A validity of ultrasound subdivision of Risser grade 4 in assessment of skeletal maturity.

In the treatment of adolescent idiopathic scoliosis, one of the most frequently used technique to determine skeletal maturity is the method described by Risser. The ossification of iliac apophysis progresses from ventral to caudal through the four zones and the fusion of the iliac apophysis to the iliac crest (Risser grade 5) indicated vertebral growth completion, therefore the termination of scoliotic deformity progression. The main disadvantages of Risser method are exposure to radiation and the questionable reliability, so there are efforts to examine iliac apohysis by ultrasound. There is also no resolute recommendation when to discontinue brace treatment of scoliosis. Using ultrasound, in this study, we subdivided Risser grade 4 to grade 4a and 4b, according to the amount of cartilage left unossified, in order to make clear when is safe to end brace treatment. We measured increase in height, during six month period, for 92 healthy children, who were classified by ultrasound in Risser 4a or 4b group. There was significantly larger increase in height for group 4a (p < 0.001). For girls, we also noted time past from menarche as sign of biological maturity. Girls from group Risser 4b got menarche 2.74 years before they were examined while group Risser 4a got menarche only 1.57 years before (p < 0.001). Subdvision of Risser 4 grade by ultrasound is promising method in determining end of brace treatment for scoliosis.

A correlation of peak height velocity and olecranon apophysis ossification assessed by ultrasound.

Peak height velocity (PHV) is defined as the period of the fastest growth during puberty. An ability to predict annual growth and the timing of PHV may provide an opportunity to modify treatment of many diseases and conditions of the skeletal system such as scoliosis and kyphosis, slipped capital femoral epiphysis, leg length inequality and adolescent Blount's disease. There is a good correlation of peak height velocity and skeletal age determined from the radiographic assessment ofolecranon. To avoid radiation, we tested value of olecranon ultrasound in prediction of annual growth and peak height velocity. In present study, using ultrasound, we made a classification of olecranon apophysis in 7 levels (0-6) according to the amount of cartilage left unossified. In 134 healthy children, aged from 10 to 15, evaluation of olecranon sonographs and staging was done by two observers in two spaced time intervals. Calculation of intra-examiner and inter-examiner agreement presented satisfactory reliability (intraclass correlation coefficient for Rater 1 = 0.967 and Rater 2 = 0.836) and very good reproduciblity (Cohen's Kappa 0.85). We measured increase in height, during six month period, for 54 children, who were classified by ultrasound in levels from 0 to 6. The greatest growth was noted in children classified as level 4. Olecranon apophysis maturity level 4, assessed by ultrasound could correspodent to peak height velocity.

Retrospective study of total hip arthroplasty in Brod-Posavina and Pozega- Slavonia counties in 2010.

The aim of this retrospective study is to present the incidence of total hip arthroplasty (THA) in Brod-Posavina and Pozega-Slavonia counties in 2010 along with an analysis of post-operative complications. The research was carried out at orthopaedic departments in three hospital institutions, "Dr. Josip Bencevic "Slavonski Brod General Hospital, the Nova Gradiska General Hospital and the Pozega General County Hospital. A total of 27 849 patients was examined in orthopedic outpatient clinics, 1 457 surgical procedures were conducted, of which 239 (16.40%) were THA. There were five (2.09%) dislocations of endoprosthesis, one case (0.42%) of endoprostheses infection, whereas none of periprosthetic fractures and peroneal nerve palsy were presented.

Primary malignant melanoma of gallbladder.

Gallbladder primary malignant melanoma (GPMM) is a rare and controversial entity. The existing controversy on the subject appears mainly because of the lack of definitive objective criteria of primitivity. Objective criteria proposed by the specific literature for distinguishing GPMM from secondary gallbladder melanoma include the exclusion of previous primitive melanoma, absence of synchronous involment of other sites, the unicity of lesion, its polipoid or papilary shape and the presence of a junctional melanocitary component. After laparoscopic cholecystectomy in one of our patients, dark polypus inside the gallbladder was found. A malignant melanoma was diagnosed according to all five criteria for GPMM.

Laparoscopic treatment of achalasia--first case in Croatia.

Esophageal achalasia is a primary esophageal motility disorder. Commonly used treatments are botulinum toxin injections, endoscopic balloon dilation and surgical myotomy with or without fundoplication. We are hereby presenting the first case of laproscopic myotomy with fundoplication performed in Croatia. A 32-year old female was admitted to the hospital due to the symptoms of dysphagia, regurgitation, chest pain and weight loss. Upper gastrointestinal tract radiography with contrast and flexible endoscopy confirmed the clinical diagnosis of achalasia. She was treated by the Heller laparoscopic procedure and Dor anterior fundoplication. The patient had a successful recovery and was discharged on the fifth postoperative day. This case shows that laparoscopic treatment of achalasia is a feasibile and safe procedure which can be performed even in a small country hospital, but it requires great technical care and experience of the surgeon.