Tiska se u 500 primjeraka -Printed in 500 copies The printing of the Journal is subsidized by the... more Tiska se u 500 primjeraka -Printed in 500 copies The printing of the Journal is subsidized by the Ministry of Scien ce, Education and Sports of the Republic of Croatia Acta Med Croatica, 66 (2012) 95-103 Uvodnik 95 Brojnim istraživanjima dokumentiran je višegodišnji trend porasta prevalencije alergijskih bolesti u industrijaliziranim zemljama, pri čemu su alergeni unutarnjeg okoliša, a posebno grinje kućne prašine, vodeći rizični čimbenik (1). Novijim epidemiološkim istraživanjima potvrđena je i u našem području visoka prevalencija simptoma alergijskih bolesti (2), a među alergenima odgovornima za senzibilizaciju, grinje su pokazivale najveću učestalost (3). Od oko 50000 poznatih vrsta grinja samo je manji broj stalnih ili povremenih stanovnika kućne prašine. Naziv "grinje kućne prašine" tradicionalno se koristi za samo nekoliko vrsta porodice Pyroglyphidae, koje se u kućnoj prašini mogu naći redovito (4). Za razliku od većine vrsta koje pripadaju ovoj porodici, a žive na pticama i u njihovim gnijezdima na ograničenim zemljopisnim područjima, vrste vezane uz kućnu prašinu rasprostranjene su širom svijeta. Tu spadaju tri roda potporodice Pyroglyphinae (Euroglyphus, Hughesiella, Gymnoglyphus) i četiri roda potporodice Dermatophagoidinae (Dermatophagoides, Hirstia, Malayoglyphus, Sturnophagoides) (tablica 1). Drugu skupinu čine grinje vezane ponajprije uz različita skladišta, farme, tla i druga slična staništa, tradicionalno nazvane "skladišne grinje" (4). Međutim, one se povremeno mogu naći i u kućnoj prašini ruralnih, ali i urbanih područja te se u novije vrijeme prepoznaje njihova važnost kao uzročnih čimbenika alergijskih bolesti (5). Sve skladišne grinje spadaju u četiri porodice. Porodica Acaridae zastupljena je s dva roda potporodice Acarinae (Acarus,
O izboru između otvorene i laparoskopske apendektomije postoje kontroverzni stavovi. Dobro su poz... more O izboru između otvorene i laparoskopske apendektomije postoje kontroverzni stavovi. Dobro su poznate prednosti i nedostatci laparoskopije. Tijekom 3 godine proveli smo prospektivnu studiju (1. sijecnja 2008.- 31. prosinca 2010.) 123 bolesnika operiranih zbog akutne upale crvuljka. Bolesnici su slucajno odabrani, a podijeljeni su u dvije skupine: (LA) - laparoskopska apendektomija sa 42 i (OA) – otvorena apendektomija sa 81 zapisom. Proucavali smo: dob, spol ; vrijednosti broja leukocita prije operacije, CRP, nalaz ultrazvuka (UZ), prepisanu analgeziju i poslijeoperacijski PHD nalaz, te usporedili duljinu trajanja kirurskog zahvata, duljinu hospitalizacije i komplikacije. Provedena je telefonska anketa s pitanjima o osobnom zadovoljstvu nakon operacije. U 90% bolesnika PHD nalaz bio je pozitivan na upalu. CRP je u 42 bolesnika preoperacijski (34%) bio sa srednjom vrijednosti 59 ; u 31 (74%) bolesnika s povisenim preoperacijskim vrijednostima CRP PHD nalaz bio je pozitivan. UZV je uc...
