Antihypertensive drugs in blood donations in Serbia - Observational study

INTRODUCTION

Most of the blood banks worldwide do not defer donors for their medication, with the exception of the teratogenic and platelet aggregation-inhibiting drugs use. In Serbia, where around 245.000 units of blood are collected each year, it is not common practice to consider the medication of potential blood donors. Therefore, the aim of this study was to quantify the presence of antihypertensive drugs in blood samples collected from blood donors treated for hypertension and to raise the issue of the recipient risks posed by drug residues in blood products.

METHODS

Serum samples were obtained from 450 volunteer blood donors collected during the year 2017 who reported the use of antihypertensive drugs. All blood donors were required to interrupt regular antihypertensive therapy for 24 h before blood donation and LCMS determination of antihypertensive drugs was performed.

RESULTS

Beta blockers were detected in 81 out of 203 samples which tested positive for the presence of antihypertensive drugs. Concentrations above the limit of quantification were determined in 58% of samples positive on beta blockers, containing metoprolol and bisoprolol in amounts sufficient to produce a therapeutic effect in the recipient.

CONCLUSION

Therefore, the obtained results suggested that the safety of blood donation from individuals with treated hypertension should not be neglected. A solution for this problem might be the establishment of a standard LCMS screening procedure as a tool for testing the blood of donors taking drugs.

From single-objective to multiple-objective multiple-rainfall events automatic calibration of urban storm water runoff models using genetic algorithms

The calibration of storm water runoff models is a complex task. Early attempts focused on the choice of a performance criterion function that could capture all the facets of the problem into a single-objective framework. Subsequently, the awareness that a good calibration must necessarily take into account conflicting objectives led to the adoption of more sophisticated multi-objective approaches. Only recently, the focus has shifted towards effective ways of exploiting the mounting information provided by the availability of many sets of concurrent rainfall and flow measurements. This paper revisits through a case study the transition just elucidated: the calibration of a SWMM model applied to a catchment in Singapore is tackled through a single-objective, a multi-objective and a multi-objective multiple-event (MOME) paradigm respectively. A new approach to support the latter is presented herein. It consists in formulating the problem of model calibration as a multi-objective problem with m x r objective functions, where m and r are the number of performance criteria and rainfall events respectively, that must be optimized simultaneously. Results suggest that the new MOME framework performs significantly better than the others tested on the case study presented.

Haplotype analysis of the DM1 locus in the Serbian population

OBJECTIVES

Analysis of the CTG-repeat number and three biallelic markers, Alu(+/-), HinfI(+/-), and TaqI(+/-), in the DMPK gene in healthy and myotonic dystrophy type 1 (DM1) Serbian individuals. Also, the consideration of haplotypes in the light of the proposed models of CTG-repeat evolution and origin of the DM1 mutation.

MATERIALS AND METHODS

Markers were analyzed by PCR and haplotypes were obtained on 203 unrelated normal chromosomes and 24 unrelated DM1 chromosomes.

RESULTS

A strong linkage disequilibrium was detected between the three biallelic markers alone (P <0.0001) and between distinct CTG-repeat size classes and reconstructed haplotypes. Greater than 98% of normal chromosomes contain (+++) and (- - -) haplotypes. The (+++) haplotype is the most common, while the (CTG)(9-17) are the most frequent alleles. We found a complete association of (+++) haplotype with (CTG)(> or =18) and mutated alleles.

CONCLUSIONS

(CTG)(9-17)/(+++) haplotype is the ancestral haplotype and DM1 mutation occurred on (CTG)(18-35)/+++ chromosome.

JP-3 gene polymorphism in a healthy population of Serbia and Montenegro

Expansions of CTG repeats in JP-3 gene are associated with a phenotype similar to Huntington disease. These expansions are the cause of Huntington disease like-2 (HDL-2) phenotype. CTG repeats in JP-3 gene are polymorphic in healthy population. Analyses of CTG repeat polymorphism of JP-3 gene in various healthy populations could help in estimating the population at risk for developing HDL-2. CTG repeat polymorphism of JP-3 gene was analysed in healthy population of Serbia and Montenegro. Study included 198 unrelated subjects. Analyses of JP-3 locus were performed using PCR and sequencing. Six different JP-3 alleles were obtained and they were in the range of 11 to 18 CTG repeats showing a bimodal distribution, with peaks at 14 and 16. Results show that the distribution of JP-3 alleles in population of Serbia and Montenegro is consistent with distributions in other analysed populations. The absence of alleles with more then 18 CTG repeats suggests that HDL-2 is very rare in the populations of Serbia and Montenegro.

