Carotid Body Tumor as a Cause of Stroke.

We herein report a case of a 78-year-old woman who was admitted to our hospital due to a stroke with left-sided hemiparesis. Ultrasound of the carotid arteries showed a carotid body tumor on the bifurcation of the right common carotid artery, which was subsequently confirmed by a further neuroradiological investigation. Magnetic resonance imaging of the head confirmed an acute ischemic lesion located in the right periventricular region. The carotid body tumor (CBT) was surgically removed and confirmed on histopathology. Our case reveals the role of carotid ultrasound in the diagnosis of a CBT, which may be a potential cause of stroke.

SPONTANEOUS HETEROTOPIC, ECTOPIC CERVICAL AND ECTOPIC TUBAL PREGNANCY - EVER PRESENT DIAGNOSTIC DIFFICULTY: THREE CASE REPORTS.

The incidence of heterotopic/ectopic pregnancy in recent times has increased partly due to the increase in assisted reproductive technologies, whereas such medical cases and cervical pregnancy in particular are extremely rare with spontaneous conception. We report on three patients referred to our department in one week: one patient each with spontaneous heterotopic pregnancy, cervical pregnancy and tubal pregnancy. All of them had conceived spontaneously and were properly diagnosed and treated, however, additional care is needed in diagnosing and managing the potentially fatal consequences of ectopic pregnancy if not recognized early and managed properly, despite its low incidence.

Asymptomatic dissecting intimal lesions of common carotid arteries after carotid endarterectomy.

PURPOSE: Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid artery stenosis. The aim of this article is to present possible intimal lesions after carotid endarterectomy. These lesions could be manifested as intimal flaps, intimal steps or dissections with or without occlusion or stenosis of the artery. METHODS: The evaluation of the frequency and characteristics of the asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy for symptomatic high-grade stenosis of the internal carotid artery. RESULTS: We found five patients with asymptomatic dissecting intimal lesions of the common carotid arteries. CONCLUSION: The most common causes of these intimal lesions were shunting and prolongation of the clamping time. Routine carotid ultrasound follow-up exams are necessary because of the potential need for a change in the antithrombotic therapy or due to a need to perform an endovascular treatment.

[Early carotid endarterectomy in symptomatic patients - our experience]. / Karotidna endarterektomija u simptomatskih bolesnika u ranoj fazi - nasa iskustva.

Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlin's sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61 %) patients had TIA symptoms with verified significant ACl stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid endarterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely.

[Rare disorders of extracranial carotid arteries]. / Rijetke bolesti ekstrakranijskih karotidnih arterija.

Abnormalities of the internal carotid arteries (ACI) are rare findings, usually not linked with neurologic symptoms and frequently are diagnosed during routine duplex scanning or angiographic examination. These abnormalities are predominantly elongation of the vessel that leads to kinking, coiling or tortuosity of the artery, and the origin is congenital or acquired related to atherosclerosis. We report on two symptomatic cases related to elongation of AC. The first case was a 56-year-old female that had bilateral coiling. The second patient was a 64-year-old female that suffered from symptomatic double coiling of the left ACI connected with high grade stenosis. In both cases, successful operation was done with resection of the elongated and stenosed ACI segment and reanastomosis of the ACI and common carotid artery. Postoperatively, symptoms were resolved. In symptomatic cases of isolated carotid elongations, surgical treatment is a better option than conservative medical treatment alone, whilst in asymptomatic ACI elongation, conservative medical treatment is advised.

Spontaneous isolated dissection of the abdominal aorta.

Isolated spontaneous dissection of the abdominal aorta is such a rare entity and there are only a few cases reported in literature up to date. A 42-year old male was admitted to the hospital with mild pain in the lower abdomen and back that had began seven days prior to admission together with the sudden onset of the ischemic symptoms of the left leg (ischemic ulcers of the calf gangrenous toe and pallor foot). Patient denied any trauma, hypertension history was negative, while he was active cigarette smoker. MSCT and digital subtracted angiography have shown a dissection of the abdominal aorta approximately two centimeters below the origin of the inferior mesenteric artery extending in the left common iliac artery, with no sign of the aneurysmatic dilatation of the abdominal aorta. Emergent surgery was performed with aorto-biiliacal bypass graft interposition, amputation of the left toe and necrectomy of the left calf Postoperative follow up and local vascular condition were satisfied. Even though is rare entity, isolated abdominal aorta dissection accounts for approximately 2-4% of all aortic dissection. Nowadays therapeutic regimen includes endovascular, open surgery or conservative treatment.

[Surgical and radiotherapy in treatment of postauricular keloids--case report]. / Kirurska i iradijacijska terapija u lijecenju postaurikularnih keloida.

Treatment of keloid remains a great challenge for clinicians, in spite of numerous therapeutic regimens reported in the literature to date. Earlobe or postauricular regions are predominant locations for postoperative keloids due to the treatment of lop ears. There are several treatments that include intralesional steroid injections, surgical excision, cryotherapy, laser therapy, radiotherapy and pharmacotherapy. A case is presented with fourth recurrence of keloids after surgical treatment of lop ears with final satisfactory outcome after combined therapy that included surgical excision, skin flap transposition and radiotherapy. It is concluded that interdisciplinary approach that includes a combination of surgery and radiotherapy results in a satisfactory outcome of keloid treatment.

[Trauma of the brachial plexus and associated vascular injury--a case report]. / Traumatska ozljeda brahijalnog pleksusa s ozljedom krvnih zila--prikaz bolesnika.

Acute vascular trauma in the axillary region is usually associated with brachial plexus injury and presents a great challenge to surgeon and formidable obstacle to restore a useful limb function. Interdisciplinary operative and postoperative approach is mandatory providing an optimal care of these severe patients. Here we present a case of neurovascular trauma that affected axillary artery and vein, complete transection associated with complete transection of the brachial plexus. Immediately after admission emergency surgery was performed and in postoperative follow up, after several operations and rehabilitation that continued for 24 months, entire functional recovery was achieved without any disabling consequences.

[Spontaneous aortocaval fistula]. / Spontana aortokavalna fistula.

Spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysm rupture. A definitive preoperative diagnosis sometimes is difficult, because ofnonspecific and highly variable clinical symptoms. Classic signs such as low back pain, palpable pulsatile abdominal mass, abdominal bruit and thrill, dyspnea and high-output cardiac failure are present in less than 50% of cases. In this article we report the case of a 68-year-old patient with an aortocaval fistula who was admitted in hospital because of abdominal pain and hematuria.

Analysis of internal deletions of a rat Col1a1 promoter fragment in transfected ROS17/2.8 cells.

The aim of this paper is identification of regulatory sequences downstream of -1683 base pairs (bp) in the rat Col1a1 promoter important for expression in osteoblasts. Previous findings suggest that a rat Col1a1 gene fragment extending from -1719 to + 115 bp linked to the chloramphenicol acetyl transferase (CAT) reporter gene (ColCAT1719) is highly and selectively expressed in osteoblasts. Three internal deletions within the ColCAT1719 construct were generated and stably transfected into ROS 17/2.8 cells. CAT activity was measured in cell extracts. An internal deletion of ColCAT1719 from -1637 to -504 bp caused an almost complete loss of CAT activity, whereas deletions of -1284 to -905 bp and -1284 to -451 bp had little effect on CAT activity. We hypothesized that removal of a Runx2/Cbfa1 consensus site at -1376 bp may have caused the loss of activity produced by the -1637 to -504 bp deletion. To test this hypothesis, we produced a more restricted internal deletion of ColCAT1719 from -1418 to -1284 bp, which removes this site. This deletion did not affect promoter activity. Our results suggest that the Runx2 site at -1376 bp by itself does not influence Col1719 promoter activity. Future studies will focus on the region between -1637 to 1418 bp, which contains several potentially interesting transcription factor binding sites.

A rare case of multiple aneurysms in a young patient.

Multiple aneurysms are clinically common in population aged over sixty and are caused mainly by atherosclerosis. When occurring in young population other etiologies such as trauma, infections, Bechet's disease, Marfan syndrome, neurofibromatosis or inflammatory disease are responsible for the development of arterial aneurysms. A rare case of multiple aneurysms in a 40-year-old man, affecting the infrarenal part of abdominal aorta, both iliac arteries, common femoral arteries, left femoral superficial and popliteal arteries on, both legs, is reported. The underlying pathology was progressive atherosclerosis, favored by familial hyperlipidemia and excessive cigarette smoking.

[Iatrogenic injury of the brachiocephalic arterial trunk and its branches--case report]. / Jatrogena ozljeda brahiocefalicnog arterijskog stabla i njegovih ogranaka: prikaz slucaja.

Iatrogenic vascular traumas are increasing and their proportion exceeds 40% of all vascular injuries. We report on a rare case of iatrogenic injury of the brachiocephalic arterial trunk during surgical intervention due to postirradiation arteriopathy, which was successfully treated with a silver prosthesis graft. A 58-year-old male underwent surgery for metastases of papillary carcinoma of the thyroid gland, located in lymph nodes adjacent to the right common carotid artery and right subclavian artery. During the surgery, there was an intraoperative injury of the brachiocephalic arterial trunk that included spontaneous rupture and tear of the subclavian and common carotid artery, as the result of extreme fragility of the arterial wall, probably due to the previous irradiation therapy. Emergency sternotomy and clavicle resection were followed by blood flow reconstruction by use of an Y prosthesis that was applied for terminoterminal anastomosis between the brachiocephalic trunk to common carotid artery and subclavian artery. The authors concluded that irradiation therapy may lead to progressive arteriopathy in affected arteries.

