Bezglutenski proizvodi namijenjeni osobama s celijakijom nisu dobar izvor folata i vitamina B12

The gluten-free diet, the only treatment in coeliac disease, can be nutritionally unbalanced and deficient in several nutrients. Gluten-free products contain much lower levels of B vitamins, especially lower folate concentrations than their gluten-containing counterparts. Folate intake is considered as a major dietary determinant of plasma homocysteine concentration in healthy population. Elevated homocysteine is an independent risk factor for cardiovascular disease and has been associated with osteoporotic fractures, which are an increased risk factor in coeliac disease. The aim of this study is to determine dietary folate intake and plasma homocysteine concentration as metabolic markers of suboptimal intake of folate and B12 in Croatian coeliac patients living on a gluten-free diet. Subjects were 52 coeliac patients (83 % female, age 35±13) adhering to a gluten-free diet. Blood samples were analyzed for plasma homocysteine, serum and red blood cell folate and serum B12. Quantitative food frequency questionnaire was used to measure dietary folate intake. Mean dietary folate intake was 206 mg of dietary folate equivalents (DFE), which was far below the national recommendation of 400 µg of DFE (or 200 μg of folic acid). Mean homocysteine was (9±2) μmol/L (range from 5.42 to 13.90 μmol/L), while elevated homocysteine concentrations (>10 μmol/L) were found in 34 % of subjects. In conclusion, coeliac patients adhering to gluten-free diet included in this study showed low folate intake and suboptimal folate and vitamin B12 status, possibly due to low folate content in gluten-free products. Therefore, folate fortification or enrichment of gluten-free products could be beneficial for coeliac patients and it would be of great interest for the food industry.Bezglutenska prehrana, jedini lijek za oboljele od celijakije, može biti neuravnotežena zbog nedostataka nekih hranjivih tvari. Bezglutenski proizvodi sadrže manju količinu vitamina B, osobito folata, nego slični proizvodi koji sadrže gluten. U zdravih osoba koncentracija homocisteina u plazmi uglavnom ovisi o prehrambenom unosu folata. Povećana vrijednost homocisteina u posljednje se vrijeme povezuje s osteoporozom koja je učestala u osoba s celijakijom. Svrha je ovoga rada utvrditi unos folata i status homocisteina kao metaboličkoga biljega suboptimalnog unosa folata i vitamina B12 u osoba s celijakijom na području Republike Hrvatske. U istraživanju su sudjelovale 52 osobe s celijakijom koje su na bezglutenskoj prehrani (83 % žena, dobi 35±13 godina). Analizom krvi utvrđena je koncentracija homocisteina, folata u serumu i eritrocitima te vitamina B12 u serumu. Kvantitativni je upitnik za procjenu unosa hrane i pića upotrijebljen radi utvrđivanja prehrambenog unosa folata. Prosječni je unos folata bio 206 µg ekvivalenata folata (eng. dietary folate equivalents-DFE), što je kudikamo manje od nacionalne preporuke koja navodi 400 µg DFE odnosno 200 µg folne kiseline. Prosječna vrijednost homocisteina iznosila je 9±2 µmol/L (raspon 5,42-13,90 µmol/L). Povećana vrijednost homocisteina (>10 µmol/L) utvrđena je u 34 % ispitanika. Može se zaključiti da osobe s celijakijom koje se pridržavaju bezglutenske prehrane, a sudjelovale su u ovom istraživanju, imaju mali unos folata i suboptimalan status folata i vitamina B12, vjerojatno zbog unosa folatom siromašnih bezglutenskih proizvoda. Stoga bi obogaćivanje ili dodatak folata u bezglutenske proizvode mogao povoljno utjecati na osobe s celijakijom, te predstavljati izazov prehrambenoj industriji

The Carcinoid Tumour in Meckel’s Diverticulum: How to Treat Young Adults with Appendicitis? – Case Report

This case reports the concomitant and unexpected finding of carcinoid tumour within a Meckel’s diverticulum presenting as an acute abdomen due to gangrenous appendicitis in a young adult male. Both Meckel’s diverticula and carcinoid tumour are rare clinical entities, and carcinoid tumours occurring within a Meckel’s diverticulum are even more uncommon. The initial clinical presentation of carcinoid tumours occurring in a Meckel’s diverticulum is usually similar to that of appendicle carcinoids.Carcinoid tumours are the most common primary tumour of the small bowel. They resemble appendicle carcinoids to the extent that they are usually small, single, and asymptomatic. Surgical treatment of Meckel’s diverticula is recommended procedure. By presenting this case we wished to stress the value of systematic identification and removal of the diverticulum during laparotomy and to underline the importance of exploration the Meckel’s diverticulum particularly in case of young adult subjects

Early diagnosis of breast angiosarcoma

Angiosarcoma is a rare and aggressive soft tissue breast cancer. It occurs in a primary form without a known precursor, typically in younger patients. In a secondary form, it is associated with a history of irradiated breast tissue, and it usually occurs in older patients. It can happen as many as 8-10 years after getting radiation treatment to the breast. When combined with chronic lymphedema, secondary angiosarcoma in an edematous limb after mastectomy and radiotherapy is referred to as Stewart- Treves syndrome. Secondary angiosarcomas spread to the parenchyma, while primary forms arise in the parenchyma

Bilateral Synchronous Breast Cancer

We report a rare case of synchronous bilateral breast cancer in 79-year old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical removal of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor

Blunt Trauma of Thorax with Subclavian and Axillary Artery Lesion - Case Report

We report a rare case of blunt trauma of the axillary artery in the 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there is a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination is made to the patient (X-ray, US, CDFI, MSCT - angiography) and we found out that there is trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition in to the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg is made and emergency exploration of earlier mentioned arteries. Bypass of the damaged arteries with synthetic graft 6mm in diameter was made. Control MSCT angiography showed normal flow in the arterial tree of the whole left hand and the MRI of the cervical spine and shoulder girdle did not found lesions of the brachial plexus. SSEP demonstrate the absence of pulses on the left hand. Patient on regular check-ups showed normal general condition, with adequate passable graft and pronounced paralysis on the left hand. In the process of rehabilitation physiotherapy was also included. Blunt trauma to the axillary artery is an extremely rare example of trauma of blood vessels which makes only 0.03% of all vascular injuries

Orbitalni kavernozni hemangiom

The aim of this case report was to present a patient with a benign orbital tumor, cavernous hemangioma, who presented with symptoms of compressive orbital mass: unilateral axial proptosis, with motility restriction and sudden vision loss in the left eye. Ophthalmologic examination (visual acuity, applanation tonometry, Goldmann tonometer, visual field) and radiologic examination diagnosed a benign, well circumscribed, vascular, intraconal tumor that compresses the optic nerve. Treatment was operative: lateral orbitectomy Krönlein procedure and the tumor was removed. Pathologic and pathohistologic examination confirmed the previous diagnosis. Follow up examination, visual field and MRI of the orbit showed considerable improvement. Surgical treatment was also the final treatment and no adjuvant therapy was necessary. Prognosis for visual acuity and life is excellent.Cilj ovog rada bio je prikazati slučaj pacijentice s benignim tumorom orbite, kavernoznim hemangiomom, koji se javlja sa simptomima kompresivne tvorbe u orbiti: unilateralnom proptozom, smetnjama motiliteta te naglim gubitkom vida lijevog oka. Oftalmološkom obradom (ispitivanje vidne oštrine, aplanacijska tonometrija, ispitivanje vidnog polja po Goldmannu) te radiološkom obradom (MR, MSCT, MSCT angiografija) postavlja se dijagnoza benigne, dobro ograničene, vaskularne tvorbe u konusu koja pritišće očni živac. Pristupilo se operativnom zahvatu, napravila se lateralna orbitektomija po Krönleinu i odstranio tumor u cijelosti. Patološka i patohistološka pretraga potvrđuju raniju dijagnozu. Postoperativni tijek protiče uredno te se na nalazu kontrolnog vidnog polja i kontrolnim snimkama MR-a utvrđuje značajno poboljšanje. Kod pacijentice je kirurško liječenje bilo i konačno te nije bila potrebna dodatna terapija. Prognoza za vidnu oštrinu i život je odlična

Hernia of Morgagni – Case Report

Morgagni’s hernia is result of penetration of the abdominal contents into the chest through an anterior retrocostoxiphoid defect in the anterior midline of the diaphragm. It can be manifested with symptoms since birth as a bloated feeling, nausea and belching after meals. We present a patient with symptomatic herniation of the torqued antral part of stomach and loops of the transverse colon. In our case, chest and abdominal radiography after oral intake of contrast are used to diagnose this condition. Herniation was reduced surgically by a transabdominal approach. At the control examination one year after surgery in our patient all symptoms have disappeared, and was given 15 kg of body weight

Fist Fractures at Child’s Age

The aim of this work is to confirm or deny the hypothesis that the fist fracture medical treatment at child’s age in the General Hospital in Zadar does not differ much from the medical treatment method in other centers which have already published their results. The work is based on the retrospective study. The examinees are children with fist fractures in the General Hospital in Zadar from 1999 to 2003. The control group is formed by the examinees of the published studies about children fist fractures, which have been collected and statistically elaborated. The examinees of our group and the control group are classified by the same criterion: age, sex, place, sort and type of fracture as well as the method of medical treatment. The used statistical methods are the testing of frequency differences and c 2 test. Statistically essential differences between our group and the control group have been noticed. There are also differences among the control group subgroups. The difference in the method of medical treatment is statistically essential and shows that the methods are not the same as in our group and the control group. The surgical way of treatment is less represented by our results than in those of the control group. The different attitude in medical treatment is conditioned by the attitude that surgical intervention of finger bones does not always give us the expected functional result

Diet Quality in Elderly Nursing Home Residents Evaluated by Diet Quality Index Revised (DQI-R)

The objective of this research was to evaluate diet quality in elderly nursing home residents and to point out the critical dietary components. The participants (277 females and 62 males) were recruited from all elderly nursing homes in Zagreb and each of elderly nursing homes was equally represented in this study. The age of subjects was ranging from 61 to 93 years; most of the females (53.4%) and males (53.2%) were between 70 and 80 years old. The dietary data from the multi pass 24-hour recall were used to compute the Diet Quality Index Revised (DQI-R). DQI-R is an instrument that provides a summary assessment of a diet’s overall healthfulness and is based on ten different aspects, including recommendations for both nutrient and food types. Pearson correlation analysis was used to compare the total DQI-R score with dietetic parameters and t-test was calculated between mean values of all the components of DQI-R as well as for total DQI-R score for men and women. The mean DQI-R score for the 339 sample was 62.1±11.7. The biggest number of participants satisfied recommendations about dietary cholesterol intake (88.5 % of participants) and dietary moderation score (71.1% of participants) but nobody satisfied recommendation about dietary diversity score. Only 3.2% of subjects had an adequate calcium intake (6.5% of male participants and only 2.5% of female participants). Recommended servings of fruit intake were satisfied by 19.8% of population, 30.4% satisfied vegetables recommendations and 38.6% recommendations for grains. According to DQI-R, beside positive dietary habits regarding dietary moderation and dietary cholesterol intake the population of elderly nursing home residents in the capital of Croatia needs improvement in other dietary habits in order to enhance successful aging

Giant Spinal Schwannoma in a 76-year-old Woman - A Case Report

A schwannoma is a benign nerve sheath tumor composed of Schwann cells. Spinal schwannoma originates from dorsal roots of the spinal cord, causing symptoms due to the compression of neighboring structures. We present a patient with a low back pain and left L2 and L3 radiculopathy. Neuroimaging techniques (CT, MRI) showed a large expansive mass in the left lumbar paraspinal area. The tumor was removed totally by the posterior approach and was verified to originate from the left L2 spinal nerve root. The histopathological examination revealed typical findings of a schwannoma. The pain was resolved promptly after the surgery, however the patient’s neurological condition wasn\u27t improved. Surgical treatment was a final treatment, and no additonal therapy was necessary