IN MEMORIAM: 100th ANNIVERSARY OF PROFESSOR DRAGUTIN (DRAGO) VRBANIĆ’S BIRTHDAY

Prof. dr. sc. Dragutin (Drago) Vrbanić (1912. – 1996.) nezaobilazno je ime riječko-istarske i hrvatske povijesti medicine. Nizom stručno-znanstvenih, publicističkih, organizacijskih i rukovodnih postignuća zaslužan je za riječki klinički opstetričko-ginekološki razvitak, za organiziranje i afirmaciju medicinsko-primaljskoga dijela riječkoga školstva. Odgojno-obrazovna dimenzija, stručno-istraživački i znanstveni habitus profesora Vrbanića bio je dijelom širih intelektualnih interesa i ljudske angažiranosti ginekologa koji je cijeli radni vijek predano služio izabranu pozivu i pritom mentorski pratio i poticao mnoge mlađe kolege liječnike prema visoko postavljenim zahtjevima struke.Professor Dragutin (Drago) Vrbanić, MD, PhD (1912 - 1996) was an eminent figure of Croatian medicine, especially in Rijeka and Istria. His work includes a number of publications and managerial accomplishments that encouraged the development of gynaecology and obstetrics. He can also be credited for the organisation and affirmation of midwifery in Rijeka. Professor Vrbanić was highly appreciated not only for his educational and scientific achievements, but also as a valuable mentor to younger colleagues, whom he encouraged to pursue their profession to the fullest

ANNUAL REPORT BY IVAN KRSTITELJ ANDRIANIC, THE CITY SURGEON OF THE SANITARY REGION OF CRIKVENICA FOR YEAR I859

This paper presents and comments on an annual report by lvan Krstitelj Andriani6, the chief physician of the sanitary region of Crikvenica (North-Croatian littoral) for the year 1859 . Beside interesting and very precise medico-historical data, the report is an excellent source for demographic, ethnographic, and cultural-anthropological considerations within this particular time and space frame

Thalassotherapy and health tourism in Crikvenica: origins and development

Razvoj talasoterapije i zdravstvenog turizma u Crikvenici počinje 1888. otvaranjem prvoga javnog kupališta. Nakon toga, uz naklonost nadvojvode Josipa Habsburga, u Crikvenicu stižu mađarski kapitalisti koji sukcesivno ulažu u izgradnju niza hotela i pansiona. Od 1895. počinje djelovati prvi hotel Nadvojvoda Josip, koji je 1900. preimenovan u hotel Therapia. Slijede hotel Miramar, vojničko lječilište Militar Kurhaus koje 1897. seli u novoizgrađenu Villu Miru. Godine 1898. nadvojvodina supruga Clotilda u pavlinskom samostanu uređuje Ladislavov dječji dom za liječenje i oporavak djece. Dr. Oskar Seidl 1908. uređuje pansion – sanatorij Dom Dr. Seidl, 1913. otvoren je Hrvatski učiteljski dom Villa Ružica. Godine 1909. Marija Steyskalova osniva i otvara Češko dječje oporavilište za više od 400 djece. Kraće vrijeme prije Prvoga svjetskog rata djelovao je sanatorij i (lječilište) Pečić-Odilon. Istodobno je djelovalo osam lječilišta u funkciji zdravstvenog turizma. Godine 1906. Crikvenica je i službeno od Hrvatske zemaljske vlade proglašena "morskim kupalištem i klimatskim zimskim lječilištem", što je uvelike pospješilo njezin daljnji napredak.Thalassotherapy and health tourism of Crikvenica date back to the opening of the first public beach in 1888. Favoured by the Archduke Joseph von Hapsburg, Crikvenica soon won over considerable Hungarian capital, invested in hotels and boarding houses. The first hotel was Archduke Joseph, renamed in 1900 to Therapia, followed by hotel Miramar and army resort Militar Kurhaus, which moved to a new Villa Mira in 1897. In 1898, the Archduke’s wife Clotilda set up a Ladislaus’ Children’s Home for paediatric treatment and recovery in St. Paul’s monastery. In 1908, Dr Oskar Seidl set up a sanatorium Dr Oskar Seidl’s Home. 1913 saw the opening of Villa Ružica, which was a sanatorium for Croatian teachers. In 1909, Marija Steyskalova established a sanatorium for over 400 Czech children. Shortly before the break of the Great War, another sanatorium (and resort) saw the light of day – Pečić – Odilon. At one point, there were eight sanatoriums/health resorts in function. No wonder then that, in 1906, Crikvenica received the official title "Seaside resort and climate therapy resort" from the nation’s government. This recognition boosted the town’s progress

