Bilateral Abducens Nerve Palsy Due to Extensive Cerebral Venous Sinus Thrombosis.

Cerebral venous sinus thrombosis (CVST) is a relatively rare condition. We present a case of an acute aseptic thrombosis of the sagittal, transverse and sigmoid sinus in a puerperium patient with protein S deficiency. The specifics of the case include high intracranial pressure (ICP) caused by sinus thrombosis with typical symptomatology and bilateral papilloedema, which also manifested in transient bilateral abducens nerve palsy and, consequently, bilateral horizontal diplopia. The recovery of the cranial nerve function occurred 3 to 4 weeks after it was initially reported. Prompt and adequate anticoagulant therapy contributed to the almost complete recanalization of the dural venous sinus thrombosis and a positive outcome of the disease.

Reliability of Ultrasound Measurement of Muscle Thickness in Patients with Supraspinatus Tendon Pathology.

Objectives of the study were to observe supraspinatus muscle thickness in patients with supraspinatus tendon pathology using ultrasound (US) and examining inter- and intra-rater reliability, and to compare muscle thickness with cross-sectional area (CSA) and occupation ratio measured by both US and magnetic resonance imaging (MRI). The investigation was designed as a prospective cohort study. Two groups of patients were included in the study: 43 patients with tendon rupture and 44 patients without tendon rupture as a control group. A written consent was obtained from all patients. In both groups, muscle thickness, CSA and occupation ratio were measured with US, and CSA and occupation ratio with MRI. Study results showed statistically significant between-group differences. The mean supraspinatus muscle thickness measured by US was 14.01 mm and 19.83 mm in patients with and without tendon rupture, respectively. CSA and occupation ratio measured by US and MRI also showed statistically significant between-group differences. Pearson correlation coefficient between supraspinatus thickness and occupation ratio and CSA measured by US and MRI showed strong to moderate correlation. US measurements showed moderate to strong intra- and inter-rater reliability. In conclusion, supraspinatus muscle thickness measurement by US is a reliable method for muscle atrophy evaluation and strongly correlates with other acknowledged methods.

INFLAMMATORY RESPONSE FOLLOWING PERIPHERAL ENDOVASCULAR TREATMENT CORRELATES WITH THE EXTENT OF PERIPROCEDURAL ARTERIAL INJURY.

- The aim was to examine whether the postprocedural change in C-reactive protein (CRP) and fibrinogen levels was associated with the extent of periprocedural arterial injury caused by endovascular treatment (EVT). The study recruited 71 patients undergoing EVT. Eighty-four patients that underwent angiography served as a control group. CRP and fibrinogen were measured at baseline, and at 8, 24 and 48 hours following the procedure. In all experimental group patients, lesion complexity, percutaneous transluminal angioplasty (PTA) treated segment length, balloon inflation time and stented segment length were recorded. There was significant increase in plasma CRP and fibrinogen levels 48 hours following EVT (p<0.001). There was no significant difference in CRP and fibrinogen levels among different TASC groups. CRP levels were significantly higher in stent subgroup compared to PTA subgroup. Significant positive correlation was found between PTA treated segment length and CRP increase between 8 and 24 hours following EVT (r=0.313, p=0.02), balloon inflation time and CRP increase in the aforementioned time frame (r=0.270, p=0.03), as well as between CRP increase at 8 hours and stented segment length (r=0.535, p=0.01). This study showed that the arterial injury caused by EVT reflected on the level of inflammatory biomarkers.

Estimated collective effective dose to the population from nuclear medicine diagnostic procedures in Croatia: A comparison of 2010 and 2015.

OBJECTIVE: This study presents national surveys of patient exposure from nuclear medicine (NM) diagnostic procedures in 2010 and 2015 in the Republic of Croatia. METHODS: The survey was performed according to the European Commission Dose DataMed (DDM) project methodology. 28 most frequent NM diagnostic procedures were identified. Data about frequencies of procedures and average administered activities of radioisotopes used in those procedures were collected. Average administered activities were converted to effective doses according to the dose conversion coefficients. Then the collective effective dose to the population and an effective dose per capita were calculated based on the number of the most frequent NM diagnostic procedures and the average effective dose per procedure. RESULTS: In 2010, 41200 NM diagnostic procedures led to 146.7 manSv collective effective dose to the population and in 2015, 42000 NM diagnostic procedures led to 146.8 manSv collective effective dose to the population. The frequencies of NM diagnostic procedures were 9.7 and 9.8 annually per 1000 population with 34.1 µSv and 34.2 µSv effective dose per capita for 2010 and 2015, respectively. The main contributors to the annual collective dose from NM in Croatia are examinations of the bone, heart, thyroid and PET/CT tumour diagnostic. Average administered activities have not changed considerably from 2010 to 2015. Nevertheless, within the frequency of some of the procedures, significant changes were found in five-year period. CONCLUSIONS: Frequencies, average administered activities and collective effective dose to the population from NM diagnostic procedures in Croatia are comparable to the values reported by other European surveys. Changes were found between 2010 and 2015 and we intend to perform this study periodically to identify possible trends, but also to raise awareness about the potential dose optimization.

