16 research outputs found
Massive Gastrointestinal Bleeding and Obstruction of the Ureter Caused by the Migration of a Swallowed Toothpick from the Sigmoid Colon ā A Case Report
In this study, a case of an ingested toothpick partially migrating from the sigmoid colon, causing massive lower gastrointestinal
bleeding due to arterial-colic fistula, and stricture of the left ureter is presented. A 70-year-old male was admitted
to the emergency department after having feces mixed with fresh and coagulated blood for the past two days. Computed
tomography and retrograde ureteropyelography showed the stricture of the left ureter, 1.5 cm below the branching
of iliac artery, without any signs of malignancy. Colonoscopy showed fresh blood in the rectum and sigmoid colon up to
the neoplasm like granulation tissue mixed with fresh and coagulated blood, which almost obstructed the lumen. Explorative
laparotomy showed a foreign body (toothpick) perforating the sigmoid colon through the mesenterial wall, and being
stocked with one-third into the left internal iliac artery, causing arterial-colic fistula. The remaining part of the
toothpick was surrounded by granulation tissue and chronic inflammatory process, pressing on the distal third of the left
ureter. We conclude that a swallowed toothpick may cause a significant gastrointestinal injury with a wide variety of
clinical manifestations, and it must be treated with caution. The imaging studies are often inadequate in detecting toothpicks,
and thus, we insist on a physical examination, as the best indicator of injury
Obesity and Gastroesophageal Reflux Disease
Gastroezofagealna refluksna bolest (GERB) jedan je od najÄeÅ”Äih razloga posjeta lijeÄniku. Etiologija i patogeneza bolesti multifaktorske su i stalni su predmet brojnih istraživanja. Pretilost, Äija je prevalencija znatno porasla posljednjih desetljeÄa, deEnirana je kao neovisni Äimbenik rizika od razvoja GERB-a. Pritom je centralni tip pretilosti, neovisno o indeksu tjelesne mase, zasebni faktor rizika od nastanka komplikacija GERB-a, od kojih su najÄeÅ”Äe erozivni gastritis, Barrettov jednjak i adenokarcinom. Time se znatno poveÄava socioekonomski aspekt povezanosti debljine i GERB-a. Prekomjerna tjelesna težina porastom intraabdominalnog tlaka i sniženjem tonusa donjeg ezofagealnog sEnktera mehaniÄki poveÄava vjerojatnost re-uksne bolesti. S druge strane, patogeneza GERB-a može se objasniti i hormonalnom te endokrinom aktivnoÅ”Äu masnog tkiva. Redukcija tjelesne mase, kao dio prve linije terapije, znatno poboljÅ”ava simptomatologiju GERB-a kod pretilih bolesnika.Gastroesophageal re-ux disease (GERD) is one of the most common reasons for visiting a physician. Etiology and pathogenesis
of the disease is multifactorial and is still the subject of numerous studies. Obesity, whose prevalence has significantly increased over recent decades, is defined as an independent risk factor for GERD development. The central type of obesity, independently of the body mass index, is a separate risk factor for the emergence of GERD complications, including erosive gastritis, Barrett\u27s esophagus, and adenocarcinoma. This significantly increases the socioeconomic aspect of obesity and GERD. Excess body weight mechanically increases the likelihood of reflux disease, increases intraabdominal pressure, and decreases tonus of the lower esophageal sphincter. On the other hand, GERD pathogenesis can be explained by both hormonal and endocrine fatty tissue activity. Body mass reduction, as part of the Erst line of therapy, significantly improves GERD symptomatology in obese patients
Obesity and Gastroesophageal Reflux Disease
Gastroezofagealna refluksna bolest (GERB) jedan je od najÄeÅ”Äih razloga posjeta lijeÄniku. Etiologija i patogeneza bolesti multifaktorske su i stalni su predmet brojnih istraživanja. Pretilost, Äija je prevalencija znatno porasla posljednjih desetljeÄa, deEnirana je kao neovisni Äimbenik rizika od razvoja GERB-a. Pritom je centralni tip pretilosti, neovisno o indeksu tjelesne mase, zasebni faktor rizika od nastanka komplikacija GERB-a, od kojih su najÄeÅ”Äe erozivni gastritis, Barrettov jednjak i adenokarcinom. Time se znatno poveÄava socioekonomski aspekt povezanosti debljine i GERB-a. Prekomjerna tjelesna težina porastom intraabdominalnog tlaka i sniženjem tonusa donjeg ezofagealnog sEnktera mehaniÄki poveÄava vjerojatnost re-uksne bolesti. S druge strane, patogeneza GERB-a može se objasniti i hormonalnom te endokrinom aktivnoÅ”Äu masnog tkiva. Redukcija tjelesne mase, kao dio prve linije terapije, znatno poboljÅ”ava simptomatologiju GERB-a kod pretilih bolesnika.Gastroesophageal re-ux disease (GERD) is one of the most common reasons for visiting a physician. Etiology and pathogenesis
