Uloga polimorfizma veznoga mjesta Sp1 gen COL1A1 u ranjivosti ligamenata i tetiva

Recently published papers implicate a genetic predisposition towards tendon and ligament injury. Studies have shown that COL1A1 Sp1 binding site polymorphism was implicated in ACL ruptures, however findings for tendon ruptures are inconclusive. ACL reconstruction is performed using autologous grafting of gracilis and semitendinosus tendons. This study was conducted on patients operated by a single surgeon in University Hospital „Sveti Duh” from June 2007 until June 2012. A retrospective analysis of the operated patients was performed and a group of patients with graft ruptures was identified. We excluded from the sample those patients that suffered a reeinjury in the early postoperative period of up to one year after the surgery. This was done in order to exclude the possible influence of technical errors during surgery and rehabilitation protocol errors on graft injury. The control group of patients consisted of injured patents at least one year after surgery that returned to their preoperative level of activity. The genetic polymorphism of the Sp1 binding site of the COL1A1 gene was assessed in the DNA extracted from peripheral leukocytes of the two groups. After statistically interpreting the results of the DNA analysis our conclusion is that the presence of Thimine (T) on Sp1 binding site of COL1A1 gene increases the risk for tendon injury in patients operated for ACL rupture. Furthermore, the statistical analysis performed also identified younger age as a risk factor for tendon injury

Agresivna granulomatoza nakon ugradnje bescementne totalne endoproteze kuka kao rezultat upalne reakcije na čestice metala: prikaz slučaja

Massive osteolysis and granulomatous pseudotumor tissue reactions are longterm complications of total hip replacement. It is a condition of localized bone resorption in contact with prosthetic material. It is speculated to be a consequence of metal hypersensitivity or inflammatory reaction to excessive wear. Ten years after total cementless hip replacement (metal on polyethylene surface), a 70-year-old patient presented with hip pain and pseudotumor with massive osteolysis of proximal femur on x-ray. Intraoperatively, extensive metallosis with significantly worn metal head (316L stainless steel) and only slightly worn polyethylene insert was found. Upon extraction, parts of the affected tissue and bone that were in direct contact with the prosthesis were sent for histopathologic analysis. Microscopic examination showed necrotic soft and bone tissue, mainly bone marrow with numerous histiocytes and multinucleated giant cells containing lots of pigmented particles (presumed to be metal particles as a result of implant surface wear). In this case, the primary cause of osteolysis and granulomatosis was inflammatory reaction to metal debris. Aggressive granulomatosis has been first described in cemented prostheses and afterwards also in cementless ones. Conditions such as primary or metastatic neoplastic processes and infection should be excluded. The presence of foreign molecular particles due to wear of the prosthesis by different mediators has been presumed to cause an inflammatory reaction that leads to bone resorption and loosening of the prosthesis.Masivna osteoliza i pseudotumorska granulomatozna reakcija su dugoročne komplikacije totalne artroplastike kuka. Radi se o stanju lokalizirane koštane resorpcije na mjestu kontakta s protetskim materijalom. Pretpostavlja se da je to posljedica preosjetljivosti na metal ili upalne reakcije na prekomjerno trošenje materijala. Deset godina nakon totalne artroplastike kuka (metalna glava, polietilenski acetabularni umetak) 70-godišnji bolesnik dolazi s bolovima u kuku te masivnom osteolizom proksimalng femura na radiogramu. Intraoperacijski je nađena opsežna metaloza sa značajno istrošenom metalnom glavom (316L nehrđajući čelik) i samo manjim dijelom istrošenim polietilenskim umetkom. Dijelovi zahvaćenog tkiva i kosti koji su bili u izravnom dodiru s protezom su poslani na patohistološku analizu. Mikroskopski pregled je pokazao nekrotično meko i koštano tkivo, koštanu srž s brojnim histiocitima i multinuklearnim gigantskim stanicama koje sadrže puno pigmentnih čestica (pretpostavlja se da su to čestice metala kao rezultat trošenja površine implantata). Uzrok osteolize s granulomatozom u ovom slučaju je bila upalna reakcija na čestice metala nastale trošenjem glave proteze. Agresivna granulomatoza je prvi puta opisana u cementnim protezama, a potom i kod bescementnih proteza. Primarni ili metastatski neoplastični procesi i infekcije prvotno moraju biti isključeni kao uzrok. Pretpostavlja se da prisutnost molekularnih čestica kao posljedica trošenja endoproteze preko različitih posrednika uzrokuju upalnu reakciju koja dovodi do resorpcije kosti i nestabilnosti proteze

CAPACITY OF ACCREDITED DIAGNOSTIC TESTING VETERINARY LABORATORIES IN BOSNIA AND HERZEGOVINA IN 2017, FROM THE STANDPOINT OF DIAGNOSTIC TESTS IN VETERINARY MEDICINE, IN RELATION TO FIELDS OF ACCREDITATION

Accreditation refers to the formal recognition that a confirmity assessmentbody (laboratory) is competent to conduct confirmity assessment activities accordingto internationally accepted rules. The accreditation of conformity assessment bodiesin Bosnia and Herzegovina (B&H) is implemented by the Institute for Accreditationof B&H (BATA). Accreditation provides confidence in the laboratory test results.Veterinary laboratories for diagnostic testing refer to laboratories for testingmaterials of animal origin.The aim of the study is to determine the capacity of accredited diagnostic veterinarylaboratories for diagnotic testing in B&H in relation to the field of examination orthe scope of accreditation.This enables a clear insight into the capacity of diagnostic veterinary laboratoriesto respond to animal health control requirements in order to protect animal andhuman health.During 2017, six diagnostic veterinary laboratories were accredited in Bosnia andHerzegovina, three in Republika Srpska and three in the Federation of B&H.Of the seven accredited fields of testing in B&H, laboratories in Rebublika Srpskaaccredited all seven fields (100%), while laboratories in the Federation of B&Haccredited six fields (85.70%). The veterinary laboratories for diagnostic testing inB&H accredited a total of 42 different test methods. In the RS 30 test methods wereaccredited (71.40%), while in the Federation of B&H there are 31 accredited testmethods (81.60%).When it comes to various fields of veterinary diagnostic tests, B&H has thecapacity concerning accredited laboratories to respond to the reqirements , capacitiesof particular significance are those for serological (100% accredited laboratories),bacteriological (66.70% of accredited laboratories) and parasitological tests (50% ofaccredited laboratories). In relation to the total number of test methods regardingtype of animals, the most test method are accredited for diagnosis of cattle diseases(in the RS 36.70%, in the FB&H 38.70%, and at the B&H level 33.30%), they arefollowed by the methods for diagnosis of sheep and goat diseases and bird diseases

ROLE AND DEVELOPMENT DIRECTION OF VETERINARY LABORATORIES IN BOSNIA AND HERZEGOVINA RELATED TO THE ACCREDITATION SYSTEM

Veterinary laboratories include laboratories dealing with veterinary diagnostics and foodsafety studies. These are laboratories that carry out diagnostic tests in veterinary medicine, regardingto bacteriological, serological, virological, parasitological, chemical, biochemical, physical,pathological and radiological tests. These laboratories are also engaged in testing food, feed anddrinking water, as well as tests in order to assess the microbiological purity of equipment, devices,appliances, working surfaces, work clothes and workers' hands in production and marketing infacilities and means of transport that come in contact with food, in which there is a risk of theoccurrence and spread of an infectious disease.The aim of the study is to determine the role and directions of the development of veterinarylaboratories in B&H in relation to the accreditation system. In this way, we are getting an insightinto the condition and significance of veterinary laboratories in food and animal health control inorder to protect the health of animals and humans.In Bosnia and Herzegovina, eight veterinary laboratories are accredited, three in Republic of Srpskaand five in Federation of B&H. All eight (100%) accredited test methods in the field of food testing,while six (75%) accredited test methods in the field of veterinary diagnostics.The participation of accredited veterinary laboratories in the total number of accredited laboratoriesfor food in the Republic of Srpska is 37.50%, in the Federation B&H it is 23.80%, while at the levelof B&H it is 27.60%. Accredited veterinary laboratories in B&H have accredited tests in 10 technicalsub-areas of food testing, and in seven sub-areas their participation in the total number of accreditedlaboratories for food in B&H amounts to 50% or more. The participation of accredited veterinarylaboratories in the microbiological examination of feed and surface swabs is 80%. Physico-chemicaltesting of feed, testing of residues and contaminants in food and testing of radionuclide activity infood and feeds in B&H are performed exclusively by accredited veterinary laboratories (100%).Accredited veterinary laboratories in B&H have accredited a total of 41 different test methods inseven technical sub-areas in the field of veterinary diagnostics. 30 different test methods wereaccredited in the RS (73.20%), while 31 test methods (75.60%) were accredited in the Federation ofB&H. In accredited veterinary laboratories in B&H, test methods for the diagnosis of the causitiveagents of 25 different animal diseases were accredited, of which 19 in the Republic of Srpska(63,30%), and 20 in the Federation of B&H (66,70%). The technical sub-area of serological testingwas accredited by all accredited veterinary laboratories, and the participation of serological testingmethods in the total number of accredited test methods in the field of veterinary diagnostics in theRepublic of Srpska is 53.30%, in the Federation of B&H 64.50%, and in B&H 53.70%

CAPACITY OF ACCREDITED TESTING LABORATORIES FOR FOOD IN BOSNIA AND HERZEGOVINA IN 2017 IN RELATION TO THE FIELDS OF ACCREDITATION

Accreditation refers to the formal recognition that a conformityassessment body (laboratory) is competent to conduct conformity assessmentactivities according to internationally accepted rules. The accreditation ofconformity assessment bodies in Bosnia and Herzegovina (B&H) is implemented bythe Institute for Accreditation of B&H (BATA). Accreditation provides confidence inthe laboratory test results and it is carried out according to the standard BAS EN ISO/ IEC 17025: 2006. Test laboratories for food in a wider sense include laboratoriesdealing with food, animal feed, drinking and swabs. The aim of the test is to determinethe capacities of accredited test laboratories for food in B&H in relation to the fieldof examination or the field of accreditation. This enables a clear insight into thereadiness of test food labs to respond to food control requirements in order to protectthe health of animals and humans. During 2017, 29 food laboratories were accreditedin Bosnia and Herzegovina, 8 in Republika Srpska, and 21 in the Federation ofB&H. Out of 13 accredited testing areas in B&H, laboratories in Republika Srpskaaccredited 10 fields (76.90%), while laboratories in the Federation of B&H accredited13 areas (100%). When it comes to different food testing fields, B&H has capacities inthe form of accredited laboratories to respond to these requirements, and especiallyimportant capacities are those for physicochemical food and water testing andmicrobiological food testing (over 55% of accredited laboratories). They are followedby microbiological testings of animal feed and water and toxicological testing ofresidues and contaminants in food (over 30% of accredited laboratories)

Je li kronični sindrom bolne prepone bermudski trokut sportske medicine?

Chronic groin pain is one the most complex conditions encountered in the field of sports medicine. Conservative treatment is long lasting and the result of treatment is often uncertain and symptom recurrences are common, which can be very frustrating for both the patient and the physician. The complex etiology and uncertainties during treatment of chronic groin pain is the reason why some authors call it the Bermuda Triangle of sports medicine. In our prospective, 7-year study, 114 athletes with chronic groin pain resistant to conservative therapy were treated surgically. In 109 athletes with sports hernia, we performed nerve neurolysis along with resection of the genital branch of the genitofemoral nerve and we also reinforced the posterior wall of inguinal canal using a modified Shouldice technique. In 26 athletes that had concomitant adductor tendinosis and in 5 athletes with isolated tendinosis we performed tenotomy. Eighty-one of 83 patients with isolated sports hernia returned to sports within a mean of 4.4 (range, 3-16) weeks. Thirty-one athletes with adductor tenotomy returned to sports activity within a mean of 11.8 (range, 10-15) weeks. If carefully diagnosed using detailed history taking, physical examination and correct imaging techniques, chronic groin pain can be treated very successfully and quickly, so it need not be a Bermuda Triangle of sports medicine.Kronični sindrom bolne prepone je jedno od najsloženijih stanja u sportskoj medicini. Konzervativno liječenje je dugotrajno, ishod liječenja neizvjestan uz brojne recidive, a sve to djeluje frustrirajuće na sportaša i na liječnika koji ga liječi. Zbog brojnih nejasnoća oko etiologije i liječenja kronični sindrom bolne prepone neki nazivaju i bermudskim trokutom sportske medicine. U prospektivoj studiji kroz 7 godina 114 sportaša s kroničnim sindromom bolne prepone otpornim na konzervativnu terapiju liječeno je operativno. Kod 109 sportaša sa sportskom hernijom učinjena je neuroliza ilioingvinalnog živca, resekcija genitalne grane genitofemoralnog živca i pojačanje stražnje stijenke ingvinalnog kanala duplikaturom transverzalne fascije modificiranom tehnikom po Shouldiceu. Kod 26 sportaša koji su uz sportsku herniju imali i tendinozu aduktora te kod 5 sportaša s izoliranom tendinozom aduktora učinjena je tenotomija aduktora. Od 83 sportaša s izoliranom sportskom hernijom 81 se vratio sportu nakon 4,4 tjedna (raspon 3-16 tjedana). Sportaši s tenotomijom aduktora (n=31) vratili su se sportskim aktivnostima nakon 11,8 (raspon 10-15) tjedana. Ako se pažljivo razmotre smetnje sportaša, učini detaljan pregled i utvrdi pravi uzrok bolova, liječenje može biti kratkotrajno i uspješno, a sindrom bolne prepone ne mora predstavljati bermudski trokut sportske medicine

Bleeding Meckel\u27s diverticulum: case report

Meckelov divertikul ispoljava svoje simptome u oko 4 - 30% bolesnika u dobi ispod 2 godine, a u starijih od 8 godina u oko 10% slučajeva. Dijagnostička scintigrafija tehnecij 99m pertehnetatom je zlatni standard dijagnostike. Osjetljivost pretrage je svega 62% u odrasloj populaciji. Iako je prva scintigrafija i u ovdje prikazanom slučaju negativna, ima načina kako se lažno negativni rezultati mogu smanjiti na najmanju moguću mjeru, odnosno kako se može povećati osjetljivost pretrage, a samim time i izbjeći ponavljana testiranja.Symptomatic presentation of Meckel\u27s diverticulum occurs in 4-30% of patients under 2 years of age and in 10% of cases where the patients are older than 8. Diagnostic Technetium-99m-Pertechnetate scintigraphy is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in adult population. Although the Technetium Pertechnetate scan is falsely negative in this case report (and in a number of other cases) there are ways to increase its sensitivity and possibly avoid repeated testing

Obrnuta proteza ramena: primjena i iskustvo u Hrvatskoj

Reverse shoulder prosthesis has become one of the most often used prosthetic implants in shoulder replacement surgery. It has a wide spectrum of indications, starting from comminuted humeral fractures and posttraumatic arthritis to arthritis caused by the rotator cuff loss. Its application at our hospital began in 2004, at first in few specific cases and with time in ever growing number of patients. Over 8 years, more than 250 reverse shoulder prostheses were implanted at our institution. In addition, our surgeons supervised its application in other hospitals all over Croatia. In the postoperative course, the shoulder was immobilized for 4-6 weeks with a thoracobrachial cast. After removal of the cast, physical therapy was initiated. The length of physical therapy program depended upon many factors. As a rule, immobilization lasted longer in patients that were operated on due to posttraumatic arthritis and those that suffered from deltoid muscle atrophy and shoulder contracture before surgery. Complications included dislocation of the prosthesis shortly after surgery (in the first four weeks) and infection. Infection was a special problem and treatment included even explantation of the prosthesis.Inverzna ili obrnuta proteza ramena je implantat koji se posljednjih godina sve češće ugrađuje na mjesto ramenog zgloba. Ima širok spektar indikacija, od višeivernih prijeloma humerusa, posttraumatskih artroza pa do artroza uzrokovanih gubitkom rotatorne manžete. U našoj Klinici ugrađuje se od 2004. godine, isprva sporadično, a potom sve više. Tijekom idućih 8 godina ugrađeno je preko 250 ovih proteza. U to nisu uključene proteze koje su ugrađene u drugim bolničkim ustanovama, ali pod vodstvom stručnjaka iz naše ustanove. U poslijeoperacijskom tijeku, prvih 4-6 tjedana, bolesnik je bio imobiliziran, najčešće torakobrahijalnim gipsom. Nakon skidanja imoblizacije uslijedila bi fizikalna terapija. Dužina fizikalna terapije ovisila je o mnogo čimbenika. U pravilu je duže trajala kod bolesnika koji su operirani zbog posttraumatske artroze i prijeoperacijski su imali atrofiju deltoidnog mišića i kontrakturu ramena. Od komplikacija treba spomenuti luksacije proteze u kratkom poslijeoperacijskom tijeku (prva 4 tjedna) i infekcije. Infekcija je osobit problem, a njezino liječenje uključuje i vađenje proteze

Past studies and potential measures for rehabilitation of the shallow lake (Lake Ludas)

Lake Ludaš has been under a strong anthropogenic influence for a very long time, so the history of fruitful scientific investigation was very often connected with the evaluation of a human impact and potential rehabilitation measures. Unfortunately, attempts to improve the lake's natural status remain more in the field of theoretical models than concrete practical solutions. Aiming to better understand the potential of different rehabilitation measures for Lake Ludaš, we combined our ecological analyses (unpublished results) and the literature survey. The continuous massive cyanobacterial bloom and the formation of a thick sediment layer rich in different organic and inorganic pollutants represent two major challenges in the lake's rehabilitation. The unknown ecological role of invasive species that have already colonised Lake Ludaš will make the attempts to improve conditions in the lake even more challenging. The reduction of nutrient load, changes in the intensity and directions of water circulation, as well as top sediment layer removal in the lake, are measures under consideration for several decades. But their combination, order of implementation and possibilities of successful execution are still under debate. However, there is no doubt that the restoration of a natural hydrological regime should be a key step in the rehabilitation of Lake Ludaš

Complications of the urgent abdominal laparoscopic procedures and potential conversion to the conventional surgical procedure

Laparoskopski operacijski zahvati sve se češće izvode u hitnoj kirurškoj službi što ovisi o opremljenosti ustanove i educiranosti kirurškog tima. Materijal i metode: U Odjelu abdominalne kirurgije II KB "Dubrava", Zagreb u 2003. godini operirana su 902 bolesnika, od toga je bilo 276 (30 %) laparoskopskih kirurških zahvata. Među laparoskopskim zahvatima bila su 63 hitna laparoskopska zahvata ili 22% ukupnog broja laparoskopskih zahvata. Od hitnih laparoskopskih zahvata učinjeno je sljedeće: 36 laparoskopskih kolecistektomija zbog akutnog kolecistitisa, 12 laparoskopskih apendektomija zbog akutne upale crvuljka, dvije cistektomije s hemostazom i elektrokoagulacijom rupturiranih cista jajnika, pet sutura s omentoplastikom kod perforiranog duodenalnog ulkusa, tri eksploracije trbuha kod politrauma, jedna prezervacija slezene, jedna drenaža akutnog hidrocefalusa i tri lavaže i drenaže kod adneksitisa i pelveoperitonitisa. Rezultati: Kod četiri bolesnika učinjena je konverzija (6 %). Tri bolesnika su imali komplikacije (4,7%). Bila je jedna upala supraumbilikalne incizije prilikom laparoskopske kolecistektomije zbog gangrenoznog kolecistitisa. Kod jedne apendektomirane bolesnice zbog flegmonozne upale crvuljka bilo je krvarenje iz trbušne stijenke nakon odstranjenja troakara desno iznad razine pupka, a kod jednog bolesnika operiranog zbog gangrenoznog perforiranog crvuljka paralitički ileus s peritonealnim podražajem. Zaključak: Laparoskopski kirurški zahvati sve češće zamjenjuju otvorene kirurške zahvate u hitnoj kirurškoj službi. Za prevenciju infekcije rane preporuča se uvijek koristiti najlonsku vrećicu kod vađenja upaljenog žučnjaka ili crvuljka. Za prevenciju krvarenja iz stijenke preporuča se osvijetliti trbušnu stijenku laparoskopom u mračnoj operacijskoj dvorani prilikom postavljanja abdominalnih troakara.The popularity of laparoscopic procedures is increasing in the emergency surgical care, depending on equipment and surgical training. Materials and methods: In our Department, in the year 2003, the authors performed 902 surgical procedures. The procedures were completed by laparoscopy in 276 (30%) patients. 63 (22%) of the laparoscopic procedures were urgent procedures. 36 patients underwent laparoscopic cholecystectomy as treatment of the acute cholecystitis, 12 underwent laparoscopic appendectomy because of acute appendicitis, 2 patients underwent laparoscopic cystectomy of the ovarian cysts with haemostasis and electrocoagulation, 5 patients had perforated duodenal ulcer and we made sutures with omentoplasty, 3 patients underwent laparoscopic exploration because of abdominal trauma, 1 patient underwent laparoscopic haemostasis of bleeding spleen, 1 patient underwent laparoscopic setting of Pudenz drain because of hydrocephalus and 3 patients underwent aparoscopic drainage and lavage because of adnexitis and pelveoperitonitis. Results: 4 (6%) laparoscopic procedures had to be converted to conventional surgical procedures. 3 (4,7%) patients had surgical complications. One patient who underwent laparoscopic cholecystectomy had inflammation of supraumbilical incision because of gangrenous cholecystitis. One patient had abdominal wall bleeding after removing supraumbilical port, and one patient had paralytic ileus after laparoscopic appendectomy. Conclusion: The popularity of laparoscopic procedures is increasing due to the apparent advantages of the procedure even in the emergency care. As a prevention of wound infection it is always recommended to use a plastic bag when removing an inflamed billiar cyst or an appendix. As a prevention of abdominal wall bleeding it is always recommended to make a laparoscopic diascopy of abdominal wall when setting laparoscopic ports