CONTEXT Although impunity for those responsible for trauma is widely thought to be associated with psychological problems in survivors of political violence, no study has yet investigated this issue. OBJECTIVE To examine the mental health and cognitive effects of war trauma and how appraisal of redress for trauma and beliefs about justice, safety, other people, war cause, and religion relate to posttraumatic stress responses in war survivors. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey conducted between March 2000 and July 2002 with a population-based sample of 1358 war survivors who had experienced at least 1 war-related stressor (combat, torture, internal displacement, refugee experience, siege, and/or aerial bombardment) from 4 sites in former Yugoslavia, accessed through linkage sampling. Control groups at 2 study sites were matched with survivors on sex, age, and education. MAIN OUTCOME MEASURES Semi-structured Interview for Survivors of War, Redress for Trauma Survivors Questionnaire, Emotions and Beliefs After War questionnaire, Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS The mean (SD) age was 39 (12) years, 806 (59%) were men, and 339 (25%) had high school or higher level of education. Participants reported experiencing a mean of 12.6 war-related events, with 292 (22%) and 451 (33%) having current and lifetime posttraumatic stress disorder (PTSD), respectively, and 129 (10%) with current major depression. A total of 1074 (79%) of the survivors reported a sense of injustice in relation to perceived lack of redress for trauma. Perceived impunity for those held responsible for trauma was only one of the factors associated with sense of injustice. Relative to controls, survivors had stronger emotional responses to impunity, greater fear and loss of control over life, less belief in benevolence of people, greater loss of meaning in war cause, stronger faith in God, and higher rates of PTSD and depression. Fear and loss of control over life were associated with PTSD and depression (odds ratio [OR], 2.91; 95% CI, 2.27-3.74 and OR, 2.30; 95% CI, 1.75-3.03, respectively), and emotional responses to impunity showed a relatively weaker association with PTSD (OR, 1.53; 95% CI, 1.16-2.02) and depression (OR, 1.39; 95% CI, 1.02-1.91). Appraisal of redress for trauma was not associated with PTSD or depression. CONCLUSIONS PTSD and depression in war survivors appear to be independent of sense of injustice arising from perceived lack of redress for trauma. Fear of threat to safety and loss of control over life appeared to be the most important mediating factors in PTSD and depression. These findings may have important implications for reconciliation efforts in postwar countries and effective interventions for traumatized war survivors.

Introduction  Uremia is associated with different endocrinologic abnormalities, which in some cases induce polyendocrinopathia. Female patients on dialysis are often subject to menstrual disorders that are variously manifested. The aim of our paper is to evaluate the etiology of menstrual dysfunctions in female dialysis patients. Material and methods  Anamnesis, clinical and hormonal tests were performed on 25 female patients that were in chronic dialysis programs 4 hours, 3 times per week. Oligomenorrhea is considered as menstrual interval between 35 and 90 days and amenorrhea as cease of menstruation in the last six months. Results All patients had had normal menstrual cycles before the dialysis. Mean age of patients was 42.7 ± 9.96 years and mean dialysis duration was 75.5 ± 62.41 months. Out of the 25 patients, 10 developed amenorrhea when beginning dialysis and 5 of them regained regular menstrual cycle after one year. Seven patients had oligomenorrhea and 8 patients had an early menopause. Prolactin concentration was significantly higher in the group which developed menopause (N = 8), cpr = 1222.3 ± 1013.4, amenorrhea (942.2 ± 1061.2), oligomenorrhea (860.4 ± 897.2), compared to the group with a regular menstruation cycle (444.8 ± 299.7). The luteinizing hormone (LH) level in serum was increased in all groups. FSH was insignificantly higher in groups with oligomenorrhea and amenorrhea and amounted to 51.1 ± 69.9, while β-estradiol and progesterone were in normal ranges. Hemodialysis duration influenced the prolactin level and after one year of follow up prolactin level significantly decreased in the group with amenorrhea that regained regular menstruation (cpr = 596.2 ± 297.2). Conclusion  Different menstrual disorders are developed in dialyzed patients. Hyper prolactinemia was present in our dialysis population. Significant lowering of prolactin level in 20% of patients led to normalization of menstrual cycle.

Myasthenia gravis is in group of disorders transmission at the motor end-plates is abnormal. Myasthenia gravis is characterised by fluctuating weakness, consisting principally of abnormal fatiguability, with improvement after rest. Since this symptom is subjective the diagnosis is very difficult in the early stages. Lambert Eaton's myasthenic syndrome (LEMS) is characterised by weakness and fatiguability of proximal limb muscles, mainly in legs, with improvement after exercise. Considering the degree of disease, similar symptomatology with a substantially different treatment, we performed this paper to enable the earlier diagnosis and adequate care of these patients.

