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Radiofrequency Denervation of Lumbar Facet Joints in the Treatment of Chronic low Back Pain
No full textLow back pain is the most common pain syndrome and a global health burden. The etiology in most cases is multifactorial and the facet joints can be a source of low back pain. The facet joint is innervated by the medial branch of the dorsal ramus of the spinal nerve. Facet joint disturbances can be responsible for 10% to 50% of all cases of chronic lumbar pain. In the absence of predictive clinical or radiologic findings, nerve blocks are considered to be the best way of diagnosing presumed facet-mediated pain. Radiofrequency ablation to induce thermal necrosis of the facet neural fibers has been reported to provide significant pain reduction in patients for 6–12 months. A radiofrequency neurotomy is a type of injection procedure used to treat facet joint pain caused by arthritis or other degenerative changes, or from an injury. In this procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain. Medial Branch Neurotomy could be considered an option for patients suffering persistent axial and referred non-radicular leg pain unresponsive to less invasive conservative measures
Lumbar Spinal Stenosis: Methods of Treatment with Emphasis on Epidural Steroid Injections
No full textBackground and Purpose: The aim of the study was to compare two techniques of steroid application into epidural space to patients with lumbar spinal stenosis (LSS), a chronic degenerative spine disorder. Patients and Methods: Sixty LSS patients have been distributed into 2 groups: “BLIND” (n=30, interlaminar epidural steroid injection without RTG control) and “RTG” (n=30, transforaminal epidural injection with RTG control). All patients have received 80 mg of triamcinolon (Kenalog) into epidural space on L4/L5 level, together with 0,5% lidocain (patients in RTG group 3 ml and those in BLIND group 10 ml) in 3 week intervals. They were asked to describe the pain using visual analogue scales (VAS) at the beginning of treatment (VAS-0), after the first (VAS-1), the second (VAS-2) and the third epidural injection (VAS-3). The differences between groups were shown using t-test (age) and c2-test (gender). Medians of VAS scores were statistically described using non parametrial methods. P<0.05 was considered as a statistically significant.
Results: There is no statistical difference among patients regarding to age (P=0.93), gender (P=0.12) and VAS-0 score before the first injection (P=0.27). There is a statistically significant reduction of pain in relation to VAS-0 in both groups (P<0.001). Both groups do not statistically differ when it comes to their effectiveness in regards to VAS scores .
Conclusions: We did not find any statistical difference in postinterventional VAS scores among two groups of patients. Choice of technique depends on the experience of the anesthesiologist, as well as on the local technical possibilities (availibility of RTG devices)
Cystic Fibrosis: Model of Pathogenesis Based on the Apical Membrane Potential
No full textA simple model of cystic fibrosis (CF) is proposed, based on the apical membrane (ApM) potential. The ApM of epithelial cells is highly permeable to sodium and activation of CFTRs makes it permeable to chloride. Calculated ApM potentials of cells with activated cystic fibrosis transmembrane conductance regulators (CFTRs) are between the sodium and chloride Nernst values and thus allow rapid absorption of both ions in exocrine glands. In CF patients the potential is near the sodium Nernst value and thus more salt is left in the ducts. Simulation predicts that the sodium driving force increases more than 3.5 times if the ApM permeability for Cl- increases from 5-94% of the sodium permeability. In pancreatic ductal cells basolateral sodium bicarbonate cotransporters (pNBC1) allows influx of bicarbonates with sodium. Bicarbonates are exchanged for intraductal chloride by anion exchanger 1 (AE1) in the ApM. Activated CFTRs let some chloride to leak back to ducts, followed by water that dilutes ductal proteins. Replenished intraductal chloride allows more bicarbonate secretion. In CF patients, pancreatic water and bicarbonate secretion is limited by the intraductal chloride pool
Retrospective data analysis of the patients with inflammatory joint diseases treated with golimumab in Croatia
No full textGolimumab je humano monoklonsko protutijelo koje inhibira čimbenik nekroze tumora-alfa (TNF-α), a indiciran je u liječenju upalnih reumatskih bolesti (reumatoidni artritis, psorijatični artritis, ankilozantni spondilitis) nakon što se konvencionalnom farmakološkom i nefarmakološkom terapijom ta stanja ne uspiju dovesti u remisiju ili nisku aktivnost bolesti. U ovom retrospektivnom istraživanju uključeni su bolesnici oboljeli od reumatoidnog artritisa, psorijatičnog artritisa i ankilozantnog spondilitisa u Hrvatskoj, liječeni golimumabom u dvogodišnjem razdoblju (od lipnja 2011. do lipnja 2013.). Promatrane su standardne varijable aktivnosti bolesti i funkcionalne sposobnosti. Rezultati su pokazali znatnu učinkovitost golimumaba u smanjenju aktivnosti bolesti i poboljšanju funkcionalne sposobnosti bolesnika s navedenim upalnim reumatskim bolestima. Zaključno, golimumab se u ovom retrospektivnom istraživanju liječenja kroz dvije godine pokazao učinkovitim u smanjenju aktivnosti bolesti i poboljšanju funkcionalne sposobnosti bolesnika s reumatoidnim artritisom, psorijatičnim artritisom i ankilozantnim spondilitisom.Golimumab is a human monoclonal antibody which inhibits tumor necrosis factor-alpha (TNF-α) and is approved for the treatment of infl ammatory arthritides (rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis) when the conventional non-pharmacological and pharmacological therapies fail to cause remission or low disease activity. In this retrospective study there were included patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis who were treated in Croatia with golimumab, from June 2011 to June 2013. included and these retrospective data are compared with similar data from clinical trials and other available databases. Standard variables of disease activity and functional ability were observed. Results demonstrated signifi cant effi cacy of golimumab regarding lowring the disease activity and imrpving functional ability in pateints with these infl ammatory rherumatic disease. In conclusion, in this retrospective study during two years treatment golimumab showed effi cacy in decreasing disease activity and imrpove functional ability in patiemts with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis
Croatian Guidelines for Diagnosis and Management of Benign Paroxysmal Positional Vertigo (BPPV)
No full textBPPV je općenito najčešći uzrok vrtoglavice, prouzročen otkidanjem sitnih kristalića kalcijeva karbonata, zvanih otokonije ili otoliti, iz otolitičke mrlje utrikulusa, najčešće zbog degenerativnih procesa ili traume. Djelovanjem sile teže, pri određenom položaju glave koji se podudara sa smjerom sile teže, otoliti dospijevaju u jedan od polukružnih kanalića labirinta, najčešće stražnji zbog postojećih anatomskih odnosa. Plutajući endolimfom, podražuju kupularno osjetilo, izazivajući simptome kratkotrajne, ali snažne vrtoglavice. Razlikuju se dva glavna klinička oblika BPPV-a: kanalolitijaza – nakupljanje otolita u kanalićima i kupulolitijaza – nakupljanje otolita neposredno uz sámo kupularno osjetilo. Dijagnoza bolesti postavlja se pozitivnom položavajućom probom, Dix-Hallpikeovom za stražnji polukružni kanalić, a supine roll za bočni kanalić. Premda se može očekivati spontani oporavak nakon nekoliko tjedana ili mjeseci, različiti postupci repozicije otolita dovode do trenutačnog poboljšanja, smanjenjem ili potpunim povlačenjem simptoma bolesti. Ove smjernice namijenjene su svima koji se u svojem radu mogu susresti s BPPV-om, a cilj im je pomoć u postavljanju dijagnoze i primjeni odgovarajućeg načina liječenja oboljelih.BPPV is generally the most common cause of vertigo, caused by a pinch-off of tiny calcium carbonate crystals (called the otoconia or the otoliths) from the macula utriculi, most frequently due to the degenerative processes or a trauma, whereby the crystals, under the action of gravity in certain head positions coinciding with its direction, arrive to some of the semicircular canals, usually the posterior one, due to the existent anatomical circumstances and relationships, thus creating an inadequate stimulus of the cupular senses while fl oating through the endolymph and provoking symptoms of a strong and short-term dizziness. Two main clinical forms can be distinguished: canalolythiasis, with an accommodation of otolithic debris in the semicircular canal, and cupulolythiasis, with their location immediately next to the cupular sense. The diagnosis is established by a positive positioning test, Dix-Hallpike for the posterior and the supine roll for the lateral canal. Although one can expect a spontaneous recovery subsequent to few weeks or months, various methods of otolith repositioning to a less sensitive place lead to a prompt improvement while reducing or withdrawing the symptoms completely.These guidelines are intended for all who treat the BPPV in their work, with an intention to assist in the diagnosis and application of an appropriate therapeutic method
