Different therapeutic modalities in a patient with multiple spontaneously developed keloids: a case report

Keloids are benign tumors that usually develop as an excessive healing response to injury. They remain a challenging therapeutic problem to this day. Numerous treatment approaches are available, yet therapeutic results are often not satisfactory. A female patient with multiple spontaneously developed keloids on her trunk is presented. In this patient, four different therapeutic options were employed at different sites, with variable responses. The first option included cryotherapy, with poor effect. Slight flattening was observed after intralesional corticosteroid therapy. Treatment with excision followed by radiotherapy resulted in recurrence after 3 months. The best effect was noticed when excision and injection of corticosteroids into surgical margins were followed by radiotherapy. To the authors' knowledge, this is the first report of three-modal therapy in the management of keloids, which resulted in no recurrences over a 3-year follow-up

Evolution and Current Status of the Competitive Environment in the Serbian Banking Sector: Concentration Indices Analysis

This paper analyzes the degree of concentration and competition in the Serbian banking sector during the 2010-2017 period and in its current state, by considering the financial statements of banks for the years 2016 and 2017. For this purpose, both traditional concentration indicators (concentration ratio CRn and the Herfindahl-Hirschman index), and the relatively rarely used Linda indices have been used. The degree of concentration has been calculated based on five variables: total assets, deposits, capital, operating income of banks, and loans. The degree to which these indicators are compliant with the basic antitrust regulations has been illustrated. It has been demonstrated that in the current case of a relatively large number of banks operating in Serbia, the existing degree of concentration is relatively low. This provides suitable conditions for the development of healthy competition among them. However, the approximation of the indices to moderate concentration within the period analyzed warns of the appearance of oligopoly

The Impact of Atopic Dermatitis and Corticophobia on the Quality of Family Life

ABSTRACT The aim of the study was to investigate the impact of atopic der- matitis (AD) in children and corticophobia on the quality of family life. Chil- dren with AD and their parents were included in a cross-sectional study. The severity of AD was self-assessed using the Patient Oriented-Scoring of Atopic Dermatitis (PO-SCORAD) index, and the severity of corticophobia using the Topical Corticosteroid Phobia (TOPICOP) score, and the general impact of AD on family quality of life using the Family Dermatology Life Quality Index (FDLQI). We included 330 parents, mostly mothers (99.4%) and children with a median age of 3 years (interquartile range, IQR 1.5-5.0 years). The median values of the PO SCORAD index and TOPICOP score were: 19.1 (IQR 13.6-24.1) and 58.3 (IQR 41.7-72.2), respectively. The median FDQLI score was 12 (IQR 7-16). The influence of independent variables such as parental age, child’s age, child’s gender, family history of allergies, place of residence, parental education, associated allergic disease in the child, PO SCORAD, and the TOPI- COP score on the FDLQI was analysed. The significant models were the age of the parents (protective factor), the PO SCORAD index, and the TOPICOP score, which together accounted for 26.1% of the variability of FDLQI. Concu- sion of the study is that AD in children, its severity, and the parent’s fear of chronic corticosteroid treatment impair the quality of family life

New management practice in the hotel business – The case of the hotel Excelsior

The paper analyses the new management practice in the hotel industry. Over recent years, the environment for hotel management in Croatia has changed radically. Difficult business conditions require the transformation of management in the hotel industry. From the old-style business model, in which hotel managers were focused inwards on the hotel and its operation, a new paradigm encompassing a more externally oriented focus is now required. The current transformation of socially-owned hotels into capital-based and market-oriented business enterprises will accelerate the general process of privatisation and promote incentive management strategies. The article gives the research results of the new management practice in the case of the hotel "Excelsior" in Dubrovnik. It is one of the most successful hotels on the Croatian coast, which practises modern management. The research referred to management level, sex, age and educational structure of managers, their continuing education, knowledge, skills and characteristics of management, main functions of management, delegation of authorities and responsibilities, management system, decision-making, styles of leading and governing of managers by their time. The received results have been compared with the earlier management approach of the above-mentioned hotel. The objective of the paper is to point out the importance of the new management practice and its contribution to the successful hotel business

Incarcerated Diaphragmatic Hernia – Differential Diagnoses

The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a signifi cant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with a previous control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax