Evaluation of filling material remnants after basic preparation, apical enlargement and final irrigation in retreatment of severely curved root canals in extracted teeth.

AIM: To compare the retreatment ability of several rotary and reciprocating file systems in curved root canals of extracted teeth and to evaluate the influence of additional apical enlargement performed after a basic retreatment on the amount of remaining filling material. METHODOLOGY: A total of 65 round curved root canals were used. The root canals were prepared with the ProTaper Next rotary system to size 25, .06 taper and filled with an epoxy resin-based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. The canals were randomly divided into four groups according to the retreatment system used: Group I. ProTaper Universal Retreatment system + ProTaper Gold (PTG) instrumentation system up to PTG F2; Group II. Reciproc Blue system up to the instrument RB25; Group III. Reciproc system up to the instrument R25; Group IV. Wave One Gold (WOG) system up to the instrument WOG25. After the basic retreatment, additional apical enlargement was performed in each group with an instrument that was one size larger: in Group I, II and III up to apical size 40, and in Group IV up to 35. The final irrigation protocol included the following: 15% ethylenediaminotetraacetic acid followed by NaOCl irrigation. The volume of filling material was measured using an industrial micro-CT four times: after root canal filling (Volume I), after basic retreatment with size 25 files (Volume II), after additional root canal enlargement with larger instruments (Volume III), and after the final irrigation protocol (Volume IV). The decrease in the amount of filling material after each retreatment protocol was analysed using a Kruskal-Wallis test. Intergroup analyses were performed with a Kruskal-Wallis test and between-group differences were further analysed with Mann-Whitney U test. RESULTS: There were no significant differences amongst the systems tested in the amount of remaining filling material, or the reduction rates after each phase of the retreatment procedures (P > 0.05). Intragroup analysis indicated that the use of a larger final instrument removed significantly more filling material in all groups (P < 0.001). CONCLUSION: The four tested instrumentation systems were equally effective in removing filling materials from curved root canals in extracted teeth. Additional apical enlargement with larger files improved the removal of filling remnants after basic retreatment.

Comparison of the effectiveness of various rotary and reciprocating systems with different surface treatments to remove gutta-percha and an epoxy resin-based sealer from straight root canals.

AIM: To compare the Reciproc Blue, Reciproc and ProTaper Universal Retreatment systems with regard to the effective removal of epoxy resin-based sealer and gutta-percha during the retreatment of oval, straight root canals. METHODOLOGY: Forty-five extracted, human mandibular first premolars with single straight oval canals were selected on the basis of cone beam computed tomography evaluations. The root canals were instrumented with the ProTaper Next system up to the X2 file, and filled with gutta-percha and epoxy resin-based sealer using the cold lateral condensation technique. After 1 month, the samples were randomly divided into three groups (n = 15) according to the retreatment system used: Reciproc Blue R40, Reciproc R40 and ProTaper Universal. The specimens were scanned at the resolution of 1.2 µm by a microcomputed tomography device after the root filling and retreatment procedures, and the decrease in the volume of filling material after each retreatment protocol was measured. The results were analysed using the Kruskal-Wallis test and additional box-and-whisker plots. RESULTS: Although the volume of the filling material decreased significantly in all three groups (P < 0.05), none of the systems removed the material completely. The Reciproc system removed significantly more material than the ProTaper Universal (P < 0.001) and Reciproc Blue (P = 0.005) systems, with the latter two exhibiting equal volumes of remaining material (P = 0.068). CONCLUSION: The Reciproc system was more effective than the Reciproc Blue and ProTaper Universal Retreatment systems during the removal of filling material from oval, straight canals, although none of the systems completely removed the filling material.

[PERSONALIZED APPROACH TO PATIENT WITH CHRONIC WOUND IN FAMILY MEDICINE].

It can be said that the occurrence and development of wounds, healing, delayed healing, and the notion of chronic wound are some of the basic characteristics of all living beings. When it comes to people, there are a number of processes that take place during wound healing, and even under ideal circumstances, they create a functionally less valuable skin tissue, along with structural and functional changes. Fibrosis in the form of hypertrophic scars and keloids, contractures and adhesions are examples of excessive healing. Microcirculation is significantly different from healthy skin circulation with consequential formation of local hypoxia and stagnation in lymph flow with edema. Poor functionality of the scar tissue, particularly in the areas exposed to stronger forces, can cause forming of wounds. Such wounds are hard to heal despite the inexistence of other possible reasons for delayed healing, precisely because of their poor functionality and placement. The presence of wound requiring long-term treatment affects all areas of patient life and leads to decline in the quality of life. Exemplified by case presentation of a patient with post-traumatic wound in the scar area, in our office we showed a model of care based on the principle of overall personalized care with the biopsychosocial approach. Diagnostic and therapeutic procedures included wound assessment, biofilm and lymphedema detection, assessment of the patient's psychosocial status, risk factors for wound healing, vascular ultrasound diagnostics, carboxytherapy as specialized adjuvant therapy, use of modern wound dressings, and compression therapy. Supportive psychotherapy was conducted in positive communication environment during treatment. In this way, in an atmosphere of cooperation with the patient, it was possible not only to influence the process of wound healing as the primary objective, but also to improve the quality of the patient's life, as well as to influence our professional satisfaction with the results achieved. Family doctors are involved in the care of chronic wound patients as part of the multidisciplinary team of experts. Additional specific knowledge and skills are required for such care in order to ensure overall quality care as a supplement of the existing knowledge, skills and working experience in family medicine.

[PALLIATIVE CARE OF PATIENT WITH GASTROINTESTINAL CANCER IN FAMILY MEDICINE].

Palliative care is defined as the care for patients whose disease is not responsive to curative treatment. The goals of palliative care are symptom control, life prolongation and enabling the best possible quality of life for patients and their families. For most patients with an advanced progressive incurable disease, 90% of care in their last year of life is provided at home by family physician and his team and patient family. Patients suffering from cancer have a mean of of 11.9 symptoms in the last three months of life. The most common symptoms are digestive tract symptoms and pain. The growth and spread of cancer, as well as the therapeutic procedures applied are the most important causes of symptoms. The most common symptoms in patients with cancer of digestive system are nausea, vomiting, constipation, pain, cachexia, anorexia, and psychological problems. These most common symptoms and many others will be of varying intensity and appearance depending on localization and aggressiveness of digestive system cancer, modality of treatment and patient condition. Patients with advanced cancer have longer survival and all health care professionals involved in the care of patients should have more knowledge and skills necessary to effectively treat various symptoms. Coordination, organization and implementation of palliative care in family medicine, when large part of care is provided at patient home, are one of the most complex tasks of family physician. This task requires a family practitioner with specific knowledge and skills to know how effectively control a number of symptoms and to provide adequate support to the patient and his family. Communication between doctor and patient suffering from advanced cancer of digestive system is a fundamental aspect of care. The quality of communication significantly affects the course of treatment, the benefit to patients and their families, the choice of treatment and adherence to treatment, as well as care planning. In the management of patients with advanced cancer of the digestive system, family physician should use holistic approach and respect the patient as a person and his decision.

Biochemical and epigenetic changes in phytoplasma-recovered periwinkle after indole-3-butyric acid treatment.

AIM: To elucidate the possible mechanism of phytoplasma elimination from periwinkle shoots caused by indole-3-butyric acid (IBA) treatment. METHODS AND RESULTS: It has been shown that a transfer of in vitro-grown phytoplasma-infected Catharanthus roseus (periwinkle) plantlets from medium supplemented with 6-benzylaminopurine (BA) to one supplemented with IBA can induce remission of symptoms and even permanent elimination of 'Candidatus Phytoplasma asteris' reference strain HYDB. Endogenous auxin levels and general methylation levels in noninfected periwinkles, periwinkles infected with two 'Candidatus Phytoplasma' species and phytoplasma-recovered periwinkles were measured and compared. After the transfer from cytokinin- to auxin-containing media, healthy shoots maintained their phenotype, methylation levels and hormone concentrations. Phytoplasma infection caused a change in the endogenous indole-3-acetic acid to IBA ratio in periwinkle shoots infected with two 'Candidatus Phytoplasma' species, but general methylation was significantly changed only in shoots infected with 'Ca. P. asteris', which resulted in the only phytoplasma species eliminated from shoots after transfer to IBA-containing medium. Both phytoplasma infection and treatment with plant growth regulators influenced callose deposition in phloem tissue, concentrations of photosynthetic pigments and soluble proteins, H(2) O(2) levels and activities of catalase (CAT) and ascorbate peroxidase (APX). CONCLUSION: Lower level of host genome methylation in 'Ca. P. asteris'-infected periwinkles on medium supplemented with BA was significantly elevated after IBA treatment, while IBA treatment had no effect on cytosine methylation in periwinkles infected with 'Candidatus Phytoplasma ulmi' strain EY-C. SIGNIFICANCE AND IMPACT OF THE STUDY: Hormone-dependent recovery is a distinct phenomenon from natural recovery. As opposed to spontaneously recovered plants in which elevated peroxide levels and differential expression of peroxide-related enzymes were observed, in hormone-dependent recovery changes in global host genome, methylation coincide with the presence/absence of phytoplasma.

The role of insulin and IGF-1 signaling in longevity.

There are many theories of aging and parameters that influence lifespan, including genetic instability, telomerase activity and oxidative stress. The role of caloric restriction, metabolism and insulin and insulin-like growth factor-1 signaling in the process of aging is especially well conserved throughout evolution. These latter factors interact with each other, the former factors and histone deacetylases of the SIR family in a complex interaction to influence lifespan.

Immunostimulatory effect of natural clinoptilolite as a possible mechanism of its antimetastatic ability.

PURPOSE: Many biochemical processes are closely related to ion exchange, adsorption, and catalysis. Zeolites reversibly bind small molecules such as oxygen or nitric oxide; they possess size and shape selectivity, the possibility of metalloenzyme mimicry, and immunomodulatory activity. These properties make them interesting for pharmaceutical industry and medicine. METHODS: The experiments were performed on mice. Different biochemical and molecular methods were used. RESULTS: Micronized zeolite (MZ) administered by gastric intubation to mice injected with melanoma cells significantly reduced the number of melanoma metastases. In mice fed MZ for 28 days, concentration of lipid-bound sialic acid (LSA) in serum increased, but lipid peroxidation in liver decreased. The lymphocytes from lymph nodes of these mice provoked a significantly higher alogeneic graft-versus-host (GVH) reaction than cells of control mice. After i.p. application of MZ, the number of peritoneal macrophages, as well as their production of superoxide anion, increased. However, NO generation was totally abolished. At the same time, translocation of p65 (NFkappaB subunit) to the nucleus of splenic cells was observed. CONCLUSION: Here we report antimetastatic and immunostimulatory effect of MZ and we propose a possible mechanism of its action.

Surface anatomy of the face in Down's syndrome: anthropometric proportion indices in the craniofacial regions.

The objective of the study was to identify the proportions closest to normal and those indicating mild-to-moderate and severe degrees of disproportion. Eight proportion indices were analyzed in five craniofacial regions of 125 Down's syndrome patients, based on a total of 985 data points. More than two thirds of the patients fell within the normal range, although more than one quarter were abnormal (disproportionate). All statistical summaries were based on z-scores (adjusting for age and sex differences), converted into descriptive anthropometric categories to yield a simplified frequency distribution for each proportion index. Normal proportions were harmonious in 55.9% of patients. Disproportions were mild to moderate in 66.4%, severe in 33.6%. The highest frequency of harmony was found in the head (70.2%), the lowest in the orbits (40.8%). The highest percentage of mild-moderate disproportion was found in the face (79.3%). The highest percentage of severe disproportions was recorded in the intercanthal index of the orbits (44.7%) and the smallest frequency in the face (20.7%). In the five craniofacial regions among the normal proportions, harmonies were more frequent than disharmonies. Among the disproportions, the percentage of mild-moderate ones was greater than those of severe degree.

Surface anatomy of the face in Down's syndrome: linear and angular measurements in the craniofacial regions.

Measurements (23 projective linear, 2 angular) taken in the 6 craniofacial regions of 127 patients with Down's syndrome showed that 63.1% (1,836 of 2,908) were within normal limits and 36.9% (1,072) were outside them. Abnormal measurements were subnormal in 90.8% (973) and supernormal in 9.2% (99). All statistical summaries were based on z scores (adjusting for age and sex differences) classified into a small number of ranges to yield a simplified frequency distribution for each measurement. The purpose of the study was to identify the measurements closest to normal and those indicating the most severe degrees of sub- or supernormality. Approximately a quarter of normal measurements were classified as optimal, and half the subnormal or supernormal measurements were classified as severe. Intercanthal width had the highest frequency of optimal measurements (93.7%, 119 of 127), head circumference the smallest (28.6%, 36 of 126). Knowledge of the frequency of extreme abnormalities in the craniofacial regions will help during visual examination of patients with Down's syndrome. This study found the highest percentage of severely subnormal measurements in the orbital region (57.8%, 74 of 128) and the smallest in the labio-oral region (32.7%, 16 of 49). The measurement with the highest proportion of severely subnormal to all subnormal values was the palpebral fissure length (68%, 51 of 75), and the nose width had the smallest proportion (14.3%, 1 of 7).

[Use of international databases for improvement of comprehensive care of patients with head and neck cancer]. / Uporaba medunarodnih baza podataka pri unapredivanju sveobuhvatne skrbi za bolesnika s rakom glave i vrata.

The aim of this paper was to examine the usefulness of CancerNet in the improvement of knowledge of general practitioners on specific types of cancer and the procedures for patient management, thus indirectly producing an impact on quality improvement in comprehensive health care of patients with the head and neck cancer. Data on 58 patients with the head and neck cancer were collected from medical records in 28 general practices of the "Novi Zagreb" Health Center and from GPs' information. The GPs' knowledge on cancer of the larynx and hypopharynx was examined before and after they had studied the information provided by CancerNet. The mechanism of transferring information from the clinical and public health levels towards GPs was examined on GPs having in their care patients with the head and neck cancer. The following methodological characteristics were determined to have had an impact on patient care: within the structure of health care, a possible contribution of this procedure was identified in completing patient medical documentation as well as GPs' specific knowledge; within the health care process, a possible impact of this procedure on the quality of monitoring of a population health status, on more regular referrals to specialist consultations, as well as on pain and anxiety management, and a higher quality education on elimination of risk factors in patients' lifestyles. In average, the usefulness was scored by GPs with 4.0 for improving the communication with patients, and with 4.3 for expanding the GPs' knowledge. Three fifths of GPs involved in the study considered the contact range provided by CancerNet sufficient. All GPs assessed such information as useful for GPs in Croatia.

Natural zeolite clinoptilolite: new adjuvant in anticancer therapy.

Natural silicate materials, including zeolite clinoptilolite, have been shown to exhibit diverse biological activities and have been used successfully as a vaccine adjuvant and for the treatment of diarrhea. We report a novel use of finely ground clinoptilolite as a potential adjuvant in anticancer therapy. Clinoptilolite treatment of mice and dogs suffering from a variety of tumor types led to improvement in the overall health status, prolongation of life-span, and decrease in tumors size. Local application of clinoptilolite to skin cancers of dogs effectively reduced tumor formation and growth. In addition, toxicology studies on mice and rats demonstrated that the treatment does not have negative effects. In vitro tissue culture studies showed that finely ground clinoptilolite inhibits protein kinase B (c-Akt), induces expression of p21WAF1/CIP1 and p27KIP1 tumor suppressor proteins, and blocks cell growth in several cancer cell lines. These data indicate that clinoptilolite treatment might affect cancer growth by attenuating survival signals and inducing tumor suppressor genes in treated cells.

Patients' views on the professional behaviour of family physicians.

BACKGROUND: Patient satisfaction is an important part and a measure of the quality of health care. Patient satisfaction with family physicians was studied within the project 'Analysis of Transition of Health Care System in Croatia'. OBJECTIVES: The aim of this study was to explore patient satisfaction with family physicians through evaluation of some characteristics of physician behaviour. The specific goals of this study were to determine whether there were differences in the evaluation of patient satisfaction with physician behaviour with regard to some sociodemographic characteristics of the respondents. METHODS: The study group consisted of 1217 respondents: 479 (39.4%) men and 738 (60.6%) women. Medical students interviewed the respondents 'face-to-face' immediately after their consultation with the physician. An anonymous questionnaire was created providing answers to 10 questions on patient satisfaction. Data on sociodemographic characteristics and the reason for encounter of the respondents were also collected. RESULTS: The average positive rating over 10 questions on patient satisfaction was 85.3%. There was a statistically significant difference in age distribution between geographic areas (P < 0.001). Differences in answers were found regarding sex, age, educational level (P < 0.001) and reason for encounter (P < 0.01). Two factors were obtained by factor analysis: the first could be called physician's competence/expertise estimated by respondents, and the other physician's empathy evaluated by respondents. The respondents were divided into two groups based on the reason for encounter as a criterion for discriminant analysis: acute (symptoms and complaints, injuries; n = 553) and other reasons (n = 664). The discriminant function obtained was statistically significant (P < 0.01). Younger respondents, regardless of sex, whose reason for encounter was an acute condition, were less satisfied with the physician's expertise, agreeableness during the consultation, physician's interest in what they were saying and physician's friendliness. CONCLUSION: Considering the difficulties present in the health systems of countries in transition, the results of our study were surprisingly encouraging, showing that the respondents were satisfied with the physician's behaviour and that the physicians fulfilled the basic elements of professional behaviour.

[Family practitioners in the primary health care of preschool-age children--a report on well-child care in the practice of 2 family medicine physicians]. / Obiteljski lijecnik u primarnoj zdravstvenoj zastiti djece predskolske dobi--prikaz rada savjetovalista za zdravu djecu u dvije ordinacije obiteljske medicine.

Primary health care of preschool children is organized in the Republic of Croatia by pediatricians, general practitioners and family/general practice specialist. The aim of this study is to evaluate the care for preschool children in the well baby clinics led by general/family specialist. Vaccination and visits data were collected from the medical records of 148 children born from January 1st 1992 till December 31st 1997, registered in two family practice offices in the well baby clinics at the Dugave-Travno Health Station of the "Novi Zagreb" Health Center. Comparison was made between data on compulsory immunization minimum in the Republic of Croatia and data from the Croatian National Institute of Public Health on vaccination of infants and preschool children in the Republic of Croatia in 1997. Diphtheria, tetanus and poliomyelitis vaccination was 100%, pertussis vaccination was 97.2%, measles and parotitis vaccination was 92.2% and rubella vaccination was 91.5%. Diphtheria and tetanus revaccination of children in the second year of life was 97.6%, pertussis revaccination was 94.4% and poliomyelitis revaccination was 96.8%. Comparison of those results proves the efficacy of compulsory immunization program of preschool children in family/general specialists' offices. The accessibility of general/family practice, appropriate education of general/family specialists during the specialization in family medicine for primary care of preschool children as well as for other family members, the ability of family physician to offer integrated continuous care and good cooperation of the family physician and the public nurse are the factors that enable appropriate primary care for preschool children in general practice/family medicine.

General practitioners' patterns of antimicrobial drugs prescription in the therapy of acute pharyngitis.

OBJECTIVE: To analyse the patterns of antibiotic prescription in the treatment of acute pharyngitis among a group of general practitioners (GPs). DESIGN: From the records of their patients, 11 specialists in general practice have collected post hoc data on their patients and on acute pharyngitis in the period from October 1, 1994 to September 30, 1995. SETTING: 11 teaching practices in four health centres in Zagreb, Croatia. SUBJECTS: GPs grouped according to whether they had pre-school children in their care. MAIN OUTCOME MEASURES: The choice and cost of the prescribed antimicrobial drug, and the impact of the characteristics of the population in care to the prescription rate and structure. RESULTS: An antimicrobial drug was prescribed in 784 (72.1%) cases of pharyngitis. Two groups of GPs have shown significant differences in the prescription rate (p < 0.001), and in the choice of antimicrobial drugs (p < 0.001). CONCLUSION: GPs with a larger number of patients in their care suffering from chronic diseases tend to prescribe antimicrobial drugs more often in the treatment of acute pharyngitis.

Benchmarking the vital risk of waiting for coronary artery bypass surgery in Ontario.

BACKGROUND: Deaths among patients awaiting coronary artery bypass grafting (CABG) are a source of private grief and public concern in Canada. However, some deaths are expected over time among patients with coronary artery disease. Methods of benchmarking the burden of delayed care may be useful in understanding and managing waiting lists for CABG and other health services. The authors therefore determined the vital risk among people waiting for CABG in Ontario and compared it with the risk in the general population and among people living with coronary artery disease. METHODS: Patients registered to undergo CABG in Ontario between 1991 and 1995 were followed to ascertain numbers and dates of preoperative deaths or completed operations. Linking hospital discharge abstract data to vital statistics for 1991 to 1994, the authors defined a cohort of people who had survived 6 months after an acute myocardial infarction (AMI) and followed them for an additional 6 months to determine numbers and dates of deaths. They matched patients by age and sex and then calculated the standardized mortality ratio for each cohort (i.e., the ratio of observed deaths to those expected based on age- and sex-specific daily probabilities of death for the provincial population). RESULTS: Among 21,220 patients awaiting CABG, there were 82 preoperative deaths over a median follow-up of 18 days; the standardized mortality ratio was 2.92 (95% confidence limit [CL] 2.29-3.55). Among 21,220 matched 6-month survivors of an AMI, there were 663 deaths over a median follow up of 185 days; the standardized mortality ratio was 3.84 (95% CI 3.54-4.14). INTERPRETATION: Patients awaiting CABG in Ontario are at a much greater risk of death than the general population. However, when compared with thousands of other patients living with coronary artery disease, they are at similar or decreased vital risk.

An in vitro model of the early genetic events in multistage carcinogenesis of malignant insulinoma.

The aim of this study was to establish an in vitro model to confirm earlier observations on the role of the myc/ras oncogenes as promoting factors in the process of normal Langerhans islet beta cell transformation. For that purpose we infected primary mouse Langerhans islets with a recombinant retrovirus containing the v-H-ras and v-myc oncogenes, before or after treatment with transforming growth factor alpha (TGFalpha). Normal Langerhans islets, when grown in culture, are viable for 2-3 weeks. After treatment with TGFalpha, viability was extended by 10 days, following which islets disintegrated. Langerhans islets transformed with v-H-ras and v-myc became immortal and insulin negative. Single infected beta cells, liberated from a primary islet into the surrounding medium, gave rise to neo islet formation. Moreover, single infected beta cells were able to grow and divide, even without fibroblast support. These results indicate that the myc and ras oncogenes are sufficient for commencement of beta cell transformation and, therefore, could represent 'early events' in the multistep carcinogenesis of insulinomas.

Comparison of anthropometric and cephalometric measurements of the adult face.

To tabulate and assess quantitative differences between anthropometric and corresponding radiographic cephalometric measurements obtained from the same persons, 19 projective linear measurements were taken from the surface of the heads and faces of 41 patients with cleft lip, cleft palate, or both, all of whom were white North Americans aged 14 to 29 years. They underwent radiographic examination shortly afterward, and corresponding cephalometric measurements were obtained. Differences between the methods were assessed by the numeric differences between the mean values of concurrent measurements. Statistical difference was assessed by paired t test, Pearson product-moment correlations, and intraclass index for degree of agreement between findings. By numeric difference, 6 of 19 anthropometric measurements were similar to (within 2% of) those taken from radiographs. Paired t tests disclosed significant differences between 16 of 19 measurements. Half of the six surface measurements similar to their skeletal counterparts showed no statistical difference; the other half showed only moderately significant differences. Differences between the 13 "dissimilar" measurement pairs (differences > 2%) were highly significant. Good correlations were found in five of the six similar measurements, which may have an important prognostic value in understanding changes in the craniofacial measurements of the face. Knowledge of the correlations between all major measurements of the head and face on the surface and skeleton is essential for anticipating changes in the morphologic characteristics of the growing face.

Anthropometry of soft-tissue orbits in Bulgarian newborns: norms for intercanthal and biocular widths and length of palpebral fissures in 100 boys and 100 girls.

OBJECTIVE: To establish early postnatal norms for the main measurements of the soft-tissue orbits for the Slavic Bulgarian population (9 million), we measured intercanthal (en-en) and biocular width (ex-ex) and length of the palpebral fissures (ex-en) in a representative sample of newborns less than six days old. METHOD: Eye measurements were taken with a sliding caliper from randomly chosen subjects by the senior author using standard anthropometric methods. Findings were compared to those published for other Caucasian ethnic groups of infants (Germans and two groups of North American Caucasians). RESULTS: The mean values of all three soft orbital measurements were greater in newborn Bulgarian boys than girls. Measurements of Bulgarian intercanthal width (en-en) were greater in both sexes but those of biocular width (ex-ex) and palpebral fissure length (ex-en) were less than those that have been reported for North American Caucasian infants. Bulgarian intercanthal and biocular measurements were wider than German babies in both sexes. Differences, although small, were statistically highly significant but greatly influenced by differing sample sizes and subject age among the four Caucasian populations. CONCLUSION: Anthropometric differences between ethnic groups of Caucasians already exist shortly after birth. Knowledge of the soft orbital data in early stages of the postnatal development in healthy populations is essential for determination in individuals of deviations from normal data. These Bulgarian norms can be helpful in anthropometric studies of the ethnically mixed Caucasian populations of North America.

Determinants of left ventricular mass in early hypertension.

One hundred seventy-six unmedicated mildly hypertensive subjects (113 men, 63 women) underwent M-mode echocardiography to determine left ventricular mass (LVM) and relative wall thickness (RWT), 24-h ambulatory blood pressure monitoring, and completed standardized questionnaires measuring marital and job stress. Subjects were aged 46 +/- 9 years old; 45.4% had daytime diastolic blood pressure < 90 mm Hg; 96.1% of LVM results were in the normal range. We found that neither marital distress nor job strain was a determinant of LVM. However, a segmental regression approach revealed inflection points of 131 mm Hg systolic daytime blood pressure and 83 and 87 mm Hg nighttime diastolic blood pressure in the relation between LVM and RWT, respectively, and ambulatory BP. In addition, we found that the variability of LVM was best explained by indexing LVM by height, rather than body surface area.

[Acute respiratory infection in general clinical practice]. / Akutne respiratorne infekcije u praksi lijecnika opce medicine.

Due to high frequency, certain risk of related complications, absenteeism, direct and indirect costs related to them, acute respiratory infections represent a significant health problem. The aim of the paper is to examine the frequency and characteristics of acute respiratory infections, as well as the characteristics of patients with these infections among the population in care of general practitioners/family physicians. In 11 teaching general practices in Zagreb, data were collected from medical records on patients and acute respiratory infections which the patients developed over the period from October 1, 1994 to September 30, 1995. For statistical data processing description, distribution analysis and chi-square test were used. Out of 17,888 patients in care of general practitioners involved in the study, acute respiratory infections were noticed in 4,114 (22.9%) patients ranging in age from newborn to 97 years out of which 1,473 (35.8%) were males and 2,641 (64.2%) were females. A total of 5,892 acute respiratory infections were observed, in average 1.43 infections per patient, for which the patients visited their general practitioners 11,610 times (1.97 visits per infection). Most of the patients 2,958 (71.9%) attended their general practitioners because of one acute respiratory infection. The initial diagnosis of acute upper respiratory tract infection was registered in 4,601 (78.1%) infections, and final diagnosis in 4,475 (75.9%) infections. The most frequent diagnoses included: pharyngitis and tonsillitis (including streptococcal pharyngitis and tonsillitis), nasopharyngitis, sinusitis and bronchitis. In 4,874 (82.7%) cases, general practitioners based their diagnosis on patient history and clinical examination. Antibiotics were prescribed in 3,892 (66.1%) cases. Out of 42 (1.2%) patients treated in hospital, seven patients were admitted for tuberculosis and two for bronchi cancer detected during the acute respiratory infection. Follow-up was reported in 3,644 (60.3%) cases, and sick leave in 1,236 (31%) cases. The results of this study have shown significantly higher frequency of acute respiratory infections in the morbidity in outpatient health care, and also that management of patients with these diseases is mainly the responsibility of general practitioners. In order to improve professional competence of general practitioner/family physician and quality of work in the management of patients with acute respiratory infections in general practice/family medicine, it is necessary to continuously improve the knowledge on all characteristics of the management of patient with these diseases in general practice, as well as to make a critical assessment of the existing practice.