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

Comparative Outcome Analyses of Differently Surgical Approaches to Lumbar Disc Herniation

Lumbar disc herniations (LDH) occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. It is evident lack of studies dealing with comparative analysis of the surgical outcomes of the spine operation techniques. In this paper we analyzed and compared outcomes of the LDH standard techniques (laminectomy and hemilaminectomy), and contemporary operation techniques (interlaminectomy, and microdiscectomy). Adult patients (18–75 years of age) surgically treated on the Neurosurgery Department of the University Clinical Hospital Mostar – Bosnia and Herzegovina between January 1998 and December 2007 were sampled as subjects. We analyzed and compared, number of the LDH surgically treated patients; age, patient’s satisfaction with postoperative status, postoperative recurrence of the LDH; incidence of the postoperative complications, and duration of hospitalization. In conclusion, modern operating methods have to be considered as superior over traditional operating types mostly because of smaller violations of forms and integrity of lumbar spine

CORRELATION OF ANXIETY AND CHRONIC PAIN TO GRADE OF SYNOVITIS IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background: This study was conducted with the objective of finding out the correlation between synovial inflammation measured histopathologically and subjective symptoms; anxiety and chronic pain, in knee osteoarthritis (OA). Subjects and methods: Thirty patients were included in the study. Ten of them were in a control group with meniscal injury, ten had early OA and 10 had late OA. Knee radiographs were graded using Kellgren-Lawrence classification. Synovial biopsies were taken during surgery or arthroscopy and synovitis score was measured by Krenns method. Anxiety was measured with Beck Anxiety Inventory and pain was taken as part of the WOMAC score (The Western Ontario and McMaster Universities Arthritis Index). Results: Krenn synovitis score was determined as: no synovitis, low-grade synovitis and high-grade synovitis. Group with lowgrade synovitis had significantly higher pain score than high-grade synovitis group (p=0.011). No-synovitis group had significantly lower Beck Anxiety Inventory than low-grade synovitis group (p=0.014) and high-grade synovitis (p=0.008). There are no significant differences between low-grade synovitis and high-grade synovitis in anxiety score (p=0.912). Conclusions: Chronic pain is more present in late osteoarthritis, when synovitis is less pronounced. Anxiety affects patients who suffer osteoarthritis, but it is statistically the same regarding synovitis grade, i.e. whether it is early or late osteoarthritis

Određivanje aktivnosti specifičnih enzima krvi u peripartalnom periodu i tokom pune laktacije

This study examined the activities of aspartate-aminotransferase (AST), gamma-glutamyl-transferase (GGT) and lactate-dehydrogenase (LDH) in the blood serum of 45 dairy Simmental cows divided into three groups according to production period. The first group (n=15) consisted of late pregnant dairy cows, the second group (n=15) cows in the early lactation, and the third group (n=15) cow in mid lactation. The significant higher activity (P (lt) 0.05) of AST, GGT and LDH were determined in the early lactation period than in dry period and during full lactation. Research results showed possibility of mild degree of hepatic lesions, probably due to fat infiltration in early lactation cows. Serum AST enzyme activities were significant correlated (P (lt) 0.05) with GGT and LDH activities and may be most sensitive indicator.U ovom radu je određivana aktivnost aspartat-aminotransferaze (AST), gama-glutamat-transferaze (GGT) i laktat dehidrogenaze (LDH) u krvnom serumu kod 45 simentalskih mlečnih krava, podeljenih u tri grupe u zavisnosti od produktivnog perioda. Prvu grupu (n=15) su činile visoko gravidne krave, drugu grupu (n=15) krave u ranoj laktaciji, a treću grupu (n=15) krave tokom pune laktacije. Statistički značajno veće aktivnosti AST (P (lt) 0.05),GGT (P (lt) 0.05) i LDH (P (lt) 0.05) u krvnom serumu su utvrđene kod krava u ranoj laktaciji u odnosu na aktivnosti ovih enzima u serumu kod zasušenih krava i krava u punoj laktaciji. Dobijeni rezultati ukazuju na mogućnost blagog stepena oštećenja ćelija jetre, odnosno masnu infiltraciju hepatocita kod krava na početku laktacije. Serumske aktivnosti AST su bile u značajnoj korelaciji (P (lt) 0.05) sa aktivnostima GGT i LDH u krvnom serumu pa se AST može smatrati pouzdanim indikatorom u tvrđivanju funkcionalnog stanja jetre kod mlečnih krava tokom peripartalnog perioda i pune laktacije

Advantage and competitiveness of Bosnia and Herzegovina's wine foreign trade

The aim of this article is to observe the trade exchange by calculating Relative Trade Advantage index with the wine products (HS 2204) of Bosnia and Herzegovina and the most common destinations concerning export and import. The data is used from the trade map data and wine institute data. The trade is based on the former Yugoslavia countries (Serbia, Croatia, North Macedonia, Slovenia, and Montenegro). Export market share and Import market share with these countries ranges from 60% to 95% of overall trade. The most important import partner is Serbia with a stake of 28.2%. The largest export partner is Croatia with 52.3% of all BiH's export. The calculated RTA index had values from (-0.674) in 2012 to (-0.567) in 2019. Negative values of RTA index represent relative trade disadvantages in Bosnia and Herzegovina's wine foreign exchange

Influence of a vertical subject on research in biomedicine and activities of The Cochrane Collaboration branch on medical students’ knowledge and attitudes toward evidencebased medicine

Aim To investigate whether the introduction of a vertical subject on research in biomedicine and founding of The Cochrane Collaboration branch at the University of Split School of Medicine influenced students’ knowledge and attitudes toward evidence-based medicine (EBM), including the use of research literature. Methods We used a 26-item questionnaire on EBM knowledge and attitudes to survey 1232 medical students of all study years in 3 medical schools in Croatia (Split, Rijeka, Osijek) and the Croatian-speaking medical school in Mostar (Bosnia and Herzegovina). Results Students from the University of Split School of Medicine who had been exposed to the vertical subject on research in biomedicine and activities of The Cochrane Collaboration at the school had better knowledge and more positive attitudes toward EBM. In general, students rarely searched for evidence; 28% of students searched for evidence more than once a month and 96% of students used only textbooks in Croatian and teachers’ handouts, even though 74% of students agreed that articles from scholarly journals were an important supplement for textbooks. Conclusion Building up an environment that fosters EBM may be beneficial for students’ knowledge and attitudes toward EBM. Teachers should encourage and require using evidence during all the courses in medical schoo

Razvoj banke koštanog tkiva u Sveučilišnoj kliničkoj bolnici Mostar

Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.Banke koštanog tkiva su odgovorne za skupljanje, proizvodnju, ispitivanje, pakiranje, skladištenje i isporuku koštanih transplantata. Banka koštanog tkiva premosnica je od donora k primatelju prilikom koje se donacija pretače u sredstvo za poboljšanje zdravstvenog stanja kako primatelja tako i davatelja. Na Klinici za ortopediju Sveučilišne kliničke bolnice Mostar na godinu se ugradi oko 200 totalnih proteza kuka. Većini bolesnika kojima se ugrađuje totalna proteza kuka (90%) identificirana je dijagnoza osteoartritisa te su pogodni davatelji, s tim da se u obzir uzimaju komorbiditeti i životna dob. Na godinu se na Klinici izvodi oko 50 različitih operacija za koje trebaju koštani presatci. Tim visoko kompetentnih kirurga bavi se intenzivnim procesom adaptacije koji je orijentiran poboljšanju kvalitete i jačanju aktivnosti s ciljem zadovoljenja standarda izvrsnosti u ortopedskoj kirurgiji. Prisutnost ovakve koštane banke učinkovito utječe na kvalitetu skrbi kako zbog brže dostupnosti implantata tako i zbog znanstvene uloge visoko specificirane ustanove koja bazično istražuje svojstva koštanog tkiva

COMPUTER REPRESENTATION OF OSTEOSYNTHESIS STABILITY IN LOCKING PLATES USED FOR THE TREATMENT OF OSTEOPOROTIC PROXIMAL HUMERUS FRACTURES

Background: Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age. Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method. Subjects and methods: This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0°, 10° and 20° in four types of static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf ). Results: When examining the Philos plate in axial load on the bone with fracture gap angle from 0°, 10° and 20° no significant differences between the results for the displacements were observed. Therefore, results for other loads are related to total displacements of the bone only at the angle of 0°. Given that the results of the total bone displacement and maximum bone displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and 79.96% for flexion of maximum displacement in the fracture gap in Artrex plate. Conclusions: Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to be more stable than with Arthrex plate

THE RESULTS OF INTERNAL FIXATION OF PROXIMAL HUMERAL OSTEOPOROTIC FRACTURES WITH PHILOS LOCKING PLATE

Background: In the last fifty years since plate and screw osteosynthesis has been implemented in fracture treatment, osteosporotic bone fractures were observed as a special problem. Due to special histologic, anatomic, physical and biomehanic properties of osteoporotic changed bone the laws of biomechanics suggest that stable osteosynthesis for osteoporotic bone is necessary to increase the contact surface of metallic implants and bone and the stability of the screw-plate-bone compound. There are numerous surgical techniques and methods for treatment of osteoporotic proximal humeral fractures. Every surgical procedure has to establish anatomical reduction and stable fixation that will enable early mobilisation. Subjects and methods: The aim of this study was to present results of internal fixation of proximal humeral osteoporotic fractures with PHILOS locking plate. Between 2007 and 2012, a total of 67 patients older than 65 years with closed proximal humerus fractures underwent surgical treatment with PHILOS plate system (Synthes, Switzerland). 42 patients were operated with deltopectoral approach and 25 with deltoid split approach. After a mean follow up period of 14.68 (6-28) months functional and radiologic results were assessed. Results: We noted 9 postoperative complications related to surgical technique (1 intraarticular screw placement, 1 displacement in major tuberculum fragment, 1 displacement in major tuberculum fragment along with oblique placement of the plate, 2 cases of inadequate reduction, 1 case of humeral head avascular necrosis, varus humeral head fixation in 3 cases). None of the patients developed superficial or deep surgical infection. There was no nonunions. In the final evaluation, the Constant shoulder score was 91.75 (72-100). Conclusions: In this study PHILOS locking plate showed good applicability, respecting bone biologic properties because of negligible interference with blood supply of the humeral head. There was no requirement to shape the plate enabling stabilization at constant angles as clear benefit of this plate. All that enables early mobilisation, and no implant insufficiency resulting in satisfactory treatment results and high Constant shoulder scores