Aim: The aim of this article was to present a case of epidermoid cyst, which is a rare tumor in t... more Aim: The aim of this article was to present a case of epidermoid cyst, which is a rare tumor in this area and has some specific imaging features. To our knowledge, intracranial epidermoid cysts and its imaging features were often described, but only a few cases have been previously reported with imaging fetaures of presacral epidemoid cysts. Case report: A 32-year-old woman presented with symptoms of difficult labor, and during the childbirth, a large tumor pressing from behind in to the birth canal was noticed. After recovery, multislice computerized tomography (MSCT) with intravenous contrast administration was performed. A cystic lesion in the presacral space on the left side with thin ring enhancement and no internal enhancement was demonstrated. Further magnetic resonance imaging (MRI) showed morphologic features of epidermoid cyst with high protein content (heterogenous signal on T1W and T2W). Surgery was performed and pathohistological analysis confirmed the diagnosis of epid...
This paper presents a case of skull trepanation from the town of Ludbreg in north-western Croatia... more This paper presents a case of skull trepanation from the town of Ludbreg in north-western Croatia. This is the second case of trepanation reported in human skeletal remains from archaeological sites in Croatia. The procedure was performed on an adult male buried in a tomb under tegulae at the "Somođi Garden" site. The archaeological context and radiocarbon analysis date the bone sample to the 5 th century AD, i.e. to the Migration Period. The trepanned aperture is located on the left side of the frontal bone and the left parietal bone. The lesion is oval in shape with all three layers of the calvarium breached, leaving dura mater exposed. This neurosurgical intervention was most probably performed by scraping for therapeutic reasons (head injury). The morphology of the lesion strongly indicates that the individual survived the operation and lived for a longer period of time, several years at least. skull trepanation; anthropological analysis; scraping technique; 5 th century,
Rad predstavlja preliminarne rezultate bioarheološke analize provedene na koštanim ostacima 46 os... more Rad predstavlja preliminarne rezultate bioarheološke analize provedene na koštanim ostacima 46 osoba pronađenih u kasnoavarskoj nekropoli u Šarengradu u istočnoj Hrvatskoj. Dobiveni rezultati ukazuju da populaciju iz Šarengrada karakterizira visoka smrtnost djece prouzročena lošim zdravljem u ranome djetinjstvu što se očituje u visokim učestalostima pokazatelja subadultnoga stresa (cribra orbitalia i linearna hipoplazija zubne cakline) i periostitisa kao i slučajevima skorbuta. Paleodontološka analiza snažno ukazuje kako je veliki udio prehrane bio baziran na ugljikohidratima, tj. na poljodjelstvu kao glavnoj privrednoj grani. Odsustvo perimortalnih ozljeda snažno ukazuje na činjenicu da su članovi ove zajednice bili izloženi niskim stopama namjernoga nasilja te da su primarni uzroci uočenih ozljeda nesretni slučajevi. Tri slučaja maksilarnoga sinusitisa mogu se povezati s postupkom grijanja/kuhanja (peći i otvorena vatrišta) gdje je produljeno izlaganje dimu moglo dovesti do različ...
This study aims to explore the relation between charisma and healing and how the concept of chari... more This study aims to explore the relation between charisma and healing and how the concept of charisma evolved within medical profession over time. The development of medical profession from shamans to modern medical doctors, the gradual transition from ritual to physical healing, the relation between the physician and common people, and the transition from personal to professional charisma are presented in a medico-historical context. The article concludes that there is an indisputable link between the phenomenon of charisma and healing. Healers have often been considered among the most significant charismatic figures in their societies. With time physicians have lost their personal charisma and replaced it by a stable professional charisma. Today, the growing involvement of patients in healing and demystification of the medical profession is diminishing the charisma of the physicians, although medical profession still retains qualities found in classic charismatics and with it also ...
