11 research outputs found
Etiopathogenesis and treatment of graves orbitopathy
Gravesova orbitopatija (takoÄer poznata kao bolest oka povezana sa Å”titnjaÄom āengl. TED) je autoimuni upalni poremeÄaj koji u sklopu Gravesove hipertireoze (GH) zahvaÄa orbitalni sadržaj. KlasiÄni kliniÄki simptomi razvijene Gravesove orbitopatije (GO) su periokularni edemi, proptoza, retrakcija vjeÄa, poremeÄaj bulbomotorike, smetnje prednjeg segmenta oka te pad vidne oÅ”trine.
GodiÅ”nja incidencija Gravesove orbitopatije je 16/100.000 u žena, te 3/100.000 u muÅ”karaca. Od ukupnog broja oboljelih otprilike 50% bolesnika razvija kliniÄki signifikantan oblik bolesti od kojih 15-20% zahtijeva bolniÄko lijeÄenje, a oko 3-5% ima težak oblik bolesti s kompresivnom neurooptikopatijom poznatom kao DON (distiroidna optiÄka neuropatija) koji ponekad osim sistemskog lijeÄenja zahtijeva i hitno kirurÅ”ko lijeÄenje. 45% svih oboljelih razvija blagi oblik bolesti koji zahtijeva samo simptomatsku terapiju, NajznaÄajniji modulatorni ekstrinziÄki faktor za GO je puÅ”enje. KliniÄke studije dokazale su da puÅ”enje pospjeÅ”uje nastanak GO kod bolesnika sa GH, produžuje bolest i umanjuje uÄinak lijeÄenja. Obzirom na stigmatizirajuÄi tip bolesti, bolesnici sa GO imaju znaÄajno smanjenu kvalitetu života, a druÅ”tvo znaÄajne ekonomske reperkusije. DosadaÅ”nji zlatni standard lijeÄenja kliniÄki signifikantnog i teÅ”kog oblika bolesti bila je imunosupresija kortikosteroidima, dok se zadnjih godina sve viÅ”e istraživanja bavi sa uÄinkom imunomodulatornih bioloÅ”kih lijekova.
EUGOGO (European Group on Graves' Orbitopathy) koji okuplja multidisciplinarnu grupu eksperata iz 15 europskih centara izdalo je 2015. godine smjernice za dijagnostiku, kliniÄku obradu i lijeÄenje razliÄitih oblika GO.Graves' orbitopathy (also known as thyroid eye disease TED) is an autoimmune inflammatory disorder in the Graves' hyperthyroidism (GH) that affects the orbital contents. The classic clinical symptoms developed Graves' orbitopathy (GO) are periocular edema, proptosis, eyelid retraction, eye movement disorder, disturbance of the anterior segment of the eye and decrease in visual acuity.
The annual incidence of Graves' orbitopathy is 16/100,000 in women and 3/100,000 in men. Of the total number of patients approximately 50% of patients developed clinically significant form of the disease, among which 15-20% require hospitalization, and about 3-5% have severe disease with compressive neuroopticopathy known as DON (Dysthyroid optic neuropathy) that sometimes requires treatment in addition to the system and urgent surgical treatment. 45% of all patients with a mild form of the disease that require only symptomatic treatment, with most important modulatory extrinsic factor for GO being smoking. Clinical studies have proven that smoking promotes the formation of GO in patients with GH, prolonged illness and reduces the effect of treatment. Given the type of stigmatizing of this disease, patients with GO have a significantly reduced quality of life and society has significant economic repercussions. The current golden standard treatment of clinically significant and severe form of the disease is immunosuppression with corticosteroids, while in recent years more and more research deals with the effect of immunomodulatory biologicals.
EUGOGO (European Group on Graves' orbitopathy), which brings together a multidisciplinary group of experts from 15 European centers issued the 2015 guidelines for the diagnosis, clinical management and treatment of various forms of GO
Nova metoda lijeÄenja patele alte kod bolesnice s cerebralnom paralizom: prikaz sluÄaja s pregledom literature
Patella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often required and can be, if necessary, combined with other surgical procedures. Here, we report a case of combining both conservative method and surgical procedure in a 26-year-old female patient with cerebral palsy and bilateral patella alta. One month prior to surgical intervention we administered a botulinum toxin type A (BTX-A) in the ipsilateral quadriceps. Reduced muscle spasticity of the knee extensor mechanism facilitated the patellar tendon shortening procedure and yielded excellent postoperative results. After a six-month postoperative rehabilitation course, the patient had no pain and the knee range of motion improved from 5-50Ā° preoperatively to 0-140Ā° postoperatively in both knees. To our knowledge, we are the first to report a use of preoperative BTX-A in the treatment of patella alta in a patient with cerebral palsy. The efficacy and safety of this treatment modality may give encouragement to a wider use of preoperative BTX-A in order to facilitate surgical intervention and postoperative rehabilitation in cases of muscle spasticity.Patela alta relativno je Äesto stanje u ambulatornih bolesnika s cerebralnom paralizom, osobito onih koji se prezentiraju ÄuÄeÄim hodom. LijeÄenje simptomatske patele alte u takvih je bolesnika složeno i konzervativne metode lijeÄenja rijetko daju zadovoljavajuÄe rezultate. Stoga je u veÄini sluÄajeva indicirano operacijsko lijeÄenje u smislu izolirane distalizacije patele ili udružene s drugim kirurÅ”kim zahvatima. U ovom radu prikazan je sluÄaj udružene primjene konzervativne metode lijeÄenja i kirurÅ”kog zahvata kod 26-godiÅ”nje bolesnice s cerebralnom paralizom i obostranom patelom altom. Mjesec dana prije kirurÅ”ke intervencije apliciran je botulinum toksin tip A (BTX-A) u ipsilateralni miÅ”iÄ kvadricepsa. PosljediÄno smanjena spastiÄnost miÅ”iÄa ekstenzora koljena olakÅ”ala je postupak skraÄivanja ligamenta patele i omoguÄila je sigurniju rehabilitaciju. Å est mjeseci nakon operacije pojedinog koljena bolesnica se nije žalila na bolove, a opseg pokreta oba koljena poboljÅ”an je s 5-50Ā° prije operacije na 0-140Ā° poslije operacije. Ovim radom prvi smo izvjestili o uporabi prijeoperacijskog BTX-A u lijeÄenju patele alte kod bolesnika sa cerebralnom paralizom. Dokaz o uÄinkovitosti i sigurnosti ove metode lijeÄenja mogao bi potaknuti Å”iru prijeoperacijsku primjenu BTX-A kako bi se, u sluÄajevima poviÅ”enog tonusa miÅ”iÄa, olakÅ”ala kirurÅ”ka intervencija i unaprijedila poslijeoperacijska rehabilitacija
Etiopathogenesis and treatment of graves orbitopathy
Gravesova orbitopatija (takoÄer poznata kao bolest oka povezana sa Å”titnjaÄom āengl. TED) je autoimuni upalni poremeÄaj koji u sklopu Gravesove hipertireoze (GH) zahvaÄa orbitalni sadržaj. KlasiÄni kliniÄki simptomi razvijene Gravesove orbitopatije (GO) su periokularni edemi, proptoza, retrakcija vjeÄa, poremeÄaj bulbomotorike, smetnje prednjeg segmenta oka te pad vidne oÅ”trine.
GodiÅ”nja incidencija Gravesove orbitopatije je 16/100.000 u žena, te 3/100.000 u muÅ”karaca. Od ukupnog broja oboljelih otprilike 50% bolesnika razvija kliniÄki signifikantan oblik bolesti od kojih 15-20% zahtijeva bolniÄko lijeÄenje, a oko 3-5% ima težak oblik bolesti s kompresivnom neurooptikopatijom poznatom kao DON (distiroidna optiÄka neuropatija) koji ponekad osim sistemskog lijeÄenja zahtijeva i hitno kirurÅ”ko lijeÄenje. 45% svih oboljelih razvija blagi oblik bolesti koji zahtijeva samo simptomatsku terapiju, NajznaÄajniji modulatorni ekstrinziÄki faktor za GO je puÅ”enje. KliniÄke studije dokazale su da puÅ”enje pospjeÅ”uje nastanak GO kod bolesnika sa GH, produžuje bolest i umanjuje uÄinak lijeÄenja. Obzirom na stigmatizirajuÄi tip bolesti, bolesnici sa GO imaju znaÄajno smanjenu kvalitetu života, a druÅ”tvo znaÄajne ekonomske reperkusije. DosadaÅ”nji zlatni standard lijeÄenja kliniÄki signifikantnog i teÅ”kog oblika bolesti bila je imunosupresija kortikosteroidima, dok se zadnjih godina sve viÅ”e istraživanja bavi sa uÄinkom imunomodulatornih bioloÅ”kih lijekova.
EUGOGO (European Group on Graves' Orbitopathy) koji okuplja multidisciplinarnu grupu eksperata iz 15 europskih centara izdalo je 2015. godine smjernice za dijagnostiku, kliniÄku obradu i lijeÄenje razliÄitih oblika GO.Graves' orbitopathy (also known as thyroid eye disease TED) is an autoimmune inflammatory disorder in the Graves' hyperthyroidism (GH) that affects the orbital contents. The classic clinical symptoms developed Graves' orbitopathy (GO) are periocular edema, proptosis, eyelid retraction, eye movement disorder, disturbance of the anterior segment of the eye and decrease in visual acuity.
The annual incidence of Graves' orbitopathy is 16/100,000 in women and 3/100,000 in men. Of the total number of patients approximately 50% of patients developed clinically significant form of the disease, among which 15-20% require hospitalization, and about 3-5% have severe disease with compressive neuroopticopathy known as DON (Dysthyroid optic neuropathy) that sometimes requires treatment in addition to the system and urgent surgical treatment. 45% of all patients with a mild form of the disease that require only symptomatic treatment, with most important modulatory extrinsic factor for GO being smoking. Clinical studies have proven that smoking promotes the formation of GO in patients with GH, prolonged illness and reduces the effect of treatment. Given the type of stigmatizing of this disease, patients with GO have a significantly reduced quality of life and society has significant economic repercussions. The current golden standard treatment of clinically significant and severe form of the disease is immunosuppression with corticosteroids, while in recent years more and more research deals with the effect of immunomodulatory biologicals.
EUGOGO (European Group on Graves' orbitopathy), which brings together a multidisciplinary group of experts from 15 European centers issued the 2015 guidelines for the diagnosis, clinical management and treatment of various forms of GO
ARTHROSCOPY OF THE FIRST METATARSOPHALANGEAL JOINT
Artroskopija prvoga metatarzofalangealnog zgloba (1. MTF zglob) danas je neizostavna metoda kirurÅ”kog zbrinjavanja ozljeda i njihovih posljedica te oÅ”teÄenja koja zahvaÄaju taj zglob. Prednosti artroskopske kirurgije 1. MTF zgloba u odnosu prema klasiÄnoj otvorenoj metodi operacijskog lijeÄenja viÅ”estruke su. U prvome redu artroskopija nam omoguÄuje izvanredan prikaz unutarzglobnih struktura i time detaljan pregled Äitavog zgloba te potpuno izvoÄenje zahvata bez otvaranja zgloba. Nadalje, morbiditet je znatno niži, rehabilitacija brža, a brži je i povratak svakodnevnim aktivnostima. Osnovni preduvjeti za uspjeÅ”nu primjenu