The Impact of Thrombolytic Therapy on Anxiety, Depression and Quality of Life of Patients with Acute Ischemic Stroke.

BACKGROUND: It is well established that thrombolytic therapy improves the functional recovery by reducing disability measured as National Institutes of Health Stroke Scale (NIHSS) and Rankin score in patients with ischemic stroke. However, the role of alteplase treatment on anxiety and depression in those patients is less clear. Therefore, the aim of this study was to determine whether patients treated with thrombolytic therapy had a better quality of life, less anxiety and depression compared to patients who were not treated with thrombolysis. SUBJECTS AND METHODS: In this "single canter study" 60 patients with acute ischemic stroke were divided into two groups: alteplase treated (AT) group, and not treated (NT) group. The sociodemographic data including gender, age, marital status, education, employment, financial status, place of residence, refugee status were collected at the beginning of study. The NIHSS score and modified Rankin score (mRS) were performed on admission and at discharge from hospital. Six months following discard from hospital the Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI) and the Short Form 36 quality of life (SF-36 QoL) were performed. RESULTS: There were no differences in mean NIHSS and mRS at admission to hospital between the groups. At discharge from hospital patients in AT group had significantly lower NIHSS and mRS than patients in NT group. In post-stroke period the patients from AT group had significantly less anxiety and depression than patients from NT group (BAI in AT 6.4+4.17 vs BAI in NT 14.27+7.01 and BDI in AT 9.20+6.61 vs BDI in NT 18.0+7.49). Patients in AT group had significantly better SF-36 QoL score in all components than NT group. CONCLUSION: The results of this study showed that thrombolytic therapy reduced the intensity of anxiety and depression and improves the quality of life of patients six months after ischemic stroke.

Morphology and digitally aided morphometry of the human paracentral lobule.

The human paracentral lobule, the junction of the precentral and postcentral gyri at the medial hemispheric surface, contains several important functional regions, and its variable morphology requires exact morphological and quantitativedata. In order to obtain precise data we investigated the morphology of the paracentral lobule and quantified its visible (extrasulcal) surface. This surface corresponds to commonly used magnetic resonance imaging scout images. We studied 84 hemispheres of adult persons (42 brains; 26 males and 16 females; 20-65 years) fixed in neutral formalin for at least 4 weeks. The medial hemispheric surface was photographed at standard distance and each digital photo was calibrated. Using the intercommissural line system (commissura anterior-commissura posterior or CA-CP line), we performed standardised measurements of the paracentral lobule. Exact determination of its boundaries and morphological types was followed by digital morphometry of its extrasulcal surface using AutoCAD software. We found two distinct morphological types of the human paracentral lobule: continuous type, which was predominant (95.2%), and rare segmented type (4.8%). In hemispheres with segmented cingulate sulcus we also found the short transitional lobulo-limbic gyrus (13.1%). The mean extrasulcal surface of the left paracentral lobule was significantly larger, both in males (left 6.79 cm2 vs. right 5.76 cm2) and in females (left 6.05 cm2 vs. right 5.16 cm2). However, even larger average surfaces in males were not significantly different than the same in females. Reported morphological and quantitative data will be useful during diagnostics and treatment of pathologies affecting the human paracentral lobule, and in further studies of its cytoarchitectonic and functional parcellations.

Kinking, coiling and diameters of vertebral artery first segment and their relationships to sex and side.

INTRODUCTION: Recent information on tortuosity in the prevertebral (V1) segment of the vertebral artery is based on case reports rather than systematic data on its presence, types, diameters, and sex- or left-right differences.

Morphological variability of the subcallosal area of man.

BACKGROUND: Knowledge of morphology of human anterior cingulate and medial frontal cortex related to the knee of corpus callosum is important in the diagnostics and neurosurgical treatment. Neuroimaging studies did not provide a clear picture of this region, what is also caused by terminological inconsistencies. It is not always clear what is actually defined under the terms subcallosal area, subcallosal cingulate gyrus, subcallosal gyrus, subcallosal region, or subgenual prefrontal gyrus. Our study of subcallosal area provides morphological data useful for recent imaging studies. METHODS: Digital photographs (42 formaline fixed brains: 26 males, 16 females) were used in morphometry (surfaces and lengths) of subcallosal area. We defined all its boundaries: superoanterior, anterior, posterior, and inferior one. If anterior subcallosal sulcus, as anterior delineation of subcallosal area was absent, we used intercommissural line system. RESULTS: Anterior subcallosal sulcus we found in 86.9% of cases. Its variations were classified into four types: Type 1-vertical or slightly oblique sulcus (most often type on right hemispheres-30.1%), Type 2-in form of letter C or inverted letter C (most often type on left hemispheres-42.9%), Type 3-sulcus in form of letter S or inverted letter S, and Type 4-sulcus not belonging to any previous type. Mean surface of subcallosal area was in males 2.65 cm(2) (right hemispheres), and on left 2.70 cm(2). In females on right it was 2.56 cm(2), and on left 2.55 cm(2). All measured values were not significantly different (left/right; males/females). CONCLUSIONS: Accurate neuroanatomical localization requires exact determination of boundaries of subcallosal area. Therefore, standardized criteria were proposed for definition of subcallosal area.

Alternative method for direct measurement of tibial slope.

BACKGROUND/AIM: The tibial slope is one of the most frequently cited anatomical causes of anterior cruciate ligament trauma. The aim of this study was to determine the possibility of direct measuring of the tibial slope of the knee without prior soft tissue dissection in cadavers. METHODS: Measurement was performed on the two groups of samples: osteological and cadaveric. The osteological group consisted of 102 matured tibiae and measurement was performed: indirectly by sagittal photographing of the tibia, and directly by a set of parallel bars. The cadaveric group consisted of 50 cadaveric knees and measurement was performed directly by a set of parallel bars. The difference and correlation between indirect and the direct measurements were observed, which included also measuring of the difference and correlation of the tibial slope on the medial and lateral condyles. RESULTS: A statistically significant difference between the direct and indirect method of measuring (p < 0.01) of 1 degree was found for the tibial slope on the medial condyle, which is of no practical importance. Direct measurement of the osteological and cadaveric groups of samples did not show a statistically significant difference regarding the values of the tibial slope on the lateral condyle (p > 0.05). However, the slope on the medial condyle, as well as indirect measurement showed a statistically significant difference (p < 0.01). CONCLUSION: By the use of a set of parallel bars it is possible to measure the tibial slope directly without removal of the soft tissue. The results of indirect, photographic measurement did not statistically differ from the results of direct measurement of the tibial slope.

Predicting ACL rupture in the population actively engaged in sports activities based on anatomical risk factors.

The purposes of this article were identification (ie, verification and gradation) of anatomical risk factors that lead to anterior cruciate ligament (ACL) injury and determination of the probability of ACL injury among the population actively engaged in sports activities. We evaluated 66 patients divided into 2 groups: 33 patients in the examined group diagnosed with ACL lesion, and 33 patients in the control group diagnosed with patellofemoral pain. Patients were matched by age, sex, type of lesion, and whether the lesion was left or right sided. Measurements were carried out by radiography and magnetic resonance imaging. The study examined 32 anatomical factors. After identifying factors that lead to ACL injury, the following were determined: the coefficient of significance for each individual factor via the discriminant analysis and the canonical discriminant (i.e., canonical correlation). Fifteen factors in men and 8 factors in women were differentiated as having influence on ACL injury. Based on these factors, it was determined whether the patients belonged to the examined or the control group with a success rate of 100% in men (100% sensitivity and specificity) and 91.7% in women (100% sensitivity and 83.3% specificity). The anatomy of the ACL prone to rupture and of the skeletal structures influencing it is significantly different from the anatomy of the ACL ligament resistant to injury. The probability of precise prognosis of ACL injury based on differentiated anatomical factors is 88.9% in men and 75.7% in women actively engaged in sports activities.

The third branch of the main trunk of the left coronary artery in Cercopithecus aethiops sabaeus. Is the nonhuman primate model appropriate?

The aim of this study was to investigate the morphometry of branching patterns of the main trunk of the left coronary artery (MT of LCA) in nonhuman primates, and comment on the current nomenclature. The biometric study was performed using stereomicroscopic dissection of hearts of healthy and fertile nonhuman primates (Cercopithecus aethiops sabaeus) of both sexes. Our results reveal that the MT of LCA terminates in a bifurcation into the anterior interventricular branch (AIB) and the circumflex branch (CB) (74.6%), trifurcation into the AIB, CB, and diagonal branch (DB) (23.6%), or occasionally quadrifurcation into the AIB, CB, and two DBs (1.8%). This is similar to the case in humans. Furthermore, two morphological aspects of the DB spatial distribution, in addition to its branching pattern, resemble the DB in humans. Myocardial bridges observed over the DB in the Cercopithecus aethiops heart further contribute to the similarity with humans. The resemblance of the DB and its branches to their human counterparts make them a suitable model for experimental study on coronary circulation.

[Digital morphometric study of the extrasulcal surface of the cingulate gyrus in man].

INTRODUCTION: The frequency of different morphological types and extrasulcal (visible) surface area of the cingulate gyrus, were measured and analysed in order to obtain more precise data about morphology, right/left and sex differences in the human brain. MATERIAL AND METHODS: The study included 42 brains (84 hemispheres) from persons of both sexes and of different age (26 males, 16 females, 20-65 years old), without neuropathological changes. After fixation in 10% formaline (3-4 weeks) and removal of meninges the brains were photographed under standard conditions by digital camera. Following determination of morphological type, regions of interest of cingulate gyrus were determined in stereotactic system system of coordinates and the extrasulcal surface was measured by digital AutoCAD planimetry. RESULTS AND DISCUSSION: Three basic morphological types of cingulate gyrus were found: the continuous type (34.5%), segmented type (35.7%) and double paralel type (29.8%). There was no statistically significant difference in the frequency of morphological types related to the side (right/left) or sex (p 0.05). The area of extrasulcal cortex of cingulate gyrus was statistically significantly (p < 0.05) larger on the left hemispheres (for 1.13 cm) than on the right (left: 14.58 cm; right: 13.45 cnm. 7he extrasulcal surface of the left cingulate gyrus was significantly larger (p 0 .05) in males (males 15.9 cm; females - 13.6 cm), while for the right cingulate gyrus this difference was not significant. CONCLUSION: Morphometry indicated sex and right/left differences of extrasulcal surface area of the human cingulate gyrus. However, the morphological analysis itself did not indicate corresponding differences, suggesting complexity of the problem of sex dimorphism and of right/left asymmetries in the domain of limbic cortex.

[Asymmetry and sexual dimorphism of the medial frontal gyrus visible surface in humans].

BACKGROUND/AIM: Studies of visible (extrasulcal) surface of the brain hemispheres are not feasible for measurements of the brain size, but are valuable for analysis and quantification of sexual dimorphism and/or asymmetries of the human brain. Morphological and morphometric investigations of the brain may contribute in genetic studies of the human nervous system. The aim of this study was to determine and to quantify sexual dimorphism and the right/left morphological asymmetry of the visible surface of medial frontal gyms (gyrus frontalis medialis - GFM). METHODS: Measurements and analysis of the visible surface of GFM were done on 84 hemispheres (42 brains from the persons of both sexes: 26 males and 16 females, 20-65 years of age). After fixation in 10% formalin and dissection, digital morphometric measurements were performed. We studied these in relation to the side of the hemisphere and the person's sex. Standardized digital AutoCAD planimetry of the visible surface of GFM was enabled by the use of coordinate system of intercommissural line. RESULTS: In the whole sample, the visible surface of the right GFM (21.39 cm2) was statistically significantly greater (p < 0.05) than the left GFM (18.35 cm2) indicating the right/left asymmetry of the visible surface of GFM. Also, the visible surface of the right GFM in the males (22.66 cm2) was significantly greater (p < 0.05) than in the females (19.35 cm2), while the difference in size of the left GFM between the males and the females was not significant (p > 0.05). CONCLUSION: Morphological analysis of visible surface of GFM performed by digital planimetry showed sexual dimorphism of the visible surface and the presence of right/left asymmetry of GFM.

[Outcome of the pediatric post-traumatic contracture of the elbow]. / Ishod lijecenja posttraumatskih kontraktura lakta kod djece.

INTRODUCTION: Pediatric elbow contractures may happen as a consequence of the various injuries in the elbow area. PURPOSE: The aim of this article has been to analyze outcome of the therapy of the pediatric elbow posttraumatic contracture in relation to primary injury and to establish if the age of the children has effect on the length of hospital stay of the children with posttraumatic elbow contractures. WORK METHOD: We analyzed 75 children (51 boys and 24 girls); average age 9.1 +/- 3.2 years that have been treated in Rehabilitation center because of the posttraumatic elbow contractures. The average duration of rehabilitation was 40.1 days. Rehabilitation included procedures of the physical therapy and splints. The other group of the 80 healthy children was control group. Range of motion of elbow joint was measured for each child by goniometry. WORK RESULTS: The most often pediatric elbow contractures were in the children with supracondylar fractures (39 or 52%) at the beginning of the therapy and at the end of the therapy in the children with condylar fractures (7 children or 9.3%). Outcome of the therapy was the best in the children with supracondylar fracture (34 children or 87.2% had full range of motion of the elbow at the discharge). The average value of the range of motion of the elbow joint after physical therapy was 124.1(0). Outcome was the best in the children with supracondylar fractures. Age of the children was not significantly correlated with length of hospital stay (Pearson's coefficient of correlation, r = 0.267282). DISCUSSION AND CONCLUSION: Physical therapy has favorable effect on the outcome of the therapy of the pediatric elbow contractures and age of the children did not significantly correlate with length of hospital stay.

[Sexual dimorphism of the human corpus callosum--digital morphometric study].

BACKGROUND/AIM: Changes in the morphology and the size of the corpus callosum, are related to various pathological conditions. An analysis of these changes requires data about sexual dimorphism of the corpus callosum, which we tried to obtain in our study. We also investigated the method of digital morphometry and compared the obtained results with the results of other authors obtained by magnetic resonance imaging or by planimetry. METHODS: A morphological research included 34 human brains (cadavers of both sexes--19 female and 15 male aged 26-72 years). By digital morphometry using an AutoCAD software we performed measurements in the corpus callosum: the length (L), width in the half of its length (WW'), length of its cortical margin (LCM), area and perimeter of the anterior and posterior callosal segments, as well as the area and perimeter of the corpus callosum section area. The investigated parameters were analyzed and compared between the females and males. RESULTS: There was not a statistically significant difference between the males and females in the investigated parameters of the corpus callosum (t test; p > 0.05), including the mean values of the two most important parameters, the surface of its mid-sagittal section area (males 654.11 mm2; females 677.40 mm2) and of its perimeter (males 19.61 cm; females 19.72 cm). The results obtained by digital morphometry were in the range of the results of other authors obtained by magnetic resonance and by planimetry. However, the value of Pearson coefficient of linear correlation between the section surface area and perimeter of the corpus callosum in the males was highly significant (rxy = 0.6943, p < 0.01), while in the females this value was statistically insignificant. CONCLUSION: Digital morphometry is accurate method in encephalometric investigations. Our results suggest that the problem of sexual dimorphism of the corpus callosum is very complex, because the identical variables (section surface area or its perimeter) do not exhibit the same behavior in males and in females, implicating that these variables even cannot be simply compared between the sexes.

[Morphometric variability of precuneus in relation to gender and the hemisphere of human brain]. / Morfometrijska varijabilnost prekuneusa u odnosu na pol i hemisferu mozga covenka.

Precuneus, a quadrangular gyms of the medial surface of the human parietal lobe, is bound by three primary brain sulci and by superior hemispheric border. Precise encephalometric data about precuneus are important in the studies of brain lateralization, sex dimorphism, and brain functions in general. In this study, total and visible (exstrasulcal) surface area of the precuneus were measured on 50 brains of the adult persons (31 male, and 29 female), together with the investigation of its relationship to the side (left/right) and gender (sex dimorphism). The average total surface area of the precuneus was 16.07 cm2 on the right (males 16.44 cm2, females 15.27 cm2), and 15.44 cm2 on the left (males 15.67 cm2, females 14.62 cm2). The average visible (extrasulcal) surface area of cortex of precuneus was 9.97 cm2 on the left (males 10.75 cm2, females 8.91 cm2), and 9.38 cm2 on the right (males 10.25 cm2, females 8.19 cm2). Exstrasulcal surface area of the left precuneus was larger, by 0.59 cm on the average, which was not statistically significant. Total surface area of precuneus of males was significantly larger on the right (16.44 cm2) (p<0.01) than on the left (15.67 cm2). In females it was also larger on the right (15.27 cm2) than on the left (14.62 cm2), but with no statistical significance. Visible (exstrasulcal) surface area of both, (left and right precuneus of males), was highly significantly larger in comparison with the females (p<0.001). The obtained results and other facts suggested that sex dimorphism of human brain, including precuneus, was present, but not always easily observable, studied or proven in all the details.