EEG CHARACTERISTICS IN DEPRESSION, „NEGATIVE“ AND „POSITIVE“ SCHIZOPHRENA

Objective: qEEG investigations present differences in the comparison of schizophrenic patients and healthy examinees, as well as of depressive patients and healthy controls. The comparison of “positive” and “negative” schizophrenia also presents differences in the qEEG parameters. Changes in qEEG are various in these studies, but not always consistent. In this research we wanted to compare “positive” schizophrenia, “negative” schizophrenia and depression. Subjects and methods: The sample comprised 55 examinees (all women): 20 patients with “positive” schizophrenia, 15 patients with “negative” schizophrenia and 20 patients with depression. The standard EEG registration was done in all of them. From the recorded material, the 20-second period without artifacts was analyzed by the FFT method. The results were presented as absolute special power values (μV2) for individual segments of the spectrum: delta (0.5-4.0), theta (4.0-8.0), alpha (8.0-13.0) and beta (13.0-30.0). The observed regions included Fp1, Fp2, F3, F4, F7, F8, T3, T4, P3, P4, O1 and O2. Results: The “positive” type schizophrenia differs from the “negative” in the increase in both delta and theta activities, and in the decline of beta activity over frontal regions. The “positive” type of schizophrenia differs from depression in the increase in delta activity over frontal regions, while the “negative” form of schizophrenia differs from it in the decrease in beta activity over frontal regions. Conclusions: qEEG parameters differ in the comparison of “positive” and “negative” types of schizophrenia. These differences are more numerous and more significant than those obtained in the comparison of each of these types of schizophrenia with depression

ARTHROSCOPY OF THE ELBOW

Artroskopija lakta danas je neizostavna metoda kirurškog zbrinjavanja kako ozljeda i njihovih posljedica tako i oštećenja koja zahvaćaju lakat. Prednosti artroskopske kirurgije lakta prema klasičnoj otvorenoj metodi operacijskog liječenja su višestruke. U prvome redu artroskopija nam omogućuje izvanredan prikaz unutarzglobnih struktura i time detaljan pregled čitavog zgloba te kompletno izvođenje zahvata bez otvaranja zgloba. Nadalje, morbiditet je znatno manji, rehabilitacija brža, a brži je i povratak svakodnevnim aktivnostima. Osnovni preduvjeti za uspješnu primjenu artroskopije lakta su pažljivo prijeoperacijsko planiranje, izvanredno dobro poznavanje regionalne anatomije lakta, striktno praćenje pravila izvođenja zahvata, dobra tehnika te iskusan operater. Osnovnim indikacijama za artroskopiju lakta danas se smatraju osteohondritis disekans lakta, lateralni epikondilitis, sindrom sinovijalnih nabora, osteoartritis zgloba lakta, kontraktura lakta, kao i stanja kod kojih je potrebna sinoviektomija, primjerice reumatoidni artritis, pigmentirani vilonodularni sinovitis, sinovijalna hondromatoza te hemofilični sinovitis.Elbow arthroscopy has become an indispensable method of surgical care of injuries and their consequences and damages that affect the elbow. The advantages of elbow arthroscopy 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 elbow arthroscopy are careful planning of the procedure, very good knowledge of regional anatomy of the elbow, strictly following the rules of performing the procedure, good technique and an experienced surgeon. Pathologies that can currently be addressed arthroscopically include osteochondritis dissecans of elbow, lateral epicondylitis, synovial plica syndrome, elbow osteoarthritis, elbow contracture, as well as the diseases where the synovectomy is needed, such as rheumatoid arthritis, pigmented villonodular synovitis, synovial chondromatosis and hemophiliac synovitis

Ima li tendoskopija mjesto u kirurškom liječenju nedostatnosti funkcije tetive tibijalis posteriora? [Is there any room for tendoscopy in the surgical treatment of posteriortibial tendon insufficiency]

Posterior tibial tendon insufficiency (PTTI) is nowadays considered to be the main cause of adult-acquired flatfoot deformity (AAFD). The purpose of this study is to report the outcomes of tendoscopic treatment of tibialis poste- rior tendon (TP) in eleven patients with stage 1 or 2 PTTI and failed prior conservative treatment. Tendoscopy was carried out as a solitary procedure in 8 patients, while in 3 patients additional procedures such as ,,mini-open" tubularization of TP or anterior ankle arthroscopy were necessary. In a single patient transfer of flexor digitorum longus tendon was performed as a second stage surgery due to complete rupture of TP. Related with tendoscopic procedure, no complications were re- ported. TP tendoscopy is a useful and beneficial minimally invasive procedure to treat TP pathology at earlier stages of PTTI. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small ioints and excellent knowledge of repional anatomy

Arthroscopic Treatment of Localized and Diffuse Pigmented Villonodular Synovitis of the Knee

Pigmented villonodular synovitis (PVNS) is a rare proliferative synovial disorder of uncertain etiology. Two forms of this disorder, a localized (LPVNS) and diffuse (DPVNS) form, are well differentiated. The therapy of choice for LPVNS is arthroscopic partial synovectomy with excision of the lesion. Total synovectomy, whether done arthroscopically or through an open arthrotomy, is the recommended treatment for DPVNS. During an eight-year period 13 patients, six male and seven female, average age 28 years (range, 16 to 60 years) were treated for PVNS of the knee with arthroscopic synovectomy. Average follow-up was 84 months (range, 28 to 127 months). Four patients were affected by localized PVNS and were subjected to partial arthroscopic synovectomy (two to three portals) with a complete lesion excision. The remaining nine patients presented with the diffuse form of PVNS and all of them underwent total arthroscopic synovectomy (five portals). The diagnosis was confirmed by synovial biopsy. Each patient was evaluated before treatment and at final follow-up. Results were assessed clinically, radiographically and subjectively and were rated as excellent, good, fair, or poor. No complications or recurrences were noted in the LPVNS group, and all four patients were rated as excellent. In the DPVNS group, eight patients were rated as excellent and one patient was rated as fair and it was the patient who suffered the only recurrence in our case series. No relevant complications were encountered. No cases of infection, joint stiffness or neurovascular lesions were seen. Arthroscopy has become the golden standard in treatment of LPVNS, and can undoubtedly give results that are as good as with open synovectomy when treating DPVNS, if performed by an experienced arthroscopic surgeon

Ima li tendoskopija mjesto u kirurškom liječenju nedostatnosti funkcije tetive tibijalis posteriora? [Is there any room for tendoscopy in the surgical treatment of posteriortibial tendon insufficiency]

Posterior tibial tendon insufficiency (PTTI) is nowadays considered to be the main cause of adult-acquired flatfoot deformity (AAFD). The purpose of this study is to report the outcomes of tendoscopic treatment of tibialis poste- rior tendon (TP) in eleven patients with stage 1 or 2 PTTI and failed prior conservative treatment. Tendoscopy was carried out as a solitary procedure in 8 patients, while in 3 patients additional procedures such as ,,mini-open" tubularization of TP or anterior ankle arthroscopy were necessary. In a single patient transfer of flexor digitorum longus tendon was performed as a second stage surgery due to complete rupture of TP. Related with tendoscopic procedure, no complications were re- ported. TP tendoscopy is a useful and beneficial minimally invasive procedure to treat TP pathology at earlier stages of PTTI. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small ioints and excellent knowledge of repional anatomy

IS THERE ANY ROOM FOR TENDOSCOPY IN THE SURGICAL TREATMENT OF POSTERIOR TIBIAL TENDON INSUFFICIENCY?

Nedostatnost funkcije tetive tibijalis posteriora (engl. posterior tibial tendon insufficiency – PTTI) danas se ­smatra glavnim uzrokom nastanka spuštenoga medijalnog uzdužnog svoda stopala u odraslih osoba (engl. adult-acquired flatfoot deformity – AAFD). Cilj je ovog istraživanja pokazati rezultate tendoskopskog liječenja tetive tibijalis posteriora (TP) kod 11 bolesnika s 1. ili 2. stadijem PTTI-a nakon neuspješnoga neoperacijskog liječenja. Tendoskopija kao samostalan kirurški zahvat provedena je kod 8 bolesnika, dok je kod 3 bolesnika bio potreban i dodatni zahvat poput mini-open tubularizacije TP-a ili artroskopske toalete prednjeg dijela gležnja. U jednog je bolesnika s kompletnom rupturom TP-a u drugom aktu načinjen transfer tetive fleksora digitorum longusa. Nisu zabilježene komplikacije tendoskopskih zahvata ni kod jednog bolesnika. Tendoskopija TP-a djelotvorna je i minimalno invazivna operacijska tehnika u liječenju ozljeda i oštećenja TP-a u početnim stadijima PTTI-a. Ta tehnički zahtjevna endoskopska tehnika iziskuje veliko iskustvo operatera u artroskopiji malih zglobova i odlično poznavanje regionalne anatomije.Posterior tibial tendon insufficiency (PTTI) is nowadays considered to be the main cause of adult-acquired flatfoot deformity (AAFD). The purpose of this study is to report the outcomes of tendoscopic treatment of tibialis posterior tendon (TP) in eleven patients with stage 1 or 2 PTTI and failed prior conservative treatment. Tendoscopy was carried out as a solitary procedure in 8 patients, while in 3 patients additional procedures such as „mini-open” tubularization of TP or anterior ankle arthroscopy were necessary. In a single patient transfer of flexor digitorum longus tendon was performed as a second stage surgery due to complete rupture of TP. Related with tendoscopic procedure, no complications were reported. TP tendoscopy is a useful and beneficial minimally invasive procedure to treat TP pathology at earlier stages of PTTI. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small joints and excellent knowledge of regional anatomy

Synovial Chondromatosis of the Elbow

Synovial chondromatosis (SC) is a rare, mostly benign proliferation of the synovium of the joint, tendon or bursa which results in the formation of loose bodies. It can appear in one of 33 described localisations, but it is most common in the knee. In our study we gathered a group of 7 patients (6 male and 1 female) with SC of the elbow, which underwent arthroscopic surgery of the elbow, performing both removal of the loose bodies and complete synovectomy. Mayo Elbow Performance Score (MEPS) was used to evaluate and compare the patients’ condition before the operation and at the final follow-up, 31 months, on average, after the operation (range 18–56 months). All patients had poor MEPS before the operation, with an average of 40.7 (range 15–50 points). At the final follow-up, 6 patients had a good or excellent MEPS, while a poor MEPS was present in a single patient. The average MEPS was 85 (range 45–100 points). The one patient who’s MEPS remained poor developed heterotopic ossification in the same elbow shortly after arthroscopic surgery. This patient was reoperated 8 months later using an open technique. No other complications occurred in the rest of the operated patients and no recurrence of SC occurred in any of the operated patients. Our results confirm that arthroscopic removal of loose bodies and complete synovectomy should be the treatment of choice for SC of the elbow