Congenital cytomegalic inclusion disease with disseminated Herpes simplex infection.

We report a case of congenital cytomegalovirus and Herpes simplex virus infection suspected via ultrasound indicated by the presence of fetal cerebral abnormalities. The pregnancy was electively terminated at 31 weeks of gestation. The postmortem examination of the foetus showed brain with lissencephaly. The histopathological examination revealed numerous enlarged cells containing cytomegalic inclusions and multinucleated giant cells in multiple fetal organs and placenta. Documented evidence of histopathological detection of cytomegalovirus inclusions in multiple organs are very sparse in literature. This case highlights the causal relationship of viral infections in early pregnancy and abnormalities of the central nervous system.

Vitamin C Depletion in Prenatal Guinea Pigs as a Model of Lissencephaly Type II.

Humans and guinea pigs are unable to produce vitamin C, with deficiency resulting in a well-known disorder of collagen synthesis. Pial basement membrane structure preservation is essential in the proper migration of neurons. In our study, intrauterine deprivation of vitamin C in guinea pig fetuses led to a collagen synthesis disorder, weakness, and finally a breach of pial basement membrane. We found excessive migration of the external germinal layer cells into the subarachnoid space of the cerebellum through defects in the pial basement membrane. The changes ranged from focal rupture of pial basement membranes to their complete disintegration. The loss of proper folia formation resulted in macroscopically visible flattening of the cerebellar surface. Different grades of dysplastic changes in the folia of the cerebellar cortex were observed in 2 experimental groups assigned different limits to mark the time of commencement and duration of vitamin C deprivation. The most severe form of dysplastic changes was characterized by marked irregularity of the cerebellar cortex similar to that in lissencephaly type II. Thus, prenatal vitamin C deficiency represents a novel animal model to study the effects of collagen synthesis on development of breaches in the pial basement membrane, disordered migration of neurons, dysplasia of cerebellar cortex, and the pathogenesis of lissencephaly.

Disorder verbal memory in alcoholics after delirium tremens.

AIMS: Alcohol delirium tremens suggests dysfunction of numerous brain regions. Several Authors suggest that alcohol and withdrawal from alcohol could cause neurotoxic lesions in the frontal lobe and thereby affect cognitive function. However, it is not that well known whether the consequences of the damage following delirium are only quantitative or qualitative. PATIENTS AND METHODS: Thirty alcohol-dependent patients after alcohol delirium (ADT-n1 = 30), and 30 alcohol-dependent patients without alcohol delirium (ALC-n2=30) were compared with neuropsychological test-battery. [(Wechsler Bellevue Intelligence Scale - WB form I, Wechsler memory scale and Rey Auditory Verbal Learning Test (RAVLT)]. Examinees were selected as equivalent pairs, in such a manner that they were of approximately same age, i.e. age difference was 0-5 years, they were of the same education level, and difference in the duration of drinking was not more than 3 years. RESULTS: In the group of ADT patients, IQ was 97.53, while it is 109.53 for ALC patients. Mental deterioration of the examined group is 40, and in the control group 13. Group of ADT patients had significantly lower achievements on subtests: arithmetic, block design and digit symbol. ADT patients' average memory quotient (MQ) is 81.8, which is three standard deviations lower compared to ALC patients (MQ 102.2) and standard values, according to Wechsler. In the first repetition of the series of 15 words RAVLT, is no difference (t-test=1.88; p > 0.05), while the difference in other repetitions is significant. Difference is also statistically significant regarding recollection after 30 minutes (t-test=3.66; p < 0.05). CONCLUSION: There is qualitative difference in cognitive deficiencies in alcoholics with delirium tremens and those with no alcohol delirium, while the predominant pathology of the cognitive-amnestic deficiency is in compliance with the dysfunction of the prefrontal lobe. Following alcohol delirium, verbal memory disorders occur within the intellectual decrease and attention disorder in general.

The impact of heroin on visual memory.

