A bimanual manipulation technique for establishing the CR position

In this work, we demonstrate a modern concept of the cr position. We analyze main characteristics of the central relation position from mechanical and physiological aspects. Furthermore, we discuss the bimanual manipulation technique on the lower jaw, required for balancinh procedures or investigation of premature contacts. Since an effective manipulation technique requires a combination of gentle yet firm digital pressure in a cranial direction., with a good sense of timing, clinician needs to have ! a mental picture of what is happening in TMJs and how are muscles affected by different movements and pressure. We have specifically presented instructions on firm-digital-pressure test. With this test it is possible to effectively verify the consistency of a certain cr position as well as to exclude the intra-articulating problems. Most of the time when the patient is tense and uncooperative, it is because the pressure is applied on the mandibule before the lower jaw is gently positioned into its most cranial position with separate dental arches. It seems, at least for now, that there are no procedures which can provide so much practical benefit for both the clinican and the patient at the same time, as can routine registration of the cr position and verification of its accuracy

COMBINED PENETRATING WOUNDS OF THE HEART, ABDOMEN AND TRUNK – CASE REPORT

Prikazan je četrdesetogodišnji muškarac s kombiniranim penetrirajućim ubodnim ozljedama lijevog prsišta, srca, trbuha i trupa nanesenima nožem. Izložena je klinička slika, tijek pružanja prve i sveobuhvatne kirurške pomoći ozlije|enomu s multiplim ubodnim ozljedama, upozoreno je na učinkovitost brze dijagnostike i kirurškog pristupa ubodnoj penetrirajućoj ozljedi srca, a iznesen je i postoperacijski tijek te konačni ishod liječenja.This is an overview of a forty-year-old male with combined penetrating knife inflicted stab wounds to the left chest, heart, abdomen and trunk. Presented are clinical manifestations, course of first aid and overall surgical help given to the injured with multiple stab wounds. Efficiency of rapid diagnostics and surgical approach to penetrating stab wound of the heart is pointed out. Postoperative course and definitive outcome of treatment are presented

COMBINED PENETRATING WOUNDS OF THE HEART, ABDOMEN AND TRUNK – CASE REPORT

Prikazan je četrdesetogodišnji muškarac s kombiniranim penetrirajućim ubodnim ozljedama lijevog prsišta, srca, trbuha i trupa nanesenima nožem. Izložena je klinička slika, tijek pružanja prve i sveobuhvatne kirurške pomoći ozlije|enomu s multiplim ubodnim ozljedama, upozoreno je na učinkovitost brze dijagnostike i kirurškog pristupa ubodnoj penetrirajućoj ozljedi srca, a iznesen je i postoperacijski tijek te konačni ishod liječenja.This is an overview of a forty-year-old male with combined penetrating knife inflicted stab wounds to the left chest, heart, abdomen and trunk. Presented are clinical manifestations, course of first aid and overall surgical help given to the injured with multiple stab wounds. Efficiency of rapid diagnostics and surgical approach to penetrating stab wound of the heart is pointed out. Postoperative course and definitive outcome of treatment are presented

Evaluation of surgical care for polytraumatized patients suffering from major abdominal trauma using pati and triss methods

