[Importance of self-assessment of functional and communication abilities on the outcome of rehabilitation in patients with hemiplegia after cerebrovascular stroke]. / Znacaj licne procene funkcionalnih i komunikacionih sposobnosti na ishod rehabilitacije bolesnika sa hemiplegijom nakon cerebrovaskularnog insulta.

INTRODUCTION: Cerebrovascular insult causes focal damage of the central nervous system structures consequently causing loss or disturbance of their functions. Motor deficit is often associated with personality alterations generally speaking, as well as changes in behavior and loss of numerous neuropsychological functions. Rehabilitation of such patients should be defined by all members of the team, including the patient himself and members of his family. MATERIAL AND METHODS: This is a case report on a male patient 49 years of age with rightsided paralysis accompanied by aphasia. Thirty days after cerebrovascular insult he was transferred from the Clinic of Neurology in Novi Sad to the Clinic of Medical Rehabilitation. Functional disability assessment was made using Barthel Index, whereas communication was assessed by Boston Diagnostic Aphasia Examination. The rehabilitation program included, apart from the usual team, the patient himself and members of his family. The patient became the center of the team and was informed about the disease. Personal assessment of the patient on his functional and communication abilities and their importance for further progress was used to set the objectives of the rehabilitation program. The rehabilitation program was performed by a speech therapist and a psychologist, including kinesis, work activities, occupational therapy, individual and group therapy. RESULTS: The outcome of the rehabilitation program in this patient was significantly better than expected. DISCUSSION AND CONCLUSION: This case report shows that being the center of the rehabilitation team the patient takes an active part in setting objectives of the rehabilitation program, whereas involvement of the family, knowledge on necessary medical issues about the disease, contribute to better motivation and better outcome of the rehabilitation program in patients with hemiplegia caused by cerebrovascular insult.

[Successful treatment of patients with thrombotic thrombocytopenic purpura]. / Uspesno lecenje bolesnika sa tromboznom trombocitopenijskom purpurom.

The paper presents the case of a 23 years old patient diagnosed with thrombotic thrombocytopenic purpura on the basis of increased body temperature, thrombocytopenia, microangoipathic hemolytic anemia, renal function disorders and a rapid development of coma after the epileptic seizure of Jacsonian type. The treatment included the therapy with antithrombocytic drugs such as lysin acetysalicylate, dipridamol, methylprednisolon, and other symptomatic and substitutional therapies. Fifteen therapeutic plasmaphereses were made with the replacement of 33.150 ml of plasma substituted with albumin and freshly frozen plasma (20.080 ml totally). The applied therapy gradually improved patient's neurologic finding. The patient was discharged from the hospital with normal neurological finding and magnetic resonance of the brain. In the conclusion we emphasize the importance of therapeutic replacement of plasma with the infusion of freshly frozen plasma, antithrombocytic therapy and the application of corticosteroids in the treatment of thrombotic thrombocytopenic purpura.

[Occurrence, causes and clinical characteristics of status epilepsy in adults]. / Ucestalost, uzroci i klinicke karakteristike epilepticnog statusa kod odraslih.

INTRODUCTION: Status epilepticus, particularly grand mal, is one of the gravest and most dramatic conditions in neurology requiring immediate attention. Status epilepticus can occur in epileptic patients, often with higher mortality rates in symptomatic than idiopathic, but also as an initial symptom of a number of neurological and systemic diseases. No data are available on the exact incidence rates of status epilepticus. According to some assessments, 10% of patients have at least one status epilepticus in their lifetime (3,6). The prognosis mostly depends on the main cause, time in which seizures are stopped and age of patients. Latest data available in literature suggest the mortality rate of 2-8%. MATERIALS AND METHODS: We analyzed frequency of hospital admissions, causes and clinical characteristics of status epilepticus in adults. The study was retrospective, based on case histories of epileptic patients from the Intensive Care Unit of the Neurology Clinic in Novi Sad in 1990, 1993 and 1995. Special emphasis was placed on differences in studied parameters between cases confirmed earlier and those with status epilepticus occurring as an initial symptom of some other illness or condition. RESULTS: Number of hospital admissions rose slightly in the interval observed in comparison with total admissions (0.68% in 1990, 1.24% in 1993, and 1.73% in 1995) (Tabs 1 and 2). During 1993, status epilepticus was more frequent in cases confirmed earlier (69%) compared with the years 1990 (56%) and 1995 (43%) (Graf.1). Epileptic patients were younger on the average than nonepileptic ones (Tab. 3). Status epilepticus occurred more often in male patients (Tab. 4). Irregular treatment was the prevailing cause in epileptic patients (Tab 5). Symptomatic status epilepticus was reported higher in 1990 and 1995, and stroke was definitely the predominant cause (Tab 6). Convulsive grand mal status prevailed in all patients (Graf 2). Focal status was a more frequent finding in nonepileptic patients (Graf 3). Every third in 16 patients died in 1993 and every fifth in 23 in 1995 probably due to the acute destructive brain damage rather than the status itself. No deaths occurred in 1990. DISCUSSION: According to research carried out by other authors, half of grand mal status cases occurred in confirmed epileptics (4). In our study the grand mal status was reported in 70.4% cases of epilepsy. Primary cause was abrupt withdrawal of antiepileptic treatment, infections, alcohol abuse and use of convulsive drugs. This is compatible with our results which confirm that grand mal status either primary or with secondary generalization prevail in both groups of patients (7,8,9). In terms of causes of status epilepticus in nonepileptic patients, literature data mainly suggest cerebral trauma, frontal brain tumors, cerebral arteriosclerosis or other vascular disorders and anaphylaxis (4). Our results point to stroke as the major cause of status epilepticus in nonepileptic patients, similar with data presented by Towne (10). There is no data in literature concerning the relation between sex of patients and occurrence of status. In our study status epilepticus occurred more frequently in male patients. CONCLUSION: The grand mal status was the major clinical type of status in all patients and was primarily caused by discontinued or irregular antiepileptic treatment in patients with confirmed epilepsy, and by stroke in nonepileptic patients.

The effects of X-ray irradiation of the head region of eight-day-old rats on the development of molar and incisor teeth.

The effects of irradiation on the development of molars and incisors up to the age of 57 days was studied applying locally a single dose of 9.6 Gy of X-rays to the head region of eight-day-old female rats. Radiography of jaws revealed the absence of the third molar in all irradiated rats, as a result of germ stunting which was, at the moment of irradiation, in the phase of histodifferentiation. In the case of the first and second molar, being at the time of irradiation in the phase of root formation, changes were noted in the development and morphological features of the roots. In animals sacrificed 18 days after irradiation, the radiographs of jaws showed a break in the continuity of the incisors located under the mesial root of the first molar. In all animals the break in continuity of the incisors became macroscopically visible between the 28th and 42nd day after irradiation. 15 days after the loss of incisors, the incisival functional occlusion was restored in all animals.