Biomedical subjects

Irena Hrstić

Publications and source records attributed to Irena Hrstić.

5 recordsLinked to original sources

PubMed2006

Pyoderma gangrenosum associated with ulcerative colitis.

We report the case of a 45-year old man with non-healing ulcers located on his chest, lumbal, sacral, retroauricular areas and forehead. Both clinical and histopathological examinations suggested pyoderma gangrenosum (PG). For six months the diagnosis of ulcerative colitis was established. PG in our patient was presented as a rapidly enlarging, painful ulcer with purple, undermined edges and a necrotic, haemorrhagic base. Initially, he was treated with a high dosage of peroral glucocorticosteroid, sulfasalazine, and systemic antibiotics, together with daily wound care. Ulceration partially regressed. Total colonoscopy showed pancolitis. When the dose of glucocorticosteroids was tapered down to 35 mg, new ulcerations on his right thigh and abdomen were formed. He also developed E. coli sepsis and flare up of bowel disease. Azathioprine, together with two pulse doses of glucocorticosteroids and antibiotics, were administered. He was scheduled for a total colectomy. The management of PG continues to be a therapeutic challenge.

Colitis, Ulcerative↗

PubMed2005

[Viral hepatitis: Croatian consensus statement].

There has been a dramatic improvement in diagnostic procedures and therapy of viral hepatitis in the last 20 years. Improvements in therapy caused an increase in actual cost, however, with significant long-term savings through a decreased cost of treatment of advanced liver disease including liver transplantation. The Croatian National Board for Viral Hepatitis has decided to initiate the organization of consensus conference on viral hepatitis enabling the leading experts in the country to give the best possible recommendations for the diagnosis, prophylaxis and therapy in our circumstances. The Consensus Conference took place in Zagreb in June 2004, with update in March 2005, organized by the Croatian National Board for Viral Hepatitis, Reference Centers of the Ministry of Health for Chronic Liver Diseases, Infectious Diseases and AIDS, Croatian Society of Gastroenterology--Hepatology Section, Croatian Society for Nephrology, Dialysis and Transplantation, and Croatian Institute for Health Insurance. Invited experts provided written reports on the respective subjects that appear in this issue and their recommendations resulting in this consensus statement.

Consensus Statements as Topic↗

PubMed2005

[Viral hepatitis: clinical and histological assessment].

Viral factors are important in the pathogenesis of liver disease either directly, through cell injury associated with the accumulation of intact virus or viral proteins, or indirectly, through the host immune response. The immune response of the host is more important than viral factors in the pathogenesis of liver injury caused by HBV. There is little genomic variability in HBV, but mutant forms of HBV with mutations in the precore, surface and X genes, as well as the core promoter region have been implicated in a number of clinical syndromes. The mechanisms of viral persistence and hepatocellular injury in patients with hepatitis C infection are poorly understood. Viral infection can produce cellular injury by direct cytotoxicity and by indirect immune-mediated injury. The range of histologic findings in patients with hepatitis B and C is broad, from minimal inflammatory changes to fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma. The goal of histologic analysis is quantitative and qualitative assessment of necroinflammatory lesions and fibrosis, changes of liver structure and follow-up of histologic changes due to the natural course of the disease or antiviral therapy. Subjective impression in the assessment of histologic changes is not satisfactory and numerical indices should be used. Presently, Knodell's index is being replaced by METAVIR system and Ishak system. Clinical assessment of patients with viral hepatitis must include detailed physical examination, description of the clinical course and extrahepatic manifestations, definition of viral factors, histologic assessment of inflammatory activity and degree of fibrosis, and a number of relevant laboratory parameters.

Acute Disease↗

PubMed2003

[Primary sclerosing cholangitis: case report of a young patient with an atypical diagnostic process in complications of the disease].

The primary sclerotic colangitis is the chronic disease of the liver which in its finish very often requires the liver transplantation. The disease gets diagnosed mainly in males of middle age and is often joined with the inflammation disease of the intestines. The course of the disease not rarely is complicated by the stenosis of the liver ducts or by the occurrence of the concrements. In the presented case it is the word about the young patient in which the is the diagnosis made with the atypical way primarily from the reason that the biopsy of the liver is performed too early and the patohystologic changes were non specific. Immediately after the graft is being developed the biliary peritonitis because of the injury of the gallbladder so is done the cholecystectomy. Only in the later course is performed the endoscopic retrograde colangiography, during which are getting the typical changes of the biliary trunk for the primary sclerotic colangitis. The underlying disease in the demonstrated patient is complicated by the recidivens occurrence of the concrements of the choledokus and stenoses of the bladder ducts primarily for the left slice what, up to new, always successfully was treated by the extraction of the concrements and the dilatation of the liver ducts by endoscopic way.

Adolescent↗

PubMedDate not supplied

[Percutaneous endoscopic gastrostomy: 5-year experience at out center (1997-2002)].

Gauderer and Ponsky first described percutaneous endoscopic gastrostomy (PEG) in 1979. It was introduced as a routine method in the Division of Gastroenterology, University Hospital Rebro, Zagreb, in 1995. Over the years the number of PEG insertions has increased significantly. We reviewed the available literature and compared the results with our experience according to indications, complications and efficacy of the procedure. We inserted PEG in 86 patients from January 1, 1997 until January 31, 2002. There were 40 females and 46 males. The most frequent indication for PEG insertion was a neurological condition (60/86). There were no deaths directly related to the procedure. One patient had a leakage of PEG feeding into the peritoneal cavity that caused severe peritonitis and required urgent laparatomy within 24 hours of the PEG insertion. Two patients had local infection and the tube had to be removed. The antibiotic prophylaxis has been given to 65 patients. Our experience confirms that PEG is a relatively safe and well tolerated procedure.

Adolescent↗