OSTEOARTHROSIS OF THE KNEE - WITH REGARD TO COMPARATIVE EFFICIENCY OF DISTINC THERAPEUTIC TREATMENTS

Cilj istraživanja bio je usporediti i evaluirali učinkovitost terapijske prunJene lasera i ultrazvuka na kliničke manifestacije osteoartroze zgloba koljena. Ispitivano skupinu či nilo je 53 bolesnika s manifestnom artrozom zgloba koljena. Uvjet uključenja u ispitivan u skupinu bio je da u zadnjih mjesec dana nije apliciran intraartikularni lijek. Tijekom ispitivanja praćeno je ll kliničkih pokazatelja. Njihovom usporedbom prije i poslije fizikalne terapije utvrdili smo značajno kliničko poboljšanje, s tim da je primjena ultrazvuka učinkovitija na jedan dio parametara, a terapijska primjena lasera na drugi dio. Iz navedenih rezultata nameće se zaključak o mogućnosti kombiniranog liječenja osteoartroze koljena ultrazvukom i laserom. čime bi se optimalno iskoristio povoljan učinak oba oblika fizikalne terapije.This paper tries to compare and evaluate the therapeutic efficiency following the application of laser and ultrasonics, as clinically manifested in patients with knee osteoarthrosis. The group being tested consisted 53 patients with manifest arthrosis of the knee joint. A month prior to testing no medicine was allowed to be applied intraarticularly on the patients being tested. The testing comprised ll parameters being observed before and after the therapeutic treatments. The comparision showed significant clinical improvement which, as to some parameters, seemed more effective after the ultrasonics treatment and, as to others, after the laser treatment. The conclusion implies the possibility of treating the osteoarthrosis of the knee by combining the application of both ultrasonics and laser therapy, which might bring about the best results of both therapeutic treatments

Correlation of Chronological Age with Tooth Wear in Archaeological Populations

Knowing that attrition and abrasion are most common wear processes of dental hard tissue, which occurs along with aging, the aim of this paper is to determine the correlation between dental age and loss of dental hard tissue on archeological bone residues. For the purpose of this research, the collection of skeletal remains of the Croatian Academy of Sciences and Arts (HAZU) was used. The study includes 392 samples of the remains of both upper and lower jaws from 7 Croatian archaeological sites, whereas 4 of them from continental and 3 of them from coastal Croatia. The remains of bones belong to two different archeological periods, late antiquity and early Middle Ages. Visa Metrix computer system was used on digital photography of occlusal tooth surfaces to measure total exposed area of dental hard tissue and surface of dental hard tissues damaged by attrition and abrasion. Data provided were defined in sq. cm, and as such were inserted in excel table and processed statistically. In the statistical analysis of data, Shapiro-Wilk test, Mann-Whitney U test and Kruskal-Wallis test were used. There is a statistically significant correlation between the total teeth number and estimated chronological age (χ² = 46.3, ƞ² = 0.23, p <0.001). Total number of teeth negatively correlates with chronological age (r = –0.41, p <0.001). The total surface area of the teeth available decreases with the estimated chronological age (r = –0.39, p <0.001), while the proportion (%) of the total damaged area of the teeth in relation to the total available area increases with the estimated chronological age (r = 0.622, P <0.001). The proportion of damaged surface in overall teeth surface increases with the estimated chronological age (r = 0.686; p <0.001) both in males and females (r = 0.534; p <0.001). The lifelong loss of hard tooth tissue positively correlates with chronological age in both sexes despite of historical period. The loss of hard tooth tissue due to attrition and abrasive changes, and with usage of Vista Metrix Inc. computer system can now be used to determine age in forensic dentistry as well as forensic anthropology and archeology

