Zadar, Croatia
Zadar, Croatia

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Kovacic M.,Zadar General Hospital | Baraka I.,Zadar General Hospital | Rudic M.,Zadar General Hospital
Acta Clinica Croatica | Year: 2011

Parathyroid gland carcinoma is a rare malignancy. The tumor is mostly functioning, causing severe hyperparathyroidism, with high serum calcium level and severe bone disease. Non-functioning parathyroid carcinomas are extremely rare. We report on a 60-year-old male patient admitted to ENT Department due to a large neck tumor mass compressing the thyroid and trachea. Preoperatively, thyroid hormone, parathyroid hormone (PTH) and calcium serum levels were normal. The following immunohistochemical markers (DAKO, Denmark) were used: bcl-2; CD-10; Chromogranin-A; Cyclin-D1; EM A; Ki-67; Mdm-2; p-53; PGP-9,5; RCC; Synaptophysin; Thyroglobulin; and TTF -1. Immunohistochemical analysis indicated the diagnosis of a primary parathyroid gland carcinoma. Tumor cells showed diffusely positive immunohistochemical staining with chromogranin-A and PGP-9,5, positive staining of variable intensity with synaptophysin, and weakly positive reaction with EM A. Also, the cytoplasm of tumor cells was diffusely positively stained with bcl-2, while the nuclei showed positive reaction with p-53 oncogene and TTF -1. The remaining markers (CD-10, cyclin-D1, Ki-67, Mdm-2, RCC and thyroglobulin) were negative. Four years after the surgery, the patient died from renal carcinoma pulmonary metastases and liver cirrhosis complications. In conclusion, non-functioning parathyroid gland carcinoma is a very rare disease. Detailed immunohistochemical analysis is needed to distinguish it from other thyroid and parathyroid neoplasms and metastatic carcinoma. Surgical treatment is presently the best mode of therapy.


PubMed | Zadar General Hospital, Sibenik General Hospital, Dialysis and Kidney Transplantation, UHC Rijeka and 2 more.
Type: | Journal: European journal of internal medicine | Year: 2016

We investigated the association among long-term proton-pump inhibitors (PPIs) use with serum magnesium (Mg) levels in chronic hemodialysis (HD) patients, as well as possible association among PPI use and increased risk of cardiovascular (CVD) morbidity in HD patients.Of 418 HD patients that were screened for inclusion, 136 were excluded due to incomplete medical data, duration of renal replacement therapy (RRT) for less than 12months, use of Mg-based-phosphate binders or other Mg-based medications or either to presence of chronic increased GI losses. Among 282 patients included in the study, 170 patients were on PPIs.Serum Mg levels were significantly lower among PPI users vs. non-users (0.940.2 vs. 1.030.2mmol/L; p<0.0001). The median duration of PPI use was 279.6months (range from 12 to 108) and it was not significantly associated with Mg levels (r=0.116; p=0.167). Additionally, residual renal function didnt show a significant correlation with Mg concentration (r=-0.102; p=NS) in both groups of patients. The use of PPIs was an independent and strong predictor of low Mg concentrations even in multivariate analysis (OR 3.05; 95% CI 1.2498-7.4594, p=0.01). On the other hand, the daily dose of PPIs was not associated with low Mg levels. PPI users had a higher rate of adverse CVD events during the 1 year of follow-up in comparison to non-PPI users but that difference wasnt statistically significant (17.6% vs. 10.7%; p=0.110).We have found a significant association between PPI use and lower serum Mg levels in chronic HD patients.


Dzelalija B.,Zadar General Hospital | Dzelalija B.,University of Split | Punda-Polic V.,University of Split | Medic A.,Institute of Public Health | Dobec M.,Medizinische Laboratorien Dr F Kaeppeli
Travel Medicine and Infectious Disease | Year: 2016

Aim To review the current state of knowledge concerning rickettsiae and rickettsioses in Croatia and to discuss their implications for travellers. Methods The PubMed database was searched from 1991 to 2015 by combining the words “rickettsia,” “rickettsiosis”, “travellers” and “Croatia”. Results Since 1969, Croatia appears to be free of epidemic typhus (ET) caused by Rickettsia prowazekii and the last case of Brill-Zinsser disease was recorded in 2008. Mediterranean spotted fever (MSF) caused by Rickettsia conorii is the most frequent human rickettsial infection in Croatia, followed by murine typhus caused by Rickettsia typhi. Human cases of MSF and murine typhus have been predominantly observed along the eastern Adriatic coast from Zadar to Dubrovnik and between Zadar and Split, respectively. Rickettsia akari, etiologic agent of rickettsialpox, was isolated from blood of a patient diagnosed with MSF in Zadar, but no cases of rickettsialpox were reported. Several species of pathogenic (Rickettsia slovaca, Rickettsia aeschlimannii, Ricketsia helvetica, and Ricketsia raoultii) and species of undetermined pathogenicity (Ricketsia hoogstraalii sp. nov.) rickettsiae were identified in ticks collected in different ecological regions of Croatia. A search of the literature revealed no evidence of rickettsial infection in travellers visiting Croatia. Three imported cases of Rickettsia africae were observed in travellers returning from South Africa. Conclusion Rickettsiae and rickettsial diseases continue to be present in Croatia. As they can be acquired while travelling, physicians should consider rickettsial infection in the differential diagnosis of patients returning from Croatia and presenting with febrile illness. © 2016 Elsevier Ltd


Mladina R.,University of Zagreb | Castelnuovo P.,University of Insubria | Locatelli D.,Clinica di Neurochirurgia | Duric Vukovic K.,University of Zagreb | Skitarelic N.,Zadar General Hospital
ORL | Year: 2013

Background: One of the major challenges of cranial base surgery is reconstruction of dural defects and cerebrospinal fluid leak closure. Various grafting methods have been used for smaller skull base defects with great success. The indications for endoscopic reconstruction have recently evolved to encompass much larger breeches in the skull base following tumor removal, thus emphasizing the need for vascularized tissue flaps for reconstruction. Methods: Some authors proposed a pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium, which is very vascularized and has quite a large surface. It is also long enough to easily cover even larger defects of the skull base. The elevation of a nasoseptal flap is based on a particularly advanced surgical technique and thus requires proper training before being performed in a real patient. Results: Anatomical differences between human and lamb heads were observed and explained although they do not affect the procedure of the elevation of the nasoseptal flap. Conclusions: The lamb's head has been shown to be an ideal model for the adequate training of the surgical skills required for this demanding procedure. Copyright © 2013 S. Karger AG, Basel.


Klaric D.,Zadar General Hospital | Prkacin I.,University of Zagreb
Acta Medica Croatica | Year: 2014

According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.


Morovic M.,Zadar General Hospital | Hrstic I.,Pula General Hospital
Acta Medica Croatica | Year: 2013

Clinical practice guidelines for the management of chronic hepatitis B infection continue to evolve from year to year but the goal remains the same, i.e. long-term continued suppression of viral replication to prevent disease progression and development of cirrhosis and hepatocellular carcinoma. Out of seven drugs approved for the treatment of chronic hepatitis B, current guidelines recommend entecavir and tenofovir from the nucleos(t)ide analogues and pegylated interferon alfa-2a for the selected group of patients as first-line monotherapies. Both groups showed good results in a number of clinical trials and are used according to the consensus criteria. The treatment of special populations with chronic HBV infection, i.e. those with HCV/HDV/HIV co-infections, immunocompromised patients, patients who have undergone transplantation, patients with solid tumor and cirrhosis, patients with chronic renal failure on dialysis, pregnant women and children, is more often required and more demanding than for usual chronic hepatitis B.


Although the majority of peritonitis cases in peritoneal (PD) dialysis patients are caused by gram-positive cocci, streptococcus agalactiae, a gram-positive group B β haemoliticus streptococcus, may rarely be found in this group of patients. We present a case of acute peritonitis caused by streptococcus agalactiae with bacteriemia and septic shock occurring after a curettage indicated because of gynecologic bleeding. The patient did not receive antimicrobial prophylaxis since the gynecologist considered this case as a "routine" procedure without the need to administer antibiotics. Our case demonstrate that small procedures may cause great problems and therefore one should always give priority to individual approach regardless of the protocol for "routine" surgery, especially if there are no indications for the emergency procedure.


Klaric D.,Zadar General Hospital
Acta medica Croatica : časopis Hravatske akademije medicinskih znanosti | Year: 2012

Peritoneal dialysis is an equally valuable method for some patients. It is a method with some advantages and thus should be considered the method of choice. Are the trends of treatment with this method instead of terminal kidney disease replacement stagnating? In our ten-year retrospective study, we tried to do assess how to control the efficiency of dialysis and what was its influence on patient survival. We compared clinical state of patients, laboratory indicators of dialysis dosage (Kt/v) and peritoneal membrane transport function (PET). Patients were divided according to Kt/v values <1.7, 1.7-2.2 and >2.2. According to PET findings, they were divided into four standard groups. Kt/v and PET are unavoidable evaluation factors of peritoneal membrane and for prescribing dialysis. The transport, ultrafiltration and other membrane characteristics change with time and with inflammatory processes. On any calculation of adequacy, it is essential to distinguish diuretic and anuric patients. The adequacy of peritoneal dialysis should be incorporated in the conclusion on prescriptions and quality treatment of each individual patient.


Patrk I.,Zadar General Hospital | Morovic M.,Zadar General Hospital | Markulin A.,Zadar General Hospital | Patrk J.,Zadar General Hospital
Dermatology | Year: 2014

Background/Objective: Peginterferon alfa and ribavirin could cause various cutaneous reactions. Treatment-related cutaneous reactions are common, and treatable complications can contribute to the treatment discontinuation. Methods: We performed a 6-year prospective study of cutaneous reactions in 271 patients with chronic hepatitis C treated with peginterferon and ribavirin. Results: Cutaneous reactions of mild to moderate degree were seen in 36 (13.3%) patients: localized cutaneous reactions in 7 (2.6%) patients, generalized reactions - pruritus, skin xerosis and eczematous changes - in 28 (10.3%) patients, alopecia in 11 (4.1%) patients; exacerbation of lichen planus was seen in 1 patient. Conclusion: The study showed a relatively low prevalence of cutaneous reactions without the need for discontinuation of any of the drugs used. These reactions correlated only with the age of the patients and treatment duration. This finding is of particular importance with regard to the recently introduced direct-acting antivirals in the treatment of hepatitis C virus infection, which can cause a very severe form of cutaneous reactions. © 2014 S. Karger AG, Basel.


Klaric D.,Zadar General Hospital | Klaric V.,Zadar General Hospital
Acta Medica Croatica | Year: 2014

We have shown in this work the influence of acute and chronic stress on the blood pressure level and have considered the pathophysiological effects of it on the cardiovascular system and morphological changes. Present society, with its way of life, causes potential great emotional stress on the human being confronting him with different problems in different fields of life: work, family, society (i.e. rise in violence, mobbing, existential difficulties, loss of employment, problems in interrelationships with people, etc). If stresses are not dissolved on time, they can cause serious physical damages. Consequently, our work shows that short-term stress (acute) does not have to have an influence on chronic changes, while chronic stress participates in damages of the endothelium blood vessels and aimed organs.

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