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Prikazan je odnos informacijskih tehnologija i integracije skrbi za kompleksne pacijente. Učinjena je SWOT analiza uloge informacijskih tehnologija u integraciji skrbi. Na primjerima situacija/slučaja bolničke putovnice za osobe s poremećajem iz spektra autizma, palijativne skrbi te neformalne skrbi prikazano je kako informacijske tehnologije mogu služiti kao podrška u integraciji skrbi.

Deklaracija o e-zdravlju, projekt Odbora za e-zdravlje Akademije medicinskih znanosti Hrvatske (AMZH), objavljena je 2011. godine na mrežnim stranicama Akademije medicinskih znanosti Hrvatske. Uz manje izmjene, tekst Deklaracije na hrvatskom jeziku dostupan je na mrežnim stranicama Akademije medicinskih znanosti Hrvatske i, na engleskom jeziku, u Biltenu Hrvatskog društva za medicinsku informatiku te na društvenoj mreži ResearchGate.net. Da bi se vidjelo što se dogodilo s Deklaracijom nakon 10 godina provelo se je vrednovanje prema OECD-ovom modelu „ulog-odgovor-ishod-učinak“, i to kroz direktne posljedice, tj. službene dokumente koji u potpunosti preuzimaju pojedine njezine navode, i kroz činjenice realizirane nakon objave Deklaracije a koje su u skladu s navodima u njoj. U radu je opisan svaki korak (ulog, odgovor, ishod, učinak). Glavni ishodi su navedeni u tablici s nazivima dokumenata i citata koji potvrđuju usklađenost s navodima Deklaracije. Što se tiče učinka, pet je navoda iz Deklaracije postiglo zamjetljiv učinak, impakt u zdravstvenom sustavu. Iako još nije realizirano u potpunosti (npr. nemaju sve bolnice zadovoljavajući sustav koji se uklapa u centralni zdravstveni informacijski sustav; zdravstveni portal za komunikaciju s građanima postoji ali je otvoreno pitanje koliko ga građana koristi; certifikacija se provodi prema određenim kriterijima i protokolima ali nije u potpunosti usklađena s kriterijima EuroRec-a; medicinsko/zdravstveno informatičko obrazovanje postoji ali nije ujednačeno na svim medicinskim/zdravstvenim obrazovnim ustanovama – ni sadržajno, niti mjestom u obrazovnom kurikulu), postoji niz ishoda koji su usklađeni s Deklaracijom i međunarodnim stremljenjima i koji su na putu da postanu zamjetljiv učinak Deklaracije. Treba uzeti u obzir da i međunarodno gledajući nema konačnog i zadovoljavajućeg rješenja i da još treba i vremena i napora da bi se realizirao digitalizirani zdravstveni sustav u nacionalnim okvirima ali i međunarodno., Declaration on eHealth (Declaration), the project of the eHealth Committee of the Croatian Academy of Medical Sciences (CAMS), was published in 2011 on the website of CAMS. With minor changes, the text of the Declaration in Croatian is available on the website of the CAMS and, in English, in the Bulletin of the Croatian Society for Medical Informatics (CroSMI) and on the social network ResearchGate.net. To find out what happened to the Declaration after 10 years, an evaluation was carried out according to the OECD's input-output-outcome-impact model, (a) through direct consequences, i.e., official documents quoting some of Declaration’s statements, and b) through facts being in line with the Declaration, occurred after the Declaration was published. The paper describes input, output, outcome, and impact as the steps in evaluation. The main outcomes are listed in the table, then titles of documents, as well as quotations confirming compliance with statements in the Declaration. Considering the effect, five statements in the Declaration have achieved a noticeable effect in the Croatian eHealth. Although not yet fully implemented (like, some hospitals have not yet implemented the system compatible with the central health information system; there is the health portal for communication with citizens, but it is unknown how many citizens use them for now; criteria and protocols for the certification process have been defined, but certification is not entirely in accordance with EuroRec criteria; medical / health informatics issue (MHI) for future healthcare professionals exists, but differently in different teaching programs, even for the same type and level of educational institutions). There are several outcomes in accordance with Declaration and international trends, which could be considered as the effect of the Declaration. Finally, there is no complete and satisfactory solution for eHealth even internationally. Thus, it takes more time and effort to fully achieve the digitalized health system at the national and international level.

Rad govori o osnovanju centra za liječenje raka dojke sa europskim certifikatom.

Na tragu iskustva britanskog zdravstvenog sustava koji je osmislio bolničku putovnicu koja zdravstvenim radnicima na učinkovit način posreduje složene informacije o takvim pacijentima, KBC Rijeka odlučio je uvesti ovaj nestandardni dokument koji sažima ključne informacije o pojedinom zahtjevnom pacijentu. Rad opisuje proces uvođenja bolničke putovnice u praksu.

Prikazan je odnos informacijskih tehnologija i integracije skrbi za kompleksne pacijente. Učinjena je SWOT analiza uloge informacijskih tehnologija u integraciji skrbi. Na primjerima situacija/slučaja bolničke putovnice za osobe s poremećajem iz spektra autizma, palijativne skrbi te neformalne skrbi prikazano je kako informacijske tehnologije mogu služiti kao podrška u integraciji skrbi.

Zakon o zaštiti osoba s duševnim smetnjama definira osobu od povjerenja kao osobu ovlaštenu za davanje ili uskratu pristanka na određene medicinske postupke umjesto osobe koja ju je na to ovlastila obvezujućom izjavom.Iako je definiran zakonom, institut osobe od povjerenja nije dovoljno iskorišten u praksi kod traženja pristanka za medicinske postupke s osobama koje imaju duševne smetnje. Iz tog razloga najčešće se pokreće postupak lišavanja poslovne sposobnosti osobe i dodjele skrbnika od Centra za socijalnu skrb. Međutim, ovaj postupak traje dugo i samim time nije u interesu pacijenata s duševnim smetnjama.

Smjernice kod odbijanja transfuzije krvi iz religijskih razloga nastale su kao pomoć u rješavanju komunikacijskih teškoća u odnosu liječnik – pacijent koje se ponekad javljaju u praksi zbog zakonskih nedorečenosti.

U Primorsko-goranskoj i Istarskoj županiji postoji desetogodišnje iskustvo sustavnoga razvoja mreže profesionalne palijativne skrbi. Razvijena je vlastita informatička aplikacija za podršku profesionalnoj komunikaciji te upravljanju i odlučivanju u palijativnoj skrbi – CISPAL. U posebnim slučajevima za informatičko praćenje palijativnih pacijenata primjenjuje se MKB-šifra Z02.8 kao alternativa šifri Z51.5. Kako je bol vodeći problem u mnogih pacijenata, osobito onih s malignim bolestima probavnoga trakta, u praksu je uvedena supkutana infuzija koja im omogućuje kvalitetnu kontinuiranu analgeziju u kućnoj skrbi. U suradnji sa Školom narodnoga zdravlja „Andrija Štampar“ izrađena je opsežna količina stručnih materijala te pohranjena na internetskom repozitoriju www.palijativna-skrb.hr.

Temeljni cilj ove knjige jest odgovoriti na pitanje zašto se potrebne promjene u zdravstvu Republike Hrvatske ne provode, ili se odvijaju presporo. Pronalaženje odgovora zamišljeno je kao sinteza znanstvenih i stručnih spoznaja s analizama stanja i trendova u zdravstvu RH. Knjiga je nastala kao rezultat višegodišnjeg rada troje autora koji su, samostalno ili u timovima, ne samo pratili i analizirali zdravstveni sustav, već su često i sudjelovali u procesima uvođenja promjena. Većina tema obrađenih u ovoj knjizi proizašla je iz rezultata znanstvenih istraživanja, javnih rasprava, te zaključaka stručnih skupova. Knjiga obuhvaća različite tekstove: narative, prikaze slučajeva, analize, osvrte, zapažanja, te praktične alate i preporuke. Prikazi slučajeva iz realiteta zdravstvenog sustava u Hrvatskoj izabrani su da doprinesu razumijevanju problema interregnuma. Slijedi blok propitivanja iz perspektive stewardshipa, a ključno mu je pitanje kako i zašto sustav opstaje usprkos interregnumu. Na njega se nastavlja serija priloga koji odgovaraju na pitanje zašto Hrvatska ne može izaći iz interregnuma. U posljednjem dijelu su sadržaji namijenjeni kao pomoć za gradnju strategije izlaska iz interregnuma.

U radu je opisan pravac djelovanja u izgradnji sustava elektroničkih zdravstvenih zapisa koji će zadovoljiti potrebe svih dionika zdravstvene zaštite, podržati zdravstveno-profesionalni rad i omogućiti kontinuirano unaprjeđivanje kvalitete na svim razinama i u svim segmentima zdravstvene zaštite te na taj način doprinijeti očuvanju i poboljšanju zdravlja svih korisnika zdravstvene zaštite.Defi nirani su pojmovi: • elektronički zdravstveni zapis (EZZ) i njegovi dijelovi • elektronički medicinski zapis (EMZ) • elektronički osobni zdravstveni zapis (EoZZ) pri čemu svaki korisnik zdravstvene zaštite ima jedan EZZ, jedan EoZZ i više EMZ-ova. Pojedini dijelovi EZZ-a ne moraju biti fizički na istom mjestu, ali se moraju moći povezati preko identifi kacijskog atributa korisnika zdravstvene zaštite i određenih pravila autentifi kacije. Pojedini EMZ sadrži podatke koji se prikupljaju na zdravstvenim radilištima (PZZ, SKZZ, bolnice, javnozdravstvena radilišta i sl.), a prikupljaju ih zdravstveni profesionalci, direktnim upisom ili prijenosom iz uređaja koji te podatke proizvode. EoZZ sadrži podatke koje prikuplja i s njima raspolaže korisnik zdravstvene zaštite. Ti se podatci unose direktno ili prenose iz uređaja koji te podatke proizvode. Podatci iz EZZ-a moraju biti dostupni isključivo ovlaštenim osobama. Propisima treba defi nirati pojam ovlaštene osobe. Zaštitu podataka u EZZ-u treba osiguravati tehnički, propisima i etičkim kodeksima, usklađeno s međunarodnim inicijativama (certifi kacija, EU uredbe, norme i sl). EZZ i njegovi dijelovi moraju udovoljiti i primarnoj i sekundarnoj uporabi, pri čemu se primarna uporaba odnosi na pojedinca (dijagnostika, terapija, cijepljenje, zdravstvena njega i sl.), a sekundarna na skupine, tj. populaciju u skrbi, unaprjeđenje kvalitete rada u zdravstvu, učinke preventivnih aktivnosti, fi nanciranje i istraživanja. Sadržaj i oblik podataka u EZZ-u trebaju defi nirati stručne udruge zdravstvenih profesija, a IKT profesionalci iznalaziti primjerena tehnološka rješenja. Strategiju i izgradnju EZZ-a kao i nadzor sa svih aspekata treba povjeriti krovnoj instituciji koja djeluje na nacionalnoj razini. Unaprjeđivanje EZZ-a treba se odvijati u fazama, u skladu s postojećim znanjima, tehnološkim novinama i materijalnim mogućnostima., The course of action to build electronic health records able to meet health stakeholder needs is described. The electronic health record system should contribute to improvement of service for all healthcare users by supporting daily work of healthcare professionals and enabling continuous quality improvement at all healthcare levels. The electronic health record (EHR), electronic medical record (EMR) and electronic personal health record (EpHR) have been defi ned; every healthcare user should have one EHR, one EpHR and several EMRs. The EHR parts, i.e. EMRs and EpHR, should not be kept at the same place physically, but they must be linked together (by use of identifi cation attributes of the healthcare user and certain authentication rules). Particular EMRs contain data collected at healthcare settings (primary healthcare, specialistconsultant health care, hospitals, public health settings, etc.) by health professionals. These data can be entered directly or by transfer from medical devices producing them. The EpHR contains data collected and maintained by the healthcare user. They can be entered directly or transmitted from the devices producing them. The EHR data should be made accessible to authorized persons only. Data protection in EHR should be provided through technical, regulatory and ethical codes, in line with international initiatives (certifi cation, EU regulations, standards, etc.). The EHR and its components should be used for both primary and secondary purpose. Primary use of EHR data refers to individual subjects (diagnosis, therapy, vaccination, etc.). Secondary use refers to population groups (reporting health status of the population, quality of healthcare, effects of preventive activities, funding, and research). The EHR data (structured or not) should be defi ned by associations of health professionals. The ICT professionals should be able to fi nd appropriate technological solutions. The EHR development strategy, as well as surveillance (medical, legal, technical and ethical points of view, as well as standardization) should be delegated to an institution at the national level. The EHR (EMR and EpHR) should be deployed in phases, step by step, depending on the current knowledge, technology, and material resources.

19. riječki dani bioetike na temu „Bioetičke dileme u palijativnoj skrbi: od teorije do prakse“ bili su usmjereni na pitanja i izazove u palijativnoj skrbi s kojima se zdravstveni radnici susreću u svakodnevnom radu s palijativnim pacijentima. S naglaskom na potrebi za interdisciplinarnim pristupom u radu s palijativnim pacijentima, cilj ovogodišnjih Riječkih dana bioetike bio je sjediniti izazove i dileme praktičnog rada kroz izlaganja zdravstvenih radnika te pokušati dati odgovore kroz teorijske postavke koje pruža akademska zajednica.

Smjernice za rad izvanbolničke i bolničke hitne medicinske službe s pacijentima kojim je potrebna palijativna skrb: prepoznavanje, komunikacija, najčešća hitna stanja, prognoziranje.

Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity ; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991–1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of “concessions” in 2009 (public–private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care ; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIF’s xviii Health systems in transition Croatia revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope of the MHI scheme are broad, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced since 2003, although with exemptions for vulnerable population groups. Configuration of capital and human resources in the health care sector could be improved: for example, homes for the elderly and infirm persons operate close to maximum capacity ; psychiatric care in the community is not well developed ; and there are shortages of certain categories of medical professionals, including geographical imbalances. Little research is available on the policy process of health care reforms in Croatia. However, it seems that reforms often lack strategic foundations and/or projections that could be analysed and scrutinized by the public, and evaluation of reform outcomes is lacking. The overall performance of the health care system seems to be good, given the amount of resources available. However, there is a lack of data to assess it properly

Prikazan je povijesni razvoj hitne medicinske službe u Kliničkom bolničkom centru Rijeka od osnutka 1984. godine do danas. Tijekom godina prosječan je dnevni broj obrađenih bolesnika postojano rastao, kao i udio manje hitnih bolesnika te prosječno trajanje i opseg obrade. Razlog tome je nedostatak trijažnih mehanizama prije ulaska u bolničku hitnu službu, budući da zbog njezine prirode nije moguće jednostavno razlučiti hitne slučajeve od onih koji to nisu., Historical development of emergency medical services at the University Hospital Center Rijeka since inception 1984th year to date was reviewed. Over the years, the average daily number of treated patients is steadily growing, as well as share of less urgent patients, and the average duration and the extent of patient workup. The reason for this is the lack of triage mechanisms before entering the hospital emergency department, as the nature of the hospital emergency service is such that emergency cases cannot be easily distinguished from non-urgent cases.

Drafting the Strategy was based on a partnership approach, and was organised in such a manner to include as wide a circle of interested expert and general public as possible. The process implementers were the Minister of health as the Editor in Chief and the Editorial Board.

Cilj rada. Mnogi oftalmolozi i opstetričari još uvijek za dovršenje trudnoće odnosno poroda u žena s visokom miopijom preporučuju carski rez ili instrumentalni vaginalni porod, iako za to nema valjanih medicinskih dokaza. Budući da je u zdravstvenoj ustanovi autora došlo do promjene doktrine prema kojoj visoka miopija više nije predstavljala indikaciju za elektivni carski rez, cilj rada bio je istražiti je li spomenuta promjena imala ikakve implikacije glede zdravlja, osobito vida rodilje i perinatalnog ishoda. Namjera autora bila je dati preporuke glede stručnog postupanja s trudnicama i rodiljama koje imaju problem s umjerenom i visokom miopijom. Metode. U retrospektivnoj petogodišnjoj studiji međusobno su uspoređene skupine rodilja s niskom, umjerenom i visokom miopijom glede načina dovršenja jednoplodne terminske trudnoće i perinatalnog ishoda s osobitim osvrtom na eventualnu progresiju retinalnih promjena u majki neposredno nakon poroda. Rezultati. Studija je obuhvatila 240 rodilja, od čega 137 s niskom, 54 s umjerenom i 49 s visokom miopijom. Učestalost carskog reza iznosila je u prvoj ispitivanoj skupini 11%, u drugoj 14,8%, dok je u skupini rodilja s visokom miopijom učestalost carskog reza iznosila tek 10,2%. Između spomenutih rezultata nije bilo statistički znakovitih razlika, kao što ih nije bilo ni u odnosu na prosječnu učestalost carskog reza u Klinici u istraživanom razdoblju, koja je iznosila 10,1%. Ni jedan carski rez kao elektivni zahvat nije izvršen zbog miopije rodilje, bez obzira na njezinu vrijednost. Učestalost vakuum ekstrakcije u prvoj skupini rodilja s niskom miopijom bila je 5,1%, među rodiljama s umjerenom miopijom 1,9%, dok je učestalost vakuum ekstrakcije u skupini ispitanica s visokom miopijom iznosila 12,2% i bila je statistički znakovito viša u odnosu na učestalost u prve dvije skupine rodilja te u odnosu na prosječnu učestalost vakuum ekstrakcije u Klinici od 1,9% u istom razdoblju. Ni u jedne od skupina istraživanih rodilja nije nastala ablacija retine ni bilo koji drugi ozbiljan poremećaj vida. Zaključak. Uz gotovo jednaku učestalost carskog reza u skupinama rodilja s normalnim vidom, niskom, umjerenom i visokom miopijom nije se dogodio ni jedan slučaj akutnog pogoršanja vida u rodilje. Autori zaključuju da je spontani vaginalni porod kao prva opcija siguran način rađanja za rodilje s umjerenom i visokom miopijom te da planski carski rez u takvim slučajevima nikako nije opravdan., Objective. Many obstetricians and ophthalmologists recommend in cases of preexisting high myopia either a cesarean section or an instrumental vaginal delivery, although these recommendations are not evidence based. According to a changed professional policy at author’s Department, moderate and high myopia were not indications for an elective operative delivery any more (since 2003). The aim of the study was to investigate did a changed obstetric policy had any implication on patient’s health, especially on vision condition, and perinatal outcome. Authors decided to give recommendations regarding optimal mode of delivery of pregnant women with moderate and high myopia. Methods. In a 5-year retrospective study a comparison between three groups of pregnant patients with low, moderate and high myopia regarding a mode of delivery of term single pregnancies and perinatal outcome is presented. Authors were interested particularly on eventual progression of retinal changes in mothers after deliveries. Results. The study encompassed 240 pregnant women. Out of total there were 137 patients with low myopia, 54 patients with moderate myopia, and 49 patients were highly myopic. The incidences of cesarean section in the studied groups of women were 11%, 14.8%, and 10.2%, respectively. There were not statistically significant differences either among the mentioned results or in relation to an average incidence of cesareans during the same study period, which was 10.1%. Not even a single elective cesarean was performed due to patient’s myopia of any degree. The incidences of instrumental vaginal deliveries with vacuum extraction were 5.1% in the group of women with low myopia, 1.9% in the group of patients with moderate myopia, and 12.2% in highly myopic group. The last result was significantly higher than the percentages of vacuum extractions in patients with low and moderate myopia, and in relation to an average incidence of vaginal deliveries with vacuum extraction during the same study period, which was 1.9%. Not a single case of either a retinal detachment or any other vision disturbance was recorded. Conclusion. With almost identical rates of cesarean section reported in the groups of eumetropic, low, moderate and high myopic puerperas, there was not even a single case of acute deterioration of patient’s visus. Authors concluded that spontaneous vaginal birth as a first option is an accurate mode of delivery for women with moderate and high myopia, and in those cases planned cesarean section is not justified.

There is hardly a topic as odious to doctors as the one about their faults. Such an opinion is a consequence of the prejudice that medical staff should be infallible and, more generally, a product of today’ s culture, which discourages admitting mistakes. This prejudice is built into modern health practitioners already in the medical school, where students are nourished by the belief: “ If I am diligent enough in studying and working, I will not commit a mistake ; have I made one, it would mean that I have not learned or worked diligently enough.” The one who acts makes mistakes. Making mistakes is human. Mistakes in medicine, although sometimes fatal, are simply unavoidable. Of course, there are bad apples among the doctors too, although their number is negligible. The majority of medical faults are faults of the system ; individual faults are rare. That is to say, a doctor might be the most experienced expert, doing the best in his power, and he or she might still commit a mistake.

The aim of this prospective study was to investigate the effectiveness of sub-tenon application of triamcinolone for neovascular age-related macular degeneration. The study included 38 eyes (26 patients ; 14 women and 12 men, aged 63 to 82 years) with newly diagnosed subfoveal neovascular age-related macular degeneration. Each eye received sub-tenon injection of 0.5 mL suspension of triamcinolone-acetonide (20 mg of active substance). Follow up period was 12 months. After initial application, the injections were repeated on individual case, none to five times. Elevated intraocular pressure occurred in five patients (seven eyes) and was treated with topical antiglaucomatous therapy. Transient ptosis of upper eyelid occurred in one case and completely recovered in two days. The mean visual acuity was 0.13 +/- 0.17 on the beginning of the study and 0.22 +/- 0.22 at the end of the study. Visual acuity improved in 15/38 (39%) eyes, remained unchanged in 10/38 (26%) eyes, and worsened in 13/38 (35%) eyes. Improvement by three or more lines on Snellen optotype occurred in two cases. Comparing our results to those from other authors, sub-tenon application of triamcinolone did not prove as effective as when applied intravitreally, but is substantially less expensive and easier to perform.

To present longterm results of laser photocoagulation for retinal ruptures in preventing retinal detachment. METHODS: Retrospective analysis of 405 patients (430 eyes) operated on (treated) with argon laser photocoagulation for retinal tear from January 1992 to January 2002. Inclusion criteria were retinal rupture(s) on one or both eyes. Follow up period was 2 to 9 years. Indications for laser treatment were symptomatic retinal ruptures, ruptures with vitreoretinal tractions, ruptures associated with high myopia, retinal pathology in the fellow eye, aphakia, pseudophakia, eye trauma, vitreous hemorrhage, and ruptures with shallow retinal detachment not exceeding 1-2 disc diameter. Laser treatment was done with Coherent 900, Novus and Ultima lasers, usually in one session under topical anesthesia. Laser surgery consisted of 2-3 continuous rows surrounding the lesion, power setting 100-300 mW, time 0.2 s, spots 100-200 micron in size. RESULTS: The types of tear were analyzed and tabularly presented. There were 20 (4.6%) round holes with no operculum, 32 (7.4%) round holes with operculum and 143 (33%) horseshoe tears with visible vitreoretinal tractions. Retinal ruptures were associated with vitreous hemorrhage in 96 (22.3%) eyes, myopic changes were found in 82 (19%) eyes, and pseudophakia in 56 (13%) eyes. Posterior vitreous detachment was found in 146 (34%) eyes and traumatic ruptures were found in 27 (6.3%) eyes. The position and number of retinal ruptures were analyzed. Single ruptures were found in 255 (59%) and multiple ruptures in 175 (45%) eyes. In the group of single ruptures, superotemporal localization was found in 120 (28%) eyes. The most common complication following laser treatment was retinal detachment in 24 (6%) eyes. Two (0.5%) eyes developed proliferative vitreoretinopathy. Twenty-four eyes with retinal detachment after laser treatment were operated on. Scleral buckling procedure was done in 20 (83%) and pars plana vitrectomy in 4 (17%) eyes. Two (8.5%) eyes underwent repeat vitrectomy due to postoperative complications. DISCUSSION: Today there is a strong suggestion that all symptomatic retinal ruptures should be treated. Ruptures with small and shallow retinal detachments should be treated. If there is vitreoretinal traction and retinal defect, these eyes should be treated. There are some medical eye conditions where it is wise to perform laser treatment for retinal rupture (aphakia, pseeudophakia, myopia, retinal changes in fellow eye, vitreous hemorrhage, trauma). In our study there was a number of asymptomatic retinal ruptures that were treated. The reason was a very long period of time elapsed from the treatment of our first patients (15 years before), when it was considered necessary to treat these patients. CONCLUSION: The most serious complication of retinal rupture, retinal detachment, can be prevented by early laser photocoagulation. There are some conditions associated with retinal rupture that require obligatory treatment. In our study, the success rate was 94%. No major complications attributable to laser treatment were noted.

Ziel der Studie war die Analyse der Microsporum canis-Infektionen in der Region Rijeka, Kroatien in der Zeit von 1990 bis 2001. Insgesamt wurden 724 Dermatophytose-Fälle durch M. canis bei 320 Tinea capitis- und 404 Tinea corporis-Patienten diagnostiziert. Die M. canis-Infektionen machten 32, 8% aller in dieser Zeit isolierten Dermatophyten aus.

Ovaj rad je prospektivna studija 35 slučajeva čiji je cilj bio usporediti primarnu i sekundarnu rekonstrukciju rane kao metodu izbora u Gustilo tip III otvorenih prijeloma tibije. Rad je pokazao da primarna rekonstrukcija rane zahtjeva manji broj operativnih zahvata i kraće vrijeme oporavaka u odnosu na sekunadrnu rekonstrukciju.

Ovaj rad je prospektivna studija 35 slučajeva čiji je cilj bio usporediti primarnu i sekundarnu rekonstrukciju rane kao metodu izbora u Gustilo tip III otvorenih prijeloma tibije. Rad je pokazao da primarna rekonstrukcija rane zahtjeva manji broj operativnih zahvata i kraće vrijeme oporavaka u odnosu na sekunadrnu rekonstrukciju.

Korištenje algoritma (Ottawa ankle rules) kojim se može učinkovito procijeniti oštećenje skočnog zgloba.

Pigmentna retinopatija ili retinitis pigmentoza dobro je poznata nasljedna bolesti koja zahvaća oba oka uglavnom simetrično. Atipični (asimetrični, sektorni ili unilateralni) oblici pigmentne retinopatije iznimno su rijetki i većinom nisu klascficirani kao pravi oblik pigmentne retinopatije u punom smislu, nego kao posljedica nekih drugih uzroka poput ozljede ili upale (infekcije ili inflamacije). Ovaj članak ističe važnost točne dijagnoze aberantnih manifestacija pigmentne retinopatije te ističe malobrojnost radova koji opisuju takove slučajeve.