Može li dugotrajna velika depresija izazvati osteoporozu?

A marked clinical, physiologic, and biochemical connection between osteoporosis and major depressive disorder (MDD) is described. There are numerous states and diseases associated with osteoporosis. The aim of the study was to assess the presumed association between hypercortisolism and osteoporosis. Some recent studies provided evidence for association between previous history of MDD and marked osteoporosis. In MDD, there are two well documented biochemical abnormalities, hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 male and 12 female), mean age 37±1.3, age range 29-41 years, and 17 healthy male volunteers mean age 39±1.6, age range 34-45 years. The levels of free cortisol in 24-h urine, serum cortisol at 8 a.m. and 5 p.m., and cortisol in dexamethasone suppression test as well as bone mineral density were measured in all study subjects. The results obtained were analyzed by use of Spearman\u27s nonparametric rank correlation, rho=-0.805, with a statistical significance level of p<0.01 (2-tailed). Study results suggested that patients with a long-term history of depression may develop a severe form of osteoporosis. Also, a severe form of osteoporosis has been known to develop in patients with untreated Cushing\u27s syndrome.Opisana je klinička, fiziološka i biokemijska povezanost osteoporoze i velike depresije. U oba stanja dolazi do hiperaktivnostiosi HPA, sustava LC/NE, te povišenog lučenja CRH, kortizola i katekolamina. Mnoga stanja i bolesti povezane su s osteoporozom, uključujući hiperkorticizam. Novija istraživanja povezuju raniju povijest velike depresije s osteoporozom. U velikoj depresiji zabilježene su dvije biokemijske abnormalnosti: hiperkorticizam i rezistencija na supresiju deksametazonom. U naše je istraživanje bio uključen 31 bolesnik s velikom depresijom (19 muškaraca i 12 žena) prosječne dobi od 37±1,3 godine, te 17 muških dobrovoljaca u dobi od 34 do 45 godina, prosječne dobi od 39±1,6 godina. U svih je bolesnika određivana razina kortizola u 24-satnoj mokraći, serumski kortizol, kortizol u testu supresije deksametazonom, a gustoća kostiju je određivan adenzitometrijski. Bila je to skupina mlađih muškaraca i žena s održanim menstruacijskim ciklusom, u početku bez osteoporoze, ali godinama pod antidepresivnom terapijom. Analiza rezultata pokazala je povišene vrijednosti kortizola, te pojavu osteoporoze razvoj koje je bio posljedica povišene razine kortizola. U analizi rezultata primijenjena je neparametrijska korelacija rangova, pri čem je Spearmanov rho bio -0,805 uz statistiku značajnost od p<0,01. Na temelju rezultata ispitivanja zaključeno je da bolesnici liječeni zbog depresije imaju povišenu razinu kortizola u 24-satnoj mokraći. Bolesnici koji su duže bolovali od depresije imali su jače izraženu osteoporozu. Kortizol vjerojatno ima značajnu ulogu u nastanku osteoporoze u bolesnika s depresijom, a poznato je da se u bolesnika s neliječenim Cushingovim sindromom također razvija jak oblik osteoporoze

God’s Punishment or Bad Strategy: Anti-Epidemic Measures in the Lower Neretva Basin at the Time of Cholera in 1886

The epidemic of cholera that took place in the Neretva basin in 1886 was part of the fifth pandemic wave that was spreading throughout Europe. Based on the death records, vital statistics and the newspaper articles from that period, in this paper we present the emergence and the course this epidemic. In the context of analysis and experience of the epidemic of cholera in the lower Neretva basin, the newspaper articles have been recognized as a sensitive register of the changes of behavioural patterns, the way of speaking, the mechanisms of reacting and adjusting to the spreading epidemic, but also the resistance to it. It is based on this material that we can make conclusions about the relationship between the individual and the collective in the time of danger, as well as about the particularities of historical events that have been left out in other sources. Two potential paths for cholera to enter the area of the lower Neretva basin have been identified: one from the sea and the other from land, via the neighbouring country of Bosnia and Herzegovina. Quarantine measures had been taken in order to prevent the onslaught of the epidemic, a sanitary cordon was organized, disinfection of the land was carried out and a cholera hospital organized in Metković. However, despite the undertaken measures, an inefficiency of the government organs was obvious, because their actions mainly applied to formal fulfilment of anti-epidemic measures and they quite easily handed over individual initiatives to physicians. The analysis of strategies concerning the application of anti-epidemic measures in the past can be useful for learning more about the multilayered nature of social mechanisms in the time of epidemics, which makes it convincing and valuable even in the present day

