From Selye's and Szabo's Cysteamine-Duodenal Ulcer in Rats to Dopamine in the Stomach: Therapy Significance and Possibilities.

We reviewed gastric ulcer healing by dopamine considering several distinctive duodenal key points. Selye and Szabo describe the cysteamine-induced duodenal ulcer in rats as a duodenal stress ulcer in patients. Szabo's cysteamine duodenal ulcer as the dopamine duodenal healing and cysteamine as a dopamine antagonist signifies the dopamine agonists anti-ulcer effect and dopamine antagonists ulcerogenic effect. From these viewpoints, we focused on dopamine and gastric ulcer healing. We mentioned antecedent studies on the dopamine presence in the stomach and gastric juice. Then we reviewed, in the timeline, therapy significance arising from the anti-ulcer potency of the various dopamine agonists, which is highly prevailing over the quite persistent beneficial evidence arising from the various dopamine antagonists. Meanwhile, the beneficial effects of several peptides (i.e., amylin, cholecystokinin, leptin, and stable gastric pentadecapeptide BPC 157, suggested as an acting mediator of the dopamine brain-gut axis) were included in the dopamine gastric ulcer story. We attempt to resolve dopamine agonists/antagonists issue with the dopamine significance in the stress (cysteamine as a prototype of the duodenal stress ulcer), and cytoprotection (cysteamine in small dose as a prototype of the cytoprotective agents; cysteamine duodenal ulcer in gastrectomized rats). Thereby, along with dopamine agonists' beneficial effects, in special circumstances, dopamine antagonists having their own ulcerogenic effect may act as "mild stress (or)" or "small irritant" counteracting subsequent strong alcohol or stress procedure-induced severe lesions in this particular tissue. Finally, in the conclusion, as a new improvement in further therapy, we emphasized the advantages of the dopamine agents' application in lower gastrointestinal tract therapy.

Stable Gastric Pentadecapeptide BPC 157 Therapy: Effect on Reperfusion Following Maintained Intra-Abdominal Hypertension (Grade III and IV) in Rats.

Given in reperfusion, the use of stable gastric pentadecapeptide BPC 157 is an effective therapy in rats. It strongly counteracted, as a whole, decompression/reperfusion-induced occlusion/occlusion-like syndrome following the worst circumstances of acute abdominal compartment and intra-abdominal hypertension, grade III and grade IV, as well as compression/ischemia-occlusion/occlusion-like syndrome. Before decompression (calvariectomy, laparotomy), rats had long-lasting severe intra-abdominal hypertension, grade III (25 mmHg/60 min) (i) and grade IV (30 mmHg/30 min; 40 mmHg/30 min) (ii/iii), and severe occlusion/occlusion-like syndrome. Further worsening was caused by reperfusion for 60 min (i) or 30 min (ii/iii). Severe vascular and multiorgan failure (brain, heart, liver, kidney, and gastrointestinal lesions), widespread thrombosis (peripherally and centrally) severe arrhythmias, intracranial (superior sagittal sinus) hypertension, portal and caval hypertension, and aortal hypotension were aggravated. Contrarily, BPC 157 therapy (10 µg/kg, 10 ng/kg sc) given at 3 min reperfusion times eliminated/attenuated venous hypertension (intracranial (superior sagittal sinus), portal, and caval) and aortal hypotension and counteracted the increases in organ lesions and malondialdehyde values (blood ˃ heart, lungs, liver, kidney ˃ brain, gastrointestinal tract). Vascular recovery promptly occurred (i.e., congested inferior caval and superior mesenteric veins reversed to the normal vessel presentation, the collapsed azygos vein reversed to a fully functioning state, the inferior caval vein-superior caval vein shunt was recovered, and direct blood delivery returned). BPC 157 therapy almost annihilated thrombosis and hemorrhage (i.e., intracerebral hemorrhage) as proof of the counteracted general stasis and Virchow triad circumstances and reorganized blood flow. In conclusion, decompression/reperfusion-induced occlusion/occlusion-like syndrome counteracted by BPC 157 therapy in rats is likely for translation in patients. It is noteworthy that by rapidly counteracting the reperfusion course, it also reverses previous ischemia-course lesions, thus inducing complete recovery.

Pentadecapeptide BPC 157 as Therapy for Inferior Caval Vein Embolization: Recovery of Sodium Laurate-Post-Embolization Syndrome in Rats.

After inferior caval vein embolization therapy, post-embolization syndrome (sodium laurate 10 mg/kg, 0.1 mL into rat inferior caval vein, assessment at 15, 30, 60 min, prime lung lesions, thromboemboli occluding lung vessels), as a severe occlusion/occlusion-like syndrome, might be resolved as a whole by stable gastric pentadecapeptide BPC 157 therapy. At 5 min after laurate injection, stable gastric pentadecapeptide BPC 157 was implemented as therapy (10 µg/kg, 10 ng/kg intraperitoneally or intragastrically). As before, confronted with the occlusion of major vessel(s) or similar noxious procedures, such as rapidly acting Virchow triad circumstances, the particular effect of the therapy (i.e., collateral pathways activation, "bypassing vascular key", i.e., direct blood flow delivery via activation of azygos vein) assisted in the recovery of the vessel/s and counteracted multiorgan failure due to occlusion/occlusion-like syndrome as a whole in the laurate-injected rats. Along with prime lung lesions and thromboemboli occluding lung vessels, post-embolization syndrome rapidly occurred peripherally and centrally as a shared multiorgan and vessel failure, brain, heart, lung, liver, kidney, and gastrointestinal tract lesions, venous hypertension (intracranial (superior sagittal sinus), portal, and caval), aortal hypotension, progressing thrombosis in veins and arteries and stasis, congested and/or failed major veins, and severe ECG disturbances. Whatever the cause, these were all counteracted, eliminated, or attenuated by the application of BPC 157 therapy. As recovery with BPC 157 therapy commonly and rapidly occurred, reversing the collapsed azygos vein to the rescuing collateral pathway might initiate rapid direct blood delivery and start blood flow reorganization. In conclusion, we suggest BPC 157 therapy to resolve further vascular and embolization injuries.

