Sarkoidoza - scintigrafija cijelog tijela galijem-67

The sensitivity of gallium scintigraphy in intra- and extrapulmonary sarcoidosis is about 97%. The method is by far more sensitive than other noninvasive methods/tests. Typical scintigraphic patterns are lambda and panda signs. In addition to its diagnostic value for revealing all areas involved and estimating their activity, gallium 67 scintigraphy is an excellent indicator of therapy efficacy.Osjetljivost scintigrafije galijem za aktivnu sarkoidozu u plućima ili izvan njih je oko 97%. Metoda je znatno osjetljivija od drugih neinvazivnih metoda/pretraga. Tipičan scintigrafski nalaz je znak lambda i panda. Uz vrijednost u postavljanju dijagnoze, gdje otkriva zahvaćena mjesta i procjenjuje njihovu aktivnost, scintigrafija galijem je vrijedan pokazatelj odgovora na terapiju

Ima li scintigrafija galijem još uvijek svoje mjesto u dijagnostici vrućice nepoznatog uzroka?

Owing to its characteristics, gallium 67 citrate still has its place in diagnostic procedures for various diseases, among them fever of unknown origin. Because of the lack of specificity of gallium 67 citrate, which is an advantage in this case, most authors agree that gallium is practically the agent of choice for initial screening of these patients. Gallium 67 citrate accumulates at the site of inflammation/ infection as well as in some neoplasms. Positive gallium finding can demonstrate or exclude a focal or diffuse lesion, indicate the disease extent and activity, and identify an appropriate biopsy site if necessary.Zahvaljujući svojim značajkama, 67-Ga-citrat još uvijek ima svoje mjesto u dijagnostici različitih bolesti, među njima i u vrućici nepoznatog uzroka. Zbog njegove nedovoljne specifičnosti, koja se u tom slučaju pretvara u prednost, većina autora se slaže da je galij zapravo radiofarmaceutik izbora u početnom probiru tih bolesnika. Galij se nakuplja na mjestu upale/infekcije, ali i u tumorima. Pozitivan nalaz potvrđuje ili isključuje žarišno ili difuzno oštećenje, ukazuje na proširenost i aktivnost bolesti, te određuje mjesto biopsije ako je potrebna

