Risk factors for developing chronic whiplash disorders.

BACKGROUND: Whiplash injury is one of the most common injuries in traffic accidents. Most of the injured recover within three months, however, a significant number have symptoms much longer. OBJECTIVE: The aim of this study was to determine the basic epidemiological characteristics of whiplash (gender, age, collision type, the type of participants in an accident, clinical signs) on Bosnia and Herzegovina roads and identify risk factors for chronic symptoms. METHODS: The subjects of this retrospective study were traffic accident whiplash patients who were diagnosed, treated and monitored in a single hospital center. The initial examination was performed on the day or the day after the accident and follow-up examinations after four weeks, three months, and six months. RESULTS: Out of the 241 patients in this study, 14.1% had symptoms over six months after the trauma. 54.7% of the injured belong to the third and fourth decade and close to 80% were younger than 50 years. In addition to neck pain, the most common symptoms were limited neck mobility (69.7%), muscle spasms (63.5%), palpable pain of neck muscles (56%), headache (43.6%), nausea (23.7%). Statistical analysis showed a positive impact of age, Quebec Task Force (QTF) grade II, and more injury severity and cervical spine degenerative changes on prolonged recovery. CONCLUSIONS: The overwhelming majority of the injured belong to the working population. QTF2+ score is a useful indicator for prolonged recovery and chronic symptoms. Age, QTF score and degenerative changes of the cervical spine indicate an increased risk for poor recovery and chronic symptoms.

Fatal poisoning by ingestion of Taxus Baccata leaves.

In this report we describe a first suicide case in Serbia related to ingestion of Taxus baccata leaves. A 30-year old woman was found dead, and the green plant material in a plastic bag was found near her bed. Autopsy revealed dark green needle-like leaves in the stomach, similar to that contained in the plastic bag, and both were botanically identified as Taxus baccata, also known as yew. Using gas chromatography-mass spectrometry (GC-MS), 3,5-dimethoxyphenol (3,5-DMP) as toxicological evidence for the ingestion of yew leaves, was detected in biological samples. As the autopsy showed unspecific findings, and also the routine toxicological examination, based upon 3,5-DMP identification, the cause of death was determined to be suicide, caused by yew poisoning.

Fatal Intoxication with Toluene Due to Inhalation of Glue.

Two cases of fatal intoxications with toluene due to glue sniffing are described. In case 1, the autopsy did not indicate cause of death, while in case 2, the cause of death was determined to possibly be due to mechanical asphyxia by drowning. As the decedents had a history of glue sniffing, toxicological analyses were performed. Using gas chromatography with flame ionization detector and gas chromatography/mass spectrometry (GC/MS) with headspace method, toluene was detected in biological samples. Toluene ranged from 3.81 to 20.97 µg/g, with the highest concentrations observed in liver and brain (13.82-20.97 µg/g) in both cases. Based upon this data, the cause of death in both cases was determined to be toluene poisoning. Toxicological investigations are extremely important and should be considered mandatory in all deaths thought to be due to volatile substance abuse, as well as all deaths that are thought to be due to poisoning in young people.

Neonatal multiple blood cysts of heart valves.

The female neonate, 27 days, 53 cm, 3450 g, was found dead in early morning hours. Baby was healthy, well nourished, and not neglected, up to the day before when she started to cough and scheduled for next-day regular pediatrician visit. Due to unexpected death, the autopsy was performed. Multiple oval, blood cysts, up to 0.5 cm, were found on the free valvular margins of the mitral valve, tricuspid valve, and aortic valve. The blood cysts were unilocular, filled with blood, and lined with flattened endothelial cells. The surrounding stroma was slightly edematous but without myxoid changes.

[Homicide or suicide by strangulation--case report].

