Although the measurements of the lumbar spine and pelvic flexion have shown that subjects with radiculopathy exhibited greater decreases of motion when compared with subjects with low back pain, ...there is still a lack of evidence regarding the changes in flexion relaxation ratio in patients with radiculopathy. The aims of this study were to investigate the flexion relaxation ratio and flexion of the lumbar spine and pelvis in subjects with low back pain (LBP) and LBP with radiculopathy (LBPR) in comparison with healthy subjects (CG-control group). A total of 146 participants were divided in three groups: LBP patients (54 males; 21 females); LBPR patients (26 males; 11 females); and CG subjects (16 males; 18 females). The lumbar spine and pelvis flexion was recorded using optoelectronic motion capture system. The electrical activity of the erector spinae muscles was assessed by surface electromyography during flexion-extension movements. Comparisons between groups were made using one-way ANOVA tests and Mann-Whithney U test with the level of statistical significance at 0.05. The lumbar and pelvic flexion and electromyography of the erector spinae muscle showed significant differences between LBP and LBPR patients compared to CG. Patients LBPR showed significantly smaller angles of lumbar and pelvic flexion compared to LBP patients and CG. An increase in the erector spinae muscle activity during flexion was also observed in patients with radiculopathy. The increased muscular activity of the erector spinae is related to the reduced flexion of the lumbar spine in order to protect the lumbar spine structure. Measurements of trunk, lumbar spine and pelvic flexion, and the flexion relaxation ratio may allow us to predict better outcomes or responsiveness to treatment of LBPR patients in the future.
Depression and anxiety are co-morbid condition in diabetes as disease-related psychological reactions on this chronic metabolic illness. This study was aimed to determine the occurrence of depression ...and anxiety in seafarer's type 2 diabetic patients. A random sample of 52 diabetic seafarers treated with diet and oral glucose lowering agents, and 56 healthy seafarers were screened for depression with The Beck Depression Inventory (BDI) and for anxiety with State-Trait Anxiety Inventory (STAI 1, STAI 2). Depression (BDI > 18.5) and anxiety (STAI < 28.5) was significantly higher in the group of diabetic seafarers than in control group (more than 30%). Significant correlation was noted between depression and duration of diabetes mellitus, degree of obesity and poor glycaemic control (HbA1C > 8%) and longer duration of shipping routes (over 6 months). The proportion of depression and anxiety was found higher in seafarer's type 2 diabetic patients than in the healthy seafarers.
Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the growth of intracranial pressure (ICP) can no longer be controlled with conservative ...methods. DC belongs to class III "Guidelines"--"option" which has not clear clinical certainty. They do not correspond to "Standards" (class I) in treatment protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard craniotomy. 22 patients did not undergo any surgical procedures. In each patient we analyzed ICP changes within the first 11 days and in that way we correlated them statistically with the initial Glasgow Coma Scale (GCS) and then with Glasgow Outcome Scale (GOS), after the end of the treatment. We particularly analyzed the outcome with reference to the time of the operation and the size of DC. The standard measurement of ICP shows statistical significance in recovery in the group without DC after 5 days of intensive treatment, when the pressure is stabilized between 20-25 mm Hg. The stabilization of ICP in the DC group is observed already after 3 days of intensive treatment. Furthermore, better functional recovery according to GOS, which is statistically significant, was observed in patients who underwent DC where the area of craniectomy was larger than 25 cm2, within the first 24 hours from the time of injury. The use of DC considerably reduces the need for CT check-ups. Increase in the number of encephalocele was noted, which is to be expected considering that dural decompression is used in DC procedure. The results of our study indicate that the utilization of DC is characterized with lower mortality and better functional recovery if it is applied at an early stage of treatment and if the size of DC is satisfactory.
