Stražnja ubodna ozljeda vrata: prikaz slučaja

A 45-year-old male patient was admitted to the emergency unit due to posterior stab wound of the neck. The knife was directed diagonally from the left to the right side of the neck in the dorsoventral axis. The patient was fully conscious upon admission with pain and paresthesia along the upper right extremity. The patient underwent computed tomography (CT) and CT angiography scan of the neck, which revealed the knife blade piercing the left sided neck muscles and through the intervertebral ligaments of the C IV/C V in direction to the contralateral internal carotid artery, vertebral artery and the C5 nerve root. The patient underwent an urgent surgery according to the radiographs. Electromyography was performed during the early postoperative care and revealed an acute lesion of the right-sided C5 nerve root. Postoperative follow-up magnetic resonance imaging revealed intact brachial plexus bundles at the site of injury. Symptoms of reduced muscle strength and limited range of motion of the upper right extremity prevailed. Penetrating neck injuries represent a rare entity of all trauma injuries. Meticulous preoperative radiographs revealed close proximity of the knife blade tip to the right-sided vertebral artery and common carotid artery. Limited abduction at the right shoulder during postoperative period correlated to the C5 nerve root injury.Muškarac u dobi od 45 godina primljen je u Objedinjeni hitni prijam zbog stražnje ubodne rane vrata. Oštrica noža bila je dijagonalnog usmjerenja od lijeve prema desnoj strani vrata u dorzo-ventralnoj osovini. Pri prijmu je bolesnik bio prisvjestan, žalio se na bol i trnce desnog gornjeg ekstremiteta. Učinjena je kompjutorizirana tomografija (CT) i CT angiografska obrada vrata kojima se verificira položaj noža koji penetrira lijevostranu vratnu muskulaturu i intervertebralne ligamente u segmentu C IV/C V, usmjeren prema kontralateralnoj zajedničkoj karotidnoj arteriji, vertebralnoj arteriji te korijenu živca C5. Učinjen je hitan operacijski zahvat. Tijekom ranog poslijeoperacijskog razdoblja učinjena je elektroneuromiografija kojom se dokazala akutna lezija korijena C5 desno. Poslijeoperacijskim nalazom magnetske rezonancije verificiran je intaktni brahijalni pleksus na strani ozljede. Kliničkom slikom u poslijeoperacijskom tijeku dominirala je smanjena mišićna snaga i limitirani pokreti desnog gornjeg ekstremiteta. Ubodne ozljede vrata predstavljaju rijetku kliničku patologiju s obzirom na sve slučajeve traumatskih ozljeda. Pravodobna prijeoperacijska radiološka obrada pokazala je blizinu oštrice noža spram desne vertebralne i desne zajedničke karotidne arterije. Tijekom poslijeoperacijskog boravka u kliničkoj slici zaostala je limitirana abdukcija desnog ramena kao posljedica ozljede korijena živca C5

Giant Cell Arteritis: How to Diagnose? – A Case Report

We present a case of 77 years old male with suspected giant cell arteritis. With anamnesis, physical examination, immunological tests, Colour Doppler ultrasonography of superficial temporal artery and finally with patohistological analysis of temporal artery biopsy, we came to right diagnosis

ARE THE PERSISTENT POSTURAL-PERCEPTUAL DIZZINESS (PPPD) PATIENTS MORE ANXIOUS THAN THE PATIENTS WITH OTHER DIZZINESS?

Background: The Behavioral Subcommittee of the Bárány Society Committee for Classification of Vestibular Disorders recently established the diagnostic criteria for a persistent postural-perceptive dizziness (PPPD). Objectives: This study aims to determine how significant the degree of anxiety and depression of PPPD patients is, compared to the patients with other dizziness. Subjects and methods: The study was conducted on 78 patients, 39 (50%) of whom suffer from PPPD, and of a control group consisting of the same number of patients with other types of dizziness. All the patients filled out the DHI and HADS questionnaire and were subjected to a VNG and VEMP examination. Results: The DHI showed significant disability in the majority of patients, slightly more in the control group. The HADS showed an equal degree of anxiety in both groups of patients, but significantly higher pathological anxiety in the PPPD group (49%:31%). Conclusions: Majority of the patients in both groups experienced mild anxiety, while those with the pathological degree were more represented in the PPPD group. Depression was more expressed in the group of other dizziness. We can consider only the patients with a pathological degree of anxiety as predisposed to the emergence of PPPD

Pyrethrins – secondary metabolites with insecticidal activity

Sekundarni metaboliti biljaka imaju važnu ulogu u reakciji biljaka na abiotički i biotički stres. Neke od bioaktivnih komponenti imaju izražena insekticidna svojstva, pa onda govorimo o insekticidnim biljkama poput dalmatinskog (Tanacetum cinerariifolium /Trevir./ Sch. Bip.) i kavkaškog buhača (Tanacetum coccineum (Willd.) Grierson) (aktivne komponente - piretrini), duhana (nikotin), neema (azadirahtin) i dr. Botanički insekticidi su uglavnom kraće perzistentnosti, pa su na osnovi njihove kemijske strukture razvijeni stabilniji sintetski insekticidi – piretroidi i neonikotinoidi, S ograničavanjem primjene kemijskih insekticida, botanički insekticidi dobivaju sve značajniju ulogu i u konvencionalnoj zaštiti bilja, ne samo ekološkoj. Posebno su značajni prirodni piretrini. Zbog brze razgradnje imaju kratku karencu što je često nedostatak, ali je i prikladno za zaštitu bilja prije same berbe, što je posebno prikladno kod suzbijanja octene mušice ploda.Plants’ secondary metabolites have an important role in the plant’s response to abiotic and biotic stress. Some of the bioactive components have pronounced insecticidal properties, so they are called insecticidal plants such as Dalmatian (Tanacetum cinerariifolium /Trevir./ Sch. Bip.) and Caucasian pyrethrum (Tanacetum coccineum (Willd.) Grierson) (active components - pyrethrins), tobacco (nicotine), neem (azadirachtin), etc. Botanical insecticides are generally having shorter persistence. Based on their chemical structures, more stable synthetic insecticides have been developed – pyrethroids and neonicotinoids. With the restrictions in use of chemical insecticides, botanical insecticides are gaining an increasingly significant role in conventional plant protection, not only ecological. Natural pyrethrins are especially important. Due to their quick decomposition, they have a short withdrawal period, which is often a shortcoming, but it is also suitable for protecting plants before harvesting, which is especially suitable for spotted wing drosophila’s control

CLINICAL TRIALS IN DEVELOPING COUNTRIES - ETHICAL CONSIDERATIONS

When designing clinical trial or considering decision to take part in particular clinical trial as investigators, even before submission to responsible Central Ethic Committee, we always make certain private assessment about ethical justification of this clinical trial. When making assessment if any clinical trial is ethically justifiable, there should make no difference in which country this clinical trial will be executed. Physicians coming from developing countries must ensure that patient population of developing countries is not misused in any ethically questionable clinical trial. There must be careful assessment of clinical protocols by various independent local advisory committees (e.g. hospital review boards, hospital drug committees, hospital administration and whatever is applicable) to exclude the possibility that only one person or one group of people has concentrated power to make decisions for entire country. Many times physicians/clinical researchers from developing countries are faced with the criticisms that they are not of the same quality as physicians from developed countries and that they can be easily bribed by sponsors, which are based on the prejudice that any clinical trial can be executed in developing countries, no matter of quality or risks for patients. Physicians coming from developing countries must ensure that patient population of developing countries is not misused in any ethically questionable clinical trial

Utjecaj neurotropnih virusa na preživljenje pacijenata operiranih od glioblastoma

Introduction: Glioblastoma represents the most aggressive tumor of the brain with an estimated survival rate of twelve to fifteen months after the primary diagnosis. The role of neurotropic viruses in pathogenesis of the tumor has remained unclear to date. During the last two decades, many studies were conducted with the aim of confirming viral influence in the development of glioblastoma. Methods: We conducted a retrospective study in a time period of five years using formalin-fixed paraffin-embedded tissues of glioblastoma. Immunohistochemistry was performed for three viruses: CMV, EBV and HSV-1, using an automated staining system. Results: Mean age of patients in our group was 66.7±8.5 years. A slight male dominance was noted. Negative immunohistochemistry results were obtained for CMV and EBV, which were excluded from further investigation. Based on IRS score, we confirmed six HSV-1 samples which were rated as IRS score 2. Five more samples of HSV-1 were rated as IRS score 1 and were excluded from the study. Conclusion: According to our retrospective study and its results, we found no impact of neurotropic viruses in the survival rate of glioblastoma. Further studies should be conducted including a wider range of viral detection methods.Uvod: Glioblastom predstavlja najagresivniji tumor mozga s procijenjenom stopom preživljenja od dvanaest do petnaest mjeseci nakon primarne dijagnoze. Uloga neurotropnih virusa u patogenezi tumora do danas je nejasna. Tijekom posljednja dva desetljeća provedena su mnoga istraživanja s ciljem potvrde utjecaja virusa na razvoj glioblastoma. Metode: Provedena je retrospektivna studija u vremenskom razdoblju od pet godina. Korištena su arhivska tkiva glioblastoma uklopljena u parafin. Imunohistokemija je rađena za tri virusa: CMV, EBV i HSV-1 pomoću automatiziranog sustava bojenja. Rezultati: Prosječna dob bolesnika u našoj skupini bila je 66,7 ± 8,5 godina. Zabilježena je blaža predominacija oboljelih muškaraca. Dobiveni su negativni imunohistokemijski rezultati za CMV i EBV koji su isključeni iz daljnjeg ispitivanja. Prema IRS procjeni potvrdili smo šest uzoraka HSV-1 koji su ocijenjeni kao IRS 2. Još pet uzoraka HSV-1 ocijenjeno je kao IRS 1 i izuzeti su iz studije. Zaključak: Prema našoj retrospektivnoj studiji i posljedičnim rezultatima, nismo pronašli utjecaj neurotropnih virusa na stopu preživljenja u oboljelih od glioblastoma, no potrebna su daljnja istraživanja koja uključuju širi spektar metoda dokazivanja virusa

Lumbalna spondiloptoza nakon teške politraume: prikaz slučaja

A rare case of thoracolumbar spondyloptosis after a severe polytraumatic event is presented. Spondyloptosis accounts for a minor proportion of all spine trauma cases and is usually accompanied by complete neurological deficit. A 48-year-old man suffered severe polytrauma after having been hit by a truck at the work place. Radiographic scanning revealed multiple traumatic injuries and spondyloptosis at the L1/L2 level in coronal plane. However, despite extensive injuries, ASIA score was estimated as D. The patient underwent urgent multidisciplinary surgery due to severe head injuries. The next surgery was performed to stabilize the thoracolumbar segment and to preserve neurological functions. The surgery included implantation of transpedicular titanium screws via posterior approach. Good postoperative recovery was achieved during early postoperative rehabilitation at our Department, which was estimated as ASIA score D. In conclusion, prompt operative treatment to achieve neural integrity and early rehabilitation should be considered as the gold standard in such complicated injuries. Postoperative recovery largely depends on the quality of rehabilitation, which leads to improvement of patient self-care and normal social and psychological functions. In our case, the good preoperative neurological status of the patient also contributed to better postoperative outcome.Prikazuje se rijedak slučaj torako-lumbalne spondiloptoze nakon teške politraume. Manji udio svih trauma kralježnice odnosi se na spondiloptoze koje su najčešće popraćene potpunim neurološkim deficitom. Muškarac u dobi od 48 godina na radnom mjestu zadobio je politraumatske ozljede nakon udarca kamiona. Radiološka obrada pokazala je višestruke traumatske ozljede i spondiloptozu segmenta L 1/L 2 u koronarnoj projekciji. Unatoč ovoj opsežnoj traumi kralježnice ozljeda je prema ljestvici ASIA procijenjena kao D. Bolesniku je učinjen hitni multidisciplinski operacijski zahvat u svrhu zbrinjavanja teških ozljeda glave. Sljedećoj operaciji pristupljeno je radi stabilizacije torako-lumbalnog segmenta i s ciljem očuvanja neuroloških funkcija. Operacija je učinjena uobičajenim stražnjim pristupom te implantacijom transpedikularnih vijaka. Zadovoljavajući poslijeoperacijski oporavak postignut je tijekom rane poslijeoperacijske rehabilitacije u Klinici, procijenjen kao ASIA D. Izvrstan poslijeoperacijski oporavak potvrđen je daljnjom ambulantnom kontrolom bolesnika, uz učinjene neurološke testove. Poslijeoperacijska neurorehabilitacija smatra se nužnom za što bolji oporavak fizioloških funkcija u ovakvim životno ugrožavajućim nesrećama

Functional dizziness in the light of the newly-established entity – Persistent postural-perceptual dizziness

Funkcionalne vrtoglavice ističu se svojom učestalošću i drugi su najčešći uzrok vrtoglavica u općoj populaciji, dok su u dobnoj skupini od 30 do 50 godina i najčešći. Klasični dijagnostički proces usmjeren je na pronalaženje medicinske ili kirurške dijagnoze, a ako se ona ne pronađe, obično kažemo da je uzrok bolesti „psihogen“. Posljednjih desetljeća, napuštanjem uvriježenoga dihotomnoga dijagnostičkog pristupa i primjenom novog, integrativnog načina dijagnostičkog razmišljanja došlo se do spoznaje o postojanju funkcionalnih vestibularnih poremećaja. Oni su uvijek posljedica loše readaptacije posturalnog sustava na neku vestibularnu, neurološku, strukturnu ili psihijatrijsku bolest. Uzrok tomu leži u uskoj povezanosti živčanih projekcija u mozgu odgovornih za kontrolu pokreta i položaja tijela u prostoru s onima odgovornima za opasnost i strah. Odbor za klasifikaciju vestibularnih poremećaja Bárányjeva društva nedavno je utemeljio dijagnostičke kriterije za perzistentnu posturalno-percepcijsku vrtoglavicu (PPPD). Riječ je o najčešćem funkcionalnom vestibularnom poremećaju, koji obuhvaća prije uspostavljene entitete: fobičnu posturalnu vrtoglavicu, vizualnu i kroničnu subjektivnu vrtoglavicu. Dominantni simptomi PPPD-a jesu: vrtoglavica koja kontinuirano traje najmanje 3 mjeseca i uvijek je povezana s držanjem tijela, a nije kružnog tipa. Javljaju se preosjetljivost na pokretne podražaje, uključujući i vlastite pokrete, ali i kretanje velikih vizualnih objekata ili kompleksnih vizualnih podražaja u širokome vidnom polju, kao i teškoće pri izvođenju preciznih vizualnih radnja. Kod blažih i umjerenih smetnja poželjno je provesti vestibularnu rehabilitaciju, jer većina pacijenata ima provokativne čimbenike vezane uz vid i kretanje. Indicirano je i farmakoterapijsko liječenje selektivnim inhibitorima ponovne pohrane serotonina i noradrenalina. Dobri rezultati postižu se i primjenom kognitivno-bihevioralne psihoterapije, mijenjanjem negativnih automatskih misli, refokusiranjem pažnje, reatribucijom, sustavnim i postupnim izlaganjem ili, pak, izlaganjem odjedanput i dr. Prognoza bolesti znatno je bolja kod pacijenata bez komorbiditeta u odnosu prema onima s njime.Functional dizziness is noted for its frequency and is the second most common cause of dizziness in the general population, most prevalent in the age group of 30–50 years. The classic diagnostic process is aimed at finding a medical or surgical diagnosis, and in case it is not found, it is said to be caused by a “psychogenic” disease. In recent decades, using a new, integrative way of thinking, there has been a discovery of functional vestibular disorders. They have always been overcome by acute or back vestibular disease due to poor readout of the postural system. The reason for this lies in a close connection to the brain of nerve projections responsible for controlling motion and position of the body in space with those responsible for danger and fear. The Nomenclature and Classification Committee of Barany’s Vestibular Disorders recently established diagnostic criteria for persistent postural-perceptive dizziness (PPPD). This is the most common functional vestibular disorder, which includes the previously established: persistent postural dizziness, visual and chronic subjective dizziness. The dominant symptom of PPPD is non-rotatory dizziness that lasts for at least three months continuously and is always associated with the condition of the body. The hypersensitivity to moving stimuli occurs, including the movements of large visual objects or complex visual stimuli in a wide field of vision and the difficulty of performing precision visual actions. For mild and moderate interferences it is advisable to conduct vestibular rehabilitation, as most patients have provocative factors related to vision and movement. Individually tailored exercises are used to reduce susceptibility to provocative movements, and conditioning exercises are very useful for repairing disturbed body posture. Pharmacotherapeutic treatment with selective serotonin or serotonin and norepinephrine reuptake inhibitors is also indicated. Good results are achieved by the use of cognitive-behavioural psychotherapy, changing of negative automatic thoughts, refocusing attention, re allocation, systematic and gradual exposure or exposure at once, biofeedback etc. The prognosis of the disease is better in patients without comorbidity, while in those with comorbidity it is significantly worse

