Ruptura tetive ekstenzora digitoruma nakon prednje artroskopije gležnja

Aim: The aim of this paper is to increase awareness of orthopaedic surgeons about an uncommon yet possible complication of ankle arthroscopy – iatrogenic extensor digitorum rupture. Ankle arthroscopy is becoming more widespread and according to the literature, the complication rate varies from 9% up to 17%. Case report: We are presenting a case of 32-year old police officer who recreationally plays soccer. The patient presented with clear signs of anterior ankle impingement confirmed by X-ray and the MRI. During ankle arthroscopy massive tibial and talar bone spurs were found with significant synovial reaction, nearly 10 loose intraarticular bodies and syndesmotic ossification. The patient was placed in a walking boot and early postoperative recovery went as planned. Physical therapy started 14 days after the procedure. Five weeks after the surgery while dorsiflexing his fingers patient felt a "snap" over his ankle followed by swelling. He couldn\u27t dorsiflex his fingers afterwards. MRI showed a rupture of the common extensor digitorum tendon. The patient was treated with open reconstruction of the tendon and lower leg immobilisation for 6 weeks followed by physical therapy and partial weight bearing. The patient made a full recovery. Conclusion: It is of the utmost importance to keep in mind that ankle arthroscopy alongside it\u27s obvious benefits is not void of complications. Iatrogenic tendon lesion is always possible and should be suspected with any loss of movement in foot and ankle after the procedure. Urgent MRI and immediate reconstruction showed good results in our case.Cilj: Cilj prikaza je podići svijest ortopeda o vrlo rijetkoj no mogućoj komplikaciji artroskopije gležnja – jatrogenoj rupturi tetive ekstenzor digitoruma. Artroskopija gležnja postaje sve raširenija i prema literaturi učestalost komplikacija varira od 9 % do 17 %. Prikaz slučaja: Prikazujemo slučaj 32-godišnjeg policajca koji se rekreativno bavi nogometom. Pacijent se javio s izraženim simptomima prednjeg sraza gležnja koji su potvrđeni RTG-om i MR-om. Tijekom artroskopije pronašli smo masivne koštane izdanke tibije i talusa uz znatnu sinovijalnu reakciju, 10 slobodnih zglobnih tijela te osifikaciju sindesmoze. Poslijeoperativno je postavljena hodna ortoza te je poslijeoperacijski oporavak išao prema planu. Fizikalna terapija započeta je 14 dana od zahvata. Pet tjedana od zahvata, kada je pacijent učinio dorzifleksiju prstiju, osjetio je kako je „nešto puknulo” u gležnju te se pojavila oteklina. Više nije mogao učiniti dorzifleksiju prstiju. MR je pokazao puknuće zajedničke tetive ekstenzora digitoruma. Pacijent je podvrgnut sekundarnom zahvatu – otvorenoj rekonstrukciji tetive te potom potkoljeničnoj imobilizaciji tijekom 6 tjedana. Potom je uslijedila fizikalna terapija te postepeno povećanje oslonca na operiranu nogu. Pacijent se potpuno oporavio. Zaključak: Neizmjerno je važno imati na umu kako artroskopija gležnja, osim svojih očitih prednosti, ima i ozbiljne komplikacije. Jatrogeno puknuće tetiva uvijek je moguće te ga treba imati na umu kod bilo kakvog gubitka pokreta u gležnju i stopalu nakon zahvata. Hitni MR te rekonstruktivni zahvat u našem su slučaju pokazali izvrsne rezultate

Djeca s ozljedama liječena u bolničkim ambulantama hitnog prijma [Children with injuries treated in hospital emergency departments]

The aim of this study was to determine characteristics of injuries of children admitted to the Emergency Department (ED) of University Hospital Split, and also to define the mechanisms of injuries, as well as the type and severity of injuries. We evaluated 3,221 children with injuries treated in the ED of the University Hospital of Split in the period from January to July 2009. The following indicators were analyzed: age, gender, anatomic distribution of injuries, mechanism, Injury Severity Score (ISS) and the need for hospital and intensive care admission. Chi-square and Mann-Whitney tests were used in order to determine statistical relevance of the results. Boys were more often injured than girls (65.6%), and most of the injured children were older than 13 years (41.7%). The majority of patients (96%) had minor injuries (ISS < 10), and only 3.7% of patients were hospitalized. The majority of injuries were caused by falls (71.3%), and limbs were the most frequently injured body region (67.1%). However, road traffic accidents (RTA) required hospitalization more often than any other mechanism (25% of patients), and the leading injury in RTA victims was head injury (38% of patients). Older children were more susceptible to RTAs (64.5%), and the majority of children were injured as passengers in cars (36.4%). Children with head injuries, and those injured in RTAs, were more often hospitalized and more often admitted to intensive care unit than other patients. The most frequently injured body region in children treated in ED are limbs, and the most frequent mechanism of injury is fall. However, the most severe are head injuries, and the majority of severe injuries are caused by RTAs. These data are important for programs of injury prevention

CHILDREN WITH INJURIES TREATED IN HOSPITAL EMERGENCY DEPARTMENTS

Svrha ovog rada bila je utvrditi učestalost ozljeda u djece pregledane u hitnoj službi Kliničkoga bolničkog centra Split, a zatim odrediti mehanizme kojima su te ozljede nastale, kao i vrstu i težinu ozljeda. Prikupljeni su podaci o djeci koja su u razdoblju od siječnja do srpnja 2009. pregledana u Kliničkome bolničkom centru Split zbog ozljeda. Za svako dijete upisani su ovi pokazatelji: dob, spol, anatomska raspodjela ozljeda, mehanizam, Injury Severity Score (ISS), kao i potreba za prijmom u bolnicu ili jedinicu intenzivnog liječenja djece (JILD). Za određivanje statističke značajnosti rezultata korišteni su hi-kvadrat i Mann-Whitneyev test. Među ozlijeđenom djecom bilo je više dječaka (65,6%). Najviše ozlijeđenih bilo je u dobnoj skupini od 13 do 18 godina. Od 3221 djeteta pregledanog u hitnoj službi 96% imalo je lakše ozljede (ISS<10), a 3,7% njih bilo je hospitalizirano. Udovi su bili najčešće ozlijeđeni (67,1%), a pad je uzrokovao ozljedu u 71,3% djece. Djeci ozlijeđenoj u prometnim nesrećama hospitalizacija je bila potrebna mnogo češće (25%) nego onoj koja su ozljedu zadobila bilo kojim drugim mehanizmom. Prometne nesreće bile su najčešće u starijoj dobnoj skupini. Većina žrtava bili su putnici u automobilu, a većini ozlijeđenih u prometnoj nesreći vodeća ozlijeđena regija tijela bila je glava. Djeca s ozljedom glave i ona ozlijeđena u prometnoj nesreći bila su češće hospitalizirana i primljena u JILD od ostale djece. Zaključujemo da su udovi najčešće ozlijeđena regija tijela u djece pregledane u hitnoj službi, a najučestaliji mehanizam ozljeda je pad. Međutim najteže su ozljede glave, a većinom su posljedica prometnih nesreća. Ovi su podaci važni za programe prevencije ozljeda u zajednici.The aim of this study was to determine characteristics of injuries of children admitted to the Emergency Department (ED) of University Hospital Split, and also to define the mechanisms of injuries, as well as the type and severity of injuries. We evaluated 3,221 children with injuries treated in the ED of the University Hospital of Split in the period from January to July 2009. The following indicators were analyzed: age, gender, anatomic distribution of injuries, mechanism, Injury Severity Score (ISS) and the need for hospital and intensive care admission. Chi-square and Mann-Whitney tests were used in order to determine statistical relevance of the results. Boys were more often injured than girls (65.6%), and most of the injured children were older than 13 years (41.7%). The majority of patients (96%) had minor injuries (ISS<10), and only 3.7% of patients were hospitalized. The majority of injuries were caused by falls (71.3%), and limbs were the most frequently injured body region (67.1%). However, road traffic accidents (RTA) required hospitalization more often than any other mechanism (25% of patients), and the leading injury in RTA victims was head injury (38% of patients). Older children were more susceptible to RTAs (64.5%), and the majority of children were injured as passengers in cars (36.4%). Children with head injuries, and those injured in RTAs, were more often hospitalized and more often admitted to intensive care unit than other patients. The most frequently injured body region in children treated in ED are limbs, and the most frequent mechanism of injury is fall. However, the most severe are head injuries, and the majority of severe injuries are caused by RTAs. These data are important for programs of injury prevention

