LIVER BIOPSY IN HEPATITIS C INFECTION

SAŽETAK Biopsija jetre iglom, najbolji je dijagnostički postupak koji daje uvid u stvarno oštećenje jetrenoga parenhima, ne samo kod hepatitisa C već i kod drugih bolesti koje pogađaju jetru. Materijal dobiven punkcijom koristi se uglavnom za patohistološku analizu, ali može se koristiti i za elektronsko mikroskopiranje, te za molekularnu analizu. Materijal mora biti najmanje duljine 1,5 cm i širine 0,2 cm, a određuje li se stupanj oštećenja jetre numeričkim indeksom HAI (engl. histology activity index), mora sadržavati bar 6 cjelovitih portalnih prostora. Godine 1995. Ishak i suradnici uveli su numerički indeks koji koristi grading i staging. Grading označava stupanj oštećenja jetre (piecemeal nekroze, konfluirajuće i premošćujuće nekroze, žarišne nekroze i apoptoze, te portalna upala), a staging označava promjene u građi jetre, količinu fibroze, odnosno cirozu kao krajnju fazu bolesti. Ukupni zbroj bodova kliničaru daje podatke o stanju jetrenoga tkiva, te se na osnovi toga određuje terapijski protokol.SUMMARY Liver needle biopsy is the best diagnostic procedure to estimate a profound of liver damage, not only in Hepatitis, then in the other liver diseases. Specimen provided by liver needle biopsy is used generally for patohistological analysis, but also could be used for electron microscopy and molecular analysis. Specimen has to be 1,5 cm long and 0,2 cm wide at least and must contain 6 whole portal areas for assesing HAI (histology activity index). HAI is a numerical score for evaluation the grade of liver damage. In 1995, Ishak and colleagues were introduced a numerical score which used a terms grading and staging. Grading means the degree of liver damage (piecemeal necrosis, confluent ang bridging necrosis, focal necrosis and apoptosis, portal inflammation), staging means architectural changes, fibrosis and cirrhosis. Total score is a guideline for a clinician to choose an exact therapeutic protocol

The pathophysiological foundations of the circulatory shock syndromes

Krvotočni urušaj sindrom je akutnog zatajenja krvotoka, koji uzrokuje postupno višeorgansko sustavno zatajenje. Gubitak dostatne arteriovenske razlike tlaka može biti posljedicom kardiogenih vazohipotonusnih i hipovolemijskih patogenetskih mehanizama. U kardiogenim urušajima zbog sistolitičke i/ili dijastolitičke disfunkcije, nastaje gubitak dostatne tlakotvorne funkcije srca. U vazohipotonusnim je urušajima oštećena prilagodbena sposobnost žilja uz očuvan unutaržilni volumen krvi. Hipovolemijski urušaji se razvijaju kao posljedica gubitka krvnog volumena ispod prilagodbene sposobnosti kardiovaskularnog sustava. Krvotočni se urušaj često pojavljuje u patogenetski složenom obliku, koji uključuje dva ili sva tri osnovna patogenetska oblika sindroma. U kompenziranom stadiju je obdržana dostatna arteriovenska razlika tlakova u vitalnim organima. To se obdržavanje arteriovenske razlike tlakova postiže brojnim i snažnim negativnim neurohormonalnim homeostatskim spregama. Pri tome se u stanicama razvija diskretna hipenergoza tkiva (snižena koncentracija ATP-a u stanicama). U dekompenziranom se stadiju mnoge homeostatske sprege pretvaraju u pozitivne, što produbljuje hipenergozu u tkivima (često je koncentracija ATP-a ispod 0,1 mmol/L). Krajnja hipenergoza može uzrokovati citoplazmatsku smrt stanice. Posljedično se razvija slom regulacijskih međuodnosa u organizmu, s mogućim letalnim ishodom na razini organizma. Patogenetski ishod krvotočnog urušaja odražava trajanje i stupanj hipoperfuzijske hipenergoze tkiva, te sposobnost prilagodbenog odgovora organizma (reaktivnost organizma). Na razini organizma posturušajne se promjene očituju kao potpuna uspostava funkcije, smanjenje funkcijske rezerve organa, afunkcija pojedinih organa te smrt organizma. Urušajna hipenergoza u tkivu očituje se prvo disfunkcijom, a potom strukturnim promjenama, te smrću stanice, koje se mogu prepoznati kao postupne funkcijske i morfološke promjene pojedinog organa. Usporednim je prikazom kliničkog očitovanja i patogenetskog razvitka sindroma naznačen razvitak od kompenziranog do dekompenziranog stadija. Dodatno k tome, u radu su sabrana posebna klinička pravila (empirijski kriteriji) prosudbe i prognoze stanja. Isto tako, u radu su ukratko raspravljeni srodni hemodinamski poremećaji koji imaju zajednički patogenetski tijek s kompenziranim stadijem urušajne patofiziologije.Hemodynamic shock syndrome represents an acute circulatory failure leading to a multiple organ failure. Such circulatory failure develops due to a decrease of arteriovenous blood pressure gradient as a consequence of three independent groups of pathogenetic mechanisms (cardiogenic, vasohypotonic and hypovolemic), all of which lead to the common pathogenetic pathways. A decrease of arteriovenous pressure gradient induces vasomotoric responses, reactive body fluids redistribution, endocrine, metabolic as well as tissue energy adjustments. In this review a comprehensive synopsis of pathogenetic processes is shortly outlined. The cardiogenic mechanisms include the acute systolic and/or diastolic heart failure, which produce an increase of venous pressure and decrease of arterial pressure and heart output. Vasohypotonic mechanisms (neurogenic, septic and anaphylactic) are due to vascular tonus missadjustment. Hypovolemia caused by blood, plasma, water and electrolytes losses and/or sequestration, leads to a decrease of pressure gradient as soon as the extent of hypovolemia overcomes the compensatory vascular capacity. The shock syndromes very often consist of parallel pathogenic processes which therefore can be classified as a complex pathogenic forms of the shock. A list of clinical disorders which develop due to a complex shock pathogenesis, are outlined in the paper. Tissue hypoperfusion is direct consequence of the arteriovenous pressure gradient loss. It causes a progressive depletion of cellular ATP concentration (cellular hypoenergosis), which very often falls lower than 0,1 mmol/L. Cellular hypoenergosis plays the critical role in conversion of negative homeostatic regulation into a positive feedback mode. Positive homeostatic regulation (circuli vitiosi) amplifies deterioration of arteriovenous blood pressure gradient, which reversely intensifies the degree of energy depletion in the tissues. Such homeostatic conversion plays a critical role in the development of progressive phase (systemic failure, decompensation) of the shock. Functional restitution, decrease of functional organ capacity, permanent absence of certain organs’ function and death, represent a possible clinical status caused by and developed during the shock syndrome. Progessive pathologic alteration of tissue function and structure correlates well with the degree of tissue hypoenergosis. A short detailed description of the tissue alterations is outlined in the paper. Clinical symptoms and signs, as well as laboratory parameters give a valuable information which points to the level of shock development and reversibility. Correlation of clinical parameters and pathophysiologic processes are summerized. Simple predictive rules are re-discussed in the scope of underlying pathophysiology. In addition, a related hemodynamic disorders are shortly discussed in the paper