Isolated quadrilateral plate fracture with central hip dislocation after epileptic seizure in a postpartum patient: A case report.

Isolated quadrilateral plate fractures are extremely rare and their treatment is complex. The postpartum period and recent caesarean section additionally increase already significant risks of surgical treatment. Modified Stoppa approach and the use of infrapectineal plate represent the optimal surgical treatment method. One case of central hip dislocation and isolated quadrilateral plate fracture was reported during an epileptic seizure 1 day postpartum, which was treated with open reduction and internal fixation. A 25-year-old female patient had given birth via cesarean section. One day postpartum, she had multiple generalized tonic clonic seizures. Arteriovenous malformation was identified as the cause of seizures by MRI. The patient complained of left hip pain and inability to move the left leg which prompted clinical and radiological examination. A pelvic CT scan verified multifragmentary fracture of the quadrilateral plate without fracture of the acetabular columns. The central hip dislocation was verified. Due to the rarity of the fracture, the clinical decision-making process was difficult. The patient, being in the postpartum period, was also at a greater risk of infection. The patient was treated surgically, and osteosynthesis was performed with an infrapectineal plate for the acetabulum using the modified Stoppa approach. The initial incision was done through the same Pfannenstiel incision from caesarean section. The patient's postoperative recovery was good at 1 year follow-up.

Stable Gastric Pentadecapeptide BPC 157 May Recover Brain-Gut Axis and Gut-Brain Axis Function.

Conceptually, a wide beneficial effect, both peripherally and centrally, might have been essential for the harmony of brain-gut and gut-brain axes' function. Seen from the original viewpoint of the gut peptides' significance and brain relation, the favorable stable gastric pentadecapeptide BPC 157 evidence in the brain-gut and gut-brain axes' function might have been presented as a particular interconnected network. These were the behavioral findings (interaction with main systems, anxiolytic, anticonvulsive, antidepressant effect, counteracted catalepsy, and positive and negative schizophrenia symptoms models). Muscle healing and function recovery appeared as the therapeutic effects of BPC 157 on the various muscle disabilities of a multitude of causes, both peripheral and central. Heart failure was counteracted (including arrhythmias and thrombosis), and smooth muscle function recovered. These existed as a multimodal muscle axis impact on muscle function and healing as a function of the brain-gut axis and gut-brain axis as whole. Finally, encephalopathies, acting simultaneously in both the periphery and central nervous system, BPC 157 counteracted stomach and liver lesions and various encephalopathies in NSAIDs and insulin rats. BPC 157 therapy by rapidly activated collateral pathways counteracted the vascular and multiorgan failure concomitant to major vessel occlusion and, similar to noxious procedures, reversed initiated multicausal noxious circuit of the occlusion/occlusion-like syndrome. Severe intracranial (superior sagittal sinus) hypertension, portal and caval hypertensions, and aortal hypotension were attenuated/eliminated. Counteracted were the severe lesions in the brain, lungs, liver, kidney, and gastrointestinal tract. In particular, progressing thrombosis, both peripherally and centrally, and heart arrhythmias and infarction that would consistently occur were fully counteracted and/or almost annihilated. To conclude, we suggest further BPC 157 therapy applications.

Stable Gastric Pentadecapeptide BPC 157 and Striated, Smooth, and Heart Muscle.

First, we review the definitively severed myotendinous junction and recovery by the cytoprotective stable gastric pentadecapeptide BPC 157 therapy, its healing that might combine both transected and detached tendon and transected muscle, ligament and bone injuries, applied alone, as native peptide therapy, effective in rat injury, given intraperitoneally or in drinking water or topically, at the site of injury. As a follow up, we reviewed that with the BPC 157 therapy, its cytoprotective ability to organize simultaneous healing of different tissues of and full recovery of the myotendinous junction might represent the particular muscle therapy against distinctive etiopathology muscle disabilities and weakness. In this, BPC 157 therapy might recover many of muscle disabilities (i.e., succinylcholine, vascular occlusion, spinal cord compression, stroke, traumatic brain injury, severe electrolyte disturbances, neurotoxins, neuroleptics, alcohol, serotonin syndrome and NO-system blockade and tumor-cachexia). These might provide practical realization of the multimodal muscle-axis impact able to react depending on the condition and the given agent(s) and the symptoms distinctively related to the prime injurious cause symptoms in the wide healing concept, the concept of cytoprotection, in particular. Further, the BPC 157 therapy might be the recovery for the disabled heart functioning, and disabled smooth muscle functioning (various sphincters function recovery). Finally, BPC 157, native and stable in human gastric juice, might be a prototype of anti-ulcer cytoprotective peptide for the muscle therapy with high curing potential (very safe profile (lethal dose not achieved), with suited wide effective range (µg-ng regimens) and ways of application).

