Stroke and Arterial Hypertension

Arterijska hipertenzija je zbog visoke prevalencije u svijetu jedan od najvažnijih globalnih uzroka pobola i smrtnosti. Ishemijski i hemoragijski moždani udar predstavljaju treći uzrok smrtnosti povezan s arterijskom hipertenzijom. Liječenje akutnoga moždanog udara zahtijeva opreznije ili značajnije snižavanje krvnog tlaka, ovisno radi li se o ishemijskome ili hemoragijskome cerebrovaskularnom incidentu te je li primijenjena fibrinolitička terapija. Poseban je naglasak na prevenciji moždanog udara dobrom regulacijom hipertenzije antihipertenzivnom terapijom i promjenom životnih navika, što uključuje smanjenje unosa soli u prehrani, regulaciju prehrane, izbjegavanje prekomjernog unosa alkohola, prekid pušenja i održavanje idealne tjelesne težine. Smanjenje unosa soli može rezultirati smanjenjem antihipertenzivnih lijekova potrebnih za postizanje ciljnih vrijednosti arterijskog tlaka. Uravnotežena prehrana s niskomasnim mliječnim proizvodima te nezasićenim masnim kiselinama značajno smanjuje rizik moždanog udara. Prekid pušenja značajno smanjuje rizik od moždanog udara, posebno u pacijenata s arterijskom hipertenzijom. Navodi se nepovoljan učinak konzumacije alkohola na arterijski krvni tlak jer se povisuje rizik hemoragijskoga moždanog udara koji nadmašuje potencijalnu povoljnu povezanost umjerene konzumacije alkohola s ishemijskim moždanim udarom. U prevenciji i liječenju kardiovaskularnih bolesti i smrtnosti, uključujući arterijsku hipertenziju, preporučena je redovita tjelesna aktivnost. Gubitak tjelesne mase u pretilih osoba poboljšava učinkovitost antihipertenzivnih lijekova i cjelokupni profil kardiovaskularnih rizika, pa tako i rizik od moždanog udara.Due to its high prevalence throughout the world, arterial hypertension is one of the leading global causes of morbidity and mortality. Ischemic and hemorrhagic stroke are the third leading causes of death associated to arterial hypertension. Treatment of acute stroke requires cautious and significant reduction in blood pressure, depending on whether it is an ischemic or hemorrhagic cerebrovascular incident, and whether fibrinolytic therapy has been used. Special emphasis is placed on stroke prevention through proper regulation of hypertension with antihypertensive therapy and lifestyle changes, which include the reduction of salt intake, regulation of diet, avoidance of excessive alcohol intake, quitting smoking and maintaining optimal body weight. Reducing salt intake may result in a decrease of antihypertensive drugs needed to achieve target blood pressure values. A balanced diet with low-fat dairy products and unsaturated fatty acids significantly reduces the risk of stroke. Quitting smoking also considerably reduces the risk, especially in patients with arterial hypertension. There is evidence of adverse effects of alcohol consumption on arterial blood pressure as it increases the risk of hemorrhagic stroke, which surpasses the potentially favorable link between moderate alcohol consumption and ischemic stroke. Regular physical activity is recommended in the prevention and treatment of cardiovascular disease and mortality, including arterial hypertension. Weight loss in the obese improves effectiveness of antihypertensive drugs and the overall profile of cardiovascular risks, hence the risk of stroke

Stroke and Arterial Hypertension

Arterijska hipertenzija je zbog visoke prevalencije u svijetu jedan od najvažnijih globalnih uzroka pobola i smrtnosti. Ishemijski i hemoragijski moždani udar predstavljaju treći uzrok smrtnosti povezan s arterijskom hipertenzijom. Liječenje akutnoga moždanog udara zahtijeva opreznije ili značajnije snižavanje krvnog tlaka, ovisno radi li se o ishemijskome ili hemoragijskome cerebrovaskularnom incidentu te je li primijenjena fibrinolitička terapija. Poseban je naglasak na prevenciji moždanog udara dobrom regulacijom hipertenzije antihipertenzivnom terapijom i promjenom životnih navika, što uključuje smanjenje unosa soli u prehrani, regulaciju prehrane, izbjegavanje prekomjernog unosa alkohola, prekid pušenja i održavanje idealne tjelesne težine. Smanjenje unosa soli može rezultirati smanjenjem antihipertenzivnih lijekova potrebnih za postizanje ciljnih vrijednosti arterijskog tlaka. Uravnotežena prehrana s niskomasnim mliječnim proizvodima te nezasićenim masnim kiselinama značajno smanjuje rizik moždanog udara. Prekid pušenja značajno smanjuje rizik od moždanog udara, posebno u pacijenata s arterijskom hipertenzijom. Navodi se nepovoljan učinak konzumacije alkohola na arterijski krvni tlak jer se povisuje rizik hemoragijskoga moždanog udara koji nadmašuje potencijalnu povoljnu povezanost umjerene konzumacije alkohola s ishemijskim moždanim udarom. U prevenciji i liječenju kardiovaskularnih bolesti i smrtnosti, uključujući arterijsku hipertenziju, preporučena je redovita tjelesna aktivnost. Gubitak tjelesne mase u pretilih osoba poboljšava učinkovitost antihipertenzivnih lijekova i cjelokupni profil kardiovaskularnih rizika, pa tako i rizik od moždanog udara.Due to its high prevalence throughout the world, arterial hypertension is one of the leading global causes of morbidity and mortality. Ischemic and hemorrhagic stroke are the third leading causes of death associated to arterial hypertension. Treatment of acute stroke requires cautious and significant reduction in blood pressure, depending on whether it is an ischemic or hemorrhagic cerebrovascular incident, and whether fibrinolytic therapy has been used. Special emphasis is placed on stroke prevention through proper regulation of hypertension with antihypertensive therapy and lifestyle changes, which include the reduction of salt intake, regulation of diet, avoidance of excessive alcohol intake, quitting smoking and maintaining optimal body weight. Reducing salt intake may result in a decrease of antihypertensive drugs needed to achieve target blood pressure values. A balanced diet with low-fat dairy products and unsaturated fatty acids significantly reduces the risk of stroke. Quitting smoking also considerably reduces the risk, especially in patients with arterial hypertension. There is evidence of adverse effects of alcohol consumption on arterial blood pressure as it increases the risk of hemorrhagic stroke, which surpasses the potentially favorable link between moderate alcohol consumption and ischemic stroke. Regular physical activity is recommended in the prevention and treatment of cardiovascular disease and mortality, including arterial hypertension. Weight loss in the obese improves effectiveness of antihypertensive drugs and the overall profile of cardiovascular risks, hence the risk of stroke

Lijevi lateralni pogled tijekom perkutane koronarne intervencije kod akutnog infarkta donje stijenke miokarda s podizanjem ST spojnice i dekstrokardijom

Rapid recognition of ST-segment elevation myocardial infarction and electrocardiogram interpretation in patients with dextrocardia could be a challenging situation. This case report discusses presentation in a patient with dextrocardia and situs inversus who was found to have acute inferior myocardial infarction. Percutaneous coronary intervention in cases of dextrocardia can be technically challenging considering coronary origin and orientation, and difficulty in appropriate catheter selection.Pravodobno prepoznavanje infarkta miokarda s elevacijom ST segmenta i interpretacija elektrokardiograma u bolesnika s dekstrokardijom predstavlja klinički izazov. Ovim prikazom slučaja opisujemo bolesnika s dekstrokardijom i situs inversusom za kojeg je utvrđeno da ima akutni infarkt miokarda s podizanjem ST segmenta. Perkutana koronarna intervencija u slučajevima dekstrokardije može biti tehnički izazovna s obzirom na poziciju ušća koronarnih arterija te poteškoće u odgovarajućem odabiru i manipulaciji intervencijskim kateterima

Epidemiološka analiza raka pluća u području srednje Dalmacije (20-godišnji rezultati)

