Acta medica Iugoslavica最新文献

The effects of intrauterine hypoxia on the motorial development of forty infants was studied by synthesizing the findings obtained by a team of obstetricians, neonatologists and physiatrists. The pH of the blood of the examinees was measured during delivery to detect hypoxia. Analyses of the results obtained have shown that the degree of deviation from a normal neurophysiological development is directly proportional to the degree of hypoxia. The findings indicate the importance of the early detection of intrauterine hypoxia.

The author examined 20 hypermetropic eyes with functional amblyopia with application of the objectively sciascopically determined diopters and, separately, without such correction, during the investigation of the visual field using Goldmann kinetic light perimetry in photopia. The starting hypothesis was statistically tested by means of differences of the two arithmetic mean values. Based on the obtained results, the author has found that the values denoting the degree of visual field damage are in correlation with the degree of visual acuity decrease. He also observed that the application of the objectively determined dioptric value leads to the normalization of the visual field in amblyopic persons, although it does not improve visual acuity. This is an important observation, since extensive visual field failings without the introduction of the objectively determined correction may raise suspicion of a retrobulbar inflammation or atrophy of the optic nerve.

The authors deal with the demographic, social, psychiatric and diagnostic characteristics of the patients requiring urgent hospitalization, analyzes these characteristics in urgently hospitalized patients and their differences regarding sex. Urgent hospitalization of a psychiatric patient is caused primarily by the necessity for a medical care because of acute psychopathological disturbances. Biological conditions are essential in the urgent hospitalizations of psychiatric patients. There are significant differences between males and females as to the morbidity of urgently hospitalized patients. In males acute alcoholic conditions, alcoholism and alcoholic psychoses prevail, in females acute psychogeriatric disturbances, reactive psychotic conditions, non-psychotic reactive conditions, undefined depressions and suicidal attempts resulting from psychoreactive conditions and neurotic disturbances. Age, working and marital status are the characteristics more closely connected with the sex and urgent hospitalization, while other social and demographic characteristic have no great influence on urgent hospitalization. Urgently hospitalized males are more often employed, young and not married, the females are retired, elderly and widows. The analysis of these data allows the planning of the organization of urgent hospitalizations, but also it offers an insight into the structure of urgent hospitalizations of psychiatric patients, the urgency of psychic disturbances, characteristics of this urgency and its underlying conditions.

A case of neuro-cutaneous melanoma, in the course of which a bifocal melanoma of the cerebral hemisphere had developed, was used as a natural model for the study of the relation between tumorous and non-tumorous elements. The need is pointed out for the definition of such a cutaneous-meningeal syndrome before the development of a neoplasm. As tumours develop from the cells defining leptomeningeal melanosis, the possibility of a neuroradiological diagnosis of this process is accentuated, primarily by a minute examination of the sites characteristic of the disease. A premorbid detection of all such cases is imperative in order to introduce an early anti-tumour treatment.

Advanced head and neck tumors have a very low survival rate when treated by classical methods of irradiation and surgery. This is why in the last ten years cytostatics and immunotherapy have been applied. Clinical experience speaks in favour of polychemotherapy in comparison to monochemotherapy. In head and neck tumors bleomycin, methotrexate, 5-fluorouracil, vincristine and cis-Platinum have been used most often. They can be applied as initial therapy, additional therapy after surgery and irradiation, and finally as palliative therapy. Present experiences have shown the best results with initial therapy in 2-3 cycles, before surgery and irradiation. Toxicity of cytostatics depends on the dose and the sensitivity of the patient. The interval between cycles is 2-3 weeks. According to clinical experience, active specific immunotherapy with tumor vaccine did not prove successful. The investigations have thus been directed towards the means which would mobilise the immunological forces of the organism and remove obstacles in reaction of cytotoxic drugs and tumor cells. Such biological response modifiers are interferon, hormone of the thymus, substances which increase, change or restore immunological reactivity, lymphocytes, tumor preventive agents, NK cells, lymphokines, monokines and allokines, plasmophoresis and indomethacin.