INTRODUCTION: Ligature strangulation represents a violent mechanical asphyxiation caused by tightening a loop around the victim's neck, pulled either by an active or passive force. Mechanism of death is most often due to cerebral hypoxia caused by compression of blood vessels which feed the brain, but it can also occur either due to compression and closing the air passages or by stimulating the superior laryngeal nerve. CASE REPORT: An 81-year-old woman was found in her home lying across the couch with a bathrobe belt tied around her neck and a knot at the back side. Body examination showed congestion of the face, conjunctival petechiae as well as a ligature mark in the middle of the neck. The internal examination revealed hematomas on the left side of the tongue, on its base and in the neck muscles on the left side. CONCLUSION: Thorough forensic expertise of a strangulation case includes the circumstances surrounding the death, detailed information of a crime scene and a complete autopsy report. The relevant pieces of information obtained from each of the investigation phase can be vital for making the right decision about the cause of death.

Hypolipidemic and antioxidant effects of buckwheat leaf and flower mixture in hyperlipidemic rats.

As a source of biologically active compounds, buckwheat has beneficial effects in nutrition due to its high content of flavonoids, particularly rutin. Aim of our study was to examine effects of buckwheat on plasma lipid status and phospholipids fatty acids composition, histological and parameters of oxidative stress in Wistar rats fed a high-fat diet. This study showed that buckwheat leaf and flower (BLF) mixture supplementation significantly reduce weight gain, plasma lipid concentrations and atherogenic index in rats fed a high-fat diet. Treatment of the high-fat group of animals with buckwheat significantly increased percentage of n-6 fatty acids as well as eicosapentaenoic acid (EPA) and decreased percentage of saturated fatty acids (SFA) and oleic acid. Buckwheat antioxidant effects diminished negative influence of high-fat diet in hyperlipidemic rats, while pathohistological analysis of liver confirmed changes after high-fat consumption. Our results showed hypolipidemic, antiatherogenic and antioxidative features of buckwheat leaf and flower mixture, and these parts of the plant with the highest rutin content could be beneficial in prevention and curing of hyperlipidemia.

Correlation between subjective and objective nasal breathing assessments in examinees with nasal septum deformities.

BACKGROUND/AIM: Nasal obstruction is one of the most frequent disorders because of which patients see their Ear, Nose and Throath (ENT) doctors. Impaired nose breath ing is a subjective symptom and it often does not coincide with clinical nose findings and functional tests of breath ing function. Therefore, the aim of this study was to es tablish if there is an accordance between a subjective nose breathing assessment and objective methods (rhinoma nometry and acoustic rhinometry) in assessing nose breathing function in patients with diverse nasal septum deformity degrees, as well as to establish an accordance between these two objective methods. METHODS: This study involved the total of 90 examinees divided into three groups. The group I consisted of examinees with nasal septum deformities less than 10 degrees. The group II consisted of examinees with nasal septum deformities ranged from 10 degrees to 15 degrees. The group III involved examinees with nasal septum deformities over 15 degrees. Each examinee had subjec tively graded his/her nasal breathing on the side of the nose septum deformity from 0 to 10, and afterwards the whole noses. Rhinomanometry and acoustic rhinometry were done on the side of the nasal septum deformities and after that on the other side of the nose using the Interacoustics SRE 2000 device. RESULTS: In the groups II and III there was a positive correlation between a subjective nose breathing assessment and rhinomanometric values both on the side of the nasal septum deformities and the nose as a whole, (p < 0.05), and no correlation between these traits in the group I (p > 0.05). In none of the exam ined groups correlation was found between a subjective nose breathing assessment and rhinometric values, both minimum cross-sectional area (MCA) and volume (VOL), both on the side of the nasal septum deformities and the nose as a whole (p > 0.05). There was no correlation found between rhinomanometric and rhinometric MCA and VOL values in either on the sides of nasal septum deformities or the nose as a whole in any of the examined groups (p > 0.05). CONCLUSION: Rhinomanometry significantly correlates with the subjective nose breathing assessment and it can be used as a reliable and objective indicator of nose breathing in everyday clinical practice. Acoustic rhinometry, on the other hand, which does not correlate with a subjective nose breathing assessment could have a greater significance in a scientific sense than in clinical applying.