Good functional recovery after bilateral elbow dislocation associated with bilateral distal radius and ulna fractures.

Bilateral elbow dislocation associated with bilateral distal forearm fractures is extremely rare, therefore its optimal treatment, complications, and outcomes remain unclear. We present an illustrative case with a 2-year follow up of a patient who sustained a complex injury of the upper extremity and underwent combined surgical and conservative treatment.

Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.

PURPOSE: To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia. METHODS: A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3. RESULTS: We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis. CONCLUSION: It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

Stable Gastric Pentadecapeptide BPC 157 as a Therapy for the Disable Myotendinous Junctions in Rats.

(1) Aim: The stable gastric pentadecapeptide BPC 157 is known to heal transected muscle, tendon, and ligament. Thereby, in this study, we investigated the effect of BPC 157 on the dissection of the quadriceps tendon from the quadriceps muscle in rats. (2) Materials and Methods: Myotendinous junction defect, which cannot heal spontaneously in rats, as evidenced with consistent macro/microscopic, biomechanical, functional assessments, eNOS, and COX-2 mRNA levels and oxidative stress and NO-levels in the myotendinous junctions. BPC 157 (10 µg/kg, 10 ng/kg) regimen was given (i) intraperitoneally, first application immediately after surgery, last 24 h before sacrifice; (ii) per-orally, in drinking water (0.16 µg/mL, 0.16 ng/mL, 12 mL/rat/day), till the sacrifice at 7, 14, 28 and 42 postoperative days. (3) Results: These BPC 157 regimens document prominent therapy effects (macro/microscopic, biomechanical, functional much like eNOS and COX-2 mRNA levels and counteracted oxidative stress and NO-levels in the myotendinous junctions), while controls have a poor presentation. Especially, in rats with the disabled myotendinous junction, along with full functional recovery, BPC 157 counteracts muscle atrophy that is regularly progressive and brings muscle presentation close to normal. Accordingly, unlike the perilous course in controls, those rats, when receiving BPC 157 therapy, exhibit a smaller defect, and finally defects completely disappear. Microscopically, there are no more inflammatory infiltrate, well-oriented recovered tissue of musculotendon junction appears in BPC 157 treated rats at the 28 days and 42 days. (4) Conclusions: BPC 157 restores myotendinous junction in accordance with the healing of the transected muscle, tendon, and ligament.

Stable Gastric Pentadecapeptide BPC 157 and Wound Healing.

Significance: The antiulcer peptide, stable gastric pentadecapeptide BPC 157 (previously employed in ulcerative colitis and multiple sclerosis trials, no reported toxicity (LD1 not achieved)), is reviewed, focusing on the particular skin wound therapy, incisional/excisional wound, deep burns, diabetic ulcers, and alkali burns, which may be generalized to the other tissues healing. Recent Advances: BPC 157 has practical applicability (given alone, with the same dose range, and same equipotent routes of application, regardless the injury tested). Critical Issues: By simultaneously curing cutaneous and other tissue wounds (colocutaneous, gastrocutaneous, esophagocutaneous, duodenocutaneous, vesicovaginal, and rectovaginal) in rats, the potency of BPC 157 is evident. Healing of the wounds is accomplished by resolution of vessel constriction, the primary platelet plug, the fibrin mesh which acts to stabilize the platelet plug, and resolution of the clot. Thereby, BPC 157 is effective in wound healing much like it is effective in counteracting bleeding disorders, produced by amputation, and/or anticoagulants application. Likewise, BPC 157 may prevent and/or attenuate or eliminate, thus, counteract both arterial and venous thrombosis. Then, confronted with obstructed vessels, there is circumvention of the occlusion, which may be the particular action of BPC 157 in ischemia/reperfusion. Future Directions: BPC 157 rapidly increases various genes expression in rat excision skin wound. This would define the healing in the other tissues, that is, gastrointestinal tract, tendon, ligament, muscle, bone, nerve, spinal cord, cornea (maintained transparency), and blood vessels, seen with BPC 157 therapy.

Distribution of coolant during drilling with open type internally cooled medical steel drill.

INTRODUCTION: Internally cooled bone drills with an open system, conduct coolant directly to the point of contact of cutting surface of the drill and the bone and lower the temperature at the drilling site. During bone drilling with internally cooled drills of open type, there is a possibility that coolant enters the intramedullary canal and has an adverse effect on intramedullary pressure. In this research, the intramedullary distribution of the coolant during and after drilling was analyzed. MATERIALS AND METHODS: Specially constructed open type internally cooled medical steel drills were used. Experimental studies were conducted on the porcine femoral bone diaphysis. Coolant (saline) was mixed with water-soluble contrast agent and x-ray images of the distribution of coolant during and after drilling were taken with different regimes of drilling (drill rotational speed from 1300 rpm to 5000 rpm, and coolant flow rate from 0,6 l/min to 1,35 l/min). RESULTS: An x-ray images showed that coolant did not spread from the borehole and has not spread intramedullary with any combination of coolant flow and drill rotation regimes. CONCLUSION: Coolant does not disperse into the intramedullary canal outside of the borehole in given flow ranges (0,6-1,35 l/min) and drill rotational speed regimes (1300-5000 rpm). Open type internally cooled can safely be used for bone drilling.

Surgical treatment of scapular fractures: Results and complications.

