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Biomedical subjects

D Kovac

Publications and source records attributed to D Kovac.

At least 19 recordsLinked to original sources
PubMed1999

The effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome.

The authors retrospectively analysed two groups of consecutive patients who were similarly matched for brain injury severity. From a total of 39 severe head injury patients, 23 were treated according to the Guidelines for the Management of Severe Head Injury with intracranial pressure (ICP) monitoring ("Guidelines group"). Such an approach allowed the maintenance of ICP within normal values, especially in patients with intraventricular ICP monitoring allowing the release of cerebrospinal fluid (CSF) from the ventricular system. In the Guidelines group only two patients were administered barbiturates, after all other means of ICP lowering had been exhausted. The second group consisted of 16 patients who were not monitored for ICP ("non-Guidelines group"). In this group, management consisted of the prophylactic administration of barbiturates, high dose osmotic diuretics and hyperventilation usually at levels below 25 mm Hg. In the Guidelines group the mortality rate was 30% compared to 44% in the non-Guidelines group. Almost twice as many patients achieved a "favourable" (good recovery and moderate disability) outcome (49%) compared to the non-Guidelines treated patients (25%). Furthermore, there was a 32% decrease in severe neurological disabilities in those patients in the Guidelines group. It seems that the implementation of "Guidelines" in the treatment of severe head injury, based on the result of our clinical study, reduces death and disability rates in patients with severe head injury. The administration of therapy based on the "Guidelines principles" and monitoring of ICP, can minimise the application of those therapeutic modalities (barbiturate coma and prolonged hyperventilation) which, in addition to favourable effects, may also have harmful effects on patients with severe head injury.

Adolescent↗
PubMed1998

Omeprazole, azithromycin and either amoxycillin or metronidazole in eradication of Helicobacter pylori in duodenal ulcer patients.

BACKGROUND: Azithromycin is a new generation, acid stable, macrolide antibiotic that achieves remarkably high concentrations in gastric tissue (above the minimal inhibitory concentration for Helicobacter pylori) after oral administration. AIM: To establish whether azithromycin plus omeprazole in association with either amoxycillin or metronidazole are useful in curing H. pylori infection in patients with a duodenal ulcer. METHODS: One hundred patients with active duodenal ulcers and H. pylori infection were treated with omeprazole (days 1-10, 40 mg b.d.; days 11-24, 40 mg o.m.; days 25-42, 20 mg o.m.) plus azithromycin 500 mg o.m. for the first 6 days. Patients were randomly assigned to receive either amoxycillin 1 g b.d. (OAzA group: n = 50) or metronidazole 400 mg t.d.s. (OAzM group: n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before the treatment and 6 weeks after completion of therapy. RESULTS: Ninety-seven patients completed the study. H. pylori infection was eradicated in 85% (41/48) of patients in the OAzA group (intention-to-treat analysis 82%) vs. 74% (36/49) of patients in the OAzM group (intention-to-treat analysis: 72%) (N.S.). All ulcers had healed after 6 weeks of omeprazole treatment. Side-effects, usually minor, were recorded in 13% (OAzA group) and 47% (OAzM group) of patients (P < 0.001), but therapy was discontinued for only one patient in the OAzA group (N.S.). CONCLUSION: Ten days of treatment with omeprazole plus (for the first 6 days) azithromycin and either amoxycillin or metronidazole provides effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.

Adult↗
PubMed1998

[Surgical treatment of lumbar disc hernias in athletes].

In a 7-year period (1988-1995) a series of 55 patients was surgically treated at our Department for lumbar disk herniation following a certain sports activity, i.e. sports injury. The above number accounts for 2% of the total number of lumbar disk patients operated upon at our Department. The majority of patients in our series were amateur athletes, whereas a few of them were active or professional athletes. The most common cause of disk herniation among our patients was playing soccer (13 cases), which is followed by basketball (8), field athletics (7), tennis (6) and handball (4). In most cases our surgical method of choice was flavectomy (interlaminectomy). Most commonly seen intraoperative finding was intervertebral disk extrusion. In some athletes the onset of symptoms was due to a change of their usual sports activity, for example a tennis player who was injured in skiing. We believe that the onset of disk herniation in athletes is a consequence of numerous micro traumas of the intervertebral disk which are further compounded by the syndrome of overstraining. In the case of a positive indication, surgical treatment leads to a faster recovery in professional athletes.

Adolescent↗
PubMed1998

Omeprazole, azithromycin and amoxicillin or amoxicillin plus clavulanic acid in eradication of Helicobacter pylori in duodenal ulcer disease.

