Liver transplantation in patients with neuroendocrine tumors: a case series and literature review

Neuroendocrine tumors (NET) are a rare and heterogeneous group of neoplasms with variable biological behavior. They frequently metastasize to the liver, requiring active, multimodality treatment. Surgical resection, possible in only a minority of cases, was until recently the only potentially curative option. For unresectable NET with liver metastases, liver transplantation (LT) emerged as a potential curative treatment due to relatively slow growth and indolent behavior of the metastases. In this case series with literature review, we retrospectively analyzed the characteristics of 12 highly selected patients with metastatic NET disease as an indication for LT treated in our center. We also summarized the proposed prognostic factors, and evaluated and compared the existing selection criteria. The main poor prognostic factors in our patients were high grade NET and primary tumor in the pancreas. Inconsistent liver transplantation outcome parameters make it difficult to standardize patient selection criteria. There is a need for further studies that would fully elucidate the curative potential of LT in patients diagnosed with NET

Report on the Adult Congenital Heart Disease Multidisciplinary Team Meeting Held During the COVID-19 Pandemic

U svrhu obilježavanja pete godišnjice sustavne brige za odrasle bolesnike s prirođenom srčanom bolesti organizirali smo u Nacionalnom centru u Kliničkom bolničkom centru Zagreb sastanak uz prikaz kompleksnih kliničkih slučajeva iz tog područja. Zbog pandemije COVID a 19 sastanak je otkazan, ali je umjesto toga održan multidisciplinarni konzilij uz sudjelovanje vrhunskoga međunarodnog stručnjaka. Prikazano je više bolesnika i doneseni zaključci o njihovu daljnjem liječenju. Ovdje iznosimo podatke o četirima bolesnicima: o dva bolesnika sa slučajno otkrivenom kasnom dijagnozom prirođene srčane bolesti (o jednom s atrijskim septalnim defektom i drugom s Fallotovom tetralogijom), o bolesnici sa slomom Fontanove cirkulacije, liječenom transplantacijom srca te o bolesnici s transpozicijom velikih krvnih žila i problemima nastalima nakon operacije. Uz prikaze bolesnika, u raspravama su iznesene dvojbe u vezi s liječenjem te najvažniji zaključci vezani uz svaki pojedini slučaj.To mark the fifth anniversary of systematic care for adult patients with congenital heart disease, we organized a meeting at the National Center at the University Hospital Centre Zagreb with the intention of presenting complex clinical cases from the field. The meeting was canceled due to the COVID-19 pandemic, but a multidisciplinary council was held with the participation of an international top expert. Several patients were presented and conclusions were made about their further treatment. Herein we present four interesting cases: two patients with an accidental late diagnosis, one with atrial septal defect and a second with tetralogy of Fallot, a patient with failing Fontan circulation treated by heart transplantation, and a patient with surgically corrected transposition of great arteries with postoperative problems. In addition to patient reports, the discussions sections present dilemmas about treatment, available literature, and conclusions related to each case

Marketing of innovative products in business systems

Najznačajniji faktori koji u današnje vrijeme utječu na poduzetničku snagu poduzeća uključuju sposobnost inoviranja procesa, proizvoda i usluga. Ukoliko je osnovna preokupacija suvremenog poduzeća stvaranje konkurentske pozicije na tržištu, danas to više nije moguće samo cijenom postojećih proizvoda ili usluga, njihovim kvalitetom ili paletom izbora, već prvenstveno brzinom kojom poduzeće može uvesti nove proizvode. Dotična brzina ovisi o inovativnosti u proizvodnim i poslovnim procesima. Uvođenje inovacija suvremeno je pitanje opstanka, a vrijeme potrebno za inoviranje sve je kraće. Obim i brzina inovacija posljedica su velikog broja naučnih i tehnoloških dostignuća te njihove primjene u praksi. To je ujedno i jedan od razloga zbog kojeg su ulaganja u istraživanja i razvoj danas najuže povezana s budućnošću poduzeća. Steve Jobs, jedan od najvećih inovatora modernog doba i vlasnik kompanije čiji je uspjeh baziran na čistom inoviranju i plasiranju novih proizvoda, kaže: “Ne možete svoje klijente pitati što žele i onda im to pokušati dati. Dok vi tu stvar izradite, oni će već htjeti nešto drugo.” Ovaj rad bavit će se marketingom jednog takvog inovativnog proizvoda s kojim osobno radim. Riječ je o inovativnoj tehnologiji čišćenja samo sa vodom koju je patentirala američka tvrtka Tennant.The most significant factors nowadays that influence the entrepreneurial capacity of our company includes the ability to innovate processes, products and services. If the main concern of modern enterprises is to create competitive position in the market, today this is no longer possible only with price of existing products or services, their quality and range of choice, but rather with the speed with which a company can introduce new products. The particular speed depends on innovation in production and business processes. The introduction of modern innovation is a matter of survival, and the time required for all innovation is shorter. The extent and speed of innovation are due to the large number of scientific and technological advances and their application in practice. It is also one of the reasons why the investment in research and development today is closely linked to the future of the enterprise. Steve Jobs, one of the greatest innovators of modern times and the owner of the company whose success is based on pure innovation and marketing of new products, says: "You cannot ask your customers what they want and then try to give it to them. As you create this thing, they will already want something else". This paper will address the marketing of one of such innovative products with which I personally work. It is an innovative technology for cleaning only with water, which is patented by an American company Tennant

