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Posttraumatic Stress Disorder and Orofacial Pain
No full textOd kronične orofacijalne boli često pate pacijenti s PTSP-om. Moramo istaknuti da se istodobno bilo koji patološki proces orofacijalnog područja može uplesti u emotivnu interpretaciju boli te kod takvih pacijenata potaknuti niz katastrofičnih reakcija povezanih sa simptomima iz skupine onih za posttraumatski stresni poremećaj. Tako izazvani bolni podražaji mogu se pojaviti i nakon što je primarno oštećenje prestalo djelovati i izazivati bol izvan anatomskog mjesta na kojemu se ozljeda dogodila. Kroničnu orofacijalnu bol i PTSP dijagnosticiramo na temelju subjektivnog iskaza, a to se redovito događa u kontekstu društvenih interakcija između pacijenata, liječnika, medicinskog osoblja ili istraživača, što otežava standardiziranje rezultata i uključuje mnoge kulturološke fenomene.Chronic orofacial pain occurs frequently in patients with posttraumatic stress disorder (PTSD) and at the same time any pathological process involving orofacial area can be reflected in emotional interpretation of pain and can trigger a series of reactions associated with the PTSD group of symptoms in patients with PTSD. Painful stimuli caused in this way may occur after the primary cause ceased, and because of convergence can cause referred pain outside of the anatomical site
where the primary injury occurred. Chronic orofacial pain and PTSD are diagnosed on the basis of subjective testimony and this regularly occurs in the context of social interaction between patients, doctors, medical staff or researchers making it difficult to standardize the results and introduces many cultural phenomena
Musculosceletal ultrasound: what are we looking at and what do we see
No full textThe aim of the presentation is to analyze pitfalls, limitations and artifacts in ultrasound imaging of the most commonly scanned parts of the musculoskeletal system that can lead to false positive and/or false negative diagnoses
Application of neurosonology in craniocervical artery dissection
No full textCraniocervical arterial dissections (CCAD) is a single etiology of ischemic stroke in young adults. They are being increasingly identified due to growing awareness of diverse clinical picture along with advances in imaging technologies
Ultrasound vascular markers for cognitive impairment and dementia
No full textIncreased aging of the population nowadays is connected with increased incidence of age-related diseases, primarily cardiovascular and cerebrovascular diseases (CVD) as well as dementia. It is well known that cognitive abilities mostly decline with age so different rates of cognitive impairment may be present in older individuals
Ultrazvučna aparatura, 2d i volumni ultrazvuk, artefakti ultrazvučne slike
No full textUltrazvučni val je mehanički val koji se u mekom tkivu širi longitudinalno prosječnom brzinom od 1540 m/sec. Ultrazvučni val nastaje deformacijom piezoelektričnog elementa ili pretvarača ultrazvučne sonde. Ultrazvučni se pretvarači proizvode od sintetičkog keramičkog kompozitnog materijala olovnog cirkonata titanata PZT
Ultrasound of the thyroid and neck
No full textThyroid nodules can be detected in more than 50% of adults, with higher frequencies in women and the elderly. The clinical importance of thyroid nodules lays in fact that cancer can occur in 5% to 15% of patients (pts), depending on age, gender, family history, radiation exposure history, and other factors
Uloga laparoskopije u liječenju raka jajnika
No full textLaparoscopy is usually undertaken in young women with adnexal disease that is believed to be benign, but found to be malignant at surgery. Some surgeons use laparascopy for staging, but mainly for presumed stage I or II ovarian cancer. Also, laparoscopy can be useful for selecting women who can be optimally debulked at primary surgery. There are some concerns about using laparoscopic approach in women with ovarian cancer: port-site metastasis, possibility of intraoperative rupture of tumor and effect of pneumoperitoneum. Studies showed that rate of port-site metastasis after laparoscopic surgery in women with ovarian cancer is low and usually occurs when there is peritoneal carcinomatosis or distant metastatic disease. Also, it seems that laparoscopy with CO(2) pneumoperitoneum does not reduce the overall survival in women with intraabdominal metastases. Preoperative rupture, surface capsular invasion and positive peritoneal cytology are more relevant in terms of prognosis than intraoperative rupture, but further research is needed. Conventional laparoscopy and robotic-assisted laparoscopy are comparable in both early and advanced disease. These approaches are not inferior to laparotomy and they are acceptable access in selected patients.Laparoskopija se najčešće koristi kod žena za koje se mislilo da imaju benignu bolest, ali se tijekom operacije ispostavilo da se radi o malignoj bolesti. Neki kirurzi koriste laparoskopski pristup za stupnjevanje bolesti i to najčešće za pretpostavljeni I ili II stadij. Također, laparoskopija može biti korisna za odabir žena kojima se može primarno napraviti „debulking“. Postoji nekoliko briga prilikom korištenja laparoskopskog pristupa: pojava metastaza na mjestu ulaska troakara, mogućnost intraoperacijske rupture tumora i učinak pneumoperitoneuma. Studije su pokazale da je udio metastaza na mjestu ulaska troakara nizak i da se najčešće javlja kod žena koje imaju karcinomatozu peritoneuma i udaljene metastaze. Također, čini se da laparoskopija s CO2 pneumoperitoneumom ne smanjuje ukupno preživljenje žena s intraabdominalnim metastazama. Preoperacijska ruptura, površinska invazija kapsule i pozitivan peritonealni ispirak su važniji za prognozu od intraoperacijske rupture, no daljnja istraživanja su potrebna. Konvencionalna i laparoskopija pomoću robota su usporedive i u ranoj i u proširenoj bolesti. Ovi pristupi nisu inferiorni laparotomiji i prihvatljivi su kod odabranih pacijenata
Ultrasonographic features of enlarged parathyroid glands
No full textTo evaluate the ultrasonographic features of enlarged parathyroid glands (PG) in patients (pts) with hyperparathyroidism
Comparison of sonographic features between papillary thyroid cancer ≥ 1 cm and micropapillary thyroid cancer
No full textThe objective of our study was to compare sonographic features of proven papillary thyroid cancer (PTC)≥1cm and PTC<1cm in size
(Re)habilitation guidelines for children with neurodevelopmental disorders
No full textSredišnji interes smjernica (re)habilitacije djece s neurorazvojnim poreme-ćajima jest identifikacija neurorizične djece. Neurorizična djeca nisu uvijek i djeca s neuromotoričkim odstupanjem. Neurorizična djeca čine 10 do 15% novorođenih. Kod 50% djece s neurorizikom dolazi do neurorazvojnog odstupanja s mogućim trajnim posljedicama. Smjernice (re)habilitacije djece s neurorazvojnim poremećajima temelje se na sljedećem: dječji fizijatar voditelj je programa (re)habilitacije; vrši rani probir novorođenčadi sa simptomima neurorizika (neuromotoričko odstupanje) u rodilištu; vrši procjenu spontane motorike, aktivnih pokreta, kvalitativnu analizu općih pokreta, procjenu mišićne snage i tonusa, palpaciju i ispitivanje pasivne pokretljivosti, refleksa; testiranje po Vojta principu; vrši testiranja pomoću dijagnostičkih testova. Isključivo dječji fizijatar indicira kojim će kineziterapijskim postupkom dijete biti stimulirano; donosi odluku o provođenju ambulantnog i stacionarnog liječenja; prema potrebi uključuje logopeda, defektologa, psihologa i drugih specijalista u tim. Zbog nepostojanja subspecijalizacije iz dječje (re)habilitacije, kazuistikom tog područja trebaju se baviti fizijatri koji imaju radnog iskustva u navedenom području minimalno 5 godina ili završen tečaj iz Bobath koncepta ili Vojta principa. Potrebno je uvođenje adekvatne nomenklature za određene neurorazvojne poremećaje vezano za samu patologiju bolesti i dob kada se pojavljuje. Neuromotoričko odstupanje treba se identificirati na prvom pregledu i pri svakom kontrolnom pregledu evaluirati radi li se o 1. vrlo blagom, 2. blagom, 3. umjerenom ili 4. teškom odstupanju, te shodno nalazu primijeniti adekvatnu stimulaciju. Stoga predlažemo da u DTS postupnik uvrstimo dvije nove vodeće dijagnoze Neuromotoričko odstupanje i Neurorizično dijete. koje bi bile indikacijama za stacionarno liječenje, a obračunavale bi se jednakovrijedno kao već postojeće Distoni sindrom i Parapareza. Klinička slika neuromotoričkog odstupanja može se brže ili sporije mijenjati jer je ovisna o maturaciji, neuroplasticitetu i primijenjenim terapijskim postupcima. Pristigao je potvrdan odgovor iz HZJZ za pokretanje Nacionalnog registra neurorizične djece, putem kojeg bi se organizirano i stručno pratila djeca, što ne bi isključivalo mogućnost da koordinator bude dječji fizijatar.The central interest of (re)habilitation guidelines for children with neurodevelopmental disorders is to identify children at neurorisk. Children at neurorisk are not always children with neurodevelopmental disorders. Those children make 10 to 15% of newborns. About 50% of children at neurorisk might develop potential disorder with lasting consequences. (Re)habilitation guidelines for children with neurodevelopmental disorders are based on the following: children’s physiatrist is the head of the (re)habilitation program; he or she performs early screening of newborns with symptoms of neurorisk in the maternity ward; evaluates spontaneous and active movements, provides qualitative analysis of the general movements, does assessment of muscle strength and tone, performs palpation and testing passive mobility, reflexes; performs diagnostics by Vojta principle; evaluates using other diagnostic tests. Only a children’s physiatrist indicates specific kinesiotherapeutic procedure for stimulation; makes a decision on the implementation of ambulatory and stationary treatment; if necessary, a defectologist, speech therapist, psychologist and other specialists are included in the team. Due to the absence of subspecialisation in children’s (re)habilitation, the casuistry of the area should be address by a physiatrist who has experience in this area for at least 5 years or certificate in Bobath concept or Vojta principle course. It is necessary to maintain appropriate nomenclature for certain neuromotoric disorders related to the varying pathology disease and age when it occurs. Neurodevelopmental disorder should be identified at baseline and at each follow-up examination to evaluate whether it is a 1) very mild, 2) mild, 3) moderate or 4) severe disorder, and according to the findings apply adequate stimulation. Therefore, we suggest that the DTS checklist admit two new leading diagnosis: neurodevelopmental disorder and child at neurorisk, which would be the indication for inpatient treatment, and accounted equally as existing dystonia syndrome and paraparesis. The clinical presentation of neurodevelopmental disorders can change slowly or rapidly, because of its dependenence upon maturation, neuroplasticity and applied therapeutic procedures. To sum up, we received a positive answer from HZJZ for the launch of the National register of children at neurorisk, through which children would be monitored in a professional and organized manner, which would not exclude the possibility that its coordinator might be a children’s physiatrist