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Biomedical subjects

M Pećina

Publications and source records attributed to M Pećina.

At least 19 recordsLinked to original sources
PubMed2006

Current concepts in gene therapy of the musculoskeletal system.

The purpose of this article is to review the remarkable progress in the field of musculoskeletal system gene therapy. Since the introduction of this concept 15 years much of the preclinical and clinical data have emerged. The original target, rheumatoid arthritis, has been subjected to clinical phase II efficacy protocol, and osteoarthritis gene therapy efficacy is being thoroughly investigated in various animal models. The most promising area of research in this field however, is the tissue repair, because it doesn't require prolonged period of gene expression, local delivery is reasonably simple and it avoids substantial risk associated with systemic delivery, and levels of gene expression don't need to be so finely regulated. Gene transfer is successfully being used to aid the repair and regeneration of bone, cartilage, ligament tendon, meniscus and intervertebral disc. Other potential applications of gene therapy in musculoskeletal system include osteoporosis, aseptic loosening, genetic diseases and tumors. Highly encouraging data gained from these studies have confirmed that gene therapy is a promising therapeutic solution to treat various musculoskeletal system disorders.

Genetic Therapy↗
PubMed2004

Multiple stress fractures in a young female runner.

The effect of exercise on female's bone metabolism has received much attention in recent years. We report on unusual case of a female runner with low body mass and amenorrhea, who suffered 4 stress fractures. Three of the stress fractures occurred during her sports career, and the fourth occurred 7 years after the cessation of sports activities. It seems that exercise-induced amenorrhea together with food restriction in the young age may cause long-term consequences on bone metabolism.

Adult↗
PubMed2003

Arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture.

The authors describe two cases of severely angulated tibial non-unions after proximal tibia stress fractures associated with ipsilateral osteoarthritis treated with modular knee endoprosthesis with a long tibial stem to stabilize non-union fragments. During the procedure, no additional osteosynthesis or bone grafting was added. Both non-unions healed after 6 months with no post-operative complications. The authors suggest implantation of modular knee endoprosthesis, as a single procedure, in treatment of proximal tibia non-union after a stress fracture as a result of severe varus/valgus deformity. It provides a solution for osteoarthritis treatment, axis correction and non-union osteosynthesis.

Aged↗
PubMed2002

Intraoperatively proven anomalous Struthers' ligament diagnosed by MRI.

A case of median nerve entrapment at the elbow between the supracondylar process and an anomalous insertion of Struthers' ligament is presented. The diagnosis of anomalous insertion of the ligament was made by MRI and confirmed at operation. Struthers' ligament originated as usual from the supracondylar process but did not reach the medial epicondyle of the humerus, inserting instead in the brachial fascia above the epicondyle. The incomplete Struthers' ligament functioned, however, as a complete ligament. It produced symptoms identical to supracondylar process syndrome. Excision of the supracondylar process of the humerus and Struthers' ligament relieved symptoms in this athlete.

Adolescent↗
PubMed2001

Surgical treatment of obturator nerve palsy resulting from extrapelvic extrusion of cement during total hip arthroplasty.

A female patient was successfully treated surgically for obturator nerve palsy resulting from extrapelvic extrusion of cement during total hip arthroplasty. Obturator nerve palsy developed because of the extrapelvic extrusion of cement medially in the anterior part of the incisura acetabuli in the zone of the extrapelvic exit of the obturator tunnel. Compression of the obturator nerve was confirmed by electromyography. After surgical removal of a piece of cement, 2.5 cm in length, which was done 11 months after total hip arthroplasty, and after 6 months of intensive postoperative rehabilitation, the patient was able to return to everyday activities and normal working habits. After 1 year, clinical and electromyography results were almost completely normal. A review of current knowledge regarding obturator nerve injuries resulting from total hip arthroplasty is presented.

Arthroplasty, Replacement, Hip↗
PubMed2001

Surgical treatment of extension contractures caused by war injuries to the knee.