Automatic calibration of urban drainage model using a novel multi-objective genetic algorithm

In order to successfully calibrate an urban drainage model, multiple calibration criteria should be considered. This raises the issue of adopting a method for comparing different solutions (parameter sets) according to a set of objectives. Amongst the global optimization techniques that have blossomed in recent years, Multi Objective Genetic Algorithms (MOGA) have proved effective in numerous engineering applications, including sewer network modelling. Most of the techniques rely on the condition of Pareto efficiency to compare different solutions. However, as the number of criteria increases, the ratio of Pareto optimal to feasible solutions increases as well. The pitfalls are twofold: the efficiency of the genetic algorithm search worsens and decision makers are presented with an overwhelming number of equally optimal solutions. This paper proposes a new MOGA, the Preference Ordering Genetic Algorithm, which alleviates the drawbacks of conventional Pareto-based methods. The efficacy of the algorithm is demonstrated on the calibration of a physically-based, distributed sewer network model and the results are compared with those obtained by NSGA-II, a widely used MOGA.

[Comparison of clinical results of anterior cruciate ligament reconstruction using two different procedures]

During the last two decades the "golden standard" in reconstruction of anterior cruciate ligament knee was the middle third of patellar tendon, but now are more used hamstrings tendon autograft. The aim of this work was to compare our results of the artroscopic reconstruction ACL (anterior cruciate ligament) of the knee using two different technics. We were controling 60 patients within the period of two years after operation. Group A was composed of 39 patients which had reconstructed ACL done with bone-patella tendon- bone autografts, in the group B were 21 patients and at them as autographts have been used hamstring tendon. Difference between healthe and the ill knee by the Lachman's test after operation, in the group A was 2,4 mm, but in the group B was 2,2mm (p> 0,05 ). Postoperative middle value of the Lysholm and Gillquist score in the group A was 97,74, in the group B it was 96,67 (p>0,05). IKDC score results are following: Group A- mark A 32 patients (84,6%); mark B 5 (12,8%); mark C 1 (2,6%) and in the group B: mark A 17 patients (81%); mark B 3 (14,28%): mark C 1 (4,72%) (p> 0,05). Postoperative value for the Tegner and Lyscholm score activity in the A group was 8,23, in B group it was 8,81. The reconstruction of ACL with bone- patella tendon-bone grafts gave better results then the reconstruction with the hamstring tendon only according to Tegner score values. In other parameters between those two groups there was no statisticaly significant difference.

SIPSON--simulation of interaction between pipe flow and surface overland flow in networks

The new simulation model, named SIPSON, based on the Preissmann finite difference method and the conjugate gradient method, is presented in the paper. This model simulates conditions when the hydraulic capacity of a sewer system is exceeded, pipe flow is pressurized, the water flows out from the piped system to the streets, and the inlets cannot capture all the runoff. In the mathematical model, buried structures and pipelines, together with surface channels, make a horizontally and vertically looped network involving a complex interaction of flows. In this paper, special internal boundary conditions related to equivalent inlets are discussed. Procedures are described for the simulation of manhole cover loss, basement flooding, the representation of street geometry, and the distribution of runoff hydrographs between surface and underground networks. All these procedures are built into the simulation model. Relevant issues are illustrated on a set of examples, focusing on specific parameters and comparison with field measurements of flooding of the Motilal ki Chal catchment (Indore, India). Satisfactory agreement of observed and simulated hydrographs and maximum surface flooding levels is obtained. It is concluded that the presented approach is an improvement compared to the standard "virtual reservoir" approach commonly applied in most of the models.

Spinocerebellar ataxia type 17 in the Yugoslav population

OBJECTIVES

(1) Analysis of Spinocerebellar ataxia type 17 (SCA17) locus in a group of ataxic patients excluded on other known SCAs; (2) assessment of frequency distributions of SCA17 alleles in the Yugoslav population.

MATERIAL AND METHODS

Study includes 115 non-related Yugoslav patients belonging to autosomal-dominant cerebellar ataxias or to sporadic idiopathic adult-onset ataxia and 115 controls. Analysis of SCA17 locus was performed using polymerase chain reaction.

