Osteochondritis dissecans of the elbow: excellent mid-term follow-up results in teenage athletes treated by arthroscopic debridement and microfracture

AIM: To evaluate the outcome of patients who underwent microfracture procedure on osteochondritis dissecans (OCD) lesions in the elbow, which had already been proven successful on OCD lesions in the knee and ankle. ----- METHODS: Nine young patients who were previously treated by arthroscopic debridement and microfracture by a single surgeon were included in the study. The median age at operation was 15 years (range 12-19). The median time between the procedure and evaluation was 5 years (range 2-9). The evaluation included physical examination and patient interview with elbow function scoring. Success of treatment was determined according evaluation Mayo Elbow Performance Index scores and the patients' return to sports. ----- RESULTS: Eight patients scored excellent results and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. ----- CONCLUSIONS: We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum

Large Chondrosarcoma of the Lumbar Spine – A Rare yet Important Cause of Lower Back Pain

We report a case of a large chondrosarcoma of an L4 vertebral body causing iliac vein thrombosis. The slow-growing tumor eluded definitive diagnosis early in its development since the main symptom it caused was only lower back pain. Five years after onset of the disease, the patient presented with fever, tenderness and swelling in the leg, the tumor was diagnosed and found to be exerting a mass effect causing further pain and compressing the left common iliac vein. Due to inoperability of the tumor, a multidisciplinary surgical approach was used to resect the majority of the tumor as a palliative measure and rid the patient of her symptoms. Due to the chemoresistance and relative radioresistance of these tumors, prompt full surgical resection before the tumor invades vital structures remains the mainstay of successful treatment of chondrosarcoma of the spine

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

Systematic review - A backbone of evidence based medicine

U ovom članku opisuju se temeljna načela izrade sustavnog pregleda i metaanalize. Izdvojene su važne značajke koje se odnose na postavljanje specifičnoga kliničkog pitanja, prikupljanje objavljenih studija, kritičku procjenu podataka i objedinjavanje znanstvenih spoznaja. glavni je cilj ovog rada potaknuti što više medicinskih djelatnika da se u svakodnevnom donošenju kliničkih odluka služe najboljim dostupnim spoznajama iz literature te da se i sami okušaju u izradi kvalitetnoga sustavnog pregleda.This article gives an overview of the basic principles of systematic reviews and meta-analysis. Important issues that need to be considered when addressing a specific clinical question, collecting published studies, critically evaluating data, and synthesizing research evidence are outlined. The main purpose of this review is to motivate as many healthcare professionals as possible to use the best available evidence in their everyday practice and to make an attempt to produce a quality systematic review as well

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods

Nurses’ Assessments Versus Patients’ Self-Assessments of Postoperative Pain: Knowledge and Skills of Nurses for Effective Pain Management

Postoperative pain is the most common form of acute pain. Nurses contribute to effective pain management with their knowledge and skills. The aims of this research were to examine differences between nurses’ assessments and patients’ self-assessments of postoperative pain, differences in the mentioned (self) assessments with respect to characteristics of both groups of respondents, and the correlation between the NRS and the VRS scale. The study included 103 nurses employed at a hospital and 103 patients treated in the surgical departments after the surgical procedures. Data were collected using the standardized Numerical rating scale (NRS) and Verbal rating score (VRS). The median of patients’ self-assessments of pain intensity on the NRS scale was 4, while the nursing assessment of patients’ pain was 3, with no significant difference (p = 0.083). No significant differences were found on the VRS scale between nurse assessments and patient self-assessments of current pain intensity. The pain was described as moderate by 35% of participants, including 35.9% nurses and 35% patients. Significant positive correlations were recorded between values on the VRS and NRS scales for nurses (Rho = 0.812; p p < 0.001). The results of this study may have implications for the improvement of postoperative pain management protocols, with regular use of pain assessment scales and individualization of analgesic prescriptions