Koncept sentinel limfnog čvora i njegova uloga u liječenju bolesnika s melanomom

Melanoma is still one of the most life threatening tumors throughout the world. In the United States of America, its mortality rate has raised by 191% in men and 84% in women in the past forty years. It is mainly a cancer of light-pigmented persons like European populations. The incidence and mortality rates have increased substantially during the past decade, although there are extreme variations in the melanoma rates among different countries. Cutaneous melanoma can spread unpredictably and widely through the lymphatics. Identification of patients with occult melanoma metastases is important for accurate staging, treatment planning and prognosis. Based on the AJCC Melanoma Database, the most important prognostic factor in overall survival is melanoma thickness, however, the revised staging system recognizes the presence of metastases in regional lymph nodes as an independent powerful prognostic factor in the 5-year survival rate in stage II and III. Melanoma has a variable lymphatic drainage pathway, particularly those lesions located in the trunk, head and neck. In the past 15 years, a novel approach has been introduced in the management of skin melanoma. As the result of modern nuclear medicine techniques, identification of sentinel lymph node (SLN) by lymphoscintigraphy (LS) and sentinel lymph node biopsy (SLNB) using hand held gamma probe has become a standard procedure. In the early stage disease (AJCC I and II) and intermediate tumor thickness (1.2-3.5 mm), LS with SLNB is the method of choice for nodal staging and to define further surgical procedure, although in melanoma thinner than 1 mm surgical management of regional lymph nodes is still controversial. The overall conclusion from more than 1500 articles published during the last decade is that LS followed by SLNB with selective lymph node dissection in patients with cutaneous melanoma is still only of prognostic value, although it identifies patients with nodal metastases whose survival can be prolonged by immediate lymphadenectomy. Therefore, the AJCC staging system continues to consider micrometastases detected only by immunohistochemistry or polymerase chain reaction to be N0 disease. This article brings a review of current concepts and utility of LS and SLNB in cutaneous melanoma.Melanom je još uvijek jedan od najpogubnijih tumora u čitavom svijetu. U Sjedinjenim Američkim Državama se je stopa smrtnosti povećala u prošlih 40 godina za 191% kod muškaraca i 84% kod žena. To je većinom rak svijetlo pigmentiranih osoba poput europskih populacija. U prošlom desetljeću bitno su se povećale stope incidencije i smrtnosti, no postoje veoma velike razlike u stopi melanoma među različitim zemljama. Kožni melanom može se nepredvidivo i u velikoj mjeri širiti limfnim sustavom. Utvrđivanje bolesnika s okultnim metastazama melanoma važno je radi točnog određivanja stadija, planiranja liječenja te za prognozu. Prema podacima iz AJCC Melanoma Database, debljina melanoma najvažniji je prognostički čimbenik u sveukupnom preživljenju, ali je revidirani sustav određivanja stadija prepoznao i prisutnost metastaza u regionalnim limfnim čvorovima kao snažan neovisan prognostički čimbenik u 5-godišnjoj stopi preživljenja u stadiji I. i II. Melanom ima različite limfne puteve u limfnoj drenaži, poglavito melanomi smješteni na trupu, glavi i vratu. U proteklih 15 godina uveden je nov pristup u liječenju kožnog melanoma. Zahvaljujući suvremenim tehnikama nuklearne medicine, identificiranje sentinel limfnog čvora (SLN) limfoscintigrafijom (LS) i biopsija sentinel limfnog čvora (SLNB) pomoću ručne gama sonde postali su standardnim postupkom. U bolesti ranog stadija (AJCC I i II) i srednje debljine tumora (1,2-3,5 mm) LS uz SLNB čine metodu izbora za određivanje stadija čvora i odluku o daljnjem kirurškom zahvatu, iako je kod melanoma tanjih od 1 mm kirurško liječenje regionalnih limfnih čvorova još uvijek proturječno. Prema više od 1500 članaka objavljenih tijekom prošlog desetljeća, sveukupni zaključak je kako LS sa SLNB uz selektivnu disekciju limfnih čvorova u bolesnika s kožnim melanomom još uvijek ima tek prognostičku vrijednost, iako ukazuje na one bolesnike s metastazama u čvorovima čije se preživljenje može produžiti hitnom limfadenektomijom. Tako sustav određivanja stadija prema AJCC i dalje smatra mikrometastaze otkrivene samo pomoću imunohistokemijskih metoda ili lančanom reakcijom polimeraze kao bolest stadija N0. Ovaj članak donosi pregled današnjih spoznaja i primjene LS i SLNB kod kožnog melanoma

Pathohistological Diagnosis of Adrenal Tumors: Experience of a Single Center

Introduction: To investigate adrenal tumors of patients operated on at the University Hospital Center Osijek from 2016 to 2019 for the purpose of examining the location and histopathological findings of the tumors and determining whether there is a difference related to that in terms of the age and sex of the subjects. Subjects and Methods: This was a cross-sectional study with historical data analysis. The subjects were patients of both sexes (N=23) diagnosed with adrenal tumors (N=23) who underwent surgery at the University Hospital Center Osijek in the period from 2016 to 2019. The archive was used in the University Hospital Center Osijek. Results: Adrenal tumors were more often unilateral than bilateral. No differences were found in the localization of tumors of the right and left adrenal glands. Benign tumors were more common than malignant tumors and were the most common adenoma. Seventeen women underwent surgery and were 10 years older on average (61.6 years). There were no significant differences regarding tumor occurrence with respect to the patients’ age. Benign tumors were more common in women, but the difference was not statistically significant. Regarding histopathological findings, women were more likely to have adenoma (N=10) and hyperplasia (N=4), while men had other benign tumors (N=3) and metastatic tumors (N=1). However, the difference was not statistically significant. Conclusion: In patients who have undergone surgery for adrenal tumors, there were more unilateral tumors compared to bilateral ones, but there was no difference in tumor localization (left and right). Benign tumors were more common, the most common of which were adenomas. There were no significant differences with respect to age and sex. (Lekić I, Banović V, Marjanović K, Kovačić B, Feldi I, Bačun T. Pathohistological Diagnosis of Adrenal Tumors: Experience of a Single Center. SEEMEDJ 2020; 4(2); 108-112

Intraoperacijska navigacija detekcijskom gama sondom kod resekcije osteoidnog osteoma – prikaz dvaju slučajeva

