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Cerebellopontine angle tumors
No full textTumori pontocerebelarnog kuta čine gotovo desetinu svih intrakranijskih tumora. Zbog određenih značajki u kliničkoj slici i pristupu u liječenju, ove će tumore mnogi autori svrstati u zajedničku skupinu patologije u neurokirurgiji. Ove lezije predstavljaju poseban izazov u dijagnostici i kirurškom liječenju zbog specifičnog anatomskog smještaja i vrlo raznolike etiologije. Unatoč svojoj kompleksnosti, a sukladno rezultatima najnovijih kliničkih istraživanja, u modernoj neurokirurgiji očekuje se uspješno prepoznavanje kao i praćenje progresije lezija pontocerebelarnog kuta na temelju kliničke slike i visoko specifičnih neuroradioloških i drugih metoda diferencijalne dijagnostike. U konačnici kirurško liječenje dovodi do niskog morbiditeta i zanemarivog mortaliteta operiranih bolesnika.Cerebellopontine angle tumors comprise almost 10 % of all intracranial tumors.
Due to their distinct clinical features and therapy approaches these tumors are listed within
the same neurosurgery pathological group. Such lesions represent a unique challenge in diagnostics
and surgical treatment which reflects their specific anatomic position and a large variety in etiology.
Despite the complexity of such tumors the most recent clinical research studies indicate
that modern neurosurgery can provide successful recognition and monitoring of cerebellopontine
angle lesion progression based on the clinical features and highly specific neuroradiological
and other diagnostic methods. Surgical treatment results in low morbidity and
minimal mortality rate of patients going through such surgery
Computer supported thermography monitoring of hand strength evaluation by electronic dynamometer in rheumatoid arthritis – a pilot study
No full textThis paper describes the implementation of a new dynamometer system with thermography monitoring of heat dissipation, and the implications of this new system in physiatry, rheumatology and neurology. The system includes a single data processing algorithm and the concept of motor hand function evaluation involving the determination of quantitative indicators. In rehabilitation medicine, muscle function is assessed during the physical examination of a patient. Although a simple computer- supported approved dynamometer instrument improves the assessment of static strength, it is rarely used in clinical practice where dynamic measurements are preferred. A computer-assisted electronic dynamometer has been developed to enable a clinician to measure dynamic muscle function in standardized manner. Dynamometer comprises a force transducer and a movement transducer interfaced to a personal computer. In the study, dynamic measurement protocols were used that are based on biomechanical analysis. During the execution of test exercise used the method of thermographic recording of heat dissipation using dedicated software for analysis of characteristic parameters. The results obtained showed the possibility of objectification biomechanical properties and heat dissipative characteristics of the hand. The results of data analysis from calculated characteristic parameters show the correlation with patients’ clinical status, i.e. the motor status of the hand and efficiency of temperature monitoring (standard deviation 0.92.). From the results of this pilot-study it can be concluded that computer supported dynamometer might be suitable for use in diagnostics in physical and rehabilitation medicine, possibly in conjunction with thermography. Further studies on larger numbers of participants are needed to evaluate these preliminary results
Potpuno iščezavanje medikamentno tvrdokorne epilepsije temporalnog režnja nakon fenestracije arahnoidne ciste
No full textIntracranial arachnoid cysts are congenital lesions that are frequently detected incidentally. About 30% of patients have a symptomatic epileptic seizure as the presenting symptom, occasionally with other focal neurologic signs. A case is presented of a young male patient with medically refractory temporal lobe epilepsy. Following his neurological examination, epileptic zone was defined in the right temporal lobe that correlated with the MRI-detected sylvian arachnoid cyst. Microneurosurgical cyst fenestration with volume reduction was performed, which resulted in a decremental but eventually complete seizure freedom. In conclusion, the arachnoid microsurgical cyst reduction is a safe procedure and may result in complete remission of symptomatic