INTRODUCTION: The aim of this study was to describe a surgical technique and report on patient-based functional outcomes and complications following open reduction and internal fixation in patients with scapular fractures. METHODS: The study comprised 14 patients who were treated with open reduction and internal fixation (ORIF) of a scapular fractures between September 2010 and July 2018. Surgical indications were as follows: medial/lateral displacement greater than 20 mm; shortening greater than 25 mm; angular deformity greater than 40°; intra-articular step-off greater than 4 mm; and double shoulder suspensory injuries (including fracture of the clavicle, coracoid or acromion with displacement greater than 10 mm). All patients underwent X-ray examination (true AP, Y scapular view) and computed tomography (CT) scans. Fractures were classified according to the revised (AO/OTA) classification system. Functional outcomes were measured using Constant-Murley scores. RESULTS: Seven patients had glenoid fossa fractures, six patients had scapular body fractures and one patient had an acromion process fracture. All glenoid fossa and scapular body fractures were exposed via the Judet approach. Eleven of 14 patients were given Constant-Murley scores at the final follow-up examination; three patients were lost to follow-up. The mean follow-up after injury was 44 months (range, 6-92 months). We found infraspinatus muscle hypotrophy in four patients. The mean Constant-Murley score was 93.45 (±8.93) for the injured arm and 98.36 (±2.91) for the uninjured arm. The mean score between the injured and uninjured arm was 4.91(±6.49), which is an excellent functional outcome according to the Constant-Murley score. CONCLUSIONS: Open reduction and internal fixation of displaced scapular fractures is a safe and effective treatment option that results in a reliable union rate and good-to-excellent functional outcome.

Intramedullary nailing of adult forearm fractures: Results and complications.

INTRODUCTION: The aim of this study was to evaluate the clinical and radiological results of adult forearm fractures treated with interlocking intramedullary nailing. METHODS: This retrospective study included 21 patients who were treated with intramedullary interlocking nailing for forearm fractures between January 2010 and September 2017. All patients were treated with intramedullary forearm nails designed to allow interfragmentary compression. The medical records and radiographs of all patients were evaluated. Fractures were classified according to the AO/OTA classification system by analyzing the radiographs. Union time, union rate, clinical outcome, and complications were evaluated. RESULTS: Primary intramedullary osteosynthesis was performed in 17 patients with forearm shaft fractures. The average union time was 10 weeks (range, 8-16 weeks) in the primary osteosynthesis cohort. Secondary intramedullary osteosynthesis was performed in four patients following the removal of plates and screws due to nonunions. For this group of patients, bone union took an average of 17 weeks (range 8-24 weeks). The overall union rate was 95.24% in the 21 forearm fractures which were treated with an intramedullary interlocking nail with a compression screw that allows interfragmentary compression to be obtained. Overall complications included one nonunion, one postoperative rupture of the extensor pollicis longus tendon, and 1 postoperative transitory radial nerve palsy. CONCLUSIONS: Intramedullary interlocking nailing with a compression screw is an alternative method of fixation for treating adult forearm fractures and provides good clinical outcomes with reliable union rates.

Pilot study: Internally cooled orthopedic drills - standard sterilization is not enough?

Bone drilling causes focal temperature rise due to metal-to-bone contact, which may result in thermal osteonecrosis. Newly constructed internally cooled medical drill of an open type decreases temperature rise at a point of metal-to-bone contact although standard sterilization of such a drill could be inadequate due to bacteria retention within the drill lumen. The aim of this pilot study was to examine the effectiveness of sterilization and to propose sterilization recommendations for internally cooled open type bone drills. Unused internally cooled medical steel bone drills were tested. Drills were contaminated with Pseudomonas aeruginosa, Bacillus sp., beta-hemolytic Streptococcus sp., Enterobacter sp. and methicillin-resistant Staphylococcus pseudintermedius and then incubated for 24 hours at 37 °C. Afterwards, drills were autoclaved for 15, 20 and 30 minutes at 132 °C and 2.6 bar. When 15-minute sterilization was used, one out of 16 drills was contaminated with Pseudomonas aeruginosa, while the other 15 drills were sterile. Extended cycle sterilization in autoclave lasting for 20 and 30 minutes resulted in 100% sterility of all drills tested. In conclusion, lumened drills should be exposed to extended sterilization times in autoclave. Minimal recommended time for sterilization of lumened drills is 20 minutes.

From the History of the Croatian Dermatovenereological Society - The Croatian Medical Association and an Overview of Important Information Regarding the Journal Acta Dermatovenerologica Croatica.

Everything included in this overview is a list of facts without analyses, which makes this a purely factual overview. The circumstances of the preparation for the foundation of the Croatian Dermatovenereological Society - the Croatian Medical Association (hereafter CDS-CMA) and the journal Acta Dermatovenerologica Croatica (hereafter ADC) Geopolitical changes in former Yugoslavia following 1990 and the Homeland War (1991-1995) led to new circumstances in almost all areas of social activity and the need for a restructuring and further development of professional physicians associations in our Homeland. In such new conditions, it was necessary to appropriately organize the professional work of our dermatovenerologists with the aim of founding and maintaining their professional ties to each other and to our colleagues abroad. The aforementioned appropriate organization primarily meant the founding of the Croatian Dermatological Society and the journal for Croatian dermatovenerologists, the first professional journal in the history of dermatology and venerology in our Homeland. Legal regulations for the founding of CDS-CMA and the journal ADC The legal regulations resulted from the conclusions and decisions of the 99th annual assembly of the Association of Croatian Physicians (hereafter ACP) that took place on the 26th of February 1991 (1), at which, at the suggestion of Prof. Mirko Gjurasin, PhD, the president of CMA, it was renamed to the Croatian Medical Association (CMA). Furthermore, on the basis of article 12 of the Statute of CMA, the creation and activity of professional societies of CMA was enabled, which replaced the Sections of ACP (1), and soon there appeared the Regulation of the work of the professional society of CMA. Finally, on the 30th of September 1991, CMA left the Alliance of Yugoslav Medical Societies (1). More detailed information on the aforementioned events can be found in reference 1, and the data on historical, political, national, and military aspects of the war against our Homeland can be found in the article of the esteemed member of CMA, Prof. Eduard Klain, PhD (2) and in the message by Prof. Vladimir Cajkovac, PhD (3). Preparations for the founding of CDS-CMA and ADC Ideas concerning a new founding of the Croatian Dermatological Society - CMA (hereafter CDS-CMA) and the first journal in the history of Croatian dermatovenerologists developed during 1990 and 1991. These suggestions were discussed in the meetings of the Professional college of the Department of Dermatology and Venerology at the Clinical Hospital Centre Zagreb (hereafter CHC Zagreb), and were formed at the meeting of the Professional college of the Department on the 27th of January 1992, when the Professional college provided the following suggestions, which the secretary of the Dermatovenerological Section of CMA (Primarius D. Paljan, MD, MSc) gave to the president of the Dermatovenerological section of CMA, Prof. V. Cajkovac, PhD. The suggestions were as follows: 1) for the Dermatovenerological section of CMA to leave the Association of Yugoslav dermatologists; 2) to found a Croatian Dermatological Society; 3) to found a Croatian Journal of Dermatology; and 4) to inform colleagues from clinics abroad with the state in Croatia. Of course, Prof. Cajkovac immediately agreed with all of these suggestions. Afterwards, on the 9th of October 1991, I presented the members of the Professional college of the Department of Dermatology and Venerology of CHC Zagreb and the members of the Chair of Dermatovenerology at the School of Medicine, University of Zagreb (hereafter SM Univ. of Zagreb), with the suggestions regarding the founding of the Croatian Dermatological Society - CMA and the founding of a Journal of Croatian Dermatologists (4,5). Both suggestions were accepted unanimously (4). After accepting the abovementioned suggestions, my colleagues and I undertook a number of consultations, and from the Department of Dermatology and Venerology of CHC Zagreb I sent out invitations to all the members of the Dermatovenerological Section of ACP (hereafter Section) to a meeting in the lecture room of the Clinic on Salata, scheduled for the 29th of May 1992 (6). At that meeting, I notified the members of the Section of the decisions made at the 99th annual assembly of CMA on the 26th of February 1991, as well as of the fact that the CMA had left the Alliance of Yugoslav Physicians Societies on the 30th of September 1991 (6). Also, following the example of many other medical professions, I told the members of the Section about my suggestion regarding the founding of CDS-CMA. Therefore, on the 29th of May 1992, CDS-CMA was founded again* (6). On that occasion, a temporary Board of directors of CDS-CMA was also chosen, and Prof. Vladimir Cajkovac, who was the president of the former Dermatovenerological Section of ACP, was chosen as the president of the Board (6), while the following were chosen as members of the Board (6): Primarius Zlatka Cabrijan, MD (Rijeka), Adalbert Stasic, MSc, MD (Rijeka), Assist. Prof. Vjekoslav Stipic, PhD (Split), Primarius Boris Petricic, MD (Zadar), Prof. Ivan Dobric, PhD (Zagreb), Assist. Prof. Teodora Gregurek-Novak,PhD (Zagreb), Primarius Jasna Lesic, PhD (Zagreb), and Primarius Aida Pasic, MD (Zagreb). Titles according to the state in 1992. *Why was CDS-CMA founded again? To understand this question, it is important to know the following: a) On the 22nd of November 1920, the Dermatological Section of the Physicians Association (7) was founded in the Hospital Sestre milosrdnice, Zagreb, Croatia (quotation from reference 7); b) this Section acted until the 19th of January 1941, when a formal session was held in the lecture room of the Clinic on Salata under the title of the 1st (jubilee) meeting of the Croatian Dermatovenerological Society of the Croatian Medical Association, which was opened by its president, Prof. Kogoj (7); c) therefore, it is apparent that the Croatian Dermatovenerological Society of the Croatian Medical Association was founded on the 19th of January 1941, and the forerunner of the Society was the former Dermatological Section of the Physicians Association (7); the name Croatian Dermatovenerological Society of CMA has been used in professional publications since then (8); d) at the extraordinary session of the Croatian Physicians Society (probably a reference to ACP) held on the 30th of September 1945, the name of the Association of Croatian Physicians was changed to the name Croatian Medical Association, and since then the Croatian Dermatovenerological Society has appeared in professional publications under the name of the Dermatovenerological Society of the Croatian Medical Association (9); e) later the name Dermatovenerological Society - CMA was replaced with the name Dermatovenerological Section of ACP, but I am not familiar with the exact date of this change; f) the name Dermatovenerological Section of ACP existed until the 29th of May 1992, when, as it was stated above, the CDS-CMA was founded (6). NOTE: The original name of the Society founded on the 29th of May 1992 was the Croatian Dermatological Society of the Croatian Medical Association (CDS-CMA), and later this name was changed to the Croatian Dermatovenerological Society of the Croatian Medical Association (CDVS-CMA), which is the name used by the Society nowadays. The election of the Assembly and the regular Board of Directors of CDS-CMA On the 10th of July 1992, in the same lecture room in which the meeting was held on the 29th of May 1992, there was a meeting on the newly founded CDS-CMA (6). According to the book of regulations of the CMA, which was established over time, the Assembly of CDS-CMA was elected, and at the suggestion of the Assembly the following attending colleagues were elected to the regular Board of Directors of CDS-CMA, along with Prof. Vladimir Cajkovac as the president (6): Primarius Zlatka Cabrijan, MD (Rijeka), Adalbert Stasic, MD, MSc (Rijeka), Assist. Prof. Vjekoslav Stipic, PhD (Split), Primarius Boris Petricic, MD (Zadar), Prof. Ivan Dobric, PhD (Zagreb), Assist. Prof. Teodora Gregurek-Novak, PhD (Zagreb), Primarius Jasna Lesic, PhD (Zagreb), and Primarius Aida Pasic, MD (Zagreb). Titles according to the state in 1992. Branches of CDS-CMA As we can see, colleagues from all university centers existing at the time (Osijek, Rijeka, Split, and Zagreb) were elected to the Board of Directors, in which Branches of CDS-CMA were later founded. Therefore, from the beginning of the creation of CDS-CMA, it has been our goal to found CDS-CMA with four Branches (Osijek, Rijeka, Split, and Zagreb), which is how the Society is structured even today. NOTE: Since there were no representatives from Osijek at the meeting held on the 10th of September 1992, the Assembly suggested that the president of CDS-CMA-Osijek Branch enter the Board of Directors after the Branch is founded (6). The election of the president, vice president, secretary, and treasurer of CDS-CMA Through a secret ballot, the members of the Assembly elected the following from among the members of the Board of Directors to a term of four years (6): Prof. Vladimir Cajkovac, PhD as the president of the Board of Directors of CDS-CMA (on the basis of the accepted work program), Prof. Ivan Dobric, PhD and Assist. Prof. Vjekoslav Stipic, PhD as the vice president of the Board, Primarius Zlatka Cabrijan, MD and Assist. Prof. Teodora Gregurek-Novak, PhD as secretaries, and Primarius Aida Pasic, MD as the treasurer of the Board of Directors of CDS-CMA. The founding of the ADC and its organizational overview from Vol 1, No 1 to Vol 4, No 2 At the aforementioned meeting of CDS-CMA held on the 10th of July 1992 (6), I presented my suggestions from the 9th of October 1990 (4), which were accepted by the members of the Professional college of the Clinical Hospital Centre Zagreb and the members of the Department of Dermatovenerology ofthe School of Medicine, University of Zagreb, regarding the