Bone Fractures in a 53-Year-Old Patient with Parathyroid Adenoma – A Case Report

The study reports a case of primary hyperparathyroidism in a middle-aged patient who was first admitted for persistent ankle pain and local swelling. The subsequent clinical procedures suggested cystic changes in several leg bones, which were later shown to be caused by the parathyroid adenoma. Clinical presentation of the primary hyperparathyroidism can be highly misleading, sometimes causing various clinical procedures before it is certainly diagnosed

Cerebrovascular Insult Hospital Cases in the Clinical Hospital Mostar (Bosnia and Herzegovina) From 1999 to 2003 – An Example of an Institutional Register

The analysis of a cerebro-vascular insult hospitalized cases in the Clinical Hospital Mostar as a retrospective epidemiological study was done in the Clinical Hospital Mostar for the period from 1999 to 2003. The major source of data was medical documentation of this hospital (an institutional register), the only hospital for the treatments of 457,491 inhabitants who gravitate by a health insurance for the treatment in this hospital. The study included a total of 1,555 cerebro-vascular insult cases treated in the Clinical Hospital Mostar. Among them 727 (46.8%) were male patients, while 828 (53.2%) cases were female. The majority of the cases were above 50 years of life. Majority of treated female patients were older than 61 (45.6% of all cases), as well as among male patients (31.3%). The least number of cases was under 41 years in both groups (1.2%). Prevalence of risk factors was 2,035 cases (74%). During the same period risk factors research for entire Federation of Bosnia and Herzegovina (FBiH) was performed on the sample of 2,750 national insurance holders, out of which 852 gravitate for treatment in CB Mostar. Out of them 1.7% was found to suffer of cerebro vascular insult

Serum and Tissue Angiotensin Converting Enzyme in Patients with Psoriasis

Recent evidence suggests that the angiotensin converting enzyme (ACE) is present in skin. The real value of the determination of ACE activity as a clinical-biochemistry test for the diagnosis of psoriasis has not been attained. Serum and tissue ACE were measured in 60 patients with psoriasis, 20 patients with lichen planus, 20 patients with seborrhoic dermatitis and in 20 healthy individuals. The serum and tissue ACE activity was determined before and after therapy, using the spectrophotometric method and hippuryl-l-histidyl-l-leucine as a substrate. The results showed that serum ACE activity before therapy was significantly increased in both groups – patients with psoriasis (p<0.001) and patients with lichen planus (p<0,001) in comparison to healthy individuals. However, there were no significant differences in serum ACE activity among patients with seborrhoic dermatitis and healthy individuals. After therapy, serum ACE activity significantly decreased in both groups of patients with psoriasis and patients with lichen planus comparing it to the level found in the control group. The values in both were similar. The tissue ACE activity in altered skin was significantly increased only in the patients with psoriasis in comparison to uninvolved skin of these patients, as well as the skin of healthy individuals. After therapy, there were no significant differences in tissue ACE activity between the treated skin and the healthy skin. In conclusion, determination of tissue angiotensin converting enzyme activity can be used in the differential diagnostic of indistinct clinical forms of psoriasis

Lung Function Changes in Pleural Asbestosis

The aim of this study was to examine the relationship between radiographically detectable pleural changes and lung function in pleural asbestosis. One hundred and twenty chrysotile asbestos-exposed workers were enrolled in this retrospective study. For each examinee the length of asbestos exposure and the degree of dust cover at the workplace were assessed as well as the radiological and functional tests has been performed. The examinees were divided into two groups based on radiologically detectable changes: a) group with pleural changes (29%) and b) group without perceived pleural changes (71%). The obtained results indicate association between the length of asbestos exposure, pleural changes and the impairment of lung function

Results of Treatment of Displaced Supracondylar Humeral Fractures in Children by K-wiring

The supracondylar fracture of the humerus in children remains the most challenging injury for the orthopedic surgeon. It is important to consider the options of treatment very carefully and tailor the treatment according to the characteristics of each fracture. In this study we observed outcomes of surgical procedures using the Kirschner-wire for the dislocated (displaced) supracondylar fractures in 135 children (mean age 6.7 years). In 96 patients closed reposition (reduction) and fixation with crossed K-wire was done. A total of 41 children were operated by the means of open reposition and crossed K-wire fixation. Another 41 underwent similar (1-mm) K-wire application. In classifying the fractures Gartland classification of the supracondilar fractures of the humerus was used. Postoperatively, cubitus varus was found in seven, and cubitus valgus in three children (5% and 2% respectively). Stiffness of the elbow was recorded in 18 patients, while the paresis of the ulnar nerve was recorded in three cases (13 and 2% respectively). In conclusion, we can suggest crossed fixation while applying the K-wire throughout two cortexes, since such technique ensures the most superior fixation and stable osteosynthesis

Bilateral Congenital Dislocation of the Knee with Ipsilateral Developmental Dysplasia of the Hip – Report of Three Patients