Immobilization with external fixation bridging the knee joint in extension is frequently used after sustaining a war injury to the region of the knee joint with femoral and tibial bone fractures. Immobilization of the knee with plaster splints is performed in the same position. This usually prolonged treatment results in extension contractures of the knee joint. From June 1991 until March 1994, 54 patients with extension contractures of the knee caused by war wounds were treated at the Department of Orthopedics, Zagreb University Hospital Center, in Zagreb, Croatia. Results of surgical treatment of 44 patients are presented. The operative procedure consisted of extensive intra- and extra-articular adhesiolysis of the knee. The control group included 30 patients with knee contractures caused by injuries sustained in car crashes or secondary to previous operative procedures. The mean duration of immobilization was 5 months and 6 days. The mean preoperative knee motion amplitude ranged from 5 degrees in extension to 38 degrees in flexion. The mean postoperative knee motion was 98 degrees (range, 2 to 110 degrees). Treatment results did not depend on either duration of preoperative immobilization of the knee or previous infection in the region of injury. Previous knee joint bridging with an external fixator had no impact on the results of extension contracture treatment. Adequate intra- and extra-articular adhesiolysis with appropriate long-term postoperative rehabilitation is essential for the success of the operative treatment for knee joint contracture.

Adolescent↗
PubMed2001

[Overuse injury syndromes of the locomotor system].

Related either to athletic activities and recreation or to various professional activities, overuse injuries of the musculoskeletal system are common in the life of modern humans. Various studies indicate that approximately 30% to 50% of all sports injuries are caused by overuse. Therefore, it is not surprising that overuse injuries are frequently discussed. The mode of this discussion is usually limited to the analysis of different individual painful syndromes, specific localization of the painful syndrome in the musculoskeletal system, or the specific tissues affected by overuse injuries (tendinitis, bursitis, stress fractures, etc.). The purpose of this article is to systematically present today's knowledge of overuse injuries which affect the musculoskeletal system as a whole. Regardless of the localisation and the affected tissue, all clinical entities are presented in the same manner: the name and the definition of the syndrome, aetiopathogenesis, clinical picture, diagnostic, non operative, and surgical treatment, and the possibility of prevention. Beside presenting the newest discoveries reported in medical literature, this article also brings a wealth of individual cases and experiences encompassing histopathological examination, x-ray analysis, and the results of both conservative and surgical procedures.

Cumulative Trauma Disorders↗
PubMed2001

[Overuse injury syndromes of the knee].

Overuse injuries are frequent in the knee joint. The reason for this is that the knee joint is engaged in all sports activities. Furthermore, the joint area has numerous attachment points for muscles and tendons and numerous bursae. Another reason is that the specific joint between the patella and femur (patellofemoral joint) constitutes a part of the knee joint. Speaking in general terms, all overuse injuries in the knee joint can be divided in four groups according to the aspect: anterior aspect--patellofemoral pain syndrome, patellar tendinitis (jumper's knee), Osgood-Schlatter disease, Sinding Larson Johanson disease, stress fracture of the patella, fat pad syndrome; medial aspect--plica syndrome, semimembranosus tendinitis, pes anserinus tendinitis (bursitis), breaststroker's knee, medial retinaculitis; lateral aspect--Iliotibial band friction syndrome (runner's knee), Popliteal Tendinitis, Bicipital tendinitis; posterior aspect--fabellitis, medial gastrocnemius strain. There are numerous possible reasons for pain caused by overuse injuries around the knee joint, but two are the most frequent: patellar tendinitis (jumper's knee) and Iliotibial band friction syndrome (runner's knee). This paper gives a brief overview of overuse injuries of the knee joint including their definition, anatomy, aetiology, clinical symptoms and signs, and non-operative and surgical treatment.

Athletic Injuries↗
PubMed2001

[Anterior knee pain associated with sports and work].

Anterior knee pain is not a disease, but a syndrome with numerous causes. This paper describes its appearance in the patellofemoral joint in sportsmen and in untrained people. Chondromalacia patellae is a condition of the cartilage, not a disease, that is, it is never diagnosed alone. Relative muscular insufficiency, especially of the knee extensors, may occur in children and adolescents, as they grow rapidly. The consequence is a unbalance of active stabilizers and the disturbance of the slippery trail of patella, particularly in the presence of dysplasia of patellofemoral joint. The impingement syndrome pain occurs in sportsmen and people overloading the patellofemoral joint. Other causes of anterior knee pain should be excluded in clinical examination and slippery trail of patella, its position, and signs of instability should be determined. This paper gives an overview of patellar chondromalacia, lateral pressure syndrome, patellar subluxation, patellar acute and recurrent luxation, and idiopathic anterior knee pain. The treatment is basically conservative. Stretching exercises and the strengthening of certain groups of femoral muscles serves to regain the balance, thus normalising the slippery trail and taking off the burden from the patellofemoral joint. If conservative treatment fails, surgery is the alternative.

Athletic Injuries↗
PubMed2001

[Stress fractures].

Stress fractures are common overuse injuries, ranging between 1.1% and 3.7% of all athletic injuries. Causes are many and usually involve repetitive submaximal stress. There is a wide research evidence showing that training errors cause stress fractures in as many as 22% to 75% of cases. Intrinsic factors such as hormonal imbalance may also contribute to the onset of stress fractures, especially in women. During medical examination, it is essential always to bear in mind the possibility of stress fracture. Clinical diagnosis is therefore the basic procedure, followed by other diagnostic methods in the following order: radiology, scintigraphy, and MRI. Most stress fractures are uncomplicated and can be managed through rest and restriction from precipitating activities for 4-6 weeks. A subset of stress fractures can present a high risk for progression to complete fracture, delayed union, or nonunion. Specific sites for this type of stress fracture are the femoral neck, the anterior cortex of the tibia, the tarsal navicular, the fifth metatarsal (Jones fracture), and the great toe sesamoids. Therefore, high-risk stress fractures require aggressive treatment, and in some cases even surgical intervention is appropriate.

Athletic Injuries↗
PubMed2001

[Physical procedures in the treatment of overuse injury syndromes of the locomotor system].

As a rule, the treatment of the overuse syndrome in the locomotor's system is non-surgical, and surgical treatment is needed on rare occasions. Non-surgical treatment should start as soon as possible. The first step is to half or modify sports activities. The treatment includes administration of non-steroidal anti-inflammatory drugs, physical therapy, stretching exercises, and the strengthening of affected muscles. The programme should be adapted to the patient, taking into account the localization and the degree of the injury, as well as his/her sport or work-related activities. The RICE therapeutic programme is important in the treatment of overuse syndromes, especially within the first 72 hours from the occurrence of first symptoms, as it shortens the duration of convalescence for as much as 50%-70%. Beside stabilisation of the joint with optimal loading of antagonistic muscles, stretching exercises have the leading position in prevention and treatment of overuse injuries. During rehabilitation, it is necessary to change activity, its duration and intensity. When a person successfully resumes its sports activities with full load, the rehabilitation is considered completed. No surgical or non-surgical method can warrant a hundred percent recovery for any localization of overuse injury. Prevention, education, and close co-operation between the physician, athlete, and the coach is therefore crucial and is receiving increasing attention.

Cumulative Trauma Disorders↗
PubMed2000

Survival of cementless and cemented porous-coated anatomic knee replacements: retrospective cohort study.

AIM: To evaluate the effect of cement use in porous-coated anatomic (PCA) total knee prosthesis on its survival. METHODS: The study was a retrospective analysis of 142 PCA total condylar arthroplasties performed in 124 patients from 1985 to 1991. Uncemented prostheses were used in 87 knees, the prostheses were cemented in 44 knees, and hybrid prosthesis components were used in 11 knees. The average follow-up time was 88 months (range 66-140). The survival of prosthesis was assessed using the Kaplan-Meier's method. The Baltimore score was evaluated as a measure of clinical performance in 115 replacements. RESULTS: The overall cumulative survival rate of a PCA total knee prosthesis was 77% over the average follow-up period of 88 months. No significant differences in survival rates among cementless, cemented, or hybrid fixations could be demonstrated. The survival rate of the prostheses in patients with rheumatoid arthritis (82.5%) was significantly higher than in patients with osteoarthritis (73.8%). Revision was necessary in 29 (20.4%) replacements. CONCLUSION: The survival of PCA endoprosthesis, regardless of the components used for implantation, is not satisfactory.

Adult↗
PubMed2000

Osteochondroma in a skeleton from an 11th century Croatian cemetery.

We present a case of a well-preserved bone tumor in a skeleton from a Croatian skeletal series dated to the 11th century AD. The tumor is located on the anterior side of the neck of the right femur. The gross morphology of the tumor - a round, lumpy, cauliflower-like appearance with a fairly smooth external surface - is consistent with osteochondroma. The diagnosis is supported by x-ray and CAT-scan findings, which show thickened trabeculae and an internal structure of cancellous bone interspersed with areas of dense compact bone. Comparison with x-rays from a patient surgically treated in 1999 for an osteochondroma with the same localization shows that the characteristics of the tumor have remained unchanged from the 11th century.

