Antropometrijske posebnosti stopala djece u dobi od druge do sedme godine

INTORDUCTION: The anatomical specificity of children’s feet change during their growth and development, and the foot therefore adapts to its static and dynamic function of bearing the body's full weight. When children start walking, their feet begin to change shape and the changes become visible when the natural fat pads on the bottom of each foot begin to disappear. The shape of the foot is determined by many anthropometric measurements. It is during the period of the child’s learning to walk phase that more intense changes to the foot begin, which allow a base of support wide enough for the child to stand and walk, decreasing the temporary weakness of the muscles. The dynamic muscular strength and ligament firmness allow the foot to adapt normally as they bear weight on their legs by the stretching of the feet. Contrary to other body systems, foot length proportionally reaches its adult size. The length of girls' feet reach half their adult size by the age of 1, while boys' feet reach half their adult size by 18 months. According to various toe lengths and shapes, three types of forefoot shapes can be distinguished: Egyptian, square and Greek. Variations in foot shapes are based on numerous anatomical differences, such as foot arch height, heel width and toe length. Foot length is the basic unit of measurement for monitoring the development and growth of the foot. The foot length of growing children is strictly standardized in certain countries and varies depending on geographical location and ethnic differences. AIMS: The aim of this thesis is to first determine the foot shapes (Egyptian, Greek, square) and anthropometric measurements of the foot (foot length, metatarsus width, heel width, metatarsus height, heel, instep and metatarsus circumference and big toe height among a representative sample of preschool aged girls and boys of different age groups. Second, to study the changes which occur in the shapes and sizes of feet on a representative sample of preschool children in Croatia, and then to determine the regional differences in the measured foot shapes and sizes among the representative sample. And finally, to create reference tables of foot sizes among girls and boys of different age groups. MATERIALS AND METHODS: The research for this thesis was conducted as a cross sectional, multicenter study and was approved by the Ethical Committees of the Children's Hospital in Zagreb and the School of Medicine in Zagreb. The study included Croatian preschool children that live in both the Zagreb and Split-Dalmatia Counties. The sample includes preschool children between the ages of 2 (1.50-2.49) and 7 (6.50-7.49), divided in to 6 age groups. Measurements were performed on a sample size of 2745 children, totalling to 5490 feet, including 1375 boys and 1370 girls. The first age group (two-year-olds) included 242 girls and 149 boys; the second age group (three-year-olds) included 214 girls and 181 boys; the third age group (four-year-olds) included 221 girls and 263 boys; the fourth age group (five-year-olds) included 196 girls and 245 boys; the fifth age group (six-year-olds) included 259 girls and 288 boys; and the sixth age group (seven-year-olds) included 238 girls and 249 boys. Children with congenital and acquired foot deformities were not a part of the research group. The measuring technique was standardized and the children were measured while standing on their feet. The feet were measured barefoot and were fitted in a specially designed measuring device with an index of measurements. To obtain other anthropometric measurements we used a measuring tape and a pedometer with a movable goniometer. RESULTS: In children between the ages of 2 and 7, on average 80.3% of boys and 78.8% of girls had an Egyptian-shaped foot. The Greek foot was found in 14.7% of boys and 17.6% of girls, while the square-shaped foot was found in 5% of boys and 3.6% of girls. No significant differences were found in foot shapes between boys and girls. The annual foot growth in length measures approximately 1 cm, except at age 2 when the foot grows an average 1.6 cm annually. An annual growth of approximately 1.3 cm was measured among girls between the ages of 3 and 6. The foot grows most rapidly in length between the ages of 2 and 3 in both of the sexes, while the slowest growth rate was measured between the ages of 6 and 7, more so among girls (0.65 cm). While more profound differences in foot length and circumference of the metatarsus, heel and instep were found in the anthropometric measurements between boys and girls, boys were measured to have only slightly wider heels than girls between the ages of 2 and 7, and the heel was found to be only 0.1 cm wider among boys than the girls at the age of 7. Similarly, the big toe was measured 0.1 cm higher among boys at the age of 7, while metatarsus height was found to be equal among both sexes. CONCLUSION: The existing standards of foot length and shape are not suitable for children in Croatia. The Egyptian foot was found to be most common throughout all age and sex groups, more than 80% of boys and girls. When analysing all anthropometric foot measurements of boys and girls, the most significant growth could be measured between the ages of 2 and 3, followed by a period of rather steady growth between the ages of 3 and 6. The smallest foot growth values could be measured at 7 years old. Boys were found to have slightly longer feet, as well as a larger circumference than girls, but the difference in certain age groups was not measured to be larger than 0.6 cm. No significant differences in anthropometric measures between the right and the left foot were found in any of the age groups

Developmental dysplasia of the hip: prevention and conservative treatment in children aged 1-6 months

Sekundarna prevencija razvojnog poremećaja kuka usmjerena je na rano otkrivanje i primjenu najučinkovitijih terapijskih i preventivnih postupaka. Primjena selektivnog ili neselektivnog probira ovisi o incidenciji razvojnog poremećaja kuka i povezana je s troškovima zdravstvenog sustava pojedine države. Cilj konzervativnog liječenja razvojnog poremećaja kuka je postići i zadržati koncentričnu redukciju, usmjeriti rast i razvoj zgloba kuka prema normalnim morfološko-anatomskim odnosima i izbjeći komplikacije tijekom liječenja, posebice avaskularnu nekrozu. Ranim liječenjem razvojnog poremećaja kuka sprječava se adolscentna koksartroza i rani invaliditet. U liječenju se primjenjuju različite vrste ortoza čija je funkcija zadržavanje koncentrične redukcije kuka u poštednoj poziciji.Fizikalna terapija je važna za dobivanje normalne pokretljivosti kuka kod aduktorne kontrakture, simetrične ili asimetrične, koja otežava stabilnu retenciju nakon koncentrične redukcije kuka.Secondary prevention of developmental dysplasia of the hip is aimed at early diagnosis through application of the most effective screening methods, and initiating optimal treatment as soon as possible. Applying either selective or universal screening depends onthe incidence and costs of screening in the healthcare system of each individual country. The aim of conservative treatment of development aldysplasia of the hip is geared towards obtaining and maintaining concentric reduction of the hip joint, stopping pathophysiologicalprocesses, guiding growth in a normal morphological-anatomic direction, and preventing treatment complications,i.e. avascular necrosis of the femoral head. Early treatment of developmental dysplasia of the hip prevents adolescent hip arthrosisand early disability. Different types of orthoses are used in conservative treatment; their function is to maintain stable reduction ofthe hip joint in the standard protected position. Physical therapy is important for obtaining normal mobility of the hip when there islimited hip motion, particularly in the presence of unilateral adductor contracture, which would prevent stable retention upon concentricreduction of the hip

Anthropometric measurements of foot length and shape in children 2 to 7 years of age

Background and purpose: A child’s foot changes shape and proportions during growth so that it adapts to function. The purpose of this article is to determine foot length in children aged 2-7 years as a fundamental unit for measuring the growth of the foot, with which it will be able to compare other anthropometric measures of the foot. Determination of the shape of the foot and interpretation of the growth curve of the foot in length are important for standardization of the foot.Materials and methods: The study was conducted on a sample of 2745 children, totalling 5490 feet. Of this, there were 1375 boys and 1370 girls. The population encompassed children aged 2 (1.50-2.49) to 7 (6.50-7.49) years and subjects were divided into 6 age groups. Foot length was measured by measuring tape, while shape was determined clinically.Results: There is no difference in length and shape between the left and right feet of boys and girls across all age and sex groups, and the most common shape was the Egyptian foot shape. The foot grows most rapidly between the 2nd and 3rd year. From the 3rd to 6th years, the foot grows by approximately 1cm yearly, while in girls between the 6th and 7th year the foot grows 5mm.Conclusions: Foot length is the basis for size comparison and determination of foot shape type. The results obtained demonstrate that the foot grows in length equally yearly and that there is no difference between the left and right feet.</p

