Endoscopic Treatment of Pancreatic Diseases

Uz medikamentnu i kiruršku terapiju u liječenju bolesti gušterače sve važnije mjesto ima endoskopska terapija. Za neke bolesti gušterače to je terapijska metoda izbora, a za neke pak pomoćna metoda na koju se nadovezuje kirurška terapija. Endoskopska terapija provodi se u bolestima gušterače s reperkusijama na samu gušteraču, ali i u onim bolestima gušterače koje dovode do stenoze bilijarnog stabla s posljedičnim ikterusom i kolestazom. Endoskopski plasman stenta u takvim slučajevima omogućuje primjenu drugih oblika liječenja ili je pak to trajno rješenje. Osim u terapiji bolesti gušterače endoskopske tehnike imaju vrlo važno mjesto i u dijagnostici bolesti gušterače.Along with drug and surgical therapy, endoscopic techniques are increasingly used in the treatment of pancreatic diseases. For some pancreatic diseases, it is a therapeutic method of choice, and for some, however, an auxiliary method followed by a surgical therapy. Endoscopic therapy is used in pancreatic diseases having repercussions on the pancreas itself, but also in those pancreatic diseases that lead to biliary tree stenosis with consequent icterus and cholestasis. Endoscopic placement of stent in such cases enables the use of other forms of treatment or it represents a permanent solution. In addition to the therapy of pancreatic diseases, endoscopic techniques also play a very signifi cant role in their diagnosis

Endoscopic Treatment of Pancreatic Diseases

Uz medikamentnu i kiruršku terapiju u liječenju bolesti gušterače sve važnije mjesto ima endoskopska terapija. Za neke bolesti gušterače to je terapijska metoda izbora, a za neke pak pomoćna metoda na koju se nadovezuje kirurška terapija. Endoskopska terapija provodi se u bolestima gušterače s reperkusijama na samu gušteraču, ali i u onim bolestima gušterače koje dovode do stenoze bilijarnog stabla s posljedičnim ikterusom i kolestazom. Endoskopski plasman stenta u takvim slučajevima omogućuje primjenu drugih oblika liječenja ili je pak to trajno rješenje. Osim u terapiji bolesti gušterače endoskopske tehnike imaju vrlo važno mjesto i u dijagnostici bolesti gušterače.Along with drug and surgical therapy, endoscopic techniques are increasingly used in the treatment of pancreatic diseases. For some pancreatic diseases, it is a therapeutic method of choice, and for some, however, an auxiliary method followed by a surgical therapy. Endoscopic therapy is used in pancreatic diseases having repercussions on the pancreas itself, but also in those pancreatic diseases that lead to biliary tree stenosis with consequent icterus and cholestasis. Endoscopic placement of stent in such cases enables the use of other forms of treatment or it represents a permanent solution. In addition to the therapy of pancreatic diseases, endoscopic techniques also play a very signifi cant role in their diagnosis

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

Uloga standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih sitnih kolorektalnih polipa

To date, there are no reliable endoscopic criteria to discriminate a diminutive (<5 mm) colorectal adenomatous from nonadenomatous polyps. Studies have demonstrated the usefulness of high-resolution chromoendoscopy (high-resolution colonoscopy with topically applied indigo carmine dye) in discrimination of adenomatous from nonadenomatous colorectal polyps. However, the clinical utility of standard videocolonoscopy and chromoscopy with indigo carmine dye in differentiating diminutive colorectal polyps has not yet been completely defined. The aim of this study was to determine whether a combination of standard videocolonoscopy and staining with indigo carmine dye could differentiate between adenomatous and nonadenomatous colorectal polyps smaller than 5 mm. Colonoscopy by use of an Olympus EVIS 140 video system was performed in 42 patients in whom colorectal polyps smaller than 5 mm were found. Polyps were sprayed with up to 40 ml of 0.5% indigo carmine dye, and polypectomy was performed, and the material was referred for histology. In 42 patients included in the study, 48 polyps sized <5 mm were detected. Histologic analysis showed 14 of them to be adenomatous and 34 nonadenomatous polyps. Endoscopist\u27s diagnosis was confirmed by histology in 12 of 14 (85.7%) adenomatous and 31 of 34 (91.2%) nonadenomatous colorectal diminutive polyps. The sensitivity, specificity, positive predictive value and negative predictive value of standard videochromocolonoscopy in distinguishing between adenomatous and nonadenomatous polyps sized <5 mm were 85.7%, 91.2%, 80% and 93.9%, respectively. The likelihood ratios (LR) were 0.157 (LR-) and 9.74 (LR+). In conclusion, standard videocolonoscopy combined with indigo carmine dye is a reliable method to differentiate adenomatous from nonadenomatous colorectal polyps sized <5 mm. Such a technique could limit the requests for unnecessary biopsies and repeat colonoscopy, thus significantly reducing the cost of colorectal cancer screening.Danas ne postoje pouzdani endoskopski kriteriji koji bi razlikovali sitne (<5 mm) kolorektalne adenomatozne od neadenomatoznih polipa. Ranije su studije pokazale korisnu uporabu visoko-rezolucijske kromoendoskopije (visoko-rezolucijska kolonoskopija s topičkom primjenom indigo crvene boje) u razlikovanju adenomatoznih od neadenomatoznih kolorektalnih polipa. Ipak, klinička upotreba standardne video-kolonoskopije i kromoskopije s indigo crvenom bojom u razlikovanju sitnih kolorektalnih polipa nije još potpuno utvrđena. Namjera ovoga ispitivanja bila je utvrditi može li se kombinacijom standardne video-kolonoskopije i bojanja indigo crvenom bojom razlikovati adenomatozne od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Kolonoskopija uz primjenu video sustava Olympus EVIS 140 izvedena je u 42 bolesnika u kojih su nađeni kolorektalni polipi manji od 5 mm. Polipi su poprskani 0,5%-tnom indigo crvenom bojom u količini do 40 mL, izvedena je polipektomija i provedena histološka analiza. U 42 bolesnika uključenih u ispitivanje nađeno je 48 polipa manjih od 5 mm. Histološka analiza pokazala je postojanje 14 adenomatoznih i 34 neadenomatoznih polipa. Endoskopist je ispravno predvidio histološki nalaz u 12 od 14 (85,7%) adenomatoznih, te u 31 od 34 (91,2%) neadenomatoznih kolorektalnih sitnih polipa.Osjetljivost, specifičnost, pozitivna prediktivna vrijednost i negativna prediktivna vrijednost standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih polipa manjih od 5 mm bile su 85,7%, 91,2%, 80%, odnosno 93,9%. Omjer vjerojatnosti (LR) iznosio je 0,157 (LR-) i 9,74 (LR+). Standardna video-kolonoskopija u kombinaciji s indigo crvenom bojom pouzdana je metoda za razlikovanje adenomatoznih od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Ovakvom bi se tehnikom mogli smanjiti zahtjevi za nepotrebnim biopsijama i opetovanim kolonoskopijama, te tako značajno sniziti troškovi probiranja na kolorektalni karcinom

THE ROLE OF BIOLOGIC THERAPY IN THE TREATMENT OF EXTRAINTESTINAL MANIFESTATIONS AND COMPLICATIONS OF INFLAMMATORY BOWEL DISEASE

