Sindrom kubitalnog kanala

Sindrom kubitalnog kanala susrećemo relativno često te on predstavlja značajan javnozdravstveni problem. Specifičnost tijeka ulnarnog živca niz ruku, a napose anatomski međuodnosi s koštanim i mekotkivnim strukturama u području lakta čine ga vrlo podložnim vanjskim utjecajima, ponajviše silama kompresije. Progresija parestezija na ulnarnoj strani četvrtog prsta i na čitavom petom prstu zahvaćene šake uz pojavu motoričke slabosti i atrofije mišića šake uvelike ograničava bolesnike, najčešće one koji se bave aktivnostima koje zahtijevaju da im je lakat duže vremena u fleksiji, da neometano obavljaju svakodnevne aktivnosti. Stoga je iznimno važno pravovremeno dijagnosticiranje sindroma koje se zasniva na iscrpnoj anamnezi i detaljnom kliničkom pregledu uz pomoć niza specifičnih testova koji su detaljno opisani u radu. Elektromioneurografijom možemo utvrditi stupanj kompresije ulnarnog živca te pratiti uspješnost daljnjeg liječenja. Blaži oblici sindroma kubitalnog kanala uspješno se liječe konzervativnim načinom, dok teže oblike sindroma te one koji su neosjetljivi na provedeno konzervativno liječenje treba liječiti kirurški. Metode kirurškog liječenja sindroma možemo podijeliti na one koje ostavljaju živac u ležištu u kubitalnom kanalu poput in situ dekompresije i medijalne epikondilektomije te na one tijekom kojih se živac premješta u novo ležište ispred i iznad medijalnog epikondila, što nazivamo antepozicijom ulnarnog živca. Sve opisane metode pokazale su se gotovo jednako uspješnima, no usprkos tomu istraživanja pokazuju da se u današnje vrijeme kao metoda izbora kirurškog liječenja sindroma kubitalnog kanala najčešće koristi in situ dekompresija

Endoskopsko liječenje sindroma škljocavog kuka vanjskog tipa: kirurška tehnika i prikaz dvaju slučajeva

Snapping hip or coxa saltans is a condition characterized by an audible and/or palpable snapping during hip movement and can be associated with pain around the hip. There are various causes of this condition and can be divided into two types: extra-articular and intra-articular. The most common type is the external extra-articular, where the snapping is due to thickened posterior part of the iliotibial band or anterior part of the gluteus maximus muscle sliding over the greater trochanter during hip movement. Two patients with external snapping hip are presented, who were treated with our original endoscopic iliotibial band release and greater trochanteric bursectomy. There were no surgical complications and the patients did not experience snapping or pain in the hip during 24-month follow-up period. Results of various open techniques and one endoscopic technique in the treatment of external snapping hip are also reported.Škljocavi kuk ili coxa saltans je stanje u kojem dolazi do čujnog i/ili palpabilnog škljocanja prilikom pokreta u kuku, tijekom čega se mogu javljati i bolovi. Prema uzrocima škljocavi kuk se dijeli na ekstra-artikularni i intra-artikularni. Najčešći tip je vanjski ekstra-artikularni, gdje do škljocanja dolazi zbog preskakanja zadebljanog stražnjeg dijela traktusa iliotibijalisa ili prednjeg dijela mišića gluteusa maksimusa preko velikog trohantera tijekom pokreta u kuku. U ovom radu prikazujemo dvoje bolesnika s vanjskim tipom škljocavog kuka koji su podvrgnuti endoskopskom opuštanju traktusa iliotibijalisa i uklanjanju burze nad velikim trohanterom našom vlastitom metodom. Oba zahvata su prošla bez komplikacija te bolesnici nisu imali bolove ili škljocanje u kuku u vremenu praćenja od dvije godine. Ujedno prikazujemo rezultate mnogobrojnih otvorenih tehnika i jedne endoskopske tehnike u liječenju škljocavog kuka