Proinflammatory and remodeling processes in subcutaneous and visceral adipose tissue defined through the activity of immunomodulatory adipocytokines in male children and adolescents

Cilj: Pretilost u dječjoj dobi ozbiljan je javnozdravstveni problem koji se često prenese i u odraslu dob gdje se povezuje s nizom metaboličkih oboljenja koje zatim znatno utječu na kvalitetu života. Cilj ovog istraživanja bio je ispitati procese koji utječu na remodeliranje izvanstaničnog matriksa u masnom tkivu zdrave muške djece i adolescenata ovisno o njihovoj tjelesnoj masi. Ispitanici i metode: Za vrijeme elektivnog abdominalnog zahvata prikupljeni su uzorci subkutanog masnog tkiva (SAT) i visceralnog masnog tkiva (VAT) od 75 zdravih ispitanika muškog spola dječje i adolescentske dobi koji su podvrgnuti elektivnom zahvatu orhidopeksije ili popravku hernije. Ispitanici su podijeljeni u dvije skupine prema Z-vrijednostima. Na prikupljenim uzorcima je provedena analiza morfometrije masnog tkiva histološkom metodom bojanja hemalaun eozinom te procjena stupnja fibroze u izvanstaničnom matriksu masnog tkiva standardnim trikromnim bojanjem po Massonu za detekciju kolagena; imunohistokemijska metoda za određivanje broja CD163+ stanica i detekciju krunastih struktura (CLS); enzimska imunokemijska metoda za utvrđivanje razine adipocitokina u serumu - kemerin, visfatin, adiponektin i omentin te na 20 uzoraka metoda lančane reakcije polimeraze u realnom vremenu (rtPCR) za određivanje relativnog izražaja gena – interleukina 6 (IL-6), interleukina 8 (IL-8), tumorskog faktora nekroze alfa (TNF-α) i kolagena 6 alfa 3 (COL6α3). Rezultati: Kod ispitanika prekomjerne tjelesne mase i pretilih ispitanika pronađeni su adipociti veće površine u SAT, veći broj CD163+ stanica u VAT, više CLS u oba depoa masnog tkiva, veći postotak kolagena u VAT te veći izražaj COL63 u oba depoa masnog tkiva i veći izražaj IL-6 i IL-8 u SAT. Pretilost i prekomjerna tjelesna masa pozitivno je povezana s površinom adipocita u SAT, brojem adipocita u VAT te brojem CD163+ stanica i krunastih struktura u oba masna tkiva. Zaključak: Kod muške djece i adolescenata pretilost može dovesti do hipertrofije adipocita u SAT, povećanog taloženja kolagena u VAT, pojačanog izražaja COL63 te time potaknuti promjenu u polarizaciji makrofaga, utjecati na njihovo nakupljanje, strukturnu stabilnost izvanstaničnog matriksa kao i na razvoj upalnog procesa.Objective: Childhood obesity is a serious public health problem that is often transmitted in adulthood where it is associated with a numerous metabolic diseases wich significantly affect quality of life. The aim of this study was to examine the processes affecting the remodeling of the extracellular matrix in adipose tissue of healthy male children and adolescents depending on their body weight. Methods: During the elective abdominal procedure, subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) samples were collected from 75 healthy male and adolescent subjects who underwent elective orchidopexy or hernia repair. Subjects were divided into two groups according to their body mass index Z-score. On the collected samples, analysis of adipose tissue morphometry was performed by histological staining method hematoxylin and eosin and the assessment of fibrosis in extracellular matrix of adipose tissue was performed by Massons's standard trichrome staining method for collagen detection; immunohistochemistry was performed for determining the number of CD163+ cells and detection of crown like structures (CLS); enzyme linked immunosorbent assay was performed for determination of serum adipocytokine levels for - chemerin, visfatin, adiponectin and omentin. Real-time polymerase chain reaction (rtPCTR) was performed for determination of relative gene expression for – interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-α), collagen VI subtype alpha 3 (COL6α3) on 20 samples. Results: Overweigth and obese subjects were found to have larger surface area adipocytes in SAT, higher number CD163+ cells in VAT, higher number of CLS in both adipose tissue depots, higher collagen staining in VAT and significantly higher gene expression of COL6α3 in both depots and higher gene expression of IL-8 and IL-6 in SAT. Overweight and obesity was positively correlated with larger surface area in SAT, higher number of adipocytes in VAT, CD163+ cells and CLS in both depots of adipose tissue. Conclusion: In male children and adolescents, obesity can lead to subcutaneous adipocyte hypertrophy, increased collagen deposition in VAT, increase COL6α3 expression and promote changes in macrophage polarization, affect their accumulation, structural stability of the extracellular matrix and the development of inflammation process

Proinflammatory and remodeling processes in subcutaneous and visceral adipose tissue defined through the activity of immunomodulatory adipocytokines in male children and adolescents

Cilj: Pretilost u dječjoj dobi ozbiljan je javnozdravstveni problem koji se često prenese i u odraslu dob gdje se povezuje s nizom metaboličkih oboljenja koje zatim znatno utječu na kvalitetu života. Cilj ovog istraživanja bio je ispitati procese koji utječu na remodeliranje izvanstaničnog matriksa u masnom tkivu zdrave muške djece i adolescenata ovisno o njihovoj tjelesnoj masi. Ispitanici i metode: Za vrijeme elektivnog abdominalnog zahvata prikupljeni su uzorci subkutanog masnog tkiva (SAT) i visceralnog masnog tkiva (VAT) od 75 zdravih ispitanika muškog spola dječje i adolescentske dobi koji su podvrgnuti elektivnom zahvatu orhidopeksije ili popravku hernije. Ispitanici su podijeljeni u dvije skupine prema Z-vrijednostima. Na prikupljenim uzorcima je provedena analiza morfometrije masnog tkiva histološkom metodom bojanja hemalaun eozinom te procjena stupnja fibroze u izvanstaničnom matriksu masnog tkiva standardnim trikromnim bojanjem po Massonu za detekciju kolagena; imunohistokemijska metoda za određivanje broja CD163+ stanica i detekciju krunastih struktura (CLS); enzimska imunokemijska metoda za utvrđivanje razine adipocitokina u serumu - kemerin, visfatin, adiponektin i omentin te na 20 uzoraka metoda lančane reakcije polimeraze u realnom vremenu (rtPCR) za određivanje relativnog izražaja gena – interleukina 6 (IL-6), interleukina 8 (IL-8), tumorskog faktora nekroze alfa (TNF-α) i kolagena 6 alfa 3 (COL6α3). Rezultati: Kod ispitanika prekomjerne tjelesne mase i pretilih ispitanika pronađeni su adipociti veće površine u SAT, veći broj CD163+ stanica u VAT, više CLS u oba depoa masnog tkiva, veći postotak kolagena u VAT te veći izražaj COL63 u oba depoa masnog tkiva i veći izražaj IL-6 i IL-8 u SAT. Pretilost i prekomjerna tjelesna masa pozitivno je povezana s površinom adipocita u SAT, brojem adipocita u VAT te brojem CD163+ stanica i krunastih struktura u oba masna tkiva. Zaključak: Kod muške djece i adolescenata pretilost može dovesti do hipertrofije adipocita u SAT, povećanog taloženja kolagena u VAT, pojačanog izražaja COL63 te time potaknuti promjenu u polarizaciji makrofaga, utjecati na njihovo nakupljanje, strukturnu stabilnost izvanstaničnog matriksa kao i na razvoj upalnog procesa.Objective: Childhood obesity is a serious public health problem that is often transmitted in adulthood where it is associated with a numerous metabolic diseases wich significantly affect quality of life. The aim of this study was to examine the processes affecting the remodeling of the extracellular matrix in adipose tissue of healthy male children and adolescents depending on their body weight. Methods: During the elective abdominal procedure, subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) samples were collected from 75 healthy male and adolescent subjects who underwent elective orchidopexy or hernia repair. Subjects were divided into two groups according to their body mass index Z-score. On the collected samples, analysis of adipose tissue morphometry was performed by histological staining method hematoxylin and eosin and the assessment of fibrosis in extracellular matrix of adipose tissue was performed by Massons's standard trichrome staining method for collagen detection; immunohistochemistry was performed for determining the number of CD163+ cells and detection of crown like structures (CLS); enzyme linked immunosorbent assay was performed for determination of serum adipocytokine levels for - chemerin, visfatin, adiponectin and omentin. Real-time polymerase chain reaction (rtPCTR) was performed for determination of relative gene expression for – interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-α), collagen VI subtype alpha 3 (COL6α3) on 20 samples. Results: Overweigth and obese subjects were found to have larger surface area adipocytes in SAT, higher number CD163+ cells in VAT, higher number of CLS in both adipose tissue depots, higher collagen staining in VAT and significantly higher gene expression of COL6α3 in both depots and higher gene expression of IL-8 and IL-6 in SAT. Overweight and obesity was positively correlated with larger surface area in SAT, higher number of adipocytes in VAT, CD163+ cells and CLS in both depots of adipose tissue. Conclusion: In male children and adolescents, obesity can lead to subcutaneous adipocyte hypertrophy, increased collagen deposition in VAT, increase COL6α3 expression and promote changes in macrophage polarization, affect their accumulation, structural stability of the extracellular matrix and the development of inflammation process

