Epidemiological characteristics of surgically treated civilian traumatic brachial plexus injuries in Serbia.

BACKGROUND: Traumatic brachial plexus injuries are generally severe, and in many cases associated with surrounding tissue injuries, which makes them hard to diagnose at the right time. This paper presents etiological and epidemiological characteristics of surgically treated civilian traumatic brachial plexus injuries. METHODS: This retrospective study included 68 patients, operated due to the traumatic brachial plexus injuries at Clinic for Neurosurgery, Clinical Center of Serbia, during the 11-year period. RESULTS: The vast majority of injured patients were men in full working maturity. In our study, there were seven different etiological factors. The road traffic accidents were the most common-41 (60.3%), while the motorcycle accidents were the most dominant subtype (53.7%) of all road traffic accidents, and also representing 32.4% of all causes of trauma. Supraclavicular elements of the brachial plexus were injured in more than 80% of patients. A total of 49 (72.1%) patients from our study had one or more associated injuries. The most common associated injuries were bone fractures, brain contusions, and vascular injuries. CONCLUSION: Although rare, non-war-related severe brachial plexus injuries represent a group of patients carrying high risk of insufficient functional recovery regardless of treatment modality, or surgical technique. Epidemiological and etiological data are therefore very important to identify the groups in risk and to induce preventive actions aimed at these patients.

Kinematic magnetic resonance imaging study of the brain stem and cervical cord by dynamic neck motion.

BACKGROUND: The aim was to examine the position of the brain stem and cervical cord following the neck flexion and extension. MATERIALS AND METHODS: The serial sagittal T2-weighted magnetic resonance imaging (MRI) sections of the cervical cord and brain stem were made in 6 volunteers. The images were mainly used to measure certain distances and angles of the brain stem and cervical cord in the neutral position, and then following the head and neck flexion and extension. RESULTS: The measurements showed that the pons is slightly closer to the clivus following the neck flexion; the medulla oblongata is somewhat distant to the basion but closer to the odontoid process. At the same time, the spino-medullary angle diminishes in size. On the other hand, the upper cervical cord slightly approaches the posterior wall of the spinal canal, the lower cervical cord is closer to the anterior wall, while the angle between them is significantly larger in size. After the cervical cord extension, the rostral pons is somewhat distant to the clivus, whereas the caudal pons and the medulla are slightly closer to the clivus and the basion. At the same time, the spino-medullary angle diminishes in size. The cervical cord is mainly closer to the posterior wall of the spinal canal, whilst its angle is significantly smaller. CONCLUSIONS: The obtained results regarding the brain stem and cervical cord motion can be useful in the kinetic MRI examination of certain congenital disorders, degenerative diseases, and traumatic injuries of the craniovertebral junction and the cervical spine.

Biological variations of hematologic and biochemical parameters in cows during early lactation.

The aim of the study was to determine biologic variations of the main parameters in cows in early lactation and to compare intra-individual variations of parameters in cows and other species. 50 cows were included in the experiment. Blood samples were taken at the moment of calving, then on 1st, 7th, 14th and 28th day after calving. CVi had the following values: 1.9-5% for MCV, MCH, MCHC, GLU, TProt, ALB, UREA, Ca, P and Mg; 5.1-10% for RBC, Hgb, Hct, WBC, NEU, LYM, BHB, ALT, CHOL, TGC and >10% for PLT, NEFA, TBil, AST and GGT. For RBC, Hgb, Hct, MCV, MCH subject-based reference values or the reference change value should be used. For all other parameters except AST, population-based reference intervals should be used with caution. For LYM, NEU, PLT, GLU, TProt, ALB, CHOL and TGC index of individuality was close to 0.6 which means that subject-based reference values can be much more adequate to use then population-based reference intervals. For AST population-based intervals should be used. There is little effect of parity (increase CVi with parity) and no effect of milk production. CVi values obtained in cows in early lactation are specific because they deviate from the CVi values of other animal species and human. Calculated RCVs varied from 5.5% for MCHC to 41% for AST. High individuality index for many metabolic parameters opens possibility for development of model for longitudinal monitoring of metabolic status of individual animals during lactation. That requires further research.