THE EFFICIENCY OF LASER TREATMENT IN TREA TING SPORT INJURIES

Ocjenjujući uč inkovi tost liječenja laserom nakon dijagnosticirane sportske ozljede u -B aktivnih sportaša, ustanovili srno da tijekom liječenja dolazi do značajnog smanjenja boli u ispitanika, do zna čajnog smanjenja otekline te nestanka krepitacija i značajne redukcije posljedičnih kontraktura. Na temelju dobivenih rezultata, mišljenja smo da laser spada u vrlo učinkov ite oblike fizikalne terapije za liječenje sportskih ozljeda.The laser treatment of sport injuries has been applied on 43 professional sportsmen. The research proved the pain considerably relived during the treatment. It also showed the swelling considerably decreasing, the crepitations disappearing and the contractures resulting from injuries considerably reduced. On the basis of these results the authors fmd laser treatment one of the most useful physioterapeutic means in trcating sport injuries

THE CHARACTERISTICS OF THE URINARY BLADDER WALL IN INFANTS DURING THE FIRST 6 MONTHS OF

Cilj: Odrediti ultrazvukom normalne vrijednosti debljine stijenke mokraćnog mjehura zdrave dojenčadi u prvih 6 mjeseci života i utvrditi postoje li razlike s obzirom na spol. Ispitanici i metode: Obavljen je ultrazvučni probir mokraćnog mjehura 416-ero zdrave donošene dojenčadi (216 muške i 200 ženske) u dobi od 0,5 do 6 mjeseci života. Debljine stijenke mokraćnog mjehura analizirane su ultrazvučnim aparatom Siemens Sonoline Prima, semikonveksnom sondom od 5,0 MHz i linearnom sondom od 7,5 MHz. Rezultati: Prosječna vrijednost debljine stijenke iznosila je 2,32 0,542 mm (95% indeks povjerenja: 2,27 – 2,37). Najmanja zabilježena debljina stijenke je bila 1 mm, a najveća 4 mm. Prosječna vrijednost debljine stijenke mokraćnog mjehura u muške dojenčadi iznosila je 2,42 0,56 mm, a prosječna vrijednost za žensku dojenčad iznosila je 2,21 0,50 mm. Studija je pokazala da postoji statistički značajna razlika u smislu nešto većih vrijednosti debljine stijenke mokraćnog mjehura u muške dojenčadi nego u ženske (t=3,97, p=0,00009, p0,01). Zaključak: Ovakvi bi se rezultati mogli očekivati jer mokraćni mjehur muškog djeteta mora proizvesti nešto veći tlak da bi izbacio urin kroz značajno dulju i užu uretru, nego mjehur ženskog djeteta. Takva relativna hiperfunkcija mokraćnog mjehura muškog dojenčeta rezultira relativnim zadebljanjem njegove stijenke, što pridonosi fiziološkoj različitosti među spolovima.Objectives: to determine by ultrasonograph the normal values of bladder wall thickness in healthy infants in the first 6 months of life and to observe the possible differences between sexes. Patients and Methods: Ultrasonograph screening was performed in 416 healthy term infants (216 males and 200 females) aged between 0.5 and 6 months. Bladder wall thicknesses were analyzed using a Sonoline Prima ultrasound machine with semi convex probe of 5.0 MHz, and linear probe of 7.5 MHz. Results: The mean bladder wall thickness was 2.32 0.542 mm (95% confidence interval: 2.27-2.37). The minimal bladder wall thickness was 1.0 mm, and maximal 4.0 mm, respectively. The average bladder wall thickness was 2.42 0.56 mm in males, and 2.21 0.50 mm in females. We found a statistically significant difference between bladder wall thickness of male and female infants in the first 6 months of life. The bladder wall in the male infants was thicker than in female infants (t=3.97, p=0.00009, p<0.01). Conclusion: These results might be expected because the male urinary bladder needs somewhat higher pressure to expel the urine via the significantly longer and narrower urethra than the bladder in female infants. That relative hyperfunction of the male bladder results in a relatively thicker bladder wall, what contributes to physiologic variances between sexes in infancy