To the Editor: Retief and Cilliers 1 suggest an interesting new theory about Akhenaten's physical... more To the Editor: Retief and Cilliers 1 suggest an interesting new theory about Akhenaten's physical appearance, but omitted to refer to previously suggested differential diagnoses: for example, schistosomiasis, 2 myotonic dystrophy, 3 elephantiasis 4 and Antley-Bixler syndrome have also been suggested. More recently, we proposed homocystinuria as a possible cause. 6 Since Kallman's syndrome is a hereditary disease, it is important to see how this diagnosis fits into Akhenaten's family tree. The fact that Akhenaten's wife, Nefertiti, and their children were similarly depicted implies that they suffered from the same disease. Akhenaten's parents, Amenhotep III and Tiye, were most probably healthy. The genetics of Kallman syndrome are still not fully understood. 7 However, two of the best-described forms of Kallman syndrome are inherited autosomal dominant and X-linked disorder. An obvious problem with this diagnosis is the healthy father, although it cannot be fully rejected because the phenotype of these patients varies from partial to complete. However, as we explained in our article, an autosomal recessive disease, such as homocystinuria, is the most probable explanation. Although, admittedly, all proposed diagnoses have their advantages and drawbacks, it is important to note that all of them are made under one assumption: that art from the Amarna period was realistic, i.e. that this was not just a form of artistic expression creating a distance from traditional Egyptian art. The authors do not cite an investigation by Hawass et al., in which it was suggested that a mummy found in KV55 was actually Akhenaten; 8,9 they also suggest that the depictions of Akhenaten exaggerate his actual appearance. However, the definitive confirmation of both the identity of the KV55 mummy and a possible diagnosis can be made only by DNA analysis. Unfortunately, the method for DNA sampling is the subject of heavy criticism, and the results do not appear to be totally trustworthy.
International Journal of History and Philosophy of Medicine, Aug 5, 2012
The aim of the current study was to investigate the impact of World War I on public interest in m... more The aim of the current study was to investigate the impact of World War I on public interest in medical topics, as reflected by the contents of a Croatian magazine. Sixty issues (30 before and 30 after the declaration of war) of the Croatian weekly news magazine "Ilustrovani list" were analyzed, and the number of pages dedicated to medical topics was calculated. The results demonstrate that the number of medical articles increased substantially after the war began. The total number of pages concerning medical issues was seven times greater during wartime than before war broke out (P < 0.001). We conclude that on the basis of publications in a news magazine, public interest in medical-related subjects increased during World War I. The potential impact of this finding on health-related policies and biomedical research of that era requires further exploration.
Aim: Aim of this article is to present acute aortic occlusion as an emergent vascular event, ofte... more Aim: Aim of this article is to present acute aortic occlusion as an emergent vascular event, often called "vascular catastrophe" because of its poor prognosis. It is a diagnostic challenge because it requires early recognition and urgent intervention. We will present two cases of acute aortic occlusion. Case report: In both cases, patients referred to the Emergency Department of the Clinical Hospital Dubrava. Both patients were female, from 55 to 65 years, who presented pain in both legs as deterioration in their condition. One patient had weakness in both legs and neurological symptoms, and the other one had only signs of arterial insufficiency (cold extremities and absence of pulse). In the first case we started with duplex doppler examination, which showed low flow velocities in both superficial femoral arteries with peak systolic velocity lower than 5cm/sec and changed spectra indicating proximal pathology. Multi-slice computerized tomography (MSCT) angiography of abdominal aorta showed thrombosis in infrarenal part of the abdominal aorta which completely filled the lumen. Thrombectomy of the infrarenal aorta was performed. In the second case, we immediately performed MSCT angiography of abdominal aorta by standard protocol in emergency department, which showed complete occlusion of the aorta above the bifurcation and occlusion of both common iliac arteries. Fogarty embolectomy was performed. Discussion and conclusion: Acute aortic occlusion is a rare condition which is easy to overlook, but has a characteristic presentation. A proper indication for imaging methods is of crucial importance for diagnosis of this condition which is treated with surgical methods and has a high mortality.
Laparoscopic surgery for hepatic echinococcosis is a technically difficult and demanding surgical... more Laparoscopic surgery for hepatic echinococcosis is a technically difficult and demanding surgical procedure even for the most experienced abdominal surgeon. Surgery is performed after the conservative treatment with albendazole for 28 days. We report a case of laparoscopic partial pericystectomy with biliostasis and omentoplasty in a patient with two previously open surgeries (laparotomies)--right subcostal laparotomy for acute inflammation of the gallbladder and right pararectal laparotomy for perforated gangrenous appendix. The patient underwent extensive laparoscopic adhesiolysis due to pronounced intra-abdominal adhesions to gain access to a large hydatid cyst with the diameter of 11 cm. Laparoscopic surgery is much less traumatic to the patient with a better cosmetic effect.
