Treatment of proximal humerus fractures

Prijelomi proksimalnog humerusa su izrazito česte ozljede koje uglavnom zahvaćaju starije pacijente. Većina prijeloma proksimalnog humerusa su posljedica traume male sile u prisutstvu osteoporoze. Sa starenjem stanovništva broj ozljeda proksimalnog humerusa raste. Najčešći simptomi su bolnost i gubitak funkcije uz oteklinu ekstremiteta. Uspješno liječenje ovih prijeloma ovisi od detaljnoj anamnezi, temeljitom kliničkom pregledu, detaljnim, pažljivim i točnim RTG i CT snimkama. Cilj liječenja prijeloma proksimalnog humerusa je omogućiti cijeljenje kosti i mekog tkiva u normalnu anatomsku poziciju kako bi se ostvarila normalna funkcija gornjeg ekstermiteta. Izazovi u liječenju prijeloma proksimalnog humerusa su kompleksni i zbog raznolikosti tipova prijeloma koji kompliciraju klasifikaciju. Većina tih ozljeda se može liječiti neoperativno, a dio njih zahtijeva operativno liječenje. Operativno liječenje uključuje otvorenu repoziciju i fiksaciju pločicom, osteosintezu intramedularnim čavlom i primarnom artroplastikom. Nema očite prednosti bilo koje metode s obzirom na tip prijeloma. Liječenje trodijelnih i četverodijelnih prijeloma s pomakom ostaje kontroverzno i ovisi o mnogo faktora. Liječenje prijeloma s pomakom zahtijeva rekonstrukciju, zbog velike vjerojatnosti nastanka limitirane funkcije ramena. Najčešće prijavljene komplikacije nakon prijeloma proksimalnog humerusa su bolnost, avaskularna nekroza, infekcije, disfunkcija aksilarnog živca, revizijska operacija. Opća prognoza prijeloma proksimalnog humerusa ovisi o brojnim čimbenicima, kao što su: tip prijeloma, dob pacijenta, opće zdravstveno stanje pacijenta, volja pacijenta ići na dugotrajnu rehabilitaciju. Rehabilitacija mora biti prilagođena svakom pacijentu, ali blage rane kretnje se preporučaju u svim slučajevima.Proximal humerus fractures are extremely common injuries and primarily affects elderly patients. The majority of proximal humeral fractures result from low-energy trauma in the presence of osteoporosis. With the aging of population the number of injuries of the proximal humerus increases. Pain and loss of function with swelling of the involved extremity are the most common symptoms. Successful treatment of these fractures depends upon patient history, thorough clinical exam careful and accurate X-rays, and CT scans. The treatment objective in proximal humerus fractures is to allow bone and soft tissues healing in a normal anatomical position to achieve normal function of upper extermity. Challenges in the treatement of proximal humerus fractures are complex and the variety of fracture types complicates classification. Many of these injuries can be managed nonoperatively, a certain percentage require operative treatment. Operative treatment options include open reduction and plate fixation, intramedullary nail osteosynthesis, and primary arthroplasty. There is no clear advantage of any one method for a given fracture type. The treatment of displaced three and four-part fractures remains controversial and depends on variety of factors. Displaced fractures require reconstruction, because of high probability of limited function. The most frequently reported complications after proximal humerus fractures are pain, avascular necrosis,infections, axillary nerve dysfunction, revision surgery. The overall prognosis fro proximal humerus fractures depends on numerous factors, including the fracture type, patient age, overall health of patient, willingness of the patient to undergo long rehabilitation. Rehabilitation must be tailored to each patient but gentle early motion is encouraged in all cases

Treatment of proximal humerus fractures

Prijelomi proksimalnog humerusa su izrazito česte ozljede koje uglavnom zahvaćaju starije pacijente. Većina prijeloma proksimalnog humerusa su posljedica traume male sile u prisutstvu osteoporoze. Sa starenjem stanovništva broj ozljeda proksimalnog humerusa raste. Najčešći simptomi su bolnost i gubitak funkcije uz oteklinu ekstremiteta. Uspješno liječenje ovih prijeloma ovisi od detaljnoj anamnezi, temeljitom kliničkom pregledu, detaljnim, pažljivim i točnim RTG i CT snimkama. Cilj liječenja prijeloma proksimalnog humerusa je omogućiti cijeljenje kosti i mekog tkiva u normalnu anatomsku poziciju kako bi se ostvarila normalna funkcija gornjeg ekstermiteta. Izazovi u liječenju prijeloma proksimalnog humerusa su kompleksni i zbog raznolikosti tipova prijeloma koji kompliciraju klasifikaciju. Većina tih ozljeda se može liječiti neoperativno, a dio njih zahtijeva operativno liječenje. Operativno liječenje uključuje otvorenu repoziciju i fiksaciju pločicom, osteosintezu intramedularnim čavlom i primarnom artroplastikom. Nema očite prednosti bilo koje metode s obzirom na tip prijeloma. Liječenje trodijelnih i četverodijelnih prijeloma s pomakom ostaje kontroverzno i ovisi o mnogo faktora. Liječenje prijeloma s pomakom zahtijeva rekonstrukciju, zbog velike vjerojatnosti nastanka limitirane funkcije ramena. Najčešće prijavljene komplikacije nakon prijeloma proksimalnog humerusa su bolnost, avaskularna nekroza, infekcije, disfunkcija aksilarnog živca, revizijska operacija. Opća prognoza prijeloma proksimalnog humerusa ovisi o brojnim čimbenicima, kao što su: tip prijeloma, dob pacijenta, opće zdravstveno stanje pacijenta, volja pacijenta ići na dugotrajnu rehabilitaciju. Rehabilitacija mora biti prilagođena svakom pacijentu, ali blage rane kretnje se preporučaju u svim slučajevima.Proximal humerus fractures are extremely common injuries and primarily affects elderly patients. The majority of proximal humeral fractures result from low-energy trauma in the presence of osteoporosis. With the aging of population the number of injuries of the proximal humerus increases. Pain and loss of function with swelling of the involved extremity are the most common symptoms. Successful treatment of these fractures depends upon patient history, thorough clinical exam careful and accurate X-rays, and CT scans. The treatment objective in proximal humerus fractures is to allow bone and soft tissues healing in a normal anatomical position to achieve normal function of upper extermity. Challenges in the treatement of proximal humerus fractures are complex and the variety of fracture types complicates classification. Many of these injuries can be managed nonoperatively, a certain percentage require operative treatment. Operative treatment options include open reduction and plate fixation, intramedullary nail osteosynthesis, and primary arthroplasty. There is no clear advantage of any one method for a given fracture type. The treatment of displaced three and four-part fractures remains controversial and depends on variety of factors. Displaced fractures require reconstruction, because of high probability of limited function. The most frequently reported complications after proximal humerus fractures are pain, avascular necrosis,infections, axillary nerve dysfunction, revision surgery. The overall prognosis fro proximal humerus fractures depends on numerous factors, including the fracture type, patient age, overall health of patient, willingness of the patient to undergo long rehabilitation. Rehabilitation must be tailored to each patient but gentle early motion is encouraged in all cases

Efficacy of Sling Procedures for Treatment of Female Stress Urinary Incontinence

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagović method as the control group. All patients were prospectively clinically assessed over a period of 3, 6 and 12 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p<0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p<0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19±7 and 9±5 minutes, respectively (p<0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6±1.0, range 2-7) days than in the control group of (9.6±1.8, range 6-18), (p<0.001<0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient\u27s satisfaction

Wilsonova bolest u trudnoći

Wilson’s disease is a rare autosomal recessive disorder of copper metabolism. It causes cirrhosis of the liver, consequently followed by disorder of the menstrual cycle and infertility. Successful decopperizing may lead to restoration of the ovulatory cycle and enable pregnancy. Increased copper levels may cause preeclampsia, intrauterine growth restriction and neurologic damages in the fetus. Pregnant women with decompensated liver cirrhosis face more complications, including bleeding from esophageal varices, liver failure, encephalopathy, and rupture of the splenic artery. We present a case of Wilson’s disease in a patient who had spontaneously conceived three times. The first pregnancy ended with delivery of a healthy baby at term. In second pregnancy, medically induced abortion was performed in the 12th week because of deterioration of the underlying disease, liver cirrhosis with portal hypertension. In the same year, the patient underwent liver transplantation. Two years after the transplantation, the patient spontaneously conceived and delivered vaginally a healthy child.Wilsonova bolest je rijedak autosomno recesivni poremećaj metabolizma bakra. Uzrokuje cirozu jetre te posljedično poremećaj menstruacijskog ciklusa i infertilitet. Uspješna dekuprinizacija može dovesti do ponovne pojave ovulacijskih ciklusa i omogućiti trudnoću. Povećane vrijednosti bakra mogu uzrokovati preeklampsiju, intrauterini zastoj u rastu te neurološka oštećenja ploda. Trudnoća kod trudnica s dekompenziranom cirozom jetre povećava komplikacije kod majke, uključujući krvarenje iz varikoziteta jednjaka, zatajenje jetre, encefalopatije i rupture lijenalne arterije. Prikazuje se bolesnica s Wilsonovom bolešću koja je tri puta spontano zanijela. Prva trudnoća okončana je porodom zdravog djeteta u terminu. Druga trudnoća prekinuta je u 12. tjednu medicinski induciranim pobačajem zbog pogoršanja osnovne bolesti, ciroze jetre s portalnom hipertenzijom. Iste godine u bolesnice je učinjena transplantacija jetre, a dvije godine nakon transplantacije spontano je zanijela i vaginalno rodila zdravo dijete

Metastasis of endometrial cancer in ovary or synchronous primary cancers of endometrium and ovary – case report

Primarni karcinom endometrija najčešća je maligna neoplazma ženskoga spolnog sustava. Prvotni simptomi, kada se i dijagnosticira u početnom stadiju bolesti, jesu nepravilna i/ili produljena krvarenja u premenopauzi ili krvarenja u postmenopauzi. Ostali su simptomi boli u zdjelici ili abdomenu ili abnormalni Papanicolaouov test. Bolesnice su najčešće u postmenopauzalnom razdoblju, ali ni žene generativne dobi nisu isključene. Radovi su pokazali da žene generativne dobi s dijagnosticiranim karcinomom endometrija imaju povišen rizik i od istodobne bolesti karcinoma jajnika i nasljednoga nepolipoznog karcinoma kolona. Upravo je entitet istodobnoga primarnog karcinoma endometrija i jajnika velika dijagnostička zamka jer ne postoje jedinstveni histološki algoritam ni kirurški postupnik, a potrebno ga je odvojiti od primarnog karcinoma jajnika i metastatskog širenja karcinoma endometrija u jajnik radi povoljnije prognoze i mogućnosti poštednijega kirurškog zahvata u mlađih bolesnica te očuvanja fertiliteta. U radu prikazujemo bolesnicu u dobi od 49 godina, s anamnestičkim podacima o obilnijim krvarenjima i postojanju ciste na jajniku, kod koje se nakon intenzivnih i naglih boli te zbog sumnje na rupturu ciste pristupilo hitnom laparoskopskom zahvatu. Zbog intraoperativnoga citološkog nalaza sa sumnjom na maligni proces i pozitivnoga patohistološkog nalaza operacija je konvertirana u laparotomiju. Detaljnom patohistološkom analizom uz imunohistokemijsku dopunu dijagnosticirana je rasadnica (metastaza) endometrioidnog adenokarcinoma endometrija.Primary endometrial cancer is the most common malignant neoplasm of the female reproductive system. It is most commonly detected in the first stage of the disease. The most frequent initial symptoms are irregular or prolonged bleeding in premenopausal or bleeding in postmenopausal women. Other symptoms are pain in the pelvis or abdomen, or abnormal Pap smear. Patients are most often in postmenopausal period of life but women in generative age are not excluded. Different researches have shown that women of generative age with endometrial cancer have an increased risk of the synchronous disease of ovarian cancer and hereditary non-polypoid colon cancer. This is exactly corroborated by the fact that primary cancer in the reproductive system of women may occur at the same time, especially in endometrial cancer and in ovarian cancer. The entity of the synchronous primary cancer of endometrium and ovary is a large diagnostic trap because there is no unique histological algorithm or unique attitude for surgical procedure. However,, it is necessary to separate this entity from primary ovarian cancer and metastatic endometrial cancer in the ovary because of its better prognosis and possibility for less aggressive surgery in younger patients with preservation of fertility. We present a 49-year-old patient with history data on abundant bleeding and the existence of ovarian cyst. After intense and severe pain, and because of the suspicion of the rupture of the cyst, the emergency laparoscopic surgery was done. Intraoperative cytological analysis raised doubt about malignant process. Intraoperative histological finding was positive for endometrioid malignant process. Operation was converted to laparotomy. Detailed histopathological analysis, complemented with immunohistochemical procedure, diagnosed metastasis of endometrioid adenocarcinoma of endometrium

Vulvar Paget’s Disease – A Case Report

Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less than 1% of all vulvar neoplasia and usually appears in postmenopausal women. Histologically it is analogous to Paget’s disease of the breast. The most common clinical symptom is pruritus. The lesion appears as an erythematous or as an eczematous lesion with islands of hyperkeratosis. Occasionally, single anaplastic Paget’s cells can be found on the vulvar smears which make cytological diagnosis of the disease possible. However, the disease can be diagnosed only by biopsy. We present a case of 49-year old woman with vulvar symptoms of pruritus, who had liver and kidney transplantation two years ago. During the standard gynecological examination the vulvar smear was taken for cytological evaluation. The smear was scanty, with inflammatory background, overloaded with squamae. There were two types of cells: dysplastic squamous cells from lower layer of the epithelium and the single, anaplastic cells with a high nuclear:cytoplasmic ratio who possessed eccentric, large nucleus. Nucleoli were rare. Cytoplasm varied from pale and delicate to densely basophilic. Accordingly, cytological diagnosis vulvar intraepithelial neoplasia (VIN III) with differential diagnosis of vulvar Paget’s disease was made. The pathological verification supported the diagnosis of MP and an immunohistochemistry panel confirmed type III of Paget’s disease and an evaluation of bladder was suggested

Treatment of proximal humerus fractures

Prijelomi proksimalnog humerusa su izrazito česte ozljede koje uglavnom zahvaćaju starije pacijente. Većina prijeloma proksimalnog humerusa su posljedica traume male sile u prisutstvu osteoporoze. Sa starenjem stanovništva broj ozljeda proksimalnog humerusa raste. Najčešći simptomi su bolnost i gubitak funkcije uz oteklinu ekstremiteta. Uspješno liječenje ovih prijeloma ovisi od detaljnoj anamnezi, temeljitom kliničkom pregledu, detaljnim, pažljivim i točnim RTG i CT snimkama. Cilj liječenja prijeloma proksimalnog humerusa je omogućiti cijeljenje kosti i mekog tkiva u normalnu anatomsku poziciju kako bi se ostvarila normalna funkcija gornjeg ekstermiteta. Izazovi u liječenju prijeloma proksimalnog humerusa su kompleksni i zbog raznolikosti tipova prijeloma koji kompliciraju klasifikaciju. Većina tih ozljeda se može liječiti neoperativno, a dio njih zahtijeva operativno liječenje. Operativno liječenje uključuje otvorenu repoziciju i fiksaciju pločicom, osteosintezu intramedularnim čavlom i primarnom artroplastikom. Nema očite prednosti bilo koje metode s obzirom na tip prijeloma. Liječenje trodijelnih i četverodijelnih prijeloma s pomakom ostaje kontroverzno i ovisi o mnogo faktora. Liječenje prijeloma s pomakom zahtijeva rekonstrukciju, zbog velike vjerojatnosti nastanka limitirane funkcije ramena. Najčešće prijavljene komplikacije nakon prijeloma proksimalnog humerusa su bolnost, avaskularna nekroza, infekcije, disfunkcija aksilarnog živca, revizijska operacija. Opća prognoza prijeloma proksimalnog humerusa ovisi o brojnim čimbenicima, kao što su: tip prijeloma, dob pacijenta, opće zdravstveno stanje pacijenta, volja pacijenta ići na dugotrajnu rehabilitaciju. Rehabilitacija mora biti prilagođena svakom pacijentu, ali blage rane kretnje se preporučaju u svim slučajevima.Proximal humerus fractures are extremely common injuries and primarily affects elderly patients. The majority of proximal humeral fractures result from low-energy trauma in the presence of osteoporosis. With the aging of population the number of injuries of the proximal humerus increases. Pain and loss of function with swelling of the involved extremity are the most common symptoms. Successful treatment of these fractures depends upon patient history, thorough clinical exam careful and accurate X-rays, and CT scans. The treatment objective in proximal humerus fractures is to allow bone and soft tissues healing in a normal anatomical position to achieve normal function of upper extermity. Challenges in the treatement of proximal humerus fractures are complex and the variety of fracture types complicates classification. Many of these injuries can be managed nonoperatively, a certain percentage require operative treatment. Operative treatment options include open reduction and plate fixation, intramedullary nail osteosynthesis, and primary arthroplasty. There is no clear advantage of any one method for a given fracture type. The treatment of displaced three and four-part fractures remains controversial and depends on variety of factors. Displaced fractures require reconstruction, because of high probability of limited function. The most frequently reported complications after proximal humerus fractures are pain, avascular necrosis,infections, axillary nerve dysfunction, revision surgery. The overall prognosis fro proximal humerus fractures depends on numerous factors, including the fracture type, patient age, overall health of patient, willingness of the patient to undergo long rehabilitation. Rehabilitation must be tailored to each patient but gentle early motion is encouraged in all cases

Efficacy of sling procedures for treatment of female stress urinary incontinence [Učinkovitost sling postupaka u liječenju žena sa statičkom inkontinencijom urina]

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagovid method as the control group. All patients were prospectively clinically assessed over aperiod of 3, 6 and l2 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p < 0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p < 0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19 +/- 7 and 9 +/- 5 minutes, respectively (p < 0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6 +/- 1.0, range 2-7) days than in the control group of (9.6 +/- 1.8, range 6-18), (p < 0.001 < 0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient's satisfaction

In-vitro fertilization resulting in heterotopic pregnancy, ovarian hyperstimulation and paralytic ileus: A case report

Heterotopic pregnancy followed by ovarian hyperstimulation syndrome and paralytic ileus are rare and potentially fatal complications associated with assisted reproduction. A 37-year-old nulliparous woman, after in-vitro fertilization and embryo transfer, presented to the gynaecology department with severe abdominal distension, diffuse abdominal pain and vaginal bleeding. Transvaginal ultrasound examination revealed an intrauterine pregnancy, with both ovaries enlarged, measuring 10cmx10cm, with free fluid in the pouch of Douglas. Another gestational sac was visualized in the left adnexal region with a viable pregnancy, crown–rump length (CRL) 6.6 mm at 6 weeks of gestation. Left salpingectomy via laparotomy and uterine evacuation were performed. The patient's postoperative course was complicated by the development of ovarian hyperstimulation syndrome and paralytic ileus. The patient recovered well after receiving supportive therapy. Clinicians should always be aware of the complications associated with assisted reproductive techniques. Keywords: Heterotopic pregnancy, Ovarian hyperstimulation syndrome, Paralytic ileus, In-vitro fertilizatio