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Street and network sampling in evaluation studies of HIV risk-reduction interventions. AIDS Rev ; 4: From networks to populations: the development and application of respondent-driven sampling among IDUs and Latino gay men.

AIDS Behav ; 9 : Heckathorn D. Respondent driven sampling: a new approach to the study of hidden populations. Social Problems ; Respondent driven sampling II: deriving valid population estimates from Chain-Referral samples of hidden populations.

Social Problems Extensions of respondent-driven sampling: a new approach to the study of injection drug users aged AIDS and Behavior ; 6: Introduction to respondent-driven sampling.

Participant manual. Atlanta: Centres for Disease Control and Prevention, Prevalence of sexually transmitted infections among men who have sex with men in Zagreb, Croatia.

AIDS Behav ; Phylogenetic analysis of HIV sequences obtained in a respondent-driven sampling study of men who have sex with men. Walker B Jr.

J Public Health Policy ; We describe the existing health status and health care needs assessment practices in the Republic of Croatia.

Health care needs assessment in Croatia includes mortality and morbidity information available through vital records but does not include community input opinion and attitude and participation.

Health needs are not analyzed in order to determine the causes of health problems. Analysis of health needs of the population groups at highest risk also does not exist.

Resources assessment is not part of the process, so we do not know how adequate the existing health resources are. In the Croatian health care system practice, the assessment function is limited through the almost exclusive use of the routine health and demographic statistics.

Academic public health has introduced other kinds of more participative, subgroups oriented, qualitative methodologies but in daily routine, these methods are hardly used.

Since health needs assessment is one of the core public health functions, in the future its practice has to be reoriented from pure monitoring towards identifying and solving community health problems.

Partnership with community has to be a cornerstone for more efficient health needs assessment practice.

In the light of previous statement, we present and discuss new trends in the assessment practice in Croatia, i. Vlada Republike Hrvatske Ciljevi Akcijskog plana za Rome Zbog visoke stope nezaposlenosti vrlo mali broj radno sposobne romske populacije aktivno je osiguran.

Framework Convention ETS no. European Charter ETS no. Ustavni zakon o pravima nacionalnih manjina. Zagreb, Vlada Republike Hrvatske.

Nacionalni program za Rome. Roma in an Expanding Europe: Challenges for the Future. Budapest, Body mass index and nutritional status of the Bayash Roma from eastern Croatia.

Indikatori za ocjenu zdravstvenog stanja. Zagreb: Medicinska naklada, , UNDP ured za Hrvatsku. Zagreb, studeni Decade Watch. Hungary: Decade Watch, Ravnopravan pristup Roma kvalitetnom odgoju i obrazovanju.

Zagreb: Dizajn Q. Publishing, Sedlak J. Tacling cultural barriers to health care service delivery in Croatia. Health systems confront poverty.

Public Health Case Studies, no. Copenhagen, World Health Organisation, , A Regional Human Development Report 4. Nacionalni program za mlade.

Zagreb, kolovoz Novak J. Romi i Romkinje u visokom obrazovanju ili dok temelji klize Institut za razvoj obrazovanja.

Bratislava: UNDP, , Fond za obrazovanje Roma REF. Datum pristupa informaciji: Miletic GM. Housing Conditions and Residential Aspirations of the Roma.

Most of these indicators are only obtainable through special studies, while routinely monitored indicators simply do not satisfy quantitative needs.

Another problem is Romanies not stating their ethnic denomination. Consequently, routine Roma mortality and cause of death statistics are unreliable.

Baranja used state budget funds to conduct preventive examinations of Romani women who have no health insurance, and to educate them in health measures of safe motherhood, family planning and infant health care.

U razdoblju tranzicije nakon U jesen U razdoblju od Za njih je obrazovanje provedeno tijekom Kako bi se prikazalo ukupne razlike provedena su dva kruga sumiranja, jedan u kojem su sve dimenzije svedene na tri sastavnice 1.

Ne postoji organizacijska samoprocjena resursa. Evaluacija S. Funkcija procjene stanja 1 A, 1B i 1 C. Funkcija oblikovanja zdravstvene politike 2 A, 2B, 2C.

Funkcija osiguravanja resursa 3A, 3B, 3C i 3D. Acta Med Croatica, 64 programa i osiguravanje kvalitete ne postoji.

Od The once and future health system in the former Yugoslavia: myths and realities. Hebrang A. Reorganization of the Croatian health care system.

U: Shakarishvili E, ur. Acta Med Croatica, 64 5. Evaluation of Croatian model of polycentric health planning and decision making.

Health Policy ; Screening survey to assess local public health performance. Public Health Rep ; Am J Prev Med ; 11 Suppl 2 : Assessing public health practice: application of 10 core function measures of community health in six states.

AJPM ; 11 Suppl. Our hypothesis was that decentralized model of health planning and management would not occur just by changing legislation alone.

Counties in Croatia needed educational support learning-bydoing training in order to improve public health practices at the county level.

Sample and Methods: During the period, the first 15 county teams so-called first cycle counties completed their training.

The teams consisted of 12 to 15 members, representatives of political and executive component, technical component public health professionals, representatives of health and social welfare institutions and community members non-government sector and media.

Teams were trained in cohorts. The remaining 5 counties second-cycle counties completed the same kind of training in Each county team had to fill it out at the beginning of education.

Results: Comparison of the Public Health Performance Matrices of first cycle counties training in with those of the second cycle counties trained several years later yielded no differences.

Although training materials were publicly available accessible through the Croatian Healthy Cities web pages for years, the second cycle counties did not spontaneously without training increase their county-level capacities for participative health needs assessment, health planning, and provision of health services tailored to the local needs.

Conclusion: Results of this study showed that decentralized model of health planning and management in Croatia could not be developed without educational support given to the lower level of administration.

Za daljnju analizu zasebno su razmatrani magisteriji i doktorske disertacije, te znanstvene publikacije indeksirane na PubMed-u. S aspekta upravljanja skrbi za zdravlje, Povelja o zdravstvenim sustavima usvojena na Europskoj ministarskoj konferenciji SZO Acta Med Croatica, 64 nadzora, analiza i kontrola.

Acta Med Croatica, 64 Tablica 1. U tablici 2. Tako je u razdoblju do Acta Med Croatica, 64 Tablica 4. Doktorske disertacije i magisteriji Od 2.

World Health Organisation. The world health report Health Systems: Improving Performance. Geneve: WHO, Phillips CD. What do you do for a living?

Agency for Healthcare Research and Quality. University of Washington School of Public Health. Delnoij D, Groenewegen PP. Health services and systems research in Europe: overview of the literature Eur J Public Health ; 17 Suppl.

Ettelt S, Mays N. Draft report. The Hague, April Garrido MV, Busse R. Health systems research in Europe. This project is being implemented with the aim of identifying, evaluating and improving the contribution of Health System Research to the development of Health Policy in Europe.

This study included scientific publications indexed in the PubMed database and master theses and doctoral dissertations published at Schools of Medicine in Zagreb, Osijek, Rijeka and Split during the period.

Access to master theses and doctoral dissertations at the other three medical schools was done by the Internet.

We analyzed the collected summaries of all publications, master theses and doctoral dissertations and excluded all those that did not correspond to our research.

Results: Using this method, we found a total of publications indexed in PubMed-in, 70 master theses and 22 doctoral dissertations meeting the study criteria.

For further analysis, we separately considered master theses and doctoral dissertations on the one side, and scientific publications indexed in PubMed on the other side.

All papers were listed by the year of publication, J. Acta Med Croatica, 64 the author and the means of publication. Upon inclusion of the key words, papers met the required criteria.

After abstract analysis, PubMed indexed papers were found to meet all the criteria and addressed the Health System Research in Croatia.

There was a significant increase in the number of published papers during the 5-year study period. Upon analysis of the summary contents of master theses and doctoral dissertations, we separated 6 doctoral dissertations and 35 master theses that met the criteria of the research.

They were divided into four groups: research of macro-, mezzo- and micro-level of Health System and assessment of Health Care System results.

There were only a small number of high quality researches dealing with HSR in Croatia. Descriptive approach to the analysis predominated.

Reform interventions require research, but are not part of the designed strategy. Funding of HSR is an important issue.

In all publications, we could not find a systematic research of the Health System; however, we recognized a growing trend in the number of articles dealing with HSR in Croatia over the past 20 years.

Comparison of the number of papers on the Health Care System in Croatia indicated a significant lag in comparison to Western Europe, and similarity with the countries of Eastern Europe.

Basic Information Sheet po T. Naime, St. Vincentskom deklaracijom iz Vremensko razdoblje od Ispitanici su podijeljeni u dvije skupine.

Povremeno prijavljivanje podrazumijevalo je prijavljivanje tijekom dvije godine koje nisu bile uzastopne, odnosno prijave koje su dostavljene Redovito prijavljivanje podrazumijevalo je najmanje jednu prijavu svake godine tijekom promatranog razdoblja, odnosno prijave dostavljene Provedena je deskriptivna analiza promatranih pokazatelja: normalnost raspodjele testirana je Shapiro-Wilksovim testom, a homogenost varijance Leveneovim testom.

Registar CroDiab je implementacijom ekspertnog sustava Global estimates of the prevalence of diabetes for and Prevalence of diabetes mellitus in Croatia.

Diabetes Res Clin Pract ; No , Geneva: World Health Organization. Listopada Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis.

JAMA ; Measuring clinical performance and outcomes from diabetes information systems: an observational study. Diabetologia ; Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS Lancet ; Ten-year follow-up of intensive glucose control in type 2 diabetes.

N Engl J Med ; The Croatian model of diabetes care and St. Vincent Declaration. Diab Nutr Metab ; Diabet Med ; 7: Studenog Ministarstvo zdravstva i socijalne skrbi.

Ministarstvo zdravstva i socijalne skrbi, Diabetes Care ; 33 Suppl. The quality of health care delivered to adults in the United States.

Diabetes Care ; Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study UKPDS Keeping a diabetes registry facilitates monitoring of the epidemiological situation, while a structured approach to the registration of diabetic patients reporting on an optimum information cluster for the follow-up and improvement of diabetes care contributes to better regulation of patient risk factors.

Active patient reporting at the primary health care level has begun in with setting up the legislative background.

The aim of this study was to establish the effect of the CroDiab registry on metabolic parameters in type 2 diabetic patients treated at primary health care level by comparing diabetes indicators between the regularly annually reported type 2 diabetic patients and those that were only intermittently reported to the registry from until Methods: Family physicians submit their reports mainly via CroDiab web, a Croatian web-based system for the collection of data on diabetic patients, which enables analysis of the basic clinical and public health indices.

The levels of fasting and postprandial blood glucose, HbA1c, triglycerides, total cholesterol, HDL- and LDL-cholesterol, systolic and diastolic blood pressure, and body mass index were analyzed in and , and compared between the two study groups.

Results: At baseline, differences between the intermittently reported I and regularly reported R groups were only observed in the systolic I There were no statistically significant differences in body mass index, fasting glucose, HDL-cholesterol and triglycerides.

Discussion and Conclusion: Electronic medical records and structured health care are associated with increased benefits and improvement in metabolic indicators at the primary health care level.

Regular reporting and monitoring via CroDiab registry lead to a significant improvement in the majority of metabolic indicators, which is less marked with intermittent reporting.

The more pronounced effect observed in the group of patients that were regularly covered by the registry could be attributed to a more comprehensive and regular insight and better patient care associated with continuous monitoring.

Further efforts are therefore needed to achieve the widest possible implementation of the CroDiab web system to improve diabetes care at the primary health care level.

Prema ukupnom broju kreveta, Hrvatska je na Prema broju akutnih bolnica na 1. Jedina je iznimka Knin, koji je bolnicu dobio u kasnijem razdoblju Pokazatelji o bruto nacionalnom proizvodu po glavi stanovnika BNP-a p.

Broj stanovnika, Moldavija 3 21 ,04 17 ,22 54,85 Gruzija 4 14 ,9 12 ,5 28,14 79,65 6,77 Ukrajina 46 ,97 ,85 93,9 ,7 Armenija 3 13 ,82 11 ,7 45,4 31,3 Albanija 3 9 ,53 8 ,6 23,06 7,77 Makedonija 2 9 ,69 6 ,43 58,47 29,41 Bosna i H 3 11 ,56 12 ,53 37,24 - - Crna Gora 2 ,8 1 ,37 49,67 - - Bjelorusija 9 ,87 - - 69,93 ,58 - Bugarska 7 48 ,43 57 ,35 58,24 - Srbija 9 52 ,26 - - - - - - 21 ,29 ,21 77,34 - - Rusija 1 ,85 1 ,27 ,29 15,2 Turska 70 ,59 ,94 8,99 26,47 Poljska 38 ,17 ,75 64,78 - - 3 27 ,95 17 ,33 ,29 ,26 Rumunjska Litva Hrvatska 4 24 ,6 16 ,41 93,85 - - Estonija 1 7 ,99 5 ,2 56,2 ,91 10 83 ,52 61 ,54 ,01 70,01 3 ,26 1 ,38 ,4 ,78 Malta Italija 59 ,9 ,31 13,02 ,78 Slovenija Cipar Francuska 60 ,78 ,83 92,59 ,69 Belgija 10 54 ,06 49 ,18 ,78 ,68 Austrija 8 64 ,34 53 ,9 62,88 - - 61 ,72 ,64 82,85 ,25 Britanija 5 36 ,49 12 ,59 84,05 - - BNP 9.

Finska 1 ,72 1 ,31 75,65 1 ,37 8. Nizozemska ,46 16 78 ,8 55 ,18 ,07 7. Irska 4 23 ,91 11 ,23 85,09 ,32 2 ,8 1 ,17 ,85 ,73 4. Danska 5.

Island 5 19 ,48 16 ,65 60,37 ,55 3. Luxemburg 1. Hrvatska prati ta zbivanja te je od S ukupnim brojem od 79 bolnica Manje bolnica za akutne bolesnike od Hrvatske ima samo Nizozemska.

Hrvatska sa 0,6 bolnica na 1. Bolnice su neophodnost koja se mora prihvatiti. Po broju bolnica na broj stanovnika, Hrvatska zaostaje za europskim zemljama.

Posebno je vidljivo smanjenje broja akutnih bolnica. Ne smije se zaboraviti niti utjecaj ratnih zbivanja u Domovinskom ratu, gdje je, uz smanjenje broja zdravstvenih djelatnika, ubrzan trend smanjenja broja kreveta i bolnica 5.

Acta Med Croatica, 64 razvoju. Udaljenost od bolnica, tj. Datum pristupa informaciji Global environmental change and health: impacts, inequalities, and the health sector, BMJ ; : doi: AD Published 24 January The District Hospital.

Health Systems. HCJZ ; 5: broj Int J Health Geographics , doi The health of nations. BMJ ; a McKee M, Healy J.

The changing role of the hospital in Europe: causes and consequences. Fister K, McKee M. Health and health care in transitional Europe.

BMJ ; 23 July , doi Hrvatski zavod za javno zdravstvo. Acta Med Croatica, 64 Sanitarni kordon nekad i danas, Zagreb, Dostupno na URL adresi: 1.

Zagreb: Ministarstvo zdravstva Republike Hrvatske, Building new university hospital--what citizens know and policy makers should be aware of.

Ministarstvo zdravstva i socijalne skrbi Republike Hrvatske, Ministarstvo zdravstva i socijalne skrbi Republike Hrvatski sabor. Nacionalna strategija razvitka zdravstva Trebaju nam 4 velike bolnice, ostale ukinite!

Jutarnji list Novi list Vjesnik 1. Novi list 7. Odrednice hrvatskog zdravstvenog sustava u razdoblju HCJZ ; 3: br.

Dostupno na URL adresi: www. Magnusson G. Sociology of Health ; 2: Travel times to health care and survival from cancers in Northern England.

Eur J Cancer ; Cancer survival in New Zealand: Ethnic, social and geographical inequalities. Posnett J. The hospital of the future.

Is bigger better? Concentration in the provision of secondary care. BMJ ; HCJZ ; 3: broj Epidemiologija zaraznih bolesti. Care of military and civilian casualties during the war in Croatia.

Acta Med Croatica ; Besides education of health workers, equipped devices and efficiency of work in hospitals, it is important to compare the number of hospitals, their size, type of hospitals, their distribution and availability to users.

These elements are essential to the overall quality and efficiency of health work of an area. Based on the analysis, to answer the question whether Croatia has a sufficient number of hospitals, particularly in County of Split-Dalmatia and Dalmatia.

Method: In this article are used methods of descriptive epidemiology based on available electronic data of the WHO Office for Europe.

Results: Of the 44 European countries, Croatia is in the 35th place with a total of 79 hospitals 1. Without 10 hospital wards, and 6-of-hospital maternity, Croatian average is 1.

By the number of acute hospitals with no out-patient clinic and maternity wards, Croatia is in the penultimate 43rd place with 36 hospitals 0.

By the size of the hospitals per average number of hospital beds per one acute hospital Croatia has no clinic and outpatient hospitals which puts Croatia in the second place behind the Netherlands The most acute hospitals are in County of Pozega-Slavonia 2.