There are several options for surgical treatment of large bowel obstruction caused by cancer, dep... more There are several options for surgical treatment of large bowel obstruction caused by cancer, depending on location of obstruction, intraoperative local findings (perforation, peritonitis, bowel dilatation proximal to obstruction) and patients' condition. Resection and anastomosis as one stage surgery would be prefered procedure. Anastomotic leakage, on the other hand, highly elevates risk of mortality and mobidity. The most important question is whether to, in resectable cases, perform primary resection with anastomosis or not. This study was retrospective and included 40 patients that have undergone emergency surgery for large bowel obstruction caused by cancer. According to whether resection and anastomosis was made at initial surgery or not, patients were grouped in group A (N = 18) and group B (N = 21), respectively. We have analysed the type of surgical procedure, days of hospitalization, mortality, anastomotic leakeage, wound infection and other postoperative complication...
This paper presents a case of skull trepanation from the town of Ludbreg in north-western Croatia... more This paper presents a case of skull trepanation from the town of Ludbreg in north-western Croatia. This is the second case of trepanation reported in human skeletal remains from archaeological sites in Croatia. The procedure was performed on an adult male buried in a tomb under tegulae at the "Somođi Garden" site. The archaeological context and radiocarbon analysis date the bone sample to the 5th century AD, i.e. to the Migration Period. The trepanned aperture is located on the left side of the frontal bone and the left parietal bone. The lesion is oval in shape with all three layers of the calvarium breached, leaving dura mater exposed. This neurosurgical intervention was most probably performed by scraping for therapeutic reasons (head injury). The morphology of the lesion strongly indicates that the individual survived the operation and lived for a longer period of time, several years at least.
The challenging mission of paleopathologists is to be capable to diagnose a disease just on the b... more The challenging mission of paleopathologists is to be capable to diagnose a disease just on the basis of limited information gained by means of one or more paleodiagnostic techniques. In this study a radiologic, anthropologic and paleopathologic analysis of an ancient Egyptian mummy through X-rays, CT and MR was conducted. An Ancient Egyptian mummy ("Mistress of the house", Archeological Museum, Zagreb, Croatia) underwent digital radiography, computed tomography and magnetic resonance imaging employing 3-dimensional ultra-short-echo time (UTE) sequence, that allows to image ancient dry tissue. Morphological observations on the skull and pelvis, the stages of epiphyseal union and dental wear indicated that the remains are those of a young adult male. Multiple osseous lytic lesions were observed throughout the spine as well as on the frontal, parietal, and occipital bone, orbital wall and the sella turcica of the sphenoid. Considering the sex and age of the individual and th...
The paper provides the results of the microbiological analysis of samples taken from the mummifie... more The paper provides the results of the microbiological analysis of samples taken from the mummified remains of St. Marcian. Microorganisms found belong to bacteria and fungi of the genera Aspergillus, Bacillus, Penicillium, Sarcina, and Shewanella which are all apart of the common air, soil, and human microbial flora and therefore present no health hazard.
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2010
In the cases of incarcerated Richter hernia the diagnosis is difficult especially for obese patie... more In the cases of incarcerated Richter hernia the diagnosis is difficult especially for obese patients. Laparoscopic diagnostics and desincarceration, can be combined with mini laparotomy in lieu of bowel resection and open hernioplasty, or conversion to classic laparotomy and open hernioplasty. Here is presented a case of incarcerated Richter inguinal hernia managed through the combination of laparoscopy, mini laparotomy for segmental bowel resection and open hernioplasty.
