Salvage on the Sea and the Protection of the Marine Environment

Na moru oduvijek vlada solidarnost glede spašavanja ljudi i imovine. Donesene su dvije međunarodne konvencije o spašavanju na moru. Međunarodna konvencija za izjednačenje nekih pravila o pomoći i spašavanju na moru, Bruxelles, 1910. godine (revidirana Protokolom iz 1967.) i Međunarodna konvencija o spašavanju, London, 1989. godine, koju je Republika Hrvatska ratificirala. Konvencija iz 1989. u svojim odredbama značajnu pozornost posvećuje i zaštiti i očuvanju morskog okoliša. Osobite su važnosti, kao novost, odredbe čl. 14. o tzv. posebnoj naknadi. U tim se odredbama kumulativno zahtijeva ispunjenje dvaju uvjeta da bi se pristupilo odmjeravanju posebne naknade. Spašavatelj mora spašavati brod koji je sam ili svojim teretom prijetio štetom za okoliš. Zatim nije uspio u spašavanju jer nije spasio imovinu koja bi mu bila osnovica za utvrđivanje nagrade prema tradicionalnim mjerilima («no cure – no pay»), a ta bi nagrada bila barem u visini posebne naknade. A posebna naknada, koja se može tražiti samo od vlasnika broda u opasnosti, bit će u visini troškova koje je imao spašavatelj. U Konvenciji se određuju troškovi spašavanja. Ako je pak spašavatelj djelima spašavanja stvarno spriječio ili umanjio štetu za morski okoliš, posebna naknada koju vlasnik mora platiti spašavatelju za priznate troškove može se povisiti čak do 100% troškova koje je spašavatelj imao i koji se priznaju. I Pomorski zakonik Republike Hrvatske (2004.), po uzoru na Konvenciju iz 1989. godine, sadrži odredbe o zaštiti i očuvanju morskog okoliša u operaciji spašavanja te poglavito one o posebnoj naknadi (usp. čl. 761. toč. 4., 770. st. 3., 772., 774. st.2. toč. 2., 775., 784., 785.).On the sea, there always exists solidarity as to the salvage of persons and vessels and other property. There are two international conventions on marine salvage: the 1910 Brussels Convention for the Unification of Certain Rules with Respect to Assistance and Salvage at Sea (revised by the Protocol of 1967) and the 1989 International Convention on Salvage (ratified by the Republic of Croatia). The International Convention devotes a significant part to the protection of the marine environment. Especially important is Art. 14, which introduces “special compensation”. This means that if the salvor carries out salvage operations in respect of a vessel, which in itself or its cargo threatened to cause damage to the environment, and fails to earn a reward under the well-known criteria (“no cure – no pay”), at least equivalent to the special compensation assessable in accordance with Art. 14, he shall be entitled to special compensation from the owner of that vessel, equivalent to his expenses. Art. 14, paragraph 2 defines the salvor’s expenses. If the salvor by his salvage operations prevents or minimizes the damage to the environment, the special compensation payable by the owner to the salvor may be increased to a maximum of 100% of the expenses incurred by the salvor. The Croatian Maritime Code (2004) has the same rules for the protection of the marine environment, and especially for the special compensation , as the Convention of 1989 (see Articles 761, 4, 770, para. 3, 772, 774 para. 2, 2, 775, 784, 785)

ENGINEERING GEOLOGICAL AND GEOTECHNICAL CHARACTERISTICS OF THE PLOČE BY-PASS ROAD

Obilaznica Ploča bit će izvedena dijelom na vapnencima, a dijelom na glinovito-prašinasto-pjeskovitim sedimentima. S ciljem postizanja pouzdanih rezultata za sigurno temeljenje prometnice i izvedbu objekata na njoj, obavljena su terenska i laboratorijska istraživanja čiji se rezultati prikazuju u ovom radu. Razredba vapnenaca učinjena je prema GSI, a značajke glinovito-prašinasto-pjeskovitih sedimenata određene su u laboratoriju i poslužili su kao podloga računskom modelu za geostatički proračun i temeljenje.The Ploče by-pass road will be constructed partly in limestones and partly in clayey-silty-sandy sediments. In order to obtain reliable data for purposes of safe foundation technique for the road and respective structures, field and laboratory investigations were performed. The results are given in this paper. The limestones were classified based on Geological Strength Index (GSI) while the properties of clayey-silty-sandy sediments were determined in the laboratory. The obtained results were used as a base for geostatic calculations by a numerical model and for the design of foundations

