Biomedical subjects
Publications and source records attributed to R Raicević.
We evaluated the effect of PTH on blood pressure in haemodialysed patients. The correlation was found between systolic, diastolic pressure and PTH. The results have shown that PTH might have the influence on regulation of arterial blood pressure in these patients.
The purpose of these studies was to assess the effect of 6 month calcidol treatment on Ca and PO4 metabolism in haemodialyzed patients. During 3 and 6 month on alpha calcidol therapy, there was significant increase of total and ionized Ca (p < 0.05; p < 0.01 respectively). After 6 months on alpha calcidol therapy there was significant decrease of alkaline phosphatase level (p < 0.05) and increase in bone density (up to 82%, p < 0.05). The study has shown that appropriate use of alpha calcidol could be effective in treatment of Ca and PO4 disbalance in haemodialyzed patients.
Most common complications of peritoneal dialysis are those related to anatomic defect of the abdominal wall and peritoneum. The aim of this investigation was to examine the frequency of congenital and acquired wall defects in patients on CAPD treatment causing complications. Fifty patients, 32 women and 18 men, on CAPD treatment for more than two years, were investigated. Most common was a defect in the anterior-lateral abdominal wall predisposing to hernias in 14% of patients. Umbilical and pericatheteral hernias were more common than other, with a mean time of 21 months for the appearance. Persistence of vaginal process of peritoneum related to scrotal oedema was documented in 4% of patients. Communication of peritoneal cavity with the abdominal ostium of tuba uterina was found not to be an important factor for peritonitis.
Peritonitis is a very serious complication in patients treated by CAPD. The frequent and grave episodes are the main cause for CAPD withdrawal. The effective prevention and adequate therapy of peritonitis are very important for a successful CAPD treatment. The aim of this study was to present our results of peritonitis therapy in CAPD patients using the following protocol: Vancomycin 1.0 g.i.p. immediately after the admission to the unit, 250 mg Ceftriaxon (Longaceph) after a bag exchange for seven days, and the 1.0 g Vancomycin. Using this protocol we treated 97 peritonitis episodes; 74 of them (80%) were treated successfully by this antibiotics combination. The clearness of peritoneal fluid was attained 1-3 days within 56.7% of cases, and 4-6 days within the 29.7% peritonitis episodes (86.4%). A common cause of peritonitis was Staphylococcus epidermidis episodes (28.4%), Staphylococcus aureus (13.5%), and in 39.1% episodes the cultures were sterile. Uneffective antibiotic application according to this protocol was found in cases of pseudomonas and fungal peritonitis. The mentioned antibiotic therapy had no effect in a small number of peritonitides provoked by S. epidermidis (8.7%) and S. aureus (13.0%) This required the application of a third antibiotic. It could be concluded that this antibiotic combination in treatment of peritonitis in patients on CAPD was very effective.
The estimation of CAPD efficacy presents a complex problem in the patients treated by this method. The most important parameters are: clinical indications, biochemical parameters, Kt/v, PCT, PET indexes, and others. Numerous factors may influence CAPD efficacy. Peritonitis, particularly the frequent episodes, significantly affects permeability and ultrafiltration capacity of the peritoneal membrane. The aim of this paper is to investigate the peritonitis incidence and its influence on some parameters of CAPD efficacy. Forty-four CAPD patients of both sexes, aged 55.7 +/- 13.5 yrs, dialysis duration 19.6 +/- 15 months, were studied. The influence of peritonitis incidence was studied using urea, creatinine, hemoglobin, hematocrit parameters and K t/v, PET indexes. Statistically significant low K t/v values were found in the patients who had four or more peritonitis episodes. Our results, as well as those in the literature, indicate that frequent peritonitis episodes significantly decrease the peritoneal membrane permeability.
In significant number of diabetic patients are observed numerous complications during the disease onset and course. One of the most frequent is diabetic polyneuropathy that can, during its course, assume such types and imitate various diseases that can by the intensity of revealance be prominent and couse significant differential-diagnostic difficulties, especially if some forms of polyneuropathy are more rarely considered. The patient with poorly regulated diabetes, in whom the couse of disturbances was unknown for the longer period of time was presented in this study. Leading clinical phenomenology indicated the signs of impairment of cauda equina roots and extensive diagnostic procedures had to be performed. However, just after the favorable response to the glycemia regulation and withdrawal of neurologic phenomenology it was concluded that the patient suffered from diabetic polyneuropathy with clear signs of autonomic nervous system involvement, as well as autonomic neuropathy at the some time, respectively.
Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.
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Migraine is a syndrome clinically manifested in attacks which dominant symptom is unilateral, rarely generalized, recurrent headache that can last for hours, and occasionally, days. According to different sources, it is considered that about 10-15% of world population suffers from some type of this syndrome. Migraine is most frequently clinically revealed in the age of 30-40, therefore in the most productive period with significant share in treatment costs and a great influence to the working ability of those patients. The aim of this trial was to determine analgesic efficacy of Imigran (sumatriptan) and Famalgin in the treatment of acute attacks of migraine headache. Trial results revealed significant analgesic efficacy of both preparations without significant differences in analgesic effect, with significantly better tolerability of Famalgin. It was concluded that both preparations were efficacious drugs for the treatment of headache as the most prominent clinical symptom of migraine, with significantly rarer and less pronounced adverse effects of Famalgin.
Epileptic seizures in the patients with multiple sclerosis (MS) were reported more than 100 years ago. The question of mutual physiopathologic association between MS and epilepsy is even nowadays controversial. The question is if epileptic seizures are the symptoms of MS or are just coincidential, i.e., are those two separate neurological diseases? The development of contemporary immunologic, electrophysiologic and neuroradiological diagnostic procedures enabled the diagnosis of MS to be much more certain, and in that way the differentiation of some symptoms and signs, as well as epileptic seizures in those patients became more reliable. In this report are presented three patients in whom the diagnosis of MS was confirmed by clinical, laboratory, immunological, electrophysiological and neuroradiological diagnostic analyses and procedures, and in whom were simultaneously clinically and/or electrophysiologically (EEG) registered epileptic seizures with specific alterations in EEG that were obviously associated with the development of primary disease--MS.
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During the onset and development of pathologic events, numerous changes occur in the body as the result of an attempt of dynamic equilibrium maintenance. Results of such sequence of events may lead to organic, as well as psychic impairment of the body that is often referred to as the onset of psychosomatic disease. This paper deals with the disorder that could provide better insight in the possible physiopathologic mechanisms of psychosomatic disease or disorders. In a patient, chronic alcoholic subdural hematoma was diagnosed. Peptic ulcer hemorrhage occurred after surgical removal of the hematoma. Possible physiopathologic mechanisms in the origin of this disorder have been described.
Vascular brain diseases are ranked the third as the cause of morbidity and mortality, in spite of the progress in diagnostic, therapeutic and preventive procedures. In the majority of cases of vascular brain diseases, it is ischemic brain disease, which is the final and the most severe stage of cerebral arteries atherosclerosis. Etiopathogenesis of atherosclerosis is not closer defined yet, but oxidative hypothesis is distinguished among the numerous theories. Within this theory, main place is attached to oxidative modification of LDL and Lp(a), together with numerous physiopathologic facts with the central role of reactive oxidative matters, where endothelial dysfunction is the main disorder responsible for the onset of numerous impairments, such as changes in coagulation-anticoagulation system. Considering these facts, it was established the hypothesis that in patients with IBD existed changes in hemostatic system, which were in positive correlation with the degree of cerebral atherosclerosis. The study comprised 36 patients with acute IBD and 28 patients with atherosclerotic encephalopathy. Control group was comprised of 30 patients with non-vascular diseases of similar characteristics. We investigated the correlation of the changes in hemostatic system (platelet aggregation, anti-thrombin III, D-dimer, protein C, factor VII, factor VIII, PAI-1) compared to the degree of cerebral atherosclerosis (ultrasonographically) and compared to the observed groups of patients. On the basis of all, the results of this study revealed significant increase of procoagulant factors concentration in patients with IBD, and similar changes were observed in patients with atherosclerotic encephalopathy, but less pronounced. All these changes in the total sample of patients, and particularly in patients with the pronounced cerebral atherosclerosis, are of primary and chronic character.
This paper deals with the experimental results of the effect of 1% dopamine on intraocular pressure, pupillary diameter and hemodynamic parameters after its local application in the rabbit eye. Our results show that locally applied dopamine caused an initial increase of intraocular pressure (IOP) (1 h), followed by its decrease that was the most pronounced 3 hours later. Mydriasis was an immediate effect of dopamine, which persisted until the end of the second hour. There were no changes in blood pressure and heart rate. Although the exact mechanism of dopamine effect on IOP is not known yet, our results point out that this is mainly due to the decrease fo aqueous humor formation.
The results of certain clinical studies indicated the possibility of the onset and development of cerebrovascular diseases during pregnancy. Pathogenesis of this cascade of developments is frequently unknown. Eclampsia is the leading clinical syndrome, associated with numerous neurological complications. This is a case report of a 24 years old patient, who in a short period became extremely psychomotorically, agitated, with bilateral iridoplegia and positive Babinsky reflex during the development of eclampsia. Soon, a series of grand-mal epileptic attacks developed in the patient. However, the revealed clinical phenomenology was completely withdrawn within 6 hours, after the adequate estimation of clinical status and timely therapeutic measures. We have concluded that the patient had transient global cerebral ischemia, as a part of acute hypertensive endephalopathy.
Syndromes of intracranial hemorrhage, and particularly subarachnoidal, i.e., intracerebral hemorrhage (SAH and IH) present clinical entities that are the most severe conditions in neurology. Timely recognition, diagnosis and adequate therapy are imperative. The most important factor that aggravates an already difficult prognosis of those entities is cerebral vasospasm. Upon the presented facts, the aim of this investigation was to establish the value and role of administration of selective calcium channel blocker--nimodipine in patients with SAH and IH compared to the degree of neurological and functional impairment, as well as the recovery of the function of consciousness compared to the patients with those syndromes from an earlier period, who were not treated with this medicament. Investigation comprised 30 patients who received nimodipine and 20 patients without this agent in therapeutic program. Results of the investigation confirmed significant difference concerning the neurological recovery, improvement of functional capability and recovery or consciousness disturbances, respectively, in patients who received nimodipine compared to the group without this agent. It can be concluded that nimodipine as calcium channel blocker with multitopic pharmacological effects on mechanism of SAH or IH development, respectively, as well as on the development of complications of those syndromes, particularly to the development of vasospasm and reactive ischemia, with the improvement of hemorrheologic disorders deserves to be included as the unavoidable segment of therapeutic program of SAH and IH syndrome immediately after clinical phenomenology is revealed.