Srp Ark Celok Lek
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The obstruction of blood vessels or heart chambers with fat globules, reached by circulation, is fat embolism [1, 2]. Clinical manifestation of the presence of fat emboli in vital organs is Fat Embolism Syndrome (FES). This syndrome is characterized by neurologic, respiratory and cutaneous signs and different symptoms [5-8], grouped in major and minor signs by Gurd and Wilson. ⋯ In the analyzed sample of 56 patients who died of FES, FES was clinically established onl
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Neurosyphilis is still a significant medical problem in developing countries and its occurrence in HIV infection is the reason for a growing number of new cases in developed countries [1-4]. Personality changes are the commonest symptom of late neurosyphilis [5]. Neurologic deficits are usually due to syphilitic vasculitis with lacunar infarctions [6]. The laboratory confirmation of neurosyphilis must depend on a cluster of tests (Venereal Disease Research Laboratories--VDRL; Fluorescent Treponemal Antibody-Absorption--FTA-ABS; Treponema Pallidum Immobilization--TPI or Nelson-Mayer). The diagnosis of active neurosyphilis also requires an inflammatory cerebrospinal fluid (CSF) test [4]. ⋯ None of our patients reported previous venereal disease. They complained of impaired gait, headache, hearing loss, speech difficulties, forgetfulness, and mood changes. Pupillary changes, hemiparesis, gait disturbances and cerebellar signs, hearing loss, dysarthria, paraparesis, hypesthesia, mood disorders, mild cognitive decline and tremor of the tongue and hands were found during the examination. Pupillary signs are the most important symptoms because they can point to neurosyphilis. A two-step approach is recommended for establishing the diagnosis of syphilis with simple nontreponemal tests for screening purpose, and specific treponemal tests for its confirmation [21]. In our patients all but one were positive for syphilis in serum-tests and/or CSF. (ABS
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The number of old persons (over 65 years) with arterial hypertension is in a steady increase [1]. Such finding is mainly related to patients with isolated systolic hypertension. They present more than 60% of old persons with arterial hypertension [2]. Isolated systolic hypertension can be defined as increased systolic blood pressure to the value more than 160 mmHg and diastolic pressure to 90-95 mmHg [4, 5]. It has been suggested that the pathologic basis of this entity is in a decreased distensibility of aorta and great arteries. In patients with isolated systolic hypertension we studied the correlation between decreased aortic distensibility and systolic arterial blood pressure value. We also evaluated changes in the left ventricular structure and function during this type of hypertension. ⋯ In old persons with isolated systolic hypertension we found that aortic distensibility was significantly lower in comparison to normotensive subjects of the same age. Such finding supports the hypothesis that the reduced aortic distensibility is the cause of isolated systolic hypertension. At the same time, we found the inversed correlation between aortic distensibility and the mean systolic blood pressure value. Aging has an effect on reduction of aortic and great vessels distensibility. Thus, it causes arterial hypertension which changes the elastic properties of aorta. It is still questionable in which degree the systolic blood pressure value compromises the elastic properties of aorta. (ABSTRACT TRUNCATED)
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Hereditary thrombophilia is caused by various inherited disorders which lead to familial tendency to recurrent venous thrombosis usually at an early age and with spontaneous onset. In the studies reported so far, the different prevalence of hereditary thrombophilia among patients with venous thrombosis was found, greatly depending on criteria for selection of patients. Arterial thrombosis is most often the consequence of arteriosclerosis but the prevalence of hereditary thrombophilia among young patients with arterial thrombosis and without recognized risk factors for arteriosclerosis is not known . In this study, the frequency of hereditary deficiencies of antithrombin III (AT III), protein C (PC), protein S (PS), plasminogen (PLMG), factor XII (F XII) and dysfibrinogenaemia was investigated over a 2-year period in 121 patients with venous or arterial thrombosis selected according to the recommendations of the British Committee for Standards in Haematology. ⋯ The prevalence of hereditary thrombophilia in nonselected patients with venous thrombosis is relatively low, and for that reason the selection of patients, according recommended criteria, in whom the screening tests for congenital thrombophilia should be performed, is strongly suggested by many authors. In our study we used the generally accepted recommendations for investigation of patients with venous and arterial thrombosis. The presence of congenital thrombophilia was found in 15 (12.4%) of 121 studied patients, what is in accordance with results of other similarly designed studies. (ABSTRACT TRUNCATED)
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Sulcus vocalis is an epithelial invagination along the free edge of the membranous vocal fold. It interferes with the glottic closure and vibration pattern. Sulcus vocalis provokes voice fatigue, hoarseness and breathiness, and it usually appears in association with hyperkinetic phonatory pattern. Hyperkinesis develops secondarily, due to the compensatory effort to overcome the deficiency in glottic closure. The treatment of sulcus vocalis is very difficult. Phonosurgery is used, and is followed by postoperative voice therapy. ⋯ The surgical procedure which is safe and accepted by the majority of surgeons has not yet been at our disposal. The treatment of sulcus vocalis should start with voice therapy, which lasts as long as the patient shows a progress. Only then the surgical procedure can be discussed. We obtained the best results with the combination of excision and voice therapy. However, the surgeon and the patient must be aware that the treatment is demanding and long-lasting.