Discussion: Croatia is getting behind by the number of hospitals, compared to Europe, especially concerning acute hospitals. Given the density and area unit in the Southern Croatia there is a striking lack of acute hospitals, causing a disparity in the availability of hospital and specialist health care.

To make hospital and specialist health care available to the , inhabitants of Dalmatia, who are more than an hour away from the hospital, it is necessary to replace outpatient-clinics and maternity hospitals with the general hospitals.

Conclusion: Given the fact that Croatia is at the top of Europe by the size of the hospitals by the number of beds for acute patients, and there is the sufficient number of beds to population, but also a lack of spatial coverage of acute hospitals and therefore poor availability of hospital and specialist care for the advisory large population of south and east of the state and Istria.

U praksi se pokazuje potreba za izradom plana osiguranja kontrole kvalitete svih postupaka programa probira engl.

Izostalo je kontinuirano obrazovanje zdravstvenih djelatnika kao i medijska kampanja. Pozivno razdoblje iznosi dvije godine.

Neodazvane osobe se ne pozivaju ponovno. Programu se do Testiranje je R. Tako je ukupno testirano 5.

Kolonoskopiju je do Ukupno opravdani razlozi 2 1 0 20 39 68 70 Tablica 3. Ukupno 17,2 22,3 R. Stoga je Ministarstvo zdravstva Republike Hrvatske u mjesecu listopadu U to vrijeme kraj U susjednoj Sloveniji koja je nacionalni program pokrenula Susjedna Slovenija je tijekom Tako je npr.

Zanimljivo je da je u Francuskoj u 1. Naime, u Dodatni problem nastao je zbog nekontinuiranog slanja poziva na teren.

Za kvalitetnu provedbu programa u ovom segmentu neophodna je njihova aktivna uloga. Do U Francuskoj je odaziv na kolonoskopiju u 1.

Istodobno je u Sloveniji u pilot programu stopa otkrivenih karcinoma na osoba pregledanih u probiru iznosila 5,3 Minesota Colon Cancer Control Study.

No, u usporedbi sa zemljama Europe koje koriste iste metode probira, zadovoljstvo je manje. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood.

Natl Cancer Inst ; Incidencija raka u Hrvatskoj Zagreb: Hrvatski zavod za javno zdravstvo, Registar za rak Republike Hrvatske, Reducing mortality from colorectal cancer by screening for fecal 5.

Nacionalni program ranog otkrivanja raka debelog crijeva. Zagreb: Republika Hrvatska, Ministarstvo zdravstva i socijalne skrbi, Colorectal cancer screening in Europe.

World J Gastroenterol. Cancer screening in the European Union. ISBN European Communities publ. Printed in Luxemburg by the services of the European Commision, Colorectal cancer screening in Europe: differences in approach; similar barriers to overcome.

Int J Colorectal Dis ; Estimates of the cancer incidence and mortality in Europe in Ann Oncol ; Strnad M, Znaor A. Registar za rak Hrvatske.

Zagreb: Hrvatski zavod za javno zdravstvo, Ninth plenary meeting; May. Committe B, Third Report. Program Svit.

Final Evaluation Report; Oct. Report No. ISBN 0 82 3. J Med Screen ; Osvrt na 1. Kronja Lj. Datum pristupa informaciji Stipanov I.

Vitalia A. Strnad M. Lessons learnt from a populationbased pilot programme for colorectal cancer screening in Catalonia Spain.

Many participants in fecal occult blood test population screening have a higher-than-average risk for colorectal cancer. Eur J Gastroenterol Hepatol ; Coll Antropol ; 33 Suppl.

Cardiovaskular risk factors in Croatia: struggling to provide the evidence for developing policy recomendations.

World Gastroenterology Organisation, International Digestive Cancer Alliance. Practice Guidelines: Colorectal cancer screening.

Young GP. Population-based screening for colorectal cancer: Australian research and implementation. J Gastroenterol Hepatol ; 24 Suppl 3: Haemoccult screening for colorectal cancer: the effect of dietary restriction on compliance.

Eur J Surg Oncol; Random comparison of guaiac and immunochemical fecal occult blood test for colorectal cancer in a screening population. Gastroenterology ; Gut ; The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial.

Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial ISRCTN BMC Public Health ; 5: Slovenian colorectal cancer screening programme SVIT-result of pilot phase.

Zdrav Vestn ; Yeoman A, Parry S. A survey of colonoscopy capacity in New Zealands public hospitals. N Z Med J ; Mohammad A, Khan Y. Barriers to timely screening colonoscopy: the role of health insurance.

Conn Med ; Z Gastroenterol ; 46 Suppl 1: According to the incidence of CRC in men and women, and mortality in men, it is the second most common malignancy, and the leading one in women.

The main obstacles and suggestion for improvement are presented. Study results are compared with international references. The target group includes approximately 30, individuals suitable for CRC screening aged years.

In the first screening round, between January and September , 19, invitation letters with test kits gFOBT were sent to people born and The overall attendance to screening was Blood in the stool was detected in The waiting time for follow up colonoscopy was too long median days.

Colonoscopy rate reached A total of 22 individuals were diagnosed with cancer and the percentage of cancer detected by colonoscopy was 6. The main limitations to program implementation are inappropriate software for data collection and the lack of a protocol for standardized data collection; the rate of positive test results is unacceptably high, local colonoscopy service is insufficient and waiting time for colonoscopy too long.

Also, the inclusion of general practitioners GPs in the program has proved inadequate. The role of local public health institutes as coordinators is of crucial importance, but financial and human resources are inadequate.

Reminder letters had a significant impact on participation, so this strategy should be adopted. For better success of the program, the involvement of GPs should increase and it is important to make a strategic plan to improve the population and GP awareness of the screening program importance.

Conclusion: The national program is tested in local conditions and it needs change based on the difficulties observed. The results of program implementation are quite satisfactory considering the conditions in which it is carried out, but less satisfactory than those reported from the neighboring countries.

In the next period, the program should be allocated due financial and human resources, and it is important to agree upon a strategy that would yield the best results.

Lokacije bunara odnosno mjesta uzorkovanja prikazane su na sl. Udio uzoraka s obzirom na izmjerene koncentracije prikazan je interkvartilima tablica 1.

Farming, Fertilizers and the Nitrate Problem. Hydrogeol J ; 6: Kattan Z. Use of hydrochemistry and environmental isotopes for evaluation of groundwater in the Paleogene limestone aquifer of the Ras Al-Ain area Syrian Jezireh.

Environ Geol ; Kazemi GA. Temporal changes in the physical properties and chemical composition of the municipal water supply of Shahrood, northeastern Iran.

Hydrogeol J ; Hallberg GR. Nitrates in groundwater in the United States of America. U: Follet RF, ur. Nitrogen management and groundwater protection: developments in agriculture and managed-forest ecology.

Dordrecht: Elsevier, , vol. Trends in ground water nitrate contamination in the Phoenix, Arizona region.

Predicting ground water nitrate concentration from land use. Jalali M. Nitrates leaching from agricultural land in Hamadan, western Iran. Agr Ecosyst Environ ; Zagreb: Agronomski fakultet, Shuman LM.

Phosphorus and nitrate nitrogen in runoff following fertilizer appliccation to turfgrass. J Environ Qual ; Nitrate temporal and spatial patterns in 12 water-supply wells, Yucatan, Mexico.

Abu Naser A. A, Ghbn N. Relation of nitrate contamination of groundwater with methaemoglobin level among infants in Gaza. EMHJ ; Canter LW. Nitrates in groundwater.

Lewis publishers, Environ Health Persp ; Risk of non-Hodgkin lymphoma and nitrate and nitrite from drinking water. Epidemiology ; Nitrate in aquifers beneath agricultural systems.

Water Sci Technol ; Nitrate intake from drinking water on Tenerife island Spain. Sci Total Environ ; Nitrate in groundwaters of intensive agricultural areas in coastal Northeastern Australia.

Nitrate concentration in drinking water from wells at three different locations in northwest Croatia.

Cereal Res Commun ; A preliminary assessment of nitrate degradation in simulated soil environments.

Environ Sci Technol ; The total amount of downfalls subsequently correlated to nitrate concentrations was determined by summing up individual metric values provided by the State Meteorological and Hydrological Service.

Data were analyzed in a descriptive manner and compared to the maximal allowable concentrations MAC stipulated under the Ordinance on Potable Water Safety, as well as to the limit values recommended under the Nitrates Directive.

The mean range spanned from 0. The highest mean nitrate concentration of Given the detected nitrate concentrations in the sampled well water, the wells were classified as satisfactory, occasionally unsatisfactory and unsatisfactory.

The influence of point sources was assessed based on their distance. Discussion and Conclusions: The results obtained are comparable to those of similar studies undertaken in regions having a similar agro-ecological and agricultural profile.