In this paper we report the results of the microbiological analysis of the samples taken from the... more In this paper we report the results of the microbiological analysis of the samples taken from the mummy from the collection of the Archaeological museum in Zagreb, Croatia. Samples were taken from specific places such as oral, orbital, abdominal cavity and bandages surrounding the mummy, and analyzed in Department of Microbiology and Hospital Infections in University Hospital "Dubrava" in Zagreb and in National Reference Laboratory for systemic mycoses of Croatian National Institute of Public Health in Zagreb. The analysis indicated that all of the found organisms were non-primary pathogenic and are not harmful for healthy humans. Isolated microorganisms mainly belonged to the group of saprophytic fungi as listed: Monilia spp., Penicillium spp., Alternaria spp., Aspergillus fumigatus, Aspergillus nidulans, Rhizopus spp. and Chrysosporium spp. and to the genus of saprophytic bacteria, Bacillus spp.
The aim of the study was to analyze possible human skeletal remains within the wrappings of a mum... more The aim of the study was to analyze possible human skeletal remains within the wrappings of a mummy from the Archaeological Museum, Zagreb, Croatia through the use of the multidetector CT (MDCT) technology. Plain X-ray films and MDCT images of the mummy were taken in both frontal and lateral views. In a single volumetric acquisition of the whole body by MDCT 0.75 mm axial slices were obtained and combined with sagittal and coronal reformatting and three-dimensional (3D) reconstruction. Sex and age was assessed visually using standard anthropological methods. The results suggest that the mummy was of an adult female, most likely over 40 years of age at death. Pathologies observed included degenerative changes on the vertebral column and healed fractures of the lower right arm. Damage of the ethmoid bone at the roof of the nasal cavity was most likely caused by mortuary brain removal practice. Remnants of a resin and an unusual object were found inside the cranial cavity. An elongated...
Operative treatment of hepatic hydatid cyst is technically demanding procedure. The method of cho... more Operative treatment of hepatic hydatid cyst is technically demanding procedure. The method of choice is conservative treatment with Albendazolum followed by surgery. Open laparotomy or laparoscopic operation can be performed. We prefere laparoscopic exploration followed by laparoscopic total pericystectomy or laparoscopic partial pericystectomy. If laparoscopic operation is not possible due to technical reasons and patient safety, conversion to an open operation should be done, followed by total or partial pericystectomy. The case and our detailed technique of laparoscopic partial pericystectomy with biliostasis and omentoplasty is described. Laparoscopic operation is equally safe for the patient, yet with minor trauma and better aesthetic effect.
Although prevalence of peptic ulcer is decreasing, the number of peptic ulcer perforations appear... more Although prevalence of peptic ulcer is decreasing, the number of peptic ulcer perforations appears to be unchanged. This complication of peptic ulcer is traditionally surgically treated. In recent years, a number of papers have been published where the authors managed perforated duodenal peptic ulcer in selected patients using laparoscopic approach. Laparoscopic treatment of perforated duodenal ulcer has been described as safe and advantageous compared to open technique but advantages are still not clear due to small number of cases in published studies. Based on these recommendations we decided to establish our own protocol for laparoscopic treatment of perforated peptic duodenal ulcer. In this prospective study we evaluated the first 10 patients in whom we performed laparoscopic repair of perforated duodenal ulcer. There were no conversions to open procedure and no early postoperative complications. The patients were contacted by phone a year after the operation, and all were sati...
Pharaoh Amenophis IV (Amenhotep IV), also known as Akhenaten, is the most mysterious person in Eg... more Pharaoh Amenophis IV (Amenhotep IV), also known as Akhenaten, is the most mysterious person in Egyptian history and he still remains the object of academic argues. This revolutionary king introduced a new concept in Egyptian religion and arts. It is still unexplained if images of him and his family were just an artistic outbreak from old Egyptian canon or an excellent paleopathological study. Several pathologic conditions were proposed to explain his appearance but neither is completely acceptable. We propose a different disease that he could have suffered of homocystinuria--lack of cysthationine-synthase. Our conclusion is that in comparison with up to date most convincing theory, that he was suffering of Marfan syndrome, our theory equally well explains his physical appearance but is better in explaining affecting and unaffecting of his relatives. This is the only theory about Akhenaten's disease that could be checked in the near future.
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Papers by Mislav Čavka