Time trend and clinical pattern of extrapulmonary tuberculosis in Serbia, 1993-2007

Background/Aim. Increased incidence of extrapulmonary tuberculosis (XPTB) is reported worldwide. Serbia is a country in socio-economic transition period with lowmiddle HIV prevalence and intermediate-to-low tuberculosis (TB) incidence rate, 100% directly observed treatment (DOT) coverage, and mandatory BCG vaccination at birth. The aim of the study was to examine the incidence trend and clinical features of XPTB in Serbia during a 15-year period. Methods. This retrospective observational study included XPTB cases diagnosed in the period between 1st January 1993 and 31st Decembre 2007, according to the reports of the National Referral Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data. Results. While the overall TB incidence rate showed a slight, not significant decreasing trend (p = 0.535), a significant increase was found for XPTB (y = 1.7996 + 0.089x; R2 = 0.4141; p = 0.01). A total of 2,858 XPTB cases (newly diagnosed and 10% relapses) gave an average age specific incidence rate of 2.51/100,000 population (95% confidence interval, SD = 0.6182) with 8.9% annual increase. The male-to-female ratio was 0.54. Lymph nodes were most frequently affected site (48.5%) followed by genitourinary (20.5%), pleural (12%), and osseo-arthicular (10.3%) TB. Treatment outcome was successful in 88.29% of patients (cured and completed), 3.64% died, 5.18% interrupted, 0.57% displaced, and 2.3% unknown. Conclusion. Increasing trend of XPTB incidence rate may be a result of increased morbidity due to still present risk factors, possible higher detection rate in Serbia and better notification. A high coverage of newborns with BCG vaccination at birth might contribute to a decreased number and rare XPTB cases in children

The treatment of scaphoid nonunion using the Ilizarov fixator without bone graft, a study of 18 cases

<p>Abstract</p> <p>Objectives</p> <p>Evaluating the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft.</p> <p>Design</p> <p>A retrospective review of 18 consecutive patients in one centre.</p> <p>Patients and Methods</p> <p>18 patients; 17 males; 1 female, with a mean SNU duration of 13.9 months. Patients with carpal instability, humpback deformity, carpal collapse, avascular necrosis or marked degenerative change, were excluded. Following frame application the treatment consisted of three stages: the frame was distracted 1 mm per day until radiographs showed a 2-3 mm opening at the SNU site (mean 10 days); the SNU site was then compressed for 5 days, at a rate of 1 mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the third stage involved immobilization with the Ilizarov fixator for 6 weeks. The technique is detailed herein.</p> <p>Results</p> <p>Radiographic (CT) and clinical bony union was achieved in all 18 patients after a mean of 89 days (70-130 days). Mean modified Mayo wrist scores improved from 21 to 86 at a mean follow-up of 37 months (24-72 months), with good/excellent results in 14 patients. All patients returned to their pre-injury occupations and levels of activity at a mean of 117 days. Three patients suffered superficial K-wire infections, which resolved with oral antibiotics.</p> <p>Conclusions</p> <p>In these selected patients this technique safely achieved bony union without the need to open the SNU site and without the use of bone graft.</p

An aggressive chondroblastoma of the knee treated with resection arthrodesis and limb lengthening using the Ilizarov technique

This case report describes the management of a 15 year old male with a biologically aggressive chondroblastoma of the knee. Following CT, bone scan, angiography and an open biopsy, the diagnosis was confirmed histologically and immunohistochemically. The patient underwent a 13 cm en-bloc excision of the knee, and knee arthrodesis with simultaneous bone transport using an Ilizarov ring fixator. Following 136 days of bone transport, the patient achieved radiological and clinical bony union after a total frame time of 372 days. He then commenced 50% partial weight-bear in a protective knee brace and gradually worked up to full weight-bearing by 4 months. The patient developed superficial pin tract infections around the k-wires on 2 occasions; these settled with a cephalosporin antibiotic spray and local dressings. At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site. The patient is able to fully weight bear and stand independently on the operated leg. Knee arthrodesis with simultaneous limb-lengthening is an effective treatment modality following en-bloc resection of an aggressive chondroblastoma. The case is discussed with reference to the literature

Physicians founders of orthopedic surgery in Serbia

The beginnings of the development of orthopedic surgery in Serbia have been related to the name of Dr Nikola Krstic and his first radiography of the hand in 1908. The foundation of the Orthopedic Ward, led by Dr Nikola Krstic, within the General State Hospital in Belgrade, in 1919, marks the definition of orthopedics as a separate branch of surgery. In addition to Dr Nikola Krstic, Dr Borivoje Lalovic and Temp. Docent Dr Borivoje Gradojevic, who published the first orthopedics textbook in Serbian in 1934, also worked at the orthopedic ward between the two world wars. The work at the orthopedic ward, which grew into a clinic in 1947, was continued by Prof. Dr Milos Simovic, Prof. Dr Svetislav Stojanovic and Prof, dr Ljubisa Boric. Their successors would have high achievements: Prof. Dr Zivojin Bumbasirevic became the only orthopedist who was a regular member of the Serbian Academy of Sciences and Arts, and Chief of Staff Dr Predrag Klisic and Prof. Dr Branko Radulovic provide impetus for further development of orthopedics by founding Specialist Orthopedics Hospital "Banjica"

Main morphological characteristics of the vascular pedicle of latissimus dorsi muscle and their relevance in operative treatment

Introduction. Considering operative treatment of various pathological conditions and traumatic injuries of extremities latissimus dorsi flap presents the most frequently used flap in reconstructive surgery. Objective. The aim of this paper was to analyze anatomical characteristics of the vascular pedicle of the latissimus dorsi muscle followed by morphometric analyzes of vascular elements. Methods. This paper was carried out in cooperation with the Institute of Anatomy of the School of Medicine, University of Belgrade. The study was based on 40 cadaver dissections followed by anatomical and morphometric analyzes. The first analysis included the determination of thoracodorsal artery (TDA) origin and its lateral and terminal branches, and the second one the observation of artery path. Furthermore the same features were analyzed on the thoracodorsal vein. During morphometric analyzes artery and vein length and diameter were recorded. Results. Our results showed that TDA always contains one lateral branch, while three other lateral branches were inconstant. In most cases TDA terminated in two branches, upper and lower, with average distance of 3.4 cm from the muscle. The mean recorded pedicle length was 9.9 cm. The average inner diameter of TDA was 1.85 mm. In further analyses the average observed thoracodorsal vein length was 10.5 cm with mean diameter of 2.93 mm. The result showed that vein origin was usually represented with two branches. Conclusion. The thoracodorsal artery is a blood vessel of considerable length and diameter which represents a great advantage in reconstructive flap surgery

Epidemiological analysis of demographic characteristics and type of injuries in patients with multiple trauma with respect to conclusive treatment outcome

Introduction Multiple trauma is one of the leading causes of mortality and morbidity in the population of people under 45 years of age. The consequences of multiple trauma have huge epidemiological, social and economic significance. Objective The aim of the paper was to analyze the conclusive treatment outcome of multiply traumatized patients with respect to their sex, age, injury mechanism and type. METHOD This retrospective study included 100 patients with multiple injuries (ISS&gt;16) treated in the Emergency Room of the Clinical Centre of Serbia in the course of 2004. Clinical, X-ray, laboratory and numerical presentation methods - scores (ISS and GCS) were used to show the injury severity. Results Most of the injured were males (80%), and the average age was 40±20 (5-83). Out of the total number of patients who died, 23 (82%) were males, and 5 (18%) were females. The average age of the patients with fatal outcomes was 48±21 (8-86). Traffic accidents were the leading cause of injury (59%). The median GCS was 10±3 (3-15). The average ISS was 30 (20-66) in the surviving patients, and 53 (27-77) in those who died. Conclusion With respect to sex, in most cases multiple trauma affects males (p&lt;0.01), with the average age of about 40. With respect to injury mechanism, the main cause of the occurrence of multiple trauma is traffic accidents (p&lt;0.01). There is a statistically significant difference in the values of GCS and ISS relative to the definitive outcome (p&lt;0.01). Statistical data processing indicated that there was a statistically significant correlation between mortality and type of injury in a given organic system (p&lt;0.01), but that there was no statistically significant correlation between mortality and age.

The results of surgical and nonsurgical treatment of mallet finger

Introduction: The injury of the hand tendon classified as mallet finger presents the loss of continuity of the united lateral band of the extensor apparatus above distal interphalangeal joint, which consequently leads to specific deformity of distal interphalangeal joint which is called mallet (hammer) finger. Objective Our paper had several research Objectives: presentation of the existing Results of surgical and nonsurgical treatment of mallet finger deformities and comparison of our findings and other authors’ Results. Method: The study was retro-prospective, and analyzed 62 patients treated in the Clinical Center of Serbia in Belgrade (at the Institute of Orthopedic Surgery and Traumatology, and the Emergency Center) in the period 1998 to 2003. The follow up of these patients lasted at least 8 months (from 8.3 months to 71.7 months). An average follow up was 28.7 months. The Objective parameters used in the study were as follows: sex, age, dominating hand, hand injury, finger injury, mode of treatment, complications, distal interphalangeal joint flexion and total movement of the distal interphalangeal joint. Collected data were analyzed by χ2-test and Student’s t-test. The confidence interval was p=0.05. Results: A total range of motion was 51.9±6.6 for nonsurgically treated patients, and 48.2±4.2 degrees for operated patients. Mean extension deficit of the distal interphalangeal joint was 6.5±3.3 for nonsurgical and 10.0±3.2 for operated patients. Conclusion: The Results confirmed that nonsurgical mode of treatment of mallet finger deformity was much more successful than surgical Method of treating the same deformity