Preoperative evaluation in the era of laparoscopic surgery.

To confirm the importance of preoperative evaluation of a patient's health state, to reduce perioperative morbidity and mortality after laparoscopic surgery. A total number of 1,070 patients were selected into groups based on a type of intervention, gender, ASA and NYHA classification. The most common laparoscopic procedure that was performed was cholecystectomy in 920 (86%) patients. Cardiovascular disease had been presented in 952 (89%) patients, 1006 (94 %) of patients were ASA class I- III, while 1049 (98%) patients were NYHA class I and II. Frequency of lethal outcome was 0.1% due to postoperative thromboembolic complications. A lower mortality rate is a result of prescribed protocol and adequate preoperative examination.

Distribution of opiate alkaloids in brain tissue of experimental animals.

The present study examined regional distribution of opiate alkaloids from seized heroin in brain regions of experimental animals in order to select parts with the highest content of opiates. Their analysis should contribute to resolve causes of death due to heroin intake. The tests were performed at different time periods (5, 15, 45 and 120 min) after male and female Wistar rats were treated with seized heroin. Opiate alkaloids (codeine, morphine, acetylcodeine, 6-acetylmorphine and 3,6-diacetylmorphine) were quantitatively determined in brain regions known for their high concentration of µ-opiate receptors: cortex, brainstem, amygdala and basal ganglia, by using gas chromatography-mass spectrometry (GC-MS). The highest content of opiate alkaloids in the brain tissue of female animals was found 15 min and in male animals 45 min after treatment. The highest content of opiates was determined in the basal ganglia of the animals of both genders, indicating that this part of brain tissue presents a reliable sample for identifying and assessing contents of opiates after heroin intake.

Sudden death of a swimmer in water caused by heterotopic intracranial ossification and anomaly of the skull base.

BACKGROUND: Expression of immersion syndrome implies sudden and unexpected death of swimmer in water. A drowned swimmer is still a riddle for the forensic and clinical doctors. Pathophysiological mechanisms which cause immersion syndrome may be divided into vegetatively regulating and mechanical ones. CASE REPORT: We presented heterotopic intracranial ossification with the anomaly of the skull base bones development in a young man, a swimmer, drowned after entering water and where the circumstances required expertise in forensic medicine. CONCLUSION: Intracranial heterotopic ossification with or without a disorder in the development of skull bones may be one of the causes of immersion syndrome.

Inhibitory effect of Ginkgo biloba extract on the tonus of the small intestine and the colon of rabbits.

Ginkgo biloba is widely used in folk medicine. Patients very often use the plant preparation with no concern for purity. They also tend to increase the dosage by themselves and this may result in certain insufficiently researched acute effects. Due to this extremely widespread application, the aim of this work is an examination of the possible acute effects of Ginkgo bilobaon the motility of the small and the large intestine of rabbits. capital TE, Cyrilliche effects of Gingium - a standardized ginkgo biloba extract (GBE) [one milliliter preparation contained 8.8-10.8 mg ginkgo flavonol glycoside and 2.0-2.8 mg lactone ring-containing terpenes (ginkgolides and bilobalides)], on the tonus of isolated segments of the ileum and the colon of rabbits were examined. The experiments were carried out on isolated bowel incisions according to the Magnus method. Data was registered by physiography (Narco-Bio-System). Our results show that GBE (0.006 g/L, - 0.06 g/L) concentration-dependently reduces the tonus of the ileum and the colon of rabbits. Apart from that, GBE reduces the increase of the tonus of the ileum caused by acetylcholine (ACh), but does not change colon tonus intensified by ACh. This indicates that the effects of the used extract in the ileum are predominantly achieved through cholinergic mechanisms, while the relaxant effects in the colon are achieved in some other way.

Gender-related differences in the pharmacokinetics of opiates.

