Milica Lazovic

Clinical significance of the heterotopic ossification after total hip arthroplasty.

Heterotopic ossification represents one of the most frequent complications following any type of hip arthroplasty. However, disagreement exists regarding the clinical significance of heterotopic ossification after total hip arthroplasty (THA). This study evaluated the effect of different grades of heterotopic ossification on range of hip motion, pain, and the clinical outcome in patients after THA. The study included 198 patients with primary THA because of unilateral hip osteoarthritis, followed for a minimum of 1 year after THA. Diagnosis and classification of heterotopic ossification according to Brooker was achieved on anteroposterior radiograph of the hips 1 year postoperatively. The clinical outcome was assessed at 1-year follow-up with the use of the Harris hip score. Pain was assessed as the pain component of the Harris hip score. Hip range of motion was measured passively in the lying position with a goniometer and recorded in degrees according to the method suggested by the American Academy of Orthopaedic Surgeons 1988. The incidence of heterotopic ossification was 47% and the incidence of severe ossification was 11%. The severe heterotopic ossification significantly reduced clinical outcome, overall range of hip motion and certain components such as flexion, abduction and external rotation, but had no significant effect on pain, while the lower degree of ossification did not significantly influence the clinical outcome, hip motion and pain. This study has shown that only severe heterotopic ossification is of clinical significance.

Evaluation of low level laser and interferential current in the therapy of complex regional pain syndrome by infrared thermographic camera

UNLABELLED BACKGROUND/AIM; Complex regional pain syndrom type I (CRPS I) is characterised by continuous regional pain, disproportional according to duration and intensity and to the sort of trauma or other lesion it was caused by. The aim of the study was to evaluate and compare, by using thermovison, the effects of low level laser therapy and therapy with interferential current in treatment of CRPS I. METHODS The prospective randomized controlled clinical study included 45 patients with unilateral CRPS 1, after a fracture of the distal end of the radius, of the tibia and/or the fibula, treated in the Clinical Centre in Nis from 2004 to 2007. The group A consisted of 20 patients treated by low level laser therapy and kinesy-therapy, while the patients in the group B (n = 25) were treated by interferential current and kinesy-therapy. The regions of interest were filmed by a thermovision camera on both sides, before and after the 20 therapeutic procedures had been applied. Afterwards, the quantitative analysis and the comparing of thermograms taken before and after the applied therapy were performed. RESULTS There was statistically significant decrease of the mean maximum temperature difference between the injured and the contralateral extremity after the therapy in comparison to the status before the therapy, with the patients of the group A (p < 0.001) as well as those of the group B (p < 0.001). The decrease was statistically significantly higher in the group A than in the group B (p < 0.05). CONCLUSIONS By the use of the infrared thermovision we showed that in the treatment of CRPS I both physical medicine methods were effective, but the effectiveness of laser therapy was statistically significantly higher compared to that of the interferential current therapy.

Hip Fractures in a Geriatric Population - Rehabilitation Based on Patients Needs

With an increased life expectancy in humans and thus an increase in the number of the elderly population, the frequency of hip fractures will rise as well. Aside from a higher incidence, hip fractures in a geriatric population is a significant problem due to the possible onset of severe and in some cases dramatic complications and consequences. The primary purpose of treatment and rehabilitation in the elderly after a hip fracture is to improve an individuals quality of life. It is important to underline that principles and methods of functional restoration after hip fracture should consider careful planning of a rehabilitation program individually for every patient and its implementation with respect to decisions made by the rehabilitation team.

In vitro evaluation of cytotoxic and mutagenic activity of avarol

The cytotoxicity of avarol, a main secondary metabolite of the Mediterranean sponge Dysidea avara, was in vitro screened by MTT assay against four human tumour cell lines. The colon HT-29 tumour cells practically showed to be the only sensitive ones towards this organic compound. No toxicity was found against the fetal lung fibroblast MRC-5 cells at the concentrations tested. In comparison with doxorubicin, used as a positive control, avarol actually exhibited at least 588-fold less toxicity towards normal MRC-5 cells. Finally, comet assay indicated that DNA fragmentation was almost fivefold higher upon the treatment with doxorubicin, compared to avarol. The obtained results have actually confirmed that avarol scaffold may contribute to development of new cytostatics inspired by nature.

