Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches.

INTRODUCTION: Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. OBJECTIVE: The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. METHODS: Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn's criteria. RESULTS: Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p = 0.011). CONCLUSION: Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

Redox status in acute ischemic stroke: correlation with clinical outcome.

Connection between oxidative stress and clinical outcome in acute ischemic stroke (AIS) has been poorly investigated. This study was aimed to assess redox state (through measurement of oxidative stress markers) of patients with acute ischemic stroke during different stages of follow-up period, and to find association between values of mentioned markers and clinical outcome. The investigation was conducted on 60 patients (both sexes, aged 75.90 ± 7.37 years) who were recruited in intensive care units at the Special Hospital for Cerebrovascular Diseases "Sveti Sava," Belgrade. After verification of AIS, patients were followed up in four interval of time: (1) at admission, (2) within 24 h after AIS, (3) within 72 h after AIS, and (4) 7 days after AIS. At these points of time, blood samples were taken for determination of oxidative stress parameters [index of lipid peroxidation (measured as TBARS), nitric oxide (NO) in the form of nitrite ([Formula: see text]), superoxide anion radical ([Formula: see text]), hydrogen peroxide (H2O2)], and enzymes of antioxidant defense system [superoxide dismutase (SOD) and catalase (CAT)] using spectrophotometer. Present study provides new insights into redox homeostasis during ischemic stroke which may be of interest in elucidation of molecular mechanisms involved in this life-threatening condition. Particular contribution of obtained results could be examination of connection between redox disruption and clinical outcome in these patients. In that sense, our finding have pointed out that [Formula: see text] and NO can serve as the most relevant adjuvant biomarkers to monitor disease progression and evaluate therapies.

Dialysis headache in patients undergoing peritoneal dialysis and hemodialysis.

OBJECTIVES: Headache is among most frequently encountered neurological symptom during hemodialysis (HD), but still under investigated in peritoneal dialysis (PD) patients. The aim of this study was to assess the incidence and clinical characteristics of dialysis headache (DH) in HD and PD patients. MATERIAL AND METHODS: A total of 409 patients (91 on PD and 318 on HD) were interviewed using a structured questionnaire, designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. Patients with DH underwent a thorough neurological examination. RESULTS: DH was reported by 21 (6.6%) HD patients and 0 PD patients. PD patients had significantly lower serum sodium, potassium, calcium, phosphate, urea and creatinine, calcium-phosphate product, and diastolic blood pressure than HD patients. HD patients had significantly lower hemoglobin compared to PD patients. Primary renal disease was mostly parenchymal in HD patients, and vascular in PD patients. DH appeared more frequently in men, mostly during the third hour of HD. It lasted less than four hours, was bilateral, non-pulsating and without associated symptoms. CONCLUSION: Biochemical alterations may be implicated in the pathophysiology of DH. Specific features of DH might contribute to better understanding of this secondary headache disorder.

Habitual coffee consumption enhances attention and vigilance in hemodialysis patients.

OBJECTIVE: Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. METHODS: In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. RESULTS: Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). CONCLUSIONS: Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

Clinical characteristics and outcome in the acute phase of ischemic locked-in syndrome: case series of twenty patients with ischemic LIS.

BACKGROUND: Locked-in syndrome (LIS) is a condition characterized by quadriplegia and anarthria. The most common cause is a ventral pontine lesion due to atherosclerotic basilar artery disease. METHODS: Cases with LIS were prospectively identified among the patients with acute ischemic stroke over 3 years, between 2009 and 2011. Clinical characteristics, topographic localization of lesions, and outcome were determined during the first 6 months from onset of LIS. RESULTS: Our case series consists of 20 patients (mean age 62 ± 10 years; range 46-82). Initially 16 patients had a reduced level of consciousness (mean 3 days; range 1-15). Respiratory disturbance, mainly as impairment of the breathing pattern, was noted in all cases. Five patients died within the first 10 days due to stroke progression or cardiac arrest. In the remaining cases the most frequent causes of death were pulmonary infections and sepsis. Overall mortality in the acute phase of LIS is 75%, and the median survival time is 42 days. There was a statistically significant association between the more extensive parenchymal brain stem lesions and observed mortality. CONCLUSIONS: Ischemic LIS is commonly caused by an acute complete occlusion of the basilar artery due to atherosclerotic lesions in intracranial vertebrobasilar vessels. Mortality remains high in the acute phase of the disease.

[Headache associated with haemodialysis].

INTRODUCTION: Haemodialysis (HD) is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE: The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD: The study involved 126 patients (48 female and 78 male) with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Krusevac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II). Subsequently, the patients were clinically evaluated and patients with headaches were further subclassified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of haemodialysis headache (HDH). RESULTS: In the group of 126 evaluated patients, 41 (32.5%) patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count, serum concentration of haemoglobin, blood urea nitrogen, creatinine, glucose, MCHC, total protein, sodium and potassium. Fourteen patients (34% of those with headaches) experienced headache during the HD session and were subclassifled as HDH using diagnostic criteria of the International Headache Society. Tension type headache (41% of those with headaches) and migraine without aura (10%) were most common in the primary headache group and headache due to arterial hypertension (7%) was the most prevalent among the secondary headaches. Although there were some common clinical characteristics, we could not find a unifying clinical pattern in the patients with HDH. CONCLUSION: Haemodialysis headache is the most common headache in patients undergoing haemodialysis, and despite some common symptoms, it does not appear to be uniform in its clinical characteristics.

[Restless legs syndrome prevalence in patients on chronic hemodialysis in central Serbia].

BACKGROUND/AIM: Restless legs syndrome (RLS) is a sensorymotor disorder and the core feature of this syndrome is a distressing, irresistible need or urge to move the legs. RLS is one of the most troublesome conditions experienced by endstage renal disease patients treated with regular hemodialysis, and is significantly associated with their increased mortality. The aim of this study was to assess the prevalence of RLS in the patients with end-stage renal failure in the three dialysis centers in central Serbia, and to investigate the association of the syndrome with clinical characteristics and biochemical variables. METHODS: A cross-sectional multicentric study in which 166 consecutive hemodialysis patients were evaluated using a standard questionnaire based on diagnostic criteria elaborated by the International Restless Legs Syndrome Study Group was performed. All patients were reinterviewed and clinically examined by a qualified neurologist. The data on the patients with and without RLS were compared. RESULTS: The prevalence of RLS was 22.96% (95% CI, 16.57% to 29.35%). There was no significant difference in duration of hemodialysis and clinical characteristics when we compared the patients with RLS with those without RLS. We found significantly higher levels of blood urea nitrogen and creatinine and lower level of Kt/V index in the patients with RLS, which might point to inadequate dialysis in these patients. CONCLUSION: In our study the prevalence of RLS in the patients on the regular hemodialysis was 22.96%. The obtained results are similar to those of other studies using the same methodology in the white population on the regular hemodialysis.

Carotid atherosclerosis, coronary atherosclerosis and carotid intima-media thickness in patients with ischemic cerebral disease: Is there any link?

OBJECTIVES: The present study examined the association between carotid atherosclerosis, coronary atherosclerosis and common carotid artery intima-media thickness (CCA-IMT) in patients with incident ischemic stroke and its subtypes (75 cases and 21 controls). METHODS: Cases with ischemic brain infarctions (IBIs) were consecutively recruited and classified into subtypes by computed tomography and Bamford's classification (the size and site of the infarct) as one of the following: total anterior circulation infarcts (TACIs); partial anterior circulation infarcts (PACIs); posterior circulation infarcts (POCIs); and lacunar infarcts. Controls were recruited among individuals hospitalized for a reason other than cerebrovascular disease at the same institutions and matched for age and sex. Patients and controls underwent B-mode ultrasonographic measurements of CCA-IMT, and were evaluated by a qualified internist and neurologist for the presence of ischemic coronary disease and a history of previous stroke or transient ischemic attack. RESULTS: Of the 75 patients with an acute ischemic stroke, 10 (14%) were classified as TACIs, 34 (45%) as PACIs, 12 (16%) as POCIs and 19 (25%) as lacunar infarcts. Mean CCA-IMT was higher in patients (1.03+/-0.18 mm) than in controls (0.85+/-0.18 mm; P<0.0001). The history of cerebrovascular disease was much lower in the patients with POCI and TACI, and the prevalence of ischemic cardiac disease was in the range of 20% in patients with TACIs to more than 40% in patients with PACIs. CONCLUSIONS: An increased CCA-IMT as a marker of general atherosclerosis was associated with IBI and reflects cardiovascular risk. Carotid and coronary atherosclerosis were positively correlated with IBIs, with significant differences across the subtypes.

[Common carotid artery intima-media thickness, carotid atherosclerosis and subtypes of ischemic cerebral disease]. / Debljina intima-medija kompleksa zajednicke karotidne arterije, karotidna ateroskleroza i suptipovi ishemicnog mozdanog udara.

INTRODUCTION: Common carotid artery intima-media thickness (CCA-IMT) measurements are widely used to study atherosclerosis. CCA-IMT is a useful outcome measure in clinical studies and intervention trials because it reflects early stages of atherosclerosis and cardiovascular risk. The present study examined the relationship between common carotid artery intima-media thickness and ischemic brain infarction. MATERIAL AND METHODS: The present study examined the association between CCA-IMT and incidence of ischemic stroke and its subtypes in 75 cases and 21 controls. Cases with internal borderzone infarction (IBI) were consecutively recruited and classified into subtypes using CT and Bamford's classification. It classifies cerebral infarctions regarding vascular territory using clinical features to determine the size and site of infarction. These subtypes included: total anterior circulation infarctions (TACIs), partial anterior circulation infarctions (PACIs), posterior circulation infarctions (POCIs), and lacunar infarctions (LACIs). Controls were recruited among individuals hospitalized at the same institution and matched for age and sex. Patients and control subjects underwent B-mode ultrasonographic measurements of IMT of the far wall of both common carotid arteries. RESULTS: Of 75 patients with acute ischemic stroke, 10 (14%) were classified as TACIs, 34 (45%) had PACIs, 12 (16%) had POCIs and 19 (25%) had LACIs. Mean CCA-IMT was higher in investigation group (1.03+/-0.18 mm) than in controls (0.85+/-0.18 mm; p<0.0001). The difference in CCA-IMT between investigation group and controls was significant and the relation between CCA-IMT and IBI remained unchanged after adjustments of main cardiovascular risk factors. Regarding the subtypes of IBI, IMT values were significantly higher in patients with TACIs and PACIs versus those with LACIs and POCIs. CONCLUSIONS: An increased CCA-IMT was established in all subtypes of IBI and was significantly higher in those with anterior circulation infarctions versus posterior circulation and lacunar infarctions. This study points to importance of noninvasive measurement of CCA-IMT with ultrasonographic techniques as a diagnostic tool for selecting patients at high risk for IBI and identifying different subtypes of ischemic stroke.