[Septic encephalopathy--prognostic value of the intensity of consciousness disorder to the outcome of sepsis]. / Septicka encefalopatija--prognosticka vrijednost intenziteta poremaca svijesti za ishod sepse.

Septic encephalopathy (SE) is a common term indicating the development of signs of progressing cerebral dysfunction and is associated with the presence of microorganisms and their toxins in the blood. Aim of this investigation was to analyze the frequency of this complication considering the consciousness disorders in quantitative sense and prognosis of the survival in patients with SE. The investigation comprised patients (n = 54) with positive hemoculture and signs of septic syndrome by the accepted criteria (fever, clinical signs of infection, respiratory frequency, heart rate, plasma lactate, oliguria). Patients with confirmed cerebral injury, hemorrhage or cerebral ischemia were excluded from the study. Lumbar punction and CT-scan of the brain were performed in all patients in order to exclude visible lesions of cerebral parenchyma and eventual presence of cerebral nervous system (CNS) infection as the causes of sepsis. Results of the investigation demonstrated that in 30 (55%) of patients existed mild consciousness disorder at the level of somnolescence, in 18 (33%) consciousness disorder at the level of sopor and in 6 (11%) consciousness disorder at the level of deep coma. Level of consciousness disorder was in positive correlation with the outcome of sepsis syndrome, which was additionally confirmed by the fact that only in the group of patients with deep coma lethal outcome was observed in 3 cases (50% of this subgroup) regardless of intensive antibiotic, metabolically active and symptomatic therapy. It can be concluded that SE syndrome has a favorable prognosis if macroscopic lesion and dissemination of microorganisms in CNS are not present, and simultaneously it represents changes in metabolic-electrolytic state with early presentation of consciousness disorders that represent clinically significant indicator for sepsis syndrome outcome.

[The closed head injury syndrome--frequency and character of brain parenchyma lesions]. / Sindrom zatvorene povrede glave--ucestalost i karakter lezija mozdanog parenhima.

The aim of this investigation was to determine the frequency and character of the brain parenchyma lesions using CT scan and MR in patients with closed head injury, and afterwards to establish the connection of those changes with clinical parameters (neurological deficit and the degree of consciousness disorder), evaluating the sensitivity and specificity of neuroradiological procedures. The investigation comprised 40 patients with closed head injury. Grade of neurological deficit (Canadian Neurological Scale) and the degree of consciousness disorder (Glasgow Coma Scale) were determined in all patients by the same neurologist. The results revealed significantly higher specificity and sensitivity of brain examination using MR in patients with closed head injury, particularly in the detection of small ischemic and contusion lesions. Likewise, the correlation of positive findings using MR was more significant concerning the grade of neurological deficit and the degree of consciousness disorder compared to the brain examination using CT scan.

[Neurologic manifestations after surgical interventions]. / Neuroloske manifestacije nakon hirurskih intervencija.

Administration of general anesthesia is rarely accompanied with newly developed postoperative neurological complications. We analyzed postoperative complications after general anesthesia where an urgent neurologic assistance was necessary. The investigation included 120 patients. The same neurologist performed neurologic examination and electroencephalography, and computerized tomography (CT) was performed if necessary. In 96 (80%) patients focal stimulative or destructive phenomena such as epi-seizures or neurologic deficit were not detected by neurologic examination. In 9 (7.5%) patients were detected consciousness crisis. In 6 patients (5%) were registered right extremities weakness with motor dysphasia, which was withdrawn in first 24 hours. In these cases EEG revealed weak activity in theta frequency, above frontoparietal regions, bilaterally. In 6 (5%) patients was registered neurologic deficit of hemiparesis or semi-severe degree with development of ischemic lesion confirmed by CT. In 6 (5%) patients, CT scan revealed the presence of mild brain edema. Also, positive correlation between duration of anesthesia, age and metabolic disorders, specially diabetes mellitus, was found. We concluded that age, type of surgical intervention and duration of general anesthesia had the greatest influence on the development of neurologic disorders during and after general anesthesia, and the presence of metabolic disorders and previous brain damage increase the risk for the onset of these complications.

[Therapeutic value of antioxidants and calcium channel blockers in patients in the acute phase of closed head injuries]. / Terapijska vrijednost antioksidanasa i blokatora kalcijumski kanala kod bolesnika sa zatvorenom povredom glave u akutnoj fazi.

Knowing that uncontrolled calcium signalization with excessive production of reactive oxidative matters is present in case of neurotrauma, aim of the investigation was to establish therapeutic value of combined administration of antioxidants (AO) and calcium channel blockers (CCB) in patients with closed head injury (CHI). Investigation comprised 120 patients with CHI who received AO (vitamins C and E) parenterally during 10 days and CCB (nimodipine), and control group was comprised of 60 patients with CHI who did not receive these medicinals in therapeutic program. We have established the influence of the therapy on neurologic and functional deficiency and consciousness disorder, respectively. Results of the investigation confirmed better recovery of all three observed parameters (degree of neurologic deficiency, degree of functional deficiency and consciousness disorder) in a group of patients receiving AO and CCB, which was statistically significant. It can be concluded that the administration of AO and CCB in patients with CHI in the acute phase should be included into therapeutic program of this significant clinical syndrome.

[Stress ulcer in a patient with a subacute subdural hematoma]. / Stres ulkus kod bolesnika sa subakutnim subduralnim hematomom.

