The choice of operative treatment of acromioclavicular dislocation

Akromioklavikularna dislokacija (AC dislokacija) poremećaj je odnosa zglobnih tijela ramenog vrha lopatice (lat. acromion scapule) i ključne kosti – klavikule (lat.clavicula) u akromioklavikularnom zglobu (lat. articulatio acromioclaviculare). AC dislokacija nije česta ozljeda, te primarno pogađa muškarce u mlađoj i srednjoj životnoj dobi, osobito sportaše. Rockwood je AC dislokaciju ovisno o stupnju dislokacije podijelio na šest tipova. Ozljede tipa Rockwood I i II liječe se konzervativno. Ozljeda tipa Rockwood III liječi se operacijski kod mlađih bolesnika, dok se kod starijih liječi konzervativno. Od mogućih operacijskih metoda (Bosworthova metoda, AC TightRope sistem (Arthrex, SAD), kukasta pločica, PDS omča, fiksacija akromioklavikularnog zgloba uvođenjem Kirschnerovih žica kroz akromioklavikularni zglob i metoda obuhvatne sveze) najbolje rezultate daje operacija pomoću AC TightRope sistema. Ozljede tipa Rockwood IV i V liječe se operacijski. Najbolje rezultate daje otvoreni minimalno invazivni pristup pri kojem se zglob stabilizira pomoću dvostrukog AC TightRope sistema uz šivanje deltoido-trapezoidne fascije. Ozljede tipa Rockwood VI liječe se operacijski, a budući da su iznimno rijetke, ne postoji preporuka kojom ih operacijskom metodom treba liječiti. Kronične AC dislokacije liječe se operacijski jednom od ekstraanatomskih operacijskih metoda (Weaver-Dunnova metoda, metoda stabilizacije pomoću tetive semitendinoznog mišića (lat. musculus semitendinosus).Akromioclavicular dislocation (AC dislocation) is a disorder of the relationship between the tip of the shoulder blade (lat. acromion scapule) and collarbone - clavicle (lat. clavicula) in the acromioclavicular joint (lat. Articulatio acromioclaviculare). AC dislocation is not a common injury, and it primarily affects men of young and middle age, especially athletes. Rockwood describes six types of AC dislocation depending on the degree of dislocation. According to Rockwood, type I and II of injury are treated conservatively while type III is treated operatively in younger patients and conservatively in older patients. Out of possible surgical methods ( Bosworth method, AC Tightrope system (Arthrex, SAD), hooked plate, K - wires, PDS loop), the AC Tightrope system provides the best results. Type IV and V are treated operatively. The best method to treat this type of injury is the open minimally invasive approach in which the joint is stabilized by the double AC Tightrope system with sutturing the deltodio - trapezoidal fascia. Type VI is treated operatively but since this injury is extremely rare, there is no recommendation about the operative method the injury should be treated with. Chronic AC dislocation is treated by one of the extraanatomical methods (Weaver - Dunn's method, stabilization using m. semitendinosus tendon)

The choice of operative treatment of acromioclavicular dislocation

Akromioklavikularna dislokacija (AC dislokacija) poremećaj je odnosa zglobnih tijela ramenog vrha lopatice (lat. acromion scapule) i ključne kosti – klavikule (lat.clavicula) u akromioklavikularnom zglobu (lat. articulatio acromioclaviculare). AC dislokacija nije česta ozljeda, te primarno pogađa muškarce u mlađoj i srednjoj životnoj dobi, osobito sportaše. Rockwood je AC dislokaciju ovisno o stupnju dislokacije podijelio na šest tipova. Ozljede tipa Rockwood I i II liječe se konzervativno. Ozljeda tipa Rockwood III liječi se operacijski kod mlađih bolesnika, dok se kod starijih liječi konzervativno. Od mogućih operacijskih metoda (Bosworthova metoda, AC TightRope sistem (Arthrex, SAD), kukasta pločica, PDS omča, fiksacija akromioklavikularnog zgloba uvođenjem Kirschnerovih žica kroz akromioklavikularni zglob i metoda obuhvatne sveze) najbolje rezultate daje operacija pomoću AC TightRope sistema. Ozljede tipa Rockwood IV i V liječe se operacijski. Najbolje rezultate daje otvoreni minimalno invazivni pristup pri kojem se zglob stabilizira pomoću dvostrukog AC TightRope sistema uz šivanje deltoido-trapezoidne fascije. Ozljede tipa Rockwood VI liječe se operacijski, a budući da su iznimno rijetke, ne postoji preporuka kojom ih operacijskom metodom treba liječiti. Kronične AC dislokacije liječe se operacijski jednom od ekstraanatomskih operacijskih metoda (Weaver-Dunnova metoda, metoda stabilizacije pomoću tetive semitendinoznog mišića (lat. musculus semitendinosus).Akromioclavicular dislocation (AC dislocation) is a disorder of the relationship between the tip of the shoulder blade (lat. acromion scapule) and collarbone - clavicle (lat. clavicula) in the acromioclavicular joint (lat. Articulatio acromioclaviculare). AC dislocation is not a common injury, and it primarily affects men of young and middle age, especially athletes. Rockwood describes six types of AC dislocation depending on the degree of dislocation. According to Rockwood, type I and II of injury are treated conservatively while type III is treated operatively in younger patients and conservatively in older patients. Out of possible surgical methods ( Bosworth method, AC Tightrope system (Arthrex, SAD), hooked plate, K - wires, PDS loop), the AC Tightrope system provides the best results. Type IV and V are treated operatively. The best method to treat this type of injury is the open minimally invasive approach in which the joint is stabilized by the double AC Tightrope system with sutturing the deltodio - trapezoidal fascia. Type VI is treated operatively but since this injury is extremely rare, there is no recommendation about the operative method the injury should be treated with. Chronic AC dislocation is treated by one of the extraanatomical methods (Weaver - Dunn's method, stabilization using m. semitendinosus tendon)

Decrease of Environmental Temperature May Trigger the Onset of Acute Aortic Dissection

Aim: The most important risk factors for a Stanford type A acute aortic dissection (AAD) include arterial hypertension and connective tissue disorders, while numerous studies have identified meteorology factors, such as environmental temperature also play an important role. The aim of this study is to explore the relationship between environmental temperature and the frequency of AAD surgically threated over a 12-year period at a Croatian university hospital. Methods: This is a retrospective, monocenter observational study conducted at the University Hospital Centre Zagreb. The study includes 134 patients who were threated surgically for Stanford type A AAD between January 2001 and December 2012. Temperature categories (low, moderate and high) were based on the calculated monthly average environmental temperature and standard deviation given from official daily environmental temperatures for the respective period. Results: The results show a higher frequency of AAD in days of low temperature compared to days of moderate temperature or high temperature. The frequency of days with AAD was somewhat higher in moderate than high temperature category, but the difference is not statistically significant. The relative frequency of AAD for low, moderate and high temperature categories were 4.55, 2.96 and 1.93, respectively. Conclusion: Environmental temperature drop induces stressful adaptive body response, including an additional hemodynamic load and increase in arterial blood pressure, strong enough to trigger the AAD-etiopathogenesis. Furthermore, our findings indicate that body response to environmental heat may differ from a response to reduced environmental temperature, due to observed small number of events in days of high temperature. (Švagelj* I, Vlahović I, Ogresta D, Belina D, Kovač Z. Decrease in Environmental Temperature May Trigger the Onset of Acute Aortic Dissection. SEEMEDJ 2020; 4(1); 40-48

Ballast Waters

U radu su analizirane suvremene metode upravljanja i obrade balastnih voda korištenih u svrhu minimaliziranja njihova štetnog utjecaja na globalni ekosustav. Opisane su najčešće korištene metode obrade balastnih voda s njihovim prednostima i manama. Posebno poglavlje posvećeno je razvoju međunarodnih propisa i opisu Međunarodne konvencije o upravljanju brodskim balastnim vodama i talozima te Propisa Obalne Straže SAD-a. Prikazane su, također, statistike prošlogodišnjeg inspekcijskog nadzora brodova te problemi brodara s implementacijom novih sustava i regulacija.The paper analyzes modern ballast water management and treatment methods used for minimizing their harmful impact on the global ecosystem. It describes the most commonly used methods of ballast water treatment with their advantages and disadvantages. Special chapter is devoted to the development of international regulations and description of the International Convention on the Management of Ballast Water and Waste and the US Coast Guard Regulation. Last year's ship inspection statistics and ship owners’ problems with the implementation of new systems and regulations have also been presented

Ballast Waters

U radu su analizirane suvremene metode upravljanja i obrade balastnih voda korištenih u svrhu minimaliziranja njihova štetnog utjecaja na globalni ekosustav. Opisane su najčešće korištene metode obrade balastnih voda s njihovim prednostima i manama. Posebno poglavlje posvećeno je razvoju međunarodnih propisa i opisu Međunarodne konvencije o upravljanju brodskim balastnim vodama i talozima te Propisa Obalne Straže SAD-a. Prikazane su, također, statistike prošlogodišnjeg inspekcijskog nadzora brodova te problemi brodara s implementacijom novih sustava i regulacija.The paper analyzes modern ballast water management and treatment methods used for minimizing their harmful impact on the global ecosystem. It describes the most commonly used methods of ballast water treatment with their advantages and disadvantages. Special chapter is devoted to the development of international regulations and description of the International Convention on the Management of Ballast Water and Waste and the US Coast Guard Regulation. Last year's ship inspection statistics and ship owners’ problems with the implementation of new systems and regulations have also been presented

