Complications in rehabilitation of elderly spinal cord injury patients

Cilj rada: pokazati incidenciju komplikacija u rehabilitaciji starijih pacijenata s ozljedom kralježnične moždine (OKM). Pacijenti i metode: tijekom 2000. godine rehabilitirana su 32 (13 žena i 19 muškaraca) pacijenta s OKM-om u dobi od 65 do 76 godina. Neurološki status određen je prema skali ASIA (American Spinal Injuries Association). Zabilježene su laboratorijske vrijednosti krvi i urina, respiratorni status, uz mikrobiološku i ultrazvučnu kontrolu mokraćnog sustava. Praćena je vrsta i učestalost komplikacija. Rezultati: na prvom pregledu 20 (63%) pacijenata imalo je neurološki status ASIA A, a 12 (37%) ASIA B. Infekcije urotrakta i kronična, neuropatska bol dokumentirane su kod 20 (63%) pacijenata, respiratorne infekcije (upala pluća) zabilježene su kod 13 (41%) pacijenata, a duboka venska tromboza kod 11 (34%) pacijenata. Dekubitusi kao komplikacija ranog poslijeoperativnog liječenja zabilježeni su kod 9 (28%), kamenci mokraćnog mjehura kod 7 (22%) pacijenata, a u jednom slučaju došlo je do fatalne masivne plućne embolije. Zaključak: infekcije mokraćnog sustava i neuropatska bol najčešće su komplikacije u rehabilitaciji starijih osoba s OKM-om, praćene upalom pluća, dubokom venskom trombozom i dekubitusima.Aim: to describe incidence of complications in elderly spinal cord injury (SCI) patients. Patients and methods: during y. 2000 32 (13 female and 19 male) patients with SCI aged 65 - 76 years were rehabilitated. Neurological assessment was made according to ASIA (American Spinal Injuries Association) standards. Basic laboratory findings, respiratory status and urine cultures accompanied by urinary ultrasound was performed. Range and type of complications were noted. Results: neurological examination revealed 20 (63%) ASIA A patients, while 12 (42%) were ASIA B grade. Urinary tract infections and chronic, neuropathic pain were observed in 20 (63%) patients, respiratory tract infections in 13 (41%) patients, deep vein thrombosis in 11 (34%) patients. Pressure sores were complications of early postoperative treatment in 9 (28%) patients, bladder stones in 7 (22%) patients and in one case fatal massive pulmonary embolism occurred. Conclusion: urinary tract infections and neuropathic pain are most frequent complications in rehabilitation of elderly patients with spinal cord injury, followed by pneumonia, deep vein thrombosis and pressure ulcers

Influence of Aeroallergens on the Incidence of Conjunctivitis in Zagreb and Zagreb County

The aim of this study was to determine the temporal and spatial variations of pollen spectra in the City of Zagreb and Zagreb County according to frequency of inhalation allergy and rhino-conjunctivitis in the adult population by setting allergen/patient relationship. The study was carried out at three inland sites in Croatia during four years (2003–2006). A number of 2,192 patients have been tested for allergy skin prick tests over the same period. The majority of patients allergic to pollen allergens were sensitized to allergens from the plant pollen which belong to the botanical family of grass 46.91%, ambrosia 42.07%, birch 25.66%, hazel 15.19% (with symptoms of rhinoconjunctivitis (42.5%), conjunctivitis (28.3%) and rhinitis (23.9%). Increased symptoms in patients allergic to pollen allergens in the entire study period coincided with the presence of pollen in the air. Patients sensitized to dust mites have symptoms throughout the year with a slightly increased number of cases in April and June. In patients sensitized to fungi and mold spores and animal hairs, the number of cases with worsening of symptoms is equal during the same year

Guidelines for rehabilitation of patients with hip fracture

Prijelom kuka čest je klinički problem povezan s ozbiljnim posljedicama glede očekivanog trajanja i kvalitete života. Najčešći je u starijih osoba od kojih polovica treba dugoročnu pomoć u svakodnevnim aktivnostima i korištenje pomagala u kretanju. Incidencija prijelom kuka je u porastu, a liječenje i rehabilitacija predstavljaju velik izazov za zdravstveni sustav. Ciljevi rehabilitacije nakon prijeloma u području kuka jesu smanjenje bolova, izbjegavanje komplikacija i poboljšanje cijeljenja, povećanje opsega pokreta i snage te funkcionalni oporavak koji dovodi do najviše mogućeg sudjelovanja u aktivnostima i socijalne uključenosti. Rehabilitacijski postupci trebali bi započeti odmah nakon postavljanja dijagnoze i biti provođeni kontinuirano, potrebnim intenzitetom do pretpostavljenog najboljeg mogućeg oporavka. Ti postupci uključuju edukaciju bolesnika, pozicioniranje, različite vrste vježbi, primjenu pomagala, procedura fizikalne medicine i lijekova, prilagodbu okoline i drugo. S obzirom na to da je u postupke liječenja i rehabilitacije prijeloma proksimalnog okrajka bedrene kosti uvijek uključeno više stručnjaka iz različitih institucija, ali i bolesnik i njegovi bližnji, potrebno je razvijati timsku suradnju. Specijalisti fizikalne medicine i rehabilitacije zbog svojih kompetencija na ovom području morali bi biti dostupni u svim fazama rehabilitacije te bi trebali, uz liječnika opće/obiteljske medicine, biti zaduženi za koordinaciju i vođenje rehabilitacijskog tima. Sve ciljeve, planove, preporuke, nalaze, postupke i evaluaciju potrebno je jasno i dostupno bilježiti radi bolje komunikacije i sprečavanja pogrešaka. Stoga se razvijaju smjernice koje pomažu u ostvarivanju tog cilja svima uključenima u proces liječenja. Smjernice su namijenjene specijalistima fizikalne medicine i rehabilitacije i ostalim liječnicima koji su uključeni u liječenje prijeloma proksimalnog okrajka bedrene kosti.Hip fracture presents common clinical problem connected with serious consequences on patients health and quality of life. It is more common in elderly, half of whom face long term need for help in everyday activities and continuous use of walking aids. Incidence of hip fracture is raising and treatment and rehabilitation presents big challenge for health care system. Rehabilitation goals after hip fracture are pain diminution, healing enhancement and complication prevention, increased range of motion and strength and overall functional restitution that leads to maximal possible activity and social participation. Rehabilitation should begin immediately after fracture diagnosis and should be continuous with adequate intensity until best possible recovery is achieved. Rehabilitation includes patient education, positioning, exercises, using walking aids, applying physical medicine procedures, medication etc. Team treatment should be emphasized since several specialties, as well as patient and patient’s family, are active participants in the treatment. Physical medicine and rehabilitation specialists due to their competence in this field should be available during all rehabilitation phases and alongside with family physician leaders and coordinators of rehabilitation team. All goals, planes, recommendations, procedures and evaluation results should be clearly documented and available to achieve better communication and error prevention. Therefore guidelines are developed to achieve set goals. These guidelines are developed for physical medicine and rehabilitation specialists and other physicians involved in proximal femur fracture treatment

Bibliografija akad. prof. dr. Kajetana Gantarja od 1953–2010

1953 »Struktura Horacove epistule Numiciju.« Živa antika 3 (1953): 79–81. 1954 »Balada o kugi.« Živa antika 4 (1954): 60–68. »De compositione Horati ‘Epistulae ad Pisones’.« Živa antika 4 (1954): 277