The range of the mean nitrate concentrations established in potable water samples recovered from shallow wells was wide; the total mean nitrate concentration was relatively high Contaminating point sources located not farther than 10 meters from shallow wells significantly influence the quality of drawn water.

Respective of correlations between the amount of downfalls and water nitrate concentrations, both negative and positive links were established.

Podaci su dobiveni od Hrvatskoga zavoda za zdravstveno osiguranje. U promatranom razdoblju od U Promatrano je razdoblje od jedne godine dana.

NN br. Methods for the economic evaluation of health care programme. Third edition. Oxford: Oxford University Press, Zagreb: Medicinski fakultet, Kampmann JP.

Rational Pharmacoterapy: Contents and Scope. Perspectives and achievements with Rational Pharmacotherapy. Larsen TH. Drug Industry and Rational Pharmacotherapy.

Agencija za lijekove i medicinske proizvode. Hydrochlorotiazide versus chlorthalidone in the management of hypertension.

Cardiol Rev ; Curr Med Res Opin ; Ann Pharmacother ; WHO Euromedstat. European Library of Pharmaceutical Indicators.

Utilization and price indicators. Vrhovac B. V izdanje. Selection of therapy with nitrates in patients with stable effort angina: result of comparative study of common isosorbide dinitrate and long acting preparation of isosorbidemononitrate.

Kardiologiia ; Int Heart J ; Beck OA, Hochrein H. Indications and risk of antiarrhythmia treatment with propafenone. Dtsch Med Wochenschr ; Retardation of the excitation conducting by propaphenone.

Duration and dosage effect relation after oral administration. Garcia A. Adverse effect of propafenone after long-term therapy with the addition of citalopram.

Am J Geriatr Pharmacother ; 6: Os I, Stokkle HP. Doxazosin GITS compared with doxazosin standard and placebo in patient with mild hipertension.

Blood Press ; 8: Grzeszczak W. Przegl Lek ; Safety of furosemide administration in an elderly woman recovered from thiazide-induced hyponatremia.

Eur J Intern Med ; Comparison of bisoprolol with atenolol for systemic hypertension in four groups young, old, black and nonblack using ambulatory blood pressure monitoring.

Am J Cardiol ; A randomised double-blind study of bisoprolol versus atenolol in mild to moderate essential hypertension.

Early mechanisms of renal injury in hypercholesterolemic or hypertriglyceridemic rats. Diabetes mellitus. Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes.

Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Association between elevated serum C-reactive protein and triglyceride levels in young subjects with type 1 diabetes.

Inflammatory and endothelial dysfunction markers and proteinuria in persons with type 1 diabetes mellitus. Tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors.

Received on January 28, Revised on September 22, Accepted on October 1, Bone bruise is a common finding in acutely injured knee examined by magnetic resonance MR.

The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament ACL and menisci.

Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage.

MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques. A representative review of MR examinations for the acute knee trauma was conducted.

All the patients were examined within one month of trauma. All MR examinations were performed by using a 0. Posttraumatic bone bruise was seen in 39 We analyzed only bone bruises without these fractures of the cortex.

Only two patients with bone bruise had neither ACL nor menisci lesions. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen.

The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.

Magnetnom rezonancom pregledano je bolesnika sa akutnom traumom kolena. Svi bolesnici pregledani su u prvih mesec dana nakon traume.

Pregledi su obavljeni na 0,3T MR aparatu. Key words: knee injuries; bone and bones; contusions; magnetic resonance imaging; sensitivity and specificity.

Bone bruise is posttraumatic bone marrow change which is caused by the combination of hemorrhage, edema and microtrabecular fracture without disruption of adjacent cortex.

Magnetic resonance imaging is a method of choice for detecting bone bruises which usually can not be seen using other radiological methods 1.

The terms: bone bruise, bone contusion and posttraumatic edema of the bone marrow have been seen for the last ten years in scientific literature and are in fact synonyms in the case of posttraumatic findings of bone marrow contusion.

Bone bruise of the knee is very important as a reason for acute pain and reduced knee function in patients 7, 8. Bone bruise is best seen in STIR sequence.

The aim of this study was to evaluate the diagnostic power of MR in detecting bone bruise of the knee and to show the association anterior cruciate ligament ACL and menisci lesions with bone bruise of the knee.

Methods Magnetic resonance imaging of the knee was performed in patients with the acute trauma. All the patients were examined within one month of the trauma.

All scans were performed by using 0. On MR imaging bone bruise is characterized by focal abnormal signal of the bone marrow of femoral condyles or tibial plateau.

On T1 weighted images the alterations in signal are characterized by ill-defined low signal intensity. On T2-weighted images these lesions are characterized by areas of high signal intensity.

Bone bruise is best differentiated in STIR sequence where the signal of bone marrow fat is significantly suppressed while there is a bright, hyperintense signal of bone bruise.

The meniscal tear is diagnosed as linear or irregular hyperintense signal which can be spread to the margins od hypointense meniscal triangle.

Anterior cruciate ligament injuries are characterized by a low signal intensity on T1-weighted images and hyperintensity of the signal on T2-weigted images.

A complete rupture of the ACL is diagnosed when there is a complete lack of the fibers on the ligament spread and the partial rupture when there are some fibers left intact.

Strana For the statistical analysis of the results we used descriptive statistical methods and the Mc Nemar test for the evaluation of statistical significance between the patients with and without bone bruise.

In 15 patients bone bruise was located on femoral condyles. Overall, bone bruises were more often seen in the lateral than in the medial compartment.

In 3 patients, so-called occult fractures not seen on plain radiography were diagnosed. Discussion Bone bruise, as an unique entity on MR, was first identified by Mink et al 12 in Few years later, bone bruises and occult fractures were divided Occult fractures usually can not be seen on conventional radiography but have MR characteristics very similar to those of bone bruises with one major difference and that is a disruption of adjacent cortex or osteochondral surface.

Conventional radiological techniques are rather limited in showing bone marrow. Because of that, analysis of bone marrow characteristics especially bone bruises, is based on MR imaging.

Normal intensity signal of bone marrow is the same as the signal of subcutaneous fat. It is hyperintense on T1-weighted images and medium intense on T2-weighted images.

Bone bruise on MR is presented as focal abnormal signal of the bone marrow of the femoral condyles or tibial plateaus. The best appearance of bone bruise is described on STIR sequence where the signal of normal bone marrow is suppressed and bone bruise is characterized by the hyperintensity of the signal.

This change in signal intensity is caused by posttraumatic edema which is one of the major pathohistological features of bone bruise.

The two others are hemorrhage and microtrabecular fracture. Owing to these pathohistological features, it is considered that bone bruise is one of the causes of a painful knee.

Owing to the pathohistological analysis of bone bruise, different degrees of subchondral and articular cartilage changes can be observed 13, Pathogenesis of bone marrow edema which is characteristic for bone bruise is connected with acute or chronic knee injuries, but bone bruises can be seen with no obvious trauma.

Bone bruises associated with posttraumatic lesions of the internal knee structures last more than isolated bone bruises In the overlying cartilage, degenerative changes including necrosis are described, whereas loss of proteoglycans and different degrees of osteocyte necrosis was seen in the bone matrix.

These findings are the basis for further research in the field of late complications of bone bruises such as posttraumatic arthritis Latest studies show that bone marrow edema seen on MR imaging is a result of different atypical histological changes and that intensity of the signal does not depend only on bone marrow edema The main finding in bone bruise is posttraumatic edema which is most responsible for signal intensity.

Location and size of bone bruise usually speak for the mechanism of knee injury. There are five different mechanisms of knee trauma which give different patterns of bone marrow edema and they are: pivot shift injury, dashboard injury, hyperextension injury, clip injury, and lateral patellar dislocation.

There have not been many studies which analyze the incidence of bone bruises following knee injury 10, 20, Our study was designed so to analyze the presence of bone bruise in acute knee trauma as well as the association with internal knee lesions of LCA and menisci.

This study is very important because MR of the knee was done twice in order to confirm diagnosis. In the study of Lynch et al.

The highest association of bone bruise with LCA rupture was seen in study of Atkinson et al. The term LCA injury is used because in our study we had no arthroscopy done in our patients in order to distinguish partial from a complete rupture of the anterior cruciate ligament.

It is very important to emphasize that in acute knee injury it is very hard to distinguish traumatic menisci tears from the degenerative ones which was not the aim of our study.

Cothran et al. It is therefore essential to consider menisci lesions not only as a cause of a painful knee and a diminished knee function but also as a predictor of further osteoarthritis There have been many studies with the aim to confirm the associations of bone bruise and LCA lesions.

