Showing papers in "Lijec̆nic̆ki vjesnik in 1993"

Growth and development in children with congenital heart defects

Abstract: Growth and development have been analyzed in 222 children with congenital heart disease. Results were compared to a group of 50 control children. There was no significant difference in age and sex between the groups (p 1.80). No statistically significant difference in growth retardation was established among the children with acyanotic heart disease (p > 0.01).

Changes in plasma proteins and drug distribution in kidney and liver diseases

Abstract: Kidney and liver diseases induce alterations in drug binding to plasma proteins. These alterations are caused by qualitative and quantitative changes of plasma proteins and the presence of endogenous substances which act as competitive inhibitors of drug binding to plasma proteins. These changes are the most prominent in nephrotic syndrome and uremia among kidney diseases and in cirrhosis among liver diseases. The more important drugs in which the free fraction is changed in these entities are listed in the tables. The changes in drug distribution caused by plasma protein alterations may induce significant changes in entire drug pharmacokinetics. Discussed are theoretically expected and experimentally proven changes in plasma proteins in kidney and liver diseases and their influence to drug action and dosing regimen.

Determination of immune antitetanus antibodies using hemagglutination tests

Abstract: The active immunization by the in vitro method was analyzed with the aim to assess whether it can be recommended for the judgement of the immune status of the individuals. The technique developed by Boyden was used: the examinee's blood serum was mixed with sheep (or human) erythrocytes which were carriers of tetanus toxoids, agglutination developed and the reaction was read after 2 and then after 4 hours. The agglutination titre was expressed in IU/ml calculated by means of parallely titred working serum (human tetanus immunoglobulin). Three hundred and sixty-five serum samples from 258 immunized persons (183 males and 75 females) and 20 nonimmunized controls with the range of ages between 10 and 65 years were examined. Fifty-one serum samples were simultaneously tested by the in vivo neutralization test (mice), the so-called "L+" method. The examinees immunized by the classic method had antitoxin level above 0.01 IU/ml for at least 5 years and more. The group of examined persons with the incomplete classic immunization (2 injections) showed a very similar antitoxin level in 91.2% of the cases. Equal results were obtained for a group of examinees with simultaneous immunization (antitoxic serum+tetanus adsorbate and 2 adsorbate injections in succession). The examinees who had a history of only one tetanus adsorbate injection had antitoxin levels above 0.01 IU/ml in 18.75% of the cases. The examinees with the so-called accelerated immunization showed antitoxin concentration above 0.01 IU/ml in a greater percentage (28.6%), but the level decreased very quickly and it was below 0.01 IU/ml already after one year.(ABSTRACT TRUNCATED AT 250 WORDS)

Are there too many doctors in Croatia

Abstract: Estimates of the needs for education of physicians in Croatia must be based on analysis of population health condition and age structure, on the country's economic capacities on which the employment of those specialists depends, and on estimates of realistic educational capacities of the Croatian medical schools. Basic analysis of mentioned parameters indicates that in the upcoming decade there are no possibilities of more extensive employment. Thus, it is obvious that it is necessary to educate only a certain number of physicians: those which will serve as replacement for the deceased, retired or physicians leaving for other positions. To keep in mind--presently the unemployed physicians constitute a number which usually satisfies two-year needs for new employment. Thus it is recommended that the number of enrolled medical students in Croatia be reduced to around 400 students yearly. Together with a proper selection of candidates at admission, these would guarantee that about 320 students would be graduating eventually. This number does not include students from abroad, yet their number is almost inconsiderable according to the past few years and their studies are financed from separate funds. Medical studies should not be financed according to the number of enrolled students, because it stimulates larger enrollment, but according to the actual cost of the educational programme. Financing the programme, and not the number of students, would improve its quality and stimulate a larger number of highly skilled and competent students. Medical studies are expensive not only because of the length of the programme (6 years) but also because of the nature of these studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical management of war injuries involving soft tissue defects