Sinus lifting in implantoprosthetic rehabilitation – Case report

Cilj: Gubitak svih zuba u gornjoj čeljusti ponekad dovodi do otežanog uzimanja hrane i otežanog govora. Odabir kvalitetne implantoprotetske terapije s predvidljivim rezultatima omogućuje bolesnicima bolju kvalitetu života. Prikaz slučaja: Bolesnica u dobi od 62 godine koristila je gornju totalnu protezu s kojom nije bila zadovoljna. Učinjen je sinus lifting obostrano i kirurško-protetska rehabilitacija te je bolesnica dobila fiksni protetski nadomjestak sidren na implantati ma. Rasprava i zaključak: Sinus lift ing, suvremena implantološka i protetska terapija nude nam različite mogućnosti u zbrinjavanju totalne bezubosti u maksili. Na taj način mogu se dobiti odlični estetski i funkcionalni rezultati.Aim: Loss of all maxillary teeth oft en leads to diffi culti es in patient’s feeding and speaking. A high quality selecti on of prosthetic implant rehabilitati on with foreseable results off ers a bett er quality of life to the pati ents. Case report: A 62-year-old pati ent was unhappy with her upper complete denture. A billateral sinus lift ing was performed followed by placement of 6 implants in the upper jaw and prostheti c rehabilitati on with a fixed denture anchored on the forementi oned implants. Discussion and conclusion: Sinus lift ing and contemporary prosthetic implant rehabilitati on off er various soluti ons in the treatment of edentulous maxilla with an excellent esthetic and functional outcome

Decrease of Environmental Temperature May Trigger the Onset of Acute Aortic Dissection

Aim: The most important risk factors for a Stanford type A acute aortic dissection (AAD) include arterial hypertension and connective tissue disorders, while numerous studies have identified meteorology factors, such as environmental temperature also play an important role. The aim of this study is to explore the relationship between environmental temperature and the frequency of AAD surgically threated over a 12-year period at a Croatian university hospital. Methods: This is a retrospective, monocenter observational study conducted at the University Hospital Centre Zagreb. The study includes 134 patients who were threated surgically for Stanford type A AAD between January 2001 and December 2012. Temperature categories (low, moderate and high) were based on the calculated monthly average environmental temperature and standard deviation given from official daily environmental temperatures for the respective period. Results: The results show a higher frequency of AAD in days of low temperature compared to days of moderate temperature or high temperature. The frequency of days with AAD was somewhat higher in moderate than high temperature category, but the difference is not statistically significant. The relative frequency of AAD for low, moderate and high temperature categories were 4.55, 2.96 and 1.93, respectively. Conclusion: Environmental temperature drop induces stressful adaptive body response, including an additional hemodynamic load and increase in arterial blood pressure, strong enough to trigger the AAD-etiopathogenesis. Furthermore, our findings indicate that body response to environmental heat may differ from a response to reduced environmental temperature, due to observed small number of events in days of high temperature. (Švagelj* I, Vlahović I, Ogresta D, Belina D, Kovač Z. Decrease in Environmental Temperature May Trigger the Onset of Acute Aortic Dissection. SEEMEDJ 2020; 4(1); 40-48

PHYSICAL AND CHEMICAL PROPERTIES IN RELATION WITH SOIL PERMEABILITY IN THE AREA OF VELIKA GORICA WELL FIELD

Hidraulički parametri utječu na ponašanje različitih iona u tlima. Cilj ovoga rada bio je prikazati odnos između fizičkih i kemijskih svojstva te propusnosti tla u svrhu boljih spoznaja njihove interakcije na području Velike Gorice. Profil tla smješten je u južnome dijelu zagrebačkoga vodonosnika. Zagrebački vodonosnik predstavlja glavni izvor pitke vode za stanovnike grada Zagreba i Zagrebačke županije. Na temelju podataka o teksturi i hidrauličkim parametrima tla te izmjerenim sadržajima vode u tlu izračunate su vrijednosti nesaturirane hidrauličke vodljivosti koje su korištene za procjenu propusnosti tla. Krivulje zadržavanja vode u tlu i nesaturirane hidrauličke vodljivosti slične su za sve dubine. Sadržaj aniona i kationa u tlu određen je pomoću ionske kromatografije. Rezultati su pokazali pad koncentracije iona nakon 60 centimetara dubine, što se slaže s izračunanim vrijednostima nesaturirane vodljivosti koje upućuju na dominantno nepropusno tlo. Najveće vrijednosti CEC-a i EC-a određene su u horizontu Bv ispod 60 cm, što je u skladu sa najvećim vrijednostima SAR-a i koncentracijama iona. Svi rezultati upućuju na to da su fizička i kemijska svojstva istraživanoga profila tla povezana s propusnosti tla.Hydraulic parameters affects behaviour of various ions in soils. The goal of this paper was to get better understanding of relationship between physical and chemical properties and soil permeability at the location of case study profile Velika Gorica, based on the physical and chemical data. Soil profile is situated in the Eutric Cambisol of the Zagreb aquifer, Croatia. Zagreb aquifer represents the only source of potable water for inhabitants of the City of Zagreb and Zagreb County. Based on the data obtained from particle size analysis, soil hydraulic parameters and measured water content, unsaturated hydraulic conductivity values were calculated for the estimation of soil profile permeability. Soil water retention curves and unsaturated hydraulic conductivities are very similar for all depths because soil content does not change significantly through the depth. Determination of anions and cations on soil samples was performed using the method of ion chromatography. Results showed decrease of ions concentrations after 0.6 m depth. SAR distribution in the soil profile shows that SAR values are not significantly changing at the soil profile. The highest CEC and EC values are determined in horizon Bw developed in 0.6 m depth which is consistent with highest SAR value and ions concentrations. All results suggest that physical and chemical properties of investigated profile are in relationship with soil permeability

Prevencija degeneracije olfaktorne sluznice nakon totalne laringektomije

Olfactory rehabilitation after a laryngectomy is based on establishing nasal airflow to allow odorant molecules to come into contact with the olfactory mucosa. Currently, the polite yawning technique (PYT) is the gold standard for post-laryngectomy olfactory rehabilitation, but it is usually introduced in patient’s rehabilitation programs one month after the surgery. To prevent loss of valuable time and pathophysiological changes of the nasal and olfactory mucosa, a new device was developed, named the LaryScent. The timely establishment of nasal air flow with LaryScent would prevent histopathological changes and facilitate regenerative processes in olfactory mucosa.Olfaktorna rehabilitacija nakon totalne laringektomije temelji se na uspostavi protoka zraka kroz nos čime se omogućuje doticaj mirisnih molekula u zraku s olfaktornom sluznicom nosa. Trenutno je „Polite yawning” tehnika (PYT) zlatni standard u olfaktornoj rehabilitaciji nakon totalne laringektomije, ali pacijenti obično započinju s rehabilitacijom mjesec dana nakon operacije. Kako bi se prevenirao gubitak dragocjenog vremena i spriječio nastanak patohistoloških promjena sluznice nosa, razvijena je nova naprava nazvana LaryScent. Pravovremena uspostava protoka zraka kroz nos s LaryScent napravom prevenirat će histopatološke promjene olfaktorne sluznice i potaknuti regenerativne procese

Domestic Homicide Cases Related to Schizophrenic Offenders

The goal of this study was identification of highly specific patterns of schizophrenia related domestic homicides by comparing schizophrenic homicide offenders with related domestic homicide group of offenders diagnosed with other psychiatric disorders. This study was based on the comparison of schizophrenic homicide group and other homicide group of offenders on the basis of differences in psychosocial and sociodemographic patterns and the modality of crime. The survey was conducted on mentally insane domestic homicide offenders diagnosed with schizophrenia (n=44) and second group of mentally insane offenders diagnosed with other psychiatric diagnosis (n=43). All offenders were admitted to Department of Forensic Psychiatry (Neuropsychiatric Hospital »Dr. Ivan Barbot«, Popovaca, Croatia) for psychiatric evaluation. They have undergone psychological testing and psychiatric evaluation in order to make forensic expert analyses of each case particularly. This study showed some specific characteristics in the cases of schizophrenic offenders; they are more often commit parricides and siblicides, the victims are often males with their own physical strength. Furthermore, schizophrenic offenders were indifferent upon killing their victim; they were less often provoked by a victim itself and were sober tempore criminis. Moreover, in the same homicide group we found young, single offenders with high school education, average intelligence and with positive psychiatric heredity. Finally, in the same group of offenders we have found no history of military serving, less social developmental disruptions, less history of drug and alcohol abuse during adolescence and adult age