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Radiological Diagnostics of Tumors of the Musculoskeletal System
No full textNovotvorevina, neoplazma (grč. neos- nov, plasia – rast) ili tumor ( lat. tumor – oteklina) patološka je tvorba nastala kao posljedica prekomjernog umnažanja abnormalnih stanica. Novotvorevine mogu biti dobroćudne (benigne) i zloćudne (maligne). Tumori kostiju mogu nastati od različitih vrsta tkiva koja sudjeluju u građi kosti. Velik broj histološki i biološki različitih oblika tumora kostiju znatno otežavaju njihovo prepoznavanje. Većina tumora mekih tkiva se pojavljuje sporadično i etiologija ostaje nepoznata. Radiološka dijagnoza ima ključnu ulogu u otkrivanju, stupnjevanju i praćenju bolesnika s malignim tumorima. U svrhu definiranja stupnja lokalne, regionalne i sustavne proširenosti, za različite tumore koristimo različite dijagnostičke pretrage. U dijagnostičke pretrage koje koristimo u onkologiji nam spadaju: konvencionalna radiologija, ultrazvučna dijagnostika, kompjuterizirana tomografija, magnetna rezonancija, nuklearno-medicinske metode, pozitronska emisijska tomografija (PET/CT) i intervencijska radiologija. Rendgenska slika, u dvjema projekcijama, je zapravo prvo detaljnije prikazivanje tumorskog procesa. Klasična radiološka obrada bi trebala obuhvatiti cijelu kost, a može se nadopuniti slojevnim snimkama koje nam omogućuju kvalitetniju analizu koštane strukture. Ultrazvučna dijagnostika nam može pomoći u otkrivanju, lokalizaciji i parcijalnoj karakterizaciji površinskih tumora mekih tkiva, a njime možemo procjeniti i vaskularizaciju tumora. Kompjuterizirana tomografija je jedna od temeljnih dijagnostičkih metoda u onkologiji jer daje informacije o lokalizaciji i veličini tumorskog procesa te informacije o njegovom odnosu prema okolnim strukturama. Zbog velikog kontrasta mekih tkiva i mogućnosti multiplanarne rekonstrukcije, MRI je često najbolji odabir kod lokalnog stupnjevanja tumorskog procesa. Nuklearno-medicinske metode mogu se primjenjivati u detekciji malignih tumora svih organa i organskih sustava. Načela scintigrafske detekcije tumora temelje se na razlici u sposobnosti nakupljanja radiofarmaka između normalnog i tumorskog tkiva. PET/CT je metoda kojom se pomoću radiofarmaka prikazuje funkcionalno stanje tkiva i organa, odnosno metabolička aktivnost stanica. To je najosjetljivija molekularna slikovna metoda današnjice, te je standardna metoda u praćenju bolesnika s različitim tumorima. Intervencijska radiologija se bavi dijagnostikom i intervencijom širokog spektra različitih poremećaja koristeći pri tome minimalno invazivne postupke.Neoplasm (from Ancient Greek neos- new, plasia – creation) or tumor (lat. tumor – swelling) is pathological formation resulting from excessive multiplication of abnormal cells. A neoplasm can be benign or malignant. Bone tumors may arise from different types of tissues involved in the bone structure. Large number of histological and biological different forms of bone tumors considerably complicates their recognition. Most soft tissues tumors occur sporadically and etiology remains unknown. Radiological diagnosis plays a key role in the discovery, classification and monitoring of patients with malignant tumors. In order to define the degree of local, regional and systemic spread of tumor, for various tumors we use different diagnostic examinations. The diagnostic examinations used in oncology include: conventional radiology, ultrasound, computed tomography, magnetic resonance imaging, nuclear-medical methods, positron emission tomography (PET/CT) and interventional radiology. X-ray image, in two projections will actually be the first detailed presentation of tumor process. Classical radiological evaluation should cover the whole bone, and can be complemented by layering images that allow us better analysis of bone structure. Ultrasound diagnosis can help in the detection, localization and partial characterization of surface soft tissues tumors, and it can evaluate its vascularization. Computed tomography is one of the basic diagnostic methods in oncology because it gives information about the location and size of a tumor process, and information about its relation to surrounding structures. Due to the high soft tissue contrast and multiplanar reconstruction capabilities, MRI is often the best choice in local tumor staging process. Nuclear-medical methods can be applied in the detection of malignant tumors of all organs and systems. The principles of scintigraphic detection of the tumor are based on the difference in the ability of radiopharmaceutical accumulation between normal and tumor tissue. PET/CT is the method of using radiopharmaceutical in order to show the functional state of tissues and organs, and metabolic activity of cells. It is the most sensitive molecular imaging method nowadays, and is the standard method in monitoring patients with various tumors. Interventional radiology deals with diagnosis and intervention of a wide range of different disorders, using minimally invasive procedures
Influence of Patient Positioning on Number and Type of Artifacts in Combined Morphological and Metabolic Imaging
No full textU ovom radu opisani su glavni principi rada morfološko-metaboličkih snimanja, navedene su trenutne preporuke za protokole snimanja, opisana je uloga radiološkog tehnologa u PET/CT dijagnostici te ispitani utjecaji namještanja bolesnika za pretragu PET/CT-om.
