Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach-a University clinic case control study of 120 cases.

INTRODUCTION: The surgical approach used in total hip arthroplasty (THA) has been identified as a factor affecting the outcome. In our University Hospital, the posterior surgical approach is the gold standard. The Rottinger approach is an anterolateral approach which is truly minimally invasive, as it does not vertically cut any muscle fibers. The objective of this study was to determine the difference in surgical outcomes between the posterior hip approach and the Rottinger approach which was newly adopted at our Hospital. METHODS: In a retrospective study, a total of 120 patients underwent THA; 60 patients using the Rottinger approach by the young consultant surgeon and another 60 patients using the standard posterior approach by the senior orthopaedic surgeon. Patients have been controlled for age, gender, and ASA grades. All preoperative demographic data showed no significant difference between the control and study groups. The following parameters were analyzed: incision length, duration of the surgery, intraoperative blood loss, WOMAC index, Harris Hip Score, range of motion at 3 and 12 months after surgery, time of quitting the crutches, and willingness for the contralateral hip arthroplasty. RESULTS: WOMAC index, surgical time, and incision lengths have been without significant difference in both approaches. Intraoperative blood loss was significantly lower in the Rottinger group (CI: - 10.903, - 0.064). Harris Hip score was significantly higher (CI: 4.564, 12.973) in the Rottinger group at 3 months, but similar (CI: - 3.484, 2.134) at 12 months follow-up. At 3 months, active flexion and extension were significantly higher in the Rottinger group (CI: 0.595, 8.239; 2.487, 4.480, respectively), and active abduction and passive adduction (CI: - 5.662, - 0.338; - 6.290, - 1.410, respectively) in the posterior approach group. Patients in the Rottinger approach group on average quit crutches 3 weeks earlier and had no postoperative dislocations compared to 2 dislocations in the control group. CONCLUSION: The Rottinger approach offered faster rehabilitation with less need for crutches and with lower complication rates.

ESTABLISHMENT OF THE BONE TISSUE BANK AT MOSTAR UNIVERSITY CLINICAL HOSPITAL.

Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.

Prevalence of Intellectual Disabilities and Epilepsy in Different Forms of Spastic Cerebral Palsy in Adults.

BACKGROUND: Spastic cerebral palsy may be interconnected with other neurodevelopmental disorders such as intellectual disabilities, and epilepsy. Brain synaptic plasticity and successful restorative rehabilitation may also contribute to diminish neurological deficit of patients having cerebral palsy. The aim of this study was to investigate the prevalence of intellectual disabilities and epilepsy in adult patients with different forms of spastic cerebral palsy and to find out correlation between the severity level of intellectual disabilities and epilepsy. SUBJECTS AND METHODS: Adults diagnosed with different forms of spastic cerebral palsy were analyzed during a three-month period. The investigated features were: gender and age; form of cerebral palsy; the prevalence of intellectual disabilities and epilepsy. Intellectual disabilities were divided into 4 severity levels. The correlation between the severity level of intellectual disabilities and epilepsy was statistically analyzed. RESULTS: Intellectual disability was present in 55% of patients diagnosed with spastic cerebral palsy. Epilepsy was present in 36% of such patients. It was recorded in 51.1% of quadriplegic, 21.9% of diplegic, and 19.2% of hemiplegic patients. Intellectual disability was present in 73.8% of quadriplegic, 31.3% of diplegic, and 53.8% of hemiplegic patients. The statistically significant correlation existed between the severe intellectual disability and epilepsy. CONCLUSIONS: Intellectual disabilities and epilepsy most frequently occurred in patients with most severe forms of spastic cerebral palsy. Epilepsy is strongly correlated to the severity level of intellectual disability. Such patients require additional special modes of treatment and restorative rehabilitation to improve the functional outcome.

Substance abuse prevalence and its relation to scholastic achievement and sport factors: an analysis among adolescents of the Herzegovina-Neretva Canton in Bosnia and Herzegovina.

