From Clinical Hospital Split, *Department of Gastroenterology and Hepatology, †Department of Nephrology, ‡Department of Pathology, §Department of Microbiology, Split, CroatiaCorrespondence:Prof. Izet Hozo MD, PhDDepartment of Internal Medicine,Clinical Hospital Split, Soltanska 1, Split, CroatiaTel: 385-21-55-76-58Fax: 385-21-55-76-58Izet.Hozo@st.htnet.hrAccepted for publicationNovember 2004

The aim of this study was to evaluate the results of single-session sclerotherapy with mixture of alcohol and polidocanol and a subsequent injection of albendazole for devisceration of hydatid cysts in the spleen. Eight patients (four women and four men, average age 22.9+/-11.4 with hydatid cyst in the spleen were treated with 10 minutes time of exposure to mixture of ethanol 95% and polidocanol 1%. After that, 2 to 5 ml of albendazole was injected into the cyst cavity. Two patients had 2 cysts. At follow-up the patients were examined with clinical and biochemical examinations, ultrasonography, and serologic test for echinococcal antibody titres. The mean hospital stay was 2.5+/-0.93 days. During the follow-up period, mean cyst diameter decreased from 46+/-16.4 mm to 13.6+/-16.26 mm. In all ten cysts, a reduction of post procedural recolection of fluid over 40% was observed. Five cysts (50%) disappeared during the follow-up period. All cysts (5) smaller then 50 mm in diameter disappeared during follow-up period. After an initial rise, the echinococcal-antibody titres fell progressively and at the last follow-up were negative (< 1: 160) in 7 (88%) patients. No complications were observed, except for pain, fever and urticaria during the first 24-hours after the procedure. Sclerotherapy using only one session and 10 min time of exposure to the mixture of ethanol and polidocanol, and a subsequent injection of albendasole solution represents an effective treatment of hydatid cysts in the spleen. This procedure is even more efficacious for hydatid cyst with diametar smaller then 50 mm.

Serum and tissue angiotensin-converting enzyme (ACE) was measured in 20 patients with lichen planus before and after therapy, and in 20 healthy individuals. Serum and tissue ACE activity was determined by spectrophotometric method using hippuryl-l-histidyl-l-leucine as a substrate. The enzyme activity is expressed in the following units: 1 U corresponds to 1 nmol of hippuric acid released by hydrolysis of hippuryl-l-histidyl-l-leucine per minute and one liter of serum or 50 mg tissue. Before therapy, serum ACE activity was significantly increased in patients with lichen planus (35.9 +/- 2.33 U/L) in comparison to healthy individuals (28.16 +/- 1.7 U/L). Tissue ACE activity was increased in patients with lichen planus (2.24 +/- 0.41 U/50 mg) in comparison to healthy individuals (1.86 +/- 0.16 U/50 mg), but the difference was not significant. After therapy, serum and tissue ACE activity decreased and no significant difference in ACE activity was found. The determination of serum ACE activity may be a good non-specific parameter for the assessment of therapeutic effects.

In order to study concentration of nitric oxide (NO) in the saliva of patients with Parkinson's disease (PD), we measured the concentration of its stable metabolite nitrite (NO(2)-) in the saliva of these patients and healthy subjects. We analyzed saliva flow rate and salivary NO concentrations in 16 subjects with Parkinson's disease and in 16 healthy subjects. Concentration of nitrite was determined by colorimetric method using Griess reaction. Saliva flow rate was significantly lower in patients with Parkinson's disease (0.2+/-0.03 mL/min; X+/-SEM) than in healthy subjects. Salivary NO(2)-concentration was significantly lower (5.02+/-0.64) than in healthy individuals (22.39+/-1.24, p<0.0001).