epileptic seizures and favorable outcomes, as reported in other studies.Intrakranijske arahnoidne ciste su prirođena oštećenja koja se često otkrivaju slučajno. U oko 30% bolesnika manifestiraju se simptomatskim epileptičnim konvulzijama, ponekad i uz druge žarišne neurološke znakove. Prikazuje se slučaj mladog muškog bolesnika s medicinski refraktornom epilepsijom temporalnog režnja. Nakon neurološkog pregleda epileptična zona je definirana u desnom temporalnom režnju, što je koreliralo s arahnoidnom cistom Sylvianove fisure otkrivenom magnetskom rezonancijom. Izvedena je mikroneurokirurška fenestracija ciste sa smanjenjem volumena, što je rezultiralo ublažavanjem i na kraju potpunim izostankom konvulzija. Zaključuje se kako je mikrokirurško smanjenje ciste siguran zahvat koji može dovesti do potpune remisije simptomatskih epileptičnih napadaja i dobrog ishoda, kao što izvještavaju i autori drugih studija
Guidelines for the treatment of chronic wounds
No full textNajčešće vrste kroničnih rana su rane na donjim ekstremitetima dijabetičara (dijabetičko stopalo), ulkusi u bolesnika sa smetnjama venske odnosno arterijske cirkulacije (venski i arterijski ulkusi), rane zbog pritiska (dekubitus), kronične postraumatske rane, odnosno kronične rane nakon kirurških zahvata, te kronični postiradijacijski ulkusi. Najčešći uzrok kroničnog potkoljeničnog ulkusa je kronična venska insuficijencija i periferna arterijska bolest. Komplicirano dijabetičko stopalo je najveći uzrok netraumatskih amputacija. Uz poznavanje dijagnostike i odgovarajućeg kirurškog liječenja uzroka kronične rane, potrebno je i poznavanje rekonstrukcijskih modaliteta defekta koji nastaje nakon obavezno učinjenog debridmana. U obzir dolazi pokrivanje defekta slobodnim kožnim transplantatom, lokalnim fasciokutanim i mišićnim režnjevima, kao i slobodnim fasciokutanim, kutanim i mišićno-kutanim, odnosno mišićnim režnjevima. Postoje i drugi oblici tretiranja defekata primjenom negativnog tlaka, posebnih obloga, rasteretne obuće, hiperbarične oksigenoterapije kao i primjene zamjenskih oblika kožnog pokrova (faktori rasta, matične stanice). S ciljem maksimalnih funkcionalnih i rekonstrukcijskih rezultata, multidisciplinarni i «holistički» pristup ima vodeću ulogu u modernom konceptu liječenja kroničnih rana.The leading causes of chronic wounds are diabetic foot, chronic venous insufficiency and peripheral arterial disease (chronic leg ulcers), wounds due to pressure (pressure sores), chronic post traumatic wounds, chronic post surgical and chronic postirradiation ulcers. The leading causes of chronic leg ulcers are chronic venous insufficiency and peripheral arterial disease. Diabetic foot ulcers are the single biggest risk factor for nontraumatic foot amputations. Understanding the pathophysiology of chronic wound formation is the basis for appropriate treatment and healing. Antibiotic therapy is necessary for virtually all infected wounds, but it is often insufficient without appropriate wound care. After adequate surgical debridement, reconstructive options are split thickness skin graft, local cutaneous and muscle flap, and fasciocutaneous free flaps in strongly selective cases. Other treatment modalities include topical negative pressure device, special dressings, hyperbaric oxygen therapy, off-loading regimens, and advanced tissue replacement possibilities (growth factors, cellular therapy). For maximal functional and reconstructive results, multidisciplinary and holistic approach in the treatment of chronic wounds has the leading role in the modern concept of wound healing
Obesity Treatment Using a Bioenterics Intragastric Balloon (BIB)—Preliminary Croatian Results
No full textAim of Study: This study aims to assess the effectiveness, tolerance, safety, and patient satisfaction of obesity treatments using the Bioenterics intragastric balloon (BIB). Methods: Prospective controlled trial of 33 obese patients who were treated with the BIB from March 2008 to March 2009 and who completed the 6 months treatment. Patients were selected on the basis of workup by a multidisciplinary team. The 33 obese patients (26 females, seven males) had a median age of 35 years (range 20–58). Their median baseline body weight (BW) was 114 kg (range 89–197) and their median body mass index (BMI) was 41.4 kg/m2 (range 31.2–60.8). Results: Average weight reduction was 14 kg (range 2–37), loss total weight 10.1% (range 1.4–23.1), control BMI
