[Show abstract][Hide abstract] ABSTRACT: Despite enormous number of publications on classifications and treatment of ankle fractures, this problem remains actual till present days. Never the less, the ultimate goal remains the same--anatomically correct position of articular surfaces, painless and stabile ankle joint.
Through prospective study we processed over 50 patients from policlinic data of Orthopedic-Traumatology ward in Cantonal Hospital Zenica. Research lasted over one year and we collected tremendous data from patients which filled in surveys. These data were processed and presented in this study. From collected data we determined statistical incidence of so called "overseen" and poorly treated injuries of lateral ligaments, origin and mechanism of injuries, number of previous injuries of same nature and then compared with data on treatment method, whether conservative or operative.
We paid special attention and presented findings on age and gender groups that are most involved in ankle injuries. We've confirmed that RTG-Varus stress test is still the method of choice in diagnostics of ankle lateral ligaments injuries. We also determined how treatment duration correlates to time between injury and check in, number of recidivism and most importantly correlation between duration of symptoms and length of immobilization and physical therapy duration. We appeal to our colleagues to approach these injuries with higher level of interest and methodically during diagnosis and therapy because every oversight leads to increased risk of repeated injury, chronic instability of ankle joint, cartilage damage and progression of arthritic joint changes. All of those factors greatly impairs patient's life quality. Competent and quality examination will determine, with more accuracy, degree of injury and set basis for adequate therapy which will not leave any consequences for the patient. That would provide him to continue with normal everyday activaties.
[Show abstract][Hide abstract] ABSTRACT: Idiopathic scoliosis is a significant health problem which occurs in 2%-4% school kids in adolescent age. Reasons of occurrence are not quite clear, there are many theories, but probably it is multifactor disease. Among the theories that are mentioned some of them included environmental and behavioral factors.
Research the impact of some environmental and behavioral factor on development and progression of idiopathic scoliosis in school kids.
Research was conducted on 421 pupil in adolescent age, where 120 pupils was from urban schools and 301 pupil from rural schools. Environmental factors and habits like the bigger osteomuscular structure mobility at kids from rural schools, longer outdoor time spending, different nutrition, alcoholism and smoking, different obligations, etc. factors which can be cause of scoliosis development.
In this research we assumed that different environmental and behavioral factors of school kids, which exist in rural and urban areas, can develop to different expression of scoliosis in these areas. In our research we proved that the scoliosis occurrence is more often in urban areas than in rural (Fisher's exact test P<0.001).
It is necessary to research all factors of lifestyle individually, which are different between the urban and rural kids.
Full-text · Article · Aug 2012 · Materia Socio Medica
[Show abstract][Hide abstract] ABSTRACT: Appendicitis is one of the most common diseases that require urgent surgical intervention. Due to its position, the inflamed appendix can cause many complications in abdominal cavity. Most of these complications are based on the anatomical position of the appendix. According to world literature over 65% of the anatomical positions of appendix is retrocaecal position, followed paracaecal and then the other positions of the appendix in different percentages.
The main goal of this research is to shown that anatomical retrocaecal position of the appendix can lead to prolonged hospitalization and more often occurrence of appendicitis complications.
The research is based on patients who had appendectomy during 2009 at the Cantonal Hospital Zenica and General Hospital Tesanj. The study included approximately 400 respondents and the method of research was of retrospective, descriptive and analytical type.
According to the results of this research we can conclude that in our country is not devoted enough attention to the anatomic position of the appendix and that we are not using enough diagnostic methods such as ultrasound and CT in determining the anatomic position to help determine the course of the disease.
Retrocaecal appendix position according to the obtained data from this study did not cause many complications in classical appendectomy but this can be attributed to insufficient observation of the anatomical position of the appendix.
[Show abstract][Hide abstract] ABSTRACT: Osim agenasa koji se danas uobičajeno nalaze u kliničkoj praksi, postoje i medikamenti koji se nalaze u nekoj od faza kliničkog ispitivanja, a koji bi zbog dobrih rezultata, mogli biti uključeni u oficijelnu listu imunosupresiva koji se koriste u fazi posttransplantacijske imunosupresije. To su TOR-inhibitori, everolimus, 40-O methyl ripamycin kao i jedan analog mikofenolne kiseline, a koji bi mogao obezbjediti povećanje gastrointestinalne tolerantnosti. Biološki agensi čija su ispitivanja usmjerena na kostimulativnu blokadu su CTLA4 Ig, anti-B7.1/7.2 monoklonalna antitijela, anti–CD40 ligand i humanizirane forme anti-CD3 i anti-B, te rituximab i campath-1H, pokazali su dobre kliničke rezultate i za očekivati je da će vremenom biti uključeni u oficijelnu listu lijekova koji se koriste u procesu posttransplantacijske imunosupresije (1).
[Show abstract][Hide abstract] ABSTRACT: Cilj transplantacije pankreasa je da se poveća kvalitet života i ublaže sekundarne komplikacije postizanjem insulin-nezavisnog euglikemijskog stanja kod pacijenata sa insulin-zavisnim dijabetes melitusom. Transplantacija pankreasa je jedini tretman Tip I dijabetesa kojim se može postići dosljedna neovisnost o insulinu i normalizovati glukozilirani hemoglobin. Loša strana normalne glukoza-homeostaze su operativni rizici u proceduri transplantacije i potreba za hroničnom imunosupresijom.
[Show abstract][Hide abstract] ABSTRACT: Fractures of the bones that make the wrist joint together with injury to the ligaments and joint capsules are frequent traumas. It can cause besides limited movement also the pathological mobility. These mild injuries often do not provide the degree of recognizable symptoms and signs. They are diagnosed by X-ray imaging, stress images. Before arthrography was an important method, but nowadays arthroscopy has the advantage. Fresh bone and ligament injuries can be and should be repaired in the early posttraumatic period. Unrecognized and undiagnosed injuries are leading to instability of the wrist, to motion abnormalities or impingement overload syndrome. In the treatment of instability important place have reconstruction of the ligaments and arthrodesis of the wrist.
Preview · Article · Mar 2012 · Materia Socio Medica
[Show abstract][Hide abstract] ABSTRACT: SY level is amputation in level of ankle joint. Ch level is ampuatation of front and middle part of foot with preserved calcaneus and talus. Treatmen of both type of patients demands pedantic ortophedic - technical treatment. Differencies in stump's is that SY level stump is stabile and 100% can be loaded, a stump after CH level is instabile. Within amputations during peace, where the talus and calcaneus are fully preserved, stump is instabile, heel is moving cranial, talus plunge forward and often became a part of support. It all happens beacuse of the overbalance of Achilles tendon, it is all happening beacuse the flexors of fornt and midlle part of foot are missing. Support is mainly on outer edge of the foot. Recomended procedures with tendon transplantation are trying to make balance between inner and outer edge of the foot, they are trying to make horisontal balance in foot during the support. Stump load after the CH amputation is less than 50%, proff Baum- Gartner recomends Achille tendon elongation and primary arthrodesis for improvement of balance and stability in stump during the support. During the war time situation is even more changned in negative way. Beside that for SY level of amputation all the characteristic stay the same, at CH ampuattion it is often that just parts (usually 1/2 or less) of talus and calcaneus are reamaning. Stump like that is often more instabile than the CH stump during the war conditions, Muminagic ́ recommends primary arthrodesis and elongation of Achilles tendon (Baum-Gartner procedure), primarni postponed suture (4-7 day), or secundary after 6 or more weeks after the infection is gone. War CH stump is more insuficient in teh manner of capacity and load. There is a dillema what ot decide in war time conditions and to preffer SY level of amputations. Our results have shown reamputation and sy level amputation are needed at most patients (beacuse of torpid ulceration at skin od instabile and deformated stump). We have followed patients with Chopart amputation during 1992 - 1995 and during 15 years. Our experience show's that Chopart have advantage, but it is necessery to perform Baum - Gartner procedure during the first 6 weeks.
[Show abstract][Hide abstract] ABSTRACT: Caring for the health of people is a potent factor in the development of social values. However, a bad set of health policy framework, without firm control mechanisms, creating the possibility of making politically motivated protectionist decisions that will give the poor outcomes of health services. Following the health needs of patients in the period since 2005 to 2010 in the area of Zenica-Doboj Canton and behavior of specialist consultants, after making an poorly judged, politically motivated decisions, we found increased demands of patients within primary health care (PHC) and specialist health care (SHC), an increase in the number of hospital patients, increasing demands for diagnostic tests, and dissatisfied patients for an inefficient health service. In order to prevent the possibility of making such decisions, or unethical behavior of health professionals, it is necessary to establish clear regulatory mechanisms and responsibilities in society and the health system, such as strategic plans, bylaws and standards, with guidelines for good practice.
Full-text · Article · Jun 2011 · Materia Socio Medica
[Show abstract][Hide abstract] ABSTRACT: In practical terms, whenever tissues are transplanted from one person to another it is essential to suppress the immune response of the recipient, no matter how perfect the HLA matching has been. When cellular (i.e. histo) compatibility differences exist, between donor and recipient, it is necessary to modify or suppress the immune response in order to enable the recipient to accept a graft. Immunosuppressive therapy, in general, suppresses all immune responses, including those to bacteria, fungi, viruses and even malignant tumors. Current scientific research and real life experiences show that the immunosuppression process can be more safely induced by utilizing the pharmacological means. Agents used in humans to suppress the immune response are discussed in more detail in the continuation of our paper. Financing of the organ transplantation will most probably be among one of the key questions, which need to be answered, before the patients begin to undergo this complex, tedious and costly procedure. The average actual costs and the associated financial contributions for the transplantation of liver and kidney, as well as other organs, have been reduced in the last decade. The main reason for this cost reduction is particularly the reduction
of the time period of the patients’ hospital stay. Other reasons that contribute to this reduction, among others, include, (e.g. the pressure from the taxpayers as well as the increased innovation and availability of the
new, highly potent and more effevctive and efficient immunosuppressive agents). The process of the cost estimation, in simplified terms, usually includes the costs involved in the following actions and procedures: (i.e. in the evaluation of the transplantation suitability, proper maintenance of the transplantatory candidacy, the costs related to the procurement of the compatible organs from the living and deceased-cadaveric
donors, all hospital and physicians’ costs, post transplant care as well as the funding of the cost of the immunosuppressive medications within the first year after the organ transplantation). Finally, the aspect of the interest group lobbying and their effect on the key policy decision makers must also be mentioned. The population of patients who, due to their medical conditions, have to prepare for, undergo and follow up after the organ transplantation, by utilizing the special and costly immunosuppressive therapy must have the keen interest in improving their medical, legal and financial status.
Full-text · Article · Jun 2011 · Acta Informatica Medica
[Show abstract][Hide abstract] ABSTRACT: Frontal sinus fractures make up about 2-15% of all facial fractures.This is relatively low frequency of occurrence, but it has a large potential of complication and may involve not only the frontal sinuse but more importantly the brain and the eyes. The management depends of the complexity. If anterior wall is fractured with grossly involved nasofrontal duct (NFD) in the injury it is paramount to occlude NFD. Very often, sinus obliteration is done at the same time. In our expirience autogenous cancellous bone graft is considered to be the best grafting material. It has the less short - or long-term complications and the donor site morbidity is insignificant.
[Show abstract][Hide abstract] ABSTRACT: Frontal sinus fractures make up about 2-15% of all facial fractures.This is relatively low frequency of occurrence, but it has a large potential of complication and may involve not only the frontal sinuse but more importantly the brain and the eyes. The management depends of the complexity. If anterior wall is fractured with grossly involved nasofrontal duct (NFD) in the injury it is paramount to occlude NFD. Very often, sinus obliteration is done at the same time. In our expirience autogenous cancellous bone graft is considered to be the best grafting material. It has the less short - or long-term complications and the donor site morbidity is insignificant. KEY
No preview · Article · Jan 2011 · Medical Archives
[Show abstract][Hide abstract] ABSTRACT: Complete or partial deficiencies (inherited and acquired) of all complement components, its regulatory proteins and receptors, are associated with autoimmune diseases such as Systemic lupus erithematodes (SLE) and Rheumatoid arthritis (RA). These deficiencies are more common in women than in men. The pathoethiological basis of this phenomenon is still unclear. Metabolism of C3 complement molecules started by their cleavage into C3b and then into C3c and C3d fragments. C3c is rapidly catabolized and cleared, but C3d molecules, because of its small molecular mass (35 kDa), have relatively slow catabolism. For this reason C3d molecules can moved by diffusion in blood circulation from extravascular sites of complement activation. The measurement of C3d concentration in plasma or serum specimens of RA patients can be a useful tool for monitoring of in vivo parallel complement activation, which may be involved in the pathogenesis of rheumatoid arthritis. Measurement of the serum concentration of C3d is thus a useful index of in vivo complement activation or index of disease activity. C3d effector molecules, as degradation products of C3b, tend to bind to B-cell CR-2/CD21receptors and to the surface of bacteria and fungi as well. Because of increased C3 catabolism during RA the level of C3d component is generally increased in plasma from RA patients. In clinical management of RA the monitoring and quantification of C3d levels in combination with C1q-CIC quantification is common in investigation of complement activation. For this reasons, we investigated the level variation of C3d component concentrations in 53 serum specimens taken from RA patients, in correlation with C1q-CIC values and other clinical findings, by ELISA-HYCOR quantitative automated method. Our results suggest that extreme high levels of C3d are always followed by C1q-CIC positivity. Never opposite case did not found. Almost, all RA patients were female. It was established specific level variation of commonly used markers of RA disease activity such as RF (rheumatoid factor), CRP (serum C-reactive protein), CICs, ESR (erythrocyte sedimentation rate) in relation with C3d concentrations in specific cases. On the basis of obtained values specific for markers of RA activity, we described four grades of RA disease activity: I = inactive; grade II= slightly active; grade III = moderately active, grade IV = very active. In our investigations the extremely high values of C3d and C1q-CIC levels in correlation with other clinical findings, in most cases suggest to grade III or moderate disease activity in RA patients. During chemotherapy by corresponding drugs mainly, it was achieved the reduction of disease activity to a level II (slightly active).