A validity of ultrasound subdivision of Risser grade 4 in assessment of skeletal maturity.

In the treatment of adolescent idiopathic scoliosis, one of the most frequently used technique to determine skeletal maturity is the method described by Risser. The ossification of iliac apophysis progresses from ventral to caudal through the four zones and the fusion of the iliac apophysis to the iliac crest (Risser grade 5) indicated vertebral growth completion, therefore the termination of scoliotic deformity progression. The main disadvantages of Risser method are exposure to radiation and the questionable reliability, so there are efforts to examine iliac apohysis by ultrasound. There is also no resolute recommendation when to discontinue brace treatment of scoliosis. Using ultrasound, in this study, we subdivided Risser grade 4 to grade 4a and 4b, according to the amount of cartilage left unossified, in order to make clear when is safe to end brace treatment. We measured increase in height, during six month period, for 92 healthy children, who were classified by ultrasound in Risser 4a or 4b group. There was significantly larger increase in height for group 4a (p < 0.001). For girls, we also noted time past from menarche as sign of biological maturity. Girls from group Risser 4b got menarche 2.74 years before they were examined while group Risser 4a got menarche only 1.57 years before (p < 0.001). Subdvision of Risser 4 grade by ultrasound is promising method in determining end of brace treatment for scoliosis.

A correlation of peak height velocity and olecranon apophysis ossification assessed by ultrasound.

Peak height velocity (PHV) is defined as the period of the fastest growth during puberty. An ability to predict annual growth and the timing of PHV may provide an opportunity to modify treatment of many diseases and conditions of the skeletal system such as scoliosis and kyphosis, slipped capital femoral epiphysis, leg length inequality and adolescent Blount's disease. There is a good correlation of peak height velocity and skeletal age determined from the radiographic assessment ofolecranon. To avoid radiation, we tested value of olecranon ultrasound in prediction of annual growth and peak height velocity. In present study, using ultrasound, we made a classification of olecranon apophysis in 7 levels (0-6) according to the amount of cartilage left unossified. In 134 healthy children, aged from 10 to 15, evaluation of olecranon sonographs and staging was done by two observers in two spaced time intervals. Calculation of intra-examiner and inter-examiner agreement presented satisfactory reliability (intraclass correlation coefficient for Rater 1 = 0.967 and Rater 2 = 0.836) and very good reproduciblity (Cohen's Kappa 0.85). We measured increase in height, during six month period, for 54 children, who were classified by ultrasound in levels from 0 to 6. The greatest growth was noted in children classified as level 4. Olecranon apophysis maturity level 4, assessed by ultrasound could correspodent to peak height velocity.

Results of the surgical reconstruction of the anterior cruciate ligament.

Results of the surgical reconstruction of the anterior cruciate ligament (ACL), using as a graft fourfold hamstring tendons (gracilis and semitendinosus) and middle third of the patellar ligament, were compared. In all patients that were participating in this study clinical examination and magnetic resonance showed ACL rupture, and apart from the choice of the graft, surgical technique was identical. We evaluated 112 patients with implemented patellar ligament graft and fourfold hamstring tendons graft six months after the procedure. Both groups were similar according to age, sex, activity level, knee instability level and rehabilitation program. The results showed that there was no significant difference between groups regarding Lysholm Knee score, IKDC 2000 score, activity level, musculature hypotrophy, and knee joint stability 6 months after the surgery. Anterior knee pain incidence is significantly higher in the group with patellar ligament graft (44% vs. 21%). Both groups had a significant musculature hypotrophy of the upper leg of the knee joint that was surgically treated, six months after the procedure. Both grafts showed good subjective and objective results.

Pulmonary embolism caused by a migrated gunshot projectile.

Pulmonary embolism caused by a foreign body is an exceedingly rare event. We report on a 62 year old woman who suffered a gun shot injury to her left knee with concomitant vascular lacerations. The bullet migrated through the venous system into the pulmonary circulation causing a pulmonary embolism. The projectile remained stationary for ten years. Taking into consideration that she is virtually asymptomatic and that regular follow up examinations showed no further migration of the foreign body, we opted for a conservative venue of management.