Civilian gunshot injuries of the foot are not so common in Croatia. They are related with accidents in hunting or weapon cleaning. Gunshot injuries represent a special challenge for surgeon because ...of specific anatomical relations and biomechanical function of the foot. We have decided to present a patient with a complex foot injury caused by hunting firearm in self-inflicted accident. A 45-year-old male presented with 12-gauge shotgun wound to his left foot. We found a complicated fracture with bone defect of 3rd, 4th and 5th metatarsals and wide soft tissue injury with skin and subcutaneous defect of the dorsal and lateral side of the foot. The wound was contaminated with numerous metal fragments, particles of rocks and ground. Surgical treatment was performed three hours after trauma and included extensive debridement of damaged soft tissue, removing of the non-viable bone and metal fragments, rocks and other foreign bodies. Negative Pressure Wound Therapy (NPWT) was applicated in the operating table. The starting therapy was continuously -125 mm Hg of vacuum. We continued with intermittent therapy of -100 mm Hg and change NPWT dressing every fourth day. After four weeks of NPWT the defect was filled with granulation tissue and split thickness skin graft was applied. Skin graft was additionally fixed with NPWT using continuous therapy at -100 mm Hg for a period of four days. Forthy days after injury there was a complete healing of all soft tissue. Control X-ray showed good bone healing process.
Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the ...wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag - Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (4%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration. In the traditional technique group 4 (16%) patients developed wound infection as inflammation and secretion as a sign of superficial infection. In the other group we analyzed the results of 50 patients after implantation of partial endoprosthesis after hip fracture. 20 patients were treated by Molndal technique and 30 patients by the traditional technique of wound dressing. In the group treated by Molndal technique no patient has revealed a wound infection (0%). In the traditional technique group 4 (13%) patients developed wound infection. All complication in both group were superficial incisional surgical infection (according to HPSC). There was no deep incisional surgical site infection or organ/space surgical site infection. Our results are clearly showing that Molndal technique is effective in preventing the postoperative wound infection.
The aim of the study was to analyze the senior population when deciding to choose either going to the private or public physical medicine practice in Croatia. 240 patients (public and private group, ...120 participants each) from the Croatian medium large county Primorje-Gorski kotar, were enrolled from 6 physical medicine practices (3 public and 3 private). Between December 1st 2009 and January 31st 2010, in the public and private practices seniors aged 65 to 85 years were 64.17%, 52.40% respectively, of all interviewed participants in single group. The results showed that in Croatia majority of seniors visiting the physical medicine were females in revisit and dependents of government health insurance. Study suggested the great influence of general practitioner, closeness to home and time of the appointment for patients going to public physical medicine, while in private peers and sooner appointment outweigh. In either practice seniors were satisfied with the overall quality of health services and graded the best average-higher in favor for the private. Elderly Croatian residents showed to be the important feature in physical medicine and rehabilitation and to participate actively in their health issues. Following those results, we will perform the study in the rest of the country and compare it to this data. That could enable the specific improvement for the health care of seniors in Croatia.
A prospective, open-labelled, multicentre 6-month study was designed to assess three categories that have high impact on Health-Related Quality of Life (HR-QoL). These categories were: satisfaction, ...preference and drug tolerability in postmenopausal patients with osteoporosis in Croatia, at first treated with weekly oral bisphosphonates, followed by monthly oral ibandronate. Three hundred eighty-five postmenopausal women who were treated with one of the weekly bisphosphonates for at least 6 months were included into the study and after they had signed written informed consent, the therapy was changed to monthly ibandronate. Satisfaction with the treatment was assessed with the Osteoporosis Patient Satisfaction Questionnaire (OPSAT-Q). Patients completed OPSAT-Q at the baseline visit before the change of therapy (visit 1) and 6 months after the change of therapy (visit 2). Following 6 months ibandronate therapy, the values in all four domains of the OPSAT-Q (convenience, confidence with daily activities, overall satisfaction, side effects) as well as in the Composite Satisfaction Score were higher in visit 2 (
p
< 0.001). Values in subjects enrolled into the patient assistance programme did not differ significantly from the values in subjects that were not (
p
= 0.399) except for the domain convenience (
p
= 0.026). This study demonstrates significantly higher satisfaction in patients who switched from the weekly bisphosphonate therapy regimen to monthly ibandronate in all observed aspects of treatment. Patients expressed preference for monthly bisphosphonate (ibandronate) in comparison with weekly bisphosphonates and found it to be a more convenient method of treatment. At the time of study, however, it was not known that the anti-fracture effect of ibandronate was smaller for hip fractures than with other bisphosphonates.
Cilj: Protetička rehabilitacija nakon amputacije donjeg uda uključuje sve kompleksne postupke i interakcije rehabilitacijskog tima i pacijenta koje su usmjerene cilju uspostavljanja sigurnog i ...stabilnog hoda s protezom. Nakon otpuštanja iz rehabilitacijskog centra pacijent koristi protezu, sukladno dobi, stilu života i okolini u kojoj živi. Cilj: Cilj rada je procijeniti uspješnost protetičke rehabilitacije osoba s amputacijom donjeg uda koristeći indekse predviđene mobilnosti pacijenta (engl. Amputee Mobility Predictor; AMP) i brzinu hoda. Ispitanici i metode: U radu su korišteni podaci pacijenata iz baze podataka Zavoda za fizikalnu i rehabilitacijsku medicinu Kliničkog bolničkog centra u Rijeci, a pri tome su u skladu s Helsinškom deklaracijom ostali anonimni: dob, spol, vrsta i strana amputacije, AMP, brzina hoda i vrijeme provedeno u protezi. Od sto pacijenata s amputacijom 62 su bila transtibijalna (TT) i 38 transfemoralna (TF). U ispitivanju je sudjelovalo 27 žena i 73 muškarca. Svim pacijentima je utvrđen AMP indeks prije rehabilitacijskog postupka (AMPnoPRO) te nakon završenog rehabilitacijskog postupka (AMPPRO). Rezultati: Nakon provedene protetičke rehabilitacije utvrđena je statistički značajna razlika u konačnoj mobilnosti (AMP: p < 0,001) i brzini hoda (p = 0,002) između TT i TF grupa, odnosno bolji rezultat su postigli pacijenti s nižom razinom amputacije (TT). Također je utvrđena statistički značajna povezanost između vremena provedenog u protezi i brzini hoda te AMP indeksa (p < 0,001). Zaključak: Razina amputacije je važna stavka koja pridonosi konačnom ishodu rehabilitacijskog postupka, odnosno viša razina amputacije kod pacijenata (TF) predstavlja jedan oblik ograničenja za bolji uspjeh u odnosu na pacijente s nižom razinom amputacije (TT).
Aim: Prothetic rehabilitation after lower limb amputation includes all complex procedures and interactions between the rehabilitation team and the patient aimed for establishing a safe and stable walk with the prosthesis. After being released from the rehabilitation center, the patient uses the prosthesis, according to age, lifestyle and the environment in which he lives. Aim: The aim of the paper is to evaluate the success of the prosthetic rehabilitation after lower limb amputation patients using Amputee Mobility Predictor (AMP) and walking speed measures. Patients and methods: The following patients’ data ware taken from the database at the Department of Physical and Rehabilitation Medicine of the Clinical Hospital Center Rijeka, used in purpose of this work only, and stayed anonymous according to the Helsinki Declaration: age, sex, type and side of amputation, AMP, walking speed and the time spent in the prosthesis. From the 100 patients with amputation, 62 of them was transtibial (TT) and 38 transfemoral (TF). The AMP index was established for all patients prior to the rehabilitation procedure (AMPnoPRO) and after the completed rehabilitation procedure (AMPPRO). Results: After the prosthetic rehabilitation, a statistically significant difference in ultimate mobility (AMP: p < 0,001) and walking speed (p = 0.002) between the TT and the TF group was established, respectively, in a patients with a lower level of amputation (TT). A statistically significant correlation between the time spent in the prosthesis and walking speed and AMP index (p < 0.001) was also established. Conclusion: The level of amputation is an important factor contributing to the ultimate outcome of the rehabilitation process, and a higher level of amputation in patients (TF) is one form of limitation for better success compared to patients with lower amputation levels (TT).
Sexually transmitted infections (STIs) are diseases transmitted by direct contact during sexual intercourse. Because of high incidence and possibility of development severe consequences on general ...and reproductive health, STIs are a major problem among young people in the world. Lack of information is one of the major risk factors for STI transmission. Most of young people (53.3%) had their first sexual intercourse at the age of 18 years, 67.7% of students have no knowledge about STI, 53.3% of students have already entered into sexual relations and 13% of them with more than 4partners. 31.1% of students who are sexually active was not examined by a gynecologist because of shame and fear. Most sexually active adolescents did not use contraceptives and they are not satisfied with the available information about STI. There is also continuing problem of teen pregnancy. The main goal of this research is to examine whether there is relationship between level of information and awareness of surveyed adolescents and their perception of sexually transmitted diseases.
Sexually transmitted infections (STIs) are diseases transmitted by direct contact during sexual intercourse. Because
of high incidence and possibility of development severe consequences on general ...and reproductive health, STIs are a major
problem among young people in the world. Lack of information is one of the major risk factors for STI transmission.
Most of young people (53.3%) had their fi rst sexual intercourse at the age of 18 years, 67.7% of students have no knowledge
about STI, 53.3% of students have already entered into sexual relations and 13% of them with more than 4 partners. 31.1%
of students who are sexually active was not examined by a gynecologist because of shame and fear. Most sexually active
adolescents did not use contraceptives and they are not satisfi ed with the available information about STI. There is also
continuing problem of teen pregnancy. The main goal of this research is to examine whether there is relationship between
level of information and awareness of surveyed adolescents and their perception of sexually transmitted diseases.
The aim of the study was to analyze the senior population when deciding to choose either going to the private or public
physical medicine practice in Croatia. 240 patients (public and private group, ...120 participants each) from the Croatian
medium large county Primorje–Gorski kotar, were enrolled from 6 physical medicine practices (3 public and 3 private).
Between December 1st 2009 and January 31st 2010, in the public and private practices seniors aged 65 to 85 years were
64.17%, 52.40% respectively, of all interviewed participants in single group. The results showed that in Croatia majority
of seniors visiting the physical medicine were females in revisit and dependents of government health insurance. Study
suggested the great influence of: general practitioner, closeness to home and time of the appointment for patients going to
public physical medicine, while in private peers and sooner appointment outweigh. In either practice seniors were satisfied
with the overall quality of health services and graded the best average-higher in favor for the private. Elderly Croatian
residents showed to be the important feature in physical medicine and rehabilitation and to participate actively in
their health issues. Following those results, we will perform the study in the rest of the country and compare it to this
data. That could enable the specific improvement for the health care of seniors in Croatia.
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