Miran Martinac - Academia.edu (original) (raw)
Papers by Miran Martinac
Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases
Digestive Surgery, 2000
To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatm... more To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts </=3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. After a follow-up of 18-36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a </=3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract </=3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.
Collegium Antropologicum, Mar 19, 2014
We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured... more We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there was a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination was made to the patient (X-ray, US, CDFI, MSCTangiography) and we found out that there was trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition into the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg was performed and emergency exploration of earlier mentioned arteries. Bypass of the damaged arteries with synthetic graft 6 mm in diameter was made. Control MSCT angiography showed normal flow in the arterial tree of the whole left hand and the MRI of the cervical spine and shoulder girdle did not found lesions of the brachial plexus. SSEP demonstrated the absence of pulses on the left hand. Patient on regular check-ups showed normal general condition, with adequate passable graft and pronounced paralysis on the left hand. In the process of rehabilitation physiotherapy was also included. Blunt trauma to the axillary artery is an extremely rare example of trauma of blood vessels which makes only 0.03% of all vascular injuries.
Collegium Antropologicum, Feb 20, 2014
Aim of the research is to establish the prevalence of constipation in Osje~ko-baranjska County, t... more Aim of the research is to establish the prevalence of constipation in Osje~ko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric and socioeconomic factors. It is a cross-sectional study conducted in 2010. on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional constipation. The chi-square test (÷ 2 test), t-test and logistic regression were used for analysis. The prevalence of constipation in our study was 22.19%, which is higher than the prevalence in most other countries, where it ranges from 5% to 18%. In our study statistically significant variables were: place of current residence (urban), education level (high school), marital status (divorced people), a larger number of household members and a lower health status by self-assessment. According to t-test persons with constipation on average are older, have higher average BMI and lower average grade valued financial status of households and their health. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. Functional constipation presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosing this functional disorder in clinical-consilliary and primary health care, and for persons showing signs of alarm and needing further diagnostic treatment.
Clinical and anorectal motility features in chronically constipated children
Collegium Antropologicum, Jun 1, 2011
Constipation is a common problem in children. It can be a symptom of functional disorder in major... more Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan.
![Research paper thumbnail of [Delirium assessment scoring scales]](https://attachments.academia-assets.com/47623750/thumbnails/1.jpg)
](Acta Medica Croatica C̆asopis Hravatske Akademije Medicinskih Znanosti, Mar 1, 2012
Delirij je značajni psihijatrijski poremećaj u jedinicama intenzivnog liječenja koji negativno ut... more Delirij je značajni psihijatrijski poremećaj u jedinicama intenzivnog liječenja koji negativno utječe na morbiditet i mortalitet bolesnika. Subjektivna klinička procjena bolesnika od strane nepsihijatrijskog zdravstvenog osoblja u jedinicama intenzivnog liječenja nije dostatna za otkrivanje i mjerenje delirija pa su stoga razvijene različite bodovne ljestvice. U ovom radu su prikazane karakteristike najčešće korištenih bodovnih ljestvice u jedinicama intenzivnog liječenja za procjenu delirija: Metoda procjene konfuzije za jedinicu intenzivnog liječenja (engl. Confusion Assessment Method-Intensive Care Unit, CAM-ICU), Nadzorna lista za probiranje delirija u intenzivnoj jedinici (engl. Intensive Care Delirium Screening Checklist, ICDSC), Sestrinska ljestvica za probiranje delirija (engl. Nursing Delirium Screening Scale Nu-DESC) i Ljestvica za otkrivanje delirija (engl. Delirium Detecting Scale, DDS). Rutinska implementacija objektivnih bodovnih ljestvica nije saživjela. Dokazi govore da objektivizacija procjene delirija pridonosi ranom otkrivanju delirija u jedinicama intenzivnog liječenje i započinjanju adekvatnog liječenja. Stoga je preporučljivo uložiti dodatni edukacijski napor kako bi objektivne bodovne ljestvice za procjenu delirija poput CAM-ICU ušle u rutinsku uporabu u jedinicama intenzivnog liječenja. Ključne riječi: delirij, procjena, bodovne ljestvice Adresa za dopisivanje: Tatjana Goranović, dr. med. Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje Klinička bolnica "Sveti Duh" Sveti Duh 64 10000 Zagreb, Hrvatska Tel: 00385-91-37 12 288; e-pošta: tanjagoranovic@hotmail.com T. Goranović, V. Nesek Adam, d. Tonković, M. Martinac, k. šakić Bodovne ljestvice za procjenu delirija Acta Med Croatica, 66 (2012) 33-40 T. Goranović, V. Nesek Adam, d. Tonković, M. Martinac, k. šakić Bodovne ljestvice za procjenu delirija Acta Med Croatica, 66 (2012) 33-40 36 Tablica 3. Kriteriji za ICDSC bodovnu ljestvicu (engl. Intensive Care Delirium Screening Checklist, ICDSC) (26)
Bilateral synchronous breast cancer
Collegium Antropologicum, Sep 1, 2014
We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treate... more We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical re moval of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor.
