Breast Reconstruction after Mastectomy

Results of our analysis show as that breast reconstruction become a standard part of the care of female patients with breast cancer. We will analyse the factors that are important for the primary or secondary breast reconstruction after mastectomy, and also take a closer look on the most recent scientific advances on breast reconstruction and on the protocols regarding them. The breast is the most common site of cancer in Croatia women. Breast cancer is the first leading cause of cancer death among women today. The incidence of female breast cancer in Croatia estimates that approximately 2.200 news cases of female breast will be diagnosed every year. We retrospectively analysed data of 101 female patients undergoing reconstructive surgery for breast reconstruction after mastectomy at Division of Plastic Surgery and Burns, University Hospital Center Split and University Clinic of Plastic and Reconstructive Surgery, Innsbruck, Austria, between 1998 and 2008. For the purpose of outcome assessment, we performed the tree different type of questionnaire: (1) Personal/medical profile (Table 1), (2) Aesthetic assessment (Table 2), and (3) Psychosocial assessment (Table 3). The occurrence of main complications during breast reconstruction (partial necrosis of flap, hernia of donor site, pulmonary embolism, deep venous thrombosis, infection rate, hemathoma and seroma formation, and extrusion of expander/implant) during hospitalisation and follow up period until 6 post operatively were analysed with respect to use different type of reconstructive methods for breast reconstruction. The difference in complication between patients groups was evaluated by c2-test. The level of significance was set up at p=0.05. Mann-Whitney test was used to compare the time from mastectomy to breast reconstruction, due to asymmetrical data distribution. The three main variables of this study were to identify significant risk factors, asses the aesthetic outcome, and patient satisfaction with performed different methods for breast reconstruction (LD flap with or without tissue expander and implant, pedicle and free TRAM flaps, and expander /implants only. These variables determined the current guidelines for early and late breast reconstruction after mastectomy such as patient data, age and own decision, relation ship between reconstruction and radiotherapy, and chemotherapy, and finally about breast preserving operation. The result should confirm that breast reconstruction after mastectomy is justified, especially in young women, as well as how essential is team work involved in breast cancer operation and breast reconstruction after mastectomy

Breast Reconstruction after Mastectomy

Results of our analysis show as that breast reconstruction become a standard part of the care of female patients with breast cancer. We will analyse the factors that are important for the primary or secondary breast reconstruction after mastectomy, and also take a closer look on the most recent scientific advances on breast reconstruction and on the protocols regarding them. The breast is the most common site of cancer in Croatia women. Breast cancer is the first leading cause of cancer death among women today. The incidence of female breast cancer in Croatia estimates that approximately 2.200 news cases of female breast will be diagnosed every year. We retrospectively analysed data of 101 female patients undergoing reconstructive surgery for breast reconstruction after mastectomy at Division of Plastic Surgery and Burns, University Hospital Center Split and University Clinic of Plastic and Reconstructive Surgery, Innsbruck, Austria, between 1998 and 2008. For the purpose of outcome assessment, we performed the tree different type of questionnaire: (1) Personal/medical profile (Table 1), (2) Aesthetic assessment (Table 2), and (3) Psychosocial assessment (Table 3). The occurrence of main complications during breast reconstruction (partial necrosis of flap, hernia of donor site, pulmonary embolism, deep venous thrombosis, infection rate, hemathoma and seroma formation, and extrusion of expander/implant) during hospitalisation and follow up period until 6 post operatively were analysed with respect to use different type of reconstructive methods for breast reconstruction. The difference in complication between patients groups was evaluated by c2-test. The level of significance was set up at p=0.05. Mann-Whitney test was used to compare the time from mastectomy to breast reconstruction, due to asymmetrical data distribution. The three main variables of this study were to identify significant risk factors, asses the aesthetic outcome, and patient satisfaction with performed different methods for breast reconstruction (LD flap with or without tissue expander and implant, pedicle and free TRAM flaps, and expander /implants only. These variables determined the current guidelines for early and late breast reconstruction after mastectomy such as patient data, age and own decision, relation ship between reconstruction and radiotherapy, and chemotherapy, and finally about breast preserving operation. The result should confirm that breast reconstruction after mastectomy is justified, especially in young women, as well as how essential is team work involved in breast cancer operation and breast reconstruction after mastectomy

Current Trends in Breast Reduction

Results of our study describe the long term effects of reduction mammaplasty. Many women with excessively small or large breasts have an altered personal self-image and often suffer from low self-esteem and other psychological stresses. This procedure is designed to reduce and reshape large breasts, and since the size, shape, and symmetry of a woman’s breasts can have a profound effect on hermental and physical well-being it is important to observe the patient’s long-term outcome. Currently, breast reduction surgery is safe, effective and beneficial to the patient. In Croatia, reduction mammoplasty is often excluded from the general health care plan. The distinction between »reconstructive« versus »cosmetic« breast surgery is very well defined by the American Society of Plastic Surgeons Board of Directors. Unfortunately, the Croatian Health Society has yet to standardize such a distinction. There is an imperative need for evidence-based selection criteria. We retrospectively analyzed data of 59 female patients suffering from symptomatic macromastia who underwent reduction mammaplasty over a 16 year period (1995 until 2011). Our aim was to compare and contrast the various techniques available for reduction mammaplasty and to determine, based on patient outcome and satisfaction, which technique is most suited for each patient. The results of our study generally reinforce the observation that reduction mammaplasty significantly provides improvements in health status, long-term quality of life, postsurgical breast appearance and significantly decrease physical symptoms of pain. A number of 59 consecutive cases were initially treated with the four different breast reduction techniques: inverted-T scat or Wisa pattern breast reduction, vertical reduction mammaplasty, simplified vertical reduction mammaplasty, inferior pedicle and free nipple graft techniques. The average clinical follow-up period was 6-months, and included 48 patients. The statistical analysis of the postoperative patient complications revealed a significant positive relationship in regards to smoking. The majority of these complications were wound related, with no significant relationship between patient complications and variables such as age, BMI, ASA score, resection weight of breast parenchyma, nipple elevation, duration of surgery, and type of pedicle. The higher number of complication correlated with a lower volume of parenchyma resection (rho=–0.321). Overall satisfaction with the new breast size (79%), appearance of the postoperative scars (87%), overall cosmetic outcome score (91%), overall outcome (100%), psychosocial outcome (46%), sexual outcome (85%), physical outcome (88%), satisfaction with preoperative information data (92%), and finally satisfaction with overall care process (96%) was calculated. As expected, the physical symptoms disappeared or were minimized in 88% of patients. Each method of breast reduction has its advantages and disadvantages. The surgeon should evaluate each patient’s desires on the basis of her physical presentation. Breast reduction surgery increases the overall personal and social health; not only for the patient, but for their family and friends as well. It is an imperative that every surgeon is aware of this, in order to provide the highest level of care and quality to their patients

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods

ULOGA PSIHIJATRA U LIJEČENJU OPEKLINSKIH TRAUMA

Psihijatrijski simptomi općenito se pojavljuju kao dio složenog sistemskog odgovora na opeklinsku ozljedu. Psihološko i farmakološko liječenje neophodno je za uspješni oporavak bolesnika ili barem za smanjenje psihijatrijskih posttraumatskih posljedica. Treba imati na umu da je psihološka adaptacija dugotrajan proces koji traje mjesecima pa i godinama. Nužno je da opeklinski tim stručnjaka uz procjenjivanje tjelesnog oporavka bolesnika, uporedo procjenjuje i njegovo psihičko i afektivno stanje. Iako većina bolesnika može postići zadovoljavajuću prilagodbu, mnogi se nastavljaju boriti sa slikom o sebi, ljutnjom, bijesom, tugom, nesanicom, strahom, povlačenjem, bijegom od ranijih aktivnosti, što iziskuje nastavak psihoterapijskog i psihijatrijskog liječenja. Psihijatrijsko bi liječenje zahtijevalo i usvajanje određenih smjernica u liječenju takvih bolesnika

Influence of Adjuvant Hyperbaric Oxygen Therapy on Short-term Complications During Surgical Reconstruction of Upper and Lower Extremity War Injuries: Retrospective Cohort Study

Cilj Odrediti utjecaj liječenja hiperbaričnom oksigenacijom (HBO) na kratkoročne komplikacije složenih ratnih ozljeda gornjih i donjih udova u ranjenika koji su bili i koji nisu bili liječeni u skladu s kirurškom strategijom Organizacije Sjeverno-atlantskog sporazuma (NATO). Postupci Retrospektivno smo analizirali podatke o kohorti 388 muških bolesnika na kojima je izveden rekonstruktivni kirurški zahvat ratnih ozljeda Gustilo tipa III A, B i C na udovima na Odjelu za rekonstruktivnu kirurgiju Sveučilišne bolnice u Splitu u razdoblju između 1991. i 1995. godine. Analizirani su pojava glavnih komplikacija ozljeda (duboka infekcija, osteomijelitis, liza kožnog presadka i nekroza tkivnoga presatka) za vrijeme hopitalizacije, te vrijeme od ranjavanja do stvaranja granulacijskog tkiva s obzirom na korištenje HBO liječenja kao rizičnog čimbenika. Izračunat je omjer izgleda (OR) s 95% rasponom pouzdanosti (CI) za pojavu komplikacija uzimajući u obzir adjuvantno liječenje HBO, a on je potom logističkom regresijom prilagođen s obzirom na kiruršku strategiju NATO-a. Rezultati Od 388 bolesnika, 310 (80%) su liječeni u skladu s kirurškom strategijom NATO-a, a 99 (25%) ih je primilo adjuvantnu HBO. Duboka infekcija mekog tkiva razvila se u 196 (68%) bolesnika koji nisu primili HBO i u 35 (35%) koji su je primili (P<0.001). Osteomijelitis se razvio u 214 (74%) bolesnika koji nisu primili HBO i u 62 (63%) bolesnika koji su je primili (P=0.030). Liza kožnog presadka pojavila se u 151 (52%) bolesnika koji nije primio liječenje s pomoću HBO i u 23 (23%) bolesnika koji su ga primili (P<0.001, χ2 test). Nekroza tkivnoga presatka pojavila se u 147 (51%) bolesnika koji nije primio HBO i u 15 (15%) koji su je primili (P<0.001). Medijan vremena do stvaranja granulacijskog tkiva bio je 9 (5-57) dana u bolesnika koji su primili adjuvantno liječenje HBO i 12 (1-12) dana u bolesnika koji ga nisu primili (P<0.001, Mann-Whitney test). Rezultati su ostali dosljedni i u skupinama bolesnika stratificiranim prema stupnju ozbiljnosti ozljede i nisu se promijenili ni nakon prilagođavanja s obzirom na kiruršku strategiju NATO-a. Utjecaj adjuvantnog liječenja s pomoću HBO bio je veći u bolesnika koji su razvili duboku infekciju mekog tkiva a nisu bili liječeni u skladu s NATO strategijom (OR, 10.7 vs OR, 3.8; P=0.031 za interakciju). Zaključak Adjuvantno liječenje s pomoću HBO smanjilo je učestalost komplikacija ozljeda u ranjenika s ozljedama Gustilo tipa III i skratilo je vrijeme do stvaranja granulacijskog tkiva. U ranjenika koji nisu bili liječeni u skladu s doktrinom NATO-a HBO se pokazala važnijom u za sprječavanje duboke infekcije mekog tkiva, ali ne i nekroze tkivnog presatka.Aim To determine the effects of hyperbaric oxygen (HBO) therapy on shortterm complications of complex war wounds to the upper and lower extremities in patients who were and those who were not treated according to North Atlantic Treaty Organization (NATO) emergency war surgery recommendations. Method We retrospectively analyzed data of 388 male patients undergoing reconstructive surgery for Gustilo type III A, B, and C war wounds to the extremities at the Department of Reconstructive Surgery, Split University Hospital Center, between 1991 and 1995. The occurrence of main wound complications (deep infection, osteomyelitis, skin grafts lyses, and flap necrosis) during hospitalization and time from wounding to granulation formation were analyzed with respect to the use of HBO therapy as a risk factor. Odds ratio (OR) with 95% confidence intervals (CI) was calculated for the occurrence of wound complications with respect to HBO therapy and adjusted for NATO surgical strategy by logistic regression. Results Of 388 patients, 310 (80%) were initially treated according to the NATO surgical strategy and 99 (25%) received HBO therapy. Deep soft-tissue infection developed in 196 (68%) patients who did not receive HBO therapy and in 35 (35%) who received it (P<0.001, χ2 test). Osteomyelitis developed in 214 (74%) patients who did not receive HBO therapy and in 62 (63%) who received it (P = 0.030). Skin graft lysis occurred in 151 (52%) patients who did not receive HBO therapy and in 23 (23%) who received it (P<0.001). Flap necrosis occurred in 147 (51%) patients who did not receive HBO therapy and in 15 (15%) who received it (P<0.001). Median time to granulation formation was 9 (5-57) days in patients who received HBO therapy, and 12 (1-12) days in those who did not (P<0.001, Mann-Whitney test). These results were consistent over the groups of patients stratified according to the wound severity and remained unaltered after the adjustment for NATO surgical strategy. The effect of HBO therapy was greater in non-NATO than in NATO treated patients in case of deep soft-tissue infection (OR, 10.7 vs OR, 3.8; P = 0.031 for interaction). Conclusion HBO therapy reduced the frequency of wound complications in patients with Gustilo type III wounds and shortened the time to granulation formation. HBO therapy was more effective in non-NATO than in NATO treated patients for the prevention of deep soft-tissue infection but not flap necrosis