Twelve-year experience in identification of skeletal remains from mass graves.

AIM: To present twelve-year (1993-2005) experience in identification of human remains found in mass graves in Croatia and Bosnia and Herzegovina (BH), as well as remains that presumably belonged to Croatian citizens given by Serbia and Montenegro. The unique experience of identification of more than a thousand of skeletal samples is valuable for better organization of post-mortem identifications. METHODS: Standard forensic methods and methods based on DNA analysis were used for identification of human remains from mass graves. DNA was isolated using standard phenol/chloroform/isoamyl alcohol extraction. In some cases, decalcification and repurification were used prior to the extraction to overcome inhibition of amplification process. Different DNA systems were used for DNA quantitation and amplification (AluQuant, short tandem repeats (STR) commercial systems, Y chromosome STRs, and mitochondrial DNA [mtDNA]). Typing of PCR products was performed on AmpliType PM and AmpliType DQA1 DNA probe strips, ABI PRISM(R) 310 Genetic Analyzer and immobilized sequence-specific oligonucleotide (SSO) probes. RESULTS: Up-to-date analysis of 1,155 skeletal samples resulted in 703 positively identified bodies: 577 using standard forensic methods, 109 by DNA typing, and 17 by combination of these two methods. The majority of identifications from 1993 to 1999 was, as usual, achieved by standard forensic methods. Later on, these methods were not sufficient and DNA analysis was requested. It was performed in 42% of all cases in 12 years. The crucial step in DNA analysis is extraction of genomic DNA. Standard phenol/chloroform/isoamyl alcohol extraction, complemented with other methods and modifications, proved as the most successful method for this step. In certain cases, the quality and/or quantity of nDNA was not satisfying and the analysis of the mtDNA was performed. CONCLUSION: Our experience demonstrated that the advent of forensic DNA analysis methods greatly increased our ability to positively identify previously unknown skeletal remains by a comparative genetic analysis with presumptive relatives.

Familial idiopathic intracranial hypertension.

AIM: To analyze the development and occurrence of the idiopathic intracranial hypertension and consequent visual loss in a family affected with idiopathic intracranial hypertension. METHODS: We studied 15 members of the same family and found six of them affected with idiopathic intracranial hypertension, which was accompanied with visual loss as a repercussion of the disease. Idiopathic intracranial hypertension was diagnosed on neurological and radiological examination. Visual examination to establish visual loss included fundoscopy, visual acuity, visual field testing, and ultrasonography of the optic nerve. RESULTS: The construction of a family tree and detailed examination of 15 family members revealed idiopathic intracranial hypertension with visual disturbances, even amaurosis, and different stages of visual field constriction in three members of the family: the mother and her two daughters. Due to the symptoms of idiopathic intracranial hypertension, such as headaches, nausea, vertigo, and the presence of transient visual obscuration and papilledema, in three other members of this family (aged 16, 17, and 25 years), we considered a presumptive diagnosis of idiopathic intracranial hypertension, and the need for thorough follow-up. Medical data on the family grandmother, who died 34 years ago, suggested that she also had symptoms of idiopathic intracranial hypertension. One of the patients underwent surgical treatment by a lumbo-peritoneal shunt operation worsening of the symptoms. CONCLUSION: It is very important to include idiopathic intracranial hypertension in differential diagnosis of papilledema and recognize it in early stages to prevent vision loss. Current successful therapeutic approaches and close follow-up of such patients require teamwork of neurologists, ophthalmologists, and neurosurgeons.

Huntington's disease, case report.

Huntington's disease (HD) is a chronic neurodegenerative disorder, characterized by the following triad of clinical hallmarks: chorea, cognitive impairment and behavior disorders [8]. In 1993 the gene responsible for HD, whose mutation results in HD, was identified and mapped on the chromosome 4p16.3 [6]. The mutation is a characteristic expansion of a CAG nucleotide triplet. In this paper we present a 36-years-old female patient with HD who was submitted to a complete diagnostic procedure including genetic testing. Her pedigree was reconstructed using available medical documentation and tracing other members of her family.

Pulmonary alveolar microlithiasis in childhood: clinical and radiological follow-up.

This report describes a case of pulmonary alveolar microlithiasis that was diagnosed in an 8.5-year-old girl by high-resolution computed tomography (CT) and open lung biopsy. Presence of symptoms (productive cough, fever), their periodic occurrence (lasting up to 1 week), and comparatively long asymptomatic periods should be emphasized. Despite extensive X-ray abnormalities, tests of pulmonary interstitium involvement and exercise tests revealed normal results. A therapeutic regimen, including disodium etidronate, was administered for 18 months with no significant clinical or radiological improvement.