Distalni tibiofibularni zglob odgovoran je za širinu i stabilnost takozvane zglobne viljuške gležnja koju sačinjavaju distalna tibija i distalna fibula. Prema nekim autorima tijekom uganuća gležnja u ...95 % slučajeva dolazi i do ozljede ligamenta distalnog tibiofibularnog zgloba. Upravo je prepoznavanje ovih ozljeda od velike važnosti, jer se pacijenti s tim ozljedama liječe dvostruko dulje od pacijenata s ozljedama ligamentarnih struktura lateralne strane gležnja, a do povratka sportskim aktivnostima protekne i do 6 mjeseci. Standardni klinički testovi i klasične rendgenske snimke nisu često dostatni za postavljanje dijagnoze, pa je pri sumnji na ozljede sindezmoze potrebno učiniti i magnetsku rezonanciju. Način liječenja akutnih izoliranih ozljeda sindezmoze ovisi o stupnju nestabilnosti gležnja. Danas još uvijek postoje nedoumice i nesuglasja u postavljanju dijagnoze i liječenja takvih ozljeda. U ovom radu pokušali smo na sistematičan način prikazati anatomske karakteristike distalnog tibiofibularnog zgloba, ali i najnovije stavove u dijagnostici i liječenju ozljede sindezmoze.
Distal tibiofibular joint is responsible for the distal crucial anatomic structure responsible for the ankle joint stability. According to some authors syndesmosis injury occurs in 95% of the lateral ankle sprain during sport activity. Syndesmotic injuries often require twice as long to return to sport as compared to isolated lateral ligament sprains and can lead to prolonged pain and disability. Clinical tests and plain radiography have limited diagnostic capacity and often MRI imaging is necessary. The treatment of the acute isolated syndesmotic injury depends on the ankle stability. Today still, there is some doubt and disagreement regarding diagnostic criteria, classification, and treatment of syndesmotic injury.
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.
Superior mesenteric artery, the second ventral branch of the abdominal aorta, supplies the distal duodenum, the small intestine, and the large intestine to the mid transverse colon. Superior ...mesenteric artery branches include the inferior anterior and inferior posterior pancreaticoduodenal arteries, middle colic artery, right colic artery, ileocolic artery, jejunal and ileal branches. The vascular anatomy of superior mesenteric branches is frequently variant. The explanation of variant vascular anatomy of branches and pathological consequences of diseases which impact the mesenteric vasculature might be due to the changes that appear in the development of ventral splanchnic arteries and their blood supply. Knowledge of mesenterical variations is valuable to radiologists and surgeons.
Cilj: Cilj rada bio je ispitati oblik Blumensaatove linije te utvrditi položaj lateralnog interkondilarnog grebena u odnosu na nju. Ispitanici i metode: U radu je korišteno 12 preparata femura sa ...Zavoda za anatomiju Medicinskog fakulteta u Rijeci. Na svakom preparatu tankom savitljivom žicom obilježen je lateralni interkondilarni greben. Učinjena je postranična rendgenska snimka femura uz potpuno preklapanje kondila. Na snimkama je analiziran oblik Blumensaatove linije, razlika u rendgenološkoj gustoći prikaza pojedinih dijelova te položaj lateralnog interkondilarnog grebena u odnosu na Blumensaatovu liniju. Rezultati: Na rendgenološkom prikazu Blumensaatova linija bila je ravna u 25 % preparata. U 75 % preparata stražnji dio linije bio je konveksan u smjeru prema distalno. S obzirom na radiografsku gustoću Blumensaatove linije mogla se podijeliti u tri dijela. Prednji i stražnji dio imali su gustoću intenziteta kortikalne kosti, dok je gustoća srednjeg dijela odgovarala intenzitetu spongiozne kosti. Lateralni interkondilarni greben spaja se s Blumensaatovom linijom u točki koja stražnji segment dijeli u omjeru 58 % : 42 %. Lateralni greben s Blumensaatovom linijom zatvara kut od 62.40 stupnjeva. Zaključak: Blumensaatova linija u 75 % analiziranih preparata nije ravna, već je u stražnjem dijelu zaobljena s konveksitetom usmjerenim prema distalno. Na profilnoj RTG snimci LIR koljena zatvara kut od 62.40 stupnjeva.
Aim: The aim of this study was to analyze the shape of the Blumensaat's line and the relationship with lateral intercondylar ridge on the lateral radiographic view. Patients and Methods: On twelve femoral specimens, the lateral intercondylar ridge were labeled with the thin wire. A full lateral view with the distal femur was taken. At the X-ray we analyzed the radiographic shape of the Blumensaat’s line and a possible difference of the radiographic density during its course. The angle between lateral intercondylar ridge and Blumensaat’s line was calculated as well. Results: The Blumensaat’s line was straight in 25% of specimens. In 75% the posterior part had convexity. Regarding the radiographic density the BL could be divided into three parts. The density of the anterior and posterior was similar as the cortical bone, while the middle part corresponds to the cancellous bone. The posterior part was the longest. The lateral intercondylar ridge and the Blumensaat’s line formed the angle of average 62,40 and intersect with the LIR at the point which divides the posterior part of the BL at the 58%:42% ratio. Conclusion: In 25% the Blumensaat’s line was straight. In 75% of the specimens the posterior convexity was observed. The lateral interc ondylar ridge and the Blumenssat’s line formed the angle of the 62,50. They intersected at the point which divides the posterior part in the 58:42 ratio.
Povećana napetost lateralnog retinakula patele može se javiti kao samostalni entitet ili u sklopu drugih poremećaja patelofemoralnog zgloba kao što su patelofemoralna displazija, lateralna ...nestabilnost patele, ozljede medijalnog patelofemoralnog ligamenta i hondromalacija. Presijecanje lateralnog retinakula, kako bi se postigao bolji balans aktivnih i pasivnih stabilizatora patele i na taj način korigirao njen položaj, bila je jedna od najizvođenijih operacija u ortopediji bez obzira na etiologiju poremećaja. Biomehaničke i kliničke analize pokazale su mogućnost nastanka brojnih komplikacija koje mogu nastati neselektivnom primjenom ove operacijske tehnike od kojih je najteža medijalna nestabilnost patele. Danas se kao metoda za korigiranje napetosti lateralnih stabilizatora patele češće upotrebljava tehnika produljivanja lateralnog retinakula kojom se puno bolje može regulirati napetost lateralnih struktura uz značajno manje komplikacija.
Tightness of the lateral patellar soft tissue complex could be isolated entity or associated with other patellofemoral disorders such as patellofemoral dysplasia, lateral patella instability, medial patellofemoral ligament injury and chondromalatia. Lateral retinacular release was a method of choice among orthopaedic surgeons for improving the patellofemoral balance and congruency regardless the etiology of patellofemoral disorders. Biomechanical and clinical studies have shown that nonselective use of this surgical method could cause numerous complications among which medial patellar instability is the worst. Today most orthopaedic surgeons prefer lengthening instead release, because lateral lengthening is a more precise technique, with reduced complication rates.
Pedijatrijska je populacija po mnogo čemu specifična. Iako na prvi pogled djeca djeluju kao umanjena verzija odraslih, oni se uvelike razlikuju u anatomiji, kao i fiziologiji. Kada govorimo o ...pedijatrijskoj anesteziji moramo imati na umu sve anatomske, fiziološke, farmakodinamske i farmakokinetičke razlike jer će one uvelike utjecati na sve aspekte anestezije – od uvoda, preko osiguravanja i održavanja dišnog puta, do konačnog buđenja iz anestezije i ekstubacije. Kada se fiziološkim i anatomskim varijancama u pedijatrijskoj populaciji pridruže još stanja ili sindromi koji mogu dodatno otežati uspostavu dišnog puta ili ventilaciju, suočavamo se s problemom koji treba ozbiljno shvatiti i trenutno reagirati. U nebrojeno je mnogo istraživanja odavno dokazano da hipoventilacija s posljedičnom hipoksijom i hiperkarbijom može iznimno brzo rezultirati kobnom respiratornom insuficijencijom koju, ako se promptno ne reagira, u stopu može pratiti kardijalni arest. Uz pregled literature prikazujemo i primjer četveromjesečnog djeteta kod kojega je bila planirana operacija rascjepa usne u općoj endotrahealnoj anesteziji. Nakon uvoda u anesteziju, uz otežani prikaz laringealnih struktura direktnom laringoskopijom, uz pomoć videolaringoskopa i dobru vizualizaciju glotisa pokušana je intubacija koja nije bila izvediva zbog nemogućnosti plasiranja
tubusa kroz preusku rimu glotidis. Operativni zahvat je odgođen za mjesec dana. U drugom pokušaju dijete je uspješno intubirano i operirano, bez ikakvih komplikacija. Zbog anatomskih i fizioloških varijacija vezanih za životnu dob svakog pojedinog djeteta, zatim različitih vrsta i opsega rascjepa, potreban je individualizirani pristup. Važno je prepoznati i situacije u kojima ne treba inzistirati na kirurškoj ili anesteziološkoj intervenciji, već odustati i malo pričekati kako bi se anatomski odnosi uslijed somatskog rasta okrenuli u djetetovu korist.
Background: Anal incontinence severely impairs quality of life. It affects 4 to 19 % of women and is statistically related to number of vaginal deliveries. It is grossly underreported and most ...patients that do seek help are referred to gastroenterologists or colorectal surgeons. Incidence of recognized sphincter injuries at time of delivery is 1 to 2 %. However studies with anal ultrasound showed incidence of anal sphincter injuries at 28 to 41 %. Depending on the degree of injury symptoms range from partial to complete inability to control passing of winds, liquid or solid stools. About three thirds of patients are asymp- tomatic in puerperium, however half of them are at risk of developing anal incontinence in later life. Hypoestrogenisem, additional perineal trauma during consequent deliveries and sphincter atrophy can unmask anal sphincter damage years later. Timely recognition and treatment are vital for good long term results and quality of life, if possible immediately after delivery. Good knowledge of perineal anatomy, recognition of risk factors, intense search and appropriate treatment and follow-up are essential to management of anal sphincter injuries. All secondary sphincter repair is less effective. Content: Updated overview of current opinion and guidelines on anal sphincter injuries are pre- sented. Anal sphincter is composed of external anal sphincter (EAS) and internal anal sphincter (IAS). Striated EAS is divided into three parts – subcutaneous, superficial, deep, and con- nected to puborectalis muscle posteriorly. Smooth-muscled IAS is a continuation of a cir- cular smooth-muscle layer of rectum. In between there is a thin longitudinal muscle layer. IAS constitutes 70 % of resting tone and is under constant contraction. EAS contributes to 30 % of resting tone and almost all pressure during active contraction. EAS injury leads to insufficient contraction after rectal sampling and filling which causes urgency – patient can feel the pressure but cannot hold bowel contents for long. IAS injury leads to complete inability to control passing of bowel contents. Perineal tears are classified to four degrees depending on tear depth. With first degree tear only vaginal mucosa is torn, second degree perineal muscles are damaged, third degree describes any tearing of anal sphincter and fourth of rectal mucosa. New guidelines recom- mend further classification of 3rd degree tears: 3a = < 50 % EAS ruptured 3b = > 50 % EAS ruptured 3c = IAS rupture Ultrasound with anal plug is nowadays considered to be the golden standard for diagnosis and follow-up of anal sphincter injuries. Entire length of anal sphincter muscle is shown from U shaped puborectalis muscle to anus. IAS appears as hypo-echoic homogenous circle around rectal mucosa, while EAS appears as outer hyper- echoic heterogenous circle. Dur- ing voluntary contraction distance between ruptured ends of EAS enlarges. 3D ultrasound shows promising results but is not yet standardized. Anal sphincter manometry, pudendal nerve latency and EMG of anal sphincter also contribute valuable information on anal sphincter function and injuries. Risk factors are: fetal weight over 3500g, forceps delivery (but not vacuum extraction) occipito-posterior presentation, shoulder dystocia, prolonged second stage of delivery, median episiotomy, previous anorectal surgery and maternal age over 35 years at first delivery are described as risk factors. Caesarean section prevents anal sphincter injuries. Studies show that restrictive use of mediolateral episiotomy in comparison to spontaneous delivery prevents anal sphincter injuries. Rectal examination prior to suturing perineal tears is essential for timely recognition of anal sphincter injuries. EAS appears more read while IAS smooth muscle has a lighter colour (white meat). Sphincter continuity can be palpated between index finger and thumb (pill-rolling motion) and voluntary contraction felt. Immediately after delivery voluntary contraction can be diminished or absent due to temporary loss of sensation or epidural analgesia. Studies currently show better results with overlap comparing to end-to-end technique for sphincter repair. Further randomised controlled trial will give final answers on the sub- ject. Application of wide-spectrum antibiotics, continued oraly for 5 to 7 days is recommended. No specific diet is needed, patients are advised to take lactulose 15 ml per day for 7 to 10 days and defecate regularly. Application of Foley catheter for 24 hours and NSARs are also recommended. Follow up with anal ultrasound and manometry after 3 to 6 months in perineal clinic is mandatory. Conclusions: Anal sphincter ruptures during vaginal delivery often remain unrecognised, which can later lead to fecal incontinence and impaired quality of life. Timely recognition and proper treatment are vital to good healing results.
