Objectives: The group of spondyloarthritis (SpA) disorders shares common clinical manifestations, including internal derangement (ID) of temporomandibular joint (TMJ). This study aimed to investigate SpA activity in patients with ID of TMJ. Materials and Methods: We assessed 200 patients with neck pain using the Assessment of Spondyloarthritis International Society (ASAS) criteria. TMJ was examined using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol). Patients with SpA were divided into three groups: symptomatic ID of TMJ, asymptomatic ID of TMJ, or healthy TMJ (controls). Activity of SpA was evaluated using the Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Disease Activity Index in Psoriatic Arthritis (DAPSA), patients’ self-estimated SpA activity, difficulties in performing daily activities, pain intensity (visual analogue scale) and laboratory parameters. Results: Patients with symptomatic and asymptomatic ID showed statistically significantly increased ASDAS, anti-streptolysin titer, patients’ self-estimated axial pain and activity of SpA, and decreased hematocrit than the control. Patients with symptomatic ID also had statistically significant earlier onset of SpA, along with increased BASDAI and DAPSA, total body pain, difficulties in performing daily activities, platelet count, and serum alpha-amylase but lower hemoglobin concentration than controls. Patients with asymptomatic ID had higher frequencies of exacerbated axial SpA and sacroiliac joint ankylosis compared to the control. Conclusion: All patients with SpA and ID showed increased axial disease activity.

We aimed to evaluate the diagnostic accuracy of the proinflammatory monocyte chemotactic protein-1 (MCP-1) in the diagnosis of asymptomatic diastolic dysfunction (DD) in patients with psoriatic arthritis (PsA). The disease activity in psoriatic arthritis (DAPSA) was determined using clinical and laboratory parameters, and echocardiography was performed to estimate DD. Serum MCP-1 concentrations were elevated in PsA patients with DD diagnosed with ultrasound (median (25th percentile, 75th percentile): 366.6 pg/mL (283, 407.1 pg/mL) vs. 277.5 pg/mL (223.5, 319.1 pg/mL) in controls; P < 0.0017 ). PsA patients with serum MCP-1 concentration higher than the cut-off value of 347.6 pg/mL had a 7.74-fold higher chance of developing DD than PsA patients with lower serum MCP-1 concentrations (controls), with a specificity of 86.36% and sensitivity of 55%, as verified using ultrasound. The group with MCP-1 concentrations above the cut-off value also showed a higher late peak diastolic mitral inflow velocity, A-wave value ( P = 0.000005 ), E/E ′ ratio ( P = 0.00005 ), and a lower E/A ratio ( P = 0.000002 ), peak systolic left atrial reservoir strain, SA value ( P = 0.0066 ), early peak diastolic displacement of the mitral septal annulus, E ′ wave value ( P = 0.003 ), than controls. Systolic blood pressure ( P = 0.01 ), LDL cholesterol concentration ( P = 0.012 ), glucose concentration ( P = 0.011 ), and DAPSA ( P = 0.0000 ) increased in the PsA group with higher MCP-1 concentrations, although there were no differences in comorbidities and therapy between the groups compared. Thus, the serum MCP-1 concentration was a significant and independent prognostic indicator for asymptomatic DD in PsA patients ( area under the curve = 0.730 , P = 0.001 ). The DAPSA score in PsA patients might indicate the need for echocardiography and adjustment of anti-inflammatory treatment in terms of DD prevention.

BACKGROUND Brain maturation is considered completed around the age of 25, when prefrontal cortex maturation has been achieved. The aim of our study was to investigate the alterations of grey matter (GM) in patients with the onset of schizophrenia before and after the completion of brain maturation. SUBJECTS AND METHODS The study group included 100 schizophrenia patients, while the control group comprised 50 healthy individuals. Brain magnetic resonance imaging was acquired on a 1.5 T scanner. Voxel-based morphometry (VBM) analyses were performed between groups. RESULTS GM of the schizophrenic patients is reduced in many regions (p<0.005 FDR corrected). Most widespread reduction is detected in frontal cortex and cerebellum, the other regions being limbic cortex, insula, cuneus, precuneus, superior temporal gyrus and motor cortex. The decrease of grey matter volume (GMV) increases with the increase in number of psychotic episodes and is more pronounced in the patients with earlier onset of the disease. CONCLUSIONS The age of the onset of the disease is important for both total and relative loss of GMV. Earlier onset of schizophrenia, prior to full brain maturation results in significant reduction of GM in comparison with healthy subjects and patients with later, post full brain maturation onset of the disease.

Objective: Providing suggestions for the evaluation of the sagittal spine curvatures in the supine patients because the sagittal spine curvatures are usually analyzed only in the erect patients. Methods: 196 patients had their sagittal spine curvatures analyzed in a retrospective study on both the standard X rays done in the erect position and on the native MR scans done in the supine position during the six months period, between the 1st January and the 30th June 2019, on the Somatom Avanto, Erlangen 1,5 T machine at the Department of Radiology of the Clinical Hospital Center Rijeka. Harrison’s posterior tangential method was used for the evaluation of the sagittal spine curvatures due to its lesser standard mistake and a greater measurement precision than the Cobb’s method. Results: In the cervical spines there were no significant changes in the patients with hyperlodoses and kyphoses, lesser changes were seen in the patients with hypolordoses and applanations, while the greatest changes were in the patients with normolordoses. The smallest changes overall were observed in the thoracic spines. Regarding the lumbar spines there were again no significant changes in the patients with hyperlordoses and kyphoses, lesser changes were seen in the patients with hypolordoses and applanations, while the greatest changes were observed in the patients with normolordoses. Conclusion: In the supine patients the sagittal spine curvatures could with a certainty be assessed in the cases of thoracic spines and lumbar normolordoses as well as in the cervical and lumbar hyperlordoses and pathological kyphoses.

BACKGROUND Schizophrenia is a severe illness whose clinical course is characterized by various numbers of psychotic episodes (PE). The neurotoxic hypothesis (NH) of schizophrenia assumes that psychosis is biologically toxic. The aim of the study was to investigate whether schizophrenia patients (SP) with multiple PE have greater grey matter volume (GMV) reduction compared to SP with fewer PE. SUBJECTS AND METHODS We enrolled 106 adult SP and 63 healthy controls. Demographic and clinical data were collected and statistically analysed for all included subjects. Magnetic resonance imaging (MRI) of the brain was acquired on a 1.5 T scanner. SP were grouped according to the number of PE into a group with up to 3 PE (SCHG-1) and with 4 or more PE (SCHG-2). SCHG-1 was further subdivided into two groups regarding to disease duration (DD). Voxel-based morphometry (VBM) analyses were performed between SP groups as well as between SP groups and the healthy controls group (HCG). RESULTS No relevant GMV differences were detected between SP groups. Comparison between HCG and SCHG-1 showed only 3 regions with reduced GMV, while multiple regions with reduced GMV were detected when comparing HCG and SCHG-2. CONCLUSIONS GMV reduction in schizophrenia varies depending on the number of PE when compared to HCG, regardless of disease duration (DD), but PE is not the only contributing factor that leads to neurotoxicity.

Background: Mitochondrial disorders are heterogeneous clinical syndromes caused by defective activity in the mitochondrial respiratory chain, resulting in a faulty oxidative phosphorylation system. These inherited disorders are individually rare, and furthermore they are phenotypic variables. The genetically characterized mitochondrial disorders are rarely associated with epileptic encephalopathies. Case presentation: We present the clinical phenotype, biochemical analysis, and electrographic and neuro-radiological features of a 5-month-old girl with epileptic encephalopathy, microcephaly, severe psychomotor delay, hypertrophic cardiomyopathy, and abnormal MRI scan. Using whole-genome sequencing technique, compound heterozygous mutations of the VARS2 gene were revealed, with one previously unreported frameshift mutation. Conclusion: Our report extends the phenotypic spectrum of VARS2-related disorders with an initial presentation of epileptic encephalopathy and early death due to malignant arrhythmia.

The LaryngoscopeVolume 127, Issue 3 p. 574-576 Facial Plastics and Reconstructive Surgery Auricular epithesis Dubravko Manestar MD, PhD, Corresponding Author Dubravko Manestar MD, PhD dubravko.manestar1@gmail.com Department of Otorhinolaryngology–Head and Neck Surgery, University of Rijeka, Rijeka, CroatiaSend correspondence to Dubravko Manestar, MD, Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital Rijeka, Krešimirova 42, 51000 Rijeka, Croatia. E-mail: dubravko.manestar1@gmail.comSearch for more papers by this authorSven Maričić, Sven Maričić Faculty of Engineering, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorDean Komljenović MD, Dean Komljenović MD Department of Otorhinolaryngology–Head and Neck Surgery, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorDamir Miletić MD, Damir Miletić MD Department of Radiology, University Hospital Rijeka, Rijeka, CroatiaSearch for more papers by this authorAntonija Ružić Baršić MD, Antonija Ružić Baršić MD Department of Radiology, University Hospital Rijeka, Rijeka, CroatiaSearch for more papers by this authorEmanuel Borović MD, Emanuel Borović MD Department of Anesthesiology and Intensive Care Unit, University Hospital Rijeka, Rijeka, CroatiaSearch for more papers by this author Dubravko Manestar MD, PhD, Corresponding Author Dubravko Manestar MD, PhD dubravko.manestar1@gmail.com Department of Otorhinolaryngology–Head and Neck Surgery, University of Rijeka, Rijeka, CroatiaSend correspondence to Dubravko Manestar, MD, Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital Rijeka, Krešimirova 42, 51000 Rijeka, Croatia. E-mail: dubravko.manestar1@gmail.comSearch for more papers by this authorSven Maričić, Sven Maričić Faculty of Engineering, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorDean Komljenović MD, Dean Komljenović MD Department of Otorhinolaryngology–Head and Neck Surgery, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorDamir Miletić MD, Damir Miletić MD Department of Radiology, University Hospital Rijeka, Rijeka, CroatiaSearch for more papers by this authorAntonija Ružić Baršić MD, Antonija Ružić Baršić MD Department of Radiology, University Hospital Rijeka, Rijeka, CroatiaSearch for more papers by this authorEmanuel Borović MD, Emanuel Borović MD Department of Anesthesiology and Intensive Care Unit, University Hospital Rijeka, Rijeka, CroatiaSearch for more papers by this author First published: 08 July 2016 https://doi.org/10.1002/lary.26113Citations: 3 This work was performed in the Department of Otorhinolaryngology–Head and Neck Surgery and in the Faculty of Engineering, University of Rijeka, Rijeka, Croatia. This work was supported in part by the Ministry of Science, Education and Sports of the Republic of Croatia under the project Research Infrastructure for Campus-based Laboratories at the University of Rijeka (RC.2.2.06-0001). This project has been co-funded by the European Fund for Regional Development. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume127, Issue3March 2017Pages 574-576 RelatedInformation

The spinal epidural space is located between the spinal dura mater and the vertebral column and extends from the foramen magnum to the sacral canal at the level of S2/S3.It is divided into anterior and posterior compartment.Due to its excellent soft tissue contrast magnetic resonance imaging is the gold standard for imaging and diagnosis of pathological processes of the spinal epidural space which differ in etiology.Many processes origin in the spinal epidural space or extend from adjacent structures and epidural space is a frequent location for metastatic processes.Due to the possibility of spreadingof the pathological processes along spinal nerves and the spinal cord, they may present with symptoms of radiculopathy or myelopathy.

Obesity is a disease characterized by excessive accumulation of body fat, resulting in negative impact on an individual’s health and shortened life span. One of the most important problems in the diagnosis and study of obesity is the selection of the best methods for its determination. Using water labeled with stable isotopes of hydrogen and oxygen (2H and 18O) it is possible to accurately determine the share of adipose tissue in body mass and reliably determine total energy expenditure of the organism in a continuous period of several days. The use of 2H and/or 18O is of special importance in clarifying the pathophysiology and etiopathogenesis of obesity as well as in monitoring the metabolism of lipids, particularly fatty acids and triglycerides. Application of the method in which water labeled with isotopes 2H and 18O is used does not require the hospitalization of participants, is suitable for field research on a large number of subjects, and is applicable to all age groups. Despite many advantages, the methods in which 2H and 18O labeled water is used for the study of obesity are still not common in Croatia. The aim of this paper is to familiarize the Croatian medical profession, as well as other interested scientists and experts with the methods, in order to successfully follow global trends in the approach to the problem of excessive body weight and obesity. In addition, the paper critically discusses some other methods that are commonly used in the diagnosis and study of obesity.

Pretilost je bolest u kojoj dolazi do prekomjernog nakupljanja masnog tkiva, sto rezultira negativnim utjecajem na zdravlje pojedinca i skracenim životnim vijekom. Jedan od najvažnijih problema u dijagnostici i istraživanju pretilosti je odabir najboljih metoda za njeno određivanje. Upotrebom vode obilježene stabilnim izotopima vodika i kisika (2 H i 18O) moguce je precizno determinirati kolicinu masne mase u ukupnoj tjelesnoj masi i pouzdano odrediti ukupnu potrosnju energije organizma u visednevnom kontinuiranom periodu. U razjasnjavanju patofiziologije i etiopatogeneze pretilosti od posebnog je znacaja i koristenje 2 H i/ili 18O u pracenju metabolizma lipida, osobito masnih kiselina i triglicerida. Primjena metoda u kojima se koristi voda obilježena izotopima 2 H i 18O ne zahtijeva hospitalizaciju ispitanika, pogodna je za terenska istraživanja na velikom broju ispitanika i primjenjiva je u svim dobnim skupinama. Unatoc mnogobrojnim prednostima, metode koje koriste vodu obilježenu 2 H i 18O u istraživanju pretilosti u nas jos uvijek nisu dovoljno poznate. Cilj ovog rada je pojasniti i približiti ih hrvatskoj lijecnickoj struci, ali i ostalim zainteresiranim znanstvenicima i strucnjacima, kako bi se sto uspjesnije mogli pratiti svjetski trendovi pristupa problemu prekomjerne tjelesne mase i pretilosti. Osim toga, u radu su kriticki razmotrene i druge metode koje se najcesce koriste u dijagnostici i istraživanju pretilosti.

Background: Internal carotid artery agenesis is a rare anomaly that can be clinically asymptomatic. Klippel-Feil syndrome is a skeletal malformation characterized by vertebral fusion. Presence of postaxial polydactyly is suggestive of an underlying syndrome.Case Report: We report a rare case of a 44-year-old patient with non-specific symptoms and an association between these three rare abnormalities. Vascular anomalies were found using intracranial MR angiography and multi-detector CT angiography of the supraaortic arteries.Conclusions: Presence of a single aforementioned anomaly requires cautious imaging assessment in order to detect possible associated anomalies and avoid diagnostic pitfalls. A possible common genetic background could explain the coexistence of these three anomalies.

Epilepsy often occurs in comorbidity with mental diseases and disorders. Early detection and/or treatment of such disorders in patients affected by epilepsy, as well as their socialisation are crucially important since epileptic patients tend to suffer more due to lack of social support than to frequent epileptic seizures. Prevalence of psychiatric disorders is higher in patients with epilepsy than in general population, the most frequent being: anxiety, depression, panic attacks, behavioural disorders as well as psychotic states with paranoid elements. The efficacy of AE treatment of patients affected by epilepsy and mood disorders has also directed clinicians to investigate possible AE benefits in treating other mental disorders such as anxiety states, depression and bipolar disorder. The examined case displays complex partial epilepsy and comorbid mental disorder. The use of lamotrigine, a fourth-generation antiepileptic, which is also a mood stabilizer, has assured a favourable remission of symptoms related to both epilepsy and mood disorders. Side-effects caused by lamotrigine were only temporary and dose reduction was sufficient to eliminate their symptoms.

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years.

This article reports the case of a patient with partial agenesis of the corpus callosum manifested with corpus callosum syndrome together with signs of brain hemispheres dysfunction: mental impairment, epilepsy and pyramidal signs. The patient's malformation is combined with left-handedness while signs of callosal disconnection are not present. Mild cognitive impairment and late epilepsy onset require a multidisciplinary approach since the patient also displays elements of central nervous system malformations.

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