Glavni sanitetski stožer - osnivanje, uloga i rad

Mlada Hrvatska država premda počiva na temeljima povijesnih činjenica postojanja Hrvatske, raspadom federacije u mnogim je segmentima započinjala organizaciju države iz početka. Civilno zdravstvo u tim prvim danima stvaranja države suočeno je s problemima kao i cijela država oslonjeno isključivo na vlastite snage i rezerve. Agresija na Hrvatsku, prometna izolacija područja, pojava prognanih i izbjeglih povećalo je probleme i naizgled smanjilo izglede za opstanak Hrvatske u što je, danas se već zna, sumnjao cijeli svijet. U tim i takovim uvjetima, odlukom ministra zdravstva Republike Hrvatske stvoreno je tijelo koje je bilo u stanju promptno odgovoriti na sve zahtjeve kako su se oni pojavljivali. Rastom potreba, rasla je i organizacija od štaba zdravstva do Kriznog stožera Ministarstva zdravstva RH te su postavljeni temelji za uspostavu Glavnog zdravstvenog stožera, tijela koji će u punoj mjeri ostvariti i provoditi ideju integralnog zdravstvenog sustava Republike Hrvatske kao jedinog stručnog i gospodarskog modela zdravstva i saniteta Hrvatske države

Radiofrequency ablation as locoregional therapy for unresectable hepatic malignancies: initial results in 24 patients with 5-years follow-up

Radiofrequency ablation (RFA) is one treatment modality for unresectable liver metastases. Patients with hepatic malignancies (n = 24) underwent elective RFA. All tumors were ablated with a curative intent, with a margin of 1 cm, in a single session of RFA. The median diameter of tumor was 3.1 cm (range 1.7-6.9 cm). Studied patients were not candidates for resection due to multifocal hepatic disease, extrahepatic disease, proximity to major vascular structures or presence of cirrhosis with functional hepatic reserve inadequate to tolerate major hepatic resection. Complete tumor necrosis was achieved in 87.5% and tumor recurred in 3 patients (12.5%) with lesions larger than 5 cm. Distant intrahepatic recurrence was diagnosed in another 4 (16.7%). Distant metastases were found in 7 (29.2%) patients. Four of these 7 patients had also distant intrahepatic recurrence of disease. Two and 5-years survival rates were 41.7% (10 patients) and 8.3% (2 patients) respectively. RFA is safe and effective option for patients with unresectable hepatic malignancies smaller than 5 cm without distant metastatic disease. RF ablation resulted in complete tumor necrosis in 87.5% with 2 and 5-years survival rates much higher than with chemotherapy alone or only supportive therapy, when survival is measured in weeks or months. If RFA is unavailable, percutaneous ethanol injection therapy can be done but with inferior survival rates

Surgical treatment of perihilar cholangiocarcinoma: 10-year experience at a single institution

Background: Our study evaluates surgical outcomes of patients treated for perihilar cholangiocarcinoma in a single institution and demonstrates postoperative (90 days) morbidity and mortality rates and potential prognostic factors associated with complications. Methods: Medical records of all patients with a diagnosis of perihilar cholangiocarcinoma (pCC) between 2007 and 2017 who underwent a surgical procedure at the University hospital centre Zagreb, were retrospectively evaluated. Statistical analysis to determine predictors of postoperative mortality was performed using the Chi-square test and Fisher exact probability test where appropriate. Results: Out of 52 surgically treated patients, 43 underwent radical and 9 palliative procedures. Hilar resection and hilar resection along with right hepatectomy were the most commonly performed procedures in 34 radically treated patients. Overall morbidity and mortality rates were 46% and 5.7%, respectively. Significantly higher morbidity rate was observed in a group of patient with untreated preoperative jaundice and in those aged 70 and over. Conclusion: Current guidelines favor extension of radicality in treatment of pCC by performing left or right hepatectomy in addition to hilar resection. This may increase R0 resection rates and prolong disease free survival. Our experience shows similar mortality/morbidity rates as reported in other centers and confirms that in selected patients, concomitant hepatectomy for perihilar pCC is a safe and feasible surgical strategy