Sleep Problems and Disabilities of the Arm, Shoulder, and Hand in Persons with Thoracic Outlet Syndrome-A Cross-Sectional Study.

Thoracic outlet syndrome (TOS) arises as a result of a specific relationship among the anatomical structures that may cause compression in the muscles, nerves, and/or blood vessels in the neck, thereby compromising the local circulation. The aim of the current study was to establish the presence of sleep disturbance and disability in the shoulder, arm, and hand in individuals affected by TOS, as well as to ascertain if there are any differences in these findings relative to TOS-free individuals. The study sample comprised 82 TOS patients and 81 TOS-free individuals aged 19-66 years. Data were gathered by administering the Disabilities of the Arm, Shoulder, and Hand (DASH) and Pittsburgh Sleep Quality Index (PSQI) instruments. The results showed that both the DASH (t = -13.21, p < 0.001) and PSQI (t = -7.27, p < 0.001) scores obtained by the TOS group were higher relative to the controls and were strongly and positively correlated (ρ = 0.58, p < 0.01). As positive DASH scores may be indicative of TOS, they signal the need for further diagnostic evaluations. In individuals in whom TOS is already diagnosed, high DASH scores imply that further sleep quality assessments are required, as compromised sleep patterns may undermine quality of life.

Niacin Status Indicators and Their Relationship with Metabolic Parameters in Dairy Cows during Early Lactation.

Previous experimental models on cows have examined the difference in the metabolic adaptation in cows after niacin administration, without identifying the most important mediators between niacin administration and its biological effects, namely active forms of niacin. All tissues in the body convert absorbed niacin into its main metabolically active form, the coenzyme nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP). The aim of this study was to determine the influence of niacin administration in periparturient period on NAD, NADP and the NAD:NADP ratio and to determine relationship between these indicators of an active form of niacin with metabolic parameters in cow blood. The study included 90 healthy cows: 45 cows receiving niacin and 45 cows were negative control. The niacin group was treated with nicotinic acid for two weeks before, as well as two weeks after parturition. Nicotinic acid was applied per os with feed. In cows receiving niacin, there was a significantly higher concentration of NAD and NADP, but the NAD:NADP ratio did not differ compared with control. All three indicators were able to separate cows who received and who did not receive additional niacin. NAD and NADP are good indicators of the availability of niacin from additional sources. The NAD:NADP ratio is a good indicator of the biological effect of applied niacin on metabolites in cows due to its correlation with a number of metabolites: positive correlation with glucose, insulin, glucose to insulin ratio and the revised quantitative insulin sensitivity check index (RQUICKIBHB) of insulin resistance, triglycerides and cholesterol, and a negative correlation with nonesterified fatty acid (NEFA), beta hydroxybutyrate (BHB), gamma-glutamyltranspherase (GGT) and urea in cows receiving niacin. The same amount of added niacin in feed can produce different concentrations of NAD, NADP and NAD:NADP in the blood, and this was not related to their concentration before the addition of niacin. The change in the concentration of the active form of niacin (NAD, NADP and NAD:NADP) further correlates with the concentration of metabolic parameters, which indicates that the intensity of the biological effect of additional niacin can be accurately determined only if we know the concentrations of its active forms in blood. Under basal conditions (without additional niacin), active forms of niacin that already exist in the blood do not show significant correlations with metabolic parameters.

Severe vaso-occlusive retinopathy associated with systemic lupus erythematosus.

Introduction: Systemic lupus erythematosus (SLE) is a systemic idiopathic autoimmune inflammatory disease, with multiple organ involvement. Severe vaso-occlusive retinopathy is a rare, sight threatening lupus-related manifestation of the disease, which is more common in patients with coexisting antiphospholipid syndrome. Case report: We reported a 36-year-old female with severe vaso-occlusive retinopathy that manifested in the absence of antiphospholipid syndrome. In a 4-year follow-up, despite aggressive systemic corticosteroid and immunosuppressive therapy and panretinal laserphotocoagulation treatment, the disease progressed to retinal neovascularisation, neovascular vitreoretinopathy, neovascular glaucoma and, consecutively, severe visual loss. As the final option for preservation of visual function, pars plana vitrectomy with laserphotocoagulation was performed and had good results. Progression of ophthalmological findings indicated the progression of the systemic disease, as well as neurolupus. Conclusion: Severe vaso-occlusive retinopathy occurred as the ophthalmological manifestation of SLE in the absence of antiphospholipid syndrome, but correlated with neurolupus and led to visual deterioration despite the treatment.

