Sonography in the pathology of the locomotory system

Ultrazvukom možemo dobro analizirati tkiva i strukture lokomotornog sustava. Pregledi pojedinih regija lokomotornog sustava zahtijevaju poznavanje standardnih pristupa i položaja ultrazvučne sonde, ali je pretraživanje promatrane regije sondom prijeko potrebno kako bi se iz dvodimenzionalne slike stvorila prostorna predodžba o analiziranoj regiji. Za interpretaciju ultrazvućne slike veoma je važno poznavanje topografske anatomije pregledavane regije. Očekivanu patološku promjenu “treba tražiti” pri ultrazvučnom pregledu. Preporučljivo je ultrazvučni nalaz uvijek usporediti sa suprotnom, zdravom stranom tijela. Na temelju anamneze i kliničkog pregleda potrebno je ultrazvučne slike pravilno objasniti i prema potrebi upotpuniti s ostalim dijagnostičkim pretragama. Nepravilno je očekivati da samo ultrazvučni pregled bude dovoljan za postavljanje dijagnoze. Sonografija je dokazano vrijedna i jeftina neinvazivna dijagnostička metoda u liječenju ozljeda i bolesti lokomotornog sustava. U članku su prikazana najčešća patološka stanja iz kliničke praks

Sonography in the pathology of the locomotory system

Ultrazvukom možemo dobro analizirati tkiva i strukture lokomotornog sustava. Pregledi pojedinih regija lokomotornog sustava zahtijevaju poznavanje standardnih pristupa i položaja ultrazvučne sonde, ali je pretraživanje promatrane regije sondom prijeko potrebno kako bi se iz dvodimenzionalne slike stvorila prostorna predodžba o analiziranoj regiji. Za interpretaciju ultrazvućne slike veoma je važno poznavanje topografske anatomije pregledavane regije. Očekivanu patološku promjenu “treba tražiti” pri ultrazvučnom pregledu. Preporučljivo je ultrazvučni nalaz uvijek usporediti sa suprotnom, zdravom stranom tijela. Na temelju anamneze i kliničkog pregleda potrebno je ultrazvučne slike pravilno objasniti i prema potrebi upotpuniti s ostalim dijagnostičkim pretragama. Nepravilno je očekivati da samo ultrazvučni pregled bude dovoljan za postavljanje dijagnoze. Sonografija je dokazano vrijedna i jeftina neinvazivna dijagnostička metoda u liječenju ozljeda i bolesti lokomotornog sustava. U članku su prikazana najčešća patološka stanja iz kliničke praks

Bone Remodeling after Supracondylar Humeral Fracture in Children

The aim of this study was to evaluate bone remodeling in treated supracondylar humeral fractures in children. The study was carried out at the Department of Pediatric Surgery of University Hospital Rijeka on 58 patients with an average of 6.2 years, followed up during 1 to 7 years. The Baumann angle of the humerus was measured by five observers on the anteroposterior radiographs of the injured elbow right after the surgery, and on routine follow-up. The results obtained were compared with the results of the Baumann angle on the healthy arm, and statistically processed. There was a significant difference in number of cases that showed an increase of Baumann angle, when related to cases with no change of the angle or its decrease. The mean value change of Baumann angle in cases of its increase was 4.22° and in cases of its decrease 2.65°. Because of relatively low mean values of the angles of remodelation, we concluded that an adequate reduction is essential to prevent malunion in supracondylar humeral fractures

Bone Remodeling after Supracondylar Humeral Fracture in Children

The aim of this study was to evaluate bone remodeling in treated supracondylar humeral fractures in children. The study was carried out at the Department of Pediatric Surgery of University Hospital Rijeka on 58 patients with an average of 6.2 years, followed up during 1 to 7 years. The Baumann angle of the humerus was measured by five observers on the anteroposterior radiographs of the injured elbow right after the surgery, and on routine follow-up. The results obtained were compared with the results of the Baumann angle on the healthy arm, and statistically processed. There was a significant difference in number of cases that showed an increase of Baumann angle, when related to cases with no change of the angle or its decrease. The mean value change of Baumann angle in cases of its increase was 4.22° and in cases of its decrease 2.65°. Because of relatively low mean values of the angles of remodelation, we concluded that an adequate reduction is essential to prevent malunion in supracondylar humeral fractures

