[Croatian Medical Association--Branch Bjelovar (1974-2014)]. / Hrvatski Lijecnicki Zbor--podruznica bjelovar (1974-2014).

For four decades, members of the Croatian Medical Association, Branch Bjelovar, continuously make efforts in the promotion of expertise and excellence in everyday professional work--more than 300 professional meetings and workshops have been organized in Bjelovar in the forementioned period. Branch members have been actively involved in a number of public health projects aimed at health education of the population.

Analysis of the key issues in the organization of emergency care for stroke and heart attack patients in Bjelovar-Bilogora County.

Emergency care for patients with acute ischemic stroke and acute myocardial infarction according to the principles of evidence-based medicine is a challenge for the healthcare system, as it requires a multidisciplinary approach and good cooperation of all the subjects involved. The time elapsed from symptom onset to patient admission to the hospital, and the period from admission to the hospital to the beginning of therapy play an essential role in the thrombolytic treatment of stroke. For the patient, effective functioning of the system can mean the difference between preserved functional independence and disability. In recent years in Bjelovar-Bilogora County, there has been some development in emergency care of patients with acute heart attack by applying thrombolytic therapy and organizing transfer of indicated cases to the nearest clinical department for invasive cardiologic therapy. In case of acute ischemic stroke, thrombolysis has so far remained the only method of causal treatment. Results of a retrospective study conducted in 2010 in Bjelovar General Hospital on 169 patients with the established time of ischemic stroke symptom onset showed that only 39.64% of patients reached the hospital for treatment within the target time window. The results indicated the need for continuous efforts in preventing cardiovascular and cerebrovascular disease, as well as for education of citizens and healthcare professionals in recognizing the early symptoms of stroke and understanding them as an emergency condition. The present situation calls for permanent education of health workers in first line contact, an increase in the number of neurologists and cardiologists, as well as the introduction of stroke units on the model of coronary units, with constant presence of specialists. The radiology and laboratory services need adjustment to enable performing diagnostic procedures within the given time limit. At the national level, a network of stroke units should be organized, which would eliminate distance to county hospitals as a limiting factor in effective treatment.

Lumboischialgia as the first sign of stomach cancer.

The paper reports on a case of a seventy-three-year-old male patient, whose disease was initially manifested by severe low back pain and lumboischialgia of the right leg as the first and only, and later, the leading symptom of disseminated adenocarcinoma of the stomach. The unusual presentation of stomach cancer confirms the necessity of simultaneous treatment of pain and determination of its etiology. It also indicates the need for re-evaluation of diagnosis when there is no favorable clinical effect of applied therapy.

Acute paroxysmal praecordial pain as a somatosensory elementary partial onset of epileptic seizure.

It presents a 60-year-old female patient with acute paroxysmal intensive pain attacks in the praecordial area that spread to the left hand and were associated with mild transient left hemiparesis, progressing to a myoclonic focal seizure in the region of left abdomen. The diagnostic procedure was interrupted several times by intensive pain attacks, but excluded acute thoracic pathological process, whilst a brain scan found a large, partially necrotic tumour with incipient bleeding and severe oedema subcortically in the right parietal lobe. We are describing a clinical presentation of symptomatic, simple focal, somatosensory epileptic seizure with dominance of intensive pain that progress in myoclonic, somatomotor focal seizure and Todd's Palsy as the first sign of glioblastoma bleeding.

Differential diagnosis of acute abdominal pain - acute intermittent porphyria.

Acute intermittent porphyria (AIP) is a rare autosomal dominant disorder of heme biosynthesis in liver due to deficiency of porphobilinogen deaminase enzyme. Clinically, AIP is dominated by a colicky type pain, which does not subside after taking usual analgesics. Additional frequent symptoms are vomiting, hypertension, peripheral neuropathy, seizures, depression, delirium and coma. This paper reported a case of a twenty-five- year-old female patient, who had undergone a period of six days between the first presentation to the medical department and the diagnosis confirmation. It has accentuated possible mistakes in symptomatic therapy administration as well as dangers of a delayed diagnosis.