THE OCCURRENCE AND TREATMENT OF STAGE IA CERVICAL CANCER IN KBC SPLIT

Cilj istraživanja: Cilj istraživanja je bio ispitati pojavnost i naĉine liječenja oboljelih od IA stadija raka materničnog vrata (RMV) u Klinici za ženske bolesti i porode u KBC-u u Splitu u trinaestogodišnjem razdoblju (od 1. 1. 2000. do 1. 1. 2014.). Materijal i metode: Retrospektivnom analizom, trinaestogodišnjeg razdoblja (od 1. 1. 2000. do 1. 1. 2014.), povijesti bolesti operiranih zbog IA stadija raka materničnog vrata u Klinici za ženske bolesti i porode u KBC-u u Splitu, ispitan je: broj operiranih, dob u trenutku operacije, patohistološka dijangoza, stadij bolesti (IA1 /IA2), limfokapilarna invazija (LKI), status rubova i vrha konizata te ukupan broj konizacija, histerektomija i radikalnih operacija. Rezultati: Od ukupno 66 bolesnica operiranih zbog RMV-a stadija IA, 51 bolesnica imala je stadij IA1, a 15 bolesnica imale su stadij IA2. Najmlađa bolesnica s dijagnozom raka materničnog vrata stadija IA imala je 26 godina u trenutku operacije, a najstarija 76 godina. Srednja dob bolesnica bila je 46,29 godina u trenutku operacije. Planocelularni karcinom materničnog vrata dijagnosticiran je kod 55 (83,33 %) operiranih bolesnica, adenokarcinom dijagnosticiran je kod devet (13,64 %) bolesnica, multicentrični karcinom klara stanica dijagnosticiran je kod jedne (1,52 % ) bolesnice, adenoskvamozni karcinom dijagnosticiran je kod jedne (1,52 %) bolesnice. Pozitivnu limfokapilarnu invaziju (LKI) imalo je pet operiranih bolesnica s histološkom slikom planocelularnog karcinoma i jedna adenokarcinomom. Pozitivnu LKI imale tri bolesnice sa stadijem IA1 i tri bolesnice sa stadijem IA2. Podaci o zahvaćenosti rubova u trenutku operacije postoje kod 36 bolesnica. Slobodni rubovi konizata zabilježeni su kod njih 27. Zahvaćenost rubova zabilježena je kod tri bolesnice. Zahvaćenost udaljenosti < 2mm od ruba zabilježena je kod četiri bolesnice. Zahvaćenost udaljenosti ≥ 2mm od ruba zabilježena je kod tri bolesnice. Zahvaćenost vrha konizata zabilježena je kod dvije bolesnice. Najviše zahvaćenih rubova na konizatima zabilježeno je kod planocelularnih karcinoma stadija IA1, zatim adenokarcinoma stadija IA1. Od ukupno 66 zahvata, učinjena je 31 konizacija, 26 histerektomija i devet radikalnih Piver II operacija. Zaključci: RMV pogađa široku dobnu skupinu od adolescentica do žena u postmenopauzi. Većini bolesnica dijagnosticira se mikroinvazivni (IA1) RMV histološkog tipa planocelularnog karcinoma. Drugi najčešće dijagnosticiran histološki tip tumora bio je adenokarcinom, kod devet bolesnica. LKI zabilježena je kod samo šest bolesnica; tri stadija IA1 i tri stadija IA2. Stanje rubova konizata zabilježeno je kod svega 36 pacijentica. Slobodni su bili kod njih 27. Najvažniji parametar za određivanje vrste konačnog zahvata bio je stadij (IA1 ili IA2). Najčešće korišten zahvat bila je konizacija, zatim histerektomija, a najrjeđe radikalna operacija. Od ukupno 66 zahvata, učinjena je 31 konizacija, 26 histerektomija i devet radikalnih Piver II. Najvažniji napredak u liječenju očekuje se u primjeni HPV cjepiva.Objectives and background: The objectives of this thesis were to determine the occurrence and different modalities of treatment of stage IA cervical cancer (CC) at the Clinic for women’s disease and labor, University Hospital of Split, during a thirteen year period. Materials and Methods: The medical history of all women that underwent surgery upon diagnosis of stage IA cervical cancer during the thirteen year period from Jan, 1st 2000 to Jan, 1st 2014 at the Clinic for women’s disease and labor, University Hospital of Split, had been retrospectively reviewed. The following parametres had been analysed: the number of patients that underwent surgery, the patient's age during surgery, the pathohistological diagnosis, the stage of the tumor (IA1 /IA2), lymphovascular space involvement (LSI), cone-biopsy margin status (CBMS) and the sum of all conisations, hysterectomies and radical Piver II operations. Results: Out of 66 patients that underwent surgery due to stage IA CC, 51 were diagnosed with stage IA1 and 15 with stage IA2. The youngest patient was 26 years old during surgery, and the oldest was 76. The mean age during surgery was 46,29 years. 55 (83,33 %) patients were diagnosed with squamous cell cervical cancer (SCC), nine (13,64 %) were diagnosed with adenocarcinoma (AC). One (1,52 % ) patient was diagnosed with multicentric clara-cell carcinoma (MCC) and one (1,52 % ) patient was diagnosed with adenosquamous (ASC) cell carcinoma. Five patients diagnosed with SCC and one patient diagnosed with AC had positive LVI. Three stage IA1 patients and three stage IA2 patients had positive LVI. The CBMS was mentioned in the medical history of 36 patients. Clear margins were noted in 27 patients. The cone-biopsy margins were affected in three patients. The affected distance from the margins < 2 mm was noted in four patients. The affected distance from the margins ≥ 2 mm was noted in three patients. The cone-biopsy apex was affected in two patients. Cone-biopsies belonging to patients diagnosed with stage IA1 SCC had the highest rates of affected margins. The second-highest rates belong to stage IA1 AC. Out of the 66 surgical procedures, 31 were conisations, 26 were hysterectomies and nine were radical Piver type II operations. Conclusions: CC affects a large age group, from adolescents to postmenopausal women, most diagnosed with stage IA1 SCC. LVI was noted in six patients. The stage of disease IA1 or IA2 determines the surgical procedure. CBMS was mentioned in the medical history of 36 patients, of which 27 had clear margins. The most common surgical procedure practised in treatment of stage IA CC was conisation and subsequently hysterectomy. Radical Piver type II was the least common method. Out of the 66 surgical procedures, 31 were conisations, 26 were hysterectomies and nine were radical Piver type II operations. The most progress in treatment is expected from the application of an HPV vaccine

Effects of spirodiclofen on the reproductive potential of two-spotted spider mite (Acari: Tetranychidae) ovipositing females

A laboratory bioassay was conducted to evaluate the effects of spirodiclofen on the survival and reproduction of young and mated females of two-spotted spider mite (Tetranychus urticae Koch). The females were sprayed with a series of acaricide concentrations (96, 48, 24, 12, and 6 mg/l) 24-30 h after adult emergence, i.e., at the age most likely to exhibit dispersal behavior and close to their reproductive maximum. The proportions of T. urticae females that survived treatment without symptoms of poisoning were concentration-dependent, ranging between 0.41 and 0.88 (0.96 in the control). With the exception of females that survived 6 mg/l, fecundity of the treated female mites was strongly affected during the exposure, compared to the control. The mean daily fecundity (EL) and mean daily fertility (EH) of surviving females, transferred daily to new leaf disks over the following five days, significantly decreased as spirodiclofen concentrations increased. In treatments with 6 mg/l and 12 mg/l, only the latter concentration significantly reduced both EL and EH, compared to the control. In females that survived 24 mg/l and 48 mg/l, these life history parameters were reduced by over 90%, while treatment with 96 mg/l completely terminated egg-laying. The treated females lived for a significantly shorter time than untreated ones, with the exception of females that survived 6 mg/l. Compared to the control females, gross fecundity (GL) and gross fertility (GH) of the treated females were strongly reduced on the first and second day; from the third day onward, females treated with the lowest concentrations achieved marked recovery, their GL and GH going even above the values in the control. However, net fecundity (NL) and net fertility (NH) of all treated females decreased considerably throughout the trial, indicating that survival rates of these females were lower, compared to the control. Calculated as total sums of gross and net daily schedules within five days, fecundity and fertility significantly decreased as spirodiclofen concentration increased. The two lowest concentrations failed to achieve a significant reduction of GL, while GH, NL, and NH were significantly lower than control values starting with the females treated with 6 mg/L. A high percentage of unhatched eggs, especially during the initial two days after treatment (35-100%), further contributed to the significant reduction in fertility of the females treated with spirodiclofen. All concentrations of spirodiclofen significantly reduced the instantaneous rate of increase. Regression analysis showed a linear population decline with increased acaricide concentrations (y = 1.13 - 0.24x; R2 = 0.91, p &lt; 0.05)