Spinal and pelvis motion has been studied by a variety of different methods, the majority of which have a number of limitations. The present study investigated motion characteristics of the lumbar ...spine and pelvis using a three-dimensional optoelectronic system. The aim of our study was to determine kinematic parameters of spine and pelvis during trunk flexion, extension and lateral bending in normal, healthy subjects. Kinematic motion analysis was performed on 63 asymptomatic volunteers for four different trunk motions. This study has shown that the pelvis range of motion is affected by the gender Contribution of pelvic movement to trunk flexion was 50%, while pelvic angle was significantly higher in women. During lateral bending female subjects had statistically significant higher values of vertebral arc with respect to male subjects. During extension the contribution of pelvic movement was 45%. There was no significant difference found in total angle, pelvic angle and vertebral arc.
Muscle fibers are dynamic structures capable of altering their phenotype under various pathological conditions. The aim of the present study was to investigate the influence of long-lasting diabetes ...mellitus on the process of muscle regeneration in the skeletal muscle. Wistar rats were made diabetic by a single intraperitoneal injection of streptozotocin (STZ). The regeneration process in the skeletal muscle was induced in slow (m. soleus, SOL) and fast (m. extensor digitorum longus, EDL) muscles by injection of local anesthetic (bupivacaine). Skeletal muscles were analyzed 10 days, 4 and 8 weeks after bupivacaine treatment. Diabetes mellitus has changed morphological properties of both slow and fast skeletal muscles during the process of regeneration. These changes are evident in redistribution of muscle fibers and significant level of atrophy. All fiber types of diabetic fast muscles showed stronger atrophy than muscle fibers in slow muscles which have more oxidative metabolism. The changes of redistribution of muscle fibers depend on duration of diabetes and affect all types of muscle fibers.
Nespecifična križobolja (NK) predstavlja značajni zdravstveni i socijalno-ekonomski problem zbog svoje velike učestalosti, dugotrajnosti smetnji, rekurentnosti te funkcionalne i radne ograničenosti ...oboljelih. Čest izostanak određivanja uzroka križobolje i slaba korelacija kliničke slike i dijagnostike pomoću slikovnih prikaza, prvenstveno magnetske rezonancije i rendgena ukazuju na potrebu funkcionalnih mjerenja u pacijenata s NK-om. Funkcionalna mjerenja omogućavaju kvantitativno mjerenje funkcionalnih promjena koje mogu biti uzrokom i posljedicom NK-a te razlogom rekurentnosti i radne ograničenosti. Na temelju podataka funkcionalne procjene mogu se programirati i planirati postupci prevencije NK-a te individualizirati terapijski i rehabilitacijski postupci. Isto tako, funkcionalna mjerenja tijekom liječenja i rehabilitacije omogućavaju praćenje učinkovitosti pojedinih postupaka, a po završetku rehabilitacije i procjenu radne sposobnosti. Premda je značaj funkcionalnih mjerenja za uspješnost rehabilitacije pacijenata s NK-om nedvojben, ne postoji konsenzus o standardizaciji protokola funkcionalnih mjerenja. Definiranje valjanih protokola predstavlja nužnost i važna je pretpostavka uspješnog izlječenja, prevencije rekurentnosti i razvoja kroniciteta nespecifične križobolje.
Cilj: Anatomska tehnika rekonstrukcije predstavlja zlatni standard pri operacijskom liječenju lezija prednjeg križnog ligamenta. Kod postavljanja femoralnog tunela glavni orijentir predstavlja ...lateralni interkondilarni greben. Greben se nalazi uz prednji rub hvatišta ligamenta i tuneli se postavljaju ispod njega, u centar hvatišta ligamenta. Cilj ove studije je opisati položaj grebena u odnosu na intaktno femoralno hvatište. Materijali i metode: U studiji je korišteno 10 svježe smrznutih kadaveričnih zglobova koljena. Nakon što je uklonjen medijalni kondil femura, vizualno i uz palpaciju analizirano je područje femoralnog hvatišta ligamenta, i to najprije uz očuvan bataljak prednjeg križnog ligamenta, a zatim nakon uklanjanja čitavog hvatišta. Rezultati: Uz održani ligament, u 70 % preparata niti jedan dio lateralnog interkondilarnog grebena nije bio vidljiv izvan hvatišta. U 20 % preparata greben je bio vidljiv samo iznad posterolateralnog snopa prednjeg križnog ligamenta. Nakon što smo odstranili sva vlakna hvatišta prednjeg križnog ligamenta, u jednom preparatu nismo sa sigurnošću mogli odrediti postojanje grebena. Zaključak: U 90 % ispitivanih preparata lateralni interkondilarni greben bio je unutar hvatišta prednjeg križnog ligamenta. Navedeno bi trebalo uzeti u obzir prilikom anatomske rekonstrukcije ovog ligamenta.
Aim: The lateral intercondylar ridge (LIR) represents the main bony landmark for determining the ACL femoral footprint and for placing the tunnel in the center of the native femoral footprint below the LIR. This study aimed to describe the relationship between the LIR and the intact femoral insertion of the anterior cruciate ligament. Materials and Methods: Ten fresh-frozen, cadaveric knee specimens were obtained for this study. The medial femoral condyle was removed with the aim of finding any protrusion or ridge on the medial wall of the lateral femoral condyle. The exposed areas were carefully analyzed, visually and by palpation. Analyses were performed with ACL stump and after removing the whole ACL from the femoral insertion. Results: In 70% of specimens the ridge was not visible while the ligament was attached to its femoral insertion. In 20% of specimens the ridge was observed outside the fibrous insertion, but only above posterolateral bundle. After removing all ligament fibers in one specimen we could not find bone ridge. Conclusion: In 90% of specimens the LIR was an integral part of the femoral insertion. This observation must be taken into account during ACL reconstructive surgery.
Traffic accidents represent a significant cause of death in Croatia, therefore being an important social and public-health problem. The aim of our study was to analyze the forensic characteristics of ...traffic accidents with fatally injured drivers in Southwestern Croatia. Study population included 277 fatally injured drivers, in a 10 year period (between 1994 and 2004). As for the gender, 92% were male and only 8% were female. The median age was 35 (13-86), with 53% of them aging 20-39, therefore being a part of the working population. Most of the accidents happened during the summertime (44%) and weekend (57%). Half of the fatally injured drivers (139) were sober (0.00 g/kg) and only 10% (28) had blood alcohol level of 0.00-0.5g/kg. Our results suggest that, as opposed to the current public opinion in Croatia, alcohol might not be the only crucial factor contributing to the drivers' mortality in Croatia. As for the prevention measures, other factors (drug intoxication, fatigue...) should also be taken into consideration and further studied.
Pedestrians are often considered the most vulnerable group of road users. The aim of our study was to analyze the forensic aspects of pedestrian traffic fatalities in Rijeka region. We analyzed ...pedestrian fatalities in a 5-year period (2002-2006), which included 44 fatally injured pedestrians examined at the Rijeka Institute of Forensic Medicine. The male:female ratio was 1:1. The median age was 57 (ranging from 2-95), with 66% aging over 60 and 89% aging over 40. The least of the accidents happened in July and during weekend. Almost 65% of the fatally injured pedestrians were sober (0.00 g/kg) and 24% had blood alcohol level of more than 1.50 g/kg. Our study showed that pedestrian fatalities in Rijeka region have specific forensic characteristics. These findings suggest the necessity of the specific approach and caution in planning of prevention measures for specific traffic fatalities, in this case pedestrian ones.
Alcohol is the psychoactive substance most frequently associated with suicidal behavior. We hypothesized that the level of alcohol intoxication and the choice of specific methods of committing ...suicide are related. Suicides in the Southwestern Croatia in a 10-year period, especially regarding the method of committing and alcohol intoxication, were analyzed. Ten various methods of committing suicide were recorded. The average blood alcohol concentration at the moment of suicide was 0.68 g/kg with male, and 0.29 g/kg with female victims. The highest blood alcohol levels at the moment of suicide were recorded with suicides by explosive device (with the average blood alcohol concentration of 1.71 g/kg). This especially drastic method of suicide was rare in Croatia in a period prior to the Croatian Independence War (1991-1995), but its incidence significantly increased during the war and in a post-war period. These victims were not chronic alcoholics, but the excessive alcohol consumption occurred as a result of psychiatric disorders as a consequence of war stress they suffered.
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