Sy.Dravet-atypical form od severe myoclonic epilepsy in infancy

Purpose of this case report is to present patients in the age is 16.9 years with a rare atypical form of severe myoclonic epilepsy (SME) in infancy and poor outcome. The disease occurred in mild-infancy in form of repeated, lengthy hemiconvulsions, clonic or generalized tonic-clonic convulsions caused by fever, which had little reaction to a small applied anticonvulsive drugs. Current age of little and preschool children frequently appeared focal motor, generalized tonic-clonic seizures and with or without fever. Myoclonic nor atypical apsans attacks were not reported by any. The attacks were extremely stubborn on polytherapy. Were used at least 2 or 3 drugs simultaneously, and experienced all of our available antiepileptics and ketogen diet. The success of applied treatment was partial. In the second and third years reveals a very slow speech development, behavioral hyperactivity prevails with autistic elements. The motor is characteristically awkwardness (clumsiness). EEG recording was made several times in wakefulness, drowsiness and sleep disrupted showed a moderate basic activity with multifocal primary focal changes. Neither one revealed no generalized paroxysmal changes as well as paroxysmal response to fotostimulation. Neuroimagine search: CT brain was normal and MR of brain showed a small arachnoid cyst on the left temporo-basal to the other normal finding. Genetic analysis revealed a mutation in exons 12 SCN1A gene corresponding to the clinical syndrome of severe myoclonic epilepsy in infancy. The same analysis in the parents showed normal findings indicating the occurrence of fresh mutations in patients (de novo). The patient continues to have daily uncontrolled generalized tonic and / or clonic seizures, focal motor less frequently, usually during sleep, lasting 1-2 minutes, taking in therapy topiramat, klobazam, stiripentol. Expressed as moderate to severe mental retardation. The boy can not speak, but their demands expressed by mimics and gestures, self-moved, but it is extremely awkward (clumsy) with atactic walk. The participant is a school for children with special needs and is completely dependent on the care of another person

Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee

The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement. In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot

Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee

The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement. In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot

Dislocated Left Knee Injury and Popliteal Arteries of the Left Knee

The bone and joint injuries include fractures of the extremities, sprains and strains of joints. The complications that threaten the vitality of the limb or permanently damage its functions have been reported in a small percentage of injuries of extremities. The biggest threat to the limb are threatening injuries blood supply, primarily direct injury artery or sometimes vein. Closed injuries can cause ischemia by interruption of arterial blood supply, as is the case at the back sprains knee, hip and supracondylar humerus fractures with displacement. In our case, the rear dislocation of the knee led to the injury of artery with ischemia on the periphery of the left leg , and the only timely diagnosis and surgery, the patient was saved foot

Analysis of Grooup Patients with Occlusive Arterial Disease in the Femoro-Popliteal Segment in the Istria County

Arterial diseases nowadays represent a widespread phenomenon of epidemic character. In this work we have tried to analyze certain characteristics of patients suffering from arterial occlusive diseases in the femoro-popliteal segment. As these diseases are connected with the possible occurrence of gangrene in legs and consequently with the amputation of the lower limbs, thus considerably disabling the patients and shortening their lifetime

Analysis of Grooup Patients with Occlusive Arterial Disease in the Femoro-Popliteal Segment in the Istria County

Arterial diseases nowadays represent a widespread phenomenon of epidemic character. In this work we have tried to analyze certain characteristics of patients suffering from arterial occlusive diseases in the femoro-popliteal segment. As these diseases are connected with the possible occurrence of gangrene in legs and consequently with the amputation of the lower limbs, thus considerably disabling the patients and shortening their lifetime

Sy.Dravet-atypical form od severe myoclonic epilepsy in infancy

Purpose of this case report is to present patients in the age is 16.9 years with a rare atypical form of severe myoclonic epilepsy (SME) in infancy and poor outcome. The disease occurred in mild-infancy in form of repeated, lengthy hemiconvulsions, clonic or generalized tonic-clonic convulsions caused by fever, which had little reaction to a small applied anticonvulsive drugs. Current age of little and preschool children frequently appeared focal motor, generalized tonic-clonic seizures and with or without fever. Myoclonic nor atypical apsans attacks were not reported by any. The attacks were extremely stubborn on polytherapy. Were used at least 2 or 3 drugs simultaneously, and experienced all of our available antiepileptics and ketogen diet. The success of applied treatment was partial. In the second and third years reveals a very slow speech development, behavioral hyperactivity prevails with autistic elements. The motor is characteristically awkwardness (clumsiness). EEG recording was made several times in wakefulness, drowsiness and sleep disrupted showed a moderate basic activity with multifocal primary focal changes. Neither one revealed no generalized paroxysmal changes as well as paroxysmal response to fotostimulation. Neuroimagine search: CT brain was normal and MR of brain showed a small arachnoid cyst on the left temporo-basal to the other normal finding. Genetic analysis revealed a mutation in exons 12 SCN1A gene corresponding to the clinical syndrome of severe myoclonic epilepsy in infancy. The same analysis in the parents showed normal findings indicating the occurrence of fresh mutations in patients (de novo). The patient continues to have daily uncontrolled generalized tonic and / or clonic seizures, focal motor less frequently, usually during sleep, lasting 1-2 minutes, taking in therapy topiramat, klobazam, stiripentol. Expressed as moderate to severe mental retardation. The boy can not speak, but their demands expressed by mimics and gestures, self-moved, but it is extremely awkward (clumsy) with atactic walk. The participant is a school for children with special needs and is completely dependent on the care of another person

