Secondary neurosurgical management of craniocerebral war injuries

In Belgrade Military Medical Academy 88 males and 1 female (aged 13-55, average 28.6 years) with war craniocerebral injuries (CCI) were secondarily neurosurgically treated from October 1991 trough December 1992. Primary neurosurgical management of these patients was performed in war hospitals in former Yugoslavia. Out of 89 patients, 78 had penetrating, and 11 closed CCI. Out of 55 patients with penetrating CCI who underwent surgery, intracranial debridement was performed in 34 patients. All patients with severe CCI (GCS = 3-8) were severely by disabled or died, and in the majority of patients with minor CCI (GCS = 13-15) the outcome was good (p < 0.01). Statistical analysis showed no significant correlation between the extent of cerebral lesion and the outcome of penetrating CCI (p > 0.05). Eight (10.3%) patients with penetrating CCI died. The outcome of war CCI mostly depended on the severity of injury.     

The effect of cell phones on pacemaker function

The aim of the study was to examine if there existed a risk from interference of cellular phones on patients with implanted permanent pacemakers. The study comprised 144 patients (134 VVI/VVIR and 10 DDD/DDDR) with permanent pacemakers of different manufactures. METHODS: During the routine pacemaker check, cellular phone aerial (Nokia 1610; GSM Standard) was placed against the skin of patients above the spot of pacemaker implantation, while the phone calls were repeated and ECG was continuously monitored. The effect of cellular phone on pacemaker was established upon: a) preexisting parameters of electric pacemaker stimulation; b) minimal ventricular rate of 90 beats/min, while electric stimulation parameters were set to their most sensitive values (MSV). RESULTS: Only in 9 (6.25%) patients was observed intermittent pacemaker inhibition, when pacemaker settings were on preexisting values of electric stimulation, while in 17 patients (11.8%) inhibition was noticed, when pacemaker settings were changed to their MSV. Besides, programmed values of electric stimulation in our patients remained unchanged. CONCLUSION: Although the electromagnetic interference interactions of cellular phones on pacemaker function were observed in relatively small number of our patients, we were of the opinion that pacemaker-dependent patients should avoid the use of cellular phones.     

Urticarial vasculitis--a syndrome with low complement levels and secondary glomerulopathy

In female patient, aged 41, 3 years ago appeared skin changes of urticarial type, and occasional pain in the joints of shoulders and hands, followed by complete weakness and exhaustion, as well as the occurrence of face and eyelid edema. Laboratory findings confirmed the presence of hypocomplentemia with proteinuria, microhematuria and cylindruria. Histopathologic (HP) finding of skin biopsy was leukocytoclastic vasculitis, and HP finding of the kidneys was mesangioproliferative glomerulonephritis. The regression of skin changes was observed during hospitalization after Dapsone was administered. The therapy started with corticosteroids (Prednisone 40 mg/day with weekly dose from 5 mg to 30 mg). In spite of the therapy, hypocomplementemia and proteinuria up to 335 mg/24 h have maintained for a year in the later controls in an outpatient department. The patient is without discomfort, and renal function is stable.     

Cortical potentials related to decision-making: comparison of two types of go/no-go decision

The S1-S2 go/no-go reaction time task has been frequently used to assess volitional inhibition. In this study our aim was to compare the ERPs elicited by S1 and S2 by using a modified S1-S2 paradigm which involved a two-stage go/no-go decision. The go and the no-go S1 ERPs did not differ substantially, and both displayed a prominent negativity with peaks at 260 ms (S1N260) and at 330 ms (S1N330) post-S1. The S1N260 was similar to the N2 from no-go S2 trials. Since after all three types of stimuli, movement is not required and is inappropriate, this negativity may represent the correlate of the voluntary decision to suppress movement. Later, the S1 ERPs were dominated by frontal negativity (S1N330), probably reflecting further processes related to response preparation, while the S2 ERPs displayed a large central and parietal positivity (P3), probably reflecting the processes of evaluation of response accuracy.     

Alteration in plasma antioxidant capacity in various degrees of chronic renal failure

AIM, PATIENTS AND METHODS: To obtain a more comprehensive profile of extracellular antioxidant capacity in chronic renal failure (CRF), markers of oxidative stress (malondialdehyde, MDA and hydrogen peroxide), protein SH groups (as an important chain-breaking antioxidant) and activity of antioxidant enzymes (glutathione peroxidase, [GPX], catalase and superoxide dismutase, [SOD]) were studied in plasma of 36 non-dialyzed patients with various degrees of CRF and 10 hemodialyzed (HD) patients. RESULTS: The results show that plasma MDA concentrations significantly increase with the severity of kidney dysfunction (r = -0.543, p < 0.01). A marked and profound fall in plasma thiol group levels was observed in all groups tested, independent of the degree of renal failure (r = 0.082, p > 0.05). Plasma SOD activity increased in CRF patients with the progression of renal insufficiency (r = -0.370, p < 0.05). On the other hand, plasma GPX activity decreased progressively in strong correlation with endogenous CCr (r = 0.712, p < 0.001). However, despite this imbalance between extracellular SOD and GPX activities, plasma concentration of hydrogen peroxide remained unchanged in non-dialyzed CRF patients. Catalase activity in non-dialyzed CRF patients was increased, suggesting the significant involvement of catalase in the regulation of plasma hydrogen peroxide level. CONCLUSION: In hemodialyzed patients significantly lower plasma catalase activity, associated with higher hydrogen peroxide levels, was found. It seems reasonable to assume that the imbalance in the activity of extracellular antioxidant enzymes in chronic renal failure may result in accumulation of free radical species, and in unscheduled oxidation of susceptible molecules.     

A scoring system for polytrauma patients

The paper presents a review study on score systems in current emergency surgery including its classification, application and value, based on the experiences of other authors, the paper suggests application of score systems in different phases of polytraumatized patients treatment (in prehospital, as well as in early and late phases of the inpatient period). The paper also points out certain objective difficulties in everyday scoring of patients at the Department of the Emergency Surgery (daily engagement, computer center, etc.). As a conclusion, the authors present their opinion indicating that in absence of introduction of these systems into the practice, the approach to a polytraumatized patient cannot be adequate.