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Prispevek opredeljuje vlogo dejavnosti varstva dediščine v območjih zavarovane krajine oziroma parkov, ki vsekakor presega običajne delovne postopke. Izpostavlja vlogo etnologa konservatorja s poudarkom na pomenu temeljnih raziskav izbranega območja kot osnove za načrtovanje obsega vsebine, predstavitve dediščine, upravljanja, skratka celovitega razvoja zavarovanega območja. The article is defining the role of heritage - conservation activity in sites of protected landscape and parks respectively; the activity which by all means surpasses the habitual working processes. It exposes the role of ethnologist - conservationist with the stress on inevitability of basic researches on the chosen site, which should serve as grounding for planning the complex development of the protected region (i.e.: the extent of content, heritage presentation, management, ...).

Background: Gamma-hydroxybutyrate (GHB) is an illicit drug causing unconsciousness and respiratory depression. The aim of this study was to evaluate the clinical presentation and treatment in patients admitted to the University Medical Centre Ljubljana (UMCL).Methods: In this study we included all retrospectively reviewed cases of GHB-poisoning admitted to the UMCL between 2000 and 2014. We collected all the data regarding the overdose circumstances, clinical presentation, treatment and toxicological analysis of blood and urine.Results: In the previous 15 years a total of 74 patients were admitted to the UMCL due to GHB-poisoning. The first case of GHB-poisoning was observed in 2002 and the numbers have largely increased since 2012. 86% of all the patients ingested the drug intentionally, 82% were male and the median age of admitted patients was 27 years. We recorded 6 mass GHB-poisonings in which 2-4 patients were admitted simultaneously. The most common presenting symptom of GHB-poisoning was diminished level of consciousness (95%), with 53% being unresponsive to pain. Vomiting (30%), bradycardia (28%), hypotension (26%), hypoventilation with respiratory insufficiency (19%) and agittation upon awakening (31%) were common as well. Concomitant alcohol and illicit drug use was recorded in 61% of cases. 80% of all the patients were treated symptomatically, 14% were mechanically ventilated.Conclusions: The incidence of GHB-poisoning has increased in recent years. GHB-poisoned patients are predominantly male, often admitted in groups, who ingest the drug intentionally at parties during weekends. The most common presenting symptom of GHB-poisoning is unconsciousness. Treatment is symptomatic.

Makedonsko glavno mesto je tako kot številna druga mesta v sosednjih državah doživelo radikalne spremembe, ki so v zadnjih dvajsetih letih in že prej vplivale na urbanistične procese. V zadnjem stoletju se je prebivalstvo Skopja povečalo za več kot desetkrat, družbene spremembe v tem obdobju pa niso vplivale samo na načrtovalske procese, temveč tudi na grajeno tkivo mesta. Posledično so mesto preoblikovale najrazličnejše dinamike. V zadnjih dvajsetih letih je razvoj Skopja zaznamoval dolg in boleč prehod – proces, med katerim se je mesto moralo prilagoditi novim kompleksnim razmeram. Kriza, ki je zajela Skopje, je povzročila slabšo kakovost grajenega okolja in ustvarila plodna tla za špekulativno gradnjo. Postalo je jasno, da urbanistično načrtovanje ne more več delovati kot orodje nadzora in razvoja, katerega glavni cilj je varovati in spodbujati javne interese. V članku so analizirane načrtovalske pobude, sprejete pred 90. leti 20. stoletja in pozneje, pri čemer so opredeljene glavne faze preobrazbe od 90. let naprej, in sicer v skladu s ključno zakonodajo, političnimi dejavniki in z upravnimi odločitvami, ki so prispevali k urbani preobrazbi mesta.

