Tensor fasciae suralis - Prevalence study and literature review.

Tensor fasciae suralis (TFS) is an accessory muscle of the posterior lower extremity. Although TFS has been documented in cadaveric and radiological reports, its prevalence remains unknown. The TFS variant is noteworthy to anatomists, as it may be encountered in the dissection laboratory, and clinicians, as the muscle could potentially cause confusion during physical examination or diagnostic imaging. Multiple variations of TFS have been reported in the literature, suggesting the need for a classification system. We dissected 236 formalin-fixed cadaveric lower limbs to determine the prevalence of TFS. The PubMed and MEDLINE databases were searched to compare the anatomical features of independent TFS case reports. In our prevalence study, the TFS muscle was identified in three lower limbs (1.3%). In total, 38 cases of TFS (32 cadaveric and six radiological) were identified in the literature. Our literature review revealed that the accessory muscle most often arises as a single head from the long head of the biceps femoris, yet many other presentations have been documented. The need for a classification system to distinguish between the subtypes of TFS became apparent during the literature review. Tensor fasciae suralis is a rare muscle, present in only 3 of 236 (1.3%) cadaveric lower limbs dissected in this study. We propose the use of a classification system, based on muscle origin and number of heads, to better organize the subtypes of TFS.

[Postoperative changes in left ventricular systolic function in patients with aortic valve stenosis]. / Postoperativne promene sistolne funkcije leve komore kod bolesnika sa stenozom aortne valvule.

Left ventricular systolic function in aortic stenosis remains intact for long period due to myocardial hypertrophy. Aim of this study was postoperative follow-up of the left ventricular systolic function both in patients with preserved and with decreased systolic performance. The study comprised 78 patients with severe and moderate aortic valve stenosis, out of whom 42 patients underwent surgery. In the majority of patients (88.1%) systolic function was improved, both in patients with preoperatively preserved systolic performance, and those who were with decreased systolic performance before the surgery. Systolic function was not improved in only 4.8%, while 3 (7.1%) patients died. Systolic function was improved mainly in the patients in whom systolic function disturbance was caused by the increase of afterload, and less frequently in patients with the decrease in myocardial contractility.

[Echocardiographic evaluation of left ventricular diastolic function in patients with aortic valve stenosis]. / Ehokardiografska procena dijastolne funkcije leve komore kod bolesnika sa stenozom aortne valvule.

Impairment of left ventricular diastolic function in aortic valve stenosis occurs very early and precedes the impairment of systolic function. Aim was to examine left ventricular diastolic function and its association with severity of myocardial hypertrophy and clinical picture. The paper comprised 78 patients with isolated aortic valve stenosis in whom were performed ultrasonography and catheterization. No significant differences in parameters of diastolic filling were observed in patients with mild hypertrophy and preserved systolic function compared to healthy subjects. In patients with moderate myocardial hypertrophy, left ventricular filling was decreased in an early diastole (Emax 51 +/- 5 cm/s, Evti 6.4 +/- 1.1 cm) and increased in late diastole (Amax 88 +/- 11 cm/s, Avti 11.4 +/- 1.8 cm), while deceleration time was prolonged (DT 171 +/- 32 ms). Pulmonary vein flow was decreased during diastole (Dmax 33 +/- 5 cm/s, Dvti 7.6 +/- 2 cm). Pseudonormalization of flow through mitral valve was observed in patients with pronounced hypertrophy of left ventricular wall (mass > 180 g/m2): increase of the velocity during the phase of fast left ventricular filling (Emax 72 +/- 13 cm/s, Evti 9.8 +/- 2.1 cm), decrease during atrial contraction (Amax 31 +/- 6 cm/s, Avti 3.7 +/- 0.4 cm), reduction in deceleration time (DT 116 +/- 11 ms), while pulmonary vein flow velocity was increased during the early diastole (Dmax 64 +/- 17 cm/s, Dvti 10.7 +/- 2.2 cm). Likewise, significant correlation between clinical picture and type of blood flow through mitral valve was observed.

[The electrocardiogram during physical stress and Holter monitoring in the detection of asymptomatic myocardial infarct]. / Elektrokardiogram pri fizickom opterecenju i Holterski monitoring u otkrivanju asimptomske infarkta miokarda.