Ekstraintestinalne manifestacije javljaju se u oko 35 % bolesnika s upalnim bolestima crijeva. Najčešće su zahvaćeni koštanozglobni sustav, koža, oči te jetra i žučni sustav. Zahvaćenost koštano-zglobnog sustava se javlja u 5-10 % bolesnika s ulceroznim kolitisom (UC) i u 10-20 % bolesnika s Crohnovom bolešću (CB). Simptomi variraju od blage artralgije do teškog akutnog artritisa. Primarni sklerozirajući kolangitis (PSC), autoimuni hepatitis, bolesti gušterače, kolestaza, kolelitijaza i porast aminotransferaza smatraju se hepatobilijarnim manifestacijama. Najčešće se prepoznaje PSC, osobito kod bolesnika s UC (oko 7,5 %). Biološka terapija neučinkovita je u liječenju te nema utjecaja na prirodni tijek bolesti. Od kožnih manifestacija najčešće se javljaju nodozni eritem (3-20 %) i gangrenozna pioderma (0,5-20 %). Oftalmološki poremećaji javljaju se u 2-5 % bolesnika s upalnim bolestima crijeva. Tegobe variraju od blagog konjunktivitisa do teških upala očnih ovojnica. Infliksimab je u CB indiciran u liječenju spondiloartropatija, artritisa/artralgija, gangrenozne pioderme, nodoznog eritema te oftalmoloških manifestacija, osim optičkog neuritisa. Slične su indikacije za upotrebu adalimumaba, osim što nema indikacije u liječenju nodoznog eritema. Kod bolesnika s UC, infliksimab je indiciran u liječenju spondiloartropatija i gangrenozne pioderme. Komplikacije upalnih bolesti crijeva su fistule, stenoze I strikture crijeva, apscesi, perforacije, krvarenja iz probavnog sustava te nastanak karcinoma crijeva i drugih maligniteta. Liječenje anti-TNF lijekovima dokazano je učinkovito jedino u liječenju perianalnih fistula u bolesnika s CB.Extraintestinal manifestations occur in about 35% of patients with inflammatory bowel diseases (IBD). Most frequently affected are bones and joints, skin, eyes, liver and biliary ducts. Extraintestinal manifestations of IBD are divided in two groups: reactive manifestations which depend on activity of IBD – peripheral arthritis, erythema nodosum, aphthous stomatitis, episcleritis and other manifestations which are independent on activity of IBD – pyoderma gangrenosum, uveitis, axial arthropathy, primary sclerosing cholangitis (PSC). Most affected are bones and joints. Symptoms vary from mild arthralgia to severe arthritis with painful swallowing of joints. They occur in about 5-10% of patients with ulcerative colitis (UC) and in 10-20% of patients with Crohn’s disease (CD). Both peripheral and axial joints can be affected. According to available data, most patients with active IBD and concomitant arthritis have benefit from infliximab therapy. Infliximab is also effective in maintenance of remission in group of patients with spondyloarthropathy. Adalimumab showed similar efficacy in treatment of ankylosing spondylitis, but there are still no data about efficacy of adalimumab in treatment of patients with IBD and concomitant arthritis. Primary sclerosing cholangitis, autoimmune hepatitis, cholestasis, cholelithiasis and elevation of aminotransferase are also considered to be extraintestinal manifestations of IBD. Most frequent is PSC which affects usually patients with UC (7.5% of patients). Course of liver disease is completely independent on activity of IBD, and destruction of biliary ducts is usually irreversible and refractory on treatment and most of the patients need liver transplantation. Anti-TNF therapy is also ineffective in treatment of PSC and has no impact on disease course and outcome. However, there is no contraindication for anti-TNF therapy of concomitant active IBD in this group of patients. Erythema nodosum (EN) and pyoderma gangrenosum (PG) are usual skin manifestations of IBD. Erythema nodosum occurs in about 3-20%, and pyoderma gangrenosum in about 0.5-20% of patients with IBD. Infliximab is proven to be effective in treatment of PG,but there is still not enough evidence on efficacy of anti-TNF drugs in treatment of EN and other rare skin manifestations of IBD. About 2-5% of patients with IBD have also some ophthalmological disorder. Symptoms vary from mild conjunctivitis to severe inflammation of eye membranes – iritis, episcleritis, scleritis and uveitis. It seems that infliximab and adalimumab can diminish uveitis and scleritis in patients with different autoimmune disorders and IBD. According to guidelines of American Gastroenterology Association (AGA), in group of patients with CD, infliximab is indicated in treatment of spondyloarthropathies, arthritis, arthralgia, pyoderma gangrenosum, erythema nodosum, uveitis and other ophthalmological manifestations of IBD except optical neuritis which can worse or be consequence of anti-TNF treatment. Similar indications exist for use of adalimumab except in case of erythema nodosum. In group of patients with extraintestinal manifestations of UC, infliximab is indicated in treatment of spondyloarthropathies and pyoderma gangrenosum. Complications of IBD are fistulas (perianal and non-perianal), stenosis and strictures, abscesses, bowel perforations, gastrointestinal bleeding and development of different malignomas. Anti-TNF drugs are proven to be effective and indicated only for treatment of perianal fistulas in patients with Crohn’s disease. In group of patients with UC, there are only few case reports on beneficial effect of infliximab in treating chronic pouchitis and infliximab in treatment of these patients still cannot be recommended

Uloga standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih sitnih kolorektalnih polipa

To date, there are no reliable endoscopic criteria to discriminate a diminutive (<5 mm) colorectal adenomatous from nonadenomatous polyps. Studies have demonstrated the usefulness of high-resolution chromoendoscopy (high-resolution colonoscopy with topically applied indigo carmine dye) in discrimination of adenomatous from nonadenomatous colorectal polyps. However, the clinical utility of standard videocolonoscopy and chromoscopy with indigo carmine dye in differentiating diminutive colorectal polyps has not yet been completely defined. The aim of this study was to determine whether a combination of standard videocolonoscopy and staining with indigo carmine dye could differentiate between adenomatous and nonadenomatous colorectal polyps smaller than 5 mm. Colonoscopy by use of an Olympus EVIS 140 video system was performed in 42 patients in whom colorectal polyps smaller than 5 mm were found. Polyps were sprayed with up to 40 ml of 0.5% indigo carmine dye, and polypectomy was performed, and the material was referred for histology. In 42 patients included in the study, 48 polyps sized <5 mm were detected. Histologic analysis showed 14 of them to be adenomatous and 34 nonadenomatous polyps. Endoscopist\u27s diagnosis was confirmed by histology in 12 of 14 (85.7%) adenomatous and 31 of 34 (91.2%) nonadenomatous colorectal diminutive polyps. The sensitivity, specificity, positive predictive value and negative predictive value of standard videochromocolonoscopy in distinguishing between adenomatous and nonadenomatous polyps sized <5 mm were 85.7%, 91.2%, 80% and 93.9%, respectively. The likelihood ratios (LR) were 0.157 (LR-) and 9.74 (LR+). In conclusion, standard videocolonoscopy combined with indigo carmine dye is a reliable method to differentiate adenomatous from nonadenomatous colorectal polyps sized <5 mm. Such a technique could limit the requests for unnecessary biopsies and repeat colonoscopy, thus significantly reducing the cost of colorectal cancer screening.Danas ne postoje pouzdani endoskopski kriteriji koji bi razlikovali sitne (<5 mm) kolorektalne adenomatozne od neadenomatoznih polipa. Ranije su studije pokazale korisnu uporabu visoko-rezolucijske kromoendoskopije (visoko-rezolucijska kolonoskopija s topičkom primjenom indigo crvene boje) u razlikovanju adenomatoznih od neadenomatoznih kolorektalnih polipa. Ipak, klinička upotreba standardne video-kolonoskopije i kromoskopije s indigo crvenom bojom u razlikovanju sitnih kolorektalnih polipa nije još potpuno utvrđena. Namjera ovoga ispitivanja bila je utvrditi može li se kombinacijom standardne video-kolonoskopije i bojanja indigo crvenom bojom razlikovati adenomatozne od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Kolonoskopija uz primjenu video sustava Olympus EVIS 140 izvedena je u 42 bolesnika u kojih su nađeni kolorektalni polipi manji od 5 mm. Polipi su poprskani 0,5%-tnom indigo crvenom bojom u količini do 40 mL, izvedena je polipektomija i provedena histološka analiza. U 42 bolesnika uključenih u ispitivanje nađeno je 48 polipa manjih od 5 mm. Histološka analiza pokazala je postojanje 14 adenomatoznih i 34 neadenomatoznih polipa. Endoskopist je ispravno predvidio histološki nalaz u 12 od 14 (85,7%) adenomatoznih, te u 31 od 34 (91,2%) neadenomatoznih kolorektalnih sitnih polipa.Osjetljivost, specifičnost, pozitivna prediktivna vrijednost i negativna prediktivna vrijednost standardne video-kromokolonoskopije u razlikovanju adenomatoznih od neadenomatoznih polipa manjih od 5 mm bile su 85,7%, 91,2%, 80%, odnosno 93,9%. Omjer vjerojatnosti (LR) iznosio je 0,157 (LR-) i 9,74 (LR+). Standardna video-kolonoskopija u kombinaciji s indigo crvenom bojom pouzdana je metoda za razlikovanje adenomatoznih od neadenomatoznih kolorektalnih polipa manjih od 5 mm. Ovakvom bi se tehnikom mogli smanjiti zahtjevi za nepotrebnim biopsijama i opetovanim kolonoskopijama, te tako značajno sniziti troškovi probiranja na kolorektalni karcinom