Previous studies have documented gender-related differences in a number of aspects of the pharmacology of opiates, including their analgesic activity, stimulative properties and generation of physical dependence. The current experiments were carried out with the aim to examine whether male-female differences exist in the blood and brain levels of opiates attained after their intraperitoneal injection to male and female Wistar rats. The tests were performed 5, 15, 45 and 120 min after the animal treatment with seized heroin. Gas chromatography-mass spectrometry (GC-MS) method was developed to quantitatively determine opiate alkaloids in blood and brain regions (known for their high concentration of mu-opiate receptors): cortex, brainstem, amygdala and basal ganglia. Maximal contents of opiates in blood of animals of both genders were found in the second measurement time (15 min), the values measured in the males being significantly higher, which suggests a faster passage of the opiates from blood to brain tissue in female animals. The highest content of opiates in the brain tissue of female animals was measured 15 min and with male animals 45 min after the treatment, which also indicates faster distribution of opiates from blood to brain in the female compared to male rats. The highest proportion of opiates was found in the basal ganglia of the animals of both genders. The obtained results offer the possibility of selecting this part of the brain tissue of both males and females as a representative sample for identifying and assessing contents of opiates.

[Treatment of neglected and abused children and their families in the context of complicated divorce].

INTRODUCTION: Coceptualisation of complicated divorce, as an escalation of systemic dysfunctioning in a highly disturbed and unbalanced system, acquires attributes of trauma-organised-system, and yields itself for therapeutic interventions. COMPLICATED DIVORCE ISSUES: The authors comment on their experience while treating families sent by Court order in divorce custody disputes, with explicit aim of evaluating parental competence. This type of systemic dysfunction is severely affecting communication styles, family rules and norms, whereas parenting is frequently marked by tendency to repeat relational-style experienced in marital, partners' conflicts. Feelings of discontent and resentment are projected onto children, and may take form of disqualifications, rejection, discrimination or else, those feelings stemming out of personal ambition such as favoring children. Parental rivalry worsens these processes, leading to attempts of establishing inappropriate level of control over children (instrumentalisation or favorisation). Therefore, care and protection of children is inadequate and children are emotionally neglected DISCUSSION AND CONCLUSION: Many of these highly disturbed families, especially those sent by Court order are engaged in a network of different social, legal and mental health institutions. Intervention plans are thus conceived and specifically tailored to suit individual families, confronting dysfunctional patterns and appealing to enhance parental responsibilities. Overcoming family crisis of complicated divorce where childresn's emotional needs are neglected is highly indicated for systemic intervening. The authors discuss their experience in treating such families and offer their questions, dilemmas and recommendations.

[Classification and qualification of nose injuries--clinical and forensic aspects].

INTRODUCTION: Nose injuries are of great importance in ENT and medico-legal practice. The importance lies in the frequency of injuries, diverse approaches to diagnosis, treatment and qualification of injuries used in legal proceedings in court. Objective assessment of health impairements due to an injury, requires knowledge about morphofunctional nasal characterics, therapeutic procedures and medico-legal expertise. NOSE INJURES: ETIOLOGY AND DIAGNOSIS: Nasal fractures are the most common types of facial fractures which occur in different situations. They are often combined with soft tissue injuries. The diagnosis of nasal injuries involves clinical examination, radiography and nasal endoscopy. CLASSIFICATION AND THERAPY OF NOSE INJURIES: There are several classifications of nasal injuries depending on pathological findings. The most acceptable one is the modified categorization after Harrison. The treatment of nasal injuries depends on the type of injury and possible complications. QUALIFICATION OF NOSE INJURIES: Nasal soft tissue injuries, nasal fractures, dislocations and partial dislocations should be assessed at the time of diagnosis. CONCLUSION: Medical assessment of injuries is of utmost importance for legal purposes and regarding medico-legal aspects.

[Sense of smell in patients with bilateral nasal polyposis]. / Osecaj mirisa kod pacijenata sa obostranom polipozom nosa.