Surgical treatment of partial anomalous pulmonary venous connection

UVOD: Parcijalni anomalni utok plućnih vena (PAUPV) prirođena je srčana greška u kojoj jedna ili više plućnih vena, ali ne sve, utječu u sistemsku vensku cirkulaciju. Liječenje PAUPV-a je gotovo isključivo kirurško, a najčešće korištene kirurške tehnike su tehnika jednostruke zakrpe, tehnika dvostruke zakrpe te Wardenova tehnika. ----- CILJ: Prikazati karakteristike pacijenata operiranih zbog PAUPV-a u Kliničkom bolničkom centru Zagreb od 2011. do 2019. godine. ----- ISPITANICI I METODE: U istraživanje je uključeno 35 osoba (20 muškog i 15 ženskog spola). Demografski podaci, podaci o morfologiji greške, podaci o kliničkoj slici i dijagnostici, te podaci o operaciji i postoperativnom razdoblju prikupljeni su s Bolničkog informacijskog sustava. ----- REZULTATI: Ispitanici su prema uzrastu svrstani u kategoriju djece (N=18) i kategoriju odraslih s prirođenim srčanim greškama (N=17). Dvoje pacijenata imalo je ljevostrani PAUPV, a dvoje sindrom scimitar. Izolirani PAUPV imalo je 6,1% ispitanika, a najčešća pridružena anomalija bio je ASD (84,8%). Simptome prilikom postavljanja dijagnoze imalo je 62,9% ispitanika. Najčešća metoda kojom je postavljena dijagnoza bila je ehokardiografija (52,9%). Kod 32,4% pacijenata PAUPV je korigiran tehnikom jednostruke zakrpe, a kod 61,8% tehnikom dvostruke zakrpe. Preživljenje nakon operacije bilo je 100%. Kod sedam je pacijenata nastala komplikacija, koja je kod dvoje iziskivala reoperaciju, a kod troje se radilo o novonastaloj aritmiji. ----- ZAKLJUČAK: Morfologija PAUPV-a, kliničke manifestacije te rezultati kirurškog liječenja u proučavanom uzorku odgovaraju onima iz literaturnih izvora.INTRODUCTION: Partial anomalous pulmonary venous connection (PAPVC) is a congenital heart defect in which one or more, but not all, pulmonary veins connect to systemic venous circulation. PAPVC treatment is almost exclusively surgical, most commonly used surgical procedures being single patch, double patch and Warden procedure. ----- AIM: To present the characteristics of patients from University Hospital Centre Zagreb in which PAPVC repair was done in the period from 2011 to 2019. ----- SUBJECTS AND METHODS: 35 patients (20 male and 15 female) were included in this research. Demographical data, information about morphology of the defect, clinical presentation and date regarding the surgery and postoperative period were obtained using hospital information system. ----- RESULTS: The subjects were, in regard to age, assigned to a category of children (N=18) or grown-ups with congenital heart defects (N=17). Two patients had a left-sided PAPVC while two had scimitar syndrome. Isolated PAPVC was present in 6.1% of subjects and most common associated heart defect was ASD (84.8%). Symptoms were present in 62.9% upon diagnosis. Most common method used as diagnostic procedure was echocardiography (52.9%). In 32.4% of patients, single patch procedure was used to repair PAPVC, while double patch procedure was used in 61.8% of patients. Survival was 100% in postoperative period. A complication of surgery occurred in seven patients, requiring reintervention in two patients and in three being the case of newly discovered arrhythmia. ----- CONCLUSION: PAPVC morphology, clinical presentation and surgical treatment results in this sample are similar to those described in literature

Surgical treatment of partial anomalous pulmonary venous connection

UVOD: Parcijalni anomalni utok plućnih vena (PAUPV) prirođena je srčana greška u kojoj jedna ili više plućnih vena, ali ne sve, utječu u sistemsku vensku cirkulaciju. Liječenje PAUPV-a je gotovo isključivo kirurško, a najčešće korištene kirurške tehnike su tehnika jednostruke zakrpe, tehnika dvostruke zakrpe te Wardenova tehnika. ----- CILJ: Prikazati karakteristike pacijenata operiranih zbog PAUPV-a u Kliničkom bolničkom centru Zagreb od 2011. do 2019. godine. ----- ISPITANICI I METODE: U istraživanje je uključeno 35 osoba (20 muškog i 15 ženskog spola). Demografski podaci, podaci o morfologiji greške, podaci o kliničkoj slici i dijagnostici, te podaci o operaciji i postoperativnom razdoblju prikupljeni su s Bolničkog informacijskog sustava. ----- REZULTATI: Ispitanici su prema uzrastu svrstani u kategoriju djece (N=18) i kategoriju odraslih s prirođenim srčanim greškama (N=17). Dvoje pacijenata imalo je ljevostrani PAUPV, a dvoje sindrom scimitar. Izolirani PAUPV imalo je 6,1% ispitanika, a najčešća pridružena anomalija bio je ASD (84,8%). Simptome prilikom postavljanja dijagnoze imalo je 62,9% ispitanika. Najčešća metoda kojom je postavljena dijagnoza bila je ehokardiografija (52,9%). Kod 32,4% pacijenata PAUPV je korigiran tehnikom jednostruke zakrpe, a kod 61,8% tehnikom dvostruke zakrpe. Preživljenje nakon operacije bilo je 100%. Kod sedam je pacijenata nastala komplikacija, koja je kod dvoje iziskivala reoperaciju, a kod troje se radilo o novonastaloj aritmiji. ----- ZAKLJUČAK: Morfologija PAUPV-a, kliničke manifestacije te rezultati kirurškog liječenja u proučavanom uzorku odgovaraju onima iz literaturnih izvora.INTRODUCTION: Partial anomalous pulmonary venous connection (PAPVC) is a congenital heart defect in which one or more, but not all, pulmonary veins connect to systemic venous circulation. PAPVC treatment is almost exclusively surgical, most commonly used surgical procedures being single patch, double patch and Warden procedure. ----- AIM: To present the characteristics of patients from University Hospital Centre Zagreb in which PAPVC repair was done in the period from 2011 to 2019. ----- SUBJECTS AND METHODS: 35 patients (20 male and 15 female) were included in this research. Demographical data, information about morphology of the defect, clinical presentation and date regarding the surgery and postoperative period were obtained using hospital information system. ----- RESULTS: The subjects were, in regard to age, assigned to a category of children (N=18) or grown-ups with congenital heart defects (N=17). Two patients had a left-sided PAPVC while two had scimitar syndrome. Isolated PAPVC was present in 6.1% of subjects and most common associated heart defect was ASD (84.8%). Symptoms were present in 62.9% upon diagnosis. Most common method used as diagnostic procedure was echocardiography (52.9%). In 32.4% of patients, single patch procedure was used to repair PAPVC, while double patch procedure was used in 61.8% of patients. Survival was 100% in postoperative period. A complication of surgery occurred in seven patients, requiring reintervention in two patients and in three being the case of newly discovered arrhythmia. ----- CONCLUSION: PAPVC morphology, clinical presentation and surgical treatment results in this sample are similar to those described in literature

