Large-cell neuroendocrine carcinoma of the ampulla of Vater.

Large-cell neuroendocrine carcinoma is a high-grade neuroendocrine carcinoma, originally described in the lung. The tumor rarely occurs in extrapulmonary sites like the gastrointestinal tract, and only few examples have been described in the ampulla of Vater. A new case of large-cell neuroendocrine carcinoma of the ampulla of Vater in a 60-year-old man is reported. After pancreatoduodenectomy, macroscopic examination revealed ulcerated tumor in the region of the ampulla of Vater. Microscopically, the tumor exhibited organoid, predominantly nested growth pattern, consisting of large, polygonal cells with pleomorphic nuclei. Average number of mitoses was 36 per 10 high-power fields. Small and large areas of necrosis were identified. Immunohistochemically, the tumor cells were positive for synaptophysin, chromogranin A, PGP 9.5, neuron-specific enolase, pancytokeratin, CK8 and somatostatin and negative for CK7, CK20, S-100, TTF-1, HMB-45, CD117, E-cadherin and regulatory peptides. Ki-67 proliferative index was 41%. Histone deacetylase (HDAC) analysis showed almost identical results for HDAC1, HDAC2 and HDAC3--60, 60.3 and 61%, respectively. Two months after surgery, liver metastases occurred, confirming highly aggressive behavior of large-cell neuroendocrine carcinoma.

[Hemorrhagic shock].

Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and can be rapidly fatal. Despite improved understanding of the pathophysiology and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the state of shock is well establish and the compensatory mechanisms have started to fail. The primary goal is to stop the bleeding and restore the intravascular volume. This review addresses the pathophysiology and treatment of haemorrhagic shock.

[Coagulopaty in associated with massive transfusion].

Massive hemorrhage is a formidable challenge for anesthesia care providers in the elective setting and poses even greater potential challenges in the trauma setting. In all this cases, the anesthesia care providers are faced with large-volume resuscitations that typically start with crystalloid and colloid and rapidly progress to blood and blood products. These large-volume replacement may cause coagulopathy, which can be difficult to manage in the setting of ongoing blood loss. Coagulopathy associated with massive transfusion is multifactorial event that results from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Treatment strategies include the maintenance of adequate tissue perfusion, the corection of anemia, and the use of hemostatic blood products.

What is happening to the health of the Croatian population?

AIM: To describe the problems in the interpretation of Croatian mortality data and explore possible reasons for the recorded increase in mortality in the 1990-1999 period, particularly related to different methods of collection and estimation of data on deaths and population. METHODS: Numbers of recorded deaths and population estimates were first obtained from the Croatian Institute for Public Health and examined in detail. The Institute used population estimates supplied by the Croatian Statistics Bureau, which included de jure population data (including all Croatian citizens wherever they live) until 1996 and de facto population data (including only population living in Croatia at least for a year, irrespective of citizenship) since 1996. A different set of population estimates based on de facto estimates since 1992 was obtained from the Croatian Bureau of Statistics. We examined trends in age- and sex-specific death rates from major causes in 1990-1999 period, using the mortality data from the Croatian Institute for Public Health and both sets of population estimates. Lung cancer as a cause of death was examined in more detail, since it is relatively stable over short periods of time. Interviews were undertaken with key informants to identify the reasons for any discrepancies. RESULTS: In Croatia, relatively stable death rates from lung cancer in men ranged from 84/100,000 in 1990 to 79/ 100,000 in 1995. In 1996, a marked discontinuity appeared in the Croatian data, with a 14% increase compared to 1995 (from 79/100,000 to 91/100,000) and a further increase in 1999 (94/100,000), which is not credible on the basis of the natural history of lung cancer. Analysis of mortality rates with de facto population estimates showed more gradual increase from 1992-1996. Methods used to estimate population and mortality during the 1990s were inconsistent and misleading. At present, it is impossible to be certain about the true level of mortality in Croatia during 1990s, as the numerator (deaths) and denominator (population) were incompatible until 1998. CONCLUSION: Major problems in data collection would have been identified if the investigation of unexpected mortality trends in Croatia in the 1990s had been done. Systematic analysis of health patterns should be done as soon as data from the 2001 census become available. Capacities in public health should be strengthened to make this possible. This issue has received little recognition from the international donor organizations, particularly those that use health data.

Cancer incidence in eastern Adriatic isolates, Croatia: examples from the islands of Krk, Cres, Losinj, Rab and Pag.

As an extension of previous research this study investigates the incidence of cancer in five genetic isolate island populations of the Eastern Adriatic, Croatia. Thorough anthropological research over the past three decades has established some of those populations as outstanding examples of genetic isolates. A previous study which found higher cancer incidence in 5 Eastern Adriatic islands than in a control population supported a hypothesis that among the founders of these populations there were genetic variants (especially with recessive inheritance) responsible for genetic susceptibility to certain types of cancer. This study sought to investigate cancer incidence in 5 further island populations. All cancer cases in five island populations (Krk, Cres, Losinj, Rab and Pag) over the 20-year period (1971 to 1990) was extracted from the data of the Croatian Cancer Registry. The mainland populations of Istrian and Primorsko-Goranska County, characterized by similar environmental factors but an outbred genetic structure, represented a control population. After standardization by by sex and age, cancer incidence was higher in the island populations than in the control population in both sexes. The cancer sites primarily responsible for the excess incidence were prostate, stomach and pancreatic cancer in males, and ovarian, breast, stomach, bowel, and brain cancer in females. The reasons for the increased cancer incidence are uncertain and may be due to different environmental exposure between the two populations. However, it is possible that genetic isolation and inbreeding are important factors. Further investigations of cancer in these isolate populations are warranted to explore these findings further.

Surname as 'cancer risk' in extreme isolates: example from the island of Lastovo, Croatia.

The aim of this study was to analyze whether there are surnames which appear more frequently among the ancestors of cancer cases in a small isolate, in comparison to the ancestral surnames of the healthy controls, using the classic case-control design. The chosen setting was the island of Lastovo, Croatia, located more than 100 kilometers from the nearest coastal region. The period of study was 1970-1995, during which a total of 76 cancer cases were recorded in a population of approximately 800. The comparison of surname frequencies was performed in current and in five ancestral generations. The leading hypothesis was that, if inbreeding and common ancestry contributed to the development of the disease, then those phenomena should be reflected in increasing frequency of some surnames among ancestors, identifying the 'hidden' consanguinity, or 'following' cancer-promoting genes on the Y-chromosome. The results imply that there are surnames representing a classic "risk" for cancer, but also those "protecting" from its development, which all underscores the importance of founder effect and genetic predisposition to the disease in a small, reproductively isolated population. All of the results become more evident and increasingly significant when analyzed in more distant ancestral generations.

Migrations of the population.

PIP: The author outlines trends in Yugoslav migration in the twentieth century. Both internal and international flows are examined, with a focus on political events and labor migrations.^ieng

Fatalities in the war in Croatia, 1991 and 1992. Underlying and external causes of death.

OBJECTIVE: To show the underlying and external causes of death and selected characteristics of those killed in the war in Croatia between March 1991 and December 1992. DESIGN: Analysis of 4339 fatalities recorded on two national mortality statistics documents that specified war operations as the cause of death: a demography mortality statistical form and a death certificate. MAIN OUTCOME MEASURES: The frequency of clinical causes of death and their association with methods of wounding, length of survival, and attendant diagnoses. RESULTS: Half of those killed were men aged 21 to 35 years. Among women killed, the majority were aged 61 to 75 years. Skull fracture with intracranial injuries was the leading cause of death (28.9%), followed by multiple traumas and injuries of unspecified site (17.9%), and thoracic wounds with lung and heart injuries (17.6%). The most common methods of wounding were bombs and fragments of other explosive devices involving 1907 persons (43.9%), followed by deaths from bullet wounds (33.0%). More than 50% of those killed had sustained multiple injuries. In 78.6% of the cases, death immediately followed the wounding.

The population of Yugoslavia, 1948-1991.

"On 31 March, 1991, the sixth population census after World War Two was taken in Yugoslavia. The census of households, apartments and farms took place simultaneously to the population census. The census was taken in extremely difficult political, economic and other conditions, which greatly hindered its organization, and the work of the census takers and census commissions. The census was not taken in the province of Kosovo, nor partially in some other communes, thus the total population in these regions was estimated, which is explicitly stated in the tables. Furthermore, the method used to make this estimation is also cited. A comparison of the first results of the 1991 population census with data from previous censuses, and with available estimates, indicates the reliability of the results obtained in the territory in which the 1991 population census was taken."

[New medicine forms of controlled release of fluorides into enamel]. / Novi lekoviti oblici za kontrolisano oslobadanje fluorida na povrsinu gledi.

The article deals with the description of the therapeutic system for the local application on fluorides, principles of its functioning, advantage upon classical dosages, as well as a short survey of previous attempts of its formulation.

[Analysis of modified laterally positioned flap]. / Primena modifikovanog lateralno pomerenog reznja u lecenju mukogingivnih defekata.