Sintetička karbonska proteza u rekonstrukciji prednjeg ukrštenog ligamenta kolena psa - radiološka i histološka slika

The biological response and strength of a reconstruction of the anterior cruciate ligament (ACL) by carbon fibers was investigated in the canine knee. The allografts were inserted to replace the ACL according to the technique recommended by the manufacturer of the carbon fiber prostheses. The clinical radiological and pathohis-tological picture of the neoligament and bone-neoligament-bone connections were evaluated at one, two and six months later. Clinically and radiologically the knee joints were stable, without degenerative changes. Pathohistologically there were marked fibrous tissue ingrowth between the carbon fibers. The canine knee is a suitable model for experimental knee surgery. The characteristics of the carbon ACL prosthesis are suitable in cases when an autograft (patelar tendon, semitendinosus-gracilis) cannot be performed in seriosly injured or elderly patients.U okviru ovog rada vršeno je ispitivanje biološkog ponašanja i čvrstine prednjeg ukrštenog ligamenta koji je zamenjen karbonskom protezom. Procenjivana su klinička, radiološka i patohistološka slika neoligamenta i njegovog spoja sa kostima, u periodima od 1, 2 i 6 meseci. Klinički i radiološki koleno je bilo stabilno, bez degenerativnih promena. Histološki je bilo izraženo prorastanje vezivnog tkiva oko karbonskih vlakana. Koleno psa je odgovarajući model za eksperimentalnu hirurgiju kolena. Karakteristike karbonske LCA proteze su podesne u slučajevima kada autograft (ligamenta patele ill m.semitendinosus - gracilisa) nije dostupan, kod obimnijih povreda ili starijih pacijenata

Transplantacija meniskusa u kolenu kunića duboko zamrznutim meniskalnim alograftom, patohistoloska slika

The aim of the study was to assess the clinical, radiological and histological characteristics of deep frozen meniscal allograft for the rabbit knee. Eighteen (18) New Zealand white rabbits were operated on both knees and evaluated at three time intervals: after 2 weeks (first group), 8 weeks (second group) and 36 weeks (third group). Left knees without meniscal transplantation, served as the controls. Meniscal grafts obtained from other rabbits were stored in a deep freeze at -17 °C when required deep frozen menisci were thawed in sterile saline and transplanted in the place of the removed right medial meniscus of the experimental animal. The general condition, operated knees and X-ray pictures were monitored. After sacrifice the meniscal allografts were histologically analyzed. There were no adverse clinical and radiological pathological findings after transplantation, while in the control group changes were noted. At histological evaluation, 2 weeks after transplantation the collagen fibers were not oriented and there was a low cell population. Vascularity was observed in the second group, with cell repopulation and young immature collagen fibers. In the third group at 36 weeks the collagen tissue was more mature, with significant cell repopulation. We may conclude that deep frozen meniscal allografts show significant collagen remodeling and cellular repopulation. New menisci protect the underlying cartilage. Thus this procedure appears beneficial in cases where there is no possibility to reconstruct the meniscal lesion.Cilj ovog istraživanja je bio da se klinički, radiološki i histološki procene karakteristike duboko zamrznutog transplantata menuskusa na kolenu kunića. Ukupno je operisano osamnaest kunića, soja New Zeland i posmatrano u tri vremenske grupe: posle 2 nedelje (prva grupa), 8 nedelja (druga grupa) i posle 36 nedelja (treća grupa). Stanje životinje i operisanog kolena je praćeno klinički i radiološki, a po žrtvovanju je izvršena patohistološka analiza. Kod operisanih životinja, nije bilo kliničkih i radioloških promena za razliku od kontrolne grupe. Na histološkoj proceni meniskusa, u prvoj grupi (posle 2 nedelje) kolagena vlakna su bila neorijentisana sa izraženom ćelijskom depopulacijom, dok su posle 36 nedelja kolagena vlakna bila zrelija, sa značajnom ćelijskom repopulacijom. Duboko zamrznuti meniskalni alograft pokazuje značajnu kolagenu remodelaciju i ćelijski oporavak a novi meniskus je štitio hrskavicu zgloba. Zbog toga je primena duboko zamrznutog alografta meniskusa opravdana u slučajevima gde nije moguće očuvati povređeni meniskus