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju

NEWBORNS OF MOTHERS WITH EPILEPSY

Cilj rada. Na temelju izabranih parametara usporediti novorođenčad majki s epilepsijom i novorođenčad rođenu od zdravih majki te utvrditi utječe li i u kojoj mjeri epilepsija na rani neonatalni ishod. Metode. Retrospektivnim istraživanjem u razdoblju od deset godina izdvojeno je 869 novorođenčadi. Ispitivanu skupinu sačinjavalo je 175 novorođenčadi majki oboljelih od epilepsije, a kontrolnu skupinu 694 novorođenčadi zdravih majki. Analizirani su gestacijska dob kod poroda, način dovršenja poroda, porodna težina, porodna duljina, opseg glave, Apgar ocjena u 1. i 5. minuti, ­postojanje prirođenih anomalija, postupci primijenjeni u okviru postnatalnog prihvata i skrbi novorođenčeta te eventualne bolesti u novorođenčeta. Rezultati. Novorođenčad kojih su majke bolovale od epilepsije nije se statistički značajno razlikovala od novorođenčadi rođenih od zdravih majki ni u jednom promatranom parametru. Zaključak. Rezultati našeg istraživanja pokazuju da uz odgovarajuću antenatalnu skrb, prihvat i opskrbu novorođenčeta, žene oboljele od epilepsije mogu roditi zdravo dijeteObjective. To compare specific parameters in children born to mothers with epilepsy and children born to healthy mothers. The aim is to determine possible differences among groups and to establish whether and in which degree mother\u27s disorder affects the neonates. Methods. Retrospective study of children born to mothers with epilepsy and ­children born to healthy mothers at the University Hospital of Rijeka, Department of Obstetrics and Gynecology, over ­period of ten years. Statistical evaluation of the hospital records data. Compared parameters were gestational age, mode of delivery (vaginal delivery/ caesarean section), birth weight, birth length, head circumference, Apgar scores in first and fifth minute, the presence of congenital anomalies, performed postnatal procedures (divided in two groups: more and less invasive procedures) and the neonatal health condition. Neonatal disorders were grouped in five diagnostic categories: breathing disorders, birth damages (with the exception of brain damages), brain damages and convulsions, icterus, infections and skin diseases. A total of 869 neonates have been studied. Among them, 175 children were born to mothers with epilepsy. The control group consisted of 694 children born to healthy mothers. Multiple pregnancies and still-born ­children were not taken into the consideration. Results. A total of 869 neonates have been evaluated and their corresponded parameters compared. The mean gestational ages, birth lengths, birth weight, head circumferences, mode of ­delivery and Apgar scores, as well as the evaluation of performed postnatal procedures and existence of the disorders ­presented no statistically significant differences among groups. The appearances of congenital disorders within specific groups measured in percentages show that the incidence is about twice as high in the group of children born to mothers with epilepsy, compared to the group of children born to healthy mothers (6,28% and 3,03%, respectively). There is, ­however, no statistically significant difference between the groups (2= 3,82; p=0,05). Conclusion. There are no statistically significant differences between children born to mothers with epilepsy compared to those born to healthy mothers. Evaluation of the mean birth weights among groups shows that the values are within the referent borders. Obtained results oppose to current findings that suggest low birth weight is seen about twice as often in infants of mothers with epilepsy. Our results confirm the fact that the risk for congenital malformations in children born to mothers with epilepsy is about twice that for the general population. Lack of statistically significant difference in the rate of congenital anomalies ­between the group of children born to mothers with epilepsy and those born to healthy mothers could be explained by the retrospective design of the study and the fact that the information were taken from the hospital records (instead of being collected specifically for the purpose of the study). Such results urge for prospective follow up of women with epilepsy and their offspring and for development of registries of pregnant women with epilepsy and their children which would ­ensure recognition and register of congenital malformations. Obtained results show that, with adequate antenatal and postnatal medical care of mothers and neonates, women with epilepsy can fulfill their reproductive function and give birth to a healthy child

MAGNETSKA REZONANCA POBOLJŠAVA PRENATALNU DIJAGNOZU TUBEROZNE SKLEROZE

Tuberous sclerosis (TS) is a genetically determined, multisystem disorder. There is no consistent correlation between specific TSC gene mutation and clinical outcome. This fact diminishes the value of prenatal TS genetic testing to future infant’s clinical outcome. Authors have shown how imaging techniques could increase accuracy of prenatal diagnosis. They have described a case of prenatally diagnosed TS by using high frequency real time ultrasound and fetal cranial magnetic resonance imaging (MRI) in the second half of an uneventful pregnancy. A 25-year old patient has been studied from 27 weeks of gestation and repeating echocardiographic examinations of the female fetus revealed two solid cardiac tumors. One of them arose from the interventricular septum, while the other from the right atrium. Fetal cranial MRI has been performed at 36 weeks of gestation. Identified signal abnormalities, which correspond to brain hamarto¬mas, highly suggested presence of TS in fetus. An infant was born at term by vaginal delivery. At the age of four months West’s syndrome has been diagnosed. In addition, authors discuss an ethical problem that may arise when the fetal tests reveal presence of TS.Tuberozna skleroza (TS) je genetski poremećaj koji se nasljeđuje autosomno dominantno, a hipotetski geni koji svojom mutacijom mogu uzrokovati TS su na kromosomu 9 (TSC 1) i 16 (TSC 2). Pretpostavlja se prevalencija od jednog slučaja TS na 6000 živorođenih, podjednako zahvaća oba spola i sve rase i etničke skupine. Najčešće se dijagnosticira u ranom djetinjstvu zbog neuroloških simptoma – epileptičkih napadaja i različito izraženog mentalnog hendikepa. Bolest je karakterizirana rastom dobroćudnih tumora (angiofibroma) u brojnim organima, primarno u mozgu, očima, srcu, koži i plućima, što otvara realne mogućnosti da se spomenuti poremećaj otkrije i prije rođenja. U radu je opisana 25-godišnja trudnica, prvorotkinja, u čijeg su djeteta pomoću ultrazvuka odnosno magnetske rezonance prenatalno otkriveni tumori srca i mozga. Prigodom ultrazvučnog pregleda u 27. tjednu trudnoće, na poprečnom presjeku kroz fetalni grudni koš, opažene su dvije solidne, homogene i hiperehogene strukture. Jedna, u području interventrikularnog septuma, izgledala je kao njegovo vretenasto odnosno trokutasto zadebljanje od 10 mm u najdebljem dijelu, dok je druga, u ¬području lateralne stijenke desnog atrija uz inserciju trikuspidalnog zaliska, bila sličnih mjera, ali više okruglasta. Obje opisane tumorske tvorbe bile su avaskularne. Rad srca bio je ritmičan i nije bilo poremećaja hemodinamike. Preostala ¬fetalna morfologija bila je uredna. U pupkovini su se nalazile samo dvije krvne žile, pri čemu je promjer jedine umbilikalne arterije iznosio 4 mm. Kontrolnim pregledima ustanovljava se uredan fetalni rast, povećanje spomenutih rabdomioma srca uz očuvanu kontraktilnost i ritmični rad. U 36. tjednu trudnoće učinjen je pomoću magnetske rezonance fetalni ¬kraniogram. Otkriveni hiperintenzivni signal subependimalno, u blizini nukleus kaudatusa odnosno foramena Monroi s desne strane, odgovarao je ekspanzivnoj formaciji (hamartomu) čije je prisustvo sugeriralo postojanje TS u fetusa. Točno u terminu porođeno je vitalno žensko novorođenče urednog fizikalnog odnosno auskultatornog nalaza srca i pluća. U dobi od četiri mjeseca života majka po prvi put primjećuje u svog djeteta iznenadne trzajeve tijela, ruku i nogu, uz plač i vrisak. U neurološkom statusu prevladava generalizirana mišićna hipotonija, dok su refleksi uredni. EEG-ski se otkrivaju žarišna izbijanja lijevo temporoparijetalno s generalizacijom po tipu hipsaritmije. Postavljena je dijagnoza tuberozne skleroze i West-ova sindroma. CT mozga pokazuje progresiju cerebralnih promjena, a ultrazvučni nalazi blažu regresiju ¬rabdo¬mioma srca. Opisani slučaj dokazuje da se uz kombiniranu uporabu navedenih slikovnih dijagnostičkih metoda može računati s prenatalnom dijagnozom i onih relativno rijetkih genetskih poremećaja koji se klinički manifestiraju i uobičajeno dijagnosticiraju tek u dječjoj dobi. Autori raspravljaju o etičkom problemu priopćavanja medicinskih informacija ¬nakon što se postavi prenatalna dijagnoza TS

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju