Zoran Vukasinovic

Asthma School Program in children and their parents

BackgroundThis study was undertaken to analyze the clinical efficiency of Asthma Education Intervention (AEI, Asthma School) in children and their parents, a program was designed to produce acceptable asthma knowledge and to improve the treatment.MethodsThis study assessed the effectiveness of an educational intervention within 12 months after attending Asthma School. The study was designed as a population based cohort study. The project endorsed by the European Respiratory Society (ERS) Educational Grant was launched in 2004 and finished in 2006, but the Asthma School continued working. Three hundred and two asthmatics recruited during hospital treatment of acute asthma exacerbation completed the study together with their parents. The intervention group of 231 asthmatics received full Asthma School program. The non-intervention group enrolled 71 asthmatics receiving usual instructions for asthma management. Clinical and educational outcomes were investigated immediately after completion of the program and 12 months later.ResultsSignificant achievements were found in the intervention group in asthma knowledge (baseline score 63%, 82% after 12 months, P<0.05), compliance (70% before, 90% after), and inhalation technique (20% before, 70% after). No change was found in the attitude and behavior regarding asthma prognosis in adolescent patients and parents.ConclusionThis study together with others clearly confirm the effectiveness of educational intervention for childhood asthma.

Correlation of clinical examination, ultrasound sonography, and magnetic resonance imaging findings with arthroscopic findings in relation to acute and chronic lateral meniscus injuries

PURPOSE The aim of this study was to evaluate whether ultrasound sonography (USS) performed by orthopedic surgeons is a reliable method of investigating lateral meniscus (LM) knee lesions as compared to magnetic resonance imaging (MRI), and arthroscopy, which is the gold standard in clinical practice. METHODS In total, 107 patients were involved in this study. They were hospitalized for arthroscopy due to LM injury of the knee. Clinical examination (McMurrays, Apleys, and joint line tenderness tests), USS, and MRI were performed prior to arthroscopy. We compared the results of clinical examination, USS, and MRI with the arthroscopic findings for the knee, which were considered the reference values. RESULTS McMurrays clinical test, which is the most sensitive method of detecting lateral meniscus lesions, gave the same sensitivity rate for both acute and chronic LM injuries: 65%. USS was observed to be more sensitive and specific for chronic LM injuries (85 and 90%, respectively) than for acute LM injuries (71 and 87%). MRI also yielded higher values of sensitivity and specificity for chronic lateral meniscus injuries (75 and 95%, respectively) than for acute LM injuries (68 and 87%). CONCLUSIONS The accuracy of ultrasound examination is demonstrated by the high reliability of this method in the diagnosis of lateral meniscus lesions of the knee, and the evaluation performed in this study showed that ultrasound is a useful clinical tool for diagnosing knee pathology.

Prevalence of childhood asthma and allergies in Serbia and Montenegro

BackgroundThis is the first multi-center epidemiological study on the prevalence of childhood asthma in Serbia and Montenegro. The International Study of Asthma and Allergies in Childhood (ISAAC) phase 3 is a large epidemiological multinational and multicentric study on the prevalence of asthma, allergic rhinitis and eczema in children.MethodsThe 12-month period prevalence of asthma, allergic rhinitis and eczema was calculated using an ISAAC phase 3 questionnaire for two age groups: 6–7 years old and 13–14 years old.ResultsIn the 13 485 children from five study centers who responded to the questionnaire, the prevalence for childhood asthma ranged from 2.5% to 9.8%, for allergic rhinoconjunctivitis (hay fever) from 4.6% to 21%, and for eczema from 8.2% to 17.2%. The prevalence of current wheezing was high in both age groups (16.5% and 12.4% respectively).ConclusionsThe prevalence of asthma is higher in 6–7 years old school children in the urban and largest cities of Belgrade and Nis, and in 13–14 years old children in Podgorica. The prevalence of asthma, allergic rhinitis and eczema in the school children of Serbia and Montenegro seems similar to that of other countries in Central and South-Eastern Europe.

Triple pelvic osteotomy for the treatment of residual hip dysplasia. Analysis of complications

The aim of the paper was to present the results achieved with triple pelvic osteotomy in the treatment of residual hip dysplasia, with special interest in identifying recurrences and complications and how to avoid them. 60 patients (76 hips) with developmental dysplasia of the hip (DDH), treated by the triple pelvic osteotomy according to Tönnis and modified by Vladimirov, were included in the study. Hips were evaluated radiologically with the center-edge (CE) angle, break of the Shenton-Menard arch and index of acetabular depth by Heyman-Herndon, and functionally using the Harris Hip Score (HHS). The postoperative results showed an average increase of the CE angle by a mean of 23.5+/-9.28 degrees, with a highly significant difference between the preoperative and final postoperative findings (t-test, t=-20.85, p<0.01). The mean HHS significantly improved (p<0.01). Total complication rate was 13,1%, divided in: 1,3% (one case) of triple nonunion of iliac, pubic and ischial bones, 7,9% (six cases) of double nonunion of pubic and ischial bones, 2,6% (two cases) of peroneal palsy and 1,3% (one case) of infection. In this study the triple pelvic osteotomy showed to be reliable for acetabular dysplasia in adolescent and young adult, alone or in association with proximal femoral osteotomy and/or great trochanter distal advancement.

[Legg-Calvé-Perthes disease--diagnostics and contemporary treatment].

Legg-Calvé-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies). Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush), should be treated by Chiari pelvic osteotomy.

Treatment of multiple fractures in a patient wounded by aircraft bombing

INTRODUCTION Aircraft cluster bombs can cause severe fractures characterized by extensive destruction of affected tissues and organs. CASE OUTLINE We present the methods and results of treatment of multiple fractures (left supracondilar humeral fracture, comminuted fracture of the distal right tibia, fracture of right trochanter major without dislocation and fracture of the right second metacarpal bone) in a 24-year old soldier after multiple wounding by a cluster bomb. After short pre-operative preparation a surgical debridement of all wounds was done in general anaesthesia and the fractures of the humerus and tibia were stabilized with the Mitkovic-type external fixator after adequate reposition. For the reconstruction of bone defect of the tibia we used the method of bone transport using the Ilizarov external fixator. CONCLUSION Radical wound debridement, abundant rinsing, leaving the wound open, administration of antibiotics and antitetanus immunization, external fixation and early reconstruction of soft tissue and bone defects are the basic elements of the treatment of serious fractures caused by war injuries and aimed at saving the extremities.

Clinical Implications and Facts About Allergic Rhinitis (AR) in Children

Zorica Zivkovic1,2, Sofija Cerovic2, Ivana Djuric-Filipovic1, Zoran Vukasinovic3,4, Jasmina Jocic-Stojanovic2 and Aleksandra Bajec-Opancina5 1US Medical School, European University, Belgrade 2Children’s Hospital for Lung Diseases and Tuberculosis, Medical Center “Dr Dragisa Misovic”, Belgrade 3Faculty of Medicine, University of Belgrade, Belgrade 4Institute of Orthopaedic Surgery „Banjica“, Belgrade 5Mother and Child Health Care Institute, Belgrade Serbia

Ilizarov technique as a reliable option in limb salvage surgery

Dear Editor,We read the original paper “Osteocutaneous thermalnecrosis of the leg salvaged by TSF/Ilizarov reconstruction.Report of 7 patients” with great attention [1]. The articlereports on a complication of reamed intramedullary fixationof the tibia and a solution to the problem using the Ilizarovmethod. The authors rightfully consider the Ilizarovtechnique a method of choice in severe limb salvagesituations. There is abundant experience in application ofthe Ilizarov technique in the treatment of infected defectpseudoarthrosis, and this paper further expands indicationsfor its use.Our own experience with the Ilizarov technique insituations where other treatment methods could not beapplied or had failed to provide expected outcome, is verypositive [2–4]. The technique is tissue sparing and producessignificant regenerative and stimulative effects. Therefore,it can be successfuly and simply applied in cases ofinfection, bony and soft-tissue defects, and in multiplecomorbidity situations. Its drawbacks are minimal com-pared with its advantages and possibilities. Even in themost complex limb salvage procedures following injury ordisease, the Ilizarov technique shows great impact onhealing of bony and soft-tissue defects, bone union, andcorrection of deformity.

Laboratory diagnosis in orthopaedic surgery

Orthopaedic procedures and anaesthesia are not physiological states. To prevent orthopaedic sequelae, laboratory diagnoses are of proven value in preoperative and postoperative complications as well as preoperative diseases. Laboratory analyses have an important contribution to early diagnosis of infection, haemostasis disorders, electrolyte disbalance, and acid-base disturbance. Laboratory analyses also have a role in monitoring the effect of therapy. Metabolic bone diseases such as osteoporosis affect many patients. Laboratory analyses are useful in evaluating the treatment for preventing fractures. This article discusses specific factors causing postoperative bleeding and thrombosis after orthopaedic surgery.

Ewing’s sarcoma in children: Prognosis in relation to the method of treatment

Ewings tumor of bone is the second primary malignant bone tumor. Localized lesion is found in nearly 80% of cases and metastatic lesions are present in 20% at the time of diagnosis. Treatment protocols were analyzed, prognostic parameters were evaluated, and overall survival as well as survival until relapse of disease was studied. Prognostic features included age and sex, localization of tumor, type of applied surgical resection and treatment protocol, and presence of necrosis after neoadjuvant therapy as well as morphological characteristics of the tumor. Wide surgical resection (chi2 = 7.855; p < 0.05), and tumor necrosis (chi2 = 7.855; p < 0.05) were verified to be significant parameters for the outcome. Multimodal chemotherapy with local radiation and/or surgical resection is the best mode of modern treatment. Follow-up included the period from the completion of therapy to final control, with remission period defined by development of recurrence or metastatic lesions. Localization on distal parts of the extremities and axial skeleton is good prognostic feature, while localization on proximal parts of the extremities and pelvic girdle, presence of metastatic disease and low index of postchemotherapeutic necrosis, are associated with poor outcome. In Ewings sarcoma, prognosis of good outcome is definitely very delicate process.