Two cases of osteoid osteoma tumor (OO ) are presented and our early experience with intraoperative gamma probing to localize OO during surgery is reported. The concept of radioguided surgery was developed 60 years ago and the gamma detection probe technology for radioguided biopsy and/or resection of bone lesions has been applied since the early 1980s. Bone scintigraphy is very important for initial diagnosis of OO with almost 100% sensitivity. The bone scan finding is specific, with so called double density appearance, very intense accumulation of radiopharmaceutical in the nidus and therefore great difference between the nidus and the surrounding healthy bone, thus making possible to treat this lesion with probe guided surgery. Three phase bone scintigraphy and single photon emission computed tomography were conducted in our patients for initial diagnosis of OO . A second bone scintigraphy was performed before surgery. The surgery followed 12-15 hours later by intraoperative nidus detection with a hand-held gamma probe. Gamma hand-held probe is a system that detects gamma photons. The count rate in the nidus area on the day of surgery was 3 to 4 times higher than in the healthy bone area. Drilling was performed until the counts decreased to the level of the surrounding bone counts, thereby confirming complete excision. This is the method of choice for minimizing bone resection, the risk of pathologic fracture, the need of bone grafting, and reducing the period of convalescence. Evidence for the treatment efficiency is pain disappearance after the surgery.U radu se prikazuju dva klinička slučaja kod kojih smo koristili detekcijsku gama sondu za intraoperacijsku navigaciju prilikom kiretaže tumora osteoidnog osteoma (OO ). Zahvati su izvršeni na Klinici za traumatologiju Kliničkog bolničkog centra “Sestre milosrdnice”. Koncept radionavigacije u kirurgiji razvijao se zadnjih 60 godina, a primjena tehnologije gama detekcijske sonde za biopsiju ili resekciju koštanih lezija datira od ranih osamdesetih. Uz RTG te kompjutoriziranu tomografiju scintigrafija kosti je jedna od najvažnijih metoda u dijagnostici OO , s gotovo 100%-tnom osjetljivošću. Za početnu dijagnozu učinjena je trofazna scintigrafija kosti i SPE CT – jednofotonska emisijska kompjutorizirana tomografija. Druga scintigrafija kosti učinjena je prije zahvata. Operacija je uslijedila 12-15 sati kasnije uz intraoperacijsko otkrivanje gnijezda ručnom gama sondom. Na dan operacije brojčana vrijednost bila je 3-4 puta viša na mjestu lezije u odnosu na zdravu kost. Kiretaža tumora provođena je sve dok brojčana vrijednost nije pala na razinu vrijednosti okolne kosti, na taj način potvrđujući potpuno uklanjanje lezije. Ovo je jedna od metoda izbora liječenja OO , jer na najmanju mjeru svodi resekciju kosti te time smanjuje rizik od mogućih patoloških prijeloma i skraćuje razdoblje rekonvalescencije. Dokaz uspješnosti kirurškog zahvata bio je nestanak boli u operiranih bolesnika

