KOREKCIJA CISTOKELE SINTETSKOM MREŽICOM TRANSOBTURATORNIM PRISTUPOM (PERIGEE SISTEM)

Objectives. Our first short-term results of transobturator mesh interposition (Perigee System) for the correction of cystoceles are presented. Methods. This is our initial study on 22 women with cystocele > Grade 2 who underwent the Perigee procedure in our Center between January 2006 and March 2007. In 15 cases lateral cystocele defect was ¬diagnosed, whereas other 7 patients had central anterior vaginal wall defect. All patients were assessed by POP-Q staging. Results. The anatomical and functional reconstruction of anterior vaginal wall was achieved in all patients. Preoperatively, mean POP-Q Aa value was +1.1 (± 0.3) and Ba value was + 1.9 (± 1.3) . No major intraoperative or immediate postoperative complications were observed. One and three months postoperatively, mean POP-Q Aa value was – 2.9 (± 0.21) and – 2.82 (± 0.1) respectively and Ba was –2.85 (± 0.4) and – 2.8 (± 0.23) respectively. Patients’ satisfaction and the imposing short-time surgical outcome were achieved in all cases after three months follow-up. Conclusion. We consider Perigee procedure to be highly efficacious, minimally invasive and easy technique for correction of anterior vaginal wall defects.Cilj rada. Prikazati preliminarne rezultate transobturatornog pristupa korekcije cistocela metodom Perigee. Metode. 22 bolesnice s cistocelom drugog stupnja podvrgnute su u našoj ustanovi metodi Perigee u vremenskom razdoblju između sječnja 2006. i ožujka 2007. godine. U 15 bolesnica dijagnosticirano je lateralno paravaginalno oštećenje, dok je u 7 bolesnica verificirano centralno oštećenje prednje vaginale stijenke. Rezultati. Anatomska i funkcionalna korekcija prednje vaginalne stijenke ovom metodom postignuta je kod svih bolesnica. Preoperativno, srednja vrijednost POP-Q Aa točke bila je +1.1 (± 0.3) a Ba točle + 1.9 (± 1.3). Nije bilo intraoperativnih ni perioperativnih komplikacija zahvata. Jedan i tri mjeseca nakon zahvata, srednja vrijednost točke POP-Q Aa bila je – 2.9 (± 0.21) i – 2.82 (± 0.1) dok je srednja vrijednost točke Ba bila –2.85 (± 0.4) i – 2.8 (± 0.23). Zaključak. Smatramo da je Perigee metoda jednostavna, ¬neinvazivna i učinkovita metoda korekcije defekata svih tipova cistokela

Operative complications and results of the "SPARC" procedure for stress urinary incontinence [Operativne komplikacije i ishod metode SPARC u liječenju statičke inkontinencije mokraće]

The aim of this study was to determine the efficacy and operative complications of the suprapubic arc (SPARC) procedure in stress incontinent women with and without previous anti-incontinence surgery. One-hundred and twenty-one patients with stress urinary incontinence (SUI) were treated with SPARC for correction of urethral hypermobility (N = 65) and intrinsic sphincter deficiency (N = 56) between August 2002 and February 2007. The long-term surgical results, operative complications (bladder injury, retropubic hematoma, de novo urgency and urinary infection) and patients' satisfaction were assessed. The overall complication rate was 9.9% (12/121). The perioperative complication rate was 1.7% including 2 urinary bladder injuries. Significant difference in the overall complications rate was detected between women with and without previous surgery (23/45, 51.1% vs. 6/108, 5.5%, chi2 = 49.89, P < 0.001). The overall postoperative complication rate was 8.3% (10/121) including 4 de novo urgencies, 4 urinary infections and 2 retropubic hematomas. There were 3 patients with postoperative urinary retention managed conservatively, without voiding difficulties on control visits. The objective cure rate after the follow-up was 86.8% (105/121). In patients with SUI and without preceding vaginal operations SPARC is a good method with low incidence of perioperative complications, promising long-term results and high patient satisfaction

Efficacy of Sling Procedures for Treatment of Female Stress Urinary Incontinence

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagović method as the control group. All patients were prospectively clinically assessed over a period of 3, 6 and 12 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p<0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p<0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19±7 and 9±5 minutes, respectively (p<0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6±1.0, range 2-7) days than in the control group of (9.6±1.8, range 6-18), (p<0.001<0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient\u27s satisfaction

