Biliary brush cytology for the diagnosis of malignancy: a single center experience [Citološki razmazi brisa četkicom u dijagnostici malignih promjena bilijarnog stabla: naše iskustvo]

Differentiation between benign and malignant biliary strictures is critical to the provision of adequate treatment. Brush cytology during the endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly used method for obtaining tissue confirmation of the nature of biliary strictures. It’s specificity is remarkably high but reported sensitivities for the diagnosis of malignancy are low. Aim of our study was to assess sensitivity and specificity of biliary brush cytology in our institution, to find out main causes of false negative diagnoses and to confirm impression that the team approach has impact on sensitivity. Gold standard for diagnosis was definitive surgical histology or adequate clinical follow up for minimum of six month. Direct smears made by cytotechnician at the endoscopy room, and stained according to Papanicolaou and May-Grünwald Giemsa (MGG) were examined for well-recognized features of malignancy on conventional smears as a part of diagnostic routine. Cytologic diagnoses were benign, atypical/reactive, suspicious for malignancy and malignant. Of 143 brushings with available definitive diagnosis 36 (25%) had malignant cytologic diagnosis and 91(63.6%) were classified as benign, 3 were atypical/reactive and 13 suspicious for malignancy with 20 »false-negative« cases. When specimens with atypical and suspicious cytology were excluded from data analysis sensitivity was 64% and specificity was 100% and when suspicious findings were taken into account as true positives sensitivity rose to 71%. We find that biliary brush cytology, although mainly depending on the skill of endoscopist, as well as the experience of the cytologist, is a valuable method for obtaining accurate tissue diagnosis of biliary strictures, thus solving eternal diagnostic dilemma: benign or malignant

Life Satisfaction and School Performance of Children Exposed to Classic and Cyber Peer Bullying

This paper analyses the relationship between the exposure of school children to various forms of peer bullying (classic/cyber) and their life satisfaction in the domain of school, family, friends and school performance. The sample included 562 children from rural and urban areas of Croatia who were attending the seventh and the eighth grade of primary school. Results show that children were more often exposed to classic forms of peer bullying, especially verbal, and then physical bullying. On the other hand, cyber bullying most often comprises harassment in forums, blogs, chats or social networks, then on the web, by e-mail and mobile phone. Almost half of the examinees knew the identity of the bully, while a minority believes that bullies are the same ones who also physically abuse them at school. We found that children exposed to all forms of both classic and cyber bullying, unlike their peers who do not have such experience, show less satisfaction with friends, while those exposed to physical and cyber bullying show dissatisfaction with their family, too. However, no statistically significant difference was found in their satisfaction with school. Children exposed to physical bullying showed poorer school performance, poorer achievement in Croatian and math, while children exposed to verbal and cyber bullying and children who were not exposed to such forms of bullying showed no differences in their school achievement

Usporedna analiza utjecaja klimatskih čimbenika na radijalni rast autohtonih vrsta borova (Pinus spp.) u središnjoj Bosni i Hercegovini