The lysine renal tubular transport was studied in a patient with an unusual trait of the membrane transport inborn error characterized by persistent hyperlysinemia with hyperlysinuria. Plasma and urine concentrations of dibasic amino acids were measured basally and at different time intervals after oral lysine loading (300 mg per kg body weight). Compared with controls, the patient's basal urinary excretions were significantly elevated, especially that for lysine. Concentrations of plasma and urine cystine in the patient were within normal ranges and were not affected with lysine loading. These data, as well as the absence of other symptoms exclude the possibility that this may be the case of cystinuria or a lysinuric protein intolerance trait. The results suggest as follows: (a) in the human kidney the tubular transport of lysine occurs via two kinetically distinct systems; (b) the high affinity lysine transport system operating at a low lysine filtered load is common to all three dibasic amino acids; (c) the low affinity lysine transport system operating at a high lysine filtered load is more specific to lysine and has a greater capacity; (d) in the patient observed the high affinity transport system is impaired for all three dibasic amino acids, especially that for lysine; the affinity for lysine is, compared to controls, about three times lower; the lysine capacity of the low affinity lysine transport system is about ten times lower than that in controls; at the same time a great amount of the patient's arginine is reabsorbed by this transport systems. The case reported indicates a clinical heterogeneity of human hereditary disorders of the membrane transport.

Analysing sources, forms, and dynamic significance of resistance in individual analytically orientated psychotherapy applied to a randomly composed sample of 22 patients with a major depressive episode (12 females and 10 males), the author has found that resistance comes from all dynamic systems and that it should be looked upon through the prism of a deep narcissistic regression as reaction to narcissistic traumas and the concept of depressive disturbances as the interaction between genetic-biochemical, psychological, and sociological factors. Forms of resistance and their functions are described in more detail. The dynamic significance of resistance lies in the defence of the narcissistic injuries of the vulnerable self and a further disorganization of mental functions. The nature and dynamic importance of resistance in depressive patients determine the kind of therapeutic interventions which essentially differ from procedures in the psychotherapy of neuroses.

Cardiac manifestations of sarcoidosis reflect the presence of granulomata in the myocardium or pulmonary arterial hypertension due to the advanced pulmonary form of the disease. Electrocardiographic changes may point to the form of the underlying pathology. The electrocardiograms of 150 newly diagnosed, untreated sarcoid patients, of whom no one had cardiac symptoms were analysed. Pathologic ECG changes indicative of myocardial sarcoidosis and/or pulmonary arterial hypertension were found in 20 (13.3%) patients. In cases with pathologic changes the ECG following the corticosteroid therapy was examined to test the stability or transitoriness of these changes. Two thirds of them disappeared following the corticosteroid therapy. Patients with the pathologic ECG, compared to the group as a whole, had a significantly more frequent pulmonary form of sarcoidosis and more severe restrictive and obstructive ventilatory changes.

Complications associated with the intraocular lenses (IOL) implantation can be classified into 3 groups: intraoperative, early and late complications. Some of the complications have to be treated at once, otherwise the condition may deteriorate and lead to the occurrence of various secondary complications. One of the intraoperative complications during the IOL implantation can be the impairment of the corneal endothelium which occurs due to the inadequate size of the incision. A part of the IOL loop can remain incarcerated in the corneo-scleral wound during surgery. A strong choroidal hemorrhage may occur, as well as the shallowing of the anterior chamber. Iridodialysis may appear as a consequence of the implant manipulation. IOL can also be subluxated or luxated anteriorly or below the sclera. All of these complications should be promptly attended to. Early postoperative complications that should be treated as soon as possible are the occurrence of the pupillary block, shallow anterior chamber, secondary glaucoma, choroidal detachment, corneal edema and postoperative iritis. Besides the corneal edema, late postoperative complications include the formation of secondary cataract, the occurrence of cystoid macular edema and retinal detachment. The treatment of some of these complications can be delayed for a certain period, while other require the immediate treatment and correction. In this work the author presents his results, the complications encountered in different stages of the IOL implantation, and the immediate interventions that were carried out.