Uloga tonzilektomije u prevenciji infekcije s Helicobacter pylori
No full textThe incidence of Helicobacter pylori infection varies globally and depends on the socioeconomic situation of a location. In the territory of Croatia, the incidence rate among the populace is 40-50% in persons with normal gastroscopic findings, whereas it is increased in persons with the pathohistological finding of the ulcus disease1. This study examines the potential preventive role of tonsillectomy with regard to H. pylori infection in later stages of life. The survey was conducted on a sample of 115 examinees (63 male, 52 female), aged between 19 and 86. The survey included examinees who underwent esophagogastroscopy at the Institute of Gastroenterology of the University Hospital Centre Osijek based on indication by a gastroenterology specialist. The survey has shown that of the total of 115 examinees, 28 of them had been tonsillectomised, and 87 had not been tonsillectomised. In the examinees who had not been subjected to tonsillectomy, positive H. pylori result was found in 63,2%, and 53,6% of those who had been tonsillectomised at a young age were positive to H.pylori. The results have shown that H. pylori infection was equally represented in all age groups, and the rate varies at 52.9 – 64.8%. Hence, the final conclusion was reached that tonsillectomy has no preventive role with regard to H.pylori infection.Učestalost Helicobacter infekcije je različita diljem svijeta i ovisi o socijalno-ekonomskom položaju sredine. U našim je krajevima učestalost u populaciji 40-50 % u osoba s urednim gastroskopskim nalazom, dok se povećava kod osoba sa patohistološkim nalazom ulkusne bolesti. U ovoj studiji ispituje se moguća preventivna uloga tonzilektomije, na infekciju H. pylori u kasnijoj životnoj dobi. Istraživanje je provedeno na uzorku od 115 ispitanika (63 muškarca, 52 žene), u dobi od 19 do 86 godine. U istraživanje su uključeni ispitanici koji su pristupili ezofagogastroskopiji na Zavodu za gastroenterologiju KBC Osijek na temelju indikacije specijalista gastroenterologa. Istraživanje je pokazalo da je od ukupno 115 ispitanika bilo tonzilektomirano 28, a 87 ispitanika nije tonzilektomirano. Kod ispitanika koji nisu tonzilektomirani, pozitivan nalaz na H. pylori imalo je 63,2 % ispitanika, a 53,6 % onih koji u mladosti tonzilektomirani je pozitivno na H. pylori. Rezultati su pokazali jednaku zastupljenost infekcije H. pylori u svim dobnim skupinama, a ona iznosi između 52,9 – 64,8 %. Time se na posljetku došlo do zaključka da tonzilektomija nema preventivnu ulogu kod infekcije s H. pylori
Evolution of Human Posture and Bipedal Locomotion Within a Provisional Time Frame of Harsh Climate Changes
No full textIn this review paper several emerging issues related to development of human posture and locomotion are arranged in a provisional time frame.
Accumulated evidences show that the Eurasian climate was often cold and arid with abundant dust in the atmosphere during the last 500 Ky. These dusty periods of cold, aridity and low insolation lasted from 360 to 340 Kya, 270 to 255 Kya, 170 to 130 Kya, 80 to 60 and finally 40 to 10 Kya. They coincide with migrations of Neanderthals and H. sapiens out of Africa, suggesting that harsh climates might have been important factors in forcing global migrations of our ancestors.
When reaching the middle Eurasian latitudes, with reduced sun exposure due to dusty atmosphere and no sea food, our ancestors developed a deficit of vitamin D with compromised locomotion of young individuals due to rickets. This problem of bone maturation made a strong selection pressure toward lighter skin pigmentation.
New evidences suggest that skin pigmentation genes in our genome came from the Neanderthals. They have survived several dusty periods, under the selection pressure of becoming pale skinned during their more than 400 Ky in Eurasia.
On the other hand, H. sapiens came much later from Africa. Long-legged modern men could easily chase smaller prays, while groups of slower Neanderthals proambushed larger prays. Fossil evidence suggests that both hominid species lived in the same areas for thousands of years, until the final survivors turned out to be mixed individuals, possibly of Caucasian phenotype although with pale skin genes inherited from their Neanderthal ancestors
Incidence of Type 1 Diabetes Mellitus in 0 to 14-yr-old Children in Croatia – 2004 to 2012 Study
No full textBACKGROUND: The incidence of type 1 diabetes mellitus (T1DM) among children and adolescents increased during the last 50 yr. The T1DM incidence in Croatia was 8.87/100.000/yr over 1995-2003, with an annual increase of 9%, which placed Croatia among countries with moderate risk for T1DM.
AIM: To investigate incidence rates and trends of T1DM from 2004 to 2012 in 0 to 14-yr-old Croatian children, and to compare the results with previous studies in Croatia and other European countries.
METHODS: T1DM crude incidence rates are estimated for the entire group and three subgroups: 0-4, 5-9, and 10-14 yr. Standardized incidence is calculated using the method of direct standardization according to World Health Organization (WHO) standard world population. The incidence rates by gender, age groups, seasonality, and calendar year, and their interactions were analyzed using Poisson regression model.
RESULTS: A total of 1066 cases were ascertained over 2004-2012. The standardized incidence was 17.23/100.000/yr (95% CI: 16.19-18.26), with no significant differences in incidence rates or trends between boys and girls. Statistically significant annual increase of 5.87% (p < 0.001) was found for the whole group, and for the subgroups 5-9 yr (6.82%; p < 0.001) and 10-14 yr (7.47%; p < 0.001). In the youngest subgroup (0-4 yr), annual increase was lower (2.43%; p = 0338) and not statistically significant.
CONCLUSION: The incidence of childhood T1DM is increasing in Croatia, thus placing Croatia among countries with high risk for T1DM. The annual increment of 5.87% is considerably lower than 9.0% reported earlier, but still higher than the European average (3.9%). The increase in incidence ceased in youngest children
Pathohistological Changes of Tracheal Epithelium in Laryngectomized Patients
No full textAbstract Total laryngectomy results in a permanent disconnection of the upper and lower airways. Thus, the upper airways are bypassed and can no longer condition, humidify, and filter the inhaled air, leading to damage of the tracheobronchial epithelium. There is little scientific information available about the effects of tracheostoma breathing and the degree of mucosal damage in laryngectomized patients. The aims of this study were to determine the histopathologic findings and investigate the potential impact of using a heat and moisture exchanger (HME) on the tracheal epithelium in long-term tracheostomy patients. Tracheal mucosal biopsies were taken from a total of 70 patients. Specimens were stained with hematoxylin and eosin and examined by a light microscope. Normal pseudostratified ciliated columnar epithelium was found in only 9 (12.9 %) cases; while, 17 (24.3 %) cases had some degree of basal cell hyperplasia. Squamous metaplasia was the most common finding (50 %). Pre-invasive lesions (mild and moderate squamous dysplasia) were found in only one patient who used an HME, and in eight (11.4 %) non-users. Although the HME cannot completely restore the physiological functions of the upper respiratory track, it delivers a better quality of air to the lower airways and has a positive effect on tracheal mucosa
The Investigation of Hereditary and Acquired Thrombophilia risk Factors in the Development of Complications in Pregnancy in Croatian Women
No full textOBJECTIVES: To investigate the genetic and acquired thrombophilic risk factors in pregnancy-associated complications and venous thromboembolism (VTE) and evaluate the association between particular thrombophilic risk factors and thromboembolic complications.
METHODS: In this study, pregnant women with pregnancy complications and VTE (N = 101) were the study group, and the control group were women with normal pregnancy (N = 102). All women underwent testing for factor V Leiden mutation (FVL), mutation of the coagulation factors II (FII20210), methylenetetrahydrofolate reductase (MTHFR), plasminogen activator inhibitor-1, antithrombin III (ATIII), protein C (PC) and protein S, lupus anticoagulant (LAC) antibodies, anticardiolipin antibodies and anti-beta-2-glycoprotein-1.
RESULTS: In this study group, mutations of the FVL was 15.8% (16/101), FII20210 5.9% (6/101) and the MTHFR at locus 677 was TT in 19.8% (20/101). Deficiency of ATIII and PC were rare: 3.0% and 1.0%, respectively. LAC were significantly higher in the study group than in the control group: 32.7% versus 3.9%; p < 0.0005. Pregnant women with VTE have been more frequent for FVL (41.7%; p < 0.005), PC deficiency (25.0%; p < 0.005) and LAC (33.3%; p < 0.005). Combination of FVL and MTHFR mutation was related to the risk of recurrent fetal death and habitual abortion.
CONCLUSION: The inherited and the acquired thrombophilic risk factors were found to be up to 10 times more common in the study group than in the control group