of the disease is multifactorial and is still the subject of numerous studies. Obesity, whose prevalence has significantly increased over recent decades, is defined as an independent risk factor for GERD development. The central type of obesity, independently of the body mass index, is a separate risk factor for the emergence of GERD complications, including erosive gastritis, Barrett\u27s esophagus, and adenocarcinoma. This significantly increases the socioeconomic aspect of obesity and GERD. Excess body weight mechanically increases the likelihood of reflux disease, increases intraabdominal pressure, and decreases tonus of the lower esophageal sphincter. On the other hand, GERD pathogenesis can be explained by both hormonal and endocrine fatty tissue activity. Body mass reduction, as part of the Erst line of therapy, significantly improves GERD symptomatology in obese patients
Posttraumatic hepatic artery pseudoaneurysm presenting as gastrointestinal bleeding
Posttraumatic hepatic artery pseudoaneurysm is a rare, but life threatening condition which should be considered in patients
with a history of blunt abdominal trauma who present with abdominal pain or gastrointestinal bleeding. We report a
case of a patient with such a pseudoaneurysm discovered five months after a bicycle accident resulting in hepatic rupture
that was treated conservatively. The patient presented with fatigue, dizziness, inability to tolerate major exertion and gastrointestinal
bleeding. After extensive diagnostic procedures, a right hepatic artery pseudoaneurysm was found. The condition
was treated successfully with transcatheter coil embolization
Coincidence of colorectal cancer and diverticular disease of the colon
Uvod: Divertikuloza (DK) debeloga crijeva i karcinom debeloga crijeva (KDC) imaju neke zajedniÄke karakteristike (npr. ÄeÅ”Äi su u zapadnom dijelu svijeta i kod starijih osoba, sliÄne prehrambene znaÄajke ukljuÄene su u obje bolesti) a povremena povezanost izmeÄu njih je ispitivana. NaÅ” cilj je bio procijeniti koincidenciju KDC-a i DK u kontinentalnoj i primorskoj Hrvatskoj, kao i prehrambenu varijabilnost u naÅ”oj populaciji - prehrana s manjim udjelom vlakana u kontinetalnoj Hrvatskoj i mediteranska prehrana u primorskoj Hrvatskoj stvara povoljnu situaciju za istraživanje bolesti sa sumnjom na prehrambenu etiologiju. Metode: Analizirane su medicinske povijesti 710 bolesnika iz kontinentalne regije i 406 bolesnika iz primorske regije s dijagnozom KDC od 2011. do 2016. godine s obzirom na prevalenciju DK. Skupine su nadalje podijeljene prema razliÄitim dobnim i spolnim skupinama, a prevalencija DK u svakoj skupini izraÄunata je i usporeÄena. Analizirane su i distribucije DK i KDC-a za skupine KDC u usporedbi s DK. Rezultati: Prevalencija DK u skupini KDC u obalnom podruÄju iznosila je 32,3%, a u kontinentalnoj regiji 11,5%. Prevalencija DK u primorskom podruÄju bila je znatno veÄa u ukupnom broju u usporedbi s kontinentalnom regijom, kao i u ukupnom broju muÅ”karaca i žena, te u dobno stratificiranoj skupini > 65. Lijevi kolon je ÄeÅ”Äe zahvaÄen s DK i KDC u obje skupine. ZakljuÄci: NaÅ”i podaci upuÄuju da bolesnici s KDC i DK mogu proizaÄi iz razliÄitih ispitivanih skupina, a uÄinak prehrane tek treba ustanoviti.Background: Diverticular disease (DD) of the colon and colorectal cancer (CRC) have common characteristics (e.g. more common in the westernized world and in the elderly, similar dietary features implicated for both diseases) and a casual relationship between them has been suggested. Our aim was to evaluate the coincidence of CRC and DD in continental and coastal Croatia as a dietary variability observed in our population ā low fiber diet in the continent and Mediterranean diet on the coast creates a favourable situation for the investigation of diseases with suspected nutritional aetiology. Methods: Medical histories of 710 patients from the continental region and 406 from the coastal region diagnosed with CRC from 2011 to 2016 were analyzed with regard to the prevalence of DD. The groups were furthermore divided in different age and sex groups and the prevalence of DD in each group was calculated and compared. Distribution of DD and CRC in the colon for the groups of CRC in concomitance with DD were also analyzed. Results: The prevalence of DD among the CRC group in the coastal region was 32.3% and in the continental region 11.5%. The prevalence of DD in the coastal region was significantly higher in the overall number compared to the continental region as well as in the overall number of men and women, and in the age-stratified group > 65. The left colon was affected more often with DD and CRC in both groups. Conclusions: Our findings suggest that patients with CRC and DD could derive from distinct groups and the effect of the diet has yet to be established
