Karmen Lončarek

Acne vulgaris: myths and misconceptions among patients and family physicians

The objective of the study was to evaluate the health beliefs and knowledge about acne among acne patients and family physicians. A total of 100 patients referred to a dermatologist for management of acne vulgaris and 120 family physicians completed questionnaires. The questionnaires consisted of questions about health beliefs, the natural course of the disease, the causes of acne, and a set of questions about the knowledge of acne therapy. Acne was considered as a trivial and transitory condition by 52% of the acne patients and 44% of the family physicians. The overall score of correct answers pertaining to the causes of acne among the acne patients and family physicians was 11 and 15%, respectively. The percentage of correct answers regarding the natural course of the disease was 6% for both subsets of subjects. Acne was believed to be curable by 96% of acne patients. Most patients (66%) believed that acne would improve immediately after the first treatment. The knowledge of isotretinoin teratogenecity was reasonable among family physicians (55% correct answers), but it was much lower for other side effects (9%). The overall score of correct answers regarding antibiotic therapy among family physicians was only 21%. Impact of the disease was underestimated by family physicians and also by acne patients. Overall knowledge pertaining to the causes, natural course and therapy was very low. Myths and misconceptions still exist among patients but also among family physicians.

Delayed onset of warts over tattoo mark provoked by sunburn

Multiple warts in a 32‐year‐old‐man are reported that developed after tattooing and remaining exclusively confined to that area. The tattooing was done 2.5 years earlier by a professional tattoo artist. It was previously a lesion‐free tattoo, but when damaged by sunburn developed multiple skin warts. The ability of a latent virus to induce warts after cutaneous ultraviolet exposure was discussed.

The epidemiology of Microsporum canis infections in Rijeka area, Croatia.

Summary

Melanocyte as a possible key cell in the pathogenesis of psoriasis vulgaris

Current research in pathogenesis of psoriasis vulgaris suggests that the inflammatory mechanisms are immune based and most likely initiated and maintained by T cells. However, the question of lymphocyte being an initiator of psoriatic events remains open so far. Clinical observations such as plaque symmetry, stress-induced onset or exacerbations, pruritus, and possibility of generalization, suggest a role of the nervous system and neurogenic inflammation in pathogenesis. A key to understanding the role of melanocyte in psoriasis is their ability to act as regulatory cell in maintaining epidermal homeostasis. In suggested hypothetic event, melanocyte, acting as a local stress sensor, provide communicatory link between CNS and skin. The disease probably begins with so far unknown signal directed through neuronal network to the melanocyte, placed in the center of epidermal unit. That signal governs keratinocyte cellular activities and lead to reactive abnormal epidermal differentiation and hyperproliferation. Increased proliferation of basal keratinocytes and high metabolic demands creates angiogenesis in papillary dermis and elongation of dermal papillae. Stimulated melanocytes and basal keratinocytes become an important source of proinflammatory cytokines that attract lymphocytes in dermis. In conclusion, according to our hypothesis, lymphocyte infiltrate in psoriasis is secondary event rather than vice versa as presented in the literature.

Prevalence of anencephaly in the region of Rijeka, Croatia

This retrospective study determines the prevalence of anencephaly in the region of Rijeka, Croatia. Records of all spontaneous and therapeutic abortions terminated in medical institutions, all fetuses weighing more than 500 g or more than 22 weeks gestation (whether the product of abortion, therapeutic termination, stillborn or liveborn) and infants who died in the first year of life in the region of Rijeka, Croatia, during the 1963–2000 period were reviewed. There were 135,451 births; 22 of them were anencephalics (19 stillborn), which comprises 0.2% of all births and 2.1% of stillbirths. Annual prevalence of anencephaly varied in range from 0.00 to 7.42 per 10,000 births. In two cases pregnancy was electively terminated after ultrasonographic diagnosis of anencephaly. Fifteen anencephalics were female, six were male, and in one case sex was undetermined due to aplasia of genital organs. Associated congenital malformations were detected in 18 anencephalics. The importance of establishing national and international registers of congenital malformations in all countries is stressed. The authors suggested that the setting of obligatory reporting of all congenital malformations would be the first step toward this practice in Croatia, as well as in other developing countries.

Intra-abdominal migration of a Kirschner wire

A 87-year-old male was admitted with dislocation of bone fragments after osteosynthesis of a pertrochanteric fracture using a condylar plate and Kirschner wire. Radiographic examinations revealed secondary dislocation of bone fragments of the operated hip and migration of the Kirschner wire through the acetabulum roof into the peritoneal cavity (Fig. 1). A surgical procedure was performed through the anterolateral Watson – Jones approach to the hip joint, and the condylar plate, the femoral head, and the neck were extracted. Th e Kirschner wire was not reachable through the opening on the acetabular roof (Fig. 2). During the surgery the patient developed cardiac instability and the procedure was fi nished immediately. Th ree days later his cardiac condition was stable and we scheduled the laparotomy. Kirschner wire was found among small intestine loops and extracted (Fig. 3). Postoperative course was unremarkable, and 14 days after the laparotomy the patient was discharged from the hospital. Migration of fi xation devices, and especially Kirschner wires is a wellrecognized complication of osteosynthesis surgery [1–3]. Hrvoje Štalekar, Karmen Lončarek, Miljenko Kovačević Confl ict of interest Th e authors declare no confl ict of interest.

Dacryocystitis provoked by recurrence of extramedullary plasmacytoma of the orbit: a case report

Extramedullary plasmacytoma (EMP) of the orbit is an extremely rare tumor, which frequently manifests with nonspecific symptoms. In the case reported, the symptoms of relapsing dacryocystitis appeared before the diagnosis of orbital EMP in a 60-year-old man. Moreover, EMP of the right submandibular gland that had been excised and treated by radiotherapy preceded the orbital lesion by seven years. The present report emphasizes the importance of an extensive medical workup to rule out multiple myeloma or other malignant lymphoproliferative diseases, because their treatment and prognosis are very different. Additionally, it is necessary to consider all tumors that can provoke relapsing dacryocystits.

Myopia and operative delivery in Croatia

There is not even a single report in the literature of a case that can connect retinal detachment and childbirth in myopic women. However, myopia is considered as an indication for cesarean section in some European countries. Our retrospective study comprised all women diagnosed with myopia during or before pregnancy, who delivered during period 1993– 2002 in the Department of Obstetrics and Gynecology, University Clinical Hospital Rijeka. Our study confirms the practice of myopia as indication for cesarean section in Croatia, although strong recommendations to allow high myopic patients deliver spontaneously arose as far back as 1985. It is essential to recognize scientific or non-scientific criteria for operative delivery in order to avoid the surgical overtreatment.

From Shape to Pathogenesis: Fractal Formation of Lichen Planus

The unique skin disease with involment of the immune system, accompanied by polygonal flat papules, is lichen planus. A lichen planus lesion progresses by agglomeration of polygonal papules. In contrast, lesions in the other lymphocyte-mediated skin diseases develop and progress by circular spreading from a primary point. Presuming that the shape of the object encodes its development, we hypothesized the pathogenesis of a typical lesion in lichen planus.

Origins and effects of the 2014–2016 national strategy for palliative care in Croatia

Croatia is among the last countries in Europe to develop organized palliative care at the national level. Real changes in this area started after the parliamentary elections in 2011 and culminated in the 2013 adoption of the Strategic Plan for Palliative Care Development 2014-2016. The National Board for Palliative Care (NBPC), appointed by the Ministry of Health, was in charge of creating a scalable palliative care model and national guidelines. The Board drew on experiences from both neighbouring countries with similar societies and/or health care models (Bosnia and Herzegovina, Poland) and an international leader in palliative care (United Kingdom). It recognised that provision of palliative care in Croatia, thus far based on volunteering and isolated enthusiastic activities, needed to be improved through professionalization, regulation, and organized development. A variety of policy measures was used to implement these changes, including the introduction of professional guidelines and new payment models. The development of new palliative care structures and services significantly increased the number of patients who could access palliative care, from around 1-2% of patients needing such care in 2011 to 20-35% in 2014. It also ensured the provision of more appropriate services at each point of the palliative care pathway. The Strategy was extended for the 2017-2020 period.