The role of a family doctor concerning laryngeal cancer

Obiteljski liječnik, kao osoba prvog kontakta na relaciji liječnik bolesnik, ima izuzetnu ulogu ne samo u prevenciji raka grla, već i u njegovom ranom otkrivanju blago vremenim opažanjem onih simptoma koji će bolesnika na vrijeme dovesti do postavljanja prave dijagnoze i pravovremene terapije. Bolesnik sa rakom grla je specifičan ne samo zbog toga što ima malignu bolest, već i zbog toga što rak grla dovodi do gubitka, ili bar smanjenja, funkcija organa tako važnog u svakodnevnom životu čovjeka, a to je glas i govor. Bolesnik sa karcinomom grla postaje problem i sam sebi zbog teškoća u komunikaciji sa okolinom, ali i problem svojoj radnoj i obiteljskoj sredini koja ga takvog teže prihvaća. Gdje je tu mjesto obiteljskom liječniku?Family doctor as a person of the first contact between doctor and patient has an exceptional task not only in prevention but also in the early discovery of laryngeal cancer. Observation of symptoms will help make the right diagnosis timely and prescribe medical treatment for the patient. Such a patient is specific not only because of his malignant disease, but because laryngeal cancer affects the function of the speech organs, causing partial or complete loss of voice and speech. In everyday live a patient with laringeal cancer has difficulties in communication with other people. He becomes a burden to himself and to his family and working environment that accept him with difficulty. Where is there the place of the family doctor

Develpment of endoscopy at the ward for ear, nose and throat disease of the Bjelovar general hospital

U radu je dan pregled razvoja endoskopije u djelatnosti za bolesti uha, nosa i grla Opće bolnice Bjelovar, od osnutka do današnjih dana. Prikazan je slijed nabavke endoskopskih instrumentarija, te mogućnosti endoskopskih pretraga koje se na odjelu rade. Zatim se govori o broju i vrsti endoskopskih zahvata koji su obavljeni u posljednjih šest godina. ORL odjel u Bjelovaru raspolaže suvremenim instrumentarijem za ezofagoskopiju, traheobronhoskopiju, s krutim i fleksibilnim instrumentima, a u posljednje dvije godine i instrumentarijem za funkcionalnu endoskopsku sinusnu kirurgiju. Godišnje se napravi u prosjeku 33 ezofagoskopije, 7 traheobronhoskopija s rigidnim traheobronhoskopom, a zadnje dvije godine 85 bolesnika operirano je prema načelima funkcionalne endoskopske sinusne kirurgije.The development of endoscopy at the Ward for ear, nose and throat diseases of the General Hospital in Bjelovar was reviewed from its foundation to these days. The sequence of endoscopic instruments\u27 acquisitions and possibilities of endoscopic examinations preformed at the wadr are presented. The Otolaryngological ward in Bjelovar has at its disposal modern instruments for oesophagoscopy, tracheobronchoscopy, solid and flexibile instruments and since two years ago, the instruments for functional endoscopic sinus surgery. Annually an average of 33 oesophagoscopies and 7 tracheobronchoscopies with rigid tracheobronchoscope are done and up to now 85 patients have been operated on according to the principles of functional endoscopic sinus surgery

Perioperative blood transfusion as a possible prognostic factor in laryngeal cancer

Retrospektivno je istraživan značaj perioperativne transfuzije krvi na tijek i ishod bolesti u 116 bolesnika koji su zbog raka grkljana operirani u Klinici za bolesti uha, nosa, grla i cervikofacijalnu kirurgiju Kliničkog bolničkog centra u Zagrebu u razdoblju od 1985. do 1990. godine. U istraživanu skupinu uključeni su bolesnici s karcinomima II. do IV. stupnja bolesti, jer među bolesnicima I. stupnja karcinomske bolesti nije zapažen ni jedan recidiv, niti je u bilo kojeg bolesnika tog stupnja primijenjena transfuzija krvi. Recidiv je zapažen u 73 bolesnika (62,9%), i to: u 42 (70%) od 60 bolesnika koji su perioperativno primili transfuziju krvi; te u 31 (55,4%) od 56 bolesnika koji nisu primili transfuziju krvi. Uočena razlika nije statistički značajna. U prvoj godini praćenja registrirano je u skupini osoba koje su perioperativno dobile transfuziju krvi 33 (45,2%) recidiva od 73 recidiva zapažena u obje skupine (ili 78,6% od 42 osobe koje su perioperativno primile transfuziju krvi te dobile recidiv u cijelom trogodišnjem razdoblju praćenja; preostalih 9 recidiva zapaženo je u drugoj godini praćenja). U skupini osoba koje nisu primile transfuziju krvi, recidivi su raspodijeljeni tako da je 15 recidiva zapaženo u prvoj godini, te 16 u drugoj i trećoj godini praćenja. U skupini osoba koje su primile transfuziju krvi statistički je značajno zapažanje ranije pojave recidiva (x2 12,379; DF2;P<0.001).A retrospective study was conducted on the influence of perioperative blood transfusion on the course and outcome of the disease with 116 patients on whom a surgical proce­dure had been performed at the ENT department, Zagreb University Hospital, in the period from 1985 to 1990. The group under research in cluded only the patients with laryngeal cancer in the 2nd do 4th stage, be cause patients in the 1st stage of the disease had neither received blood transfusion nor had a recurrence. Recurrence, however, was noted in 73 (62.9 %) patients i.e. in 42 (70 %) patients who received blood transfusion perioperatively and in 31 (55.4 %) patients who did not received blood transfusion. The difference was not statistically significant. During the first post-operative year 73 recurrences occurred, 33 (45.2%) of which in the group that received perioperative blood transfusion (i.e., 78.6% of the 42 persons who received perioperative blood transfusion and had a recurrence in the three-year observation period; the remaining 9 recurrences occurred during the 2nd year of the observation), and 16 during the remaining two years of the observation. Earlier recurrences in the patients who received perioperative blood transfusion are statistically significant (x2 12.379; DF 2; P<0.001)

ENGINEERING GEOLOGY PROPERTIES OF \u27KONJSKO\u27 TUNNEL

Istraživačkim radovima za potrebe projektiranja tunela «Konjsko» s dvije tunelske cijevi na autocesti Split-Zagreb, dobiveni su svi relevantni podaci o značajkama stijena i terena temeljem kojih su izrađeni prognozni inženjerskogeološki uzdužni profili. Zapadni portali tunela su locirani u naslagama zgnječenih i dijelom dinamički metamorfoziranih lapora eocenskog fliša, a istočni u naslagama senonskih vapnenaca. Kontakt flišnih lapora i vapnenaca je navlačan. Početkom iskopa tunela počelo je i redovito registriranje svih pojava i stanja stijenske mase nakon svakog miniranja, što je rezultiralo stvarnim uzdužnim inženjerskogeološkim profilima i poprečnim profilima čela. Odstupanja od prognoziranog stanja je bilo, a nastala su zbog nemogućnosti posve točnog određivanja nagiba navlačne plohe koja se nalazila plitko ispod nivelete tunela i pojave poprečnih rasjeda koji su raskinuli navlaku i uzdignuli lapore u dio tunelskog profila. Podaci prikupljeni prije i tijekom izvedbe tunela upotpunili su spoznaje o geološkoj građi šireg okoliša i fizičko-mehaničkim značajkama naslaga.Investigation works for the design of the Konjsko Tunnel with two pipes, part of the Split-Zagreb Motorway, provided relevant data on rock mass and soil properties for construction of the prognose engineering-geological longitudinal sections. West tunnel portals are situated in tectonically deformed and partly dynamically metamorphosed Eocene flysch marls, while east ones are located in Senonian limestones. There is an overthrust contact between flysch marls and limestones. With the beginning of the excavations, rock mass characteristics were regularly registered after each blasting and actual longitudinal engineering-geological cross-sections were constructed as well as cross-sections of the excavation face. There were some differences between prognosticated and registered sections since it was infeasible to accurately determine the dip of the overthrust plane that was at shallow depth below the tunnel grade line and also due to the occurrence of transversal faults that intersected the overthrust. Data collected before and during the tunnel construction complemented the knowledge on geological structure of the surroundings and physical-mechanical characteristics of strata

Reconstruction of ala nasi defect in patients with facial and trigeminal nerve paralysis caused by trigeminal trophic syndrome

Nosno krilo predstavlja važan izražajni detalj ljudskog lica čija rekonstrukcija predstavlja pravi izazov za kirurga. U radu se željelo prikazati mogućnosti rekonstrukcije potpunog defekta nosnog krila kod bolesnika s paralizom ličnog i trigeminalnog živca u sastavu trigeminalnog trofičkog sindroma. Pri rekonstrukciji se koristio otočasti transpozicijski režanj kože zdrave strane čela na subkutanoj peteljci koji posjeduje vlastitu vaskularizaciju i inervaciju, čije preživljenje ne ovisi o primajućoj regiji. Ovaj režanj pokazao se izuzetno pogodnim prilikom rekonstrukcije defekata nosnog krila u bolesnika s paralizom ličnog i trigeminalnog živca, jer donosi zdravo tkivo u neurološki mrtvu regiju.Ala nasi represents a significant expressive detail of human face, whose reconstruction represents a real challenge for a surgeon. The intention of the paper was to present the options for reconstruction of total ala nasi defect in patients with facial and trigeminal nerve paralysis in the pattern of the trigeminal trophic syndrome. During the reconstruction, the insular transposition flap was used from the healthy side of the forehead on the subcutaneous stalk, which possesses its own vascularization and innervation, and whose survival does not depend on the recipient area. This flap proved itself extremely suitable during the reconstruction of the ala nasi defects in patients with facial and trigeminal nerve paralysis, because it brings healthy tissue in the neurologically dead area

ALGORITHMS FOR PERIPROCEDURAL MANAGEMENT AND MANAGEMENT OF BLEEDING IN PATIENTS TREATED WITH NON-VITAMIN K ORAL ANTICOAGULANTS

Cilj terapije antagonistima vitamina K (varfarin) i novim oralnim antikoagulantnim lijekovima (NOAK-ima) jesu prevencija moždanog udara i drugih embolija kod bolesnika s nevalvularnom fibrilacijom atrija te liječenje i prevencija venske tromboembolije. Kod svih bolesnika potrebno je odrediti bubrežnu funkciju klirensom kreatina jer o tome ovise izbor i doziranje NOAK-a. Izuzetno je važno obratiti pozornost na starije bolesnike s brojnim pridruženim stanjima i interakcijama lijekova zbog velike učestalosti neuroloških simptoma i lošijeg ishoda. Oralno antikoagulantno liječenje izazov je, posebno u stanjima nenamjernog predoziranja lijeka, u krvarenjima ili u stanjima hitnoga prijeoperacijskog zbrinjavanja. Zbog sve većeg broja bolesnika koji uzimaju NOAK-e osnovana je 2015. godine ekspertna grupa specijalista hitne medicine koja je u listopadu 2015. održala u Zagrebu Konsenzusnu konferenciju radi donošenja postupnika za prijeoperacijsko zbrinjavanje i zbrinjavanje bolesnika u hitnim stanjima koji uzimaju NOAK-e u Hrvatskoj.The goal of therapy with vitamin K antagonists (warfarin), and new direct oral anticoagulant drugs (NOAC or DOAC) is the prevention of stroke and embolic events in patients with non-valvular atrial fibrillation and treatment and prevention of venous thromboembolism. In all cases it is necessary to determine renal function with creatinine clearance because it determines the choice and dosage of NOAC’s. It is extremely important to pay attention to older patients with a number of associated conditions and drug interactions, with a high incidence of neurological symptoms and worse outcomes. Oral anticoagulation can represent a challenge, especially in cases of drug overdose or emergencies such as bleeding and need for urgent surgery. The need for the guidelines has emerged during the last years because of new classes of oral anticoagulants being prescribed more frequently. The expert working group of emergency specialists was formed and gathered on Consensus Conference in October 2015 in Zagreb, to design guidelines for the patients with NOAC therapy and provides details of preoperative management and managements in emergency conditions