate and multivariate data analysis and chi2-test. Chest radiography, clinical and functional findings were used as a diagnostic tool. The most common finding was dyspnea, then cough and chest pain. Clinical symptoms were more common in workers exposed to crysotile asbestos than in those exposed to crocidolite asbestos. There is strong evidence for association between the symptoms and the duration of asbestos exposure. The symptoms were not specific for asbestosis. A significant positive correlation was found between physical examination and duration of asbestos exposure. Basal rales and pleural rub were recorded in 72% of exposed workers.
PubMed, Dec 1, 2009
Asbestos-related diseases are one of the burning public health issues worldwide. The incidence an... more Asbestos-related diseases are one of the burning public health issues worldwide. The incidence and the epidemiological patterns of malignant pleural mesothelioma in Split-Dalmatian County, where a large part of Croatian industry related to asbestos processing and use have been situated were assessed in this study. The history of asbestos-related issues and development of current legislation in Croatia was also discussed briefly. Data on the incidence were collected retrospectively from the medical records of patients with malignant pleural mesothelioma treated at Department of Pulmonary Diseases University Hospital Split during the 2000-2007 period. A total of 137 new cases was recorded with the mean incidence of 3.55/100,000 and the trend was increasing over years compared with 1992-1995 period in the same county when the mean incidence was 1.7/100,000. Men accounted for 85.4% of all cases. The mean age of patients was 64.9 +/- 15.4 years. The majority of patients were occupationally exposed to asbestos (85.4%), 8.8% had environmental exposure, and 2.2% had domestic exposure. The type of household exposition was in 5.8% of patients. More than half of the cases were exposed to asbestos 31-40 years. The mean length of exposure was 28.87 +/- 15.63 years. The incidence of malignant pleural mesothelioma in Split-Dalmatian County has been obviously increasing due to the predominantly occupational exposure and it is reasonable to assume that it will remain high in the next two-three decades and to be a reason for concern and fear among the general population.
Tussive syncope, or cough syncope, is most often found in middle-aged, moderately obese men, who ... more Tussive syncope, or cough syncope, is most often found in middle-aged, moderately obese men, who smoke or have stopped smoking. The reason why the male gender and obesity are predisposing factors for cough syncope is unknown. The majority of patients also suffer from chronic cough, episodes of severe cough, and clinical evidence of obstructive pulmonary disease. There are several proposed mechanisms. The first is that when a person coughs, intrathoracic pressure rises and obstructs venous outflow, which results in an acute decrease of cardiac output and blood pressure. As a result, the cerebral flow also decreases, which finally causes loss of consciousness. A second possible mechanism is the decrease of cerebral perfusion, as a consequence of increased pressure of the cerebrospinal liquor. Besides these mechanisms, tussive syncope is also found in patients with hypersensitive carotid sinus syndrome, gastroesophageal reflux, etc. Tussive syncope is considered as one of the situational syncopes, which take place after certain processes: e.g. defecation, micturition, swallowing and coughing. We will present the diagnostic guidelines through the case of a 45 year-old patient with tussive syncope, treated at the
PubMed, Oct 1, 2003
Aim: To examine the presence of radiologically visible lung and pleural changes in patients who w... more Aim: To examine the presence of radiologically visible lung and pleural changes in patients who were exposed to the asbestos dust, and to correlate the progression of these changes with the duration and intensity of exposure and smoking. We also evaluated possible correlation between non-malignant asbestos-related pleural abnormalities and the occurrence of malignant pleural mesothelioma. Methods: Among 7,300 patients who visited our department between 1991 and 2000 due to non-specific respiratory symptoms, we selected 2,420 with chest X-rays indicating the possible existence of non-malignant asbestos-related diseases. The selected group was followed-up for progression of radiological changes and the development of malignant pleural mesothelioma, and the changes were correlated with the intensity and duration of exposure to asbestos dust and smoking. Results: Radiological changes characteristic for non-malignant asbestos-related pleural disease or lung asbestosis were identified in 340 (14%) out of 2,420 examined patients, of whom 77 (22.6%) developed malignant pleural mesothelioma, as compared with 13 patients out of 2,080 (0.6%) without radiological signs of asbestosis or pleural changes. Twenty-three (29.9%) patients who presented with a progression of pleural disease and lung asbestosis had a very significant incidence of malignant pleural mesothelioma (p<0.001). We also found that 55 (71.4%) patients with the highest asbestos exposure level (grade 3) developed malignant pleural mesothelioma more often (p=0.044). No correlation was found between malignant pleural mesothelioma development and duration of asbestos exposure (p=0.149) or smoking habit (p=0.617). Professionally exposed patients were at 3.3-times higher relative risk (95% confidence interval, 2.28-4.75) than those who were not exposed to develop malignant pleural mesothelioma. Conclusions: The risk of developing lung asbestosis increased with the level of exposure to asbestos dust and smoking. The risk of developing pleural disease correlated with the intensity and duration of exposure, but not with smoking. The patients with progressive pleural and parenchymal changes are at particularly high risk of developing malignant pleural mesothelioma and must be under special surveillance.
Arhiv Za Higijenu Rada I Toksikologiju, Mar 1, 2011
Pulmonary diseases are well documented and diverse in many patients with HIV in clinical stages 3... more Pulmonary diseases are well documented and diverse in many patients with HIV in clinical stages 3 and 4. It is not unusual that these patients, most of whom do not know that they are already HIV-infected, are fi rst examined and hospitalised by respiratory medicine specialists. While HIV-infection is relatively simple to diagnose if accompanied by advanced clinical manifestations and is regularly checked in patients with increased risk, this is not the case in low-risk patients, particularly in countries with low-level HIV epidemic and therefore low index of suspicion. Regular examination involves a series of tests, often including bronchoscopy with transbronchal lung biopsy in order to identify an interstitial lung disease and/or progressive dyspnoea. It is not uncommon that patients provide false or incomplete information about their lifestyle, which can mislead the clinician. At this point, HIV-infection is usually not suspected and healthcare workers may not strictly be following the safety principles which are otherwise applied when HIV-infection is known or suspect, although universal precautions are routine practice. At this point, the risk of exposure is the highest and HIV-transmission to healthcare workers is the most likely to occur. The cases presented here indicate that patients with progressive dyspnoea, which is typical of interstitial lung diseases, should undergo HIV-testing as a part of good clinical practice, even in a country with low-level HIV epidemic.
Journal of International Medical Research, Nov 29, 2018
Objectives: This study aimed to directly measure pH in the lungs, determine lactate dehydrogenase... more Objectives: This study aimed to directly measure pH in the lungs, determine lactate dehydrogenase (LDH), C-reactive protein (CRP), and glucose levels in serum and bronchoalveolar aspirate, and identify bacterial pathogens from bronchoalveolar fluid during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: We performed an observational, analytical case-control study from February 2015 to March 2017. We included 84 patients with AECOPD and 42 with stable chronic obstructive pulmonary disease (COPD). All participants underwent detailed medical anamnesis, a clinical examination, chest radiography, spirometry, an arterial blood gas test, bronchoscopy, bacterial culture, and serum/bronchiolar aspirate laboratory testing. Results: The mean pH of bronchoalveolar fluid was significantly higher in patients with AECOPD than in patients with stable COPD. The mean lung pH value, bronchoalveolar and serum LDH levels, and serum CRP levels in patients with isolated bacteria were higher than those in patients without isolated bacteria in the AECOPD patient group. Lung pH values in patients with AECOPD were significantly correlated with bronchoalveolar LDH and glucose levels.