Alternative ways of hazardous waste treatment from petroleum industry

Dio tehnološkog otpada koji nastaje u procesima naftnog rudarstva u Hrvatskoj spada u opasni otpad. Prije odlaganja u centralne otpadne jame (COJ) takav otpad se obrađuje živim vapnom i kroz proces stabilizacije/solidifikacije pretvara u slabo topivi - inertni materijal. Stabilizacija/solidifikacija živim vapnom u svijetu se koristi kao tehnika obrade i organskog i anorganskog tehnološkog otpada. Svjetska iskustva međutim pokazuju da pri primjeni te tehnike kod obrade organskog tehnološkog otpada, ili otpada koji sadrži i organske i anorganske onečiščivaće ne dolazi do dovoljnog reduciranja kretanja onečišćivača u okoliš. Za materijale koji sadrže organske ili anorganske i organske onečišćivače razvijaju se nove tehnike obrade. Cilj ovog istraživanja je bilo ispitivanje alternativnih načina obrade tehnološkog otpada iz naftnog rudarstva. Uzorak tehnološkog otpada iz COJ-Vinkovci u laboratorijskim uvjetima je obrađivan primjenom pojedinačnih materijala ili primjenom kombinacije nekoliko materijala i to: (a) cement, (b) organofilna glina, (c) kalcinirana Moler glina, (d) vapno + organofilna glina + bentonit, (e) cement + organofilna glina + bentonit, (f) vapno + kalcinirana moler glina i (g) cement + kalcinirana moler glina. Za usporedbu rezultata korišten je uzorak tehnološkog otpada obrađen vapnom. U obrađenim uzorcima određeni su sljedeći parametri: (a) ukupna ulja, (b) mineralna ulja, (c) policiklički aromatski ugljikovodici (16 komponenata) i (d) teški metali i potencijalno toksični elementi (10 elemenata). Osim ukupnog sadržaja navedenih parametara u obrađenim uzorcima, određen je i njihov sadržaj u vodenim eluatima istih uzoraka. Od primjenjenih tretmana, tretman organofilnom glinom se pokazao bitno najuspješnijim za većinu parametara. Tako tretiran uzorak otpušta na primjer 63 puta manje ukupnih ulja, 67 puta manje mineralnih ulja, 798 puta manje naftalena i 136 puta manje olova od uzorka tretiranog vapnom. Po uspješnosti iza organofilne gline nalazi se kalcinirana Moler glina. Dobiveni rezultati jasno ukazuju da odabiru najpovoljnijeg sredstva za obradu tehnološkog otpada u naftnom rudarstvu treba prethoditi smanjenje sadržaja ugljikovodika nekim od terenskih prihvatljivih načina i detaljna kemijska analiza preostalih organskih i anorganskih onečišćivača. Ovisno o rezultatu analize opasni tehnološki otpad može se tretirati puno efikasnije, uz upotrebu primjerenijih materijala (npr. organofilna glina) čime se može bitno reducirati otpuštanje onečišćivača iz tako obrađenog otpada u okoliš. Na taj način mogao bi se rješiti problem trajnog odlaganja obrađenog otpada.Part of the technological waste produced in petroleum industry in Croatia is hazardous waste. Such kind of waste is treated with lime and through processes of stabilization / solidification it transforms in poorly soluble - inert material which is then deposited in central oilfield pits. Stabilization/solidification with lime is worldwide used as a technique of treatment of organic and inorganic technological waste. Foreign experiences showed that by usage of this technique for treatment of organic technological waste, or waste with organic and inorganic pollutants, sufficient reduction of pollutant movement in the environment is not caused. Due to this fact, one has to be careful in its application. The new techniques of treatment are being developed for materials which contain organic or inorganic and organic pollutants. The aim of this research was to examine alternative ways of treatment of technological waste from petroleum industry. The sample of technological waste from central oilfield pit Vinkovci was treated in laboratory conditions with application of single material or application of material combinations: (a) cement, (b) organophilic clay, (c) calcined Moler clay, (d) lime + organophilic clay + bentonite, (e) cement + organophilic clay + bentonite, (f) lime + calcined Moler clay and (g) cement + calcined Moler clay. The sample of technological waste treated with lime was used for comparison of results. The following parameters were determined in treated samples: (a) total oils, (b) mineral oils, (c) polycyclic aromatic hydrocarbons (16) and (d) heavy metals and potentially toxic elements (10). The content of stated parameters is determined in original samples and their distilled water leachate. The most successful treatment for majority of parameters was treatment with organophilic clay. Such treated sample releases, for example, 63 times less total oils, 67 times less mineral oils, 798 times less naphthalene and 136 times less lead than sample treated with lime. The organophilic clay, as the most successful material, is followed by calcined Moler clay. The obtained results clearly show that reduction of hydrocarbons content with some of the field acceptable ways and detailed chemical analysis of left organic and inorganic pollutants has to be done before the selection of the best mean for treatment of technological waste in petroleum industry. Depending on results of analysis, hazardous technological waste can be treated more effective by application of more suitable materials (e.g. organophilic clay) which reduce pollutant release from such treated waste in the environment. In this way the problem of permanent disposal of treated waste can be solved