Uvod: U radu je predočena vrsnoća traumatološke skrbi vrjednovana metodama TRISS i PATI u odnosu na standarde ishoda u MTOS-u (Major Trauma Outcome Study). Bolesnici i metode: U deskriptivno-retrospektivnu studiju uključeni su politraumatizirani bolesnici s vodećom ozljedom abdomena zaprimljeni u hitnom prijatnu kirurškoga odjela Opće bolnice u Novoj Bili u razdoblju od 1. siječnja 2006. do 31. prosinca 2007. godine. Analizirano je preživljavanje operiranih bolesnika metodom TRISS i W, M i Z statistikom u svrhu usporedbe sa standardima MTOS-a, rizik razvoja poslijeoperativnih komplikacija metodom PATI. Rezultati: Većina bolesnika bili su muškarci (91,7 %) prosječne starosne dobi od 39,6 godina. Trećina bolesnika (33,3 %) ozljede su zadobili u prometnim nezgodama. Očekivano preživljavanje bilo je 86,4 %, dok je stvarno preživljavanje bilo 86,1 %. W vrijednost iznosila je - 0,268, M vrijednost 0,822 i Z vrijednost 0,074 (p < 0,05). Indeks penetrantnih abdominalnih ozljeda bio je 17,6 22,5. Zaključak: Z vrijednost 0,074 kazuje da nema statistički značajne razlike između očekivanoga i stvarnoga preživljavanja. Izvedba kirurške skrbi u bolnici odgovara standardima MTOS-a.Introduction: This study presents the quality of trauma care evaluated by TRISS and PATI methods in relation to the standards of outcomes in MTOS (The Major Trauma Outcome Study). Patients and Methods: Descriptive- retrospective analysis includes polytraumatized patients with a major abdomen injury who were hospitalized in the emergency room of the Department of Surgery in the General Hospital in Nova Bila in the period from 1 January, 2006 to 31 December, 2007. The survival of surgically treated patients was analyzed using TRISS method and W, M and Z statistics with the purpose of comparison with MTOS standards, and the risk of development of postoperative complications was analyzed using PATI method. Results: Most of the patients were men (91,7%) with an average age of 39,6. One third of patients (33,3%) were injured in traffic accidents. Predicted survival was 86,4%, while the actual survival was 86,1%. W equals -0,268, M equals 0,822 and Z equals 0,074 (p< 0,05). Penetrating abdominal trauma index (PATI) was 17,6 22,5. Conclusion: Z statistics 0,074 indicate that there is no statistically considerable difference between the real and predicted survival. Surgical care in hospital suits MTOS standards

Evaluation of surgical care for polytraumatized patients suffering from major abdominal trauma using pati and triss methods

Uvod: U radu je predočena vrsnoća traumatološke skrbi vrjednovana metodama TRISS i PATI u odnosu na standarde ishoda u MTOS-u (Major Trauma Outcome Study). Bolesnici i metode: U deskriptivno-retrospektivnu studiju uključeni su politraumatizirani bolesnici s vodećom ozljedom abdomena zaprimljeni u hitnom prijatnu kirurškoga odjela Opće bolnice u Novoj Bili u razdoblju od 1. siječnja 2006. do 31. prosinca 2007. godine. Analizirano je preživljavanje operiranih bolesnika metodom TRISS i W, M i Z statistikom u svrhu usporedbe sa standardima MTOS-a, rizik razvoja poslijeoperativnih komplikacija metodom PATI. Rezultati: Većina bolesnika bili su muškarci (91,7 %) prosječne starosne dobi od 39,6 godina. Trećina bolesnika (33,3 %) ozljede su zadobili u prometnim nezgodama. Očekivano preživljavanje bilo je 86,4 %, dok je stvarno preživljavanje bilo 86,1 %. W vrijednost iznosila je - 0,268, M vrijednost 0,822 i Z vrijednost 0,074 (p < 0,05). Indeks penetrantnih abdominalnih ozljeda bio je 17,6 22,5. Zaključak: Z vrijednost 0,074 kazuje da nema statistički značajne razlike između očekivanoga i stvarnoga preživljavanja. Izvedba kirurške skrbi u bolnici odgovara standardima MTOS-a.Introduction: This study presents the quality of trauma care evaluated by TRISS and PATI methods in relation to the standards of outcomes in MTOS (The Major Trauma Outcome Study). Patients and Methods: Descriptive- retrospective analysis includes polytraumatized patients with a major abdomen injury who were hospitalized in the emergency room of the Department of Surgery in the General Hospital in Nova Bila in the period from 1 January, 2006 to 31 December, 2007. The survival of surgically treated patients was analyzed using TRISS method and W, M and Z statistics with the purpose of comparison with MTOS standards, and the risk of development of postoperative complications was analyzed using PATI method. Results: Most of the patients were men (91,7%) with an average age of 39,6. One third of patients (33,3%) were injured in traffic accidents. Predicted survival was 86,4%, while the actual survival was 86,1%. W equals -0,268, M equals 0,822 and Z equals 0,074 (p< 0,05). Penetrating abdominal trauma index (PATI) was 17,6 22,5. Conclusion: Z statistics 0,074 indicate that there is no statistically considerable difference between the real and predicted survival. Surgical care in hospital suits MTOS standards