Respiratory medicine case reports, 2015
Benign thyroid disorders such as goiter, especially retrosternal, can cause tracheostenosis by ex... more Benign thyroid disorders such as goiter, especially retrosternal, can cause tracheostenosis by extrinsic tracheal compression, which is due to the lack of specific symptoms often misdiagnosed. Tracheomalatia develops as a result to long term tracheal compression and refers to weakness of the trachea characterized by softness of the tracheal cartilage arches and by loss of regular tracheal structure. Tracheomalatia is characterized by reduction of the endotracheal lumen and may affect the entire trachea or may be localized to one portion of it. We present the case of a 72-year old patient with distinct tracheostenosis and tracheomalatia, caused by long term pressure by the retrosternal goiter. We have been monitoring the patient for last 20 years after the second endotracheal stent had been placed. The first one was placed 34 years ago, in 1981. On both occasions granulation tissue and colonization of bacteria occurred. In the end the placed stents were rejected and migrated to the main carina. Despite the tracheal diameter narrower than 5 mm the patient has been living normally without the stent for 17 years, with the exception of no hard physical labor. He had a few short term antibiotic therapies and bronchial toilets during symptomatic deteriorations. Diagnosing retrosternal goiter and surgical treatment on time is of crucial importance in cases such as this one. Considering the complications caused by the stent, our opinion is that the majority of patients may require conservative treatment with closely monitoring during respiratory infections.
Arhiv Za Higijenu Rada I Toksikologiju, Jun 1, 2009
Inhalation of asbestos fi bres leads to asbestosis of the pleura and the lung, with possible prog... more Inhalation of asbestos fi bres leads to asbestosis of the pleura and the lung, with possible progression to lung cancer and malignant pleural or peritoneal mesothelioma. Asbestosis remains diffi cult to diagnose, especially in its early stages. The most important role in its diagnosis is that of chest radiographs. The aim of this cross-sectional study was to address interobserver variations in interpreting chest radiographs in asbestos workers, which remain to be an issue, despite improvements in the International Labour Offi ce (ILO) classifi cation system. In our ten-year study, we investigated 318 workers occupationally exposed to asbestos, and in 210 workers with diagnosed asbestos-related changes we compared interpretations of chest radiographs according to ILO by two independent radiologists. The apparent degree of interobserver variation in classifying lung fi brosis was 26.66 % for the diameter of changes and 42.2 % for the profusion of the changes. In cases with diffuse pleural thickening, the interobserver variation using ILO procedures was 34.93 %. This investigation raises the issue of standardisation and objectivity of interpretation of asbestosis according to the ILO classifi cation system. This study has revealed a signifi cant disagreement in the estimated degree of pleural and parenchymal asbestos pulmonary disease. This is why we believe highresolution computed tomography (HRCT) should also be used as a part of international classifi cation.
Rad obrađuje desetogodisnju retrospektivnu studiju progresije azbesne bolesti sagledanu kroz radi... more Rad obrađuje desetogodisnju retrospektivnu studiju progresije azbesne bolesti sagledanu kroz radiolosku sliku i funkcijske parametre pluca.
PubMed, Nov 1, 2009
Impairment of respiratory function is one of the most sensitive indicators used in the evaluation... more Impairment of respiratory function is one of the most sensitive indicators used in the evaluation of the effects of air pollution on human health. We compared predicted values of flow-volume curve according to Knudson and the spirometry results in 81 healthy children; 40 girls and 41 boy, aged (10.69 +/- 2.24) years. We also measured the transfer factor of the lungs for carbon monoxide (TLCO) using the single-breath method and compared the results with reference values by Cotes. Patients were selected randomly among pre-school and elementary school children from the Split area, who were residentially exposed to asbestos. Children with atopic diseases, family history of atopy, history of severe respiratory diseases, and history of smoking were excluded from study. We found a statistically significant difference in FVC (p < 0.0001) from normal values according to Knudson, but when expressed in the percentage of the Knudson values, this difference was not significant (p > 0.05). No statistically significant difference was found for FEV1, FEF75, FEF50, FEF25, and FEV1/FVC. TLCO reached (107.37 +/- 20.50)% of normal values according to Cotes, and was not significantly different. At this point, it is hard to predict the consequences of exposure to low levels of asbestos in childhood, because it takes a long time for complications such as neoplasms, pulmonary fibrosis, or respiratory insufficiency to develop.