BACKGROUND: Substance abuse among adolescents is a major public health and social problem. However, studies rarely investigate the relationships between substance abuse, educational achievement and sport factors. Substance abuse is an even more significant problem in societies that have experienced trauma, such as Bosnia and Herzegovina, which have had recent wars. The aims of this study were to investigate substance abuse among adolescents in Bosnia and Herzegovina and to study the potential gender-specific relationships between a) sport factors (physical activity/exercise/athletic participation) and substance abuse and b) scholastic achievement and substance abuse. METHODS: Our sample consisted of 1,032 adolescents who were 17 to 18 years old (435 boys and 597 girls) and who were in the final grade of high school. These subjects were randomly selected from the territory of Herzegovina-Neretva Canton of Bosnia and Herzegovina. Retrospective testing was performed using an extensive self-administered questionnaire. The questionnaire included questions involving topics such as sociodemographic variables, scholastic variables, sport factors, and substance abuse data (smoking habits, drugs consumption and alcohol consumption using the AUDIT questionnaire). Descriptive statistics, frequencies, analyses of the differences and correlational analyses were performed. RESULTS: Our results found that greater than one-third of the boys and one-fourth of the girls were daily smokers, and almost half of the boys and one-fifth of the girls practiced harmful drinking; other drugs (i.e. heroin, cocaine, amphetamines, etc.) were rarely consumed. Boys dominated in sport factors, whereas girls were more successful in scholastic achievement. Approximately 23% of the boys and 6% of the girls reported that they practiced harmful drinking and smoked simultaneously. Educational failure, which was defined as having one or more negative grades at the end of the last two school years, was identified in 20% of the boys and 9% of the girls. In both genders, substance abuse was negatively correlated with educational achievement, and half of those students who failed educationally reported daily smoking. Among the girls who experienced education failure, 33% were smokers, and 22% practiced harmful drinking. Sport factors were weakly correlated with substance abuse in boys; thus, we could not support the hypothesis that sports are a protective factor against substance abuse among male adolescents. In girls, participation in team sports was related with a higher incidence of smoking, but there was no evidence of sport factors having an influence on the consumption of alcohol. CONCLUSION: In this study, the incidence of smoking and the consumption of alcohol were alarmingly high. These findings demonstrate the need for intervention programs to address these issues. These problems are particularly important, considering that substance abuse has a negative impact on educational achievement among boys and girls, and sport factors have not been found to be protective factors against substance abuse.

Is there a danger for myopia in anti-doping education? Comparative analysis of substance use and misuse in Olympic racket sports calls for a broader approach.

BACKGROUND: Racket sports are typically not associated with doping. Despite the common characteristics of being non-contact and mostly individual, racket sports differ in their physiological demands, which might be reflected in substance use and misuse (SUM). The aim of this study was to investigate SUM among Slovenian Olympic racket sport players in the context of educational, sociodemographic and sport-specific factors. METHODS: Elite athletes (N=187; mean age=22±2.3; 64% male) representing one of the three racket sports, table tennis, badminton, and tennis, completed a paper-and-pencil questionnaire on substance use habits. Athletes in this sample had participated in at least one of the two most recent competitions at the highest national level and had no significant difference in competitive achievement or status within their sport. RESULTS: A significant proportion of athletes (46% for both sexes) reported using nutritional supplements. Between 10% and 24% of the studied males would use doping if the practice would help them achieve better results in competition and if it had no negative health consequences; a further 5% to 10% indicated potential doping behaviour regardless of potential health hazards. Females were generally less oriented toward SUM than their male counterparts with no significant differences between sports, except for badminton players. Substances that have no direct effect on sport performance (if timed carefully to avoid detrimental effects) are more commonly consumed (20% binge drink at least once a week and 18% report using opioids), whereas athletes avoid substances that can impair and threaten athletic achievement by decreasing physical capacities (e.g. cigarettes), violating anti-doping codes or potentially transgressing substance control laws (e.g. opiates and cannabinoids). Regarding doping issues, athletes' trust in their coaches and physicians is low. CONCLUSION: SUM in sports spreads beyond doping-prone sports and drugs that enhance athletic performance. Current anti-doping education, focusing exclusively on rules and fair play, creates an increasingly widening gap between sports and the athletes' lives outside of sports. To avoid myopia, anti-doping programmes should adopt a holistic approach to prevent substance use in sports for the sake of the athletes' health as much as for the integrity of sports.

