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The objective of this study was to assess whether the positioning of the wrist joint in the cast in such a manner that it counteracts the direction of angulation of fragments is more important than the cast index in the prevention of secondary displacements in distal forearm fractures. A retrospective review of all pediatric patients (0-16 years of age) who were hospitalized in our institution with displaced fractures of the distal forearm (either isolated fractures of the distal radius or both bone fractures) who underwent subsequent closed reduction and splinting in the period from August 2018 to October 2020. Patients with physeal fractures and open fractures, and skeletally mature patients were excluded from the study. Patients were divided into two categories - the first one in which the cast index was below 0.9 and the second in which it was above 0.9. In each category, we have identified two groups of patients - the first one in whom the wrist joint was positioned in such a manner that it counteracts the direction of angulation of fracture fragments and the second one in whom the wrist joint was in a neutral position. The two groups in each category have been compared according to age, sex, initial angulation, fracture type (isolated radius or both bone fractures), displacement type (angulation or complete dislocation) and the rate of secondary displacement. In both categories, the two groups were comparable according to age, sex, initial angulation, fracture and displacement type. In both categories (cast index below 0.9 and cast index above 0.9), a statistically significant higher portion of patients with secondary displacement was identified in the group of patients who had the wrist joint in a neutral position (Z = -2.1997; P = 0.0278 - for cast index0.9 and Z = -2.1672; P = 0.030216 for cast index0.9). Our research supports the notion that positioning of the wrist joint in the position that counteracts the force that leads to angulation of fracture fragments is more important than the cast index in the prevention of secondary displacements in pediatric distal forearm fractures.

Introduction In the “Children’s Hospital Zagreb Referral Centre for Paediatric Trauma of the Ministry of Health Republic of Croatia (MHC)” we observed a significant decline in the number of both hospitalised and ambulatory treated paediatric patients with burn injuries in the period from 2011 to 2018. Our hypothesis is that this decline could be either due to the decline of the paediatric population of Croatia or due to the economic growth and the improvement in the standard of living that Croatians have enjoyed in the past decade. Materials and methods In this observational study, we analysed data on the numbers of patients treated due to burn injuries from January 2011 to December 2018 in the Children’s Hospital Zagreb Hospital. Indicators of standard of living and population size estimates were obtained from Eurostat and the Croatian Bureau of Statistics. Associations between the proportion of people with poor standard of living and the number of treated patients were analysed with logistic regression models. Results Percentage of the population with low housing standards, percentage of Croatians with low level of education, percentage of children that live in jobless households, and percentage of children at risk of poverty and social exclusion were predictors of the rate of hospital admissions, ambulatory treated patients and total number of treatments. The slight decrease in the rate of treated patients was interrupted with notable decline in 2014 followed by the slight increase in 2015. Over following years, the rate did not change remarkably. Conclusion Apart from the decline of the paediatric population of Croatia, it is reasonable to assume that the improvement in the standard of housing, level of education and employment rate as well as the reduction in the risk of poverty and social exclusion in children had a notable contribution to the decline in the rate of paediatric burns in the observed period.

SUMMARY The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p

Prijelomi članaka prstiju šake kod djece patologija su s kojom se vrlo često susreću liječnici hitnog prijma. U najvećem broju slučajeva riječ je o ozljedama koje zahtijevaju kratko razdoblje imobilizacije, a tek je u rijetkim slučajevima potrebno kirurško liječenje. Stoga, da se kod svakog djeteta osigura optimalan ishod, potrebno je poznavati rijetke prijelome članaka prstiju kod djece kod koje bi operativno liječenje bilo indicirano. Seymourov prijelom zahtijeva liječenje po načelima otvorenog prijeloma. Koštani mallet finger s prisutnom subluksacijom zgloba valjalo bi operativno stabilizirati. Subkapitalni i kondilarni prijelomi, kao i skijaški palac sa značajnom dislokacijom, indikacija su za kirurško liječenje. Kod kompleksnih dislokacija metakarpofalangealnog zgloba u najvećem je broju nužna otvorena repozicija i fiksacija. Avulzije volarne ploče su prijelomi koji mogu rezultirati ukočenošću proksimalnog interfalangealnog (PIP) zgloba u slučaju preduge imobilizacije, a u slučaju avulzijskih ozljeda u području dorzuma srednjeg članka treba uvijek isključiti pridruženu rupturu sagitalnog kraka ekstenzorne tetive., Phalangeal fractures are a pathology that is often encountered in the emergency room setting. In the majority of cases, only a brief period of immobilisation is required while only few require operative treatment. In order to achieve an optimal outcome, it is necessary to be able to recognise the few types of fractures that require operative treatment. Seymour fracture should be treated according to the principles of open fracture management. Bony mallet finger with joint subluxation should be operatively stabilised. Subcapital fracture, condylar fracture as well as skier’s thumb with significant dislocation are indications for operative treatment. In the majority of complex metacarpophalangeal dislocations, open reduction and fixation is required. Avulsions of the volar plate may result in proximal interphalangeal joint stiffness when immobilised longer than one week, and in cases of avulsion from the dorsum of the middle phalanx, one should always exclude central slip rupture.

Karcinom dojke je jedan od najraširenijih malignih tumora u žena, češće je duktalnog nego lobularnog podrijetla. Nalazi se na prvom mjestu i po pojavnosti i po mortalitetu. Vrlo je važno što ranije otkriti bolest jer dijagnosticiranje karcinoma u početnom stadiju jamči bolje izlječenje. Postoji mnogo dijagnostičkih metoda. Citološka punkcija pod nadzorom ultrazvuka i core biopsija imaju veliku ulogu u ranom otkrivanju bolesti i boljem preživljenju. Velik broj pacijentica operiran je poštednom operacijom zahvaljujući ranom otkrivanju karcinoma. Mastektomija se obično radi u pacijentica s multicentričnim, velikim ili ponovljenim tumorom nakon konzervativne terapije. Ponekad se mastektomija s poštedom kože i bradavice radi kod pacijentica s pozitivnim genom BRCA-1 i BRCA-2. U 5 do 10% pacijentica s karcinomom dojke tumorske se stanice mogu otkriti u bradavici. Intraoperacijska citološka analiza otiska baze mamile vrlo je važna i točnost ovisi o pravilno označenom dijelu bradavice (najvažnije je dobro označavanje vanjske i unutarnje površine bradavice) i znanju citologa. Tijekom jedne godine od 9. studenoga 2010. do 10. studenoga 2011. napravljena je mastektomija s poštedom bradavice u 47 pacijentica. Usporedbom hitne citološke i konačne patohistološke dijagnoze, citološka je dijagnoza pokazala specifičnost 97%, osjetljivost 85% i dijagnostičku točnost 91%. Moramo biti oprezni u interpretaciji rezultata zbog pukotina u smrznutim hitnim patohistološkim rezovima i sklonosti malignih stanica grupiranju, kao i kod nekrotičnih citoloških otisaka u kojima mogu biti skrivene i razorene maligne stanice. Intraoperacijska analiza omogućuje rekonstrukciju dojke tijekom iste operacije., Breast cancer is one of the most widespread malignant tumours in women, more commonly of ductal than lobular origin. It also has the highest incidence and mortality rates. Early detection is very important since breast cancer diagnosis in the initial stages guarantees better outcomes. There are many diagnostic methods. Ultrasound-guided cytological puncture and core biopsy have a major role in early detection of this disease and better chances of survival. A large number of patients had breast-conserving surgery thanks to the early detection of cancer. Mastectomy is usually performed on patients with multicentric, large or recurrent tumours after conservative treatment. Sometimes skin-sparing and nipple-sparing mastectomy is performed on patients with positive BRCA-1 and BRCA-2 genes. Tumour cells can be detected in the nipple in 5-10% of patients with breast cancer. Intraoperative cytologic analysis of the nipple-areola complex imprint is very important and the accuracy depends on the properly marked part of the nipple (the most important step is to properly label the inner and outer surface of the nipple) and the skill of the cytologist. Over the course of one year, from 9 November 2010 to 10 November 2011, 47 patients had nipple-sparing mastectomy. The comparison of the cytologic and final histopathological diagnosis showed that cytological diagnosis had 97% specificity, 85% sensitivity and 91% diagnostic accuracy. We need to exercise caution in the interpretation of results due to cracks in frozen urgent histopathological cuts and the grouping tendency of malignant cells, as well as necrotic cytologic imprints which can contain hidden and destroyed malignant cells. Intraoperative analysis allows for breast reconstruction during the same surgical procedure.

Tijekom posljednjih desetljeća svjedoci smo velikog napretka u izvedivosti i kliničkoj iskoristivosti genetičkog testiranja kod nasljednih karcinoma. Nasljedni karcinomi dojke i jajnika najčešće su posljedica mutacija u genima BRCA1 i BRCA2. Ovim smjernicama obuhvatili smo kriterije za upućivanje pacijenata na genetičko savjetovanje i testiranje; kriterije za upućivanje zdravih pojedinaca na prediktivno testiranje ako nije moguće testiranje oboljelog člana obitelji; postupak genetičkog savjetovanja prije i nakon testiranja; nalaz testiranja, kategorije nalaza i razine rizika; preporuke za daljnje praćenje osoba s povišenim rizikom; kemoprevenciju i profilaktičku kirurgiju kod nositelja/-ica patogenih mutacija gena BRCA 1 i BRCA 2; očuvanje reproduktivne funkcije u žena oboljelih od raka dojke i nositeljica mutacija BRCA i pristanak informiranog bolesnika na genetičko testiranje. Smjernice su namijenjene svim specijalistima koji su na bilo koji način uključeni u zbrinjavanje oboljelih od nasljednih karcinoma dojke i jajnika, a sastavila ih je radna skupina prema podacima iz relevantne medicinske literature te kliničkim iskustvima članova radne skupine., The last few decades have witnessed a great progress in feasibility and clinical utilization of genetic testing for hereditary cancers. Hereditary breast and ovarian cancers are most often the result of BRCA1 and BRCA2 gene mutations. In these guidelines we have covered: the criteria for referral of patients to genetic counselling and testing; the criteria for referral of healthy family members to predictive testing in the event when there is no possibility of testing the patient; the process of genetic counselling before and after testing; test results, their categories and risk levels; recommendations for monitoring of individuals with an increased risk; chemoprevention and prophylactic surgery for carriers of BRCA1 and BRCA2 gene mutations; preservation of reproductive function in women with breast cancer and in carriers of BRCA mutations; and informed consent for genetic testing. The guidelines are intended for all specialists who are in any way involved in the care of patients with hereditary breast and ovarian cancer, and are compiled by the working group according to the data from the relevant medical literature and from clinical experience of the members of the working group.

Ekscizijska biopsija kožnih promjena sumnjivih na zloćudnost je zlatni standard u dijagnostici takvih promjena. Dermatološki klinički pregled je unaprijeđen dermatoskopijom kako bi se reducirao broj lezija klinički sumnjivih na zloćudnost za koje je potrebno kirurško liječenje i patohistološka verifi kacija. U kirurškoj praksi se uočava velik broj zahvata kod kojih se dermatoskopska indikacija razlikuje od defi nitivnog patohistološkog nalaza. U ovoj studiji od 125 dermatoskopski suspektnih zloćudnih kožnih promjena (u 66 bolesnika) patohistološki su potvrđena tri bazocelularna karcinoma, dva planocelularna karcinoma i dva maligna melanoma. Rezultati pokazuju pozitivnu prognostičku vrijednost dermatoskopskog nalaza za sve malignitete od 5,6 %., Excisional biopsy of skin lesions suspected of malignancy has been the gold standard as a diagnostic method. Dermatologic clinical examination has been updated by dermoscopic examination with the idea to reduce the number of clinically equivocal skin lesions needed to treat surgically with further histopathologic verifi cation. In clinical practice, there is a considerable rate of false-positive indications made only by clinical examination or with dermoscopic examination in comparison with later histopathologic examination, putting the reliability of dermatologic examination in question. Consecutive patients (n=66) presenting with doubtful lesions (n=125) were considered for enrolment. The lesions were assessed by histopathology, which is considered as the reference standard. Dermatologic indication for skin lesions suspected of malignancy yielded a positive predictive value of 5.6%. There was a discrepancy between our results and the values reported from other studies.

Prikazani rezultati kirurškog liječenja dekubitusa na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju KB Dubrava u vremenu od 2011. do 2016. nisu bitno različiti u odnosu na rezultate kirurškog liječenja iste patologije u studiji iz vremena 2003.-2008., što dokazuje i dalje odličnu planiranost i izvedivost kirurških zahvata, odgovarajuću pripremu bolesnika i adekvatnu postoperacijsku skrb. Unatoč manjem broju hospitaliziranih bolesnika s dekubitusom u studiji 2011.-2016. (31 bolesnik; 42 rekonstrukcijska zahvata) i dalje je učinjen sličan broj rekonstrukcijskih zahvata uspoređujući sa studijom 2003.-2008. (47 bolesnika; 57 rekonstrukcijskih zahvata). Kod rekonstrukcije dekubitusa na sakralnoj regiji kod naših bolesnika najbolje rekonstrukcijske rezultate postigli smo i dalje kliznim fasciokutanim, odnosno mišićnokutanim režnjevima. Kada je god to moguće, ovisno o kliničkoj slici defekta trebalo bi dati prednost mišićnokutanim režnjevima, posebno u slučajevima recidiva dekubitusa. Kod rekonstrukcije dekubitusa u području ishijadičnih zona vrlo dobri rezultati postignuti su uporabom mišićnih režnjeva semimembranozusa i /ili semitendinozusa koji se mobiliziraju u defekt, dok za područje trohanterne regije koristimo transpozicijski režanj fascije late. Liječenje bolesnika s dekubitusom je multidisciplinarno s naglaskom na kirurško liječenje koje se sastoji od radikalnog debridmana, ostektomije i egzaktno planirane i učinjene rekonstrukcije. Konzervativno liječenje mora biti podrška kirurškom liječenju s naglaskom na njegu i visoke higijenske mjere bolesnika. U novije vrijeme (studija 2011.-2016.) sve kvalitetnija uporaba konzervativnog načina tretmana dekubitalnih rana realno je dovela do smanjenja potrebe za hospitalizacijom i kirurškim liječenjem. Daljnjim edukacijama medicinskih sestara u smislu „wound care“-a u zdravstvenim učilištima i bolnicama trebalo bi dati posebno značenje što bi dovelo do prevencije, ali i pravodobnog početka liječenja bolesnika s dekubitusom., Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further ‘wound care’ nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment.

Gubitak kožnog pokrova ima različite uzroke te zahtijeva pokrivanje defekta da bi se smanjile posljedice i komplikacije, te produljenje hospitalizacije uz povećanje troškova liječenja. Standarne plastično rekonstrukcijske metode često nisu moguće ili su prekompleksne, tako da alternativni oblici liječenja koji uključuju zamjene za kožu imaju važnu ulogu., Damage to skin barrier has different causes, and in case of prolonged exposure without expeditious coverage it entails consequences such as prolonged hospitalization and higher treatment costs. Standard plastic reconstructive techniques of coverage are not always possible, so alternative skin coverage techniques have an important role in treatment.

Veliki broj bolesti nastaje prvenstveno zbog nedostatka kisika u tkivima zbog akumulacije toksina u tijelu. Bezbolan i prirodan tretman ozonom pomaže kod operativnog oporavka i liječenja brojnih ozljeda i bolesti, pa čak i tumora, a za sada se najčešće koristi u stomatologiji. Ozon ima pozitivan utjecaj na zacjeljivanje rana, stimulaciju imunološkog sustava, oksigenaciju i protok krvi u tkivu, te smanjuje oticanje i bol., A large number of disease is primarily due to the lack of oxygen in the tissue due to the accumulation of toxins in the body. Painless and natural treatment with ozone helps with after-operating recovery and cure numerous injuries and illnesses, even tumors, and for now the most commonly used in dentistry. Ozone has a positive effect on wound healing, stimulation of the immune system, oxygenation and blood flow to tissues and to reduce swelling and pain.

Der Autor verwendet in der Beschreibung die Bora (des Sturmes) Wörter, die ausschilisslich auf den Inseln Krk, Cres, Lošinj und Rab gesprochen werden, und von diesen überwiegend Wörter und grammatikalische Foremen, die aus der »Čakavski« Mundart um das Gebiet Punta auf der Insel Krk stammen. Alle diese Inseln befinden sich geographisch am Rande des Slawentums unt Kroatentums. Die Insulaner sind sehr konservativ in ihrer Kulturpflege und hüten eifersüchting die überlieferten Lieder und gesprochenen Worte. In diesel Beschreibung gibt es viele Wörten aus der »Čakavski« Mundart, die mit grosser Wahrscheinlichkeit genau so bereits im altkroatischen glagolischen Wortschatz in Verwendung waren. Die Meinung des Autors ist, dass diese Wörter auf jeden Fall zur Bereicherung der kroatischen Sprache dienen und es deshalb wert sei, sie zu voröffentlichen und dadurch einem breiteren Leserkreis zugänglich zu machen. In der Beilage befindet sich auch ein umfangreiches Wörterbuch, ohne das es fast unmöglich wäre, dem text zu folgen.