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Intervencijski postupci koji se u medicini provode uporabom rendgenskih uređaja podrazumijevaju potrebu za zaštitom od ionizirajućeg zračenja i pacijenata i osoblja koje te postupke provodi. Međunarodna stručna društva izdala su preporuke vezano uz mjere kojima se zaštita pacijenata i osoblja provodi na optimalan način. U cilju stjecanja uvida u poznavanje i primjenu tih mjera provedeno je ispitivanje među liječnicima i radiološkim tehnolozima koji sudjeluju u provedi intervencijski postupaka. Ispitivanje je provedeno putem upitnika koji je sadržavao 38 pitanja iz područja praćenja osobnog ozračenja te mjera zaštite pacijenata i osoblja od ionizirajućeg zračenja, uključujući i samoocjenu vlastitog znanja. U ispitivanju je sudjelovalo 93 ispitanika koji provode ili sudjeluju u provedbi radioloških i kardioloških intervencijskih postupaka te postupaka u okviru vaskularne kirurgije i endoskopske retrogradne kolangiopankreatografije. Najveći broj ispitanika imao je više od 10 godina radnog iskustva u intervencijskoj sali (41%), 39% ispitanika do 5 godina, a 20% ispitanika 6 - 10 godina. Rezultati provedenog ispitivanja pokazuju podjednaku razinu znanja i kod liječnika i kod radioloških tehnologa. Nešto bolje rezultate ostvarili su ispitanici u grupi s 6 - 10 godina radnog iskustva u intervencijskoj sali. Zaključak: Rezultati provedenog ispitivanja ukazuju na potrebu unapređenja kvalitete obrazovanja liječnika i radioloških tehnologa koji provode ili sudjeluju u provedbi intervencijskih postupaka uporabom rendgenskih uređaja.

Purpose or Learning Objective: Purpose of this study is to compare typical doses for ten CT clinical indications in three Croatian university hospitals with EU clinical DRLs, as given in Radiation protection 195 publication (hereinafter: RP 195). Methods and Background: The previous practice in Croatia involved comparison of typical doses with the national DRLs only for anatomical regions since Croatian legislation still does not recognize clinical DRLs. After RP 195 was published, it became possible to perform a comparison of typical values of CT dosimetric quantities for clinical indications. Three university hospitals with five CT units were involved in this study. Typical values for ten clinical indications for which EU clinical DRLs are given in RP 195 were calculated for CTDIvol, p, DLPp, DLPt and scanning length (L). Typical values were compared with DRL values given in RP 195. Data were collected for at least 30 standard patients if DMS was unavailable and for more than 100 patients in case of hospitals where DMS is available, for each CT unit and clinical indication. Results or Findings: The results of the analysis show that for the same clinical indications, imaging is performed differently in different hospitals and in some cases differently when more CT units are used at the same hospital, including different numbers of phases (precontrast and postcontrast). Only in case of two clinical indications, typical values for CTDIvol, p and DLPp are lower than RP 195 DRL values for all CT units involved in the study. Conclusion: Results of this study emphasise the importance of the use of clinical DRLs (instead of anatomical) and shows the need for thorough analysis of used CT protocols and continuation of cooperation of all involved professions towards further optimisation

Purpose or Learning Objective: Purpose of this study is to assess the knowledge of the physicians and radiographers regarding radiation protection of staff and patients in interventional procedures. Methods and Background: Questionnaire based on various recommendations issued by professional societies in the field of interventional radiology and cardiology was developed and disseminated among physicians and radiographers who perform interventional procedures at university hospitals. Questions were related to individual exposure monitoring, means of staff and patient radiation protection and previous ways of acquiring the knowledge. At the same time, the questionnaire gave the participant of the survey the opportunity to assess his/her own knowledge. Results or Findings: The questionnaire was answered by 80 professionals from four university hospitals. Almost half of the participants gained their knowledge from older colleagues and more than three quarters of them self-assessed their knowledge as insufficient. Similar knowledge of physician and radiographers was found but working experience in interventional suite was important. Also, level of the knowledge is lower in specialities other than radiology and/or cardiology. In hospitals where medical physicist is available better results were achieved in case of both, physicians and radiographers. Conclusion: Quality of education on radiation protection of both, physicians and radiographers involved in interventional procedures should be improved and availability of medical physicist in hospitals where those procedures are performed should be encouraged. Special emphasis should be on education in case of those specialities whose main focus is not on radiology and/or cardiology.

Introduction: Multiple endocrine neoplasia type 1 (MEN 1) is a rare disorder that is inherited autosomally dominantly and is characterized by a predisposition to the tumor of the parathyroid glands, anterior pituitary gland, and pancreas. It is caused by mutations in the MEN 1 gene located on chromosome 11 and encodes the protein menin which acts as a tumor- suppressor protein. Case report: We present a 32-year-old patient who underwent surgery at the age of 20 for a pituitary tumor (15 mm prolactinoma). He was previously checked by a pediatrician from the age of 16 due to growth restriction and development during puberty. Uncle had late puberty. Several years ago, several family members of the maternal line became ill. One aunt had pancreatic cancer ; has a positive genotype MEN 1. Another aunt had lung carcinoid, cousin underwent treatment for gastritis and pancreatic and liver tumors were diagnosed ; he and three children have a positive MEN 1 genotype. The mother is being treated for suspected primary hyperparathyroidism ; mother and sister have a positive genotype MEN 1. He underwent molecular genetic analysis: genotype MEN1: c(572dupG) ; (=), p.((Glu191Glyfs*5)) ; ((Glu191=)), and there is a high probability that the variant is pathogenic. Monitoring is planned: calcium, prolactin, magnetic resonance (MR) of the pancreas (every year), MR of the selar region (every 3 years). Conclusion: MEN 1 is an inherited syndrome, so if any of the clinical features of the syndrome occur in the family, a whole family screening should be performed to allow for early diagnosis and treatment of the tumor.

Cilj: Prikazati slučaj pacijenta obrađenog zbog gubitka na tjelesnoj masi i anksioznosti kojemu je utvrđen tumor srži nadbubrežne žlijezde, a naknadnim uvidom u medicinsku dokumentaciju utvrđene su i višegodišnje povremene palpitacije, tahikardije i skokovi tlaka. Prikaz slučaja: Prikazan je šezdesetdvogodišnji pacijent koji se žalio na oslabljen apetit unatrag 3 mjeseca, gubitak na tjelesnoj masi 10 kg te anksioznost. Ultrazvukom abdomena utvrđena je, a kompjutoriziranom tomografijom (CT) abdomena potvrđena, oštro ograničena heterogena tvorba desne nadbubrežne žlijezde promjera 4, 2 x 5 cm i denziteta 26 Hounsfieldovih jedinica. Iz medicinske dokumentacije saznaje se da je prethodnih 4 godina povremeno imao palpitacije i supraventrikularne tahikardije s vrijednostima krvnog tlaka do 190/100 mmHg. Endokrinološkom obradom utvrđene su povišene vrijednosti metanefrina i normetanefrina u plazmi (12 i 9 puta). Nakon operacije patohistološki je potvrđena dijagnoza feokromocitoma. Kontrolni nalazi metanefrina i normetanefrina bili su uredni. Planira se kontrola metanefrina i normetanefrina u plazmi jedanput godišnje. Zaključak: U ovom prikazu slučaja želi se istaknuti važnost postavljanja sumnje i pravovremenog utvrđivanja feokromocitoma te sprječavanja mogućih komplikacija. Ako postoji klinička sumnja na feokromocitom ili je tijekom obrade incidentaloma nadbubrežne žlijezde CT-om isključeno da se radi o adenomu, potrebno je učiniti biokemijsku obradu feokromocitoma. Ako se ne prepoznaju na vrijeme, ovi tumori zbog svoje hipersekrecije katekolamina imaju visok kardiovaskularni morbiditet i mortalitet.

Health is the main focus of studies on quality of life. Cancer can lead to changes in quality of life in post-mastectomy women. The aim of this study was to examine the relation among sociodemographic factors and to assess the quality of life of women with breast cancer a year from their surgery.

Introduction Acromegaly occurs due to high secretion of growth hormone The most common cause is an anterior pituitary adenoma Some of the most common symptoms are headache/vision loss, increased cartilage and soft tissue growth (enlarged mandible, swollen and/or enlarged extremities) and sleep apnea Case report 67 y o man with known arterial hypertension and prostatectomy due to adenocarcinoma was examined for pain in his right foot after physical exertion, with swelling of both feet During examination, accentuated facial bones, an enlarged nose, ears, hands and feet were noticed Basic laboratory findings were unremarkable An endocrinologic examination was recommended Additional laboratory findings showed elevated IGF 1 118 nmol/L) and GH in OGTT 34 7 g/L) MRI of sellar region showed pituitary macroadenoma 21 mm in diameter) Glucose intolerance was diagnosed, while other pituitary and gland hormones and ACTH test were normal The patient also complained that his old shoes were tight, he snored heavily, woke up at night and was drowsy during the day, sweated and had morning headaches Trans sphenoid ablation of pituitary macroadenoma was performed and pathohistological findings revealed eosinophilic pituitary adenoma with ability to synthesize GH and TSH Postoperatively, laboratory findings and sellar MRI were normal, and further follow up was recommended Conclusion The clinical features of acromegaly are attributed to high serum concentrations of GH and IGH 1 Somatotropic adenomas can also cause symptoms due to local expansion Surgical treatment of pituitary adenoma and strict control of the biochemical balance of pituitary hormones is required to achieve a complete therapeutic effect for acromegaly

Introduction:Pheochromocytoma is a tumor arising from chromaffin cells of the adrenal gland medulla and sympathetic ganglia that releases catecholamines. Case report: The clinical photograph shows a 62-year-old patient having arterial hypertension, type 2 diabetes, and hypercholesterolemia, who had a reduced appetite for three months, lost 10 kg, suffered from pain in the lumbosacral spine and felt depressed. The abdominal ultrasound showed an inhomogeneous tumor mass on the right adrenal gland, 5cm x 4.5 cm in size, with minor cystic spaces in the middle. The computed tomography (CT) scan of the abdomen showed a sharply defined heterogenous mass on the right adrenal gland of 4.2x5 cm in diameter with higher absorption coefficients on the edge and lower in the middle (central necrosis), measuring a density of 26 Hounsfield units (HU), on native non-homogeneous post-contrast opacification sections, showing a slow flush of the contrast on post-contrast sections (a relative wash out amounting to 9%, and the absolute one accounting for 20%) a pheochromocytoma is clinically suspected. Medical records indicate that during the previous four years the patient occasionally suffered from palpitation and supraventricular tachycardia with blood pressure levels up to 190/100mmHg. The laboratory analysis showed elevated plasma levels of metanephrine and normetanephrine (12 and 9 times), confirming the diagnosis. A pre- opeartive preparation was performed using alpha-adrenergic receptor blockers (phenoxybenzamine), followed by beta blockers (bisoprolol). Following the surgery, the histopathological examination confirmed the pheochromocytoma diagnosis. The metanephrine and normetanephrine follow-up results were normal. Annual follow-up checkup is recommended for the next 10 years. Conclusion: In case of a clinically suspected pheochromocytoma or during the adrenal gland incidentaloma CT imaging the adenoma is excluded (including a density of more than 10 HU), a biochemical analysis of pheochromocytoma must be performed.

Background/introduction Description of activity and work performed Conclusion and recommendations Personal/organisational information References, Background/introduction: With very few dedicated children's healthcare institutions in Croatia placed mainly in big cities, children are very often imaged in adult radiology departments. As there is no subspecialisation in paediatric radiology in Croatia, children might be...

Although the differential diagnosis of acute abdominal and thoracic pain include a large spectre of disorderes, in patients older than 65 years-of age and ones that have history of osteoporotic fractures in family, compressive fractures should also be considered.

Cilj: Cilj rada je ispitati kvalitetu života žena nakon mastektomije i nakon kvadrantektomije, te ispitati razliku u kvaliteti života žena nakon mastektomije u odnosu na kvalitetu života nakon kvadrantektomije. Ispitanici i metode: Prospektivno kohortno istraživanje u kojem su sudjelovale 204 sudionica: 101 sudionica je bila u grupi nakon mastektomije, a 103 sudionice nakon kvadrantektomije. Korištena je anonimna anketa primjenom hrvatske inačice upitnika Europske organizacije za istraživanje i liječenje raka EORTC QLQ-C 30 (version 3), upitnika s modulom raka dojke EORTC QLQ – BR 23. Rezultati: Na ljestvici EORTC QLQ C 30, mjesec dana nakon operacije, sudionice nakon kvadrantektomije značajno su bolje ocijenile svoj opći zdravstveni status (p = 0,007). Poremećaj spavanja imaju značajno više sudionice s mastektomijom (p = 0,03). Ljestvicom QLQ-BR23 mjesec dana od operacije, sudionice s mastektomijom značajno su lošije ocijenile seksualno funkcioniranje (p < 0,001) i užitak u seksu (p < 0,001), dok su im značajnije izražene nuspojave uz sistemske terapije (p = 0,04). Godinu dana nakon operacije, još uvijek je značajno lošije seksualno funkcioniranje (p < 0,001) i užitak u seksu (p = 0,04) kod sudionica nakon mastektomije. Ukupna skala funkcionalnosti je značajno niža za sudionice s mastektomijom (p = 0,03) Zaključak: Kvaliteta života žena nakon kvadrantektomije bolja je u odnosu na kvalitetu života nakon mastektomije. Žene kojima je učinjena kvadrantektomija bolje su ocijenile svoj opći zdravstveni status u odnosu na žene kojima je učinjena mastektomija. Seksualno funkcioniranje bolje je u žena s kvadratektomijom.

Digitalni marketing je v današnjem svetu skoraj nepogrešljiv v vsakem podjetju. Tako internet kot uporaba družbenih omrežij sta v zadnjih letih med nami močno narasla. Dejstvo je, da se nahajamo v največjem vzponu digitalne dobe in transformacije. Kam nas bo to pripeljalo in kako daleč se bo vse skupaj razvilo, zaenkrat ostaja še skrivnost. V tem času razcveta digitala pa za podjetja to predstavlja veliko priložnosti. Digitalni marketing uporablja že skoraj vsako podjetje do tiste mere, kot ga poznajo oz. koliko se informirajo o njem. Nekatera podjetja, predvsem manjša, pa gledajo nanj predvsem iz vidika stroškov in mu posvečajo nekoliko manj pozornosti. Večja podjetja, ki se pa poglobijo vanj, spoznajo, da vsebuje veliko več koristnih informacij kot samo stroške, in pridobijo veliko podatkov o uporabnikih in bodočih zvestih kupcih. Nekatera podjetja so veliko pridobila na podlagi digitala, predvsem nove uporabnike, ki se odločajo za nakup in s tem prispevajo k boljšim rezultatom podjetja. Gre predvsem za poznavanje in razumevanje potrošnika in njegovega obnašanja od samega začetka iskanja informacije do končnega nakupa, se pravi spoznamo njegovo celotno nakupno izkušnjo. V magistrski nalogi bomo predstavili razvoj digitalnega marketinškega komuniciranja ter raziskali, kateri so elementi in aktivnosti na tem področju. Spoznali bomo, preko katerih digitalnih marketinških kanalov podjetja komunicirajo in ali bo v prihodnosti digitalni marketing v celoti nadomestil tradicionalni marketing. Raziskali bomo, kako se eno najuspešnejših turističnih podjetij v Sloveniji sooča s tem oz. kako uspešni so na področju digitalnega marketinškega komuniciranja. Spoznali bomo, katera so tista družbena omrežja, ki podjetju prispevajo največ ter kakšne so napovedi in plani za uspešno digitalno pozicijo na trgu. Todays' vital part of every sucessful company is digital marketing. Usage of internet and social networks are in steady growth. Undeniable fact is, that we are in the middle of the biggest rising of digital era. Where will it bring us and how far will it develope is still questionable and mystery. Digital marketings' big boom is also companies' exceptional opportunity and it's used by almost every company, small companies still sees it mostly as a cost, but big one, which are mastering at it, know that it contains far more informations about their users and clients. They are able to getting new clients with it, which contributes to better business sales. It's all about knowing and understanding client and his behaviour from the very beggining of looking for information, to final checkout, it's all about user experience. In masters degree, we will present digital marketing communication development and explore it's core elements and activity. We will find out in which digital channels companies communicate and if digital marketing is about to replace traditional marketing. We will research how Slovenian most sucessful travel company is coping with it and their sucess in digital marketing communication. We will find out, which are companies' most profitable social channels and forecast and plans for sucessful digital position on market.