Treatment with omeprazole (OME), azithromycin (AZI) and amoxicillin (AMO) resulted in encouraging Helicobacter pylori cure rates in pilot and control studies. The aim of this study was to establish whether OME + AZI in combination with either AMO or ACA (amoxicillin plus clavulanic acid) are effective in curing H. pylori infection. A hundred patients with active duodenal ulcer and H. pylori infection were treated with OME (day 1-10: 2 x 40 mg/day, day 11-24: 40 mg/day, day 25-42: 20 mg/day) plus AZI 500 mg/day for the first 6 days. Patients were randomly assigned to either AMO 2 x 1000 mg/day (group A, n = 50) or ACA 2 x 1250 mg/day (group B, n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before and 6 weeks after completion of therapy. Ninety-five patients completed the study. H. pylori infection was eradicated in 85.4% (41/48) patients from group A (intention-to-treat (ITT) analysis: 82%) versus 91.5% (43/47) patients from group B (ITT) analysis: 86%) (NS). All ulcer had healed after 42 days of omeprazole treatment. Side effects, usually minor, were recorded in 12.5% (group A) and 14.9% (group B) of patients (NS). Therapy had to be discontinued in two patients (one in group A and one group B) only. Ten-days treatment with OME and AZI (for the first 6 days) with AMO or ACA are simple and highly effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.

Adult↗
PubMed1997

Correlation between instability of fundamental voice frequency and malignant infiltration of vocal fold nerve endings.

Performing systematically acoustical objective voice analysis in patients with chronic chorditis and glottic cancer we detected a certain number of cases with exceptional acoustical pattern. In 7 of 50 patients with chronic chorditis this acoustical pattern was highly specific demonstrating frequent changes of fundamental frequency in short time interval. In 31 of 50 patients with glottic cancer the same phenomenon was recorded. Histology revealed in 6 of those 7 patients with clinical diagnosis of chronic chorditis invasive cancer of the vocal fold. Detailed and more sophisticated techniques (PAF Halmi for elastic and collagen fibres and neurohistochemical technique S-100 and NSE for nerve elements) demonstrated mainly preserved layer structure of vocal fold lamina propria and infiltrated nerve endings. Such histological findings strongly suggest that cancer infiltration is responsible for rapid changes of fundamental frequency (via mucosal reflexes) although vibratory segments are regular because of preserved layer structure. Such findings could contribute to better understanding of laryngeal control mechanisms and laryngeal mucosal reflexes in human. Also this acoustical sign may be a useful diagnostical parameter for very early diagnosis of glottic cancer. This is possible because of the great sensitivity and complexity of phonatory function.

Chronic Disease↗
PubMed1997

[Smokers' edema of the vocal cords].

The purpose of this study was the analysis of the etiology, clinical and phonatory characteristics in the subjects with Reinke's oedema. The research was done on 105 subjects, of whom 95 women and 10 men of the age between 28 and 83. The results show that according to the sex, the frequency of the Reinke's oedema is higher in women than in men. The disturbances, not according to the sex, appear mostly in the age between 40 and 60. The voice disturbances last usually for some years. Most of the subjects were smokers (80%) which confirms that smoking (with great intensity and for many years) is the main etiological factor in the development of Reinke's oedema. Less important are considered the voice loadings of long duration, while allergy and acute respiratory infection are mentioned as the possible factors. The values of the phonatory index show less effective air usage during the phonation in the subjects. From the tridimensional spectral analysis of voice that was done on 44 women and 4 men, the data about the frequency of the fundamental laryngeal tone (f degree) were taken. Analysing these data, the lower values of the frequency of the fundamental laryngeal tone were found. The elaboration with the Student's t-test was obtained a statistically important difference of the mentioned parameter in both sexes among the subjects and persons with normal voice. We can conclude that the alteration of the phonatory function is present and in consequence of that, the voice is not effective in communication and less valorous in the media.

Adult↗
PubMed1996

Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus.