Obostrano iščašenje polumjesečastoga zgloba

Carpal instability is a rare injury of the wrist, but it can cause adverse disability and morbidity of the patient. Lunate dislocation is the fourth and last stage of perilunate dislocation. Bilateral perilunate dislocation is an even more uncommon injury, and only several cases have been reported in literature. We are presenting a case of bilateral perilunate dislocation of wrists in 27-year-old men who sustained injury of both wrists falling from a 7-meter-high tree.Nestabilnost pešća predstavlja rijetku ozljedu ručnoga zgloba koja može uzrokovati značajnu nesposobnost i morbiditet pacijenta. Iščašenje polumjesečaste kosti je četvrti i zadnji stadij perilunatne dislokacije. Obostrano iščašenje polumjesečaste kosti je još rjeđe stanje, te je svega nekoliko sličnih slučajeva opisano u literaturi. Ovdje prikazujemo slučaj obostranog iščašenja polumjesečaste kosti ručnoga zgloba kod 27-godišnjeg muškarca, koji je zadobio ozljede oba ručna zgloba prilikom pada s drveta visokog 7 metara

Sadašnji pristup šivanju meniska

Objective: To present surgical treatment options, meniscal suturing techniques and surgery results. Materials and methods: Over a period from September 2008 till August 2014, we performed 203 meniscal suturing procedures in our hospital. We used outside-in, inside-out and all-inside repair techniques (Rapid Loc and FasT-Fix). In the research conducted in our hospital, we prospectively monitored 175 patients who were 27 (14-53) years old, 120 male (69 %) and 55 female (31 %). Of these 175 patients, 88 (50.3 %) participated in recreational sports and 42 (24 %) were actively engaged in sports. Almost 50 percent (87 patients) also had anterior cruciate ligament tear. We monitored the patients for 36 (7-66) months through regular medical examinations, and with Lysholm and Tegner functional tests before and after surgeries. Results: Before surgery, the Lysholm score showed the average result of 59, which increased to 92 after surgery. The Tegner questionnaire value was 6.3 before surgery, and 5.4 after it on average. Out of 135 patients who were active in sports before their surgeries, 68 (50 %) returned to the same activity level. Subsequent arthroscopies were performed on 27 patients (15.4 %), and 15 of those patients (56 %) had new knee injuries after meniscal repair. Meniscectomy had to be done on 24 patients and meniscus was to be fixed by one Omni span system on two patients. There were 84.6 % of patients with no complications. Conclusions: Meniscal repair is a procedure that allows healing of some torn menisci and thus prevents the occurrence of early osteoarthritis. Meniscal repair shows very good results, especially if the suturing is performed along with the anterior cruciate ligament reconstruction.Cilj: Prikazati mogućnosti kirurškog liječenja, operacijske tehnike šivanja meniska i rezultate operacijskog liječenja. Materijali i metode: U našoj bolnici u razdoblju od rujna 2008. do kolovoza 2014. godine u 203 pacijenta učinjeno je šivanje meniska. Koristili smo se tehnikama šivanja out-in, in-out te all-in (RapidLoc i FasT-Fix). U istraživanju koje je provedeno u našoj bolnici prospektivno smo pratili 175 pacijenata prosječne životne dobi 27 godina (u rasponu od 14 do 52 godine), od toga 120 muškaraca (69 %) i 55 žena (31 %). Sportom se rekreativno bavilo 88 pacijenata (50,3 %), a aktivno 42 pacijenta (24 %). Ruptura prednje ukrižene sveze bila je prisutna kod 87 pacijenata (50 %). Pacijente smo pratili 36 mjeseci (7 – 66), praćeni su prospektivno redovitim ambulantnim kontrolama, a funkcionalno testiranje pomoću Lysholm i Tegner upitnika izvršili smo prije i nakon operacijskog zahvata. Rezultati: Lysholm upitnik je prije operacije iznosio u prosjeku 59, a nakon operacije 92. Tegner upitnik je prije operacije u prosjeku iznosio 6,3, a nakon operacije u prosjeku 5,4. Od 135 pacijenata koji su se prijeoperacijski bavili sportom, njih 68 (50 %) vratilo se potpuno istoj razini aktivnosti u sportu. Kod 27 pacijenata (15,4 %) učinjena je naknadna artroskopija. Od tih 27 pacijenata, njih 15 (56 %) imalo je novu povredu koljena nakon šivanja meniska. U 24 pacijenta učinjena je meniscektomija, a u dva pacijenta učinjena je ponovna fiksacija meniska sa jednom Omni span kopčom. Postotak pacijenata bez komplikacija iznosio je 84,6 %. Zaključci: Šivanje meniska je postupak koji omogućuje izlječenje kod određenih ruptura meniska koljenskog zgloba i na taj način sprječava nastanak ranog osteoartritisa. Šivanje meniska pokazuje izrazito dobre rezultate, osobito ukoliko se učini zajedno s rekonstrukcijom prednje ukrižene sveze

