Retropharyngeal calcific tendinitis in the neurological emergency unit, report of three cases and review of the literature.

BACKGROUND: Retropharyngeal calcific tendinitis (RCT) is a relatively benign condition of calcination of the longus colli muscle tendon of unknown origin, which causes severe acute neck pain. However, it is often not recognised, which leads to delayed diagnosis and unnecessary treatment. PATIENTS AND METHODS: We have searched PubMed and Google Scholar for publications which reported at least one patient with RCT and were published in the last 20 years. The literature was then analysed according to the PRISMA-S protocol. We also report three patients with RCT presenting at the Neurological Emergency Unit, University Medical Centre, Ljubljana, Slovenia, from 1 January 2020 to 1 June 2022. We discuss their clinical presentation and differential diagnosis, explain our decision-making process, and briefly describe the clinical course. Case reports have been performed according to the CARE protocol. RESULTS: We have analysed a total of 112 titles with 231 patients. The most frequent symptoms and signs were: neck pain, neck stiffness and odynophagia, as was the case in our reported cases. CONCLUSIONS: RCT is a dramatic yet self-limiting condition, often not recognised in time. An effort should be made to increase neurologists' awareness about this condition.

Dynamic Susceptibility Contrast Enhanced (DSC) MRI Perfusion and Plasma Cytokine Levels in Patients after Tonic-clonic Seizures.

BACKGROUND: Inflammatory events in brain parenchyma and glial tissue are involved in epileptogenesis. Blood concentration of cytokines is shown to be elevated after tonic-clonic seizures. As a result of inflammation, blood-brain barrier leakage occurs. This can be documented by imaging techniques, such is dynamic susceptibility contrast enhanced (DSC) MRI perfusion. Our aim was to check for postictal brain inflammation by studying DSC MRI perfusion and plasma level of cytokines. We looked for correlations between number and type of introducing seizures, postictal plasma level of cytokines and parameters of DSC MRI perfusion. Furthermore, we looked for correlation of those parameters and course of the disease over one year follow up. PATIENTS AND METHODS: We prospectively enrolled 30 patients, 8-24 hours after single or repeated tonic-clonic seizures. RESULTS: 25 of them had normal perfusion parameters, while 5 had hyperperfusion. Patients with hyperperfusion were tested again, 3 months later. Two of 5 had hyperperfusion also on control measurements. Number of index seizures negatively correlated with concentration of proinflammatory cytokines IL-10, IFN-ϒ and TNF-α in a whole cohort. In patients with hyperperfusion, there were significantly lower concentrations of antiinflammatory cytokine IL-4 and higher concentrations of proinflammatory TNF-a. CONCLUSIONS: Long lasting blood- brain barrier disruption may be crucial for epileptogenesis in selected patients.

Quantitative morphometric analysis of the myenteric nervous plexus ganglion structures along the human digestive tract.

BACKGROUND/AIM: All the functions of the digestive system are controlled, guided and initiated by the autonomic nervous system. A special part of this system placed in the wall of the gastrointestinal tract is known as the enteric or metasympathetic nervous system. The aim of this study was to analyse myenteric nervous plexus in different parts of the digestive tract. METHODS: We examined the myenteric nervous plexus of the esophagus, stomach, duodenum, jejunum, ileum, transverse colon and rectum in tissue samples taken from 30 cadavers of persons aged 20-84 years. After standard histological processing sections were stained with hematoxylin-eosin, cresyl violet (CV) and AgNO3 method. Multipurpose test system M42 was used in morphometric analysis. The results were analyzed by t-test and analysis of variance. RESULTS: The number of neurons per cm² surface was the lowest in the esophagus (2.045 ± 310.30) and the largest in the duodenum (65,511 ± 5,639). The statistical processing showed significant differences (P < 0.001) in the number of neurons between the esophagus and all other parts of the digestive tract. The maximal value of the average surface of the myenteric nervous plexus neurons was observed in the esophagus (588.93 ± 30.45 µm²) and the lowest in the stomach (296.46 ± 22.53 µm²). CONCLUSION: There are differences in the number of ganglion cells among different parts of the human digestive tract. The differences range from a few to several tens of thousands of neuron/cm2. The myenteric nervous plexus of the esophagus was characterized by a significantly smaller number of neurons but their bodies and nuclei are significantly larger compared to other parts of the digestive tract.

Age-related structural changes in the myenteric nervous plexus ganglion along the anterior wall of the proximal human duodenum--a morphometric analysis.