Application of Wound Dressing Molndal Technique in Clean and Potentially Contamined Postoperative Wounds – Initial Comparative Study

Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag – Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives.We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (4%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration. In the traditional technique group 4 (16%) patients developed wound infection as inflammation and secretion as a sign of superficial infection. In the other group we analyzed the results of 50 patients after implantation of partial endoprosthesis after hip fracture. 20 patients were treated by Molndal technique and 30 patients by the traditional technique of wound dressing. In the group treated by Molndal technique no patient has revealed a wound infection (0%). In the traditional technique group 4 (13%) patients developed wound infection. All complication in both group were superficial incisional surgical infection (according to HPSC). There was no deep incisional surgical site infection or organ / space surgical site infection. Our results are clearly showing that Molndal technique is effective in preventing the postoperative wound infection

Polytrauma in Elderly

The aim of this study is to present certain particularities in treating polytraumatized patients age of 65 and above. All of the patients were treated in our hospital. 413 patients were included in this 4 year study (2006–2010). Injury severity score was 17 and above (ISS>17). Patients aged above 65 were sub grouped. In this 4-year period, we treated 52 or 13% elderly patients. In this subgroup there were 30 (58%) males and 22 (42%) females, with mean age of 74 (max age 95 years old). Demographic factors, injury mechanisms, patients resuscitation protocols, imaging used, etc. were also included as variables. Mortality rate in elderly patients was 31%, while in patients below 65 years of age as 12%. Taking relevant data into consideration, a special emphasis was given to certain circumstances of intensive and surgical treatment of elderly patients. A large portion of polytraumatized patients are consisted of elderly. Patients aged 65 and above have higher mortality rate with lower ISS in the mortal group and falls are the most frequent mechanism of trauma. In this study, we tried to emphasize some clinical implications when treating those patients, as well as importance in continuous medical staff education in trauma principles to minimize mortality rates

Polytrauma in Elderly

The aim of this study is to present certain particularities in treating polytraumatized patients age of 65 and above. All of the patients were treated in our hospital. 413 patients were included in this 4 year study (2006–2010). Injury severity score was 17 and above (ISS>17). Patients aged above 65 were sub grouped. In this 4-year period, we treated 52 or 13% elderly patients. In this subgroup there were 30 (58%) males and 22 (42%) females, with mean age of 74 (max age 95 years old). Demographic factors, injury mechanisms, patients resuscitation protocols, imaging used, etc. were also included as variables. Mortality rate in elderly patients was 31%, while in patients below 65 years of age as 12%. Taking relevant data into consideration, a special emphasis was given to certain circumstances of intensive and surgical treatment of elderly patients. A large portion of polytraumatized patients are consisted of elderly. Patients aged 65 and above have higher mortality rate with lower ISS in the mortal group and falls are the most frequent mechanism of trauma. In this study, we tried to emphasize some clinical implications when treating those patients, as well as importance in continuous medical staff education in trauma principles to minimize mortality rates

Perioperative and Early Postoperative Neurological Deficit in Older Patients during Carotid Artery Thrombendarterectomy

Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries1–3. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels1–5. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke prevention. Between 2006 and 2009, 209 patients underwent surgical intervention at the Clinical Hospital Center in Rijeka for high degree of carotid artery narrowing. In the group younger than 65 years of age, which consisted of 53 patients, a neurological deficit was noted in 4 patients (7.54%) in the perioperative and early postoperative course. In the group of individuals older than 65 years of age, which consisted of 156 patients, a neurological deficit was noted in 9 patients (5.76%). There was no significant statistical difference in the incidence of neurological deficit, nor in the mortality in individuals older than 65 years of age during carotid arteries thrombendarterectomy