RESULTS

None of the analyzed patients show the presence of mutation in SCA17 locus. In the group of patients 12 different alleles in the range of 30-42 repeats were observed, while in healthy population eight alleles in the range of 30-40 repeats were detected.

CONCLUSION

(1) None of 115 non-related Yugoslav ataxic patients belong to any known SCAs nor to DRPLA gene; (2) the distribution of SCA17 alleles in the Yugoslav population is consistent with the distribution in other populations and (3) the paucity of alleles with more than 39 repeats could suggest that SCA17 is very rare in the Yugoslav population.

SCA2 and SCA3 mutations in young-onset dopa-responsive parkinsonism

In this study no one of our 85 patients of Serbian origin with young-onset (</= 45 years) dopa-responsive parkinsonism (YOP), previously proved negative for PARK1 and PARK2 mutations, had either spinocerebellar ataxia type 2 (SCA2) or SCA3 mutation. These data do not prove the significance of these two mutations in either sporadic or familial YOP suggestive of Parkinson's disease.

[Transplantation in peripheral nerve injuries]

Autologous nerve grafting is the most commocommnlynly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient's age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.

CTG repeat polymorphism in DMPK gene in healthy Yugoslav population

OBJECTIVES

Myotonic dystrophy type 1 (DM1) is caused by large expansions of cytosine-thymine-guanine (CTG)-repeats in myotonic dystrophy protein kinase (DMPK)-gene. This gene is highly polymorphic in healthy individuals. It has been proposed that expanded alleles originated from the group of large sized normal alleles. If this is correct, one should expect a positive correlation between the frequency of large sized normal alleles and a prevalence of this disorder in a population. In this paper we determined the distribution of alleles of DMPK gene in healthy Yugoslav population.

MATERIAL AND METHODS

A sample of 235 healthy individuals of Yugoslav origin have been genotyped for the alleles of DMPK locus.

RESULTS

We found 22 different alleles, ranging in size from 5 to 29 repeats. Among 470 chromosomes studied, 41 chromosomes had more than 18 repeats (8.72%).

CONCLUSIONS

Relatively high frequency of large sized normal alleles found in our population, suggest that prevalence of DM1 in Yugoslavia should not be different from the prevalence in other European populations.

Is the 31 CAG repeat allele of the spinocerebellar ataxia 1 (SCA1) gene locus non-specifically associated with trinucleotide expansion diseases?

A number of human hereditary neuromuscular and neurodegenerative disorders are caused by the expansion of trinucleotide repeats within certain genes. The molecular mechanisms that underlie these expansions are not yet known. We have analyzed six trinucleotide repeat-containing loci [spinocerebellar ataxias (SCA1, SCA3, SCA8), dentatorubral-pallidoluysian atrophy (DRPLA), Huntington chorea (HD) and fragile X syndrome (FRAXA)] in myotonic dystrophy type 1 (DM1) patients (n = 52). As controls, we analyzed two groups of subjects: healthy control subjects (n =133), and a group of patients with non-triplet neuromuscular diseases (n = 68) caused by point mutations, deletions or duplications (spinal muscular atrophy, Charcot-Marie-Tooth disease, type 1A, hereditary neuropathy with liability to pressure palsies, and Duchenne and Becker muscular dystrophy). Allele frequency distributions for all tested loci were similar in these three groups with the exception of the SCA1 locus. In DM1 patients, the SCA1 allele with 31 CAG repeats account for 40.4% of all chromosomes tested, which is significantly higher than in two other groups (11.3% in healthy controls and 6.6% in the group of non-triplet diseased patients; P < 0.001, Fisher's exact test). This is consistent with our previous findings in HD patients. The absence of this association in non-triplet diseases as well as in healthy controls could indicate a possible role of this SCA1 allele with 31 repeats in triplet diseases. Here we discuss a possible role of the SCA1 region in pathological trinucleotide repeat expansions.

[Soft tissue injuries of the neck]

Thirty five patients were examined. All had soft tissue spinal cord injury and were not treated in a hospital. Complete diagnostic and therapeutical protocol was carried out only for 13 patients. The goal was to compare their initial condition with condition after the control examination after the therapy. Results showed that 8 patients (23%) suffered from pain in the neck, 25 (72%) had limited neck mobility, and 17 (49%) manifested neurological symptoms. Signs of osteochondrosis at isolated spinal levels and dyscoligamental instability were noted in one fifth of the observed patients. In 24 patients (69%) the condition was defined as "serious". Although soft tissue spinal cord injuries are considered as "light" injuries, they can cause serious consequences that reduce the quality of patient's life due to inadequate treatment. From that point of view, a serious approach to diagnosis and treatment is necessary.

