Arterijska hipertenzija i bubrežna bolest - neočekivana komplikacija

Arterial hypertension and chronic kidney disease are mutually interconnected. Uncontrolled arterial hypertension along with diabetes is one of the two most common causes of end-stage chronic kidney disease. On the other hand, chronic kidney disease, as well as renal artery stenosis, results in the development of arterial hypertension. Hypertensive crisis with target-organ damage, also known as a hypertensive emergency, is a serious arterial hypertension complication which is however becoming less frequent. It requires urgent parenteral antihypertensive treatment adjusted to the values of arterial hypertension and accompanying clinical signs. Damage can manifest on numerous organ systems primarily eyes, brain, cardiovascular system, and the kidneys. This is a case report of a patient who presented with hypertensive crisis and kidney damage and was eventually diagnosed with abdominal aortic dissection expanding into the renal arteries, but without typical clinical presentation of stabbing pain. MSCT aortography, despite the risk of progression of renal damage due to the effect of contrast agent, allowed us to set definitive diagnosis and clarify the aetiology of kidney damage and resistant arterial hypertension.Arterijska hipertenzija i kronična bubrežna bolest uzročno-posljedično su povezane. Neregulirana arterijska hipertenzija uz šećernu bolest jedan je od dva najčešća uzroka završnog stadija kronične bubrežne bolesti, a s druge strane, kronična bubrežna bolest, jednako kao i bolest bubrežnih arterija, dovodi do razvoja arterijske hipertenzije. Hipertenzivna kriza s oštećenjem ciljnih organa, takozvana hipertenzivna emergencija, ozbiljna je komplikacija arterijske hipertenzije koja se ipak sve rjeđa viđa. Iziskuje hitno parenteralno antihipertenzivno liječenje prilagođeno prema vrijednostima arterijskog tlaka i pridruženim kliničkim znako-vima. Oštećenja se mogu manifestirati na brojnim organskim sustavima, prvenstveno očima, mozgu, kardiovaskularnom sustavu i bubrezima. Prikazan je slučaj bolesnika s hipertenzivnom krizom uz bubrežno oštećenje u kojeg se obradom izdiferencirala disek-cija abdominalne aorte sa širenjem u renalne arterije, no bez tipične kliničke slike s parajućim bolovima. Učinjenom kontrastnom pretragom, unatoč riziku, postavljena je definitivna dijagnoza i razjašnjena je etiologija bubrežnog oštećenja i uzrok pogoršanja arterijske hipertenzije

Geotechnical reconnaissance of an extensive cover-collapse sinkhole phenomena of 2020–2021 Petrinja earthquake sequence (Central Croatia)

This article presents geotechnical reconnaissance data that characterize the formation of 122 new and 49 historical cover-collapse sinkholes within 1.13 km2 area in 12 months following the MW 6.4 earthquake that occurred on 29 December 2020, in Petrinja, Croatia. Data include a geological background, seismic sequence information, sinkhole geometric characteristics, rainfall data, and results of detailed geotechnical subsurface investigation. The sinkhole geometrical features were collected using aerial and satellite imagery, terrestrial lidar, and manual measurements. Soil properties and groundwater levels were obtained from four geotechnical boreholes, accompanied by in situ geotechnical characterization and standard penetration tests (SPTs). Soil parameters were obtained from consolidated undrained conventional triaxial compression, oedometer, soil water retention, and index tests performed on 31 soil samples. Clayey cover, 4–10 m thick, with sporadic gravel lenses overlying cavernous, intensely karstified carbonate rocks, characterizes the sinkhole area. Clays are mostly overconsolidated, with varying degrees of saturation ranging from very small to fully saturated. Seasonal and climate-induced variations in the groundwater table interact with artesian/subartesian karst aquifer, thus affecting the suction and the shear strength. Soil water retention curves (SWRCs) indicate that desaturation is possible for deeper groundwater tables, thus further affecting the effective stress, shear strength, and interparticle tensile forces. Finally, the observed vertical walls that accompanied sinkholes opening can occur in the overconsolidated cohesive cover clay layer with varying degree of saturation. The presented data provide essential geomechanical information necessary to understand the associated sinkhole failure mechanism. This article will help future investigators to perform detailed analyses and provide a background for complementing future sinkhole precursor research. Geotechnical, geological, seismic, and precipitation data generally indicate that the formation of cover-collapse sinkholes in the study area is a consequence of a specific local geological setting but is significantly expedited by earthquake-induced dynamic loading and complemented by multiple hydro-mechanical factors

Clinical guidelines for diagnosis, treatment and monitoring of patients with invasive breast cancer – Croatian Oncology Society (BC-3 COS)

Rak dojke je najčešći zloćudni tumor u žena koji se može probirom, redovitim kontrolama i zdravstvenim odgojem otkriti u ranim stadijima bolesti i uspješno liječiti. Metode liječenja uključuju kirurgiju, kemoterapiju, radioterapiju, endokrinu terapiju, imunoterapiju, ciljanu terapiju te simptomatsko-suportivnu terapiju, koja se primjenjuje ovisno o stadiju bolesti, biološkim obilježjima tumora i općem stanju, dobi i komorbidetima bolesnica. Plan liječenja definira multidisciplinarni tim. S obzirom na pojavnost ove bolesti, mogućnost ranog otkrivanja i mogućeg značajnog učinka terapijskih postupaka na tijek bolesti, potrebno je definirati i pravilno standardizirati pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu su iznesene smjernice s ciljem primjene standardiziranih postupaka u svakodnevnom radu s bolesnicama s rakom dojke u Republici Hrvatskoj.Breast cancer is the most common cancer in women, which can be diagnosed early through screening, early detection and through education. When diagnosed early, it can be successfully treated. Treatment modalities include surgery, chemotherapy, radiotherapy, endocrine therapy, immunotherapy, targeted therapy and supportive therapy applied depending on the stage of the disease, tumor and patient´s characteristics. Treatment should be defined by a multidisciplinary team. Due to the incidence of this disease, opportunity of early detection and possible significant influence of various treatment modalities on the course of the disease, it is important to define and implement a standardized approach for diagnosis , treatment and monitoring algorithm. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis,treatment and monitoring of breast cancer patients in the Republic of Croatia