[Risk factors in the development of bleeding peptic ulcer]. / Faktori rizika u nastanku krvareceg peptickog ulkusa.

INTRODUCTION: Gastric or duodenal peptic ulcer is the most common cause of bleeding from upper parts of the alimentary tract. Although there is a great number of these patients in the clinical practice, there are some contradictory characteristics in regard to the age of patient, localization of ulcer, the diameter of ulcer and Helicobacter pylori infection as possible risk factors in development of bleeding peptic ulcer. The aim of this work is evaluation of risk factors in our patients. MATERIAL AND METHODS: During this research we examened two groups of patients: a) first group consisted of patients with acute gastric or duodenal bleeding peptic ulcer, b) the second group consisted of patients without peptic ulcer bleeding. In both groups of patients we examined the most common risk factors for development of bleeding. This research took place in the Clinic for Surgery "Dr Dragisa Misovic" in the period from January to December 1997. RESULTS: In both groups we had male predominance. Patients with bleeding peptic ulcers are statistically older when compared with the non-bleeding group (52.2 +/- 7.3:65.3 +/- 8.1). In both groups the anterior wall of the duodenum is the most common localization. In the group of bleeding ulcers we had high frequency of patients with localization of ulcers in the back wall of the duodenal bulb (20%). In this group of patients there was a high percentage of penetrating ulcers (62.5%) with active arterial bleeding (Forrest I a). Ulcers on the front wall of duodenal bulb and in small bend of stomach, as most common (over 50%), gave small peptic ulcers (under l cm) with capillary bleeding (oozing-Forrest I b) without haemodynamic complications. The presence of Helicobacter pylori infection is statistically significantly higher in the group of patients with bleeding peptic ulcers. DISCUSSION: The age of patients and localization of ulcer are very important and well known risk factors for development of bleeding peptic ulcer. However, in the last ten years Helicobacter pylori infection has become one of the most important risk factors. All Helicobacter pylori positive patients were treated with three component eradicational therapy for Helicobacter pylori. In this way we restricted the number of recurrent bleeding. CONCLUSION: In our opinion the age of patient, localization of ulcer, diameter and Helicobacter pylori infection are very important risk factors for development of bleeding peptic ulcer.

[Helicobacter pylori infection and a decrease in the pH of gastric juice as a possible cause of bleeding in erosive gastritis]. / Infekcija helikobakterom pilori i pad lokalne pH-vrednosti zeludacnog soka kao moguci uzrocnici nastanka krvarecih erozivnih gastritisa.

INTRODUCTION: Bleeding erosive gastritis and ulcer disease are the most common causes of bleeding from the upper parts of the alimentary tract. Over the period of the last 10 years there has been an increased number of patients where Helicobacter pylori is mentioned as the possible cause of infection. At the same time in this group of patients pH values were decreased. During our research we wanted to examine the influence of local pH value and Helicobacter pylori infection on the occurrence of bleeding erosive gastritis. MATERIAL AND METHODS: During this research we examined two groups of patients. The following parameters were examined within these two groups of patients: 1. presence of Helicobacter pylori infection; 2. histopathologic changes in mucus; 3. there were 57 patients with a bleeding form of gastritis of unknown etiology, whereas the second group consisted of 351 patients with non-bleeding form of gastritis. We examined the localization: 4. local pH. RESULTS: The presence of Helicobacter pylori infection is statistically significantly higher in the group of patients with bleeding gastritis, when compared to the non-bleeding group (72%:57%). Within the Helicobacter positive patients the most common change of mucose (over 90%) is active chronic gastritis. The presence of erosions and histopathological changes characteristic for Helicobacter pylori infection coincides with colonization of Helicobacter in the antrum. The pathogenetic action of bacteria in antrum decreases the local pH. Therefore the lowest value of local pH occurred in the group of bleeding Helicobacter pylori positive gastritis (1.72). DISCUSSION: Results of this research helped us in treatment of helicobacter pylori positive patients making a risk group for development of recurrent bleeding. We accomplished therapeutical effect in 80% of patients by using a three component eradication therapeutic protocol for helicobacter pylori. Within the group of patients who have been cured, regression of histopathological changes occurred and increase of local pH took place. In the group with persistent infection we have come across with high percentage of recurrent bleeding (37.5%). CONCLUSION: In our opinion helicobaceter pylori infection and decrease of local pH, which take place during the reaction of mucose on the presence of infection, are very aggressive factors which can cause bleeding erosions.

[The electrophysiological diagnosis of carpal tunnel syndrome]. / Elektrofiziologicheskaia diagnostika zapiastnogo tunnel'nogo sindroma.

Electrophysiological investigations were carried out both in patients with carpal tunnel syndrome (CTS) and in healthy individuals. The evoked potentials were examined during stimulation of sensitive branches of n. medianus and of other nerves. The most sensitive and important for diagnosis appeared to be the electrophysiological test of alteration of responsive reaction to the stimulation of the sensitive branch of n. medianus for 4 finger and the considerable difference of evoked reactions on stimulation of skin palm branch and branch of the 1-st finger of n. medianus. The diagnostic importance of these indices corresponds well to anatomical and pathophysiological characteristics of CTS.

[Anticardiolipin antibodies in patients with ischemic brain disease]. / Antikardiolipinska antitela kod bolesnika sa ishemijskom bolescu mozga.