THE ROLE OF BIOLOGIC THERAPY IN THE TREATMENT OF EXTRAINTESTINAL MANIFESTATIONS AND COMPLICATIONS OF INFLAMMATORY BOWEL DISEASE

Ekstraintestinalne manifestacije javljaju se u oko 35 % bolesnika s upalnim bolestima crijeva. Najčešće su zahvaćeni koštanozglobni sustav, koža, oči te jetra i žučni sustav. Zahvaćenost koštano-zglobnog sustava se javlja u 5-10 % bolesnika s ulceroznim kolitisom (UC) i u 10-20 % bolesnika s Crohnovom bolešću (CB). Simptomi variraju od blage artralgije do teškog akutnog artritisa. Primarni sklerozirajući kolangitis (PSC), autoimuni hepatitis, bolesti gušterače, kolestaza, kolelitijaza i porast aminotransferaza smatraju se hepatobilijarnim manifestacijama. Najčešće se prepoznaje PSC, osobito kod bolesnika s UC (oko 7,5 %). Biološka terapija neučinkovita je u liječenju te nema utjecaja na prirodni tijek bolesti. Od kožnih manifestacija najčešće se javljaju nodozni eritem (3-20 %) i gangrenozna pioderma (0,5-20 %). Oftalmološki poremećaji javljaju se u 2-5 % bolesnika s upalnim bolestima crijeva. Tegobe variraju od blagog konjunktivitisa do teških upala očnih ovojnica. Infliksimab je u CB indiciran u liječenju spondiloartropatija, artritisa/artralgija, gangrenozne pioderme, nodoznog eritema te oftalmoloških manifestacija, osim optičkog neuritisa. Slične su indikacije za upotrebu adalimumaba, osim što nema indikacije u liječenju nodoznog eritema. Kod bolesnika s UC, infliksimab je indiciran u liječenju spondiloartropatija i gangrenozne pioderme. Komplikacije upalnih bolesti crijeva su fistule, stenoze I strikture crijeva, apscesi, perforacije, krvarenja iz probavnog sustava te nastanak karcinoma crijeva i drugih maligniteta. Liječenje anti-TNF lijekovima dokazano je učinkovito jedino u liječenju perianalnih fistula u bolesnika s CB.Extraintestinal manifestations occur in about 35% of patients with inflammatory bowel diseases (IBD). Most frequently affected are bones and joints, skin, eyes, liver and biliary ducts. Extraintestinal manifestations of IBD are divided in two groups: reactive manifestations which depend on activity of IBD – peripheral arthritis, erythema nodosum, aphthous stomatitis, episcleritis and other manifestations which are independent on activity of IBD – pyoderma gangrenosum, uveitis, axial arthropathy, primary sclerosing cholangitis (PSC). Most affected are bones and joints. Symptoms vary from mild arthralgia to severe arthritis with painful swallowing of joints. They occur in about 5-10% of patients with ulcerative colitis (UC) and in 10-20% of patients with Crohn’s disease (CD). Both peripheral and axial joints can be affected. According to available data, most patients with active IBD and concomitant arthritis have benefit from infliximab therapy. Infliximab is also effective in maintenance of remission in group of patients with spondyloarthropathy. Adalimumab showed similar efficacy in treatment of ankylosing spondylitis, but there are still no data about efficacy of adalimumab in treatment of patients with IBD and concomitant arthritis. Primary sclerosing cholangitis, autoimmune hepatitis, cholestasis, cholelithiasis and elevation of aminotransferase are also considered to be extraintestinal manifestations of IBD. Most frequent is PSC which affects usually patients with UC (7.5% of patients). Course of liver disease is completely independent on activity of IBD, and destruction of biliary ducts is usually irreversible and refractory on treatment and most of the patients need liver transplantation. Anti-TNF therapy is also ineffective in treatment of PSC and has no impact on disease course and outcome. However, there is no contraindication for anti-TNF therapy of concomitant active IBD in this group of patients. Erythema nodosum (EN) and pyoderma gangrenosum (PG) are usual skin manifestations of IBD. Erythema