Koncept sentinel limfnog čvora i njegova uloga u liječenju bolesnika s melanomom

Melanoma is still one of the most life threatening tumors throughout the world. In the United States of America, its mortality rate has raised by 191% in men and 84% in women in the past forty years. It is mainly a cancer of light-pigmented persons like European populations. The incidence and mortality rates have increased substantially during the past decade, although there are extreme variations in the melanoma rates among different countries. Cutaneous melanoma can spread unpredictably and widely through the lymphatics. Identification of patients with occult melanoma metastases is important for accurate staging, treatment planning and prognosis. Based on the AJCC Melanoma Database, the most important prognostic factor in overall survival is melanoma thickness, however, the revised staging system recognizes the presence of metastases in regional lymph nodes as an independent powerful prognostic factor in the 5-year survival rate in stage II and III. Melanoma has a variable lymphatic drainage pathway, particularly those lesions located in the trunk, head and neck. In the past 15 years, a novel approach has been introduced in the management of skin melanoma. As the result of modern nuclear medicine techniques, identification of sentinel lymph node (SLN) by lymphoscintigraphy (LS) and sentinel lymph node biopsy (SLNB) using hand held gamma probe has become a standard procedure. In the early stage disease (AJCC I and II) and intermediate tumor thickness (1.2-3.5 mm), LS with SLNB is the method of choice for nodal staging and to define further surgical procedure, although in melanoma thinner than 1 mm surgical management of regional lymph nodes is still controversial. The overall conclusion from more than 1500 articles published during the last decade is that LS followed by SLNB with selective lymph node dissection in patients with cutaneous melanoma is still only of prognostic value, although it identifies patients with nodal metastases whose survival can be prolonged by immediate lymphadenectomy. Therefore, the AJCC staging system continues to consider micrometastases detected only by immunohistochemistry or polymerase chain reaction to be N0 disease. This article brings a review of current concepts and utility of LS and SLNB in cutaneous melanoma.Melanom je još uvijek jedan od najpogubnijih tumora u čitavom svijetu. U Sjedinjenim Američkim Državama se je stopa smrtnosti povećala u prošlih 40 godina za 191% kod muškaraca i 84% kod žena. To je većinom rak svijetlo pigmentiranih osoba poput europskih populacija. U prošlom desetljeću bitno su se povećale stope incidencije i smrtnosti, no postoje veoma velike razlike u stopi melanoma među različitim zemljama. Kožni melanom može se nepredvidivo i u velikoj mjeri širiti limfnim sustavom. Utvrđivanje bolesnika s okultnim metastazama melanoma važno je radi točnog određivanja stadija, planiranja liječenja te za prognozu. Prema podacima iz AJCC Melanoma Database, debljina melanoma najvažniji je prognostički čimbenik u sveukupnom preživljenju, ali je revidirani sustav određivanja stadija prepoznao i prisutnost metastaza u regionalnim limfnim čvorovima kao snažan neovisan prognostički čimbenik u 5-godišnjoj stopi preživljenja u stadiji I. i II. Melanom ima različite limfne puteve u limfnoj drenaži, poglavito melanomi smješteni na trupu, glavi i vratu. U proteklih 15 godina uveden je nov pristup u liječenju kožnog melanoma. Zahvaljujući suvremenim tehnikama nuklearne medicine, identificiranje sentinel limfnog čvora (SLN) limfoscintigrafijom (LS) i biopsija sentinel limfnog čvora (SLNB) pomoću ručne gama sonde postali su standardnim postupkom. U bolesti ranog stadija (AJCC I i II) i srednje debljine tumora (1,2-3,5 mm) LS uz SLNB čine metodu izbora za određivanje stadija čvora i odluku o daljnjem kirurškom zahvatu, iako je kod melanoma tanjih od 1 mm kirurško liječenje regionalnih limfnih čvorova još uvijek proturječno. Prema više od 1500 članaka objavljenih tijekom prošlog desetljeća, sveukupni zaključak je kako LS sa SLNB uz selektivnu disekciju limfnih čvorova u bolesnika s kožnim melanomom još uvijek ima tek prognostičku vrijednost, iako ukazuje na one bolesnike s metastazama u čvorovima čije se preživljenje može produžiti hitnom limfadenektomijom. Tako sustav određivanja stadija prema AJCC i dalje smatra mikrometastaze otkrivene samo pomoću imunohistokemijskih metoda ili lančanom reakcijom polimeraze kao bolest stadija N0. Ovaj članak donosi pregled današnjih spoznaja i primjene LS i SLNB kod kožnog melanoma

Prijeoperacijska pulmološka obrada kod plućnih i izvanplućnih operacijskih zahvata

The purpose of preoperative pulmonary assessment is to predict which patients are at greatest risk of pulmonary complications, under which circumstances such complications may occur, and whether surgery should be denied based on that risk. Surgical site is the most important predictor of pulmonary risk. The American College of Physicians suggest the following indications for preoperative pulmonary function tests: patients undergoing cardiac or upper abdominal surgery with a history of smoking or dyspnea, patients undergoing lower abdominal surgery if prolonged operation is anticipated, patients undergoing orthopedic surgery with uncharacterized lung disease, and all patients undergoing lung resection. These tests include spirometry, diffusing capacity for CO, arterial blood gases; symptom limited cardiopulmonary exercise testing, and quantitative differential lung perfusion scanning. None of these tests absolutely excludes a patient for surgery; however, they do identify patients at an increased risk of surgical morbidity and mortality.Svrha prijeoperacijske pulmološke obrade je predvidjeti koji bolesnici imaju najveći rizik od nastanka plućnih komplikacija, pod kojim okolnostima takve komplikacije mogu nastati i treba li operaciju otkazati zbog rizičnosti samoga zahvata. Najvažniji prediktor pulmonalnog rizika je lokacija operacijskog reza. Američka liječnička udruga preporuča slijedeće indikacije za prijeoperacijsku funkcijsku obradu pluća: bolesnici u kojih se planira operacija srca ili gornjeg abdomena s anamnezom pušenja ili zaduhe, bolesnici u kojih se planira operacija na donjem dijelu trbuha ako se predviđa dugotrajni zahvat, bolesnici s neodređenom plućnom bolešću u kojih se planira ortopedska operacija, te svi bolesnici u kojih se planiraju resekcijski zahvati na plućima. Funkcijske plućne pretrage obuhvaćaju spirometriju, difuzijski kapacitet za CO, arterijsku plinsku analizu, simptomima ograničene kardiopulmonalne stres testove, kvantitativnu diferencijalnu plućnu perfuziju. Prednost se daje individualnom pristupu glede operacije, poštivajući pritom i volju bolesnika

Prijeoperacijska pulmološka obrada kod plućnih i izvanplućnih operacijskih zahvata

The purpose of preoperative pulmonary assessment is to predict which patients are at greatest risk of pulmonary complications, under which circumstances such complications may occur, and whether surgery should be denied based on that risk. Surgical site is the most important predictor of pulmonary risk. The American College of Physicians suggest the following indications for preoperative pulmonary function tests: patients undergoing cardiac or upper abdominal surgery with a history of smoking or dyspnea, patients undergoing lower abdominal surgery if prolonged operation is anticipated, patients undergoing orthopedic surgery with uncharacterized lung disease, and all patients undergoing lung resection. These tests include spirometry, diffusing capacity for CO, arterial blood gases; symptom limited cardiopulmonary exercise testing, and quantitative differential lung perfusion scanning. None of these tests absolutely excludes a patient for surgery; however, they do identify patients at an increased risk of surgical morbidity and mortality.Svrha prijeoperacijske pulmološke obrade je predvidjeti koji bolesnici imaju najveći rizik od nastanka plućnih komplikacija, pod kojim okolnostima takve komplikacije mogu nastati i treba li operaciju otkazati zbog rizičnosti samoga zahvata. Najvažniji prediktor pulmonalnog rizika je lokacija operacijskog reza. Američka liječnička udruga preporuča slijedeće indikacije za prijeoperacijsku funkcijsku obradu pluća: bolesnici u kojih se planira operacija srca ili gornjeg abdomena s anamnezom pušenja ili zaduhe, bolesnici u kojih se planira operacija na donjem dijelu trbuha ako se predviđa dugotrajni zahvat, bolesnici s neodređenom plućnom bolešću u kojih se planira ortopedska operacija, te svi bolesnici u kojih se planiraju resekcijski zahvati na plućima. Funkcijske plućne pretrage obuhvaćaju spirometriju, difuzijski kapacitet za CO, arterijsku plinsku analizu, simptomima ograničene kardiopulmonalne stres testove, kvantitativnu diferencijalnu plućnu perfuziju. Prednost se daje individualnom pristupu glede operacije, poštivajući pritom i volju bolesnika

Reaktivni artritis kao moguća posljedica septičnog poliartritisa uzrokovanog bakterijom Staphylococcus Aureus

Three HLA-B27 positive patients with staphylococcal polyarthritis are reported. After six weeks of treatment with antibiotics, the bacterial infection was eradicated. However, clinical and laboratory signs suggestive of reactive arthritis developed during the convalescence period. The patient became sub-febrile, with persistent arthralgias and elevated total level of circulating immune complexes and erythrocyte sedimentation rate. Further treatment consisted of non-steroidal anti-inflammatory drugs alone, with good response and complete recovery in several months. These observations require additional investigations; however, similar experience in the future may reduce too long and unnecessary antibiotic therapy.Opisano je troje bolesnika sa stafilokoknim poliartritisom pozitivnih na HLA-B27. Bakterijska je infekcija iskorijenjena Šest-tjednim liječenjem antibioticima. Međutim, tijekom razdoblja oporavka razvili su se klinički i laboratorijski znaci koji su upućivali na reaktivni artritis. Bolesnici su bili subfebrilni, uz ustrajne artralgije te povišenu ukupnu razinu cirkulirajućih imunokompleksa i sedimentaciju. Daljnje se liječenje sastojalo samo od nesteroidnih protuupalnih lijekova, uz vrlo dobar odgovor i potpun oporavak kroz nekoliko mjeseci. Ova zapažanja zahtijevaju daljnja ispitivanja, no slična bi iskustva u buduće mogla skratiti predugo i nepotrebno liječenje antibioticima