Artefakti PET/CT slike mogu predstavljati značajan problem u interpretaciji nalaza, stoga ih je potrebno prepoznati te poznavati način njihovog nastanka.
Detaljno su opisani uzroci nastanka artefakata, te načini kako spriječiti njihov nastanak s posebnim osvrtom na ulogu radiološkog tehnologa.
Uz tehnološka ograničenja i varijabilno zdravstveno stanje pacijenta, ponekad je nemoguće izbjeći pojavu artefakata na slici, ali se može i treba nastojati svesti njihovu pojavnost na što manji broj.In this study, the main principles of combined morphological-metabolic imaging methods are described as well as current recommendations for imaging protocol, the role of radiologic technologist in PET/CT diagnostics and the impacts of patient positioning for PET/CT imaging.
Artifacts on PET/CT images can present an significant problem in interpretation of medical reports, therefore it is necessary to recognize them and to know the ways of their occurrence.
The causes of apearence of artifacts on images are described in detail, as well as the ways to prevent their incidence with special focus on the role of radiologic technologist. Considering the complexity and significance of this diagnostic procedure, it's important to have a quality approach to the work.
With technological constraints and variable health condition of the patient, sometimes it is impossible to avoid artifacts on image, but it may be and should be reduced as much as possible
PHYSICAL THERAPY ASSESSMENT OF MUSCLE DYSFUNCTION AND REHABILITATION FOR PATIENTS WITH MYASTHENIA GRAVIS
Full text linkMiastenija gravis je autoimuna bolest neuromuskularne spojnice, kod koje dolazi do blokade prijenosa impulsa sa živca na mišić što dovodi do slabe mišićne kontrakcije. Pojavljuje se kod osoba svih dobnih skupina. Najčešći simptomi su ptoza oka, dvoslike, slabost mišića lica, padanje donje čeljusti, slabosti mišića udova te poteškoće u govoru, gutanju, žvakanju i disanju. Svi simptomi su najizraženiji u poslijepodnevnim i večernjim satima, a najblaži su ujutro. Miastenička kriza je najteži oblik, gdje dolazi do slabosti mišića, posebno respiratornih i to stanje je opasno po život. U liječenju se primjenjuju blokatori kolinestreaze kao što su piridostigminbromid, kortikosteroidi i imunosupersivi poput ciklosporina i azatropina. Plazmafereza se uvodi kod pogoršanja bolesti. Timektomija je operativno odstranjivanje timusa, ako je potrebno. Rehabilitacija je uz pravovremeno dijagnosticiranje i liječenje od neprocjenjive važnosti kod osposobljavanja za neovisan život i podizanje kvalitete životaMyasthenia gravis is an autoimmune disease of neuromuscular junctions, which leads to blocking transmission of impulses from nerve to muscle, leading to poor muscle contraction. It happens to people of all ages. The most common symptoms are ptosis eye, double vision, muscle weakness of the face, falling lower jaw, muscle weakness of the limbs, and difficulties with speech, swallowing, chewing and breathing. All symptoms are most pronounced in the afternoon and evening, the mildest symptoms happen in the morning.. Miastenic crisis is the most severe form, which leads to muscle weakness, especially respiratory and this condition is life threatening. The treatment is applied: kolinestreaze blockers such as piridostigminbromid, such as corticosteroids and cyclosporin and imunosupersivi azatropina. Plasmapheresis is introduced with worsening disease. Thymectomy is surgically removing the thymus, if necessary. Rehabilitation is a timely diagnosis and treatment is invaluable in training for independent living and quality of life
THE ROLE OF PHYSICAL THERAPISTS IN REHABILITATION AFTER MITRAL VALVE REOPERATION - CASE STUDY
Full text linkRazlikujemo stečene i prirođene srčane greške.
Sve srčane greške koje nastaju kao posljedica bolesti zalistaka, kao i sve druge koje čovjek stekne u tijeku života, nazivamo stečene srčane greške. Srčane greške s kojima se čovjek rodi nazivaju se prirođene ili urođene srčane greške.
Srčane greške koje se javljaju na mitralnom zalisku su mitralna stenoza, mitralna insuficijencija, prolaps mitralnog zaliska i miješana mitralna bolest.
Navedene srčane greške dijagnosticiramo elektrokardiografijom, rendgenogramom, ehokardiografijom, te kateterizacijom srca i angiokardiografijom. Liječenje svih bolesti mitralnog zaliska može biti medikamentozno, te kirurško. Prije i nakon kirurškog liječenja vrlo je bitna rehabilitacija bolesnika. Fizioterapeutski preoperativni postupci obuhvaćaju procjenu kroz fizioterapeutski karton i edukaciju bolesnika, dok u postoperativnoj fazi koristimo različite tehnike poput dijafragmalnog disanja, CLINFLO aparata, položajne drenaže, pozicioniranja pacijenata u krevetu, vježbi cirkulacije, perkusije, vibracije i inhalacijske terapije.
Za uspješnu rehabilitaciju pored fizioterapeutskih znanja i vještina, najvažnija je aktivna suradnja s bolesnikom, jer ga tako možemo maksimalno rehabilitirati i pripremiti za aktivnosti svakodnevnog života.We discriminate acquired and congenital heart disease.
All heart defects that arise as a result of valvular disease, as well as any others that we may acquire in the course of life, we call acquired heart defects. Cardiac diseases with which man is born are called congenital heart defects.
Heart defects that occur in the mitral valve are mitral stenosis, mitral regurgitation, mitral valve prolapse and mixed mitral disease.
These heart defects could be diagnosed by electrocardiography, x-ray, echocardiography, and cardiac catheterization and angiocardiography. The treatment of mitral valve disease may be hormonal and surgical. Before and after surgical treatment is very important to rehabilitate the patient. Physiotherapy preoperative procedures include assessment through physiotherapy card and patient education, while in the post-operative phase we use various techniques such as inferior breathing, apparatus CLINFLO, positional drainage, positioning patients in bed, circulation excercises, percussion, vibration and inhalation therapy.
For successful rehabilitation physiotherapy in addition to knowledge and skills, the most important is active cooperation with the patient, because like that we can rehabilitate maximum and prepare for activities of daily living
The Use of Contrast Agents in Radiology
No full textSvrha primjene kontrastnih sredstava je pojačati i poboljšati dijagnostičke informacije kod slikovnih prikaza anatomije i patologije organskih sustava. Kontrastna sredstva uvelike sudjeluju u proračunu radiologije jer se radi o materijalu koji se svakodnevno koristi u velikim količinama, posebice kod CT pretraga i angiografija te u intervencijskoj radiologiji. Kontrastna sredstva u konvencionalnoj radiologiji i CT dijagnostici se razlikuju od kontrastnih sredstava u magnetnoj rezonanciji i ultrazvučnoj dijagnostici zbog načina rada samih uređaja. Izuzetno je važno poznavati indikacije za primjenu kontrastnih sredstava kako bi njihova primjena bila optimalna, a samim time i reducirale potencijalne mogućnosti nastanka alergijskih reakcija odnosno drugih neželjenih komplikacija.The purpose of the application of contrast agents is to strenghten and improve the diagnostic information with illustrations of the anatomy and pathology of organ systems. Contrast agents participate in the radiology budget because it is a material that is used daily in large quantities, especially for CT scans and interventional radiology.Contrast agentsin conventionalradiologyand CT diagnostics are different from contrast agents inmagnetic resonance imaging and ultrasound diagnostics because of the different modes of the devices. It is important to know the indications for the use of contrast agents so that their use was optimal, and reduced the potential possibilities of allergic reactions or other unwanted complications
Abnormalities of the Second Stage of Labor and Birth Injury
No full textPorođaj je niz mehaničkih i fizioloških procesa prilikom kojih se rodilja oslobađa svih pet elemenata trudnoće (ploda, posteljice, pupkovine, plodovih ovoja i plodove vode) vaginalnim putem. Porođaj se dijeli u četiri stadija, odnosno porođajna doba. U ovom radu opisane su nepravilnosti drugog porođajnog doba.