Bone mineral density at different sites and vertebral fractures in Serbian postmenopausal women

Abstract Objectives: This randomized study aimed to evaluate the correlation between bone mineral densities (BMD) measured at different sites and the frequency of vertebral fractures in a group of Serbian postmenopausal women. Method: BMD was measured in 130 naïve postmenopausal women by dual X-ray absorptiometry (DXA) at the ultra-distal part of the forearms, at the hip and at the lumbar spine. At each of the measurement sites, the patients were categorized as osteoporotic, or osteopenic, or in the reference range. Vertebral fractures were examined using thoracic and lumbar spine radiography. Results: A T-score at different skeletal sites showed discordance in the site-specific region. Vertebral fractures were found in 58.82% of patients with hip osteopenia, in 45% with forearm osteopenia and in 54.54% with lumbar spine osteoporosis. Conclusions: The study confirmed that the reduction of BMD depends on age and choice of measurement site. The best correlation was obtained in the women with osteopenia at all measurement sites. The discovery of vertebral fractures by lateral thoracic and lumbar spine radiography improves prompt treatment. Reference values of BMD do not exclude vertebral fractures. Of vertebral fractures, 72.5% were asymptomatic and thus spine radiographies are obligatory. Currently discussed is the position of DXA for measuring BMD as a method of detection for patients at risk of fracture.

Relationship between fear of falling and functional status in nursing home residents aged older than 65 years

The present study investigated the relationship between fear of falling and functional status, and sociodemographic and health‐related factors in nursing home residents aged older than 65 years.

Are Interferential Electrical Stimulation and Diaphragmatic Breathing Exercises Beneficial in Children With Bladder and Bowel Dysfunction

OBJECTIVE To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBEs) in children with bladder and bowel dysfunction. PATIENTS AND METHODS Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits. Physical examination, including abdominal and anorectal digital examination, was performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys, and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A, B, and C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBEs and IC stimulation, whereas group B received only DBEs. The treatment was conducted for 2 weeks in the clinic in all 3 groups,. The behavioral modifications and DBEs were continued at home for 1 month. Clinical manifestations, uroflowmetry parameters, and postvoided residual urine were analyzed before and after 6 weeks of therapy. RESULTS After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P < .001 and P < .05, respectively). These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine (P < .001 and P < .05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% of group A patients (P < .001). CONCLUSION IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.

Scintigraphy evaluation of the types of functional constipation in children with bowel bladder dysfunction

PURPOSE To evaluate the types of constipation according to colonic transit time in chronically constipated children with dysfunctional voiding (bowel bladder dysfunction, BBD group) and to compare the results with transit type in children with chronic functional constipation without urinary symptoms (constipation group) and children with normal bowel habits, but with lower urinary tract symptoms (control group). PATIENTS AND METHODS One-hundred and one children were included and their medical histories were obtained. The BBD group kept a voiding diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Radionuclear transit scintigraphy was performed in all children according to a standardized protocol. Patients were categorized as having either slow-transit (ST), functional fecal retention (FFR) or normal transit. RESULTS FFR was diagnosed in 31 out of 38 children with BBD, and 34 out of 43 children in the constipation group. ST was found in seven children with BBD, compared with nine children in the constipation group. The control group children demonstrated normal colonic transit. Urgency, daily urinary incontinence and nocturnal enuresis were noted only in children with FFR. Both children with ST constipation and FFR complained of difficulties during voiding, voiding postponement and urinary tract infections. CONCLUSIONS FFR is the most common form of constipation in children with dysfunctional voiding. However, some children might suffer from ST constipation. Differentiation between these two types of constipation is clinically significant because they require different treatment. Future studies with larger numbers of patients are needed to confirm the noted differences in urological symptoms in these two groups of constipated children..

Prediction functional independence measure in HIP fracture patients

The importance of early inclusion in rehabilitation program and exercise of older people after the hip fracture could be explained by the fact that physical activity influences the muscle strength, balance and eventually degree of hip pain [11]. Such determinants are very important particularly for individuals quality of life and could prevent further risks of comorbidities and falls later in life. It has been often hypothesized that the success of recovery is extremely dependent on the timeliness and adequacy of the treatment. While it is desirable to provide the best possible care as soon as possible the actual limitations that may exist in health-care systems due to a limited number of medical staff as well as limited capacity in rehabilitation programs may create need for appropriate planning and/or scheduling.

The Effects of Preoperative Physical Therapy in Total Hip Replacement Surgery

METHODS Prospective clinical study included 36 patients 37-72 years old, assigned for unilateral THR due to end-stage hip osteoarthritis. Patients were randomized to a 4-week physical therapy program or education (control group) prior to surgery. After intervention all patients received rehabilitation regimen that included kinesy and occupational therapy, low frequency pulse magnetic fi eld (20 mT, 50 Hz) and interferent electrotherapy (1-100 Hz), for another 4 weeks. The WOMAC (Western Ontario and McMaster Universities) Index of Osteoarthritis and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were used for assessing outcomes a month before surgery, just prior to surgery and 6 months after. Range of motion in the affected hip and pelvifemoral muscle strength were measured, too.