Prescribing nonsteroidal anti-rheumatics in family medicine

Uvod: Prema izvješću Hrvatske agencije za lijekove i medicinske proizvode (HALMED), za 2012. prema potrošnji lijekova, po terapijskim skupinama nesteroidni antireumatici (NSAIR) (M01) zauzimaju 8. mjesto sa 42,43 DDD/1000 stanovnika/dan. Cilj: Istražiti propisivanje NSAIR u ordinaciji obiteljske medicine s obzirom na: indikacije, duljinu terapije, nepoželjne komorbiditetne bolesti i nepoželjne kombinacije lijekova, adjuvantnu terapiju, te njihovu potrošnju. Ispitanici i metode: U tri ordinacije obiteljske medicine koje u skrbi imaju 5.716 ispitanika, provedeno je retrospektivno longitudinalno istraživanje u razdoblju od 1. 1. 2011 do 31. 12. 2011. Uzorak je činilo 1194 ispitanika kojima je propisan NSAIR. Sastavljen je upitnik koji je sadržavao demografske podatke, kliničke podatke, te podatke o dnevno definiranim dozama (DDD) NSAIR. Podaci za upitnik, te podaci o potrošnji NSAIR i ukupnoj potrošnji dobiveni su iz e-kartona u medicinskom informatičkom sustavu Medicus.net. Rezultati: NSAIR je propisan kod 21% (1194) ispitanika. Dva ili više NSAIR dobilo je 14% ispitanika. Najčešći razlog propisivanja NSAIR su koštano-mišićne bolesti (67,8%). Prosječna duljina trajanja terapije je 49,2 DDD (st. dev 62,0). Duljina terapije povećava se sa starošću ispitanika. Najčešće propisivan NSAIR je ibuprofen (31,6%). Najčešći nepoželjni komorbiditet su kardiovaskularne bolesti 38,4%), a nepoželjna interakcija s diureticima (34,1%). Od adjuvantne terapije benzodiazepini su propisani u 43%, a opioidni analgetici u 15,8% ispitnika. Inhibitori protonske pumpe (IPP) su propisani tek u 13,5% ispitnika. Udio nesteroidnih antireumatika u ukupnoj potrošnji iznosi oko 2%. Zaključak:NSAIR su propisani prečesto svakom petom ispitaniku i predugo. Preko polovine ispitanika imalo je nepoželjnu komorbiditetnu dijagnozu za primjenu NSAIR i koristilo lijekove s nepoželjnom interakcijom s NSAIR. Preporuke za daljnje istraživanje je istražiti mjere ishoda propisivanja NSAIR –a kod bolesnika s nepoželjnim komorbiditetima i nepoželjnim interakcijama, te temeljem toga izračunati stvarnu cijenu koju generira propisivanja NSAIR-a.According to HALMED (Croatian agency for medical products and medical devices) the consumption of NSAID (M01) occupied eighth place with 42.43 DDD/1000 inhabitants/day in 2012. Objective: To investigate the frequency of NSAIDs in GP offices regarding: participation in drug expenditure, indications, duration of therapy, unwanted comorbid diseases and drug interactions. Patients and methods: Retrospective longitudinal study of a sample of 5,716 patients from three GP offices was carried out in a one-year period (1.1.2011-31.12.2011). The sample included 1,194 patients with prescribed NSAID. A questionnaire designed for this investigation included questions about patients\u27 demographic and social characteristics, clinical information and the pattern of NSAID prescription (subgroup and DDD). Data were taken from computerized medical records in the information system Medicus.net. Results: NSAIDs were prescribed to 21% of patients. Musculoskeletal diseases (67.8 %) were the most common reason to prescribe NSAID. The average duration of the therapy was 49.2 DDD (SD 62.0). The most commonly prescribed NSAID was ibuprofen (31.6%). Two or more NSAIDs were prescribed to 14 % of respondents. The most common unwanted comorbidities were cardiovascular (38.4 %), and then gastrointestinal (17%) followed by renal diseases (1%). The most common unwanted drug interaction was with diuretics (34.1%). NSAIDs participated with about 2 % in total drug expenditure in GP offices. Conclusion: NSAIDs were prescribed to every fifth patient too often and too long. More than a half of the patients had unwanted comorbid diagnoses. The recommendation for further investigation is to investigate the outcome measures of prescribed NSAID among patients with unwanted diseases and drug interactions and to calculate real expenditure which generated NSAID prescription