A several-fold increase in the incidence of lung cancer during the last 20 years has been obvious in the central Dalmatia region. It has been on a constant increase in both men and women. A 2.4-fold increase has been recorded in male, and 4.2-fold in female population. The majority of patients are long-time cigarette smokers. Thirty years ago this habit was characteristic for men, while today the number of female smokers has been on an increase (the percentage of female patients cigarette smokers increased from 17.8% to 47.3%). Most patients are older than 65 and together with those over 60 years of age they make over 42% of lung carcinoma patients. The increased incidence of adenocarcinoma not directly connected with cigarette smoking, on the account of a decrease in the incidence of squamous cell carcinoma of the lung has been confirmed. The highest increase was recorded during the postwar years (by as much as 32% in 2000), which could be attributed to severe psychical traumas and other hardships related to the war and life in the postwar period. The increase in the incidence of squamous cell carcinoma in women (from 17.5% to 20.4%) could probably be attributed to the increase in the number of female smokers. The decrease in the incidence of small cell anaplastic lung carcinoma was evenly distributed in both sexes (from 27% to 22.6%). Comparison of data obtained for one part of Croatia (coastal region) with global data suggests a similar epidemiological pattern to exist in the south and southeast Europe (south Italy, Spain, and Greece).Porast raka pluća zadnjih 20 godina ošit je i u našem području, i to višestruko. Širi se iz godine u godinu, kako u muškaraca tako i u žena. Bilježi se porast u muškaraca za 2,4 puta, a u žena čak za 4,2 puta. Najveći broj oboljelih su bili dugogodišnji pušači. Ova navika bila je još prije 30-tak godina značajka muškaraca, a sada sve više i žena (porast bolesnica koje su pušile od 17,8% na 47,3%). Najveći broj oboljelih je iznad 65. godine života, a zajedno s brojem onih iznad 60. godine života čine preko 42% oboljelih. Dokazana je povećana učestalost adenokarcinoma, koji nije bio u izravnoj vezi s pušenjem, na račun pada broja učestalosti planocelularnog raka pluća. Najveći porast nalazi se u poratnim godinama (2000. g. čak 32%), a za taj porast mogli bismo kriviti teške psihičke traume i ostale životne nedaće u ratu i nakon njega. Porast planocelualrnog raka u žena (sa 17,5% na 20,4%) je vjerojatno zbog većeg broja žena koje su pušile. Bilježi se pad mikrocelularnog anaplastičnog raka pluća, koji je podjednako zastupljen u oba spola (s 27% na 22,6%) oboljelih. Uspoređujući iznesene podatke iz jednoga dijela Hrvatske (priobalnog područja) s podacima iz svijeta možemo zaključiti da su epidemiološki podaci slični onima iz područja južne i jugoistočne Europe (južne Italije, Španjolske, Grčke)

Influence of Passive Smoking on Basic Anthropometric Characteristics and Respiratory Function in Young Athletes

The primary objective of this study is to investigate the maintenance difference in basic anthropometric characteristics and to outline the dynamics of respiratory function change in youngsters athletes exposed to passive smoking (PS) and athletes not exposed to passive smoking in their families (NPS). High and weight were determined as basis anthropometric characteristics. Measured parameters for respiratory function were vital capacity (VC), forced expiratory volume in the first second (FEV1), maximum expiratory flow (PEF), forced expiratory flow at 50% forced vital capacity (MEF 50) and forced expiratory flow at 25% forced vital capacity (MEF 25). Significant statistical differences in separate spirometric variable were found in three variables (FEV1, MEF50, and MEF25) for group older youngsters. Analysis of variance showed statistical differences between athletes unexposed to passive smoking (NPS) and athletes exposed to passive smoking (PS) in even four spirometric variables (VC, FEV1, MEF50 and MEF25)

Increasing of Malignant Pleural Mesothelioma: Burning Issue in Split-Dalmatian County, Croatia

Asbestos-related diseases are one of the burning public health issues worldwide. The incidence and the epidemiological patterns of malignant pleural mesothelioma in Split-Dalmatian County, where a large part of Croatian industry related to asbestos processing and use have been situated were assessed in this study. The history of asbestos-related issues and development of current legislation in Croatia was also discussed briefly. Data on the incidence were collected retrospectively from the medical records of patients with malignant pleural mesothelioma treated at Department of Pulmonary Diseases University Hospital Split during the 2000–2007 period. A total of 137 new cases was recorded with the mean incidence of 3.55/100 000 and the trend was increasing over years compared with 1992–1995 period in the same county when the mean incidence was 1.7/100000. Men accounted for 85.4% of all cases. The mean age of patients was 64.9±15.4 years. The majority of patients were occupationally exposed to asbestos (85.4%), 8.8% had environmental exposure, and 2.2% had domestic exposure. The type of household exposition was in 5.8% of patients. More than half of the cases were exposed to asbestos 31–40 years. The mean length of exposure was 28.87±15.63 years. The incidence of malignant pleural mesothelioma in Split-Dalmatian County has been obviously increasing due to the predominantly occupational exposure and it is reasonable to assume that it will remain high in the next two –three decades and to be a reason for concern and fear among the general population