Helicobacter Pylori Infection and Coronary Artery Disease

The aim of this investigation was to determine the seroprevalence of H. pylori in patients with coronary artery disease (CAD). Patients with coronary artery disease (n=90) and control group (n=90) were enrolled into this randomized, multi-centre study. CAD risk factors analyzed included age, male gender, diabetes mellitus, systemic hypertension, cigarette smoking, hypercholesterolemia and socioeconomic status. The results of this study showed a higher seroprevalence of Helicobacter pylori infection in patients with CAD compared to controls (78,8% versus 58,3%, p<0.05). However, Helicobacter pylori seropositivity was not associated with coronary artery risk factors (smoking, body mass index, diabetes mellitus, hypertension, total cholesterol and socioeconomic status) either in the whole study population or in the patients and control subjects analyzed separately (P>0.05). Further study are needed to clarify the precise role of Helicobacter pylori infection on the development of coronary artery disease

Clinical Characteristics of Patients with Spondyloarthritides and HLA-B27 Positive Antigen

The aim of this study was to present our experiences in diagnosing spondyloarthritides (SpA), and to list the most common clinical features of HLA-B 27 positive patients.The study included 65 HLA-B 27 positive patients with confirmed diagnosis of ankylosing spondylitis(AS) and psoriatic arthritis (PsA) who were analyzed between 2009 and 2010 in Clinic of Internal Medicine in Osijek. The diagnosis of seronegative spondyloarthritides was based on the ASAS (Assessment in AS Working Group) classification criteria for axial and then supplemented with ASAS criteria for peripheral SpA and was confirmed by radiological techniques. For diagnosing the ankylosing spondylitis (AS), there have been applied the modified New York criteria. Radiological criteria for definite sacroiliitis according to the modified New York criteria is bilateral sacroiliitis, grade 2–4 (2) or unilateral sacroiliitis, grade 3–4. For diagnosing the psoriatic arthritis (PsA), there were used CASPAR diagnostic criteria. Other features of SpA are defined within the existing classification criteria. HLA-B27 antigen was determined by direct immune-fluorescence technique using flow cytometer. The average age of patients was 50.34 years, of whom 27 female (41.53%), 38 male (58.46%). Duration of illness was 15.79 years on average.With 75.38% of patients, there had been determined the diagnosis of AS; 24.62% of patients had the diagnosis of PsA. The most common clinical characteristics that patients had were: inflammatory back pain (pain Inflammation along the lumbosacral spine), peripheral arthritis, intermittent pain in the gluteus, sacroiliitis, enthesitis, uveitis, dactilitis