Loss of body mass in ex-prisoners of war.

Body mass was examined in the defenders of Vukovar (n = 71) from eastern Slavonia, Republic of Croatia, immediately on release from enemy concentration camps. The sample consisted of a group of 33 male smokers who had been imprisoned for (mean +/- SD) 127.4 +/- 18.4 days (age 31.6 +/- 7.2 years) and 38 male smokers, imprisoned for 271.6 +/- 14.4 days (age 30.8 +/- 6.5 years). According to subjective estimations the prisoners of war had lost 18.4 +/- 6.1% and 21.6 +/- 10.2% respectively, in relation to body mass before the war. For comparison data were used on a healthy population of male smokers from eastern Slavonia (Vinkovci, Republic of Croatia (n = 75) aged 32.4 +/- 5.2 years taken from a study carried out in 1976. Data were analysed on body mass, body mass index, triceps, subscapular skinfolds and percentage of body fat. All parameters were statistically significantly lower in males imprisoned for 271.6 +/- 14.4 days in relation to the comparative group (P < 0.0001-0.05). A negative deviation from body mass nomogram was registered in prisoners of war in relation to the comparative group (5-16%). Basic biochemical parameters were examined in the prisoners of war. In the group imprisoned for 127.4 +/- 18.4 days statistically significant differences and pathological values of mean corpuscular volume and haematocrit were verified in relation to the group of prisoners with longer duration of imprisonment (P < 0.001). Although the prisoners of war had lost weight during imprisonment in the camps due to the frugal diet no clinical signs of malnutrition were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Q-T and JT dispersion in the elderly with urban hypothermia.

Twenty elderly patients (12 females and 8 males, aged 65-88 years) were treated because of hypothermia: 11 suffered from moderate (35-32 degrees C) and nine from severe hypothermia (<32 degrees C). The control group consisted of 20 age and sex-matched healthy elderly persons. Twelve-channel electrocardiograms were recorded on admission and during hospitalization. In patients with moderate hypothermia Osborn wave was present in eight of 11, and minimal Osborn wave in three of 11; in severe hypothermia Osborn wave was seen in seven of nine, and minimal in two of nine. The corrected Q-T interval (Q-Tc) was analyzed according to the formula of Bazett: measured Q-T(s)/ radical R-R(s). The JT and the corrected JT interval (JTc) were measured according to the formula: JT=Q-T-QRS. The Q-T interval index (Q-TI) was measured according to the formula: (Q-TI:656)x(HR+100); and the JT interval index JTI: (JT:518)x(HR+100). The dispersion of the Q-Tc (JTc) was defined as the difference between maximum and minimum measured Q-Tc interval (JTc). The Q-Tc interval in the group with hypothermia was 651.41+/-130.06 ms, while in the control group it was 398.14+/-76.21 ms (P<0.001). The Q-Tc dispersion in the group with hypothermia was 91.39+/-51.98, and in the control group 33.21+/-10.25 ms (P<0.001). The Q-TcI in the group with hypothermia was 89.91+/-21.44, and in the control group 39.56+/-9.41 ms ((P<0.001). The JTc in the group with hypothermia was 542.66+/-132.74, in the control group: 328.06+/-76.92 (P<0.001). The JTc dispersion in the group with hypothermia was 79.35+/-46.22, and in the control group 28.53+/-7.99 (P<0.0001). The JTcI in the group with hypothermia was 93.06+/-17.38, in the control group it was 40.23+/-7.59 (P<0.001). The mean values of the Q-TcI were greater than Q-TI, and the mean values of the JTcI were greater than JTI, but the difference was not significant (P>0.10). The mean values of the JTcI were greater than Q-TcI, but the difference was not significant as well (P>0.05). There was no correlation between rectal temperature and dispersion of Q-T, Q-Tc, JT, JTc, and Osborn wave. The maximum Osborn wave and the maximum Q-T interval were registered in anteroseptal leads (V(2)-V(3)). The dispersion of the Q-Tc and of the JTc lasted more than Osborn wave. There was no correlation between rectal temperature and PR interval, RR interval and QRS duration. The prolonged dispersion of the Q-Tc (and JTc) last 24-48 h longer than Osborn wave.