Influence of Maternal Diet and Intergenerational Change in Diet Type on Ovarian and Adipose Tissue Morphology in Female Rat Offspring

Background and Objectives: A high-fat diet causes inflammation in the organism and many metabolic disorders. Adipose tissue secretes adipokines that affect the function of many organs. The health status of the mother before and during pregnancy affects the health of the offspring. The aim of this study was to determine how the type of maternal diet and the change in the type of diet in the offspring affects the histological characteristics of the ovaries and subcutaneous and perigonadal adipose tissue in female rat offspring. Materials and Methods: Ten female rats were divided into two groups. One group was fed standard laboratory chow, and the other was fed a high-fat diet and mated with a male of the same breed. The offspring of both groups of dams were divided into four subgroups with different feeding protocols. At 22 weeks of age, the offspring were sacrificed. Ovaries and subcutaneous and perigonadal adipose tissue were isolated. In the ovaries, the presence of cystic formations was investigated. Histomorphometric analysis was performed in two types of adipose tissue. Results: The weight of the ovaries of the offspring of mothers fed a high-fat diet was significantly higher than that of the offspring of mothers fed standard laboratory diets. Cystic formations were found in the ovaries of the offspring of mothers fed a high-fat diet. In subcutaneous adipose tissue, the percentage of small-sized adipocytes was significantly higher in the offspring of mothers fed standard laboratory diets. There were no significant differences in adipocyte surface area and adipocyte number between groups. Conclusion: Maternal diet influences the morphology of the ovaries and adipose tissue of the offspring

Early Childhood Fat Tissue Changes—Adipocyte Morphometry, Collagen Deposition, and Expression of CD163+ Cells in Subcutaneous and Visceral Adipose Tissue of Male Children

Childhood obesity is a complex health problem, and not many studies have been done on adipose tissue remodeling in early childhood. The aim of this study was to examine extracellular matrix remodeling in the adipose tissue of healthy male children depending on their weight status. Subcutaneous and visceral adipose tissue was obtained from 45 otherwise healthy male children who underwent elective surgery for hernia repairs or orchidopexy. The children were divided into overweight/obese (n = 17) or normal weight groups (n = 28) depending on their body mass index (BMI) z-score. Serum was obtained for glucose, testosterone, triglyceride, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) measurements. Sections of adipose tissue were stained with hematoxylin and eosin to determine the adipocytes’ surface area, and Masson’s trichrome stain was used to detect the adipocytes’ collagen content. Immunohistochemistry for CD163+ cells was also performed. The results showed that male children in the overweight group had higher serum triglyceride levels, greater adipocyte surface area and collagen content in their subcutaneous adipose tissue, more crown-like structures in fat tissues, and more CD163+ cells in their visceral adipose tissue than males in the normal weight group. In conclusion, in male children, obesity can lead to the hypertrophy of adipocytes, increased collagen deposition in subcutaneous adipose tissues, and changes in the polarization and accumulation of macrophages