Sa1948 Esophageal Manometric Characteristics in Patients With Acute Pancreatitis
Gastroenterology, 2013
Influence of various factors on functional dyspepsia
Wiener klinische Wochenschrift, Jan 14, 2015
Aim of the research is to establish the prevalence of dyspepsia in Osječko-baranjska County, to e... more Aim of the research is to establish the prevalence of dyspepsia in Osječko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric, and socioeconomic factors. It is a cross-sectional and case control study conducted in 2010 on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional dyspepsia (FD). The chi-square test, t-test and logistic regression were used for analysis.Prevalence of dyspepsia was recorded in 16, 56 %, of subjects. There is no statistically significant difference in prevalence of dyspepsia male and female. The prevalence of dyspepsia increases with age. Correlation with the place of birth was proven. There is no correlation between the current place of residence (rural area and town) and dyspepsia. There is ...
Collegium antropologicum, 2014
We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured... more We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there was a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination was made to the patient (X-ray, US, CDFI, MSCT-angiography) and we found out that there was trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition into the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg was performed ...
Bilateral synchronous breast cancer
Collegium antropologicum, 2014
We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treate... more We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical re moval of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor.
Collegium antropologicum, 2014
Aim of the research is to establish the prevalence of constipation in Osjecko-baranjska County, t... more Aim of the research is to establish the prevalence of constipation in Osjecko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric and socioeconomic factors. It is a cross-sectional study conducted in 2010. on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional constipation. The chi-square test (chi2 test), t-test and logistic regression were used for analysis. The prevalence of constipation in our study was 22.19%, which is higher than the prevalence in most other countries, where it ranges from 5% to 18%. In our study statistically significant variables were: place of current residence (urban), education level (high school), marital status (divorced people), a larger number of household members and a lower health sta...
![Research paper thumbnail of [Delirium assessment scoring scales]](https://attachments.academia-assets.com/47623768/thumbnails/1.jpg)
](Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2012
Delirium is a significant psychiatric disorder in intensive care units that has negative impact o... more Delirium is a significant psychiatric disorder in intensive care units that has negative impact on morbidity and mortality of intensive care patients. Subjective clinical assessment of patients by non-psychiatric health professionals in intensive care units is not sufficient for detection and measurement of delirium. Therefore, different scoring scales for delirium assessment have been developed. This paper reviews the characteristics of commonly used scoring scales for assessment of delirium in intensive care units: the Confusion Assessment Method-Intensive Care Unit (CAM-ICU), the Intensive Care Delirium Screening Checklist (ICD-SC), the Nursing Delirium Screening Scale (Nu-DESC) and the Detecting Delirium Scale (DDS). Routine implementation of objective scoring scales is not widespread. Evidence suggests that objective assessment of delirium contributes to its early detection in intensive care and initiation of appropriate treatment. It is therefore advisable to make additional e...
Clinical and anorectal motility features in chronically constipated children
Collegium antropologicum, 2011
Constipation is a common problem in children. It can be a symptom of functional disorder in major... more Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method an...
Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis
Journal of Hospital Administration, 2014
Asymptomatic dissecting intimal lesions of common carotid arteries after carotid endarterectomy
Surgery Today, 2014
Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid arter... more Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid artery stenosis. The aim of this article is to present possible intimal lesions after carotid endarterectomy. These lesions could be manifested as intimal flaps, intimal steps or dissections with or without occlusion or stenosis of the artery. The evaluation of the frequency and characteristics of the asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy for symptomatic high-grade stenosis of the internal carotid artery. We found five patients with asymptomatic dissecting intimal lesions of the common carotid arteries. The most common causes of these intimal lesions were shunting and prolongation of the clamping time. Routine carotid ultrasound follow-up exams are necessary because of the potential need for a change in the antithrombotic therapy or due to a need to perform an endovascular treatment.
Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases
Digestive Surgery, 2000
To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatm... more To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts </=3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. After a follow-up of 18-36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a </=3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract </=3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.
Periodicum …, 2011
Saetak Background and Purpose: In this study the goal was to analyze costs of regional versus ge... more Saetak Background and Purpose: In this study the goal was to analyze costs of regional versus general anaesthesia techniques through a retrospective study. Using an interdisciplinary approach of cost management in health care institutions, independent financial analysis of costs of ...
Pancreatic head cystadenoma: A case report
Hepato-gastroenterology
An 18 year-old resident of Zagreb was admitted to our hospital with intermittent pain in the righ... more An 18 year-old resident of Zagreb was admitted to our hospital with intermittent pain in the right subcostal region. On examination, a palpable resistance was found in the upper abdomen. After extensive clinical and laboratory tests, a tumor of the pancreatic head, 80-85 mm in diameter, was verified. Cytologically, a diagnosis of microcystic adenoma of the pancreas was established. The patient underwent a cephalic pancreatoduodenectomy with preservation of the pylorus. Six months later the patient was no longer on a diet and, at follow-up, 3 years after surgery, she is symptom-free and feeling well.
Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases
Digestive Surgery, 2000
To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatm... more To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts </=3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. After a follow-up of 18-36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a </=3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract </=3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.
Collegium Antropologicum, Mar 19, 2014
We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured... more We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there was a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination was made to the patient (X-ray, US, CDFI, MSCTangiography) and we found out that there was trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition into the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg was performed and emergency exploration of earlier mentioned arteries. Bypass of the damaged arteries with synthetic graft 6 mm in diameter was made. Control MSCT angiography showed normal flow in the arterial tree of the whole left hand and the MRI of the cervical spine and shoulder girdle did not found lesions of the brachial plexus. SSEP demonstrated the absence of pulses on the left hand. Patient on regular check-ups showed normal general condition, with adequate passable graft and pronounced paralysis on the left hand. In the process of rehabilitation physiotherapy was also included. Blunt trauma to the axillary artery is an extremely rare example of trauma of blood vessels which makes only 0.03% of all vascular injuries.
Collegium Antropologicum, Feb 20, 2014
Aim of the research is to establish the prevalence of constipation in Osje~ko-baranjska County, t... more Aim of the research is to establish the prevalence of constipation in Osje~ko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric and socioeconomic factors. It is a cross-sectional study conducted in 2010. on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional constipation. The chi-square test (÷ 2 test), t-test and logistic regression were used for analysis. The prevalence of constipation in our study was 22.19%, which is higher than the prevalence in most other countries, where it ranges from 5% to 18%. In our study statistically significant variables were: place of current residence (urban), education level (high school), marital status (divorced people), a larger number of household members and a lower health status by self-assessment. According to t-test persons with constipation on average are older, have higher average BMI and lower average grade valued financial status of households and their health. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. Functional constipation presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosing this functional disorder in clinical-consilliary and primary health care, and for persons showing signs of alarm and needing further diagnostic treatment.
Clinical and anorectal motility features in chronically constipated children
Collegium Antropologicum, Jun 1, 2011
Constipation is a common problem in children. It can be a symptom of functional disorder in major... more Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method and contributes to clarify the diagnosis, which is very important for treatment plan.
Acta Medica Croatica C̆asopis Hravatske Akademije Medicinskih Znanosti, Mar 1, 2012
Delirij je značajni psihijatrijski poremećaj u jedinicama intenzivnog liječenja koji negativno ut... more Delirij je značajni psihijatrijski poremećaj u jedinicama intenzivnog liječenja koji negativno utječe na morbiditet i mortalitet bolesnika. Subjektivna klinička procjena bolesnika od strane nepsihijatrijskog zdravstvenog osoblja u jedinicama intenzivnog liječenja nije dostatna za otkrivanje i mjerenje delirija pa su stoga razvijene različite bodovne ljestvice. U ovom radu su prikazane karakteristike najčešće korištenih bodovnih ljestvice u jedinicama intenzivnog liječenja za procjenu delirija: Metoda procjene konfuzije za jedinicu intenzivnog liječenja (engl. Confusion Assessment Method-Intensive Care Unit, CAM-ICU), Nadzorna lista za probiranje delirija u intenzivnoj jedinici (engl. Intensive Care Delirium Screening Checklist, ICDSC), Sestrinska ljestvica za probiranje delirija (engl. Nursing Delirium Screening Scale Nu-DESC) i Ljestvica za otkrivanje delirija (engl. Delirium Detecting Scale, DDS). Rutinska implementacija objektivnih bodovnih ljestvica nije saživjela. Dokazi govore da objektivizacija procjene delirija pridonosi ranom otkrivanju delirija u jedinicama intenzivnog liječenje i započinjanju adekvatnog liječenja. Stoga je preporučljivo uložiti dodatni edukacijski napor kako bi objektivne bodovne ljestvice za procjenu delirija poput CAM-ICU ušle u rutinsku uporabu u jedinicama intenzivnog liječenja. Ključne riječi: delirij, procjena, bodovne ljestvice Adresa za dopisivanje: Tatjana Goranović, dr. med. Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje Klinička bolnica "Sveti Duh" Sveti Duh 64 10000 Zagreb, Hrvatska Tel: 00385-91-37 12 288; e-pošta: tanjagoranovic@hotmail.com T. Goranović, V. Nesek Adam, d. Tonković, M. Martinac, k. šakić Bodovne ljestvice za procjenu delirija Acta Med Croatica, 66 (2012) 33-40 T. Goranović, V. Nesek Adam, d. Tonković, M. Martinac, k. šakić Bodovne ljestvice za procjenu delirija Acta Med Croatica, 66 (2012) 33-40 36 Tablica 3. Kriteriji za ICDSC bodovnu ljestvicu (engl. Intensive Care Delirium Screening Checklist, ICDSC) (26)
Bilateral synchronous breast cancer
Collegium Antropologicum, Sep 1, 2014
We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treate... more We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical re moval of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor.
Sa1948 Esophageal Manometric Characteristics in Patients With Acute Pancreatitis
Gastroenterology, 2013
Influence of various factors on functional dyspepsia
Wiener klinische Wochenschrift, Jan 14, 2015
Aim of the research is to establish the prevalence of dyspepsia in Osječko-baranjska County, to e... more Aim of the research is to establish the prevalence of dyspepsia in Osječko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric, and socioeconomic factors. It is a cross-sectional and case control study conducted in 2010 on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional dyspepsia (FD). The chi-square test, t-test and logistic regression were used for analysis.Prevalence of dyspepsia was recorded in 16, 56 %, of subjects. There is no statistically significant difference in prevalence of dyspepsia male and female. The prevalence of dyspepsia increases with age. Correlation with the place of birth was proven. There is no correlation between the current place of residence (rural area and town) and dyspepsia. There is ...
Collegium antropologicum, 2014
We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured... more We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there was a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination was made to the patient (X-ray, US, CDFI, MSCT-angiography) and we found out that there was trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition into the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg was performed ...
Bilateral synchronous breast cancer
Collegium antropologicum, 2014
We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treate... more We report a rare case of synchronous bilateral breast cancer in 79-year-old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical re moval of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor.