need for founding a Journal of Croatian Dermatovenerologists, i.e. a journal of CDS entitled Acta Dermatovenerologica Croatica (ADC) (4). I remind the reader that the need for founding a "professional publication" (quotation from reference 7) was expressed as early as 1920, at the founding of the Dermatological Section of ACP (7). The election of the management of the Journal Acta Dermatovenerologica Croatica At the meeting held on the 10th of July 1992, the following were elected to the management of Acta Dermatovenerologica Croatica (with no titles): Vladimir Cajkovac as the chief editor (with the instruction that he should choose his own co-workers) (6). Several days after the meeting of the 10th of July 1992, the following colleagues were appointed to certain positions in the journal: Ivan Dobric as the deputy to the chief editor, Dragomir Budimcic as the technical editor, and Branko Baricevic as the secretary of the journal. However, Dr. Budimcic resigned, so Branka Marinovic was appointed to his position from Vol 1, No 4. After Dr. Baricevic left for a position in diplomacy, Branka Marinovic was elected to his position in the journal from Vol 4, No 2, while Mirna Situm was elected to fill in the former position of Branka Marinovic from Vol 4, No 2. Following the election of the journal's management and after certain consultations in the country and abroad were completed, members of the Editorial board* and the Editorial council** were also elected, as well as the language consultant and the translator for the English language***. *, **, ***: names and surnames of the elected colleagues are visible in the imprint of the listed volumes and issues of the journal. The titles of the particular colleagues are not included, with only the names and surnames stated (according to the statements in the journal's imprint) Addresses and the journal's office Addresses: - for Vol 1, No 1: Acta Dermatovenerologica Croatica, Department of Skin and Venereal Diseases of the Hospital Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia; - from Vol 1, No 2: Acta Dermatovenerologica Croatica, Department of Dermatology and Venerology, Clinical Hospital Centre Zagreb and School of Medicine, University of Zagreb, Salata 4, Zagreb, Croatia* (see detailed information in the imprint of the listed volume and issues of the journal). The journal office Until Vol 3, No 1-2, the journal office was located on the abovementioned addresses. From Vol 3, No 1-2, a special journal office was founded, and the office manager was Ivan Dobric, the former deputy of the chief editor, with Aleksandra Basta-Juzbasic being elected to take over Dr. Dobric's former position from Vol 4, No 1. I. Dobric performed the duties of the office manager until Vol 3, No 4, when this position was removed, and from Vol 4, No 1 the journal's office is yet again listed with the abovementioned address of the journal*. With the removal of the duties of the manager of the journal office, i.e. since Vol 3, No 4 (end of 1995), Prof. Dobric no longer performed any duties in the journal, and this remains so to this day. The reason for the founding of the abovementioned office of the journal: chief editor Prof. Vladimir Cajkovac, PhD was also the head of the Department of Dermatology and Venerology of the School of Dental Medicine, University of Zagreb, and also worked in the Hospital Sestre milosrdnice, Vinogradska cesta 29, Zagreb. However, all the duties connected to the journal (preparation, correspondence, fax, requesting article reviews, sending notifications, contacting the School of Medicine, University of Zagreb, contacting Clinical Hospital Centre Zagreb, contacting the printing office) were performed by the head office of the Department of Dermatology and Venerology at the Clinical Hospital Centre Zagreb and the School of Medicine, University of Zagreb, which was, of course, tied to the expenses. Those expenses were charged to the Clinical Hospital Centre Zagreb, but for the purposes of booking the expenses, an agreement was reached with the Directorate of Clinical Hospital Centre Zagreb, according to which the expenses were booked to the journal's office and approved by the manager of the journal's office, who was then also the head of the Department, in accordance with the powers of the head of the Department according to the Temporary decision regarding the organization of Clinical Hospital Centre Zagreb from 1991. To conclude, the existence of the journal's office and its manager was of a purely pragmatic nature at the time. (For the purposes of verifying the accuracy of the abovementioned information see the imprint of the listed volumes and issues of the journal.) The first issue of ADC (Vol 1, No 1) The first issue of the journal was published at Christmas time in 1992 (10), and It was printed in Zagrebacka tiskara (which was later renamed to Grafoplast), Preradoviceva 21-23, Zagreb. The journal's expenses were covered from the following: a) membership fees for CDS-CMA; b) donations, or subscriptions to the journal of pharmaceutical companies; c) financial support of the Ministry of Science (for the year 1994); d) the help of the Directorate of Clinical Hospital Centre Zagreb; and e) financial assets from the research task "Lyme borreliosis" (leader: Prof. Dobric). All financial business of the journal was performed through the account of the School of Medicine, University of Zagreb. Indexing the journal Thanks to all the authors who sent in their articles to our journal as well as the reviewers from our country and abroad, from January 1994 Acta Dermatovenerologica Croatica is included in the Excerpta Medica Embase database. In April 1993, the journal was already a candidate for the inclusion in Current Contents. See the letter from the institute for Scientific Information, Philadelphia, USA, dated 8th of April 1993, Mrs. Helen Szigeti, Publication Selection (Figure 2). Special thanks In the name of former associates, I extend a special thank you for the preparation for the founding of CDS-CMA to the following: a) All members of the Department and Clinic for Dermatology and Venerology of Clinical Hospital Centre Zagreb and the School of Medicine, University of Zagreb (who are listed in reference 5), as well as all colleagues from the former Dermatovenerological Section of ACP who accepted the invitation to the meeting held on the 29th of May 1992. Of course, I hereby also extend my gratitude to all those colleagues who did not attend that meeting, but explained their absence in a way that was then appropriate; b) Prof. Klaus Wolff, MD, the president of the Executive Board of the International League of Dermatological Societies, who allowed me to follow the work of the Assembly of Delegates of the International League of Dermatological Societies as a delegate of CDS-CMA (on the basis of a previously signed agreement) (New York, the 15th of July 1992); c) Prof. Stuart Maddin, MD, the general secretary of the Executive Board of the International League of Dermatological Societies, who I met with in New York some time before the beginning of the abovementioned Assembly. On that occasion, Prof. Maddin gave me many useful pieces of advice on the work of CDS-CMA and ADC (11). NOTE: Prof. Mario Gligora, PhD (an active participant at the 18th World Congress of Dermatology, New York, 1992, 12-18 June) also visited New York at that time, with whom I discussed at length, as I had done on numerous occasions prior to that, the future work of CDS-CMA and ADC, and his advice on the founding of CDS-CPA and ADC, which I presented on preparatory meetings to my colleagues, were very useful for my co-workers and myself when founding the Society and the journal; d) For everything stated above, I extend a special thank you to Prof. Mario Gligora, PhD Of course, certain pleasant events come at the very end, in order that we remember them for as long as possible. I wish here to extend special gratitude for the founding of CDS-CMA to Prof. Vladimir Cajkovac, PhD, the president of the former Dermatovenerological Section of ACP, who, after the renaming of ACP to CPA, which created the conditions for the founding of CDS-CMA and the journal ADC, always helped us with useful advice and eagerly supported each of our abovementioned initiatives. All collaboration with Prof. Cajkovac was very pleasant and useful. We repaid his favor by nominating him and electing him to the position of the first president of CDS-CMA and the first chief editor of ADC. To conclude, this article gives an overview of the important data on the founding of CDS-CMA (later CDVS-CMA) as well as the important information on ADC (until Vol 4, No 2). On my behalf and on the behalf of all my co-workers, I extend my congratulations for their achievements to everyone who continued working in CDS-CPA (later CDVS-CMA) and the journal ADC (after Vol 4, No 2), which is nowadays indexed in Science Citation Index Expanded (SCIE), Index Medicus/Medline, Embase/Excerpta Medica, Chemical Abstracts Service, Biomedicina Croatica (see ADC Vol 21, No 3, 2013). I hope the current president of the CDVS-CMA, Prof. Mirna Situm, PhD, as well as the current chief editor of ADC, Prof. Branka Marinovic, PhD, who is also the general secretary of the European Academy of Dermatology and Venerology, will enjoy many new achievements in our CDVS-CMA and the journal ADC. It is unnecessary to emphasize the importance of the fact that we have such a respectable journal in our Homeland. NOTE: The honorable duty of preparing this text was entrusted to me by the president of the CDVS-CMA, Prof. Mirna Situm, PhD, at the meeting of the Executive Board of CDVS-CMA held on the 16th of April 2012 (for the purposes of an oral presentation of this data at the 3rd Croatian Congress of Psychodermatology with international participation, Split, 4-7 October, 2012, and again at the meeting of the Executive Board of CDVS-CMA, held on the 7th of June 2013 for the purposes of the web page of CDVS-CMA).