Dobroćudni multicistični peritonejski mezoteliom s oponašanjem ginekološke patologije

Benign multicystic peritoneal mesothelioma is a rare pathology that arises from the abdominal peritoneum. It has an affinity to develop on the surfaces of pelvic viscera. It predominantly occurs in women of reproductive age. The most used form of treatment is complete surgical removal. We report a case of a a 21-year-old female patient who presented with unclear diffuse abdominal pain. Transvaginal ultrasound and magnetic resonance imaging of the abdomen and pelvis revealed multiple functional cysts in the projection of the right and left ovary and free fluid in the pouch of Douglas. Laparoscopy was performed and multicystic tumor with thin, smooth walls, filled with clear serous content was found in lesser pelvis spreading to the left paracolic region and under the spleen. The multicystic mass was removed. Histologic examination revealed cystic formations filled with mucous content and formed from connective tissue outside and single row epithelium-mesothelium inside. Definitive diagnosis was benign multicystic mesothelioma of the abdominal peritoneum. The patient was well at one year follow-up.Dobroćudni multicistični peritonejski mezoteliom je rijetka bolest koja nastaje iz abdominalnog peritoneja. Obično se razvija na zdjeličnom peritoneju, najčešće u žena generativne dobi. Najuobičajeniji način liječenja je potpuno kirurško uklanjanje. Prikazujemo slučaj 21-godišnje djevojke koja nam se javila s nejasnom difuznom boli. Transvaginalni ultrazvuk i magnetna rezonanca trbuha i zdjelice otkrili su višestruke funkcionalne ciste u projekciji desnog i lijevog jajnika i u Douglasovu prostoru. Učinjena je laparoskopija i nađen je multicistični tumor s tankim glatkim zidovima ispunjenim bistrom seroznom tekućinom u maloj zdjelici, koji se širio u lijevu parakoličnu regiju i ispod slezene. Multicistična masa je uklonjena. Patohistološka analiza je otkrila cistične formacije ispunjene sluzi i građene od vezivnog tkiva izvana i jednorednim epitelmezotelom iznutra. Konačna dijagnoza je bila dobroćudni multicistični mezoteliom abdominalnog peritoneja. Bolesnica se redovito kontrolira bez znakova bolesti

RARE LOCALIZATION OF OSTEOID OSTEOMA – DISTAL PHALANX OF THE RING FINGER

Ovim kliničkim zapažanjem želimo upozoriti na osteoid osteom kao mogući uzrok tegoba u području distalne falange prstiju šake. Ta iznimno rijetka lokalizacija osteoid osteoma predstavlja problem za prepoznavanje i zbog atipične prezentacije. Dvadesetogodišnji bolesnik se pet godina žalio na bol u području jagodice IV. prsta desne šake koja je bila praćena oteklinom i crvenilom jagodice prsta te deformacijom nokta. Na rendgenskim snimkama vidjela se osteoliza u području baze distalne falange. Magnetskom rezonancijom je postavljena sumnja na osteoid osteom, što je potvrđeno kompjuteriziranom tomografi jom. Nakon kirurškog liječenja tijekom kojeg je osteoid osteom ekskohleiran, dolazi do potpunog nestanka tegoba. Potpuni oporavak bolesnika pokazuje i rezultat DASH upitnika, koji je već tri mjeseca nakon zahvata pao sa 54,5 na 0 što je prema tom upitniku uredan nalaz. Na osteoid osteom se uvijek mora posumnjati ako je oteklina distalne falange prsta s deformacijom nokta praćena bolovima koji se smanjuju korištenjem NSAIL. Metoda izbora u dijagnostici je kompjuterizirana tomografi ja koja mora biti načinjena tako da slojevi ne budu deblji od 1 do 2 mm. Zbog blizine neurovaskularnih struktura i tetiva najboljim oblikom liječenja osteoid osteoma u području distalne falange prstiju šake smatra se kirurška ekscizija ili ekskohleacija.With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distal phalanx of the fi ngers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptoms are swelling and redness of the fi ngertip with nail deformity, while typical night pain may not be present. Unusual clinical and x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-old patient reported pain in the fi ngertip of his right ring finger persisting for fi ve years. Swelling and redness of the fi ngertip combined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonance imaging showed suspicion of osteoid osteoma, which was confi rmed by computed tomography (CT). We performed surgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateral side of the distal phalanx of the ring fi nger and the basal part of distal phalanx was cut with a small chisel to enable access to cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sent for histopathologic analysis. After surgery, the ring fi nger was immobilized in a plaster splint for a three-week period. After removal of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtain the full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoid osteoma, all symptoms disappeared completely. Histopathologic findings confi rmed the diagnosis of osteoid osteoma. After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months after surgery, clinical fi ndings were normal and the patient had no pain or discomforts. Full recovery was shown by the result of the DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx of the fi nger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearance on x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. For this reason, it may be diffi cult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swelling and redness of the fi nger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layers of 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis. Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destruction of lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures, tendons and joints, the best method for treatment osteoid osteoma in distal phalanx of the fi ngers is surgical excision or excochleation. Our conclusion is that one should always bear in mind that osteoid osteoma can be the cause of swelling of distal phalanx of the fi nger with nail deformity, and pain that alleviated with the use of non-steroidal anti-infl ammatory drugs. Surgical excision or excochleation is the best method for the treatment osteoid osteoma of distal phalanx of the finger

