A rare case of multiple unruptured intracerebral aneurysms

Aim: To present a rare case of a patient with multiple unruptured intracranial aneurysms. Case report: A 82-year-old female patient with acute onset of headache without pain relief after tak- ing analgesics. Non–Enhanced Multi-slice Computed Tomography (MSCT) of brain was performed and multiple vascular anomalies were suspected. Diagnostic procedures were completed with cerebral MSCT angiography which proved presence of multiple unruptured inracranial aneurysms. Aneurysms are of asymmetric localization, probably due to acquired causes and usually smaller than 10 mm. Conclusions: This case describes patient with the biggest number of multiple unruptured intracranial aneurysms (MUIA) so far known in literature in a single patient

A rare case of multiple unruptured intracerebral aneurysms

Aim: To present a rare case of a patient with multiple unruptured intracranial aneurysms. Case report: A 82-year-old female patient with acute onset of headache without pain relief after tak- ing analgesics. Non–Enhanced Multi-slice Computed Tomography (MSCT) of brain was performed and multiple vascular anomalies were suspected. Diagnostic procedures were completed with cerebral MSCT angiography which proved presence of multiple unruptured inracranial aneurysms. Aneurysms are of asymmetric localization, probably due to acquired causes and usually smaller than 10 mm. Conclusions: This case describes patient with the biggest number of multiple unruptured intracranial aneurysms (MUIA) so far known in literature in a single patient

Child labor and educators on projects in kindergarten

Završni rad „Rad djece i odgojitelja na projektima u vrtiću“ se sastoji od sedam velikih cjelina. Na samom početku, izneseno je nekoliko uvodnih riječi koje će nas bolje upoznati s temom rada. Nadalje, ističe se važnost suvremenog shvaćanja djeteta kao i ustanova ranog odgoja. U samom središtu pozornosti je projekt sa svojim različitim definicijama na kojeg se nadovezuju pojedina istraživanja stanja u odgojnoj praksi te uvjeti koji su potrebni da bi se kvalitetan projekt ostvario. Ciklička struktura projekta podrobnije objašnjava sam tijek projekta uz vlastite primjere projekta „Svjetlo-sjena“. Slijedi poglavlje o ulozi odgojitelja u oblikovanju projekta, a sam kraj završava dokumentacijom koja je ujedno i najvažnije sredstvo projektnog učenja. Rad obiluje brojnim fotografijama i primjerima iz vlastite prakse koji je zaokružen sa nekoliko završnih rečenica o teorijskom i praktičnom djelu projekta. Također, na kraju rada priložen je popis tablica, slika i literature.The final paper “The work of children and educators in kindergarten projects” consists of seven large wholes. In the beginning, the introductory words will give us a deeper insight into the subject matter of the final paper. Furthermore, the focus is placed on the importance of modern understanding of the child, as well as of the institutions for early age upbringing. The centre point is the project with its different definitions particular studies of the condition in teaching practices complement to, and conditions required in order for a quality project to be achieved. The cyclic structure explains more thoroughly the flow of the project by providing personal examples of the project “Light-shadow”. The following chapter deals with the role of the educator in the organization of the project, while the end of the final paper provides the documentation which is the most important resource for the project’s learning process. The final paper consists of numerous photographs and examples from personal experience while the final part of the paper ends with several sentences referring to the theoretical and practical part of the project. In the end there is also a list of tables, of pictures and literature

BRACHIAL PLEXUS PALSY AND HOARSENESS OF THE VOICE DURING LUMBAR EPIDURAL ANALGESIA FOR LABOR AND DELIVERY: A CAUTIONARY TALE

The lumbar epidural analgesia is one of better ways of controlling pain during labor but it still can be followed with complications and unintentional side effects. Neurologic complications of epidural analgesia are rare. We present two cases of healthy women where epidural analgesia was induced during active labor. Repeated intermittent epidural doses of local anesthetics and the left lateral decubitus position of the patients induced the cephalic spread of the anesthetic drug along the epidural space with the appearance of unilateral brachial plexus palsy and hoarseness of the voice. These side effects disappeared spontaneously but caused anxiety in the patients and in all medical staff. Elevated control by anesthetists is necessary in case of epidural analgesia during active labor to avoid risky complications like the high sympathetic block

New Diagnostic Criteria for Multiple Sclerosis

Multiple sclerosis (MS) is diagnosed on the basis of clinical findings. The diagnosis requires the appearance of lesions separated in time and space and the exclusion of other symptoms that imitate MS. There are many classifications based on clinical presentation. These criteria have been replaced by criteria that include subclinical deficit seen on threedimensional analysis of the EMP (visual, brainstem auditory and somatosensory) or the MRI of CNS. As techniques for CSF analyses have improved, like the oligoclonal bands (OCBs) and the intrathecal immunoglobulin G (IgG) production, a new category has been created - MS supported by laboratory tests that are included in Poser’s diagnostic criteria for MS. In 2001 the McDonald criteria were recommended, and in 2005 and 2010 they were revised. They were created with the purpose to make the MS diagnosis more exact and well-timed. Many diseases can be similar to the multiphasic syndrome of CNS with relapse remitting course in young adults. In recent times diagnostic is eased by the use of MRI. It is considered the most sensitive imaging modality for diagnosing sensitivity of imaging. Sensitivity of imaging is 93% and it can be seen in determining the number, the size and the location of lesions. Despite high sensitivity in diagnosing MS, typical discrete multifocal lesions of white matter CNS seen on MRI are not specific only for MS. Many diseases show identical lesions on MRI imaging. Some examples of these diseases are: variants of MS (Charcot, Devic, Schilder, and Marburg), the process of physiological ageing, Alzheimer dementia, migraine, subcortical atherosclerotic encephalopathy (Binswanger disease), leukodystrophy, encephalitis, (provoked by viruses, spirochete, microbacteria of tuberculosis). Particular caution is needed in patients with clinical picture compatible with MS, and identical multiple lesions of white matter on MRI, but with normal CSL findings. In that case, it is necessary to perform further tests in order to get the final diagnosis. Difficulties in differential diagnosis are caused by neurological diseases which are similar to MS even in clinical and MRI results including CSL findings. No single test helps to establish or exclude an MS diagnosis. MS and other less frequent diseases are diagnosed only after a large number of diagnostic tests

N-glikozilacija imunoglobulina G u kroničnoj bolesti presatka protiv primatelja nakon presadbe alogeničnih matičnih krvotvornih stanica [N-glycosylation of immunoglobulin G in chronic graft-versus-host disease]

Chronic graft-versus-host disease (cGvHD) is a systemic alloimmune and autoimmune disorder and the major late complication and leading cause of non-relapse morbidity and mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT). The disease is characterized by an altered homeostasis of the humoral immune response. Immunoglobulin G (IgG) glycoprotein is the main effector molecule of the humoral immune response. Changes in IgG glycosylation are associated with a number of autoimmune diseases. IgG glycosylation analysis was done on two populations, American (213 cGvHD patients) and Croatian (30 cGvHD patients and 30 controls (after alloHSCT, without cGvHD)). The American population results showed significant correlation with cGvHD NIH joint/fascia and skin score, disease activity and intensity of systemic immunosuppression. ROC analysis confirmed that IgG glycosylation increases specificity and sensitivity of models using laboratory parameters and markers of inflammation. The Croatian logistic regression model built using glycan and laboratory parameters singled out glycopeptides for which it is justified to assume that they significantly contribute to the cGvHD discrimination. This study has shown that IgG glycosylation plays a significant role in cGvHD pathology, and that further research could contribute to the understanding of the disease biology and lead to the necessary biomarker of chronic GVHD

Child labor and educators on projects in kindergarten

Završni rad „Rad djece i odgojitelja na projektima u vrtiću“ se sastoji od sedam velikih cjelina. Na samom početku, izneseno je nekoliko uvodnih riječi koje će nas bolje upoznati s temom rada. Nadalje, ističe se važnost suvremenog shvaćanja djeteta kao i ustanova ranog odgoja. U samom središtu pozornosti je projekt sa svojim različitim definicijama na kojeg se nadovezuju pojedina istraživanja stanja u odgojnoj praksi te uvjeti koji su potrebni da bi se kvalitetan projekt ostvario. Ciklička struktura projekta podrobnije objašnjava sam tijek projekta uz vlastite primjere projekta „Svjetlo-sjena“. Slijedi poglavlje o ulozi odgojitelja u oblikovanju projekta, a sam kraj završava dokumentacijom koja je ujedno i najvažnije sredstvo projektnog učenja. Rad obiluje brojnim fotografijama i primjerima iz vlastite prakse koji je zaokružen sa nekoliko završnih rečenica o teorijskom i praktičnom djelu projekta. Također, na kraju rada priložen je popis tablica, slika i literature.The final paper “The work of children and educators in kindergarten projects” consists of seven large wholes. In the beginning, the introductory words will give us a deeper insight into the subject matter of the final paper. Furthermore, the focus is placed on the importance of modern understanding of the child, as well as of the institutions for early age upbringing. The centre point is the project with its different definitions particular studies of the condition in teaching practices complement to, and conditions required in order for a quality project to be achieved. The cyclic structure explains more thoroughly the flow of the project by providing personal examples of the project “Light-shadow”. The following chapter deals with the role of the educator in the organization of the project, while the end of the final paper provides the documentation which is the most important resource for the project’s learning process. The final paper consists of numerous photographs and examples from personal experience while the final part of the paper ends with several sentences referring to the theoretical and practical part of the project. In the end there is also a list of tables, of pictures and literature