The history of tourniquet use in limb surgery.

PURPOSE: As tourniquets have been present in medicine since almost its conception, understanding and following their development through time is not only an exercise in history but also an insight into the evolution of medical devices over more than two millennia. From simple leather bands wrapped around patients' limbs to the modernised digital devices used widely in surgical theatres globally, tourniquets have undergone tectonic change both in their design and application, moving from battlefields to hospitals. Hence, the aim of this article is to outline the historical development of these devices alongside their present and modern use. METHODS: The historical development of emergency and surgical tourniquets is chronologically outlined, with particular emphasis on the impact of warfare on their widespread adoption in trauma and emergency medicine and elective surgery. Novel surgical trends and their impact on the future of tourniquet use are evaluated. RESULTS: The development of tourniquets across two millennia has closely reflected both the scientific understanding of human physiology and anatomy as well as technological discoveries and advancements that have reshaped their design and application. Prominent figures in the field of surgery, such as Sushruta, Fabricius Hildanus, John Louis Petit, Joseph Lister, Harvey Cushing and James McEwen, all fundamentally influenced their evolution and helped popularise and modernise them. The views on their use have been controversial and drastically changed across different eras, with data collected from modern warfare serving to embed their use in clinical practice. CONCLUSION: The historical development of tourniquets since pre-historic times represents an excellent outline of the adaptive nature of medicine, led, firstly, by scientific rigour and discipline and, secondly, by pioneers who serve as catalysts for change and improvement. The modern inflatable cuff tourniquets that are omnipresent in theatres globally will undoubtedly remain the standard of care for the foreseeable future. Tourniquets that can dynamically monitor blood pressure and consequently adjust inflation pressures, as well as ones with inbuilt axonal excitability monitoring, will further improve their safety profile, reduce associated complication rates and represent the next step in the evolution of these devices. Notably, there might be a shift away from tourniquet use altogether, reflected by the wide use of the wide-awake local anaesthesia no-tourniquet technique that has become the new norm in hand surgery.

[Obesity and hormone function changes in female patients with polycystic ovaries]. / Gojaznost u funkciji hormonalnih promena kod pacijentkinja sa policisticnim jajnicima.

INTRODUCTION: Polycystic ovary syndrome is commonly associated with hyperandrogenism and anovulation. The aim of this study was to investigate the impact of obesity on hormonal status in patients with polycystic ovary syndrome. MATERIAL AND METHODS: The study was performed at the Ward of Obstetrics and Gynecology of the General Hospital in Subotica. A retrospective investigation comprised 39 patients with polycystic ovary syndrome. All patients were in the fertile age-range: 18-38 years. Following ultrasonographic examination and anamnestic data, patients underwent hormonal analyses of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin and insulin obtained from the pooled serum sample. RESULTS: Values of testosterone and insulin in the group of obese patients with polycystic ovary syndrome were significantly higher than in normal weight patients. Patients with normal body weight index had significantly increased levels of LH in regard to those with increased body weight index. Values of FSH, prolactin and LH/FSH ratio were not significantly different in both groups of polycystic ovary syndrome patients. Increased values of insulin were recorded in 43% of obese and 18.2% of normal weight patients. CONCLUSION: Analysis of investigated results confirmed that obese patients with polycystic ovary syndrome and insulin resistance have been a special clinical entity, whereas an open question remains whether obesity is directly connected with polycystic ovary syndrome or it is only an additional factor interfering with metabolic and hormonal status of genetically predisposed and phenotypically indoctrinated women with polycystic ovary syndrome.

[Menstrual cycle disorders in polycystic ovary syndrome--ultrasonographic characteristics and hormonal status]. / Poremecaj menstrualnog ciklusa kod policisticnih jajnika--ultrasonografske karakteristike i hormonski status.

INTRODUCTION: The polycystic ovary syndrome is primarily characterized by an association of hyperandrogenism and anovulation. The aim was to determine the incidence of menstrual cycle disorders in patients with PCO syndrome and the relation with ultrasonographic and hormonal findings. MATERIAL AND METHODS: A retrospective study examined the ultrasonographic findings and hormonal status in patients with polycystic ovary syndrome at the Department of Obstetrics and Gynaecology of the General Hospital in Subotica. The sample comprised 39 patients. RESULTS AND CONCLUSIONS: Most frequently age at menarche was 14 years (29%) in obese and 10 years (45.5%) in normal weight patients. There was not a significant difference in duration of menstrual bleeding in both groups of examined patients, whereas amenorrhea was significantly more frequent in obese patients (29.4%) than in patients with normal weight (4.7%). On the basis of presented results (increased percentage of severe disorders of menstrual cycle in all patients in subgroup C and increased percentage of menstrual disorders in patients with high stromal density in relation to those with normal echogeneity of stroma) it can be concluded that there is a correlation between ultrasonographic findings of ovaries (number of microcysts, volume and density of the stroma) and menstrual cycle disorders, the polycystic ovary syndrome.

[Endometriosis and infertility]. / Endometrioza i infertilitet.

INTRODUCTION: Endometriosis is frequent in infertile women, but the relation between these two conditions has still remained unclear. Our intention was to present the pathogenesis of endometriosis, mechanism of the associated infertility and a rational approach to treatment of this frequent medical problem. PATHOGENESIS OF ENDOMETRIOSIS: The peritoneal form is most probably generated by implantation of the endometrium by menstrual reflux. Endometriomas are most probably formed by invagination and metaplasia of the ovarian mesothelium or by metaplasia of the epithelium of inclusion cysts. Adenomyosis of the rectovaginal septum develops from embryonic remnants of the Mullerian ducts. DIAGNOSIS: Laparoscopy is a method of choice which provides safe diagnosis, estimation of the disease and is an optimal method of treatment. PATHOGENESIS AND THERAPY OF INFERTILITY: The relation between mild forms of disease (Stage I and II) and infertility has remained unclear. Surgical removal of ectopic foci does not affect female fertility. The expectant treatment during one to four years has been followed by pregnancy in 50% of patients. In patients with III and IV stage disease, there is a frequent mechanical cause of infertility. Expectant treatment was followed by 25% incidence of pregnancy in patients with stage III disease and 0% in patients with stage IV endometriosis. Surgical reconstruction of normal anatomical relations resulted in pregnancy in 40-60% of patients. Administration of any drug therapy, either single or combined with surgical treatment does not increase the fertility rate. Methods of assisted reproduction are alternative approaches to treatment and they have to be administered after unsuccessful surgical treatment. Pretreatment with GnRH agonists increases the efficacy of in vitro fertilization.

[Chlamydia trachomatis--a possible cause of premature labor]. / Chlamydia trachomatis--moguci uzrocnik prevremenog porodaja.

INTRODUCTION: The aim of this study was to investigate the incidence of urogenital infection with Chlamydia trachomatis in patients with preterm delivery in relation to those with term delivery. MATERIAL AND METHODS: The investigation included a random sample of 116 parturients. Direct immunofluorescence (DIF) test was used to diagnose Chlamydia trachomatis. RESULTS: In the investigated group (N = 53), positive finding of Chlamydia trachomatis in the urogenital tract was established in 6 (11.32%) patients in cervix and in 5 (9.43%) patients in the urethra, whereas in the control group there were 3 (4.76%) positive findings in the cervix and 1 (1.59%) in the urethra. The control group included patients with term delivery (N = 63). DISCUSSION AND CONCLUSION: Results of investigation point to the necessity of diagnostics and treatment of Chlamydia trachomatis in prevention of preterm delivery, particularly in women with previous unsuccessful pregnancies.