nodosum occurs in about 3-20%, and pyoderma gangrenosum in about 0.5-20% of patients with IBD. Infliximab is proven to be effective in treatment of PG,but there is still not enough evidence on efficacy of anti-TNF drugs in treatment of EN and other rare skin manifestations of IBD. About 2-5% of patients with IBD have also some ophthalmological disorder. Symptoms vary from mild conjunctivitis to severe inflammation of eye membranes – iritis, episcleritis, scleritis and uveitis. It seems that infliximab and adalimumab can diminish uveitis and scleritis in patients with different autoimmune disorders and IBD. According to guidelines of American Gastroenterology Association (AGA), in group of patients with CD, infliximab is indicated in treatment of spondyloarthropathies, arthritis, arthralgia, pyoderma gangrenosum, erythema nodosum, uveitis and other ophthalmological manifestations of IBD except optical neuritis which can worse or be consequence of anti-TNF treatment. Similar indications exist for use of adalimumab except in case of erythema nodosum. In group of patients with extraintestinal manifestations of UC, infliximab is indicated in treatment of spondyloarthropathies and pyoderma gangrenosum. Complications of IBD are fistulas (perianal and non-perianal), stenosis and strictures, abscesses, bowel perforations, gastrointestinal bleeding and development of different malignomas. Anti-TNF drugs are proven to be effective and indicated only for treatment of perianal fistulas in patients with Crohn’s disease. In group of patients with UC, there are only few case reports on beneficial effect of infliximab in treating chronic pouchitis and infliximab in treatment of these patients still cannot be recommended

Manuscript "Many different remedies for headache treatment" from the archives of Sinj friary

U ovome je radu prvi put opisan rukopis Mnoge različite Likarie od bolesti glave koji je nađen u arhivu Franjevačkog samostana u Sinju. Pretpostavlja se da je tekst dio veće cjeline, neke ljekaruše, a nastao je vjerojatno u XVIII. stoljeću. Rukopis sadržava 16 recepata za izradu i upotrebu lijekova za liječenje glavobolje. Služio je vjerojatno kao priručnik za izradu i upotrebu lijekova za liječenje. Materia medica ovoga rukopisa sastoji se isključivo od pripravaka biljnog podrijetla. U popisu ljekovitog bilja narodnim su nazivima koji su korišteni u rukopisnom fragmentu pripisana suvremena imena te latinska imena biljne vrste i porodice. Analiziran je jezik teksta i priređen rječnik manje poznatih pojmova i arhaizama. U raspravi je način pripreme lijekova uspoređen sa suvremenim farmaceutskim postupcima. Sastavljen je rječnik manje poznatih izraza i arhaizama. Priložen je izvorni tekst fragmenta kako bi mu se omogućio multidisciplinaran pristup.Manuscripts containing collections of folk recipes for treatment of deseases were written mostly by Catholic priests especially Franciscians in Croatia in the past centuries. They were used as manuals for preparation of remedies and gave directions for their use. These writtings provide valuble data for etnographers and historians of ethnomedicine. The paper describes the manuscript “Many different remedies for headache treatment” written by unknown author probably in 18. century in Sinj, Dalmatia. The manuscript was found in the archives of Sinj Friary. The collection contains 16 recipes for headache treatment. Materia medica of the manuscript is composed of drugs of plant origin. Valuable information is given about the folk names for medicinal plants as well as descriptions of the ways of preparing remedies. Latin as well as contemporaly croatian names are attributed to the plants species mentioned in the manuscript. Use of the plants for treatment of the specific deseases were compared with their use in modern fitotherap

Biliary Brush Cytology for the Diagnosis of Malignancy: A Single Center Experience

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

UTJECAJ POVRŠINE I OBLIKA REZA REZNIH PLOČICA NA UČINAK LANČANE SJEKAČICE

The cutting design of the chain saw is defined by the number, the arrangement and the geometry of the cutting tools. When using chisel cutting tools, the cross sectional area of the cut and the shape of the groove are determined by the width and depth of the cut. The laboratory tests analyzed the impact of the cross sectional area and the shape of the cut on the forces and the specific energy. The testing was performed on a linear cutting machine with tool holders and cutting tools in real-scale size. According to the processed statistical data, increasing the cross sectional area of the cut reduces the specific energy, whereby the width of the cut has a considerably larger impact. The tests have shown that besides the cross sectional area of cut, the shape of the surface also affects the forces and specific energy. Through increasing the width to depth ratio upon a constant cross sectional area of the cut, the value of the specific energy and the cutting forces are reduced. Above the width to depth ratio of 2.5 the cutting forces and the specific energy appear to be constant.Konstrukcijom lanca lančane sjekačice određen je broj, raspored i geometrijske veličine reznih pločica. Kod kvadratičnih reznih pločica površina i oblik reza određeni su širinom i dubinom reza. Laboratorijskim ispitivanjima analiziran je utjecaj površine i oblika reza na sile i specifičnu energiju rezanja. Ispitivanja su provedena na uređaju za pravocrtno rezanje stijena s nosačima i reznim pločicama u prirodnoj veličini. Laboratorijska ispitivanja podijeljena su u dva dijela. U prvome dijelu ispitivanja analiziran je utjecaj površine reza na sile i energiju rezanja, dok je u drugome dijelu ispitivanja analiziran utjecaj oblika površine reza. Tijekom svakoga pojedinačnog ispitivanja mjerena je tangencijalna, vertikalna i bočna sila brzinom uzorkovanja od 4800 Hz. Na temelju vrijednosti tangencijalne sile i prijeđenoga puta rezne pločice izračunana je energija rezanja. Statističkom obradom podataka ustanovljeno je da se povećanjem površine reza specifična energija rezanja smanjuje, pri čemu širina reza ima znatno veći utjecaj od dubine reza. Na temelju rezultata regresijske analize višestruke ovisnosti sila o širini i dubini reza proizlazi da dubina reza ima znatno veći utjecaj na vrijednost tangencijalne sile, dok vrijednost normalne sile ovisi o širini reza. Osim površine reza ispitivanjima je ustanovljeno da oblik površine također utječe na sile i energiju rezanja. Povećanjem omjera širine i dubine reza, pri konstantnoj površini, smanjuju se vrijednosti sila i specifične energije rezanja. Pri većim omjerima od 2,5 vrijednosti sila i specifične energije rezanja približno su konstantne. Omjer širine i dubine reza moguće je povećati smanjenjem dubine reza i/ili povećanjem širine reza. Kod lančanih sjekačica veću širinu reza moguće je ostvariti isključivo smanjenjem broja reznih pločica unutar reznoga segmenta. Broj reznih pločica u reznome segmentu ovisi o optimalnome omjeru širine i dubine reza, pri kojemu je omjer utrošene energije i reznih alata najpovoljniji