A prospective study of S-T segment depression in the electrocardiogram and mortality in the population.

A prospective study was carried out of all degrees of horizontal or descending depression of the S-T segment in the electrocardiogram (more than 1 mm or 0.1 mV, 0.5-0.9 mm or 0.05-0.05 mV and up to 0.5 mm or 0.05 mV) in a sample of 2414 subjects of both sexes, aged 35-54 years, (1326 females and 1088 males) in six Croatian regions on three occasions during a 13-year period: 1969, 1972 and 1982, according to the Minnesota code. S-T segment depression in the ECG was found during the first examination in 10.69% of females and 4.13% of males; during the second examination in 12.66% females and 6.24% males, and in the third examination in 19.06% females and 12.12% males. S-T segment depression of up to 0.5 mm was dominant and twice as frequent in females than in males, and the difference was significant. S-T segment in the ECG was also analyzed in a sample of 239 subjects (141 males and 98 females) who died during the period between the second and third examination, and for whom ECGs had been recorded in 1969 and 1972. In the group of females who died during the period between the first and second examination, 16.32% had all degrees of S-T segment depression, while in the group of surviving females this amounted to 10.6%. In the group of deceased males this finding was found in 4.24% of deceased and 4.13% of surviving males. In the group of females who died between the second and third examination, S-T segment depression was found in 18.36% of deceased and 12.66% of surviving females, and 10.62% in deceased males and 6.24% in surviving males (depression of 1 mm or deeper and 0.5-0.9 mm was found in 7.08% of deceased and 1.28% surviving males). The relative risk of mortality in middle-aged females with S-T segment depression of 0.5 mm or deeper, was 3.65 times higher than in females without such ECG changes, while the relative risk of mortality in males of the same age with the same finding was 5.85 times higher than in those without such ECG changes.

Urban hypothermia and hyperglycemia in the elderly.

From December 1993 to March 1999 we treated 18 elderly patients aged 66-87 years, suffering from urban hypothermia: 11 women and 7 men. Ten patients suffered from moderate hypothermia (rectal temperature 32-35 degrees C), and eight from severe hypothermia (rectal temperature < 32 degrees C). Regarding consciousness, in the group suffering from moderate hypothermia, 3 were somnolent and 6 in various degrees of comatose states. In the group suffering from severe hypothermia, 3 patients were somnolent or soporous and 5 in comatose states of various degrees. Values of arterial blood pressure in the group with moderate hypothermia was normal in one, in 3 arterial hypotension was observed and 6 were in a state of shock. In the group with severe hypothermia, 3 presented arterial hypotension and 5 were in a state of shock. In the group with moderate hypothermia the blood glucose level was elevated in six: 9.3-10.2-10.7-17.9-21.3-99.0, and in one patient the blood glucose level was low: 2.3 mmol/L, in correlation with hypoglycemic coma. In the group with severe hypothermia in all eight patients the values were elevated: 6.7-7.4-7.6-8.7-9.1-11.2-12.4-17.9 mmol/L.

The corrected Q-T interval in the elderly with urban hypothermia.

During winter time in the period from 1993 to 1998, 18 elderly patients: 11 female and 7 male aged 65-88 years, were treated because of hypothermia. Rectal temperature on admission was 20-34.5 degrees C. Ten patients suffered from moderate hypothermia (35-32 degrees C), and eight suffered of severe hypothermia (< 32 degrees C). Arterial hypotension was recorded in 7, and shock in 11 patients. In all of them, and in 18 controls, an electrocardiogram was analyzed with the special reference to the corrected Q-T interval. Decompensated metabolic acidosis was observed in 7/8 patients with severe hypothermia and in 4/10 with moderate hypothermia. Among patients with moderate hypothermia, sinus tachycardia was present in 2, sinus bradycardia in 2, idioventricular rhythm in 2 and atrial fibrillation in 4/10 patients. In patients with severe hypothermia, sinus tachycardia was present in 2, sinus bradycardia in 3, idioventricular rhythm in one, and atrial fibrillation in 2/8 patients. In moderate hypothermia Osborn's or Tomaszewski's J wave was present in 7/10, and it only appeared in 3/10 patients; in severe hypothermia it was present in 6/8 and only appeared in 2/8 patients. The corrected Q-T interval in the group with hypothermia ranged 0.450-0.688 s, in the control group 0.343-0.444 s. The X minimum (s) in the group with hypothermia was 0.508 +/- 0.079, in the control group it was 0.371-0-139 s, and the difference was statistically significant (p < 0.001). The X maximum (s) in the group with hypothermia was 0.576 +/- 0.067 s, in the control group 0.390 +/- 0.019 s, and the difference was also statistically significant (p < 0.0001). In both groups the most significant prolongation of the corrected Q-T interval in the majority of patients was found in anteroseptal leads. The dispersion of the corrected Q-T interval in the group with hypothermia was 87.19 +/- 28.44 ms, in the control group it was 32.06 +/- 8.94 ms, and the difference was statistically significant (p < 0.001).

Hypothermia and acute renal failure in the elderly.

During 1993-1998, in winter time 14 elderly patients: 8 female and 6 male aged 65-88, were treated because of hypothermia. Rectal temperature on admission was 20-34.9 degrees C. Sopor was present in 2 and various grades of coma were present in 10 patients. Arterial hypotension was recorded in 5, and shock in 9 patients. Increased serum creatinine level was found in 8 patients. The mean rectal temperature in the whole group was 31.3 degrees C +/- 4.7, ranging from 20.0 to 34.9 degrees C, and the mean serum creatinine level was 172.2 +/- 93.5, in range of 66.0 to 360.0 mumol/L. Negative correlation between those two parameters was found: r = -0.572. In 2 of them parameters of renal failure were analyzed: urine sodium concentration, creatinine urine/plasma ratio, urine osmolality, urine/plasma osmolality ratio, renal failure index and fractional excretion of filtered sodium. In one of the patients all parameters were within the range of functional oliguria, in an other the urine sodium concentration serum showed acute renal failure, but all other findings showed borderline values between functional oliguria and acute renal failure. Twelve out of 14 patients died within 1-216 hours from admission.

Meso-2,3-dimercaptosuccinic acid in the treatment of occupationally exposed lead workers.

The aim of this study was to evaluate the efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) treatment in workers with increased lead absorption and no overt symptoms of lead poisoning. Seven occupationally lead exposed male workers with blood lead concentrations (PbB) exceeding 50 micrograms/100 ml and a positive calcium disodium ethylenediaminetetraacetate (EDTA) lead mobilization test were treated with DMSA for 19 days. Individual doses were 700 mg DMSA, three times a day from day one to five, and twice a day from day six to 19. The treatment intensified urinary lead excretion, most rapidly during the first five days. The increased elimination was followed by a decline of mean PbB to 15% of the pretreatment values. However, 15 days after the treatment, the PbB concentrations rebounded, yet kept below the baseline values and did not exceed 40 micrograms/100 ml. After repeated EDTA lead mobilization test, urine lead was 23-68% of that before DMSA treatment. It can be concluded that DMSA can effectively reduce chelatable lead in occupationally exposed workers.

[Rheumatic complaints and diseases in ex-prisoners of war in Croatia in 1991. A review of medical prognosis for work capacity]. / Reumatske tegobe i bolesti uhicenika u domovinskom ratu u Hrvatskoj u 1991. Godini. Osvrt na medicinsku prognozu radnih mogucnosti.

The results are presented of an examination of the locomotor system in 48 ex-prisoners of war, previously maltreated in prison camps in Serbia and occupied areas of Croatia. They were part of a group of 508 prisoners of war, examined in the Clinic for Infectious Diseases in Zagreb. They were all male, aged 33.9 +/- 11.56 years, in whom, after the first medical examination a rheumatological examination was indicated because of disorders of the locomotor system. Only 16.7% of the subjects had not been physically maltreated. Blows to the lumbo-sacral spine were the most frequent (43.7%), shoulders (33.4%) and the head (27.0%). Earlier rheumatic disorders were reported by 41.7% of the ex prisoners, and during the examination in our Rheumatological clinic 70.8%. In 21% of the ex-prisoners the rheumatological disorders started as a direct consequence of maltreatment in the prison camps. In one of the ex-prisoners acquisition of ankylosis spondylitis occurred and in another uric arthritis. In 50% of the ex-prisoners a marked reduction in work ability was confirmed. Disability retirement was proposed for two ex-prisoners. Optimal health treatment is discussed and medical prognosis of work ability.

Electrocardiographic changes in ex-prisoners of war released from detention camps.

The aim of the study was to determine whether and to what extent changes in the electrocardiograms occurred in released prisoners of war (POWs) from Serbian detention camps and whether the frequency of occurrence differed from similar changes in a control group. An electrocardiogram was recorded and medical examinations conducted on 182 randomly selected ex-POWs. The subjects were male with a mean age of 35.8 +/- 11.0 years, age range 18-65 years and the average length of imprisonment 164.5 +/- 87.1 days. The electrocardiograms were analysed according to the Minnesota côde. The following changes were frequently found: postinfarction Q-wave in 3.3%, control 1.1% (not significant), ST-segment depression horizontal or descendent in 14.3% (controls 3.8%, P < 0.01), particularly S-T segment depression of up to 0.5 mm in 12.1% (controls 2.2%, (P < 0.01), total negative T-wave in 7.1% (control group 3.3%, not significant), total arrhythmia 18.1% (controls 7.1%, P < 0.01), particularly ventricular premature beats in 2.2% (controls 0.5%, not significant), incomplete left bundle-branch block 2.2% (not registered in the control group), complete left bundle-branch block in 0.5% (not registered in the control group), sinus tachycardia in 12.1% (controls 6.6%, not significant), sinus bradycardia 3.3% (not registered in the control group) and microvoltage QRS complex in 11.5% (controls 0.5%, P < 0.001). The results of this study confirm that changes in the electrocardiograms of the POWs released from Serbian detention camps were far more frequent than in the controls.

Variation in survival in coastal and continental regions of Croatia--results of a longitudinal study.

After 25 years of follow-up, regional variations in survival were analysed on a sample of 3343 participants (1780 female, 1563 male) from three urban and three rural municipalities in Croatia. Age of participants was in the range 35-54 years at the beginning of the study (1969). Cox regression for general mortality singled out one continental rural municipality (Virovitica) with the lowest survival in both genders. The relationship between the risk of death and age at the beginning of the study was approximately linear throughout its range for men, and after the age of 45 for women. Men showed a trend of better survival in the coastal region, which was consistent with findings of a similar concurrent study of rural Croatian population.

Wartime migration and the incidence of tuberculosis in the Zagreb region, Croatia.

The objective of the present study was to investigate the rate of decline in the incidence of tuberculosis (TB) in residents (1985-1994) and in refugees and displaced persons (1992-1994) during prewar and war periods (1985-1994) in the region of Zagreb, Croatia, and to examine a possible change in the trend of decline in the resident population. Data on the incidence of TB were obtained from the Epidemiology Department, Institute for Lung Diseases, Zagreb, Croatia. The sample comprised two groups of subjects: residents (800,000-1,000,000 inhabitants) and all refugees and displaced persons temporarily residing in the Zagreb region (78,000-95,000 persons). Data were analysed by stepwise logistic regression. The most significant predictors of the TB incidence rate were the square of the year and residence status. The rate of TB incidence in nonresidents was significantly higher than in residents. The decline in incidence in residents was significantly slower than in the nonresident group. The results did not indicate a potential change in the natural decline of the incidence of tuberculosis in the resident population during the study periods. The difference between the regression trends of the incidence of tuberculosis in residents and nonresidents was the result of various concomitant factors, including artefacts of the war.