Arhiv Za Higijenu Rada I Toksikologiju, 2007
As a rule, asbestosis is a disease of workers who are occupationally exposed to inhalation of asb... more As a rule, asbestosis is a disease of workers who are occupationally exposed to inhalation of asbestos dust, leaving permanent alterations on the lung parenchyma or pleura. In our ten-year study, we investigated 318 workers with pleural asbestosis from whom we took medical history which included occupational exposure to asbestos, radiological examinations and lung function, which is mandatory for the diagnosis and the follow up of the disease. We analysed functional parameters such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1) and intermediate forced expiratory flow at 25 % to 75 % (FEF 25 %-75 %). In addition, we investigated the predicted values of functional parameters according to smoking and non-smoking habits. We found a significant reduction in vital capacity, particularly in smokers after 25 years of exposure to asbestos. During the first 15 years, values of vital capacity on the group basis remained inside the 80 % of the normal values and were not significant for assessing the dynamics of the lung function. To better assess the effects of occupational asbestos exposure, it is necessary to interpret lung function data not only on the group basis, but also for each subject individually.
Folia Microbiologica, Sep 14, 2017
Your article is protected by copyright and all rights are held exclusively by Institute of Microb... more Your article is protected by copyright and all rights are held exclusively by Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i.. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Hemoptiza je iskašljavanje krvi, odnosno pojava krvi u iskašljaju. Ishodište krvarenja može biti ... more Hemoptiza je iskašljavanje krvi, odnosno pojava krvi u iskašljaju. Ishodište krvarenja može biti larings, dušnik, bronhi, te parenhim pluća. Iskašljavanje krvi traži hitan pregled specijaliste pulmologa, te zbrinjavanje pacijenta. Tijekom 2010. godine na hitnom prijmu Klinike za plućne bolesti KBC-a Split su obrađena ukupno 123 pacijenta s krvi u iskašljaju. Analizirajući podatke koje smo prikupili iz povijesti bolesti, došli smo do određenih rezultata. Hemoptize su bile učestalije kod muškaraca u starijoj životnoj dobi i to u mjesecu svibnju. Kod 80% bolesnika je rađen standardni radiogram torakalnih organa. Kod 5 pacijenata su izmjerene vrijednosti arterijskoga tlaka više ili jednake 180 mmHg. Kod pacijenata kod kojih je rađena mikrobiološka obrada, u 83,3% slučajeva rezultati su bili uredni. Što se tiče bronhoskopskog nalaza, u 57% hospitaliziranih se vidio uzrok, odnosno mjesto krvarenja. Kao uzrok krvi u iskašljaju na prvom mjestu se nalazi upala pluća s udjelom od 31% u ukupno...
Sleep Medicine, 2017
Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation an... more Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation and increased risk of cardiovascular and chronic kidney disease. Cystatin C (Cyst C) is a novel biomarker of both latent renal damage and cardiovascular disease. Aim of the study was to measure serum levels of Cyst C, as well as IL-8 and CRP in otherwise healthy OSAS patients. Materials and methods: 84 individuals examined with polysomnography for OSAS symptoms without known comorbidities were prospectively recruited. Results: According to apnea hypopnea index (AHI) subjects were divided in two groups: OSAS group (AHI>5/hour, n¼64) and controls (AHI< 5/hour, n¼20), which were age-and BMI-matched. Cyst C levels were higher in OSAS patients vs. controls (1176.13±351.33 vs. 938.60±245.83 ng/ml respectively, p¼0.017) while serum IL-8 and CRP levels did not differ significantly. A positive correlation was found between Cyst C levels and respiratory disturbance index (RDI) (r¼0.240, p¼0.039), percentage of time with oxygen saturation < 90% (r¼0.290, p¼0.02) and a negative correlation with average oxygen saturation during sleep (r¼-0.291, p¼0.012). After adjustment for age and BMI, RDI was the only independent predictor of Cyst C (b¼0.256, p¼0.039).