In the last few decades there has been a great development of regional anesthesia; all the postulates are defined and all the techniques of usage are perfected. However, like any other medical procedure, the block of brachial plexus carries a risk of certain unwanted complications, like possible intraneural and intravascular injections. The reason for great discrepancy between the injury of brachial plexus and other periphery nerves while performing the nerve blockade is the frequent usage of this block, but also the specific proximity of neurovascular structures in axilla. The purpose of this work is to determine the values of pressures which appear in para-neural, intraneural and intravascular injection applications of local anesthetic, and to compare those values in order to avoid cases of intraneural and intravascular injections in clinical practice with consequential complications. In experimental study there have been used 12 Wistar rats of both genders. After anesthesia with ether and mid-humoral access to the neurovascular structures in axilla, the injection of 2% lidocaine with epinephrine was performed with the help of automatic syringe charge. The needle was at first placed para-neural, and then also intraneural and intravascular. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program. All para-neural injections resulted with the pressure between 13,96-27,92 kPa. The majority of intraneural injections were combined with the injection pressure greater than 69,8 kPa, while the intravascular injections were combined with injection pressure less than 6,98 kPa. Based on the available data it can be noticed that so far none of the methods of prevention from unwanted complications of regional anesthesia can insure the avoidance of intraneural and intravascular injection of local anesthetic. Based on our research it is obvious that the measuring of pressure during the nerve blockade is very important in order to decrease the risk of neurological and possible systematic complications. It is also clear that a small, mobile, and financially quite available apparatus for pressure measurement can help in differentiation between para-neural, intraneural and intravascular injection. Avoiding high injection pressure prevents from lodging the needle into intraneural space, while avoiding a very low injection pressure prevents from lodging the needle into intravascular space followed by consequential complications. The usage of this apparatus can find its application in other blockades of periphery nerves, and in other branches of medicine as well.

Endogen phospholipids play a major role in determining the structure and nature of cell membranes. A deficiency of phospholipids in cellular membranes makes it almost impossible for the cell membrane to perform its function as a selective barrier between what passes in and out of the cell. Polyenylphosphatidylcholine chemical structure corresponds to that of endogen phospholipids, but it possesses functional superiority because of its content of unsaturated fatty acids. Polyenylphosphatidylcholine integrates in the cell membrane and organelle systems while becoming their constitutive elements. A healthy cell membrane leads to healthy cells and then healthy tissue and then to healthy organs or body systems and finally, healthy bodies and minds. For a long time, polyenylphosphatidylcholine in combination with vitamins has been used in the treatment of numerous health problems such as liver diseases, dyslipoproteinaemias and different intoxications with consequent liver failure. The main aim of toxicology studies is evaluation of the toxic potential and risks of human exposition to the substance. According to the Organization for Economic Cooperation and Development (OECD) acute oral toxicity refers to those adverse effects occurring following oral administration of a single dose of a substance or multiple doses given within 24 hours. LD50 (median lethal dose), oral, is a statistically derived single dose of a substance that can be expected to cause death in 50 per cent of animals when administered by the oral route. Our acute toxicity study was performed on albino Wistar rats. Animals were randomised in three experimental and one control group, each of 5 males and 5 females. Study was based on the administration of a single oral dose of the test substance (polyenylphosphatidylcholine) to each experimental animal. There were three dose-levels of the test substance: 300, 500 and 1000 mg/kg. Test substance administration day was the first day of the observation period that lasted 14 days. Control animals were given milk vehicle. At the end of the study, no statistically significant differences between experimental and control animals were observed concerning the recorded parameters: body weight, respiratory rate, tremor, faeces and phonation quality, indicating the absence of the test substance acute toxicity.

Proficiency in the anatomy of coronary arteries and their variations is significant for proper interpretation of the coronary angiographies, assessment of the complexity and result of the coronary insufficiency as well as surgical myocardium revascularization. The objective of this study is anatomy-radiology research of the methods of branching the main trunk of left coronary artery and to prove importance of the diagonal branch (ramus diagonalis) existence in the conditions of coronary insufficiency. In this study we have analyzed 100 coronary angiographies done at the Clinic for Heart Diseases and Rheumatism of the Clinic Center of University of Sarajevo and dissected 20 human hearts from the Institute of Anatomy. In our study we have come upon two methods of branching of main trunk of left coronary artery (bifurcation and trifurcation). By the method of the angiography we have found the bifurcation in 71% of cases while 65% of cases were proved by the dissection method. Trifurcation has been discovered in 29% of cases of analyzed angiographies i.e. 35% of cases of dissected hearts. We believe that third terminal branch of the left coronary artery should be marked as ramus diagonalis. This branch, including its anastomoses, presents important pattern of the collateral blood flow, which has special meaning, under conditions of coronary insufficiency.

This article reviews the history and current management concepts of flexor tendon lacerations. Classic and contemporary repair techniques are discussed. The most popular rehabilitation protocols are also reviewed.