TREA TING OSTEOARTHROSIS OF THE KNEE JOINT BY SHORTWAVE THERAPY

Cilj istraživanja je bio utvrditi i dokazati učinkovitost kratkovalne dijatennije kod manifestne osteoartroze koljena (gonartroza) u 40 bolesnika prosječne životne dobi 64,43 godine. U terapiji je korišten aparat "Oscilotenn 400 E" "Elektromedicine" iz Ljubljane, tijekom 10 terapijskih procedura po 20 minuta. Praćeno je šest kliničkih pokazatelja (jutarnja zakočenost, bol u mirovanju, izljev u koljenu, opseg pokreta, opseg koljena preko sredine patele, udaljenost vrška pete i glutealnog nabora). Dokazano je da je nakon l O terapijskih procedura kratkovalnom dijatennijom došlo do značajnog povećanja funkcijskog kapaciteta koljena.The aim of this research was to observe and prove the efficiency of the short-wave therapy ("Oscilotenn 400 E" Elektromedicina Ljubljana) applied to 40 patients with manifested osteoarthrosis of the knee joint. Their average age being 64,43 years. The treatment comprised l O applications of 20 minutes each. The six eli ni cal parameters being observed (morning stiffuess of the knee, the pain in the rest, the effusion of the knee, the motion range, the knee perimeter circumference measured over the patella center, the distance between the heel tip and the gluteal wrinkles) and their showed that functional capacity of the knee joint being significantly increased after l O therapeutic procedures

Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia

Aim To study drug-induced mortality and characteristics of overdose deaths in the war (1991-1995), pre-war (1986- 1990), and post-war period (1996-2000) in Split-Dalmatia County. Methods We retrospectively searched through Databases of the Department of Forensic Medicine, University Hospital Split, the national register of death records, the archives of the Split-Dalmatia County Police, and the Register of Treated Drug Addicts of the Croatian National Institute of Public Health, covering the period from 1986 to 2000, according to drug poisoning codes IX and X of the International Classification of Diseases. The indicators were statistically analyzed. Results There were 146 registered drug-induced deaths, with 136 (93%) deceased being men. The median age of all cases was 27 years (interquartile range 8). Most of them were single (70.6%), unemployed (44.6%), and secondary school graduates (69.2%). In the war period, there were 4.8 times more deaths than in the pre-war period (P = 0.014), and in the post-war period there were 5.2 times more deaths than in the pre-war period (P = 0.008). The most common site of death was the deceased person’s home. The toxicological analyses showed that 59 (61%) deaths were heroin related, alcohol use was found in 62 cases (42.5%), and multi-substance use was found in more than a half of the cases. In 133 (91.1%) cases, deaths were classified as unintentional, whereas 13 (8.9%) were classified as suicides. Conclusion The war, along with other risk factors, contributed to unfavorable developments related to drug abuse in Split-Dalmatia County, including the increase in the drug-induced mortality rate

Uloga gena nm23 u kolorektalnom karcinomu

The aim of this study was to investigate the correlation of immunohistochemical expression of nm23 gene in colorectal cancer cells with tumor stage according to Dukes, tumor differentiation, occurrence of distant metastases and patient survival. This retrospective study included 100 colorectal cancer patients who underwent surgical treatment. Both pathological and clinical data were analyzed according to sex, age, immunohistochemical expression of nm23, tumor stage, tumor differentiation, occurrence of distant metastases and patient survival. Overexpression of nm23 gene was related to both good tumor differentiation and Dukes’ stage A, whereas no significant correlation was found between the occurrence of metastases and nm23 gene expression. There was no significant correlation between nm23 gene expression and 5-year survival of colorectal cancer patients either. Although the results of this study suggested that higher expression of nm23 gene correlated with an early stage of tumor and its good differentiation, this parameter cannot yet be taken as an independent and reliable prognostic indicator in colorectal cancer.Cilj ovoga rada bio je istražiti povezanost između promjene ekspresije gena nm23 u stanicama kolorektalnog karcinoma sa stadijem tumora po Dukesu, diferenciranosti tumora, pojavom udaljenih metastaza i petogodišnjim preživljenjem. U ovom istraživanju obrađeno je 100 bolesnika oboljelih od karcinoma debelog crijeva koji su operirani u Klinici za kirurgiju KBC Split. Patohistološki i klinički podaci analizirani su prema spolu, dobi, imunohistokemijskoj ekspresiji gena nm23, stadiju tumora po Dukesu, stupnju histološke diferenciranosti tumora, pojavi udaljenih metastaza i petogodišnjem preživljenju. Utvrđeno je da dobro diferencirani karcinomi pokazuju statistički značajnu prekomjernu ekspresiju gena nm23. Isto tako, nađena je prekomjerna ekspresija gena nm23 u stadiju tumora Dukes A. Nije nađena povezanost između promjene ekspresije gena nm23 i pojave udaljenih metastaza ni petogodišnjeg preživljenja. Promjena ekspresije gena nm23, prema rezultatima ovoga istraživanja, ne može se rabiti za predviđanje pojave metastaza i procjenu petogodišnjeg preživljenja, ali povezanost prekomjerne ekspresije gena nm23 s ranim kliničkim stadijem (Dukes A) i dobrom diferencijacijom tumora upućuje na mogućnost zaštitnog djelovanja gena nm23 u ranom procesu tumorigeneze