In central Bosnia and Herzegovina, in the Zavidovići-Teslić area, the study of the radial growth of Austrian and Scots pine (autochthonous pine species) trees was conducted using the dendrochronological method in order to identify the differences between the species in terms of the influence of climatic variables on the tree ring formation. Trees were sampled in five experimental areas or five sites. The first site had a Scots pine stand, while the second had an Austrian pine stand, and the other three sites had mixed stands of Scots and Austrian pine. Cross-dating was conducted using visual on-screen techniques of CDendro software and statistical methods using Cofecha software. The tree ring series were standardized using the Arstan program and cubic smoothing spline. It produced Scots pine regional chronology, 145 years long (1870-2014), and Austrian pine regional chronology, 180 years long (1835-2014). Correlation analysis of the relationship between the index of tree-ring width and precipitation and temperature in the characteristic periods of the year showed a negative effect of temperature (except in winter months) and a positive effect of precipitation on the tree ring formation. The statistically significant dependence of the tree-ring width index on the SPEI indices indicates a significant impact of moisture deficiency on the tree ring formation in the period from June to August (r = 0.33 in June, r = 0.45 in July and r = 0.47 in August) for Scots pine and in the period from June to September (r = 0.36 in June, r = 0.43 in July, r = 0.47 in August and r = 0.30 in September) for Austrian pine. The analysis of the relationship between climatic parameters and the chronologies of Scots and Austrian pine shows similar relationships between radial growth and climate but the influence of climate is somewhat more pronounced in Austrian pine. In the study area, the radial growth of both tree species is significantly determined by climate conditions. In other words, the chronology of these species has a good climatic signal, especially the drought signal in the summer months.U Zavidovićko - Teslićkom području, u središnjoj Bosni i Hercegovini, dendrokronološkom metodom je proučavan radijalni rast stabala crnog i bijelog bora, autohtonih vrsta u pomatranom području. Cilj je bio identifikacija razlika između spomenutih vrsta glede utjecaja klimatskih čimbenika. Uzorci su uzeti iz stabala s pet lokaliteta. Na prvom lokalitetu je sastojina bijelog bora, na drugom crnog bora, a na ostala tri lokaliteta su mješovite sastojine. Standardizacija serija širina godova (radijalnih prirasta) obavljena je primjenom Arstan programa. Dobivena je regionalna kronologija bijeloga bora dužine 145 godina (od 1870. do 2014.) i regionalna kronologija crnoga bora dužine 180 godina (od 1835. do 2014.). Ispitivanje zavisnosti između indeksa širine goda i oborina odnosno temperature u pojedinim karakterističnim periodima godine, pokazalo je negativan utjecaj temperature (osim u zimskim mjesecima) na formiranje goda i pozitivan utjecaj oborina. Statistički značajna zavisnost indeksa širine goda od SPEI indeksa ukazuje na značajan utjecaj nedostatka vlage u periodu lipanj – kolovoz (r = 0,33 u lipnju, r = 0,45 u srpnju i r = 0,47 u kolovozu) za bijeli bor i periodu lipanj - rujan (r = 0,36 u lipnju, r = 0,43 u srpanju, r = 0,47 u kolovozu i r = 0,30 u rujnu) za crni bor na formiranje godova. Analiza odnosa klimatskih parametara i formiranih kronologija bijeloga i crnoga bora pokazuje slične odnose između širine goda i klime, ali je utjecaj klimatskih čimbenika nešto više izražen kod crnog bora, kojemu više odgovaraju uvjeti staništa na promatranom području. U promatranom području radijalni prirast stabala obje vrste drveća značajno je uvjetovan klimatskim čimbenicima, odnosno kronologije navedenih vrsta imaju dobar klimatski signal, a posebno signal suše u ljetnim mjesecima

Prognostical Characteristics of the W-PTSD Instrument for Determining Posttraumatic Sterss Disordes in Persons with Visual Impairment

Posttraumatski stresni poremecaj je u novijoj literaturi definiran kao skup specificnih simptoma koji se javljaju u nekih osoba, nakon što su izravno ili kao svjedoci bile izložene nekom traumaticnom iskustvu koje bi za vecinu ljudi bilo jako traumaticno, i na to iskustvo su reagirale snažnim strahom, osjecajem bespomocnosti ili užasnutosti. Razvoj simptoma ovog poremecaja odreen je karakteristikama licnosti izložene osobe, vrstom i jacinom traume, ulogom koju je osoba imala tijekom traumatskog dogaaja, kao i karakteristikama okoline. Utvrivanje postojanja posttraumatskog poremecaja u neke osobe moguce je provesti nizom standardiziranih instrumenata. Iako je u literaturi dostupan znatan broj istraživanja koja proucavaju ovaj poremecaj kao i njegove razlicite aspekte, gotovo je nemoguce pronaci ona koja se bave ovim poremecajem u populaciji osoba oštecena vida. Stoga se sa sigurnošcu nije moglo tvrditi da su instrumenti, prikladni za utvrivanje PTSP-a u opcoj populaciji, jednako pouzdani i kod osoba oštecena vida u kojih se ocekuje pojavnost ovog poremecaja. Kako bi se utvrdila pouzdanost W-PTSD instrumenta za osobe oštecena vida koje su proživjele traumatsko iskustvo bilo je potrebno uz ovaj instrument primjeniti i dodatni standardizirani instrument za utvrivanje PTSP-a. U tu svrhu upotrijebljen je LASC-01 upitnik. Rezultatima istraživanja, koje je provedeno na 28 slijepih invalida Domovinskog rata, utvreno ja da na oba upitnika u podrucju varijabli koje mjere PTSP ispitanici postižu slicne rezultate. Na osnovi toga moguce je zakljuciti da se instrument W-PTSD može s pravom koristiti za utvrivanje PTSP-a u populaciji osoba oštecena vida.Post-traumatic Stress Disorder has been defined in the more recent literature as a set of the specific symptoms occurring in some individuals, after they have been exposed directly or as witnesses to a traumatic experience that would be very traumatic for the most persons. Their reaction to such experience was strong fear, feeling of helplessness or horror. The development of the symptoms of such disorder is determined by the traits of the personality of the exposed individual, type and intensity of the trauma, role that the person had during the traumatic incident, and the environment-circumstances. The existence of the posttraumatic disorder in a person can be identified with a number of the standardized instruments. Although there is a significant number of research works available in the literature studying this disorder and its various aspects, it is almost impossible to find those dealing with this disorder in the population of the persons with vision impairments. Therefore, it could not be established with certainty whether the instruments adequate to identify PTSP in the general population were equally reliable concerning the persons with vision impairments that were likely to manifest such disorder. In order to determine the reliability of the W-PTSD instruments for the persons suffering from vision impairments that had been exposed to the traumatic experience it was necessary to apply along with this instrument also the additional standardized instrument to determine PTSP. The LASC-01 questionnaire was used for this purpose. It was determined based on the results of the research that was carried out on 28 blind persons disabled in the Croatian War of Independence that in both questionnaires in the area of the PTSP measuring variables the respondents had similar results. The conclusion that can be made based on this is that the W-PTSD instrument is the proper instrument to be used to determine PTSP in the population of the persons with vision impairments

Endoskopsko liječenje pseudociste gušterače

Pancreatic pseudocyst, the most common cystic lesion of the pancreas, may occur as a consequence of acute or chronic pancreatitis, pancreatic trauma, or obstruction of the pancreatic duct. Symptomatic, complicated, or enlarging pseudocysts require therapy that can be endoscopic (transmural and transpapillary drainage), percutaneous, or surgical. We present a patient with pancreatic pseudocyst treated by blinded endoscopic transgastric puncture and stenting after an unsuccessful attempt at endoscopic transpapillary drainage, suggesting that this simple approach is safe and effective in a selected group of patients.Pseudocista gušterače kao najčešće cistično oštećenje gušterače može nastati kao posljedica akutnog ili kroničnog pankreatitisa, traume gušterače ili opstrukcije gušteračnog kanala. Simptomatične, komplicirane ili pseudociste koje se povećavaju zahtijevaju liječenje koje može biti endoskopsko (transmuralna i transpapilarna drenaža), perkutano ili kirurško. Prikazuje se bolesnica s pseudocistom gušterače liječenom endoskopskom transgastričnom punkcijom naslijepo i postavljanjem stenta nakon neuspjelog pokušaja endoskopske transpapilarne drenaže. Ukazuje se na to da je ovaj jednostavan pristup siguran i učinkovit u odabranoj skupini bolesnika