Zvonimir Puljiz

University Clinical Hospital Center "Sestre Milosrdnice", Zagrabia, Grad Zagreb, Croatia

Are you Zvonimir Puljiz?

Claim your profile

Publications (12)6.37 Total impact

  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Senile lentigo or age spots are hyperpigmented macules of skin that occur in irregular shapes, appearing most commonly in the sun-exposed areas of the skin such as on the face and back of the hands. Senile lentigo is a common component of photoaged skin and is seen most commonly after the age of 50. There are many disscusions on whether senile lentigo represents a melanoma precursor, namely lentigo maligna melanoma and, if there is a need for a regular follow up in cases of multiple lesions. Clinical observations sometimes report that in the location of the newly diagnosed melanoma, such lesion preexsisted. On contrary, some authors believe that senile lentigo represents a precursor of seborrheic keratosis, which does not require a serious medical treatment. However, the observation of the possible association of senile lentigo with the melanoma development makes us cautious in the assessment of this lesion. Histologically, there are elongated rete ridges with increased melanin at the tips, and the number of melanocytes is not increased. The dermatoscopic features are also distinctive. If the lesion becomes inflammed it may evolve into benign lichenoid keratosis. Cryotherapy and laser treatment are common therapeutic approaches. Sun protection creams may be useful in early lesions.
    Collegium antropologicum 04/2010; 34 Suppl 2:85-8. · 0.61 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Ovarian leiomyoma is a rare benign tumor that accounts for 0.5 to 1% of all benign ovarian tumors. It probably arises from smooth muscle cells in the ovarian hilar blood vessels but there are other possible origins including cells in the ovarian ligament, smooth muscle cells or multipotential cells in the ovarian stroma, undifferentiated germ cells, or cortical smooth muscle metaplasia. Additionally, smooth muscle metaplasia of endometriotic stroma, smooth muscle present in mature cystic teratomas, and smooth muscle in the walls of mucinous cystic tumor may explain their occurrence in the ovary in some cases. A 31-year-old woman was admitted to our surgical emergency service with a one-day history of appendicitis-like symptoms. Upon laparotomy, there was a solid, oval left-sided ovarian tumor located behind the uterus. The tumor was sent to the pathology department. A diagnosis of primary ovarian leiomyoma associated with an endometriotic cyst was established. The origin of ovarian leiomyoma is still unresolved. In our case, the tumor probably arose from smooth muscle cells derived from myofibroblasts that originate from metaplastic ovarian stromal cells present in the rim of the endometriotic cyst. Despite its rarity, ovarian leiomyoma should be considered in the differential diagnosis of ovarian spindle cell tumors. Appropriate diagnosis may require additional immunohistochemical analysis in some cases.
    Diagnostic Pathology 08/2009; 4:25. · 1.85 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: All follow up protocols for patients with malignant melanoma (MM) are oriented to early detection of metastases. As most of the relapses happened in regional lymph nodes, special attention is given to this region, using different diagnostic tools. Sentinel lymph node biopsy (SLNB) is generally accepted method in determining status of lymph nodes in MM patients, in their staging. This method provides valuable prognostic information, facilitates early therapeutical lymphadenectomy and so provides good base for identification of those patients who are candidates for different adjuvant modalities of treatment. (In 2001 American Joint Committee on Cancer introduced new staging system for melanoma patients which presents good frame for prognosis and therapeutical approach. Inclusion of new criteria will allow better and more individualized prognosis and treatment.) The most important predictor of SLNB outcome is thickness of tumor according to Breslow, while there is no sufficient data to show correlation with other factors. We retrospectively studded 431 patients, out of which SLNB was performed on 188. Forty patients or 21.3% had positive lymph nodes. Our results showed strong correlation of tumor thickness and Clark level of invasion with SLNB outcome. Metastatic lymph nodes were founded in all acral-lentiginous melanoma patients, followed by nodular melanoma--55.6% and superficial spreading melanoma--14.1%. Results showed statistically significant predilection of positive SLNB in male patients and no correlation of positive SLNB with histological type of tumor. On the contrary, it showed significant correlation with development of metastases. Thus our results are similar to other comparable studies.
    Collegium antropologicum 11/2008; 32 Suppl 2:57-60. · 0.61 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The purpose of the present study was to evaluate and compare the long-term results of operative treatment of a multifragment fracture of the inferior patellar pole by basket plate osteosynthesis and partial patellectomy. We retrospectively studied two groups of patients who had operative treatment of a multifragment fracture of the inferior patellar pole between 1988 and 2004. Seventy-one patients who had osteosynthesis by basket plate (Group 1) and 49 patients who had partial patellectomy (Group 2) were followed for an average of 5.3 years. The final evaluation was based on the modified Cincinnati Knee rating system test. The results were excellent or good in 90.1% patients of Group 1, and 73.5% patients of Group 2. Significant differences between the groups were noted with regard to knee pain, swallowing, level activity, compression pain, range of motion, muscular atrophy, muscular strength, and final patellofemoral score which confirms statistical analysis. The stability of the osteosynthesis by basket plate allows osseous consolidation of the fracture and permits immediate mobilization and early weight bearing. Osteosynthesis by basket plate can provide better clinical results.
    Archives of Orthopaedic and Trauma Surgery 05/2008; 128(4):403-8. · 1.36 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: All follow up protocols for patients with malignant melanoma (MM) are oriented to early detection of metastases. As most of the relapses happened in regional lymph nodes, special attention is given to this region, using different diagnostic tools. Sentinel lymph node biopsy (SLNB) is generally accepted method in determining status of lymph nodes in MM patients, in their staging. This method provides valuable prognostic information, facilitates early therapeutical lymphadenectomy and so provides good base for identification of those patients who are candidates for different adjuvant modalities of treatment. (In 2001 American Joint Committee on Cancer introduced new staging system for melanoma patients which presents good frame for prognosis and therapeutical approach. Inclusion of new criteria will allow better and more individualized prognosis and treatment.) The most important predictor of SLNB outcome is thickness of tumor according to Breslow, while there is no sufficient data to show correlation with other factors.We retrospectively studded 431 patients, out of which SLNB was performed on 188. Forty patients or 21.3% had positive lymph nodes. Our results showed strong correlation of tumor thickness and Clark level of invasion with SLNB outcome. Metastatic lymph nodes were founded in all acral-lentiginous melanoma patients, followed by nodular melanoma – 55.6% and superficial spreading melanoma – 14.1%. Results showed statistically significant predilection of positive SLNB in male patients and no correlation of positive SLNB with histological type of tumor. On the contrary, it showed significant correlation with development of metastases. Thus our results are similar to other comparable studies.
    Collegium Antropologicum (croantro@inantro.hr ); Vol.32 No.Supplement 2. 01/2008;
  • [show abstract] [hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the basket plate in the treatment of comminuted fractures of the distal pole of the patella (patellar apex fracture). The basket plate was designed by Smiljanić Branimir M.D., Clinical Professor of Surgery, at the Department of Surgery, The University Hospital Sestre milosrdnice, Zagreb, Croatia. In the period from 1988 to 2003, more than 100 patients with comminuted patellar apex fractures had been treated with basket plate osteosynthesis in the Department of Surgery. Only 51 patients were subsequently available for knee examination. For evaluation of the knee, we used a modified Cincinnati knee rating system, using a manual dynamometer in the evaluation of the knee extension. The results were excellent in 30 patients, good in 16 and satisfactory in 5 patients; no poor results were observed. The stability of the osteosynthesis by basket plate allows osseous consolidation if the fracture and permits loading the leg with full body weight early in the postoperative period.
    Injury 07/2006; 37(6):525-30. · 1.93 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: The aim of the study was to assess functional status of the knee extensor system in the late postoperative period (at least two years of the operation and implant removal) in patients submitted to basket plate osteosynthesis for transverse or comminuted fracture of the apex of patella. The study included 71 patients with comminuted patellar apex fracture who had undergone basket plate osteosynthesis. The status of the knee extensor system was evaluated by a modified Cincinnati test. Excellent results were recorded in 59.2%, good in 30.6% and satisfactory in 10.2% of study patients. There were no poor results. In addition to ensuring osteosynthesis stability and the potential of early weight bearing, basket plate osteosynthesis meets the requirements of modern traumatology and the authors are inclined to consider it the method of choice to treat comminuted or transverse fractures of the apex of patella.
    Acta Clinica Croatica; Vol.43 No.3.
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: The aim of the study was to evaluate the status of all soft tissue and osseous structures by magnetic resonance imaging (MRI) in patients with acute ankle injury. During a two-year period (2001-2003), 50 patients with acute ankle injury (osseous injury excluded by conventional radiography) underwent MRI evaluation within 7 days of injury infliction. The following injuries were confirmed: joint effusion, joint capsule extension, lateral collateral ligament injury, fibular malleolus infraction, flexor hallucis longus tendon injury, brevis and longus peroneus tendon injury, infraction of talus and injury of tibiofibular syndesmosis. Study results pointed to a great variety of capsule-ligament andosseous structure injuries as well as to the existence of injuries undetectable by clinical examinationi and conventional radiography, where MRI proved highly useful in identifying selected patients sustaining ankle injury.
    Acta Clinica Croatica; Vol.44 No.1.