The aim of this study was to investigate the effects of the covering of denuded root surfaces by the use of modified laterally positioned flap (MLPF) and application of supersaturated citric acid of pH 1. The following measurements were carried out: the width of attached gingiva, attachment of epithelium level, gingival recession, and plaque and gingival indices. The surface area of the exposed root was also measured. All measurements were made before MLPF and one, three, six and twelve months after the treatment. The average surface area of the gingival recession before surgery was 15.75 mm2 and one year after the treatment 4.20 mm2. This means that 73.30% of the denuded surfaces were covered. After the application of MLPF there was a statistically significant decrease of dental plaque index values and of gingival index values. The epithelium attachment was on the coronal level. Gingival recession was significantly decreased. The width of attached gingiva was statistically increased. It can be concluded that MLPF after the application of citric acid is a useful surgical procedure in the covering of denuded root surfaces.

[Study of efficacy of single-visit-treatment of caries profunda simplex in deciduous teeth]. / Ispitivanje efikasnosti lecenja "caries profunda simplex" mlecnih zuba jednoseansnom metodom.

The article deals with comparative study of the success of the treatment of "caries profunda simplex" of deciduous teeth by multi-seance and single-seance-methods. With multi-seance-method, where ZOOK paste was used for pulp capping during the one year period, 49.2% teeth were finally filled; the complications appeared in 23.0% of cases. Treatments were not finished in 27.8% of cases. With single-seance-method, where for the indirect pulp capping the base consisted of calcium hydroxide (Dycal, Reolit) and where the teeth were filled during the same seance, the success was achieved in 82.2% of cases; the complications appeared in 17.8% of cases. There was unfinished no treatment. On the basis of the obtained results single-seance-method of the treatment of "caries profunda simplex" is recommended as a significantly more efficient method in relation to the classical multi-seance-method.

[Principles of dental treatment of handicapped children in general anaesthesia]. / Principi stomatoloske obrade hendikepirane dece pod opstom anestezijom.

The long experience and practice in the treatment of handicapped children determined the appropriate general type of anaesthesia as well as the method and order of dental operations under general anaesthesia. A wide variety of dental treatment in such conditions concerns the "serial work per quadrants", strong measures of preventive extension and pulp protection, and selection of indications for extraction of teeth. It is emphasized that during the postoperative period frequent control examinations and intensified preventive measures by parents and dentists are necessary.

[Investigation of chemical reaction and isolation of calcium hydroxide and Zn-phosphate cement in vitro conditions]. / Ispitivanje medusobne hemijske reakcije i mogucnosti izolacije kalcijum hidroksid paste i fosfatnog cementa u in vitro uslovima.

An important question in conservative dentistry is whether in direct contact of calcium hydroxide paste and phosphate cement the neutralization of pH calcium hydroxide occurs and how it can be prevented. Chemical investigations performed in vitro conditions (in the test tube) concerned 3 groups, each of which had 12 samples. In the A group (control group) calcium hydroxide paste was put at the bottom of the test tube and ZOOK paste and phosphate cement layer were put over it; in the B group, Tubulitec base in 2 layers was applied over calcium hydroxide cement and then the phosphate cement; and in the C group, the calcium hydroxide paste and phosphate cement were put in the test tube in direct contact. Within 12 weeks, after 7 days, the 3 samples were investigated (1 in each group). Contrary to expectations the results showed that in direct contact of calcium hydroxide paste and phosphate cement no change occurred in pH calcium hydroxide, and that its average value was 12.70. Further were there was no statistically significant difference in values of pH calcium hydroxide paste among the A, B and C groups. On the basis of these studies and in the opinion of other authors, it may be concluded that, although there was no decrease in pH calcium hydroxide in direct contact of calcium hydroxide paste and phosphate cement, it should be necessary to make the mutual isolation of these materials; in practice this is most efficiently done on two-layer Tubulitec base.

Internal migration.

PIP: Postwar internal migration trends in Yugoslavia are reviewed. The data are presented separately by republic and autonomous region. The age and sex characteristics and ethnic status of migrants are analyzed.^ieng

Comparative clinical performances of 4 copper-releasing IUDs.

Clinical performances of the Copper 7, Gyne T 200, MLcu 250 and Tcu 200 were compared on 203 patients in this random study conducted over a period of 18 months. Insertion-linked events, tolerance (markers were bleeding or spotting, IUD-linked pain and partner discomfort) and causes for removal (spontaneous expulsion, pregnancies and pelvic infection) were considered. Randomization was performed at the beginning, using prescriptions that came from a randomized pool. Validity of the randomization method was checked against four criteria: number of models inserted per IUD type, prevalence of IUD type per age group, per previous gravidities and per previous means of contraception. No major difference in clinical performance among the four IUD types appeared upon analysis of the resulting data.