Early and final outcome of patients suffered from muscle weakness aquired in COVID Intensive Care Unit – How precise we can be about eary and final outcome of patients at the time of the end of mechanical ventilation?

Pojam kritične bolesti odnosi se na širok spektar medicinskih stanja opasnih po život koja obično zahtijevaju liječenje u jedinici intenzivnog liječenja (JIL). Prema dostupnoj literaturi, u prosjeku 50–80% bolesnika liječenih u JIL-u zbog kritične bolesti razvije mišićnu slabost stečenu u jedinici intenzivnog liječenja (eng. Intensive care unit – aquired weakness, ICUAW) koja se definira kao difuzna, generalizirana slabost koja se može objasniti isključivo kritičnom bolesti. Neuspjeh odvajanja od respiratora često je povezan s ovim stanjem te dovodi do duljeg liječenja i boravka u bolnici, što stvara dodatnu patnju za bolesnika, opterećuje medicinsko osoblje i stvara troškove za sustav koji bi se mogli izbjeći ili barem umanjiti i zato je ova stanja važno prepoznati, prevenirati i liječiti. Cilj studije / istraživanja: Utvrditi učestalost razvoja ICUAW-a u bolesnika liječenih u COVID JIL-u te promatrati ishode bolesnika u skupini bolesnika koji su imali zadovoljavajuću mišićnu snagu i skupine bolesnika sa ICUAW-om. Rani ishod označava ponovnu potrebu bolesnika za mehaničkom ventilacijom, a konačan ishod bolesnika označava preživljenje ili smrtni ishod. Metode: Istraživanje je provedeno u COVID JIL-u Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje. Uključeni su svi bolesnici koji su liječeni mehaničkom ventilacijom najmanje 48 h te odvojeni od mehaničke ventilacije tijekom veljače 2022. godine, a isključni kriterij za bolesnike je bio od ranije postojanje neurološke i mišićne bolesti. Bolesnici su pregledani nakon isključena analgosedacije i nakon odvajanja bolesnika od mehaničke ventilacije. Dijagnoza je postavljena klinički po testu Vijeća za medicinska istraživanja (eng. Medical Research Council test, MRC). Rezultati: Tijekom veljače 2022. u COVID JIL-u liječeno je 77 bolesnika. Od navedenih 77 bolesnika, 36 je uspješno odvojeno od mehaničke ventilacije na period duži od 24 h, u 12 (33%) bolesnika je klinički postavljena dijagnoza ICUAW-a, jednog bolesnika zbog poremećaja svijesti nije bilo moguće procijeniti. Dokazali smo da između bolesnika koji su zadovoljavajuće mišićne snage postoji značajna razlika u duljini mehaničke ventilacije, potrebi za reintubacijom, traheotomijom, smrtnom ishodu za vrijeme hospitalizacije, vremenu hospitalizacije i duljini liječenja bolesnika u JIL-u. Zaključak: ICUAW je česta komplikacija liječenja bolesnika u JIL-u. Budući da navedeno komplicira tijek i produljuje liječenje bolesnika navedeno bitno je što ranije prepoznati i liječiti. Daljnja istraživanja će biti potrebna kako bi se utvrdila točna etiopatogeneza i na taj način navedeno uspješnije liječilo, a po mogućnosti i preveniralo.Critical illness refers to all medical life-threatening condition that should be treated in Intesive care unit (ICU). According to literature, about 50–80 % patients treated in ICU because of critical illness develop Intensive care unit – aquired weakness, ICUAW. It is defined as diffused, generalised muscle weakness that could only be explained by critical illness. Unsuccessful weaning from ventilator is very often associated with this condition and it causes more complications, prolonges hospitalization and increases health-care related costs. Considering all of this, ICUAW is very important to notice, prevent and treat. Aim of the study: Define the ICUAW incidence of ICU patients and compare the early and final outcome of patients who had sufficient muscle strenght to those who developed ICUAW. Eary outcome refers to need to reintubation of patient and final outcome refers to survival or death outcome. Material and methods: The research was done in COVID ICU Clinic of anesthesia, reanimatology and intensive care during the February 2022. All pateint that were mechanicaly ventilated more than 48 h, and weaned from ventilator successfuly were included. All patient that had a muscle or neurologic disorder were excluded. The patients were examined after abolition of analgosedation and after weaning from ventilator. The diagnosis was made clinically by Medical Research Council test (MRC test). Results: During the February 2022 in COVID ICU, 77 patients were treated. In this group 36 patients were successfully weaned from ventilator in a period longer than 24 hours and 12 patients developed ICUAW, one patient becuase of impared consciousness was not able to be examined. We determined that group that develop ICUAW needed prolonged mechanical ventilantion, there was more need for reintubation and there was a higher probability of mortal outcome. Conclusion: ICUAW is very often complication of patient treated in ICU. Considering the fact that it prolonges mechanical ventilation, hospitalization and increases healtcare cost it is very important to prevent and treat this condition. Further investigation will be needed to define the exact etiopathogenesis in order to prevent ICUAW and treat propertly

