CORRELATION BETWEEN MAMMOGRAPHY DETECTED BREAST ARTERIAL CALCIFICATIONS AND LIFESTYLE RISK FACTORS.

The aim of the study was to investigate the association between some lifestyle-attributable risk factors of atherosclerosis, such as body mass index (BMI), oral contraceptives, hormone replacement therapy, smoking and alcohol consumption with breast arterial calcification (BAC) and its intensity on mammograms, and to assess the impact of these lifestyle risk factors on mammography findings of BAC. This prospective study included 300 women aged 47-69, i.e. a group of 149 women with BAC on mammograms and control group of 151 women without BAC. Self-reported BMI, use of oral contraceptives, hormone replacement therapy, smoking and alcohol consumption were recorded by medical interview. The presence of BAC and its intensity on mammography was compared according to the presence of high BMI and use of hormone therapy, smoking and alcohol consumption. The results showed the highest proportion of smokers (28.9%) in the group with mild BAC as compared with the groups without calcification (14.6%) and with intense calcification (12.1%). Women taking oral contraceptives had a higher level of calcified breast arteries but no significant between-group difference was found for high BMI, hormone therapy and alcohol consumption. Thus, study results showed the mammographic finding of BAC to be inadequate to identify women with some lifestyle-attributable risk factors such as BMI, hormone replacement therapy, smoking and alcohol consumption.

Primary uterine cervical cancer: correlation of preoperative magnetic resonance imaging and clinical staging (FIGO) with histopathology findings.

The most commonly used staging system for cervical cancer is based on the International Federation of Gynaecology and Obstetrics (FIGO) staging system. Magnetic resonance imaging (MRI) has been accepted as the optimal tool for evaluation of the main prognostic factors and selection of therapeutic strategy. The purpose of this study was to compare the preoperative clinical examination FIGO staging findings with MRI and postoperative pathology report in females with primary cancer of the cervix. The study prospectively included 46 females consecutively hospitalized at the Department of Gynaecology and Obstetrics at the "Sestre milosrdnice" University Hospital Center in Zagreb. Interviews, clinical examination, transvaginal ultrasound and MRI were performed in all patients. In selected patients the surgical procedure was done and the correlation of clinical findings according to FIGO classifications, MRI and histopathological findings was completed. According to FIGO classification, positive clinical findings for stage IIA were found in 26/46 (55.5%) and stage IIB in 20/46 (44.5%)patients. FIGO MR modified classification confirmed stage IIA in 30/46 (66.6%) and stage IIB in 16/46 (33.4%) patients. Surgery (Wertheim radical hysterectomy with bilateral pelvic and selective para-aortic lymphadenectomy) was performed in 33/46 (71%) patients with clinically, MR, cytologically and pathohistologically confirmed findings of cervical cancer: 26 patients with IIA clinically FIGO stage and 7 with IIB stage. MRI examination proved better than clinical examination in staging of cervical carcinoma with 90.9% versus 79.0% accuracy rate. We suggest the application of the following MR protocol in all clinically staged FIGO IIA and IIB patients: T1W, T2WI and postcontrast dynamic T1WI after 3 and 60 seconds and after 5 minutes, performed on 1.5T MR machine.

[Clinical guidelines for diagnosing, treatment and monitoring patients with prostate cancer--Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association]. / Klinicke upute za dijagnostiku, lijecenje i pracenje bolesnika oboljelih od raka prostate Hrvatskoga Onkoloskog Drustva i Hrvatskoga Uroloskog Drustva Hrvatskoga Lijecnickog Zbora.

Prostate adenocarcinoma is the second most common solid neoplasm in male population in Croatia. It rarely causes symptoms unless it is advanced. The finding of PSA rise is the most common reason for diagnostic workout. Treatment plan is based on TNM classification, Gleason score and PSA. Clinically localized disease is successfully treated by radical prostatectomy or radiotherapy with or without hormonal therapy. Locally advanced disease is treated with radiotherapy and hormonal therapy. Metastatic disease can be controlled for many years by androgen deprivation. For castration resistant disease appropriate treatment is chemotherapy or secondary hormonal therapy. The following paper presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, management, treatment and monitoring of patients with prostate cancer in the Republic of Croatia.

Causal connection of non-specific low back pain and disc degeneration in children with transitional vertebra and/or Spina bifida occulta: role of magnetic resonance--prospective study.

The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, "Sestre milosrdnice" University Hospital Center, Zagreb Children's Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56 patients with spinal anomaly could have DD as known cause of LBP.

Study of temporomandibular joint disorder in older patients by magnetic resonance imaging.

OBJECTIVES: To compare characteristics in older patients in a sample of the general population of those with temporomandibular joint disorder (TMJD). MATERIALS AND METHODS: A prospective study was carried out between 2001 and 2008 in patients with TMJD. The whole sample consisted of 141 patients divided in two groups: 31 patients aged over 60 (median age 67.9, ranging from 60 to 82) and the remaining 110 patients (median age 36.3, ranging from 12 to 59) who were seeking treatment. Clinical diagnostics was confirmed by MRI. Pain intensity was rated on a visual analogue scale (VAS 0-10). RESULTS: There was no statistical difference between average pain in older patients (6.2) and patients aged up to 59 (5.7) evaluated by VAS. There was a statistically significant difference (p = 0.002) in pain duration: older patients reported shorter duration of experienced pain (7.8 months) than patients aged up to 59 (12.2 months). CONCLUSION: In this study, it was found that 22% were older patients with TMJD. A higher level of anxiety was shown in both patients' groups, regardless of shorter pain experience in the older patients.

Temporomandibular joint development and functional disorders related to clinical otologic symptomatology.

Temporomandibular disorders (TMDs) are a form of musculoskeletal pain of the temporomandibular joint (TMJ) and/or masticatory muscles of nonspecific etiology. In this study, the relationship between embryonic and anatomic-topographic similarities of the TMJ and the ear was analyzed, i.e. secondary otologic symptoms that can be closely connected to TMJ disorder. Nonspecific otologic symptoms are not primary diagnostic symptoms of TMD, but may cause diagnostic confusion due to patients' inability to correctly locate the origin of pain. The most common otologic symptoms that can be related to TMDs are otalgia, tinnitus and vertigo. Otorhinolaryngologists have to differentiate between primary otologic symptoms and those caused by TMJ disorders. In TMD diagnosis, manual techniques are used to determine the arthrogenic or myogenic form, whereas in the diagnosis of arthrogenic disorders magnetic resonance imaging is indicated as the highly specific imaging method ofjoint disk and osteoarthritic changes. Symptomatic treatments for TMD as well as the etiologic diagnosis of the pain require multidisciplinary cooperation between dentists and medical specialists.

Magnetic resonance imaging in the diagnosis of malignant tumors of the maxillofacial region.

Magnetic resonance imaging (MRI) is a radiological imaging method that has not yet found routine application in the detection and assessment of malignant tumors of the maxillofacial region. The aim of this study was to evaluate MRI in the detection, diagnosis and differential diagnosis of malignant tumors of the maxillofacial region. This prospective study included 42 patients with clinically confirmed malignant tumors of the maxillofacial region. All patients were examined by MRI. This imaging method was evaluated for the ability to detect tumor location and to analyze dimensions and structure of the tumor, bone involvement, effect on neurovascular structures and extension to soft tissues. MRI results were compared with histopathologic and intraoperative findings as the 'gold standard' methods. MRI identified all of the clinically confirmed tumors. The sensitivity for tumor location was 94.4%, tumor necrosis 93%, hemorrhage 93.3% and bone involvement 91.4%. The specificity for tumor location was 84%, tumor necrosis 92.8%, hemorrhage 92.8% and bone involvement 85.7%. In the evaluation of soft tissue tumor extension to bone structures, MRI sensitivity and specificity was 94.4% and 88.2%, respectively. The sensitivity for perineural infiltration and tumor involvement of vascular structures was 91% and 91.6%, respectively. The specificity for perineural infiltration was 96.7% and for tumor involvement of vascular structures 88%. MRI sensitivity and specificity for intracranial extension, intraorbital propagation, extension to pterygopalatine fossa and other surrounding anatomic spaces was 93.5% and 90.9%, respectively. MRI proved advantageous for the ability to distinguish neurovascular structures from adjacent soft tissues without the use of intravenous contrast media. Study results demonstrated MRI to provide valuable information in the analysis of tumor structure, bone involvement and extension to soft tissues of malignant tumors of the maxillofacial region.

Recommendations for the management of patients with carotid stenosis.

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.

Skin changes in the elderly people--how strong is the influence of the UV radiation on skin aging?

Just like every other part of the organism, the skin ages as a result of the passage of time. That process is called chronologic or intrinsic aging. However, skin is also exposed to external insults, such as UV radiation, which is the most influential extrinsic factor in skin aging, causing so called photoaging or extrinsic skin aging. Photoaging is a cumulative process which depends on the degree of UV exposure and the skin type. It is much more visible in individuals with skin types I and II and, less prominent in dark-skinned population. Chronic sun exposure can result in numerous changes in human skin, particularly on the face, nape, and arms. Keratinocytes, melanocytes, fibroblasts, and endothelial cells are altered by UV radiation. Therefore, changes in photoaging include wrinkling, elastosis, actinic keratoses, irregular pigmentation, telangiectases, and the development of malignant skin tumours. In the last decades, important progress has been made in understanding molecular mechanisms of photoaging. It is a complex process in which UV radiation has effects on numerous molecular processes that damage the skin, especially connective tissue of the skin. These processes include cell surface receptors, certain signal transduction pathways, transcription factors and, various enzymes involved in the synthesis and degradation of the dermal elements. Initial process in the activation of this process is UV-induced generation of the reactive oxygen species, which can also directly damage cell's DNA, membrane and proteins. Most of alterations found on the photoaged skin had formerly been considered to be caused by UVB wavelengths. However, a number of recent studies have demonstrated that UVA can also cause burning, elastosis, and skin cancer.

Magnetic resonance imaging study on temporomandibular joint morphology.

Magnetic resonance imaging (MRI) has enabled the accomplishment of a more effective diagnostics of temporomandibular disorders (TMD). The sample included 40 patients with clinical symptoms of disc displacement (DD) of temporomandibular joint (TMJ) and 25 subjects included in our study were asymptomatic. DD were diagnosed by clinical examinations which were subsequently confirmed by MRI. DD was found in 18% of the TMJs of the asymptomatic patients. The highest prevalence of total DD without reduction was found in 44.1% of the patients' joints subsequently followed by total DD with reduction comprising 34.9% of the TMJs and by partial DD with reduction comprising 21% of the TMJs. This study may help us clarify the complicated relationship which exists between the radiographic and clinical findings of TMJ disorders.

Assessment of ultrasound for use in detecting lipoatrophy in HIV-infected patients taking combination antiretroviral therapy.

The aim of this study was evaluation of ultrasound (US) as a tool for the assessment of lipoatrophy in a population of HIV-infected patients. We enrolled a convenience sample of 151 HIV-infected Caucasian participants (males, 79%) who were treated for at least 1 year with combination antiretroviral therapy (CART) in Zagreb, Croatia. US measurements of subcutaneous fat thickness were done over the malar, brachial, and crural region. We determined sensitivity and specificity of US as a diagnostic tool for lipoatrophy using receiver-operating curves and concordant patient and clinician assessment as our reference for the presence of lipoatrophy. HIV was acquired through heterosexual contact in 50% of participants and by sex between men in 42%. The mean current CD4 cell count was 503.1 cells=mm3 (standard deviation [SD] = 250.8). Seventy-seven (51%) participants were treated with stavudine and 91 (64%) with a protease inhibitor for at least 6 months. Nineteen (13%)participants had lipoatrophy in at least one anatomic site. Sensitivity of US ranged from 67%-71%, specificity from 65%-71%, positive and negative predictive values ranged from 11%-20% and 96-97%, respectively. US diagnosed lipoatrophy was more frequently found in patients with a history of stavudine treatment and in females. Patients with lipoatrophy had a longer duration of CART than those without lipoatrophy. US is a useful tool in ruling out the presence of clinical lipoatrophy in patients on CART. Using this objective measure of subcutaneous fat may be useful in helping clinicians make decisions about changing therapy.

[Metric analysis of temporomandibular joint in asymptomatic persons by magnetic resonance imaging]. / Metricka analiza temporomandibularnog zgloba magnetskom rezonancijom u asimptomatskih ispitanika.

AIM: The objective of this study was to investigate the prevalence of anterior disk displacement and condyle position in volunteers free from clinical symptoms and signs of temporomandibular disorders. MATERIAL AND METHODS: Bilateral parasagittal T1-weighted magnetic resonance images of temporomandibular joints (TMJ) in 25 asymptomatic volunteers (age range 21-27, mean 23.4 years; 18 (72%) female and 7 (28%) male) were analyzed and metric measurements of disk and condyle position were investigated. Metric analysis of the position and relationship between the disk and the condyles were described using Kurita et al. method of measuring relative and absolute distances of reference points. On statistical data analysis, the left and right TMJs of each person were presented as two separate entities. The methods of nonparametric statistics were used. RESULTS: Anterior disk displacement was found in 5 (20%) asymptomatic volunteers (four of them female). Anterior displacement with unilateral reduction and anterior displacement without reduction unilaterally was present in two subjects each, whereas one volunteer had anterior displacement without reduction bilaterally. There was no difference in the calculated position of condyle between joints with and without disk displacement (Kruskal-Wallis test, p < 0.05). DISCUSSION: This study evaluated the prevalence of asymptomatic anterior disk displacement in symptom-free healthy volunteers and the condyle position in the glenoid fossa. Displaced disk is the main cause of temporomandibular pain; however, studies in asymptomatic volunteers also suggest it to be an anatomic variant. The relationship between dorsocranially positioned condyle and anteriorly displaced temporomandibular joint disk is a controversial issue. Metric analyses were only made in parasagittal plane. CONCLUSION: There was difference in the calculated disk position between joints with and without disk displacement, but this study found no difference in the calculated condyle positions according to the presence or absence of disk displacement.

Occlusion in patients with temporomandibular joint anterior disk displacement.

The aim of this study was to determine the correlation between the static and dynamic occlusal factors in patients with anterior disk displacement (DD) and to compare it with occlusion in asymptomatic individuals. The study included a group of 40 patients with DD (median age 35.5) and a control group of 25 students of dental medicine (median age 23.4). In all subjects, the position, i.e. DD was determined by magnetic resonance imaging of temporomandibular joints. The study was focused on data gathered by direct analysis of occlusion: relationship between the molars (Angle class), horizontal and vertical overlap, preservation of occlusal contacts between the molars (Eichner classification), difference between contact points in maximal intercuspidation and centric position, and contact points on the laterotrusive and mediotrusive side. There was a statistically significant difference in tooth contact in maximal intercuspidation and centric positions between patients and asymptomatic subjects (p < 0.0001). There was also a difference between occlusal contact points on the mediotrusive side (p < 0.05) since the hyperbalanced contacts were only determined in asymptomatic subjects. Study results support the fact that a number of occlusal factors are related to DD. The fact that hyperbalanced contacts were only determined in asymptomatic subjects suggests that their mutual etiopathogenetic correlation is not quite clear.

UV damage of the hair.

Hair is a very important for our self-confidence as well as a very important part of appearance and self-concept. It reflects our personality and hair loss or hair damages are considered aesthetic imperfections and social handicap. Outward part of the hair is a "hair shaft" keratin fiber structure sensible to external effects whether they are mechanical, physical or chemical. Excessive sun exposition is the most frequent cause of hair shaft's structural impairment. Photochemical impairment of the hair includes degradation and loss of hair proteins as well as degradation of hair pigment. Hair protein degradation is induced by wavelengths of 254-400 nm. UVB radiation is responsible for hair protein loss and UVA radiation is responsible for color changes. Absorption of radiation in photosensitive amino acids of the hair and their photochemical degradation is producing free radicals. They have adverse impact on hair proteins, especially keratin. Melanin can partially immobilize free radicals and block their entrance in keratin matrix. It also absorbs and filters adverse UV radiations. Therefore melanin is important for direct and indirect protection of hair proteins. Protecting the cuticle is very important for keeping hair shaft's integrity. One can achieve that by avoiding noxious impacts or by implementation of hair care products with UV filters. Nowadays major studies and researches are conducted in order to create hair care products that prevent hair damage.

The risk of sports activities--the injuries of the Achilles tendon in sportsmen.

The aim of this study was to determine whether professional sports activities and intensive training practice affect pathological changes of the Achilles tendon. We also aimed to investigate whether these injuries primarily occur earlier or later in life. This was a cross sectional study of 214 athletes and non-athletes between the ages of 17-66. Participants were divided into four groups: 63 active young athletes, 64 young persons not involved in sports, 6 elderly athletes and 58 elderly people who did not participate in intensive athletic activities during their lifetimes. Ultrasound measurements of the Achilles tendon were performed on all participants. All participants also completed a self-administered survey to collect demographic information and data on athletic participation. Data were analyzed using the chi-square test and Fisher's exact test. Overall, those who were active athletes sought medical care more often than those who did not participate regularly in sports. Twenty-seven (33%) of young athletes had some Achilles tendon pathology, compared to 9 (14%) younger non-athletes. A total of 36 (64%) of elderly athletes were diagnosed with Achilles tendon disorders, compared to 15 (26%) of elderly people who were not active in sports. Microtears, acute tendonitis and peritendonitis were associated with younger age. By contrast, calcifications, scar tissue, and partial or complete rupture were only seen in the elderly

Using magnetic resonance imaging to identify the lumbosacral segment in children.

Identification of the lumbosacral (L-S) segment on magnetic resonance (MR) images is important for appropriate treatment of disease in the lumbosacral (L-S) area. In the study, data obtained from plain A-P radiographs of the L-S spine and sagittal MR imaging scans (sagittal T1- and T2-weighted sequences) of the L-S spine and sacrum with the coccygeal bone, are analyzed. Twenty-six children aged 10 to 14 years were examined for back pain. On the standard A-P radiographs of the L-S spine, a L-S transitional vertebra as classified according to the method of Castellvi et al. was found in 17 subjects. The problem arose as to whether this was lumbalisation or sacralisation, and how to determine which vertebra was L5 wich S1. On the sagittal MR imaging studies the same question applied. A need emerged for a simple method which would identify the L-S segment on the sagittal MR imaging studies of the L-S spine in children so that in case of a tumor, inflammation, spondilolystesis, or protrusion of a disc, the level in the L-S spine where the problem is localized can be accurately identified. To this objective we selected the method using detection of the S1 vertebra. This involved that, in addition to the sagittal MR imaging scans of the L-S spine, sagittal images of the sacrum and coccygeal bone be also obtained. on the T2-weighted sequence, the sacrum can be clearly distinquished from the coccygeal bone. By counting from the S5 up, the S1 vertebra can be accurately identified. Determination of the S1 vertebra enables detection of the L5 vertebra and, in turn, of all other lumbar vertebrae. In patients in whom a T2-weighted MR studies were done S1 could be precisely determined and so could the L5 vertebra. In this process, whether the patient had a transitional vertebra or whether there was lumbarisation or sacralisation was irrelevant.

[Initial treatment of temporomandibular joint osteoarthritis]. / Inicijalna terapija osteoartritisa celjusnoga zgloba.

The diagnostic procedure and the initial treatment of a female patient suffering from temporomandibular disorder is described. Osteoarthritis and the discopathy of the temporomandibular joint were diagnosed both clinically and by magnetic resonance imaging. Anxiety was confirmed by measuring instrument State-Trait Anxiety Inventory. Pains in temporomandibular joints were removed after the initial treatment in which the occlusion splint had been used so that conditions for carrying out the definite occlusal treatment were fulfilled.

Retained surgical textilomas occur more often during war.

Retained surgical textile foreign bodies are a problem despite precautions taken by surgeons. Computed tomography (CT) is a method of choice in diagnosing the cases of retained textilomas. Over 12 years, we diagnosed 11 acute textilomas in 10 patients in the early postoperative period within 3 months after abdominal surgery. The presence of considerable amount of air bubbles within textile fibers was the most representative sign. A 3-10 mm wide peripheral rim was present in all textilomas. In additional 3 cases, chronic, encapsulated foreign body granulomas were found, two were mimicking renal neoplasms. All granulomas contained discrete or coarse calcifications. The period between surgery and CT diagnosis was from 6 months to 14 years in chronic lesions. It is important to emphasize that 9 textilloma in 8 patients were associated with the years of war in Croatia (1991 and 1992), in hospitals on battle fronts, where surgeons worked under extremely strenuous conditions and with great inflow of wounded soldiers and civilians.

Enkephalin degradating enzymes in pheochromocytoma patients.

Adrenal gland as a major source of enkephalins on the periphery can be affected by a rare adrenal gland tumor, adrenal pheochromocytoma. It has been demonstrated that this tumor might be associated with altered concentration of enkephalin-like peptides. The effect of these peptides can be either prolonged or abbreviated by two neutrophil membrane bound enzymes; aminopeptidase N (APN) and neutral endopeptidase (NEP). We assumed that altered enkephalin level in pheochromocytoma patients (but not in patients with non-functional adenomas or tumors of different origin) might result in differently regulated APN and/or NEP activity. We measured APN and NEP activity on surface of neutrophils, level of lipid peroxidation (LPO) in plasma and enkephalin concentration in plasma in patients with pheochromocytomas, non-functional adenomas, malignant renal tumors and healthy controls. Catheholamines and vanyllmandelic acid (VMA) were measured in 24-h urine of pheochromocytoma patients. NEP and APN activity on neutrophils from all pheochromocytoma patients was significantly increased as compared with healthy controls, non-functional adenomas and malignant renal tumors. In all pheochromocytoma patients NEP activity was reduced almost to the control level after surgery. At the same time APN activity was in some patients up- and in others down-regulated. In comparison, elevated levels of cateholamines and VMA were found after multiple determinations in 6 out of 10 pheochromocytoma patients. Although preliminary, this study has shown specifically and consistently up-regulated NEP activity on neutrophils from pheochromocytoma patients, and uniformly decreased NEP activity in these patients after adrenalectomy.

The advancement in the early diagnostics of developmental hip dysplasia in infants--the role of ultrasound screening.

Developmental hip dysplasia (DDH) is a deformation of the locomotor system that can occur on previously normal bone structures in late fetal development. The study was undertaken to determine the value of continuous ultrasound screening in early diagnosis of DDH. In the area covered by the Labin Primary Health Center, clinical and ultrasound examination of the hips was performed in all children during the fourth month of life from 1989 to 2001. The incidence of DDH was 3.3%. The authors compared the obtained results with results of clinically examined hips in the period from 1968 to 1988 (incidence 1.7%), before the ultrasound diagnostics was introduced. The hip radiograms were performed only in children with clinically positive signs of higher degree of DHD. The ultrasound examination was performed with Hitachi EUB 410 real time linear transducer with a 5 MHz probe. The examiners used methods and criteria suggested by Graf. The most useful feature of the ultrasound method is that it allows the visualization of cartilaginous femoral head and its relationship to the acetabulum in infants. The method is non-invasive, repeatable, without risk of ionizing radiation or need for the contrast material administration. The results of the study revealed an important increase of DHD incidence after the introduction of ultrasound examination. US is highly sensitive in hip imaging and reveals the existence of a number of dislocated and subluxated hips that otherwise would be missed. The anomaly was discovered in the early period of life, which is very important for appropriate therapeutic effects.