Comparative analysis of substance use in ballet, dance sport, and synchronized swimming: results of a longitudinal study.

There have been few studies comparing substance use and misuse (SU&M) in different performing arts forms. Herein, we identified and compared SU&M in women studying an art (ballet, n = 21), a non-Olympic sport (dance sport, n = 25), and an Olympic sport (synchronized swimming, n = 23). The sample of variables comprised general, educational, and sport factors, as well as SU&M data, including consumption of opiates, cigarettes, alcohol, nutritional supplements, doping behaviors, and beliefs. Using the Kruskal-Wallis test, we found no significant differences between study groups in potential doping behaviors. Most of the examinees reported that they did not rely on physicians' and/or coaches' opinions regarding doping. Only sport dancers recognized their consumption of cannabis as a violation of anti-doping rules. Those more convinced that doping habits are present in their sport (or art) have a certain tendency toward doping usage. In conclusion, a strong anti-doping campaign within the studied arts is suggested, focusing on the health-related problems of SU&M.

Results of treatment of displaced supracondylar humeral fractures in children by K-wiring.

The supracondylar fracture of the humerus in children remains the most challenging injury for the orthopedic surgeon. It is important to consider the options of treatment very carefully and tailor the treatment according to the characteristics of each fracture. In this study we observed outcomes of surgical procedures using the Kirschner-wire for the dislocated (displaced) supracondylar fractures in 135 children (mean age 6.7 years). In 96 patients closed reposition (reduction) and fixation with crossed K-wire was done. A total of 41 children were operated by the means of open reposition and crossed K-wire fixation. Another 41 underwent similar (1-mm) K-wire application. In classifying the fractures Gartland classification of the supracondilar fractures of the humerus was used. Postoperatively, cubitus varus was found in seven, and cubitus valgus in three children (5% and 2% respectively). Stiffness of the elbow was recorded in 18 patients, while the paresis of the ulnar nerve was recorded in three cases (13 and 2% respectively). In conclusion, we can suggest crossed fixation while applying the K-wire throughout two cortexes, since such technique ensures the most superior fixation and stable osteosynthesis.

Treatment of peritrochanteric fractures by the use of gamma nail.

The Gamma nail was designed to treat unstable intertrochanteric and subtrochanteric fractures. In this study we analysed a total of 60 patients (44 men and 16 women), who were surgically treated for the peritrochanteric fracture in period 2006-2007 at the University Hospital Mostar. After the surgical treatment good bone healing was achieved in 50 patients (83.3%). A total of five patients had delayed healing or protrusion of the cervical screw, and in two patients nails were not appropriately distally locked. During the follow-up period a total of 7 patients died. The average operation time was 40 minutes, and the average blood loss was 400 mL, which is a comparable result with the previously published studies. In conclusion, although most of the peritrochanteric fractures treated at the University Hospital Mostar were fixated by gamma nail, the final decision regarding the operational technique should be left to surgeon's judgment, since the efficacy of the treatment plan is highly dependent on experience of the operational team and surgeon's operational technique.

Bone fractures in a 53-year-old patient with parathyroid adenoma--a case report.

The study reports a case of primary hyperparathyroidism in a middle-aged patient who was first admitted for persistent ankle pain and local swelling. The subsequent clinical procedures suggested cystic changes in several leg bones, which were later shown to be caused by the parathyroid adenoma. Clinical presentation of the primary hyperparathyroidism can be highly misleading, sometimes causing various clinical procedures before it is certainly diagnosed.

Bilateral congenital dislocation of the knee with ipsilateral developmental dysplasia of the hip--report of three patients.