ANALYSIS OF TIME SERIES FOR THE CURRENCY PAIR CROATIAN KUNA / EURO

The domestic currency Croatian kuna (HRK) was introduced in May 1995. To date, the Croatian National Bank (HNB), as a regulator and formulator of monetary policy in Croatia has operated a policy of stable exchange rate, typically referenced to the formal currency of the European Union euro (EUR). From the date of introduction of the euro 01/01/1999 until 01/01/2016 the value of the currency pair HRK / EUR changed in value by only 4.25% (HNB). Although the value of the Croatian kuna is relatively stable, there are some fluctuations on an annual level (e.g. in ­­­the last few years because of the global crisis) as well as  on periodic levels within a year. The aim of this paper is to show the movement of the value of the currency pair since the beginning of 2002 to the present day (the time curve), analyze the correctness, trends and periodicity (seasonal behavior), if any exist.The research will be done using the method of Time Series Analysis, assuming that the external (global economy) and internal factors (economic policy) remain similar or the same. According to the results, further assessment of price developments in the period followed will be made by using the obtained predicative models. In the event that the curve contains the component of periodicity, the observed patterns will be studied further

The Validity of ESIN Method of Osteosynthesis Compared to other Active Surgical Methods of Treatment of Diaphyseal Fractures of Long Bones in Children and Adolescents

We investigated the relationship of efficiency in the application of the ESIN method of intramedullary osteosynthesis and other active surgical methods in the treatment of diaphyseal fractures of long bones in children and adolescents. The study comprised 100 subjects treated by elastic stable intramedullary osteosynthesis (ESIN – group A) and 50 subjects in whom other active surgical methods were applied (group B). The following criteria of efficiency of treatment were applied: 1. length of perioperative hospitalization, 2. time elapsed since the operation until the beginning of loading of the traumatized extremity, 3. time elapsed since the operation until the full loading of the extremity, i.e. until the recovery of the fracture, 4. incidence of complications, 5. number of post-operative outpatient clinical visits until the recovery of the fracture and 6. overall number of X-ray images of the fractured bone since the accident until the coalescence of the fracture. The results obtained in both groups were compared. 1. The length of perioperative hospitalization is shorter in patients in whom ESIN method was applied. The difference between arithmetic means was 4.45 days and is statistically significant (p<0.001). 2. The time between the operation until the beginning of loading of the extremity is shorter in patients subjected to ESIN method of osteosynthesis, the difference of mean values being 23.49 days and is statistically significant (p<0.001). 3. The time between the operation until the full loading of the extremity is shorter in patients subjected to ESIN method of osteosynthesis, the difference being 16.6 days and is statistically significant (p<0.001). 4. The number of complications in patients treated by the ESIN method of osteosynthesis is not statistically different from that in group B (÷ 2=0.25, p=0.62). 5. In postoperative period there were fewer outpatient controls in patients to whom ESIN method of osteosynthesis was applied, and the difference is statistically significant (Z=7.69, p<0.001). 6. Likewise, the overall number of X-ray controls was lesser (Z=8.06, p<0.001). The results of examining the above parameters point to a greater efficiency of treating diaphyseal fractures of long bones in children and adolescents by the ESIN method of osteosynthesis, compared to other active surgical methods

Gingivni i dentalni parametri u proceni estetskih obeležja fiksnih nadoknada - I deo

