The long-term risk of stroke in patients with acute myocardial infarction complicated with new-onset atrial fibrillation.

BACKGROUND: The long-term risk of stroke after acute myocardial infarction (AMI) complicated with new-onset atrial fibrillation (AF) remains unclear. The aim of this study was to determine the long-term risk of AF and stroke in patients with AMI complicated with new-onset AF. METHODS: Patients with AMI complicated with new-onset AF (n = 260) and those without new-onset AF (n = 292) were followed for a mean of 7 years. All patients had sinus rhythm at hospital discharge. RESULTS: During the follow-up, AMI patients with new-onset AF had more frequent AF than those without new-onset AF (10.4% vs 2.7%, respectively; P < 0.0001). New-onset AF during AMI was a significant predictor of subsequent AF occurrence (the time elapsing between 2 consecutive R waves [RR] = 3.15, P = 0.004); but AF recurrence in follow-up (RR = 5.08, P = 0.001) and non-anticoagulation at discharge (RR = 0.29, P = 0.008) were independent predictors of stroke (Cox regression analysis). A period of 3.5 hours of AF within the first 48 hours of AMI was the high sensitivity cut-off level for the prediction of low long-term risk of stroke obtained by receiver operating characteristic analysis. Among patients who did not receive anticoagulants at discharge, the patients with short AF did not experience stroke and AF recurrence during follow-up, while those in the other group developed it (10.8%, P = 0.038 and 13.5%, P = 0.019, respectively). CONCLUSION: New-onset AF during AMI identifies the patients at long-term risk for stroke who may potentially benefit from anticoagulant therapy. Atrial fibrillation recurrence in follow-up was independently related to the development of stroke. However, for low-risk patients with AF (those with short AF occurring early in AMI) long-term anticoagulants might not be required.

[The ischemic diabetic foot]. / Ishemijsko dijabetesno stopalo.

Among chronic complications of diabetes mellitus, the so-called diabetic foot is one of the most frequent causes of hospitalization. This paper is a report on contemporary data on etiopathogenesis, clinical features and diagnostics of angiopathic disorders causing diabetic foot. Special attention must be paid to initial lesions causing processes on subendothelial structures. Apart from well known risk factors causing ischemic ulcerations, increased values of Lp(a) are significant, as well as the decreased values of HDL cholesterol. Knowing causes of this disorder enables early detection of high-risk patients. Efficient identification and education of diabetics may stop large amputation in up to 50% of cases.

[Identification and rehabilitation of high-risk patients in the prevention of atherosclerotic ulceration]. / Identifikacija i rehabilitacija visokorizicnog pacijenta u prevenciji ateroskleroznih ulceracija.

From the medicosocial point of view, arteriosclerosis obliterans is important not only because of the increased number of the diseased, but also because of being more and more prominent in the mortality of cardiovascular diseases. This paper presents a case report which points to the importance of synchronized diagnostic and therapeutic process--on time identification of the II clinical stage of arteriosclerosis obliterans (electromyoneurography, US-Doppler, perfusion pressure), and application of physiotherapeutic measures which can contribute to effective therapy and rehabilitation. Using vasotrain apparatus (hyper-hypo-baric-effect) and other therapeutic measures in the patient with arteriosclerosis obliterans, diabetic polyneuropathy and compression traumatic radiculopathy, regression from the IIB to IIA clinical stage was achieved as well as of features of diabetic polyneuropathy. In this way the III clinical stage of arteriosclerosis obliterans can be delayed.

Denture cleaning techniques in the elderly affecting the occurrence of denture-induced stomatitis.

The aim of this paper was to establish if and to what extent being informed on oral hygiene procedures affects occurrence of denture-induced stomatitis in the elderly population. The investigation included 150 elderly denture wearers. The following was examined: denture cleaning techniques, incidence of denture-induced stomatitis, source of information in regard to oral health and level of education. The level of denture plaque was registered on the denture surface and expressed in percents. Only 30% of dentures were clean. It has been established that there is a statistically significant difference in occurrence of denture-induced stomatitis in patients who clean their dentures correctly and those who do it incorrectly. In patients with dentures demonstrating a greater level of plaque, the incidence of denture-induced stomatitis was higher. Only 18% denture wearers were given instructions on denture cleaning by their dentists. The level of education is not directly connected with oral health care. Apart from others, dentists should pay more attention to oral health care of the elderly.

[Acute painful neuropathy--2 case reports]. / Akutna bolna neuropatija--povodom dva slucaja.

Diabetic neuropathy, clinically established, occurs in up to 50% of diabetics, sometimes even prior to detection of diabetes mellitus. Distal symmetric polyneuropathy is the most frequent clinically established lesion of the nervous system. Other clinical entities, however, are not so rare, if they are studied with attention using differential diagnostic procedure. In this paper authors present two patients with sub-types of one of the rare forms of diabetic peripheral neuropathy--so called acute painful neuropathy: the first case associated with unregulated diabetes mellitus and in the second patient it occurred as a consequence of abrupt normalization of glycemic control with so-called insulin neuritis. The authors described the most important clinical characteristics of patients, differential diagnosis, therapy and the course of the disease.