TECHNOLOGY OF OZONE APPLICATIONS IN VITAL MEDICAL FIELDS

Veliki broj bolesti nastaje prvenstveno zbog nedostatka kisika u tkivima zbog akumulacije toksina u tijelu. Bezbolan i prirodan tretman ozonom pomaže kod operativnog oporavka i liječenja brojnih ozljeda i bolesti, pa čak i tumora, a za sada se najčešće koristi u stomatologiji. Ozon ima pozitivan utjecaj na zacjeljivanje rana, stimulaciju imunološkog sustava, oksigenaciju i protok krvi u tkivu, te smanjuje oticanje i bol.A large number of disease is primarily due to the lack of oxygen in the tissue due to the accumulation of toxins in the body. Painless and natural treatment with ozone helps with after-operating recovery and cure numerous injuries and illnesses, even tumors, and for now the most commonly used in dentistry. Ozone has a positive effect on wound healing, stimulation of the immune system, oxygenation and blood flow to tissues and to reduce swelling and pain

Properties of the Celiac Trunk – Anatomical Study

Although anatomical properties and vessel variations of the celiac trunk are well explored in the literature, there is not so much information on the arterial diameters, and this data is important for surgical procedures and angiographic examinations. The aim of this study was to investigate properties of the celiac trunk in humans by using anatomical dissection. Ninety cadavers were dissected for the celiac trunk identification and arterial diameter measurements. The results of anatomical examination showed that in 72% of all cases the celiac trunk divides into the splenic artery and the common hepatic artery, while the left gastric artery arises as a first branch and had origin between aorta, all over the celiac trunk up to a bifurcation. From the 90 cadavers, 4 presented anatomical variations. Where normal anatomy was present, the mean length of the celiac trunk was 1.9±0.08 cm and its mean arterial diameter was 0.78±0.08 cm. The splenic artery had the largest diameter (0.61±0.05 cm) and the left gastric artery had the smallest diameter (0.38±0.03 cm). Our data represent original results about anatomical variations and arterial diameter of the celiac trunk and its main branches provided by anatomical dissection

Obostrano iščašenje polumjesečastoga zgloba

Carpal instability is a rare injury of the wrist, but it can cause adverse disability and morbidity of the patient. Lunate dislocation is the fourth and last stage of perilunate dislocation. Bilateral perilunate dislocation is an even more uncommon injury, and only several cases have been reported in literature. We are presenting a case of bilateral perilunate dislocation of wrists in 27-year-old men who sustained injury of both wrists falling from a 7-meter-high tree.Nestabilnost pešća predstavlja rijetku ozljedu ručnoga zgloba koja može uzrokovati značajnu nesposobnost i morbiditet pacijenta. Iščašenje polumjesečaste kosti je četvrti i zadnji stadij perilunatne dislokacije. Obostrano iščašenje polumjesečaste kosti je još rjeđe stanje, te je svega nekoliko sličnih slučajeva opisano u literaturi. Ovdje prikazujemo slučaj obostranog iščašenja polumjesečaste kosti ručnoga zgloba kod 27-godišnjeg muškarca, koji je zadobio ozljede oba ručna zgloba prilikom pada s drveta visokog 7 metara