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Chronic venous insufficiency is a major health and socioeconomic issue throughout the world. Some 2%-5% of the adult population suffers from chronic venous insufficiency, while about 1% of the European population has chronic leg ulceration. The role of retrograde blood flow through incompetent perforating veins has an important role in the development of chronic venous insufficiency. Duplex ultrasound imaging is the preferred diagnostic tool, which is used to confirm the presence of bidirectional flow through the perforators adjacent to the areas of lipodermatosclerosis, healed ulcers and open ulcerations, i.e. in patients with chronic venous insufficiency CEAP class 4, 5 and 6. Subfascial endoscopic perforating vein surgery (SEPS) is a minimally invasive surgical procedure, which is the treatment of choice in these patients. The endoscope and surgical instruments are introduced through skin incisions that are distant from the areas of skin changes. The perforating veins are excellently visualized, while clipping and dividing the perforators interrupt retrograde blood flow. In patients with insufficiency of the superficial venous system, ligation and stripping of the superficial veins are usually performed at the same time. The lesser saphenous vein can be occluded with SEPS itself. The healing time with SEPS is substantially decreased when compared with conventional treatment and carries low complication and recurrence rates. However, SEPS should be offered to selected patients, i.e. to those with chronic venous insufficiency CEAP class 4, 5 and 6.
    Acta Clinica Croatica; Vol.42 No.4.
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Bile duct injury is one of the most severe complications of cholecystectomy. Several multi-center studies have demonstrated these injuries to be more commonly associated with laparoscopic cholecystectomy than with open cholecystectomy. During a 7-year period, from January 1995 till December 2001, 4528 patients underwent cholecystectomy at the University Department of Surgery, Sestre milosrdnice University Hospital in Zagreb, Croatia. Laparoscopic cholecystectomy was performed in 2657 (58%) of these patients. Bile duct injury was recorded in 15 (0.33%) patients, three (0.16%) of them submitted to open cholecystectomy. Of the latter, partial transsection of the common bile duct occurred in two patients and complete transsection in one patient. In the series of patients with laparoscopic cholecystectomy, bile duct injury occurred in 12 (0.45%) patients, with complete transsection of the common bile duct observed in five, partial transsection in three, and bile duct injury with a metal clip in three patients. Common bile duct stricture without apparent intraoperative injury developed in one patient during the late postoperative period. All these 15 patients with iatrogenic bile duct injury that occurred during either open or laparoscopic cholecystectomy were surgically managed. Roux-en-Y choledochojejunostomy was performed in nine patients, whereas the remaining six patients underwent common bile duct reconstruction by creating a terminoterminal anastomosis and T-tube insertion. Stricture of the anastomosis in the late postoperative period developed in five of these patients, who underwent secondary reconstruction of biliary continuity by Roux-en-Y choledochojejunostomy.
    Acta Clinica Croatica; Vol.42 No.3.
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Senile lentigo or age spots are hyperpigmented macules of skin that occur in irregular shapes, appearing most commonly in the sun- exposed areas of the skin such as on the face and back of the hands. Senile lentigo is a common component of photoaged skin and is seen most commonly after the age of 50. There are many disscusions on whether senile lentigo represents a melanoma precursor, namely lentigo maligna melanoma and, if there is a need for a regular follow up in cases of multiple lesions. Clinical opservations sometimes report that in the location of the newly diagnosed melanoma, such lesion preexsisted. On contrary, some authors believe that senile lentigo represents a precursor of seborrheic keratosis, which does not require a serious medical treatment. However, the opservation of the possible association of senile lentigo with the melanoma development makes us cautious in the assessment of this lesion. Histologically, there are elongated rete ridges with increased melanin at the tips, and the number of melanocytes is not increased. The dermatoscopic features are also distinctive. If the lesion becomes inflammed it may evolve into benign lichenoid keratosis. Cryotherapy and laser treatment are common therapeutic approaches. Sun protection creams may be useful in early lesions.
    Collegium Antropologicum (croantro@inantro.hr ); Vol.34 supplement 2 No.2.
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Achalasia is a relatively uncommon gastrointestinal disorder characterized by the absence of normal peristalsis of the esophagus and markedly diminished or absent relaxation of the lower esophageal sphincter during swallowing, caused by degenerative changes of parasympathetic innervation. All treatment modalities are palliative and include drug administration, endoscopic injection of botulinum toxin into the lower esophageal sphincter, pneumatic balloon dilatation, and surgery. Surgery offers the best long term results and may be performed as an open or endoscopic procedure, the latter yielding excellent results accompanied by all well-known advantages of minimally invasive surgery. Presentation is made of a patient with esophageal achalasia who was treated with balloon dilatation and laparoscopic esophagomyotomy.
    Acta Clinica Croatica; Vol.43 No.3.