35.6 kg/m2 (range 29.4–50.3), delta BMI 4.5 (range 0.6– 13.1), percentage excess weight loss 29.2 (range 2.8–53.6), and percent of excess BMI loss 29.3 (range 2.7–67.4). In one female patient the BIB was removed early due to intolerance. During the first week, minor side effects were noticed: nausea/vomiting occurred in 21 patients (63.6%), and abdominal cramps in 15 (45.5%). There was one balloon deflation and one impaction in the stomach. Those incidents were both successfully treated endoscopically. Patients had no major complications from mucosal lesions and no need for surgical interventions. All intragastric
balloons were successfully removed endoscopically. Patients’ treatment satisfaction correlated with the degree of BW loss (p=0.0138). Conclusion: BIB treatment in our setting showed the best results for individuals with BMI from 35 to 40 kg/m2. Our
preliminary results showed that BIB is safe, well tolerated with minor side effects, and alters quality of life for the better. The complication rate was negligible, due to the detailed pretreatment examinations and follow-up
Aplastic Crisis Induced by Human Parvovirus B19 as an Initial Presentation of Hereditary Spherocytosis
No full textThe association between aplastic crisis and human parvovirus (HPV) B19 infection has been described in patients with hereditary spherocytosis (HS). Most cases of aplastic crisis in patients with HS induced by HPV B19 have been reported in children and adolescents. In this paper, we describe an aplastic crisis induced by HPV B19 in the 34 year old female as an initial presentation of HS. Although other viral illnesses cause some decompensation in HS, the anemia is rarely as profound as seen in acute HPV B19 infections
Doppler Ultrasound of Hepatic and System Hemodynamics in Patients with Alcoholic Liver Cirrhosis
No full textObjective: The progression of liver cirrhosis eventually increases cardiac output, while blood pressure and systemic vascular resistance are reduced. A complex behavior of portal hemodynamic to hepatic artery and system circulation has not yet been presented. There is a lack in knowledge about the correlation of local and systemic circulation parameters to the degree of liver failure, with respect to presence of ascites and esophageal varices.
Patients and Methods: The study sample was 76 patients hospitalized for established alcoholic liver cirrhosis. Patients were divided into groups according to Child-Pugh clinical score; grade A (n = 24), B (n = 18) and C (n = 18). Ascites was found in 28 patients and esophageal varices in 46. Portal vein flow velocity (PVFV), hepatic artery resistance index (HARI), heart and great vessels within mediastinal cavity were assessed with ultrasound devices equipped with spectral Doppler.
Results: Significant differences in mean blood pressure, systemic vascular resistance index (SVRI) minute volume, cardiac index and PVFV were found in the group of patients with the most severe stage (C). In regard to presence of ascites statistically significant difference was observed in elevated mean blood pressure and SVRI. Correlation was found between conjugated HARI to blood pressure and to SVRI. Conclusions In patients with liver cirrhosis there is an inversely reciprocal relationship of conjugated HARI with PVFV, correlating to disease grade. PVFV in cirrhosis decreases and HARI values were over 0.7. Study demonstrated that combining echocardiography with abdominal Doppler ultrasound served as valuable non-invasive diagnostic insight in liver and systemic circulation among different grade of cirrhosis
The impact of temporal variability of biochemical markers PAPP-A and free β-hCG on the specificity of the first-trimester Down syndrome screening: a Croatian retrospective study
No full textBackground: The variability of maternal serum biochemical markers for Down syndrome, free β-hCG and PAPP-A can have a different impact on false-positive rates between the 10+0 and 13+6 week of gestation. The study population comprised 2883 unaffected, singleton, spontaneously conceived pregnancies in Croatian women, who delivered apparently healthy child at term. Women were separated in 4 groups, dependently on the gestational week when the analyses of biochemical markers were performed. The concentrations of free β-hCG and PAPP-A in maternal serum were determined by solid-phase, enzyme-labeled chemiluminiscent immunometric assay (Siemens Immulite). Concentrations were converted to MoMs, according to centre-specific weighted regression median curves for both markers in unaffected pregnancies. The individual risks for trisomies 21, 18 and 13 were computed by Prisca 4.0 software.