ENERGY SYSTEMS IN SURGERY.

INTRODUCTION: The systems of energy in surgery are applied in order to achieve better and more effective performing of procedures. Whereas various energy sources, including electricity, ultrasound, laser and argon gas, may be used, the fundamental principle involves tissue necrosis and hemostasis by heating. ELECTRO SURGERY: Electro Surgery is a surgical technique by which surgical procedures are performed by focused heating of the tissue using devices based on high-frequency currents. It represents one of the most frequently used energy systems in laparoscopy. ULTRASOUND ENERGY: The basic principle of operation of the ultrasound surgical instruments is the usage of low-frequency mechanic vibrations (ultrasound energy within the range of 20-60 kHz) for cutting and coagulation of tissue. LASER: Laser is the abbreviation for Light Amplification by Stimulated Emission of Radiation, aimed at increasing light by stimulated emission of radiation and it is the name of the instrument which generates coherent beam of light. ARGON PLASMA COAGULATION: It has been in use since 1991 for endoscopic hemostasis. It uses high-frequency electric current and ionized gas argon. The successful application of devices depends on the type of surgical procedure, training of the surgeon and his knowledge about the device. Surgeons do not agree on the choice of device which would be optimal for a certain procedure. CONCLUSION: The whole team in the operating room must have the basic knowledge of the way an energy system works so as to provide a safe and effective treatment of patients. The advantages and shortcomings of different systems of energy have to be taken into account while we use a special mode.

PHARMACOLOGICAL INTRAVITREAL TREATMENT FOR MACULAR EDEMA IN BRANCH RETINAL VEIN OCCLUSION - THREE-MONTH RESULTS.

INTRODUCTION: Macular edema is the main cause of visual loss in patients with branch retinal vein occlusion. Macular edema is initially reversible, but over time, permanent loss ofvision occurs from structural damage to the macula. For this reason, there is a need for more rapid and effective treatments than laser photocoagulation which has been established as a gold standard. There are several pharmacologic agents which have changed the management of macular edema. MATERIAL AND METHODS: Twenty eyes of 20 consecutive patients of the Department of Eye Diseases, Clinical Center of Vojvodina, in Novi Sad, were enrolled in this prospective, randomized and consecutive study conducted from January 2012 to January 2013. The patients were randomly assigned into two treatment groups, and they were given an intravitreal injection of bevacizumab 1.25 mg/0.05 mL (Avastin®), or triamcinolone acetonid injection 4 mg/0.1 mL (Kenalog®). Reinjections were performed according to the following retreatment criteria a loss of visual acuity or increase in central retinal thickness. RESULTS: Both intravitreal bevacizumab and triamcinolon-acetonid were very effective in reducing macular edema and improving visual acuity in the eyes with macular edema secondary to retinal vein occlusion. The effect of the treatment was more pronounced if it started early after the onset of macular edema. The reported temporary effects of intravitreal triamcinolon-acetonide and bevacizumab could be explained by their clearance from the eye. CONCLUSION: The short-term results of our clinical trial showed that pharmacological intravitreal agents, such as bevacizumab and triameinolon-acetonid, lead to rapid resolution of macular edema and significant improvement of visual acuity.

[The effects of functional knee bracing after anterior cruciate ligament reconstruction].

INTRODUCTION: Limited surgical technology in treating injuries of the anterior cruciate ligament (ACL) in the past led to the development of a huge number of functional braces. Today, with the advance of the surgical techniques and a more aggressive rehabilitation approach in the postoperative course the use of functional braces after the ACL reconstruction is seriously questioned. The aim of this study was to review the basic functions of functional braces. Mechanical, and biomechanical functions of functional braces have been described, the psychological aspect of wearing them, their impact on thigh circumference, functional performance, muscle activity and postural control and propriocepation have also been addressed. Functional braces definitely increase the knee stability under low clinical loads. However, biomechanical investigations show that functional knee braces do not restore the normal knee stability under high forces related to certain activities. Furthermore, functional braces do not significantly influence proprioceptive abilities, nor functional performance, but have a negative impact on thigh atrophy, and inhibit joint muscle stabilizing activity. CONCLUSION: Given the generally high surgical success rates, there has been no scientific evidence so far to support the routine use of a functional knee brace following a successful anterior cruciate ligament reconstruction in the controlled rehabilitative postoperative course.

Clinical characteristics of infectious spondylodiscitis.

Spondylodiscitis represents an inflammatory process, localized in the vertebrae body and in the intervertebral discs. The goals of this research were to identify subjective complaints, clinical findings, and laboratory characteristics in patients with spondylodiscitis, as well as to establish the importance of magnetic resonance imaging in diagnosing this disease. The data of 40 patients treated at the Clinic for Infectious diseases of the Clinical Center of Vojvodina from 2003 till 2007 were reviewed. Majority of the patients had low back pain (90%). Fever was present in 37.5% of patients (chi2 = 2.5; p > 0.05). Laboratory parameters of inflammation were higher than normal in most of the patients before the treatment. Diagnosis of spondylodiscitis was made using MRI in 97.5% of the patients. Keeping in mind unspecific subjective complaints and clinical findings in patients with spondylodiscitis, a health professional should always suspect spondylodiscitis when back pain occurs, in order to diagnose and treat this severe disease as early as possible. Magnetic resonance imaging is the most advantageous method in diagnosing spondylodiscitis.

[Evaluation, treatment and evolution of Broca's aphasia].

This paper presents the evaluation treatment and improvement of a patient with Broca's aphasia. A specific form of speech therapy, based on the peculiarities of the clinical picture of Broca's aphasia, was applied during one year. Our results have shown that this form of therapy leads to a significant improvement of the communicative abilities, even in the cases with severe form of aphasia. The importance of application of the specific methods and therapies for the rehabilitation of aphasic patients is pointed out.

[A historical review of the development of physical medicine and rehabilitation service in Vojvodina].

At the end of 1959, the Department of Physical Medicine and Rehabilitation was founded as a part of the Main Provincial Hospital in Novi Sad and it was located in the building built for that purpose in 1958. This institution specialized for rehabilitation was the first of its kind in the region of Vojvodina. Drilling of the first well in the area of today's Futoski park began in 1897. Chemical analysis showed the presence of iodine in the mineral water. Construction of the iodine spa started at the beginning of the 20th century, and it has been changing ever since. The Department of Child Rehabilitation, the first and only in Vojvodina, was established at the end of 1968, at the Institute of Mother and Child Health Care, and it has been treating children with cerebral palsy from the territory of Novi Sad. Although their names have been changed through the time, all three physically separated objects for medical rehabilitation have the same purpose: to promote and improve the quality of healthcare for children and adults with various disabilities, by using modern principles of physical therapy and medical rehabilitation. All three institutions, the present Medical Rehabilitation Clinic, Special Hospital for Rheumatic Diseases and the Child Rehabilitation Clinic, are teaching hospitals of the Faculty of Medicine and of the Secondary Medical School Physical Medicine and Rehabilitation is also an undergraduate and graduate course for medical students of the Faculty of Medicine in Novi Sad.

[Acute myocardial infarction incidence and mortality rates in the population of the city of Nis in the period 1974-2000].

INTRODUCTION: The aim of this study was to investigate the annual incidence of hospital morbidity and mortality rates of acute myocardial infarction (AMI) in the population of Nis who were treated at the Cardiology Clinic in Nis during the period 1974-2000. MATERIAL AND METHODS: A retrospective clinical-epidemiological study was carried out in the population of the city of Nis aged 30 years and over. The number of citizens of Nis, aged 30 years and over, was 71,500 in 1974, and 100,000 in 2000, while the male to female ratio was 48%:52%. RESULTS: During the period from 1974 to 2000, 4319 patients of both sexes with AMI received hospital treatment. The average annual incidence rate was 159.92 per 100,000 inhabitants aged 30 years and over. The average annual incidence of AMI showed a trend of progressive increase, and in 2000 it was 274.87 (2.7 times higher than in 1974--102.19). The average annual mortality for both sexes was 1.57% (9.82% for males and 15.89% for females). The female mortality rate was significantly higher (p < 0.001). CONCLUSION: Trends in annual incidence rate of AMI in the population of the city of Nis aged 30 years and over are characterized by progressive increase during the period from 1974 to 2000. The trend line: yt = 159.92 + 6.2432x shows that without primary prevention further increase in the incidence of AMI can be expected.

Types of psychological reactions in patients with lower-extremity amputations.

The aim of this study was to establish types of psychological reactions and conditions in patients with lower-extremity amputations. Apart from using psychological interviews, detection was performed using psychometric tests: Minnesota Multiphasic Personality Inventory and Beck Depression Inventory. Psychometric parameters were analyzed in a group of 20 examinees treated at the Medical Rehabilitation Clinic in Novi Sad. Out of the whole sample, 45% of patients presented with adaptive reactions to amputation and consequent disability, whereas 55% presented with maladaptive responses. The registered psychopathological symptoms included nosologic categories: reaction to stressful events and adjustment disorder (predominantly affecting other emotions; mixed disorder of conduct and emotions; prolonged depressive reaction) and dysthymia. When working with lower-extremity amputees, apart from adaptive, nonpathological forms of behavior, one also encounters maladaptive responses with predomination of mood disorders due to severe somatic stress.

[Post-surgery medical rehabilitation of patients with malignant bone tumors].

INTRODUCTION: Bone tumors are relatively rare tumors. The incidence of malignant bone tumors is 8.7 per million. The most frequent and also the most dangerous are osteosarcomas and Ewing's sarcoma. TREATMENT OF BONE TUMORS: which usually affect young people under the age of twenty. These tumors are treated with chemotherapy, radiotherapy, immunotherapy and surgery. Modern surgical pracitce in treatment of bone tumors relies on sparing the affected extremity. Lower limb amputation for bone cancer patients used to be the most frequent surgical procedure, but today it is being done only in the minority of cases. Amputations were performed to prevent local spreading of the tumor, as well as secondary deposits. With major advance of chemotherapy and surgical techniques in order to spare the extremity, therapeutical significance of amputation has decreased, although their number is still high. PROSTHETIC REHABILITATION: In cases where amputation has been suggested as an option, the patient must be informed about all the aspects of prosthetic rehabilitation, from those directly concerning the psychophysical integrity up to technical and functional possibilities of prosthetic rehabilitation. Saving the patient's life is, of course, the first priority, but it must be followed by social reintegration and return to work. CONCLUSION: If we analyze the length of rehabilitation, we can conclude that patients with cemented modular oncological endoprostheses recover faster than patients undergoing other techniques as well as amputees. However, the level of patient's functional performance is different. Sometimes, higher functional impairment and sparing the extremity, at the end of the rehabilitation is associated with a lower degree of functional capacity and esthetically a less appealing walk than it is the case with patients undergoing amputation, provided with modern prostheses.

[The role of physical training in patients after myocardial infarction].

INTRODUCTION: Physical training is an optimal method of rehabilitation of cardiovascular patients, especially in patients with myocardial infarction. The aim of this study was to evaluate the effects of physical training in patients with myocardial infarction during the post-hospital phase and prolonged rehabilitation by determining the test exercise parameters. MATERIAL AND METHODS: This prospective clinical study included 230 patients after myocardial infarction. Group A (180 patients) participated in organized forms of exercise (post-hospital rehabilitation and prolonged rehabilitation at home) for 48 +/- 6.4 months, while the control group was without physical training. The first clinical examination and the exercise test were performed in group A after post-hospital rehabilitation and after 191 +/- 16.4 days in the control group. In all patients the last control was performed 48 +/- 6.4 months after myocardial infarction. RESULTS: After the first control, the mean physical workload in group A was significantly higher compared with the control group (p < 0.05). After a 48 month follow-up period the physical workload was significantly higher in group A (p < 0.01), while in the control group a significant increase of workload was not observed (p > 0.05). Comparing the duration of exercise testing, significant differences were found after the first and last control (p < 0.05; p < 0.01, respectively). The double product was significantly higher in group A than in the control group after the first and last control (p < 0.05; p < 0.01, respectively). CONCLUSION: Prolonged physical training is beneficial for patients after myocardial infarction, because it improves cardiovascular functions and physical work capacity, improves angina threshold and the patient's general health.

[Early rehabilitation after traumatic brain injury and cerebrovascular accident--functional tests database].

INTRODUCTION: This paper deals with implementation of functional tests used in early rehabilitation into medical record databases. A pilot-testing of certain measurement instruments was performed to establish if they can be used in short intervals as variables for traumatic brain injury patients and those with stroke in intensive care units. The steering group gave critera for inclusion/exclusion. MATERIAL AND METHODS: We followed up four groups of 15 patients. On admission, their Glasgow Coma Score (GCS) was 5-8, 9-12, 13-15. Patients with isolated traumatic brain injury (TBI) were examined using Disability Rating Score (DRS); patients with GCS 13-15 underwent Galveston Orientation and Amnesia Test (GOAT); stroke patients were tested using Motricity Index and the Canadian Stroke Scale. All test were performed for five days in a row. RESULTS: In the first group, DRS results were identical in all cases. Differences were found in patients with GCS higher than eight, while GOAT was positive in four patients that required neuropsychological testing. In stroke patients, Motricity Index was more discriminative than the Canadian Stroke Scale. CONCLUSION: In accordande with our results, the steering group accepted DRS as the variable for patients with GCS 9-12 and 13-15, GOAT for patients with GCS 13-15 and Motricity Index for stroke patients.

[Effects of physical training on the lipid profile of patients after myocardial infarction].

INTRODUCTION: Positive effects of physical training on blood lipoprotein have been clearly demonstrated and they are constituive elements in prevention and treatment of hyperlipoproteinemia. The aim of this study was to evaluate the effects of physical training (PT) on lipid risk factors in patients with myocardial infarction (MI) during posthospital rehabilitation (PHR) and prolonged rehabilitation (48 months). MATERIAL AND METHODS: The prospective clinical study included 230 patients after MI. Patients were divided into two groups: group A (180 patients) participated in organized PT (PHR and prolonged rehabilitation at home) that lasted 48&6.4 months and the control group (50 patients) without PT. The intensity of PT was recommended to be 70% of maximal heart rate obtained during the exercise test (ET). Evaluation of lipid profile was done after the last control (48+/-6.4 months after MI). Parameters in the control group were compared with the parameters in the examined group of patients. RESULTS: Hyperlipidemia, as a risk factor, was present in 39% of patients of group A and in 38% of patients ofthe control group just after MI. A statistically significant difference wasn't established in lipoprotein levels in examined groups of patients before MI (p>0.05). Prolonged PT leads to significant deacrese of total cholesterol (p< 0.01), LDL/cholesterol (p < 0.05) and triglycerides (p<0.01), but increase in HDL/holesterol (p 0.01), in patients after MI with organized rehabilitation in comparison with the control group. CONCLUSION: Prolonged PT has a beneficial effect on hyperlipoproteinemia inl patients after MI. We have to practice PT over the "threshold" of physical activities if we want to achieve optimal results.

[Quality of life in patients with subacute low back pain treated with physiotherapy rehabilitation].

INTRODUCTION: Low back pain is one of the most frequent health problems. The aim of the study was to investigate clinical effects of complex rehabilitation programs on quality of life of patients with subacute lumbar pain, and also to investigate the relationship between quality of life and the intensity of pain and local functional status of the lumbar spine. MATERIAL AND METHODS: The prospective study included 60 patients suffering from subacute low back pain with radiculopathy caused by lumbar disc syndrome, without any previous treatment, and who did not need surgery. In a single blind trial patients were divided into two groups. The first group (A group, n=30) was treated by low level laser therapy (wavelength 904 nm, frequency 4000 Hz, at dose 2J per point); the whole dose of 12J, then with TENS (frequency 80 Hz, 30 minutes, pulse duration 200 micros), with exercise, and simultaneously with conventional therapy with NSAIDs which inhibit COX-2 (meloxicam, 15 mg per day). Patients were treated 5 times a week, a total of 15 treatments. The second group (B group, n =30), was treated only by meloxicam (15 mg per day). The subjects were evaluated before the first treatment and three days after the last treatment (21st to 24th day). Data were analyzed using Student's t test and with analytic statistical methods. RESULTS: The mean Oswestry scores before and after therapy for group A have reduced from 25+/-2 to 16+/-3, with statistical significance (t= 8.84 p<0.001) and in group B from 24+/-2.5 to 22+/-2.5 (t=2.56 p<0.05). Statistical analysis has shown an increase of mean values for the 12-item health survey (SF-12) from 22.33+/-4.66 to 36.33+/-3.66 (t=9.12 p<0.001), in group A and from 23.66+/-3.66 to 30.33+/-4.66 (t=3.15 p <0.001) in group B. Mean values of intensity of pain in group A have been reduced from 82+/-6.50 to 46+/-5.50, (t=7.85, p<0.001) and from 80+/-5.50 to 62+/-6.50 in group B (t=5.65; p<0.001). No significant changes have been recorded in Schober measurement. The intensity of pain was in positive correlation with Oswestry score (Ft=7.84; p<0.001) in group A and also in group B (Ft=5.25: p<0.05), as for the 12-item health survey (SF-12) (Ft=8.34: p<0.001) in group A and in group B (Ft=5.98; p<0.05). Two measurements of quality of life have shown close relationship (Ft=5.45; p<0.05) in group A and group B (Ft=6.45: p<0.05). CONCLUSION: Results of this study showed that better results were achieved in group treated with complex rehabilitation methods in comparison with patients treated only with anti-inflammatory drugs. Also, the 12-item health survey (SF-12) has shown positive correlation with intensity of pain reduction and with Oswestry disability score and so it is valid for measuring the effectiveness of therapeutic modalities in subacute lumbar pain.

[The frequency of metabolic and endocrine diseases in patients with various types of osteoarthritis].

INTRODUCTION: Osteoarthritis is characterized by the breakdown and loss of joint cartillage, increased bone density just underneath the cartillage and bone hypertrophy on the edges of the joint surfaces. The aim of the study was to determine the age and sex distribution, as well as the incidence of metabolic and endocrine diseases in patients with osteoarthritis. MATERIAL AND METHODS: The research included 347 patients hospitalized at the Clinic for Medical Rehabilitation in Novi Sad during 2005. RESULTS: Analysis of the age distribution shows that most patients over sixty years of age have degenerative changes of the peripheral joints and large percentage of the working population has changes of the spinal column. The most frequent metabolic disease is obesity (74% of patients), followed by diabetes, ostheoporosis and hypothyroidism. The average age of surgically treated women is lower compared with the surgically treated men. CONCLUSION: By analyzing the results of the study, we can conclude that there is a large incidence of metabolic and endocrine diseases among patients with osteoarthritis, as well as that rehabilitation leads to faster and a more complete recovery of patients with degenerative joint diseases.

[Value and methods of respiratory rehabilitation after chest trauma].

INTRODUCTION: In developed countries, traffic accidents are the primary cause of multiple injuries, while falls and violence are notable contributors as well. Rehabilitation techniques are therefore used in semi-intensive and intensive care units during the pre- and postoperative period for the most appropriate treatment of such patients. REHABILITATION TECHNIQUES AFTER CHEST TRAUMA: Rehabilitation techniques in patients with chest trauma who are unconscious and on mechanical ventilation are significantly different than in patients who are conscious and breathe spontaneously. The goals of rehabilitation in these patients are to prevent respiratory complications, skeletal and muscular changes, deep venous thrombosis, and to maintain skin integrity. Respiratory techniques are combined, depending on the general condition of the patient and type of trauma (unilateral or bilateral serial rib fracture, thoracic shutter, lung contusion, pleural effusion, bronchial trauma). CONCLUSION: Opportune use of early rehabilitation prevents appearance of early (lung atelectasis, bronchopneumonia) and late complications (hematoma, empyema). Value of rehabilitation techniques in these patients is great, because most of them were in good health and fully capable of working prior to the injury.

[Effects of intermittent negative pressure ventilation on impaired microcirculation in diabetes--a case report].

INTRODUCTION: Generally impaired microcirculation, with microvascular and neuropathic complications, is one of the most severe consequences of diabetes mellitus. Considering the fact that drug therapy ad physical training may have adverse effects, we decided to utilize the beneficial effects of hypobaric sac treatment on skin microcirculation (using Greensac-Iskra Medical, Slovenia). CASE REPORT: A female patient, 64 years of age, with a past medical history of diabetes mellitus type IIb (last 18 years) complained of intermittent claudication (the pain score after a 150 m walk was 7, on a scale from 1 to 10). The temperature at her left popliteal pit was 34.8 degrees C, and at the right pit 34.9 degrees C. The temperature at the left dorsal pedis artery was 34.4 degrees C and at the right 34.1 degrees C. We applied intermittent negative pressure ventilation on the lower limbs in order to improve the microcirculation (using Greensack by Iskra-Medical, Slovenia). A total of ten 20-minute treatments were delivered in a month time, three treatments a week. After treatment, the temperature at the left popliteal pit was 35.2 degrees C, and at the right pit 35.4 degrees C. The temperature at the left dorsal pedis artery was 34.7 degrees C and at the right 34.6 degrees C. The pain score after a 150 m walk lovered to 4. CONCLUSIONS: We concluded that the one-month treatment with Greensack (10 treatments in total) had beneficial effects on patient's microcirculation. These initial results are considered encouraging, but the number of examined parameters and the length of treatment should also be increased.