Quality of life of patients after stroke in county Osijek-Baranya

The purpose of this prospective study was to determine quality of life of patients after stroke in Osijek-Baranya County. The research included 161 patients (82 men and 79 women) who had their first acute stroke and were treated at Department of Neurology, Osijek University Hospital Center The Barthel Index (BI) was used to assess functional deficiency and SS-QOL (Stroke-Specific Quality of Life) questionnaire was used for self-evaluation of patients' physical and mental health. The first assessment was carried out in the acute phase of the disease, and control assessments 30, 90 and 180 days after the stroke. Mean Barthel Index score was higher at every successive measurement (55, 80, 95, 95). All BI items were statistically significant (Friedman, p < 0.001) apart from dressing and bowel control. BI score indicated greater dependence in women in all assessments except for those taken 90 days after onset of symptoms (chi2-test, p = 0.111). Mean values of SS-QOL for physical health were: 105.2, 98.3, 105.7, 117.5 and for mental health: 64.24, 57.9, 64.3, 68.1. Statistically significant difference was present in men, both for physical health (Friedman p = 0.009) and total SS-QOL (Friedman p = 0.014), while in women there was no statistically significant difference between the measurements (Friedman p = 0.719). The research showed that stroke has significant influence on basic and specific daily life activities and interferes with the quality of life of stroke patients. Women have lower level of independence. Patients who live with their families make better evaluation of their physical and mental health.     

Vertebroplasty--high viscosity cement versus low viscosity cement

The patients with intensive pain caused by the vertebra body fracture were treated by application of low viscosity cement (LVC), (Vertebroplastic, DePuy) and high viscosity cement (HVC), (Confidence, DePuy,) into the body, by means of diascopy through unilateral transpendicular approach. Application of LVC was made in 75 patients, on 109 vertebrae, and HVC was applied in 12 patients on 14 vertebrae. Application of LVC was performed on 48 thoracic and 61 lumbar vertebrae and 5 thoracic and 9 lumbar vertebrae were stabilized with HVC. 43 patients were treated for malignancy and in 38 for osteoporosis. For LVC, preoperative VAS score was 8.32 and 2.23 (p < 0.00001) 24 hours after surgery, and it remained stable 3 month later. For HVC, preoperative VAS score was 7.99 and it was 2.5 (p < 0.00001) 24 hours after surgery and 3 months later. In the group of patients treated with LVC, there was 1 serious complication, a paraparesis caused by the leakage of cement into the spinal canal, which was partially recovered after decompression and rehabilitation treatment and 2 superificial infections with S. epidermidis which were cured by means of antibiotics. In 32 vertebrae (32) cement leakage extra ossal, either into vein plexus or intradiscal during surgery were noticed. When HVC was applied, intradiscal leakage occurred in one case only (8%). By means od Wilcoxon paired test a significant difference was found between the preoperative VAS, and the values immediately after surgery and 3 months later (Z = 7.52, p < 0.00001) when LVC was applied., and with HVC it was ( Z = 3.04, p < 0.00001), which indicates that the fast achieved pain reduction remained stable during the 3 month follow-up. The vertebroplasty is a safe and efficient surgical method in treatment of compressive vertebrae fractures which do not react to the conventional method of treatment. This method, when HVC is applied, shows significantly less complications related to cement leakage.     

Solar spectral lines ("solar halo")--healing or harmful for the retina?

The sungazing method has been known for thousands of years as healing method based on chromotherapeutic principle. Our examinations on the island of Rab show that it is acceptable only if applied 10 min before the sunset. Gazing has to be directed towards the green-yellow part of the spectrum, since the remaining part of the sun halo contains harmful energy. However, authors suggest that it would be preferable to use spectacles with medical filters transmitting wavelight of green-yellow colour, especially for treatment of macular degeneration.     

Multiple primary melanoma: epidemiological and prognostic implications; analysis of 36 cases

Patients who are already diagnosed with cutaneous melanoma are at increased risk of developing another primary melanoma. The occurrence of multiple primary melanoma is a rare phenomenon, varying in frequency, with an estimated incidence ranging from 0.2% to 8.6%. The authors are presenting data on the patients with multiple primary melanoma from the Croatian Referral Melanoma Centre. The clinical, histological and epidemiological characteristics of 36 (3.6%) patients, identified from 991 patients with histologically confirmed melanoma, are analyzed in this study. Twenty-eight of the patients (78%) had two primary melanomas, six had three melanomas (16.7%) and two (5,6%) had four melanomas. Diagnosis was established synchronously in 11 patients (30%) and, in the rest of the patients, time interval between the diagnosis of the first and second melanoma varied from 1 month to the longest interval of 16 years. However, the majority of subsequent melanomas were removed within 2 years of the initial operation. The mean Breslow's thickness of the first melanoma was significantly higher than the mean Breslow's thickness of the second primary melanoma. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Therefore, we emphasize the importance of regular follow-up as well as the education in regular self--skin examinations in melanoma patients in order to detect subsequent primary melanomas in the early phase.     

Increased bone turnover markers after renal transplantation

Bone remodeling is a process that occurs continuously in a seemingly inactive tissue like bone. Because of decreased vitamin D synthesis, phosphorus retention and decreased calcium blood concentration, patients with chronic renal failure (CRF) develop secondary hyperparathyroidism. Elevated PTH levels shifts balance between osteoblast and osteoclast activity in favor of osteoclast activity and, therefore, bone resorption. Bone metabolic disorder that affects patients with CRF is called renal osteodystrophy (ROD). We presume that renal transplantation reverses bone metabolism disorder and our goal was to establish whether osteoblast and osteoclast activity returns to the levels of healthy individuals.     