Oral kinetics and bioavailability of the cholinesterase reactivator HI-6 after administration of 2 different formulations of tablets to dogs.

A one-compartment open model with first-order absorption was used for comparing new oral formulations of the potent acetylcholinesterase reactivating oxime HI-6. Although mean peak plasma levels did not differ between retard and conventional tablets (21.38 and 20.74 mumol/l), the time for reaching peak levels was significantly longer (5.5 h) with retard than with conventional tablets (2.86 h). Among other pharmacokinetic estimates only absorption half-lives and areas under the concentration-time curve (AUC) were significantly different (P less than 0.05). The AUC with retard tablets was 8.07% and that of conventional tablets 5.42% of intravenous AUC, indicating low bioavailability of oral HI-6 formulations. Potential therapeutic use of HI-6 requires, therefore, further investigations in order to improve its gastrointestinal absorption.

Antimelanoma immunity in vitiligo and melanoma patients.

Cutaneous melanoma and vitiligo are diseases etiology of which evolves around melanocytes. The nature of immunological disturbances associated with these diseases is not elucidated. The experiments performed in this work were aimed to determine antimelanoma immunotoxicity in patients with melanoma and patients with vitiligo. Twelve patients with melanoma, ten patients with vitiligo and seventeen healthy volunteers were studied. The cytotoxicity of PBMC was evaluated indirectly through determination of target melanoma (Fem-x) or control tumor (HeLa) cell survival, in the presence of 15% of AB or autologous sera, by MTT test. The mean values of antimelanoma cytotoxicity in AB serum were similar in both patients groups and in controls. However, the frequency of patients with the enhanced cytotoxicity against melanoma cells, in relation to control tumor cells, was lower in both patients groups than in controls. The intensity of antimelanoma cell-mediated cytotoxicity in melanoma patients, in the presence of autologous serum, was significantly lower in comparison to that found in control subjects and vitiligo patients (p<0.014, in both cases). This indicates that some factors from melanoma patient's sera contribute to impairment of the cytotoxicity of autologous PBMC, while other factors from the serum of vitiligo patients and control subjects enhanced their PBMC antimelanoma cytotoxicity.

Effect of dietary fish supplementation on lipoprotein levels in patients with hyperlipoproteinemia.

Effect of dietary fish was investigated in 51 study group patients and 50 age- and sex-matched control group patients, all with type II-b hyperlipoproteinemia. In the study and control group, 21 and 22 patients, respectively, had well regulated non-insulin dependent diabetes mellitus. Neither the study group nor control group patients smoked or consumed alcohol beverages. Blood pressure was within normal limits (16/11-20/12 kPa) in both groups. During a six-month study period, the study group took 0.5-1 kg breaded pilchard per week, whereas the control group patients were on their standard hypolipoproteinemic diet. The following parameters were determined in both study and control group patients before the study, every 3 months during the study, and 3 months after the completion of the study, total cholesterol, HDL cholesterol (HDL2 and HDL3), LDL cholesterol, VLDL cholesterol, triglycerides, blood glucose and uric acid. Fish intake was found to statistically significantly decrease the levels of total cholesterol (-10.7%), LDL cholesterol (-11.7%), VLDL cholesterol (-14.8%) and triglycerides (-12.3%) (p < 0.05), whereas a statistically significant increase was observed in the levels of HDL cholesterol (+5.3%) and HDL3 (+7.4%) (p < 0.05). Three months after the completion of the study, when the study group patients had resumed their standard hypolipoproteinemic diet without extra fish intake, the levels of lipoprotein fractions returned to those recorded before the study. There were no statistically significant changes in the levels of blood glucose, uric acid and HDL2. In the control group, no statistically significant changes in lipoprotein fractions were recorded. Our findings suggested that dietary intake of 0.5-1 kg fish containing a small amount of omega-3 fatty acids, along with the standard hypolipoproteinemic diet, may decrease the level of atherogenic lipoprotein fractions, and increase the level of lipoprotein protective fractions, thus reducing or at least delaying the development of atherosclerosis.