Abstract: In this article, the authors emphasize that the knowledge of terminal ballistics is important for understanding of the pathophysiology of war wounds. They present their own experiences in the treatment of war wounds in 126 casualties, treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center, Zagreb. About 96% of the wounded sustained extremity injuries, while head, neck and thoracoabdominal injuries appeared in a significantly smaller number of cases. War wound were divided into four main categories with regard to type of injury and extension of soft-tissue defect, thus showing the differences in primary excision and in reconstruction of the wounds; 78.6% of head and neck injuries were treated by primary or early primary reconstruction (within three to five days after the injuries have been sustained), while 45.4% of thoracoabdominal injuries were treated by a secondary closure. The greatest number of sophisticated reconstructions were used in extremity injuries (15 wound were reconstructed by local flaps, while free flaps were used in 8 cases). The authors emphasize the importance of proper primary treatment which enables an early reconstruction. This results in significantly shorter hospitalization, so that 87.5% of patients were treated within 20 days and then transferred to early rehabilitation.

Pulmonary function in adolescents with idiopathic thoracic scoliosis before and after surgical correction

Abstract: The purpose of this study has been to establish pulmonary function improvement achievable by surgical correction of the scoliotic curve as compared with the achieved curve correction. The study comprised two distinct groups of patients with an average age of 15 years with idiopathic thoracic scoliosis. The first group of 33 patients were treated surgically: an average Cobb angle of 72 degrees was postoperatively reduced to 32.6 degrees. The second group of 30 patients of the same age with an average Cobb angle of 33 degrees who were not treated surgically. Cardiorespiratory function parameters were tested--preoperatively and 24 months after surgery--by spirometry and plethysmography, arterial blood gas analysis, and the exercise tolerance test. The results of the tests have demonstrated that correction of the scoliotic curve improves pulmonary function: however, the improvement does not match the degree of achieved scoliotic curve correction. Statistical analysis surgically and nonsurgically treated patients with the same degree of spinal curvature disclosed a difference in cardiopulmonary function--specifically, ther VC and PaO2 variables--to the advantage of nonsurgically treated patients. This observation suggests partial irreversibility of ventilation and perfusion in surgically treated patients.

Personal experience in the care of open fractures using external fixation during the hostilities in Osijek and surrounding region

Abstract: In the period of aggression of the Federal Army and Serbian paramilitary forces on the City of Osijek and its surrounding, beginning in the summer of 1991, 4036 wounded were treated at the Department of Surgery, Osijek General Hospital. Extremity injuries were documented in 3889 patients, including 959 bone fractures. The majority of patients had wounds caused by highly destructive explosives filled with metal fragments of different shapes and dimensions, and having sharp and uneven edges. One hundred and forty wounded were treated by external fixators. In 102 patients this mode of fixation was applied for gun- and explosive-related long bone fractures of the lower extremities. External fixator for the upper and forearm fractures was used in 38 cases. During this period, different types of external fixators were used and experience in this work has been gained. Stability of both open and unstable bone fractures of the extremities, caused by explosive devices, has been obtained by the external fixation mostly in one plane, regardless of the type of external fixator used. The advantages of use of external fixators of the types Instrumentarija Zagreb 1 and 2 for the treatment of long bone fractures has been emphasized as well as the possibility of the subsequent corrections owing to the technical construction of the bone spike. The usefulness of the longitudinal bar of the AO/ASIF fixator for the healing of fractures of the upper leg with subsequent callus formation is also stressed. The same stability has been achieved by the CMC fixator. The external fixators of a type Zagreb 2 have been a satisfactory treatment for forearm fractures as well.(ABSTRACT TRUNCATED AT 250 WORDS)

[The laryngeal mask--news in orthopedic anesthesia].

Abstract: The laryngeal mask airway (LMA) was first used at the Department of Orthopedics, School of Medicine, University of Zagreb on May 8, 1991. Two hundred and three patients were undergoing elective orthopedic surgery during the first year of the LMA use. A size-3 mask was used for women and children weighing over 25 kg (55 lbs) and a size-4 mask for men. Research has been undertaken in 12 patients aged between 30-73 years scheduled for total hip replacement. Blood pressure, heart rate and hemoglobin oxygen saturation were continuously monitored with a noninvasive method. No signs of cardiovascular disorders were noticed 1-min before and 3-min after insertion. Only 2 (16.6%) patients, who suffered no complications, had ventilating pressure higher than 20 cm H2O. The LMA proved to be very useful in anesthesia where endotracheal intubation was difficult or almost impossible. Of 12 examinees, 3 with severe rheumatoid arthritis and 2 with ankylosing spondylitis were successfully anesthetized with the LMA. Awakening from anesthesia was very pleasant. There were no serious complications in terms of laryngo- or bronchospasm, aspiration or insufflation of the stomach. The LMA has been found to be very helpful in solving problems of anesthesia in orthopedic patients. A set of laryngeal mask airways should be an integral part of every anesthetic equipment.