Findings: There were no significant differences between the sub-groups, regarding maternal age, maternal weight and the proportion of smokers. The difference in log10 MoM free β-hCG values, between the 11th and 12th gestational week, was significant (p = 0.002). The difference in log10 MoM PAPP-A values between the 11th and 12th, and between 12th and 13th week of gestation was significant (p = 0.006 and p = 0.003, respectively). False-positive rates of biochemical risk for trisomies were 16.1% before the 11th week, 12.8% in week 12th, 11.9% in week 13th and 9.9% after week 13th. The differences were not statistically significant.
Conclusions: Biochemical markers (log10 MoMs) showed gestation related variations in the first-trimester unaffected pregnancies, although the variations could not be attributed either to the inaccuracy of analytical procedures or to the inappropriately settled curves of median values for the first-trimester biochemical markers
Diabetic foot - healing modalities with a review of surgical treatment
No full textKomplicirano dijabetičko stopalo je najveći uzrok netraumatskih amputacija što dovodi do značajnog morbiditeta i mortaliteta osoba oboljelih od dijabetesa. Osnovno je u liječenju razumijevanje patofiziologije razvoja ulkusa na dijabetičkom stopalu. Antibiotska terapija, kao i revaskularizacija ekstremiteta uz odgovarajući tretman defekta, nema smisla bez dobro regulirane osnovne bolesti. Nakon odgovarajuće pripreme bolesnika i nekrektomije svih nekrozom zahvaćenih struktura u obzir dolazi direktno zatvaranje bataljka (amputacija), ali i rekonstrukcija defekata slobodnim kožnim transplantatom, lokalnim kožnim i mišićnim režnjevima, a u pojedinačnim slučajevima i slobodnim režnjevima. Ostali modaliteti liječenja kao što je terapija negativnim tlakom, hiperbarična oksigenoterapija, rasteretna terapija raznim udlagama kao i terapija faktorima rasta također ima važno mjesto u liječenju samog defekta.Diabetic foot ulcers are the single major risk factor for nontraumatic foot amputations. Because of the high incidence of foot ulcers, amputations remain the cause of morbidity and mortality in persons with diabetes. Understanding the pathophysiology of diabetic foot ulcer formation is a basis of appropriate treatment and healing. Evaluation of the limb arterial supply and revascularization when indicated are particularly important. Antibiotic therapy is necessary for virtually all infected wounds, but it is often insufficient without appropriate wound care and improvement of glycemic control. After adequate surgical debridement, the reconstructive options are split thickness skin graft, local cutaneous and muscle flap, and fasciocutaneous free flaps in strongly selective cases. Other modalities of treatment include topical negative pressure device, special dressings, hyperbaric oxygen therapy, off-loading regimens, and advanced tissue replacement methods (growth factors, cellular therapy)
Quality Management: Patients Reflections on Health Care at Outpatient Clinic of Internal Medicine Department
No full textMiddle and older age group relative share in the community permanently grows. Those are commonly burdened with several chronic health conditions or elevated incidence of acute ones and in more frequent need for consulting health services. In the era of modern technical medicine, it is important to increase quality of services particularly patients orientated. Department of Internal medicine developed questionnaire to assess reflections on medical care from the receiver of medical services point of view. Sample was formed from individuals that visited outpatient triage Unit (OTU) and voluntary enrolled, during period April 1 – August 31 2008 for any medical reason. Study population structure had similarly equally of both genders, socio-economical background, and was in age range 18–87. Questionnaire was developed by team of experienced personnel covering satisfaction on received medical care. There were 279 returned formulary in a sample of 6700 patients (4.18%). Patients visited OTU chiefly on behalf medical condition secondary to address of residency, followed by personal choice, on advice given by general practitioner, by emergency transportation services, or just due to earlier experiences. Regarding provided medical care extent, 4/5 of patients were examined in lesser than 2 hours, while total workup lasted mostly for 2–4, followed by over four. Over half of patients were moderate toward highly satisfied with provided medical information, personnel communication style and general reflection on all services while being in the Department premises. Astonishing proportion of patients (93%) was satisfied with positive personnel communication. Integration of patients’ self-perceived reports about medical services in organizing process is inevitable for augmenting content and at the same time valuable for developing overall quality of treatment. Communication excellence is of premier importance and unavoidable for giving additional positive effect to remain health status or to ease the healing process of individual and their families