BACKGROUND/AIM: Aging is one of the most complex biological processes which probably affect structure and function of the enteric nerve system. However, there is not much available information on this topic, particularly in humans. The aim of this study was to investigate the influence of aging on the structure of the myenteric ganglia in the anterior wall of the human proximal duodenum. METHODS: We examined the myenteric ganglia in the proximal duodenal anterior wall specimens obtained from 30 cadaver persons aged from 20 to 84 years. Tissue samples were classified into three age groups: 20-44, 45-64 and 65-84 years. After standard histological preparation, specimens were stained with HE, Cresyl Violet and AgNO3. Morphometric analysis of all the specimens, using a multipurpose test system M42, was performed. The data were subjected to the t-test. RESULTS: The myenteric ganglia of very old humans contains an empty space, i.e. the respective parts of ganglia show a decreased number of neuron as compared to younger population. The average number of neuron per cm2 of the duodenum in the youngest people (20-44 years) was 69,370 +/- 1,750.00, in the people aged 45-64 years 69,211 +/- 1,573.33, and in the oldest persons (65-84 years) 57,951 +/- 1,291.52. The loss of neurons in the oldest persons was 16.46%. The applied statistic test demonstrated a significant difference between the observed groups (p < 0.0001). CONCLUSION: Aging does not induce changes in size and surface of neurons in the ganglia, but it decreases the number of neurons. The nerve structures in the elderly are partly emptied of bodies of nerve cells ("empty ganglions"), which indicates the existence of changed myenteric ganglia in the duodenum. These changes could be related to the duodenum motility disorder associated with aging.

Asymmetries in numerical density of pyramidal neurons in the fifth layer of the human posterior parietal cortex.

BACKGROUND/AIM: Both superior parietal lobule (SPL) of dorsolateral hemispheric surface and precuneus (PEC) of medial surface are the parts of posterior parietal cortex. The aim of this study was to determine the numerical density (Nv) of pyramidal neurons in the layer V of SPL and PEC and their potential differences. METHODS: From 20 (40 hemispheres) formaline fixed human brains (both sexes; 27- 65 years) tissue blocks from SPL and PEC from the left and right hemisphere were used. According to their size the brains were divided into two groups, the group I with the larger left (15 brains) and the group II with the larger right hemisphere (5 brains). Serial Nissl sections (5 microm) of the left and right SPL and PEC were used for stereological estimation of Nv of the layer V pyramidal neurons. RESULTS: Nv of pyramidal neurons in the layer V in the left SPL of brains with larger left hemispheres was significantly higher than in the left SPL of brains with larger right hemisphere. Comparing sides in brains with larger left hemisphere, the left SPL had higher Nv than the right one, and then the left PEC, and the right SPL had significantly higher Nv than the right PEC. Comparing sides in brains with the larger right hemisphere, the left SPL had significantly higher Nv than left PEC, but the right SPL had significantly higher Nv than left SPL and the right PEC. CONCLUSION: Generally, there is an inverse relationship of Nv between the medial and lateral areas of the human posterior parietal cortex. The obtained values were different between the brains with larger left and right hemispheres, as well as between the SPL and PEC. In all the comparisons the left SPL had the highest values of Nv of pyramidal neurons in the layer V (4771.80 mm(-3)), except in brains with the larger right hemisphere.

[Patterns of lipofuscin accumulation in ganglionic nerve cells of superior cervical ganglion in humans].

BACKGROUND/AIM: Considering available literature lipofuscin is a classical age pigment of postmitotic cells, and a consistently recognized phenomenon in humans and animals. Lipofuscin accumulation is characteristic for nerve cells that are postmitotic. This research was focused on lipofuscin accumulation in ganglionic cells (GC) (postganglionic sympathetic cell bodies) of superior cervical ganglion in humans during ageing. METHODS: We analysed 30 ganglions from cadavers ranging from 20 to over 80 years of age. As material the tissue samples were used from the middle portion of the ganglion, which was separated from the surrounding tissue by the method of macrodissection. The tissue samples were routinely fixed in 10% neutral formalin and embedded in paraffin for classical histological analysis, then three consecutive (successive) sections 5 microm thick were made and stained with hematoxylin and eosin method (HE), silver impregnation technique by Masson Fontana and trichrome stain by Florantin. RESULTS: Immersion microscopy was used to analyse patterns of lipofuscin accumulation during ageing making possible to distinguish diffuse type (lipofuscin granules were irregularly distributed and non-confluent), unipolar type (lipofuscin granules were grouped at the end of the cell), bipolar type (lipofuscin granules were concentrated at the two opposite ends of a cell with the nucleus in between at the center of a cell), annular type (lipofuscin granules were in the shape of a complete or incomplete ring around the nucleus) and a cell completely filled with lipofuscin (two subtypes distinguishing, one with visible a nucleus, and the other with invisible one). Even at the age of 20 there were cells with lipofuscin granules accumulated in diffuse way, but in smaller numbers; the GC without lipofuscin were dominant. Growing older, especially above 60 years, all of the above mentioned patterns of lipofuscin accumulation were present with the evident increase in cells completely filled with lipofuscin, but cells without lipofuscin were also present even in the oldest persons. CONCLUSION: Lipofuscin is present in all periods of ageing with a different intensity of accumulation. GC without the pigment, diffusely distributed, as well as very rare cells with a unipolar type of lipofuscin distribution are characteristic for the age of 20-60 years. In the age above 60 years, except the cells without pigment and diffuse accumulation type, there are also bipolar and annular types and forms in which cells are completely filled with lipofuscin granules.

Complications after primary and secondary transsclerally sutured posterior chamber intraocular lens implantation.

This retrospective study analyses and compares early complications during the first month after primary and secondary posterior chamber implantation of transsclerally sutured IOL. The analysis covered medical records of 65 patients who underwent posterior chamber implantation of transsclerally sutured IOL at the Eye Clinic in Rijeka between 1998 and 2003. In 30 patients (group 1) lenses were implanted in one eye during complicated cataract surgery (primary implantation), whereas 35 patients (group 2) had lenses implanted afterwards (secondary implantation). There were 77 early complications, equally represented in both groups, i.e. 40 in (51.9%) the first and 37 (48.1%) in the second group. The most frequent complications were: vitreous hemorrhages 24.7% (14.3% and 10.4%), cystoid macular edema 19.5% (9.1% and 10.4%), keratopathy 14.3% (6.5% and 7.8%), pupil distortion 11.7% (9.1% and 2.6%), IOL decentration and tilt 10.4% (6.5% and 3.9%), high intraocular pressure 9.1% (2.6% and 6.5%), inflammation 6.5% (2.5% and 3.9%). Retinal and choroidal detachment had low incidence: 2.6% (1.3% and 1.3%) and 1.3% (0% and 1.3%) respectively. As concerns early complications, there were no statistically significant differences between the two groups, except for pupil distortion, which was more frequent in primary IOL implantation (p = 0.045). After primary implantation of IOL, the average visual acuity was 0.38 +/- 0.27, whereas after secondary implantation visual acuity was 0.52 +/- 0.21. The difference was not statistically significant.

Quality of screening for diabetic retinopathy in the Rijeka region of Croatia.

The aim of this study was to compare the quality of screening for diabetic retinopathy in cities of Rijeka and Zagreb, Croatia. Review of a random sample of 500 diabetic patient records and prospective ophthalmologic survey of 466 randomly selected diabetic patients in a secondary level diabetologic service in Rijeka (coastal region of Croatia). The main outcome measures were proportion of diabetic patient records with notes on ophthalmologic examination; rate of diabetic patients involved with screening for diabetic retinopathy; comparison with rates in Zagreb (Croatian capital). A total of 67% patients visited the ophthalmologist at least once after diagnosed with diabetes, and notes on ophthalmologic examination were found in only 28% patient records. Fifty percent of patients underwent an ophthalmologic examination within two years. Only one third of patients diagnosed with DM in last two years visited the ophthalmologist within this time, and 14% of patients older than 50 years never visited the ophthalmologist. Model of screening for diabetic retinopathy in Croatia works better in Zagreb than in Rijeka region, and needs certain improvements. The authors suggested modern methods of screening, the incorporation of the mechanisms of quality control, the obligatory reporting of newly diagnosed diabetic patients to the national registry, and the direct referral from diabetologist to ophthalmologist.

Cost of treating preventable minor ocular injuries in Rijeka, Croatia.

AIM: To determine the cost of medical services for the treatment of preventable minor ocular injuries in Rijeka, Croatia. METHODS: We analyzed data on 3,755 outpatients (3,363 men and 392 women) treated for eye injuries at the Department of Ophthalmology, Rijeka University Hospital, from April 2002 to March 2003. Median age of patients was 37 years (range, 26-47 years). Data were collected with a questionnaire designed for the study, which included sociodemographic data, type of injury, time and place of injury, and preventability. We carried out cost analysis of the procedures and determined the length of hospital stay. RESULTS: Out of 5,143 emergencies, minor eye injuries comprised 3,755 cases (73%). Minor injuries were potentially preventable in 90% of cases, as they resulted from nonuse or misuse of obligatory protection devices. Total one-year cost of preventable eye injuries was 135,529.55 Euros. CONCLUSION: Preventable minor eye injuries in Rijeka, Croatia, cause a serious medical and economic burden. Stricter adherence to the use of protection devices should be promoted.

Hyperbaric oxygen treatment: the influence on the hippocampal superoxide dismutase and Na+,K+-ATPase activities in global cerebral ischemia-exposed rats.

The influence of hyperbaric oxygen (HBO) treatment on the activities of superoxide dismutase (SOD) and Na(+),K(+)-ATPase was determined during different time periods of reperfusion in rats exposed to global cerebral ischemia. Ischemic animals were either sacrificed or exposed to the first HBO treatment 2, 24, 48 or 168 h after ischemic insult (for SOD activities measurement) or immediately, 0.5, 1, 2, 6, 24, 48, 72 or 168 h after ischemic procedure (for Na(+),K(+)-ATPase activities measurement). Hyperbaric oxygenation procedure was repeated for seven consecutive days. The results of presented experiments demonstrated the statistically significant increase in the hippocampal SOD activity 24 and 48 h after global cerebral ischemia followed by a decrease in the enzymatic activity 168 h after ischemic insult. In the ischemic rats treated with HBO the level of hippocampal SOD activity was significantly higher after 168 h of reperfusion in comparison to the ischemic, non HBO-treated animals. In addition, it was found that global cerebral ischemia induced a statistically significant decrease of the hippocampal Na(+),K(+)-ATPase activity starting from 1 to 168 h of reperfusion. Maximal enzymatic inhibition was obtained 24 h after the ischemic damage. Decline in Na(+),K(+)-ATPase activity was prevented in the animals exposed to HBO treatment within the first 24 h of reperfusion. Our results suggest that global cerebral ischemia induces significant alterations in the hippocampal SOD and Na(+),K(+)-ATPase activities during different periods of reperfusion. Enhanced SOD activity and preserved Na(+),K(+)-ATPase activity within particular periods of reperfusion, could be indicators of a possible beneficial role of HBO treatment in severe brain ischemia.

Changes in the interpupillary distance (IPD) with ages and its effect on the near convergence/distance (NC/D) ratio.

This study aims at determining the mean value of the ophthalmic anthropometrics parametar-IPD (Interpupillary distance) and the mean value of NC/D (Near convergence/distance) in 300 subjects aged 5 to 60 years. The influence of IPD on the NC/D ratio in the same subjects will also be investigated. The investigation showed that the mean value of IPD is 60.5 +/- 2.4 cm, and the mean value of NC/D ratio is 4.95 +/- 2.28 prD. Mean IPD of 5.1 cm in 5-year old children increases to 6.3 cm in adult over 20. In adulthood, IPD remains the same, i.e. 6.3 cm. Our study showed that the NC/D ratio is stable during lifetime. Since NC/D is stabile and IPD changes during lifetime, it is evident that factors other than IPD, such as convergence and accommodation, influence the stability of the NC/D ratio.

Earlier detection of amblyopia and strabismus by ophthalmologic screening card attached to the vaccination card.

BACKGROUND: In 1983, in Rijeka, Croatia, an ophthalmologic screening card was introduced for the detection and prevention of ophthalmologic diseases, including amblyopia and strabismus, in children. The card was attached to the vaccination card. The main goal of this study was to investigate whether this model of screening decreased the age at which children were first admitted to our Department of Strabismus and Pediatric Ophthalmology. METHODS: We randomly selected 100 of the 225 children who underwent examination for the first time in the Department of Pediatric Ophthalmology and Strabismus of a clinical hospital centre in Rijeka in 1980, and 100 of the 412 examined for the first time in 1990. Only children aged 5 years or less who were born in the maternity hospital in Rijeka were included in the study. We reviewed the records for these groups, noting the sex, age, diagnosis, refraction and visual acuity. RESULTS: The average age of the children examined in 1980 was 4.4 (standard deviation 1.4) years, compared with 2.5 (standard deviation 1.2) years in 1990, a statistically significant difference (p < 0.01, Student's t-test). In 1980, 17% of the children were under 3 years, compared with 80% in 1990 (p << 0.01). INTERPRETATION: The ophthalmologic screening card contributed to reducing the age at which strabismus and amblyopia are detected. This method of detection has been applied to the entire child population, and detection is performed continuously.