Percutaneous embolization of idiopathic renal arteriovenous fistula using Amplatzer vascular plug II

Renal arteriovenous fistula (AVF) presents a rare but important condition that can be acquired, congenital, or idiopathic. Embolization techniques have recently been considered the first-line therapy in the treatment of these lesions, but they carry a possible high risk of distal migration of embolic agents into the venous and pulmonary circulation. This risk is especially important with large, high-flow fistulas. In this report, we present a case in which a 31-year-old man with a symptomatic idiopathic AVF was treated with embolization using the Amplatzer vascular plug II after unsuccessful superselective embolization using coils. This method allowed for complete occlusion of the high-flow fistula with good preservation of arterial supply to the renal parenchyma.     

Effect of spirapril on left ventricular hypertrophy due to volume overload in rats.

The effect of the angiotensin-converting enzyme (ACE) inhibitor spirapril on structural and functional parameters of volume-overloaded rat hearts was evaluated in a time-course study. Left ventricular hypertrophy (LVH) was induced by graded disruption of the aortic valve in male Wistar rats. Four weeks later, structural (LV mass and LV wall thickness) as well as functional parameters [LV end-systolic and end-diastolic volumes, stroke volume (SV), ejection fraction (EF)] were determined in anesthetized animals by magnetic resonance imaging (MRI). The rats were then divided into two groups, one of them receiving spirapril (10 mg/kg/day) in food. LV parameters were evaluated by MRI at 4, 18, 25, and 32 days after treatment was started. MRI analysis before the start of treatment showed that both groups had developed a similar degree of eccentric LV hypertrophy. Similarly, LV wall thickness, end-systolic and end-diastolic volumes, SV, and EF did not differ between the groups. Treatment with spirapril resulted in stable LV weight during the follow-up period of 32 days, whereas the untreated group showed a significant steady increase in heart weight. LV end-diastolic volume, LV end-systolic volume, and SV were smaller in the spirapril group when measured after 25 and 32 days, but only the difference in end-diastolic volume reached statistical significance. LV wall thickness and EF were not affected by spirapril. After the last MRI determinations, blood pressure (BP) and the response to angiotensin I (ANGI) were measured in conscious animals. Systolic BP (SBP) and mean arterial pressure (MAP) were significantly lower in spirapril-treated rats, and the dose-response curve to ANGI was shifted to the right.(ABSTRACT TRUNCATED AT 250 WORDS)     

General practice in Croatia, Yugoslavia

The position and importance of general practice in the Yugoslavian Health Service is being reviewed in a study of the working conditions, the composition and relationship of the primary health care team, the workload, and the opinions of the patients in Croatia, Yugoslavia.

We found that many practices had barely half the recommended equipment, that the average workload was 40 patients a day, and that many general practitioners expected others to improve their organisation rather than undertaking it themselves.

Those general-practitioner teams which we rated highly were also the most popular with patients. The job satisfaction of nurses varied and was highest when the doctors in the team did not have a high need for status for themselves.

We consider general practice to be of crucial importance in the total system of health care in our country and believe that general practitioners should have the same status as specialists.

     

Croatia has reached iodine sufficiency

This study was performed in 2002, 6 yr after the introduction of a new regulation on salt iodination with 25 mg KI/kg of salt. The aim of the study was to evaluate whether further significant positive results of improved iodine intake could be observed among schoolchildren in Croatia. A total of 927 schoolchildren of both sexes, aged 6-12 yr, were included in the study. In Croatia, with a population of 4,437,460 the research was implemented in four major geographical regions: the Northwestern, Slavonia, Northern Adriatic and Dalmatian regions. Investigations included randomly selected pupils from regional centers and neighboring smaller towns or villages. The results have revealed that thyroid volumes were within the normal range according to the provisional WHO/ICCIDD reference values for sonographic thyroid volume in iodine-replete school-age children, updated in 2001. A significant improvement in medians of urinary iodine excretion was detected in 2002: from 9 microg/dl in 1991 to 14.6 microg/dl in Zagreb, from 4.3 microg/dl in 1995 to 13.1 microg/dl in Split, from 9.4 microg/dl in 1997 to 14.2 microg/dl in Rijeka and from 13.4 microg/dl in 1997 to 14.7 microg/dl in Osijek. An overall median of 14.0 microg/dl of urinary iodine excretion was detected in Croatian schoolchildren. The control of salt at different levels, from production to consumption, including salt produced in all three Croatian salt plants and imported salt, revealed that Croatian salt is adequately iodized. From severe iodine deficiency before the 1950s, through mild-to-moderate iodine deficiency in the 1990s, Croatia has now reached iodine sufficiency.     

Alzheimer's disease: a review of the disease, its epidemiology and economic impact

This article consists of a critical review of Canadian, American and European studies published between 1976 and 1997 on the subject of Alzheimer's disease (AD), and its epidemiology, patterns of care, prognostic factors, and economic impact. As the population ages in North America and Europe, significant increases in the prevalence of AD over the next decades have been projected. The elderly population represents the largest consumer group of health care resources and the management of common diseases occuring in this population will have major medical, social, and economic implications. As a result, researchers will need to integrate the ever-increasing knowledge on AD when addressing governmental and societal concerns regarding its impact. Described herein is the study findings, limitations, and differences observed following the review of the diagnostic criteria, prevalence rates, incidence rates and risk factors. Highlighted are the areas where data is lacking. To refine current models of disease progression, and better address where health care resources and new therapies would be most beneficial, the review of predictors of institutionalization and predictive models of disease progression and survival, was performed. New research questions are indicated.     

A comparison of methods for predicting the size of unerupted permanent canines and premolars

The aim of this study was to examine the reliability of eight methods for determining the mesio-distal crown diameters (MDD) of the permanent canines and premolars (C, P(1), and P(2)). The study models of 120 children (60 boys and 60 girls) aged from 14 to 18 years treated in orthodontic clinics were measured using Seipel's method, with callipers accurate to 0.01 mm. The correlation coefficients were determined between the MDD of C, P(1), and P(2) measured on the study models and the sums calculated using various other methods. The correlation coefficients derived by comparison with the methods of Moyers, Tanka and Johnston, Droschl et al., Legovi? and Hauz, and Berendonk-Nawrath showed a tendency to over-estimate the MDD of C, P(1), and P(2), while the regression methods of Gross and Hasund, Bachmann, and Tr?nkmann et al. under-estimated the values. Bachmann's method appeared to give the most reliable results.