Effects of preeclampsia and eclampsia on cord blood coagulation tests.

Blood coagulation tests were determined in fifty-three paired umbilical cord blood and maternal venous blood samples originating from term singleton vaginal cephalic deliveries. The index group comprised seventeen deliveries complicated by preeclampsia or eclampsia, and the control group comprised thirty-six healthy women with uneventful pregnancies and deliveries. Mean values obtained from the coagulation and fibrinolytic assays did not significantly differ between study groups, except for antithrombin III levels in index group of neonates, which were significantly lower. Comparison of coagulation and fibrinolytic characteristics between mothers and their neonates produced expected level of difference due to immaturity of their haemostatic mechanisms. We found alterations in maternal blood coagulation and fibrinolysis and evidence of increased intravascular coagulation with severe preeclampsia and IUGR.

[Percutaneous transluminal angioplasty of radiotherapy induced carotid stenosis--case report].

Frequent delayed effect of radiation therapy in the region of neck is stenosis of carotid arteries. We report the case of 32 years old man with history of radiation therapy due to Hodgkin lymphoma, and severe stenosis of the right common carotid artery. Stenosis was succesfuly treated by percutaneous transluminal angioplasty with implantation of two bare-metal stents.

The ear-leaf percentage of calcium and magnesium in maize inbred lines and their diallel progeny.

Eight maize (Zea mays L.) inbred lines and their single cross hybrids were grown for one year under field conditions near Osijek. The ear-leaf was taken in the tasseling stage and analysed for Ca and Mg percentage. Parental effects on ear-leaf content of Ca and Mg were very high. The hybrids of line C103 had low mean percentages of ear-leaf Ca and Mg while the hybrids of line Os64 had high mean percentages.

Pharmacokinetics of the oxime HI-6 from a mixture with atropine sulphate in dogs.

The pharmacokinetics of the oxime HI-6 from an aqueous solution and from a mixture containing HI-6 and atropine (in doses similar as proposed for their combination in an automatic injector) was studied in German shepherd dogs. A standard manual injection of mixed drugs was followed by enhanced resorption of HI-6 while the elimination curves were quite similar. A comparison of the parameters describing relative bioavailability at the 80% probability level did not reveal any significant differences between the formulations of HI-6. The increase in HI-6 level in blood of animals receiving a mixture is more likely to be attributed to the local vasodilatation than to the systemic cardiovascular effects of atropine.

PAM-2 Cl, HI-6, and HGG-12 in soman and tabun poisoning.

Acute sc toxicity of soman increased in the order, mice----rats----guinea pigs----dogs, being 12.6 times more toxic to dogs (LD50 = 0.05 mumol/kg) than to mice. It was 2.8 times more toxic than tabun to mice and 35 times more toxic to dogs. HI-6 was the least toxic and had similar toxicity values to the four animal species studied and HGG-12 the most toxic of the three oximes used. HGG-12 has shown the greatest interspecies variation (rats:dogs = 1:19.5). HI-6, HGG-12, and PAM-2 Cl (in conjunction with atropine and diazepam) revealed the best protective effect in soman-poisoned dogs, with the respective protective indices of 9, 6.3, and 3.5, followed by guinea pigs. In tabun poisoning the best, but relatively low, protective effect was found only in guinea pigs. The introduction of diazepam increased the protective effects of atropine-oxime combination in soman and tabun poisoning by 10 to 80%. We suggest that the high toxicity of soman and low toxicity of HI-6 may be anticipated in man. The inefficiency of HI-6, HGG-12, and PAM-2 Cl in tabun poisoning points either to the search of new compounds or to the use of the mixture of the oximes found to be effective against the known chemical warfare nerve agents.

Oral forms of the oxime HI-6: a study of pharmacokinetics and tolerance after administration to healthy volunteers.

New pharmaceutical formulations of the oxime HI-6 as sustained-release and conventional tablets were studied in healthy volunteers. Twenty-six subjects, divided into 3 groups, received 3784 mg or 7568 mg doses of HI-6 conventional tablets or 4027 mg of the oxime in the form of sustained-release tablets. Peak plasma concentrations of HI-6 were reached within 0.6 h (10.2 mumol/l) and 1.6 h (21.4 mumol/l) following the ingestion of conventional tablets. Elimination half-lives were similar (1.7 h and 1.3 h) and the respective urinary recoveries amounted to 3.2% and 2.9%. After the administration of sustained-release tablets of HI-6, maximal concentration (8.8 mumol/l) was attained in 2.2 h, elimination half-life was 1.9 h and 4.2% of the dose was excreted unchanged in urine. Undesirable side effects were not reported by the subjects or revealed by clinical or laboratory tests. The results indicate low bioavailability of the oral formulations of HI-6 in man.

[Morphologic characteristics of persons killed in armored vehicles]. / Morfoloske karakteristike blast povreda poginulih u oklopnim vozilima.

The authors have analysed macroscopic and microscopic changes in tissues and organs of 8 members of the Y.P.A. killed by granate explosion in the armoured vehicles. In all the analysed cases multiple mechanic injuries were found as well as combined mechanothermal injuries. Injuries caused by the blast wave were mainly found in the internal air-containing organs and three cases of solid blast injury were described too.

[Correlation of clinical and autopsy diagnosis during a 10-year period at the Institute for Pathology and Forensic Medicine at the Military Medicine Academy in Belgrade]. / Korelacija klinickih i autopsijskih dijagnoza na desetogodisnjem materijalu Instituta za patologiju i sudsku medicinu Vojnomedicinske akademije u Beogradu.

The comparison between the clinical and pathohistoanatomic diagnosis of 3.929 autopsied cases is performed. In 82.5% of cases the clinical and pathohistoanatomic diagnosis were in the absolute correlation; in 8% of cases the clinical diagnosis of the basic disease has no adequate pathoanatomic characteristics, while in 4.5% of cases the clinical diagnosis of the basic disease, immediate cause of death and condition which was important for the course and outcome of the treatment were not adequate. Among the pathologic states diagnosed as: pulmonary thromboembolism, myocardial infarction and cerebrovascular insult--pulmonary embolism most often was not confirmed by autopsy (47%), while in 58% of cases it remained clinically unrecognized. Malignant tumours of the liver, pancreas and kidneys have been most frequently clinically unrecognized compared to other malignancies. Duration of hospitalization has not had the essential influence on correct establishment of the clinical diagnosis.

[Convulsions in neonates and early neonatal mortality]. / Konvulzije u novorodencadi i rani neonatalni mortalitet.

The relationship between the early onset of convulsions in the early neonatal period and mortality was studied in 130 (0.26%) children with the birth weight exceeding 2,000 g in whom early neonatal convulsions were recorded. Early neonatal mortality in this group was very high reaching 25.4%. The peak mortality was noted in the first 12 hrs after birth (80.9%) and in the first 24 hrs (60.0%). In the cases of a postponed occurrence of convulsions, the mortality rate of neonates significantly decreases (p less than 0.01).

[Obytin in the treatment of superficial skin mycoses]. / Obytin u lecenju povrsnih mikoza koze.

Obytin (1% Cyclopyroxolamine) in the form of cream, a preparation of the firm Jugoremedija/Hoechst, was applied in the treatment of 33 patients with dermatophytic skin infections. The diseases were most frequently located in the intertriginous areas 19 (57%), somewhat less frequently on nude places of the skin 9 (27%), and on the hands and feet 5 (16%). The cream was applied twice daily for 28 days. Acute clinical symptoms of the disease disappeared rapidly under the influence of the preparation and disappeared completely after three weeks of treatment in 32 patients (97%); and four weeks after start of therapy mycology tests were negative in the same number of cases. Only 3% of patients had no evident changes during therapy. Obytin is one of the new topical antifungal agents with a wide spectrum of action and it can be used in all types of superficial dermatomycoses as well as in some bacterial infections. It is characterized by rapid onset of action. Side effects of local or systemic nature (irritative, alergic or toxic) had not been registered.

[Survival analysis in patients with cutaneous malignant melanoma]. / Analiza prezivljavanja bolesnika s malignim melanomom koze.

INTRODUCTION: Cutaneous malignant melanoma (MM) takes only 3% of all malignant tumours of the skin, but for reason of its increased frequency and pronounced tendency to rapid growth and metastases, it causes 60% of total lethal outcomes due to malignant tumours of the skin [1]. Primary MM is a diagnostic problem because of the great variety of its clinical features. Asymmetric configuration, irregular border, speckled color(r)diameter of more than 6 mm, and elevation of the surface, suggest suspicion of malignant alteration, but even then misdiagnosis is possible. For the final diagnosis of MM histopathological confirmation is necessary. The method to use is the extensive excisional biopsy of the lesion and its borders [2]. Histopathological diagnosis is based on microscopic findings which include: histogenetic type of MM, tumour thickness according to Breslow, level of invasion according to Clark, presence of ulceration, grade of lymphocyte infiltration, mitote rate, type of cells, presence of melanin in cells [2, 3]. PATIENTS AND METHODS: A five-year survival of patients with cutaneous malignant melanoma (MM) was studied according to sex, age and distinct features of the tumour: site, type of initial therapy, stage of the disease, time from the first signs of the disease to diagnosis of MM, histological findings (histogenetic type, Breslow's tumour thickness, Clark's level of invasion, presence of ulceration, degree of lymphocyte infiltration, number of mitoses, type of cells, intensity of pigmentation) and presence of metastases. The retrospective study included 336 patients with cutaneous MM. There were 185 female (55.1%) and 151 male patients (44.9%), aged 14-83 years, mean age 48.8 years, who were treated at the institute of Oncology and Radiology in Belgrade from 1978 to 1990. The mean follow-up was 60 months (1-144 months). Melanoma in situ had 16 (4.1%) patients. Stage I had 45 patients (14.1%), stage II 163 (48.5%), stage III 83 (24.7%) and stage IV 29 (8.6%) patients. Acral location on hands and feet had 40 (11.9%) patients, on head and neck 36 (10.7%), on the trunk 146 (43.5%) and on the extremities (except hands and feet) 114 (33.9%) patients. Nodular melanoma (NM) was the most frequent histogenetic type revealed in 150 (44.6%) patients, superficial spreading melanoma (SSM) in 105 (31.1%) patients, acral melanoma (AM) in 39 (11.5%) and lentigo malignant melanoma (LMM) in 32 (9.4%) patients (Table 1). Five-year survival rate was calculated according to Kaplan-Meier's method and significance of the difference between some categories was tested by Long-Rank's test; the significance less than 0.05 was accepted. RESULTS: Statistically highly significant differences in a five-year survival (p < 0.01) were related to sex p = 0.0005, age p = 0.0017, tumour site p = 0.0025, initial therapy p = 0.0036, stage of MM p = 0.0000, histological features of the tumour p = 0.0000 and presence of metastases p = 0.0000. A better five-year survival prognosis was found in female patients (64.5%) compared to male patients 44.5%, aged 27-46 years (87.3%) compared to patients younger than 26 years (43.5%); patients with melanoma on the extremities (except hands and feet) had a better five-year survival (66.7%) compared to patients younger than 26 years (43.5%); patients with melanoma on the extremities (except hands and feet) had a better five-year survival (65.7%) compared to patients with melanoma on the trunk or acral melanoma (47.3%). Higher survival was recorded in the group of patients with the tumour 1.5-3 mm thick, in whom the tumours was excised and regional nodes dissected as the primary therapy (66.9%) compared to those who underwent excision of the tumor only (48.8%). A five-year survival of patients with MM in situ was 100% for those in stage I; 85% in stage II; 42% in stage III, 16% and 0% in stage IV. The patients in whom the diagnosis of MM was established within 10 months after the first signs of the disease had significa