Uvod: U svom remek-djelu Canon u Tibbu Avicena je iznio zanimljiva gledišta vazana uz simptome prijeloma rebrenih kostiju i njihov fizički pregled te liječenje komplikacija. Metoda: Donosimo pregled ...Avicenina Canona i njegova pogleda na anatomiju rebrenih kostiju i njihove prijelome i uspoređujemo ih s konvencionalnom medicinom. Rezultat: Avicena je opisao anatomiju rebara; objasnio je djelotvornost njihove strukture u zaštiti vitalnih organa. Predložio je i neke od metoda za liječenje prijeloma rebara poput upotrebe vakuuma na mjestu prijeloma ili otvorene operacije u slučaju komplikacija. Zaključak: Avicenin pogled na pristup liječenju prijeloma rebara imao je neke sličnosti i razlike s konvencionalnom praksom. Neka od njegovih razmišljanja mogu se i danas uzeti u obzir.
Građa i oblik cirkulacijskog sustava među životinjskim vrstama bitno se razlikuju, napose u pojedinim poredbeno anatomskim aspektima, čak do neprepoznatljivost. Budući da cirkulacijski sustav ...osigurava funkcionalnu i morfološku povezanost svih dijelova organizma, njegova konstrukcija bitno ovisi o obliku organizma i njegovim biološkim osobitostima. U ovome radu, u obliku diskusije, izneseni su neki komparativno-anatomski aspekti temeljnih načela cirkulacijskog sustava u kralježnjaka.
Frangula rupestris and F. alnus are the only two species of the genus Frangula in the flora of the Balkan Peninsula. Frangula alnus is well-known for anthranoid content, and its stem bark and fruits ...are widely used as laxatives. Data on anatomy, plant metabolites, and potential use of F. rupestris are scarce. In this work we analysed anatomy of the stem and leaves and performed phytochemical screening of the bark and leaves of F. rupestris. Specific anatomical characteristics of the stem include the presence of large mucilage cavities in the bark and pith, as well as numerous parenchyma cells containing solitary or cluster crystals of calcium oxalate. The majority of leaf epidermal cells are filled with mucilage. In the main leaf vein there is parenchyma with numerous mucilage cavities and solitary or cluster crystals of calcium oxalate. The levels of flavonoids, total phenolics, and tannins in bark and leaves of plants from two localities were determined by spectrophotometric methods, and the results were compared with those obtained for bark of F. alnus. Bark and leaves of F. rupestris contained 2.68-3.03% and 2.22-3.77% total phenolics, 1.70-2.10% and 0.57-1.54% tannins, and 0.12-0.36% and 0.57-0.99% flavonoids, respectively. The conducted HPLC and LC-MS analyses of hydromethanol extracts of bark and leaves of F. rupestris revealed the presence of flavonols. The dominant compound in all extracts was hyperoside and its content, determined by HPLC, ranged from 30.40 to 82.03 mg/g. Swelling indices determined for 0.5 g of plant material of F. rupestris bark and leaves (5.8-11.4 and 5.8-13.8) were higher than that of the bark of F. alnus (4.4) and greater than those of the mucilaginous drugs Althaeae folium and Althaeae radix (4.7-4.8). The high swelling indices of F. rupestris bark and (especially) leaves suggest their potential use as bulk-forming laxatives. In addition, differences in the content of metabolites were observed in plants from different localities.
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