This paper argues on importance of gingival and dental parameters in evaluation of esthetic characteristics of fixed restorations. Human beauty is a specific category which is not easy to define by means of any known criteria or with mathematic formula. But, it is also important for practitioners to take into consideration some objective rules determining what is really nice and appealing. In reconstructing the personal identity, it is essential to harmonize the esthetic features. In dental practice, this approach means to establish a close correlation among the facial, dental, gingival and physical components of orofacia! system. For the purpose of this study, the authors have divided the overview of esthetic principles into two parts. The first one deals with some objective parameters such as: gingival health, the zenith of gingival contour, the balance of gingival levels, relative tooth dimensions, the golden proportion of the teeth, the design of dental arch, interdental contact areas, interdental closure, the contour of incisal edge and the shape of interincisal angles. The esthetic integration of these parameters into a frame of smile and the whole face, as well as some subjective criteria are discussed in the second part of the paper.Dentalni i gingivni parametri imaju veliki značaj u proceni estetskih obeležja fiksnih nadoknada. Činjenica da je ljudska lepota kategorija koja se ne može apsolutno definisati ni brižljivo odabranim kriterijuma, ni matematičkim formulama ipak ne zatvara vrata razmišljanju da postoji nešto što se zove objektivno važenje, saglasnost o tome šta jeste, a šta nije lepo. U želji da se sačuva ili rekonstruiše identitet jedinke, usklađivanje estetskih obeležja je od ogromne važnosti. U stomatološkom radu ovo podrazumeva uspostavljanje bliske komunikacije između facijalnih, dentalnih, gingivnih i fizičkih komponenti orofacijalnog sistema. s obzirom na složenost aktuelne problematike, autori su podelili naznačenu temu na dva dela. Ovi komplementarni delovi se bave sveobuhvatnim razmatranjima velikog broja objektivnih i subjektivnih faktora koji determinišu validnost dentalne kompozicije rekonstruisane fiksnim nadoknadama

Intermediate cervical plexus block for carotid endarterectomy in high risk patients

Background and Purpose: Regional anesthesia is the choice for patients undergoing preventive open carotid surgery. Recently intermediate cervical plexus block has been described as a reliable and safe anesthesia technique in comparison with superficial and deep cervical plexus block. The aim of our study was to assess the complications of intermediate cervical plexus block in high risk patients. Materials and Method: The study was performed in 29 ASA III and ASA IV patients with the intermediate cervical plexus block for carotid endarterectomy from January 2006 till November 2008 in the University Hospital Zagreb. The following data were collected: age, sex, ASA status and preoperative disease. Furthermore, intraoperative and postoperative complications associated with intermediate cervical plexus block and carotid endarterectomy were recorded. Results: Median age was 69 years (range, 46 – 82 years). One patient developed Horner’s syndrome, three patients developed transitory ischemic attack, one developed stroke intraoperatively and died, seven patients developed transitory hemodynamic instability, one was hypotensive in the postoperative period and required vasoactive support. Conclusion: Intermediate cervical plexus block is safe and effective for carotid endarterectomy in high risk patients