Drugo porođajno doba je doba istiskivanja (izgona) djeteta. Komplikacije koje nastaju su posljedica nepravilnosti temeljnih čimbenika u mehanizmu rađanja a to su: nepravilne kontrakcije-trudovi, porođajni kanal, nepravilnosti stava, rotacije i položaja kao i porođajne ozljede majke i djeteta. Nsjčešći položaj čeda u majčinoj zdjelici neposredno prije rođenja je dorzoanteriorni okcipitalni stav, sa zatiljkom u izlazu zdjelice i licem djeteta prema majčinim leđima. Taj stav omogućuje najlakši prolaz djeteta kroz porođajni kanal. Dijete može biti i u jednom od nekoliko drugih (nepravilnih) stavova koji mogu uzrokovati produljeni porođaj i ozljede majke i djeteta.
Ozljede novorođenčadi prilikom porođaja u najvećem broju su bezopasne, ne ostavljaju trajne posljedice i obično ne zahtijevaju posebne terapijske postupke. Najčešća su potkožna krvarenja, fraktura (lom) ključne kosti, kefalhematom, prolazna oštećenja facijalnog (ličnog) i brahijalnog (ručnog) živca. Porođajne ozljede majke su: razdor međice (ruptura perinei), razdor stidnice (ruptura vulvae) i razdor maternice (ruptura uteri).Childbirth is a succession of mechanical and physiological processes during which five elements of pregnancy are released vaginally. These elements include fetus, placenta, umbilical cord, fetal membranes and amniotic liquid. The process of labor and birth is divided into four stages. This paper deals with irregularities of second childbirth.
The second stage is the process of fetal expulsion. The complications that arise as the consequences of irregularities of fundamental factors in birth are as follows: irregular contractions, birth canal, irregular posture, rotation and position, as well as birth traumas. Occipitoanterior position of an infant in mother’s pelvis just before the birth is ideal for birth. Toward the end of pregnancy, the fetus moves into the most common position for delivery, occipital anterior, which means that fetus is head down, facing mother’s back. This position is ideal for birth as it eases the delivery through the birth canal. Several other (irregular) positions of an infant may occur and they may lead to prolonged delivery or birth traumas.
Birth traumas are mostly riskless, cause no permanent consequences and thus, there is no need for therapeutic procedures. However, some birth traumas may occur and the most common ones are subcutaneous haemorrhage, clavicular fracture, cephalhematoma, transitory facial nerve damage (nervus facialis) and brachial nerve damage (nervus brachialis). A mother may have birth traumas such as perineal rupture (ruptura perinei), vulvar rupture (ruptura vulvae) and uterus rupture (ruptura uteri)
Types and Mechanisms of Cell Damage by Ionizing Radiation
No full textPrilikom prolaska zračenja kroz materiju dolazi do njihova međudjelovanja i kao posljedica mijenjaju se svojstva zračenja i materije. Ionizacija atoma najznačajniji je učinak zračenja te ga stoga nazivamo ionizirajuće zračenje. Izravna ionizacija nastaje kada električki nabijene čestice ili fotoni iz neutralnog atoma izbace elektron. Rezultat tog izbacivanja su slobodni negativni elektron i pozitivno nabijeni atom. Posredna ionizacija nastaje kada neutralne čestice ili fotoni iz atoma izbace elektron, a taj elektron ima dovoljno energije da dalje ionizira atome. Pokazatelj stupnja ionizacije je broj ioniziranih parova stvorenih po duljini puta čestice ili fotona koji prolazi kroz određenu materiju. Prolaskom elektromagnetskog zračenja kroz materiju najčešće dolazi do fotoelektričnog efekta, Comptonovog efekta i tvorbe parova elektron-pozitron. Fotoelektrični efekt je pojava u kojoj foton, čija je energija veća od energije vezivanja elektrona u atomu, preda svu energiju elektronu, čime elektron napušta atom, a foton prestaje postojati. Comptonov efekt je pojava pri kojoj foton predaje samo dio svoje energije elektronu i nastavlja daljnji put manje energetske vrijednosti. Tvorba para elektron-pozitron jest pojava koja nastaje samo ako je energija fotona veća od 1,02 MeV. Prodre li takav foton do jezgre atoma, u njezinoj blizini pretvori se u dvije čestice – u elektron i u pozitron. Nakon vrlo kratkog vremena, nastali se pozitron spaja s nekim od elektrona iz okoline i pritom nestaju obje čestice, a nastaju dva fotona suprotnih smjerova gibanja. Vjerojatnost pojavljivanja jedne od navedenih pojava ovisi o energiji upadnog fotona i čestice. Pri niskim energijama događa se uglavnom fotoelektrični efekt, pri višim energijama fotona prevladava Comptonov efekt, a pri energijama većima od oko 5 MeV prevladava tvorba parova.
Učinci ionizirajućeg zračenja na organizam mogu nastati direktnim djelovanjem na molekule organizma ili indirektnim putem djelujući na molekule vode (radioliza) čiji slobodni radikali štetno djeluju na druge molekule tijela. Oštećenja i simptomi iradijacije mogu se manifestirati ubrzo nakon izlaganja zračenju ili nakon određenog perioda. Zračenje može izazvati kancerogenezu, leukemogena oštećenja, teratogena i genska oštećenja. Određene bolesti mogu nastati akumuliranjem zračenja kroz mnogobrojna snimanja, a pri tom se ozračene stanice nisu uspjele oporaviti, ili oštećenja mogu nastati pri neznatnim dozama, ali dovoljno velikima da utječu na normalan rast i razmnožavanje stanice. Najosjetljivije su stanice koje se brzo dijele i koje nisu dobro diferencirane.
Ionizirajuće zračenje treba koristiti oprezno, profesionalno i savjesno, imajući u vidu što bolju zaštitu svih izloženih. Postoje mnogobrojne organizacije, zakoni i principi koji ukazuju na potrebe pažljivog rukovanja radiološkim uređajima. Profesionalno osoblje treba educirati bolesnike o mogućim rizicima izlaganja ionizacijskim zračenjima i izvorima zračenja. Posebna kategorija zaštite su trudnice i mala djeca kod kojih najmanje doze zračenja mogu biti jako opasne. Stanovništvo je stalno izloženo zračenju jer je ono prisutno u mnogobrojnim prirodnim izvorima, ali možemo smanjiti sveukupnu primljenu dozu smanjivanjem neopravdanih izlaganja radiološkim dijagnostičkim i terapijskim pretragama, uzimajući u obzir opravdanost i objektivnu potrebu za pretragom u odnosu na štetnost i opasnost od zračenja.During the passage of radiation through matter comes to their interactions, which resulted in changing the properties of matter and radiation. Ionization of atoms is the most important effect which is caused by the radiation, so it is called ionizing radiation. Direct ionization occurs when electrically charged particles or photons from neutral atoms remove an electron. The result of this expulsion are free negative electrons and positively charged atoms. Indirect ionization occurs when neutral particles or photons from atoms remove an electron and the electron has enough energy to further ionize atoms. Indicator of the degree of ionization is the number of ionized pairs created by the particles or photons passing through a particular matter. During passage of electromagnetic radiation through the matter usually couses photoelectric effect, Compton effect and the formation of electron-positron pairs. Photoelectric effect is phenomenon which can appear when energy of radiaton photon is greater than the binding energy of electrons in atom. Photon emits all the energy to the electron, thus the electron leaves the atom and the photon stop to exist. Compton effect is a phenomenon in which a photon transmit only part of its energy to an electron, and continues to go further with another direction and with less energy values. The formation of an electron-positron pair is a phenomenon that occurs only if the photon energy is greater than 1.2 MeV. In case where photon penetrat to the nucleus, in its vicinity turns into two particles - electrons and positrons. After a very short time, the positron combines with some of the electrons from the environment and thereby both particles disappear. As a result of their disappearance two photons with opposite directions of motion are formed. The probability of occurrence of one of these phenomena depend on the energy of the incident photons and particles. At low energies occurs mainly photoelectric effect, Compton effect dominated at higher photon energies, and at photon energies greater than about 5 MeV predominant is formation of pairs. Effects of ionizing radiation on the human body can occur by direct action on the macromolecules of the body or by indirectly acting on the molecules of water (radiolysis) whose free harmful radicals damage other molecules of the body. Irradiation damage and symptoms can manifest soon after radiation exposure or after a longer period. Radiation can cause carcinogenesis, leukemias damage, teratogenic and genetic damage. Some diseases can be caused by the accumulating of radiation through numerous exposures, in which irradiated cells failed to recover. Also, damage may appear as a result of minor doses, but those doses are large enough to affect the normal growth of cells and their multiplications. Most sensitive cells are not well differentiated and those which reproduce rapidly.
Ionizing radiation should be used carefully, professionally and conscientiously, bearing in mind protection for all who are exposed. There are many organizations, laws and principles that indicate the importance of careful handling with radiological devices. Professional staff should educate patients about the potential risks caused by ionizing radiation and radioactive sources. Special categories of protection are pregnant women and young children for whome the smallest doses of radiation can be very dangerous. The population is constantly exposed to radiation because it is present in many natural resources, but we can reduce the overall recived doses by reducing unjustified exposure to radiological diagnostic and therapeutic procedures, taking into account the objective justification and need for examination in relation to the harm and danger of radiation