Brainstem auditory evoked potentials following head injury.

Brainstem auditory evoked potentials (BAEP) were examined in 40 patients with subjective disorders following closed head injury (CHI), with the established degree of recovery and performed CT-scan of the head. For all BAEP parameters the interval of normality was defined as 3 SD above and below mean value in the control group comprised of 20 healthy subjects. The upper limits of thus defined intervals of normality enabled the formation of four types of findings: type 1--normal finding that was registered in 23 (57.5%) patients; type 2 was a sum of individual findings with the prolonged interpeak latencies, but without the change of relative amplitude V:I--7 (17.5%) recordings; type 3--the findings where the fall of relative amplitude V:I was registered together with the prolongation of interpeak latency. It comprised of 4 (10%) recordings and the type 4 included 6 (15%) individual recordings with registered low RA V:I (0.8 or lower). The explanation of the most probable genesis of registered changes was presented.

[Submandibular secretion of immunoglobulins IgA and IgG in peripheral paralysis of the facial nerve]. / Submandibularna sekrecija imunoglobulina IgA i IgG kod perifernih paraliza zivca lica.

INTRODUCTION: In all lesions of the facial nerve suprachoroidally localized, and due to disturbance of parasympathetic and sympathetic component, there comes to qualitative and quantitative disorders of the secretion of submandibular salivary gland. Glandular immunoglobulins IgA and IgG are the secretion of the specific plasma cells in the interstice of this gland. The mechanism of the secretion of immunoglobulins is not sufficiently clear, but it is certainly under the direct neurogenic control, since the disorders of the secretion emerge after the denervation of the submandibular salivary gland. The aim of the study was to prove the direct relation between the degree of submandibular immunoglobulin secretion IgA and IgG, and the degree of the lesion of the facial nerve U which is vitally important in the clinical estimation of the peripheral paralysis of this nerve. MATERIAL AND METHODS: In 35 patients with peripheral idiopathic facial nerve paralysis, the quantity of the secreted immunoglobulins IgA and IgG was examined by laser nephelometar BLN, Module 3. The quantity of the secreted immunoglobulins IgA and IgG (mg lit) in the saliva of the paralysed side was indirectly compared to the secreted immunoglobulins of the healthy, i.e. control side. The examination was performed three times: a) after the appearance of the disease, in the first 30 days; b) two to three months later; c) after six to twelve months. RESULTS: The quantity of the secreted immunoglobulins is significantly higher in the saliva samples taken from the paralysed side (9.50U204.77 mg lit), in comparison with the samples taken from the healthy side (9.50U70.36 mg lit). In the group of patients with favourable results and significantly higher secretion (p 0.01) normalization occurred in the final period of observation. In patients with unfavourable results the difference in secretion was continuously present (p 0.05) (table 1). DISCUSSION: In the lesions of the facial nerve suprachoroidally localized, there comes to disorder concerning the secretion of immunoglobulins IgA and IgG by submandibular salivary gland, which can be applied in the estimation of the degree of paralysis and the prognosis of the final result. CONCLUSION: The results of the research show that in the peripheral idiopathic facial nerve paralysis, there comes to increased secretion of immunoglobulins IgA and IgG in submandibular gland, at the paralysed side. In the patients who, during the paralysis, show quicker fall and normalization of the previously increased quantities of immunoglobulins, the recovery of the motor function of the facial nerve comes more successfully and more certainly. The degree of the secretion of immunoglobulins IgA and IgG can be used for the estimation of the severely of the pathological process in the suprachoroidal part of the nerve, and it can be used as a reliable parameter for the prognosis of the paralysis outcome.

[Facial nerve injuries caused by firearms]. / Povrede facijalnog nerve izazvane vatrenim oruzjem.

In the period from 1990 to 1994, 52 facial nerve injuries caused by fragments firearm projectiles were managed. Their features (localization, severity and extensiveness) were correlated with 37 nerve injuries in blunt head injuries with fracture of temporal bone. In blunt head injuries, 81.1% patients were with the nerve lesion in the area of geniculate ganglion (labyrinthine and tympanic segment). Compression of nerve with bone fragments of fallopian tube was found in 56.8% cases, the cleft of neural sheath and intraneural hematoma were rarer, while the nerve tear was not found in any injured. The distal part of mastoid and beginning part of parotid nerve segment were injured in over 70% cases of gunshot injuries, and in 38.5% cases the injury was multiple. Direct suture was performed in 8 nerve injuries, neuroplasty in 6, and the other injuries were managed by skeletization of fallopian tube, nerve decompression or some other microsurgical procedure. Micro-surgery was performed 7-14 days after the injury.

[Alpha coma--a prognostic sign?]. / Alfa-koma--prognosticki snacaj?

We present a patient who has developed cardiac arrest after penetrating cardiac wound and consequent coma, with EEG characteristics of alpha coma. At the same time, auditory evoked potentials-brainstem (AEPB), subcortical and cortical were not within physiological range. During the sixth day of coma, alfa rhythm was substituted with theta and delta frequency, followed by the decreased amplitude and prolonged latency of AEPB and complete absence of cortical and subcortical responses. Lethal outcome occurred in the fifth week of coma with neurophysiological characteristics of complete brain dysfunction. Alpha coma, with EEG presentation that only resemble the normal neurophysiological cortical activity, is rather rare neurophysiological finding present mostly in cardiac arrest, metabolic disturbances and intoxication. It is probably caused by pathological pacers of alfa rhythm, so clinical presentation of alfa coma, specially in a case of cardiac arrest, does not predict a favourable outcome.

[An atraumatic approach in stapes reconstruction]. / Atraumatski postupak u stapedoplastici.

In order to prevent complications which occur in classical stapedoplasty, authors applied a new atraumatic procedure in 138 patients with otosclerosis. Along with preserved ossicular chain, stapedotomy was performed and a piston-wire prosthesis placed. Disarticulation of incudostapedial joint was the next part of the procedure with removal of suprastructure of the stapes. Early and late cochlear disorders were rare while the final functional effects were much better. This paper analyzes numerous advantages of this procedure with directives for promotion of our work in the future.

[The inverse procedure in stapedioplasty]. / Inverzni postupak u stapedoplastici.

The inverse procedure in stapedoplastic with the primary stapedectomy was done in 55 patients with otosclerosis. The early cochleo-vestibular disorders (1.8-3.6%), graver sensoneural damage after 6 months (1.8%) and bone--air conduction gap were significantly better in relation to the patients operated in classical way. Many advantages of inverse procedure were analyzed in prevention of inner ear lesions and better functional outcome.

[Facial nerve lesions in gunshot injuries of the temporofacial region]. / Lezije zivca lica u strelnih povreda temporofacijalne regije.

Experiences and difficulties in the preoperative diagnostics and treatment of facial nerve lesions concerning nine injuries of the temporofacial region caused by firearms projectiles are presented. Otosurgery treatment of the damaged nerve occurred from the 8th to 22nd day, after the vital functions normalization and taking care of maxillofacial region injuries. Apart from facial nerve paralysis, in 7 injured cophosis occurred, but immediately after they had been injured all had vertiginous disorders. Before detecting the place of the nerve lesion complete skeletization of the fallopian tube was done. Since in four cases there was a complete disconnection of the facial nerve distally from stylomastoid foramen, authors point to the importance of nerve exploration in this segment. In all cases development of connective tissue was expressed just like granulation of mastoid cells and cavum, and in 4 injured there are clear signs of infection at the place of nerve lesion, so that there is a need to perform the operation as early as possible.

[Auditory evoked brain stem potentials in the diagnosis of disseminated demyelinating processes of the central nervous system]. / Auditivni evocirani potencijali mozdanog stabla u dijagnostici diseminiranih demijelinizacionih procesa centralnog nervnog sistema.

The results of auditory evoked potentials of the brain stem of 109 patients with different clinical form of multiple sclerosis have been analysed. Pathologic findings were classified into five stages. The subclinical lesions at the level of the brain stem were found in 62% of patients in early, monosymptomatic phase of the disease. This method provides a large contribution to early detection of multiple sclerosis.

[Neurophysiologic tests for the early detection of deafness in children]. / Neurofizioloski testovi u ranom otkrivanju nagluvosti u dece.

Using brainstem auditory evoked potentials and tympanometry the authors have examined 120 children aging from several months to five years and they have found a high percentage of children with hearing impairment with sensorineural deafness. The children had also secretory inflammation of the middle ear. It has been suggested that secretory inflammation of the middle ear deteriorates the basic hearing impairment because of which it should be early diagnosed and surgically treated. Owing to the complex problem of children deafness, the authors recommend that several methods of examination should be applied in the diagnostic procedure in order to determine precisely the auditory threshold and to initiate in time hearing and speech habilitation.

[Physico-chemical characteristics of submandibular salivary secretions in patients with peripheral paralysis of the facial nerve]. / Evaluacija fizicko-hemijskih osobina submandibularne salivarne sekrecije u bolesnika sa perifernom paralizom licnog zivca.

In 53 patients with peripheral facial palsy divided in the definite groups there have been continually followed up changes in the physico-chemical features of saliva of the submandibular salivary glands and the motor function of the mimic musculature in the course of a year-observation of pH, osmotic pressure and electrolöte secretion. The reduction of Na+ and CO2 secretion resulted in the low values of pH and osmotic pressure in all saliva samples at the site of lesion. The degree of this reduction has been shown to be in the direct relationship with the severity of the nerve lesion and its final outcome.

[Sudden sensorineural hearing loss of unknown origin]. / Nagli senzorineuralni gubitak sluha nepoznatog uzroka.

The study presents the results of a ten year experience in the treatment of abrupt hearing loss of unknown etiology in 248 patients. More successful treatment was achieved in patients with lesser degree of perceptive hearing reduction and those showing no vestibular symptomatology. A decisive factor for a favourable hearing recovery is time between the onset of the disease and the beginning of the therapy. Having this in mind, the authors insist on early diagnosis and early administration of drugs affecting the inner ear perfusion.