INTRODUCTION: In patients with myocardial infarction acute myocardial ischaemia could be manifested by characteristic ischaemic symptoms or noncharacteristic symptoms such as cardiac insufficiency or heart rhythm disturbances. Sometimes myocardial ischaemia is not followed by any symptom. This condition is known as asymptomatic myocardial ischaemia. Asymptomatic myocardial ischaemia usually could be detected by treadmill exercise tolerance test or 24-hour Holter ECG monitoring. PATIENTS AND METHODS: We analyzed a group of 58 patients suffering from myocardial infarction with ST segment depression during the treadmill exercise tolerance test. All patients were on Holter 24-hour ECG monitoring. As a criterion of myocardial ischaemia during Holter monitoring ST segment depression of 1 mm and more, lasting 1 minute and more, and 0.08" of J point was accepted. RESULTS: During the treadmill exercise tolerance test segment depression was not followed by any symptom in 18 (31%) patients. There were no differences in the number of patients with hypertension in the group with symptoms and the group without symptoms. Diabetes mellitus was more frequent in the group with asymptomatic myocardial ischaemia. The average values of maximum ST segment depression and heart rates during treadmill tests were not statistically significant in both groups (with and without symptoms). During daily activities myocardial ischaemia was found in 30 (51%) patients by a 24-hour Holter ECG monitoring. We observed 198 episodes of myocardial ischaemia of which 138 (69.1%) were asymtomatic. The amplitude of ST segment depression and duration of these changes were significantly greater in the group with symptomatic episodes than in the group with asymptomatic episodes of myocardial ischaemia. DISCUSSION: Asymptomatic myocardial ischaemia is an often appearance in patients with myocardial ischaemia. Almost in 25% of persons in whom sudden death occurred obstructive changes in coronary arteries during the autopsy were found. Asymptomatic myocardial ischaemia could be found even an a "completely healthy person" without any complaints. Asymptomatic myocardial ischaemia is usually detected in a "completely healthy person" by casual diagnosis, in patients with stable and non stable angina pectoris, in patients with stenosis of the coronary arteries proved by angiography, and in patients after myocardial infarction. Some authors considered that treadmill exercise tolerance testing is less reliable to discover asymptomatic myocardial ischaemia comparing to the continuous 24-hour Holter ECG monitoring. It is know that in patients with diabetes mellitus neuropathy precedes the onset of symptomatic myocardial ischaemia. Asymptomatic myocardial ischaemia has the same predictive value for prognosis of the disease as symptomatic myocardial ischaemia. In some patients "anginal alarm system" is defective, and perception and conduction of pain sensations are disturbed. CONCLUSION: 1. In 31% of patients who suffered from myocardial infarction with ST segment depression during the treadmill testing asymptomatic myocardial ischaemia was found. 2. By Holter monitoring ischaemia ST segment depression during the exertion is observed in 52% of patients. Most of ischaemic episodes were asymptomatic. 3. The amplitude of ST segment depression is significantly greater and duration of depression is significantly longer in symptomatic episodes of myocardial ischaemia comparing to asymptomatic myocardial ischaemia obtained by Holter ECG monitoring.

Leflunomide prevents the development of experimentally induced myasthenia gravis.

Myasthenia gravis is an autoimmune disease in which autoantibodies specific to the acetylcholine receptor (AChR) are formed, leading to a gradual destruction of the receptors in muscles that are responsible for picking up nerve impulses, and results in weakness and eventual loss of muscle function. The novel immunomodulating drug leflunomide (HWA 486) has been shown to be very effective in preventing and halting ongoing disease in an array of experimental autoimmune disorders and reactions leading to organ graft rejection. Further, recent data from phase II clinical trials indicate that this drug is efficacious and is safe in humans with rheumatoid arthritis. In the studies reported here, we found that rats immunized with AChR-protein and not receiving leflunomide developed experimental myasthenia gravis (EMG) between day 7 and 11 post-immunization, and about 79% of these animals expressed clinical signs of disease. Treatment of AChR-protein immunized rats with leflunomide, from the day of disease induction, totally suppressed the development of EMG. Thus, the results we have obtained using leflunomide in EMG indicate that this drug could be beneficial in combating myasthenia gravis in humans.

Thymus changes in experimentally induced myasthenia gravis.

Experimental myasthenia gravis (EMG) was elicited in female AO rats, 8-12 weeks of age, by injection of 100 micrograms/rat Torpedo marmorata acetylcholine receptor (AChR)-protein incorporated in CFA. Bordetella pertussis, 24 x 10(9) microorganisms, rat, was injected simultaneously as additional adjuvant. Rats were sacrificed on the day of appearance of the clinical signs of EMG, and thymuses were used for histological analysis using stereologic method, and thymocyte subsets were estimated by flow cytometry. Two and three colour fluorescence was applied to determine DN (CD4-CD8-), DP (CD4+CD8+), SP-CD4+ (CD4+CD8-) and SP-CD8+ (CD4-CD8+) subsets, as well as thymocytes expressing TCR alpha/beta. Rats immunized with BSA and rats injected with saline were used as controls. From 56 rats immunized with AChR-protein, 44 rats developed the disease, between day 7 and 11 after immunization. Severity of disease varied from + to + + +. Stereologic analysis of tissue sections revealed a highly significant reduction of thymic cortex and hypertrophy of medulla in EMG thymuses. Similar, but very slight changes were observed in thymuses of rats immunized with BSA. Percentages of DN, SP-CD4+, and SP-CD8+ subpopulations were significantly increased, while the percentage of DP population showed a marked decrease. These preliminary data suggest an alteration of thymocyte maturational events. Whether these changes could be responsible for the initiation of autoimmunity, or are occurring as a secondary phenomenon, after EMG was already established following the injection of cross reactive antigen, is a matter for discussion.

[Clinical significance of the negative T wave and changes in the ST segment in the electrocardiogram of air force pilots]. / Klinicki znacaj negativnih talasa T i promena na segmentu ST u elektrokardiogramu pilota letilica.

More and more investigators, consider that nonspecific ECG changes are significant in prognosis of appearance of ischemic heart disease. It is seldom, appearance of disorder in ECG records in so high selected population, as pilots in Air Force. Around 4% of flyers present ECG record which could be of clinical importance.

[Correlation between the stress test electrocardiogram and Holter monitoring in asymptomatic myocardial ischemia]. / Korelacija elektrokardiograma snimanih u toku testa s fizickom opterecenjem i Holter-monitoringom kod asimptomske ishemije miokarda.

The author separated a group of 22 patients with ischaemic ST depression revealed by Holter-monitoring without symptoms, and compared it with the results obtained by ergonometry testing. Angina pectoris, a key symptom on which were based many epidemiological and clinical studies, could not be considered as a reliable criterion for the evaluation of patients with ischaemic heart disorder. Non-invasive diagnostic methods (ergometry testing and Holter-monitoring) used by the author in this study were particularly significant in the establishment of early diagnostic of cardiac ischaemic disorder and detection of symptomatic and asymptomatic episodes of myocardial ischaemia. Asymptomatic myocardial ischaemia during ergometry testing and Holter-monitoring has equal importance in surviving of patients as ischaemia followed with angina pectoris. For that reason, early ischaemia are of great importance for patients' fate.

[Incidence and prognostic significance of ventricular extrasystole in pilots of combat aircraft and civilian planes]. / Ucestalost i prognosticko znacenje komorskih ekstrasistola kod pilota ratnog vazduhoploustva i civilne avijacije.

It is a real challenge, for the doctor internist-cardiologist, who deals everyday, with problems of arrhythmia, especially in pilots of combat aircraft, to discover those rare cases of premature ventricular contractions (PVC) where exists great probability that PVC were caused by ischemic heart disease. Appearance of complex PVC in aircrew is seldom. Isolated appearance of single, unifocal PVC in young pilots without any symptoms and in absence of organic changes or functional heart disorder, should be considered as normal medical finding.

Experimental autoimmune oophoritis. II. Both lymphoid cells and antibodies are successful in adoptive transfer.

Experimental autoimmune oophoritis can be readily induced by passive transfer of peripheral blood lymphocytes, lymph node cells, spleen cells, T- and B-enriched cell suspensions, immune serum and gamma globulins, from ovary antigen immunized rats to naive recipients. Adoptive transfer was markedly enhanced when recipient rats were injected simultaneously with sensitized lymphoid cells and anti-ovary antibodies. Histologically, this passively induced disease was much the same as the actively induced disease. By syngeneic lymph node assay it was shown that regional lymph nodes of neonatally thymectomized rats did not enlarge upon injection of EAOO lymphocytes which otherwise produced a marked effect in lymph nodes of normal recipient rats. Therefore, it appears that enlargement of the draining lymph node was dependent on the participation of host T cells. The possibility that development of EAOO may involve cooperation between antigen-reactive and effector classes of lymphocytes was discussed.

[Aspects of acclimatization of the human body to acute and chronic high-altitude hypoxia]. / Neki aspekti aklimatizacije ljudskog organizma u uslovima akutne i hronicne visinske hipoksije.

Exposure of human body to high altitude environment initiate reaction which could be result whether of adaptation or of exhaustion. The purpose is to establish the human body environment which enables regeneration of own cells. Therefore, mechanism of reestablishment of prevention and recognition of symptoms and signs of insufficient adaptability on high altitude are of great interest for clinical and other medical investigators. Special position in research refers on cardiovascular system. Results show, according to effect of only one factor-catecholamines, that in course of physical training on high altitude, could be expected, cardiac muscle hypertrophy. It is proved, that under special circumstances catecholamines stimulate synthesis of proteins what enables faster regeneration of the cells. However, under conditions of myocardial ischemia, uncontrolled loading of these patients could lead to deterioration of heart function appearance of cardiac insufficiency.

Experimental autoimmune oophoritis. I. Inhibition of fertility in rats isoimmunized with homogenates of ovary.

Experimental autoimmune oophoritis (EAOO) induced in female Lewis rats by a single injection of isologous ovary in complete Freund's adjuvant (CFA) and concentrated pertussis vaccine resulted in a multifocal accumulation of mononuclear cells in ovaries and complete loss of fertility after 17-28 days. The time course of appearance of anti-ovary antibodies and their serum titers showed a good correlation with the reduction of litter size. Furthermore, the infertility also could be induced by passive immunization of rats with adsorbed anti-ovary serum. The contraceptive effect of the antibody does not result in permanent sterility. Besides lymphoid cell infiltrations, the most prominent histological alterations in ovaries of experimental rats were characterized by a significant increase in the number of atretic preantral and antral follicles and a decrease in the number of growing follicles of all sizes and corpora lutea. It is presumed that both the direct effect of anti-ovary antibodies and disturbance in ovarian morphology can lead to a reduction of litter size and appearance of infertile cycles in rats with oophoritis.