Acta Medica Croatica最新文献

Responsible health behavior plays an important role in every individual. Oral health quality results from the level ofinformation available, attitudes, habits and nutrition. Family is the most important environment where children can acquireknowledge, attitudes and habits related to oral health. The aim of the study was to compare the habits of parents andchildren related to their oral health, and to conclude how parental behavior influences oral health of their children. Thestudy included 101 parent-child pairs (age 11-15 years), their knowledge and behavior according to their oral hygiene,fluoro-prophylaxis and nutrition assessed by anonymous questionnaire. Oral health of parents was estimated according totheir tooth loss and compensation, while oral health of children was assessed by dental examination. A total of 101 child-parentpairs were included. Most children were excellent pupils (43.56%). In the group of parents, most participants weremothers (73.27%). Most parents had high school education (65.35%) and were employed (61.62%), and most perceivedthemselves to be living with average financial situation (86%). A comparable proportion of parents (95%) and children(87%) believed that it was necessary to wash teeth at least twice a day (p=0.125) and most of them thought it necessary tobrush teeth for 1-3 minutes (57% of children and 57.43% of parents; p=0.599). The majority of children (56%) and parents(72%) considered it necessary to use dental floss with a toothbrush and toothpaste (p=0.065), while 63% of children and71.72% of parents believed that toothpaste contained fluoride (p=0.156). Most of the parents (72.3%) and children (65.35%)brushed teeth in the morning and at bedtime (p=0.167) for 1-3 minutes (p=0.098). About 30% of parents and children usedthe handler for brushing teeth (p=1). Most children (86.32%) and parents (92.1%) had 3-5 meals a day (p=0.181), and 80%of them had their teeth examined by a dentist the year before (p=0.658). The children believing that teeth should be brushedonly in the morning have a 3.38-fold greater chance to develop tooth disorders (DMFT >0; p=0.004). Those that do notknow that caries and periodontal diseases can be prevented have a 26.3-fold greater chance to develop caries comparedto those who are aware of it. Children of parents who only brush their teeth in the morning have a 25 times higher chanceof developing CEP >0 as compared with those that brush their teeth after each meal (p=0.016). Children of parents whogive them money to buy snacks are 2.9 times more likely to develop CEP >0 (p=0.01) compared to children without moneyfor snack. Children of parents who feel that their health is not good have 3.9 times higher chance of developing CEP >0as compared to those whose parents think they have a neat bite (p=0.017). Oral hygiene in Croatia is still not at a level ofthe standards in Western countries. Ignorance about oral hygiene and irresponsible health behavior are the

The share of elderly persons in the population is growing rapidly and continuously. Requirements for their surgical treatmentare increasing and so is the number of published papers on the safety and success of some surgical procedures performedin these patients. The present study included 183 patients aged ≥65 out of 897 patients surgically treated for thyroid glanddiseases. They were divided into two groups (group 1 aged 65-69 and group 2 aged ≥70) in order to determine between-groupdifferences in the indications, surgical strategy, final histopathologic analysis, preoperative physical status, numberof comorbid diseases and postoperative complications. Analysis of the results justified our decision to divide our patientsinto two groups of younger and older ones. In group 1, the indications for surgery were mostly benign changes (93.2%),whereas malignant, verified and suspected disease was considerably more frequent in group 2 (21.8%), with a significantlyhigher percentage of compressive syndrome. Significant between-group differences were recorded in the preoperativephysical status (group 2: ASA III and IV, 73.8% and 5%, respectively), number of thyroidectomies performed (group 1,56.2% vs. group 2, 77.3%) and secondary hemithyroidectomy. A difference was also found in the number of surgical andnon surgical complications. The absence of a higher percentage of permanent complications, hypocalcemia and recurrentlaryngeal nerve paralysis, in total and by groups, confirmed that surgical treatment of thyroid gland diseases can beconsidered safe and successful in older age groups, regardless of the between-group differences observed.

The aim of this study was to examine the possibilities of measuring ADC/DWI values with the ROI method for precisedifferentiation of focal liver lesions from normal liver parenchyma. The study included 100 liver lesions sized ≥1 cm, previouslydetected in patients by ultrasound and computed tomography. It is done by measuring the diffusion coefficient ADC folder(MRI 3T), setting the ROI on the periphery of hepatic lesions, on the liver parenchyma around the focal hepatic lesions andon liver parenchyma that is distant to hepatic lesions. In our study, difference between the average ADC value of focalliver lesions (1.24 x10(-3) mm(2)/s) and normal liver parenchyma around focal liver lesions (1.001x10(-3) mm(2)/s) was statisticallyconfirmed. There was statistically proven difference in the average ADC values between normal liver parenchyma aroundfocal lesions and liver parenchyma located distant from focal lesions of (1.003x10-3 mm2/s). Wilcoxon rank test yieldeddifferences in the average (median) ADC values between total lesions in patients and liver parenchyma directly aroundfocal lesions (p<0.0005). Wilcoxon rank test showed no differences in the average (median) ADC between liver parenchymadirectly around focal lesions and distant of focal hepatic lesions (p<0.0005). The results obtained for each focal liver lesionwere compared with histopathology findings obtained by puncture or surgery, and for cystic lesions radiological follow upwas sufficient. For all liver lesions, the resulting overall DWI/ADC sensitivity was 92% and specificity 77%. Kendall’s tau-bcoefficient of concordance showed a statistically significant correlation between our DWI diagnosis and histopathologyverification for all liver lesions (p<0.0005). He mangiomas and cysts showed greatest difference in ADC values as comparedwith healthy liver. ADC values of hepatocellular carcinoma (HCC) and the surrounding normal liver parenchyma were notstatistically different, which can be explained by similarities in their cell structure. Related articles conclude that DWI hasinadequate sensitivity in detecting HCC, explaining this minimal difference in cellularity of well differentiated HCC and liverparenchyma. DWI/ADC has the potential to differentiate and reliably define the limits of focal lesions of the normal liverparenchyma. ADC delimitation of focal lesions of the liver parenchyma is most reliable for hemangiomas and cysts, whileADC delimitation of HCC can pose diagnostic difficulties.

The result of the increase in drug abuse is a growing number of patients receiving methadone or buprenorphinesubstitution therapy. Physicians are increasingly confronted with patients on substitution therapy at the time when theyare developing acute pain conditions or when they need surgery. Although pain has sensory qualities, it is a very personaland complex experience. The intensity and duration of pain are influenced by numerous factors. Poorly controlled painleads to unnecessary suffering of the patients with the possibility of permanent changes in behavior and reduced qualityof life. Efficacious pain treatment is considered a basic right of every patient. Because of the complex mechanisms of theemergence and transmission of pain and the emotional components that are involved in the experience of pain, appropriatepain relief in patients on substitution therapy is a major challenge for both the physicians and the patients. The article givesan overview of issues related to the treatment of acute pain and perioperative treatment in patients on substitution therapywith methadone and buprenorphine. The article highlights the wrong common misconception about pain treatment in thesepatients, which also are the most common cause of their inadequate treatment.

With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distalphalanx of the fingers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptomsare swelling and redness of the fingertip with nail deformity, while typical night pain may not be present. Unusual clinicaland x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-oldpatient reported pain in the fingertip of his right ring finger persisting for five years. Swelling and redness of the fingertipcombined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonanceimaging showed suspicion of osteoid osteoma, which was confirmed by computed tomography (CT). We performedsurgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateralside of the distal phalanx of the ring finger and the basal part of distal phalanx was cut with a small chisel to enable accessto cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sentfor histopathologic analysis. After surgery, the ring finger was immobilized in a plaster splint for a three-week period. Afterremoval of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtainthe full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoidosteoma, all symptoms disappeared completely. Histopathologic findings confirmed the diagnosis of osteoid osteoma.After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months aftersurgery, clinical findings were normal and the patient had no pain or discomforts. Full recovery was shown by the result ofthe DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx ofthe finger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearanceon x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. Forthis reason, it may be difficult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swellingand redness of the finger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layersof 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis.Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destructionof lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures,tendons and joints, the best method for treatment osteoid o

Unlabelled: The aim of this study was to investigate the incidence and characteristics of malignant neoplasms of the skin of the head and neck region in the Osijek-Baranya County during the 2004-2012 period according to gender, age, place of residence, place of work, occupation, type and location of the neoplasm, and phenotypic characteristics of patients.

Subjects: The study included all subjects with the diagnosis confirmed by histopathology finding and residents of the Osijek-Baranya County. The study included a total of 2952 persons, 1487 (50.4%) male and 1465 (49.6%) female, yielding an approximate annual incidence of 104/100,000. Mean age was 72 years. Respondents were mostly from rural areas (n = 1952, 66.2%). There were 2137 (72.4%) of respondents mostly working outdoors, mainly farmers (n = 907, 42.4%) and construction workers (n = 889, 41.6%).

Results: According to the type of neoplasm, the basal cell type was most common with 2160 (73.2%) patients. Ninety-three (3.1 %) patients had malignant melanoma. According to localization, face was the most common site of malignant neoplasms with 839 (28.7%) and nose with 643 (22.0%) patients. Squamous cell carcinoma was significantly more common in men (n = 341, 56.6%) as compared with women (n = 262, (43.4%; p = 0.005). Subjects with malignant melanoma were significantly younger, with median age of 67 years. There were no significant differences according to the type of malignant neoplasms and place of residence, place of business, and occupation with regard to working outdoors or indoors. According to localization, significantly more squamous cell malignancies were found on the ears and lips (p = 0.039 and p < 0.001, respectively), malignant melanomas on the neck, head and eyes (p = 0.004, p < 0.001 and p = 0.026, respectively), and basal cell neoplasms on the nose (p = 0.002). There were no significant differences in the type and frequency of malignant neoplasms according to hair and eye color.

Conclusion: It is obvious that the disease occurs after a decades-long incubation period and the cumulative effect of exposure to risk factors, with direct sun exposure, seems to have a significant role. Additional research is needed.