Endovaskularno liječenje plućne embolije je učinkovita terapijska opcija kod selektiranih pacijenata sa kontraindikacijom ili neadekvatnim efektom sistemske trombolize.

Perfusion angiography shows a great potential for evaluating revascularization outcome.

Endovaskularno liječenje periferne arterijske bolesti - površinske fomoralne arterije i poplitealne arterije- prikaz slučaja

Endovaskularno liječenje periferne arterijske bolesti - potkoljenične arterije - prikaz slučaja

Background/introduction Description of activity and work performed Conclusion and recommendations Personal/organisational information References, Background/introduction: As required by new EU BSS directive, diagnostic reference levels for radiodiagnostic examinations and interventional radiology procedures, where appropriate, shall be established, regularly reviewed and used for the purpose of optimisation [1]. This...

Karcinom bubrega je rijetka komplikacija autosomno dominantne policistične bubrežne bolesti (ADPBB). Prikazujemo 63-godišnjeg pacijenta s ADPBB, karcinomom bubrega i bubrežnom funkcijom koja je bila očuvana sve do nefrektomije. Pacijent je od 2012. g. pod kontrolom urologa pri Klinici za urologiju Kliničkog bolničkog centra Zagreb, jer je radiološkom obradom verifi cirana solidna tvorba desnoga bubrega koja je morfološki izgledala kao onkocitom. Bolesnik je od ranije znao da ima policističnu bolest bubrega i jetre. Od subjektivnih poteškoća navodio je samo povremenu lumbalnu bol. Svi laboratorijski nalazi bili su potpuno uredni. Tijekom kontrola uočen je rast tvorbe u desnom bubregu uz očuvanu bubrežnu funkciju, te je bolesniku predložena nefrektomija za koju se nije odmah odlučio. No, kada je pristao, učinjena je desnostrana radikalna nefrektomija. Radilo se o karcinomu bubrega, tipa svjetlih stanica, koji je klasifi ciran kao pT3aN0MX. U prva tri poslijeoperacijska dana dolazi do porasta kreatinina do 165 μmol/L. U trenutku otpusta iz bolnice kreatinin je bio 132 μmol/L, ureja 9,8 mmol/L. Tri mjeseca nakon kirurškog zahvata kreatinin je stabilan na 135 μmol/L, a kontrolni MSCT toraksa, abdomena, zdjelice, UZV trbuha i rendgenogram srca i pluća su, osim poznatih cističnih promjena na jetri i lijevom bubregu, uredni. Dalje su pacijentu preporučene redovite urološke kontrole, a zbog jasne bubrežne insufi cijencije koja se razvila nakon nefrektomije preporučene su i redovite kontrole nefrologa., Aim: The aim of this case report is to point out the specifi city of clinical, diagnostic and therapeutic approach to the patient with the autosomal dominant polycystic kidney disease (ADPKD), renal cell carcinoma along with preserved kidney function. We used patient medical chart, as well as relevant literature from online medical databases (PubMed, EM-base). Case report: We describe a case of a 63-year-old patient with ADPKD, renal cell carcinoma and preserved kidney function until nephrectomy. ADPKD along with hepatic cysts has been known since 2009. Because of the suspicious renal mass detected by ultrasound, non-contrast computed tomography (CT) was performed in 2009, which did not confi rm the presence of renal tumor. In 2012, the patient suffered right-fl ank pain and therefore underwent contrast CT and magnetic resonance imaging (MRI), which confi rmed renal tumor that morphologically seemed like oncocytoma. For that reason, he has been under urologist supervision ever since 2012. Laboratory blood and urine test results were within the normal range all the time and the patient only complained of right-fl ank pain. Further follow up revealed enlargement of the renal mass on MRI and contrast CT. The patient was informed about his condition from the beginning, but he did not accept nephrectomy. However, in December 2015, he agreed and radical nephrectomy of the right kidney was performed. Histopathologic report showed that it was a clear renal cell carcinoma, 6,5x5x5cm, pT3aN0MX (tumor invaded renal sinus fat). In the fi rst three postoperative days, a decline in kidney function was observed, with serum creatinine up to 165 μmol/L. At patient discharge from the hospital, creatinine was 132 μmol/L and urea 9.8 mmol/L. Three months after the operation, serum creatinine was stable (135 μmol/L) and multi-slice CT of the thorax, abdomen and pelvis was normal. Regarding the histopathologic report, the patient was advised to present for follow up by both urologist and nephrologist because of the evident kidney failure that had begun after nephrectomy. Discussion: Renal cell carcinoma is an infrequent complication of ADPKD. It does not occur with increased frequency when compared to the general population. The diagnosis of renal cell carcinoma is more diffi cult to establish in ADPKD than in the general population since fi ndings such as hematuria, fl ank mass, or complex cysts are common in ADPKD in the absence of malignancy. Malignancy should be suspected if the patient complains of systemic signs and symptoms (fever, anorexia, fatigue, weight loss) or if there is rapid growth of a complex cyst. However, there are several characteristics of renal cell carcinoma in ADPKD, i.e. fever, and tumors are more often bilateral, multicentric and sarcomatoid. CT scanning with contrast and MRI are often able to distinguish malignancy from a complex cyst. MRI is considered to be superior to CT in detecting renal cancers. Considering that clinical, radiological and histologic presentation of renal cell carcinoma in this case report was rather unusual, along with the fact that the patient had refused nephrectomy for several years, we can conclude that the outcome is principally favorable for the patient. Conclusion: We present an instructive case of renal cell carcinoma in a patient with ADPKD. Clinical presentation, radiological and histologic characteristics are different from the usual presentation of renal cell carcinoma in ADPKD. It is necessary to keep in mind an individual approach.

Percutaneous mechanical thrombectomy (PMT) is a well-established technique for treatment of acute arterial and venous thrombosis. AngioJet (Boston Scientific, Inc., Natick, MA, USA) is a unique system that uses high-velocity saline jets to fragment and aspirate thrombus with the Venturi-Bernoulli effect. This inevitably leads to intravascular erythrocyte hemolysis, resulting in hemoglobinuria. Cell-free hemoglobin can cause renal tubular damage by complex intrarenal oxidative reactions which trigger a heme toxicity response. Only several cases of acute kidney injury following AngioJet PMT have been published in literature. To our knowledge, this is the first reported case of dialysis-requiring AKI after PMT for peripheral arterial thrombosis.