Thermal changes during healing of distal radius fractures-Preliminary findings.

INTRODUCTION: The bone healing process is very complex. In simple terms, bone healing comprises three basic steps, the inflammation phase, the repair phase and the remodelling phase. The increase in blood flow around the fracture during the healing process increases the temperature of the surrounding tissue. Infrared thermography is a method of measuring body temperature that can detect temperature changes during bone healing. Studies on the application of thermography in traumatology are scarce, and there are no studies of thermal changes during normal bone healing. The authors have tried to determine the dynamics of thermal changes during bone healing. MATERIAL AND METHODS: The Flir ThermaCam B2 (FLIR Systems, Inc., Oregon, USA) was used for all measurements. Thermographic recordings were made one, three, five, 11 and 23 weeks after fracture. The contralateral, healthy, forearm was used for comparison. RESULTS: A total of 25 patients of mean age 65.9±10.4 years (range 50-80 years) with fracture of the distal radius were examined in this study. The mean temperature difference between healthy and fractured distal forearm one week after fracture was 1.20±0.48°C, three weeks after fracture was 1.42±0.54°C, five weeks after fracture was 1.04±0.53°C, 11 weeks after fracture was 0.50±0.30°C, and 23 weeks after fracture was 0.22±0.25°C. CONCLUSION: Preliminary findings during this research showed significant temperature changes during healing of distal radius fractures. Infrared thermography is a simple and reliable method in clinical practice that could be used as a good follow-up method in traumatology, but further investigations on more patients are needed.