Autoimuni poliglandularni sindrom tip II. - prikaz slučaja

Presentation is made of a 41-year-old man with Addison’s disease and coexistent Hashimoto’s thyroiditis and hypothyroidism. The two diseases are presumed to be of autoimmune etiology and to manifest as part of the autoimmune polyglandular syndrome type II, as also suggested by tissue typing for HLA B8 locus. Inadequate TSH suppression with standard levothyroxine substitution therapy for a one-year period or with higher substitution doses of 200 mg during TRH stimulation, with FT4 which showed no major increase but remained within lower normal limits, indicated partial hypophyseal resistance to thyroxin and/or possible development of autoantibodies to peripheral thyroid hormones.Prikazan je 41-godišnji bolesnik s Addisonovom bolešću i pridruženim Hashimotovim tireoiditisom i hipotireozom. Za pretpostaviti je da su ove dvije bolesti autoimune etiologije i da se javljaju u okviru autoimunog poliglandularnog sindroma tipa II., na što upućuje i tipizacija tkiva u smislu HLA B8 lokusa. Nedovoljna supresija TSH standardnom nadomjestnom terapijom levotiroksinom kroz dulje vremensko razdoblje od godinu dana, kao i većim nadomjestnim dozama od 200 mg tijekom stimulacije TRH, uz FT4 koji se nije značajnije povisio, nego je ostao u nižem normalnom rasponu, ukazivala je na djelomičnu rezistenciju hipofize na tiroksin i/ili mogućnost razvoja autoantitijela na periferne hormone štitnjače

Prijelomi dijafize humerusa: liječenje antegradnim usidrenim endomedularnim čavlom s primjenom neutralizacijskih vijaka kroz frakturnu pukotinu

The aim of this study was to compare union time between two different nail designs for the treatment of humeral shaft fracture, i.e. antegrade interlocking intramedullary nail with and without additional interlocking neutralization screws. The retrospective study included 51 patients treated with antegrade humeral intramedullary nailing between January 2015 and December 2017. The inclusion criteria of the study were proximal and middle third humeral shaft fractures. Fifty-one patients met the inclusion criteria; 23 patients were treated with antegrade intramedullary nail with additional interlocking neutralization screws through fracture site (group A) and 28 patients were treated with antegrade intramedullary nail without additional interlocking neutralization screws (group B). Medical documentation and radiographic images taken preoperatively and postoperatively were reviewed. Radiological union was defined as cortical bridging of at least three of four cortices in two-plane radiographs, with disappearance of the fracture gap. There were no significant differences in union time between the groups (p>0.05). To our knowledge, this is the first report of antegrade interlocking humeral nailing with additional interlocking neutralization screws through fracture site. Hypothetical advantages of fracture gap reduction by additional interlocking neutralization screws to promote union were not confirmed by this first clinical trial.Cilj ovoga istraživanja bio je usporediti vrijeme cijeljenja prijeloma dijafize humerusa pri liječenju s dva različita dizajna intramedularnog čavla: antegradni ukotvljeni intramedularni čavao s dodatnim ukotvljenim neutralizacijskim vijcima i bez njih. Retrospektivna studija obuhvatila je 51 bolesnika liječenog antegradnim humeralnim intramedularnim čavlima između siječnja 2015. i prosinca 2017. godine. Kriteriji uključenja u studiju bili su prijelomi proksimalne i srednje trećine dijafize humerusa. Pedeset i jedan bolesnik je ispunio kriterije uključenja: 23 bolesnika su liječena antegradnim intramedularnim čavlom s dodatnim ukotvljenim neutralizacijskim vijcima kroz mjesto prijeloma (skupina A), a 28 bolesnika je liječeno antegradnim intramedularnim čavlom bez dodatnih ukotvljenih neutralizacijskih vijaka (skupina B). Analizirana je medicinska dokumentacija i radiološke slike učinjene prije i poslije operacije. Radiološko cijeljenje prijeloma definirano je kao kortikalno premošćivanje najmanje tri od četiri korteksa u dvoprofilnim radiografima, s nestankom frakturne pukotine. Nije bilo značajne razlike u vremenu cijeljenja prijeloma između skupina (p>0,05). Prema našim spoznajama, ovo je prva studija o liječenju prijeloma humerusa antegradnim intramedularnim čavlom s dodatnim ukotvljenim neutralizacijskim vijcima kroz mjesto prijeloma. Hipotetsku prednost redukcije prijelomne pukotine s dodatnim ukotvljenim neutralizacijskim vijcima u svrhu poticanja cijeljenja nije potvrdila ova prva klinička studija