Habitual posterior dislocation of the hip

Habitualna luksacija kuka rijetko se javlja u djece. Prikazana je djevojčica u dobi od 14,5 mjeseci s habitualnom stražnjom luksacijom desnog kuka. Prve simptome luksacije majka je primjetila u dobi djeteta od 9 mjeseci. Luksacija kuka javljala se u položaju fleksije, nutarnje rotacije i adukcije, a očitovala se kao zvučni fenomen preskakanja. Najčešće je dolazilo do „iskakanja“ desnog kuka tijekom spavanja, a nikada u hodu ili u opterećenju. Dijete nije imalo bolova. Dijagnoza je postavljena na temelju anamnestičkih podataka, kliničkog pregleda, ultrazvučnog pregleda, RTG-a, CT-a i MR-a kukova. Kliničkim pregledom mogao se izazvati luksacijski fenomen u fleksiji, nutarnjoj rotaciji i adukciji desnog kuka samo ako je dijete bilo potpuno opušteno. RTG, CT i MR kukova nisu pokazivali vidljivih morfoloških promjena desnog kuka. Ultrazvučnim pregledom kuka potvrdila se luksacija kuka. Provedeno je konzervativno liječenje sadrenom imobilizacijom kuka u abdukciji i nutarnjoj rotaciji u trajanju od tri mjeseca.Habitual dislocation is very uncommon in children.We are presenting the case of a 14.5-month old girl with habitual posterior dislocation of the right hip. The onset of symptoms was noticed by her mother at the age of nine months. Dislocation occurred when the hip was flexed, internally rotated and adducted, with a clearly loud acoustic phenomenon of snapping (clunk). The „snapping“ occurred most often during the night while the child was sleeping, but never while walking or weight bearing. The child did not have any difficulties. The diagnosis was set according to anamnestic data, clinical examination, X-ray, CT scan and MRI of the hips. With clinical examination we were able to provoke dislocation in a flexed position, by internal rotation and adduction, but only when the child was completely relaxed. The X-ray, CT scan and MRI revealed no morphological changes of the right hip. Ultrasound of the hip confirmed dislocation. The treatment was conservative with immobilisation of the right hip in abduction and internal rotation within three months

Early results of intra-articular micro-fragmented lipoaspirate treatment in patients with late stages knee osteoarthritis: a prospective study

Aim To analyze clinical and functional effects of intra-articular injection of autologous micro-fragmented lipoaspirate (MLA) in patients with late stage knee osteoarthritis (KOA). Secondary aims included classifying cell types contributing to the treatment effect, performing detailed MRIbased classification of KOA, and elucidating the predictors for functional outcomes. Methods This prospective, non-randomized study was conducted from June 2016 to February 2018 and enrolled 20 patients with late stage symptomatic KOA (Kellgren Lawrence grade III, n = 4; and IV, n = 16) who received an intra-articular injection of autologous MLA in the index knee joint. At baseline radiological KOA grade and MRI were assessed in order to classify the morphology of KOA changes. Stromal vascular fraction cells obtained from MLA samples were stained with antibodies specific for cell surface markers. Patients were evaluated at baseline and 12-months after treatment with visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS).Results Three patients (15%) received a total knee replacement and were not followed up completely. Seventeen patients (85%) showed a substantial pattern of KOOS and WOMAC improvement, significant in all accounts. KOOS score improved from 46 to 176% when compared with baseline, WOMAC decreased from 40 to 45%, while VAS rating decreased from 54% to 82% (all P values were <0.001). MLA contained endothelial progenitor cells, pericytes, and supra-adventitial adipose stromal cells as most abundant cell phenotypes. Conclusion This study is among the first to show a positive effect of MLA on patients with late stages KOA

Bilateral congenital knee dislocation associated with bilateral developmental hip deformities

Prirođena dislokacija koljena je relativno rijetka deformacija, a pogotovo udružena s deformacijom drugih zglobova. Djevojčica u ovom prikazu, rođena je s obostranom dislokacijom koljena i obostranim razvojnim poremećajem kuka u smislu iščašenja. Prvi pregled u ortopedskoj ambulanti obavljen je 21. dan nakon rođenja. Učinjena je radiološka i ultrazvučna dijagnostika i genetska obrada. Nisu nađeni elementi Larsenova sindroma kao ni artrogripoze. Djevojčica je liječena trakcijom na vertikalnom okviru i sadrenim redresmanom oba koljena. Nakon repozicije kukova aplicirao se aparat Hilgenreiner. Tek nakon repozicije oba kuka omogućila se redresmanom repozicija i puna fl eksija koljena. Nakon stabilizacije kukova i koljena aplicirani su remenčići prema Pavliku, koji su nošeni dva mj. Liječenje je trajalo do sedam mj. života djevojčice a svi postupci su praćeni ultrazvukom i RTG snimkama. Praćenje još traje.Congenital knee dislocation is a relatively rare entity, especially if associated with other joint deformities. We present a case of a girl with both congenital knee and hip dislocations who was followed-up for four years. She was fi rst referred to our department when she was three weeks old. Radiographic and ultrasound examinations, as well as genetic tests excluded Larsen’s syndrome and arthrogryposis. Traction on the vertical plane was applied to make closed hip reduction easier, after which we started serial knee casting. When reduced, hips were stabilized by Hilgenreiner’s orthosis, which enabled casting of the knees to be continued and fi nished successfully. After stabilization of the hips and knees, Pavlik’s harness was applied for two months. The treatment took seven months and all the steps were followed by radiographic and ultrasound imaging when needed