INTRODUCTION AND AIM: Heroin abuse can lead to organic damage of cerebral structures, including sequels in cognitive and affective sphere, which are in positive relation with the duration of substance usage. Memory is one of the cognitive functions which is highly sensitive to opiate toxic effects. The aim of this research was determination of heroin impact on the visual memory of addicts, as well as the existence of specific relation of potential deficiencies in visual memory with the duration of substance use. METHODS: The research included 90 examinees, divided into three groups, depending on the duration of heroin intake. We used questionnaire for basic socio-demographic and addictological traits of examinees; Wechsler's scale for the assessment of the intelligence and Visual Memory Test (TVP), for the assessment of the visual memory. RESULTS: The achievements of heroin addicts with different duration of the substance abuse differ significantly (F = 1.83; df = 12; p < 0.05). Total number of errors examinees make in the first series of TVP (immediate visual memory) grows, almost linearly in the function of the duration of heroin abuse (p < 0.05), but in neither of groups meets criteria for the visual memory impairment. Deficiency of the delayed visual memory occurs in examinees who use heroin for one (total number of errors = 6.46; participation of typical organic errors = 31.7%) and longer than five years (total number of errors = 7.66; participation of typical organic errors = 26.7%). Univariate covariance analysis separates the average daily dosage of heroin as the most significant variable that contributes to the expression of the aforementioned deficiencies (F = 4.21; df = 2; p < 0.05). CONCLUSION: Heroin abuse leads to damage of delayed visual memory, whereby for the observed effect intake of the substance for a period longer than one year is necessary.

The basic morphological characteristics of astrocytomas in Vojvodina in the period 2001-2006.

PURPOSE: Astrocytomas are the most common primary intracranial neoplasms. The aim of this investigation was to register the age, sex, tumor localization, frequency and histological types of patients with astrocytomas. METHODS: The investigation was carried out from January 2001 to June 2006 and included 490 consecutive patients of both sexes with diagnosed intracranial tumors, who had undergone surgical treatment at the Neurosurgery Clinic of the Clinical Centre of Vojvodina. Tumor histological studies were carried out in the Laboratory of the Centre for Pathology and Histology of the Clinical Centre of Vojvodina. Out of 490 patients with diagnosed intracranial tumors, 139 (28.4%) had astrocytomas. RESULTS: Astrocytomas were more frequent in males (63.3%) and were most common in the 50-59-year age group (39.5%). The most common localization was the frontal region (30.2%), more commonly on the right side (51.8%). In regard to other histological types of intracranial tumors, astrocytomas were more frequent in males (34.8%). Grade III astrocytomas were most common (55.4%). The frequency of hemorrhage and thrombosis showed a positive correlation with the histological grade of astrocytomas. CONCLUSION: The typical patient with astrocytoma is a male of 50-59 years. The tumor is grade III located in the right frontal region.

Negotiating medications: patient perceptions of long-term medication use.

OBJECTIVE: To investigate how adults with one of several chronic illnesses (bipolar disorder, multiple sclerosis, rheumatoid arthritis, schizophrenia/schizoaffective disorder, or systemic lupus erythematosus) perceive their need to take medications during the course of their illness. METHOD: Eighty-three adults, aged 18-64 years, all members of a health maintenance organization, were interviewed. Each participant completed an ethnographic interview that was transcribed verbatim and analysed using grounded theory techniques. RESULTS: Participants described two forms of ongoing efforts to negotiate their need for medications, internal and external. The former category includes struggles over self-identify (e.g. worries about becoming dependent on drugs, feeling like a 'guinea pig'). The latter includes negotiations with health care providers over the type, route, and frequency of medication use. Dimensions of both negotiation types include acceptance and resistance. Specifically, patients with chronic illness must manage not only drug regimens, but also renegotiate their self-identities as formerly well persons. During this dynamic process, patients may accept and/or resist taking prescribed medications. CONCLUSION: Practitioners should recognize that patients experience not only physical, but emotional side effects of medications, and that resistance might be part of a negotiation process rather than a final stance.

[Small-plaque parapsoriasis: case report]. / Parapsorijaza malih plakova: prikaz slucaja.

