Kirurško liječenje metastaza kralježnice

Spinal metastatic disease is a rather common occurrence and definitely warrants attention and treatment due to the high likelihood of leaving cancer patients severely disabled in their final months of life. Recent developments in the understanding of the behavior of different tumor types, as well as advances in surgical treatment, are allowing for the evolution of treatment algorithms, especially when surgical treatment is to be considered. Th is paper gives an overview of the decisionmaking process and the array of surgical options currently available.Metastatska bolest kralježnice je dosta učestala i zasigurno zaslužuje pozornost i liječenje zbog visoke vjerojatnosti da bi inače bolesnici s karcinomom ostali oduzeti u svojim posljednjim mjesecima života. Novija postignuća i shvaćanja ponašanja raznih tipova tumora te unaprjeđenja u kirurškim tehnikama omogućuju evoluciju algoritama, pogotovo kada se kirurško liječenje razmatra. Ovaj rad daje pregled postupka donošenja odluka i ističe razne kirurške mogućnosti koje su trenutno dostupne

HIP ARTHROSCOPY

Artroskopija kuka intenzivno se razvija posljednjih desetak godina te ubrzano preuzima primat u liječenju raznih ozljeda i oštećenja i u samom kuku i u njegovoj neposrednoj blizini. Osnovna prednost artroskopske kirurgije kuka prema klasičnoj otvorenoj metodi operacijskog liječenja jest u izbjegavanju otvorene dislokacije kuka čime se smanjuje morbiditet bolesnika te ubrzavaju rehabilitacija i povratak svakodnevnim aktivnostima. Uspješnost artroskopskog zahvata ovisi o pravilnoj indikaciji za zahvat, iskustvu i vještini operatera, pravilno provedenoj rehabilitaciji te suradljivosti bolesnika, kao i o njegovim realnim očekivanjima. Osnovnim indikacijama za artroskopiju kuka danas se smatraju ozljede i oštećenja acetabularnog labruma i/ili zglobne hrskavice, femoroacetabularni sindrom sraza, ozljede i oštećenja ligamenta glave femura, slobodna i strana zglobna tijela te različite bolesti sinovijalne membrane (sinovijalna hondromatoza, pigmentirani vilonodularni sinovitis i druge upalne artropatije poput reumatoidnog artritisa). U ovom članku opisujemo indikacije, tehniku, komplikacije, kao i perspektivu artroskopije kuka, uz detaljan pregled suvremenih literaturnih podataka.In the last ten years, hip arthroscopy has been developing intensively and it is rapidly gaining primacy in the treatment of various injuries and damages to the hip itself and its immediate vicinity. The basic advantage of hip arthroscopy surgery versus classic open surgery is avoiding an open dislocation of the hip and, thus, reducing patient’s morbidity and accelerating his/her rehabilitation, which leads to a quicker return to everyday activities. The success of arthroscopic surgery depends on the correct indication for the surgery and on the experience and the skill of the operator. It also depends on the properly conducted rehabilitation and the patient’s compliance, as well as on the patient’s realistic expectations. Indications for hip arthroscopy today are the following: injury and damage to acetabular labrum and/or articular cartilage, femoroacetabular impingement syndrome, injuries and damages to the ligament of the femoral head, loose and foreign joint bodies as well as different conditions of synovial membrane (synovial chondromatosis, pigmented villonodular synovitis and other inflammatory arthropathy such as rheumatoid arthritis). In this article we describe the indications, technique, complications and the prospect of hip arthroscopy, with a detailed overview of contemporary literature data

Open reduction and internal fixation of isolated 4th metacarpal shaft fracture in recreation athletes: single center results