BASIC PRINCIPLES OF SURGICAL TREATMENT OF CHRONIC WOUNDS – SHARP DEBRIDEMENT

Porast zdravstvenog standarda u smislu kvalitetnije i učinkovitije zdravstvene skrbi rezultira porastom očekivane životne dobi. U populaciji dolazi do porasta broja starijih osoba. S jedne strane povećana aktivnost starije populacije dovodi do veće incidencije ozlijeđivanja, a s druge strane raste broj komorbiditeta kod takve populacije. Poremećaji cirkulacije, dijabetes melitus, metabolički disbalansi i dr. te smanjeni biološki potencijal regeneracije tkiva ima za posljedicu povećanje broja pacijenata s kroničnim ranama. One su značajan zdravstveno-sociološki i ekonomski problem za društvo. Zahtijevaju značajni angažman medicinskog i nemedicinskog osoblja u prethospitalnim i hospitalnim uvjetima, a značajni materijalni i nematerijalni resursi odvajaju se iz zdravstvene skrbi. Sve to rezultira smanjenom kvalitetom života bolesnika i njegove obitelji, odnosno skrbnika. Debridement je krucijalni medicinski postupak u liječenju akutnih i kroničnih rana. Rezultat debridmana je uklanjanje svih zapreka u rani i neposrednoj okolini rane, a koje opstruiraju odvijanje fi zioloških procesa u cijeljenju rane. Debridement se ponavlja prilikom svakog previjanja rane kada ima indikacija za njegovu primjenu. Postoji više vrsta debridmana. Svaki ima svoje prednosti i nedostatke. Metodu debridmana određuje liječnik ili druga stručna educirana osoba na osnovi karakteristika rane i u skladu sa svojom stručnosti i mogućnostima. U istoj rani mogu se kombinirati razne vrste debridmana, a sve sa ciljem što bržeg i kvalitetnijeg cijeljenja rane.The ever improving health standards in terms of quality and more effi cient health care result in an increase in life expectancy, thus increasing the number of elderly people in the population. A higher level of activity in elderly population leads to greater incidence of injuries, and on the other hand, there is an increasing number of comorbidities. Circulatory disorders, diabetes mellitus, metabolic imbalances, etc. and a reduced biological potential of tissue regeneration result in an increased number of chronic wounds that pose a signifi cant health, social and economic burden on the society. These conditions require significant involvement of medical and non-medical staff in pre-hospital institutions. Signifi cant material and other health care resources are allocated for the treatment of chronic wounds. These conditions result in a lower quality of life of patients and their families and caregivers. Debridement is a crucial medical procedure for the treatment of acute and chronic wounds. The result of debridement is removal of all barriers within and around the wound that obstruct physiological processes of wound healing. Debridement is a repeating process when indicated. There are several types of debridement, each with its advantages and disadvantages. The method of debridement should be determined by the physician or other professional trained person on the basis of wound characteristics and in accordance with their expertise and capabilities. In the same wound, we can combine different types of debridement, all with the goal of faster and better wound healing

APPLICATION OF TOPICAL HEMOGLOBIN SPRAY IN INFECTED POSTTRAUMATIC AND POSTOPERATIVE WOUNDS

Infekcije posttraumatskih i postoperacijskih rana, koje ne cijele, mogu biti ozbiljan problem za traumatiziranog pacijenta sa smanjenim biološkim potencijalom cijeljenja. Također, potreba za specifičnim i individualnim pristupom takvom pacijentu, izazov je i za liječnika. Uporaba topičkog hemoglobina u spreju, koji lokalno u rani djeluje i suportivno, osiguravajući i poboljšavajući fiziološke uvjete zarastanja, dodatno omogućava adekvatno i sigurno cijeljenje kompliciranih inficiranih rana.Posttraumatic and postoperative infective wounds that progress to chronic wounds can pose serious problem for the traumatized patient with reduced biological potential for healing. Also, due to the need for specific and individual approach to such a patient, they represent a challenge for physicians. The use of topical hemoglobin spray (Granulox®) with protective and supportive local action ensures and improves physiological conditions for healing, thus providing additional possibilities for adequate and safe healing of complicated infected wounds

Razvoj banke koštanog tkiva u Sveučilišnoj kliničkoj bolnici Mostar

Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.Banke koštanog tkiva su odgovorne za skupljanje, proizvodnju, ispitivanje, pakiranje, skladištenje i isporuku koštanih transplantata. Banka koštanog tkiva premosnica je od donora k primatelju prilikom koje se donacija pretače u sredstvo za poboljšanje zdravstvenog stanja kako primatelja tako i davatelja. Na Klinici za ortopediju Sveučilišne kliničke bolnice Mostar na godinu se ugradi oko 200 totalnih proteza kuka. Većini bolesnika kojima se ugrađuje totalna proteza kuka (90%) identificirana je dijagnoza osteoartritisa te su pogodni davatelji, s tim da se u obzir uzimaju komorbiditeti i životna dob. Na godinu se na Klinici izvodi oko 50 različitih operacija za koje trebaju koštani presatci. Tim visoko kompetentnih kirurga bavi se intenzivnim procesom adaptacije koji je orijentiran poboljšanju kvalitete i jačanju aktivnosti s ciljem zadovoljenja standarda izvrsnosti u ortopedskoj kirurgiji. Prisutnost ovakve koštane banke učinkovito utječe na kvalitetu skrbi kako zbog brže dostupnosti implantata tako i zbog znanstvene uloge visoko specificirane ustanove koja bazično istražuje svojstva koštanog tkiva

Višestruka endokrina neoplazija tipa 1 (MEN 1): prikaz slučaja

Hypoglycemia may occur as a component of type 1 multiple endocrine neoplasia syndrome. Insulinomas are rare tumors that often present a diagnostic dilemma for the clinician. The presence of inappropriately high plasma insulin and C-peptide concentrations at the time of symptomatic fasting hypoglycemia confirms the diagnosis of insulinoma. A. B., a 21-year-old girl, presented for evaluation of recurrent episodes of hyperhidrosis, confusion, and weakness with tremor, which was suggestive of hypoglycemia. Her body mass increased by 90 kg, with persistent symptoms of hypoglycemia. Because of her extremely excess sive body weight of 158 kg, the only diagnostic method available was upper abdomen ultrasonography, which revealed a tumor mass of 26 mm in size, located at the tail of the pancreas. Hemipancreatectomy and splenectomy were performed in one act. After the surgery, clinical symptoms disappeared but the patient developed diabetes, postoperatively, which required introduction of insulin therapy. Her body weight gradually normalized, she lost 54 kg, and postoperative magnetic resonance and computed tomography controls produced normal findings.Hipoglikemija se može pojaviti u sklopu sindroma višestruke endokrine neoplazije tipa 1. Inzulinom je rijedak tumor koji često predstavlja dijagnostički problem za kliničara. Neuobičajeno visoke koncentracije inzulina i C-peptida iz plazme za vrijeme hipoglikemije potvrđuju dijagnozu inzulinoma. A. B., 21-godišnja bolesnica je primljena na kliniku zbog opetovanih epizoda slabosti, psihičke konfuznosti i umora s tremorom, što je ukazivalo na hipoglikemiju. Četiri godine ranije operirala je prolaktinom hipofize i otada nije imala kontrolnih pregleda. Iste godine javili su se simptomi hipoglikemije, uza značajan porast tjelesne težine od 90 kg zbog velikih količina ugljikohidrata koje joj je obitelj davala zbog čestih hipoglikemija. Jedina dostupna dijagnostička tehnika s obzirom na njezinu prekomjernu tjelesnu težinu od 158 kg, koja bi potvrdila dijagnozu inzulinoma, bio je ultrazvuk gornjeg abdomena. Ultrazvuk je pokazao tumorsku tvorbu veličine 26 mm u području repa gušterače. Izvedena je hemipankreatektomija uz splenektomiju. Klinički znaci hipoglikemije povukli su se nakon operacijskog zahvata, ali je tada u bolesnice nastupila šećerna bolest, pa je uvedeno u terapiju inzulin. Tijekom prve godine nakon operacije tjelesna se masa približno normalizirala, bolesnica je izgubila 54 kg. Na zadnjoj kontroli su magnetska rezonanca i kompjutorizirana tomografija pokazale uredan nalaz abdomena

Application of a novel bone osteotomy plate leads to reduction in heat-induced bone tissue necrosis in sheep

Previous studies have shown substantial effect thermal damage can have on new bone formation following osteotomy. In this study we evaluated the extent of thermal damage which occurs in four different methods of osteotomy and the effects it can have on bone healing. We further wanted to test whether a special osteotomy plate we constructed can lead to diminished heat generation during osteotomy and enhanced bone healing. The four methods evaluated included osteotomy performed by chisel, a newly constructed osteotomy plate, Gigly and oscillating saw. Twelve adult sheep underwent osteotomy performed on both tibiae. Bone fragments were stabilized using a fixation plate. Callus size was assessed using standard radiographs. Densitometry and histological evaluation were performed at 8 weeks following osteotomy. Temperature measurements were performed both in vivo during the operation, and ex vivo on explanted tibiae. The defects healed without complications and showed typical course of secondary fracture healing with callus ingrowth into the osteotomy gap. Radiographic examination of bone healing showed a tendency towards more callus formation in bones osteotomized using Gigly and oscillating saw, but this difference lacked significance. Use of Gigly and oscillating saw elicited much higher temperatures at the bone cortex surface, which subsequently lead to slightly impaired bone healing according to histological analysis. BMD was equal among all bones. In conclusion, the time required for complete healing of the defect differed depended greatly on the instruments used. The newly constructed osteotomy plate showed best results based on histological findings of capillary and osteoblast density

God’s Punishment or Bad Strategy: Anti-Epidemic Measures in the Lower Neretva Basin at the Time of Cholera in 1886

The epidemic of cholera that took place in the Neretva basin in 1886 was part of the fifth pandemic wave that was spreading throughout Europe. Based on the death records, vital statistics and the newspaper articles from that period, in this paper we present the emergence and the course this epidemic. In the context of analysis and experience of the epidemic of cholera in the lower Neretva basin, the newspaper articles have been recognized as a sensitive register of the changes of behavioural patterns, the way of speaking, the mechanisms of reacting and adjusting to the spreading epidemic, but also the resistance to it. It is based on this material that we can make conclusions about the relationship between the individual and the collective in the time of danger, as well as about the particularities of historical events that have been left out in other sources. Two potential paths for cholera to enter the area of the lower Neretva basin have been identified: one from the sea and the other from land, via the neighbouring country of Bosnia and Herzegovina. Quarantine measures had been taken in order to prevent the onslaught of the epidemic, a sanitary cordon was organized, disinfection of the land was carried out and a cholera hospital organized in Metković. However, despite the undertaken measures, an inefficiency of the government organs was obvious, because their actions mainly applied to formal fulfilment of anti-epidemic measures and they quite easily handed over individual initiatives to physicians. The analysis of strategies concerning the application of anti-epidemic measures in the past can be useful for learning more about the multilayered nature of social mechanisms in the time of epidemics, which makes it convincing and valuable even in the present day