Congenital dislocation of the knee (CDK) is a very rare condition. Here we report our strategy and results in treatment of three children with CDK. All three patients were treated with conservative method, and only one had underwent a surgical procedure on one knee. Of the remaining, we recorded a good outcome with conservative treatment in three knees, while two had poorer outcome as a result of musculoskeletal anomalies. We also present here a unique case of a child born without cruciate ligaments and patellas on both sides. We performed the operative procedure by Z-plasty of the extensor apparatus on one left knee according to Niebauer and King on one child. The clinical result of this procedure was very good. Five years after the operation we decided to perform an MRI examination to assess the postoperative status of the operated knee, especially the position and the shape of left patella. We found the asymmetry and high position of the operated patella resulting in patella alta. Compared to the initial clinical presentation, we consider all patients to have good clinical presentation nowdays

Age-Related and Gender-Related Differences between Human Vertebral and Iliac Crest Bone – A Histomorphometric Study on the Population of the Mediterranean Coast of Croatia

In this study, osseous tissue was examined in normal adult population that has inhabited areas by the Croatian Adriatic Sea. The most of such studies have shown that women are prone to lose bone connectedness, while men are predisposed to be a stronger constitution and they start with greater bone mass, though. Bone samples from two different anatomic sites were analyzed. The crista iliaca and the lumbar vertebra represent functionally different organs too. We wanted to consider weather the same age- and gender-related changes affect these two organs due to normal aging. Static histomorphometry was used to quantify involution changes in the trabecular bone. Results showed that involution process more severely affects women than men. Age-related structural changes were more prominent in lumbar vertebra than in iliac crest bone. Severe structural changes in lumbar vertebra could subsequently lead to a dysfunctional and deformed vertebral column. Therefore, iliac crest bone biopsies could hardly explain involution process that affects lumbar spine

Prevalence of Scoliosis in School-Children from Mostar, Bosnia and Herzegovina

In the school-year 2002/2003 a prospective epidemiological study was performed with the aim of evaluating the prevalence and distribution of scoliosis in the population of schoolchildren from Mostar, Bosnia and Herzegovina. The general check-up of primary-school children covered a total of 2,517 children aged 7–14.The children in which at least one positive symptom of scoliosis was found were directed to undergo orthopedic examination and – if indicated – radiography. Incorrect posture was noted in 33.4% of children, and 11.8% of children were sent to orthopedic specialist examination. The prevalence of structural scoliosis amounted to 3.1%, with the spine curvature threshold being 10 degrees. In eight children (0.32%; 1 boy and 7 girls) a curvature of 20 degrees or more was diagnosed. The most common type of curvature was the thoracal (39%) and the thoraco-lumbar (39%) while 14 children had a double curvature (17.8%). A scoliosis was detected due to here performed check-up in 83.5% of children with scoliosis. No case of serious spine deformity (45 degree or more) was recorded, due to regular general check-ups taking place biannually in this population

Treatment of Peritrochanteric Fractures by the Use of Gamma Nail

The Gamma nail was designed to treat unstable intertrochanteric and subtrochanteric fractures. In this study we analysed a total of 60 patients (44 men and 16 women), who were surgically treated for the peritrochanteric fracture in period 2006–2007 at the University Hospital Mostar. After the surgical treatment good bone healing was achieved in 50 patients (83.3%). A total of five patients had delayed healing or protrusion of the cervical screw, and in two patients nails were not appropriately distally locked. During the follow-up period a total of 7 patients died. The average operation time was 40 minutes, and the average blood loss was 400 mL, which is a comparable result with the previously published studies. In conclusion, although most of the peritrochanteric fractures treated at the University Hospital Mostar were fixated by gamma nail, the final decision regarding the operational technique should be left to surgeon’s judgment, since the efficacy of the treatment plan is highly dependent on experience of the operational team and surgeon’s operational technique

PREVALENCE OF INTELLECTUAL DISABILITIES AND EPILEPSY IN DIFFERENT FORMS OF SPASTIC CEREBRAL PALSY IN ADULTS

Background: Spastic cerebral palsy may be interconnected with other neurodevelopmental disorders such as intellectual disabilities, and epilepsy. Brain synaptic plasticity and successful restorative rehabilitation may also contribute to diminish neurological deficit of patients having cerebral palsy. The aim of this study was to investigate the prevalence of intellectual disabilities and epilepsy in adult patients with different forms of spastic cerebral palsy and to find out correlation between the severity level of intellectual disabilities and epilepsy. Subjects and methods: Adults diagnosed with different forms of spastic cerebral palsy were analyzed during a three-month period. The investigated features were: gender and age; form of cerebral palsy; the prevalence of intellectual disabilities and epilepsy. Intellectual disabilities were divided into 4 severity levels. The correlation between the severity level of intellectual disabilities and epilepsy was statistically analyzed. Results: Intellectual disability was present in 55% of patients diagnosed with spastic cerebral palsy. Epilepsy was present in 36% of such patients. It was recorded in 51.1% of quadriplegic, 21.9% of diplegic, and 19.2% of hemiplegic patients. Intellectual disability was present in 73.8% of quadriplegic, 31.3% of diplegic, and 53.8% of hemiplegic patients. The statistically significant correlation existed between the severe intellectual disability and epilepsy. Conclusions: Intellectual disabilities and epilepsy most frequently occurred in patients with most severe forms of spastic cerebral palsy. Epilepsy is strongly correlated to the severity level of intellectual disability. Such patients require additional special modes of treatment and restorative rehabilitation to improve the functional outcome