High clinical accuracy of asymmetric dimethylarginine and symmetric dimethylarginine in patients with ischemic heart disease.

Elevated plasma concentrations of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) were found in various clinical settings including coronary heart disease. To assess ADMA and SDMA diagnostic validity in patients with different stages of ischemic heart disease, we studied these markers in patients having stable angina pectoris (SAP), unstable angina (USAP), and acute myocardial infarction (AMI). The results were compared with the values of healthy individuals. Plasma ADMA and SDMA levels were measured by high-performance liquid chromatography. In all patient groups both markers were significantly elevated in comparison with control ones (p < 0.001). In SAP patients, the median ADMA value was 0.75 (0.31-2.73) µmol/L, and SDMA 1.11 (0.69-0.1.42) µmol/L, in USAP patients, the marker values were 0.94 (0.34-3.13) µmol/L and 1.23 (0.88-4.72) µmol/L, and in AMI patients, 0.98 (0.48-2.01) µmol/L and 1.26 (0.75-2.93) µmol/L, while in healthy subjects they were 0.31 (0.17-0.87) µmol/L and 0.29 (0.20-0.83) µmol/L, respectively. SDMA was found significantly different in SAP and AMI patients (p < 0.05). Diagnostic accuracy was determined by receiver operating characteristic (ROC) curve analysis. The highest area under the ROC (AUC) for ADMA was obtained in AMI patients (0.976), while for SDMA in USAP patients (1.000). There was no significant difference between the AUCs. The greatest sensitivity and specificity were found in the USAP group (95.65 and 96.30 % for ADMA, and 100 % for each characteristic of SDMA). Considering these results, SDMA showed better clinical accuracy in assessing ischemic disease, where it could be used as a valid marker and a therapeutic target.

[Peacetime shooting injuries of the long bones]. / Mirnodopske sklopetarne povrede dugih kostiju

1. In our short reference we have shown the complete number of injuries sustained through shooting and we have indicated their enormous frequencies which can be regarded to be equal to those injuries in traffic communication. 2. While treating the injuries of extremities, as war injuries using the same principals as in war, we have obtained the best results and lessened the possibility of complication. 3. In the above cases for osteosinthesis of long bones, we held the principles of prolonged osteosinthesis while the primary osteosinthesis were use in special cases.

[Gunshot injuries of the gastroduodenal region]. / Strelne povrede gastroduodenalne regije

The injuries of the abdomen and in the region of duodenum sustained through shooting, present a delicate and difficult problem in treatment. During the years 1970/74, 375 cases were treated in our clinic, out of which 38 patients were with abdominal injuries while 12 cases were with gastro-duodenal injuries all derived through shooting. Special delicate problems represent the treatment of pancreas injuries if only the tissue of the pancreas is only made with simple stitch. The difficulties represent the treatment of injuried principal duct. Every attempt of sewing the principal duct leads to mortal inflamation of the gland. The problem of treatment of this kind of injury, apart from using different methods which are recommended in the world literature still remains open and unsolved.