Summating potentials in the differential diagnosis of cochlear pathology

Abstract: Three groups of patients with Meniere's disease, sensorineural hearing loss caused by acoustic trauma, and healthy controls were examined by electrocochleography in order to establish the value of absolute summating potential (SP) amplitudes in the differential diagnosis of these entities. A statistically significant increase in absolute SP amplitudes was found in patients with Meniere's disease in comparison to patients with sensorineural hearing loss caused by acoustic trauma (p < 0.01). Besides that, there was also a statistically significant increase in absolute SP amplitude values in healthy persons, as compared to patients with sensorineural hearing loss caused by acoustic trauma (p < 0.05).

Early predictors of outcome in children with head injuries

Abstract: In an attempt to determine whether the clinical data obtained by primary survey may be used as early outcome predictors in children who had sustained head trauma, children aged 0-14 with clinical diagnoses of coma, contusion, comotio, skull fracture or a combination of these diagnoses or who had been hospitalized for at least 3 days, between 1987 and 1990, were reviewed retrospectively. The outcome was defined by the clinical condition of children 6 months following head trauma using a Glasgow outcome scale (GOS), and was classified: good (good recovery and moderate disability) and poor (severe disability, persistent vegetative state, death). Of 70 children with trauma, 43 patients (61.4%) were separated by this method. The pupillary appearance and reactivity, Glasgow coma scale (GCS) and motor response graded by GCS were compared with the outcome. The analysis demonstrated that the early significant predictors of outcome of head trauma are the pupillary appearance and reactivity as well as Glasgow coma scale. Motor response graded by GCS did not achieve statistical significance (z = 1.5, P > 0.05) as a predictor of outcome. In this analysis, we have graded motor response according to the GCS criteria, thus it is not excluded that the use of different criteria could demonstrate the importance of motor response as an outcome predictor. In order to ascertain the significance of predictors in early outcome prognosis of head trauma, a relative risk for poor outcome was calculated. Our results showed that the significant predictors in descending order of preference are: pupillary reactivity, pupillary appearance and GCS.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of atmospheric conditions on the occurrence of peptic ulcer hemorrhage

Abstract: The influence of atmospheric factors on the frequency of bleeding from the peptic ulcer was studied within the period from April 1, 1984, to March 31, 1989, consequently through 1826 days. The average daily atmospheric pressure, the average daily temperature and the relative humidity have been examined. There were 1102 cases of bleeding peptic ulcer, 537 bleeding gastric ulcers and 565 bleeding duodenal ulcers. During the study period there were 454 days with bleeding form ventricular ulcer and 465 days with bleeding from duodenal ulcer. There was 793 days with bleeding form either lesion. The discriminatory analysis demonstrated that the atmospheric pressure is the variable that discriminates the days with bleeding and the days prior to bleeding from the days without bleeding. The relative humidity occurs as the relevant discriminatory variable in the days prior to bleeding for the duodenal ulcer group and for the entire group. The centroids of the discriminatory function demonstrate that the days with ulcer bleeding are characterized by the fall of atmospheric pressure. The factor analysis of meterological variables clearly shows the correlation of the atmospheric pressure and the bleeding regardless to the localisation of bleeding ulcer, where the greatest number of bleedings is correlated with lower atmospheric pressure. We conclude that the incidence of bleeding form the peptic ulcer of the stomach and duodenum correlates in great measure with low atmospheric pressure in the days prior to bleeding and in the days of bleeding, as well as with fall of atmospheric pressure in the days of bleeding with respect to previous day.(ABSTRACT TRUNCATED AT 250 WORDS)

Microdochectomy with perioperative dye localization of ducts in patients with nipple secretion

Abstract: A series of 1321 women having a discharge from the nipple were examined at the outpatient clinic Of seven basic types of discharge: milky, multicolored, purulent, watery, yellow (serous), serosanguineous and bloody, only the last four represent and indication for surgery Galactography was performed in 55 patients as a necessary element in the surgical plan of management In 36 women, the operation of microdochectomy was indicated, but only 24 accepted to be subjected to that procedure The authors describe a new technique of colour mammary ductal localization which identifies the duct from which the discharge is emerging and assures its complete excision The procedure combines preoperative methylen blue dye injection followed by periareolar incision of the involved duct using a pair of binocular loops for magnification of the nipple In all tissue specimens, the cause of a pathological discharge was found: 15 (625%) cases presented with fibrocystic disease, and in 6 carcinoma was present This technique provides a safe and effective method of complete excision of the pathologically involved mammary duct with good cosmetic results

[Aortico-left ventricular tunnel].

Abstract: The boy was first admitted to the Department of Pediatric Cardiology at the age of 4 1/2 because of cardiac murmur diagnosed on the third day of life A diastolic murmur of a grade 4/6, left ventricular hypertrophy as well as left aortal and ventricular dilatation were discovered The findings showed a tendency of increase with time, but the patient had no symptoms X-ray in the long axis view revealed a defect within the upper part of the interventricular septum immediately below the aorta, and dilated right coronary sinus An invasive diagnostic method was undertaken, as well The operative procedure was done with a total cardio-pulmonary bypass and hypothermia (29 degrees C) A tunnel from the anterior aortal wall through the outflow tract of the right ventricle to the left side of the heart was established intraoperatively The defect was solved by a "sandwich" technique (two patch technique) Postoperative period was uneventful A Doppler echocardiogram demonstrated the normal hemodynamic status of the patient without the left-to-right or right-to-left shunt and aortal insufficiency

Direct communication of the pulmonary artery with the left atrium

Abstract: A rare communication between the right pulmonary artery and the left atrium in a 3.5-year-old girl is described. Cyanosis of a central type and a continuous murmur over the heart were presenting symptoms. Echocardiography revealed only excessive pulsations of the pulmonary artery, while catheterization pointed to an abnormal aneurysmal communication between the right pulmonary artery and the left atrium. At this point the O2 saturation was at the level of the left atrium. The communication was clinically classified as a type IV according to Nelson. After an unsuccessful attempt through a right thoracotomy, the ligature of this fistula has been performed in the second attempt through a median sternotomy and under complete extracorporeal circulation. Clinical course and review of literature of this rare anomaly of the heart are being presented.

[Histology of bone tissue and histomorphology--report on standardized terminology].

Abstract: The aim of this paper was to present and describe standardized terminology used in histologic and histomorphometric analysis of bone tissue. Bone tissue is characterized by specific activities which are the result of cell function throughout life. Histologic analysis of bone tissue specimen provides an insight in the features and quality of cellular activities. Histomorphometry is direct measurement and calculation of many parameters which permits quantification of characteristics and dynamics of particular bone tissue function. This method may be applied in diagnostics and monitoring of therapy effects in different metabolic bone disorders.

Pulmonary changes in patients with type I neurofibromatosis and tuberous sclerosis

Abstract: Two patients with pulmonary affections in the course of neurofibromatosis and tuberous sclerosis are presented. We wanted to draw attention to the possibility of occurrence of diffuse interstitial pulmonary changes during congenital neurocutaneous syndromes, of which no data are reported in our literature. The affection of the lungs in 10-20% of the patients with neurofibromatosis and 1% with tuberous sclerosis is estimated, commonly in women. The most frequent changes in neurofibromatosis are fibrosing alveolitis and interstitial fibrosis, and in tuberous sclerosis cystic lung changes and lymphangiomyomatosis, what agrees with our findings. It is important to recognize such patients in order not to perform unnecessary diagnostic procedures, and not to draw wrong conclusions, thus being able to avoid an unnecessary therapy, ineffective in such cases. The patients should be followed up, and in the case of complaints symptomatic therapy has to be administered.

Respiratory symptoms and pulmonary ventilatory function in greenhouse workers

Abstract: Respiratory symptoms and ventilatory capacity were studied in a group of 135 women employed in greenhouses. In addition, a control group of 51 unexposed women were studied. Greenhouse workers had significantly higher prevalence of chronic cough, dyspnea, chest tightness and rhinitis (p < 0.01) than the controls. Smokers had significantly higher prevalence of chronic cough (p < 0.01) and rhinitis (p < 0.05) than nonsmokers. There was a high prevalence of acute symptoms during work shift. In greenhouse workers there was a statistically significant decrease of measured ventilatory capacity tests (except FVC) as compared to the predicted normal values, especially for FEF25. Smokers and nonsmokers had similar changes of ventilatory capacity as percentage of the predicted normals. Greenhouse workers exposed for more than 10 years had considerably lower FEF50 and FEF25 as percentage of the predicted values than those exposed for less than 10 years. Our data indicate that longer exposure in greenhouses may be associated with the development of acute and chronic respiratory impairment.

[Arterial hypertension in the obese--aspects of etiopathogenesis].

Abstract: Many epidemiological and clinical studies show a strong association between arterial hypertension and obesity. The underlying pathophysiological mechanism is unknown. It is thought that the etiopathogenesis of obesity hypertension is exceptional and in that view hormonal, neural, volume and hemodynamic properties of obesity, as well as salt and/or caloric consumption, are outlined. In this article all these factors are discussed. According to the current hypothesis, hyperinsulinemia which is probably a physiologic adaptation to obesity, plays a key role in the pathogenesis of arterial hypertension. Insulin increases the reabsorption of sodium by means of an immediate effect on the kidney tubules. An increase of sodium in the body leads to hypervolemia and to the elevated blood pressure. Chronic hyperinsulinemia perhaps increases the blood pressure indirectly also by means of the central nervous system, namely, by stimulating the activity of the sympathetics.

Meteorologic effects and thrombocyte aggregation in patients with myocardial infarct living in the coastal region of central Dalmatia

Abstract: The circulating platelet aggregates were measured in 90 patients admitted to the Clinical Hospital Split because of myocardial infarction developed in the costal region of Middle Dalmatia. They were divided into three groups, each consisting of 30 patients affected by coronary incident developed during the three most characteristic weather types in the region: sirocco, bora and calm weather. All the patients have had elevated values of circulating thrombocyte aggregates, but the patients in the sirocco group exhibited significantly higher values (34.77% +/- 11.67%) than the patients in both bora (27.93% +/- 11.72%; p < 0.05) and the calm weather groups (23.5% +/- 10.62%; p < 0.01). In the control group of 10 healthy examinees the values of circulating platelet aggregates were within normal range during all the three weather types (5.85% +/- 0.70%, 5.24 +/- 0.51% and 5.18 +/- 0.59%, in case of sirocco, bora and calm weather, respectively). The three groups were not significantly different regarding the values of creatinine kinase, which means that the infarct size was not the probable cause of the observed differences in platelet aggregability. Taking into account our previous finding of increased incidence of coronary events during sirocco, these results suggest that increased platelet aggregability is a contributing factor to the risk of myocardial infarction during such a weather.

The inductive approach in the routine laboratory diagnosis of thyroid dysfunction

Abstract: The method for defining strategy for thyroid function laboratory testing is presented in this study. In order to accomplish this task an available software, ASSISTANT Professional, was used. The strategy is generated by induction from routine data, using the method of minimizing entropy. Each of 1002 patients was described by 15 attributes and thyroid function status (euthyreosis, hyperthyreosis, hypothyreosis). Seventy per cent of the patients were chosen at random for generating and 30% for testing the strategy. The result is the decision tree or a set of decision rules. Absolute prognostic accuracy is estimated to 96% and relative to 90.16%.

Familial aggregation of psoriasis

Abstract: Eight hundred and eight patients with psoriasis, 490 males and 318 females, what was 64% of all the patients with psoriasis in the region of Karlovac on June 30, 1991, were included in the study. The family onset rate of the disease was 33.3% and psoriasis occurred most frequently among first-degree relatives. The distribution of psoriasis between brothers and sisters of our patients was 8.09%. If the parents were affected with the disease, the percentage of brothers and sisters, with psoriasis increased proportionally. The risk of psoriasis among fraternal relatives is 25.7% according to Weinberg. These findings suggest that psoriasis is determined by genetic factors. The age of onset of psoriasis was analyzed with respect to familial occurrence. It was found that patients with psoriatic relatives had a 10-year earlier onset of the disease, particularly females, compared to those with negative history. By 25 years of age, 58% of the patients with positive and 35% with negative history were affected with the disease. These observations are consistent with the reports of some authors that an earlier onset of the disease announces familial frequency.

Prevalence of psoriasis in the Karlovac region

Abstract: A total of 1264 psoriatic patients from the region of Karlovac registered by the Karlovac Dermatological Service up to June 30, 1991 were included in the study. The data were collected owing to the collaboration with the primary health care institutions and neighbouring dermatological centres. The investigation showed that psoriasis was more common in males, and that females develop the disease at an earlier age than males. The incidence of psoriasis was highest in the Karlovac county, over 50%. More than half of our patients belonged to the age group from 30 to 59 years; these values varied with regard to sex and counties of the region. In the region the prevalence of psoriasis was found 0.75% and was higher in males than in females. It was highest in males between the ages of 55 to 59 years in the county of Karlovac (2.2%), and among women aged 30 to 34 years in the county of Duga resa (2.31%). The distribution within the counties was different and it was higher in town communities.

[Relation between the size of the left-right shunt and pulmonary resistance in congenital heart defects].

Abstract: Relation between pulmonary vascular resistance (PVR) and left-to-right (L-D) shunt has been statistically tested in 87 patients with congenital heart diseases. In all patients, PVR and L-D shunt were calculated from the catheterization test results. Among 87 patients, 45 (52%) were female and 42 (48%) male children. The average age at the catheterization was 4.63 (min 6 mo, max 15 yr). Patients were divided into two groups with regard to the level of PVR. The first group consisted of patients with PVR higher than 160 dyn sec cm-5, and the second group with PVR lower than 160 dyn sec cm-5. The whole group was also divided according to VSD, and separate correlation was done for ASD with PVR below 160 dyn sec cm-5. A negative statistically significant correlation was observed between the height of PVR and size of L-D shunt among the entire group with PVR higher than 160 dyn sec cm-5, regardless of congenital heart disease (N = 29, r = -0.4676, P 0.05), nor among the patients with VSD r = -0.0133, P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal growth in pregnant women with chronic hypertension

Abstract: This study represents a retrospective analysis of pregnancies with chronic arterial hypertension and their outcomes. The aim was to evaluate the influence of arterial hypertension on 101 essential and 109 cases of secondary hypertension in comparison to the control group consisting of 499 normotensive pregnancies. According to the obtained data, 27.7% of the women with chronic hypertension had proteinuria, 61% had bacteriuria and 58.6% had superimposed EPH gestosis. The occurrence of EPH gestosis among the controls was 5.6%, that is significantly less than in the experimental group (X2 = 282.8%; p < 0.001). The outcomes of pregnancies associated with chronic hypertension were: 19% preterm deliveries compared to the controls in which only 9.2% preterm deliveries occurred (X2 = 14.4; p < 0.001). Newborns from pregnancies with essential hypertension were significantly heavier, weighing 3177 +/- 734 g, than those from pregnancies with secondary hypertension, which weighted 2578 +/- 932 g. Perinatal mortality was higher in the study group and significantly higher in the pregnancies with associated secondary hypertension (30.3%) than in pregnancies associated with essential hypertension (15.8%).

Auditory evoked potentials in alcoholics

Abstract: In this paper, auditory brain stem potentials in the group of 26 alcoholics were studied and a significantly delayed latencies of the peaks II through V as compared to the healthy control subjects were found. In addition, a statistically significant prolongation of brain stem transmission time (BTT) in alcoholics was observed. The study also suggests the possibility of monitoring the level of pathohistological changes of the central auditory pathway caused by excessive alcohol consumption.