Surgical treatment of a femoral neck stress fracture without endocrinal comorbidity in an amateur sportswoman

Stres prijelomi nisu česte ozljede te većinu pacijenata čine vojnici i sportaši koji su podvrgnuti teškim fizičkim naporima. Stres prijelomi vrata bedrene kosti najčešće se događaju u dobi od 18 do 35 godina i takvi pacijenti često boluju od nekog endokrinološkog poremećaja. Inicijalne rentgenske snimke kostiju kuka su uredne. MR dijagnostika kuka imperativ je za dijagnostiku takvog prijeloma. Vrsta tretmana ovisi o tipu prijeloma − kompresivni zahtijeva konzervativno liječenje, a tenzijski operativno liječenje. U našem prikazu slučaja prezentirali smo tridesetpetogodišnju sportašicu amaterku u vožnji na koturaljkama koja je unatrag šest mjeseci patila od neprepoznatih simptoma stres prijeloma vrata bedrene kosti. Klinički pregledi, RTG slike bolnog kuka, endokrinološka i denzitometrijska testiranja nisu pokazivala patološke rezultate. Na kraju je MR dijagnostika bolnog kuka pokazala značajan stres prijelom vrata bedrene kosti koji je bio indikacija za hitan operacijski tretman. Oporavak pacijentice nakon minimalno invazivnog operacijskog tretmana osteosinteze prijeloma kanuliranim vijcima bio je vrlo brz. Liječenje je završilo devet mjeseci nakon operacije, s potpuno urednim kliničkim statusom i punom sportskom aktivnošću. U slučaju nejasnih opetovanih bolova u ingvinalnoj regiji imperativ je, unatoč urednim nalazima RTG slika kuka, endokrinoloških laboratorijskih testova i denzitometrije kostiju, zbog sumnje na stres prijelom vrata bedrene kosti, pravovremeno napraviti MR dijagnostiku bolnog kuka. Takvim pristupom ovom patološkom problemu postiže se najbolji rezultat liječenja i izbjegavaju se dalekosežne posljedice tretmana komplikacija takvog prijeloma zbog previda.Stress fractures are not frequent injuries and mostly soldiers and sports people faced with severe physical exertion suffer from this kind of pathology. Most patients with femoral neck stress fracture are 18−35 years of age and often suffer from a certain endocrinal comorbidity. The clinical status of this pathology is often not followed by positive x-ray signs of fracture. MRI is an imperative in diagnostics of this pathology. These fractures are treated according to type of fracture – compression fracture is treated conservatively and tension fracture operatively. In our report we present a case of a 35-year-old roller skating amateur sportswoman who suffered from unrecognized symptoms of femoral neck stress fracture over six months. There was no sign of pathology according to the repeated clinical exams, x-rays of the painful hip, endocrinal and densitometry tests. Finally, MRI diagnostics detected a remarkable femoral neck tension stress fracture which was an indication for urgent operative treatment. The patient\u27s recovery after the minimally invasive osteosynthesis with cannulated screws was very fast. Her treatment was finished after nine postoperative months with a regular clinical status and full sports activity. In case of undefined recurrent pain in the inguinal region, despite a regular x-ray of the hip, endocrinal lab tests and densitometry results, it is imperative to perform an MRI of the painful hip because of suspicious femoral neck stress fracture. The described approach to this pathologic problem will lead to the best results of therapy and avoid far-reaching consequences of treating complications of such a fracture caused by a mistake

Surgical treatment of a femoral neck stress fracture without endocrinal comorbidity in an amateur sportswoman

Stres prijelomi nisu česte ozljede te većinu pacijenata čine vojnici i sportaši koji su podvrgnuti teškim fizičkim naporima. Stres prijelomi vrata bedrene kosti najčešće se događaju u dobi od 18 do 35 godina i takvi pacijenti često boluju od nekog endokrinološkog poremećaja. Inicijalne rentgenske snimke kostiju kuka su uredne. MR dijagnostika kuka imperativ je za dijagnostiku takvog prijeloma. Vrsta tretmana ovisi o tipu prijeloma − kompresivni zahtijeva konzervativno liječenje, a tenzijski operativno liječenje. U našem prikazu slučaja prezentirali smo tridesetpetogodišnju sportašicu amaterku u vožnji na koturaljkama koja je unatrag šest mjeseci patila od neprepoznatih simptoma stres prijeloma vrata bedrene kosti. Klinički pregledi, RTG slike bolnog kuka, endokrinološka i denzitometrijska testiranja nisu pokazivala patološke rezultate. Na kraju je MR dijagnostika bolnog kuka pokazala značajan stres prijelom vrata bedrene kosti koji je bio indikacija za hitan operacijski tretman. Oporavak pacijentice nakon minimalno invazivnog operacijskog tretmana osteosinteze prijeloma kanuliranim vijcima bio je vrlo brz. Liječenje je završilo devet mjeseci nakon operacije, s potpuno urednim kliničkim statusom i punom sportskom aktivnošću. U slučaju nejasnih opetovanih bolova u ingvinalnoj regiji imperativ je, unatoč urednim nalazima RTG slika kuka, endokrinoloških laboratorijskih testova i denzitometrije kostiju, zbog sumnje na stres prijelom vrata bedrene kosti, pravovremeno napraviti MR dijagnostiku bolnog kuka. Takvim pristupom ovom patološkom problemu postiže se najbolji rezultat liječenja i izbjegavaju se dalekosežne posljedice tretmana komplikacija takvog prijeloma zbog previda.Stress fractures are not frequent injuries and mostly soldiers and sports people faced with severe physical exertion suffer from this kind of pathology. Most patients with femoral neck stress fracture are 18−35 years of age and often suffer from a certain endocrinal comorbidity. The clinical status of this pathology is often not followed by positive x-ray signs of fracture. MRI is an imperative in diagnostics of this pathology. These fractures are treated according to type of fracture – compression fracture is treated conservatively and tension fracture operatively. In our report we present a case of a 35-year-old roller skating amateur sportswoman who suffered from unrecognized symptoms of femoral neck stress fracture over six months. There was no sign of pathology according to the repeated clinical exams, x-rays of the painful hip, endocrinal and densitometry tests. Finally, MRI diagnostics detected a remarkable femoral neck tension stress fracture which was an indication for urgent operative treatment. The patient\u27s recovery after the minimally invasive osteosynthesis with cannulated screws was very fast. Her treatment was finished after nine postoperative months with a regular clinical status and full sports activity. In case of undefined recurrent pain in the inguinal region, despite a regular x-ray of the hip, endocrinal lab tests and densitometry results, it is imperative to perform an MRI of the painful hip because of suspicious femoral neck stress fracture. The described approach to this pathologic problem will lead to the best results of therapy and avoid far-reaching consequences of treating complications of such a fracture caused by a mistake

Research drilling for evaluating the quality of the natural stone deposits

Rezultati istražnog bušenja imaju veliku vrijednost pri ocjeni i vrednovanju ležišta. Pokazalo se da kvalitetna jezgra i ispravna interpretacija rezultata bušenja u mnogome doprinose rezultatima istražnih radova, te razradi i eksploataciji ležišta.The results of research drilling are extremely important while stone deposits are being graded and evaluated. It has been shown that good quality core and proper interpretation of drilling results contribute a lot to the results of research works as well as to working with and making full use of stone deposit. Results of research drilling need much more time and attention considering that they are one of the most expensive types of research. They ease the evaluation of stone deposits according to decorative, tecnological and geological criteria. The elements that can determine the integrity and consistency of the stone mass are especially important. For a detailed assessment of the consistency, it is important to register any kind of defects that might cause breaking of the core, stone block or tablet during sawing, grinding and polishing, or which might cause it after stone elements and tablets had been installed. On the contrary, insufficient, incomplete and incorrect usage of results and information gained by research drilling, most often leads to excessive money spending and proper directing of exploatation gets much harder. Without proper data, over time, the real image of the stone material from the drill site is fading from memory. That often leads towards wrong directing and irrational exploatation. With uneccessary drilling into tectonic zones the production of blocks is slowed down and the expenses of exploatation gets higher

FRACTAL ANALYSIS OF FRACTURE SYSTEMS IN UPPER TRIASSIC DOLOMITES IN ŽUMBERAK MOUNTAIN, CROATIA

U ovome radu prikazani su rezultati fraktalne analize pukotinskih sustava u gornjotrijaskim dolomitima Žumberka. Mehanička svojstva stijena zajedno s dijagenetskim i strukturnim procesima rezultirali su pukotinskim sustavima koji se mogu opisati kao fraktali. Prirodni fraktali neovisni su o mjerilu u određenome intervalu mjerila u kojemu se pojavljuju. Raspodjela pukotina može se tada opisati raspodjelom power-law i fraktalnom dimenzijom. Fraktalna dimenzija mjera je kojom određeni objekt ispunjava prostor. Može se procjenjivati iz fotografi ja izdanaka koje su pretvorene u binarne fotografi je gdje bijela boja predstavlja pukotine/stijenu, a crna stijenu/pukotine. Fraktalna dimenzija pukotinskih sustava tada se može procjenjivati na temelju metode box-counting. U ovome radu prikazani su rezultati fraktalne analize triju izdanaka. Rezultati su vrlo slični dosad objavljenim rezultatima fraktalne analize sličnih dolomita iz Slovenije. Procijenjene fraktalne dimenzije kreću se u intervalu 2,69 – 2,78, a ovise o raspodjeli pukotinskih sustava na izdanku. Niže vrijednosti upućuju na veći utjecaj manjega broja velikih pukotina. Veće vrijednosti fraktalnih dimenzija upućuju na ujednačenu raspodjelu većega broja manjih pukotina. Fraktalna dimnezija vrlo je važan parametar u opisu pukotinskih sustava jer predstavlja mjeru kako su pukotine raspoređene na izdanku. Može se koristiti i pri izradi diskretnih modela pukotinskih sustava (engl. Discrete Fracture Network – DFN) ako se raspodjela pukotina modelira s raspodjelom power-lawThis paper presents results of fractal analysis of fracture systems in upper Triassic dolomites in Žumberak Mountain, Croatia. Mechanical rock characteristics together with structural and diagenetic processes results with fracture systems that can be considered as fractals. They are scale-invariant in specific range of scales. Distribution of fractures can be than described with power law distribution and fractal dimension. Fractal dimension is a measure of how fractures fill the space. Fractal dimension can be estimated form photographs of outcrops by converting photographs to binary photographs. In binary photo there is only black (rock or fractures) and white (fractures or rock). Fractal dimension is then estimated based on box-counting method. In this paper we present results of fractal analysis from three outcrops. Results are very similar to previous published results from outcrops of dolomites in Slovenia. Obtained fractal dimensions are in range 2,69-2,78 and it depends on how fracture systems are distributed in the outcrop. Lower values indicate smaller number of fractures and higher significance of larger fractures. Higher values indicate distribution of more similar sized fractures throughout whole outcrop. Fractal dimension is very significant parameter in rock fracture system characterisation sense it describes how fractures are distributed in the outcrop. It can be used in discrete fracture network modelling if spatial distribution of fractures is represented with power law distribution

Passive smoking and disorders of the respiratory system in children

Iako je brojnim istraživanjima dokazan štetan utjecaj pasivnog pušenja na dišni sustav djece, činjenica je da značajan broj roditelja i dalje izlaže svoju djecu duhanskom dimu. Glavni cilj ovog preglednog članka je upozoriti na štetne posljedice pasivne izloženosti duhanskom dimu na dišni sustav u dječjoj dobi te utvrditi koji bi bili mogući mehanizmi njihovog nastanka. Brojnim epidemiološkim istraživanjima dokazano je da su djeca izložena pasivnom pušenju sklonija infekcijama dišnog sustava, imaju povećanu učestalost poremećaja plućne funkcije i astme, kao i statistički značajno nižu motoričku spremnost i fi zičku kondiciju od djece čiji roditelji nisu pušači. Dokazano je da čak djeca majki koje su pušile tijekom trudnoće kasnije u djetinjstvu imaju povećani rizik za pojavu bolesti dišnog sustava. Podatci o štetnim učincima duhanskog dima trebali bi pomoći u javnozdravstvenim aktivnostima usmjerenim prema smanjenju izloženosti djece pasivnom pušenju i svih negativnih utjecaja izloženosti pasivnog pušenja na zdravlje djece.Although many investigations have noted harmful eff ects of passive smoking on respiratory health of children, a great proportion of parents continue smoking and exposing their children to tobacco smoke. The main objective of this review is to highlight the harmful eff ects of passive exposure to tobacco smoke on the respiratory system in children and to identify the possible mechanisms of development of these disorders. It has been demonstrated that passive exposure to tobacco smoke is a signifi cant risk factor for respiratory tract infections; it was found to reduce the levels of lung function and increase the incidence of childhood asthma. Several studies have reported that children of smoking parents had a lower grade of motor skills and physical condition than children of non-smoking parents. Children born to mothers that smoked during pregnancy have been shown to have an increased risk of respiratory tract illnesses during childhood. Data on the harmful eff ects of tobacco smoke should help in launching public health preventive action towards minimizing exposure of children to passive smoking and all detrimental infl uences of passive smoke exposure on the children’s health