Youth and AIDS – A Study of Attitudes, Knowledge, Behavior and Risks in the Post-War Croatia

According to the latest reports, the Eastern Europe currently exhibits the greatest relative increase in the number of newly registered HIV infections in the world. At the same time, Central Europe remains relatively spared from the epidemic, with reported rates significantly lower than those in both Eastern and Western Europe. Croatia geographically affiliates to Central Europe, but it has two specific potential risk factors in comparison to neighboring countries: recent War events and a summer season when immigration of large number of tourists from Central and Eastern Europe is expected. Therefore, it is critical to examine AIDS attitudes in young people, increase their knowledge, monitor their behavior and warn on risks in order to prevent larger spread of epidemics from Eastern Europe to Croatia. In this study, we report on a large related survey and education program among 17-year-old high school pupils that was conducted in years immediately following the War (1996–1999)

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH UTERINE CERVICAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak vrata maternice, u odnosu na malignome drugih ginekoloških sijela, jest bolest mlađih žena koja se može redovitim kontrolama i zdravstvenim odgojem prevenirati, a u slučaju pojave bolesti učinkovito liječiti. Metode liječenja uključuju kirurgiju, radioterapiju i kemoterapiju, ovisno o stadiju bolesti i općem stanju bolesnica. Odluku o liječenju donosi multidisciplinarni tim. S obzirom na važnost ove bolesti, potrebno je definirati i provoditi standardizirani pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu koji slijedi iznesene su kliničke smjernice s ciljem implementacije standardiziranih postupaka u radu s bolesnicama s rakom vrata maternice u Republici Hrvatskoj.Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented trough educational programs, screening and early detection. It also can be efficiently treated when it appears. Treatment modalities include surgery, chemotherapy and radiotherapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia

Youth and AIDS – A Study of Attitudes, Knowledge, Behavior and Risks in the Post-War Croatia

According to the latest reports, the Eastern Europe currently exhibits the greatest relative increase in the number of newly registered HIV infections in the world. At the same time, Central Europe remains relatively spared from the epidemic, with reported rates significantly lower than those in both Eastern and Western Europe. Croatia geographically affiliates to Central Europe, but it has two specific potential risk factors in comparison to neighboring countries: recent War events and a summer season when immigration of large number of tourists from Central and Eastern Europe is expected. Therefore, it is critical to examine AIDS attitudes in young people, increase their knowledge, monitor their behavior and warn on risks in order to prevent larger spread of epidemics from Eastern Europe to Croatia. In this study, we report on a large related survey and education program among 17-year-old high school pupils that was conducted in years immediately following the War (1996–1999)

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH OVARIAN CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak jajnika i jajovoda po učestalosti je peta zloćudna bolest žena u Hrvatskoj. Histološki je rak jajnika najčešće epitelnog podrijetla, i to seroznog podtipa. Rjeđi su različiti neepitelni malignomi jajnika, a posebnu skupinu čine epitelni karcinomi niskoga zloćudnog potencijala karakterizirani neinvazivnošću, klinički indolentnim tijekom i dobrom prognozom te primarni rak potrbušnice i rak jajovoda. Klinički su ovi zloćudni tumori u ranim stadijima razvoja uglavnom asimptomatski, zbog čega se najčešće dijagnosticiraju u kasnijim stadijima bolesti. Dijagnoza se potvrđuje patohistološkim nalazom, a iznimno citološkim nalazom nakon provedene dijagnostičke obrade. O liječenju odlučuje multidisciplinarni tim uzimajući u obzir dob, opće stanje i komorbiditete bolesnice, kao i obilježja samog tumora uključujući stadij bolesti, histološki tip i gradus tumora. Principi liječenja primarnog raka potrbušnice i jajovoda temelje se na principima liječenja epitelnog raka jajnika koji obuhvaćaju primjenu kirurških zahvata, kemoterapije, imunoterapije i hormonske terapije, kao i suportivno-simptomatskih mjera tijekom cijelog liječenja. Razlikuje se terapijski pristup rjeđim, neepitelnim histološkim tipovima tumora koji se češće dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek pa se kod ovih bolesnica češće primjenjuju poštedni kirurški zahvati s ciljem očuvanja plodnosti. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnica s rakom jajnika, jajovoda i potrbušnice u Republici Hrvatskoj.Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia