Učinkovitost osteosinteze s košarastom pločicom kod multifragmentnih prijeloma ivernog vrška - Procjena ekstenzije koljena u kasnom poslijeoperacijskom razdoblju

The aim of the study was to assess functional status of the knee extensor system in the late postoperative period (at least two years of the operation and implant removal) in patients submitted to basket plate osteosynthesis for transverse or comminuted fracture of the apex of patella. The study included 71 patients with comminuted patellar apex fracture who had undergone basket plate osteosynthesis. The status of the knee extensor system was evaluated by a modified Cincinnati test. Excellent results were recorded in 59.2%, good in 30.6% and satisfactory in 10.2% of study patients. There were no poor results. In addition to ensuring osteosynthesis stability and the potential of early weight bearing, basket plate osteosynthesis meets the requirements of modern traumatology and the authors are inclined to consider it the method of choice to treat comminuted or transverse fractures of the apex of patella.Cilj ove prospektivne studije bila je procjena funkcijskog statusa ekstenzornog sustava koljena u kasnom poslijeoperacijskom razdoblju (najmanje dvije godine nakon operacije i uklanjanja usatka) u bolesnika podvrgnutih osteosintezi s košarastom pločicom zbog poprečnog ili multifragmentnog prijeloma ivernog vrška. Procjena je obuhvatila 71 bolesnika s multifragmentnim prijelomom patelarnog vrška u kasnom poslijeoperacijskom razdoblju nakon osteosinteze s košarastom pločicom. Status ekstenzornog sustava koljena procjenjivan je modificiranim testom Cincinnati. Izvrsni rezultati su zabilježeni u 59,2%, dobri u 30,6% i zadovoljavajući u 10,2% bolesnika. Loši rezultati dosad nisu zabilježeni. Uz osiguranje stabilnosti osteosinteze i mogućnost ranog opterećenja, osteosinteza s košarastom pločicom ispunjava zahtjeve suvremene traumatologije, te prema našem mišljenju predstavlja metodu izbora u zbrinjavanju multifragmentnog ili poprečnog prijeloma ivernog vrška

Učinkovitost osteosinteze s košarastom pločicom kod multifragmentnih prijeloma ivernog vrška - Procjena ekstenzije koljena u kasnom poslijeoperacijskom razdoblju

The aim of the study was to assess functional status of the knee extensor system in the late postoperative period (at least two years of the operation and implant removal) in patients submitted to basket plate osteosynthesis for transverse or comminuted fracture of the apex of patella. The study included 71 patients with comminuted patellar apex fracture who had undergone basket plate osteosynthesis. The status of the knee extensor system was evaluated by a modified Cincinnati test. Excellent results were recorded in 59.2%, good in 30.6% and satisfactory in 10.2% of study patients. There were no poor results. In addition to ensuring osteosynthesis stability and the potential of early weight bearing, basket plate osteosynthesis meets the requirements of modern traumatology and the authors are inclined to consider it the method of choice to treat comminuted or transverse fractures of the apex of patella.Cilj ove prospektivne studije bila je procjena funkcijskog statusa ekstenzornog sustava koljena u kasnom poslijeoperacijskom razdoblju (najmanje dvije godine nakon operacije i uklanjanja usatka) u bolesnika podvrgnutih osteosintezi s košarastom pločicom zbog poprečnog ili multifragmentnog prijeloma ivernog vrška. Procjena je obuhvatila 71 bolesnika s multifragmentnim prijelomom patelarnog vrška u kasnom poslijeoperacijskom razdoblju nakon osteosinteze s košarastom pločicom. Status ekstenzornog sustava koljena procjenjivan je modificiranim testom Cincinnati. Izvrsni rezultati su zabilježeni u 59,2%, dobri u 30,6% i zadovoljavajući u 10,2% bolesnika. Loši rezultati dosad nisu zabilježeni. Uz osiguranje stabilnosti osteosinteze i mogućnost ranog opterećenja, osteosinteza s košarastom pločicom ispunjava zahtjeve suvremene traumatologije, te prema našem mišljenju predstavlja metodu izbora u zbrinjavanju multifragmentnog ili poprečnog prijeloma ivernog vrška

Prikaz slučaja rijetkog retroperitonealnog Schwannoma

Schwannoma is a tumor arising from peripheral nerve sheath, found very rarely in the retroperitoneal part of the pelvis. It can reach large proportions before causing symptoms due to mass effect and is mostly diagnosed incidentaly. We describe a pelvic retroperitoneal Schwannoma in a 67-year-old man presented with progressive pain in lower left abdominal quadrant with digestive discomforts, which lasted for three months. Patohistological examination after complete surgical excision revealed a Schwannoma.Schwannom je tumor koji potječe iz ovojnice perifernog živca. Retroperitonealni Schwanom smješten u zdjelici je izuzetno rijedak. Doseže velike dimenzije prije uzrokovanja simptoma zbog čega se obično slučajno dijagnosticira. Opisan je prikaz slučaja retroperitonealnog Schwannoma zdjelice u 67-godišnjeg muškarca s progresivnim bolovima u donjem lijevom kvadrantu abdomena i probavnim smetnjama, u trajanju od tri mjeseca. Kirurški je tumor potpuno odstranjen i patohistološka dijagnoza je Schwannom

Prikaz slučaja rijetkog retroperitonealnog Schwannoma

Schwannoma is a tumor arising from peripheral nerve sheath, found very rarely in the retroperitoneal part of the pelvis. It can reach large proportions before causing symptoms due to mass effect and is mostly diagnosed incidentaly. We describe a pelvic retroperitoneal Schwannoma in a 67-year-old man presented with progressive pain in lower left abdominal quadrant with digestive discomforts, which lasted for three months. Patohistological examination after complete surgical excision revealed a Schwannoma.Schwannom je tumor koji potječe iz ovojnice perifernog živca. Retroperitonealni Schwanom smješten u zdjelici je izuzetno rijedak. Doseže velike dimenzije prije uzrokovanja simptoma zbog čega se obično slučajno dijagnosticira. Opisan je prikaz slučaja retroperitonealnog Schwannoma zdjelice u 67-godišnjeg muškarca s progresivnim bolovima u donjem lijevom kvadrantu abdomena i probavnim smetnjama, u trajanju od tri mjeseca. Kirurški je tumor potpuno odstranjen i patohistološka dijagnoza je Schwannom

PERITONEAL DIALYSIS IN A PATIENT WITH RIGHT HEMIPARESIS, LUPUS NEPHRITIS, SIGNIFICANT INSUFFICIENCY OF ARTERIES OF AORTIC ARCH AND CELIAC DISEASE

Peritonejska dijaliza (PD) je metoda izbora kod bolesnika u kojih je otežano kreiranje krvožilnog pristupa za hemodijalizu. Tridesetosmogodišnja bolesnica javila se u našu Ustanovu u fazi terminalnog bubrežnog zatajenja nepoznate geneze zbog kreiranja AV fistule. Zbog preboljelog moždanog udara 1993. godine, bolesnici je zaostala desnostrana hemipareza s kontrakturom šake i epilepsija. Učinjenom obradom dijagnosticirali smo lupus nefritis s fosfolipidnim sindromom, okluziju trunkusa brahiocefalikusa, zajedničkih karotidnih arterija, te lijeve arterije subklavije. Također smo dokazali glutensku enteropatiju i značajnu anemiju. Kreiranje AV fistule na ruci nije bilo moguće, kao niti asistirana peritonijska dijaliza, a zbog desnostrane hemipareze i kontrakture desne šake bila je upitna mogućnost samostalnog provođenja peritonejskih izmjena. Unatoč tom hendikepu bolesnica je, uz jaku motivaciju, uspjela samostalno savladati tehniku peritonejske dijalize. Iako je procijenjeno da ima visok operativni rizik, zahvat postavljanja peritonejskog katetera je prošao bez komplikacija. Zbog komorbiditeta, u prvom redu zbog značajnih stenoza i okluzija arterija luka aorte, odustalo se od transplantacije bubrega. Bolesnica već petnaest mjeseci samostalno provodi peritonejsku dijalizu bez infektivnih komplikacija, osjeća se dobro, zadovoljna je kvalitetom života, sekvele kronične bubrežne bolesti zadovoljavajuće su kontrolirane, sustavni eritemski lupus je, uz malu dozu kortikosteroida, u fazi mirovanja, pothranjenost je korigirana, ali je i dalje prisutna hipoalbuminemija.Peritoneal dialysis (Pd) is a method of choice in patients in whom there are difficulties concerning creation of av fistula. a 38-year old female patient came to our hospital because of a need of making an av fistula. she had end-stage renal insufficiency of unknown origin. she had a right hemiparesis with a contracture of the right fist and epilepsy because of the stroke she suffered in 1993. after doing the diagnostics, we have found that patient had lupus nephritis, occlusion of brachiocephalic trunk, right and left common carotid artery and left subclavian artery. We also diagnosed celiac disease and a significant anemia. it was not possible to form an av fistula, as it was not possible to do an assisted Pd. because of the right hemiparesis and contracture of the right fist, the possibility of performing Pd independently was questionable. despite the handicap, the patient had strong motivation and she managed to master the technique of Pd independently. even though it was estimated that she had a high risk score for applying anesthesia (asa iv), the insertion of the peritoneal catheter went without complications. because of the comorbidity, especially because of the significant stenosis and occlusions of the arteries of aortic arch, the kidney transplantation will not be performed. in the last fifteen months, the patient is performing Pd independently, without any infectious complications, she is feeling well and is satisfied with the quality of her life. the consequences of the renal insufficiency are under control, systemic lupus erythematosus is, with a low dose of corticosteroids, in a steady state, malnutrition is corrected, but there is still hypoalbuminemia noted

