Uloga konvencionalnih i nekih manje konvencionalnih rizičnih čimbenika u patogenezi akutnog ishemijskog moždanog udara

The aim of the study was to determine the role of some conventional and some less conventional risk factors for stroke, such as inflammatory adhesion cell molecules, in the pathogenesis of ischemic stroke, and their relationship. Sixty-seven subjects with acute ischemic stroke and 76 healthy controls were enrolled in the study. On admission, the concentration of soluble adhesion molecules, C-reactive protein, erythrocyte sedimentation rate and total leukocyte count were determined. The concentrations of soluble adhesion molecules were determined using quantitative sandwich enzyme immunoassay. On the next morning, fasting blood glucose, triglycerides, total cholesterol, HDL-cholesterol and LDL-cholesterol con¬centrations were determined in patient sera. Results showed the mean levels of sICAM-1, sVCAM-1 and sE-selectin to be higher, and that of sL-selectin lower in patients with acute ischemic stroke than in controls. In patients, soluble adhesion molecule levels did not differ with respect to carotid atherosclerotic disease, smoking status, hypertension and hypercholesterolemia. Some soluble adhesion molecules correlated with blood glucose, lipid parameters and markers of inflammation.Cilj istraživanja bio je utvrditi ulogu konvencionalnih i nekih manje konvencionalnih rizičnih čimbenika za moždani udar, poput upalnih adhezijskih staničnih molekula, u patogenezi ishemijskog moždanog udara, kao i njihov međuodnos. šezdesetsedmoro bolesnika s akutnim ishemijskim moždanim udarom koji su bili primljeni na Kliniku za neurologiju, KB "Sestre milosrdnice" u razdoblju od ožujka 2000. do ožujka 2001. godine, te 76 zdravih dobrovoljaca iz Doma zdravlja "Centar" bilo je uključeno u istraživanje. Pri dolasku je svim bolesnicima određena koncentracija adhezijskih molekula, C-reaktivnog proteina te ukupan broj leukocita u serumu. Koncentracija topljivih adhezijskih molekula određena je kvantitativnim enzimskim imunotestom. Dan nakon dolaska određena je serumska koncentracija glukoze, triglicerida, ukupnog kolesterola, HDL-kolesterola. Rezultati su pokazali da su vrijednosti konvencionalnih čimbenika u bolesnika značajno veće nego u kontrolnoj skupini. Odds omjer bio je 15,8 (95% CI 6,69-37,36) za hipertenziju, 12,6 (95% CI 2,78-56,85) za stenozu karotida >50%, 2,6 (95% CI 0,98-6,9) za šećernu bolest, 6,5 (95% CI 1,36-30,79) za atrijsku fibrilaciju, te 1,6 (95% CI 0,51-4,81) za pušenje. Vrijednosti unutarstaničnih adhezijskih molekula -1 (ICAM-1), vaskularnih staničnih adhezijskih molekula -1 (VCAM-1) i E-selektina bile su više u bolesnika nego u kontrolnih osoba (p<0,001, 0,034, 0,002), dok je vrijednost sL-selektina bila niža u skupini bolesnika (p=0,043)