Almost all analyzed this association but placing LCA as primary outcome for the study. There have been fewer studies which analyze the association of bone bruises and menisci lesions 17, Our study analyzed both the association of bone bruise and the internal knee structures lesions but placing bone bruise finding as primary.

Conclusion Bone bruise is a very common finding in acute knee injury. It is more often on the lateral knee compartment.

In acutely injured knee, bone bruise can indicate the injury pattern and it can be very helpful in detecting associated posttraumatic internal knee lesions.

By the precise analysis of bone bruise and the pattern of bone injury we can focus on analysis of internal knee structures lesions.

In this way finding of bone bruise on MR leads to finding the expected but less well seen le- Volumen 68, Broj 9 sions of internal structures of the knee.

Patients with bone bruise have significantly more lesions of LCA and menisci than patients without bone bruise. Vastly undersampled isotropic projection steadystate free precession imaging of the knee: diagnostic performance compared with conventional MR.

Bone marrow oedema of the knee. Bone marrow edema in the knee. Differential diagnosis and therapeutic possibilities.

German 4. Fotiadou A, Karantanas A. Acute nontraumatic adult knee pain: the role of MR imaging. Quantitative assessment of bone marrow edema-like lesion and overlying cartilage in knees with osteoarthritis and anterior cruciate ligament tear using MR imaging and spectroscopic imaging at 3 Tesla.

Clinical consequences of bone bruise around the knee. Tapping test in patients with painful bone marrow edema of the knee. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury.

MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella.

Bone bruises associated with ACL rupture: correlation with injury mechanism. Magnetic resonance imaging of the knee. New York: Raven; Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging.

Magnetic resonance imaging of bone bruising in the acutely injured knee-short-term outcome. Bone bruising of the knee.

The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year. Association of knee bone bruise frequency with time postinjury and type of soft tissue injury.

Orthopedics ; 31 5 : Bone marrow edema and its relation to progression of knee osteoarthritis. Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings.

MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis.

The appearance of kissing contusion in the acutely injured knee in the athletes. Bone abnormalities of the knee: prevalence and significance at MR imaging.

MR imaging of meniscal contusion in the knee. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging.

Indirect soft-tissue and osseous signs on knee MRI of surgically proven meniscal tears. Received on February 1, Revised on November 15, Accepted on November 16, According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy.

Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method.

The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume.

In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetiumm scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied.

An average size of the nodule before curing was 9. An average quantity of the injected ethanol was 9. Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone TSH was noticed compared to the initial values 0.

According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram.

The number and frequency of side effects were insignificant. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in disappearing of authonomy.

Key words: thyroid diseases; thyroid hormones; goiter, nodular; ethanol; ultrasonics. Laboratory criterion for diagnosing is an inability to suppress the function of nodules by suppressive doses of thyroid hormones.

At the same time, the suppressed paranodal tissue has retained the ability to answer the stimulation by exogenous giving TSH.

Unlike toxic ones, nontoxic nodules have normal serum levels of thyroid hormones. According to the current principles, toxic nodules are treated surgically or with therapeutic application of radioactive RA iodine.

The need for curing the nontoxic AFTNs is based on the observation that most of the ill have subnormal TSH levels and, hence, subclinical hyperthyreosis.

On the other hand, taking larger quantities of iodine, which occurs when giving iodine contrast media, the drugs containing iodine, or when eating food rich in iodine, multiplies the possibility of evolution of nontoxic nodules into the toxic ones.

The results achieved by the use of ethanol in treatement of hepatocellular carcinomas 2 and benign cysts in the thyroid gland 3 were a starting point for the attempts to cure the autonomous nodules by the same method.

The procedure of percutaneous ethanol injection PAE into the nodules of thyroid gland was promoted at the beginning of the s.

Then, there were the first results published of treating eight patients in this way in whom the regression in nodules size and the disappearance of autonomy 4 were achieved, regardless a small number of ethanol injections.

In the largest number of the cured, PAE led to a complete or a partial curing, with a very small number of recidives.

In an attempt to contribute to the achievements which would make this method generally accepted we started with the fact that there was not a single study with a selection of patients regarding the autonomy level, as well as that most studies included heterogeneous groups of patients with nodal, polynodal, most often toxic nodules of various sizes.

The aim of this study was to estimate therapeutical effects of 15 mL percutaneous ethanol injection in patients with nontoxic, solitary AFTNs, which most often occur in clinical practice.

Methods The study included 25 patients with solitary nodules which appeared more intense on scintigraphy Tem and had a complete supremacy in paranodal tissue.

According to serum concentration of thyroid hormones and TSH, the patients with toxic nodules were excluded.

By cytological analysis of aspirates from nodules any doubts of malignancy were eliminated. A Hewlett Pacard apparatus with a linear probe of 7.

Color Doppler was used to direct the injection into the areas with the largest number of exposed capillaries. The injections were done in the outpatient department, repeatedly, at intervals of once a week.

The effects of treatment were defined as: successful s , partly successful ps , and unsuccessful u , the scintigraphic finding being a determiner.

Partly successful: the patients with three of the four formerly mentioned criteria fulfilled. Unsuccessful: only two of the four mentioned criteria fulfilled.

All immediate side effects were noticed, as well as their persistence. The examination was carried out according to the principle of prospective clinical study.

The criterion for excluding the patients was their own decision. An average nodule volume before treatment was 9. Regardless echo structure, all the nodules showed diffusionally accentuated vascularisation.

Injection rate was 4 to 12 applications. In all the patients, a statistically significant diminishing of nodules volume was achieved, being slightly larger nodules with the signs of cystic degeneration Table 1.

Although the successfully cured, compared to the partly successfully cured ones, showed a higher level of volume diminishing, this difference was not statistically singificant.

However, if nodules volumes were expressed in milliliters, we would find a higher level of nodule size regression in the successfully cured than in the partly successfully cured ones.

After stopping ethanol injection, all the patients were followed during the next 18 months. Control examinations were done every 6 months.

The function of the thyroid gland was estimated by measuring the levels of thyroid hormones: triodothyronine T3 , tyroxine T4 , TSH and tyreoglobulin Tg.

The values were controlled before, immediately after finishing the procedure and after 6, 12, and 18 months following finishing the injection Table 4, Figure 4.

Table 1 Nodules volume before and after percutaneous ethanol injection in realtion to echo structure ECHO structure Parenchymatous Cyst.

There are a few phases in the development of AFTN. First, there appears a functional nodule without an autonomy.

In its further evolution it can grow into an autonomus hyperfunctional or toxic tyroid nodule. In treatment nontoxic AFTN is still a subject of discussion, with a number of objections.

The opposite attitudes are problematic promoting either clinical following or surgical treatment. Those who are for clinical following base their attitude on the fact that only a small number of AFTNs evoluate into the toxic ones, as well as that the possibility of malignancy is slight 10, During the last 20 years or so, ultrasound guided percutaneous ethanol injection has become a successful way of curing both malignat and benign soft tissue tumors.

The principle of treatment is based on the knowledge that after injecting ethanol regularly spreads within the tumor lesion by diffusion and, then, it causes an inactivity of the oxidative enzymes, dehydration of the cells, denaturation of proteins, venous microthrombosis and coagulation necrosis followed by fibrosis The surrounding tissue is saved since it appears that ethanol stays within the tumor lesion.

The first reports of positive effects refer to local ethanol injection into hepatocellular carcinomas derived from cirrhosis of the liver 2.

Inactivation of parathyroid adenomas by ethanol appeared to be successful in an important number of those having primary hyperparathyroism and, in some cases, after an unsuccessful surgical exploration, it can be the only possible choice of treatment 13, Sclerosing of benign cystic nodules in the thyroid gland has been used for a long time, and there are more and more proofs of reduction in its size and therapeutical efficiency of PAE in the treatement of benign solid nodules Percutaneous ethanol injection was introduced into clinical practice by Livraghi et al.

It was shown then that regression in nodule size, followed by disappearance of autonomy, was achieved, despite a small number of ethanol injections.

Despite the fact that the criteria for estimation success in the results were very strict, looking for the reasons for such results we started with the question whether nodule volume had an effect on the results of treatment.

Strana cording to the current knowledge, are not completely unique. There prevails an attitude that nodule size only partly affects the results of treatment.

Average nodule volume in our patients was 9. Regarding the results, the nodules which were partly cured and unsuccessfully cured were bigger in comparison with the successfully cured ones.

The cited results led to a conclusion that the nodules of smaller volumes could be cured more easily.

However, by linear regressive analysis the correlation between the nodule volume and the results of treated was not proved.

It was shown that the degree of nodule vascularisation had far greater importance for a successful curing. It was noticed that during the treatment, at the time of the planned ultrasound controls, the shape of vascularisation changed in that way that the blood flow gradually weakened, first within parenchyma, and later around the edge of the nodule.

At the end of the procedure, in the successfully cured, both types of vascularisation completely disappeared. Together with the lower blood flow we noticed a regression in nodule size and appearance of fibrosis in parenchyma.

The explanation for this could lie in the noticed occurence that the well vascularised nodules made possible a quicker and a more regular distribution of the injected ethanol, so that even the small amounts of the injected ethanol reached evenly all the parts of nodules and caused the tissue degradation.

We first noticed the good effects of ethanol injecting by the signs of reducting in nodules volume, and we also took into consideration the personal sensation of the patients at control examinations.

Size regression represents the occurence about which there is the smallest number of disagreements in the literature.

We started with the supposition that if a greater size reduction was achieved during therapy there was a greater possibility of getting positive results of curing.

Despite the proved linear correlation between the degree of regression and nodule size and the success of curing, comparisons within the group offered us some interesting ideas and conclusions.

Looking for the reasons of curing to be successful in some patients, but partly successful or unsuccessful in other we analysed some characteristics of nodules and the curing procedures.

Nodules in the subgroup of the successfully treated were of smaller dimensions compared to the unsuccessfully treated but this difference was not statistically singificant.

So, we could not accept nodules size as a reason for the unsuccessful results of curing. Both subgroups did not differ in ultrasound structure of the nodules, the ways of vascularisation, the quantity of the injected ethanol and the number of injections.

A statistically singificant difference was noticed in only the time intervals between the two injections. In the successfully cured, a period between the two injections was The difference in a period between the two ethanol injections was made on purpose as the result of the first experiences during the introduction of the procedure into practical work.

Namely, very early it was noticed that the nodule size regression continued even after ceasing ethanol injection.

We supposed that for the occurence of a number of involutive changes, from cytochemical to fibrosal ones, a certain period of time was necessary. Having that in mind, there is a small possibility that a larger quantity of the injected ethanol would fasten, or that a smaller quantity would slow down this process which has its logical sequence, from functional to definite morphological changes.

We supposed that the newly injected quantity of ethanol only perpetuated the process of degradation and continued progression towards final necrosis and replacement by a fibrotic tissue.

Considering the first noticing in mind and thinking in this way, we controlled all the patients weekly, but we adjusted ethanol injection individually to a period from 2 to 3 weeks, giving chance to the previously injected ethanol to do its function of destruction.

We followed our patients 18 months after finishing the treatment. Despite stopping ethanol injections, further regression in size was noticed, which proved the cited suppositions and conclusions.

In the patient with the results of curing initially defined as unsuccessful, with already described clinical findings, after a year, during repeated scintigraphy, the nodule was not visible any more.

We suppose that quite probably, after a period of time, in all the patients who were partially treated as they were classified at the end of ethanol injection , the results of scintigraphy approved the disappearance of the autonomy.

By observing the thyroid gland function, an increase in TSH was noticed as a sign of autonomy disappearance, and as the proof of a successful treatment.

The values of Tg immediately after the end of curing showed an increase in value which we considered was due to degeneration in nodule tissue.

In the later course, with the development of fibrosis and regression of the size, Tg values lowered, too. Volumen 68, Broj 9 Carrying out PAE is primarily based on the skill and experience of the doctor who applies the procedure which, to some extent, causes the appearance and content of side effects.

Some of them, such as pain, overflowing of the thyroid hormones into circulation, and the development of thyroid antigen are justifiably present and are the consequence of a direct contact of ethanol with the nodule tissue.

In our series of patients, the side effects of the procedure were milder and did not disturb further carrying out or possible ceasing of therapy.

The degree of discomforts that appeared and the definition of the efficiency of treatment were estimated on the basis of the questionnaire which was filled in by the patients at the end of therapy, and their intensity was ranged by the index from 1 to 5.

In In nearly one half of the treated Luckily, these manifestations which can, to some extent, complicate the procedure, had a very weak intensity.

It seems that the intensity of pain and its eventual further spreading mostly depend on the location of the nodule, its ultrasound structure and its vicinity to the thyroid capsule.

Pain was less severe in cystically degenerated nodules compared to the ones with parenchymal structure, but it became more intense as the number of injections grew and with the appearance of sclerosis within the nodule.

Then, it was practically impossible to prevent overflowing of even small quantities of ethanol extranodally.

Thyroid capsule seems to be the best innerved part of the thyroid since curing nodules in its vicinity was most painful, and pain always spreaded away, most often as far as the temporomandibular joint and ear.

In nodules localized quite near the lower pole of the thyroid lobe propagation of pain went along the middle chest or into shoulder.

The mentioned discomforts were temporary and mainly lasted short. Thus, in A slight number of patients reported having difficulty with moving their neck, an occiput headache and a temporary sense of slackening of vigour, as described by other authors.

Conclusion It can be concluded that repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules lead to autonomy disappearance.

Nodule size does not affect either the result of curing or the quantity of the injected ethanol.

Side effects of the procedure are rare and directly depend on the experience of the doctor carrying out the procedure.

Hamburger JI. Solitary autonomously functioning thyroid lesions. Diagnosis, clinical features and pathogenetic considerations. Ultrasound guided percutaneous ethanol treatment of hepatic neoplasms: a therapeutic alternative in the nineties.

Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results.

Work in progress. Treatment of hyperfunctioning thyroid nodules with percutaneous ethanol injection: Eight years' experience.

Percutaneous ethanol injection of hyperfunctioning thyroid nodules: long-term follow-up in patients. Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules.

Evolution of toxicity in solitary nontoxic autonomously functioning thyroid nodules. The autonomous nodule. Clinical aspects. Italian Concurrent hyperthyroidism and thyroid carcinoma.

Autonomously functioning hot nodule of the thyroid gland. A clinical and histopathologic study of 17 cases. Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: histological, enzymatic and sub-microscopical alterations.

Nonsurgical treatment of primary hyperparathyroidism with sonographically guided percutaneous injection of ethanol: results in a selected series of patients.

Modified percutaneous ethanol injection of parathyroid adenoma in primary hyperparathyroidism. Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection.

Treatment of autonomous thyroid nodules with percutaneous ethanol injection: 4-year experience. Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection.

Treatment of the autonomous thyroid nodule: a review. Percutaneous intranodular ethanol injection: a new treatment for autonomous thyroid adenoma.

Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation.

Percutaneous ethanol injection therapy for autonomously functioning thyroid nodule. Received on February 23, Accepted on March 1, Meniscal injuries are common in professional or recreational sports as well as in daily activities.

If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures.

The study analyzed the results of arthroscopic partial medial meniscectomy in patients in a month period, from , to In our series of arthroscopically treated medial meniscus tears we noted 78 Six months after the procedure Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option.

It has small rate of complications, low morbidity and fast rehabilitation. U radu su prikazani rezultati artroskopske parcijalne medijalne meniscektomije izvedene kod bolesnika u periodu od 24 meseca, od Key words: menisci, tibial; wounds and injuries; arthroscopy; postoperative complications; treatment outcome.

Introduction The mean annual incidence of meniscal tears is 60 to 70 per 1. Meniscal tears are more common in males. The male : female ratio ranges from 2.

Meniscal injuries are a common problem in sports and they are the most frequent injury to the knee joint. In the past 25 years, with increasing popularity of professional and recreational sports the number of people participating in sports has greatly increased, resulting in a higher number of knee injuries 2.

Arthroscopic treatment of meniscal injuries has become one of the most often performed orthopedic operative procedure. In order to properly diagnose and treat meniscal injuries, understanding of meniscal anatomy and function is necessary.

Medial meniscus is C-shaped, with the posterior horn larger than the anterior horn in the anteroposterior dimension. Johnson et al.

They noted that the anterior horn of the medial meniscus has the largest insertion site surface area The capsular attachment of the medial meniscus on the tibial side is referred to as the coronary ligament.

A thickening of the capsular attachment in the midportion spans from the tibia to the femur and is referred to as the deep medial collateral ligament.

The meniscus has a fibrocartilaginous structure. The orientation of collagen fibers is mainly circumferential, with some radial fibers at the surface and within the midsubstance.

This orientation allows compressive loads to be dispersed by the circumferential fibers, while the radial fibers act as tie fibers to resist longitudinal tearing.

Elastin accounts for approximately 0. The cells of the meniscus are fibrochondrocytes because of their appearance and the fact that they synthesize a fibrocartilaginous matrix.

The menisci are important in many aspects of knee function, including load sharing, shock absorption, reduction in joint contact stresses, passive stabilization, increasing congruity and contact area, limitation of extremes of flexion and extension and proprioception 5.

Many of these functions are achieved through the ability of the menisci to transmit and distribute load over the tibial plateau.

The onset of symptoms and mechanism of injury were often of utmost importance for the diagnosis. Meniscal lesions often occured during a rotational injury or hyperflexion event, and they in most cases presented with acute pain and swelling.

Complaints of locking or catching were also present, and loss of motion with a mechanical block to extension 8. These tears were often associated with some degree of osteoarthritis.

Though not always absolutely exact clinical evaluation is a very useful tool in the diagnosis of meniscal pathology. Weinstabl et al. Plain radiographs should be obtained before any further diagnostic studies are undertaken, although these radiographic views cannot confirm the diagnosis of meniscal lesion, they are important in defining bony pathology and in evaluating the knee for joint space narrowing.

Magnetic resonance imaging is the imaging method of choice for diagnosing meniscal tears With increasing age, degenerative complex tears are more frequently seen.

Crawford et al. The aim of the study was to demonstrate that arthroscopic partial medial meniscetomy in well selected cases is a method of choice for treatment of medial meniscus injuries that are not amenable to repair, because it has small rate of complications, low morbidity and fast rehabilitation.

Methods This study analyzed the results of arthroscopic partial medial meniscectomy in patients 68 patients in the Orthopedics and Traumatology Clinic, Clinical Center in Podgorica, Montenegro, and patients in the Orthopedics and Traumatology Clinic Military Medical Academy in Belgrade, Serbia in a month period, from to A decision about the treatment of medial meniscal lesion was made according to patient factors and type of meniscal injury.

In our institutions we perform various techniques of meniscal reparation but in this study we only presented series of medial meniscus injuries with partial arthroscopic meniscectomy.

We mainly relied on joint line palpation, the flexion McMurray test, the Apley grind test. In 58 Perioperative antibiotics administered were in most cases cefazolin, ceftriaxone or in the case of a documented penicillin or cephalosporin allergy gentamycin, amikacin or clindamycin.

Some patients received intraarticular injection of hyaluronic acid intraoperatively. Partial resection of the medial meniscus is advocated when other treatment modalities are not attainable.

We followed Metcalfs et al. We used both manual and motorized resection instruments, in uncertain situations, more rather than less intact meniscal rim was left to avoid segmental resection, which essentially results in a total meniscectomy.

Afterwards the patients progressed to full weight bearing according to pain tolerance and swelling. Physical therapy exercises to achieve complete range of motion and optimal muscle strength were recommended to athletes and patients with long lasting complaints in most cases those were patients older than 40 years.

We suggested to all patients to suspend sports participation for approximately three weeks. In comparison of pre- and postoperative results, we used a IKDC subjective knee evaluation form.

Results All presented cases underwent partial arthroscopic medial meniscectomy Figures 1 and 2. In the series of arthroscopicaly treated medial meniscus tears we noted 78 There were men Mean patient age was Medial meniscus lesion was arthroscopicaly treated in left knees and in 94 right knees.

A total of 51 In 39 Totally of patients underwent knee MRI previous to arthroscopy and in 6 cases medial meniscal tear was not seen on MRI.

In our series of arthroscopic partial medial meniscectomy the accuracy of preoperative MRI was Mean preoperative IKDC score was In our series we had 6 2.

Discussion In the past two decades numerous advances in meniscal repair and meniscal transplantation techniques were achieved, mostly with the intention of achieving long-term delay of knee degenerative changes.

In some cases, however, partial meniscectomy is still required, and is the treatment of choice 15, Medial arthroscopic partial meniscectomy in general is considered as a safe and reliable procedure.

Major advantages of partial arthrocopical meniscectomy over meniscal repair include decreased hospitalization, shorter rehabilitation and a reduction in health care system costs.

Burks et al. Strana On the other side a number of studies have questioned whether partial meniscectomy is a procedure without delayed consequences.

Rangger et al. Glatthorn et al. However, in our series 6 months postoperatively in most cases we found quadriceps weakness only in knees with concomitant ACL deficiency.

Fabricant and Jokl 20 have shown in their study that patient age and sex hawe no significant association with any clinical or radiographic outcome variables at 8.

Lubowitz et al. Hempfling 22 found that intra-articular hyaluronic acid after knee arthroscopy leads to a lasting improvement in pain and functional impairment being a suitable way of achieving long-term stabilisation of the treatment outcome.

We applied intra-articular injections of hyaluronic acid following arthroscopic partial medial meniscectomy in 51 cases, and found a significant reduction in pain in the first month after arthroscopy compared to the group of patients who had not underwent postarthroscopical viscossuplementation.

In order to obtain aduequate assessments we used IKDC score. The IKDC is considered a reliable and valid instrument for use in a broad patient population There are also other scoring systems available, such as Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee that have demonstrated acceptable psychometric performances as outcome measures for patients with a meniscal injury of the knee Complication related to arthroscopical partial meniscectomy can be divided into those related to arthroscopy in general and those specific for partial meniscectomy.

Small 23 reported on the complications of 21 arthroscopists over 19month period and found that complication rate for medial meniscectomy was 1.

We had 6 2. Aside from the general complications of knee arthroscopy hemarthrosis and infection partial meniscectomy was in our series complicated by instrument failure in only 2 0.

Conclusion Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure. In most cases, arthroscopic partial medial meniscetomy surgery stands as an ideal procedure for the concept of one day surgery.

Volumen 68, Broj 9 Whenever the diagnosis of meniscal tear is less clear, preoperative knee MRI should be obtained, thanks to its accuracy, opportunity for errors is significantly reduced.

In well selected cases, when repair techniques are not viable option, partial medial meniscetomy is a method of choice for treatment of medial meniscus injuries.

Well performed partial medial meniscectomy results in alleviation of knee pain, improvement in knee function, and good patient satisfaction.

Nielsen AB, Yde J. Epidemiology of acute knee injuries: a prospective hospital investigation. Meniscal injury and repair: clinical status.

Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. The ultrastructure and biochemistry of meniscal cartilage.

Meniscal injury: I. Basic science and evaluation. Role of the menisci in the distribution of stress in the knee. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee.

A study of normal and osteoarthrotic knee joints. Partial meniscectomy and osteoarthritis. Implications for treatment of athletes.

Economic considerations for the diagnosis and therapy of meniscal lesions: can magnetic resonance imaging help reduce the expense?

Magnetic resonance imaging as a tool to predict meniscal reparability. Helms CA. The meniscus: recent advances in MR imaging of the knee. Arthroscopic meniscectomy.

Poehling GG, editors. Operative arthroscopy. Philadelphia, PA: Lippincott-Raven; Reliability, validity, and responsiveness of the IKDC score for meniscus injuries of the knee.

International Knee Documentation Committee. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee.

Fifteen-year follow-up of arthroscopic partial meniscectomy. Osteoarthritis after arthroscopic partial meniscectomy.

Neuromuscular function after arthroscopic partial meniscectomy. Fabricant PD, Jokl P. Surgical outcomes after arthroscopic partial meniscectomy.

Return to activity after knee arthroscopy. Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study.

Small NC. Complications in arthroscopic meniscal surgery. Received on October 18, Accepted on January 25, Introduction More than half of the individuals older than 65 are affected by hypertension.

Isolated systolic hypertension, characterized by an increase in systolic arterial pressure without an increase in diastolic one, is the most frequent type of hypertension in persons over 50 years of age.

It occurs de novo or after a long period of inadequately treated systolicdiastolic arterial hypertension.

The main reason for its occurence is many years mediated increase in stiffness of the large elastic arteries.

This structural change is responsible for the occurrence of high systolic pressure in the following two ways: by blood ejection from the left ventricle into the stiff arterial system of decreased distensibility, and by the increase in the pulse wave velocity with the reflection wave occurring during late systole.

The increased peripheral vascular resistance, sympathetic stimulation and activities of the Renin Angiotensin Aldosteron RAA system play a less significant role in the incidence of arterial hypertension in the elderly than is the case with individuals affected by structural and functional changes of the aorta.

Previously, vascular stiffness and an increase in systolic pulse pressure were considered as a part of the aging process and there was no insistence on treating this type of hypertension.

Nowadays, when it is known that arterial hypertension in the elderly increases the risk of cardiovascular diseases three to four times more than in younger persons, it is insisted that this significant risk factor be corrected.

In addition to necessary life style modifications, the advantage in medical treatment is given to thiazide diuretics and dihydropiridines from the group of calcium channel blockers.

The therapy should be always adjusted to comorbidities. Elderly persons are defined as individuals at the age of 65 and older.

As regards the number of elderly persons, Serbia is ranked as the fourth country in the world, after Greece, Italy and Japan.

According to the data of the Statistical Office of the Republic of Serbia, approximately Similarly, the percentage of very old persons older than 85 is constantly growing and it is assumed that there will be 16 million very old persons in the world by the middle of the 21st century 1.