CROATIAN GUIDELINES FOR DIAGNOSTICS AND TREATMENTS OF HELICOBACTER PYLORI INFECTION
DosadaÅ”njim 30-godiÅ”njim istraživanjima potvrÄena je temeljna uloga bakterije Helicobacter pylori pri razvoju kroniÄnoga gastritisa, želuÄanog i duodenalnog ulkusa, a potom i njegova etioloÅ”ka uloga u patogenezi želuÄanog karcinoma i MALT limfoma. Godine 1996. održan je prvi sastanak Europske grupe za istraživanje infekcije Helicobacterom pylori i publicirane prve smjernice za dijagnostiku i terapiju te infekcije, revidirane 2000., 2007. i 2010. godine. VeÄ 1998. godine održan je i prvi sastanak hrvatskih lijeÄnika s istim ciljem ā stvaranja hrvatskih preporuka za dijagnostiku i terapiju infekcije Helicobacterom pylori u naÅ”oj zemlji. Posljednjih se godina nametnula potreba za revizijom starih smjernica. Godine 2012. osnovana je ekspertna grupa gastroenterologa koja je u prosincu 2012. godine održala u Zagrebu Konsenzusnu konferenciju za donoÅ”enje novog postupnika za dijagnostiku, lijeÄenje i praÄenje bolesnika s infekcijom Helicobacterom pylori u Hrvatskoj. ObraÄene su ove teme iz problematike infekcije Helicobacterom pylori: 1. indikacije i kontraindikacije za dijagnostiku i lijeÄenje, 2. dijagnostiÄke metode i 3. terapija primjerena za naÅ”u zemlju.In the past 30-year period of investigations, the crucial role of Helicobacter pylori in chronic gastritis, gastric and duodenal ulcer development, and subsequently in gastric cancer and MALT lymphoma pathogenesis, has been recognized. During the first meeting of European Helicobacter Study Group in 1996 in Maastricht, the first recommendations for diagnostics and treatments of Helicobacter pylori infection were published, later reviewed in 2000, 2007 and 2010. The first meeting of Croatian doctors focusing on the same topics, but suitable to specific national circumstances, was held as early as 1998. The need for updating the old guidelines has emerged during the last years. The working expert group of gastroenterologists was formed and gathered on Consesus Conference in December 2012 in Zagreb, to arrive to current guidelines for the clinical management of Helicobacter pylori infection in Croatia. The following topics relating to Helicobacter pyloriinfection were examined: 1. indications and contraindications for diagnostics and treatments; 2. diagnostic methods and 3. treatments applicable in our country
CROATIAN GUIDELINES FOR USE OF ENTERAL NUTRITION IN CROHNāS DISEASE
Prehrana ima važnu viÅ”eznaÄnu ulogu u lijeÄenju upalnih bolesti crijeva, poglavito u bolesnika koji boluju od Crohnove bolesti. U prvom redu adekvatna nutritivna potpora nužna je u prevenciji i lijeÄenju malnutricije, kao i u prevenciji osteoporoze te u promicanju dobi primjerenog rasta u pedijatrijskih bolesnika. S druge strane, u aktivnoj fazi Crohnove bolesti u pedijatrijskih bolesnika enteralna je prehrana terapija izbora za uvoÄenje bolesnika u remisiju. Glede vrste enteralnih pripravaka istraživanja upuÄuju na jednaku uÄinkovitost elementarnih, oligomernih i polimernih enteralnih pripravaka. Uporaba standardnih polimernih enteralnih pripravaka danas se preporuÄuje i zbog boljeg okusa, lakÅ”eg prihvaÄanja od bolesnika, manje komplikacija te znaÄajno nižih troÅ”kova u usporedbi s troÅ”kovima primjene ostalih enteralnih pripravaka. Najnovije spoznaje upuÄuju i na to da neki nutrijenti poput transformirajuÄeg Äimbenika rasta beta (TGF-2), koji se nalaze u modificiranim polimernim enteralnim pripravcima, imaju farmakoloÅ”ki terapijski potencijal u lijeÄenju upalnih bolesti crijeva, potvrÄen u nekoliko kliniÄkih ispitivanja. Radna skupina koju su Äinili internisti gastroenterolozi i pedijatrijski gastroenterolozi, posebno upuÄeni u lijeÄenje bolesnika s kroniÄnim upalnim bolestima crijeva izradila je Hrvatske smjernice za primjenu enteralne prehrane u Crohnovoj bolesti. Izrada smjernica temeljena je na dokazima iz relevantne medicinske literature te kliniÄkim iskustvima Älanova radne skupine.Nutrition has an important role in the management of inflammatory bowel disease (IBD), especially in patients with Crohnās disease (CD). This role includes the prevention and correction of malnutrition, the prevention of osteoporosis and the promotion of optimal growth and development in children. In active Crohnās disease, nutritional therapy (in the form of enteral feeding) is an effective primary therapy for pediatric patients. Studies have shown that there is no difference in the efficacy of elemental, oligomeric and polymeric enteral formulas. Therefore, the use of polymeric formula is recommended because of higher palatability, better acceptance by patients, lower rate of complications and lower cost when compared with other enteral formulas. Today we have knowledge that some nutrients which are added to modified special enteral formulas have almost pharmacological terapeutic potential in the management of inflammatory bowel disease. Novel nutritional therapeutic strategies for inflammatory bowel disease, such as transforming growth factor-beta-enriched (TGF-2) enteral feeding, showed beneficial effects in several clinical studies. Croatian guidelines for enteral nutrition in Crohnās disease have been developed by interdisciplinary expert group of Croatian clinicians involved with inflammatory bowel disease. The guidelines are based on evidence from relevant medical literature and clinical experience of working group
CROATIAN GUIDELINES FOR USE OF ENTERAL NUTRITION IN CROHNāS DISEASE
Prehrana ima važnu viÅ”eznaÄnu ulogu u lijeÄenju upalnih bolesti crijeva, poglavito u bolesnika koji boluju od Crohnove bolesti. U prvom redu adekvatna nutritivna potpora nužna je u prevenciji i lijeÄenju malnutricije, kao i u prevenciji osteoporoze te u promicanju dobi primjerenog rasta u pedijatrijskih bolesnika. S druge strane, u aktivnoj fazi Crohnove bolesti u pedijatrijskih bolesnika enteralna je prehrana terapija izbora za uvoÄenje bolesnika u remisiju. Glede vrste enteralnih pripravaka istraživanja upuÄuju na jednaku uÄinkovitost elementarnih, oligomernih i polimernih enteralnih pripravaka. Uporaba standardnih polimernih enteralnih pripravaka danas se preporuÄuje i zbog boljeg okusa, lakÅ”eg prihvaÄanja od bolesnika, manje komplikacija te znaÄajno nižih troÅ”kova u usporedbi s troÅ”kovima primjene ostalih enteralnih pripravaka. Najnovije spoznaje upuÄuju i na to da neki nutrijenti poput transformirajuÄeg Äimbenika rasta beta (TGF-2), koji se nalaze u modificiranim polimernim enteralnim pripravcima, imaju farmakoloÅ”ki terapijski potencijal u lijeÄenju upalnih bolesti crijeva, potvrÄen u nekoliko kliniÄkih ispitivanja. Radna skupina koju su Äinili internisti gastroenterolozi i pedijatrijski gastroenterolozi, posebno upuÄeni u lijeÄenje bolesnika s kroniÄnim upalnim bolestima crijeva izradila je Hrvatske smjernice za primjenu enteralne prehrane u Crohnovoj bolesti. Izrada smjernica temeljena je na dokazima iz relevantne medicinske literature te kliniÄkim iskustvima Älanova radne skupine.Nutrition has an important role in the management of inflammatory bowel disease (IBD), especially in patients with Crohnās disease (CD). This role includes the prevention and correction of malnutrition, the prevention of osteoporosis and the promotion of optimal growth and development in children. In active Crohnās disease, nutritional therapy (in the form of enteral feeding) is an effective primary therapy for pediatric patients. Studies have shown that there is no difference in the efficacy of elemental, oligomeric and polymeric enteral formulas. Therefore, the use of polymeric formula is recommended because of higher palatability, better acceptance by patients, lower rate of complications and lower cost when compared with other enteral formulas. Today we have knowledge that some nutrients which are added to modified special enteral formulas have almost pharmacological terapeutic potential in the management of inflammatory bowel disease. Novel nutritional therapeutic strategies for inflammatory bowel disease, such as transforming growth factor-beta-enriched (TGF-2) enteral feeding, showed beneficial effects in several clinical studies. Croatian guidelines for enteral nutrition in Crohnās disease have been developed by interdisciplinary expert group of Croatian clinicians involved with inflammatory bowel disease. The guidelines are based on evidence from relevant medical literature and clinical experience of working group
CROATIAN CONSENSUS ON THE TREATMENT OF INFLAMMATORY BOWEL DISEASES WITH BIOLOGIC THERAPY
UvoÄenje bioloÅ”ke terapije u kliniÄku praksu je znaÄajan napredak u lijeÄenju kroniÄnih upalnih bolesti crijeva, prije svega zbog
njihove dokazane djelotvornosti te Äinjenice da su to prvi lijekovi kojima se uspjelo promijeniti prirodni tijek tih bolesti. Radi se,
meÄutim, o vrlo skupim lijekovima s vrlo kompleksnim mehanizmima djelovanja i moguÄim nuspojavama, te njihovo koriÅ”tenje u
vrlo kompliciranim bolestima kakve su upalne bolesti crijeva zahtijeva smjernice bazirane na rezultatima dobro kontroliranih studija.