UTJECAJ INDIVIDUALNIIH KARAKTERISTIKA NA NAMJERU BAVLJENJA SOCIJALNIM PODUZETNIŠTVOM

Social entrepreneurship is a growing phenomenon, both in practice and in the scientific community. The main goal of this research is to examine specific personal characteristics that might support one’s decision to pursue social entrepreneurship as a career choice. The research sample consisted of 114 students of two graduate entrepreneurship programs: Economics of Entrepreneurship at the Faculty of Organization and Informatics in Varaždin, University of Zagreb; and Entrepreneurship at the Faculty of Economics, J. J. Strossmayer University of Osijek. Based on the scientific literature, we identified several potentially important personal characteristics: creativity, proactivity, compassionate love for humanity, hardship in life and moral judgement competence. These characteristics were adequately measured and compared between three groups of students: those that want to become commercial entrepreneurs, those that want to become social entrepreneurs, and those who have no entrepreneurial intentions. The methods we used were one-way ANOVA and factor analysis. Our results showed that the factor that differed the most between the observed groups was compassionate love for humanity. This factor might be the main driving force behind social entrepreneurial activities.Socijalno poduzetništvo je rastući fenomen, kako u praksi tako i u znanstvenoj zajednici. Glavni je cilj ovog istraživanja ispitati individualne karakteristike koje mogu podržati socijalno poduzetništvo kao karijerni izbor. Uzorak je obuhvatio 114 studenata dvaju diplomskih studija poduzetništva: Ekonomike poduzetništva na Fakultetu organizacije i informatike Sveučilišta u Zagrebu te Poduzetništva na Ekonomskom fakultetu Sveučilišta J.J. Strossmayera u Osijeku. Na temelju znanstvene literature identificirano je nekoliko potencijalno važnih individualnih karakteristika: kreativnost, proaktivnost, suosjećajna ljubav prema čovječanstvu, životne poteškoće i moralna kompetencija. Te su karakteristike adekvatno izmjerene i uspoređene između triju skupina: studenata koji se žele baviti komercijalnim poduzetništvom, studenata koji se žele baviti socijalnim poduzetništvom i studenata koji nemaju nikakve poduzetničke namjere. Korištene su metoda faktorske analize i jednosmjerna ANOVA. Rezultati su pokazali da je faktor koji se najviše razlikuje između analiziranih grupa suosjećajna ljubav prema čovječanstvu. Ona bi mogla predstavljati glavnu pokretačku silu iza aktivnosti socijalnog poduzetništva