More than half of the individuals over 65 years of age have hypertension 1. The principal reason for the increased incidence of arterial hypertension in the elderly is the growing number of persons suffering from isolated systolic hypertension ISH , which is also the most frequent type of hypertension found in this age group 3, 4.

Much more significant fact than the increased incidence of the elderly is the fact that the elderly with arterial hypertension, wheter it is isolated systolic or both systolic and diastolic, are at three to four times higher risk to develop cardiovascular diseases than young individuals.

It is an important risk factor for stroke, heart failure, coronary artery disease, terminal renal failure and death 1. Epidemiology of arterial hypertension in the elderly The results of the thirty-year follow-up of patients included in the Framingham Heart Study have shown that systolic blood pressure SBP continually increases from the age of 30 to This results in the increase of pulse pressure PP 5, which is ilustrated in Figures 1 and 2.

Volumen 68, Broj 9 whereas the structure of muscular arteries does not change significantly. Levels of collagen and matrix protein rise. Calcium binds to elastin and the undifferentiated muscle cells of the tunica media that proliferate and migrate into the intima.

Proliferation of connective tissue results in the thickening of the intima and media fibrosis, along with the loss of distensibility and partial loss of its contractility.

This phenomenon is a consequence of menopause, which enhances the age-induced increase of arterial blood pressure. Structural changes of large arteries in elderly persons and the reasons of their occurrence The age-associated increase in stiffness of large arteries is the main characteristic of arterial hypertension in the elderly 2.

Structural changes affect the aorta and elastic arteries, sult of more than two billion expansions of the aorta in the course of ventricular contraction leads to fatigue of the material and consequential structural changes 9, Genetic polymorphism also plays a role in the process of cardiovascular aging A combination of two or three polymorphisms may influence the characteristics of the vascular wall much more consistently than a single polymorphism.

On the other hand, high systolic blood pressure increases wall stress that causes the damage of endothelium, which, in a vicious circle, maintains high levels of arterial blood pressure.

Pathophysiology of arterial hypertension in elderly persons The value of systolic blood pressure SBP is a result of the interaction among the following three factors: characteristics of left ventricular ejection, and compliance of large arteries, and propagative and reflective properties of the pulse wave in the arterial tree.

The direct mechanism involves the creation of high systolic pressure by the ejection of blood from the left ventricle into the stiff arterial system of decreased distensibility.

The indirect mechanism implies the influence that the arterial stiffness has on the velocity of pulse wave and on the pressure wave reflection time.

With the increase of arterial stiffness and the velocity of the pulse wave, the reflection wave returns into the central artery earlier, usually during late systole and less often during early diastole.

This causes increase in the aortic and left ventricular pressure during systole and a reduction aortic pressure during diastole This is shown in Figure 4.

Strana ceptors On the other hand, beta-adrenergic receptor sensitivity is diminished, which reflects in a decreased chronotropic response to beta antagonists and indicates a lesser significance of sympathetic stimulation in the development of arterial hypertension and less efficiency in treatment with beta blockers in elderly individuals.

Another mechanism contributing to the development of arterial hypertension in the elderly is endothelial dysfunction It is manifested in decreased nitric oxidemediated dilatation.

Taking the increase in aortic pulse wave velocity as the measure of stiffness of large arteries, Wallace et al. Additionally, the number of nephrons decreases with age and a total of , nephrons at birth reduces by half at the age of 70 The nephrosclerosis developed as a result of aging and arterial hypertension leads to the decreased secretion of renin from the kidneys.

Thus, in elderly with arterial hypertension we usually find decreased levels of renin in circulation and lower plasma renin activity.

Low levels of renin can also occur as a result of the salt retention tendency with consequential volume load, which leads to increase of arterial pressure and suppression of renin release from the juxtaglomerular cells.

This characteristic of the arterial hypertension in elderly persons explains better responsiveness of arterial hypertension to the application of diuretics and calcium channel blockers, and its lower responsiveness to the treatment with ACE inhibitors, AT1-receptor blockers and beta blockers.

Elderly hypertensive persons, as well as the normotensive ones, show salt sensitivity, which is indirectly proven by significant decrease of blood pressure values with the loss of salt or reduction of salt intake 13, Elderly persons who suffered from arterial hypertension at younger age and sustained it at old age show a more significant increase in peripheral vascular resistance than those whose aging was the reason for the occurrence of arterial hypertension.

Hemodynamically, ISH is characterised by a decrease in cardiac output, stroke volume and intravascular volume Baroreceptor sensitivity to changes in blood pressure levels is decreased, which results in significant variations of the arterial blood pressure values.

Specific characteristics of arterial hypertension in the elderly Diagnosing arterial hypertension in the elderly, especially very old ones, may be accompanied with problems.

This phenomenon is called pseudohypertension. Pseudohypertension is suspected in persons with minimal vascular damage of the retina in spite of the high measured values of arterial blood pressure, and in those who show postural symptoms after discontinuation of therapy.

In one of our researches we found that variations of systolic pressure values in hypertensive subjects older than 60 years correlated with their age and they were the most frequent in patients older than 80 years of age.

We also determined that reduction of systolic blood pressure during night inversely correlated with age However, significant individual variations of systolic arterial pressure in elderly persons during the night indicate the risk of brain stroke.

The risk of cardiovascular events is also increased during the early morning increase in the values of arterial pressure In one of our investigations we found that the prevalence of the white coat hypertension was higher in the elderly with isolated systolic hypertension than in patients with combined systolic and diastolic hypertension which were the same age Moreover, another phenomenon characteristic of the elderly population is ortostatic hypotension, which is defined as a fall in SAP by at least 20 mmHg and a fall in diastolic pressure by 10 mmHg within three minutes after getting up.

The main reasons for its occurrence are the decrease in baroreceptor sensitivity and the deficit of heart-rate response to the change in body position.

Ortostatic hypotension poses the risk of traumatism, and, on the other hand, it is a risk factor for cardiovascular diseases.

Likewise, ortostatic hypotension increases the risk of brain stroke and dementia Reduction of arterial blood pressure may also occur after eating, which is referred to as postprandial hypotension The basic reason for its occurrence is an inadequate response to vasodilatory effects of gastrointestinal peptides and insulin.

Not a small number of the elderly have a weakness, even syncope after breakfast which, besides all the possible metabolic reasons, can be also explained with the postprandial hypotension that is easily detected by the hour blood pressure monitoring.

However, if the evidence of postprandial hypotension is missing then the hour blood pressure monitoring should be repeated at least twice if there are no conditions for hospitalization.

The implications of high pulse pressure This caracteristics of arterial hypertension in the elderly complicate the treatment of these patients.

Yet, they cannot be a barrier to the medical treatment, which is extremely important due to the subclinical and clinical consequences of arterial hypertension in elderly persons.

The left ventricle Volumen 68, Broj 9 becomes stiff, in addition to the stiffness of the large arteries Moreover, left ventricle hypertrophy is often found in the elderly suffering from ISH.

In our examination of the influence of the aortic distensibility on systolic and pulse pressure in patients with isolated systolic hypertension, we found that the patients with this form of arterial hypertension in addition to impaired left ventricular relaxation also have concentric remodeling pattern of left ventricle as dominant pattern Stiffness of the left ventricle combined with decreased distensibility of the arterial system increases the risk of cardiovascular diseases in several ways.

Among other problems, the wall stress increases, which in turn enlarges the energy necessary for cardiac cicle. The increase in left ventricular stress during late systole leads to incomplete diastolic relaxation, and eventually to heart failure with preserved ejection fraction.

Isolated systolic hypertension is often combined with coronary artery disease, thrombotic and hemorrhagic strokes, dementia, peripheral arterial disease and slow progressing heart and renal failure This finding is real evidence for the significance and severity of this type of arterial hypertension.

Like in the case with hypertensive patients in younger age, reduction of body weight, restriction of salt intake according to DASH Dietary Approaches to Stop Hypertension , increased physical activity and moderate alcohol intake one serving per day for women and two servings for men is advised for the elderly regardless of the type of arterial hypertension This can be explained by the abovementioned salt sensitivity which increases through the lifetime.

One of the problems in the modification of a lifestyle is the changes in the bones and joints, which restrict mobility and require a combined medical approach including physiotherapist who will show these patients some exercises that are crucial for maintaining and prevention of the reduction of large arteries distensibility as well as for the sustenance of a desired weight and the decline of body overweight.

Each of these groups reduces the values of arterial blood pressure in a similar way, thus reducing the incidence of cardiovascular events.

Different clinical trials have shown that medicament treatment of these patients reduced the risk of cerebrovascular insult, coronary artery disease, acute myocardial infarction, mortality of coronary artery disease and total mortality Tables 1 and 2.

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