Referentni centar Ministarstva zdravlja i Sekcija za upalne bolesti crijeva Hrvatskog gastroenteroloŔkog druŔtva organizirali
su stoga konsenzus konferenciju tijekom koje su definirane hrvatske smjernice za lijeÄenje upalnih bolesti crijeva anti-TNF lijekovima.
Tekst sa smjernicama ukljuÄuje definicije upalnih bolesti crijeva, opÄe principe lijeÄenja upalnih bolesti crijeva, važnost
mukoznog cijeljenja, analizu razloga nedjelotvornosti i gubitka djelotvornosti anti-TNF terapije, daje preporuke o dužini terapije,
daje smjernice za probir na oportunistiÄke infekcije prije poÄetka anti-TNF terapije, osvrÄe se na probleme reprodukcije vezane
za anti-TNF terapiju te konaÄno daje smjernice za lijeÄenje raznih fenotipova upalnih bolesti crijeva i ekstraintestinalnih manifestacija
upalnih bolesti crijeva.Introduction of biologic therapy in clinical practice represented significant progress in the treatment of inflammatory bowel diseases
(IBD) because of its proven efficacy and due to the fact that biologics are the first drugs used in the treatment of IBD that
can change the natural course of this diseases. At the same time, biologics are very expensive drugs with complex mechanism
of action and important side effects and their use requires evidence-based clinical guidelines. These were the reasons that Referral
Center of the Croatian Ministry of Health for IBD and the IBD Section of the Croatian Society of Gastroenterology organised
Croatian consensus conference that defined guidelines for the treatment of IBD with anti-TNF drugs. The text below includes
definitions of IBD, general principles of IBD therapy, comments on the importance of mucosal healing, analysis of reasons for
nonresponse and loss of response to anti-TNF drugs, recommendation for the duration of anti-TNF therapy, rules of screening for
opportunistic infections prior to anti-TNF therapy, comments on the problems with reproduction in IBD and finally guidelines for
the treatment of various phenotypes of IBD including extraintestinal manifestations with anti-TNF therapy
Analiza konstruktivnih rjeÅ”enja ureÄaja kod ofsetnih strojeva za tisak na arke
Postoje razliÄiti ofset strojevi. Ponajprije postoje strojevi koji tiskaju iz arka, te strojevi koji tiskaju iz role. Princip otiskivanja je jednak kod obje vrste
strojeva, ali postoje velike razlike u ureÄajima za izlaganje i ureÄajima za ulaganje. Ovaj zavrÅ”ni rad opisuje iskljuÄivo ofsetne strojeve za tisak na arke i njegove osnovne dijelove. Osnovni dijelovi podijeljeni su u cjeline. To su ureÄaj za ulaganje, tiskovna jedinica i ureÄaj za izlaganje. Svaki dio ofsetnog stroja ima zadaÄu koju obavlja. Kako bi neki dio svoju zadaÄu obavio Å”to bolje,
njegova konstrukcija se unaprjeÄuje i mijenja. Ovim zavrÅ”nim radom prikazat Äe se i opisati konstrukcija ureÄaja za ulaganje, tiskovne jedinice i ureÄaja za izlaganje. Tiskovna jedinica graÄena je od ureÄaja za vlaženje, obojenje i
sistema valjaka. UreÄaj za obojenje ima nekoliko razliÄitih konstruktivnih rjeÅ”enja isto kao i ureÄaj za vlaženje. Svako od konstruktivnih rjeÅ”enja ima svoje prednosti i mane. Neki od tih rjeÅ”enja detaljno su opisani u ovom zavrÅ”nom
radu