artroskopije 1. MTF zgloba jesu pažljivo prijeoperacijsko planiranje, izvanredno dobro poznavanje regionalne anatomije, striktno praÄenje pravila izvoÄenja zahvata, dobra tehnika te iskusan operater. Osnovnim indikacijama za artroskopiju 1. MTF zgloba danas se smatraju poÄetni stadiji haluksa rigidusa, osteohondritis disekans glave 1. metatarzalne kosti, sinovitisi razliÄite etiologije te patoloÅ”ki procesi sezamskih kostiju palca stopala. U ovom Älanku opisujemo indikacije, tehniku, komplikacije, kao i perspektivu artroskopije 1. MTF zgloba, uz detaljan pregled suvremenih literaturnih podataka.Arthroscopy of the first metatarsophalangeal joint (MTP-1) has become indispensable method of surgical care to injuries and their consequences and damages that affect the MTP-1 joint. The advantages of arthroscopy of the 1st MTP joint in comparison to classical open surgery are multiple. Primarily, arthroscopy allows an excellent view of intra-articular structures and thus a detailed overview of the entire joint which enables us to perform complete surgery without opening the joint. Furthermore, morbidity is significantly smaller, rehabilitation is faster, and return to daily activities is also faster. Basic requirements for successful application of arthroscopy of the MTP-1 joint are careful planning of the procedure, very good knowledge of regional anatomy, strictly following the rules of performing the procedure, and an experienced surgeon with arthroscopy skills. Primary indications for the arthroscopy of the MTP-1 joint include early stages of hallux rigidus, osteochondral lesions, synovitis, and pathological conditions of sesamoid bones. In this article we describe the indications, technique, complications and the prospect of the arthroscopy of the MTP-1 joint, with a detailed overview of contemporary literature data
Osteochondritis dissecans of the elbow
Osteohondritis disekans (OCD) lakta je žariÅ”no oÅ”teÄenje zglobne hrskavice i pripadajuÄe subhondralne kosti. U laktu je OCD najÄeÅ”Äe
lokaliziran na kapitulumu humerusa. OCD lakta se uobiÄajeno javlja kod Å”portaÅ”a u adolescenciji, posebice kod onih koji se
bave ābacaÄkimā Å”portovima, te kod gimnastiÄara. Nastanak OCD-a lakta posljedica je kombinacije ponavljajuÄih mikrotrauma,
biomehaniÄke neusklaÄenosti i oskudne vaskularizacije distalnog dijela nadlaktiÄne kosti. OCD lakta se najÄeÅ”Äe otkriva na magnetskoj
rezonanciji i raÄunalnoj tomografi ji, iako se oÅ”teÄenje može uoÄiti i na standardno naÄinjenim radioloÅ”kim snimkama. Od
najveÄe je važnosti razlikovati stabilni od nestabilnog OCD-a lakta kako bi se odredio najbolji naÄin lijeÄenja. Stabilni OCD lakta
može se zapoÄeti lijeÄiti neoperacijski, i to poÅ”tedom i modifi kacijom aktivnosti. KirurÅ”ko je lijeÄenje potrebno kad je rijeÄ o nestabilnom
OCD-u lakta, nakon neuspjeÅ”nog neoperacijskog lijeÄenja te ako je prisutno slobodno zglobno tijelo u zglobu koje Äini mehaniÄke
simptome. Osnovne metode kirurÅ”kog lijeÄenja OCD-a lakta su stimulacija koÅ”tane srži, fi ksacija koÅ”tano-hrskaviÄnog
fragmenta te prijenos autolognog koÅ”tano-hrskaviÄnog presatka. Cilj ovog rada je prikazati dosadaÅ”nje spoznaje o etiologiji, kliniÄkoj
slici, dijagnostici, moguÄnostima lijeÄenja te ishodu lijeÄenja OCD-a lakta.Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, OCD is localized most
commonly at the humeral capitellum. OCD of the elbow can be a signifi cant problem in adolescent athletes, especially in athletes
engaged in repetitive overhead activities and gymnasts. The likely cause of OCD of the elbow is multifactorial secondary to repetitive
microtrauma, biomechanical mismatch, and tenuous vascular supply of the capitellum. Plain radiographs may disclose the lesion
but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD. It is important to diff erentiate
between stable and unstable OCD lesion to determine the best treatment option. Stable OCD lesions can be initially treated
nonoperatively with elbow rest or activity modifi cation. Surgery is indicated for patients who have unstable OCD lesion, those in
whom nonoperative management failed, or those that have loose bodies with associated mechanical symptoms. The potential
surgical interventions include bone marrow stimulation techniques, internal fi xation of large fragments, and osteochondral autograft
transplantation system. The aim of this article is to review current concepts on the aetiology, clinical presentation, diagnosis,
treatment, and outcomes of elbow OCD
Arthroscopic sesamoidectomy for managing stress fractures of the medial great toe sesamoid in adolescent athletes: two case reports and review of the literature
Ozljede sezamoidnih kostiju prvog metatarzofalangealnog zgloba relativno rijetko susreÄemo. NeÅ”to ih ÄeÅ”Äe nalazimo u Å”portski aktivnoj populaciji, i to osobito u adolescenata te mlaÄih osoba, u prvom redu gimnastiÄara, atletiÄara i plesaÄa. Bolesnici se žale na bol s plantarne strane prvog metatarzofalangealnog zgloba prilikom optereÄenja, primjerice tijekom hoda, trÄanja i/ili skokova. Bol se pojaÄava i prilikom pasivne fleksije palca stopala, a smanjuje se mirovanjem. Postavljanje dijagnoze ozljede i oÅ”teÄenja sezamoidnih kostiju prvog metatarzofalangealnog zgloba zasniva se na iscrpnoj anamnezi, detaljnom kliniÄkom pregledu te slikovnim prikazima, od kojih se danas uz standardne rengenske snimke najviÅ”e primjenjuje magnetska rezonancija. Osnova konzervativnog lijeÄenja je rastereÄenje prvog metatarzofalangealnog zgloba. No to se lijeÄenje pokazalo nedovoljno uspjeÅ”nim prilikom pokuÅ”aja vraÄanja bolesnika na razinu Å”portske aktivnosti kao prije ozljede. Stoga se danas u veÄini sluÄajeva savjetuje kirurÅ”ko lijeÄenje. KirurÅ”ko uklanjanje sezamoidne kosti, tzv. sezamoidektomija, može biti djelomiÄna ili potpuna, a može se obaviti klasiÄnim kirurÅ”kim otvorenim naÄinom ili artroskopski. U ovom smo radu prikazali dva sluÄaja adolescentnih Å”portaÅ”ica u kojih je zbog nesraslog prijeloma zamora medijalne sezamoidne kosti prvog metatarzofalangealnog zgloba uÄinjena artroskopska sezamoidektomija, i to u jedne djelomiÄna, a u druge potpuna medijalna sezamoidektomija. Detaljno je opisana operacijska tehnika, kao i provedena poslijeoperacijska rehabilitacija te je istaknuto da su se obje sportaÅ”ice vratile na istu razinu aktivnosti kao i prije ozljede.Sesamoid bone injuries of the first metatarsophalangeal joint are rarely encountered. Nonetheless, these injuries seem to occur more frequently in sports active population, thus affecting adolescents and younger people, particularly gymnasts, dancers, and track and field athletes. Patients are experiencing pain in the plantar aspect of the first metatarsophalangeal joint, which is aggravated while walking, running or jumping. Diagnosing sesamoid bone disorders relies on careful history taking, detailed physical examination and radiographic imaging such as x-rays and magnetic resonance imaging. Reduced weight bearing of the first metatarsophalangeal joint is the basis of conservative treatment of these injuries. However, such treatment offers limited success rates for return to sports at the patientās previous level of activity. Therefore, in most cases, surgical management is recommended. The sesamoid bones can be completely or partially excised, performing sesamoidectomy either by open surgery or using arthroscopy. This paper brings two case reports detailing partial and total arthroscopic sesamoidectomy due to medial sesamoid bone stress fracture of the first metatarsophalangeal joint. It includes comprehensive description of surgical techniques and postoperative rehabilitation, emphasizing that both athletes have returned to their previous level of sporting activity
Rekonstrukcija prednjeg križnog ligamenta i anterolateralnog ligamenta koljena tetivama kvadricepsa i plantarisa
Anterior cruciate ligament (ACL) reconstructions with quadriceps tendon (QT) grafts are gaining popularity, both in primary and revision procedures. Recently, the role of the anterolateral ligament (ALL) of the knee in improving rotational knee stability has been emphasised and concurrent ACL and ALL reconstruction is advocated. In this paper, a new technique utilising the QT and the plantaris tendon (PLT) for combined ACL and ALL reconstruction is analysed. Patients that underwent combined ACL and ALL reconstruction using QT and PLT grafts in a 3-years period were prospectively analysed. A total of 9 patients with 6 months minimum follow-up were assessed with Lachman and Pivot shift clinical tests, International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner activity scale. One patient had reconstructed ACL re-rupture at the final follow-up visit, leaving 8 patients with a mean follow-up of 19Ā±8 months. There was a significant improvement in anteroposterior and rotational stability in all the patients. The IKDC, KOOS, and Lysholm scores improved as well. The Tegner activity scale increased postoperatively, however, it did not reach preinjury values. QT and PLT grafts are valuable alternatives for currently used grafts in combined ACL and ALL reconstructive procedures. This new technique is a reasonable option in ACL revision surgery and a good alternative in primary ACL and ALL reconstruction, especially when hamstring grafts are not advised or they are missing.Rekonstrukcija prednjeg križnog ligamenta (ACL) presatkom tetive kvadricepsa (QT) kod primarnih i revizijskih zahvata postaje sve uÄestalija. Nedavno je istaknuta uloga anterolateralnog ligamenta (ALL) u poboljÅ”anju rotacijske stabilnosti koljena te se zagovara istodobna rekonstrukcija ACL-a i ALL-a. U ovom radu analizirana je nova kirurÅ”ka tehnika kombinirane rekonstrukcije ACL-a i ALL-a koja koristi QT i tetivu plantarisa (PLT). Prospektivno su praÄeni pacijenti kojima je uÄinjena udružena rekonstrukcija ACL-a i ALL-a presadcima QT i PLT u razdoblju od 3 godine. Ukupno je analizirano 9 pacijenata s minimalno 6 mjeseci praÄenja. Koristili su se kliniÄki testovi Lachman i Pivot shift te upitnici procjene ishoda: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm i Tegnerova ljestvica aktivnosti. Kod svih pacijenata je doÅ”lo do znaÄajnog poboljÅ”anja u anteroposteriornoj i rotacijskoj stabilnosti. Rezultati IKDC, KOOS i Lysholm upitnika takoÄer su se poboljÅ”ali. Tegnerova ljestvica aktivnosti se postoperativno poboljÅ”ala, ali nije dosegla vrijednosti prije ozljede. Jedan je pacijent zadobio rerupturu ACL-a u vrijeme posljednjeg pregleda, ostavljajuÄi 8 pacijenata s prosjeÄnim praÄenjem od 19Ā±8 mjeseci. Presadci QT i PLT vrijedna su alternativa za trenutno koriÅ”tene presatke u zahvatima udružene rekonstrukcije ACL-a i ALL-a. Ova nova tehnika razumna je opcija u revizijskim zahvatima rekonstrukcije ACL-a i dobra alternativa u primarnoj rekonstrukciji ACL-a i ALL-a, osobito kada se ne preporuÄa koristiti tetive fleksora koljena ili one nedostaju
Etiopathogenesis and treatment of graves orbitopathy
Gravesova orbitopatija (takoÄer poznata kao bolest oka povezana sa Å”titnjaÄom āengl. TED) je autoimuni upalni poremeÄaj koji u sklopu Gravesove hipertireoze (GH) zahvaÄa orbitalni sadržaj. KlasiÄni kliniÄki simptomi razvijene Gravesove orbitopatije (GO) su periokularni edemi, proptoza, retrakcija vjeÄa, poremeÄaj bulbomotorike, smetnje prednjeg segmenta oka te pad vidne oÅ”trine.
GodiÅ”nja incidencija Gravesove orbitopatije je 16/100.000 u žena, te 3/100.000 u muÅ”karaca. Od ukupnog broja oboljelih otprilike 50% bolesnika razvija kliniÄki signifikantan oblik bolesti od kojih 15-20% zahtijeva bolniÄko lijeÄenje, a oko 3-5% ima težak oblik bolesti s kompresivnom neurooptikopatijom poznatom kao DON (distiroidna optiÄka neuropatija) koji ponekad osim sistemskog lijeÄenja zahtijeva i hitno kirurÅ”ko lijeÄenje. 45% svih oboljelih razvija blagi oblik bolesti koji zahtijeva samo simptomatsku terapiju, NajznaÄajniji modulatorni ekstrinziÄki faktor za GO je puÅ”enje. KliniÄke studije dokazale su da puÅ”enje pospjeÅ”uje nastanak GO kod bolesnika sa GH, produžuje bolest i umanjuje uÄinak lijeÄenja. Obzirom na stigmatizirajuÄi tip bolesti, bolesnici sa GO imaju znaÄajno smanjenu kvalitetu života, a druÅ”tvo znaÄajne ekonomske reperkusije. DosadaÅ”nji zlatni standard lijeÄenja kliniÄki signifikantnog i teÅ”kog oblika bolesti bila je imunosupresija kortikosteroidima, dok se zadnjih godina sve viÅ”e istraživanja bavi sa uÄinkom imunomodulatornih bioloÅ”kih lijekova.
EUGOGO (European Group on Graves' Orbitopathy) koji okuplja multidisciplinarnu grupu eksperata iz 15 europskih centara izdalo je 2015. godine smjernice za dijagnostiku, kliniÄku obradu i lijeÄenje razliÄitih oblika GO.Graves' orbitopathy (also known as thyroid eye disease TED) is an autoimmune inflammatory disorder in the Graves' hyperthyroidism (GH) that affects the orbital contents. The classic clinical symptoms developed Graves' orbitopathy (GO) are periocular edema, proptosis, eyelid retraction, eye movement disorder, disturbance of the anterior segment of the eye and decrease in visual acuity.
The annual incidence of Graves' orbitopathy is 16/100,000 in women and 3/100,000 in men. Of the total number of patients approximately 50% of patients developed clinically significant form of the disease, among which 15-20% require hospitalization, and about 3-5% have severe disease with compressive neuroopticopathy known as DON (Dysthyroid optic neuropathy) that sometimes requires treatment in addition to the system and urgent surgical treatment. 45% of all patients with a mild form of the disease that require only symptomatic treatment, with most important modulatory extrinsic factor for GO being smoking. Clinical studies have proven that smoking promotes the formation of GO in patients with GH, prolonged illness and reduces the effect of treatment. Given the type of stigmatizing of this disease, patients with GO have a significantly reduced quality of life and society has significant economic repercussions. The current golden standard treatment of clinically significant and severe form of the disease is immunosuppression with corticosteroids, while in recent years more and more research deals with the effect of immunomodulatory biologicals.
EUGOGO (European Group on Graves' orbitopathy), which brings together a multidisciplinary group of experts from 15 European centers issued the 2015 guidelines for the diagnosis, clinical management and treatment of various forms of GO