Objective:Mediterranean lifestyle is slowly disappearing along the Croatian coast and Croatian islands were supposed to be the last part of healthy living. Unfortunately, healthcare system is poorer on islands than in other parts of Croatia. Our aim was to analyse lifestyle and hypertension (HT) treatment and control among inhabitants of the Croatian islands.Design and method:HSK was organised by the Croatian Society of Hypertension and conducted by the WG- medical students in hypertension. A screening site was set up at the boat by which students traveled from island to island. Adult volunteers were recruited through opportunistic screening on five Adriatic islands. Trained medical students collected information through an extended questionnaire. HT was defined as blood pressure (BP) > 140/90mmHg (single occasion; an average of 2nd–3rd measurement; Omron M3) and/or self-reported use of drugs for HT. Results were compared with results from the general Croatian population (EHUH 2 cohort).Results:A total of 424 participants were included (196 men, average age 61 years). There were less obese and current smokers at islands than in the general Croatian population (26.5% vs. 33.1%; 21.5% vs. 25%, respectively, p < 0.05). Islanders were more physically active (> 1 time/week), eat more frequently fish (> 1 time/week), and use more frequently olive oil (daily basis) (44.1% vs. 26%, 79.9% vs. 32.5%, 72.6% vs. 14.9 %, respectively; p < 0.01). However, there were no differences in consumption of red meat, processed meat, cookies and cakes (p > 0.05). Less hypertensive patients were treated and control was achieved in less subjects on islands than in the general population (60.7% vs. 72.9%; 27.2% vs. 39.3%, respectively; p < 0.01).Conclusions:Some elements of Mediterranean life are still present on Croatian islands. However, several poor lifestyle habits are equally present on islands and in other Croatian regions. Treatment and control of HT are poorer on islands reflecting inadequate healthcare and lack of physicians. Public health authorities should reorganize health care on islands. In the meantime, such public health actions are warranted and must continue.

Background:Angiosarcoma is a rare and aggressive soft tissue breast cancer. It occurs in a primary form without a known precursor, typically in younger patients. In a secondary form, it is associated with a history of irradiated breast tissue, and it usually occurs in older patients. It can happen as many as 8-10 years after getting radiation treatment to the breast. When combined with chronic lymphedema, secondary angiosarcoma in an edematous limb after mastectomy and radiotherapy is referred to as Stewart-Treves syndrome. Secondary angiosarcomas spread to the parenchyma, while primary forms arise in the parenchyma. Case report:We present a 60-year-old woman with angiosarcoma grade III on the left breast. It presented as an exulcerated bleeding mass 10 cm in diameter with enlarged axillary lymph nodes. She noticed a lump in that area about a month before. The patient has no history of irradiation. Ultrasound showed a BI-RADS 5 lesion. Thoracal MSCT revealed an expansive pathologic substrate in the upper outer quadrant of the left breast. It was not sure if it extends to axillary lymph nodes. The tumor was estrogen/progesterone-receptor negative. Tumor markers CEA, CA 15-3, CA 125 were at normal levels. An extempore biopsy was made in general anesthesia. After positive histopathologic results, the left breast was ablated. Lymph nodes were extirpated three months later. Further oncological investigation and additional treatment are required. Conclusion:Even though breast angiosarcoma is rare compared to carcinoma, we should not forget about it. Early diagnosis of angiosarcoma is essential for a favorable prognosis. As the use of breast conservative therapy has increased over the last 30 years, it is assumed that the incidence of secondary angiosarcoma will likely increase.

INTRODUCTION: Poor adherence is the main reason for inadequate blood pressure control. Pharmacists are highly accessible healthcare professionals, and it has been reported that community pharmacist-led interventions improved patients' blood pressure control and health outcomes. Some authors reported on beneficial effects of mobile applications (MA) on better drug adherence. The aim of this study was to identify subjects in general population who are likely to participate in such interventions. METHODS: A total of 1228 (479 men, average age of 57.6 years, 748 women, average age of 57.2 years) participants enrolled in the EHUH 2 study (a random sample, nation-wide survey) and 424 participants (196 men, average age of 58.8 years, and 212 women, average age of 54.6 years) of the Hunt on the Silent Killer (HSK) (opportunistic screening on islands) were included in these analyses. The same questionnaire was applied containing questions about health issues, therapy, habits and opinion on pharmacists' and MA role in hypertension treatment. RESULTS: Men of both projects had significantly higher systolic and diastolic blood pressure, BMI and waist circumference. In EH-UH 2 significantly more women had arterial hypertension and dyslipidemia,and more men suffered myocardial infarction. More HSK participants were in favour of pharmacists having a role in hypertension treatment (137 vs 34) than EH-UH 2 participants, and within EH-UH 2 there were statistically more negative answers, with women in majority (χ² = 4.74, p = 0.029). The results of the EH-UH 2 pointed out a significant more negative attitude towards MA (403 vs. 823, p < 0.001) with hypertensive participants being the majority against the mobile applications (60.5%, χ² = 47.6, p < 0.001). Education was the most common answer for the role of the pharmacists in hypertension treatment (22.8%). Smartphone ownership was higher in younger age groups in both projects, with a significant difference between the age groups. CONCLUSION: Pharmacists-led interventions (lifestyle support and adherence increasing programs) have to be individualized. This research showed the need to individualize the hypertension treatment approach to the different areas of Croatia, with less accessible area participants expressing the need for additional interventions in hypertension management.

Brain arteriovenous malformation is a type of high flow vascular malformation shunt in which blood flows from a feeding artery to a draining vein forming a connection called nidus (shunting arterioles/venous loops). They may not become clinically evident for several years. Other possible clinical presentations include headaches, seizures, and hemorrhage, which can be a vital complication. Case:Patient is a female child at age of 10 in good general condition who presented after a mild head trauma. Consequently, she had a headache, stiff neck and vomiting. All of these, led to contusi capitis diagnosis which indicated craniogram, emergency head CT and MR. In general, she is a well-being girl, with no other significant diseases in her or family history. During imaging studies AV-malformation was accidentally found on brain CT scans and proven on both MR and DSA. The AVM is located in ventral right cerebellum and its size is close to 3cm. The main feeders are a right AICA and the left Pica. Venous drainage occurs via an inferior vermian vein. Another finding is a bleeding occurred on the venous outflow. A treatment is justified due to the young age and the previous bleeding. Surgery is difficult in the base of skull location, radiation therapy is restricted in its efficiency due to the size. It is likely that transarterial embolization may lead to ischemic complication, specifically with regard to the close location of cranial nerves. However, there is no doubt that endovascular treatment can cure the patient by associating transvenous to transarterial embolization. Conclusion:Recent advances in medical imaging technologies such as CT scans, MRIs have a huge impact in modern medicine. When it is combined with the broad knowledge of clinical experts, it may result with better outcome compared to standard methods of diagnosis and treatment.

Objective:The aim of this study was to analyze the characteristics and changes in the ECG findings of adults with prehypertension (PHT) in a random sample of the general population included in the EH-UH 1 project.Design and method:Epidemiology of hypertension in Croatia 1 (EH UH-1) study is nation-wide survey on prevalence, awareness, treatment and control of hypertension (HT) in Croatia. In 2001–2003 a random sample of 1267 subjects were enrolled. Mortality data were analyzed after average period of 17 years. In this sub-analysis we included 189 untreated subjects whom GPs did an ECG. Subjects were divided into 3 groups: optimal blood pressure (OBP) < 120/80 mmHg (N = 42), PHT 120–139/80–89 mmHg (N = 78) and untreated HT (UHT) > = 140/90 mmHg (N = 69).Results:Atrial fibrillation was found in 2%, 3% and 4% in OBP, PHT and UHT group, respectively (PHT vs OBP p < 0.05). QTc interval was prolonged in 2%, 13% and 65% in OBP, PHT and UHT group, respectively (PHT vs OBP p < 0.05; UHT vs PHT p < 0.01). Tpe interval was elevated in 12%, 14% and 17% in OBP, PHT and UHT group, respectively. Left ventricular hypertrophy (Cornell) was diagnosed in 5%, 9%, and 13% in OBP, PHT and UHT group, respectively (PHT vs OBP p < 0.05; PHT vs UHT p < 0.05).Conclusions:Gradual increases in ECG changes were observed across BP groups. Even in this small cohort, we observed significantly more pathological ECG findings in the PHT group than in subjects with OBP. ECG is of utmost importance in risk stratification of subjects with PHT and helpful, simple and cheap tool in making decision how to treat PHT patient. ECG should be recorded in all subjects with PHT.