Anticardiolipin antibodies are best defined antiphospholipid antibodies and a recently described marker of increased risk for ischemic brain disease. Investigations were performed in 151 patients with ischemic brain disease in order to determine the occurrence of anticardiolipin antibodies and define the clinical characteristics of patients with an increased titer of anticardiolipin antibodies. Measurement of anticardiolipin antibody titer was performed by immunoenzyme method. Besides, analyses of certain tests indicative for blood coagulative properties were also done. In addition, the occurrence of anticardiolipin antibodies was investigated in 49 patients with other non-immune neurological diseases and disorders. Control sera were obtained from 50 healthy subjects and 6 patients with senile cataract. Investigation showed the increase of anticardiolipin antibody titer in 22.8% of the patients with ischemic brain disease (30% with transient ischemic attacks, 19% with brain infarction) and in 4% of the patients with other neurological disorders of non-immunological genesis. The patients with increased titer of anticardiolipin antibodies suffered more frequently from recurrent forms of ischemic brain disease, all of them were below 50, and they had less risk factors for atherosclerosis and ischemic brain disease. It was concluded that the presence of increased titer of anticardiolipin antibodies in younger patients with recurrent forms of ischemic brain disease and less risk factors could be the marker of the increased risk for ischemic brain disease.

[Sensitivity of atherosclerosis indices in patients with ischemic brain disease]. / Senzitivnost pojedinih indeksa ateroskleroze kod bolesnika sa ishemijskom bolescu mozga.

Epidemiological studies suggest that dyslipoproteinemias and hyperlipoproteinemias present one of the most important risk factors in the development of atherosclerosis and its complications. The aim of this study was to find out which of the lipid status disorders in patients with ischemic brain disease was the most important risk factor in the development of cerebral atherosclerosis. Patients with ischemic brain disease were examined in the acute and subacute phase. Total blood cholesterol, low density lipoproteins (LDL) and high density lipoproteins (HDL) as well as of apolipoproteins A1 and B were determined. Correlations (atherogenic indices) of some lipid components with the severity of clinical course and echo-angiographic finding were determined. It was concluded that the highest correlation with the cerebral atherosclerosis severity degree existed with the level of apoA1 and apoB apolipoproteins, followed by correlation of LDL and HDL cholesterol, and the lowest correlation was found between HDL and the total cholesterol. Accordingly, apolipoproteins, i.e., apoA1/apoB indices are the most sensitive markers of the risk for atherogenesis.

[Sensitivity of electrophysiologic tests in the diagnosis of carpal tunnel syndrome]. / Senzitivnost elektrofizioloskih metoda ispitivanja u dijagnostici sindroma karpalnog tunela.

According to anatomic characteristics of median nerve branches and pathophysiological basis of the carpal tunnel syndrome (CTS), significant difference in sensitivity of some electrophysiological parameters in the diagnosis of this syndrome was presumed. The aim of this study was to analyze characteristics of some abnormalities of electrophysiological parameters and to determine their frequency in the carpal tunnel syndrome. Investigation was performed on 34 patients with the carpal tunnel syndrome and 30 neurologically healthy subjects. EMGs of the tenar muscles, terminal latency parameters for the median nerve and sensory conductivity of the median nerve branches including cutaneous palmar branch and ulnar nerve branches of the ring finger were examined and analyzed. Results have shown that abnormalities were most frequently found in sensory conductivity parameters for median nerve branch of the ring finger. Significant difference between sensory conductivity parameters for cutaneous palmar branch and median nerve branch of the thumb was also found. These results were discussed in terms of current knowledge about anatomic characteristics of the hand innervation and pathophysiology of the carpal tunnel syndrome. It was concluded that the most frequent physiological findings could be used as a highly sensitive test for reliable and early diagnosis of CTS.

[The effect of therapeutic plasma exchange on serum immunoglobulins and the clinical course of myasthenia gravis]. / Uticaj terapijske izmene plazme na serumske imunoglobuline i klinicki tok obolelih od miastenije gravis.

Fourteen patients with clinically, pharmacologically and electrophysiologically confirmed myasthenia gravis in which therapeutic plasma exchange was performed were analyzed. Condition of these patients was assessed before and after the plasma exchange using the Besinger score. The serum immunoglobulin levels were also determined by ELISA-test before and after the plasma exchange. Findings have shown that clinical improvement was highly significant. Changes in IgM and IgA levels were significant, but not in IG and IgE. Significant correlation neither between the level of each separate immunoglobulin and clinical condition of the patient, nor between the change in the level of each separate immunoglobulin and changed clinical course was found after the series of plasma exchange. Cumulative effect of all immunoglobulins was not observed due to differences in their physical and chemical properties. Absence of significant statistical correlation between the level of each immunoglobulin and clinical condition of the patient as well as between the level changes of each separate immunoglobulin and changed clinical condition after series of plasma exchange could be explained by cumulative effect of all immunoglobulins, but probably also by the presence of some other, circulating factor not belonging to the class of immunoglobulins and associated with the development of myasthenic weakness.

Lipoprotein(a) in patients with carotid atherosclerosis and ischemic cerebrovascular disorders.

The aim of this study was to evaluate the role of lipoprotein(a) in the carotid atherosclerosis and ischemic cerebrovascular disorders. Four groups of subjects were included: 49 patients with transient ischemic attacks, 61 with acute cerebral infarction, 48 with asymptomatic carotid atherosclerosis and a group of 50 healthy subjects. Lipoprotein(a) serum concentration and its correlation with various clinical parameters was analysed. The results revealed a significant difference between lipoprotein(a) serum levels in patients and healthy subjects and positive correlation between lipoprotein(a) serum levels and the degree of carotid atherosclerosis. Moreover, some other correlations are found and discussed. It was concluded that lipoprotein(a) is involved in the pathogenesis of carotid atherosclerosis, but it is not associated with the development of ischemic cerebrovascular disorders.