Bone Neoplasms↗
PubMed2000

Surgical treatment of infected knee contracture after war injury.

From June 1991 till March 1994, sixteen patients with extension knee contracture as a war injury complication were operatively treated at the Department of Orthopedics, Zagreb University School of Medicine. Infection was present in all patients. During the same period of time, 32 patients with extension knee contracture as a war injury complication and free from the signs of infection were also treated at the Department and served as a control group. The mean age at the time of wounding was 28.3 and 31.8 years in the study and control group, respectively. Operative procedures of extensive intra- and extra-articular adhesiolysis of the knee were performed in all patients. The mean duration of immobilization following injury infliction was 5.5 and 4.9 months in the study and control group, respectively. The mean preoperative knee motion amplitude ranged from 8 degrees in extension to 37 degrees in flexion in the study group, and from 5 degrees in extension to 38 degrees in flexion in the control group. Postoperatively, the mean knee motion amplitude ranged from 2.8 degrees in extension to 97 degrees in flexion in the study group, and from 1.9 degrees in extension to 100 degrees in flexion in the control group. Treatment results did not depend on either the presence of infection in the region of injury or on the duration of preoperative knee immobilization. The treatment of infection was most important for the success of operative treatment of knee contracture. A significant role was also played by adequate intra- and extra-articular adhesiolysis with appropriate intensive postoperative rehabilitation.

Adolescent↗
PubMed1999

Arthroplasty after war injuries to major joints.

From 1992 to 1995, replacement of the joint with an endoprosthesis after serious wounding and major destruction of joint elements was performed in 10 soldiers. Arthroplasty was performed on five knees, three hips, and two shoulders. The age range of the wounded soldiers was 22 to 55 years (mean, 37.7 years). Six soldiers suffered explosive injuries, and 4 were injured by gunfire. Time elapsed from the moment of wounding to the time of total joint replacement was 9 to 42 months. We decided on arthroplasty as the preferred treatment because of the presence of strong contractures and very painful movement. In 8 patients, the results of the treatment, based on a follow-up time of 36 to 48 months, were good. In 2 patients, early septic arthritis developed after arthroplasty of the knee with concomitant loosening of the endoprosthesis. Staphylococcus aureus was detected in both patients. In those 2 patients, therefore, arthrodesis of the knee with external fixation was performed.

Adult↗
PubMed1999

Moiré topography in measurement of the sagittal curvatures of the spine.

The purpose of the investigation was to establish the accuracy of moiré topography in the analysis of the kyphotic spine. Using simplified instrumentation, moiré topogram was performed in the 50 outpatients at the Department of Orthopaedic Surgery, School of Medicine, University of Zagreb. Lateral x-ray and meticulous clinical measurements of the spine were included as well. A correlation between the obtained results was established. A high correlation (r = 0.847) was found between the results obtained by means of X-rays and those obtained by means of moiré topography. The authors concluded that the method is ideal for the determination of a morphotypology of the kyphotic spine and can significantly contribute to the differentiation between normal and pathological sagittal curvatures of the spine without the need for x-ray of the spine. The authors conclude that the application of moiré topography in the biomechanical laboratories can contribute to the new cognition on kinematics of the spine. The investigation demonstrated that simple and nonexpensive apparatus can be used for the moiré topography in the follow-up of the sagittal curvatures of the spine.

Adolescent↗
PubMed1998

[Comparison of the results of PCA knee joint endoprosthesis in patients with rheumatoid arthritis and gonarthrosis].

Hundred and forty two porous-coated anatomic (PCA) total condylar arthroplasties were performed from 1985 to 1991 in hundred and twenty-four patients, ninety-seven women and twenty-seven men. The diagnosis was osteoarthritis in 96 cases and rheumatoid arthritis in 46 cases. The mean follow-up was 88 months, range from 51 to 137 months. All operated patients were evaluated based on survivorship of the endoprosthesis with the cumulative survivorship method according to Kaplan-Meier method. The end point was defined as endoprosthesis in situ. The overall cumulative survival rate for mean follow up time was 77%. The survival rate of the rheumatoid arthritis group was significantly higher (82.5%) than that of the osteoarthritis group (73.8%). 108 PCA arthroplastes were evaluated regarding Baltimore's score. The mean postoperative Baltimore's score was 68.7. In the rheumatoid arthritis group score was 74.8 and in the osteoarthritis group it was 65.9 but this difference is not statistically significant (p = 0.06).

Adult↗