Uloga gena nm23 u kolorektalnom karcinomu

The aim of this study was to investigate the correlation of immunohistochemical expression of nm23 gene in colorectal cancer cells with tumor stage according to Dukes, tumor differentiation, occurrence of distant metastases and patient survival. This retrospective study included 100 colorectal cancer patients who underwent surgical treatment. Both pathological and clinical data were analyzed according to sex, age, immunohistochemical expression of nm23, tumor stage, tumor differentiation, occurrence of distant metastases and patient survival. Overexpression of nm23 gene was related to both good tumor differentiation and Dukes’ stage A, whereas no significant correlation was found between the occurrence of metastases and nm23 gene expression. There was no significant correlation between nm23 gene expression and 5-year survival of colorectal cancer patients either. Although the results of this study suggested that higher expression of nm23 gene correlated with an early stage of tumor and its good differentiation, this parameter cannot yet be taken as an independent and reliable prognostic indicator in colorectal cancer.Cilj ovoga rada bio je istražiti povezanost između promjene ekspresije gena nm23 u stanicama kolorektalnog karcinoma sa stadijem tumora po Dukesu, diferenciranosti tumora, pojavom udaljenih metastaza i petogodišnjim preživljenjem. U ovom istraživanju obrađeno je 100 bolesnika oboljelih od karcinoma debelog crijeva koji su operirani u Klinici za kirurgiju KBC Split. Patohistološki i klinički podaci analizirani su prema spolu, dobi, imunohistokemijskoj ekspresiji gena nm23, stadiju tumora po Dukesu, stupnju histološke diferenciranosti tumora, pojavi udaljenih metastaza i petogodišnjem preživljenju. Utvrđeno je da dobro diferencirani karcinomi pokazuju statistički značajnu prekomjernu ekspresiju gena nm23. Isto tako, nađena je prekomjerna ekspresija gena nm23 u stadiju tumora Dukes A. Nije nađena povezanost između promjene ekspresije gena nm23 i pojave udaljenih metastaza ni petogodišnjeg preživljenja. Promjena ekspresije gena nm23, prema rezultatima ovoga istraživanja, ne može se rabiti za predviđanje pojave metastaza i procjenu petogodišnjeg preživljenja, ali povezanost prekomjerne ekspresije gena nm23 s ranim kliničkim stadijem (Dukes A) i dobrom diferencijacijom tumora upućuje na mogućnost zaštitnog djelovanja gena nm23 u ranom procesu tumorigeneze