Pozadina: Prijelomi metakarpala uobičajene su povrede koje se pojavljuju kod opće populacije, kao i kod sportaša. Cilj: Cilj ove retrospektivne studije je prikaz dvostruke serije prijeloma 4. izolirane metakarpalne kosti kod rekreativnih sportaša podvrgnutih kirurškom zahvatu i njihovom razdoblju oporavka primjenjujući mjere liječenja i postoperativnu njegu do povrata njihovim svakodnevnim aktivnostima. Plan studije: retrospektivna studija promatranja.Metode: Obavljena je jedna retrospektivna studija koja je uključila 49 bolesnika (37 muškaraca, 12 žena) prosječne dobi od 25,7 s izoliranim prijelomom 4. izolirane metakarpalne kosti koji se dogodio u dvogodišnjem razdoblju od siječnja 2010. do prosinca 2011. Kriteriji su: dislocirani prijelom 4. izolirane metakarpalne kosti, akutna ozljeda koja je nastupila ne dulje od 10 dana prije prijema u bolnici kod rekreativnih sportaša i učenika mlađih od 40 godina. Mehanizmi povreda bili su izravan kontakt ili udarac šakom (26), pad (14) i rotacijski pokret rukom (9). Obavljen je kirurški zahvat s unutarnjom fiksacijom pomoću pločica niskoga profila (20) ili 2 do 3 mini-vijka. Bolesnici su obavili protokol za jednodnevni kirurški zahvat, nakon čega je slijedila standardna rehabilitacija i rana mobilizacija. Rezultati: Prosječno praćenje bolesnika bilo je 12 mjeseci. Prosječna sveukupna vrijednost MSC fleksije bila je 54,7 stupnjeva te MCO ekstenzije 8,97 stupnjeva, a sveukupna vrijednost postrehabilitacijske MCP fleksije 88,97 stupnjeva i MCP ekstenzije 17,04 stupnjeva. Nisu primijećene nikakve komplikacije, svi su se prijelomi zaliječili bez znakova infekcije ili krivoga srastanja kostiju. Zaključak: Kirurško liječenje prijeloma 4. izolirane metakarpalne kosti s pločicama niskog profila i mini-vijcima je dobra tehnika koja predstavlja čvrstu fiksaciju i osigurava brzi oporavak do pokreta prije povreda. Povećava se kvaliteta življenje uslijed brzog oporavka i povrata normalnim dnevnim i sportskim aktivnostima. Takvo liječenje znači profitabilnost s jednodnevnim operativnim zahvatom, smanjujući troškove liječenja s rezultatima od velike koristi za pacijente.Background: Metacarpal fractures are common injuries, which appear in the general population, as well as in the population of athletes. Aim: The aim of this retrospective study was to show a twofold series of isolated 4th metacarpal shaft fractures exclusively in the population of recreation athletes, which were surgically treated and the time frame of their return to everyday activities according to applied measures of treatment and postoperative care. Study design: Retrospective observational study. Methods: A retrospective single center study was conducted, including 49 patients (37 male, 12 female), mean age 25.7, with isolated 4th metacarpal shaft fracture, which occurred during the two-year period from January 2010 to December 2011. Inclusion criteria were: isolated dislocated 4th metacarpal shaft fracture, acute injury with onset no longer than 10 days before being admitted to hospital, recreation athletes and participants younger than 40 years of age. Injury mechanisms were direct contact or punch (26), fall (14) and rotational motion of the hand (9). Patients were surgically treated with internal fixation with low profile plates (20) or with 2 or 3 (29) mini-screws. Patients followed protocol for one-day surgery and afterwards standard rehabilitation protocol with early mobilization. Results: The mean follow-up of the patients was 12 months. Average total value of postoperative MCP flexion was 54.7 degrees and MCP extension was 8.97 degrees and total value of postrehabilitational MCP flexion was 88.97 degrees and MCP extension 17.04 degrees. No complications were noted, all fractures healed, without any signs of infection or malunion. Conclusion: Surgical treatment of the 4th metacarpal shaft fracture with low profile plates and mini-screws is a good technique that represents rigid fixation and provides fast recovery to pre-injury range of movements. The quality of life is enhanced due to fast recovery and return to normal daily and sports activities. Such treatment indicates profitability, hence to a one-day surgery, decreasing treatment costs and resulting in high beneficial aspects for patients

Psychiatrischer Beitrag

<jats:title>Zusammenfassung</jats:title><jats:p>Der psychiatrische Raum kennt viele unterschiedliche Zimmer und Korridore. Es gibt erhebliche Unterschiede zwischen den verschiedensten Kliniken und Institutionen. Eine offene Tagesklinik ist nicht vergleichbar mit dem geschlossenen Maßregelvollzug. Beide nutzen aber bisweilen Methoden, die das Theater bereitstellt. Dabei reicht die Spannbreite von einfachen, improvisierten Rollenspielen bis hin zu professionellen, technisch aufwendigen Inszenierungen vor einem kritisch interessierten Publikum. Zentrale Fragen sind dabei, wie wirkt Theaterspielen, kann es tatsächlich heilen, und wie verhält sich der künstlerische Anspruch zur Therapie? Diese will der nachfolgende Beitrag anhand mehrjähriger praktischer Erfahrungen in einer Maßregelvollzugsklinik aufgreifen.</jats:p&gt

Psychiatrischer Beitrag

<jats:title>Zusammenfassung</jats:title><jats:p>Sexualsadismus bezeichnet eine lustvolle Erregbarkeit durch die Kontrolle, Erniedrigung oder Schmerzzufügung zulasten einer anderen Person. In den psychiatrischen Klassifikationskatalogen wird heute auf Zwang und Nichteinvernehmlichkeit abgestellt, um die forensische Ausprägung des Sexualsadismus von der konsensuellen Spielart im Sinne sadomasochistischer Rollenspiele abzugrenzen („bondage“ und Disziplinierung, Dominanz und Submission, Sadismus und Masochismus; kurz: BDSM). Ferner ist zwischen diesen Formen des Sexualsadismus und dem sog. Charakter- oder Alltagssadismus als Persönlichkeitszug zu unterscheiden. Im vorliegenden Beitrag wird die aktuelle Nosologie der forensisch-psychiatrisch bedeutsamen zwangsweisen sexuell-sadistischen Störung („coercive sexual sadism disorder“) gemäß ICD-11 erläutert. Die <jats:italic>Sexual Sadism Scale</jats:italic> wird als diagnostisches Hilfsmittel für die gutachterliche Beurteilung vorgestellt. Befunde zur Kriminalprognose werden dargestellt, wobei die Diagnose per se nicht nennenswert mit erneuter Sexual- oder Gewaltdelinquenz nach Entlassung assoziiert ist, aber einen starken Zusammenhang mit äußerst schwerwiegenden Einweisungsdelikten zeigt (konkret: sexuell motivierte Tötungsdelikte). Wie aktuelle Literaturrecherchen ergeben, liegen aus den letzten Jahren keine Behandlungsstudien vor.</jats:p&gt

Artroskopija kuka [Hip arthroscopy]

In the last ten years, hip arthroscopy has been developing intensively and it is rapidly gaining primacy in the treatment of various injuries and damages to the hip itself and its immediate vicinity. The basic advantage of hip arthroscopy surgery versus classic open surgery is avoiding an open dislocation of the hip and, thus, reducing patient's morbidity and accelerating his/her rehabilitation, which leads to a quicker return to everyday activities. The success of arthroscopic surgery depends on the correct indication for the surgery and on the experience and the skill of the operator. It also depends on the properly conducted rehabilitation and the patient's compliance, as well as on the patient's realistic expectations. Indications for hip arthroscopy today are the following: injury and damage to acetabular labrum and/or articular cartilage, femoroacetabular impingement syndrome, injuries and damages to the ligament of the femoral head, loose and foreign joint bodies as well as different conditions of synovial membrane (synovial chondromatosis, pigmented villonodular synovitis and other inflammatory arthropathy such as rheumatoid arthritis). In this article we describe the indications, technique, complications and the prospect of hip arthroscopy, with a detailed overview of contemporary literature data

Current practice variations in the management of anterior cruciate ligament injuries in Croatia

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. ----- METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. ----- RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. ----- CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature