Marijana Kostić

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London: Oxford University Press, On T2-weighted images these lesions are characterized by areas of high signal intensity. The number and frequency of side effects were insignificant. Neodazvane osobe se ne pozivaju ponovno. Musil, Z. A Wann Ist Kirchweih of the capsular attachment in the midportion spans Sit N Go the tibia to the femur and is referred to as the deep medial collateral ligament. Medicinska naklada, Zagreb, Pseudohypertension is suspected in persons with minimal vascular damage of the retina in spite of the high measured values of arterial blood pressure, and in those who show postural symptoms after discontinuation of therapy. Supruga je zvala svaki dan.

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Heckathorn D. Respondent driven sampling: a new approach to the study of hidden populations. Social Problems ; Respondent driven sampling II: deriving valid population estimates from Chain-Referral samples of hidden populations.

Social Problems Extensions of respondent-driven sampling: a new approach to the study of injection drug users aged AIDS and Behavior ; 6: Introduction to respondent-driven sampling.

Participant manual. Atlanta: Centres for Disease Control and Prevention, Prevalence of sexually transmitted infections among men who have sex with men in Zagreb, Croatia.

AIDS Behav ; Phylogenetic analysis of HIV sequences obtained in a respondent-driven sampling study of men who have sex with men.

Walker B Jr. J Public Health Policy ; We describe the existing health status and health care needs assessment practices in the Republic of Croatia.

Health care needs assessment in Croatia includes mortality and morbidity information available through vital records but does not include community input opinion and attitude and participation.

Health needs are not analyzed in order to determine the causes of health problems. Analysis of health needs of the population groups at highest risk also does not exist.

Resources assessment is not part of the process, so we do not know how adequate the existing health resources are. In the Croatian health care system practice, the assessment function is limited through the almost exclusive use of the routine health and demographic statistics.

Academic public health has introduced other kinds of more participative, subgroups oriented, qualitative methodologies but in daily routine, these methods are hardly used.

Since health needs assessment is one of the core public health functions, in the future its practice has to be reoriented from pure monitoring towards identifying and solving community health problems.

Partnership with community has to be a cornerstone for more efficient health needs assessment practice. In the light of previous statement, we present and discuss new trends in the assessment practice in Croatia, i.

Vlada Republike Hrvatske Ciljevi Akcijskog plana za Rome Zbog visoke stope nezaposlenosti vrlo mali broj radno sposobne romske populacije aktivno je osiguran.

Framework Convention ETS no. European Charter ETS no. Ustavni zakon o pravima nacionalnih manjina. Zagreb, Vlada Republike Hrvatske. Nacionalni program za Rome.

Roma in an Expanding Europe: Challenges for the Future. Budapest, Body mass index and nutritional status of the Bayash Roma from eastern Croatia.

Indikatori za ocjenu zdravstvenog stanja. Zagreb: Medicinska naklada, , UNDP ured za Hrvatsku. Zagreb, studeni Decade Watch.

Hungary: Decade Watch, Ravnopravan pristup Roma kvalitetnom odgoju i obrazovanju. Zagreb: Dizajn Q.

Publishing, Sedlak J. Tacling cultural barriers to health care service delivery in Croatia. Health systems confront poverty. Public Health Case Studies, no.

Copenhagen, World Health Organisation, , A Regional Human Development Report 4. Nacionalni program za mlade. Zagreb, kolovoz Novak J.

Romi i Romkinje u visokom obrazovanju ili dok temelji klize Institut za razvoj obrazovanja. Bratislava: UNDP, , Fond za obrazovanje Roma REF. Datum pristupa informaciji: Miletic GM.

Housing Conditions and Residential Aspirations of the Roma. Most of these indicators are only obtainable through special studies, while routinely monitored indicators simply do not satisfy quantitative needs.

Another problem is Romanies not stating their ethnic denomination. Consequently, routine Roma mortality and cause of death statistics are unreliable.

Baranja used state budget funds to conduct preventive examinations of Romani women who have no health insurance, and to educate them in health measures of safe motherhood, family planning and infant health care.

U razdoblju tranzicije nakon U jesen U razdoblju od Za njih je obrazovanje provedeno tijekom Kako bi se prikazalo ukupne razlike provedena su dva kruga sumiranja, jedan u kojem su sve dimenzije svedene na tri sastavnice 1.

Ne postoji organizacijska samoprocjena resursa. Evaluacija S. Funkcija procjene stanja 1 A, 1B i 1 C. Funkcija oblikovanja zdravstvene politike 2 A, 2B, 2C.

Funkcija osiguravanja resursa 3A, 3B, 3C i 3D. Acta Med Croatica, 64 programa i osiguravanje kvalitete ne postoji.

Od The once and future health system in the former Yugoslavia: myths and realities. Hebrang A. Reorganization of the Croatian health care system.

U: Shakarishvili E, ur. Acta Med Croatica, 64 5. Evaluation of Croatian model of polycentric health planning and decision making.

Health Policy ; Screening survey to assess local public health performance. Public Health Rep ; Am J Prev Med ; 11 Suppl 2 : Assessing public health practice: application of 10 core function measures of community health in six states.

AJPM ; 11 Suppl. Our hypothesis was that decentralized model of health planning and management would not occur just by changing legislation alone.

Counties in Croatia needed educational support learning-bydoing training in order to improve public health practices at the county level.

Sample and Methods: During the period, the first 15 county teams so-called first cycle counties completed their training.

The teams consisted of 12 to 15 members, representatives of political and executive component, technical component public health professionals, representatives of health and social welfare institutions and community members non-government sector and media.

Teams were trained in cohorts. The remaining 5 counties second-cycle counties completed the same kind of training in Each county team had to fill it out at the beginning of education.

Results: Comparison of the Public Health Performance Matrices of first cycle counties training in with those of the second cycle counties trained several years later yielded no differences.

Although training materials were publicly available accessible through the Croatian Healthy Cities web pages for years, the second cycle counties did not spontaneously without training increase their county-level capacities for participative health needs assessment, health planning, and provision of health services tailored to the local needs.

Conclusion: Results of this study showed that decentralized model of health planning and management in Croatia could not be developed without educational support given to the lower level of administration.

Za daljnju analizu zasebno su razmatrani magisteriji i doktorske disertacije, te znanstvene publikacije indeksirane na PubMed-u.

S aspekta upravljanja skrbi za zdravlje, Povelja o zdravstvenim sustavima usvojena na Europskoj ministarskoj konferenciji SZO Acta Med Croatica, 64 nadzora, analiza i kontrola.

Acta Med Croatica, 64 Tablica 1. U tablici 2. Tako je u razdoblju do Acta Med Croatica, 64 Tablica 4. Doktorske disertacije i magisteriji Od 2.

World Health Organisation. The world health report Health Systems: Improving Performance. Geneve: WHO, Phillips CD.

What do you do for a living? Agency for Healthcare Research and Quality. University of Washington School of Public Health.

Delnoij D, Groenewegen PP. Health services and systems research in Europe: overview of the literature Eur J Public Health ; 17 Suppl. Ettelt S, Mays N.

Draft report. The Hague, April Garrido MV, Busse R. Health systems research in Europe. This project is being implemented with the aim of identifying, evaluating and improving the contribution of Health System Research to the development of Health Policy in Europe.

This study included scientific publications indexed in the PubMed database and master theses and doctoral dissertations published at Schools of Medicine in Zagreb, Osijek, Rijeka and Split during the period.

Access to master theses and doctoral dissertations at the other three medical schools was done by the Internet. We analyzed the collected summaries of all publications, master theses and doctoral dissertations and excluded all those that did not correspond to our research.

Results: Using this method, we found a total of publications indexed in PubMed-in, 70 master theses and 22 doctoral dissertations meeting the study criteria.

For further analysis, we separately considered master theses and doctoral dissertations on the one side, and scientific publications indexed in PubMed on the other side.

All papers were listed by the year of publication, J. Acta Med Croatica, 64 the author and the means of publication.

Upon inclusion of the key words, papers met the required criteria. After abstract analysis, PubMed indexed papers were found to meet all the criteria and addressed the Health System Research in Croatia.

There was a significant increase in the number of published papers during the 5-year study period.

Upon analysis of the summary contents of master theses and doctoral dissertations, we separated 6 doctoral dissertations and 35 master theses that met the criteria of the research.

They were divided into four groups: research of macro-, mezzo- and micro-level of Health System and assessment of Health Care System results. There were only a small number of high quality researches dealing with HSR in Croatia.

Descriptive approach to the analysis predominated. Reform interventions require research, but are not part of the designed strategy.

Funding of HSR is an important issue. In all publications, we could not find a systematic research of the Health System; however, we recognized a growing trend in the number of articles dealing with HSR in Croatia over the past 20 years.

Comparison of the number of papers on the Health Care System in Croatia indicated a significant lag in comparison to Western Europe, and similarity with the countries of Eastern Europe.

Basic Information Sheet po T. Naime, St. Vincentskom deklaracijom iz Vremensko razdoblje od Ispitanici su podijeljeni u dvije skupine. Povremeno prijavljivanje podrazumijevalo je prijavljivanje tijekom dvije godine koje nisu bile uzastopne, odnosno prijave koje su dostavljene Redovito prijavljivanje podrazumijevalo je najmanje jednu prijavu svake godine tijekom promatranog razdoblja, odnosno prijave dostavljene Provedena je deskriptivna analiza promatranih pokazatelja: normalnost raspodjele testirana je Shapiro-Wilksovim testom, a homogenost varijance Leveneovim testom.

Registar CroDiab je implementacijom ekspertnog sustava Global estimates of the prevalence of diabetes for and Prevalence of diabetes mellitus in Croatia.

Diabetes Res Clin Pract ; No , Geneva: World Health Organization. Listopada Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis.

JAMA ; Measuring clinical performance and outcomes from diabetes information systems: an observational study. Diabetologia ; Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS Lancet ; Ten-year follow-up of intensive glucose control in type 2 diabetes.

N Engl J Med ; The Croatian model of diabetes care and St. Vincent Declaration. Diab Nutr Metab ; Diabet Med ; 7: Studenog Ministarstvo zdravstva i socijalne skrbi.

Ministarstvo zdravstva i socijalne skrbi, Diabetes Care ; 33 Suppl. The quality of health care delivered to adults in the United States.

Diabetes Care ; Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study UKPDS Keeping a diabetes registry facilitates monitoring of the epidemiological situation, while a structured approach to the registration of diabetic patients reporting on an optimum information cluster for the follow-up and improvement of diabetes care contributes to better regulation of patient risk factors.

Active patient reporting at the primary health care level has begun in with setting up the legislative background.

The aim of this study was to establish the effect of the CroDiab registry on metabolic parameters in type 2 diabetic patients treated at primary health care level by comparing diabetes indicators between the regularly annually reported type 2 diabetic patients and those that were only intermittently reported to the registry from until Methods: Family physicians submit their reports mainly via CroDiab web, a Croatian web-based system for the collection of data on diabetic patients, which enables analysis of the basic clinical and public health indices.

The levels of fasting and postprandial blood glucose, HbA1c, triglycerides, total cholesterol, HDL- and LDL-cholesterol, systolic and diastolic blood pressure, and body mass index were analyzed in and , and compared between the two study groups.

Results: At baseline, differences between the intermittently reported I and regularly reported R groups were only observed in the systolic I There were no statistically significant differences in body mass index, fasting glucose, HDL-cholesterol and triglycerides.

Discussion and Conclusion: Electronic medical records and structured health care are associated with increased benefits and improvement in metabolic indicators at the primary health care level.

Regular reporting and monitoring via CroDiab registry lead to a significant improvement in the majority of metabolic indicators, which is less marked with intermittent reporting.

The more pronounced effect observed in the group of patients that were regularly covered by the registry could be attributed to a more comprehensive and regular insight and better patient care associated with continuous monitoring.

Further efforts are therefore needed to achieve the widest possible implementation of the CroDiab web system to improve diabetes care at the primary health care level.

Prema ukupnom broju kreveta, Hrvatska je na Prema broju akutnih bolnica na 1. Jedina je iznimka Knin, koji je bolnicu dobio u kasnijem razdoblju Pokazatelji o bruto nacionalnom proizvodu po glavi stanovnika BNP-a p.

Broj stanovnika, Moldavija 3 21 ,04 17 ,22 54,85 Gruzija 4 14 ,9 12 ,5 28,14 79,65 6,77 Ukrajina 46 ,97 ,85 93,9 ,7 Armenija 3 13 ,82 11 ,7 45,4 31,3 Albanija 3 9 ,53 8 ,6 23,06 7,77 Makedonija 2 9 ,69 6 ,43 58,47 29,41 Bosna i H 3 11 ,56 12 ,53 37,24 - - Crna Gora 2 ,8 1 ,37 49,67 - - Bjelorusija 9 ,87 - - 69,93 ,58 - Bugarska 7 48 ,43 57 ,35 58,24 - Srbija 9 52 ,26 - - - - - - 21 ,29 ,21 77,34 - - Rusija 1 ,85 1 ,27 ,29 15,2 Turska 70 ,59 ,94 8,99 26,47 Poljska 38 ,17 ,75 64,78 - - 3 27 ,95 17 ,33 ,29 ,26 Rumunjska Litva Hrvatska 4 24 ,6 16 ,41 93,85 - - Estonija 1 7 ,99 5 ,2 56,2 ,91 10 83 ,52 61 ,54 ,01 70,01 3 ,26 1 ,38 ,4 ,78 Malta Italija 59 ,9 ,31 13,02 ,78 Slovenija Cipar Francuska 60 ,78 ,83 92,59 ,69 Belgija 10 54 ,06 49 ,18 ,78 ,68 Austrija 8 64 ,34 53 ,9 62,88 - - 61 ,72 ,64 82,85 ,25 Britanija 5 36 ,49 12 ,59 84,05 - - BNP 9.

Finska 1 ,72 1 ,31 75,65 1 ,37 8. Nizozemska ,46 16 78 ,8 55 ,18 ,07 7. Irska 4 23 ,91 11 ,23 85,09 ,32 2 ,8 1 ,17 ,85 ,73 4.

Danska 5. Island 5 19 ,48 16 ,65 60,37 ,55 3. Luxemburg 1. Hrvatska prati ta zbivanja te je od S ukupnim brojem od 79 bolnica Manje bolnica za akutne bolesnike od Hrvatske ima samo Nizozemska.

Hrvatska sa 0,6 bolnica na 1. Bolnice su neophodnost koja se mora prihvatiti. Po broju bolnica na broj stanovnika, Hrvatska zaostaje za europskim zemljama.

Posebno je vidljivo smanjenje broja akutnih bolnica. Ne smije se zaboraviti niti utjecaj ratnih zbivanja u Domovinskom ratu, gdje je, uz smanjenje broja zdravstvenih djelatnika, ubrzan trend smanjenja broja kreveta i bolnica 5.

Acta Med Croatica, 64 razvoju. Udaljenost od bolnica, tj. Datum pristupa informaciji Global environmental change and health: impacts, inequalities, and the health sector, BMJ ; : doi: AD Published 24 January The District Hospital.

Health Systems. HCJZ ; 5: broj Int J Health Geographics , doi The health of nations. BMJ ; a McKee M, Healy J.

The changing role of the hospital in Europe: causes and consequences. Fister K, McKee M. Health and health care in transitional Europe.

BMJ ; 23 July , doi Hrvatski zavod za javno zdravstvo. Acta Med Croatica, 64 Sanitarni kordon nekad i danas, Zagreb, Dostupno na URL adresi: 1.

Zagreb: Ministarstvo zdravstva Republike Hrvatske, Building new university hospital--what citizens know and policy makers should be aware of. Ministarstvo zdravstva i socijalne skrbi Republike Hrvatske, Ministarstvo zdravstva i socijalne skrbi Republike Hrvatski sabor.

Nacionalna strategija razvitka zdravstva Trebaju nam 4 velike bolnice, ostale ukinite! Jutarnji list Novi list Vjesnik 1.

Novi list 7. Odrednice hrvatskog zdravstvenog sustava u razdoblju HCJZ ; 3: br. Dostupno na URL adresi: www. Magnusson G.

Sociology of Health ; 2: Travel times to health care and survival from cancers in Northern England. Eur J Cancer ; Cancer survival in New Zealand: Ethnic, social and geographical inequalities.

Posnett J. The hospital of the future. Is bigger better? Concentration in the provision of secondary care. BMJ ; HCJZ ; 3: broj Epidemiologija zaraznih bolesti.

Care of military and civilian casualties during the war in Croatia. Acta Med Croatica ; Besides education of health workers, equipped devices and efficiency of work in hospitals, it is important to compare the number of hospitals, their size, type of hospitals, their distribution and availability to users.

These elements are essential to the overall quality and efficiency of health work of an area. Based on the analysis, to answer the question whether Croatia has a sufficient number of hospitals, particularly in County of Split-Dalmatia and Dalmatia.

Method: In this article are used methods of descriptive epidemiology based on available electronic data of the WHO Office for Europe. Results: Of the 44 European countries, Croatia is in the 35th place with a total of 79 hospitals 1.

Without 10 hospital wards, and 6-of-hospital maternity, Croatian average is 1. By the number of acute hospitals with no out-patient clinic and maternity wards, Croatia is in the penultimate 43rd place with 36 hospitals 0.

By the size of the hospitals per average number of hospital beds per one acute hospital Croatia has no clinic and outpatient hospitals which puts Croatia in the second place behind the Netherlands The most acute hospitals are in County of Pozega-Slavonia 2.

Discussion: Croatia is getting behind by the number of hospitals, compared to Europe, especially concerning acute hospitals. Given the density and area unit in the Southern Croatia there is a striking lack of acute hospitals, causing a disparity in the availability of hospital and specialist health care.

To make hospital and specialist health care available to the , inhabitants of Dalmatia, who are more than an hour away from the hospital, it is necessary to replace outpatient-clinics and maternity hospitals with the general hospitals.

Conclusion: Given the fact that Croatia is at the top of Europe by the size of the hospitals by the number of beds for acute patients, and there is the sufficient number of beds to population, but also a lack of spatial coverage of acute hospitals and therefore poor availability of hospital and specialist care for the advisory large population of south and east of the state and Istria.

U praksi se pokazuje potreba za izradom plana osiguranja kontrole kvalitete svih postupaka programa probira engl. Izostalo je kontinuirano obrazovanje zdravstvenih djelatnika kao i medijska kampanja.

Pozivno razdoblje iznosi dvije godine. Neodazvane osobe se ne pozivaju ponovno. Programu se do Testiranje je R. Tako je ukupno testirano 5.

Kolonoskopiju je do Ukupno opravdani razlozi 2 1 0 20 39 68 70 Tablica 3. Ukupno 17,2 22,3 R. Stoga je Ministarstvo zdravstva Republike Hrvatske u mjesecu listopadu U to vrijeme kraj U susjednoj Sloveniji koja je nacionalni program pokrenula Susjedna Slovenija je tijekom Tako je npr.

Zanimljivo je da je u Francuskoj u 1. Naime, u Dodatni problem nastao je zbog nekontinuiranog slanja poziva na teren. Za kvalitetnu provedbu programa u ovom segmentu neophodna je njihova aktivna uloga.

Do U Francuskoj je odaziv na kolonoskopiju u 1. Istodobno je u Sloveniji u pilot programu stopa otkrivenih karcinoma na osoba pregledanih u probiru iznosila 5,3 Minesota Colon Cancer Control Study.

No, u usporedbi sa zemljama Europe koje koriste iste metode probira, zadovoljstvo je manje. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood.

Natl Cancer Inst ; Incidencija raka u Hrvatskoj Zagreb: Hrvatski zavod za javno zdravstvo, Registar za rak Republike Hrvatske, Reducing mortality from colorectal cancer by screening for fecal 5.

Nacionalni program ranog otkrivanja raka debelog crijeva. Zagreb: Republika Hrvatska, Ministarstvo zdravstva i socijalne skrbi, Colorectal cancer screening in Europe.

World J Gastroenterol. Cancer screening in the European Union. ISBN European Communities publ. Printed in Luxemburg by the services of the European Commision, Colorectal cancer screening in Europe: differences in approach; similar barriers to overcome.

Int J Colorectal Dis ; Estimates of the cancer incidence and mortality in Europe in Ann Oncol ; Strnad M, Znaor A. Registar za rak Hrvatske.

Zagreb: Hrvatski zavod za javno zdravstvo, Ninth plenary meeting; May. Committe B, Third Report. Program Svit.

Final Evaluation Report; Oct. Report No. ISBN 0 82 3. J Med Screen ; Osvrt na 1. Kronja Lj. Datum pristupa informaciji Stipanov I.

Vitalia A. Strnad M. Lessons learnt from a populationbased pilot programme for colorectal cancer screening in Catalonia Spain. Many participants in fecal occult blood test population screening have a higher-than-average risk for colorectal cancer.

Eur J Gastroenterol Hepatol ; Coll Antropol ; 33 Suppl. Cardiovaskular risk factors in Croatia: struggling to provide the evidence for developing policy recomendations.

World Gastroenterology Organisation, International Digestive Cancer Alliance. Practice Guidelines: Colorectal cancer screening.

Young GP. Population-based screening for colorectal cancer: Australian research and implementation. J Gastroenterol Hepatol ; 24 Suppl 3: Haemoccult screening for colorectal cancer: the effect of dietary restriction on compliance.

Eur J Surg Oncol; Random comparison of guaiac and immunochemical fecal occult blood test for colorectal cancer in a screening population. Gastroenterology ; Gut ; The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial.

Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial ISRCTN BMC Public Health ; 5: Slovenian colorectal cancer screening programme SVIT-result of pilot phase.

Zdrav Vestn ; Yeoman A, Parry S. A survey of colonoscopy capacity in New Zealands public hospitals.

N Z Med J ; Mohammad A, Khan Y. Barriers to timely screening colonoscopy: the role of health insurance. Conn Med ; Z Gastroenterol ; 46 Suppl 1: According to the incidence of CRC in men and women, and mortality in men, it is the second most common malignancy, and the leading one in women.

The main obstacles and suggestion for improvement are presented. Study results are compared with international references.

The target group includes approximately 30, individuals suitable for CRC screening aged years. In the first screening round, between January and September , 19, invitation letters with test kits gFOBT were sent to people born and The overall attendance to screening was Blood in the stool was detected in The waiting time for follow up colonoscopy was too long median days.

Colonoscopy rate reached A total of 22 individuals were diagnosed with cancer and the percentage of cancer detected by colonoscopy was 6.

The main limitations to program implementation are inappropriate software for data collection and the lack of a protocol for standardized data collection; the rate of positive test results is unacceptably high, local colonoscopy service is insufficient and waiting time for colonoscopy too long.

Also, the inclusion of general practitioners GPs in the program has proved inadequate. The role of local public health institutes as coordinators is of crucial importance, but financial and human resources are inadequate.

Reminder letters had a significant impact on participation, so this strategy should be adopted. For better success of the program, the involvement of GPs should increase and it is important to make a strategic plan to improve the population and GP awareness of the screening program importance.

Conclusion: The national program is tested in local conditions and it needs change based on the difficulties observed. The results of program implementation are quite satisfactory considering the conditions in which it is carried out, but less satisfactory than those reported from the neighboring countries.

In the next period, the program should be allocated due financial and human resources, and it is important to agree upon a strategy that would yield the best results.

Lokacije bunara odnosno mjesta uzorkovanja prikazane su na sl. Udio uzoraka s obzirom na izmjerene koncentracije prikazan je interkvartilima tablica 1.

Farming, Fertilizers and the Nitrate Problem. Hydrogeol J ; 6: Kattan Z. Use of hydrochemistry and environmental isotopes for evaluation of groundwater in the Paleogene limestone aquifer of the Ras Al-Ain area Syrian Jezireh.

Environ Geol ; Kazemi GA. Temporal changes in the physical properties and chemical composition of the municipal water supply of Shahrood, northeastern Iran.

Hydrogeol J ; Hallberg GR. Nitrates in groundwater in the United States of America. U: Follet RF, ur.

Nitrogen management and groundwater protection: developments in agriculture and managed-forest ecology.

Dordrecht: Elsevier, , vol. Trends in ground water nitrate contamination in the Phoenix, Arizona region. Predicting ground water nitrate concentration from land use.

Jalali M. Nitrates leaching from agricultural land in Hamadan, western Iran. Agr Ecosyst Environ ; Zagreb: Agronomski fakultet, Shuman LM.

Phosphorus and nitrate nitrogen in runoff following fertilizer appliccation to turfgrass. J Environ Qual ; Nitrate temporal and spatial patterns in 12 water-supply wells, Yucatan, Mexico.

Abu Naser A. A, Ghbn N. Relation of nitrate contamination of groundwater with methaemoglobin level among infants in Gaza. EMHJ ; Canter LW. Nitrates in groundwater.

Lewis publishers, Environ Health Persp ; Risk of non-Hodgkin lymphoma and nitrate and nitrite from drinking water.

Epidemiology ; Nitrate in aquifers beneath agricultural systems. Water Sci Technol ; Nitrate intake from drinking water on Tenerife island Spain.

Sci Total Environ ; Nitrate in groundwaters of intensive agricultural areas in coastal Northeastern Australia.

Nitrate concentration in drinking water from wells at three different locations in northwest Croatia.

Cereal Res Commun ; A preliminary assessment of nitrate degradation in simulated soil environments. Environ Sci Technol ; The total amount of downfalls subsequently correlated to nitrate concentrations was determined by summing up individual metric values provided by the State Meteorological and Hydrological Service.

Data were analyzed in a descriptive manner and compared to the maximal allowable concentrations MAC stipulated under the Ordinance on Potable Water Safety, as well as to the limit values recommended under the Nitrates Directive.

The mean range spanned from 0. The highest mean nitrate concentration of Given the detected nitrate concentrations in the sampled well water, the wells were classified as satisfactory, occasionally unsatisfactory and unsatisfactory.

The influence of point sources was assessed based on their distance. Discussion and Conclusions: The results obtained are comparable to those of similar studies undertaken in regions having a similar agro-ecological and agricultural profile.

The range of the mean nitrate concentrations established in potable water samples recovered from shallow wells was wide; the total mean nitrate concentration was relatively high Contaminating point sources located not farther than 10 meters from shallow wells significantly influence the quality of drawn water.

Respective of correlations between the amount of downfalls and water nitrate concentrations, both negative and positive links were established. Podaci su dobiveni od Hrvatskoga zavoda za zdravstveno osiguranje.

U promatranom razdoblju od U Promatrano je razdoblje od jedne godine dana. NN br. Methods for the economic evaluation of health care programme.

Third edition. Oxford: Oxford University Press, Zagreb: Medicinski fakultet, Kampmann JP. Rational Pharmacoterapy: Contents and Scope. Perspectives and achievements with Rational Pharmacotherapy.

Larsen TH. Drug Industry and Rational Pharmacotherapy. Agencija za lijekove i medicinske proizvode. Hydrochlorotiazide versus chlorthalidone in the management of hypertension.

Cardiol Rev ; Curr Med Res Opin ; Ann Pharmacother ; WHO Euromedstat. European Library of Pharmaceutical Indicators. Utilization and price indicators.

Vrhovac B. V izdanje. Selection of therapy with nitrates in patients with stable effort angina: result of comparative study of common isosorbide dinitrate and long acting preparation of isosorbidemononitrate.

Kardiologiia ; Int Heart J ; Beck OA, Hochrein H. Indications and risk of antiarrhythmia treatment with propafenone. Dtsch Med Wochenschr ; Retardation of the excitation conducting by propaphenone.

Duration and dosage effect relation after oral administration. Garcia A. Adverse effect of propafenone after long-term therapy with the addition of citalopram.

Am J Geriatr Pharmacother ; 6: Os I, Stokkle HP. Doxazosin GITS compared with doxazosin standard and placebo in patient with mild hipertension.

Blood Press ; 8: Grzeszczak W. Przegl Lek ; Safety of furosemide administration in an elderly woman recovered from thiazide-induced hyponatremia.

Eur J Intern Med ; Comparison of bisoprolol with atenolol for systemic hypertension in four groups young, old, black and nonblack using ambulatory blood pressure monitoring.

Am J Cardiol ; A randomised double-blind study of bisoprolol versus atenolol in mild to moderate essential hypertension. Eur J Clin Pharmacol ; Clin Drug Invest ; Lacidipine: a review of its use in the management of hypertension, Drugs ; Hrvatsko izdanje.

Lymph node metastases in early rectal cancer. EMR for Colorectal lesions. Oxford: Blackwell Publishing; Treatment with argon plasma coagulation reducesrecurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.

Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: longterm follow-up study.

I Revidiran III In patients with end-stage renal disease, treatment with erythropoietin lowers cardiovascular morbidity, improves quality of life and patient survival.

The aim of this study was to determine the difference in survival of hemodialysis patients treated with recombinant human beta erythropoietin and patients without this treatment, and to determine the influence of hemoglobin level and erythropoietin dose on the survival of these patients.

The study included patients undergoing maintenance hemodialysis, were on erythropoietin therapy, patients formed control group.

We analyzed basic demographic parameters, dialysis duration, underlying disease, comorbidities, death causes, bloodwork parameters and erythropoietin dosage.

Descriptive statistics, Anova, Manova, discriminant function analysis, Cox regressional model and Kaplan Meier survival curves were used as statistical methods.

Average age and dialysis duration in the experimental group were Average level of hemoglobin and hematocrit in the group in which erythropoietin had been administered was Key words: kidney failure, chronic; dialysis; hemoglobins; erythropoietin, recombinant; survival.

Pollak i sar. Ispitivanje je obuhvatilo bolesnika starijih od 18 godina. Kardiovaskularne bolesti bile su najzastupljenije komorbidno stanje i uzrok smrti kod obe grupe bolesnika.

Kod bolesnika na hemodijalizi pokazano je da su perzistentno i tranzitorno nizak nivo Hgb i velike varijacije nivoa Hgb povezani sa porastom rizika od smrtnog ishoda bolesti, dok, nasuprot tome, tranzitorno i perzistentno visok nivo Hb nije povezan sa porastom rizika od smrtnog ishoda bolesti Robinson i sar.

Regidor i sar. Selim i sar. U nekom od narednih ispitivanja trebalo bi analizirati prethodno navedene parametre.

Rao M, Pereira BJ. Optimal anemia management reduces cardiovascular morbidity, mortality, and costs in chronic kidney disease. Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients.

J Am Soc Nephrol. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure.

Effect of erythropoietin on cardiovascular prognosis parameters in hemodialysis patients. The effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron.

Nephrol Dial Transplant. The importance of iron in long-term survival of maintenance hemodialysis patients treated with epoetin-alfa and intravenous iron: analysis of 9.

BMC Nephrol ; 6. National Kidney Foundation. Carrera F, Burnier M. Use of darbepoetin alfa in the treatment of anaemia of chronic kidney disease: clinical and pharmacoeconomic considerations.

Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study.

Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.

The effect of Recombinant human Novi Sad: School of Medicine; Cardiovascular morbidity and mortality in patients treated with hemodialysis-epidemiological analysis.

Hemoglobin level variability: associations with mortality. Correction of anemia with epoetin alfa in chronic kidney disease.

Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a metaanalysis.

The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.

Anemia and mortality in hemodialysis patients: accounting for morbidity and treatment variables updated over time.

Hemoglobin predicts long-term survival in dialysis patients: a year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin.

Inflammation predicts all-cause and cardiovascular mortality in haemodialysis patients. VI VIII Results of studies which have proved an increased inflammatory activity in diabetes type 1, have been published over recent years.

The study included 76 patients with diabetes type 1 and 30 healthy controls. Key words: diabetes mellitus, type 1; blood glucose; c-reactive protein; interleukin-6; tumor necrosis factor-alpha; sensitivity and specificity.

Many studies, whose results have been published in recent years, have shown that diabetes type 1 is also associated with the increased inflammation 2.

One of the mechanisms which might explain chronic inflammation in diabetes is the condition of hyperglycemia, which leads to an increased synthesis of advanced glycation endproducts AGEs resulting from the interaction of glucose in high concentrations with structural and circulating proteins.

Of all the proteins of the acute phase and plasma inflammatory markers, C-reactive protein CRP has been most widely studied and it is believed to have a very important role in the endothelial dysfunction and the process of atherosclerosis.

It is also considered to be one of the important and independent predictors of future cardiovascular events. It is widely used in clinical setting to follow not only the disease course but also the effects of the applied antiinflammatory and antibiotic therapy 3, 4.

A high sensitivity C-reactive protein is used to detect small changes of CRP levels associated with an increased cardiovascular risk in healthy population 5.

Interleukin 6 is an intercellular mediator and primary indicator of the liver CPR 6. The circulating IL-6 stimulates hypothalamic-hypophyseal axis whose activation is responsible for the central obesity, hypertension and insulin resistance 11, It is one of the most important cytokines in the intercellular communication It has a major role in the amplification of inflammatory cascade.

Strana the development of insulin resistance associated with obesity and diabetes type 2, as well 15, Methods This cross-sectional study was performed on a group of subjects, of whom 76 were the patients with diabetes type 1 and 30 were the healthy controls.

The study group consisted of the patients with diabetes type 1, which had been diagnosed before they were 36 years of age and who were on insulin therapy in the first year after the diagnosis had been made.

They either visited day hospital for diabetes or were hospitalized in the Department of Endocrinology, Clinical Center of Vojvodina. The group of healthy controls consisted of 30 subjects of both sexes, of approximately the same age, normally nourished and without other risk factors for atherosclerosis.

The following data were taken for both groups of subjects: sex, age, length of the disease, age when the disease was diagnosed, smoking habit and family medical history.

To assess the state of metabolic regulation in diabetes the values of fasting glycemia were taken 2 hours after breakfast as well as the values of HbA1c; when the latter were less than 7.

Values of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured to analyze the lipid and lipoprotein status.

The nourishment status was assessed on the basis of anthropometric measurements, body mass, body height and body mass index BMI.

The waist was measured in centimeters and the recommended values according to the IDF criteria 17 were considered to be desirable: less than 80 cm for women and less than 94 cm for men.

The collected data were processed by the methods of descriptive and inferential statistics. The following was presented as the numerical characteristics: the arithmetic mean, median, standard deviation and either the value range or the interquartile range, depending on the data nature.

Mean values of the numerical characteristics of the two groups were compared by the t-test. Multivariate regression analysis was applied to determine the predictions and correlations between dependent variables with independent ones: the linear regression was used when the dependent variable was continuous and the logistic regression model was applied when the dependent variable was dichotomous binary.

Results Table 1 shows the characteristics of the study and the control group which did not differ in sex and age structure, nourishment status, values of total cholesterol, HDLcholesterol, LDL-cholesterol and triglycerides.

The average duration of diabetes in the group of diabetic patients was According to the HbA1c value, which was over 7. When multiple linear regression was applied, the CRP value was regarded as a dependent variable, and the rest of the mentioned values were regarded as independent variables.

The following variables were found to be significant CRP predictors: age, smoking habit, fasting glycemia, triglycerides; whereas sex, age, LDL-cholesterol and triglycerides were significant for predicting IL-6 levels.

Discussion Inflammation and oxidative stress play an important role in the process of atherosclerosis; therefore, patients having diabetes type 1 are at higher risk for cardiovascular morbidity and mortality.

Although the majority of studies on these problems dealt with diabetes type 2, recently published results have indicated that there is an increased inflammatory activity in patients having diabetes type 1, as well 1, 2, 7, 11, 13, These results are in accordance with the results of studies which have found increased CRP in adults having diabetes type 1 11, Although the mechanism of CRP rise is not completely clear, it seems to be associated with the activation of macrophages, increased oxidative stress and induction of cytokines.

In their study, Okano et al. Their study did not show statistically significant differences in age, the nourishment status index, values of LDL-cholesterol, HDLcholesterol and triglycerides between the diabetic patients and healthy controls.

This study has clearly shown that the increased level of hs-CRP correlated with the early stage of carotid atherosclerosis in young patients having diabetes type 1, measured through the level of carotid intima-media thickness Alexandraki et al.

However, the values of the above mentioned inflammatory markers were lower than in the group of patients having diabetes type 2.

A positive correlation was found between the values of CRP and postprandial glycemia and the one with fasting glycemia was determined by the multivariate regression analysis.

These results are in accordance with the most recent opinions about the importance of postprandial hyperglycemia in the development of inflammation and chronic complications.

These results can be compared with the results of some studies which have also failed to show the existence of a significant correlation between inflammatory markers and HbA1c 10, 20, thus making it clear that factors other than hyperglycemia affect inflammation and endothelial dysfunction in diabetes.

Dyslipidemia in diabetes type 1 is mostly the result of a poor metabolic regulation of the diseases, with the consequent increase in triglycerides and decrease in HDLcholesterol Besides, the development and progression of nephropathy in diabetes type 1 contribute to the development of dyslipidemia together with the increase in the total cholesterol, LDL-cholesterol, total triglycerides and the decrease in the protective HDL2-cholesterol 26, No statistically significant differences in the values of total cholesterol, HDL cholesterol and triglycerides were found between the study group of diabetic patients and the healthy controls.

A statistically significant correlation between CRP and triglycerides as well as between IL-6 with triglycerides and LDL-cholesterol was found by the multivariate regression analysis.

Eurodiab study 34 has clearly shown a correlation between the values of triglycerides and HDL cholesterol with inflammatory markers, and it has been confirmed in the healthy population, as well.

They have not confirmed a statistically significant correlation between LDL and inflammatory markers 34, In their study, Ladeia et al.

Future prospective studies should prove the importance of inflammation in the pathogenesis of chronic microand macrovascular complications in the population of diabetic patients, as well.

Correlations of certain inflammatory markers with glucoregulation parameters, lipid parameters and hypertension offer the possibility of therapeutic modification of inflammation in diabetes indirectly by improving glucoregulation, treating dyslipidemias and hypertension.

Maiti R, Agrawal NK. Atherosclerosis in Diabetes Mellitus: Role of Inflammation. Circulating endothelial progenitor cells, endothelial function, carotid intima-media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria.

Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Rifai N, Ridker PM.

High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease. Inflammation as a cardiovascular risk factor.

Creactive protein: risk marker or mediator in atherothrombosis? C-reactive protein: risk marker or mediator in atherothrombosis?

Effect of C-reactive protein on vascular cells: evidence for a proinflammatory, proatherogenic role. Creactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus.

First-trimester C-reactive protein and subsequent gestational diabetes. Determinants of raised C-reactive protein concentration in type 1 diabetes.

Elevated C-reactive protein levels in the development of type 1 diabetes. Interpretation of circulating C-reactive protein levels in adults: body mass index and gender are a must.

Increased monocytic activity and biomarkers of inflammation in patients with type 1 diabetes. Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy.

Relationship between serum levels of tumor necrosis factor-alpha and interleukin-6 in diabetes mellitus type 1 children. The metabolic syndrome-a new worldwide definition.

Eleveted C-reactive protein associates with early stage carotid atherosclerosis in young subjects with typ 1 diabetes. Cytokine secretion in longstanding diabetes mellitus type 1 and 2: associations with low-grade systemic inflammation.

Associations of serum C-reactive protein with fasting insulin, glucose, and glycosylated hemoglobin: the Third National Health and Nutrition Examination Survey, Elevated levels of interleukin-6 in young adults with type 1 diabetes without clinical evidence of microvascular and macrovascular complications.

Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. The relation of fasting and 2-h postchallenge plasma glucose concentrations to mortality: data from the Baltimore Longitudinal Study of Aging with a critical review of the literature.

Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes Importance of postprandial glycemia to achieve target HbA1c levels.

American Diabetes Association. Postprandial blood glucose. Increased urinary loss of high density lipoproteins in albuminuric insulin-dependent diabetic patients.

Vaziri ND, Liang K. Quantitative Analysis of Cytokines in Diabetic Nephropathy. Early mechanisms of renal injury in hypercholesterolemic or hypertriglyceridemic rats.

Diabetes mellitus. Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes.

Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Association between elevated serum C-reactive protein and triglyceride levels in young subjects with type 1 diabetes.

Inflammatory and endothelial dysfunction markers and proteinuria in persons with type 1 diabetes mellitus. Tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors.

Received on January 28, Revised on September 22, Accepted on October 1, Bone bruise is a common finding in acutely injured knee examined by magnetic resonance MR.

The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament ACL and menisci.

Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage.

MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques.

A representative review of MR examinations for the acute knee trauma was conducted. All the patients were examined within one month of trauma.

All MR examinations were performed by using a 0. Posttraumatic bone bruise was seen in 39 We analyzed only bone bruises without these fractures of the cortex.

Only two patients with bone bruise had neither ACL nor menisci lesions. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen.

The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.

Magnetnom rezonancom pregledano je bolesnika sa akutnom traumom kolena. Svi bolesnici pregledani su u prvih mesec dana nakon traume. Pregledi su obavljeni na 0,3T MR aparatu.

Key words: knee injuries; bone and bones; contusions; magnetic resonance imaging; sensitivity and specificity. Bone bruise is posttraumatic bone marrow change which is caused by the combination of hemorrhage, edema and microtrabecular fracture without disruption of adjacent cortex.

Magnetic resonance imaging is a method of choice for detecting bone bruises which usually can not be seen using other radiological methods 1.

The terms: bone bruise, bone contusion and posttraumatic edema of the bone marrow have been seen for the last ten years in scientific literature and are in fact synonyms in the case of posttraumatic findings of bone marrow contusion.

Bone bruise of the knee is very important as a reason for acute pain and reduced knee function in patients 7, 8. Bone bruise is best seen in STIR sequence.

The aim of this study was to evaluate the diagnostic power of MR in detecting bone bruise of the knee and to show the association anterior cruciate ligament ACL and menisci lesions with bone bruise of the knee.

Methods Magnetic resonance imaging of the knee was performed in patients with the acute trauma. All the patients were examined within one month of the trauma.

All scans were performed by using 0. On MR imaging bone bruise is characterized by focal abnormal signal of the bone marrow of femoral condyles or tibial plateau.

On T1 weighted images the alterations in signal are characterized by ill-defined low signal intensity. On T2-weighted images these lesions are characterized by areas of high signal intensity.

Bone bruise is best differentiated in STIR sequence where the signal of bone marrow fat is significantly suppressed while there is a bright, hyperintense signal of bone bruise.

The meniscal tear is diagnosed as linear or irregular hyperintense signal which can be spread to the margins od hypointense meniscal triangle.

Anterior cruciate ligament injuries are characterized by a low signal intensity on T1-weighted images and hyperintensity of the signal on T2-weigted images.

A complete rupture of the ACL is diagnosed when there is a complete lack of the fibers on the ligament spread and the partial rupture when there are some fibers left intact.

Strana For the statistical analysis of the results we used descriptive statistical methods and the Mc Nemar test for the evaluation of statistical significance between the patients with and without bone bruise.

In 15 patients bone bruise was located on femoral condyles. Overall, bone bruises were more often seen in the lateral than in the medial compartment.

In 3 patients, so-called occult fractures not seen on plain radiography were diagnosed. Discussion Bone bruise, as an unique entity on MR, was first identified by Mink et al 12 in Few years later, bone bruises and occult fractures were divided Occult fractures usually can not be seen on conventional radiography but have MR characteristics very similar to those of bone bruises with one major difference and that is a disruption of adjacent cortex or osteochondral surface.

Conventional radiological techniques are rather limited in showing bone marrow. Because of that, analysis of bone marrow characteristics especially bone bruises, is based on MR imaging.

Normal intensity signal of bone marrow is the same as the signal of subcutaneous fat. It is hyperintense on T1-weighted images and medium intense on T2-weighted images.

Bone bruise on MR is presented as focal abnormal signal of the bone marrow of the femoral condyles or tibial plateaus. The best appearance of bone bruise is described on STIR sequence where the signal of normal bone marrow is suppressed and bone bruise is characterized by the hyperintensity of the signal.

This change in signal intensity is caused by posttraumatic edema which is one of the major pathohistological features of bone bruise.

The two others are hemorrhage and microtrabecular fracture. Owing to these pathohistological features, it is considered that bone bruise is one of the causes of a painful knee.

Owing to the pathohistological analysis of bone bruise, different degrees of subchondral and articular cartilage changes can be observed 13, Pathogenesis of bone marrow edema which is characteristic for bone bruise is connected with acute or chronic knee injuries, but bone bruises can be seen with no obvious trauma.

Bone bruises associated with posttraumatic lesions of the internal knee structures last more than isolated bone bruises In the overlying cartilage, degenerative changes including necrosis are described, whereas loss of proteoglycans and different degrees of osteocyte necrosis was seen in the bone matrix.

These findings are the basis for further research in the field of late complications of bone bruises such as posttraumatic arthritis Latest studies show that bone marrow edema seen on MR imaging is a result of different atypical histological changes and that intensity of the signal does not depend only on bone marrow edema The main finding in bone bruise is posttraumatic edema which is most responsible for signal intensity.

Location and size of bone bruise usually speak for the mechanism of knee injury. There are five different mechanisms of knee trauma which give different patterns of bone marrow edema and they are: pivot shift injury, dashboard injury, hyperextension injury, clip injury, and lateral patellar dislocation.

There have not been many studies which analyze the incidence of bone bruises following knee injury 10, 20, Our study was designed so to analyze the presence of bone bruise in acute knee trauma as well as the association with internal knee lesions of LCA and menisci.

This study is very important because MR of the knee was done twice in order to confirm diagnosis. In the study of Lynch et al.

The highest association of bone bruise with LCA rupture was seen in study of Atkinson et al. The term LCA injury is used because in our study we had no arthroscopy done in our patients in order to distinguish partial from a complete rupture of the anterior cruciate ligament.

It is very important to emphasize that in acute knee injury it is very hard to distinguish traumatic menisci tears from the degenerative ones which was not the aim of our study.

Cothran et al. It is therefore essential to consider menisci lesions not only as a cause of a painful knee and a diminished knee function but also as a predictor of further osteoarthritis There have been many studies with the aim to confirm the associations of bone bruise and LCA lesions.

Almost all analyzed this association but placing LCA as primary outcome for the study. There have been fewer studies which analyze the association of bone bruises and menisci lesions 17, Our study analyzed both the association of bone bruise and the internal knee structures lesions but placing bone bruise finding as primary.

Conclusion Bone bruise is a very common finding in acute knee injury. It is more often on the lateral knee compartment. In acutely injured knee, bone bruise can indicate the injury pattern and it can be very helpful in detecting associated posttraumatic internal knee lesions.

By the precise analysis of bone bruise and the pattern of bone injury we can focus on analysis of internal knee structures lesions. In this way finding of bone bruise on MR leads to finding the expected but less well seen le- Volumen 68, Broj 9 sions of internal structures of the knee.

Patients with bone bruise have significantly more lesions of LCA and menisci than patients without bone bruise. Vastly undersampled isotropic projection steadystate free precession imaging of the knee: diagnostic performance compared with conventional MR.

Bone marrow oedema of the knee. Bone marrow edema in the knee. Differential diagnosis and therapeutic possibilities. German 4.

Fotiadou A, Karantanas A. Acute nontraumatic adult knee pain: the role of MR imaging. Quantitative assessment of bone marrow edema-like lesion and overlying cartilage in knees with osteoarthritis and anterior cruciate ligament tear using MR imaging and spectroscopic imaging at 3 Tesla.

Clinical consequences of bone bruise around the knee. Tapping test in patients with painful bone marrow edema of the knee. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury.

MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. Bone bruises associated with ACL rupture: correlation with injury mechanism.

Magnetic resonance imaging of the knee. New York: Raven; Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging.

Magnetic resonance imaging of bone bruising in the acutely injured knee-short-term outcome. Bone bruising of the knee. The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year.

Association of knee bone bruise frequency with time postinjury and type of soft tissue injury. Orthopedics ; 31 5 : Bone marrow edema and its relation to progression of knee osteoarthritis.

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis.

The appearance of kissing contusion in the acutely injured knee in the athletes. Bone abnormalities of the knee: prevalence and significance at MR imaging.

MR imaging of meniscal contusion in the knee. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging.

Indirect soft-tissue and osseous signs on knee MRI of surgically proven meniscal tears. Received on February 1, Revised on November 15, Accepted on November 16, According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy.

Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method.

The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume.

In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetiumm scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied.

An average size of the nodule before curing was 9. An average quantity of the injected ethanol was 9. Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone TSH was noticed compared to the initial values 0.

According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram.

The number and frequency of side effects were insignificant. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in disappearing of authonomy.

Key words: thyroid diseases; thyroid hormones; goiter, nodular; ethanol; ultrasonics. Laboratory criterion for diagnosing is an inability to suppress the function of nodules by suppressive doses of thyroid hormones.

At the same time, the suppressed paranodal tissue has retained the ability to answer the stimulation by exogenous giving TSH. Unlike toxic ones, nontoxic nodules have normal serum levels of thyroid hormones.

According to the current principles, toxic nodules are treated surgically or with therapeutic application of radioactive RA iodine. The need for curing the nontoxic AFTNs is based on the observation that most of the ill have subnormal TSH levels and, hence, subclinical hyperthyreosis.

On the other hand, taking larger quantities of iodine, which occurs when giving iodine contrast media, the drugs containing iodine, or when eating food rich in iodine, multiplies the possibility of evolution of nontoxic nodules into the toxic ones.

The results achieved by the use of ethanol in treatement of hepatocellular carcinomas 2 and benign cysts in the thyroid gland 3 were a starting point for the attempts to cure the autonomous nodules by the same method.

The procedure of percutaneous ethanol injection PAE into the nodules of thyroid gland was promoted at the beginning of the s. Then, there were the first results published of treating eight patients in this way in whom the regression in nodules size and the disappearance of autonomy 4 were achieved, regardless a small number of ethanol injections.

In the largest number of the cured, PAE led to a complete or a partial curing, with a very small number of recidives. In an attempt to contribute to the achievements which would make this method generally accepted we started with the fact that there was not a single study with a selection of patients regarding the autonomy level, as well as that most studies included heterogeneous groups of patients with nodal, polynodal, most often toxic nodules of various sizes.

The aim of this study was to estimate therapeutical effects of 15 mL percutaneous ethanol injection in patients with nontoxic, solitary AFTNs, which most often occur in clinical practice.

Methods The study included 25 patients with solitary nodules which appeared more intense on scintigraphy Tem and had a complete supremacy in paranodal tissue.

According to serum concentration of thyroid hormones and TSH, the patients with toxic nodules were excluded. By cytological analysis of aspirates from nodules any doubts of malignancy were eliminated.

A Hewlett Pacard apparatus with a linear probe of 7. Color Doppler was used to direct the injection into the areas with the largest number of exposed capillaries.

The injections were done in the outpatient department, repeatedly, at intervals of once a week. The effects of treatment were defined as: successful s , partly successful ps , and unsuccessful u , the scintigraphic finding being a determiner.

Partly successful: the patients with three of the four formerly mentioned criteria fulfilled. Unsuccessful: only two of the four mentioned criteria fulfilled.

All immediate side effects were noticed, as well as their persistence. The examination was carried out according to the principle of prospective clinical study.

The criterion for excluding the patients was their own decision. An average nodule volume before treatment was 9. Regardless echo structure, all the nodules showed diffusionally accentuated vascularisation.

Injection rate was 4 to 12 applications. In all the patients, a statistically significant diminishing of nodules volume was achieved, being slightly larger nodules with the signs of cystic degeneration Table 1.

Although the successfully cured, compared to the partly successfully cured ones, showed a higher level of volume diminishing, this difference was not statistically singificant.

However, if nodules volumes were expressed in milliliters, we would find a higher level of nodule size regression in the successfully cured than in the partly successfully cured ones.

After stopping ethanol injection, all the patients were followed during the next 18 months. Control examinations were done every 6 months.

The function of the thyroid gland was estimated by measuring the levels of thyroid hormones: triodothyronine T3 , tyroxine T4 , TSH and tyreoglobulin Tg.

The values were controlled before, immediately after finishing the procedure and after 6, 12, and 18 months following finishing the injection Table 4, Figure 4.

Table 1 Nodules volume before and after percutaneous ethanol injection in realtion to echo structure ECHO structure Parenchymatous Cyst.

There are a few phases in the development of AFTN. First, there appears a functional nodule without an autonomy. In its further evolution it can grow into an autonomus hyperfunctional or toxic tyroid nodule.

In treatment nontoxic AFTN is still a subject of discussion, with a number of objections. The opposite attitudes are problematic promoting either clinical following or surgical treatment.

Those who are for clinical following base their attitude on the fact that only a small number of AFTNs evoluate into the toxic ones, as well as that the possibility of malignancy is slight 10, During the last 20 years or so, ultrasound guided percutaneous ethanol injection has become a successful way of curing both malignat and benign soft tissue tumors.

The principle of treatment is based on the knowledge that after injecting ethanol regularly spreads within the tumor lesion by diffusion and, then, it causes an inactivity of the oxidative enzymes, dehydration of the cells, denaturation of proteins, venous microthrombosis and coagulation necrosis followed by fibrosis The surrounding tissue is saved since it appears that ethanol stays within the tumor lesion.

The first reports of positive effects refer to local ethanol injection into hepatocellular carcinomas derived from cirrhosis of the liver 2.

Inactivation of parathyroid adenomas by ethanol appeared to be successful in an important number of those having primary hyperparathyroism and, in some cases, after an unsuccessful surgical exploration, it can be the only possible choice of treatment 13, Sclerosing of benign cystic nodules in the thyroid gland has been used for a long time, and there are more and more proofs of reduction in its size and therapeutical efficiency of PAE in the treatement of benign solid nodules Percutaneous ethanol injection was introduced into clinical practice by Livraghi et al.

It was shown then that regression in nodule size, followed by disappearance of autonomy, was achieved, despite a small number of ethanol injections.

Despite the fact that the criteria for estimation success in the results were very strict, looking for the reasons for such results we started with the question whether nodule volume had an effect on the results of treatment.

Strana cording to the current knowledge, are not completely unique. There prevails an attitude that nodule size only partly affects the results of treatment.

Average nodule volume in our patients was 9. Regarding the results, the nodules which were partly cured and unsuccessfully cured were bigger in comparison with the successfully cured ones.

The cited results led to a conclusion that the nodules of smaller volumes could be cured more easily. However, by linear regressive analysis the correlation between the nodule volume and the results of treated was not proved.

It was shown that the degree of nodule vascularisation had far greater importance for a successful curing. It was noticed that during the treatment, at the time of the planned ultrasound controls, the shape of vascularisation changed in that way that the blood flow gradually weakened, first within parenchyma, and later around the edge of the nodule.

At the end of the procedure, in the successfully cured, both types of vascularisation completely disappeared. Together with the lower blood flow we noticed a regression in nodule size and appearance of fibrosis in parenchyma.

The explanation for this could lie in the noticed occurence that the well vascularised nodules made possible a quicker and a more regular distribution of the injected ethanol, so that even the small amounts of the injected ethanol reached evenly all the parts of nodules and caused the tissue degradation.

We first noticed the good effects of ethanol injecting by the signs of reducting in nodules volume, and we also took into consideration the personal sensation of the patients at control examinations.

Size regression represents the occurence about which there is the smallest number of disagreements in the literature.

We started with the supposition that if a greater size reduction was achieved during therapy there was a greater possibility of getting positive results of curing.

Despite the proved linear correlation between the degree of regression and nodule size and the success of curing, comparisons within the group offered us some interesting ideas and conclusions.

Looking for the reasons of curing to be successful in some patients, but partly successful or unsuccessful in other we analysed some characteristics of nodules and the curing procedures.

Nodules in the subgroup of the successfully treated were of smaller dimensions compared to the unsuccessfully treated but this difference was not statistically singificant.

So, we could not accept nodules size as a reason for the unsuccessful results of curing. Both subgroups did not differ in ultrasound structure of the nodules, the ways of vascularisation, the quantity of the injected ethanol and the number of injections.

A statistically singificant difference was noticed in only the time intervals between the two injections.

In the successfully cured, a period between the two injections was The difference in a period between the two ethanol injections was made on purpose as the result of the first experiences during the introduction of the procedure into practical work.

Namely, very early it was noticed that the nodule size regression continued even after ceasing ethanol injection. We supposed that for the occurence of a number of involutive changes, from cytochemical to fibrosal ones, a certain period of time was necessary.

Having that in mind, there is a small possibility that a larger quantity of the injected ethanol would fasten, or that a smaller quantity would slow down this process which has its logical sequence, from functional to definite morphological changes.

We supposed that the newly injected quantity of ethanol only perpetuated the process of degradation and continued progression towards final necrosis and replacement by a fibrotic tissue.

Considering the first noticing in mind and thinking in this way, we controlled all the patients weekly, but we adjusted ethanol injection individually to a period from 2 to 3 weeks, giving chance to the previously injected ethanol to do its function of destruction.

We followed our patients 18 months after finishing the treatment. Despite stopping ethanol injections, further regression in size was noticed, which proved the cited suppositions and conclusions.

In the patient with the results of curing initially defined as unsuccessful, with already described clinical findings, after a year, during repeated scintigraphy, the nodule was not visible any more.

We suppose that quite probably, after a period of time, in all the patients who were partially treated as they were classified at the end of ethanol injection , the results of scintigraphy approved the disappearance of the autonomy.

By observing the thyroid gland function, an increase in TSH was noticed as a sign of autonomy disappearance, and as the proof of a successful treatment.

The values of Tg immediately after the end of curing showed an increase in value which we considered was due to degeneration in nodule tissue.

In the later course, with the development of fibrosis and regression of the size, Tg values lowered, too. Volumen 68, Broj 9 Carrying out PAE is primarily based on the skill and experience of the doctor who applies the procedure which, to some extent, causes the appearance and content of side effects.

Some of them, such as pain, overflowing of the thyroid hormones into circulation, and the development of thyroid antigen are justifiably present and are the consequence of a direct contact of ethanol with the nodule tissue.

In our series of patients, the side effects of the procedure were milder and did not disturb further carrying out or possible ceasing of therapy.

The degree of discomforts that appeared and the definition of the efficiency of treatment were estimated on the basis of the questionnaire which was filled in by the patients at the end of therapy, and their intensity was ranged by the index from 1 to 5.

In In nearly one half of the treated Luckily, these manifestations which can, to some extent, complicate the procedure, had a very weak intensity.

It seems that the intensity of pain and its eventual further spreading mostly depend on the location of the nodule, its ultrasound structure and its vicinity to the thyroid capsule.

Pain was less severe in cystically degenerated nodules compared to the ones with parenchymal structure, but it became more intense as the number of injections grew and with the appearance of sclerosis within the nodule.

Then, it was practically impossible to prevent overflowing of even small quantities of ethanol extranodally. Thyroid capsule seems to be the best innerved part of the thyroid since curing nodules in its vicinity was most painful, and pain always spreaded away, most often as far as the temporomandibular joint and ear.

In nodules localized quite near the lower pole of the thyroid lobe propagation of pain went along the middle chest or into shoulder.

The mentioned discomforts were temporary and mainly lasted short. Thus, in A slight number of patients reported having difficulty with moving their neck, an occiput headache and a temporary sense of slackening of vigour, as described by other authors.

Conclusion It can be concluded that repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules lead to autonomy disappearance.

Nodule size does not affect either the result of curing or the quantity of the injected ethanol. Side effects of the procedure are rare and directly depend on the experience of the doctor carrying out the procedure.

Hamburger JI. Solitary autonomously functioning thyroid lesions. Diagnosis, clinical features and pathogenetic considerations.

Ultrasound guided percutaneous ethanol treatment of hepatic neoplasms: a therapeutic alternative in the nineties. Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules.

Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results. Work in progress.

Treatment of hyperfunctioning thyroid nodules with percutaneous ethanol injection: Eight years' experience. Percutaneous ethanol injection of hyperfunctioning thyroid nodules: long-term follow-up in patients.

Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules. Evolution of toxicity in solitary nontoxic autonomously functioning thyroid nodules.

The autonomous nodule. Clinical aspects. Italian Concurrent hyperthyroidism and thyroid carcinoma. Autonomously functioning hot nodule of the thyroid gland.

A clinical and histopathologic study of 17 cases. Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: histological, enzymatic and sub-microscopical alterations.

Nonsurgical treatment of primary hyperparathyroidism with sonographically guided percutaneous injection of ethanol: results in a selected series of patients.

Modified percutaneous ethanol injection of parathyroid adenoma in primary hyperparathyroidism. Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection.

Treatment of autonomous thyroid nodules with percutaneous ethanol injection: 4-year experience. Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection.

Treatment of the autonomous thyroid nodule: a review. Percutaneous intranodular ethanol injection: a new treatment for autonomous thyroid adenoma.

Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation. Percutaneous ethanol injection therapy for autonomously functioning thyroid nodule.

Received on February 23, Accepted on March 1, Meniscal injuries are common in professional or recreational sports as well as in daily activities.

If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures.

The study analyzed the results of arthroscopic partial medial meniscectomy in patients in a month period, from , to In our series of arthroscopically treated medial meniscus tears we noted 78 Six months after the procedure Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option.

It has small rate of complications, low morbidity and fast rehabilitation. U radu su prikazani rezultati artroskopske parcijalne medijalne meniscektomije izvedene kod bolesnika u periodu od 24 meseca, od Key words: menisci, tibial; wounds and injuries; arthroscopy; postoperative complications; treatment outcome.

Introduction The mean annual incidence of meniscal tears is 60 to 70 per 1. Meniscal tears are more common in males.

The male : female ratio ranges from 2. Meniscal injuries are a common problem in sports and they are the most frequent injury to the knee joint.

In the past 25 years, with increasing popularity of professional and recreational sports the number of people participating in sports has greatly increased, resulting in a higher number of knee injuries 2.

Arthroscopic treatment of meniscal injuries has become one of the most often performed orthopedic operative procedure.

In order to properly diagnose and treat meniscal injuries, understanding of meniscal anatomy and function is necessary. Medial meniscus is C-shaped, with the posterior horn larger than the anterior horn in the anteroposterior dimension.

Johnson et al. They noted that the anterior horn of the medial meniscus has the largest insertion site surface area The capsular attachment of the medial meniscus on the tibial side is referred to as the coronary ligament.

A thickening of the capsular attachment in the midportion spans from the tibia to the femur and is referred to as the deep medial collateral ligament.

The meniscus has a fibrocartilaginous structure. The orientation of collagen fibers is mainly circumferential, with some radial fibers at the surface and within the midsubstance.

This orientation allows compressive loads to be dispersed by the circumferential fibers, while the radial fibers act as tie fibers to resist longitudinal tearing.

Elastin accounts for approximately 0. The cells of the meniscus are fibrochondrocytes because of their appearance and the fact that they synthesize a fibrocartilaginous matrix.

The menisci are important in many aspects of knee function, including load sharing, shock absorption, reduction in joint contact stresses, passive stabilization, increasing congruity and contact area, limitation of extremes of flexion and extension and proprioception 5.

Many of these functions are achieved through the ability of the menisci to transmit and distribute load over the tibial plateau.

The onset of symptoms and mechanism of injury were often of utmost importance for the diagnosis. Meniscal lesions often occured during a rotational injury or hyperflexion event, and they in most cases presented with acute pain and swelling.

Complaints of locking or catching were also present, and loss of motion with a mechanical block to extension 8. These tears were often associated with some degree of osteoarthritis.

Though not always absolutely exact clinical evaluation is a very useful tool in the diagnosis of meniscal pathology.

Weinstabl et al. Plain radiographs should be obtained before any further diagnostic studies are undertaken, although these radiographic views cannot confirm the diagnosis of meniscal lesion, they are important in defining bony pathology and in evaluating the knee for joint space narrowing.

Magnetic resonance imaging is the imaging method of choice for diagnosing meniscal tears With increasing age, degenerative complex tears are more frequently seen.

Crawford et al. The aim of the study was to demonstrate that arthroscopic partial medial meniscetomy in well selected cases is a method of choice for treatment of medial meniscus injuries that are not amenable to repair, because it has small rate of complications, low morbidity and fast rehabilitation.

Methods This study analyzed the results of arthroscopic partial medial meniscectomy in patients 68 patients in the Orthopedics and Traumatology Clinic, Clinical Center in Podgorica, Montenegro, and patients in the Orthopedics and Traumatology Clinic Military Medical Academy in Belgrade, Serbia in a month period, from to A decision about the treatment of medial meniscal lesion was made according to patient factors and type of meniscal injury.

In our institutions we perform various techniques of meniscal reparation but in this study we only presented series of medial meniscus injuries with partial arthroscopic meniscectomy.

We mainly relied on joint line palpation, the flexion McMurray test, the Apley grind test. In 58 Perioperative antibiotics administered were in most cases cefazolin, ceftriaxone or in the case of a documented penicillin or cephalosporin allergy gentamycin, amikacin or clindamycin.

Some patients received intraarticular injection of hyaluronic acid intraoperatively. Partial resection of the medial meniscus is advocated when other treatment modalities are not attainable.

We followed Metcalfs et al. We used both manual and motorized resection instruments, in uncertain situations, more rather than less intact meniscal rim was left to avoid segmental resection, which essentially results in a total meniscectomy.

Afterwards the patients progressed to full weight bearing according to pain tolerance and swelling. Physical therapy exercises to achieve complete range of motion and optimal muscle strength were recommended to athletes and patients with long lasting complaints in most cases those were patients older than 40 years.

We suggested to all patients to suspend sports participation for approximately three weeks. In comparison of pre- and postoperative results, we used a IKDC subjective knee evaluation form.

Results All presented cases underwent partial arthroscopic medial meniscectomy Figures 1 and 2. In the series of arthroscopicaly treated medial meniscus tears we noted 78 There were men Mean patient age was Medial meniscus lesion was arthroscopicaly treated in left knees and in 94 right knees.

A total of 51 In 39 Totally of patients underwent knee MRI previous to arthroscopy and in 6 cases medial meniscal tear was not seen on MRI.

In our series of arthroscopic partial medial meniscectomy the accuracy of preoperative MRI was Mean preoperative IKDC score was In our series we had 6 2.

Discussion In the past two decades numerous advances in meniscal repair and meniscal transplantation techniques were achieved, mostly with the intention of achieving long-term delay of knee degenerative changes.

In some cases, however, partial meniscectomy is still required, and is the treatment of choice 15, Medial arthroscopic partial meniscectomy in general is considered as a safe and reliable procedure.

Major advantages of partial arthrocopical meniscectomy over meniscal repair include decreased hospitalization, shorter rehabilitation and a reduction in health care system costs.

Burks et al.

Marijana Kostić -

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Vincent Declaration. Diab Nutr Metab ; Diabet Med ; 7: Studenog Ministarstvo zdravstva i socijalne skrbi. Ministarstvo zdravstva i socijalne skrbi, Diabetes Care ; 33 Suppl.

The quality of health care delivered to adults in the United States. Diabetes Care ; Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study UKPDS Keeping a diabetes registry facilitates monitoring of the epidemiological situation, while a structured approach to the registration of diabetic patients reporting on an optimum information cluster for the follow-up and improvement of diabetes care contributes to better regulation of patient risk factors.

Active patient reporting at the primary health care level has begun in with setting up the legislative background. The aim of this study was to establish the effect of the CroDiab registry on metabolic parameters in type 2 diabetic patients treated at primary health care level by comparing diabetes indicators between the regularly annually reported type 2 diabetic patients and those that were only intermittently reported to the registry from until Methods: Family physicians submit their reports mainly via CroDiab web, a Croatian web-based system for the collection of data on diabetic patients, which enables analysis of the basic clinical and public health indices.

The levels of fasting and postprandial blood glucose, HbA1c, triglycerides, total cholesterol, HDL- and LDL-cholesterol, systolic and diastolic blood pressure, and body mass index were analyzed in and , and compared between the two study groups.

Results: At baseline, differences between the intermittently reported I and regularly reported R groups were only observed in the systolic I There were no statistically significant differences in body mass index, fasting glucose, HDL-cholesterol and triglycerides.

Discussion and Conclusion: Electronic medical records and structured health care are associated with increased benefits and improvement in metabolic indicators at the primary health care level.

Regular reporting and monitoring via CroDiab registry lead to a significant improvement in the majority of metabolic indicators, which is less marked with intermittent reporting.

The more pronounced effect observed in the group of patients that were regularly covered by the registry could be attributed to a more comprehensive and regular insight and better patient care associated with continuous monitoring.

Further efforts are therefore needed to achieve the widest possible implementation of the CroDiab web system to improve diabetes care at the primary health care level.

Prema ukupnom broju kreveta, Hrvatska je na Prema broju akutnih bolnica na 1. Jedina je iznimka Knin, koji je bolnicu dobio u kasnijem razdoblju Pokazatelji o bruto nacionalnom proizvodu po glavi stanovnika BNP-a p.

Broj stanovnika, Moldavija 3 21 ,04 17 ,22 54,85 Gruzija 4 14 ,9 12 ,5 28,14 79,65 6,77 Ukrajina 46 ,97 ,85 93,9 ,7 Armenija 3 13 ,82 11 ,7 45,4 31,3 Albanija 3 9 ,53 8 ,6 23,06 7,77 Makedonija 2 9 ,69 6 ,43 58,47 29,41 Bosna i H 3 11 ,56 12 ,53 37,24 - - Crna Gora 2 ,8 1 ,37 49,67 - - Bjelorusija 9 ,87 - - 69,93 ,58 - Bugarska 7 48 ,43 57 ,35 58,24 - Srbija 9 52 ,26 - - - - - - 21 ,29 ,21 77,34 - - Rusija 1 ,85 1 ,27 ,29 15,2 Turska 70 ,59 ,94 8,99 26,47 Poljska 38 ,17 ,75 64,78 - - 3 27 ,95 17 ,33 ,29 ,26 Rumunjska Litva Hrvatska 4 24 ,6 16 ,41 93,85 - - Estonija 1 7 ,99 5 ,2 56,2 ,91 10 83 ,52 61 ,54 ,01 70,01 3 ,26 1 ,38 ,4 ,78 Malta Italija 59 ,9 ,31 13,02 ,78 Slovenija Cipar Francuska 60 ,78 ,83 92,59 ,69 Belgija 10 54 ,06 49 ,18 ,78 ,68 Austrija 8 64 ,34 53 ,9 62,88 - - 61 ,72 ,64 82,85 ,25 Britanija 5 36 ,49 12 ,59 84,05 - - BNP 9.

Finska 1 ,72 1 ,31 75,65 1 ,37 8. Nizozemska ,46 16 78 ,8 55 ,18 ,07 7. Irska 4 23 ,91 11 ,23 85,09 ,32 2 ,8 1 ,17 ,85 ,73 4.

Danska 5. Island 5 19 ,48 16 ,65 60,37 ,55 3. Luxemburg 1. Hrvatska prati ta zbivanja te je od S ukupnim brojem od 79 bolnica Manje bolnica za akutne bolesnike od Hrvatske ima samo Nizozemska.

Hrvatska sa 0,6 bolnica na 1. Bolnice su neophodnost koja se mora prihvatiti. Po broju bolnica na broj stanovnika, Hrvatska zaostaje za europskim zemljama.

Posebno je vidljivo smanjenje broja akutnih bolnica. Ne smije se zaboraviti niti utjecaj ratnih zbivanja u Domovinskom ratu, gdje je, uz smanjenje broja zdravstvenih djelatnika, ubrzan trend smanjenja broja kreveta i bolnica 5.

Acta Med Croatica, 64 razvoju. Udaljenost od bolnica, tj. Datum pristupa informaciji Global environmental change and health: impacts, inequalities, and the health sector, BMJ ; : doi: AD Published 24 January The District Hospital.

Health Systems. HCJZ ; 5: broj Int J Health Geographics , doi The health of nations. BMJ ; a McKee M, Healy J.

The changing role of the hospital in Europe: causes and consequences. Fister K, McKee M. Health and health care in transitional Europe.

BMJ ; 23 July , doi Hrvatski zavod za javno zdravstvo. Acta Med Croatica, 64 Sanitarni kordon nekad i danas, Zagreb, Dostupno na URL adresi: 1.

Zagreb: Ministarstvo zdravstva Republike Hrvatske, Building new university hospital--what citizens know and policy makers should be aware of.

Ministarstvo zdravstva i socijalne skrbi Republike Hrvatske, Ministarstvo zdravstva i socijalne skrbi Republike Hrvatski sabor.

Nacionalna strategija razvitka zdravstva Trebaju nam 4 velike bolnice, ostale ukinite! Jutarnji list Novi list Vjesnik 1.

Novi list 7. Odrednice hrvatskog zdravstvenog sustava u razdoblju HCJZ ; 3: br. Dostupno na URL adresi: www.

Magnusson G. Sociology of Health ; 2: Travel times to health care and survival from cancers in Northern England. Eur J Cancer ; Cancer survival in New Zealand: Ethnic, social and geographical inequalities.

Posnett J. The hospital of the future. Is bigger better? Concentration in the provision of secondary care. BMJ ; HCJZ ; 3: broj Epidemiologija zaraznih bolesti.

Care of military and civilian casualties during the war in Croatia. Acta Med Croatica ; Besides education of health workers, equipped devices and efficiency of work in hospitals, it is important to compare the number of hospitals, their size, type of hospitals, their distribution and availability to users.

These elements are essential to the overall quality and efficiency of health work of an area. Based on the analysis, to answer the question whether Croatia has a sufficient number of hospitals, particularly in County of Split-Dalmatia and Dalmatia.

Method: In this article are used methods of descriptive epidemiology based on available electronic data of the WHO Office for Europe. Results: Of the 44 European countries, Croatia is in the 35th place with a total of 79 hospitals 1.

Without 10 hospital wards, and 6-of-hospital maternity, Croatian average is 1. By the number of acute hospitals with no out-patient clinic and maternity wards, Croatia is in the penultimate 43rd place with 36 hospitals 0.

By the size of the hospitals per average number of hospital beds per one acute hospital Croatia has no clinic and outpatient hospitals which puts Croatia in the second place behind the Netherlands The most acute hospitals are in County of Pozega-Slavonia 2.

Discussion: Croatia is getting behind by the number of hospitals, compared to Europe, especially concerning acute hospitals.

Given the density and area unit in the Southern Croatia there is a striking lack of acute hospitals, causing a disparity in the availability of hospital and specialist health care.

To make hospital and specialist health care available to the , inhabitants of Dalmatia, who are more than an hour away from the hospital, it is necessary to replace outpatient-clinics and maternity hospitals with the general hospitals.

Conclusion: Given the fact that Croatia is at the top of Europe by the size of the hospitals by the number of beds for acute patients, and there is the sufficient number of beds to population, but also a lack of spatial coverage of acute hospitals and therefore poor availability of hospital and specialist care for the advisory large population of south and east of the state and Istria.

U praksi se pokazuje potreba za izradom plana osiguranja kontrole kvalitete svih postupaka programa probira engl. Izostalo je kontinuirano obrazovanje zdravstvenih djelatnika kao i medijska kampanja.

Pozivno razdoblje iznosi dvije godine. Neodazvane osobe se ne pozivaju ponovno. Programu se do Testiranje je R. Tako je ukupno testirano 5.

Kolonoskopiju je do Ukupno opravdani razlozi 2 1 0 20 39 68 70 Tablica 3. Ukupno 17,2 22,3 R. Stoga je Ministarstvo zdravstva Republike Hrvatske u mjesecu listopadu U to vrijeme kraj U susjednoj Sloveniji koja je nacionalni program pokrenula Susjedna Slovenija je tijekom Tako je npr.

Zanimljivo je da je u Francuskoj u 1. Naime, u Dodatni problem nastao je zbog nekontinuiranog slanja poziva na teren.

Za kvalitetnu provedbu programa u ovom segmentu neophodna je njihova aktivna uloga. Do U Francuskoj je odaziv na kolonoskopiju u 1.

Istodobno je u Sloveniji u pilot programu stopa otkrivenih karcinoma na osoba pregledanih u probiru iznosila 5,3 Minesota Colon Cancer Control Study.

No, u usporedbi sa zemljama Europe koje koriste iste metode probira, zadovoljstvo je manje. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood.

Natl Cancer Inst ; Incidencija raka u Hrvatskoj Zagreb: Hrvatski zavod za javno zdravstvo, Registar za rak Republike Hrvatske, Reducing mortality from colorectal cancer by screening for fecal 5.

Nacionalni program ranog otkrivanja raka debelog crijeva. Zagreb: Republika Hrvatska, Ministarstvo zdravstva i socijalne skrbi, Colorectal cancer screening in Europe.

World J Gastroenterol. Cancer screening in the European Union. ISBN European Communities publ. Printed in Luxemburg by the services of the European Commision, Colorectal cancer screening in Europe: differences in approach; similar barriers to overcome.

Int J Colorectal Dis ; Estimates of the cancer incidence and mortality in Europe in Ann Oncol ; Strnad M, Znaor A. Registar za rak Hrvatske.

Zagreb: Hrvatski zavod za javno zdravstvo, Ninth plenary meeting; May. Committe B, Third Report. Program Svit. Final Evaluation Report; Oct.

Report No. ISBN 0 82 3. J Med Screen ; Osvrt na 1. Kronja Lj. Datum pristupa informaciji Stipanov I. Vitalia A. Strnad M. Lessons learnt from a populationbased pilot programme for colorectal cancer screening in Catalonia Spain.

Many participants in fecal occult blood test population screening have a higher-than-average risk for colorectal cancer.

Eur J Gastroenterol Hepatol ; Coll Antropol ; 33 Suppl. Cardiovaskular risk factors in Croatia: struggling to provide the evidence for developing policy recomendations.

World Gastroenterology Organisation, International Digestive Cancer Alliance. Practice Guidelines: Colorectal cancer screening.

Young GP. Population-based screening for colorectal cancer: Australian research and implementation. J Gastroenterol Hepatol ; 24 Suppl 3: Haemoccult screening for colorectal cancer: the effect of dietary restriction on compliance.

Eur J Surg Oncol; Random comparison of guaiac and immunochemical fecal occult blood test for colorectal cancer in a screening population.

Gastroenterology ; Gut ; The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial.

Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial ISRCTN BMC Public Health ; 5: Slovenian colorectal cancer screening programme SVIT-result of pilot phase.

Zdrav Vestn ; Yeoman A, Parry S. A survey of colonoscopy capacity in New Zealands public hospitals. N Z Med J ; Mohammad A, Khan Y.

Barriers to timely screening colonoscopy: the role of health insurance. Conn Med ; Z Gastroenterol ; 46 Suppl 1: According to the incidence of CRC in men and women, and mortality in men, it is the second most common malignancy, and the leading one in women.

The main obstacles and suggestion for improvement are presented. Study results are compared with international references.

The target group includes approximately 30, individuals suitable for CRC screening aged years. In the first screening round, between January and September , 19, invitation letters with test kits gFOBT were sent to people born and The overall attendance to screening was Blood in the stool was detected in The waiting time for follow up colonoscopy was too long median days.

Colonoscopy rate reached A total of 22 individuals were diagnosed with cancer and the percentage of cancer detected by colonoscopy was 6.

The main limitations to program implementation are inappropriate software for data collection and the lack of a protocol for standardized data collection; the rate of positive test results is unacceptably high, local colonoscopy service is insufficient and waiting time for colonoscopy too long.

Also, the inclusion of general practitioners GPs in the program has proved inadequate. The role of local public health institutes as coordinators is of crucial importance, but financial and human resources are inadequate.

Reminder letters had a significant impact on participation, so this strategy should be adopted. For better success of the program, the involvement of GPs should increase and it is important to make a strategic plan to improve the population and GP awareness of the screening program importance.

Conclusion: The national program is tested in local conditions and it needs change based on the difficulties observed. The results of program implementation are quite satisfactory considering the conditions in which it is carried out, but less satisfactory than those reported from the neighboring countries.

In the next period, the program should be allocated due financial and human resources, and it is important to agree upon a strategy that would yield the best results.

Lokacije bunara odnosno mjesta uzorkovanja prikazane su na sl. Udio uzoraka s obzirom na izmjerene koncentracije prikazan je interkvartilima tablica 1.

Farming, Fertilizers and the Nitrate Problem. Hydrogeol J ; 6: Kattan Z. Use of hydrochemistry and environmental isotopes for evaluation of groundwater in the Paleogene limestone aquifer of the Ras Al-Ain area Syrian Jezireh.

Environ Geol ; Kazemi GA. Temporal changes in the physical properties and chemical composition of the municipal water supply of Shahrood, northeastern Iran.

Hydrogeol J ; Hallberg GR. Nitrates in groundwater in the United States of America. U: Follet RF, ur. Nitrogen management and groundwater protection: developments in agriculture and managed-forest ecology.

Dordrecht: Elsevier, , vol. Trends in ground water nitrate contamination in the Phoenix, Arizona region. Predicting ground water nitrate concentration from land use.

Jalali M. Nitrates leaching from agricultural land in Hamadan, western Iran. Agr Ecosyst Environ ; Zagreb: Agronomski fakultet, Shuman LM.

Phosphorus and nitrate nitrogen in runoff following fertilizer appliccation to turfgrass. J Environ Qual ; Nitrate temporal and spatial patterns in 12 water-supply wells, Yucatan, Mexico.

Abu Naser A. A, Ghbn N. Relation of nitrate contamination of groundwater with methaemoglobin level among infants in Gaza.

EMHJ ; Canter LW. Nitrates in groundwater. Lewis publishers, Environ Health Persp ; Risk of non-Hodgkin lymphoma and nitrate and nitrite from drinking water.

Epidemiology ; Nitrate in aquifers beneath agricultural systems. Water Sci Technol ; Nitrate intake from drinking water on Tenerife island Spain. Sci Total Environ ; Nitrate in groundwaters of intensive agricultural areas in coastal Northeastern Australia.

Nitrate concentration in drinking water from wells at three different locations in northwest Croatia. Cereal Res Commun ; A preliminary assessment of nitrate degradation in simulated soil environments.

Environ Sci Technol ; The total amount of downfalls subsequently correlated to nitrate concentrations was determined by summing up individual metric values provided by the State Meteorological and Hydrological Service.

Data were analyzed in a descriptive manner and compared to the maximal allowable concentrations MAC stipulated under the Ordinance on Potable Water Safety, as well as to the limit values recommended under the Nitrates Directive.

The mean range spanned from 0. The highest mean nitrate concentration of Given the detected nitrate concentrations in the sampled well water, the wells were classified as satisfactory, occasionally unsatisfactory and unsatisfactory.

The influence of point sources was assessed based on their distance. Discussion and Conclusions: The results obtained are comparable to those of similar studies undertaken in regions having a similar agro-ecological and agricultural profile.

The range of the mean nitrate concentrations established in potable water samples recovered from shallow wells was wide; the total mean nitrate concentration was relatively high Contaminating point sources located not farther than 10 meters from shallow wells significantly influence the quality of drawn water.

Respective of correlations between the amount of downfalls and water nitrate concentrations, both negative and positive links were established.

Podaci su dobiveni od Hrvatskoga zavoda za zdravstveno osiguranje. U promatranom razdoblju od U Promatrano je razdoblje od jedne godine dana.

NN br. Methods for the economic evaluation of health care programme. Third edition. Oxford: Oxford University Press, Zagreb: Medicinski fakultet, Kampmann JP.

Rational Pharmacoterapy: Contents and Scope. Perspectives and achievements with Rational Pharmacotherapy. Larsen TH.

Drug Industry and Rational Pharmacotherapy. Agencija za lijekove i medicinske proizvode. Hydrochlorotiazide versus chlorthalidone in the management of hypertension.

Cardiol Rev ; Curr Med Res Opin ; Ann Pharmacother ; WHO Euromedstat. European Library of Pharmaceutical Indicators. Utilization and price indicators.

Vrhovac B. V izdanje. Selection of therapy with nitrates in patients with stable effort angina: result of comparative study of common isosorbide dinitrate and long acting preparation of isosorbidemononitrate.

Kardiologiia ; Int Heart J ; Beck OA, Hochrein H. Indications and risk of antiarrhythmia treatment with propafenone.

Dtsch Med Wochenschr ; Retardation of the excitation conducting by propaphenone. Duration and dosage effect relation after oral administration.

Garcia A. Adverse effect of propafenone after long-term therapy with the addition of citalopram. Am J Geriatr Pharmacother ; 6: Os I, Stokkle HP.

Doxazosin GITS compared with doxazosin standard and placebo in patient with mild hipertension. Blood Press ; 8: Grzeszczak W.

Przegl Lek ; Safety of furosemide administration in an elderly woman recovered from thiazide-induced hyponatremia. Eur J Intern Med ; Comparison of bisoprolol with atenolol for systemic hypertension in four groups young, old, black and nonblack using ambulatory blood pressure monitoring.

Am J Cardiol ; A randomised double-blind study of bisoprolol versus atenolol in mild to moderate essential hypertension. Eur J Clin Pharmacol ; Clin Drug Invest ; Lacidipine: a review of its use in the management of hypertension, Drugs ; Hrvatsko izdanje.

Essential Medicines. Statin prescribing in the City of Zagreb and their role in secondary prevention of cardiovascular events. The aim of the present study was to assess outpatient utilization and rationality of cardiovascular drug prescribing in the City of Zagreb and Republic of Croatia based on the generic to original drug prescribing ratio.

Methods: Data on the financial indicators and number of cardiovascular drug packages issued in were obtained from the Croatian Institute of Health Insurance.

Results: The rate of prescribing original cardiovascular drugs was significantly higher in Zagreb as compared with Croatia as a whole. The index of prescribing generic versus original drugs was 1.

The highest differences were recorded in the most widely prescribed drug groups, i. Conclusion: The significantly greater influence of pharmaceutical industry marketing in Zagreb entailed the significantly higher rate of original drug prescribing, which is associated with considerably greater drug expenses.

Measures to stimulate prescribing generic drugs should be launched at the national level. Indeks radne sposobnosti engl.

Visoki zahtjevi posla s malom kontrolom u radu smatraju se visokim radnim stresorom u zdravstvenog osoblja Work Ability Index Questionnaire 1.

Raspon bodova je od 7 do U univarijatnoj analizi ispitana je povezanost pojedinih stresora Sl. Test-retest reliability of the Work Ability Index questionnaire.

Occup Med London ; Work Ability Index. Eriksen W, Tambs K. BMC Public Health ; 6: Health complaints and job stress in Norwegian physicians: the use of an overlapping questionnaire design.

Physiological responses of rats to intermittent high-altitude stress: effects of age. J Appl Physiol ; McGrath WB. As a man thinketh.

Ariz Med ; Job, psychological factors and coronary heart disease. Adv Cardiol ; Work-related stress among paediatric nonconsultant hospital doctors.

Ir Med J ; Stress, satisfaction and burnout among Dutch medical specialist. CMAJ ; Mental health of hospital consultants: the effects of stress and satisfaction at work.

BC Med Educ ; 5: Time control, catecholamines and back pain among young nurses. Scand J Work Environ Health ; Changes in the work ability of active employees over an year period.

Work ability in the nursing profession. Working conditions and intent to leave the profession among nursing staff in Europe. Stockholm: Elanders Gotab, , Radkiewicz P, Widerszal-Bazyl M.

Psychometric properties of Work Ability Index in the light of comparative survey study. International Congress Series ; Effort-reward imbalance among nurses in stable countries and in countries in transition.

Int J Occup Environ Health ; Zeng Y. Review of work-related stress in mainland Chinese nurses. Nurs Health Sci ; Stress and work ability in oil industry workers.

Arh Hig Rada Toksikol ; Differences in stress perceptions between physicians in surgical and non-surgical specialities.

U: Budapest Meeting Abstract. Budapest, , Predictors of work ability in occupations with psychological stress.

Predictors of work satisfaction among physicians. Eur J Public Health ; Burnout and stress disorders in intensive care doctors.

Deutsch Med Wochenschr ; Stranks J. Stress at Work: Management and Prevention. Burlington: Elsevier Butterworth-Heinemann, Bamber MR.

New York: Routledge, Work organization and stress: systematic problem approaches for employers. Geneva: World Health Organization, Methods: A total of health care professionals employed at 5 Zagreb hospitals participated in this cross-sectional study.

Data were collected using the Work Ability Index Questionnaire and Occupational Stress Assessment Questionnaire for hospital health care professionals.

Results: The average WAI of all participants was WAI was significantly higher in men than in women, About 5 percent of all participants had poor WAI.

Our results suggest the need of preventive measures that would target maintenance of work ability at an organizational and individual level.

The organizational level should include the provision of a sufficient number of workers, adequate financial resources for work and adequate salaries, less paperwork, positive collaboration with the public, especially media, and education of medical staff on the risks and hazards at work.

The individual level should include individual assessment of sensitivity to night work and shift work considering age and health status, and training in stress management techniques.

Studenti su popunjavali upitnik o aktivnostima tijekom predmeta. Majer, G. Upitnik je Sl. Akademske godine U akademskoj godini Ocjenama 4 i 5 u Tablica 1.

Predavanje mi je bilo najbolji i najedukativniji dio prakse. To mi se V. Rivo i sur. Greenhill i sur. Prema Henryju i sur. Kongresa H.

Medicinski fakultet Rijeka. Fam Med ; 36 January suppl : Rural and Remote Health 5: Online , Rural and Remote Health ; 8: Ten ideas for building a strong Australian rural health system.

Rural and Remote Health ; 9: Perceptions of UK medical students on rural clinical placements. Monrouxe LV. Med Educ ; Topps M, Strasser R.

When a community hospital becomes an academic health centre. Can J Rural Med ; Why do medical graduates choose rural careers? Innovative way of teaching in community health course.

Pro- V. Subjects and Methods: The survey included 4th year medical students attending the community course during the academic year and same-generation 6th year students Students were required to fill out an evaluation questionnaire about the activities during the community health course using grades from 1-poor to 5-excellent, and to write personal remarks and essay.

I have learned in only few hours to wish less and to give more. Discussion: At some medical schools, there are similar attempts to bring students more closely to life conditions, especially to rural communities.

Different schools of medicine in the world have attempted to improve and adapt current curricula towards community-oriented education of medical students during undergraduate study and residency.

In some countries, there is also the need of improvement of health care in rural areas. Conclusion: Results of the course evaluation showed that students had recognized the exceptional value of community health course as a whole.

They perceived it as the most valuable and most useful experience in their medical study. By participating in local health care and social care activities in rural area, they got an insight into both the health care system and socio-medical determinants of health.

U Velikoj Britaniji specijalizacija hitne medicine postoji od U SAD je specijalizacija hitne medicine ustanovljena Projekt reorganizacije HMS dio je Nacionalne strategije razvitka zdravstva U tablici 1.

Tablica 5. Labin Pazin Pula Rovinj Umag Udaljenost od bolnice u km Ukupan broj timova u 24h Svi uzroci Ukupan broj vozila do 5 god.

Tablica 6. Posebnu pozornost potrebno je obratiti organiziranju HMS na otocima i rijetko naseljenim mjestima.

U svijetu postoje dva osnovna pristupa hitnog zbrinjavanja pacijenata. Doktori iz HM rade u bolnici i na poziv idu na mjesto incidenta. U svom sastavu ima doktore, S.

Ima jedinica u Izraelu. MDA ima Od toga 16,1 milijun eura iznosi vrijednost zajma Svjetske banke za razvoj HMP na vrijeme od pet godina.

Dick WF. Anglo-American vs. Franco-German emergency medical services system. Fleischmann T, Fulde G. Emergency medicine in modern Europe. Ellis DY, Sorene E.

Resuscitation ; 5. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas.

In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital.

As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up.

In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine.

County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a single point of entry for all emergencies at a particular hospital.

Upon triage, depending on the level of emergency, patients are provided with appropriate care and treatment. The objectives are going to be monitored through indicators as part of the World Bank Project for which data have already been collected throughout Croatia: number of interventions; number of emergency interventions; time between call receipt and arrival to scene; time between call receipt and arrival to hospital emergency reception area; percentage of arrivals to hospital by EMS vehicles within 12 hours of symptom onset; polytrauma and cardiac arrest survival rate before admission to hospital; time spent in hospital emergency reception areas and integrated hospital emergency admission units; polytrauma and cardiac arrest survival rate within 24 hours of hospital admission; number of integrated hospital emergency admission units per county; and number of pre-hospital EMS teams per capita.

Nadziru se zarazne i druge bolesti, zdravstveni resursi te javnozdravstveni programi i intervencije. Erceg, T. Koji sve javnozdravstveni nadzorni sustavi postoje danas u Hrvatskoj?

Nadalje, postoji modul zdravstvene ekologije koji se vodi u HZJZ i u nekim regionalnim zavodima voda, zrak, tlo.

Svi opisani izvori informacija ispunjavaju neku od funkcija koje treba imati nadzorni sustav. Iz svakog od njih mogu se dobiti potrebne informacije.

VPD se bavi nadzorom nad bolestima koje se mogu prevenirati vakcinacijom Vaccine Preventable Diseases. James i sur.

Saran i sur. Informatizacijom samo dijela zdravstvenog sustava npr. Nadzor nad bolestima Dijagnoze bolesti postavljaju se u zdravstvenim ustanovama ambulantama, bolnicama i sl.

Osim dijagnoze u medicinsku se dokumentaciju unose i podaci o Sl. Izvori podataka za nadzor nad bolestima J. Za sada se podaci prikupljaju jedanput J.

Pri tome valja napomenuti da je Izvori podataka za nadzor nad medicinskom opremom zdravstvenim ustanovama. Tako bi bilo relativno jednostavno prepoznati sve intervencije s ciljem prevencije npr.

Problem je ta J. Datum pristupa informacijama: Promjenama je potrebno upravljati 27, Winslow CEA. The Untilled Fields of Public Health.

Science ; Datum pristupa informacijama: studenog Tsimikas S. In vivo markers of oxidative stress and therapeutic interventions. Stern S. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.

Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals.

Simon A, Levenson J. May subclinical arterial disease help to better detect and treat high-risk asymptomatic individuals?

Measurement of carotid wall volume and maximum area with contrast enhanced 3D MR imaging initial observations.

Progression of calcified coronary atherosclerosis: relationship to coronary risk factors and carotid intima-media thickness.

Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial.

Prevalence and determinants of subclinical brain infarction: the Northern Manhattan Study. C-reactive protein, carotid intima-media thickness, and inci- Strana Lifecourse socioeconomic position, C-reactive protein, and carotid intima-media thickness in young adults: the cardiovascular risk in Young Finns Study.

Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis MESA.

Coronary calcium as a predictor of coronary events in four racial or ethnic groups. The role of low grade inflammation as measured by C-reactive protein levels in the explanation of socioeconomic differences in carotid atherosclerosis.

Oxidative stress markers, C-reactive protein and heat shock protein 70 levels in subjects with metabolic syndrome. Volumen 68, Broj 9 Kahn R.

Metabolic syndrome: is it a syndrome? Does it matter? A stepwise approach to assess the impact of clustering cardiometabolic risk factors on carotid intima-media thickness: the metabolic syndrome no-more-than-additive.

Evidence for in vivo carotid and femoral wall thickening in human hypertension: Groupe de Prevention Cardio-vasculaire en Medecine du Travail.

Simvastatin with or without ezetimibe in familial hypercholesterolemia. Primljen V IV Primary biliary cirrhosis PBC is a progressive, chronic liver disease with elevated serum lipids, but it is unclear whether hyperlipidemia in PBC patients is associated with atherosclerosis.

Metabolic syndrome promotes development of atherosclerotic cardiovascular disease related to abdominal type obesity and insulin resistance.

The aim of our study was to assess abdominal adiposity in patients with PBC. The study included 40 patients with PBC and 50 healthy controls.

Age, sex and anthropometric measurements weight, height, body mass index and waist circumference were registered for all patients and controls.

In controls these measurements were Considering that the amount of visceral fat plays an important role in development of metabolic syndrome and cardiovascular diseases, we concluded that the lower amount of visceral fat in PBC patients could be related to lower incidence of cardiovascular events, despite hyperlipidemia.

Studija je obuhvatala 40 bolesnika sa PBC i 50 kontrolnih zdravih osoba. Key words: liver cirrhosis, biliary; subcutaneous fat, abdominal; obesity; caradiovascular diseases; risk factors; ultrasonography.

Serum lipids are often markedly elevated in PBC 2, but it is not clear if this hyperlipidemia is associated with accelerated atherosclerosis.

The risk of cardiovascular disease in PBC has been investigated in a few studies 2, 3 but an increase in related mortality was not demonstrated.

There are few reports on the use of lipid lowering agents in PBC suggesting that lipid treatment could reduce LDL cholesterol and triglycerides leading to improved serum measures of hepatic function 4.

Metabolic syndrome MS , that has received increased attention in the past few years, consists of multiple, interrelated risk factors of metabolic origin that appear to directly promote the development of atherosclerotic cardiovascular disease ASCVD.

Most important of these underlying risk factors are abdominal obesity and insulin resistance. Other associated conditions include physical inactivity, aging, hormonal imbalance, and genetic or ethnic predisposition 5.

The measurement of abdominal obesity through waist circumference WC has been established as a simple, inexpensive and useful method for the diagnosis of abdominal obesity.

Thus, WC has been proposed as a key element for the diagnosis of MS and its use suggested as a part of the routine general physical examination in clinical practice 6.

Moreover, WC correlates with visceral obesity, and in clinical studies, it has been associated with increased cardiovascular risk 7. Ultrasonography US is a simple and reliable method for measuring both subcutaneous and visceral fat showing a strong correlation with both adiposities measured with computed tomography scan 8.

The aim of this study was to determine the amount of abdominal adipose tissue in PBC patients by anthropometry and ultrasonography measurements and to correlate these values with healthy control subject.

Volumen 68, Broj 9 Ibarra et al. It was kept perpendicular to the skin on the upper median abdomen, and longitudinal scan was done in the midpoint between the xyphoid and the navel along the alba line with regard to the surface of the liver, to be almost parallel to the skin.

Subcutaneous fat thickness SF and area SA were measured on the xyphoumbilical line in both longitudinal and transverse views.

Measurements were taken 3 times directly from the screen using electronic callipers at the inner edge of the skin and at the outer edge of the alba line and the fat muscle interfaces for area.

Preperitoneal fat thickness or visceral fat thickness VF and area VA were measured in the same sites and views Figures 1 and 2. The diagnosis was based on clinical features, laboratory tests, imaging diagnostics, and, whenever possible, on liver histology.

All subjects gave written informed consent for participation in the study. Weight was measured to the nearest 0.

Waist circumference was measured with a heavy-duty inelastic plastic fibre tape measure placed directly on the skin while the subject stood balanced on both feet, with the feet touching each other and both arms hanging freely.

The measurement was taken immediately above the iliac crest and at the end expiration 9. Then mean values were calculated. All the subjects were asked to hold their breath during the examination.

Special care was taken to keep the probe just touching the skin to prevent compression of the fat layers. All measurements were performed by a single physician.

Statistical analysis was performed using the SPSS software package version Mean values, SD, and ranges of the anthropometric and sonographic measurements were calculated.

A p-value less than 0. Results We have studied 40 patients known to have PBC 36 females, and 4 males whose mean age was In the control group we studied 50 patients 46 females, and 4 males ; mean age of the controls was No significant difference regarding sex was found, i.

Anthropometric and US measurements are shown in Table 1. Student's t-test did not reveal a significant differ- Strana Discussion Primary biliary cirrhosis produces a marked increase in total cholesterol levels, primarily due to increased Lp-X Despite a marked hypercholesterolemia, excess mortality from cardiovascular diseases was not found in our PBC population This finding is in the agreement with other studies.

It has made some investigators to conclude that PBC patients might even be protected from cardiovascular diseases 2, 14, Close patient follow-up in the same center, with immediate recording of any clinically relevant event, allowed us to reliably estimate for the first time the incidence of nonfatal cardiovascular events in PBC.

The present data suggests that despite of high prevalence of hypercholesterolemia, patients with PBC are not exposed to a higher risk of cardiovascular events than the general population.

Attentive PBC patient follow-up could explain differences in detection rates of clinical events between PBC patients and general population and account for slightly higher incidence of coronary events that appear to be of borderline significance in PBC It is shown that mesenteric fat thickness is an independent determinant of metabolic syndrome in apparently healthy Chinese subjects, with an odds ratio of 1.

The discriminating cut-off point of 10 mm indicates the presence of metabolic syndrome and identifies subjects with increased intima-media thickness.

Hypotheses Fig. In addition, adiponectin adipose specific collagen-like molecule , has been found to have antidiabetic, antiatherosclerotic and antiinflammatory functions Excessive adipose tissue is associated with a decreased production of adiponectin which may impair insulin sensitivity Measurement of mesenteric fat thickness may potentially be developed into an alternative tool to identify subjects at risk for cardiovascular diseases Several imaging methods have been proposed for estimation of visceral adipose tissue Recent advances in imaging techniques and an understanding of differences in molecular biology of different adipose tissue depots have been reported.

In addition, a great variability in the precise definition of adipose tissue compartments by CT and MRI measure- Volumen 68, Broj 9 ments is found in clinical studies The measurement of visceral fat volume using US could be as effective as CT.

This method should be used in clinical settings due to its low cost, no side effects and technical suitability 23, Analysing the data gathered by US, as non-invasive, inexpensive, and non-ionization method, we found that despite the lack of significant differences of BMI, PBC patients have smaller amount of perirenal and visceral fat, as well as visceral fat area compared to controls.

Other measurements of fat tissues diameter and surface of subcutaneous fat in the PBC patients are lower compared to the control subjects, but the observed difference was not significant.

Conclusion Using ultrasonography as a reliable method for measurement visceral fat amount and taking into account importance of visceral fat in development of metabolic syndrome and cardiovascular diseases, we conclude that patients with primary biliary cirrhosis have lower amount of visceral fat, and probably due this phenomenon a lower incidence of cardiovascular diseases, despite a marked hypocholesterolemia.

Primary biliary cirrhosis. Primary biliary cirrhosis in The Netherlands. An analysis of associated diseases, cardiovascular risk, and malignancies on the basis of mortality figures.

Hypercholesterolemia and atherosclerosis in primary biliary cirrhosis: what is the risk? Atorvastatin in patients with primary biliary cirrhosis and incomplete biochemical response to ursodeoxycholic acid.

Diagnosis and Management of the Metabolic Syndrome. Scientific Statement. Wang J. Waist circumference: a simple, inexpensive, and reliable tool that should be included as part of physical examinations in the doctor's office.

Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds.

Ultrasonography for the evaluation of visceral fat and cardiovascular risk. Comparisons of waist circumferences measured at 4 sites. Ultrasonography for the evaluation of visceral A technique for the measurement of visceral fat by ultrasonography: comparison of measurements by ultrasonography and computed tomography.

Primary biliary cirrhosis, hyperlipidemia, and atherosclerotic risk: a systematic review. Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis.

Hypercholesterolemia in primary biliary cirrhosis is no risk factor for atherosclerosis. Matsuzawa Y. The metabolic syndrome and adipocytokines. Metabolic syndrome-a new world-wide definition.

A Consensus Statement from the. International Diabetes Federation. Mesenteric fat thickness is an independent determinant of metabolic syndrome and identifies subjects with increased carotid intima-media thickness.

Quantification of adipose tissue by MRI: relationship with anthropometric variables. Adipose tissue distribution measured by magnetic resonance imaging in obese women.

Estimation of computerized tomography derived abdominal fat distribution. Iacobellis G. Imaging of visceral adipose tissue: an emerging diagnostic tool and therapeutic target.

Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases.

Received on January 12, Accepted on May 19, Endoskopska mukozna resekcija EMR ili mukozektomija je interventna procedura za minimalno invazivno endoskopsko uklanjanje benignih i malignih tumora digestivnog trakta.

U svim procedurama postignuta je potpuna resekcija tumora. EMR je sigurna i bezbedna za uklanjanje zaravnjenih i sesilnih adenoma, kao i ranih CRC, i predstavlja rutinsku endoskopsku proceduru u svakodnevnoj praksi interventnog endoskopiste.

Endoscopic mucosal resection EMR or mucosectomy is an interventional procedure for minimal invasive endoscopic removal of benign and malignant digestive tract tumors.

Mucosectomy removes flat and sessile neoplasms, early colorectal cancer CRC confined to mucosa or submucosa and lateral spreading tumors. The aim of the study was to show our first experience in application of this procedure in everyday practice in regarding completeness and efficacy of the procedure, complication rate and incidence of recurrent adenomas.

In the prospective study 51 colorectal adenomas were removed in 44 patients by EMR. Single mucosectomy was done in 43 patients, while multiple 8 in one patient.

Complete resection was obtained in all procedures. In 36 Synchronous colorectal tumors benign or malignant were detected in 20 Moderate dysplasia was found in 30 Intramucosal CRC was detected in A total of 37 There were 3 5.

Only one 2. EMR is a routine endoscopic procedure in everyday practice of interventional endoscopist. Key words: colorectal neoplasms; endoscopy, gastrointestinal; treatment outcome.

Ova procedura predstavlja glavni terapijski napredak u tretmanu gastrointestinalnih malignih tumora. Dijagnostikovano je ukupno 79 tumora debelog creva tabela 1.

Dva uznapredovala CRC verifikovana su u neposrednoj blizini mukozektomiranih adenoma sigma , dok je Transverz. Kod dva bolesnika rekurentni adenom bio je sa displazijom istog stepena kao i inicijalni adenom, a kod jednog bolesnika sa displazijom ozbiljnijeg stepena od inicijalnog adenoma.

Rekurentni adenomi ponovo su uklonjeni metodom mukozektomije i 12 meseci nakon intervencije nije bilo ponovljenog adenoma.

Krvarenje je zaustavljeno injekcionom hemostazom rastvorom adrenalina i primenom dva hemoklipsa. Prvi put opisali su je Deyhle i sar. Efekat submukozne injekcije je vidljiv tokom kolonoskopije.

Promena koja se izdigne tokom ubrizgavanja rastvora je podesna za EMR. Opisuju se krvarenje i sindrom transmuralne opekotine 16, a retko i perforacije 17, Hemostaza klipsevima, nekada u kombinaciji sa rastvorom adrenalina, je sigurna i bezbedna metoda za rano ili zakasnelo krvarenje.

Zlatanic i sar. Regula i sar. Winawer SJ. Natural history of colorectal cancer. Prevention of colorectal cancer by colonoscopic polypectomy.

Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Technology status report evaluation.

Endoscopic mucosal resection. Development of the strip-off biopsy. Japanese 6. Larghi A, Waxman I.

Endoscopic mucosal resection: treatment of neoplasia. Hurlstone DP, Fujii T. Practical uses of chromoendoscopy and magnification at colonoscopy.

Moreaux J, Catala M. Carcinoma of the colon: long-term survival and prognosis after surgical treatment in a series of patients.

Inoue H, Kudo S. Endoscopic mucosal resection for gastrointestinal mucosal cancers. Gastroenterological endoscopy. Stuttgart: Thieme; A method for endoscopic electroresection of sessile colonic polyps.

Endoscopic therapy for early colon cancer: the strip biopsy resection technique. The successive strip biopsy partial resection technique for large early gastric and colon cancers.

Cappell MS. Reducing the incidence and mortality of colon cancer: mass screening and colonoscopic polypectomy.

Endoscopic mucosal resection for advanced sessile adenoma and early-stage colorectal carcinoma. Endoscopic resection of large sessile colorectal polyps.

Bergmann U, Beger HG. Endoscopic mucosal resecion for advanced non-polypoid colorectal adenoma and early stage carcinoma.

Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of cases. Colonoscopic excision of large and giant colorectal polyps.

Technical implications and results over eight years. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Endoscopic and surgical therapy of malignant colorectal polyps.

German Endoscopic polypectomy and management of colorectal adenomas with invasive carcinoma. Lymph node metastases in early rectal cancer.

EMR for Colorectal lesions. Oxford: Blackwell Publishing; Treatment with argon plasma coagulation reducesrecurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.

Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: longterm follow-up study.

I Revidiran III In patients with end-stage renal disease, treatment with erythropoietin lowers cardiovascular morbidity, improves quality of life and patient survival.

The aim of this study was to determine the difference in survival of hemodialysis patients treated with recombinant human beta erythropoietin and patients without this treatment, and to determine the influence of hemoglobin level and erythropoietin dose on the survival of these patients.

The study included patients undergoing maintenance hemodialysis, were on erythropoietin therapy, patients formed control group.

We analyzed basic demographic parameters, dialysis duration, underlying disease, comorbidities, death causes, bloodwork parameters and erythropoietin dosage.

Descriptive statistics, Anova, Manova, discriminant function analysis, Cox regressional model and Kaplan Meier survival curves were used as statistical methods.

Average age and dialysis duration in the experimental group were Average level of hemoglobin and hematocrit in the group in which erythropoietin had been administered was Key words: kidney failure, chronic; dialysis; hemoglobins; erythropoietin, recombinant; survival.

Pollak i sar. Ispitivanje je obuhvatilo bolesnika starijih od 18 godina. Kardiovaskularne bolesti bile su najzastupljenije komorbidno stanje i uzrok smrti kod obe grupe bolesnika.

Kod bolesnika na hemodijalizi pokazano je da su perzistentno i tranzitorno nizak nivo Hgb i velike varijacije nivoa Hgb povezani sa porastom rizika od smrtnog ishoda bolesti, dok, nasuprot tome, tranzitorno i perzistentno visok nivo Hb nije povezan sa porastom rizika od smrtnog ishoda bolesti Robinson i sar.

Regidor i sar. Selim i sar. U nekom od narednih ispitivanja trebalo bi analizirati prethodno navedene parametre. Rao M, Pereira BJ.

Optimal anemia management reduces cardiovascular morbidity, mortality, and costs in chronic kidney disease. Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients.

J Am Soc Nephrol. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Effect of erythropoietin on cardiovascular prognosis parameters in hemodialysis patients.

The effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron.

Nephrol Dial Transplant. The importance of iron in long-term survival of maintenance hemodialysis patients treated with epoetin-alfa and intravenous iron: analysis of 9.

BMC Nephrol ; 6. National Kidney Foundation. Carrera F, Burnier M. Use of darbepoetin alfa in the treatment of anaemia of chronic kidney disease: clinical and pharmacoeconomic considerations.

Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients.

Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.

The effect of Recombinant human Novi Sad: School of Medicine; Cardiovascular morbidity and mortality in patients treated with hemodialysis-epidemiological analysis.

Hemoglobin level variability: associations with mortality. Correction of anemia with epoetin alfa in chronic kidney disease.

Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a metaanalysis.

The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.

Anemia and mortality in hemodialysis patients: accounting for morbidity and treatment variables updated over time. Hemoglobin predicts long-term survival in dialysis patients: a year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin.

Inflammation predicts all-cause and cardiovascular mortality in haemodialysis patients. VI VIII Results of studies which have proved an increased inflammatory activity in diabetes type 1, have been published over recent years.

The study included 76 patients with diabetes type 1 and 30 healthy controls. Key words: diabetes mellitus, type 1; blood glucose; c-reactive protein; interleukin-6; tumor necrosis factor-alpha; sensitivity and specificity.

Many studies, whose results have been published in recent years, have shown that diabetes type 1 is also associated with the increased inflammation 2.

One of the mechanisms which might explain chronic inflammation in diabetes is the condition of hyperglycemia, which leads to an increased synthesis of advanced glycation endproducts AGEs resulting from the interaction of glucose in high concentrations with structural and circulating proteins.

Of all the proteins of the acute phase and plasma inflammatory markers, C-reactive protein CRP has been most widely studied and it is believed to have a very important role in the endothelial dysfunction and the process of atherosclerosis.

It is also considered to be one of the important and independent predictors of future cardiovascular events. It is widely used in clinical setting to follow not only the disease course but also the effects of the applied antiinflammatory and antibiotic therapy 3, 4.

A high sensitivity C-reactive protein is used to detect small changes of CRP levels associated with an increased cardiovascular risk in healthy population 5.

Interleukin 6 is an intercellular mediator and primary indicator of the liver CPR 6. The circulating IL-6 stimulates hypothalamic-hypophyseal axis whose activation is responsible for the central obesity, hypertension and insulin resistance 11, It is one of the most important cytokines in the intercellular communication It has a major role in the amplification of inflammatory cascade.

Strana the development of insulin resistance associated with obesity and diabetes type 2, as well 15, Methods This cross-sectional study was performed on a group of subjects, of whom 76 were the patients with diabetes type 1 and 30 were the healthy controls.

The study group consisted of the patients with diabetes type 1, which had been diagnosed before they were 36 years of age and who were on insulin therapy in the first year after the diagnosis had been made.

They either visited day hospital for diabetes or were hospitalized in the Department of Endocrinology, Clinical Center of Vojvodina.

The group of healthy controls consisted of 30 subjects of both sexes, of approximately the same age, normally nourished and without other risk factors for atherosclerosis.

The following data were taken for both groups of subjects: sex, age, length of the disease, age when the disease was diagnosed, smoking habit and family medical history.

To assess the state of metabolic regulation in diabetes the values of fasting glycemia were taken 2 hours after breakfast as well as the values of HbA1c; when the latter were less than 7.

Values of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured to analyze the lipid and lipoprotein status.

The nourishment status was assessed on the basis of anthropometric measurements, body mass, body height and body mass index BMI.

The waist was measured in centimeters and the recommended values according to the IDF criteria 17 were considered to be desirable: less than 80 cm for women and less than 94 cm for men.

The collected data were processed by the methods of descriptive and inferential statistics. The following was presented as the numerical characteristics: the arithmetic mean, median, standard deviation and either the value range or the interquartile range, depending on the data nature.

Mean values of the numerical characteristics of the two groups were compared by the t-test. Multivariate regression analysis was applied to determine the predictions and correlations between dependent variables with independent ones: the linear regression was used when the dependent variable was continuous and the logistic regression model was applied when the dependent variable was dichotomous binary.

Results Table 1 shows the characteristics of the study and the control group which did not differ in sex and age structure, nourishment status, values of total cholesterol, HDLcholesterol, LDL-cholesterol and triglycerides.

The average duration of diabetes in the group of diabetic patients was According to the HbA1c value, which was over 7. When multiple linear regression was applied, the CRP value was regarded as a dependent variable, and the rest of the mentioned values were regarded as independent variables.

The following variables were found to be significant CRP predictors: age, smoking habit, fasting glycemia, triglycerides; whereas sex, age, LDL-cholesterol and triglycerides were significant for predicting IL-6 levels.

Discussion Inflammation and oxidative stress play an important role in the process of atherosclerosis; therefore, patients having diabetes type 1 are at higher risk for cardiovascular morbidity and mortality.

Although the majority of studies on these problems dealt with diabetes type 2, recently published results have indicated that there is an increased inflammatory activity in patients having diabetes type 1, as well 1, 2, 7, 11, 13, These results are in accordance with the results of studies which have found increased CRP in adults having diabetes type 1 11, Although the mechanism of CRP rise is not completely clear, it seems to be associated with the activation of macrophages, increased oxidative stress and induction of cytokines.

In their study, Okano et al. Their study did not show statistically significant differences in age, the nourishment status index, values of LDL-cholesterol, HDLcholesterol and triglycerides between the diabetic patients and healthy controls.

This study has clearly shown that the increased level of hs-CRP correlated with the early stage of carotid atherosclerosis in young patients having diabetes type 1, measured through the level of carotid intima-media thickness Alexandraki et al.

However, the values of the above mentioned inflammatory markers were lower than in the group of patients having diabetes type 2.

A positive correlation was found between the values of CRP and postprandial glycemia and the one with fasting glycemia was determined by the multivariate regression analysis.

These results are in accordance with the most recent opinions about the importance of postprandial hyperglycemia in the development of inflammation and chronic complications.

These results can be compared with the results of some studies which have also failed to show the existence of a significant correlation between inflammatory markers and HbA1c 10, 20, thus making it clear that factors other than hyperglycemia affect inflammation and endothelial dysfunction in diabetes.

Dyslipidemia in diabetes type 1 is mostly the result of a poor metabolic regulation of the diseases, with the consequent increase in triglycerides and decrease in HDLcholesterol Besides, the development and progression of nephropathy in diabetes type 1 contribute to the development of dyslipidemia together with the increase in the total cholesterol, LDL-cholesterol, total triglycerides and the decrease in the protective HDL2-cholesterol 26, No statistically significant differences in the values of total cholesterol, HDL cholesterol and triglycerides were found between the study group of diabetic patients and the healthy controls.

A statistically significant correlation between CRP and triglycerides as well as between IL-6 with triglycerides and LDL-cholesterol was found by the multivariate regression analysis.

Eurodiab study 34 has clearly shown a correlation between the values of triglycerides and HDL cholesterol with inflammatory markers, and it has been confirmed in the healthy population, as well.

They have not confirmed a statistically significant correlation between LDL and inflammatory markers 34, In their study, Ladeia et al.

Future prospective studies should prove the importance of inflammation in the pathogenesis of chronic microand macrovascular complications in the population of diabetic patients, as well.

Correlations of certain inflammatory markers with glucoregulation parameters, lipid parameters and hypertension offer the possibility of therapeutic modification of inflammation in diabetes indirectly by improving glucoregulation, treating dyslipidemias and hypertension.

Maiti R, Agrawal NK. Atherosclerosis in Diabetes Mellitus: Role of Inflammation. Circulating endothelial progenitor cells, endothelial function, carotid intima-media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria.

Association between C-reactive protein and features of the metabolic syndrome: a population-based study.

Rifai N, Ridker PM. High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease.

Inflammation as a cardiovascular risk factor. Creactive protein: risk marker or mediator in atherothrombosis? C-reactive protein: risk marker or mediator in atherothrombosis?

Effect of C-reactive protein on vascular cells: evidence for a proinflammatory, proatherogenic role. Creactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus.

First-trimester C-reactive protein and subsequent gestational diabetes. Determinants of raised C-reactive protein concentration in type 1 diabetes.

Elevated C-reactive protein levels in the development of type 1 diabetes. Interpretation of circulating C-reactive protein levels in adults: body mass index and gender are a must.

Increased monocytic activity and biomarkers of inflammation in patients with type 1 diabetes. Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy.

Relationship between serum levels of tumor necrosis factor-alpha and interleukin-6 in diabetes mellitus type 1 children.

The metabolic syndrome-a new worldwide definition. Eleveted C-reactive protein associates with early stage carotid atherosclerosis in young subjects with typ 1 diabetes.

Cytokine secretion in longstanding diabetes mellitus type 1 and 2: associations with low-grade systemic inflammation. Associations of serum C-reactive protein with fasting insulin, glucose, and glycosylated hemoglobin: the Third National Health and Nutrition Examination Survey, Elevated levels of interleukin-6 in young adults with type 1 diabetes without clinical evidence of microvascular and macrovascular complications.

Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. The relation of fasting and 2-h postchallenge plasma glucose concentrations to mortality: data from the Baltimore Longitudinal Study of Aging with a critical review of the literature.

Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes Importance of postprandial glycemia to achieve target HbA1c levels.

American Diabetes Association. Postprandial blood glucose. Increased urinary loss of high density lipoproteins in albuminuric insulin-dependent diabetic patients.

Vaziri ND, Liang K. Quantitative Analysis of Cytokines in Diabetic Nephropathy. Early mechanisms of renal injury in hypercholesterolemic or hypertriglyceridemic rats.

Diabetes mellitus. Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes.

Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Association between elevated serum C-reactive protein and triglyceride levels in young subjects with type 1 diabetes.

Inflammatory and endothelial dysfunction markers and proteinuria in persons with type 1 diabetes mellitus. Tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors.

Received on January 28, Revised on September 22, Accepted on October 1, Bone bruise is a common finding in acutely injured knee examined by magnetic resonance MR.

The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament ACL and menisci.

Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage.

MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques.

A representative review of MR examinations for the acute knee trauma was conducted. All the patients were examined within one month of trauma.

All MR examinations were performed by using a 0. Posttraumatic bone bruise was seen in 39 We analyzed only bone bruises without these fractures of the cortex.

Only two patients with bone bruise had neither ACL nor menisci lesions. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen.

The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.

Magnetnom rezonancom pregledano je bolesnika sa akutnom traumom kolena. Svi bolesnici pregledani su u prvih mesec dana nakon traume. Pregledi su obavljeni na 0,3T MR aparatu.

Key words: knee injuries; bone and bones; contusions; magnetic resonance imaging; sensitivity and specificity. Bone bruise is posttraumatic bone marrow change which is caused by the combination of hemorrhage, edema and microtrabecular fracture without disruption of adjacent cortex.

Magnetic resonance imaging is a method of choice for detecting bone bruises which usually can not be seen using other radiological methods 1.

The terms: bone bruise, bone contusion and posttraumatic edema of the bone marrow have been seen for the last ten years in scientific literature and are in fact synonyms in the case of posttraumatic findings of bone marrow contusion.

Bone bruise of the knee is very important as a reason for acute pain and reduced knee function in patients 7, 8.

Bone bruise is best seen in STIR sequence. The aim of this study was to evaluate the diagnostic power of MR in detecting bone bruise of the knee and to show the association anterior cruciate ligament ACL and menisci lesions with bone bruise of the knee.

Methods Magnetic resonance imaging of the knee was performed in patients with the acute trauma. All the patients were examined within one month of the trauma.

All scans were performed by using 0. On MR imaging bone bruise is characterized by focal abnormal signal of the bone marrow of femoral condyles or tibial plateau.

On T1 weighted images the alterations in signal are characterized by ill-defined low signal intensity. On T2-weighted images these lesions are characterized by areas of high signal intensity.

Bone bruise is best differentiated in STIR sequence where the signal of bone marrow fat is significantly suppressed while there is a bright, hyperintense signal of bone bruise.

The meniscal tear is diagnosed as linear or irregular hyperintense signal which can be spread to the margins od hypointense meniscal triangle.

Anterior cruciate ligament injuries are characterized by a low signal intensity on T1-weighted images and hyperintensity of the signal on T2-weigted images.

A complete rupture of the ACL is diagnosed when there is a complete lack of the fibers on the ligament spread and the partial rupture when there are some fibers left intact.

Strana For the statistical analysis of the results we used descriptive statistical methods and the Mc Nemar test for the evaluation of statistical significance between the patients with and without bone bruise.

In 15 patients bone bruise was located on femoral condyles. Overall, bone bruises were more often seen in the lateral than in the medial compartment.

In 3 patients, so-called occult fractures not seen on plain radiography were diagnosed. Discussion Bone bruise, as an unique entity on MR, was first identified by Mink et al 12 in Few years later, bone bruises and occult fractures were divided Occult fractures usually can not be seen on conventional radiography but have MR characteristics very similar to those of bone bruises with one major difference and that is a disruption of adjacent cortex or osteochondral surface.

Conventional radiological techniques are rather limited in showing bone marrow. Because of that, analysis of bone marrow characteristics especially bone bruises, is based on MR imaging.

Normal intensity signal of bone marrow is the same as the signal of subcutaneous fat. It is hyperintense on T1-weighted images and medium intense on T2-weighted images.

Bone bruise on MR is presented as focal abnormal signal of the bone marrow of the femoral condyles or tibial plateaus. The best appearance of bone bruise is described on STIR sequence where the signal of normal bone marrow is suppressed and bone bruise is characterized by the hyperintensity of the signal.

This change in signal intensity is caused by posttraumatic edema which is one of the major pathohistological features of bone bruise.

The two others are hemorrhage and microtrabecular fracture. Owing to these pathohistological features, it is considered that bone bruise is one of the causes of a painful knee.

Owing to the pathohistological analysis of bone bruise, different degrees of subchondral and articular cartilage changes can be observed 13, Pathogenesis of bone marrow edema which is characteristic for bone bruise is connected with acute or chronic knee injuries, but bone bruises can be seen with no obvious trauma.

Bone bruises associated with posttraumatic lesions of the internal knee structures last more than isolated bone bruises In the overlying cartilage, degenerative changes including necrosis are described, whereas loss of proteoglycans and different degrees of osteocyte necrosis was seen in the bone matrix.

These findings are the basis for further research in the field of late complications of bone bruises such as posttraumatic arthritis Latest studies show that bone marrow edema seen on MR imaging is a result of different atypical histological changes and that intensity of the signal does not depend only on bone marrow edema The main finding in bone bruise is posttraumatic edema which is most responsible for signal intensity.

Location and size of bone bruise usually speak for the mechanism of knee injury. There are five different mechanisms of knee trauma which give different patterns of bone marrow edema and they are: pivot shift injury, dashboard injury, hyperextension injury, clip injury, and lateral patellar dislocation.

There have not been many studies which analyze the incidence of bone bruises following knee injury 10, 20, Our study was designed so to analyze the presence of bone bruise in acute knee trauma as well as the association with internal knee lesions of LCA and menisci.

This study is very important because MR of the knee was done twice in order to confirm diagnosis. In the study of Lynch et al.

The highest association of bone bruise with LCA rupture was seen in study of Atkinson et al. The term LCA injury is used because in our study we had no arthroscopy done in our patients in order to distinguish partial from a complete rupture of the anterior cruciate ligament.

It is very important to emphasize that in acute knee injury it is very hard to distinguish traumatic menisci tears from the degenerative ones which was not the aim of our study.

Cothran et al. It is therefore essential to consider menisci lesions not only as a cause of a painful knee and a diminished knee function but also as a predictor of further osteoarthritis There have been many studies with the aim to confirm the associations of bone bruise and LCA lesions.

Almost all analyzed this association but placing LCA as primary outcome for the study. There have been fewer studies which analyze the association of bone bruises and menisci lesions 17, Our study analyzed both the association of bone bruise and the internal knee structures lesions but placing bone bruise finding as primary.

Conclusion Bone bruise is a very common finding in acute knee injury. It is more often on the lateral knee compartment.

In acutely injured knee, bone bruise can indicate the injury pattern and it can be very helpful in detecting associated posttraumatic internal knee lesions.

By the precise analysis of bone bruise and the pattern of bone injury we can focus on analysis of internal knee structures lesions.

In this way finding of bone bruise on MR leads to finding the expected but less well seen le- Volumen 68, Broj 9 sions of internal structures of the knee.

Patients with bone bruise have significantly more lesions of LCA and menisci than patients without bone bruise. Vastly undersampled isotropic projection steadystate free precession imaging of the knee: diagnostic performance compared with conventional MR.

Bone marrow oedema of the knee. Bone marrow edema in the knee. Differential diagnosis and therapeutic possibilities.

German 4. Fotiadou A, Karantanas A. Acute nontraumatic adult knee pain: the role of MR imaging. Quantitative assessment of bone marrow edema-like lesion and overlying cartilage in knees with osteoarthritis and anterior cruciate ligament tear using MR imaging and spectroscopic imaging at 3 Tesla.

Clinical consequences of bone bruise around the knee. Tapping test in patients with painful bone marrow edema of the knee. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury.

MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella.

Bone bruises associated with ACL rupture: correlation with injury mechanism. Magnetic resonance imaging of the knee. New York: Raven; Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging.

Magnetic resonance imaging of bone bruising in the acutely injured knee-short-term outcome. Bone bruising of the knee. The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year.

Association of knee bone bruise frequency with time postinjury and type of soft tissue injury. Orthopedics ; 31 5 : Bone marrow edema and its relation to progression of knee osteoarthritis.

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings.

MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis.

The appearance of kissing contusion in the acutely injured knee in the athletes. Bone abnormalities of the knee: prevalence and significance at MR imaging.

MR imaging of meniscal contusion in the knee. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging.

Indirect soft-tissue and osseous signs on knee MRI of surgically proven meniscal tears. Received on February 1, Revised on November 15, Accepted on November 16, According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy.

Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method.

The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume.

In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetiumm scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied.

An average size of the nodule before curing was 9. An average quantity of the injected ethanol was 9.

Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone TSH was noticed compared to the initial values 0.

According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram.

The number and frequency of side effects were insignificant. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in disappearing of authonomy.

Key words: thyroid diseases; thyroid hormones; goiter, nodular; ethanol; ultrasonics. Laboratory criterion for diagnosing is an inability to suppress the function of nodules by suppressive doses of thyroid hormones.

At the same time, the suppressed paranodal tissue has retained the ability to answer the stimulation by exogenous giving TSH.

Unlike toxic ones, nontoxic nodules have normal serum levels of thyroid hormones. According to the current principles, toxic nodules are treated surgically or with therapeutic application of radioactive RA iodine.

The need for curing the nontoxic AFTNs is based on the observation that most of the ill have subnormal TSH levels and, hence, subclinical hyperthyreosis.

On the other hand, taking larger quantities of iodine, which occurs when giving iodine contrast media, the drugs containing iodine, or when eating food rich in iodine, multiplies the possibility of evolution of nontoxic nodules into the toxic ones.

The results achieved by the use of ethanol in treatement of hepatocellular carcinomas 2 and benign cysts in the thyroid gland 3 were a starting point for the attempts to cure the autonomous nodules by the same method.

The procedure of percutaneous ethanol injection PAE into the nodules of thyroid gland was promoted at the beginning of the s.

Then, there were the first results published of treating eight patients in this way in whom the regression in nodules size and the disappearance of autonomy 4 were achieved, regardless a small number of ethanol injections.

In the largest number of the cured, PAE led to a complete or a partial curing, with a very small number of recidives. In an attempt to contribute to the achievements which would make this method generally accepted we started with the fact that there was not a single study with a selection of patients regarding the autonomy level, as well as that most studies included heterogeneous groups of patients with nodal, polynodal, most often toxic nodules of various sizes.

The aim of this study was to estimate therapeutical effects of 15 mL percutaneous ethanol injection in patients with nontoxic, solitary AFTNs, which most often occur in clinical practice.

Methods The study included 25 patients with solitary nodules which appeared more intense on scintigraphy Tem and had a complete supremacy in paranodal tissue.

According to serum concentration of thyroid hormones and TSH, the patients with toxic nodules were excluded. By cytological analysis of aspirates from nodules any doubts of malignancy were eliminated.

A Hewlett Pacard apparatus with a linear probe of 7. Color Doppler was used to direct the injection into the areas with the largest number of exposed capillaries.

Marijana Kostić

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