Treatment of advanced peripheral arterial insufficiency in the elderly.

Peripheral arterial insufficiency appears at all stages regardless of the patient age; however its appearance is most common in the elderly in which cases it mostly appears as stage described by Fontaine as stage III or IV The most com- mon cause of peripheral arterial insufficiency is atherosclerotic degeneration, and is remarkably often accompanied by the diabetes. In the years 2012 and 2013 department of vascular surgery, University Hospital Rijeka admitted 169 patients older than 70 with peripheral arterial insufficiency of type Fontaine III and IV That number represents 68.8% of total number of patients admitted for peripheral arterial insufficiency. The goal of this research is to identify to what extent and in what percentage can patients older than 70 with advanced peripheral arterial insufficiency be subjected to vascular treatment and if there exist and absolute indication for angiographic treatment of such patients. In majority of patients, 148 of them, three or more comorbidities were present. Diabetes was present at almost half of patients, to be exact 46.7%. Assessment of possibility for vascular treatment and the need for angiographic treatment was followed in patients in three age groups: 70-75 years of age, 76-80 years of age and over 80 years of age. Angiography was performed on 69 patients and the insight into angiographic finding resulted in only 33 patients being subjected to some type of vascular treatment. From the total number of patient's subjected to vascular treatment 20 had symptoms of Fontaine III while the remaining 13 had symptoms of Fontaine IV Amputation procedure was performed 119 times. The research shows that angiograph- ic treatment is not a routine treatment in mentioned patients and that the number of vascular procedures is significantly higher in the 70-75 years age group.

Histopathology of the pterygium in population on Croatian Island Rab.

In the 1975-2004 period, 130 cases of pterygium were estimated, 83 males and 47 females, on a small island Rab. Island Rab is located in the north part of the Adriatic sea, which has very high index of sun radiation. Pterygium is usually histopathologically defined as a hyperplasia of conjunctival tissue, elastoid degeneration of subepithelieum and fragmentation of Bowman's membrane. Our histopathological findings in 73 eyes are following: conjunctiva with neovascularisation, leukocyte margination and subepithelial basophilic degeneration, proliferation of conjunctival tissue, acanthosis and squamous metaplasia, and mucinous elements, focaly present plasma cells, focuses of increased pigmentisation in basal epithelial layers, tenon capsule with edema, diffuse neovascularisation and fragmentation of fibrils. These findings suggest that in severe cases of pterygium histopathologically exists precancerosis. In conclusion, on the basis of these histopathological findings, especially in the Tenon capsule, we suggest that for surgical procedure of pterygium the excision of the Tenon capsule, extensively under pterygium, is necessary.