Operative Complications and Results of the »Sparc« Procedure for Stress Urinary Incontinence

The aim of this study was to determine the efficacy and operative complications of the suprapubic arc (SPARC) procedure in stress incontinent women with and without previous anti-incontinence surgery. One-hundred and twenty-one patients with stress urinary incontinence (SUI) were treated with SPARC for correction of urethral hypermobility (N=65) and intrinsic sphincter deficiency (N=56) between August 2002 and February 2007. The long-term surgical results, operative complications (bladder injury, retropubic hematoma, de novo urgency and urinary infection) and patients’ satisfaction were assessed. The overall complication rate was 9.9% (12/121). The perioperative complication rate was 1.7% including 2 urinary bladder injuries. Significant difference in the overall complications rate was detected between women with and without previous surgery (23/45, 51.1% vs. 6/108, 5.5%, c2=49.89, P<0.001). The overall postoperative complication rate was 8.3% (10/121) including 4 de novo urgencies, 4 urinary infections and 2 retropubic hematomas. There were 3 patients with postoperative urinary retention managed conservatively, without voiding difficulties on control visits. The objective cure rate after the follow-up was 86.8% (105/121). In patients with SUI and without preceding vaginal operations SPARC is a good method with low incidence of perioperative complications, promising long-term results and high patient satisfaction

Public relations on the example of HEP d.d.

U radu je obrađena problematika odnosa s javnošću na primjeru poduzeća HEP d.d.. Sukladno navedenome općenito su obrađeni odnosi s javnošću kao i temeljne odrednice istih, a nakon čega se razrada sužava na odnose s javnošću u poduzeću. Kod razmatranja odnosa s javnošću u poduzeću HEP d. d. ističe se kako je za cjelokupnu HEP grupaciju, koja slovi za jednu od najvećih poslovnih organizacija u Republici Hrvatskoj, od iznimne važnosti održavati iste. Dakle, od iznimne je važnosti imati kvalitetno razvijenu komunikacijsku strategiju kako bi se omogućilo uspostavljanje kontinuiranog razumijevajućeg dijaloga s unutarnjim i vanjskim javnostima u vezi s osnovnim načelima rada, djelovanja i ciljeva HEP grupe, a što uglavnom rezultira pozitivnim utjecajem na samu provedbu strateških ciljeva. Odnosi s javnošću općenito predstavljaju jednu od najvažnijih funkcija koja bilježi stalni trend rasta, a nedvojbena je činjenica kako je kvalitetno ustrojen sustav odnosa s javnošću nužna pretpostavka ukoliko se teži održanju povoljne reputacije poduzeća na tržištu, a samim time i njegova uspješnog djelovanja.The paper deals with the problems of public relations on the example of the company HEP d.d. When considering public relations in HEP d.d, it is emphasized that it is of utmost importance for the entire HEP group, which is known as one of the largest business organizations in the Republic of Croatia, to maintain them. Therefore, it is of the utmost importance to have a well-developed communication strategy to enable the establishment of a continuous understanding dialogue with the internal and external public regarding the basic principles of work, operations and goals of the HEP group, which mainly results in a positive impact on the implementation of the strategic goals. Public relations is generally one of the most important functions of a steady upward trend, and it is undoubted that a well-established public relations system is a necessary prerequisite if it seeks to maintain a favorable reputation of the company on the market, and therefore its successful operation

LOGISTICS PROCESS COSTS

f) U radu je obrađena problematika troškova procesa logistike. Područje logistike je prisutno dugi niz godina, odnosno, logističke aktivnosti su zabilježene već u vrijeme velikih seoba naroda i brojnih ratova pa se navodi kako se logistika, kakva postoji danas, sustavno usavršavala razvojem civilizacije. Logistika se smatra upravljanjem tokovima i pohranom materijala, odnosno, ona obuhvaća sve aktivnosti u premještanju sirovina, poluproizvoda, reprodukcijskog materijala i gotovih proizvoda od proizvođača do krajnjeg potrošača. Jednako tako, predstavlja iznimno važno oružje u borbi za prednost pred konkurencijom, a što je jedan od temeljnih razloga zbog kojih poduzeća moraju imati kvalitetno definiranu vezu između strategije samoga poduzeća i vlastitih logističkih ciljeva. Troškovi logistike obuhvaćaju nabavu, proizvodnju, kontrolu kvalitete, rukovanje, transport, skladištenje, logistiku povrata, logističke tehnologije, pakiranje te administrativne poslove koji su usko vezani uz prethodno navedeno, a odnose se, zapravo, na sve aktivnosti koje se odvijaju u vremenskom intervalu od prvotne narudžbe potrebne sirovine za određeni proizvod pa sve do isporuke gotovog proizvoda krajnjem korisniku. Troškovi procesa logistike imaju izniman utjecaj na profitabilnost određenog poduzeća budući su upravo oni ti koji predstavljaju značajan dio ukupnih troškova poslovanja. Logistika, nedvojbeno, predstavlja područje sa najvećim potencijalom za stvaranje ušteda i unaprjeđenje poslovanja svakog poduzećaThe paper deals with the issue of logistics process costs. The field of logistics has been present for many years, that is, logistics activities have been recorded during the great migrations and numerous wars, so it is stated that logistics, as it exists today, has been systematically improved with the development of civilization. Logisticsis considered to be the management off low sand storage of materials, that is, it encompasses all activities in the movement of raw materials, semi-finished products, reproductive material and finished products from the producer to the final consumer. Equally, it is an extremely important weapon in the fight for anadvantage over the competition, which is one of the fundamental reasons why companies must have a well-defined link between the company's strategy and its own logistics goals. Logistics costs include procurement, production, quality control, handling, transport, storage, returnlogistics, logistics technologies, packaging and administrative tasks that are closely related to the above, and relate, infact, to all activities that take place in the time interval from initial orders of the necessary raw materials for a particular product until the delivery of the finished product to the end user. The costs of the logistics process have an exceptional impact on the profitability of a particular company, since they are the ones that represent a significant part of the total operating costs. Logistics, without a doubt, represents the area with the greatest potential for creating saving sand improving the business of every compan

Public relations on the example of HEP d.d.

U radu je obrađena problematika odnosa s javnošću na primjeru poduzeća HEP d.d.. Sukladno navedenome općenito su obrađeni odnosi s javnošću kao i temeljne odrednice istih, a nakon čega se razrada sužava na odnose s javnošću u poduzeću. Kod razmatranja odnosa s javnošću u poduzeću HEP d. d. ističe se kako je za cjelokupnu HEP grupaciju, koja slovi za jednu od najvećih poslovnih organizacija u Republici Hrvatskoj, od iznimne važnosti održavati iste. Dakle, od iznimne je važnosti imati kvalitetno razvijenu komunikacijsku strategiju kako bi se omogućilo uspostavljanje kontinuiranog razumijevajućeg dijaloga s unutarnjim i vanjskim javnostima u vezi s osnovnim načelima rada, djelovanja i ciljeva HEP grupe, a što uglavnom rezultira pozitivnim utjecajem na samu provedbu strateških ciljeva. Odnosi s javnošću općenito predstavljaju jednu od najvažnijih funkcija koja bilježi stalni trend rasta, a nedvojbena je činjenica kako je kvalitetno ustrojen sustav odnosa s javnošću nužna pretpostavka ukoliko se teži održanju povoljne reputacije poduzeća na tržištu, a samim time i njegova uspješnog djelovanja.The paper deals with the problems of public relations on the example of the company HEP d.d. When considering public relations in HEP d.d, it is emphasized that it is of utmost importance for the entire HEP group, which is known as one of the largest business organizations in the Republic of Croatia, to maintain them. Therefore, it is of the utmost importance to have a well-developed communication strategy to enable the establishment of a continuous understanding dialogue with the internal and external public regarding the basic principles of work, operations and goals of the HEP group, which mainly results in a positive impact on the implementation of the strategic goals. Public relations is generally one of the most important functions of a steady upward trend, and it is undoubted that a well-established public relations system is a necessary prerequisite if it seeks to maintain a favorable reputation of the company on the market, and therefore its successful operation

Efficacy of sling procedures for treatment of female stress urinary incontinence [Učinkovitost sling postupaka u liječenju žena sa statičkom inkontinencijom urina]

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagovid method as the control group. All patients were prospectively clinically assessed over aperiod of 3, 6 and l2 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p < 0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p < 0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19 +/- 7 and 9 +/- 5 minutes, respectively (p < 0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6 +/- 1.0, range 2-7) days than in the control group of (9.6 +/- 1.8, range 6-18), (p < 0.001 < 0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient's satisfaction

Thigh abscess as an extension of psoas abscess: the first manifestation of perforated appendiceal adenocarcinoma: case report

A 65-year-old woman presented with a painful, swollen, red right thigh and the mild pain in the right abdomen without nausea, vomiting or diarrhoea that lasted for 1 week. Laboratory findings revealed elevated inflammatory markers. Computed tomography of the right thigh, abdomen and pelvis showed an abscess formation in the adductor muscles draining from the abscess that completely occupied the right retroperitoneum up to the diaphragm, dissecting downward through the inguinal canal. Appendix was enlarged with an appendicolith. Emergent exploratory laparotomy revealed a perforated appendix with psoas abscess. Pathohistological diagnosis revealed adenocarcinoma of the appendix. Thigh abscess is an uncommon condition with insidious clinical presentation. Therefore, early recognition and setting of the correct diagnosis enables adequate treatment avoiding additional complications and in some cases potential life-threatening conditions. When upper leg abscess is suspected or proven abdominal examination is mandatory

Učinkovitost sling postupaka u liječenju žena sa statičkom inkontinencijom urina

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagovid method as the control group. All patients were prospectively clinically assessed over aperiod of 3, 6 and l2 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p < 0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p < 0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19 +/- 7 and 9 +/- 5 minutes, respectively (p < 0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6 +/- 1.0, range 2-7) days than in the control group of (9.6 +/- 1.8, range 6-18), (p < 0.001 < 0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient's satisfaction.Cilj ovog istraživanja bilo je utvrditi učinkovitost i operacijski ishod sling postupaka u žena sa statičkom inkontinencijom urina (SIU) u poredbi sa konvencionalnom prednjom kolporafijom. U razdoblju od studenog 2011. do ožujka 2013. sling postupcima liječeno je ukupno 56 bolesnica sa SIU, 39/56 (69,6%) metodom SPARC i 17/56 (30,4%) metodom MiniArc. Tijekom istog razdoblja ukupno je 49 bolesnica sa SIU operirano primjenom klasične prednje kolporafije metodom po Bagoviću kao poredbena skupina. Sve bolesnice prospektivno su klinički nadzirane u razdoblju od 3, 6 i 12 mjeseci nakon operacije. Ukupna stopa izlječenja nakon razdoblja kliničkog nadzora iznosila je 92,9% (52/56) u promatranoj skupini bolesnica i 79,6% (39/49) u poredbenoj skupini, a do poboljšanja je došlo u ostalih 5,4% (3/56) bolesnica u promatranoj i 18,4% (9/49) bolesnica u poredbenoj skupini (p<0,05). Ukupna stopa komplikacija bila je značajno niža u promatranoj skupini bolesnica nego u poredbenoj skupini, 12,5% (7/56) naspram 28,6% (14/49), (p<0,05). U skupini bolesnica liječenih sling metodama poslijeopreacijski je zabilježena nešto viša stopa inkontinencije, a u skupini klasično operiranih bolesnica nešto izraženija stopa urinarne retencije. Kirurško liječenje nije uspjelo samo kod jedne bolesnice iz svake skupine i bilo je potrebno učiniti dodatnu korekciju SIU. Prosječno trajanje operacije iznosilo je 19±7 minuta za SPARC, a 9±5 minuta za MiniArc, (p<0,0001). Prosječno trajanje bolničkog liječenja bilo je značajno kraće u skupini bolesnica liječenih sling postupkom (2,6±1,0, raspon 2–7) dana nego u poredbenoj skupinu (9,6±1,8, raspon 6–18), (p<0,001<0,0001). Slijedom prikazanih rezultata, sling metode su vrlo učinkovite u liječenja SIU sa niskom pojavnošću perioperacijskih komplikacija i obećavajućim dugoročnim rezultatima te primjerenim zadovoljstvom bolesnica