Delivery of hypertrophic term newborns in Split Clinical Hospital Center

Cilj rada: Istražiti učestalost, načine i čimbenike rađanja hipertrofične novorođenčadi u Klinici za ženske bolesti i porode KBC-a Split tijekom 2008. i 2009. godine. Materijali i metode: U istraživanje su uključene sve rodilje koje su u razdoblju od 2008. do 2009. godine rodile hipertrofičnu novorođenčad (n = 792). Iz istraživanja su isključene višeplodne trudnoće, te mrtvorođena i malformirana novorođenčad. Kontrolnu skupinu čine sljedeća dva porođaja terminske eutrofične vorođenčadi u promatranom razdoblju. Podaci su prikupljeni popisnom metodom iz pisanih rađaonskih protokola Klinike za ženske bolesti i porode KBC-a Split. Rezultati: U promatranom dvogodišnjem razdoblju rođeno je 8,76% hipertrofične novorođenčadi. Carskim rezom rođeno je 18,3% hipertrofične novorođenčadi i 15,1% eutrofične novorođenčadi (P = 0,072). Majke hipertrofične novorođenčadi su češće rađale uz pomoć epiziotomije (P = 0,002). Hipertrofična novorođenčad imala su statistički značajno veću (22,9%) prosječnu porođajnu težinu (P < 0,001), za 4,9% veću duljinu (P < 0,001), te za 6,3% viši ponderalni indeks u odnosu na eutrofičnu novorođenčad (P < 0,001). Učestalost gestacijskog dijabetesa melitusa bila je statistički značajno veća u majki hipertrofične novorođenčadi (P = 0,031). Zaključak: Fetalna hipertrofija je stanje povećanog perinatalnog rizika. Ultrazvukom prepoznat ubrzani fetalni rast može usmjeriti način daljnjega nadzora trudnoće, a neposredno prije poroda pomoći u izboru načina rađanja i vođenja porođaja.Aim: To investigate the frequency, mode of delivery and perinatal factors of hypertrophic term newborns at the Department of Gynaecology and Obstetrics, Split University Hospital in a two year period (2008- 2009). Methods: The study included all parturient women who gave birth to hypertrophic term infants between 2008 and 2009 (n = 792). Multiple pregnancies, stillborns and malformed newborns were excluded from the study. The control group consisted of two term births of eutrophic newborns following each delivery from the study group. Clinical data were gathered from the birth protocol of the Department of Gynaecology and Obstetrics, Split University Hospital. Results: In the analysed period 8.76% newborns were hypertrophic. Caesarean section was performed in 18.3% hypertrophic and 15.1% eutrophic newborns (P = 0.072). An episiotomy was preformed more frequently in women with hypertrophic newborns (P = 0.002). Hypertrophic newborns had 22.9% significantly higher average birth weight (P < 0.001), 4.9% average higher length (P < 0.001) and 6.3% higher average ponderal index (P < 0,001). The frequency of gestational diabetes mellitus was significantly higher in women with hypertrophic newborns (P = 0.031).Conclusion: Fetal hypertrophy is a state of increased perinatal risk. Ultrasound detected accelerated fetal growth can help in directing a way of further pregnancy monitoring, and immediately before delivery in selection of birth mode and conduction of delivery

Preterm births at the Department of gynecology and obstetrics, University hospital Split

Cilj: Prikazati odlike prijevremenih porođaja i nedonoščadi iz jednoplodovih trudnoća. Metode: Podaci za dvogodišnje razdoblje (2008. – 2009.) prikupljeni su popisnom metodom iz pisanih rađaoničkih protokola Klinike za ženske bolesti i porode KBC-a Split. Uključene su sve rodilje s prijevremeno rođenom novorođenčadi u ispitivanom razdoblju. Iz istraživanja su isključene višeplodove trudnoće, mrtvorođena i malformirana novorođenčad. Rezultati: Od ukupno 9 042 rođena novorođenčeta u Klinici za ženske bolesti i porode KBC-a Split tijekom dvogodišnjeg razdoblja kao nedonoščad je rođeno 436 (4,8 %). Carskim rezom rođena su 144 (33 %) nedonoščeta. Udio hipotrofične (11,6 % vs. 9,2 %; P = 0,113) i hipertrofične (7,3 % vs. 8,4 %; P = 0,438) novorođenčadi nije se razlikovao između nedonoščadi i terminske novorođenčadi. Ponderalni indeks nedonoščadi bio je manji u odnosu na terminsku novorođenčad (2,45 g/cm3 vs. 2,68 g/cm3; P < 0,001). Niska APGAR ocjena je trinaest puta češća (27,5 % vs. 2,1 %) u skupini nedonoščadi (P < 0,001). Zaključak: Učestalost rađanja nedonoščadi u Klinici ulazi u prosjek razvijenih zemalja svijeta, porođaji nedonoščadi povezani su s većom učestalosti carskog reza te nema razlike u učestalosti hipotrofije i hipertrofije nedonoščadi u odnosu na terminsku novorođenčad. Kod nedonoščadi je ponderalni indeks u prosjeku niži.Aim: This paper presents characteristics of preterm births and preterm infants from singleton pregnancies. Methods: The data refer to a 2-year period (2008-2009) and were collected from the birth protocol of the Department of Gynecology and Obstetrics, University Hospital Split. The study included all mothers with prematurely born infants. Multiple pregnancies, stillborn and malformed newborns were excluded from the study. Results: During the research period, 436 (4.8 %) of all infants (n = 9042) were born as preterm newborns. The caesarean section was performed on 144 (33 %) premature infants. The rate of hypothrophic (11.6 % vs. 9.2 %; P = 0.113) and hypertrophic (7,3 % vs. 8.4 %; P = 0.438) infants did not differ in preterm and term neonates. Ponderal index of preterm infants was lower (2.45 g/cm3 vs. 2.68 g/cm3; P < 0.001). Low APGAR score is thirteen times more frequent in the study group (27.5 % vs. 2.1 %; P < 0.001). Conclusion: The frequency of preterm birth in the Department is within the statistical average of developed countries. Preterm births are associated with higher rate of caesarean section with no difference in the frequency of occurrence of fetal hypotrophy and hypertrophy. In premature infants, ponderal index is significantly lower

Smjernice za rano prepoznavanje, dijagnostiku i terapiju neurogene orofaringealne disfagije [Guidelines for early detection, diagnostics and therapy of neurogenic oropharyngeal dysphagia]

Guidelines for the early detection, diagnostics and therapy of neurogenic oropharyngeal dysphagia have been made as a result of collaboration of clinicians of different backgrounds who are dealing with patients with neurogenic oropharyngeal dysphagia (NOD). These guidelines have been written by the representatives of the Croatian Society of Clinical Nutrition, Croatian Medical Association, Croatian Neurological Society, Croatian Medical Association, Croatian Society of Gastroenterology and Croatian Society of Nutritionists and Dietitians. The aim of these guidelines is to raise the awareness about NOD that is encountered in acute and chronic neurological diseases, especially in patients with stroke, extrapyramidal diseases, neuromuscular and demyelinisation diseases and dementia. We provide a detailed description of diagnostics of dysphagia, and we recommend the establishment of a multidisciplinary team for dysphagia involving neurologists, internists, speech therapists, dietitians, pharmacists and nurses with special competences for the management of NOD. An educated team member conducts diagnostics and rehabilitation in accordance with the validated tools, classifications and categorizations shown in these guidelines to allow a systematic and consistent treatment. The guidelines also provide detailed algorithms for introducing nutritional support – from the application of modified texture foods, proper hydration to artificial nutrition (enteral and parenteral nutrition)

GUIDELINES FOR EARLY DETECTION, DIAGNOSTICS AND THERAPY OF NEUROGENIC OROPHARYNGEAL DYSPHAGIA

Smjernice za rano prepoznavanje, dijagnostiku i terapiju neurogene orofaringealne disfagije nastale su suradnjom kliničara različitih disciplina koji se bave brojnim aspektima skrbi o bolesnicima s neurogenom orofaringealnom disfagijom (NOD). U izradi smjernica sudjelovali su predstavnici Hrvatskog društva za kliničku prehranu Hrvatskoga liječničkog zbora (HLZ-a), Hrvatskoga neurološkog društva HLZ-a, Hrvatskoga gastroenterološkog društva i Hrvatskog društva nutricionista i dijetetičara. Smjernice imaju cilj povećati svijest o NOD-u koji se javlja kod akutnih i kroničnih neuroloških bolesti, posebice kod moždanog udara, ekstrapiramidnih bolesti, neuromuskularnih i demijelinizacijskih bolesti te demencija. Nadalje, smjernice donose detaljan opis dijagnostike disfagije te preporučuju osnivanje multidisciplinarnog tima za disfagiju u kojem sudjeluju neurolozi, internisti, logopedi, dijetetičari, farmaceuti i medicinske sestre s posebnim kompetencijama na području NOD-a. Educirani član tima provodi dijagnostiku i rehabilitaciju u skladu s provjerenim alatima, klasifikacijama i kategorizacijama prikazanim u ovim smjernicama kako bi se omogućilo sustavno i izjednačeno postupanje. Smjernice donose i detaljne algoritme uvođenja nutritivne potpore – od primjene hrane promijenjene teksture, pravilne hidracije do artificijalne prehrane (enteralne i parenteralne).Guidelines for the early detection, diagnostics and therapy of neurogenic oropharyngeal dysphagia have been made as a result of collaboration of clinicians of different backgrounds who are dealing with patients with neurogenic oropharyngeal dysphagia (NOD). These guidelines have been written by the representatives of the Croatian Society of Clinical Nutrition, Croatian Medical Association, Croatian Neurological Society, Croatian Medical Association, Croatian Society of Gastroenterology and Croatian Society of Nutritionists and Dietitians. The aim of these guidelines is to raise the awareness about NOD that is encountered in acute and chronic neurological diseases, especially in patients with stroke, extrapyramidal diseases, neuromuscular and demyelinisation diseases and dementia. We provide a detailed description of diagnostics of dysphagia, and we recommend the establishment of a multidisciplinary team for dysphagia involving neurologists, internists, speech therapists, dietitians, pharmacists and nurses with special competences for the management of NOD. An educated team member conducts diagnostics and rehabilitation in accordance with the validated tools, classifications and categorizations shown in these guidelines to allow a systematic and consistent treatment. The guidelines also provide detailed algorithms for introducing nutritional support – from the application of modified texture foods, proper hydration to artificial nutrition (enteral and parenteral nutrition)