[Guided tissue regeneration--the beginning of a new era in periodontal surgery]. / Vodena tkivna regeneracija--pocetak nove ere u parodontalnoj hirurgiji.

UNLABELLED: The therapy of deep infrabony defects in periodontal diseases has been a great problem for decades both for dentists and their patients, as well. After application of classic therapy in patients with serious stages of periodontal diseases (subgingival curettage, Modified Widmann flap surgery with and without implantation of implants) a significant strengthening of teeth in alveolus was observed, as well as alleviation of patient's discomfort, and decrease of the depth of periodontal pockets, bleeding, inflammation, etc. However, in spite of the application of this therapy a postoperative defect was sometimes filled with different low tissues of periodontium, in other words periodont reparation took place. For this reason, recidives could happen, as well as gingival recession, inflammation, root resorption. At the beginning of the nineties a new principal was introduced in the therapy of periodontal diseases: Guided Tissue Regeneration. This principal includes a controlled action between four different species of periodontal tissue: gingival epithelium, gingival connective tissue, alveolar bone, and periodontal ligament. This is achieved by surgical placement of non resorbale or bioresorbable periodontal membranes, which are placed during flap surgery above the previously treated infrabony defect. With membranes placed in that way the periodontal defect is for some time phisically separated from epithelium and gingival connective tissue and in that way alveolar bone is regenerated, as well as periodontal ligament in other words restitutio ad integram takes place. Nowadays, two concepts of guided tissue regeneration can be considered: a concept of isolation and a concept of integration. The first concept includes application of non resorbable, most frequently synthetic, membranes (so-called E-PTFE polyterafluorethylene) which replace the mucoperiosteal flap into its original position. After six weeks a patient is subjected to one more surgical intervention when flap is raised again and the non resorbable membrane is removed. The second operation diminishes the value and partially discredits the application of non resorbable membranes. For this reason, the concept of integration is today more frequently applied, that is to say the application of bioresorbable membranes is nowadays very frequent. They are by their chemical composition poly D,L lactides and they provide membranes with ideal resorption properties. Of great importance is their property to stay unchanged for six weeks, and then to be resorbed by geometrical progression. As the membrane is resorbed, it is not necessary to remove it, so there is no need for another surgery, and that enables the process of healing to proceed undisturbedly. For this reason, the concept of integration is also called a Single Step Method. CONCLUSION: On the basis of papers of the leading scientists from the field of guided tissue regeneration it can be concluded that by application of Single Step Method or in other words by application of bioresorbable membranes a tremendous progress was made in the therapy of infrabony periodontal defects. The application of these membranes is especially indicated in treating degree II furcation defects, then infrabony defects particularly with 2 and 3 walls and good results were also achieved in the therapy of a big problem in esthetic periodontology--gingival recession. A relatively low price, as well as simple application, biological compatibility and undisturbed process of healing of the wound are great advantages of the application of bioresorbable membranes, so in the near future their application on a large scale can be expected in the therapy of periodontal diseases, as well as further research work on their development, especially on their impregnation by growth factors, antibiotics, etc.

[The metabolic syndrome and hyper-Lp(a)-lipoproteinemia in peripheral obliterative atherosclerosis: 2 case reports]. / Metabolicki sindrom i hiper-Lp(a)-lipoproteinemija u perifernoj obliterantnoj aterosklerozi: povodom dva slucaja.

One of the characteristics of peripheral vascular disease in diabetic patients is that it occurs at the time of detection of diabetes mellitus. As one of the possible pathogenic mechanisms, in non-smokers, is the sol-called metabolic syndrome (obesity, disorders in regard to metabolism of lipids and carbohydrates and hypertension). Lipoprotein Lp(a) is the most atherogenic among lipoproteins. While data on coronary arterial disease exist, although contradictory, there is a small number of those which document the same for peripheral vascular occlusive disease in diabetics. Two patients, non-smokers, with characteristic constellation of risk factors, are described as possible models for further epidemiologic examinations.

[The metabolic X syndrome--4 case reports]. / Metabolicki sindrom X--povodom cetiri slucaja.

The study reviews current knowledge about metabolic X syndrome characterized by android obesity, arterial hypertension, insulin resistance with hyperinsulinemia and disturbed carbohydrate tolerance, a decrease of HDL cholesterol and an increase of the triglyceride rich VLDL particle level. The study describes 4 female patients having been diagnosed for this syndrome. Only an ontime and vigorous reduction of overweight, along with intensified physical activity can prevent later development of serious complications, first of all, in cardiovascular system.