Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti 

About: Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti is an academic journal. The journal publishes majorly in the area(s): Population & Transplantation. It has an ISSN identifier of 1330-0164. Over the lifetime, 959 publications have been published receiving 4303 citations.

[Hans Berger (1873-1941)--the history of electroencephalography].

Abstract: The discovery of electroencephalography (EEG) in 1929 by the German psychiatrist Hans Berger was a historical breakthrough providing a new neurologic and psychiatric diagnostic tool at the time, especially considering the lack of all those now available in daily practice (EP, CT, MRI, DSA, etc.) whithout which the making of neurologic diagnosis and planning neurosurgical operative procedures would now be unconceivable. There are no recent reports on the topic in the Croatian medical literature. The methods used in the study included search through previous reports, bibliographic notes, Internet sources, and analysis of continuous scientific attempts made through centuries to discover the real nature and meaning of electrical activity. Galvani's accidental discovery of "biological electricity" led to Volta's discovery of the battery (voltaic pile). Using it, Rolando was the first to stimulate cerebral surface. Thus, enabling Fritsch and Hitzig and Ferrier to develop the idea of cerebral localization (Jackson, Gowers, Gotch and Horsley). It was understandable that brain electrical stimulation produces contralateral motor response, but it was unknown whether there was a spontaneous (intrinsic) brain electrical current that could be recorded. Caton was the first to report on the "current in the brain gray substances onto open brain. Based on Caton's discovery and of those of Beck, Danilevsky, Prawdicz-Neminsky and others, Berger made the first EEG (electrocorticogram) recording on July 6, 1924, during a neurosurgical operation on a 17-year-old boy, performed by the neurosurgeon Nikolai Guleke. He reported on the topic in 1929, using the terms alpha and beta waves. The "spike and waves" (Spitzenwellen) were described shortly thereafter by the American group of EEG pioneers (H. and P. Davies, F. and E. Gibbs, Lenox and Jasper), although Berger had also observed them but considered them artifacts. The discovery of electroencephalography was a milestone for the advancement of neuroscience and of neurologic and neurosurgical everyday practice, especially for patients with seizures. The real nature of the disease and its management (anticonvulsants, excision of brain scars, tumors, etc.) were unkonown at that time. Berger's persistent, hardworking and steady personal style overcame all technical and other obstacles during the experiments. Unfortunately, he gained neither acceptance nor recognition, among his fellow contemporaries from abroad. Political turmoils at the dawn of World War II, in the country of Nazi's ideology and finally the outbreak of war, along with the complete ban of any further work on EEG after his forced retirement, led him to an uneasy professional and personal end. In the era when lumbar puncture, pneumoencephalography and ventriculography were the only diagnostic tools to detect and localize "sick sites" in the brain, EEG revolutionized daily neurologic and neurosurgic procedures, and bridged a time period of about 40 years (1930-1970) until the advent of computer tomography. Nowadays its importance is not as great as it was before, but it still has its place in the diagnostic work-up of seizures, brain tumors, degenerative brain changes, and other diseases.

The fetus as a patient.

Abstract: This article highlights the concept, history and development of fetal medicine. The first attempts of fetal medicine date from the stone age and have continued throughout the medieval and modern ages. Attempts to influence fetal health and pregnancy outcome at first were purely theoretical and passive, limited by ignorance, fear, and religion. With the development of the medical sciences, the role of the obstetrician became more active. Today, not only obstetricians, but many other experts in the field of antenatal care as well, deal with the great number of medical and technological advances. The limitations arising today are mainly ethical. The main question that still has not been answered is to what extent the physician is allowed to interfere with the process of fetal development and pathology, based upon real fetal and maternal benefit. In order to answer this question and to coordinate many activities by different experts in this field, an international society antitled The Fetus as a Patient was formed in 1985. Croatian experts have played a leading role in this concept.

Pathophysiology of delirium

Abstract: Today's understanding of the pathophysiological mechanisms of delirium is still limited, but there are several promising hypotheses. It is believed that biomarkers sensitive to death of neurons or glial cells indicate delirium. Several neurotransmitters are considered to be involved in the state of delirium, with greatest emphasis on acetylcholine and dopamine acting in opposite ways; acetylcholine reduces, while dopamine increases neuron excitability. Other neurotransmitters that probably play a role in the pathogenesis of delirium are GABA, glutamate and monoamines. Sepsis leading to systemic inflammatory response syndrome often presents with delirium and perhaps is the most common causal factor for delirium in intensive care unit; sedatives and analgesics are also common iatrogenic risk factors. Patients receiving benzodiazepines are more likely to have postoperative delirium than those who do not. Postoperative cognitive changes are more common in older than in younger patients, and they can be categorized as postoperative delirium, postoperative cognitive dysfunction and dementia. The mechanisms responsible for postoperative cognitive changes are not fully understood, but it is certain that they are multifactorial. Risk factors may be associated with patient characteristics, type of surgery and type of anesthesia.

Regeneration of articular cartilage defects in rabbits by osteogenic protein-1 (bone morphogenetic protein-7).

Abstract: Osteogenic protein-1 (OP-1, BMP-7), a member of the transforming growth factor-beta family, induces cartilage and bone formation when implanted at intra and extraskeletal sites in vivo. The human OP-1 gene has been cloned and biologically active recombinant OP-1 homodimers have been produced. In the present study, the authors investigated the influence of OP-1 on healing of full-thickness articular cartilage defects, made by drilling two adjacent (phi 3mm) holes through articular cartilage of NZW rabbit knee joint were dissected and examined histomorphometrically. Results indicated that OP-1 induced articular cartilage healing and regeneration of the joint surface which contained cells resembling mature joint chondrocytes. These data imply a new strategy for biological repair of damaged joint surfaces in humans.

European guidelines for sclerotherapy in chronic venous disorders

Abstract: Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid of foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during Guideline Conference on 7-10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guiedeline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strenght of Recommendations and Quality of Evidence in Clinical Guidelines. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidokanol and sodium tetradecyl sulphate. Other sclerosants are dot discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations.