The importance of anatomical topography in nasolacrimal duct stenosis.

In our previous study the inclination of nasolacrimal canal in relation to Frankfurt horizontal plane has been analysed on 71 anatomically preparated human skulls by introducing the probe through canal. The results of that study showed that the alpha angle in the frontalplane was greater than 91 degrees in 27% of cases, i.e., nasolacrimal canals descend diverging in relation to the median plane and both probes are intersected on glabella. In 55% of cases, the alpha angle was less than 89 degrees and probes diverge on glabella, and in 18% of cases the canals were parallel to the median plane. In this study nasolacrimal ducts in patients were visualised with Omnipaque contrast that was injected with probe through the superior lacrimal punctum. Thereafter radiography was performed. These in vivo results confirm our previous results obtained on the skulls. Minimal individual variations of values of the angle were observed. These findings are very important inprobing of stenosis of nasolacrimal duct in infants, as the operator would not have to forcefully probe with rigid instrument through gentle infant nasolacrimal duct. Difficult and serious consequences for infants arise when directing the probe "via falsa" and that often happened in practice. The authors therefore suggest when using this old method ofprobing, that this "surgical" act should be performed with "soft" probe made of nylon or silver that is very pliable and does not lead to nasal or temporal rupture of the canal.

Is the term "fasciculus opticus cerebralis" more justifiable than the term "optic nerve"?

The terminology of the optic nerve had already been changed three times, since 1895 until 1955 when the term "nervus opticus" was introduced in the "Terminologia Anatomica". Following our study we claim that, from the aspect of phylogenetic evolution of binocular vision development as well as optical embryogenesis where opticus is evidently presented as a product of diencephalic structures, the addition of the term "nervus" to opticus is not adequate and justified. From the clinical aspect the term "nervus opticus" is also inadequate, both as a "nerve" that has no functional regenerative properties, unlike other cranial nerves, as well as from a pedagogical and didactical aspect of educating future physicians. We suggest that the term "Fasciculus Opticus Cerebralis" should be used as it much better explains the origin as well as its affiliation to the central nervous system.

Influence of hyperbaric oxygen treatment on myogenic transcriptional factors of denervated rat muscle.

The aim of this study was to determine whether hyperbaric oxygen (HBo2) treatment influences the expression of transcriptional myogenic factors in denervated rat's extensor digitorum longus muscle. Thus, expressing regulatory myogenic factors MyoD and myogenin were analyzed in denervated muscles (up to 30 days). Second group of denervated rats were afterwards treated with HBO2. Normal, innervated muscles were used as controls. Western blot analysis showed a significant upregulation of MyoD and myogenin proteins in denervated muscle during this period. Denervated muscles of rats exposed to HBO2 treatment had also significant upregulation of both transcriptional factors but the treatment had not altered their expression. The immunohistochemical analysis showed MyoD and myogenin protein expression through this period in the denervated, untreated muscles and in denervated muscles of rats treated with HBO2, too. One month denervation caused a reduction in muscle fiber cross-sectional area. The treatment with HBO2 had not reduced the degree of atrophy. The protocol of hyperbaric oxygenation (HBO) applied in this study had no beneficial effect either on transcriptional myogenic factors or on atrophy of denervated rat muscle.

Effect of hyperbaric oxygen treatment on myogenic transcriptional factors in regenerating rat masseter muscle.

Hyperbaric oxygen (HBO) treatment was shown to be beneficial as an additional treatment for ischemic muscles in crush injuries and ischemia-reperfusion injuries. The purpose of this study was to assess the influence of hyperbaric oxygen treatment on transcriptional myogenic factors during muscle regeneration. Those factors (MyoD, myf5, myogenin, mrf4) are essential for determination and differentiation of skeletal muscle tissue and together with several other factors control gene expression during myogenesis. The process of regeneration in rat masseter muscle was provoked with injection of local anesthetic bupivacaine hydrochloride. Following injection, the animals were treated once daily in hyperbaric chamber from one to ten days and than sacrificed. Immunohistochemical and Western blot analysis of frozen masseter muscle samples showed a transient upregulation of myoD and myogenin transcriptional factors in the muscles of hyperbaric oxygen treated rats and of rats that have not been treated after the injury. HBO treatment had no effect on the expression of MyoD and myogenin transcriptional factors in the regenerating rat masseter muscle.

Efficancy of decompressive craniectomy in treatment of severe brain injury at the Rijeka University Hospital Centre.

Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the growth of intracranial pressure (ICP) can no longer be controlled with conservative methods. DC belongs to class III "Guidelines"--"option" which has not clear clinical certainty. They do not correspond to "Standards" (class I) in treatment protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard craniotomy. 22 patients did not undergo any surgical procedures. In each patient we analyzed ICP changes within the first 11 days and in that way we correlated them statistically with the initial Glasgow Coma Scale (GCS) and then with Glasgow Outcome Scale (GOS), after the end of the treatment. We particularly analyzed the outcome with reference to the time of the operation and the size of DC. The standard measurement of ICP shows statistical significance in recovery in the group without DC after 5 days of intensive treatment, when the pressure is stabilized between 20-25 mm Hg. The stabilization of ICP in the DC group is observed already after 3 days of intensive treatment. Furthermore, better functional recovery according to GOS, which is statistically significant, was observed in patients who underwent DC where the area of craniectomy was larger than 25 cm2, within the first 24 hours from the time of injury. The use of DC considerably reduces the need for CT check-ups. Increase in the number of encephalocele was noted, which is to be expected considering that dural decompression is used in DC procedure. The results of our study indicate that the utilization of DC is characterized with lower mortality and better functional recovery if it is applied at an early stage of treatment and if the size of DC is satisfactory.

Dilemma of antiepileptic drugs withdrawal in symptomatic epilepsy.

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years.

Histomorphological analysis of the osteophytic appositions in patients with lumbar lateral recess syndrome.

Patients with lumbar lateral recess syndrome (LRS) can be successfully cured by removing osseous excrescences that grow on the peripheral edge of articular surface of the facet joint. They cause narrowing of the lateral recess and compress a root of the spinal nerve. Their appearance is related to the instability of respective dynamic vertebral segment. The aim of this study was to analyze the osteophytic composition morphohistochemically and elucidate cellular processes that lead to this new formation appearance. It is necessary to find a possible causative-consequential relation between the osteophyte and instability. The ideal object to explore was the osteophyte in the lateral recess because it had to be removed during operative treatment. The group of 30 patients with clinical feature of LRS was chosen. Each patient had clinically verified LRS with consequential radiculopathy. Bony outgrowths were removed surgically and analyzed by histological and immunohistochemical methods: toluidine blue, Goldner trichrome, TRAP, indirect peroxidase with antibodies against BMP 3 and BMP 7. The outgrowths that caused lateral recess stenosis were composed of fibrous and hyaline cartilage and cancellous bone. The changes in cartilage and bone, and occurrence of intramembranous bone formation in sense of enlargement of trabeculae, leads to the conclusion that marginal osteophytic formations could be an adaptation to changed conditions in the dynamic vertebral segment and an attempt to stabilize this segment by enlargement of articular surface.

Amaurosis fugax is in the first place, during attack, medical emergency for ophthalmologist's practice.

This paper is focused on disease Amaurosis Fugax (AF), indicating the necessary urgent therapy in attack of illnesses. In attack, the patient represents ophthalmic case, because of vision lost, but primary process and cause exists even earlier and very often is of chronical character. Authors emphasize sequencing in therapy of AF and accentuate that in 24 hours the cause of the disease may be defined. AF is a syndrome with very different etiopathogenesis, including also big complexity in diagnosis and therapy.

What associates Charles Bonnet syndrome with age-related macular degeneration?

Charles Bonnet syndrome (CBS) is a condition related to patients with visual loss due to age related macular degeneration or glaucoma that are having complex visual hallucinations. The CBS was first described by Swiss physician Charles Bonnet in 1760. Affected patients, who are otherwise mentally healthy people with significant visual loss, have vivid, complex recurrent visual hallucinations (VHs). One characteristic of these hallucinations is that they usually are "Lilliputian hallucinations" as patients experience micropsia (hallucinations in which the characters or objects are distorted and much smaller than normal). The prevalence of Charles Bonnet Syndrome has been reported to be between 10% and 40%; a recent Australian study has found the prevalence to be 17.5%. The high incidence of non-reported CBS is thought to be as a result of patient's fear to report the symptoms as they could be labeled as mentally insane since those type of visual hallucinations could be found in variety of psychiatric and neurological disorders such as drug or alcohol abuse (delirium tremens), Alice in Wonderland syndrome (AIWS), psychosis, schizophrenia, dementia, narcolepsy, epilepsy, Parkinson disease, brain tumors, migraine, as well as, in long term sleep deprivation. VHs can also be presented as the initial sign of the Epstein-Barr virus infection in infectious mononucleosis. Patients who suffer from CBS usually possess insight into the unreality of their visual experiences, which are commonly pleasant but may sometimes cause distress. The hallucinations consist of well-defined, organized, and clear images over which the subject has little control. It is believed that they represent release phenomena due to deafferentiation of the visual association areas of the cerebral cortex, leading to a form of phantom vision. Cognitive defects, social isolation, and sensory deprivation have also been implicated in the etiology of this condition. This study was conducted on 350 patients diagnosed with Age-Related Macular Degeneration (AMD) and shows incidence of CBS in 13% of patients with AMD. Furthermore, we have found higher incidence of CBS in patients with massive loss of vision in peripheral visual field which is not age related.

Management and prognosis of primary cerebral melanocytic tumors. A case report and systematic review.

Primary melanocytic cerebral tumors form a spectrum of different lesions that range from benign to extremely malignant, such as an intracranial melanoma. This article points out some characteristics of primary melanocytic cerebral tumors and discusses their management and prognosis, based on a systematic literature review and a case of primary cerebral malignant melanoma.Because the biological characteristics of primary melanocytic cerebral tumors remain unclear, it appears that total surgical resection of the tumor followed by oncologic treatment is the mainstay of the management. The prognosis still depends on the degree of malignancy.