The aim of this study was to assess nurses' and physicians' ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N=364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life decisions for physicians (27%). The main ethical issue is limiting life-sustaining therapy (nurses 15%, physicians 24%) and euthanasia and physician-assisted suicide (nurses 16%, physicians 9%). The types of help available are similar for nurses and physicians: obtaining complete information about the patient (37% vs. 50%) and clarifying ethical issues (31% vs. 39%). Nurses and physicians experience similar ethical dilemmas in clinical practice. The usage of clinical ethics consultations is low. It is recommended that the individual and team consultations should be introduced in Croatian clinical ethics consultations services.

Introduction Disordered voice quality could be a symptom of multiple sclerosis (MS). The impact of MS on voice-related quality of life is still controversial. Objectives The aim of this study was to compare the results of voice self-assessment with the results of expert perceptual assessment in patients with MS. Methods The research included 38 patients with relapse-remitting MS (23 women and 15 men; ages 21 to 83, mean = 44). All participants filled out a Voice Handicap Index (VHI), and their voice sample was analyzed by speech and language professionals using the Grade Roughness Breathiness Asthenia Strain scale (GRBAS). Results The patients with MS had significantly higher VHI than control group participants (mean value 16.68 ± 16.2 compared with 5.29 ± 5.5, p = 0.0001). The study established a notable level of dysphonia in 55%, roughness and breathiness in 66%, asthenia in 34%, and strain in 55% of the vocal samples. A significant correlation was established between VHI and GRBAS scores (r = 0.3693, p = 0.0225), and VHI and asthenia and strain components (r = 0.4037 and 0.3775, p = 0.012 and 0.0195, respectively). The female group showed positive and significant correlation between claims for self-assessing one's voice (pVHI) and overall GRBAS scores, and between pVHI and grade, roughness, asthenia, and strain components. No significant correlation was found for male patients (p > 0.05). Conclusion A significant number of patients with MS experienced voice problems. The VHI is a good and effective tool to assess patient self-perception of voice quality, but it may not reflect the severity of dysphonia as perceived by voice and speech professionals.

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We present a case series of five patients who were diagnosed in our institution with rare tumors of neuroectodermal origin. They were discovered within 1 year, by two otorhinolaryngologists at the county hospital which covers the area of about 1,00,000 inhabitants. Neuroectodermal tumors of the head and neck are rare pathologies, with extremely varied clinical behavior, treatment and prognosis. The lack of symptom specificity, the low incidence of these tumors and the difficulties associated with histopathology are main reasons for delayed diagnosis and treatment. We point out that rare tumors, if considered individually, have a low incidence, some even negligible, but the pathology detected hundreds of types which increases the likelihood that we will encounter some of them in our practice. Second, the practice in medicine does not always follow the statistical and mathematical probabilities but should take into account less possible occurrences. How to cite this article Bauer V, Aleric Z, Jancic E, Bujas T. Rare Tumors of the Neuroectodermal Origin: Report of Five Cases. Int J Head Neck Surg 2012;3(2):108-111.

Dana 3. studenoga 1969. započeo je s radom novootvoreni Odjel za neuropsihijatriju tadašnjega Medicinskog centra Karlovac, čime je omogućen sveobuhvatan i suvremen pristup osobama sa psihičkim smetnjama. Otvorenju je prethodio završetak izgradnje prve etape nove karlovačke Bolnice na Švarči. Do tada je psihijatrijska skrb bila insuficijentna, unatoč entuzijazmu pojedinaca poput dr. Andrije Štampara koji je 1912. i 1913. djelovao u Karlovcu. Prvo desetljeće rada Odjela obilježilo je opterećenje „miješanjem“ psihijatrijske i neurološke kazuistike, ali i vodstvo erudita, prim. dr. Dražena Neimarevića. Poboljšanje uvjeta rada uslijedilo je 1980. osnivanjem zasebnih odsjeka, a dodatni pomaci u skrbi realiziraju se osnivanjem dnevnih bolnica za alkohologiju i psihoterapiju. Kvalitetniji pristup pacijentima posebno se postiže osamostaljivanjem psihijatrijske službe 1994. godine. Početkom 21. stoljeća inovativni iskoraci učinjeni su otvaranjem prve ambulante za liječenje seksualnih poremećaja u Hrvatskoj te uspostavom jednog od prvih mobilnih psihijatrijskih timova u okviru nacionalne implementacije modela psihijatrije u zajednici. Obilježavajući 50. godišnjicu osnivanja Odjela za neuropsihijatriju Opće bolnice Karlovac, preostaje zahvaliti svima koji su dali svoj doprinos razvoju psihijatrijske službe. Na tim temeljima valja prilagođavati i poboljšavati pristupe osobama sa psihičkim smetnjama, a s ciljem njihova kvalitetnog oporavka i destigmatizacije. Na kraju, prateći prilike u hrvatskoj psihijatriji i paralelne procese u komparativnim ustanovama, prikaz „karlovačke Psihijatrije“ može poslužiti i kao ogledni primjer razvoja drugih ustanova u sličnim županijskim/regionalnim centrima.

Introduction:This report illustrates Croatia's experience with the terrorist attack in the city of Rijeka in October 1995. Also, the intention of this report is to outline how emergency services were functioning in this sudden-onset situation.Methods:The medical documentation of 27 wounded citizens in the attack was analyzed and the appearance of bodily wounds, severity of wounds, and the mechanisms of injury are described. From the forensic medical report, the wounds and damages sustained by the terrorist also were analyzed. All findings were compared with similar cases from around the world.Results:In the 27 wounded citizens, three (11%) had head injuries, and injuries of the abdomen in only two cases (7%) were found. The most common injuries sustained involved one or more extremities: 16 (59%) persons had wounds of an upper or lower extremity or a combination of multiple wounds. The main cause of death of the terrorist was explosive wounds to the chest and abdomen with destruction of multiple inner organs (primarily kidneys, liver, abdomen, and lung). Furthermore, the terrorist had a fracture of the skull base and multiple injuries to the brain.Conclusion:Comparing the findings with other data from the literature, the distribution in the percentages of wounded is almost the same as reported in many bomb attacks. In this case, the walls of the building protected many citizens, which is why so few were seriously injured. Forensic examination of the terrorist's body showed all of the characteristics of blast injuries.