Congenital dislocation of the knee (CDK) is a very rare condition. Here we report our strategy and results in treatment of three children with CDK. All three patients were treated with conservative method, and only one had underwent a surgical procedure on one knee. Of the remaining, we recorded a good outcome with conservative treatment in three knees, while two had poorer outcome as a result of musculoskeletal anomalies. We also present here a unique case of a child born without cruciate ligaments and patellas on both sides. We performed the operative procedure by Z-plasty of the extensor apparatus on one left knee according to Niebauer and King on one child. The clinical result of this procedure was very good. Five years after the operation we decided to perform an MRI examination to assess the postoperative status of the operated knee, especially the position and the shape of left patella. We found the asymmetry and high position of the operated patella resulting in patella alta. Compared to the initial clinical presentation, we consider all patients to have good clinical presentation nowdays.

Religiousness as a protective factor for substance use in dance sport.

Although religiousness is found to be a significant protective factor in substance use, there is an evidential lack of studies of such in athletes. The aim of the study was to identify the predictive value of the religiousness and some social, educational, and sport factors on substance use in 43 sport dancers. An originally developed questionnaire for studying substance use and precipitation factors was applied. The Chi-square showed male dancers as more religious than females. Using the Spearman's correlation, religiousness was found to be a significant protective factor in cigarette smoking, sport nutritional supplementation, and the likelihood of doping. Data were interpreted emphasizing the previous findings from the literature.

Serum and tissue angiotensin converting enzyme in patients with psoriasis.

Recent evidence suggests that the angiotensin converting enzyme (ACE) is present in skin. The real value of the determination of ACE activity as a clinical-biochemistry test for the diagnosis of psoriasis has not been attained. Serum and tissue ACE were measured in 60 patients with psoriasis, 20 patients with lichen planus, 20 patients with seborrhoic dermatitis and in 20 healthy individuals. The serum and tissue ACE activity was determined before and after therapy, using the spectrophotometric method and hippuryl-l-histidyl-l-leucine as a substrate. The results showed that serum ACE activity before therapy was significantly increased in both groups--patients with psoriasis (p < 0.001) and patients with lichen planus (p < 0.001) in comparison to healthy individuals. However, there were no significant differences in serum ACE activity among patients with seborrhoic dermatitis and healthy individuals. After therapy, serum ACE activity significantly decreased in both groups of patients with psoriasis and patients with lichen planus comparing it to the level found in the control group. The values in both were similar. The tissue ACE activity in altered skin was significantly increased only in the patients with psoriasis in comparison to uninvolved skin of these patients, as well as the skin of healthy individuals. After therapy, there were no significant differences in tissue ACE activity between the treated skin and the healthy skin. In conclusion, determination of tissue angiotensin converting enzyme activity can be used in the differential diagnostic of indistinct clinical forms of psoriasis.

Minimally invasive calcaneo-stop method for idiopathic, flexible pes planovalgus in children.

BACKGROUND: The aim of this study was to correct heel valgus in children and to lift the longitudinal arch of the foot using a temporary cancellous screw placed percutaneously across the talocalcaneal articulation. METHODS: From April, 1997, to June, 2003, 94 procedures were done on 48 children between the ages of 8 and 14 years. The Meary angle to determine the degree of collapse of the medial longitudinal arch was 170 degrees or less, and the weightbearing hindfoot was in valgus. Presumably, the screw achieves correction by stimulating the proprioceptive foot receptors allowing active inversion of the foot. RESULTS: At 5 years followup, no serious complications occurred. The correction of the Meary angle on average was 17.10 +/- 5.51 degrees. In every foot, heel valgus and the longitudinal arch of the foot were improved radiographically and clinically without the loss of function. We removed the screws in all patients. In 91 feet, the arch of the foot and heel valgus remained in the corrected position. CONCLUSIONS: The 'calcaneo-stop' method is a simple, effective, minimally invasive technique for the treatment of idiopathic, flexible pes planus in carefully selected pediatric patients.

Cerebrovascular insult hospital cases in the Clinical Hospital Mostar (Bosnia and Herzegovina) from 1999 to 2003--an example of an institutional register.

The analysis of a cerebro-vascular insult hospitalized cases in the Clinical Hospital Mostar as a retrospective epidemiological study was done in the Clinical Hospital Mostar for the period from 1999 to 2003. The major source of data was medical documentation of this hospital (an institutional register), the only hospital for the treatments of 457,491 inhabitants who gravitate by a health insurance for the treatment in this hospital. The study included a total of 1,555 cerebro-vascular insult cases treated in the Clinical Hospital Mostar Among them 727 (46.8%) were male patients, while 828 (53.2%) cases were female. The majority of the cases were above 50 years of life. Majority of treated female patients were older than 61 (45.6% of all cases), as well as among male patients (31.3%). The least number of cases was under 41 years in both groups (1.2%). Prevalence of risk factors was 2,035 cases (74%). During the same period risk factors research for entire Federation of Bosnia and Herzegovina (FBiH) was performed on the sample of 2,750 national insurance holders, out of which 852 gravitate for treatment in CB Mostar. Out of them 1.7% was found to suffer of cerebro vascular insult.

Pulmonary function in persons who are professionally exposed to formaldehyde fumes.

The present study examines long-term effects of occupational exposure to formaldehyde fumes on lung function. Forced spirometry and diffusing lung capacity were measured in 16 health-service professionals (8 medical doctors and 8 laboratory technicians) working at the pathoanatomic laboratory for at least 4 years with daily exposure 8 +/- 1 hours. Control group employed 16 males, which were matched by age and stature to members of the exposed group. Only non-smokers were included in the study. Spirometric parameters in study participants exposed to formaldehyde fumes compared to control group were not significantly different indicating absence of restrictive and/or obstructive deterioration of lung function in exposed group. The only parameter differing in two groups was blood volume of pulmonary capillaries (Vc') which was significantly larger in a group exposed to formaldehyde fumes. The possibility that the hyperemic lung reaction is the consequence of the exposure to formaldehyde fumes should be further explored.

[Hospital outcome in acute coronary syndrome in the period 1987-2001 in West-Herzegovina canton--retrospective study]. / Bolnicki ishod kod akutnog koronarnog sindroma u razdoblju 1987.-2001. u Zapadnohercegovackoj zupaniji--retrospektivna studija.

Objective of the study is to show prevalence of hospital mortality of acute coronary syndrome in pre-war (1987-1991), war (1992-1996) and after war period (1997-2001) among inhabitants of West-Herzegovina canton living in the following municipalities: Siroki Brijeg, Posusje, Grude and Ljubuski (88,992 inhabitants). Collected were data on patients who were admitted in the hospital due to acute coronar syndrome (category I 20, 21, 22- X revision, ICD) in the above period in Mostar. Data were analyzed in regard to sex, age and disease output. Hospital morality in 15 year period for both sex were 15.0 %, men 12.1 %, and women 20.2 %. Statistically it was not found significant differences in the period 1987-2001 in regards to total hospital mortality of men and women and separate hospital mortality of men. Differences were found in women where considerable larger number was in pre-war and post-war period in comparison with war period. The largest hospital mortality was in total and for women in the pre-war period and for men was during the war period. The smallest hospital mortality was in total and for women during the war and for men in pre-war period. We find that lower hospital mortality in women was caused by lower hospital admission because of war time and problems with transport and that larger number of women deceased before admission to the hospital.

Age-related and gender-related differences between human vertebral and iliac crest bone--a histomorphometric study on the population of the Mediterranean Coast of Croatia.

In this study, osseous tissue was examined in normal adult population that has inhabited areas by the Croatian Adriatic Sea. The most of such studies have shown that women are prone to lose bone connectedness, while men are predisposed to be a stronger constitution and they start with greater bone mass, though. Bone samples from two different anatomic sites were analyzed. The crista iliaca and the lumbar vertebra represent functionally different organs too. We wanted to consider weather the same age- and gender-related changes affect these two organs due to normal aging. Static histomorphometry was used to quantify involution changes in the trabecular bone. Results showed that involution process more severely affects women than men. Age-related structural changes were more prominent in lumbar vertebra than in iliac crest bone. Severe structural changes in lumbar vertebra could subsequently lead to a dysfunctional and deformed vertebral column. Therefore, iliac crest bone biopsies could hardly explain involution process that affects lumbar spine.

Prevalence of scoliosis in school-children from Mostar, Bosnia and Herzegovina.

In the school-year 2002/2003 a prospective epidemiological study was performed with the aim of evaluating the prevalence and distribution of scoliosis in the population of schoolchildren from Mostar, Bosnia and Herzegovina. The general check-up of primary-school children covered a total of 2,517 children aged 7-14. The children in which at least one positive symptom of scoliosis was found were directed to undergo orthopedic examination and--if indicated--radiography. Incorrect posture was noted in 33.4% of children, and 11.8% of children were sent to orthopedic specialist examination. The prevalence of structural scoliosis amounted to 3.1%, with the spine curvature threshold being 10 degrees. In eight children (0.32%; 1 boy and 7 girls) a curvature of 20 degrees or more was diagnosed. The most common type of curvature was the thoracal (39%) and the thoraco-lumbar (39%) while 14 children had a double curvature (17.8%). A scoliosis was detected due to here performed check-up in 83.5% of children with scoliosis. No case of serious spine deformity (45 degree or more) was recorded, due to regular general check-ups taking place biannually in this population.

Acute coronary syndrome frequency in western Herzegovina over the fifteen year period (1987-2001).

All patients who suffered from the acute coronary syndrome in western Herzegovina over the fifteen year period (1987-2001) are included in this retrospective epidemiological study. The population that was undertaken by the study is relative stabile and did not emigrate during the war period. The study compared the time before the war (1987-1991), during the war (1992-1996) and after the war (1997-2001). The data were acquired from the archives of the patients of the Mostar hospital and Clinical hospital Split during the war period. A total of 2022 acute coronary syndrome patients were found, 1305 men and 717 women. More patients were treated during the war compared to the time before the war for both male and female patients (p<0.0005). During the after-war period the number of treated patients was greater (p< 0.0005) compared to the war-time for both sexes. The comparison of the after-war period and the pre-war period reveals a statistically significant difference as the number of treated patients (male and female) is larger in the after-war period. The number of patient who are 65 years old and older than that is greater, and that is statistically significant (p= 0.0005.). We can conclude that the stress caused by the war and other factors have influenced a larger number of treated patients of acute coronary syndrome. Therefore, further epidemiological researches of acute coronary syndrome with the accent on prevention and treatment are needed.

Age- and region-dependent changes in human lumbar vertebral bone: a histomorphometric study.

STUDY DESIGN: Histomorphometric evaluation of autopsy material. OBJECTIVES: To explore region-dependent changes that occur with aging in trabecular and cortical bone of the human vertebral body. SUMMARY OF BACKGROUND DATA: Human vertebral bone is continuously subjected to external forces (loads) that promote changes in inner architecture. This functional adaptability is limited, however, and when lost, vertebral bone progressively deteriorates and becomes subject to injury with increases in mechanical loading. METHODS: Bone cylinders were drilled with a trephine from three regions (central anterior, central posterior, and lateral) of the third lumbar vertebral bodies of 48 autopsy cases 31 to 76 years old. Two consecutive 5-microm sections obtained 150 microm apart were stained with toluidine blue and Masson trichrome and photographed at x40. Differences in numerous morphometric factors were evaluated by age and region of the vertebra using repeated-measures analysis of variance and Tukey's Honestly Significant Difference test. RESULTS: Starting at about 50 years of age, significant, linearly progressive decreases occurred in trabecular and cortical bone volume (P < 0.005), trabecular surface area (P < 0.001), number of trabeculae (P < 0.001), and thickness of trabeculae (P < 0.001). Space between trabeculae increased from ages 31 to 70 years and then decreased (P < 0.001). Trabecular deterioration was significantly more pronounced in central versus lateral regions (P < 0.001). Cortical bone thickness decreased significantly with aging in central regions but increased in lateral regions between ages 61 and 70 years (P < 0.001). CONCLUSIONS: The balance between cortical and trabecular bone maintains the strength of the vertebral body until about the age of 50 years, when irreversible deterioration begins in central regions and subsequently involves lateral regions.