Sport and recreational activities suitable for patiens with osteoporosis

Tjelovježba i povećana tjelesna aktivnost neraskidivi su dio svakog preventivnog ili terapijskog postupka kod osteoporoze. Povećanje snage mišića uz opterećenje vlastitom težinom u uspravnom stavu važan su stimulator izgradnje kosti aksijalnog skeleta, čime se smanjuje rizik od frakture, a istodobno povećava potpora kralješnice i stoga su kolapsi kralješaka manje vjerojatni. Vježbom se povećava koordinacija pokreta i time smanjuje mogućnost pada, povećava sposobnost zaštite od posljedica pada i pomaže u stvaranju neovisnog života u starosti. Osobama sa blago izraženom osteoporozom (T vrijednost densitometrije od -2,5 do -3 standardne devijacije ispod normale) preporučuju se slijedeći športsko rekreativni sadržaji: tjelovježba, pješačenje, plivanje, biciklizam, boćanje, streljaštvo, mini golf, ples. U bolesnika s uznapredovalim stadijma osteoporoze i prijelomima dozvoljeno je samo plivanje, te posebno planirana i dozirana medicinska gimnastika u ležećem položaju, dok su svi športsko rekreativni sadržaji kontraindicirani. Povećanom tjelesnom aktivnošću, adekvatnom prehranom i lijekovima, te fizikalnom terapijom mogu se prevenirati, a i liječiti najteže posljedice ove podmukle bolesti.Exercising as well as inceased physical activity are inseparable part of every preventional or therapeutical procedure in osteoporosis. Increase of muscular strenght by body-weight loading in prone position is important stimulator of bone-Building of of axial sceleton. That decreases fracture risk while inceasing of spine support and making colapses of vertebras less possible. Exercising increases coordination of movements while decreasing possibility of falling, increasing ability of self protection during the eventual fall and helps in creating of independent life in Advanced years. We recommend to our patients with osteoporosis (with T values from -2,5 to -3 od standard deviations beyond normal) following recreational activities: body exercising, walking, swimming, cycling, bocce-bowling, archey, mini golf and dancing. In patients with osteoporosis combined wih fractures we allow only swimming and special dosed and planned medical exercise in supine position, while are all other recreational contents forbidden (contraindicated). With increased body activity, adequate nutrition and medications and physical therapy the most serious consequences of this malicious disease cold be prevented and event cured

PHYSIATRIC EXAMINATION OF WOUNDED PERSONS IN CLJNICAL HOSPITAL "DUBRAVA" DURING 1992-1996

Na Odjelu za fizikalnu medicinu i rehabilitaciju Kliničke bolnice Dubrava, od 1.1.1992. do 31 .12.1995. pregledano je 2313 ranjenika koji su zadobili povrede od vatrenog oružja. Težina ranjavanja je varirala, od okrznuća kože i potkožnog tkiva, do traumatskih amputacija i prostrijela lubanje s lezijom CNS-a. Pojedini ranjenici ranjavani su u više navrata (najviše 4), a 300 ranjenika imalo je povrede čak u 717 regija. U tom razdoblju najčešće smo ustanovili strijelne i eksplozivne povrede potkoljenice i stopala, zatim natkoljenice, pa ramena, ruke i trupa, a na kraju glave i vrata. Razlike po godinama statistički nisu značaj ne po regijama ranjavanja i u odnosu jednostrukih prema multiplim ranjavanjima. Razlike su značajne (P<O,Ol) kod ranjenika s lezijama perifernog i centralnog neurona te kod ranjenika s amputacijom i bez nje ( < 0,001). Naime, u prvim godinama Domovinskog rata dijagnosticirati smo više povreda centralnog neurona i amputacija, dok se njihov broj značajno smanjio 1995. godine. Da bi procijenili učinke pojedinih primijenjenih metoda liječenja ranjenika, neophodno je dalje pratiti rezultate njihove rehabilitacije.On th department for physical medicine and rehabilitation in Clinical Hospital Dubrava there were 2313 wounded from fire weapons that we examined during the period from 1.1.1992. Do 31.12.1995. Severity of injuries varied from lacerations of the skin and subcutaneus tissue to traumatical amputations and peforating gunshot wounds of seuil. Some war casulaties were wounded more than once (at most four times) so wc have found in 300 patients lesions of exactlyy 717 regions. ln this period we have diagnosed most frequently gunshot and explosive injuries of fot and leg, than thigh, shoulders, after that arms and trunk, and at least head and neck. Differences between the years of trauma were not statistically significant considering wounded regions and simple in comparison with multiple nj uries. Significant differences are .found in casualties with lesions of peripherc1l and central neuron and in wounded with od without amputations. In the first few years of our war we have diagnosed more injuries of central neoron and arnputations in comparison with 1995. When their number significantly decreased. To estimate effects of some partic ular curing methods for wounded patients it is necessary to follow up results of their rehabilitation

ESOPHAGEAL TUMORS IN FAMILY PHYSICIAN PRACTICE

Tumori jednjaka su relativno rijetki tumori. Javljaju se tipičnim simptomima u pacijenata koji konzumiraju ljutu hranu, alkohol ili su pušači, te nakon ingestije lužina, a s obzirom na dobru dostupnost, moguće ih je rano otkriti. Posljednjih godina raste incidencija adenokarcinoma u odnosu na planocelularni karcinom, što je povezano s GERB-om i razvojem Barretovog jednjaka. Korištenjem kvalitetnih algoritama u dijagnostici i praćenju rizičnih pacijenata, tumore jednjaka bi trebali otkriti u ranijem stadiju, kako bi liječenje bilo uspješnije.Esophageal tumors are relatively rare. They present with typical symptoms in patients that consume spicy food, alcohol, enjoy cigarette smoking, and after alkaline solution ingestion. Considering their accessibility, they can be diagnosed in early stages. In recent years, the incidence of adenocarcinoma has increased in comparison to squamous cell carcinoma. This surge in the incidence is associated with gastroesophageal refl ux disease and Barrett’s esophagus. Using better algorithms in the diagnosis and follow up of patients at risk, in the years to come we should diagnose patients at earlier stages of the disease

Weekly and daily intake of alendronate: comparation of tolerance in osteoporosis treatment

U radu se, na temelju zapažanja bolesnika u liječenju osteoporoze, analizira podnošljivost uzimanja alendronata tijekom tri godine u dozi od 10 mg jednom dnevno u odnosu na uzimanje alendronata u dozi od 70 mg jednom tjedno kroz godinu dana. Ispitanici su bili ambulantni bolesnici, liječeni tijekom četiri godine (2000.-2003) pod nadzorom tri fizijatra s Odjela za fizikalnu medicinu i rehabilitaciju Kliničke bolnice Dubrava. Dijagnoza osteoporoze je postavljena na temelju anamneze, kliničke slike i nalaza DXA denzitometrije. Glavni razlog prestanka uzimanja dnevne doze alendronata od 10 mg bili su bolovi u jednjaku. Na temelju našega istraživanja možemo zaključiti da bolesnici 4,22 puta bolje podnose uzimanje alendronata 70 jednom tjedno u odnosu na alendronat 10 dnevno.In this study we analyzed, considering complains of patients, tolerance of taking alendronate 70 mg once a week in comparison with daily intake of alendronate 10 mg. Subjects were patients that were treated for osteoporosis at Department for physical medicine and rehabilitation in Clinical hospital Dubrava. The diagnosis of osteoporosis was established by DXA densitometry. Pains in oesophagus were the main reason for ceasing of use of alondronate. According to our research patients tolerate taking alendronate 70 weekly 4,22 times better than alendronate 10 daily