Clinical Hospital sveti Duh

Zagreb, Croatia

Clinical Hospital sveti Duh

Zagreb, Croatia

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Rados I.,University Hospital Center Osijek | Sakic Zdravcevic K.,Clinical Hospital Sveti Duh | Hrgovic Z.,University Hospital Center Osijek
European Neurology | Year: 2013

Background: The painDETECT questionnaire (PD-Q) is a fast and uncomplicated way to ascertain the percentage of neuropathic pain in 'total pain' and is designed to detect neuropathic pain components in back pain. The purpose of this randomized, prospective study is to compare, with the assessment of the PD-Q, the efficacy of interlaminar (IL) and transforaminal (TF) steroid injections in patients with unilateral chronic lumbar radicular pain. Methods: Patients were treated fluoroscopically with epidural steroids, using the IL or TF method and with confirmation of the epidural space by contrast, using random computerized classification. The patients received a series of three IL or TF epidural steroid injections (ESI) at 2-week intervals. The patients were monitored for 6 months from the first steroid injection. Results: By analyzing the average values of the total sum of points in the PD-Q a dropping trend is confirmed for both groups. The trend equation (y = -1.1393x + 25.269) for the TF ESI shows a faster recovery than the IL ESI (y = -0.8089x + 26.654). The statistically significant difference in the two groups is proved between the first and the sixth visit (IL ESI, p = 0.014; TF ESI, p = 0.001). There is no statistically significant difference in the efficiency of the two dosages and the volumes of steroids between the IL and TF distribution of steroids. Conclusions: Steroids are efficient; besides alleviating the overall pain, they also reduce the neuropathic component in chronic lumbar radicular pain, whether it is distributed epidurally by the IL or TF approach. © 2012 S. Karger AG, Basel.


Coles A.J.,University of Cambridge | Fox E.,MS Clinic of Central Texas | Vladic A.,Clinical Hospital Sveti Duh | Gazda S.K.,INTEGRA Clinical Research | And 9 more authors.
The Lancet Neurology | Year: 2011

Background: Alemtuzumab is a humanised monoclonal antibody that depletes lymphocytes, causing long-term immunomodulation. In a 3-year, rater-blinded phase 2 study (the CAMMS223 study) in patients with relapsing-remitting multiple sclerosis (RRMS), alemtuzumab reduced relapse rate and the risk of sustained accumulation of disability compared with subcutaneous interferon beta-1a, and the mean expanded disability status scale (EDSS) score of the alemtuzumab cohort improved compared with baseline. Adverse events included infusion-associated reactions, predominantly mild to moderate infections, thyroid disorders, and immune thrombocytopenia. In this study, we further analysed the CAMMS223 data with the aim of determining whether demographic and baseline disease-related characteristics affect the beneficial effects of alemtuzumab. Additionally, we aimed to describe a new outcome measure in multiple sclerosis research: sustained reduction in disability. Methods: 334 treatment-naive patients with active, early RRMS were randomly assigned in a 1:1:1 ratio to receive interferon beta-1a (44 μg subcutaneously three times per week), or 24 mg per day or 12 mg per day alemtuzumab intravenously for 2 or 3 annual cycles. We analysed freedom from clinical disease activity (CDA; defined as no relapses and no sustained accumulation of disability) and occurrence of sustained reduction in disability (SRD; a ≥1 point decrease on the EDSS sustained for 6 consecutive months for patients with a baseline EDSS ≥2), and analysed efficacy outcomes for subgroups based on age, sex, geographic region, MRI-T1 brain volume, MRI-T2 lesion volume, disease duration, number of previous relapses within 2 years, and EDSS. Findings: 322 patients were analysed. 161 of 215 patients treated with alemtuzumab were free of CDA at 36 months (Kaplan-Meier estimate 71·8%, 95% CI 63·1-78·8%) compared with 52 of 107 patients treated with interferon beta-1a (42·6%, 32·4-52·4%; hazard ratio [HR]=0·31, 0·20-0·46; p<0·0001). For the 199 patients with a baseline EDSS score greater than or equal to 2, SRD was more likely (HR=2·61, 1·54-4·43; p=0·0004) among patients treated with alemtuzumab (66 of 133 patients, Kaplan-Meier estimate 51·6%, 95% CI 43·2-60·7%) than patients treated with interferon beta-1a (15 of 66 patients, 27·2%, 17·2-41·4%). All disability and relapse outcomes showed evidence of beneficial effects of alemtuzumab compared with interferon beta-1a across all analysed patient subsets, and no subgroup of patients consistently responded better than others to alemtuzumab. Interpretation: Alemtuzumab reduced disease activity compared with interferon beta-1a in most of the analysed subgroups. Significantly greater numbers of patients experienced sustained improvement in disability after treatment with alemtuzumab than interferon beta-1a. The efficacy offered by alemtuzumab is a substantial advance in the treatment of multiple sclerosis. Funding: Genzyme and Bayer Schering Pharma. © 2011 Elsevier Ltd.


Miskulin M.,Clinical Hospital Sveti duh | Vrgoc G.,Clinical Hospital Sveti duh | Sporis G.,University of Zagreb | Dulic O.,University of Belgrade | And 2 more authors.
International Orthopaedics | Year: 2014

Purpose: The purpose of this study was to evaluate the results of arthroscopic cuff reconstruction, which is currently preferred in our service, and to compare functional outcome after arthroscopic cuff reconstruction comparing different types and sizes of rotator cuff tears. We switched completely from open repair to the full-arthroscopic repair > ten years ago, and since then, we are developing a technique that can produce the best results. Therefore, we decided to verify results. Methods: Seventy-two patients with rotator cuff tear underwent arthroscopic shoulder surgery. Single-row arthroscopic repair using double-loaded metal anchors and margin-convergence sutures with concomitant procedures were performed in all cases. All patients were assessed and classified before and after surgery using the Constant scoring system and the Oxford Shoulder Score. Tears were measured and classified as medium (1–3 cm), large(3–5 cm) and massive (>5 cm). Results: The average age of participants was 59 ± 9 years (33–76). There were five medium, 43 large and 23 massive tears. The average functional Constant score at the last follow-up was 91.68 ± 10.62, and the Oxford score averaged 43.23 ± 5.84 without statistically significant differences (p > 0.05) among groups Best results were in the massive-tear group, with an overall Constant score of 98.60 ± 2.61 and an average Oxford score of 47.60 ± 0.55. Full recovery was obtained between six months and one year. We used our own modified rehabilitation protocol and found no postoperative stiffness in this series. Conclusions: Single-row arthroscopic rotator cuff repair using double-loaded metal anchors and margin-convergence sutures with concomitant procedures, when necessary, provides excellent results. Pain, range of motion, muscle strength and function were significantly improved after single-row repair among all morphological types of cuff lesions. © 2014, SICOT aisbl.


Predojevic M.,University of Zagreb | Stanojevic M.,Clinical Hospital Sveti Duh | Vasilj O.,University of Zagreb | Kadic A.S.,University of Zagreb
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2011

In this case report, we present prenatal and postnatal neurological evaluation of a fetus and newborn from pregnancy complicated with intrauterine growth restriction, fetal hypoxemia, and preterm labor. Despite unfavorable intrauterine conditions, this premature infant showed normal early neurological development that was verified not only by postnatal tests but also with a new prenatal neurological screening test. © 2011 Informa UK, Ltd.


Serman L.,University of Zagreb | Serman A.,Clinical Hospital Sveti Duh | Fabijanovic D.,University of Zagreb
Medical Hypotheses | Year: 2011

Due to it ability to invade deep into endometrium, as well as into other tissues at ectopic sites (testis, kidney capsule), throphoblast plays an important role in shaping the future placenta. To accomplish this task, it is necessary for throphoblast cells to differentiate into highly invasive throphoblast giant cells (TGC). The behaviour of TGC during implantation resembles that of cancer cells during metastasis. In both cases, the invasive phenotype is to a large degree controlled epigenetically, by DNA methylation, with resulting gene expression silencing. DNA demethylating agents, such as 5-azacitidine (5azaC), reverse the gene expression and change cell behaviour; already used in cancer therapy, 5azaC is also useful experimentally to elucidate epigenetic pathways in normal and malignant cells. In this paper we describe an in vivo rat model of throphoblast cell invasion, in which cells are exposed to 5azaC and transplanted ectopically under kidney capsule. We conclude that temporal variation in exposure to 5azaC, such as the gestation day, affects the throphoblast cells differentiation, and thus changes their invasive properties. We suggest that this in vivo model could be useful to study steps in epigenetic control of both the placental development and cancer cell spread. © 2010 Elsevier Ltd.


Serman L.,University of Zagreb | Martic T.N.,University of Zagreb | Serman A.,Clinical Hospital Sveti Duh | Vranic S.,University of Sarajevo
Bosnian Journal of Basic Medical Sciences | Year: 2014

Epigenetic mechanisms play a crucial role in cellular proliferation, migration and differentiation in both normal and neoplastic development. One of the key signaling pathways whose components are altered through the epigenetic mechanisms is the Wnt signaling pathway. In this review, we briefly discuss the key concepts of epigenetics and focus on the recent advances in the Wnt signaling pathway research and its potential diagnostic and therapeutic implications. © 2014 ABMSFBIH.


Klarica M.,University of Zagreb | Mise B.,University of Zagreb | Vladic A.,Clinical Hospital Sveti Duh | Rados M.,University of Zagreb | Oreskovic D.,Ruder Boskovic Institute
Neuroscience | Year: 2013

Acute osmolar loading of cerebrospinal fluid within one lateral ventricle of dogs was examined as a cause of water extraction from the bloodstream and an increase in intracranial pressure. We have shown that a certain amount of 3H2O from the bloodstream enters osmotically loaded cerebrospinal fluid significantly faster, hence causing a significant increase in intracranial pressure. The noted phenomenon in which intracranial pressure still significantly increases, but in which the hyperosmolarity of the cerebrospinal fluid is no longer present, was named "compensated hyperosmolarity". In the case of the sub-chronic application of hyperosmolar solutions into cat ventricles, we observed an increase in cerebrospinal fluid volume and a more pronounced development of hydrocephalus in the area of application, but without significant increase in intracranial pressure and without blockage of cerebrospinal fluid pathways. These results support the newly proposed hypothesis of cerebrospinal fluid hydrodynamics and the ability to develop new strategies for the treatment of cerebrospinal fluid-related diseases. © 2013 IBRO.


Ostojic V.,Clinical Hospital Sveti Duh
Allergy and Asthma Proceedings | Year: 2016

Background: Induction of specific immunoglobulin G4 (sIgG4) response (so-called blocking antibodies) in patients who receive specific immunotherapy (SIT) has been observed for many years. Although many other mechanisms have been identified as key regulators of immunologic processes in peripheral tolerance to allergens, the rise of sIgG4 during immunotherapy, together with the clinical improvement, is still believed to be one of the most important mechanisms through which SIT reaches its clinical efficacy. Objective: The aim of this prospective study was to measure levels of IgG4 and sIgE in subjects allergic to Ambrosia elatior pollen (common ragweed), before and during natural exposure to A. elatior pollen. Healthy controls were also included. Methods: Twenty-four patients with allergic diseases of the respiratory tract and 24 healthy controls entered the study. The sIgG4 and sIgE levels were measured by using the enzyme-linked immunosorbent assay method before and during A. elatior pollination season. Results: A significant increase of the sIgG4 level in subjects with allergy during natural exposure to an allergen (0.676 increased to 0.937; p < 0.05) was shown. An increase in sIgE levels was also observed. Healthy subjects had comparable levels of sIgG4 as in subjects with allergy before the pollination season and no change in sIgG4 and sIgE levels during the pollination season. Conclusion: Increases of sIgG4 and sIgE levels were induced by natural allergen exposure in subjects with allergy but not in healthy individuals. This result support further reevaluation of the "blocking" antibodies concept as one concept responsible for allergen tolerance in patients who receive SIT. Copyright © 2016, OceanSide Publications, Inc.


Pevec B.,Clinical Hospital Sveti Duh | Radulovic Pevec M.,Clinical Hospital Sveti Duh | Stipic Markovic A.,Clinical Hospital Sveti Duh | Batista I.,Clinical Hospital Sveti Duh
Journal of Investigational Allergology and Clinical Immunology | Year: 2014

Background: It is still uncertain whether house dust mite (HDM) tropomyosin present in allergen extracts can cross-sensitize patients receiving subcutaneous immunotherapy (SCIT) and thus induce food allergy. Objectives: Our aim was to assess whether new sensitization to tropomyosin occurred during HDM-SCIT, and, if so, whether it was clinically relevant. Patients and Methods: The study sample comprised 56 HDM-allergic patients treated with SCIT using HDM extract. All patients were screened for specific IgE (sIgE) to mite tropomyosin (rDer p 10) before and after SCIT. In patients with a positive result, we also monitored the dynamics of sIgE to rDer p 10 and shrimp tropomyosin (rPen a 1) at several time points. The levels of sIgE were measured using the CAP System fluorescent-enzyme immunoassay. Results: sIgE to tropomyosin was found in only 5 patients, 3 of whom expressed low and clinically irrelevant levels of sIgE to Der p 10, while sIgE to Pen a 1 was not found. The remaining 2 patients expressed sIgE to both tropomyosins. In the first, the initial increase and subsequent decrease resembled the dynamics of the IgE antibodies usually seen in SCIT patients and were never accompanied by seafood-induced symptoms. In the other, a decrease in levels of sIgE to both tropomyosins resulted in the complete loss of his reactivity toward seafood. Conclusions: Immunotherapy using HDM extracts does not induce clinically relevant sensitization to tropomyosin. In certain cases of combined mite and seafood allergy, treatment may even lead to the improvement of food allergy symptoms. The levels of sIgE to Der p 10 and Pen a 1 may be useful monitoring markers. © 2014 Esmon Publicidad.


Vasilj O.,Clinical Hospital Sveti Duh | Miskovic B.,Clinical Hospital Sveti Duh
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2012

Thanatophoric dysplasia is a severe skeletal disorder with estimated frequency of 0.2-0.5 per 10,000 births. Affected infants die shortly after birth. The diagnosis of thanatophoric dysplasia can be made by two-dimensional ultrasound but the perception of these images is very difficult for the patients. The use of four-dimensional real time ultrasound gives the physician the possibility to discuss and counsel the patients with images that are more understandable to the general public. © 2012 Informa UK, Ltd.

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