Lung Function Changes in Pleural Asbestosis

The aim of this study was to examine the relationship between radiographically detectable pleural changes and lung function in pleural asbestosis. One hundred and twenty chrysotile asbestos-exposed workers were enrolled in this retrospective study. For each examinee the length of asbestos exposure and the degree of dust cover at the workplace were assessed as well as the radiological and functional tests has been performed. The examinees were divided into two groups based on radiologically detectable changes: a) group with pleural changes (29%) and b) group without perceived pleural changes (71%). The obtained results indicate association between the length of asbestos exposure, pleural changes and the impairment of lung function

Pulmonary Function in Persons Who are Professionally Exposed to Formaldehyde Fumes

The present study examines long-term effects of occupational exposure to formaldehyde fumes on lung function. Forced spirometry and diffusing lung capacity were measured in 16 health-service professionals (8 medical doctors and 8 laboratory technicians) working at the pathoanatomic laboratory for at least 4 years with daily exposure 8+1 hours. Control group employed 16 males, which were matched by age and stature to members of the exposed group. Only non-smokers were included in the study. Spirometric parameters in study participants exposed to formaldehyde fumes compared to control group were not significantly different indicating absence of restrictive and/or obstructive deterioration of lung function in exposed group. The only parameter differing in two groups was blood volume of pulmonary capillaries (Vc’) which was significantly larger in a group exposed to formaldehyde fumes. The possibility that the hyperemic lung reaction is the consequence of the exposure to formaldehyde fumes should be further explored

Analysis of dynamic of indicators for respiratory gas exchange and heart frequencies during cardiopulmonary exercise testing

Glavni parametri procjene fizičke sposobnosti jedinke su maksimalan utrošak kisika (V̇O2max), kasnija pojava anaerobnog praga, niže vrijednosti omjera respiracijske izmjene (RER) te sporiji rast srčane frekvencije (HR). V̇O2max nije osjetljiv pokazatelj za procjenu fizičke aerobne sposobnosti, jer ne opisuje dinamička zbivanja tijekom opterećenja, a potrebno je organizam opteretiti do krajnjih granica izdržljivosti. U ovom radu smo pokušali procijeniti aerobnu sposobnost i predikciju fizičke izdržljivosti na submaksimalnim opterećenjima analizirajući omjer respiracijske izmjene plinova (RER), frekvenciju srca (HR), O2-puls, parcijalne endtidalne tlakove O2 (PETO2) i CO2 (PETCO2) te parametar ventilacije disanja (V̇E) u početnim fazama opterećenja, odnosno u prva II stupnja opterećenja po Brceovu protokolu. Ispitanici su bili muškarci (N=42), slične dobi (23±SD), koje smo podijelili u dvije skupine po kriterijima bolje i lošije fizičke sposobnosti koristeći submaksimalni i maksimalni test opterećenja na pokretnoj traci. Analizirali smo dinamiku navedenih parametra u vremenu, kao i određene njihove međuodnose. Naši rezultati su pokazali da pri početnim (submaksimalnim) opterećenjima postignute vrijednosti RER-a, O2 puls-a, PETO2, PETCO2 i V̇E mogu ukazati na veću ili manju aerobnu sposobnost organizma, odnosno na razliku u fizičkoj spremi. Također postoji potencijal za eventualnu kliničku primjenu.The main parameters of physical fitness assessment of individuals are maximal oxygen consumption (V̇O2max), subsequent occurrence of anaerobic threshold, lower values of respiratory exchange ratio (RER) and slower heart rate (HR). V̇O2max is not sensitive indicator for assessing the physical aerobic fitness, because it does not describes dynamic events during load and requires loading the body to the limit of endurance. In this paper we have attempted to assess the prediction of aerobic capacity and physical endurance at the sub maksimal loads by analyzing RER, HR, O2-pulse, endtidale partial pressure of O2 (PETO2) and CO2 (PETCO2) and respiratory ventilation parameters (V̇E) in the initial stages of loading, i.e. at the first II stages using Bruce`s treadmill protocol. The subjects were male (N = 42), similar age (23 ± SD), divided into two groups according to the criteria of better and worse physical abilities using sub maksimal and maximal loading test on a treadmill. We analyzed dynamics of the given parameters in a time, as well as certain parameter interrelationships. Our results showed that at baseline (submaksimal) loads, reached values of RER, O2-pulse, the PETO2, PETCO2 and parameters of V̇E can indicate a higher or lower aerobic capacity, i.e. the difference in the physical qualifications of individuals. There is also potential for eventual clinical application