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The purpose of this study was to evaluate a nonfiltering glaucoma technique viscocanalostomy alone or in combination with small incision phacoemulzification and intraocular lens (IOL) implantation. From January 1999 to February 2001 viscocanalostomy was performed in 18 patients with medically uncontrolled primary open angle glaucoma. In 10 patients with cataract and primary open angle glaucoma combined operation phacoemulsification and viscocanalostomy was performed. The mean IOP reduction remained statistically significant after 12 months in both groups (p < 0.01). There was also a significant decrease in the antiglaucoma medications in both groups postoperatively. Perforation of trabeculo-Descemet's membrane occurred in two eyes with POAG and the procedure was completed as trabeculectomy, and those patients were excluded from the study. Good hypotensive effect with very low complications rate was achieved. Such a low complication rate makes this operation particularly attractive to surgeons who perform an increasing number of operations in outpatient's bases.

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Objective of this study was to evaluate the intraocular pressure-reducing effect of latanoprost as monotherapy after replacing current dual therapy in glaucoma patients. The 6-months study comprised 189 patients with primary open angle glaucoma who were treated at least 6 months with two different kind of topical medications (beta-blockers, pilocarpine, dorzolamide and brimonidine). Due to local side effects, multiple dosing regime and inadequately controlled intraocular pressure (IOP), they where switched to latanoprost 0.005% monotherapy. After switched to latanoprost, mean (IOP) was measured at baseline, after 15 days, 2 and 6 months of treatment. After six-months 178 patients had completed the study. These analyses enrolled all patients (n = 189), thus, the Intention-To-Treat (ITT) results were shown instead of the results of the reduced population. IOP was clinically importantly reduced from baseline level. Five patients had uncontrolled IOP. The difference between IOP before (21.9 +/- 2.4) and after 15 days (17.4 +/- 1.7), 2 months (16.7 +/- 1.8) and 6 months (16.6 +/- 1.4) was statistically significant (p < 0.001). 90% patients has reached target IOP < or = 18 mm. A conjunctional hyperaemia in 18 (9%), stinging and itching in 7 (4%) patients was reported. Increased iris pigmentation was seen in 3 (2%) patients. The results of this study indicate that dual therapy in open-angle glaucoma can effectively be replaced by latanoprost monotherapy in many patients.

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The aim of this study was the comparison of recurrence rates of pterygia following different surgical methods. Twenty-one patients were operated by the bare sclera technique, with the application of mitomycin C (0.25 mg/ml for 2 min). Twenty-seven patients were operated by limbal stem cell transplantation. The third group contained 13 patients who were operated by amniotic membrane transplantation. Five recurrences of pterygia were noted in the mitomycin C group and 2 each in the limbal stem cell transplantation group and the amniotic membrane group. The mean time to recurrence was 5.4 +/- 4.12 months in the mitomycin C group versus 10.5 +/- 3.5 months in the group of patients with limbal transplantation. In the third group, both recurrences were evident 4 months after the operation.

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A case of 5.5-year-old girl with Haddad syndrome (congenital central hypoventilation syndrome-CCHS or Ondine's curse and Hirschsprung's disease) is presented. At the age of 1.5 months, due to severe colonic aganglionosis, temporary colostomy was performed. At the age of 4.5 years the sigmoid colon and left colon were resected and temporary colostomy was closed. Since birth, the sleep central hypoventilation characterized with shallow respirations and frequent apnoeas was noticed. The child's life was compromised and therefore the postoperative recovery was complicated and prolonged. Cardiac exam showed initial signs of pulmonary hypertension and right-sided failure. At the age of 4.5 years assisted positive pressure ventilation via face mask, with transportable ventilator was initiated during sleep and was successfully performed at home. Since then the cardiac exam showed no abnormalities. There are no significant abnormalities at neurological exam while EEG shows minimal irritative changes. The girl's physical and psychomotoric development is progressive and she is having an excellent peer contact. We expect even better quality of life after the implantation of the diaphragmatic pacemaker which is planned at early school age.

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INTRODUCTION: Colorectal war injuries can be treated with primary repair or by colostomy. We report our experience with both treatments. METHODS: During the Croatian war from July 1991 to March 1994, 155 patients with colorectal injuries were treated at the Surgical Clinic, University Hospital Split. This group represents 7% of all patients (n = 2220) with gunshot and shrapnel wounds treated in this period at our clinic. The median patient age was 24.7 years (range 14-70 years). The majority of the patients (96.7%) were male. Concomitant injuries of the colon (83.7%) and rectum (69%) were found more frequently than isolated ones. 50 patients were operated on as emergencies in our clinic, while 105 were operated on in field hospitals. In 28 patients primary repair of the colorectal injury was performed (without derivation), whereas 127 patients were treated by colostomy. In those patients 106 wounds were closed electively during a second operation. The average in hospital stay was 32.3 days (range 10-65 days). RESULTS: Using PATI and FCIS scores for colorectal injuries, 80% of our patients had life-threatening injuries. In the cases with primary repair the percentage of complications was high (92%). In the cases with the diverting colostomy it was only 34%. The high complication rate in the cases with primary repair was directly related to the presence of the anastomotic leaks and subsequent peritonitis. Explorative laparotomy was an effective diagnostic tool especially in the field hospitals. The overall mortality rate was 3.2%. CONCLUSION: In our operative strategy we preferred derivation operations in order to decrease major complications due to anastomotic leakage or peritonitis.

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A case of paracetamol poisoning in 17-month-old girl is presented. Clinical features and therapeutic procedures are described. Differences in paracetamol metabolism between children and adults are compared. Differences in the incidence of paracetamol poisoning between Croatia and USA are surveyed. The role of a physician in the education of parents and medical stuff on paracetamol toxicity is emphasized.

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In this paper, the data on some medical, social and legal aspects of abuse and/or neglect of children in Zagreb are presented which, at least, partially illustrate this societies' care of mistreated children at the end of the 20th century. We reviewed questionnaires that were administered to 44 health institutions involved in the childrens' health control and/or treatment and to 14 social work services and analyzed cases of child mistreatment reported to the Zagreb Public Prosecution Office and final court judgements for 1987 to 1988. We conclude that all these institutions encounter cases of child abuse and/or neglect but that medical institutions identify only 10% of cases detected by social work services and that judicial system sentences with imprisonment about 30% of abusers. Underdetection of child mistreatment in Zagreb, in addition to poor coordination of services, are the possible reasons for insufficient concern for these children. Up to now, only mass media and scientific publications have spoken more loudly about this problem. The authors emphasize the need and obligation of all those professionals concerned with children and of the entire community to undertake relevant measures to protect abused and/or neglected children.

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In our examination we have used clinical material of 448 cases treated in our clinics for blunt abdominal trauma in period from 1976. to 1988. with special care on the group of 172 patients in who the retroperitoneal haematoma was founded. In the group of 172 patients we have examined the frequency on way to age, sex, and presence of the retroperitoneal haematoma in clinical picture of the blunt abdominal injury, and frequency of the retroperitoneal haematoma in abdominal injury connected with the injuries of the other organs.

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We are reported eight patients after blunt abdominal trauma with rupture of retroperitoneal part of the duodenum, with etiology of injury and with their surgical treatment. We emphasized diagnostic troubles and great mortality in the cases of missed duodenal rupture in the preoperative and in the intraoperative time. The result of successful therapy depend of quick recognizing of the retroperitoneal part of the duodenum and of the operation treatment.

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At the Surgical Clinic of the University Hospital Center "Firule" Split in the period from 1977-1987. years were treated 12 patients with injuries of the pancreas. That is 4% of all abdominal injuries treated in those 11 years. We presented 10 patients after blunt abdominal trauma and 2 after penetrating injuries of abdomen associated with acute pancreatic injury. The most important is early recognizing injury of pancreas and making the time from moment of injury to surgical exploration shorter as much as possible. There is no early specific signs of injury of pancreas and the key to treatment is accurate evaluation of extent of injury.

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The authors review 28 patients with the diaphragmal injury treated at the Surgical Clinic of the Clinical hospital centre "Firule" Split in the period from 1976 to 1988. The distribution of the injuries in consideration of age and sex, the most frequent lesions of the organs connected with the diaphragmal injury, number of the patients in different years as the structure inside this group of the patients is shown.

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The paper presents 44 cases of small intestine perforation caused by blunt abdominal trauma in a period of 12 years. 34 patients were men and 10 were women. The patients were aged from 10 to 82 years which gives an average age of 39 years. The average incidence of cases was 4 per year. In 23 patients associated injuries were diagnosed, namely: 5 spleen ruptures, 3 liver ruptures, 5 colon perforations, 1 pancreas injury and 1 kidney injury. Associated injuries in which the dominant syndrome was intraabdominal hemorrhage presented no diagnostical difficulties seeing that the results of punction or abdomen lavage indicated immediate laparotomy. In patients with isolated injury of the small intestine and clinical signs of peritonitis laparotomy was treated with a two layer suture in 32 patients; in 12 patients resection with T-T or L-L anastomosis was made. Associated injuries were treated in the same act. Of 44 patients treated in our Clinic 37 were treated successfully, while 7 died.

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