During the onset and development of pathologic events, numerous changes occur in the body as the result of an attempt of dynamic equilibrium maintenance. Results of such sequence of events may lead to organic, as well as psychic impairment of the body that is often referred to as the onset of psychosomatic disease. This paper deals with the disorder that could provide better insight in the possible physiopathologic mechanisms of psychosomatic disease or disorders. In a patient, chronic alcoholic subdural hematoma was diagnosed. Peptic ulcer hemorrhage occurred after surgical removal of the hematoma. Possible physiopathologic mechanisms in the origin of this disorder have been described.

[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.

High doses of immunoglobulins decrease mortality rate of surgical patients with severe intraabdominal infections and sepsis.

Two groups of 40 surgical Intensive Care Unit patients each, were included in the study. All patients had severe intraabdominal infections and sepsis, and septic score higher than 20. All were treated with individual specified conventional symptomatic therapy, and 40 of them received high doses of intravenous immunoglobulins. Significantly lower mortality rate was noticed in IVIG group (40%) than in control group (63.7%). Immunoglobulin therapy also decreased mortality rate in patients with septic shock, but it was no more effective than conventional therapy in patients with multiple organ failure (MOF).

[Use of a 7.5% NaCl/6% Dextran 70 solution in the prevention of hemodynamic disorders during surgery of abdominal aortic aneurysms]. / Primena rastvora 7.5% NaCl/6% Dextran 70 u prevenciji hemodinamskih poremecaja u toku operacija aneurizmi abdominalne aorte.

The experience in the application of infusion solutions Ringer lactate (RL) and 6% of Dextran 70 is shown in order to replenish intravascular volume in 19 patients with the abdominal aorta aneurysm after the removal of the aortal clamp and hypertonic-hyper oncotic 7.5% NaCl/6% Dextran 70 solution in 4 to 5 ml/kg dose in 9 patients. The application 7.5% NaCl/6%Dextran 70 at the optimum time, 15-20 min before the removal of aortal clamp, in a dose of 4-5 ml/kg allowed the support of normal hemodynamic function and decreased the need for some solutions or blood, as well as the incidence of intra- and postoperative complications.

[Acute normovolemic hemodilution]. / Akutna normovolemijska hemodilucija.

Performing acute normovolemic hemodilution reduces needs for transfusion of stored homologous blood, exposure of patients to homologous blood and incidence of diseases transmitted by transfusion. Apart from that it provides significant quantities of immunologically best, completely fresh blood and/or some blood components necessary for transfusion. Apart from the latest literature data, in this paper represent the first experiences considering acute normovolemic hemodilution performed in 20 patients operated for having low localized colon's neoplasm in whom amputation of rectum was performed. 780 ml of blood was exfunded from each patient with simultaneous infusion of three times larger volume of lactated Ringer's solution (In 10 patients) one volume of Haemacell (in 5 patients) and one volume of Soludex 70 (in 5 patients). Considering these patients 15600 ml autologous and 2500 ml of homologous blood was used up for transfusion.

[Esmolol--beta-adrenergic blocking agent with ultrashort action]. / Esmolol--novi beta adrenergicki blokator sa ultrakratkim delovanjem.

Esmolol is a new, highly efficient, cardioselective beta-adrenergic receptor blocking agent for intravenous use only. Its action commences rapidly and its duration is very short (about 15 min). It is very quickly metabolized in the body into an inactive product, and hence its therapeutic effect can be easily controlled. Indications for its use are supraventricular tachyarrhythmias and hypertension during the perioperative period and noncompensated sinus tachycardia. Esmolol is considered as drug of choice in its indicational domain and hence it is being introduced into materia medica in the increasing number of countries. Its therapeutic range is wide. Hypotension is the most frequent side effect of esmolol, while bradycardia, congestive heart failure, hypotension and cardiogenic shock are the most important contraindications for its use.

[Clinical study of the therapeutic value of Kybernin in the treatment of antithrombin III deficiency]. / Klinicka studija terapijske vrijednosti Kybernina u lijecenju deficijencija antitrombina III.

Together with a detailed presentation of the physiological role of antithrombin III and a description of the pathological states in which it's acquired deficiency requires substitutional therapy with an antithrombin preparation, this report contains the results of a clinical trial of such a preparation which is in use under the name of Kybernin. Patients with severe diseases and traumas, of a septic nature mostly, were included in the trial. The experimental group includes 20 such patients treated with Kybernin, and the control group had 12 patients who did not receive this preparation. The level of antithrombin III at the time of entering the study was an average of 40.1% in the experimental group, and 53.2% in the control group. The mortality of the treated group was 45%, and in the control group it was 66.7%. Clinical and laboratory results point to a favorable effect of Kybernin therapy in the suppression of disseminated intravascular coagulation.

[Massive pulmonary thromboembolism--case report]. / Masivna plucna tromboembolija--prikaz naseg slucaja.

This paper presents a case with massive pulmonary embolism which has been successfully treated at the V.M.A. Belgrade. The diagnosis of massive pulmonary thromboembolism by right heart catheterization was confirmed and urgent surgery was performed. The pulmonary embolus was surgically removed under extra corporeal circulation, given successful reanimation and anesthesia. Postoperatively was treated by mechanical ventilation, inotropic drugs and anticoagulant therapy. The presentation of this case is justified because in well organized cardiosurgical units, the urgent surgery gives most satisfactory results.