Kompjuterska analiza okluzije kod osoba sa bruksizmom

Introduction. Sleep bruxism as nocturnal parafunction, also known as tooth grinding, is the most common parasomnia (sleep disorder). Most tooth grinding occurs during rapid eye movement - REM sleep. Sleep bruxism is an oral habit characterized by rhythmic activity of the masticatory muscles (m. masseter) that causes forced contact between dental surfaces during sleep. Sleep bruxism has been associated with craniomandibular disorders including temporomandibular joint discomfort, pulpalgia, premature loss of teeth due to excessive attrition and mobility, headache, muscle ache, sleep interruption of an individual and problems with removable and fixed denture. Basically, two groups of etiological factors can be distinguished, viz., peripheral (occlusal) factors and central (pathophysiological and psychological) factors. The role of occlusion (occlusal discrepancies) as the causative factor is not enough mentioned in relation to bruxism. Objective. The main objective of this paper was to evaluate the connection between occlusal factors and nocturnal parafunctional activities (occlusal disharmonies and bruxism). Method. Two groups were formed- experimental of 15 persons with signs and symptoms of nocturnal parafunctional activity of mandible (mean age 26.6 years) and control of 42 persons with no signs and symptoms of bruxism (mean age 26.3 yrs.). The computerized occlusal analyses were performed using the T-Scan II system (Tekscan, Boston, USA). 2D occlusograms were analyzed showing the occlusal force, the center of the occlusal force with the trajectory and the number of antagonistic tooth contacts. Results. Statistically significant difference of force distribution was found between the left and the right side of the arch (L%-R%) (t=2.773; p lt 0.02) in the group with bruxism. The difference of the centre of occlusal force - COF trajectory between the experimental and control group was not significant, but the trajectory of COF was longer in the group of bruxists (67.3±24.4mm). In addition, the significant difference of COF position in relation to the center of the elliptic fields was not found in bruxists (χ2=1.63; p> 0.05), but obtained results directly revealed uneven distribution of the occlusal forces which caused the excessive attrition and mobility of tooth. Conclusion. Our study failed to find direct correlation between occlusal factors and bruxism, so they are basically contributing factors.Uvod. Bruksizam je noćna parafunkcionalna aktivnost mandibule i svrstava se u parasomniju ili poremećaj spavanja. Javlja se u REM fazi sna u vidu ritmične hiperaktivnosti mastikatornih mišića (m. masseter) koja destruktivno deluje skoro na sve komponente orofacijalnog sistema. Posledice ovog fenomena su trošenje zubnog tkiva, bol usled spazma mišića, miogene i artrogene disfunkcije sa mogućim degenerativnim intrakapsulnim promenama, pulpalgija, oboljenja parodoncijuma, glavobolje, naročito u jutarnjim časovima, i problemi različite prirode na pokretnim i fiksnim zubnim nadoknadama (trošenje akrilatnih zuba i akrilatnih faseta). U etiologiji bruksizma najčešće učestvuju periferni okluzalni i centralni psihogeni faktori. Uloga okluzije u etiologiji bruksizma nije dovoljno istražena niti definisana. Cilj rada. Cilj istraživanja je bio da se utvrdi veza između okluzalnih disharmonija i bruksizma, odnosno da se proceni značaj okluzije u nastanku bruksizma. Metod rada U istraživanje su uključene eksperimentalna i kontrolna grupa ispitanika. Eksperimentalnu grupu činilo je 15 ispitanika s evidentnim znacima i simptomima bruksizma, prosečne starosti od 26,6 godina, a kontrolnu grupu 42 osobe s izostankom bruksizma, prosečne starosti od 26,3 godine. Okluzija je analizirana kompjuterski, T-Scan II sistemom. Na dvodimenzionalnim kompjuterskim okluzogramima komentarisani su sledeći parametri: okluzalna opterećenja, centar okluzalnih sila i njegova putanja i broj antagonističkih parova zuba. Rezultati Kompjuterska analiza okluzije ukazuje na značajne razlike u opterećenju leve i desne strane (L%-D%) zubika (t=2,773; p lt 0,02) u korist ispitanika sa bruksizmom. Razlika u trajektorijumu centra okluzalnih sila (COF) nije značajna, ali je kod osoba sa bruksizmom trajektorijum COF duži (67,3±24,4 mm). Kod ispitanika sa bruksizmom takođe nije utvrđena statistički značajna razlika u položaju COF u odnosu na centar eliptičnih polja (χ2= 1,63; p>0,05), međutim, dobijeni rezultati ukazuju na evidentno neuravnoteženo opterećenje okluzije kod njih. Zaključak. Na osnovu rezultata kompjuterske analize okluzije može se zaključiti da okluzalni faktor doprinosi nastanku bruksizma