Morphological, motor and situation-motor characteristics of elite female handball players according to playing performance and position

The aim of the study was to define biomotor characteristics that determine playing performance and position in female handball. A battery of 13 variables consisting of somatotype components (3 variables), basic motor abilities (5 variables) and specific motor abilities (5 variables) were applied in a sample of 52 elite female handball players. Differences in biomotor characteristics according to playing performance and position of female handball players were determined by use of the analysis of variance (ANOVA) and discriminative analysis. Study results showed the high-quality female handball players to predominantly differ from the less successful ones in the specific factor of throw strength and basic dash factor, followed by the specific abilities of movement without and with ball, basic coordination/agility and specific ability of ball manipulation, and a more pronounced mesomorphic component. Results also revealed the wing players to be superior in the speed of movement frequency (psychomotor speed), run (explosive strength) and speed of movement with ball as compared with players at other playing positions. Also, endomorphic component was less pronounced in players at the wing and back player positions as compared with goalkeeper and pivot positions, where endomorphic component was considerably more pronounced.     

Intensive rehabilitation in children with cerebral palsy: our view on the neuronal group selection theory

Cerebral palsy (CP) is one of the major forms of developmental disorders. There are different approaches and controversies in rehabilitation treatment. The Neuronal Group Selection theory could provide theoretical explanation for Stojcevi? Polovina rehabilitation method. The aim of the study was to evaluate long-term impact of intensive and continuously performed rehabilitation on the motor autonomy level children with CR Motor autonomy levels, defined according to the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM), were analyzed in 24 children with CP at the beginning of the study and at the last visit. During rehabilitation, GMFM scores increased above the expected value of initial GMFCS level in the majority of patients. Intensive rehabilitation had significant influence on motor improvement in children with CP.     

Assessment of nutritional status of gastroenterology patients in Croatia

Malnutrition is a common feature of gastroenterological diseases. In this study, nutritional status of the patients admitted to Department of Gastroenterology at University Hospital Center Zagreb was assessed. Anthropometric, dietetic, biochemical methods and method of Subjective Global Assessment (SGA) was used. The study group included 284 patients admitted to the Hospital. Malnutrition, as defined by SGA, was found in 61.1% of the patients, of whom 75% were moderately and 25% severely malnourished. Those patients classified as moderately and extremely malnourished by SGA were found to have statistically lower values of BMI, albumin, total proteins, calcium, iron, triglycerides, cholesterol, vitamin A and lymphocytes as compared to those who were adequately nourished. The prevalence of malnutrition in hospitalized patients treated at the Department of Gastroenterology is high. The use of nutritional screening with multiple measures would be important in the early identification and treatment of these patients and would help decrease this high prevalence.     

Expression of matrix metalloproteinase-1 in uterosacral ligaments tissue of women with genital prolapse

Collagen metabolism is altered in the pelvic organ tissues of women with genital prolapse. The aim of this study was to compare collagen metabolism by measuring matrix metalloproteinase-1 (MMP-1) expression in uterosacral ligament tissues of postmenopausal women with and without genital prolapse. Uterosacral ligament tissues were obtained at the time of abdominal or vaginal surgery from twenty-four patients with pelvic organ prolapse (POP) and 21 women who underwent gynecologic surgery for benign indications. The tissue samples were analyzed by immunohistochemistry. There were no differences in age, BMI and parity between two groups. The patients with genital prolapse demonstrated significantly higher occurences of MMP-1 expression compared to controls. These findings indicate that increased MMP-1 expression in uterosacral ligaments is associated with genital prolapse. Our data are consistent with the theory that increased collagen breakdown may play an important role in the onset and development of pelvic organ prolapse (POP).     

The circulatory influence on development of age-related macular degeneration and hearing and equilibrium impairments

This study attempts to answer the question if any level of head and neck circulation takes a part in development of Age-Related Macular Degeneration (ARMD) and hearing and equilibrium impairments. Condition of large blood vessels was examined by Color-Doppler ultrasound, and carotid and ophthalmic arteries were included. The microcirculatory changes were examined directly by fundus photography and fluorescein angiography and indirectly testing hearing and equilibrium. The study group included 40 patients (21 females, 19 males) aging from 53 to 84 years with different stages of ARMD. The control group included 40 patients (18 females, 22 males) aging from 51 to 82 years without ARMD. Patients were inhabitants of Primorsko-Goranska County. There was no relationship between ARMD and condition of large blood vessels because significant stenosis of carotid arteries was found in 2 patients (5%) in study group and 3 patients (7.5%) in the control group (p > 0.05). On the contrary, we found correlation between ARMD and hearing (p = 0.0127) and equilibrium impairments (p = 0.0242). Fluorescein angiograms shows raised number of ischemic retinal capillaries in patients with ARMD (p = 0.0053). Results lead to conclusion that circulatory disorders on microcirculatory level take a great part in development of ARMD and hearing and equilibrium impairments in the elderly. The key is damage of sensory cells of the retina and inner ear caused by microcirculatory disorders. Interesting data was noticed that 9 patients with more serious ARMD on one side of head had greater hearing loss on the same side. If we find a new treatment for microcirculatory disorders, maybe we can treat both sensory impairments in earlier stage.