Pityriasis rubra pilaris in association with laryngeal carcinoma.

Pityriasis rubra pilaris (PRP) is a rare group of hyperkeratotic, papulosquamous diseases that can be acquired or inherited. Cases of PRP associated with malignancy have been rarely reported. We report a case of 46-year-old man who presented with rapidly progressing PRP as a possible initial cutaneous symptom of a previously undiagnosed laryngeal carcinoma. Microlaryngoscopy was performed because of the patient's hoarseness, and this revealed leucoplakia on the left vocal cord. Histopathological examination led to the diagnosis of squamous cell carcinoma in situ. After surgical treatment, the clinical signs of PRP began to resolve, and the patient was free of skin lesions at follow-up. This case represents a rare coexistence of PRP with malignancy, and indicates that PRP can occur as paraneoplastic dermatosis associated with laryngeal cancer.

Giant anterior sacral meningocele presenting as bacterial meningitis in a previously healthy adult.

Meningocele may be asymptomatic and incidentally discovered. Presenting as a retrorectal mass, sacral meningocele may produce urinary, rectal, and menstrual pain. Anterior sacral meningocele may be the cause of tethered cord syndrome. This article presents a case of a previously healthy 39-year-old man with large meningeal herniation that occupied the entire pelvis who developed symptoms of bacterial meningitis. A 39-year-old man was admitted with fever, chills, headache and photophobia. Escherichia coli was isolated from cerebrospinal fluid culture. Moderate improvement regarding meningeal symptoms was noted due to intravenous antibiotic therapy, but intense pain in the lower back associated with constipation, fecal and urinary incontinence, and saddle anesthesia developed. Abdominal ultrasound was negative. Plain radiographs and computed tomography demonstrated sacral bone defect and retrorectal expansive mass. MRI confirmed anterior sacral meningocele with cord tethering. After posterior laminectomy and dural opening, communication between meningocele and intrathecal compartment was obliterated. Computed tomography-guided percutaneous drainage through the ischiorectal fossa was performed to treat residual presacral cyst. Delayed diagnosis in our patient was related to misleading signs of bacterial meningitis without symptoms of intrapelvic expansion until the second week of illness. In our patient, surgical treatment was unavoidable due to resistive meningitis, acute back pain, and symptoms of space-occupying pelvic lesion. Neurosurgical approach was successful in treatment of meningitis and neurological disorders. Computed tomography-guided evacuation of the residual retrorectal cyst was less invasive than laparotomy, resulting in normalization of defecation and miction despite incomplete evacuation. Further follow-up studies may provide insight into the most effective treatment of such conditions.

Low sero-prevalence of Lyme borreliosis in the forested mountainous area of Gorski Kotar, Croatia.

AIM: Clinical forms of Lyme disease in Gorski Kotar have occurred only sporadically, in contrast to the northwestern Croatia and the neighboring areas of Slovenia, which are well-known Lyme borreliosis endemic regions. Our aim was to assess the level of sero-prevalence of Borrelia burgdorferi sensu lato in a high-risk population of forestry workers in the mountainous region of Gorski Kotar, Croatia, and compare it with the sero-prevalence in the residents of that area and the neighboring littoral region. METHODS: A sero-epidemiological study was conducted on 520 healthy subjects, divided in 3 groups: the first group included 234 forestry workers, residents of Gorski Kotar, the second 100 residents of various professions in the same region, and the third 186 subjects of various professions from the neighboring littoral region. The sera were collected during the winters of two successive years, 1997 and 1998. Lyme borreliosis serology was performed by indirect immunofluorescence assay. Sera from 10 hunting dogs from Gorski Kotar were also analyzed. RESULTS: The IgG antibodies to B. burgdorferi sensu lato were found in 11 examinees (4.7%) from the group of forestry workers, in 3 (3%) from the second group, and in 5 (2.7%) from the third group. Four out of 10 dogs (40%) had IgG antibodies against B. burgdorferi. CONCLUSION: Our results show that the forest and mountainous area of Gorski Kotar, Croatia, has the characteristics of a low sero-prevalence area, in contrast to the endemic neighboring areas.

Malaria, a travel health problem in the maritime community.

BACKGROUND: Three to five hundred million cases of malaria occur annually, causing over one to two million deaths. Malaria is one of the leading causes of fever, resulting from travel in tropical or subtropical countries. That risk is very high, especially for sailors. By the nature of their job they cannot avoid malarial regions and generally suffer from the lack of medical help aboard, insufficient knowledge of preventive measures, and lack of up-to-date information about chloroquine resistant areas. METHODS: Retrospective analysis embraced all cases of malaria among seafarers employed in the years 1990-1993 by the Croatian sea carrier Losinjska Plovidba, and cases treated at the Clinic for Infectious Diseases, Rijeka, in the same period. RESULTS: In that period, among seafarers treated in our Port Health Office there were registered 23 cases of malaria; 19 cases among sailors and 4 among tourists, all of them aboard merchant ships. Among seafarers treated in the Clinic for Infectious Diseases from 1990-1993 there were 13 malaria patients, 12 of them sailors and 1 tourist. CONCLUSION: The aim of this work is to study the morbidity of malaria on board ships owned by the Croatian shipping company Losinjska Plovidba in the 4-year period 1990-1993 and point to the lack of a health system for their health protection. It can be concluded that the severity of malaria, the number of complications, the period of disablement for work, permanent health damage in a marked number of young persons on duty abroad, all clearly demonstrate the individual and social costs of this disease in Croatia and the maritime community worldwide.

An analysis of total expenditures on hospitalized patients with diarrhoeal syndrome.

Between the months of June, July, August and September 1992, 175 patients with acute diarrhoeal syndrome were treated at the University Department for Infectious diseases in Rijeka. Among them were 28 refugees and 7 members of the Croatian Army forces. Etiologic agents were isolated in 69 patients, among which 61 was Salmonella. The total cost of treatment was 9.737,203 Croatian Dinars or 51,529 German Marks, obtained on monthly reevaluation of expenditures. A total of 33.3% was spent on accommodation and feeding which was 6% decrease at the on of treatment. On further treatment cost was 33.7%, microbiologic examinations 13.1%, while biochemical examinations was 12.1%. Of the total cost, the X-ray, ultrasound and specialist examinations carried the lowest price of the cost of treatment. Reduction of the cost could be achieved by reducing the duration of hospitalization, which averaged about 8 days per each patient. The routine microbiologic and serologic analysis should be repeated rationally.

Ship's medicine chest on Yugoslav ship.

An insufficient medical care during sea voyage presents a great risk for the health and life seafarers at sea. Apart from an appropriate education of seamen, radio-medical services, and a good medical guide, ship's medicine chest is an important component of the primary health care on ships. The standardization and unification of these medicine chests, which all major maritime countries except Yugoslavia have already accepted, is essential. The authors present a proposal for the standardization of the list of drugs carried on Yugoslav ships.