BACKGROUND: Malignant mesenchymal uterine neoplasms are the most aggressive type of primary uterine tumors, with most patients dying within a few years of diagnosis. Thus, it would be very important to define prognostic factors for predicting the malignancy potential of at least some of their subtypes. METHODS: Flow cytometric cell cycle analysis (proliferative activity, DNA ploidy, and DNA index) was performed on archival paraffin embedded blocks from 80 patients with malignant mesenchymal uterine neoplasms (endometrial stromal sarcomas, malignant smooth muscle tumors, and malignant Müllerian mixed tumors). The Cox proportional hazards regression model was used to assess relative effects of the following factors on patient survival: clinical stage, mode of therapy, DNA+proliferative activity, DNA index, histologic type, cellularity, degree of atypia, mitotic activity, and depth of myometrial invasion. RESULTS: There were 9 low grade stromal sarcomas, 17 high grade stromal sarcomas, 8 smooth muscle neoplasms with uncertain malignant potential, 23 leiomyosarcomas, and 16 homologous and 7 heterologous malignant Müllerian mixed tumors. In univariate analysis for stromal sarcomas, statistical significance was found for DNA ploidy+proliferative activity (P < 0.001), histologic type (P = 0.005), and DNA index (P < 0.001). In multivariate analysis, DNA index appeared to be the only significant parameter influencing patient survival (P = 0.005). In univariate analysis for malignant smooth muscle neoplasms, statistical significance was detected for mitotic activity (P = 0.049) and International Federation of Gynecology and Obstetrics classification (P = 0.021), but in multivariate analysis, clinical stage appeared to be the only significant parameter influencing patient survival (P = 0.032). In univariate analysis for malignant Müllerian mixed tumors, statistical significance was found for the depth of myometrial invasion (P = 0.039), DNA index (P = 0.037), and clinical stage (P = 0.013), but in multivariate analysis, only the depth of myometrial invasion (P = 0.036) and clinical stage (P = 0.025) were of statistical significance. CONCLUSIONS: The most powerful prognostic indicator for stromal sarcomas was the DNA index, for malignant smooth muscle neoplasms it was the clinical stage, and for malignant Müllerian mixed tumors it was the depth of myometrial invasion.

Analysis of Variance↗
PubMed1996

Biochemical parameters in the early differentiation of the etiology of acute pancreatitis.

OBJECTIVES: We undertook a retrospective study to define the usefulness of various biochemical parameters in differentiation between alcoholic and nonalcoholic acute pancreatitis. METHODS: One hundred sixty-seven patients were divided into groups A (alcoholic pancreatitis) and NA (nonalcoholic pancreatitis). Group NA was further subdivided into groups B (biliary pancreatitis) and NANB (nonalcoholic, nonbiliary pancreatitis). The values of serum and urine amylase, serum lipase, AST, ALT, alkaline phosphatase, gamma glutamyl transferase, bilirubin, lipase/amylase ratio, and erythrocyte mean corpuscular volume were investigated. RESULTS: Serum amylase, ALT, AST, alkaline phosphatase (p < 0.001), and urine amylase (p < 0.01) were significantly lower in patients with alcoholic pancreatitis. Erythrocyte mean corpuscular volume and lipase/amylase ratio were significantly higher in patients with alcoholic pancreatitis (p < 0.001). There were no differences in lipase, bilirubin, and gamma glutamyl transferase between patients with alcoholic pancreatitis and those with nonalcoholic pancreatitis. Multivariate analysis showed that a combination of three variables (lipase/amylase ratio, erythrocyte mean corpuscular volume, and alkaline phosphatase) differentiated between alcoholic and nonalcoholic pancreatitis. CONCLUSIONS: Various biochemical parameters used together and with other clinical features can help in the early differentiation between alcoholic and nonalcoholic acute pancreatitis.

Acute Disease↗
PubMed1991

Diastematomyelia--case report.

An eight-month-old infant with diastematomyelia, as a very rare variety of spinal dysraphism is presented in this article. The introduction deals with a detailed description of diastematomyelia, its development, local, neurological, and orthopedic signs in affected patients, diagnostic procedures and significance of neurosurgical treatment in patients with diastematomyelia. In the particular child, immediately upon birth, a thornlike bulging was noticed in the L2-L3 region. Neurological deficit, established at the time of surgery, was due to the perinatal brain damage and corresponded to the spastic syndrome of the central origin with the right-hand side predomination, and there was no predomination in the lower extremities, which could be expected in regard to the spinal dysraphism. Plain X-ray film revealed a thornlike bulging at the L2-L3 level. Lumbar myelography showed a distinctly enlarged dural sac at the level of L2 to S1 with a well pronounced contrast medium passage defect at the L3 level. The spinal canal CT-findings revealed a bony bulging between L1 and L2, starting from the posterior arches towards the spinal canal. Besides a markedly broadened lumbar spinal canal, MR-findings also showed a well pronounced bony septum from the L2 posterior edge, and a low-lying conus medullaris with an accompanying spinal lipoma. By the neurosurgical operation bony septum and extradural lipoma were radically removed, and the spinal cord was set free from adhesions. In that way a later onset of neurological signs, due to the "tethered cord syndrome", was prevented. Six months following surgery the child's condition was still unchanged.

Female↗
PubMed1989

[Bolus death--successful resuscitation in the patient's home].

The author presented a case of successful cardiopulmonary resuscitation that was performed in the house of the patient, 58-year-old, who had experienced clinical death caused by suffocation with a mouthful of food (bolus death). In the paper is pointed out the importance of rapid intervention of Urgency Aid Service commencing from the moment of call acceptance as well as the importance of equipped and skilled staff for cardiopulmonary resuscitation, especially for endotracheal intubation either in ambulance or in outer conditions.

Airway Obstruction↗