Collegium antropologicum, 2014
Aim of the research is to establish the prevalence of constipation in Osjecko-baranjska County, t... more Aim of the research is to establish the prevalence of constipation in Osjecko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric and socioeconomic factors. It is a cross-sectional study conducted in 2010. on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional constipation. The chi-square test (chi2 test), t-test and logistic regression were used for analysis. The prevalence of constipation in our study was 22.19%, which is higher than the prevalence in most other countries, where it ranges from 5% to 18%. In our study statistically significant variables were: place of current residence (urban), education level (high school), marital status (divorced people), a larger number of household members and a lower health sta...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2012
Delirium is a significant psychiatric disorder in intensive care units that has negative impact o... more Delirium is a significant psychiatric disorder in intensive care units that has negative impact on morbidity and mortality of intensive care patients. Subjective clinical assessment of patients by non-psychiatric health professionals in intensive care units is not sufficient for detection and measurement of delirium. Therefore, different scoring scales for delirium assessment have been developed. This paper reviews the characteristics of commonly used scoring scales for assessment of delirium in intensive care units: the Confusion Assessment Method-Intensive Care Unit (CAM-ICU), the Intensive Care Delirium Screening Checklist (ICD-SC), the Nursing Delirium Screening Scale (Nu-DESC) and the Detecting Delirium Scale (DDS). Routine implementation of objective scoring scales is not widespread. Evidence suggests that objective assessment of delirium contributes to its early detection in intensive care and initiation of appropriate treatment. It is therefore advisable to make additional e...
Clinical and anorectal motility features in chronically constipated children
Collegium antropologicum, 2011
Constipation is a common problem in children. It can be a symptom of functional disorder in major... more Constipation is a common problem in children. It can be a symptom of functional disorder in majority of cases, but sometimes a serious organic disease is a cause of constipation. Anorectal manometry plays an important role in the diagnostic procedure. It can be presumed that some values of manometric parameters could be very useful in treatment plan. The aim of this study was to confirm or exclude such limits in manometric finding, to make a plan of the therapy more accurate. Therefore the group of 81 constipated children was investigated. There were 58 patients suffering from functional constipation and 23 with organic disorders. The age of the patients was 3 to 15 years. Scoring system was applied to estimate severity of constipation and anorectal manometry was performed. Our results did not show significant correlation between clinical symptoms and signs and the values that we obtained using anorectal manometry. But, we recommend anorectal manometry because it is a safe method an...
Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis
Journal of Hospital Administration, 2014
Asymptomatic dissecting intimal lesions of common carotid arteries after carotid endarterectomy
Surgery Today, 2014
Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid arter... more Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid artery stenosis. The aim of this article is to present possible intimal lesions after carotid endarterectomy. These lesions could be manifested as intimal flaps, intimal steps or dissections with or without occlusion or stenosis of the artery. The evaluation of the frequency and characteristics of the asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy for symptomatic high-grade stenosis of the internal carotid artery. We found five patients with asymptomatic dissecting intimal lesions of the common carotid arteries. The most common causes of these intimal lesions were shunting and prolongation of the clamping time. Routine carotid ultrasound follow-up exams are necessary because of the potential need for a change in the antithrombotic therapy or due to a need to perform an endovascular treatment.
Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases
Digestive Surgery, 2000
To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatm... more To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts </=3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. After a follow-up of 18-36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a </=3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract </=3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.
Periodicum …, 2011
Saetak Background and Purpose: In this study the goal was to analyze costs of regional versus ge... more Saetak Background and Purpose: In this study the goal was to analyze costs of regional versus general anaesthesia techniques through a retrospective study. Using an interdisciplinary approach of cost management in health care institutions, independent financial analysis of costs of ...
Pancreatic head cystadenoma: A case report
Hepato-gastroenterology
An 18 year-old resident of Zagreb was admitted to our hospital with intermittent pain in the righ... more An 18 year-old resident of Zagreb was admitted to our hospital with intermittent pain in the right subcostal region. On examination, a palpable resistance was found in the upper abdomen. After extensive clinical and laboratory tests, a tumor of the pancreatic head, 80-85 mm in diameter, was verified. Cytologically, a diagnosis of microcystic adenoma of the pancreas was established. The patient underwent a cephalic pancreatoduodenectomy with preservation of the pylorus. Six months later the patient was no longer on a diet and, at follow-up, 3 years after surgery, she is symptom-free and feeling well.