27 research outputs found
Stražnja ubodna ozljeda vrata: prikaz sluÄaja
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.MuÅ”karac u dobi od 45 godina primljen je u Objedinjeni hitni prijam zbog stražnje ubodne rane vrata. OÅ”trica 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. UÄinjena 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 zajedniÄkoj karotidnoj arteriji, vertebralnoj arteriji te korijenu živca C5. UÄinjen je hitan operacijski zahvat. Tijekom ranog poslijeoperacijskog razdoblja uÄinjena je elektroneuromiografija kojom se dokazala akutna lezija korijena C5 desno. Poslijeoperacijskim nalazom magnetske rezonancije verificiran je intaktni brahijalni pleksus na strani ozljede. KliniÄkom slikom u poslijeoperacijskom tijeku dominirala je smanjena miÅ”iÄna snaga i limitirani pokreti desnog gornjeg ekstremiteta. Ubodne ozljede vrata predstavljaju rijetku kliniÄku patologiju s obzirom na sve sluÄajeve traumatskih ozljeda. Pravodobna prijeoperacijska radioloÅ”ka obrada pokazala je blizinu oÅ”trice noža spram desne vertebralne i desne zajedniÄke karotidne arterije. Tijekom poslijeoperacijskog boravka u kliniÄkoj slici zaostala je limitirana abdukcija desnog ramena kao posljedica ozljede korijena živca C5
Giant Cell Arteritis: How to Diagnose? ā 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 BƔrƔny 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 ā secondary metabolites with insecticidal activity
Sekundarni metaboliti biljaka imaju važnu ulogu u reakciji biljaka na abiotiÄki i biotiÄki stres. Neke od bioaktivnih komponenti imaju izražena insekticidna svojstva, pa onda govorimo o insekticidnim biljkama poput dalmatinskog (Tanacetum cinerariifolium /Trevir./ Sch. Bip.) i kavkaÅ”kog buhaÄa (Tanacetum coccineum (Willd.) Grierson) (aktivne komponente - piretrini), duhana (nikotin), neema (azadirahtin) i dr. BotaniÄki insekticidi su uglavnom kraÄe perzistentnosti, pa su na osnovi njihove kemijske strukture razvijeni stabilniji sintetski insekticidi ā piretroidi i neonikotinoidi, S ograniÄavanjem primjene kemijskih insekticida, botaniÄki insekticidi dobivaju sve znaÄajniju ulogu i u konvencionalnoj zaÅ”titi bilja, ne samo ekoloÅ”koj. Posebno su znaÄajni prirodni piretrini. Zbog brze razgradnje imaju kratku karencu Å”to je Äesto nedostatak, ali je i prikladno za zaÅ”titu bilja prije same berbe, Å”to je posebno prikladno kod suzbijanja octene muÅ”ice ploda.Plantsā secondary metabolites have an important role in the plantās 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 ā 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 drosophilaās 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 66.7Ā±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 desetljeÄa provedena su mnoga istraživanja s ciljem potvrde utjecaja virusa na razvoj glioblastoma.
Metode: Provedena je retrospektivna studija u vremenskom razdoblju od pet godina. KoriŔtena su arhivska tkiva
glioblastoma uklopljena u parafin. Imunohistokemija je raÄena za tri virusa: CMV, EBV i HSV-1 pomoÄu automatiziranog
sustava bojenja.
Rezultati: ProsjeÄna dob bolesnika u naÅ”oj skupini bila je 66,7 Ā± 8,5 godina. Zabilježena je blaža predominacija oboljelih
muÅ”karaca. Dobiveni su negativni imunohistokemijski rezultati za CMV i EBV koji su iskljuÄeni iz daljnjeg ispitivanja.
Prema IRS procjeni potvrdili smo Ŕest uzoraka HSV-1 koji su ocijenjeni kao IRS 2. JoŔ pet uzoraka HSV-1 ocijenjeno je kao
IRS 1 i izuzeti su iz studije.
ZakljuÄak: Prema naÅ”oj retrospektivnoj studiji i posljediÄnim rezultatima, nismo pronaÅ”li utjecaj neurotropnih virusa
na stopu preživljenja u oboljelih od glioblastoma, no potrebna su daljnja istraživanja koja ukljuÄuju Å”iri spektar metoda
dokazivanja virusa
Lumbalna spondiloptoza nakon teÅ”ke politraume: prikaz sluÄaja
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 sluÄaj torako-lumbalne spondiloptoze nakon teÅ”ke politraume. Manji udio svih trauma kralježnice odnosi se na spondiloptoze koje su najÄeÅ”Äe popraÄene potpunim neuroloÅ”kim deficitom. MuÅ”karac u dobi od 48 godina na radnom mjestu zadobio je politraumatske ozljede nakon udarca kamiona. RadioloÅ”ka obrada pokazala je viÅ”estruke traumatske ozljede i spondiloptozu segmenta L 1/L 2 u koronarnoj projekciji. UnatoÄ ovoj opsežnoj traumi kralježnice ozljeda je prema ljestvici ASIA procijenjena kao D. Bolesniku je uÄinjen hitni multidisciplinski operacijski zahvat u svrhu zbrinjavanja teÅ”kih ozljeda glave. SljedeÄoj operaciji pristupljeno je radi stabilizacije torako-lumbalnog segmenta i s ciljem oÄuvanja neuroloÅ”kih funkcija. Operacija je uÄinjena uobiÄajenim stražnjim pristupom te implantacijom transpedikularnih vijaka. ZadovoljavajuÄi poslijeoperacijski oporavak postignut je tijekom rane poslijeoperacijske rehabilitacije u Klinici, procijenjen kao ASIA D. Izvrstan poslijeoperacijski oporavak potvrÄen je daljnjom ambulantnom kontrolom bolesnika, uz uÄinjene neuroloÅ”ke
testove. Poslijeoperacijska neurorehabilitacija smatra se nužnom za Å”to bolji oporavak fizioloÅ”kih funkcija u ovakvim životno ugrožavajuÄim nesreÄama
Functional dizziness in the light of the newly-established entity ā Persistent postural-perceptual dizziness
Funkcionalne vrtoglavice istiÄu se svojom uÄestaloÅ”Äu i drugi su najÄeÅ”Äi uzrok vrtoglavica u opÄoj populaciji, dok su u dobnoj skupini od 30 do 50 godina i najÄeÅ”Äi. KlasiÄni dijagnostiÄki proces usmjeren je na pronalaženje medicinske ili kirurÅ”ke dijagnoze, a ako se ona ne pronaÄe, obiÄno kažemo da je uzrok bolesti āpsihogenā. Posljednjih desetljeÄa, napuÅ”tanjem uvriježenoga dihotomnoga dijagnostiÄkog pristupa i primjenom novog, integrativnog naÄina dijagnostiÄkog razmiÅ”ljanja doÅ”lo se do spoznaje o postojanju funkcionalnih vestibularnih poremeÄaja. Oni su uvijek posljedica loÅ”e readaptacije posturalnog sustava na neku vestibularnu, neuroloÅ”ku, strukturnu ili psihijatrijsku bolest. Uzrok tomu leži u uskoj povezanosti živÄanih projekcija u mozgu odgovornih za kontrolu pokreta i položaja tijela u prostoru s onima odgovornima za opasnost i strah. Odbor za klasifikaciju vestibularnih poremeÄaja BĆ”rĆ”nyjeva druÅ”tva nedavno je utemeljio dijagnostiÄke kriterije za perzistentnu posturalno-percepcijsku vrtoglavicu (PPPD). RijeÄ je o najÄeÅ”Äem funkcionalnom vestibularnom poremeÄaju, koji obuhvaÄa prije uspostavljene entitete: fobiÄnu posturalnu vrtoglavicu, vizualnu i kroniÄnu 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, ukljuÄujuÄi i vlastite pokrete, ali i kretanje velikih vizualnih objekata ili kompleksnih vizualnih podražaja u Å”irokome vidnom polju, kao i teÅ”koÄe pri izvoÄenju preciznih vizualnih radnja. Kod blažih i umjerenih smetnja poželjno je provesti vestibularnu rehabilitaciju, jer veÄina pacijenata ima provokativne Äimbenike vezane uz vid i kretanje. Indicirano je i farmakoterapijsko lijeÄenje 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 30ā50 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 āpsychogenicā 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 Baranyās 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 2ā4 (2) or unilateral sacroiliitis, grade 3ā4. 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