Implementing the Surgical Apgar Score in patients with trauma hip fracture.

BACKGROUND: Trauma hip fractures in elderly patients are associated with high postoperative long-term morbidity and mortality and premature death. The high mortality in these patients can be explained by various factors, including the fracture itself; the preoperative poor condition and comorbidities of these patients; the influence of stressors, such as surgery and type of anaesthesia, on the patient's condition; and the postoperative development of major complications, such as cardiac failure, pulmonary embolism, pneumonia, deep venous thrombosis and acute renal failure. Thus, the Surgical Apgar Score (SAS) could be a valuable tool for objective risk stratification of patients immediately after surgery, and to enable patients with higher risk to receive postoperative ICU care and good management both during and after the hospital stay. METHODS: The SAS was calculated retrospectively from the handwritten anaesthesia records of 43 trauma hip fracture patients treated operatively in the University Hospital Centre Zagreb over a 1-year period. The primary endpoints were the 30-days major postoperative complications and mortality, length of the ICU and hospital stay, and 6-months major complications development. Statistical analysis was applied to compare SAS with the patients' perioperative variables. RESULTS: A SAS≤4 in the trauma hip fracture patients was a significant predictor for the 30-days major postoperative complications with 80% specificity (95% CI: 0.587-0.864, p=0.0111). However, the SAS was not significant in the prediction of 30-days mortality (95% CI: 0.468-0.771, p=0.2238) and 6-months mortality (95% CI: 0.497-0.795, p=0.3997) as primary endpoints in the hip fracture surgery patients. CONCLUSION: The SAS shows how intraoperative events affect postoperative outcomes. Calculating the SAS in the operating theatre provides immediate, reliable, real-time feedback information about patient postoperative risk. The results of this study indicate that all trauma hip fracture patients with SAS≤4 should go to the ICU postoperatively and should be under intensive surveillance both during the hospital stay and after hospital discharge.

Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing.

INTRODUCTION: Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. PATIENTS AND METHODS: 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. RESULTS: Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. CONCLUSIONS: Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis.

Operative management of unstable ankle fractures in the elderly: our institutional experience.

Ankle fractures represent an exceptionally common injury within the elderly population. The total incidence of ankle fractures has been reported to be up to 184 fractures per 100,000 persons per year, of which 20 to 30 percent occur in the elderly. This study reports the results of operative management of ankle fractures in the elderly, with regard to functional outcome and complication rates. This was a retrospective, non-randomized observational study. Subjects were identified from a trauma registry kept in our Department and were tested for eligibility. Patients were then categorized into two groups according to their age: Group A included all patients less than 65 years of age and Group B included all patients over the age of 65. The outcome was measured using the AOFAS Ankle-Hindfoot score and a Linear analog scale. A total of 120 consecutive patients fulfilled the eligibility criteria and were included in our study (60 patients in each group). We detected statistically significant difference between the LAS score of the two groups (p=0.02), the alignment between the two groups (p=0.04) and the AOFAS score versus LAS score in Group B (p=0.03). Two patients from Group B had wound dehiscence, but finally their wounds healed uneventfully. We didn't observe any serious complications such as skin necrosis, deep infection, osteomyelitis and failure of metalwork. Our study suggests that the operative management of Weber B2 and B3 injuries can result in a favorable outcome. It is however of great importance that there are no delays in treatment, that the reduction is anatomical, that the fracture fixation is satisfactory and that the rehabilitation is commenced early.