[Psychological approach to different skin diseases: life events and tendency to complain]. / Approche psychologique de différentes dermatoses: événements de vie et propension à se plaindre.

BACKGROUND: For nearly two decades, dermatology has associated with psychology to find a better way to care for dermatology conditions. A scientific trend called psychosomatics is creating a link between dermatology and psychology. OBJECTIVE: The purpose of this article was to examine two concepts closely linked to psychodermatology (life events and tendency to complain) and to emphasize the difference between factors playing a role in the onset of certain skin diseases (psoriasis, alopecia areata, benign tumors, eczema). RESULTS: We found that psoriasis patients have a greater tendency to complain than people with the other disease. This point to the importance of taking emotions into account when studying psoriasis. We also found that life events play a role in the onset of psoriasis and alopecia areata. Moreover, these events were anterior by more than 12 months in alopecia patients. CONCLUSION: We propose exploring emotions in psoriasis patients and life events over the prior year in alopecia areata patients.

Posttraumatic intestinal stenosis: radiographic and sonographic appearance.

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We include CT images at the time of trauma, and barium meal and abdominal sonography obtained during the subsequent admission. Examination of the resected bowel loop showed transmural infarct and posttraumatic changes in the adjacent peritoneal fat. This is the first report which includes both imaging at the time of trauma and sonographic appearance of the narrowed bowel loop. Posttraumatic intestinal stenosis should be considered in the differential diagnosis of a narrowed bowel loop in a patient with a history of blunt abdominal trauma.

Acute focal bacterial nephritis in childhood brucellosis.

Brucellosis is an infectious disease transmitted from various animal hosts to man. In children the most common route of infection is unpasteurized milk or milk products. Brucellosis affects the urinary tract uncommonly, most frequently causing orchioepididymitis. We report the case of a 4-year-old boy with brucellosis who developed acute focal bacterial nephritis (AFBN), documented by sonography, gallium scan, and computed tomography. After appropriate treatment his symptoms and his sonographic abnormality resolved completely. To the best of our knowledge, this is the first report of the association of AFBN and brucellosis.

Percutaneous transhepatic dissolution of gallbladder stones.

The method of percutaneous transhepatic dissolution with methyl tert-butyl ether (MTBE) has been used at the Zagreb Clinical Hospital Department of Medicine since 1989. From December 1989 until December 1991, 69 patients, 51 (74%) females and 18 (26%) males, with symptomatic and cholesterol gallbladder stones were hospitalised at the Department. All patients preferred percutaneous transhepatic dissolution to surgical treatment of gallbladder stones. The gallbladder was successfully punctured and the catheter placed into the gallbladder lumen in 63 (91%) patients, whereas complete dissolution was achieved in 59 (85.5%) patients. In 21 (33.9%) of these 59 patients, after completed dissolution computer-processed roentgenograms and ultrasonic scan of the gallbladder revealed residual particles of debris sized up to 2 mm. Six patients in whom puncture, i.e. the placement of the catheter into the lumen was unsuccessful, were electively operated on the following day without any complications. The mean duration of hospitalisation for 63 patients was 4.5 days.

Prophylactic administration of ranitidine after sclerotherapy of esophageal varices.

The present trial was carried out to determine the usefulness of H2-receptor antagonist drug therapy for the prevention of esophageal bleeding and esophageal varices in patients who underwent sclerotherapy. According to randomization, out of the 58 patients, 28 received, along with the usual standard therapy, ranitidine and 30 received placebo. Ranitidine, 50 mg, was administered intravenously over a period of 3 days every 8 hours, and then 150 mg of ranitidine was given per os in the evening for one month. For improvement of hemostasis and during the elective sclerotherapies, 1% polidocanol was used as the sclerosant. During each puncture, 2 ml was injected. Injections were paravasal and intravasal. After sclerotherapy, endoscopic examinations were carried out on the third day and one month later. Necrosis was noted in 42% of the patients and esophageal mucosal inflammation in 26%. Esophageal ulcers did not occur. There was no statistically significant difference between the two groups in terms of age, sex ratio, cause of liver cirrhosis, and the Child's classification. The size of the esophageal varices had no effect on the development of esophageal mucosal changes in correlation with the quantity of sclerosant. The comparison of the two groups of patients, sclerosed for hemorrhage and sclerosed electively, showed no statistically significant difference regarding esophageal mucosal changes. No differences between the ranitidine and placebo groups of patients were observed in this indication. It can be concluded that esophageal mucosal changes probably arise as a consequence of the sclerosant, its concentration, quantity and mode of application.(ABSTRACT TRUNCATED AT 250 WORDS)

[Biliary calculosis--new possibilities of treatment]. / Bilijarna kalkuloza--nove mogucnosti lijecenja.

The gallstone prevalence rate in Croatia is in the range of 10 to 20 per cent and for the population above age 65 years is around 30 per cent. Human gallstones are classified into two categories, i.e. cholesterol stones and pigment stones. Cholesterol stones account for 70-80% of gallstones. They are formed due to the bile supersaturation with cholesterol and later nucleation of cholesterol vesicles and crystal formation. Pigment stones of black type account for 20-25% of gallstones. They are formed as a result of chronic hemolysis. Surgery is still a method of choice in treatment of majority of patients with gallstones. It is a low-risk therapy with high success rate that can be used regardless the size, number, composition and localisation of gallstones. Cholesterol stones can be dissolved by direct instillation of methyl tert-butyl ether (MTBE therapy), fragmented by extracorporeal shockwaves (ESWL) and dissolved using bile salts chenodeoxycholic acid and ursodeoxycholic acid. The problems with these treatment modalities is high recurrence rate and limitation described for each method. Choledocholithiasis can be treated surgically, by endoscopic sphincterotomy combined with stone extraction and by extraction via T-tract. The decision on the best treatment modality in gallstone patients should be made only after careful evaluation of all relevant facts (type of stone, number and size of stones, localisation of stones, patient's age and general condition) taking into consideration the team experience. It is imperative not to use the treatment method with possible complication that cannot be dealt with in the institution performing the treatment.

[Laparoscopic findings in aged patients (author's transl)]. / Laparoskopische Befunde bei geriatrischen Patienten.

A group of 165 geriatric patients is compared with a control group of 114 younger patients concerning different frequency of laparoscopic diagnoses. As it was suspected from the clinical view aged patients predominently suffered from posthepatic cirrhosis and from cirrhosis of unknown origin, from recurrent cholecystitis, obstructive jaundice, metastases and carcinosis of peritoneal cavity. Younger patients much more frequently showed toxic liver damage starting from fatty liver and ending up with fatty liver cirrhosis. Persistent acute hepatitis non associated with HBSAg was scarcely seen with the aged group. It was a frequent diagnosis with the younger control group. There are explanations given for the differing endoscopic results concerning aged persons and younger control persons.