[Comparative radiographic analysis of surgical and conservative treatment of unstable injuries of the thoracic and lumbar spine]

INTRODUCTION

Treatment of fractures and dislocations of the thoracolumbar spine is aimed at achieving a stable and painless spine. Concerning mode of treatment therapists are divided into two groups--those for conservative approach and those who advocate operative stabilization of spinal column. The objective of this paper was to compare radiological findings of both modes of treatment on the basis of our clinical material.

MATERIALS AND METHODS

The examination included radiographs of 96 patients with radiolographic signs of unstable spine, treated at Clinic of Orthopaedic Surgery and Traumatology of the Institute of Surgery of the Clinical Center in Novi Sad from 1984 to 1998. Among 48 operated patients (average age of 40.7), there were more females--25, and among nonoperated, there were more males--33. The average age of conservatively treated patients was 52. Dynamic radiographs evaluated the angle of local kyphosis on the spot of injury (Cobb's angle), reduction of dimensions of the body of injured vertebra and sagittal movement of the body on affected level. Measured values were corrected by values of sagittal index.

RESULTS

Initially the average angle of local kyphosis among operated was 26.9, among conservatively treated it was 19.7. Control values for operated were 14.7 and for conservatively treated 25.6. Initially, a wedge-shaped deformity larger than half of the front part of the injured vertebra body had 42 nonoperated and 32 operated patients. Initially, the average sagittal movement of the injured vertebra body among operated patients was 6.97 mm, and at control 1.34 mm. Among nonoperated, the average movement of the body was 1.71 mm initially and 3.23 mm at control.

DISCUSSION

Similar results of angular deformity were found by other examiners. Their results are also in favor of operative treatment of unstable injuries of Th-L spine. The number of those proclaiming good results of conservative treatment of injures of thoracolumbar spine in patients with initially high values of angular deformity is much less. Willen, Mumford, Andreycik and others using wedge-shaped deformity and sagittal movement of the body as parameters in their studies had similar results as those in this study, and they conclude that the stability of segment is much higher among operated patients and that operative treatment finally ends in better radiological results.

CONCLUSION

Radiological results of operative treatment of unstable injuries of thoracolumbar and lumbar spine are better than those of conservative treatment. In order to obtain a stable spine, which is the aim of treatment of unstable spine injuries, operative stabilization is necessary.

[Arthroscopy of the knee--"surgery without complications"]

INTRODUCTION

Beside other advantages that arthroscopic surgery has, comparing to the open surgery, there is one more--the risk of complications is present but a very little. The aim of this work is to present complications that we have had and to point at possibilities how to prevent and treat them.

MATERIAL, METHODS AND RESULTS

In the period from September 1990 to December 1998, 1071 arthroscopic surgeries were performed in our hospital. 817 patients (76%) were male and 254 (24%) female, average age 30.63 (12-69). Left knee was involved in 560, while the right in 511 cases. Among all arthroscopic interventions 463 (43.23%) were diagnosed when damages of LCA or cartilage were seen, and 608 (56.76%) were patients with therapeutic arthroscopic interventions. Among different arthroscopic interventions medial meniscectomy was performed in 417 (38.93%) patients, lateral in 124 (11.57%), removal of joint loose bodies in 39 (3.64%), reconstruction of LCA in 29 (2.70%), operation on patellar and condylar cartilage in 26 (2.42%) etc. There were 39 (3.64%) complications. 10 (25.64%) of them were intraoperative (breakage of arthroscopic instruments, loss of meniscal parts, extravasation of the fluid in extremity and 29 (74.35%) of them were postoperative (infection, synovial sinus, thrombophlebitis, haemarthrosis, synovial effusion, painful scar). 8 (1.72%) of those complications appeared after diagnostic arthroscopy and 31 (5.09%) after different therapeutic arthroscopic procedures.

DISCUSSION

Advantages of arthroscopic surgery are exhibited in different ways (shortening hospital stay, lower cost of treatment, shortening the time necessary for complete recovery and return to everyday life and sport activities), while the risk of complications, although possible, is significantly diminished. Insufficient education, improvisation, rude manipulation, unprecise++ surgical approaches to the knee joint lead to aforementioned complications. Our results are discussed and compared to those found in the literature giving suggestions in the same time how to avoid and prevent them.

CONCLUSION

Orthopedic surgeons who perform arthroscopic surgery must be well trained and familiar with the arthroscopic procedures and able to prevent and overcome possible complications. Continual education and training is necessary for arthroscopic surgeons in order to be able to follow innovations in surgical techniques and instrumentation.

[Evaluation of the usefulness of suction drainage in the treatment of nonspecific bone infections monitored with C-reactive protein]

INTRODUCTION

Irrigation suction drainage (ISD) is an additional method in treatment of infected bones. Two liters of saline solution daily with an antibiotic is usually recommended for ISD, although some authors suggest that more fluid should be used without antibiotics, stressing the importance of the mechanical effect. Although the method is nowadays accepted as a routine procedure, the reported results of ISD are based on treatment of a limited number of patients and the only criteria for assessment have been clinical and bacteriologic findings. The aim of this prospective study is to show the importance of the mechanical effect of an increased fluid run and the optimal time necessary for cleaning of the osteomyelitic cavity by follow-up the C-reactive protein (CRP) levels as an indicator of an acute inflammation of the affected bone.

METHODS

The prospective study was an open, centralized and randomized clinical investigation including over 105 patients with bone infection treated in the period 1986-1996. Two parameters with possible influence on the CRP levels were determined during investigation: 1. patients were divided in three groups depending on the duration of the irrigation suction drainage (3-6 days, 7-10 days and over 10 days) and 2. quantity of the liquid used for the irrigation suction drainage (two groups: 2000 ml per day and 6000 ml per day). Groups were similar in regard to age, sex, bacteriologic agents, duration of infection, localization and previous operations. C-reactive protein (CRP) is a nonspecific, but extremely sensitive indicator of an acute inflammatory disease. The erythrocyte sedimentation rate is not always a reliable indicator of infection. CRP as a protein of an acute phase appears and disappears quickly. Decreased values are a sign of a healing process used in this study for the estimation of the efficacy of the ISD. The CRP level was controlled semiquantitatively before operation and every third day over three weeks. If the values were below 6 mg/l, the results were classified as negative.

RESULTS

There were not significant statistical differences in different groups as far as a preoperative average CRP values were concerned neither in the quantity of employed liquid nor in the duration of the ISD and interaction between these two groups. It was the same on the third postoperative day. The differences appear in the significantly lower average values of the CRP in patients of the second group (6000 ml/day) where the ISD lasted for seven or more days. During further follow up, (6th to 21st day) one can observe a significant statistical difference in average CRP values between the first (2000 ml/day) and second group (6000 ml/day) but there is not difference when the duration and sort of employed liquid is concerned. There is not significant difference in average statistical values of the CRP in blood for interaction of fluid quantity and time of ISD as well.

DISCUSSION

The main disadvantage in the function of ISD is nonuniform rinsing of the osteomyelitic cavity. Prolonged ISD has no influence on the clinical result as well as on the average values of the CRP. Starting from the third postoperative day results indicate that the quantity of employed liquid has an important influence on the average level of the CRP, while the duration of ISD is not important. Prolonged ISD can not compensate for an inappropriate surgical intervention because it is only an additional method in the treatment of an osteomyelitic process.

CONCLUSION

By observing changes in CRP levels during treatment one can conclude that the efficacy of ISD is based mostly on mechanical rinsing and the removal of debris. This points to the importance of the quantity of fluid employed in irrigation suction drainage. Application of 6000 ml liquid per day without antibiotics during 5-7 days gives opportunity of better rinsing increasing the effect of ISD and reducing the incidence of complications.

[Arthroplasty in the treatment of congenital anomalies of the hip in adults]

At the Clinic for Orthopedic Surgery and Traumatology in Novi Sad, 79 adult patients with osteoarthritic hip dysplasia underwent total joint replacement surgery in the period 1984-1993. 45 patients were followed-up for an average time of 4.2 years. The results obtained have been evaluated following the criteria of Postel-Merle-d'Aubigne's hip rating system. After surgery 37 (82.2%) patients had minimal or no pain at all, while the hip flexion was over 75 degrees in 35 (75.5%) patients. 9% of patients could not walk longer than 20 minutes with a flexion under 50 degrees. Firm footfall and slight limp in exhaustion occurred in 35 (75.5%) patients, while 7 (15.5%) patients were extremely unstable and were able to get about on crutches. The gathered results confirm that total hip replacement in patients with osteoarthritic dysplastic hip improves stability and hip joint movement as well as pain reduction.

Enteroaggregative Escherichia coli associated with an outbreak of diarrhoea in a neonatal nursery ward

Over a 9-day period in February 1995, 16 newborn babies (age range 2-11 days) and 3 infants (24, 47 and 180 days of age) in a neonatal nursery ward developed diarrhoea accompanied by pyrexia and weight loss. Known enteropathogens were not detected in their stools but Escherichia coli displaying aggregative adherence to HEp-2 cells (enteroaggregative E. coli) were found in 12 (63%) ill infants and in none of 5 well neonates (P = 0.02). The illness lasted 3-9 days (mean 5.2) in 16 babies, whereas in 3 neonates it showed a protracted course of 18-20 days. The source of infection and the mode of transmission remained unclear. The outbreak isolates manifested properties common in this new group of diarrhoeagenic E. coli: mannose-resistant haemagglutination, haemolysis on blood agar, and clump formation in liquid culture medium. They belonged to the O4 E. coli serogroup and expressed multiple antibiotic resistance.

Oxime-induced reactivation of acetylcholinesterase inhibited by phosphoramidates

The reaction of human erythrocyte acetylcholinesterase (AChE) with a set of structurally related phosphoramidates was studied in order to investigate the properties of phosphorylated enzyme and the effects of 4 oximes PAM-2, TMB-4, HI-6 and BDB-106 on the reactivation of inhibited AChE. Second-order rate constant of the phosphorylation reaction of the compounds towards the active site of AChE range between 5.0 x 10(2) and 4.9 x 10(6) M-1min-1 and their inhibitory power (I50) was from 7.3 x 10(-5) to 5.7 x 10(-9) M for 20 min incubation at 37 degrees C. The oximes used were weak reactivators of inhibited AChE except for (C4H9O)(NH2)P(O)DCP (DCP, -O-2,5-dichlorphenyl group) and (C6H13O)(NH2)P(O)SCH3 where we have obtained good reactivation. Imidazole oxime BDB-106 proved to be a potent reactivator of tabun-inhibited AChE.

[The value of local administration of antibiotics in treatment of bone infections]

An open, controlled, randomized clinical investigation was carried out in 33 patients suffering from osteomyelitis. In the first group, 17 patients, a through drainage with sterile physiologic solution was applied, while in the second group, 16 patients, antibiotic was added to the sterile physiologic solution. In all patients values of C reactive protein (CRP) in the blood were examined, and later on every third day after the operation. A significant difference of average values of CRP between the 3rd and 21st day in both groups of patients was established, as well as the similarity in average values of CRP, which points to the fact that the mechanical effect of through drainage is dominant, speaking about rinsing focus of infection and eliminating necrotic tissues and small sequesters.

[Evaluation of long-term prognosis in patients with whiplash syndrome]

We reviewed 50 patients who sustained whiplash injuries of the neck. The mean time of the follow-up was 3 years. Only 16% of observed cases recovered completely. Residual symptoms were severe in 38%. Pain in the neck, headache and paraesthesia were the commonest complaints. Older patients and patients with significantly restricted movements of the neck, sharp local kyphotic deformity, chronic instability and neurologic involvement had a worse prognosis.

[Operative versus conservative treatment of the fractures or dislocations of the thorocolumbar spine associated with neurological deficiency]

The results of treatment of injuries of the thoracic and lumbar spine with neurological involvement, have been rewieved in a retrospective study of 42 patients, of whom 14 received conservative and 28 surgical treatment. Operations were reserved for patients with grossly unstable fracture, fracture-dislocations and pure dislocations. Open reduction and short internal fixation with Roy-Camille plates, were the operative procedures of choice. After the period of "bed rest" conservative treatment 71% of the patients showed clinical instability and 64% constant spinal pain. Only one (3%) operated patient had redeplacement and kyphotic angulation of the injured thoracolumbar spine. Of the patients treated conservatively 56% showed recuperation of the incomplete neurological lesions, as compared as to 53% of those treated surgically. Cases with complete neurological involvement showed some, but statistically significant, improvement only in the operated group of patients. It is concluded that surgical approach had obvious advantages about degree of the complete lesions neural recovery, final stability of the vertebral column and local pain symptoms.

[Evidence of some antibacterial antibodies in human colostrum]

Colostrum protective function is made through passive transport of preformed antibodies agains some bacterial species made in mother body. In this study by method of indirect immunofluorescence we determine presence of antibodies on three the most common bacterial species: E coli, Staphilococus aureus and beta-hemolitic streptococus in different colostrum dilution 1:32, 1:64, 1:128. Heterogenous intensity of immunofluorescence was obtained: from almost absence to very intensive, dependent of the different specific antibodies concentration in colostrum. Low antibodies concentration in colostrum can be the reason for insufficient passiv protection with a tendency of newborn to frequent infections. These investigation give us a lot of possibilites to protect newborns where decreased level of specific bacterial antibodies in colostrum was find.

[Therapy of infected pseudarthroses of the lower leg]

The retrospective study comprised 23 patients with infected pseudoarthrosis after osteosynthesis of of the lower log fracture treated at the Clinic of Orthopedic Surgery and Traumatology in Novi Sad. Staphylococcus aureus has been the most common causative agent of infection. In all patients debridment of infection foci was performed and reosteosynthesis with the external fixator and in 10 patients spongioplasty was performed in addition. At the control examination good results were achieved in 4, satisfying in 3 and poor in 16 patients. Amputation was performed in 5 patients.

[Treatment of post-traumatic hemarthroses of the knee and ankle in children using transcutaneous electric nerve stimulation]

TENS (transcutaneous electric nerve stimulation) was applied in 36 children with knee or ankle hemarthros. Pain was diminished after first or second treatment and completely disappeared at the end of the first or second day. Swelling usually disappeared in the interval between the third and seventh day. At the end of the treatment joint movement was significantly improved. In the control group who received only conventional conservative treatment (puncture, immobilization or inactivity, drugs) swelling and pain were still present after the seventh day and these patients needed additional physiotherapy for next seven days. We consider the TENS a method of choice in the treatment of posttraumatic hemarthros providing that treatment starts immediately after the injury and that it is continually applied during 3-5 days. The patients are advised to use crutches. It is a simple, painless method which is not combined with any additional treatment. Proteolytic ointments can increase and stimulate the therapeutic effects.

[Osteomyelitis after malleolar fractures]

Over a ten-year period, 485 patients suffering from malleous fracture were operated at the Department for Orthopaedic Surgery and Traumatology in Novi Sad. Postoperative infection appeared in ten cases (2.06%). Eight of these patients primarily had open fractures, and two of them had closed ones. Osteosynthesis of the lateral malleous had most frequently been treated by the use of panel and screws. Staphylococcus aureus was isolated as symptom of the infection in eight cases. In treatment of malleous osteomyelitis, the debridement of focus of infection together with fixation material extraction was the most frequently performed operative method. During a two-year period no exacerbation, seven patients was observed while at control examination three patients had secretion from fistula. Mobility of ankle joint was limited in most cases, while walking imposed no pain.

[Use of prostin E2 in the treatment of stomatitis caused by radiotherapy]

Patients undergoing chemotherapy or radiotherapy for malignancies often develop annoying inflammation of the oral mucosa as a side-effect of cytotoxic therapy. As prostaglandins are known to be cytoprotective Prostin E2 was given to 10 patients with neoplasms of the ear, nose, pharynx or larynx, or of the maxillofacial region, who received radiotherapy. The reference group was made up of five patients with the analogous diagnosis who received the conventional therapy with Hexoral sol. One patient was not administered any therapy. The patients that were given Prostin E2 did not develop either the inflammatory process or stomatitis. In the reference group the inflammatory process appeared in two patients and lesions were noticed in one patient. Excellent results, although still preliminary, pointed out that preventive local administration of Prostin E2 was superior to the conventional therapy and that accordingly, Prostin E2 should be regarded as the drug of choice.

[Complications of stapedectomy involving the middle ear structures]

On the basis of personal experience and data from literature, the authors enumerate possible complications of the middle-ear structures during stapedectomy: perforation of the eardrum, disturbed function of the chorda tympani, peripheric paralysis of the facial nerve, incus luxation, haematotympanon, inflammatory complications, late improvement of the hearing, reoperative granuloma, cholesteatoma and sudden damage of the hearing.

[Indications for surgical treatment of fractures of the pyramid of the temporal bone]

On the basis of data from literature and personal experience, the authors precise indications for surgery of the fractured temporal bone. They suggest that after appeasement of neurosurgical phase of the disease operation should only be carried out if peripheric paralysis of the facial nerve, conductive deafness and otoliquorrheoa, are evident. In addition to these indications they also suggest operation in patients with chronic otitis due to injury or if this process preceded the injury.

[Errors in the diagnosis of Bell's facial nerve paralysis]

On the basis of personal experience, the authors present errors in the diagnosis of Bell's paralysis of the facial nerve. The commentary concerns the causes of these errors and possibilities of avoiding them.

Otogenic facial paralysis. A histopathological study

The histopathological changes of the facial canal and nerve in facial paralysis due to chronic suppurative otitis madia are described in six temporal bones. Bony destruction of the facial canal was found in its tympanic segment and in its upper mastoid part in all cases, but it was particularly notable in the labyrinthine segment as well. The pathological process, cholesteatoma or granulation tissue surrounding the exposed facial nerve was inflamed in all cases. The affected facial nerve showed degenerative and inflammatory changes throughout its tympanic segment in all cases, but its mastoid segment appeared to be relatively normal. Our findings suggest that facial paralysis occurs us chronic suppurative otitis when the inflammatory process specifically involves the facial nerve trunk.

[The small aorta syndrome]

Angiograms of 956 patients (94.7% of males and females) with aortoiliac occlusive disease were analyzed retrospectively. The existence of small aorta syndrome (SAS) was documented in 9 female patients with a mean age of 41.1 yrs. In this population the incidence was 0.9%; however, in the female patients the incidence was higher (18%). Clinical signs of arterial insufficiency of the lower limbs included: claudication in 8 pts and digital gangrene in 1 patient. Risk factor status was as follows: cigarette smoking was present in 100%, hypertension in 33%, obesitas in 25% and hyperlipidemia in 20% of cases. Dimensions of aortoiliac segments on angiograms and belongs to SAS were made by De Laurentis classification. Aortoiliac segment dimensions of SAS determined on angiograms were compared with operative findings. The mean cross sectional area of the infrarenal aorta was 14.1 mm, at the bifurcation 10 mm, common iliac artery 8 mm, and external iliac artery 4.3 mm. Of 9 female patients with small aorta syndrome 8 were operated by bypass technique. The mean follow-up time was 12.3 months. In 7 pts the reconstructive vascular procedure was successful. In one patient the graft became occluded, 3 month after operation, due to poor run-off. This necessitated limb amputation.

[Intra-temporal bone paralysis of the facial nerve]

On the basis of personal experience and data from literature, the authors enumerate causes of peripheric paralysis of the facial nerve due to diseases and injuries of the temporal bone. They made the aetiological classification of these paralyses and described some pathophysiological mechanisms of their onset.

Cholesteatoma in the oval window niche

The histopathological changes in the oval window niche into which a cholesteatoma is spreading are described in 14 temporal bones. Extension of the matrix into the niche was found commonly. In some cases the matrix passed from the facial canal to the promontory but failed to reach the niche. The perimatrix of the cholesteatoma was composed of inflamed and vascularized granulation tissue or fibrocystic tissue. A matrix covering the walls of the niche and the footplate of the stapes or the oval window was rarely found. It was surrounded by a thin layer of non-inflamed fibrous or fibrocystic tissue which covered the niche. Bone destruction of the superstructures of the stapes was observed in 12 of the 14 cases examined. The footplate of the stapes was partially or totally destroyed in 4 cases. Bone destruction of the tympanic portion of the facial canal adjacent to the oval window niche was present in all cases. Our present studies further suggest that surgical removal of a cholesteatoma from the niche may be difficult, even when done very carefully.

The relations of the mastoid segment of the facial canal to surrounding structures in congenital middle ear malformations

The authors investigated the relations between the mastoid segment of the facial canal and the temporomandibular joint, the posterior wall of the cavum tympani and the external wall of the mastoid process in 19 cases with congenital ear malformations and 10 cases with normal ears. A significantly reduced distance was found between the facial canal and the temporomandibular joint as well as between the facial canal and the posterior wall of the cavum tympani in the groups with malformed ears as compared to the control group with normal ears.

The value of computerized tomography (CT) in the evaluation of the anatomic structure of the attic

By the use of computerized tomography (CT) the authors have examined and precisely defined the radiological anatomical characteristics of the attic and its relation to other structures of the middle and inner ear. The identification of individual morphological structures has been made on axial, semi-axial and frontal CT sections. Each type of original CT section has been compared with the corresponding original anatomical section.