INTRODUCTION Correction of anemia in haemodialysed patients by recombinant human erythropoetin (R-Hu Epo) has been reported to improve sexual functions and hormonal disturbances. The purpose of this study was to evaluate how levels of sexual hormones and sexual function differ before and during a 12 month R-Hu Epo therapy. MATERIALS AND METHODS Thirty six male patients, mean age 47.5 +/- 12.78 and thirty six female patients, mean age 53.0 +/- 10.14, were included in this study. All patients were dialyzed 3 times per week with haemodialysis mean duration of 4.56 +/- 3.84 years. In order to evaluate sexual activities, the questionnaire was presented to all patients. The levels of prolactin, testosterone, FSH, LH were measured at the beginning of the study and every forth month during the study. RESULTS During twelve month therapy with Epo, serum hemoglobin significantly increased from 96.0 +/- 13.3 g/dl to 104.0 +/- 17.2 g/dl (p < 0.005), and hematocrit value rose from 0.284 +/- 0.046% to 0.308 +/- 0.052% (p < 0.05). Prolactin was not significantly decreased: at the beginning of the study was 540.3 +/- 302.2 and at the end 537.4 +/- 297.1 microIU/ml. Testosterone concentrations were in normal range in male patients (18.26 +/- 8.61 microIU/ml). There was significant difference in value of LH in female patients which increased from 57.68 +/- 62.58 to 73.79 +/- 68.52 IU/L. Improvement of sexual function was remarkable in female patients. In male patients sexual desire, frequency of sexual intercourse was strengthen after R-Hu epo therapy. CONCLUSION Better sexual functions in our patients after treatment with R-Hu Epo did not correlate with hormonal disturbances except changes of LH that increased at the end of the therapy.

The acute polyradiculoneuritis represent acute inflamatory polyneuropathy with unknown cause, frequently induced by prior virus and sometimes bacteria infection. The purpose of this paper is to establish particularities of the clinical course and results of the disease during the war and the post-war time. Within the retrospective study we performed analysis of all patients suffering from the acute polyradiculoneuritis between January 1992 and December 2003 year who during the mentioned period where treated at the Department of Neurology in Sarajevo. In addition to the anamnysis and the clinical examination, diagnostic criteria where laboratory parameters, EKG, cardiological finding, cerebrospinal liquor (LP) and the EMG finding.

– Stroke is the leading cause of mortality and the main cause of disability in adults in Europe. According to the American Heart Association, “the profile of apoplectic personality is determined by systolic blood pressure greater than 160 mm Hg, diastolic blood pressure higher than 95 mm Hg, family history of cardiovascular diseases, hypercholesterolemia, smoking, alcohol abuse and diabetes mellitus”. The aim of this retrospective study was to assess the correlation between early and late epileptic seizures during and after stroke, and some heart diseases associated with hypertension. Ten-year records (January 1, 1989 till December 31, 1998) of the University Department of Neurology, Sarajevo University Clinical Center, were examined. There were 7001 stroke patients (53.6% with cerebral thrombosis, 17.35% with embolic etiology, 21.96% with intracerebral hemorrhage, and 1.17% with subarachnoid hemorrhage), with a 3.38% incidence of symptomatic epileptic seizures. The following cardiac diseases were considered relevant for the study purpose: absolute arrhythmia, subdecompensated heart state, well treated cardiac decompensation, angina pectoris, postmyocardial infarction state, and extrasystoles. Results revealed a statistically significant difference in the correlation with cardiac diseases between patients with early and late epileptic seizures. The patients with early epileptic fits had severe heart problems compared to those with late seizures. The former suffered from angina pectoris, heart decompensation and chronic subdecompensated state, yielding a ratio of 1.1 to 0.6. There was no statistically significant difference between the groups according to absolute arrhythmia. Study results suggested the patients with cerebrovascular disease and early epileptic fits to have a significantly higher rate of heart problems compared to stroke patients with late epileptic fits, in whom the morphological changes of the brain appeared neurophysiologically to act as an epileptogenic focus.

It is a general rule today, after a relevant diagnostics of an epilepsy, to start a monotherapy treatment, depending on a kind of a seizure, a life age and a general health condition. First line of monotherapy epilepsy drugs remain carbamazapine and sodium valproat. New drugs that are being introduced are: felbamat, gabapentin, lamotrigin, oxcarbazepin, tiagabin, topiramat, vigabatin and zanisamid. These are commonly used as add-on therapy, or as an addition for previously used antiepileptic. Their indicated areas are complex resistant partial seizures with or without generalization. Attention should be paid on proper dosage, interactions and toxicity. Regardless on the new epileptic era, according to reports of International League against epilepsy, most of the patients do not receive the drug that is the most appropriate for them concerning the price (cost-benefit). Neurosurgical methods in epilepsy treatment are: selective amygdalo-hyppocampotomy, temporal lobotomy, subpial resection, hemispherectomy, corpus callosotomy, removal of lesions like tumors or cysts provide encouraging results in reduction of epileptic seizures that can be followed by reduction of drug therapy. N. vagus stimulation is being wider introduced in resident epileptics. Treatment of epilepsy in women requires an approach to sexuality, conception, pregnancy, introduction of medicaments, antiepileptic terratogenity, contraception, motherhood and menopause. A special significance of modern approach to epilepsy is in treatment of elderly who have cerebrovascular and neurodegenerative disease as a cause of seizures. A complex treatment of epilepsy using pharmacological and neurosurgical approach requires supportive psychotherapy, socio-therapy, the work with a family, education about epilepsy and living a life with more quality having one.

A seizure is a disturbance of movement, feeling or consciousness occasioned by sudden, inappropriate and excessive electrical discharges in the grey matter of the brain. The most common psychiatric disorder in epilepsy is interictal depression, with lifetime prevalence of 40 to 60%. Particular attention should be paid to suicidal ideations, due to the fact that most of the patients have easy access to potentially lethal when overdosed, antiepileptic drugs. The aim of our paper is to determine the presence of depressive symptoms in epileptic patients according to their treatment protocols (monotherapy or polytherapy), gender, age, social status, age when diagnosed, type and frequency of seizures. Prospective evaluation of monotherapy and polytherapy in 60 subjects, (30 subjects in each group), who were diagnosed with epilepsy. Assessment of depressive symptoms was performed with the use of BDI scale. In both groups there was a similar structure according to gender, mean age was 34 (with an s.d. of 11.06). More than 96 percent of the subjects had low or average socioeconomic status. Average age of first attack was 20.43 (with an s.d. of 11.9). In the group treated with monotherapy there was the biggest number of generalized convulsive seizures, and in the group treated with polyantiepileptic therapy there was the biggest number of partial complex seizures. Symptoms of moderate and severe depression were registered in 33% patients treated with monotherapy and 60% of patients treated with polytherapy (t = 2.198, for p less than 0.05). 16.7 percent of the patients had suicidal ideation. On the basis of our research we can conclude that significantly more frequent and severe depressive symptoms were found in the group of epileptic patients who were treated with polytherapy. In those patients the occurrence of partial complex seizures was the biggest, and their frequency was weekly or even daily.

UNLABELLED The state of mental confusion is described as an dependent risk factor in development of early and late epileptic-onset seizures following CVI. The aim of this paper is to determine the influence of confused state as possible predictor of symptomatic seizures in the course and following CVI. MATERIAL AND METHODS The patients who were treated in The Department of Neurology for early and late-onset seizures in the course and following CVI in the period between 1.1.1989 and 31.12.1998. RESULTS We had total number of 106 patients with symptomatic seizures, 56 in the group of late-onset and 50 in the group of early seizures. 52.8% of the patients have a registered state of mental confusion at the admission to hospital (in the stage of acute CVI), 19.2% of patients had a clear sensorium. Disorder of consciousness of the type of coma was registered in 27.4% of the patients. There was statistically significant increase of the occurrence of mental confusion in the group of patients with late-onset seizures, 62.5% while there was a statistically significant increase of coma in conditions related to type, frequency and outcome of seizures. We can conclude that mental confusion has significant influence of the occurrence of late-onset seizures while it does not influence the type and frequency of seizures.

The facial nerve has predominantly the motoric, and less sensitive function and gets nerved the muscle musculature of the face and its damages, significantly disturbs the function of the series of the muscles of the face. Regarding to this that the parases of the nervus facialis are often in the physician practice, we have written this article with aim to facilitate to the physicians in the practice the early establishing of the diagnosis, and also to give the instructions into the basic physical and rehabilitation procedures which is with success to carry out in patients with the damages of this nerve.