The first clinic of the University hospital centre in Osijek

U radu se opisuje povijesni razvoj Klinike za unutarnje bolesti Kliničkoga bolničkog centra u Osijeku. Godine 1874. osnovana je Huttler-Kohlhoffer-Monspergerova zakladna bolnica s dva odjela (Odjel za unutarnje bolesti i Odjel za „izvanjske“ kirurške bolesti). Prvi je rukovoditelj Internoga odjela, ujedno i ravnatelj bolnice, bio primarijus dr. Ferdo Knopp, koji je ijedan od osnivača i pokretača najstarijega hrvatskoga časopisa „Glasnika Družtva slavonskih liečnika“. Sljedeći je ravnatelj bolnice bio primarijus dr. Vatroslav Schwarz, internist i rukovoditelj Internoga odjela, koji pridonosi cjelokupnom razvitku i drugih struka te pod njegovom upravom bolnica od provincijske postaje središnja zdravstvena ustanova za to područje. U radu se nadalje daje kronološki pregled razvoja znanstvenoga, nastavnoga i stručnoga rada Klinike za unutarnje bolesti i zaslužnih osoba koje su pridonijele i pridonose razvoju Klinike za unutarnje bolesti, koja je uključena u znanstveno-nastavni rad i sastavnica je Medicinskoga fakulteta Sveučilišta J. J. Strossmayera u Osijeku.The paper describes historical development of the Clinic for Internal Diseases at the Clinical Hospital Centre in Osijek. Huttler- Kohlhotfer-Monsperger Foundation Hospital with two departments (Department of Internal Diseases and Department of external surgical diseases) was founded in 1874. The first head of the Department of Internal Diseases was the hospital manager, Primarius Dr. Ferdo Knopp, who was one of the founders and initiators of the oldest Croatian magazine "Glasnik Društva slavonskih liečnika". Next hospital manager was Primarius Dr. Vatroslav Schwartz, doctor of internal medicine and head of the Department of Internal Medicine, who has contributed to the general development of other specialties as well, and under his management the hospital turned from a provincial to central health facility of that area. Furthermore, the author chronologically presents the development of the professional work of Clinic tor Internal Diseases and people who have contributed to development of the Clinic for Internal Diseases, which has been included into scientific and teaching work and has been a constituent part of the Faculty of Medicine, J. J. Strossmayer University in Osijek

Myocardial Infarction and Circadian Rhythm

Human physiological activity and condition during illness are under the control of the circadian rhythm. Circadian rhythms handle a wide diversity of physiological and metabolic functions, and the interruption of these rhythms has been linked to obesity, sleep disorders, metabolic and psychological disorders, and cardiovascular events such as myocardial infarction (MI), stroke, and vascular death. Disruption of circadian rhythms increases the risk of developing myocardial infarction, indicating that circadian genes might play an essential role in determining disease susceptibility. It is well known that many cardiovascular processes show daily variations depending on the circadian rhythm (blood pressure, heart rate), and the gene expression of the cardiomyocyte circadian clock influences myocardial contractile function, metabolism, and other gene expressions. We present a review of the latest knowledge on the impact of circadian rhythm and circadian rhythm genes on myocardial infarction. Today, in a time of personalized medicine, it is essential to know each person’s circadian rhythm for its treatment and possible inclusion in the diagnostic procedures

The Role of Esophagus in Voice Rehabilitation of Laryngectomees

The total laryngectomy is a standard procedure of laryngeal carcinoma treatment which leaves multiple persistent consequences on a laryngectomized person. After laryngectomy, all of patients cannot speak loudly, and 10–58% patients have a dysphagia. In such changed anatomical condition, the esophagus has a key function in two of three primary approaches to voice—speech rehabilitation of laryngectomized patients: esophageal and tracheoesophageal speech therapy method because one of these is the only acceptable solution of substitute alaryngeal speech. In esophageal speech, the esophagus has the role of speech air reservoirs since the respiratory and digestive pathways are permanently separated after the procedure. In the production of tracheoesophageal speech, the tracheoesophageal fistula and the esophagus allow the recommunication of these pathways and the use of air from the lungs for speech. There are several prerequisites for successful esophageal and tracheoesophageal speech. After tracheoesophageal puncture and insertion, the tracheoesophageal prosthesis may occur different complications in the early or late postoperative period in 10–60% of patients. The quality of alaryngeal voice is very different from the quality of laryngeal voice, but allows communication to laryngectomees

Clinical and Molecular Features of Pleural Mesothelioma

Mezoteliom predstavlja agresivni tumor nastao neoplastičnom transformacijom mezotelnih stanica seroznih ovojnica. Iako može nastati na bilo kojoj anatomskoj lokalizaciji koja sadrži mezotel, najčešće se javlja na pleuri. U Hrvatskoj je u 2018. zabilježeno ukupno 97 slučajeva s prosječnom stopom incidencije od 2,4/100 000 osoba. Najveći broj slučajeva mezotelioma uzrokovan je profesionalnim i okolišnim izlaganjem spojevima azbesta, a otkrivaju se s latencijskim razdobljem i od nekoliko desetaka godina, vrlo često u uznapredovalom kliničkom stadiju kada su terapijske mogućnosti znatno ograničene. Stopa ukupnog preživljenja izrazito je nepovoljna. Nastanak mezotelioma temelji se na razvoju kroničnoga upalnog procesa potenciranog utjecajem mutagenih radikala iona kisika i proteinske molekule HMGB1 (engl. High Mobility Group Protein B1) što unutar mezotelnih stanica dovodi do aktivacije signalizacijskog puta NF-kB (engl. Nuclear Factor Kappa-Light-Chain-Enhancer of Activated B-Cells). Nastali mikrookoliš dovodi do neoplastične transformacije mezotelnih stanica, osobito onih s već ranije akumuliranim genskim oštećenjima. U predmetnom članku sažeta je epidemiologija, etiopatogeneza i klinički tijek mezotelioma, a dodatno se osim standardnih dijagnostičkih modaliteta diskutiraju uloge različitih slikovnih metoda prikaza i primjene serumskih i molekularnih biomarkera u kliničkoj obradi bolesnika. Također su pregledno opisane i sažete trenutno dostupne mogućnosti liječenja koje obuhvaćaju kirurško, kemoimunoterapijsko, radioterapijsko i multimodalno liječenje.Mesothelioma is an aggressive tumor caused by neoplastic transformation of mesothelial cells of the serous membranes. Although it can occur at any anatomical localization that contains a mesothelium, it most often occurs in the pleura. In 2018, a total of 97 cases were recorded in Croatia with an average incidence rate of 2.4/100.000 persons. Most cases of mesothelioma are caused by occupational and environmental exposure to asbestos compounds, and are diagnosed with a latency period of several decades, very often in an advanced clinical stage when therapeutic options are significantly limited, and the overall survival rate is extremely unfavorable. The pathophysiology of mesothelioma is based on the development of a chronic inflammatory process potentiated by the influence of mutagenic oxygen ion radicals and the protein molecule HMGB1 (High Mobility Group Protein B1), which leads to activation of the NF-κB (Enhancer of Activated B-Cells) signaling pathway within mesothelial cells. The resulting microenvironment leads to neoplastic transformation of mesothelial cells, especially those with previously accumulated genetic damage. The present article summarizes the epidemiology, etiopathogenesis and clinical course of mesothelioma, and additionally discusses the roles of different imaging techniques as well as application of serum and molecular biomarkers on top of standard diagnostic modalities. Finally, the article presents currently available treatment options that include a surgical approach, chemoimmunotherapy, radiotherapy, and multimodality treatment

Epidemiology and Clinical Presentation of Inflammatory Bowel Disease in Zadar County, Croatia

Results of the retrospective, population-based study, 2000–2010, on inflammatory bowel disease, ulceratice colitis (UC) and Crohn\u27s disease (CD), from Zadar County, have been presented and compared with world experience and com- parative data from Primorsko-Goranska and Vukovarsko-Srijemska Counties. The average incidence rates (per 100 000) were 8.2 and 8.4, for UC and CD, respectively. Prevalence rates, at the end of the follow up, were 133.9 for UC and 111 for CD. Constant increase in the incidence rates for both, UC and CD, have been recorded, for CD more prominently in the second part of the follow up, 2006–2010. Prevalence rates have being continuosly rased for both diseases, data for UC ex- ceeding that for CD. Results of data comparison among the counties contribute in favour to the hypothesis of Zadar County as a rapidly developing area and strongly argue against the existence of the North-South gradient between Vukovarsko-Srijemska and Zadar Counties

Clinical Expression of Inflammatory Bowel Diseases – A Retrospective Population-Based Cohort Study; Vukovarsko-Srijemska County, Croatia, 2010

Clinical characteristics of the cohort of 150 patients with inflammatory bowel diseases, ulcerative colitis (UC) and Crohn\u27s disease (CD), Vukovarsko-Srijemska County, Croatia, were retrospectively assessed. UC was clinically presented with frequent passage of bloody, slimy stools, while preferential symptoms of CD were fever, anemia and severe weight loss, differences reflecting longer duration of symptoms prior to the diagnosis, in patients with CD. The prevalent disease localisations, in patients with UC, were the rectum and the left colon and the anorectum, while the prevailing phenotype, in patients with CD, corresponded with younger adult age at disease onset, ileocolonic localization and stricturing dis- ease behavior. Intestinal complications, including perforation, fistula, abscess and ileus, were more prevalent in patients with CD. Of extraintestinal complications, only ankylosing spondylitis and erythema nodosum, reached marginally sig- nificant differences, in favor to patients with CD. Shortcomings of this study include the lack of associations and the time-dependent disease projections

Legislation on Dental P Practice in Croatia in the Second Half of the 19th Century

In the second half of the 19th century, Croatia experienced a radical change in the performance of dental practice and legislation that regulates such practice. From the old feudal system when dental practice was practised by barbers-surgeons and feldshers (Old Croatian language: vidari), it is transferred to a more modern system where dental practice becomes a part of medical sciences and its implementation requires adequate medical education. The most important factor that contributed to this was the adoption of new modern laws in 1874, and then in 1894, as well as accompanying regulations, which adequately regulated the matter of public health and dental practice

Infekcija hepatitis B virusom

Zdravstveni teret infekcije hepatitis B virusom se najbolje zrcali u epidemiološkim podacima Svjetske zdravstvene organizacije prema kojima 2 milijarde ljudi ima pozitivne serološke markere za preboljelu ili prisutnu HBV infekciju. Oko 350 milijuna njih postali su kronični nositelji ovog virusa i predstavljaju mogući izvor novih infekcija, a pod rizikom su razvoja ciroze jetre i primarnog karcinoma jetre. Kroničnoj HBV infekciji se može pripisati trećina svih hepatalnih ciroza i polovica slučajeva hepatocelularnog karcinoma (HCC), a procjenjuje se da HBV infekcija posredno dovodi do 500 000-700 000 smrti godišnje. Mjere prevencije i kontrole HBV infekcije obećavaju bolju epidemiološku sliku u budućnosti, najvećim dijelom zahvaljujući HBV cjepivu koje je 1981.god. odobreno u SAD-u, a danas je standard u kalendarima cijepljenja novorođenčadi, djece te svih osoba pod povišenim rizikom transmisije HBV-a. U zemljama u kojima je rano prihvaćen program cijepljenja HBV cjepivom, zamijećen je povoljan trend redukcije sekvela kronične HBV infekcije, a kako udio populacije procijepljene protiv HBV raste, predviđa se da bi epidemiološka struktura trebala biti sve bolja, bar što se tiče de novo infekcija HBV-om.  Iako je HBV tropan za hepatocite, u patogenezi lezije hepatocita direktni učinak HBV nije presudan. Značajnija je aktivacija imunih mehanizama „obrane“ stanice koja završava programiranom smrti stanice – apoptozom. Ipak, najveći problem današnjice koji ograničava uspjeh prevencije HBV infekcije je činjenica da značajan broj HBV inficiranih osoba nikada ne bude dijagnosticiran niti liječen čime se promovira opstanak rezervoara hepatitis B virusa. Smatra se da je u Hrvatskoj broj kroničnih nositelja HBV oko 65 000 (<2%), dok se pouzdano ne zna koliko je de novo infekcija HBV

Health-Related Quality of Life in Antiviral-Treated Chronic Hepatitis C Patients

Chronic hepatitis C has a profound negative impact on both physical and mental well-being, thus decreasing health-related quality of life (HRQL). The most common complaints include symptoms such as fatigue, depression, and neurocognitive deficits. The burden of chronic HCV infections is multiplied by emotional and psychological issues that affect patients’ functional health and work ability. Treatment of chronic HCV infection may at the beginning cause worse HRQL rates, as a result of common adverse effects like fatigue, muscle aches, and depression. However, the relationship between sustained virologic response (SVR) and improvement in HRQL is well known. Treatment-related adverse effects may discourage patients from starting therapy and reduce their adherence to treatment. Novel agents, with improved adverse effect profiles and SVR rates, allow more patients the opportunity to achieve improvements in HRQL during and after treatment

Gastrointestinal stromal tumour (GIST)

Stromalni / mezenhimalni tumori su dugo unosili konfuziju u klasifikaciji kao i prognostici biološkog ponašanja. Gastrointestinalni stromalni tumor uglavnom se javlja u srednjoj i starijoj životnoj dobi, s primarnom lokalizacijom 70% u želucu te 20% u tankom crijevu. Obično ostanu klinički pritajeni sve dok ne dosegnu veći promjer te izazovu simptome rupturiranjem, krvarenjem ili opstrukcijom. Terapija GIST-a je prototip liječenja zasnovanog na načelu "single target molecule" gdje je ciljni enzim abnormalni protein tirozinkinazne aktivnosti, tzv. KIT protein.Stromal/mesenchymal tumours of the gastrointestinal tract have long been a source of confusion regarding their classification and prognostic implications. GISTs predominantly occur in middle-age and older persons, primarily localized in the stomach (70%) and small intestine (20%). Usually GISTs remain silent until they reach a large size and thus provoke sympthoms by rupturing, bleeding or causing obstruction. GISTs therapy serves as prototype pattern of treatment based on the principle of" single target molecule" mechanism targeting KIT protein as abnormal enzyme with thyrosinkinase activity expressed by many GISTs