Trzajna ozljeda vrata - medicinsko-pravni problem

Whiplash injury is the most common injury sustained in traffic accidents. On exposure to different forces, multiple neck injuries may occur. Following the injury, many patients suffer from subjective symptoms that may even persist upon completion of medical treatment. As a result, there are serious problems in the objective evaluation of permanent consequences of the injury. The study included 40 randomly selected whiplash injury victims without previous lesions of cervical spine, and 40 equally selected patients with previously confirmed cervical degenerative changes. They all suffered from permanent whiplash injuries and applied for reimbursement for nonmaterial damage to Zagreb Insurance Company during 2001. Sixty-seven per cent of patients underwent continuous treatment for 5-6 months, however, the sequels of whiplash injury persisted in the form of decreased motility of cervical spine, arm paresthesia, vasospasm of vertebral arteries and permanently narrowed visual field. Pathological findings were verified by objective diagnostic methods: functional x-rays of the cervical part of the spinal cord, electromyoneurographic examination of arms, transcranial Doppler sonography of vertebrobasilar arteries, visual field assessment by Goldman method, and clinical examination by medical censor. The treatment of injured patients with previous degenerative changes of cervical spine took a longer time, with a higher level of head and neck motility reduction. Ultimately, in terms of reimbursement, they were conceded a lesser degree of permanent physical damage than those without previous cervical spine lesions.Trzajna ozljeda vratne kralježnice najčešće se događa u prometnim nesrećama. Djelovanjem sila dolazi do ozljeda brojnih struktura vrata. Nakon završenog liječenja zaostaje velik broj subjektivnih simptoma koji se ne mogu objektivno prikazati i stoga predstavljaju velik problem kod ocjene trajnih posljedica. Istraživanje je provedeno u nasumce izabranih 40 ozljeđenika bez prisutnih ranijih oštećenja vratne kralježnice i 40 isto tako nasumce odabranih ozljeđenika s prisutnim degenerativnim promjenama vratne kralježnice dokazane pomoću RTG. Svi su nakon doživljene prometne nesreće pretrpjeli trzajnu ozljedu vratne kralježnice i podnijeli zahtjev za ostvarivanje nematerijalne štete u OZ Zagreb tijekom 2001. godine. U 67% predmeta ozljeđenici su provodili liječenje tijekom 5-6 mjeseci. Nakon završetka liječenja zaostale su trajne posljedice: ograničena pokretljivost vratne kralježnice, utrnulost ruku, vazospazam vertebralnih arterija, trajno sužena vidna polja; sve prema nalazima objektivne obrade (funkcionalne radiološke snimke vratne kralježnice, elektromi¬oneurografije ruku, transkranijske Doppler sonografije vertebrobazilarnog sliva, vidnog polja po Goldmanu te klinički pregled liječnika cenzora). U ozljeđenika s prisutnim degenerativnim promjenama vratne kralježnice liječenje je u pro¬sjeku bilo dugotrajnije, nakon završetka liječenja imali su veći stupanj ograničenja pokreta glave i vrata, ali su u konačnici dobili u postotku manji stupanj trajnih posljedica u odnosu na ozljeđenike koji nisu imali izrađene degenerativne promjene vratne kralježnice

The Dissections of Craniocervical Arteries

Dissection of craniocervical arteries internal carotid artery (ICA), or vertebral artery (VA) is an increasingly recognized entity and infrequent cause of stroke. We investigated 8 patients (4 women and 4 men) with dissections of the craniocervical arteries. Diagnostic procedures for detection of craniocervical dissection included: extracranial ultrasound- color Doppler flow imaging (CDFI) of carotid and vertebral arteries, transcranial Doppler sonography (TCD) and radiological computed tomography (CT) and digital subtractive angiography (DSA) examinations. Ultrasound findings (CDFI of carotid and vertebral arteries) were positive for vessel dissection in seven patients (or 87.5 per cent) and negative in one patient. DSA was consistent with dissection in five patients (or 62.5 per cent), negative in one, while in two patients the examination was not performed due to known allergy to contrast media. Five patients (62.5 per cent) were treated with anticoagulants, one with suppressors of platelet aggregation, and two patients were operated. Six patients (75 per cent) after the treatment showed partial recovery of neurological defects, and an improvement of ultrasound finding of dissected arteries. In one patient, following operation, stroke developed with deterioration of motor deficit, and one patient was readmitted three months later due to a newly developed stroke and soon died. The diagnosis should be suspected in any young or middle-age patient with new onset of otherwise unexplained unremitting headache or neck ache, especially in association with transient or permanent focal neurological deficits

Ultrazvučno praćenje uspješnosti rehabilitacije mišića natkoljenice nakon ozljede koljenskog zgloba

The ultimate goal of successful rehabilitation of the knee joint is to achieve normal movement of the knee joint and to re-establish active muscle control in the shortest time possible. The knee joint movement during rehabilitation can be objectively measured by using a goniometer. The recovery of femoral muscles after a knee joint injury can be accurately and precisely monitored by ultrasonic measurement of the muscular volume. The aim of this longitudinal study was to standardize and evaluate the method of ultrasonographic measurement of muscular volume itself, and practical applicability of the method, in order to reach a general conclusion on the femoral muscle rehabilitation. The measurements were performed at equal intervals in 30 subjects with a history of knee joint injury, and in 30 asymptomatic subjects as a control group. The results showed that the ultrasound method could precisely and accurately monitor the process of muscular atrophy that develops during immobilization, as well as the course of muscular restitution during physical therapy. Full recovery of the rectus femoris muscle was achieved in more than a half of the patients, i.e. 54.4 per cent of women and 53.8 per cent of men. Vastus intermedius muscle responded less readily to physical therapy. Full recovery was achieved in 22.2 per cent of female and28.6 per cent of male patients. Within the same intervals, no muscular mass changes were recorded in the control group. Prior to implementation, it is necessary to precisely determine the reproducibility of the method and measurement errors. The ultrasound method has good reproducibility because the error does not exceed 2 per cent of the measurement value. However, practical application of ultrasonic measurement is not simple, because it requires experience and procedure standardization.Krajnji cilj uspješne rehabilitacije nakon ozljede koljena je postizanje normalnog opsega pokreta zgloba i uspostavljanje aktivne mišićne kontrole u što kraćem razdoblju. Mjerenje opsega pokreta zgloba može se u tijeku rehabilitacije provoditi objektivno pomoću goniometra. Točno i precizno praćenje oporavka natkoljeničnih mišića nakon ozljede zgloba koljena moguće je metodom ultrazvučnog mjerenja volumena mišića. Cilj ove longitudinalne studije bio je standardizirati i vrednovati metodu ultrazvučnog mjerenja volumena mišića i prikladnost primjene ove metode u praksi radi objektivizacije rehabilitacije četveroglavog mišića natkoljenice. Mjerenje je bilo provedeno u istim vremenskim razmacima u 30 ispitanika koji su u anamnezi imali ozljedu zgloba koljena te u 30 asimptomatskih ispitanika koji su činili kontrolnu skupinu. Rezultati su pokazali da se ehosonografijom može točno i precizno pratiti tijek promjene volumena mišića pri procesu atrofije koja nastaje za vrijeme imobilizacije i tijek restitucije mišića za vrijeme provođenja fizikalne terapije. Prije primjene treba točno odrediti ponovljivost metode i pogreške mjerenja. Ultrazvučna metoda ima dobru ponovljivost, jer pogreška ne prelazi 2% vrijednosti mjerenja

Disekcija kraniocervikalnih arterija

Once considered rare, dissection of the internal carotid artery or vertebral artery is an increasingly recognized entity. Craniocervical arterial dissection is an uncommon cause of stroke in the general population, but is relatively common in patients below the age of 40. The early clinical manifestations are often subtle; however, permanent neurologic disability and death can result if the diagnosis is delayed. The present report describes eight patients (four men and four women) with dissection of the craniocervical arteries. Patient history was taken and clinical neurologic examinations were performed immediately upon admission. Diagnostic procedures included ultrasound (CDFI and TCD) and radiologic (computed tomography and digital subtraction angiography) examinations. The leading symptoms were focal neurologic deficits, and headache and neck ache. Ultrasound findings (CDFI) were positive for vessel dissection in seven (87.5%) patients, and DSA was consistent with dissection in five (62.5%) patients and negative in one patient, whereas in two patients this examination was not performed due to the known allergy to contrast medium. Five (62.5%) patients were treated with anticoagulants, one with platelet aggregation suppressants, and two patients were operated on. Six (75.0%) patients showed partial post-therapeutic recovery of neurologic deficits and improvement of ultrasound findings of dissected arteries. One patient developed a stroke postoperatively, with deterioration of the motor deficit, and one patient was readmitted three months later for a newly developed stroke and died soon thereafter. It is concluded that early detection of craniocervical arterial dissection is important to minimize the morbidity and mortality associated with this condition.Disekcija unutarnje karotidne ili vertebralne arterije je rijetka, ali sve češće prepoznata. Disekcija kraniocervikalnih arterija rijetko je uzrokom cerebrovaskularnog inzulta u općoj populaciji, ali je češća u bolesnika mlađe dobi, ispod 40 godina. Rane kliničke manifestacije često su jedva zamjetljive, a u slučaju neprepoznate dijagnoze moguć je trajni neurološki deficit, pa i smrtni ishod. U studiju je bilo uključeno osmoro bolesnika (četiri žene i četiri muškarca) s disekcijom kraniocervikalnih arterija. Odmah nakon prijma uzeti su anamnestički podaci te je učinjen klinički neurološki pregled. Bolesnici su podvrgnuti dijagnostičkim metodama koje su uključivale ultrazvučne (CDFI i TCD) i radiološke ( CT i DSA) pretrage. Vodeći simptomi bolesti bili su žarišni neurološki znakovi i naglo nastala glavobolja i bolovi u stražnjem dijelu vrata. U 7 (87,5%) slučajeva CDFI karotidnih i vertebralnih arterija pokazao je pozitivan nalaz disekcije žile. Petoro (62,5%) bolesnika je imalo pozitivan, a jedan bolesnik negativan nalaz DSA, dok u dvoje bolesnika ova pretraga nije provedena zbog alergije na kontrastno sredstvo. Petoro (62,5%) bolesnika liječeno je antikoagulantnom terapijom, jedan antiagregansima, a dvoje operacijski. U šestoro (75,0%) bolesnika je nakon primijenjene terapije došlo do djelomičnog kliničkog oporavka i poboljšanja ultrazvučnog nalaza na diseciranim krvnim žilama. Jedan je bolesnik nakon operacijskog zahvata doživio recidiv moždanog udara uz pogoršanje neurološkog deficita, a u jednom je slučaju nakon tri mjeseca nastupio recidiv moždanog udara sa smrtnim ishodom. Od velike je važnosti rano prepoznati disekcije kraniocervikalnih arterija, kako bi se smanjio njihov pobol i smrtnost

CHARACTERISTICS OF CATTLE PRODUCTION IN THE SISAČKO-MOSLAVAČKA COUNTY

Sisačko-moslavačka županija smjestila se u južnom dijelu središnjeg dijela Republike Hrvatske i druga je po veličini županija s obzirom na površinu poljoprivrednog zemljišta. Stočarstvo je najvažnija grana poljoprivredne proizvodnje uglavnom vezana za pašno držanje životinja (goveda, konji) na području Lonjskog i Odranskog polja. Govedarstvo čini okosnicu stočarske proizvodnje pri čemu dominira simentalska pasmina. Negativni trendovi u kretanju broja goveda na državnoj razini prisutni su i na navedenom području, a odnose se prvenstveno na pad broja mliječnih i kombiniranih pasmina goveda. Tijekom posljednjeg desetljeća raste zanimanje uzgajivača za uzgoj mesnih pasmina goveda što se očituje porastom broja krava svih čistokrvnih mesnih pasmina uključujući i neke koje se nisu ranije uzgajale na području Sisačko-moslavačke županije (salers i aubrak). Također, broj izvornih pasmina bilježi blagi porast u promatranom razdoblju. Navedene promjene pasminske strukture mogle bi poslužiti kao primjer korištenja prirodnih resursa i pašnjačkih površina i na ostalom području Republike Hrvatske.Sisačko-moslavačka county is located in the southern part of the central part of the Republic of the Croatia as a second largest county in relation to amount of agricultural land. Livestock is the most important branch of agricultural sector, mainly related to grazing animals (cattle, horses) in the area of Lonjsko and Odransko fields. Cattle breeding is the backbone of livestock production, dominated by the Simmental breed. Negative trends in the number of cattle are present in this area, and relate primarily to the decline in the number of dairy and dual purpose breeds. Over the last decade, breeders’ interest in raising beef cattle breeds has grown which is reflected in the increase in the number of cows of all purebred beef cows including some that were not previously bred in Sisak-Moslavina County (salers and aubrak). Also, the number of native breeds a slight increase in the observed period. These changes in the breed structure could serve as an example of the use of natural resources and pastures in the rest of the Republic of Croatia