Changes in short-term memory processes in patients with multiple sclerosis.

In this study we compared the performance of 39 multiple sclerosis (MS) patients with 28 age-, sex- and education-matched controls on both the Mini-Mental State Examination, a global cognitive assessment tool, and the Sternberg Short-Term memory scanning task, a standardized test of short-term memory (STM) processes. While the STM span of our MS patients did not differ from that of our controls, STM scanning time of the MS group was reliably slower than that of the controls and a significant correlation was observed between STM scanning time and duration but not severity of illness. Our results suggest that processing stages other than the manipulation of data within the STM buffer are also affected by MS.

Platelet serotonin, plasma cortisol, and dexamethasone suppression test in schizophrenic patients.

BACKGROUND: Serotonin (5-HT) regulates hypothalamic-pituitary-adrenal (HPA) axis activity. Abnormal response to the dexamethasone suppression test (DST) and altered platelet 5-HT concentration have been shown in some schizophrenic patients. METHODS: Platelet 5-HT and plasma cortisol concentrations were determined simultaneously in 86 male schizophrenic patients before and after DST. Basal plasma cortisol and platelet 5-HT levels were also determined in 69 healthy male persons. RESULTS: Schizophrenic patients had higher plasma cortisol and platelet 5-HT concentrations than healthy persons. An abnormal escape from dexamethasone suppression was observed in 50% of patients. In these patients predexamethasone cortisol and platelet 5-HT concentrations were higher than in patients with normal DST. CONCLUSIONS: This study demonstrates that schizophrenic patients have the HPA axis dysregulation that could be connected with a disturbance in the 5-HT system.

Severe progression of ALS/MND after intervertebral discectomy.

We observed seven patients who developed their first signs and symptoms of motor neuron disease together with signs of protrusion/prolapse of intervertebral disc. The age of the patients was between 55 and 67, of which one female and six male patients. All of them suffered from cervical spine pain or low back pain. The female patient and one male patient developed weakness in the small feet muscles as initial symptom and they complained of paresthesia along dermatomes L5S1 and of severe pain. The other five patients developed wasting of the hands muscles. They had a rather mild pain in the cervical spine and early morning paresthesia as well as severe causalgia along dermatomes C5C6 or C6C7. After the diagnosis of compressive radiculopathy in all patients, they underwent surgical treatment and very soon developed very severe progression of muscle wasting which included muscles of limbs, trunk and bulbar innervated muscles with signs and symptoms of lower and upper motor neuron lesion. Five patients died from 12 to 15 months after surgical treatment and two patients are still living.

[Management accounting in hospital setting]. / "Management accounting" ili poslovodstveno racunovodstvo u upravljanju bolnicom.

The periodic income and expenditure accounts produced at the hospital and departmental level enable successful short term management, but, in the long run do not help remove tensions between health care demand and limited resources, nor do they enable optimal medical planning within the limited financial resources. We are trying to estabilish disease category costs based on case mixing according to diagnostic categories (diagnosis related groups, DRG, or health care resource groups, HRG) and calculation of hospital standard product costs, e.g., radiology cost, preoperative nursing cost etc. The average DRG cost is composed of standard product costs plus any costs specific to a diagnostic category. As an example, current costing procedure for hip artheroplasty in the University Hospital Center Zagreb is compared to the management accounting approach based on British Health Care Resource experience. The knowledge of disease category costs based on management accounting requirements facilitates the implementation of medical programs within the given financial resources and devolves managerial responsibility closer to the clinical level where medical decisions take place.

Deletion screening of the Duchenne/Becker muscular dystrophy gene in Croatian population.

The dystrophin gene deletion in 53 Duchenne and 21 Becker muscular dystrophy (DMD/BMD) male patients was analyzed by DNA test using multiplex polymerize chain reaction (M-PCR) in Croatian population. The overall percentage of deletion cases observed was 50%; 61% (53/32) for DMD and 38% (21/8) for BMD. The number of deleted exons was variable, but generally DMD deletions involving single-exon 19, 44, 50, 51 and larger exon deletions 3-6, 4-12, 4-17, 8-13, 12-13, 12-19, 48-50, 50-51, 50-52, 51-52 were more frequent. Eight patients with BMD had deletions exon 45-47, 45-48, and exon 3. The results obtained in the present study showed location of breakpoints in the dystrophin gene, and pointed to variability of deletion patterns in Croatian population among different European populations.

Hypothalamic-pituitary-adrenal axis function and platelet serotonin concentrations in depressed patients.

Plasma cortisol and platelet serotonin (5-hydroxytryptamine, 5-HT) concentrations were determined in 39 male psychotic and 39 male non-psychotic depressed inpatients, and in 69 male healthy control subjects. Psychotic or non-psychotic depressed patients had higher predexamethasone plasma cortisol levels than found in the control group. After the dexamethasone suppression test (DST), psychotic and non-psychotic depressed patients were subdivided into suppressors and non-suppressors. Psychotic and non-psychotic patients had significantly different platelet 5-HT concentrations among themselves and compared with the control group. However, there was no significant correlation between plasma cortisol levels and platelet 5-HT concentrations. Dexamethasone administration did not affect platelet 5-HT concentrations within subtypes of depressed patients. Abnormal cortisol suppression after the DST occurred more frequently in psychotic than in non-psychotic patients. Platelet 5-HT and plasma cortisol concentrations were decreased in patients with pronounced suicidal behaviour. Our results suggest that plasma cortisol and platelet 5-HT concentrations might serve as independent biological markers for different subtypes of depression.

Deletions in the SMN and NAIP genes in patients with spinal muscular atrophy in Croatia.

Two genes, i.e. survival motor neuron (SMN) and neuronal apoptosis inhibitory protein (NAIP) have been mapped to the SMA region of chromosome 5q13. Both genes are frequently deleted or truncated in SMA patients. We have studied 26 patients with SMA types I-III, 29 first relatives, and 14 subjects with mild adult-onset type IV. DNA deletion genotypes were determined by PCR techniques amplifying exons 7 and 8 of SMN, and exon 5 of NAIP gene which distinguish SMN and NAIP telomeric copy from a non-pathogenic gene homologue as a centromeric copy. Results revealed the homozygous deletions of exon 7 and 8 of the SMN gene and exon 5 of the NAIP gene in 3/3 infants with SMA I and in 1/20 with SMA type II. Exons 7 and 8 of the SMN gene were homozygously deleted in 10/20 and only exon 7 in 6/20 children with SMA type II. The overall percentage of deletion cases observed was 77% in children with SMA types I-III. Adult patients with type IV SMA showed no homozygous deletion of exons 7, 8 and 5 of the SMN and NAIP genes. Also, all relatives had both a telomeric and centromeric SMN and NAIP copy. Deletion analysis of SMN and NAIP genes are a significant diagnostic tool, because there are clinical entities resembling SMA which most likely have another pathogenetic background.

Autonomic dysfunction in patients with multiple sclerosis.

The disturbances of autonomic cardiovascular reflexes have already been described in patients with multiple sclerosis (MS). It seems that this disturbances are the result of reflex pathways impairment in the central nervous system. We have tested 28 patients with MS and control group of 21 healthy volunteers using a set of autonomic cardiovascular reflexes tests. In all of patients zones of demyelinization have been discovered with magnetic resonance imaging (MRI). The biggest number of abnormal results was found in respiratory sinus arrhythmia (RSA) test (60.7%) and cortical activation test (35.7%). In 11 patients we found abnormal results in 2 or more tests. Patients with abnormal results in 4 or more tests had clinical impairment of other autonomic functions (urinary bladder regulation). The results of autonomic dysfunction tests show positive correlation to the MRI findings.

Visual evoked potentials in relation to factors of imprisonment in detention camps.

