Impact of partial liberalization of driver's license regulations on the driving behavior of people with epilepsy: experience from Croatia.

Until 2005 Croatia had a driving ban for people with epilepsy (PWE) on antiepileptic therapy. To investigate the impact of partial liberalization of legislation, the results of polling performed in 1999 and 2009 were compared. The results revealed that in 1999, despite the driving ban, 46.9% of respondents had a driver's license, whereas in 2009, the majority of respondents with a driver's license (60.2%) fulfilled the requirement criterion of 2 years' remission. In both pollings, one-third of respondents answered that they were driving less often than other drivers. The rate of PWE who were driving was inversely proportional to the seizure rate. In 2009 a greater proportion stated that they drove motorcycles, and few PWE (<5%) declared they were driving more often than others. The inefficiency of rigid legislation and indicators of self-restraint of PWE may be arguments in favor of liberalization, but liberalization should be accompanied by appropriate education programs.

Efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring.

Snoring is an acoustic phenomenon, which is a consequence of vibrations of the soft tissue caused by partial obstruction of the upper breathing pathway while sleeping. It is estimated that 20% of men and 5% of women between 30 and 35 years of age snore and this rate increases to 50% of men and 30% of women over 60 years of age. The aim of this study was to evaluate the efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring by comparing snoring index and other polysomnography values before and after surgical treatment. The study included 22 patients (men 87% and women 13%), mean age 43.09 +/-9.6 (range, 28-67) years, treated for obstructive sleep apnea syndrome at University Department of ENT and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, during a 2-year period. Snoring was evaluated by preoperative and postoperative polysomnography at Department of Psychophysiology, Vrapce Psychiatric Hospital, Zagreb. Results were analyzed using Wilcoxon test. Postoperative reduction of snoring was statistically significant (P = 0.00052). Snoring index was decreased in 83% of patients, yielding a mean reduction of 83%. In 50% of patients, reduction of snoring index was over 95%. These results confirm the high efficiency of the procedure in the treatment of patients suffering from snoring.

[Central sleep apnea (Ondine's curse syndrome) in medullary infarction]. / Centralna apneja u spavanju (sindrom Ondinine kletve) kod infarkta produzene mozdine.

Ondine's curse syndrome primarily refers to cases with congenital central alveolar hypoventilation, but the term can also be used for acquired cases and implies central sleep apnea that occurs as a manifestation or complication of focal lesion in the area of the dorsolateral segment of medulla oblongata. It occurs rarely, but can lead to fatal outcome. Based on our own case report, the aim of this article is to review its clinical symptoms, and appropriate diagnostic and therapeutic procedures. We present a patient who had symptoms of vascular lesion of the dorsolateral segment of the medulla, which was verified by magnetic resonance imaging. On day 12 of his hospital stay, in the early morning, rapid development of coma was observed, which was an expression of serious respiratory failure with dominant hypercapnia. In the beginning, urgent intubation and mechanical ventilation were necessary, while in the later course of the disease breathing was assisted by noninvasive methods of Bilevel Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP). Throughout the night, polygraph recording confirmed the diagnosis of the central sleep apnea syndrome. The course of the disease was favorable, with a very slow but constant improvement of respiratory function. According to literature data, the disease course is not always favorable. There are published cases where it was concluded that ventilatory support was no longer needed but after a long period of normal breathing hypoventilation and death occurred suddenly during sleep. The treatment of central hypoventilation consists of ventilatory support, but there were also attempts of medicamentous treatment with the common aim of raising alertness and reactibility of the automatic breathing center. It is important to emphasize that patients with the risk of central sleep apnea should not be supplied with oxygen without arterial blood gas monitoring because of the possibility of delaying the right diagnosis. The use of oxygen in patients who already have hypercapnia due to hypoventilation could further intensify hyporeactivity of the breathing center and lead to respiratory arrest.

Dream recall after night awakenings from tonic/phasic REM sleep.

Eleven healthy subjects, 9 females and 2 males aged 21-23, were submitted to all night polygraphic recording and awaken in REM (Rapid Eye Movements) sleep, randomly upon tonic or phasic REM. Immediately upon awakening subjects were asked about possible dreaming according to the standardized questionnaire. Seventy-seven dreams, i.e. 79% of all 97 REM awakenings, were reported and analyzed. There were no significant differences in reported frequency of dreamings after awakening, mood and dream content due to phasic/tonic REM sleep. Dreams from phasic REM were a bit more colorful. Predictor of morning remembering of dreams was meaninglessness, not meaningfulness of dreams, and, in lesser extent, good mood, colorfulness, dreams with words and phasic REM sleep.

[Paraneoplastic syndrome associated with antiphospholipid antibodies]. / Paraneoplasticki sindrom povezan s antifosfolipidnim protutijelima.

In patients with malignant tumour signs and symptoms develop that cannot be explained on the basis of the mass effect produced by either primary tumour or its metastases, production of a hormone associated with tissue type giving rise to the malignant tumour, or patients' immune status. These symptom complexes are known as paraneoplastic syndrome. It is known that the patients with malignant tumours are prone to develop venous thromboembolism in any stage of their disease. It is suggested that thromboembolic manifestations in cancer patients may be part of the secondary antiphospholipid syndrome (APS) and an example of the paraneoplastic autoimmunity, eg., paraneoplastic syndrome. Antiphospholipid antibodies (APA), e.g., anticardiolipin antibodies (ACA) and circulating lupus anticoagulant (LAC) are known to predispose to venous and arterial thromboses. The growing number of clinical reports on the association of APA and malignant tumours suggests that APA may be one of contributory factors in the paraneoplastic thromboembolism occurring in malignancy.