EXPERIENCIES WITH CHILD FOREARM FRACTURES IN GENERAL HOSPITAL PULA

To compare surgical and conservative treatment in proximal and distal forearm child fractures. The study compared 84 patients, aged 2-14 years, who were admitted to the hospital because of with forearm fracture. Criteria for the inclusion in the study were forearm fractures of 3/4 forearm bone. Children with proximal forearm fractures (N=45) were treated: conservative, manual reposition and immobilisation, primary operated within the first 24 hours n=16, secundary within the first 12 days n=11 after the fracture) and with distal forearm fractures (N= 39, conservative n=14, primary operated n=18 , secundary operated n=7). All patients with proximal and 31 patients with distal forearm fractures were treated with physiotherapy. We recorded immobilisation time, duration of physiotherapy and complete therapy. Functional improvement or deficite was assessed according «neutral-0-test«, degree of elbow, wrist movement and rotation of forearm. There were significant differences between primary and conservative treatment for proximal forearm fractures in duration of immobilisation (median 20 days, range18-24, vs median 49 days, range 30-58, respectively, p<0.05), all therapy (median 28 days, range 22-35, median 74 days range 63-81, respectively, p<0.05). The primary surgical group also had shorter physiotherapy. After primary surgical treatment we had lower functional deficit than in the conservative treatment (elbow index of movement median 1.04 , range 0.54-1.23 (median 3.42 range 2.98-3.64, p<0.05) and rotation index of forearm median 8.30 range 7.88-8.52 median (12.75 range 12.52-12.90). In distal forearm fractures there were significant differences between primary and secundary surgical treatment in immobilisation times (median 23 range 18-25 vs median 37 range 21-47, P<0.05), all therapy and physiotherapy (p<0.05). We had lower functional deficit after primary surgical treatment (wrist index movement median 2.87 range 2.01-3.28, 4.15 range 3.55-4.45, respectively p<0.005 and rotatio index median 1.84 range 1.56-2.00 median 2.95 range 2.56-3.24). Proximal forearm fractures caused bigger functional deficit than in a distal forearm. Primary surgery treatment can be recommended in proximal forearm fractures because after rehabilitation we had minimal functional deficit

TRANSPENDICULAR FIXATOR INFORCED WITH SHORT HOOKS IN THE TREATMENT OF INSTABILE SPINAL VERTEBRAL FRACTURES

Objectives. Clinical trial to compare HR-P with anterior fixation technique in neurological outcome and preoperative parameters in the emergency treatment of unstable burst thoracolumbar fracture. Patients and methods. Twenty nine patients with burst fracture underwent either anterior neurodecompression and fixation (n=13) or posterior reposition and fixation with HR-P (n=16) depending on the type of implants available at the time of operation. Neurologically injured patients were operated within the first 8 hours and neurologically intact patients within the first 2 days after fracture. Neurological improvement was assessed according to the Frankel scale and the Prolo economic/ function outcome scale. We recorded operation time, blood loss, hospital stay and cost, complication and donor site pain. Results. There were no significant differences between the groups in either neurological improvement (p=0.789), economic and functional outcome (p=0.294, p=0.163), operative time was shorter in the HR-P posterior approach group than in the anterior group (median 172 min, range 145-220, vs. Median 255 min, range 200-295, p<0.001). Blood loss, hospital cost and complication rate was significantly lower in the posterior fixation group (p<0.001). Conclusion. Both surgical techniques were equally effective in neurological improvement. HR-P can be recommended in emergency neurodecompression and fixation of unstable lumbar and thoracolumbar fractures because of the shorter operation time and smaller blood loss

Influence of Depression on Patients’ Satisfaction with the Outcome of Microsurgical “Key-hole” vs Classical Discectomy: Prospective Matched-cohort Stud

Aim. To assess the influence of depression on patients’ satisfaction with lumbar discectomy performed by two different surgical techniques. Methods. A prospective matched-cohort analysis of classical lumbar discectomy following static imaging (n=45) and microlumbar “key-hole” discectomy after dynamic CT/myelography (n=55) was performed. The outcome was independently assessed using Prolo economic/activity (E) and functional/pain (F) scale, and depressiveness according to Hamilton rating scale. Patients without improvement on the Prolo scale were classified as failed back surgery syndrome, and with a Hamilton score 17 as depressive. Results. The groups were well matched by age, sex, clinical presentation and incidence of depression. In the “key-hole” group, both activity and pain outcome were better than in the classical technique group (median E score (range)=4 (2-5) vs 3 (2-4), p=0.002, median F score (range)=4 (2-5) vs 4 (1-5), p=0.008). Eighteen patients were classified as failed back syndrome, 6 in the “key-hole” group, and 12 in the classical group (z=3.16, p=0.075). The incidence of failed back syndrome among non-depressive patients was significantly lower in “key-hole” group (2/55 patients vs 8/45, z=2.345, p=0.009). Occurrence of unsatisfactory results among depressive patients was very similar in both groups (4/55 patients vs 4/45, z=0.296, p=0.384). Conclusion. Introduction of functional imaging and “key-hole” technique decreased incidence of failed back syndrome among non-depressive patients. Unsatisfactory outcome among depressive patients was unrelated to the imaging and surgical technique. Connection between depression and failed back syndrome, although detected, remains unclear and must be further investigated