5, 10-Methylenetetrahydrofolate Reductase (MTHFR) 677 C->T Genetic Polymorphism in 228 Croatian Volunteers

5, 10-Methylenetetrahydrofolate Reductase (MTHFR) is one of the key enzymes in the metabolism of homocysteine, where it catalyses its remethylation. The autosomal recessive bp 677 C->T mutation in the MTHFR gene leads to the substitution of valine for alanine. Individuals who are homozygous for this C677T mutation exhibit a decreased specific activity and increased thermolability of this enzyme. This leads to increased plasma levels of homocysteine, which is a known risk factor for atherosclerosis and various manifestations of the atherosclerotic disease. The aim of this study was to find out the distribution and frequency of this mutation in the general Croatian population. A group of 228 volunteers (175 males and 53 females) has been analyzed for the MTHFR polymorphism, which revealed the following distribution: 105 (46.05%) individuals were without mutation (C/C), 102 (44.74%) were heterozygous (C/T) and 21 (9.21%) homozygous (T/T). These findings are within the results of studies on other European populations

Laparoskopska ezofagomiotomija nakon neuspješne pneumatske dilatacije u bolesnika s idiopatskom ahalazijom

Achalasia is a relatively uncommon gastrointestinal disorder characterized by the absence of normal peristalsis of the esophagus and markedly diminished or absent relaxation of the lower esophageal sphincter during swallowing, caused by degenerative changes of parasympathetic innervation. All treatment modalities are palliative and include drug administration, endoscopic injection of botulinum toxin into the lower esophageal sphincter, pneumatic balloon dilatation, and surgery. Surgery offers the best long term results and may be performed as an open or endoscopic procedure, the latter yielding excellent results accompanied by all well-known advantages of minimally invasive surgery. Presentation is made of a patient with esophageal achalasia who was treated with balloon dilatation and laparoscopic esophagomyotomy.Ahalazija je relativno rijedak poremećaj probavnog sustava kod kojega je odsutna normalna peristaltika jednjaka, te je znatno smanjeno ili odsutno opuštanje donjeg ezofagusnog sfinktera kod gutanja, što je uzrokovano degenerativnim promjenama parasimpatetične inervacije. Svi oblici liječenja su palijativni, a uključuju medikamentnu terapiju, endoskopsko ubrizgavanje toksina botulina u donji ezofagusni sfinkter, pneumatsku dilataciju balonom i kirurško liječenje. Kirurški pristup pruža najbolje dugotrajne rezultate, a može se izvesti kao otvoreni zahvat ili endoskopski zahvat koji daje odlične rezultate praćene svim dobro poznatim prednostima minimalno invazivne kirurgije. Opisan je slučaj bolesnika koji je liječen dilatacijom balonom i laparoskopskom ezofagomiotomijom

Laparoskopska ezofagomiotomija nakon neuspješne pneumatske dilatacije u bolesnika s idiopatskom ahalazijom

Achalasia is a relatively uncommon gastrointestinal disorder characterized by the absence of normal peristalsis of the esophagus and markedly diminished or absent relaxation of the lower esophageal sphincter during swallowing, caused by degenerative changes of parasympathetic innervation. All treatment modalities are palliative and include drug administration, endoscopic injection of botulinum toxin into the lower esophageal sphincter, pneumatic balloon dilatation, and surgery. Surgery offers the best long term results and may be performed as an open or endoscopic procedure, the latter yielding excellent results accompanied by all well-known advantages of minimally invasive surgery. Presentation is made of a patient with esophageal achalasia who was treated with balloon dilatation and laparoscopic esophagomyotomy.Ahalazija je relativno rijedak poremećaj probavnog sustava kod kojega je odsutna normalna peristaltika jednjaka, te je znatno smanjeno ili odsutno opuštanje donjeg ezofagusnog sfinktera kod gutanja, što je uzrokovano degenerativnim promjenama parasimpatetične inervacije. Svi oblici liječenja su palijativni, a uključuju medikamentnu terapiju, endoskopsko ubrizgavanje toksina botulina u donji ezofagusni sfinkter, pneumatsku dilataciju balonom i kirurško liječenje. Kirurški pristup pruža najbolje dugotrajne rezultate, a može se izvesti kao otvoreni zahvat ili endoskopski zahvat koji daje odlične rezultate praćene svim dobro poznatim prednostima minimalno invazivne kirurgije. Opisan je slučaj bolesnika koji je liječen dilatacijom balonom i laparoskopskom ezofagomiotomijom

Subfascijalna endoskopska kirurgija perforantnih vena (SEPS): tehnika i naša stajališta

Chronic venous insufficiency is a major health and socioeconomic issue throughout the world. Some 2%-5% of the adult population suffers from chronic venous insufficiency, while about 1% of the European population has chronic leg ulceration. The role of retrograde blood flow through incompetent perforating veins has an important role in the development of chronic venous insufficiency. Duplex ultrasound imaging is the preferred diagnostic tool, which is used to confirm the presence of bidirectional flow through the perforators adjacent to the areas of lipodermatosclerosis, healed ulcers and open ulcerations, i.e. in patients with chronic venous insufficiency CEAP class 4, 5 and 6. Subfascial endoscopic perforating vein surgery (SEPS) is a minimally invasive surgical procedure, which is the treatment of choice in these patients. The endoscope and surgical instruments are introduced through skin incisions that are distant from the areas of skin changes. The perforating veins are excellently visualized, while clipping and dividing the perforators interrupt retrograde blood flow. In patients with insufficiency of the superficial venous system, ligation and stripping of the superficial veins are usually performed at the same time. The lesser saphenous vein can be occluded with SEPS itself. The healing time with SEPS is substantially decreased when compared with conventional treatment and carries low complication and recurrence rates. However, SEPS should be offered to selected patients, i.e. to those with chronic venous insufficiency CEAP class 4, 5 and 6.Kronična venska insuficijencija predstavlja značajan zdravstveni i socioekonomski problem u cijelom svijetu. Oko 2% do 5% odrasle populacije ima kroničnu vensku insuficijenciju, a oko 1% europske populacije ima kronične venske ulceracije. Za razvoj kronične venske insuficijencije važna je uloga retrogradnog protoka krvi kroz nekompetentne perforantne vene. Dupleks ultrazvučni prikaz je dijagnostičko sredstvo izbora kojim se potvrđuje prisutnost dvosmjernog protoka kroz perforatore koji se nalaze uz mjesta lipodermatoskleroze, zacijeljenih ili otvorenih ulceracija, tj. kod bolesnika s kroničnom venskom insuficijencijom 4., 5. i 6. CEAP razreda. Subfascijalna endoskopska kirurgija perforantnih vena (SEPS) je minimalno invazivni kirurški postupak koji predstavlja metodu izbora kod ovih bolesnika. Endoskop i kirurški instrument se uvode kroz rezove na koži, koji su udaljeni u odnosu na kožne promjene. Perforantne vene se odlično prikazuju, te se njihovim "klipsanjem" i presijecanjem uklanja retrogradni protok krvi. Kod bolesnika s insuficijentnim površinskim venskim sustavom se u istom aktu učini i podvezivanje, kao i odstranjivanje površinskih vena. Vena saphena parva se može okludirati i samim SEPS-om. Vrijeme cijeljenja kod SEPS-a znatno je kraće u odnosu na klasično liječenje i praćeno je niskim stopama komplikacija i recidiva. Ipak, SEPS bi se trebao indicirati samo u određenih bolesnika, tj. onih s kroničnom venskom insuficijencijom 4., 5. i 6. CEAP razreda