INTRODUCTION: Small plaque parapsoriasis is a relatively rare, chronic, idiopathic dermatosis, most often seen in middle age people. This disease shows a definite male predominance of approximately 3-4: 1. It is characterized by presence of round or oval erythematous, slightly scaly plaques on the limbs and trunk, which histologically reveal mild eczematous changes. CASE REPORT: A male patient, 61 years of age, was admitted to the Clinic of Dermatovenereology in Novi Sad due to long persisting erythematous patches on his upper and lower limbs. Plaques were of oval and round shape, pretty well marginated. They were of light red colour, covered with fine scales with a slightly wrinkled surface. He complained of itching. Laboratory findings showed no abnormalities. Histopathologic examination of the skin specimen revealed epidermal atrophy, focal parakeratosis, perivascular dermal infiltrate of mononuclear cells with exocytosis in the epidermis. This finding was compatible with the clinical diagnosis. After treatment with topical corticosteroid cream combined with whole body exposure to sunlight irradiation, vast majority of skin lesions regressed. DISCUSSION: The clinical course of small plaque parapsoriasis is very long. The plaques are remarkably stubborn, responding to treatment with steroid creams or to natural or artificial sunlight, but usually reappearing promptly when treatment is discontinued. The patches increase in number for a time, and then remain relatively constant for a long time. A small minority of cases clears entirely. Recent studies provided evidence of monoclonality and immunophenotypic abnormalities. Rearrangement of T-cell receptor genes was demonstrated by using PCR method. Detection of monoclonal T-cell populations in skin lesions, as a characteristic of lymphoproliferative diseases, forced some authors to include this dermatosis into a group of abortive cutaneous T-cell lymphomas. CONCLUSION: This case deserves a long and probably life-long clinical and histological assessment, especially due to new knowledge about the possible nature of this disease.

A qualitative study of participants' experiences with dietary assessment.

OBJECTIVE: This article reports on the use of focus groups and an experimental participatory activity to investigate factors influencing participants' decisions about what to eat and what to report on food records and food frequency questionnaires. DESIGN: Four focus groups examined participants' experience with diet records and 3 focus groups explored the topic of food portions using a group consensus activity. Twenty-two women participated in the diet record focus groups, and 15 participated in portion estimation groups. SUBJECTS: Focus group participants were equally distributed by age and body mass index values. Each woman completed a 10-day doubly labeled water protocol to measure total energy expenditure, 7 days of diet records (before and during total energy expenditure), and a food frequency questionnaire after the total energy expenditure. ANALYSIS: Transcripts of the focus groups were coded to index categories of responses and to identify themes within and across those responses. Themes discussed in this article are those that were discussed most often and at greatest length by all groups. RESULTS: The diet record focus groups revealed that 2 major factors influenced reporting on diet records: honesty vs social acceptability, and simplifying food intake. The portion estimation focus groups revealed 5 factors that influenced perceptions of portion size: the role of food in the meal, the type of food, personal preferences, product serving sizes, and comparison of personal servings with those of others. APPLICATIONS: The validity and reliability of self-reported food consumption is greatly influenced by the ways people interpret and respond to dietary assessment instruments. These findings indicate that dietetics professionals need to take extra steps to address issues of accurately recording "bad" foods when training patients to complete diet records. Extra probing is needed when dietary records do not include snacks and include simple meals and a large amount of prepared and packaged food because this may indicate that changes in normal dietary patterns were made in order to more easily complete a dietary record.

[Persistent dyschromic erythema]. / Perzistentni dishromicni eritem.

INTRODUCTION: Erythema dyschromicum perstans (ashy dermatosis) is a very rare skin disease included in the group of acquired, idiopathic hypermelanosis, with development of blue-gray macules. This disease appears more frequently in dark coloured persons, especially women in the first and second life decade. CASE REPORT: A male patient, 42 years of age, was admitted to Clinic of Dermatovenereology in Novi Sad due to appearance of slightly pruriginous, brown-reddish macules on the trunk, upper and lower extremities, without affecting the skin of the face, scalp, palm soles and visible mucous membranes. Later, the color of the macules changed into blue-gray and new lesions appeared in axilla and flexor side of the big joints, with active, erythematous and thin raised borders. Laboratory findings showed no abnormalities; antinuclear antibodies were negative. Histopathological examination of the skin specimens (which were taken from two different places) showed vacuolar degeneration of the basal cell layer, numerous pigmentophages in papillary dermis and presence of lymphohistiocytic infiltrate in dermis. No history of drug intake or exposure to UV light was established. DISCUSSION: Ashy dermatosis is included in the group of hypermelanosis of unknown origin. As possible etiological factors we can mention ingestion of ammonium nitrate, environmental pollution, hypersensitivity to cobalt chloride and postinflammatory pigmentation. Clinical characteristics: occurrence of blue-gray and gray macules on the trunk, face, neck and extremities (absence on the palms, soles, visible mucous membranes, scalp and nails). In the active phase of the disease, these macules are surrounded by erythematous and thin, raised borders. The lesions are mostly permanent. Due to clinical, histopathological, immunofluorescent and electron microscopy established similarities with lichen planus, it is considered that ashy dermatosis is a variant of lichen planus. Absence of previous drug intake, exposure to UV light, absence of the antinuclear antibodies, clinical picture and histological findings confirm the diagnosis of erythema dyschromicum perstans. CONCLUSION: This case of ashy dermatosis shows that there is a need for differential diagnosis of acquired skin pigmentations, because this dermatosis must also be taken into consideration.

Fast relief: buying time with medications.

The experience of time famine in contemporary U.S. culture affects household decisions about self-care and the use of pharmaceuticals for self-medication. This article examines the manner in which time demands shape lay interpretations of medicine efficacy and drive increases in medication use for adults as well as children. Medicines, like other time-saving commodities, appear to shift the time-power differential in favor of individuals, placing them in control of how time is spent. When there is "no time to be sick," allopathic medicines become time-saving devices that enable women to fulfill responsibilities at work or home while they attend to sick children or to being ill themselves. Medicines are used to beat the clock by increasing one's own capacity to be productive.

[Gingival hyperplasia during treatment with nifedipine]. / Hiperplazija gingive u toku lecenja nifedipinom.

INTRODUCTION: Nifedipine is a relatively new and increasingly used medication for treatment of all kinds of angina pectoris and arterial hypertension. The principal action of nifedipine is to inhibit the influx of extracellular calcium ions across the membranes of cardiac and vascular smooth muscle cells, without changing serum calcium concentration (1). One of the side effects of this drug is gingival hyperplasia which was first described in 1984 by Lederman (2). He noted that gingival hyperplasia is mostly marked on the labial gingiva of the upper and lower anterior teeth and appeared 1 to 2 months after nifedipine therapy began at a dose of 90 mg per day, and never occurs in edentulous areas. This paper reports gingival hyperplasia in a patient treated with nifedipine. CASE REPORT: A 73-year-old man referred to the dental clinic for evaluation of gingival enlargement in the maxillar left quadrant which he had noticed about 3 months after starting the nifedipine therapy. Clinical examination showed gingival enlargement around the teeth 22, 23, 24 and 27, but with normal edentulous area (Fig. 1). The enlarged gingiva was red, smooth and shiny, with no pain on touch, and bled easily on probing. There were metal crowns with overhanging margins and pseudopockets--6 mm with dental plaque and calculus. Radiographs showed moderate alveolar bone resorption of horizontal type. The patient's maxillar left first premolar exhibited severe bone loss, resulting in a hopeless prognosis. This tooth was extracted under local anesthesia. The dental treatment included replacement of the ill-fitting metal crowns, scaling and root planning, and instructions on appropriate method for brushing teeth. 6 weeks later, the hyperplastic tissues were removed surgically. In a 1-year follow-up period, the patient was recalled at regular intervals for control, and no signs of recurrence of gingival hyperplasia have been observed in spite of continued nifedipine treatment. Biopsies taken from the gingivectomy specimens were handled with standard histological method. Histological examination showed a thick epithelium with parakeratosis and acanthosis, and irregular elongation of the rete peg. The underlying connective tissues contained dense fibers with inflammatory cell infiltrate mainly composed of plasma cells. DISCUSSION: The exact mechanism of action of nifedipine in causing gingival enlargement is unknown at present. There is also no answer to the question why gingival enlargement appears in some patients treated with nifedipine, but in others not. The clinical findings (3, 4, 5, 6, 7) and results of in vitro study (8) and this case report showed that hyperplastic change of gingiva started only in areas displaying signs of inflammation, but not in healthy and edentulous areas. These observations suggest that local factors and associated inflammation is essential for onset of the nifedipine-induced gingival hyperplasa. Moreover, it was suggested that duration of nifedipine therapy (more than 2 months) and drug dosage (90 mg per day) could be important (1,2,3). This case report also demonstrates that no signs of recurrence of hyperplasia were observed after elimination of the local inflammatory factors: extensive dental pluque control and surgical removal of the hyperplastic gingival tissue even though administration of nifedipine was continued. CONCLUSION: It was concluded that gingival enlargement occurs in patients with nifedipine therapy only in the areas where local inflammatory factors are present.

[Clinico-histologic characteristics of spinocellular carcinoma of the skin]. / Klinicko-histoloske odlike spinocelularnih karcinoma koze.

INTRODUCTION: Authors present clinical-histological characteristics of squamous cell carcinomas of the skin in patients treated at the Clinic of Infectious and Dermato-Venereology Diseases in Novi Sad in the period from 1989 to 1995. MATERIAL AND METHODS: The examined group comprised 26 cases (2.32%) with histologically verified squamous cell carcinomas of the skin out of 1119 nonmelanomatous epithelial skin tumors, clinically examined by dermatologists and treated by x-ray surface therapy. All patients with SCC were clinically examined by dermatologists at the Clinic of Dermatology and Venereology in Novi Sad, while histological examinations were performed by pathologists of the department of Pathology and Histology of the Faculty of Medicine in Novi Sad. Tumor biopsy specimens were obtained by shave biopsy, saucer biopsy and punch biopsy. All the biopsy specimens wee histologically examined and verified with standard methods with haematoxyllineosin-staining. RESULTS: In the group of examined patients most were with SCC--that is exophytic tumor of the skin in 16 cases (61.54%). Histological examination revealed: squamous cell carcinoma of the skin in 9 cases (56.25%), keratotic squamous cell carcinoma in 5 cases (31.25%) and invasive squamous cell carcinoma in 2 cases (12.50%). In the examined group there were also 9 cases of SCC (36.41%) with clinical forms of endophytic tumor of the skin. By histological examination the following tumors were diagnosed: Morbus Bowen in 3 cases (incipient squamous cell carcinoma of the skin) (33.33%); squamous cell carcinoma of the skin in 5 cases (55.56%) and keratotic squa- mous cell carcinoma in 1 case (11.11%). In one case SCC with clinical features like keratoacanthoma was found (3.85%), while by histological examination keratotic squamous cell carcinoma of the skin was diagnosed. DISCUSSION: In regard to the biopsy technique, SCC of the skin was diagnosed mostly as spinocellular carcinoma of the skin in 14 cases (53.85%) without a more precise description of the degree of tumor cells degeneration as well as tumor edge characteristics and type of histological type of tumor. Keratotic squamous cell carcinoma was found in 7 cases (26.92%); it is a tumor of mature structure (1-2 Broders' grade of clinical stage of tumors), but also without a detailed description of the tumor edge and type of histological type of tumor. Invasive squamous cell carcinoma was found in 2 cases (7.96%) and it reveals a SCC of the skin with deep infiltration into the dermis and hypodermis, sometimes involving the neighboring tissue (cartilage tissue, bone, muscle tissue and so on). This histological form of SCC had 3-4 Broders' grade of clinical stage of tumors. CONCLUSION: Authors of the paper conclude that histological examinations of SCC of the skin are necessary meaning detailed analysis: degree of differentiation of tumor cells by Broders' examination, examination of tumor edges and histological types of tumor. The incisional biopsy of tumor lesions had only been used to confirm clinical diagnosis in order to perform x-ray therapy, but it could not meet necessary criteria the excisional biopsy could in regard to evaluate tumor edges and histological type of the tumor.

Changing patterns of pharmaceutical practice in the United States.

In the United States, contradictions related to medicine use abound in a social environment in which the pursuit of health has become a cultural project. In a marketplace where over half a million health products are available, choices at once seem to foster agency and encourage dependency on medical fixes. The aggressive marketing of medicines as indispensable commodities co-exits with rising concerns among the lay population about what is safe in the short- and long-term. In this paper we broadly consider medication-related practice in the United States as it is affected by social, cultural, and political-economic factors. We direct attention to changes in medicine use related to product proliferation, lowered thresholds of discomfort, the economics of health care, and a revival of the self-help ethic. We also consider the manner in which the demand for and use of medications reflect deeply embedded cultural ideals and emergent perceptions of need. We juxtapose two trends in American thinking about medicines: (1) the perception that "more is better," associated with cultural impatience with illness; and (2) a growing doubt about medicine necessity, safety, and efficacy.

Smoking experimentation and initiation among adolescent girls: qualitative and quantitative findings.

OBJECTIVE: To use qualitative and quantitative findings to describe patterns of smoking experimentation and initiation among adolescent girls. DESIGN: Ethnographic in-person interviews, focus groups, telephone interviews, and a survey questionnaire were used over a one-year period. The paper reports on cross-sectional data drawn from a three-year longitudinal study. SUBJECTS AND SETTING: 205 girls participated in the survey and interviews during year 3 of the study. Girls were drawn from two urban high schools in Tucson, Arizona (USA), and were in grades 10 and 11 (mean ages 16 and 17, respectively) during year 3. RESULTS: Overall, 30% (n = 61) of informants reported that they currently smoked, 7% (n = 15) were ex-smokers, and 63% (n = 129) were "non-smokers". The most frequently cited reasons for smoking were stress reduction and relaxation. Several stress-inducing situations, including family environment, social relations with classmates, and schoolwork, are discussed. The notion of peer pressure is re-examined in the light of teenagers' experience that there is little overt pressure to initiate smoking. Consonant with notions of adolescent autonomy, the theme of independence in smoking initiation and continuation permeated girls' narratives about their smoking behaviour. Girls projected the image that they could control their cigarettes rather than have their cigarettes control them. CONCLUSIONS: Smoking prevention and cessation programmes need to address and counter the smoking/relaxation association, which was identified as an important reason for smoking among adolescent girls. Questions typically used in surveys to measure smoking behaviour do not adequately define the smoking experience as described by teenagers.

Routine jejunal endoscopic biopsy in children.

UNLABELLED: The aim of the study was to evaluate and compare two methods of jejunal biopsy-endoscopic (EB) and suction (SB). Jejunal EB was performed using an Olympus GIF P20 endoscope in 119, and SB with a modified Crosby capsule in 254 patients. A light microscope with micrometer was used for the analysis and measurement of biopsy specimens. Calculated per patient, the total average number of all adequate specimens was: jejunal or duodenal mucosa -2.97 in EB and 0.93 in SB; jejunal mucosa only -2.82 in EB and 0.89 in SB group. Duodenal mucosa was unintentionally biopsied in 17.1% of EB and in 3.7% of SB. Jejunal mucosal specimens were selected for measurement at random -82 from the EB and 24 from the SB group. The difference in height between EB and SB specimens was not significant (EB: 0.72 +/- 0.13 mm; vs SB: 0.77 +/- 0.14 mm). The difference in length was significant (EB: 2.57 +/- 1.24 mm; vs SB: 3.22 +/- 1.38 mm; P = 0.03). The advantages of the EB over the SB technique included elimination of fluoroscopy, no failures in obtaining biopsies and a 97% success rate in obtaining specimens adequate for histological analysis. It also enabled the biopsy site to be chosen and several specimens to be taken, providing additional tissue for various analyses. CONCLUSION: Jejunal endoscopic biopsy is suggested as a good alternative to the suction biopsy, wherever paediatric upper gastrointestinal endoscopy is available.

[Sociodemographic and epidemiologic characteristics of hospitalized alcoholics in Vojvodina]. / Sociodemografske i epidemioloske karakteristike hospitalizovanih alkoholicara u Vojvodini.

Using the Register of hospitalized alcoholics in Vojvodina we analyzed data on sociodemographic and epidemiologic characteristics of the alcoholic disease. This retrospective study, using longitudinal and anamnestic data during a three-year period (1991-1993) deals with all patients treated for Alcohol Dependency Syndrome (according to the International classification of diseases, IX revision) treated at neuropsychiatric institutions in Vojvodina and living on this territory. The sample consisted of 4783 examinees. The gathered results indicate that there is a decrease in number of patients treated for alcoholic disease, that is in incidence, prevalence and risk of morbidity in regard to the population of the examined territory. As this decrease is associated with a decreased number of registered psychiatric, neurologic, and somatic complications of the alcoholic disease, the authors may conclude that the intensity of actual social pathology and social disorders, which are characteristic for the above mentioned period resulting in the decrease of production and consumption of alcohol, decreases alcoholism and its complications.

[Calcification in atherosclerotic plaque as one of the types of complicated atherosclerotic lesions]. / Kalcifikacije u ateroskleroznom plaku kao jedan od oblika komplikovane aterosklerozne lezije.

Calcifications of the atherosclerotic plaque is the form of a complicated atherosclerotic lesion. It is characterized by granular or massive deposits of calcium chloride inside the atherosclerotic plaque. It was found in at least one of the three main coronary arteries in 43 (86.00%) out of 50 autopsy cases. In all three, coronary arteries calcifications were found in 8 (18.60%) cases, in two coronary arteries in 19 (44.19%), and one coronary artery in 16 (37.21%) cases. Calcifications of atherosclerotic changes which contain fats were statistically significantly more frequently established than those which did not contain fats. In three fourths of cases calcifications were present in segments with significant narrowing of the arterial lumen (group 3 and 4). In 59.61% of calcificated atherosclerotic changes the residual lumen was of eccentric shape, in 20.51% of concentric shape, in 7.69% it was semilunar, and in 12.18% a few lumens were detected (channeled and organized thrombi). Granular deposits of calcium were established 63.46%, while massive in 36.54% of segments of atherosclerotic lesions, but no statistically significant difference in distribution of these two types of calcifications was established in regard to the type of atherosclerotic change.

[Atherosclerotic plaque hemorrhage as one form of a complicated atherosclerotic lesion]. / Krvarenje u ateroskleroznom plaku kao jedan od oblika komplikovane aterosklerozne lezije.

Atherosclerotic plaque hemorrhage is a form of a complicated atherosclerotic lesion. It is a finding of extravasation of erythrocytes (fresh hemorrhage) or siderophages (old hemorrhage) in the defined atherosclerotic changes. 510 segments of the main epicardial coronary arteries (right coronary artery, anterior interventricular branch of the left coronary artery, circumflex branch of the left coronary artery) were microscopically examined in 50 obduction cases of patients with ischemic heart diseases. Fresh hemorrhage in the atherosclerotic plaque was established in 25 cases, that is in 40 microscopically examined coronary artery segments. It was established in all cases where there was a atherosclerotic plaque rupture, in some segments where process of thrombotic organization occurred, as well as in some segments of arteries which supply the region of early myocardial infarction. All hemorrhages occur inside lipidic and fibrolipidic atherosclerotic changes of intima. The average length of fresh hemorrhage was 0.8 cm. 92.50% of segments with fresh hemorrhages occur in the first 4 cm of the examined arteries. 88% of plaque hemorrhages occur in segments with 76-100% lumen obstruction. Signs of old hemorrhages most often occur in segments with 51-75% and 76-100% lumen obstruction. Siderophages mostly occur in complicated atherosclerotic changes and thrombotic organization.

[The hypophyseal-adrenal axis in chronic alcoholism]. / Hipofizo-adrenalna osovina u uslovima hronicne alkoholisanosti.

In order to reveal the morphologic basis of clinically recognized pseudo Cushing syndrome in chronic alcoholism, we performed an analysis of histologic characteristics of hypothalamo-hypophyseal adrenal axis components. The experiment included Wistar rats which were given 15% ethanol solution in water for three months. By methods of classical histology, histochemistry and immunofluorescence adrenal and hypophyseal sections of experimental animals exposed to continual effects of alcohol and those from the control group were examined. ACTH (adrenocorticotropin) cells of the experimental group show expressed immunofluorescence as a proof of their high secretory granules present in numerous cytoplasmic endings which contribute to significantly increased number of these cells comparing to the control group. In the adrenal cortex of animals exposed to alcohol, in the zona fasciculata and zona reticularis, under the influence of hypophyseal corticotropin (ACTH) secretion, there is a statistically significant increase of the compact cells region, as synthetic active elements, in regard to vacuolized cells, as inactive elements, which has been established stereologically. Simultaneous hyperfunction of hypophyseal ACTH cells and ACTH dependent zones of the adrenal cortex in chronic alcoholism, proves that alcohol primarily acts at the level of hypothalamus and hypophysis, while adrenals react to hypersecretion of ACTH cells. The way alcohol affects neurotransmitters is the topic of the discussion, whereas stimulated synthesis of acetylcholine is pointed out.