INTRODUCTION: Sense of smell is susceptible to various changes, both in physiological and in numerous pathological conditions. Of quantitative disorders of smell, hyposmia and anosmia are quite common, whereas of qualitative disorders parosmia is most frequent. The aim of this paper was to examine impact of bilateral nasal polyposis on olfactory function. MATERIAL AND METHODS: The research was carried out at the Nose, Ear and Throat Clinic in Novi Sad. It included 80 examinees, 40 (20 male, 20 female) with bilateral nasal polyposis, while 40 examinees belonged to the control group (20 male, 20 female) without symptoms of nasal polyposes. Fortunato-Niccolini olfactometer was used for this examination. RESULTS AND DISCUSSION: In patients with bilateral nasal polyposis the average perception threshold values for examined odors were 15.50 ccm of odorous air, while in the control group they were 10.20 ccm of odorous air. The average identification threshold values for examined odors in patients with bilateral nasal polyposis were 18.80 ccm of odorous air, while in the control group they were 13.55 ccm of scented air. T-test showed that values of both thresholds were statistically significantly higher (p<0.01) in patients with bilateral nasal polyposis in relation to the control group. CONCLUSION: Olfactory deficit in patients with bilateral nasal polyposis is explained by difficult or impossible passage of odors into the olfactory region.

[Effects of ginkgo biloba extract on an experimental model of epilepsy]. / Uticaj ekstrakta gingko bilobe na eksperimentalni model epilepsije.

INTRODUCTION: The active ingredients of ginkgo biloba extracts were determined by biochemical analyses in the last ten years and they are widely used in classical medicine. The active substances of ginkgo biloba extract, mostly affect muscarinic receptors and adrenergic receptors to a lesser degree. Recently, potential effects of ginkgo biloba on NMDA receptors and on epileptogenic seizures have been considered. The main goal of this research was to investigate effects of ginkgo biloba extracts on the experimantal model of epilepsy. MATERIAL AND METHODS: The research was carried out on chinchilla rabbits. GINGIUM solution was used with 40 mg in 1 ml of dry extract of ginkgo biloba leaves. The epileptogenic area was formed by stimulating hippocampus. Bioelectrical activity was registered 60 minutes before the epileptogenic area was formed as well as 90 minutes later. Ginkgo biloba extract was given via i.m, in a single daily dose of 1 ml/kg/BW. RESULTS: A statistically significantly higher frequency of paroxysmal seizures was established after usage of ginkgo biloba. CONCLUSION: According to the results obtained in this research, we can conclude that ginkgo biloba extracts have a proconvulsive activity.

[Effect of hypoxic stress on the medullary arteries of the adrenal glands]. / Uticaj hipoksicnog stresa na medularne arterije nadbubrezne zlezde.

INTRODUCTION: It is known that suprarenal glands consist of two parts: cortex and medulla. Functional properties of circulation in these two parts are still unknown. This is a very important problem, but only a few studies have dealt with it, whereas full attention should be paid to the problem in future researches. MATERIAL AND METHODS: The experiment included 100 sexually experienced male rats which were exposed to hypoxia in testing chambers imitating conditions at 7000 m above sea level. In order to study blood vessels, we used a mixture of indian ink and 10% solution of gelatin and injected it into the left heart ventricle. RESULTS AND DISCUSSION: The most outstanding finding pointed to existence of wide ischemic areas in the outer portion of zona fasciculata, along with simultaneous strong dilatation and increased number of medullary arteries. Therefore, a conclusion can be made that the number of opened medullary arteries in the suprarenal gland depends on functional conditions and needs of the organism. The method used to present our results showed that vascular network of the suprarenal glands changed dynamically under experimental conditions. CONCLUSION: The obtained results point to functional accommodation of vascular network of suprarenal glands affected by stress, whereas medullary arteries are of predominantly functional character.

[Occurrence of congenital malformations in dead fetuses and neonates autopsied between 1991 and 2001 at the Institute of Pathology and Histology in Novi Sad]. / Ucestalost kongenitalnih malformacija u smrtnosti fetusa i novorodencadi obdukovanih 1991. i 2001. Godine u zavodu za patologiju i histologiju u Novom Sadu.

INTRODUCTION: Congenital malformations are morphological developmental anomalies visible during clinical examination or autopsy (in case of death, stillborn or abortion). Their incidence in human population is estimated to be between 5-10%, and perinatal mortality rate varies from 20-25%. MATERIAL AND METHODS: The research was conducted at the Department of Pathology and Histology and at the Department of Obstetrics and Gynecology in Novi Sad. We analyzed autopsy reports of newborns (under 28 days old), stillborns and miscarried fetuses in 1991 and 2001. Data on type and incidence of malformations in 1991 and 2001 were compared in order to determine statistically significant differences. RESULTS: Autopsy reports for 1991 revealed malformations in 21 cases, whereas autopsies were performed in 103 fetuses and newborns. The total number of deliveries at the Department of Obstetrics and Gynecology in Novi Sad was 6,160. Autopsy reports for 2001 revealed malformations in 33 cases, and autopsies were performed in 126 fetuses and newborns. The total number of deliveries at the Department of Obstetrics and Gynecology in Novi Sad was 6,101. Comparison regarding incidence of malformations in 1991 and 2001, showed no statistically significant difference. DISCUSSION: Congenital malformations are the most important cause of prenatal and perinatal mortality and morbidity. One reason for that is better treatment of other diseases, but on the other side, there are more toxic materials in human environment. CONCLUSION: It is concluded that the incidence of congenital malformations in mortality of fetuses and newborns is high (20.39% in 1991, and 26.19% in 2001). We can also point to increase of central nervous system malformations in comparison with malformations of other organ systems.

[Forensic significance of anomalies in skull development]. / Forenzicki znacaj anomalija razvoja kostiju lobanje.

INTRODUCTION: In the course of bone tissue development some genetic disorders such as exostoses and enostoses, may occur. Exostoses and enostoses represent bone tissue hyperplasia that can develop at any part of skeleton. Neurotrauma can cause fatal biological consequences, which is directly associated with skill development abnormalities. CASE REPORT: This is a case report of a male cadaver 36 years of age. The autopsy revealed massive hemorrhage on the left side of the neck and the right side of the lower jaw. A major fissure of the arterial wall was found on the basilar artery. A bony, wart-like excrescence was found on the clivus of the occipital bone. DISCUSSION: Coinciding ruptures and consequential bleeding from basilar artery with presence of development abnormalities in the clivus region, suggest that one has to clearly distinguish the result of the injury from anomalies already existing in the skull. The position of the attacker can be determined by concise and objective investigation. CONCLUSION: This is a case report of an anomaly in bone development: a bony, wart-like excrescence on the right side of the clivus. Due to neurotrauma and consequential sliding of brain structures, the damage of basilar artery and of the bony excrescence occurred, which led to bleeding and fatal outcome.

[The effect of age on the sense of smell in health individuals]. / Uticaj zivotnog doba na mirisnu funkciju kod zdravih ispitanika.

INTRODUCTION: A need for research of the olfactory function exists in everyday clinical work. The aim of this study was to determine standards for perception and identification thresholds regarding olfactory substances in healthy subjects in regard to their age. MATERIAL AND METHODS: The research included 120 healthy examinees (60 women and 60 men) classified according to age into three age groups (20-30, 31-40, 41-50 years of age). This examination was done using Fortunato-Niccolini's method. RESULTS AND DISCUSSION: The results of this work show that olfactory function becomes significantly weaker after the age of forty. Thresholds of perception in correlation with thresholds of identification for examined olfactory substances are significantly lower in older age groups. CONCLUSION: A gradual loss of olfactory capability with age can be explained by gradual destruction of olfactory cells and fibres of olfactory nerves during life.