Visual evoked potentials (VEPs) of the pattern shift reversal type were determined in a representative group of 57 prisoners of war (POWs) released in 1992 from detention camps in former Yugoslavia. The parameters were correlated with the conditions in four camps (1-4). All subjects were male, with a mean age of 34.75 years (SD +/- 8.92), average length of imprisonment 192.7 days (SD +/- 77.6), mean loss of body mass during imprisonment 19.32% (SD +/- 9.54), and the average number of reported blows to the head and neck was 25.7 (SD +/- 20.3). VEPs were determined on average 290.5 days after the last craniocerebral trauma caused by blows to the head and neck (SD +/- 152.0) i.e., on average 218.5 days after release from the camp (SD +/- 164.3). Although all the 57 POWs reported being maltreated to a certain extent, 14 reported being subjected to particularly brutal forms of torture, 5 had been held in solitary confinement and 25 had lost consciousness at least once. Solitary confinement and loss of consciousness had the most significant effect on VEPs, and the altered VEP parameters correlated significantly with the craniocerebral trauma experienced, loss of body mass and the length of time since the last craniocerebral trauma until examination, and from release until examination. However, the length of imprisonment and treatment in the camps did not have a significant effect on VEP parameters. The study confirmed that under such conditions the age of the subject is a risk factor. The results of this study also confirmed that prisoners in one camp had been subjected to the worst maltreatment.

Classic migraine and visual field defects.

A series of 116 patients with classic migraine were studied to record visual field defects. Thirty-four (29.3%) subjects had defects of the field of vision, 11 of them bilaterally, which made a total of 45 (19.4%) eyes. Downward isopter depression from above and contraction of the field of vision were the most common damages. A homonymous hemianopic defect was found in seven patients. The area of depressed vision helps to some extent in anatomical localization of the damage. Its etiology has not been fully clarified. The authors recommend more extensive clinical examinations of the visual field, i.e. follow-up of each patient with classic migraine by periodical testing of the field of vision.

Motor neurone disease associated with several immunological disorders: a case report.

A 44-year-old woman developed rheumatoid arthritis, pemphigus vulgaris and myasthenia gravis. Motor neurone disease appeared 2 years later. Hashimoto's thyroiditis was diagnosed after a severe stress in the autumn of 1991.

Correlative pathology of subdural hematoma with computerized tomography.

Subdural hematoma (SDH) develops as a result of bleeding in the subdural space. According to nowadays accepted division, three groups of subdural hematomas can be differentiated: acute, subacute and chronic. The time elapsed from the moment of the occurrence of the hematoma to the moment when it was diagnosed is the main factor for determining the stage of SDH. However, for the above-mentioned types of SDH, this time differs depending on the author reporting it. Subdural hematoma is most often diagnosed by means of computerized tomography (CT). This method is safe and reliable, giving the exact diagnosis in more than 90% of cases. According to the basic principle of the concept of "living pathology", the knowledge of histological appearance of an investigated lesion is essential for the diagnostic interpretation of this lesion in neuroimaging methods. Very few authors studied the histological picture of subdural hematoma. The only structure which was histologically examined in details was the subdural neomembrane. Studies correlating histological picture of SDH and its appearance on CT scans have not been carried out until now. In this work such a correlation was made, and some regularities connecting these two methods were pointed out. Hyperdense picture of SDH on CT scans represents a hematoma containing almost only erythrocytes and erythrocyte-fibrin component being formed. Hypodense picture of SDH on CT scans represents a hematoma containing fibrin and inflammatory cells. Hematomas of mixed density on CT scan in all cases contained a neomembrane. Obvious histological differences between the mentioned types of subdural hematoma have led to the conclusion that chronic subdural hematoma is not the last stage of an "old" acute SDH. Chronic and acute subdural hematomas are different entities, considering their etiopathogenetic and clinical picture, and especially their CT and histopathological appearances.

Genetic markers in the blood of multiple sclerosis patients.

Poligenetically determined predisposition to multiple sclerosis (MS) defines the way of immunological reaction to environmental factors and leads to clinically manifest disease. Although the connection between MS and some loci of the HLA system has been established, the hereditary predisposition to MS remains to be elucidated. We determined the phenotypes of monogenic hereditary characteristics linked to the surface of red blood cells that were obtained from 45 MS patients and 458 healthy subjects. The antigens on the erythrocytic surface of the ABO, Rh, MN, Ss, Kell, Kidd, Duffy, P and Lewis system were analyzed. Our results demonstrate that the MS patients differ from the normal subjects with regard to the Rh, ABO and Lewis erythrocytic antigens. The Rh positive factor was present in 95.55% of the MS patients compared to 84.29% of the controls, whereas the Rh negative factor was found in only 4.45% of the MS patients and 15.71% of the healthy subjects. The blood group O was demonstrated in 22.22% of the MS patients compared to 40.42% of the healthy persons. The MS patients had the blood group A in 15.11% of the cases as opposed to 43.99% of the subjects in the control groups. The blood group B was found in 22.22% of the MS patients compared to 11.10% of the controls. The distribution of the Lewis system in the MS patients was also demonstrated to be different from that in the general population. The MS patients were found to have less frequently the Le a+b- phenotype (11.12%) and more frequently Le a- b- (13.33%) compared to the healthy subjects who had the Le a+b- phenotype in 12.00% of the cases and Le a- b- in 5.00%.

CT detection of minimal brain lesions in closed cerebral trauma.

From the group of patients with clinically manifested closed head injuries, patients with minimal traumatic lesions in the brain parenchyma, were separated and in addition radiographically analyzed. There were 22 patients in the group. On plain CT scans they had foci 5 to 10 mm large caused by trauma. CT is suitable investigation technique for detecting minimal traumatic brain lesions. Besides, CT is suitable for the follow up of the lesion evolution dynamics, which comprises not only changes in the lesions density but also the possibility of registering primarily reversible but macroscopically (invisible) lesions into (visible) reversible lesions on the control scans. The finding of only one or two minimal lesions in critical locations in the "inner cerebral trauma" always indicated the existence of possible lesions in other locations within the known pattern of the ICT. Minimal traumatic lesions of the brain frequently occur in ICT or in all cases where the acceleration of traumatizing forces has anteroposterior or postero-anterior course of direction. Their recognition by neuroimaging methods is of great importance due to the central localization of the foci, which otherwise cannot be detected by other methods.

Cardiomyopathies in children with neuromuscular disorders.

In this paper eight patients with myogenic or neurogenic muscle disorders are presented, in whom cardiomiopathy was also found. Six patients developed a dilated cardiomiopathy associated with neurogenic atrophies or progressive muscular dystrophy. In patients with Mb. Friedreich and HSNM type II together with the total dilatation of the septum hypertrophy was observed and in patients with spinal muscular amyotrophy of scapuloperoneal type atriomyopathy dominated. In two patients with mitochondrial disorders a hypertrophic cardiomyopathy was found. One of them had mitochondrial encephalomyoneuropathy and the other mitochondrial encephalopathy with myoclonic epilepsy. In none of them a restrictive cardiomyopathy was found. From the presentation could be concluded that in neurogenic muscle diseases and progressive muscular dystrophy respectively most frequently dilated cardiomyopathies have been developed. Hypertrophic cardiomyopathies are usually found in children with mitochondrial disorders.

[Nerve compression syndromes of the arm]. / Neuralni kompresivni sindromi na rukama.

Among neural lesions of the arms, the most common one is the medianus lesion in the carpal tunnel, followed by the ulnar nerve lesion in the elbow, while the ulnar nerve compression in the Guyon tunnel is found rarely. Besides the history and the clinical picture, the electromyoneurographic analyses make an early and accurate diagnosis possible. The characteristics of the evoked muscle potential and distal latencies in the diagnosis of the carpal tunnel syndrome are of utmost importance. In diagnosing the cubital syndrome, the multisegmental determination of the motor conduction velocity of the ulnar nerve and the features of the M-potential obtained by means of stimulation above the compression are very important. Generally speaking, the slowing down of the motor conduction velocity remains localised to the entrapped segments. The neural potential over the compression in the elbow cannot be evoked, and it is hardly evoked in the wrist. Within the period of the last five years, the author examined 154 patients clinically and electrophysiologically. 132 had the carpal tunnel syndrome, 20 the ulnar groove syndrome, and 2 Guyon's canal syndrome. The patients were treated conservatively and operatively. The success in the conservative treatment of the carpal tunnel syndrome was evident in the first three months by the absence of sensory symptoms in more than 50% of cases. The constant effect was achieved after six months. In that period the EMG findings were not essentially changed, and motor symptoms were also stationary. With the operative treatment the unpleasant symptoms, pain and shudder, disappeared after a relatively short period. Definitive results were achieved after six months. Motor symptoms were less improved and the EMG findings were showing a tendency to improvement. The ulnar groove syndromes were not remarkably influenced by the conservative therapy. Half the operated patients lost their sensory symptoms. Within six months the other half remained with the same or even more trouble.