Surgical treatment of toxic adenoma

In the period ranging from 1985. to 1994. a total number of 86 patients have been treated for toxic adenoma (TA). Hyperthyroidism was more often present in males (70.83% versus 51.61%) and in enlarged adenomas (more then 2 cm in diameter). Pathohistologic type of adenoma influenced degenerative changes. Three carcinoma have been observed, two papillary and one follicular. Surgical treatment is the method of choice. Complications are rare (3.49%) and mild.     

Overview of the surgical importance of variations in the hepatic artery

Hepatobiliary and gastric surgery greatly depend upon knowledge and recognition of origin, relations and course of the hepatic artery. This paper presents the main variants of the arterial vessels in the hepatoduodenal ligament, with a concise review on their clinical relevance. Special attention was drawn to the aberrant hepatic arteries, which are found in nearly half of the cases, and to the macro- and microvasculature of the common bile duct.     

Local interferon therapy for lip carcinoma

In a prospective non-randomized study 21 patients with lower lip squamous cell carcinoma were treated with human natural leukocyte interferon (HNLI). The response rate was measured by a size reduction of more than 25% and was 81%. A complete response rate was considered to be a cure according to histopathological and clinical findings and was 48%. The response rate of six lower lip squamous cell carcinoma cases treated with recombinant interferon alpha 2c was 67% and the complete response rate was 17%. Three patients with basal cell carcinoma of the upper lip were also treated with HNLI. All three patients were cured, as determined by histopathological and clinical findings. These findings indicate that interferon can be a useful alternative therapy for lip carcinoma either with or without surgery.     

Occupational physical demands and hip osteoarthritis

The authors investigated the influence of physical strain at work on radiological signs of hip osteoarthritis. The study included 295 men and 298 women aged over 45 from an urban area who were classified in four groups according to physical demands of their occupation. The evaluation included clinical and radiological signs of hip osteoarthritis. The association between hip osteoarthritis and occupation was analysed using logistic regression. Though not significantly, radiological signs of hip osteoarthritis were common in subjects who worked in a standing position (odds 1.45 for men, 1.50 for women). Clinical signs of osteoarthritis in women were significantly associated with performance in a standing position (odds 3.00), whereas in men the association was more significant for jobs with high physical strain (odds 2.19). There was a sustained trend toward an increase in health risk with years of work in all job categories. Occupation did not appear to influence the development of radiological hiposteoarthritis, but the authors did establish association between clinical signs of hip osteoarthritis and work.     

Financing of dental health care in the Federation of Bosnia and Herzegovina

Financing dental health care in the Federation of Bosnia and Herzegovina (FBH) over the last 10 years was analyzed with respect to time before the war, during the 1992-1995 war, and after the war. In the first period (until 1991) the system was centralized, well structured, financed through the communities of interest, and burdened with a lack of financial discipline and high inflation. By the end of 1991, all citizens in the territory of BH Federation had the right to dental health insurance and participated in the price of dental service with 10-50%. During the 1992-1995 war, insurance and financial institutions ceased their work until the establishment of civilian governing authorities. The system of dental services was legalized within the health system as its integral part, yet, because of insufficient financial support, the rights of the insured were not fulfilled. Following the Dayton Peace Agreement in 1995, two systems (Croat and Muslim) were in function in FBH, each based on different legal grounds, and dental care stagnated considerably. The 1997 FBH Law on Health Care and Health Insurance and the Law on the Privatization of companies introduced a unique health system, widening the sources of financing and categories of health insurance. The process of health care privatization has been legalized, but not yet implemented. Lack of definitions of ownership diminish foreign investments, and without foreign financial support the improvements will be slower than needs. The process of health care restructuring will thus directly depend on the solving the political crisis in the country.     

Role of nimodipine in the therapy of subarachnoid and intracerebral hemorrhage

Syndromes of intracranial hemorrhage, and particularly subarachnoidal, i.e., intracerebral hemorrhage (SAH and IH) present clinical entities that are the most severe conditions in neurology. Timely recognition, diagnosis and adequate therapy are imperative. The most important factor that aggravates an already difficult prognosis of those entities is cerebral vasospasm. Upon the presented facts, the aim of this investigation was to establish the value and role of administration of selective calcium channel blocker--nimodipine in patients with SAH and IH compared to the degree of neurological and functional impairment, as well as the recovery of the function of consciousness compared to the patients with those syndromes from an earlier period, who were not treated with this medicament. Investigation comprised 30 patients who received nimodipine and 20 patients without this agent in therapeutic program. Results of the investigation confirmed significant difference concerning the neurological recovery, improvement of functional capability and recovery or consciousness disturbances, respectively, in patients who received nimodipine compared to the group without this agent. It can be concluded that nimodipine as calcium channel blocker with multitopic pharmacological effects on mechanism of SAH or IH development, respectively, as well as on the development of complications of those syndromes, particularly to the development of vasospasm and reactive ischemia, with the improvement of hemorrheologic disorders deserves to be included as the unavoidable segment of therapeutic program of SAH and IH syndrome immediately after clinical phenomenology is revealed.     

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.