Tussive syncope: case report

Tusigena sinkopa ili osjećaj prijeteće nesvjestice za vrijeme kašljanja, najčešće se javlja kod sredovječnih, umjereno pretilih muškaraca koji puše ili su bivši pušači. Razlozi zbog kojih muški spol i pretilost utječu na sklonost tusigenoj sinkopi nisu poznati. Većina pacijenata također pati od suhog kašlja, epizoda teškog kašlja, a prisutni su i znaci opstrukcijske plućne bolesti. Postoji niz mogućih mehanizama. Prvi mehanizam objašnjava da, kada osoba kašlje, dolazi do porasta intratorakalnog tlaka, koji ima za posljedicu akutni pad otjecanja venske krvi i krvnoga tlaka. Posljedično, dolazi do usporavanja moždanog krvotoka, što u konačnici dovodi do gubitka svijesti. Drugi mogući mehanizam podrazumijeva slabljenje moždane perfuzije, kao posljedice rasta tlaka likvora. Uz ove procese, sinkopu nalazimo i kod pacijenata sa sindromom hipersenzitivnog karotidnog sinusa, gastroezofagealne refluksne bolesti, itd. Tusigena sinkopa spada u skupinu situacijskih sinkopa koje se manifestiraju nakon određenih događaja: npr. defekacije, mikcije, gutanja ili kašljanja. Ovdje prikazujemo dijagnostičke smjernice na slučaju 45-godišnjeg pacijenta koji pati od tusigene sinkope i liječi se u Klinici za plućne bolesti Kliničke bolnice Split.Tussive syncope, or cough syncope, is most often found in middle-aged, moderately obese men, who smoke or have stopped smoking. The reason why the male gender and obesity are predisposing factors for cough syncope is unknown. The majority of patients also suffer from chronic cough, episodes of severe cough, and clinical evidence of obstructive pulmonary disease. There are several proposed mechanisms. The first is that when a person coughs, intrathoracic pressure rises and obstructs venous outflow, which results in an acute decrease of cardiac output and blood pressure. As a result, the cerebral flow also decreases, which finally causes loss of consciousness. A second possible mechanism is the decrease of cerebral perfusion, as a consequence of increased pressure of the cerebrospinal liquor. Besides these mechanisms, tussive syncope is also found in patients with hypersensitive carotid sinus syndrome, gastroesophageal reflux, etc. Tussive syncope is considered as one of the situational syncopes, which take place after certain processes: e.g. defecation, micturition, swallowing and coughing. We will present the diagnostic guidelines through the case of a 45 year-old patient with tussive syncope, treated at the Split University Hospital Department for Pulmonary Diseases

A STUDY OF COMORBIDITY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Ispitivan je utjecaj stupnja kronične opstrukcijske plućne bolesti (KOPB) na broj egzacerbacija, pojavnost i međuovisnost KOPBa i nekih popratnih bolesti i djelovanje pušenja na pojavu dugotrajnog kašlja u kroničnog plućnog bolesnika. Ispitivanje je provedeno na uzorku od 64 ispitanika, prosječne dobi 64,43 godine podijeljenih u dvije skupine od po 32 ispitanika. Nakon prikupljanja anamnestičkih podataka i kliničkog pregleda, učinjeno je spirometrijsko testiranje. Stupanj KOPB-a određivan je prema rezultatima testova plućne funkcije. Učestalost egzacerbacija veća je u pušača i ovisi o stupnju KOPB-a. Što je teži stupanj KOPB-a, egzacerbacije su učestalije i utječu na progresiju ireverzibilnih funkcionalnih promjena na plućima, a produktivni kašalj učestaliji je u pušača. Potvrđen je komorbiditet KOPB-a i kardiovaskularnih bolesti, te da u bolesnika s kroničnom plućnom bolesti postoji povezanost dobi i kardiovaskularnih komplikacija.Aims: The impact of the chronic obstructive pulmonary disease (COPD) severity on the number of exacerbations, and the interdependence of COPD and some concomitant diseases were studied in chronic pulmonary patients. In order to determine the actual influence of some risk factors and comorbidity on the course of COPD, we conducted a study in two family medicine consulting offices, one in the city of Split and the other on the island of Brač. Methods: This retrospective study included a sample of 64 subjects, mean age 64.43 years, divided into two groups of 32 subjects each (group 1 and group 2). After taking history data and clinical examination, spirometry was performed. The severity of COPD was determined on the basis of lung function tests. Results: There were 15 (46.9%) smokers in group 1, seven of them former smokers, and 20 (65.6%) smokers in group 2, eight of them former smokers. The groups differed significantly according to the mean number of annual exacerbations (1.3 in group 1 and 2.4 in group 2; p<0.001). The frequency of exacerbations was higher in smokers and depended on the stage of COPD. If COPD was more severe, the exacerbations were more frequent and influenced the progression of irreversible functional changes on the lungs. Productive cough was more frequent in smokers. The correlation of concomitant diseases and degree of COPD was found in group 2 (hypertension, r=0.305; p=0.014). In group 1, there was correlation between patient age and concomitant disease (cardiac arrhythmias, r=0.307; p=0.013), whereas in group 2 it was significant in case of hypertension (r=0.474; p<0.001) and cardiomyopathy (r=0.301; p=0.016). Discussion: Cigarette smoke causes chronic inflammatory changes in the lungs. In our study, the number of patients suffering from persistent cough accompanied by sputum was higher in group 2, which also comprised of more smokers, but differences between smokers and non-smokers according to this characteristic were not statistically significant. Study groups differed significantly according to the number of COPD exacerbations per year (with more exacerbations in the group with more smokers). In group 2, there was a correlation between COPD severity and hypertension. Conclusions: Comorbidity of COPD and cardiovascular diseases was confirmed, along with correlation between age and cardiovascular complications in patients with COPD

Shunt in the Diagnosis of Initial Lung Lesion in Smokers

Cigarette smoking is an important risk factor for all respiratory tract diseases. Unfortunately, the symptoms develop slowly, thus patients feel the consequences of the slowly developing inflammation too late. The inflammation first develops in the area of respiratory bronchioles. In this stage, the disease is asymptomatic. The study included a sample of 31 smokers, mean age 36.38 years, with normal spirometry indices, acid-base status and arterial blood gases. The mean smoking index was 11.28 smoking/years. All subjects were healthy, without any subjective health problems or disease indicators. The aim was to define dead lung area (V/Q) as an early indicator of changes in smokers. Study results demonstrated the mean shunt value in smokers of 8.25%, which showed positive correlation with smoking. The shunt size yielded negative correlation with the forced expiratory volume in one second and midexpiratory flow in smokers. In conclusion, determination of lung shunt is a simple method that is sensitive enough in the diagnosis of initial lung lesion due to cigarette smoking

Shunt in the Diagnosis of Initial Lung Lesion in Smokers

Cigarette smoking is an important risk factor for all respiratory tract diseases. Unfortunately, the symptoms develop slowly, thus patients feel the consequences of the slowly developing inflammation too late. The inflammation first develops in the area of respiratory bronchioles. In this stage, the disease is asymptomatic. The study included a sample of 31 smokers, mean age 36.38 years, with normal spirometry indices, acid-base status and arterial blood gases. The mean smoking index was 11.28 smoking/years. All subjects were healthy, without any subjective health problems or disease indicators. The aim was to define dead lung area (V/Q) as an early indicator of changes in smokers. Study results demonstrated the mean shunt value in smokers of 8.25%, which showed positive correlation with smoking. The shunt size yielded negative correlation with the forced expiratory volume in one second and midexpiratory flow in smokers. In conclusion, determination of lung shunt is a simple method that is sensitive enough in the diagnosis of initial lung lesion due to cigarette smoking

Increasing of Malignant Pleural Mesothelioma: Burning Issue in Split-Dalmatian County, Croatia

Asbestos-related diseases are one of the burning public health issues worldwide. The incidence and the epidemiological patterns of malignant pleural mesothelioma in Split-Dalmatian County, where a large part of Croatian industry related to asbestos processing and use have been situated were assessed in this study. The history of asbestos-related issues and development of current legislation in Croatia was also discussed briefly. Data on the incidence were collected retrospectively from the medical records of patients with malignant pleural mesothelioma treated at Department of Pulmonary Diseases University Hospital Split during the 2000–2007 period. A total of 137 new cases was recorded with the mean incidence of 3.55/100 000 and the trend was increasing over years compared with 1992–1995 period in the same county when the mean incidence was 1.7/100000. Men accounted for 85.4% of all cases. The mean age of patients was 64.9±15.4 years. The majority of patients were occupationally exposed to asbestos (85.4%), 8.8% had environmental exposure, and 2.2% had domestic exposure. The type of household exposition was in 5.8% of patients. More than half of the cases were exposed to asbestos 31–40 years. The mean length of exposure was 28.87±15.63 years. The incidence of malignant pleural mesothelioma in Split-Dalmatian County has been obviously increasing due to the predominantly occupational exposure and it is reasonable to assume that it will remain high in the next two –three decades and to be a reason for concern and fear among the general population

Frequency of diagnosis of dyscalculia in speech therapy

Dijagnoza diskalkulije postavlja se ako djetetove sposobnosti usvajanja matematike zaostaju dvije godine za kronološkom dobi, a nisu posljedica intelektualnih teškoća ili neodgovarajuće poduke. S obzirom na nepostojanje standardiziranog mjernog instrumenta za diskalkuliju, opravdano je pitanje koliko se taj poremećaj dijagnosticira u logopedskom radu. Cilj ovog pilot-istraživanja je utvrditi udio dijagnoze diskalkulije, kao i sumnje na istu kod pacijenata uključenih u logopedsku terapiju u Poliklinici za rehabilitaciju slušanja i govora SUVAG Zagreb. Točnije, istraživanjem se nastojalo utvrditi - je li veći broj djece kod koje postoji sumnja na postojanje poremećaja ili one koja imaju postavljenu dijagnozu diskalkulije. Podaci su prikupljeni upitnikom oblikovanim za potrebe ovog istraživanja, koji je ispunilo 45 logopeda zaposlenih u Poliklinici, koji su u trenutku istraživanja u terapiji imali ukupno 1350 pacijenata. Analiza odgovora pokazuje da je u ukupnom broju pacijenata samo 0,44 % onih kojima je postavljena dijagnoza diskalkulije (F81.2; MKB-10, 1994), dok kod 3,48% pacijenata u dobi od trećeg razreda nadalje postoji sumnja na diskalkuliju, ali ona nije izdvojena kao dijagnostički entitet. Rezultati ovog pilot-istraživanja pokazuju postojanje većeg broja djece kod koje nije dijagnosticirana diskalkulija (F81.2), iako za to postoje kliničke indikacije. Potrebna je dodatna edukacija, kao poticaj logopedima u postavljanju dijagnoze i kreiranju terapijskih postupaka.The diagnosis of dyscalculia is determined if a child’s ability to learn math is two years behind chronological age and is not the result of intellectual disability or inadequate instruction. Given the lack of a standardized measurement instrument for dyscalculia, it is reasonable to ask how much of this disorder is diagnosed in speech therapy. The aim of this pilot study was to determine the proportion of diagnosed and suspected cases of dyscalculia in patients involved in speech therapy at the Polyclinic SUVAG Zagreb. In accordance with the aim of the study, it is claimed that there is an increase in the number of children suspected of having the disorder compared to the current number of diagnoses of dyscalculia. More specifically, the study sought to determine whether there is a greater number of children suspected of having the disorder or those with the diagnosis of dyscalculia. The data were collected by a questionnaire created for the purpose of this study and filled by 45 speech therapists working at the Polyclinic. In total, they had 1350 patients included in speech therapy at the time of this study. Analysis of the responses showed that in the total number of patients, only 0.44% of those diagnosed with dyscalculia (F81.2; MKB-10, 1994) were diagnosed, while in 3.48% of patients aged from grade 3 onwards, dyscalculia was still suspected, but not isolated as a diagnostic entity. The results of this pilot study indicate the existence of a higher number of children with undiagnosed dyscalculia (F81.2), although there are clinical indications for this. This indicates the need for additional education to empower speech therapists in making diagnoses and in creating therapeutic procedures