[Show abstract][Hide abstract] ABSTRACT: The slamic authors of the medical and other works have become very known for West, but under well changed names, as for example Razes for Ar-Razi, Avicenna for Ibn Sina, Alhazen for Ibn Haitham, Avenzoar for Ibn Zuhr, Avveroes for Ibn Rusd etc. Up to those changes in the names has not come at any case come accidentally. This was the result of the religious striving to the cultural worls of the West, and not to speak about the plebs, only the giants are represented wich was imppossible to avoid. It is indusputable the great contribution of the Islamic authors to the development of the biomedical sciences. They not only succeeded to preserve the achievements of the pre Islamic authors, than they by the own researches gave the great contribution to the development of these sciences and their disciplines, and they have overgiven to us as a dowry.
[Show abstract][Hide abstract] ABSTRACT: This paper describes variations of the appendix vermiformis, found in the course of open appendectomy. Investigations involved surgeries performed in 2008 year in the Regional Hospital TeSanj. Variations in the site of formation and position of appendix vermiformis were established. Dominantly, appendix vermiformis is placed in the pelvic position in 57.71% of cases. In the smallest number of cases (2), or 3.07% lateral (paracecal) position was found. Variations of position of ostium appendicis vermiformis were registered as well. Two types of ostium appendicis vermiformis were found: dorso-medial wall of intestinum caecum below ostium ileocaecale (35.39%), dorso-lateral medial wall of intestinum caecum (30.7%) and lower pole of intestinum caecum (64.61%). Results of this research indicate very large variability of appendix vermiformis anatomy, which together with other factors (age, sex, phase in which is patient at the moment of examination) form a clinical picture of the acute appendicitis.
No preview · Article · Feb 2009 · Medical Archives
[Show abstract][Hide abstract] ABSTRACT: In 1973. J. Kramer published his own technique for the cure of hallux valgus (Orthopädische Praxis Heft 8/1982, 636-645). He corrects bad position of the first bone of the metatarsus with all the consequences which lie in the basis of the deformation. By osteotomy of the first bone of the metatarsus and re-instates functional equipise of the first foot instep in all the components. Having the experience of 550 operated patients he considered that this method has advantages over numerous described method, indicative range is practically wide, respecting the technique it is simply performed, post-operative cure does not require immobilisation, and in comparison with other methods, complications and bad results are practically unknown. On our ward, in the period between 1984 and 1988, we applied Kramer's osteotomy in 98 cases of hallux valgus. The results were satisfying, considerably better than after other methods of hallux valgus treatment.
No preview · Article · Jan 2009 · Medical Archives
[Show abstract][Hide abstract] ABSTRACT: The treatment for the pineal region tumors depends on tumor histology. Nowadays, germinomas can be cured by radiotherapy and chemotherapy without surgical resection but the other pineal region tumors should be primary treated by surgery. Two microsurgical approaches, the infratentorial supracerebellar and the occipital transtentorial, are accepted as the main standard accesses to the pineal region. For benign pineal tumors (pineocytoma, meningioma, mature teratomas, symptomatic pineal cysts, etc.) radical surgical resection can be curative. For malignant tumors radical surgical resection is not an objective. Serum and CSF markers contribute to the diagnosis of pineal parenchymal tumors. b-HCG is mainly positive in choriocarcinomas, embryonal carcinomas and mixed germ cell tumors and AFP is expressed by yolk sac tumors, embryonic carcinomas, immature teratomas and mixed germ cell tumors, b-HCG is usually low in germinomas which are often positive for PLAP on immunohistochemistry. Fifty-one pineal region tumors were surgically treated by senior author (NdT). Only 17 of them were the neoplasms originating from pineal body (pineal tumors). In conclusion it can be stressed that management of pineal tumors requires a multidisciplinary cooperation. With the exception of germinoma where only a biopsy is needed, the role of the surgeons still remains prominent as resection of pineal tumors requires high technical skill and experience as well as precise clinical judgment.