Like many cities in neighbouring countries, the Macedonian capital Skopje has undergone radical changes that have affected urban planning processes for over twenty years. Over the past century, during which Skopje’s population has grown more than tenfold, social changes have not only affected planning processes but also impacted the built fabric of the city. As a result, the city has been transformed by a diverse set of dynamics. The last twenty years of Skopje’s development have been marked by a long and painful transition, a process through which the city has had to adjust to new complexities. The current crisis engulfing the city has led to deterioration in the quality of the built environment and has created fertile ground for speculative developments. It has become clear that urban planning is no longer able to operate as an instrument of control and development with the primary aim of protecting and promoting public interests. This article analyses the planning initiatives both before and after the 1990s, defining the main phases of transformation since the 1990s according to the key legislation, political factors and administrative decisions that have contributed to the urban transformations of the city.

The opinions and arguments, claiming that Anton Janša stayed in Carinthia from 1765 until his departure for Vienna in the year 1766, that he was a member of the Carinthian agricultural society and similar, are a novelty in the knowledge of the life and work of the first c. k. beekeeping teacher in Vienna. This statement was for the first time published in the book of Ehrenfels in 1829 and for the second time in the book of Heinrich in 1832. This notice was later reproduced in other works. The message of these publications is: Anton Janša was a Carinthian, he brought the Carinthian way of beekeeping to Vienna, he originates from the Carinthian agricultural society, which also recommended him in Vienna, so he was invited by the Empress Maria Theresia to Vienna and so on. Among Slovenian authors Perc (1925a,b) and Stabej (1955) drew attention to these records. Janša describes in his books and stresses his Carniolan origin, Carniolan way of beekeeping and Carniolan wooden hive and does not refer to his life and work in Carinthia. To confirm these records and publications on Anton Janša in Carinthia, it is necessary to find archival documents in provincial archive in Klagenfurt to confirm or to reject this hypothesis.

Background: The aim of our study was to define long-term electrocardiographic and echocardiographic changes and complications after transcatheter closure of atrial septal defect and patent foramen ovale in adults.Methods: The clinical, electrocardiographic and echocardiographic follow-up of 137 consecutive patients that underwent transcatheter closure of atrial septal defect (51 patients) or patent foramen ovale (86 patients) in a 10-year period was analyzed retrospectively.Results: In the patent foramen ovale group, we observed no significant postprocedural changes. There were no changes in heart rate, heart rhythm and PR or QRS duration in both groups. In the atrial septal defect group, we observed a leftward shift in the heart axis (p = 0.017), a decrease in the estimated systolic pulmonary artery pressure (p = 0.024), decreased tricuspid early diastolic flow velocity (p = 0.002), a decrease in the right chamber dimensions (p = 0.0004) and interventricular septal movement normalization (p Conclusions: No electrocardiographic or echocardiographic changes occurred after patent foramen ovale closure. Atrial septal defect closure is related to significant early morphological and hemodynamic improvement. Postprocedural complications are usually early and mild but serious late complications can occur. For that reason, long-term follow up is recommended in these patients.

A 52-year-old patient decades after complete correction of tetralogy of Fallot is presented. The main late complication was left ventricular failure with consequential congestive heart failure. Heart transplantation was the only therapeutic option.

Anti-β2-glycoprotein I antibodies (aβ2GPI) represent a potential pathogenic candidate for coronary artery diseases. High avidity aβ2GPI (HAv aβ2GPI) are known to be associated with thrombotic and obstetric manifestations in patients with antiphospholipid syndrome, who are also susceptible to the development of premature atherosclerosis. However, there is little information about how human coronary artery endothelial cells (HCAEC) are affected by HAv aβ2GPI. The purpose of our study was to evaluate the pathophysiological effects of HAv aβ2GPI on HCAEC and determine their influence on cytokine expression and migration of peripheral blood mononuclear cells. Following the two hit hypothesis, we co-stimulated HAv aβ2GPI-treated HCAEC in the presence and absence of the acute phase protein serum amyloid A (SAA). HAv aβ2GPI induced in vitro HCAEC dysfunction, through the ERK1/2 signaling pathway, promoted the expression of chemokines (MCP-1, GROα and IL-8) and IL-6, which led to the attraction and migration of peripheral blood mononuclear cells. These effects were potentiated and intensified in conditions with SAA, indicating that HAv aβ2GPI, in the presence of physiological concentrations of acute-phase proteins represent pathogenic autoantibodies, which could lead to the development of premature atherosclerosis and/or thrombosis development.

Background: General practitioners and medical specialists are seeing adults with congenital heart disease in their everyday practice more frequently than ever. The lack of experience and knowledge in this field of cardiology often leads to mistakes in the treatment of these patients. The purpose of this article is to point out the commonest problems and mistakes in dealing with this group of patients. Conclusions: In the following article we pointed out the commonest problems and mistakes in dealing with adults with congenital heart disease, such as differing various types of atrial septal defects and differing atrial septal defect from patent foramen ovale. We also pointed out the commonest mistakes in dealing with patients with cyanotic heart disease, especially those with Eisenmenger syndrome.

Introduction: Non-compaction cardiomyopathy is a rare inborn anomaly caused by disorder of endomyocardial morphogenesis. The diagnosis is based on echocardiographic criteria. The prevalence in the adult population is not known. The symptoms are atypical. Three main groups of clinical signs exist: heart failure, thromobembolic events and arrhythmias. In the group of patients with reduced left ventricular function the prognosis is poor and the treatment options are limited. Patients and methods: In the recent 10 years, 7 patients with non-compaction cardiomyopathy were diagnosed at the Department of Cardiology of the University Medical Centre Ljubljana. Results: All seven patients were males, their mean age at the last follow-up being 39 ± 20.3 years (range 20 to 70 years). Five patients were diagnosed in adulthood. All of them fulfilled the echocardiographic diagnostic criteria of noncompaction cardiomyopathy. Five patients had depressed function of both ventricles, two patients had isolated left ventricular dysfunction. Three patients had decreased left ventricular ejection fraction, six patients showed left ventricular diastolic dysfunction. Only three patients had normal physical capacity. Two patients presented with clinical signs of overt heart failure. During follow-up, one patient died from heart failure. We observed thromboembolic events in one patient. Three patients suffered from nonsustained ventricular tachycardias and two patients had rhythm conduction abnormalities. Conclusions: Non-compaction cardiomyopathy is a rare disorder. We observed all common complications in our group of patients. The majority of patients displayed dysfunction of the affected ventricle and the dysfunction was more pronounced in older patients. Treatment of complications is an important factor in long-term survival of these patients.

There is predominate opinion among physicians managing type 1 Gauchers' disease (GD) that cardiac involvement is not an issue in these patients. In order to follow this hypothesis, we prospectively investigated 15 adult imiglucerase-treated type 1 GD patients by echocardiography, Doppler, and tissue Doppler echocardiography. This was a case-controlled study with 18 matched healthy volunteers. The obtained data was correlated with the levels of NT-proBNP (brain natriuretic peptide). None of the GD patients had clinical signs of heart disease. In 3 of the 15 patients, we observed echocardiographic signs of aortic and mitral valve calcification. The left ventricular systolic function was within normal limits. Compared to the control group, there was no statistically significant difference observed in the most sensitive indices of left ventricular diastolic function, parameter Em (P=.095), and E/Em ratio (P=.097), as demonstrated by tissue Doppler echocardiography. However, there was a positive correlation between the E/Em ratio and NT-proBNP plasma levels (P=.009). In conclusion, the prospective echocardiographic study of type 1 GD patients did not validate any left ventricular dysfunction. But, the E/Em ratio showed a strong statistical correlation with the most sensitive indicators of heart failure, NT-proBNP. Research on larger groups of patients and the usage of even more sensitive methods as strain-rate imaging will be necessary to confirm eventual myocardial involvement in GD patients.

Background: As the population ages there is an increasing number of elderly patients with severe symptomatic aortic stenosis and numerous co-morbidities. Decision for aortic valve replacement–a gold standard for the treatment of aortic stenosis–might be dii - cult in this group of patients,in whom open heart procedure may be associated with an unacceptably high risk. Less invasive percutaneous methods are being developed as alternative options for improving the quality of life and prolonging survival. Balloon aortic valvuloplasty is a percutaneous catheterbased method for dilation of the aortic valve, which was in the past almost abandoned due to a high incidence of restenosis and the lack of impact on long-term survival. Twenty years at er its introduction in the elderly patients, together with the development of percutaneous aortic valve implantation methods, balloon aortic valvuloplasty is regaining its role. Case report: We report a case of a 88-yearold woman with severe symptomatic aortic stenosis and a high perioperative risk, who was considered unsuitable for surgical aortic valve replacement. Owing to worsening of her symptoms, she had balloon aortic valvuloplasty performed. At er the procedure she improved clinically and objectively. Conclusions: Our case points out that there are additional therapeutic options for highrisk patients with severe aortic stenosis. Many share the opinion that balloon aortic valvuloplasty will play an important role as a palliative therapy or a bridge to surgical or percutaneous prosthetic valve implantation

Backgrounds: Ebstein’s anomaly of tricuspid valve is a rare congenital heart anomaly. Surgical implantation of artefi cial tricuspid valve is a standard treatment modality. Common late complication of such surgical procedure is artefi cial valve thrombosis. Th is is a life threatening condition, which demands surgical intervention promptly. Conclusions: In following article, we describe a case of a patient with Ebstein’s anomaly and late artefi cial tricuspid valve thrombosis. Th e case was complicated with a mild form of haemophilia C, a rare coagulation disorder. Genetic analysis was also performed.

BACKGROUND Tumors of the spine where spinal part of the tumor spreads trough the intervertebralforamen are so-called hourglass or dumbbell tumors. Malignant tumors of this kind arerare and most frequently neurogenic in origin. The extraspinal part of the tumor could beextremely large; however, the symptoms and signs are most commonly attributable to thespinal part. METHODS Three patients with malignant dumbbell tumors with an extensive exstraspinal part arepresented. Two patients had malignant peripheral nerve sheet tumor and one patient hadsynovial sarcoma. RESULTS In two patients operation was performed in several steps and the spinal part of the tumorwas operated first. The third patient was first operated for the extraspinal part butdied after the operation due to the general postoperative complications. Corpectomy andadequate stabilization was performed in one patient. Two patients received adjuvantoncological treatment. The longest survival was achieved in a patient who had the mostradical surgery. CONCLUSIONS Patients with rare tumors are presented where surgical and postoperative treatment ischallenging, experiences with the treatment are few, individual and multidisciplinaryapproach is mandatory, postoperative course is demanding and the prognosis is lessfavorable

BACKGROUND Recent advances in the treatment of malign haematological deseases with chemotherapyhave led to significant improvement in prognosis and quality of life of the pacients. Thesame drugs can lead to development of serious cardiac side effects, especially the syndromeof heart failure. Anthracycline drugs are best known for their cardiotoxicity, the role ofother drugs is less well understood. CONCLUSIONS Predisposing factors to cardiotoxicity should be taken into consideration when dealingwith such pacients. Careful history, clinical examination, electrocardiography, echocardiography and NT-proBNP measurement should be performed prior and at the end of thetreatment with cardiotoxic drugs. Pacients with slightest clinical, laboratory or echocardiographic parameters of developing heart failure should immediately be reffered to a cardiologist to start with appropriate treatment

Background: Stroke is the third cause of mortality and leading cause of disability regarding the World Health Organization data. Cryptogenic stroke encompasses 40% of young adults with ischemic stroke. The relationship between patent foramen ovale and cryptogenic stroke has been established in patients younger than 55 years. Furthermore, stronger correlation was found between ischemic stroke and patent foramen ovale in patients with atrial septum aneurysm.Conclusions: Patency of foramen ovale can be demonstrated using echocardiography. Transesophageal echocardiography is superior to transthoracic approach because the transducer is very close to the heart and there is less interference with the ultrasound beam. Gold standard in diagnosis of patent foramen ovale is contrast echocardiography with the transesophageal approach. Transcranial Doppler can be used to detect right to left shunt. Studies have shown that transcranial Doppler using echo contrast medium can be used for screening of patents with patent foramen ovale. Antiplatelet therapy is appropriate treatment for patients with patent foramen ovale who suffered from cryptogenic stroke. Anticoagulant treatment is justified when additional indication for such therapy exists like atrial septum aneurysm. Percutaneous closure of foramen ovale is a new method for secondary stroke prevention with no conclusive data on its effectiveness. Studies on percutaneous closure are still ongoing. In secondary stroke prevention percutaneous closure has to be done without residual shunt.

Background: Colorectal cancer is the second most common cause of cancer death in Slovenija and its incidence in the last decades is rising. According to the epidemiological data from 2001, the incidence in male is 64/100,000 in female 48/100,000. Even though the relative fiveyear survival of the patients with this disease is rising, the majority of them are discovered in the advanced stage of the disease with poor prognosis.Conclusions: If diagnosed and surgically removed in its early stage, colorectal cancer is a curable disease. Using screening tests, such as fecal occult blood test and endoscopy of the lower gastrointestinal tract, we can detect and treat premalignant lesions and early stages of colorectal cancer. In Slovenia, colorectal cancer could be the third malignant disease, after uterine cervix and breast cancer where secondary prevention should be introduced in order to reduce its incidence and mortality. In the following article the authors present and discuss the results of studies made on the prevention of colorectal cancer and the most commonly used screening methods, as well as some of the methods that are still being evaluated. They suggest measures that should be taken in Slovenia against this disease.

Background. Objective evidence of cardiac dysfunction is one of the diagnostic criteria for heart failure. It is often hard to assess systolic function and assessing diastolic dysfunction is even harder because there are no generally accepted echocardiographic criteria. Tissue Doppler imaging (TDI) enables analysis of the mitral annular descent velocity for detection of left ventricular diastolic dysfunction along the longitudinal axis.Methods. 30 patients with heart failure and 30 healthy participants were enrolled in the study. Pulsed wave tissue Doppler imaging velocities of septal and lateral mitral annulus borders were recorded in systole (Sm) and early diastole (Em). Velocities in both groups were compared. The correlations between Sm velocity and LVEF and Em velocity and age were studied.Results. Patients with heart failure had significantly decreased Sm and Em velocities compared with healthy participants (5.3 ± 1.6 cm/s vs. 8.4 ± 1 cm/s, P < 0.001, for Sm velocity and 5 ± 1.4 cm/s vs. 8.7 ± 1.6 cm/s, P < 0.001, for Em velocity). The correlation between Sm velocity and LVEF in all participants was very good and highly significant (r = 0.91, P < 0.001). The Sm velocity ≥ 6.4 cm/s was 91% sensitive and 95% specific for LVEF ≥ 0.45. There was a good correlation between age and Em velocity (r = -0.84, P < 0.001). The Em velocity < 7 cm/s had a sensitivity of 90% and specificity of 97% for diagnosing heart failure.Conclusions. Pulsed wave tissue Doppler imaging of mitral annulus enables simple, fast and precise assessment of systolic and diastolic left ventricular function. It can replace some other more time consuming echocardiographic measurements.

Background. The aim of this paper is to present and assess a surgical treatment of patients with colon cancer.Methods. All patients with colon cancer, who were operated in years 1998–2001, were included in the analysis. We have collected data including patients age, localization and stage of cancer, types of preformed procedures, postoperative mortality, disease recurrence and survival of the patients.Results. We have operated on 308 patients with histological evidence of colon cancer in abovementioned period. The average patients age was 66.5 years (SD = 11.1; 95% CI: 44.3– 88.7). Primary tumor was most commonly (36%) located in sigmoid colon. UICC stages were as follows: stage I 34 patients, 11%; stage II 141, 46%; stage III 64, 21%; stage IV 69, 22%. We have performed 287 resections of colon (93% resectabillity), of these 214 (75%) were potentially curative R0 resections. Share of urgent procedures was 21%. In the postoperative period 22 patients (7%) have died. Postoperative mortality was significantly higher by urgent (19%) compared to scheduled procedures (4%) ( χ 2 = 16; df = 1; p = 0,005). In the observed time 22% of patients developed recurrent cancer. Mean survival rate of our patients was 1274 days or 3.5 years (SD = 191; 95% CI: 900–1648). Calculated overall five years survival rate was 45%.Conclusions. Planned and registered surgical treatment of patients with colon cancer, surgical specialization in colon surgery and adjuvant oncological treatment have shown the same incentive results, reflected in increased survival rate.

Background. To obtain information on the surgical treatment of patients with colorectal cancer at the Department of Abdominal Surgery, in the General Hospital Maribor, in the year 2000.Methods. Using a computerized protocol, we prospectivelly collect and registrate data about patients with colorectal cancer. Our data contains preoperative diagnostic investigations, intraoperative findings, pathohistological examinations after surgery, operative morbidity and mortality and alterations, found during follow up examinations.Results. In the year 2000, 135 patients (72 male and 63 female) with colorectal cancer underwent surgery. The average age was 66.4 years, spanning from 39 to 90 years. 15% were presented as emergencies. The general operability rate was 99%, the resectability rate was 92%, and the portion of potentially curative resections was 69%. Cases were localised into right-sided (23%), transverse (2%), left-sided (32%) and rectal (43%). The stage distribution according to the TNM classification was as follows: Stage 0: 1 patient, Stage I: 17%, Stage II: 42%, Stage III: 19%, Stage IV: 22%, 5 patients were undefined. The portion of different surgical procedures is presented in the text. The postoperative mortality rate was 6%, 7 patients died after urgent procedures and 1 died after elective surgery. The rate of surgical complications, which required reoperation was 4.4%. The rate of conservativelly treated surgical complications was 6.6%. The average hospital stay was 12.8 days and ranged from 6 to 36 days.Conclusions. The number of surgically treated patients with colorectal cancer in our institution is growing every year like in other departments in Slovenia and western countries. The rate of potentially curative resections can be expanded by early detection of the disease, as well as with more accurate pre- and intraoperative staging of the tumor, and consideration of the modern principles of management.

Background. Carcinoid heart disease is a rare heart disease which affects endocard and heart valves on the right side of heart. It affects only patients with manifested carcinoid syndrome, which is thought to be the consequence of secretory active metastases of carcinoid tumour. The carcinoid endocardial plaques cause structural changes of tricuspid and pulmonic valve and later on their stenosis and/or insufficiency.Patients and methods. In this article we introduce a carcinoid valve heart disease (CVHD) scoring system for easier end exact echocardiographic diagnostics. Four echocardiographic parameters are beeing estimated: structural changes of tricuspid valve, tricuspid valve regurgitation, stenosis of pulmonic valve and pulmonic valve regurgitation.Conclusions. The scoring system allows us to make an early diagnosis and evaluation of progression of carcinoid heart disease, which is very important for planning the treatment process. Our experiences confirm the usefulness of this scoring system in echocardiographic follow–up of patients with carcinoid syndrome.

Background. Blunt trauma to the abdomen is more likely to damage solid organs. Blunt injuries to the colon are uncommon and usually they follows a direct blow to the abdomen. Physical findings suggesting peritoneal iritation can be present early in the postinjury period but there is usually a delay in the manifestation of colonic injury. If the colonic perforation is present as a solitary injury, signs of peritoneal iritation are easier to recognize and they lead to further evaluation and operation. Because of the force required to injure the colon, associated injuries often coexist, consequently physical findings may be masked, diagnosis delayed, and outcome compromised.Conclusions. Additionaly, the recent trend for conservative management of blunt abdominal trauma may lead to delay in diagnosis. Perioperative antibiotics and early laparotomy with complete intra-abdominal exploration and primary repair of the colon injury usually provide excellent results.

Abstract Introduction Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented. Case presentation We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal. Conclusion A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.