Objectives: The aim of this study was to analyze the epidemiology, treatment and incidence of com... more Objectives: The aim of this study was to analyze the epidemiology, treatment and incidence of complications among the patients with upper extremity war injury. Methods: In retrospective study, 123 patients with war injuries of the upper extremity have been analyzed. The results of treatment were assessed according to the rate of: complications, amputations, fracture healing and mortality. Results: Complications appeared in 17.9% of cases. Traumatic amputations were present in 19.4% of cases and in 2.4% of cases amputation was performed due to III C open fracture. Satisfactory bone healing was achieved in 49 of 55 patients available to follow up. Mortality rate was 2.4%. Conclusion: Self-inflicted injuries resulted in 41.6% amputation rate. High-energy war injuries of the upper extremity could be treated between 6 and 12 hours after injury without an increase in complication rate, compared to treatment up to 6 hours from injury. In selected cases primary reconstruction of war injury ...
Trauma with multiple injuries is associated with a high risk of complications, which may be relat... more Trauma with multiple injuries is associated with a high risk of complications, which may be related to excessive stimulation of inflammatory and anti-inflammatory responses. Although the effects of polytrauma on the immune response have been well established at the cellular and molecular levels, there is little information about the changes in the cytolytic potential of immunocompetent cells, including expression of cytotoxic molecules such as perforin. Therefore, the objective of the present study was to analyse and compare differences in the frequency and perforin expression of leukocyte subpopulations in the peripheral blood of patients with lower limb fracture, thoracic injury, and simultaneous lower limb fracture and thoracic injury. Forty-five patients with trauma injury (15 patients with lower limb injury, 15 patients with thoracic injury, and 15 patients with simultaneous lower limb and thoracic injury) were included in the study. Peripheral blood of 15 sex- and age-matched ...
Sažetak. Cilj: Procjena vrijednosti dijagnostičkog ultrazvuka kod bolesnika s rupturom medijalne ... more Sažetak. Cilj: Procjena vrijednosti dijagnostičkog ultrazvuka kod bolesnika s rupturom medijalne glave gastoknemijusa (MGM), budući da kliničkim parametrima nije moguće procijeniti opseg rupture mišića. Objektivna procjena veličine rupture i njezina klasifikacija važna je u odabiru terapijskog protokola. Metode: Šezdeset (60) bolesnika s tipičnom anamnezom za rupturu MGM-a pregledani su ultrazvukom unutar jednog tjedna od ozljede. Ozljede su klasificirane prema modificiranoj Bourgeoisovoj ultrazvučnoj klasifikaciji u 4 stupnja; 1. stupanj: hipoehogeni, povećani distalni mišićno-tetivni spoj bez prekida mišićne strukture; 2. stupanj: ruptura manja od 2 cm; 3. stupanj: ruptura veća od 2 cm; 4. stupanj: rupture s velikom anehogenom kolekcijom tekućine između soleusa i MGM-a. Rezultati: Ne postoji korelacija između promatranih anamnestičko-kliničkih parametara koji uključuju: mehanizam ozljede, tjelesnu aktivnost, bol za vrijeme ozljede, bol za vrijeme kliničkog pregleda, razliku u opsegu donjeg ekstremiteta u proksimalnoj i distalnoj trećini, opseg pokreta u nožnom zglobu ili lokalizaciju rupture na mišićno-tetivnom spoju, u odnosu na stupanj ozljede procijenjene ultrazvučnim pregledom. Zaključak: Ultrazvuk je korisna dijagnostička metoda koja omogućava procjenu opsega rupture MGM-a i treba se koristiti u cilju individualne pripreme terapijskog protokola kod ovih ozljeda.
