Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient

Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), Staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. Review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.     

Thyroglossal duct cyst with laryngeal extension

Thyroglossal cyst is frequently located in the thyrohyoid region. In rare cases, it breaches and remodeles anatomical structures of the larynx and manifests with dysphonia and laryngeal obstruction. A 60-year-old patient with a big thyroglossal duct cyst with laryngeal extension and cartilage erosion is described. Computed tomography clearly demonstrated the nature of the cyst and its extension into the larynx.     

Physical inactivity as public health problem

The aim of the paper is to present the public health aspects of physical inactivity, and the importance of sport, recreation and other types of physical activity to health of population. Reduction of physical inactivity in today's every day life became great public health concern. The causes of such situation are linked to the pattern of modern life, sedentary type of work, autoimmunization in production, passive role of citizens in sports, and others. Adequate physical activity is very important means in prevention of many health problems, like obesity, arterial hypertension, diabetes, hearth diseases, atherosclerosis, osteoporosis and others. Physical activity and regular exercises in elderly increase independency from others in every day living, increase physical condition and reduce accidents, improve mental health, satisfaction with life; reduce hypertension and quantity of drugs. Physical inactivity increases economic burden of the country. The results of the Croatian Health Survey from 2003, done on representative sample of Croatian adult population shows that 44% of men and 30% of women are physically inactive. Situation in cities is even worse. In Zagreb 85% of men and 45% of women are inactive. The criteria for physical active person were walking three times a week for 30 minutes at least. The solution of the problem for the future is to pay more and more intensive attention to develop comprehensive community programs. More support should be given in construction of facilities for sport and recreation, during wintertime and for persons with special needs. The key role and responsibility for the promotion of physical activity of citizens will have primary health services (family practitioners, public health services), nongovernmental organization and media.     

The loss of visual field after proliferative diabetic retinopathy treatment with two different techniques of panretinal photocoagulation

Diabetic retinopathy (DR) is the most common cause of blindness in the active population of industrialized countries. Panretinal argon laser photocoagulation (PRP) is used in the treatment of proliferative diabetic retinopathy. Despite its usefulness, the mentioned treatment has some side effects such as permanent visual field damage. The treatment was performed with two PRP techniques, peripheral panretinal photocoagulation (PPRP) and central panretinal photocoagulation (CPRP). Peripheral visual fields defects were assesed with Vaughans method. The aim of the study was to determine the extent of visual field defects entailed by the two different PRP techniques. RESULTS: Visual field loss in percentage was greater in the group treated with PPRP (mean 9.09 +/- 6.36%) than in group treated with CPRP (mean 4.9 +/- 4.5%) (p = 0.000037). The initial functional DR severity and presence of risk factors that influence DR severity were similar in the two treatment groups. Different results were mostly attributable to the PRP techniques employed, being significantlly less favorable with PPRP.     

Acquired neuroendocrine-positivity during maximal androgen blockade in prostate cancer patients

The acquired serum Chromogranin A (CgA) positivity was followed-up during 15 months in 79 prostate cancer patients referred to maximal androgen blockade (Mab.) In all patients normal CgA values were initially measured. This study was also performed on 24 Stage C-D1 prostate cancer patients left without therapy through their own choice and in 20 controls with benign prostatic hypertrophy. In all these subjects serum PSA, %FPSA and CgA concentrations were measured at three-month intervals and bone scans were performed 1-2 times during the overall monitoring period. After nine months of monitoring, no differences in CgA-positivity between two prostate cancer patient groups had been observed. However, during the last six months of monitoring, the acquired CgA-positivity was statistically significant in treated patients when compared to the untreated group (p<0.001). Bone metastases were found in 38% of CgA-positive prostate cancer patients (regardless of the therapy status) and in only 6% of studied patients with a steady normal serum CgA concentration. According to the data reported herein we advocate the assessment of serum CgA concentrations at 3-month intervals during hormonal manipulation. The reported results may reawaken the idea of intermittent hormone therapy and, in particular, the replacement of Mab after 9 months by Casodex (Flutamide) monotherapy for a 6-month period.     

Osteoma of the internal auditory canal

Osteomas of the internal auditory canal, inaccesible to clinical examination, are rare lesions. There are only 14 cases of osteomas and exostoses of the internal auditory canal reported in the international medical literature. A patient with an osteoma of the internal auditory canal is presented, along with differential diagnosis and possible etiologic factors for the lesion. The auditory brainsteam evoked response testing showed increased absolute latencies of 1 wave and discrepancy of the wave morphology due to bony compression of the eight nerve in the internal auditory canal. Computed tomography showed a bony growth in the internal auditory canal. Magnetic response showed no abnormalities. No surgery was performed since the symptoms improved by conservative therapy.     

Epidemiological study of suicide in the Republic of Croatia -- comparison of war and post-war periods and areas directly and indirectly affected by war.

We examined the differences in the suicide characteristics between areas directly and indirectly affected by war activities and in war and post-war periods according to the following variables: suicide rate, sex, age and method of suicide. Analysis was done on 5349 suicides committed in the period 1993-1998 (war and post-war years). The suicide rates in the Republic of Croatia oscillated in the pre-war, war and post-war periods (1985-2000) but without significant differences. In the areas directly affected by war, the suicide rate was significantly lower than in other areas during the study period 1993-1998 (chi-square = 10.3245; P = 0.0017). The number of suicides in both sexes declined in the areas directly affected by war-more in men than in women; the difference between sexes was statistically significant (chi-square = 3.6697; P = 0.055). Middle- and old-aged people were the population with high suicide risk in both areas (t = 1.76; P = 0.078). There were significant differences in the methods of suicides between war and non-war areas (chi-square = 108.8473; P = 0.001). Firearms or explosive devices were the methods used more significantly for suicides in the areas directly affected by war than in other areas, whereas hanging was more frequently used in the areas indirectly affected by war.