Značenje kvantitativnog scintigrama kosti u prognostici zaraštanja prijeloma

Studies of fracture healing are aimed at differentiating normal from delayed bone union. Delayed union, nonunion with the development of pseudarthrosis, and infection are complications of fracture healing. In the present study, quantitative analysis by three-phase bone scintigraphy was evaluated in the early prognosis of the course of fracture healing, to assess its potential in the early detection and therapy of healing complications. In 105 patients with long bone fractures, three-phase bone scintigraphy was performed early (day 4-7), and 3 weeks, 3 months and 6 months of injury. Based on clinical, laboratory and radiological findings, patients were retrospectively divided into four groups of normal healing, pseudarthrosis, delayed union, and healing with infection. The region of interest method was used to analyze all three scintigraphy phases, i.e. perfusion, vascular space image, and static scintigram at 3 h of injection. Comparison of impulse count in the fracture area with the contralateral, intact side produced a relative index for each step of three-phase scintigraphy. Infection at the fracture site can be suspected on the basis of perfusion index in the earliest stages following injury. Delayed bone union can also be predicted very early, within three weeks of injury, by use of perfusion index. Quantitative analysis of the vascular space phase and late static scintigrams can contribute to the diagnosis of complications, however, only in later stages of disease, which in part limits their clinical relevance. Three-phase bone scintigraphy is a valuable study when expecting problems in the process of bone union.Ispitivanje zarastanja prijeloma ima za cilj razlikovanje normalnog od usporenog zarastanja kosti. Odloženo zarastanje, nezarastanje s razvojem pseudoartroze te infekcija komplikacije su zarastanja prijeloma. S ciljem što ranijeg otkrivanja, a time i ranije terapije komplikacija, željeli smo ispitati mogućnosti kvantitativne analize troetapne scintigrafije kosti u ranoj prognozi tijeka zarastanja prijeloma. U 105 ispitanika s prijelomima dugih kostiju učinjena je troetapna scintigrafija kosti neposredno nakon traume (4.-7. dan nakon traume), te 3 tjedna, 3 i 6 mjeseci nakon traume. Ispitanici su na osnovi kliničkih, laboratorijskih i radioloških nalaza retrospektivno podijeljeni u četiri skupine: normalno zarastanje, pseudoartroza, odloženo zarastanje i zarastanje uz infekciju. Metodom regije interesa (ROI) analizirali smo sve tri faze scintigrama: perfuziju, snimku vaskularnih prostora, te statički scintigram 3 sata nakon injiciranja. Uspoređujući broj impulsa područja frakture s kontralateralnom, zdravom stranom dobili smo relativne indekse (RI) za svaku fazu troetapne scintigrafije. U najranijim stadijima nakon povrede moguće je, na temelju indeksa perfuzije, posumnjati na infekciju na mjestu frakture. Odloženo zarastanje također se može predskazati indeksom perfuzije vrlo rano, unutar tri tjedna od prijeloma. Kvantitativna analiza faze vaskularih prostora i kasnih statičkih scintigrama može doprinijeti dijagnostici komplikacija, ali u kasnim fazama bolesti, što donekle umanjuje njihovo kliničko značenje. Troetapna scintigrafija kosti vrijedna je pretraga u slučajevima kada se očekuju problemi zarastanja kosti