Zavod za nefrologiju i dijalizu klinike za internu medicinu 2 Zavod za traumatologiju klinike za ... more Zavod za nefrologiju i dijalizu klinike za internu medicinu 2 Zavod za traumatologiju klinike za kirurgiju 3 klinički zavod za radiologiju klinički bolnički centar rijeka, medicinski fakultet sveučilišta u rijeci, rijeka, Hrvatska Aseptična nekroza kosti je relativno rijetka komplikacija u primatelja bubrežnog transplantata. Ona može biti posljedica djelovanja brojnih uzročnih čimbenika, ali se najviše povezuje s liječenjem kortikosteroidima. Prikazat ćemo 62-godišnju bolesnicu s terminalnim bubrežnim zatajenjem, uzrokovanim poststreptokoknim glomerulonefritisom, koja se prije transplantacije bubrega 2,5 godine liječila peritonejskom dijalizom. Dvadeset mjeseci prije presađivanja bubrega, bolesnica je zbog akutnog poliradikuloneuritisa Guillaine Barré liječena visokim dozama kortikosteroida, uz primjenu imunoglobulina i plazmafereze. Kod transplantacije bubrega primijenjen je standardni imunosupresivni protokol, koji uključuje takrolimus, mikofenolat mofetil i kortikosteroid uz indukciju baziliksimabom. Četiri mjeseca nakon transplantacije, bolesnica počinje osjećati bolove u desnom kuku kod dužeg stajanja. Na radiogramu kuka ustanovljena su subhondralna prosvjetljenja u području lateralnog dijela cirkumferencije glavice, koja su se širila u proksimalni dio vrata desnog femura, dok pregled magnetskom rezonancom (MR) nije pokazao promjene u smislu aseptične nekroze kosti. Bolesnica je zbog progresije bolova i pozitivnog radiografskog nalaza, a unatoč negativnom nalazu MR-a, podvrgnuta kirurškom zahvatu dekompresije glavice bedrene kosti. Nakon zahvata bolovi su prestali i bolesnica se zadovoljavajuće oporavila. Kod primatelja bubrežnog transplantata treba rano posumnjati i utvrditi aseptičnu nekrozu kosti, jer pravodobno liječenje dekompresijom kosti može otkloniti bol te spriječiti ili odgoditi destrukciju kosti koja bi zahtijevala aloartroplastiku. Ključne riječi: transplantacija bubrega, aseptična nekroza glavice femura, dekompresija Adres aza dopisivanje: Prim.dr.sc. Stela Živčić-Ćosić, dr.med., Zavod za nefrologiju i dijalizu, Klinika za internu medicinu,
Acute acalculous cholecystitis (AAC) is a serious complication in the treatment of critically ill... more Acute acalculous cholecystitis (AAC) is a serious complication in the treatment of critically ill patients. The incidence, published up to now varies from 0.2% up to 18% in patients
We report the first case of osteochondritis dissecans (OCD) affecting a large area of lateral and... more We report the first case of osteochondritis dissecans (OCD) affecting a large area of lateral and medial femoral condyles with adult-onset in the same knee of the 22-year old professional athlete with respect to result of applied therapeutic procedure. After a clinical examination, radiograph and magnetic resonance imaging showed a huge bicondylar OCD. Through arthrotomy, the osteochondral fragment was fixed with biodegradable pins combined with two threaded 4 mm cobalt-chrome cancellous screws. By using this surgical fixation procedure, osteochondral fragments healed completely, which is evidenced artroscopically one year after a new trauma episode which resulted in the lateral meniscus reinjury. According to our knowledge this is the first reported case of bicondylar OCD affecting adult knee. In the rare case of such a large osteochondral defect, when fixation with biodegradable pins could be insufficient, a combination with cancellous screws can bring good results, even in professional athletes.
Sažetak. Posljednja dva desetljeća relevantni svjetski podaci uspoređuju problem politraume s epi... more Sažetak. Posljednja dva desetljeća relevantni svjetski podaci uspoređuju problem politraume s epidemijom, koristeći se sintagmom "traumatizirani bolesnik", svrstavajući ga na treće mjesto svih uzroka smrtnosti, a na prvo mjesto u dobnoj skupini od 1. do 44. godine života. Zbog složenosti samih ozljeda, kao i zbog nedovoljno objašnjenih odgovora organizma na samu traumu i na terapijske postupke, liječenje politraumatiziranih bolesnika jedno je od najsloženijih u suvremenoj medicini. U suvremenom pristupu liječenju od velike su pomoći algoritmi, čijom se točnom primjenom postižu bolji rezultati uz smanjenje propusta i pogrešaka na najmanju moguću mjeru. Osnovni princip liječenja politraumatiziranih bolesnika jest da ono počinje na mjestu nezgode, traje tijekom transporta i nastavlja se u bolnici uz poštovanje principa istovremenosti dijagnostike i liječenja. Uspostava registra traume i neprestano vrednovanje rezultata liječenja predstavljaju jedan od osnovnih preduvjeta za osnivanje centra trauma prve kategorije, a samim time i za poboljšanje kvalitete zbrinjavanja politraumatiziranih bolesnika.
Immediate treatment of femoral fractures after major abdominal injuries is still a challenge for ... more Immediate treatment of femoral fractures after major abdominal injuries is still a challenge for trauma surgeon. Twelve patients with major abdominal trauma and femoral fractures (ISS >= 25) were retrospectively analyzed. After laparotomy MIPO of femoral fracture was done using a long DCP, LCP or condylar plate. In a case of single femoral fracture healing was completed in 17.7 weeks. In a case of concomitant tibial fracture femoral fractures healed in 26.8 weeks. One complication was observed: malposition of the femoral neck in complex femoral fracture. Conclusions: Immediate MIPO of femoral fracture in patients with major abdominal injury could be successful. Important preconditions are: early diagnosis and successful treatment of abdominal bleeding, no massive blood loss, haemodynamical stability during surgery and minimally invasive technique of plating.
Modern thinking about fracture healing is focused to create a fine balance between biology and me... more Modern thinking about fracture healing is focused to create a fine balance between biology and mechanics that will beneficially influence to fracture healing. Proper preoperative planning, meticulous surgical technique, correct usage of implants, instruments and equipment are necessary to create optimal condition for bone healing. Minimally Invasive Plate Osteosynthesis (MIPO) technique is continuously developing according to the technical improvement and clinical implications of topographic anatomy. This minimally invasive technique can be used nowadays in various types of fracture treatment in which our main goals are preservation of healing potential and intraoperative tissue damage reduction. With a short historical overview, this article presents clinical application of MIPO technique on different anatomical regions according to published recent literature and results of operative fracture treatment. Principles and methods of internal fixation of fractures are not finally defin...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2012
Avascular bone necrosis is a relatively rare but significant complication in renal transplant rec... more Avascular bone necrosis is a relatively rare but significant complication in renal transplant recipients because it causes progressive pain and invalidity. It can be the consequence of the action of numerous causative factors, but it is mostly connected to corticosteroid treatment.The underlying pathophysiologic mechanism is a diminished blood flow to the bone leading to necrosis and bone destruction. During the past 25-years period, 570 renal transplantations and five combined kidney and pancreas transplantations were performed in our centre. A part of the patients was lost to follow-up due to the separation of Croatia from the former Republic of Yugoslavia. After transplantation, we revealed aseptic necrosis of the femoral head in five female patients. All patients had a history of treatment with pulse doses of corticosteroids. At transplantation the average age of the patients was 52.2 yrs (range 46 to 62 yrs), and dialytic treatment before transplantation lasted in average 9.2 y...
There have been reports both supporting and refuting an inverse relationship between hip fracture... more There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA). We have investigated this relationship using histomorphometric study of femoral head subchondral bone. We studied 74 subjects with hip fracture (74% females) and 24 subjects with osteoarthritis (45% females). By histomorphometric analysis of parafined sections, we analysed followed subhondral trabecular bone parameters bone volume (BV), bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th.), trabecular number (Tb.N.) and trabecular separation (Tb.S.). The subjects with osteoarthritis and subjects with hip fracture had BV/TV 31.3% and 19.6% respectively. BV/TV of osteoarthritis group was rather uniform whereas BV/TV of hip fracture group was greatly ranged and we divided it into three subgroups, 13.2%, 19.8% and 25.9% respectively. The OA group and hip fracture groups had Tb.Th. as followed 0.205 mm, 0.148 mm, 0.170 mm and 0.183 mm respectively. The...
Because of a possible delayed wound healing, critical colonization and infection of wounds presen... more Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag - Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients...
Because of a possible delayed wound healing, critical colonization and infection of wounds presen... more Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons. Colonized and infected wounds are a potential source for cross-infection. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag--Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbio...
Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death tod... more Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke pr...
Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estim... more Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estimated that treatment of GHF will spend a large amount of health care resources. The aim of this retrospective study was to compare differences in incidence of operatively treated patients with GHF, type of treatment depending of the type of fracture, early postoperative mortality, length of stay and costs of used implants within a 10 years period. Surgically treated 2478 patients, older than 65 years with hip fractures were included in the study. Patients were grouped according to the type of fracture (femoral neck fracture or intertrochanteric femoral fracture) and used implant. Results showed increasing trend in GHF in our County in the last 10 years. There was a shifting trend in used implants, and new surgical techniques were used more commonly in the last few years. In observed period there were no significant changes in revision surgery and length of hospital stay. The mortality dec...
We report a case of a traumatic pseudocyst, in a recreational soccer player, after rupture of rec... more We report a case of a traumatic pseudocyst, in a recreational soccer player, after rupture of rectus femoris muscle. 37-year-old male, with history of repetitive painful accidents, was examined because of a double fist-sized mass in the anterior thigh. Ultrasound examination revealed a cystic mass in the rectus femoris muscle. Surgical removal of the mass and proximal remnant of muscle was done. Primary healing and functional recovery was achieved. Histological analysis revealed pseudocyst filled with degenerating clot and surrounded with thick fibrous capsule. The repetitive strain muscle injury, with prolonged period of healing, can occur like pseudocyst.
The aim of this study was to describe initial experience with external thoracic stabilization by ... more The aim of this study was to describe initial experience with external thoracic stabilization by the "figure of eight" osteosynthesis in polytraumatized patients with flail chest injury. From January 2002, fifteen patients underwent this surgical procedure at the University Hospital of Rijeka. Their mean age was 52 +/- 13.69 (range 18-65) and mean ISS was 29.8 (range: 20-41). Twelve patients were weaned from artificial respiration on same day when operated, two on the post-operative day 1, and one on the post-operative day 2. Their stay within the intensive care unit following extubation was within the range of 1-12 days (mean 3.93 +/- 2.99). The early external thoracic stabilization by the "figure of eight" osteosynthesis was followed by swift extubation of patient and direct normalization of respiratory parameters. This method contributed significantly to patient's shorter stay within the intensive care unit.
Prostate cancer is a major public health problem of the male population in all the developed coun... more Prostate cancer is a major public health problem of the male population in all the developed countries. This non-skin cancer is the foremost one facing man today. Prostate cancer has become the second leading cause of cancer death2. In this study we investigated changes in the prostate carcinoma incidence and manifestation during a thirty-three years period. The study included 1226 cases of prostate cancer diagnosed from 1972 to 2005 in the Primorsko-Goranska County, Croatia. The age-adjusted incidence of prostate cancer increased from 1.69 per 100,000 men annually in 1972 to 137.58 per 100,000 men annually in 2005, which is an 81.4-fold increase. The percentage ofpatients with bone metastases on the first medical examination decreased from 1972 (75%) to 2005 (15%). The most of the patients with bone metastases at the first medical examination were between 30 and 50 years old. Early detection measures, such as prostate specific antigen testing and transrectal ultrasound guided prost...
Newborn and adult articular cartilage expresses bone (BMPs) and cartilage derived morphogenetic p... more Newborn and adult articular cartilage expresses bone (BMPs) and cartilage derived morphogenetic proteins (CDMPs). These morphogenetic proteins act over membrane receptors (BMPRs). We examined the expression pattern of BMP-7, BMP-3, CDMP-1, CDMP-2 and their receptors in adult normal and osteoarthritic, articular, knee cartilage. Immunostaining was carried out using polyclonal antibodies. The expression of BMP-7,-3, CDMP-1,-2 was detected in all layers of normal articular cartilage with the strongest expression in chondrocytes of the transitional layer. BMP-7 and CDMPs expression decreased in osteoarthritic articular cartilage whereas BMP-3 expression was absent. BMPR-IA and BMPR-II were strongly expressed in both normal and osteoarthritic articular cartilage. BMPR-IB was not expressed in osteoarthritic (OA) cartilage. BMPs and CDMPs with intact signalling play an important role in articular cartilage homeostasis, preventing cartilage degeneration.
Study Objective: To evaluate the role of a brief ultrasound examination (US) in detecting the cor... more Study Objective: To evaluate the role of a brief ultrasound examination (US) in detecting the correct position of the left double-lumen endotracheal tube (LDLT). Design: Prospective, randomized clinical study. Setting: Operating room of a university hospital. Patients: 50 elective adult thoracic surgery patients who required a LDLT during anesthesia. Intervention and Measurements: Patients were randomized to two groups: Group A, who underwent clinical assessment of the LDLT position, and Group B, who were examined clinically and by ultrasound. All 50 patients underwent the same conventional procedure of LDLT placement. In all patients, clinical assessment of LDLT positioning was made by observing chest wall expansion and checking lung compliance by manual ventilation and by auscultation of both lungs. In Group B, a very brief ultrasound (15-30 sec) examination was added. Ultrasound examination included visualization of the pleural movements ("lung sliding") and motion of the diaphragm from both sides before and after selective clamping of the bronchial and tracheal limbs. In both groups, a second anesthesiologist performed bronchoscopy to estimate actual LDLT position. Main Results: Sensitivity and negative predictive values in detecting proper LDLT positioning for both methods were 100%. For the clinical assessment alone (Group A), specificity was 22%, accuracy was 72%, and positive predictive value, 70%; for the clinical and ultrasound assessment (Group B), specificity was 50%, accuracy was 88%, and positive predictive value, 86%. Conclusion: A brief ultrasound examination added to clinical assessment ensured more precise placement of LDLT than did clinical assessment alone.
Objectives: The aim of this study was to analyze the epidemiology, treatment and incidence of com... more Objectives: The aim of this study was to analyze the epidemiology, treatment and incidence of complications among the patients with upper extremity war injury. Methods: In retrospective study, 123 patients with war injuries of the upper extremity have been analyzed. The results of treatment were assessed according to the rate of: complications, amputations, fracture healing and mortality. Results: Complications appeared in 17.9% of cases. Traumatic amputations were present in 19.4% of cases and in 2.4% of cases amputation was performed due to III C open fracture. Satisfactory bone healing was achieved in 49 of 55 patients available to follow up. Mortality rate was 2.4%. Conclusion: Self-inflicted injuries resulted in 41.6% amputation rate. High-energy war injuries of the upper extremity could be treated between 6 and 12 hours after injury without an increase in complication rate, compared to treatment up to 6 hours from injury. In selected cases primary reconstruction of war injury ...
Trauma with multiple injuries is associated with a high risk of complications, which may be relat... more Trauma with multiple injuries is associated with a high risk of complications, which may be related to excessive stimulation of inflammatory and anti-inflammatory responses. Although the effects of polytrauma on the immune response have been well established at the cellular and molecular levels, there is little information about the changes in the cytolytic potential of immunocompetent cells, including expression of cytotoxic molecules such as perforin. Therefore, the objective of the present study was to analyse and compare differences in the frequency and perforin expression of leukocyte subpopulations in the peripheral blood of patients with lower limb fracture, thoracic injury, and simultaneous lower limb fracture and thoracic injury. Forty-five patients with trauma injury (15 patients with lower limb injury, 15 patients with thoracic injury, and 15 patients with simultaneous lower limb and thoracic injury) were included in the study. Peripheral blood of 15 sex- and age-matched ...
Sažetak. Cilj: Procjena vrijednosti dijagnostičkog ultrazvuka kod bolesnika s rupturom medijalne ... more Sažetak. Cilj: Procjena vrijednosti dijagnostičkog ultrazvuka kod bolesnika s rupturom medijalne glave gastoknemijusa (MGM), budući da kliničkim parametrima nije moguće procijeniti opseg rupture mišića. Objektivna procjena veličine rupture i njezina klasifikacija važna je u odabiru terapijskog protokola. Metode: Šezdeset (60) bolesnika s tipičnom anamnezom za rupturu MGM-a pregledani su ultrazvukom unutar jednog tjedna od ozljede. Ozljede su klasificirane prema modificiranoj Bourgeoisovoj ultrazvučnoj klasifikaciji u 4 stupnja; 1. stupanj: hipoehogeni, povećani distalni mišićno-tetivni spoj bez prekida mišićne strukture; 2. stupanj: ruptura manja od 2 cm; 3. stupanj: ruptura veća od 2 cm; 4. stupanj: rupture s velikom anehogenom kolekcijom tekućine između soleusa i MGM-a. Rezultati: Ne postoji korelacija između promatranih anamnestičko-kliničkih parametara koji uključuju: mehanizam ozljede, tjelesnu aktivnost, bol za vrijeme ozljede, bol za vrijeme kliničkog pregleda, razliku u opsegu donjeg ekstremiteta u proksimalnoj i distalnoj trećini, opseg pokreta u nožnom zglobu ili lokalizaciju rupture na mišićno-tetivnom spoju, u odnosu na stupanj ozljede procijenjene ultrazvučnim pregledom. Zaključak: Ultrazvuk je korisna dijagnostička metoda koja omogućava procjenu opsega rupture MGM-a i treba se koristiti u cilju individualne pripreme terapijskog protokola kod ovih ozljeda.
Zavod za nefrologiju i dijalizu klinike za internu medicinu 2 Zavod za traumatologiju klinike za ... more Zavod za nefrologiju i dijalizu klinike za internu medicinu 2 Zavod za traumatologiju klinike za kirurgiju 3 klinički zavod za radiologiju klinički bolnički centar rijeka, medicinski fakultet sveučilišta u rijeci, rijeka, Hrvatska Aseptična nekroza kosti je relativno rijetka komplikacija u primatelja bubrežnog transplantata. Ona može biti posljedica djelovanja brojnih uzročnih čimbenika, ali se najviše povezuje s liječenjem kortikosteroidima. Prikazat ćemo 62-godišnju bolesnicu s terminalnim bubrežnim zatajenjem, uzrokovanim poststreptokoknim glomerulonefritisom, koja se prije transplantacije bubrega 2,5 godine liječila peritonejskom dijalizom. Dvadeset mjeseci prije presađivanja bubrega, bolesnica je zbog akutnog poliradikuloneuritisa Guillaine Barré liječena visokim dozama kortikosteroida, uz primjenu imunoglobulina i plazmafereze. Kod transplantacije bubrega primijenjen je standardni imunosupresivni protokol, koji uključuje takrolimus, mikofenolat mofetil i kortikosteroid uz indukciju baziliksimabom. Četiri mjeseca nakon transplantacije, bolesnica počinje osjećati bolove u desnom kuku kod dužeg stajanja. Na radiogramu kuka ustanovljena su subhondralna prosvjetljenja u području lateralnog dijela cirkumferencije glavice, koja su se širila u proksimalni dio vrata desnog femura, dok pregled magnetskom rezonancom (MR) nije pokazao promjene u smislu aseptične nekroze kosti. Bolesnica je zbog progresije bolova i pozitivnog radiografskog nalaza, a unatoč negativnom nalazu MR-a, podvrgnuta kirurškom zahvatu dekompresije glavice bedrene kosti. Nakon zahvata bolovi su prestali i bolesnica se zadovoljavajuće oporavila. Kod primatelja bubrežnog transplantata treba rano posumnjati i utvrditi aseptičnu nekrozu kosti, jer pravodobno liječenje dekompresijom kosti može otkloniti bol te spriječiti ili odgoditi destrukciju kosti koja bi zahtijevala aloartroplastiku. Ključne riječi: transplantacija bubrega, aseptična nekroza glavice femura, dekompresija Adres aza dopisivanje: Prim.dr.sc. Stela Živčić-Ćosić, dr.med., Zavod za nefrologiju i dijalizu, Klinika za internu medicinu,
Acute acalculous cholecystitis (AAC) is a serious complication in the treatment of critically ill... more Acute acalculous cholecystitis (AAC) is a serious complication in the treatment of critically ill patients. The incidence, published up to now varies from 0.2% up to 18% in patients
We report the first case of osteochondritis dissecans (OCD) affecting a large area of lateral and... more We report the first case of osteochondritis dissecans (OCD) affecting a large area of lateral and medial femoral condyles with adult-onset in the same knee of the 22-year old professional athlete with respect to result of applied therapeutic procedure. After a clinical examination, radiograph and magnetic resonance imaging showed a huge bicondylar OCD. Through arthrotomy, the osteochondral fragment was fixed with biodegradable pins combined with two threaded 4 mm cobalt-chrome cancellous screws. By using this surgical fixation procedure, osteochondral fragments healed completely, which is evidenced artroscopically one year after a new trauma episode which resulted in the lateral meniscus reinjury. According to our knowledge this is the first reported case of bicondylar OCD affecting adult knee. In the rare case of such a large osteochondral defect, when fixation with biodegradable pins could be insufficient, a combination with cancellous screws can bring good results, even in professional athletes.
Sažetak. Posljednja dva desetljeća relevantni svjetski podaci uspoređuju problem politraume s epi... more Sažetak. Posljednja dva desetljeća relevantni svjetski podaci uspoređuju problem politraume s epidemijom, koristeći se sintagmom "traumatizirani bolesnik", svrstavajući ga na treće mjesto svih uzroka smrtnosti, a na prvo mjesto u dobnoj skupini od 1. do 44. godine života. Zbog složenosti samih ozljeda, kao i zbog nedovoljno objašnjenih odgovora organizma na samu traumu i na terapijske postupke, liječenje politraumatiziranih bolesnika jedno je od najsloženijih u suvremenoj medicini. U suvremenom pristupu liječenju od velike su pomoći algoritmi, čijom se točnom primjenom postižu bolji rezultati uz smanjenje propusta i pogrešaka na najmanju moguću mjeru. Osnovni princip liječenja politraumatiziranih bolesnika jest da ono počinje na mjestu nezgode, traje tijekom transporta i nastavlja se u bolnici uz poštovanje principa istovremenosti dijagnostike i liječenja. Uspostava registra traume i neprestano vrednovanje rezultata liječenja predstavljaju jedan od osnovnih preduvjeta za osnivanje centra trauma prve kategorije, a samim time i za poboljšanje kvalitete zbrinjavanja politraumatiziranih bolesnika.
Immediate treatment of femoral fractures after major abdominal injuries is still a challenge for ... more Immediate treatment of femoral fractures after major abdominal injuries is still a challenge for trauma surgeon. Twelve patients with major abdominal trauma and femoral fractures (ISS >= 25) were retrospectively analyzed. After laparotomy MIPO of femoral fracture was done using a long DCP, LCP or condylar plate. In a case of single femoral fracture healing was completed in 17.7 weeks. In a case of concomitant tibial fracture femoral fractures healed in 26.8 weeks. One complication was observed: malposition of the femoral neck in complex femoral fracture. Conclusions: Immediate MIPO of femoral fracture in patients with major abdominal injury could be successful. Important preconditions are: early diagnosis and successful treatment of abdominal bleeding, no massive blood loss, haemodynamical stability during surgery and minimally invasive technique of plating.
Modern thinking about fracture healing is focused to create a fine balance between biology and me... more Modern thinking about fracture healing is focused to create a fine balance between biology and mechanics that will beneficially influence to fracture healing. Proper preoperative planning, meticulous surgical technique, correct usage of implants, instruments and equipment are necessary to create optimal condition for bone healing. Minimally Invasive Plate Osteosynthesis (MIPO) technique is continuously developing according to the technical improvement and clinical implications of topographic anatomy. This minimally invasive technique can be used nowadays in various types of fracture treatment in which our main goals are preservation of healing potential and intraoperative tissue damage reduction. With a short historical overview, this article presents clinical application of MIPO technique on different anatomical regions according to published recent literature and results of operative fracture treatment. Principles and methods of internal fixation of fractures are not finally defin...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2012
Avascular bone necrosis is a relatively rare but significant complication in renal transplant rec... more Avascular bone necrosis is a relatively rare but significant complication in renal transplant recipients because it causes progressive pain and invalidity. It can be the consequence of the action of numerous causative factors, but it is mostly connected to corticosteroid treatment.The underlying pathophysiologic mechanism is a diminished blood flow to the bone leading to necrosis and bone destruction. During the past 25-years period, 570 renal transplantations and five combined kidney and pancreas transplantations were performed in our centre. A part of the patients was lost to follow-up due to the separation of Croatia from the former Republic of Yugoslavia. After transplantation, we revealed aseptic necrosis of the femoral head in five female patients. All patients had a history of treatment with pulse doses of corticosteroids. At transplantation the average age of the patients was 52.2 yrs (range 46 to 62 yrs), and dialytic treatment before transplantation lasted in average 9.2 y...
There have been reports both supporting and refuting an inverse relationship between hip fracture... more There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA). We have investigated this relationship using histomorphometric study of femoral head subchondral bone. We studied 74 subjects with hip fracture (74% females) and 24 subjects with osteoarthritis (45% females). By histomorphometric analysis of parafined sections, we analysed followed subhondral trabecular bone parameters bone volume (BV), bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th.), trabecular number (Tb.N.) and trabecular separation (Tb.S.). The subjects with osteoarthritis and subjects with hip fracture had BV/TV 31.3% and 19.6% respectively. BV/TV of osteoarthritis group was rather uniform whereas BV/TV of hip fracture group was greatly ranged and we divided it into three subgroups, 13.2%, 19.8% and 25.9% respectively. The OA group and hip fracture groups had Tb.Th. as followed 0.205 mm, 0.148 mm, 0.170 mm and 0.183 mm respectively. The...
Because of a possible delayed wound healing, critical colonization and infection of wounds presen... more Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag - Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients...
Because of a possible delayed wound healing, critical colonization and infection of wounds presen... more Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons. Colonized and infected wounds are a potential source for cross-infection. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag--Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbio...
Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death tod... more Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke pr...
Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estim... more Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estimated that treatment of GHF will spend a large amount of health care resources. The aim of this retrospective study was to compare differences in incidence of operatively treated patients with GHF, type of treatment depending of the type of fracture, early postoperative mortality, length of stay and costs of used implants within a 10 years period. Surgically treated 2478 patients, older than 65 years with hip fractures were included in the study. Patients were grouped according to the type of fracture (femoral neck fracture or intertrochanteric femoral fracture) and used implant. Results showed increasing trend in GHF in our County in the last 10 years. There was a shifting trend in used implants, and new surgical techniques were used more commonly in the last few years. In observed period there were no significant changes in revision surgery and length of hospital stay. The mortality dec...
We report a case of a traumatic pseudocyst, in a recreational soccer player, after rupture of rec... more We report a case of a traumatic pseudocyst, in a recreational soccer player, after rupture of rectus femoris muscle. 37-year-old male, with history of repetitive painful accidents, was examined because of a double fist-sized mass in the anterior thigh. Ultrasound examination revealed a cystic mass in the rectus femoris muscle. Surgical removal of the mass and proximal remnant of muscle was done. Primary healing and functional recovery was achieved. Histological analysis revealed pseudocyst filled with degenerating clot and surrounded with thick fibrous capsule. The repetitive strain muscle injury, with prolonged period of healing, can occur like pseudocyst.
The aim of this study was to describe initial experience with external thoracic stabilization by ... more The aim of this study was to describe initial experience with external thoracic stabilization by the "figure of eight" osteosynthesis in polytraumatized patients with flail chest injury. From January 2002, fifteen patients underwent this surgical procedure at the University Hospital of Rijeka. Their mean age was 52 +/- 13.69 (range 18-65) and mean ISS was 29.8 (range: 20-41). Twelve patients were weaned from artificial respiration on same day when operated, two on the post-operative day 1, and one on the post-operative day 2. Their stay within the intensive care unit following extubation was within the range of 1-12 days (mean 3.93 +/- 2.99). The early external thoracic stabilization by the "figure of eight" osteosynthesis was followed by swift extubation of patient and direct normalization of respiratory parameters. This method contributed significantly to patient's shorter stay within the intensive care unit.
Prostate cancer is a major public health problem of the male population in all the developed coun... more Prostate cancer is a major public health problem of the male population in all the developed countries. This non-skin cancer is the foremost one facing man today. Prostate cancer has become the second leading cause of cancer death2. In this study we investigated changes in the prostate carcinoma incidence and manifestation during a thirty-three years period. The study included 1226 cases of prostate cancer diagnosed from 1972 to 2005 in the Primorsko-Goranska County, Croatia. The age-adjusted incidence of prostate cancer increased from 1.69 per 100,000 men annually in 1972 to 137.58 per 100,000 men annually in 2005, which is an 81.4-fold increase. The percentage ofpatients with bone metastases on the first medical examination decreased from 1972 (75%) to 2005 (15%). The most of the patients with bone metastases at the first medical examination were between 30 and 50 years old. Early detection measures, such as prostate specific antigen testing and transrectal ultrasound guided prost...
Newborn and adult articular cartilage expresses bone (BMPs) and cartilage derived morphogenetic p... more Newborn and adult articular cartilage expresses bone (BMPs) and cartilage derived morphogenetic proteins (CDMPs). These morphogenetic proteins act over membrane receptors (BMPRs). We examined the expression pattern of BMP-7, BMP-3, CDMP-1, CDMP-2 and their receptors in adult normal and osteoarthritic, articular, knee cartilage. Immunostaining was carried out using polyclonal antibodies. The expression of BMP-7,-3, CDMP-1,-2 was detected in all layers of normal articular cartilage with the strongest expression in chondrocytes of the transitional layer. BMP-7 and CDMPs expression decreased in osteoarthritic articular cartilage whereas BMP-3 expression was absent. BMPR-IA and BMPR-II were strongly expressed in both normal and osteoarthritic articular cartilage. BMPR-IB was not expressed in osteoarthritic (OA) cartilage. BMPs and CDMPs with intact signalling play an important role in articular cartilage homeostasis, preventing cartilage degeneration.
Study Objective: To evaluate the role of a brief ultrasound examination (US) in detecting the cor... more Study Objective: To evaluate the role of a brief ultrasound examination (US) in detecting the correct position of the left double-lumen endotracheal tube (LDLT). Design: Prospective, randomized clinical study. Setting: Operating room of a university hospital. Patients: 50 elective adult thoracic surgery patients who required a LDLT during anesthesia. Intervention and Measurements: Patients were randomized to two groups: Group A, who underwent clinical assessment of the LDLT position, and Group B, who were examined clinically and by ultrasound. All 50 patients underwent the same conventional procedure of LDLT placement. In all patients, clinical assessment of LDLT positioning was made by observing chest wall expansion and checking lung compliance by manual ventilation and by auscultation of both lungs. In Group B, a very brief ultrasound (15-30 sec) examination was added. Ultrasound examination included visualization of the pleural movements ("lung sliding") and motion of the diaphragm from both sides before and after selective clamping of the bronchial and tracheal limbs. In both groups, a second anesthesiologist performed bronchoscopy to estimate actual LDLT position. Main Results: Sensitivity and negative predictive values in detecting proper LDLT positioning for both methods were 100%. For the clinical assessment alone (Group A), specificity was 22%, accuracy was 72%, and positive predictive value, 70%; for the clinical and ultrasound assessment (Group B), specificity was 50%, accuracy was 88%, and positive predictive value, 86%. Conclusion: A brief ultrasound examination added to clinical assessment ensured more precise placement of LDLT than did clinical assessment alone.
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