Experiences of international travel in patients with psychotic illness: a case series.

OBJECTIVES: To identify factors influencing successful international travel among patients with psychotic illness. METHODS: Eight individuals participated in a semi-structured interview of 15-20-minute duration with a clinician in relation to their recent experience of international travel. Clinical files were reviewed and a case series was compiled. RESULTS: Four individuals engaged in international travel without any adverse effects. Four other individuals experienced significant psychotic and/or affective symptoms while travelling. Treatment non-adherence, a lack of awareness of how to obtain support and limited or no pre-travel planning were noted in these individuals. CONCLUSIONS: Pre-travel counselling, treatment adherence, provision of information packages relating to their mental illness and having contact details of their treating mental health team increase the likelihood of successful international travel in patients with psychotic illness. Travelling with a companion may reduce fear of relapse.

Assessing the Quality of Models of the Ambient Solar Wind.

In this paper we present an assessment of the status of models of the global Solar Wind in the inner heliosphere. We limit our discussion to the class of models designed to provide solar wind forecasts, excluding those designed for the purpose of testing physical processes in idealized configurations. In addition, we limit our discussion to modeling of the 'ambient' wind in the absence of coronal mass ejections. In this assessment we cover use of the models both in forecast mode and as tools for scientific research. We present a brief history of the development of these models, discussing the range of physical approximations in use. We discuss the limitations of the data inputs available to these models and its impact on their quality. We also discuss current model development trends.

Evidence for topological nonequilibrium in magnetic configurations

We use direct numerical simulations to study the evolution, or relaxation, of magnetic configurations to an equilibrium state. We use the full single-fluid equations of motion for a magnetized, nonresistive, but viscous fluid; and a Lagrangian approach is used to obtain exact solutions for the magnetic field. As a result, the topology of the magnetic field remains unchanged, which makes it possible to study the case of topological nonequilibrium. We find two cases for which such nonequilibrium appears, indicating that these configurations may develop singular current sheets.

A Twisted Flux Rope Model for Coronal Mass Ejections and Two-Ribbon Flares.

We present a new approach to the theory of large-scale solar eruptive phenomena such as coronal mass ejections and two-ribbon flares, in which twisted flux tubes play a crucial role. We show that it is possible to create a highly nonlinear three-dimensional force-free configuration consisting of a twisted magnetic flux rope representing the magnetic structure of a prominence (surrounded by an overlaying, almost potential, arcade) and exhibiting an S-shaped structure, as observed in soft X-ray sigmoid structures. We also show that this magnetic configuration cannot stay in equilibrium and that a considerable amount of magnetic energy is released during its disruption. Unlike most previous models, the amount of magnetic energy stored in the configuration prior to its disruption is so large that it may become comparable to the energy of the open field.

[The Gepiden of Viminacium during population migration. An anthropological contribution]. / Die Gepiden von Viminacium in der Völkerwanderungszeit. Anthropologischer Beitrag.

The archaeological excavations at the cemetry Vise Grobalja on Viminacium were finished in the year 1985. Altogether 94 skeletons which were attributed to the Gepiden were examined anthropologically. The graveyard was dated about the middle of the 6th century. Of special importance were the 31 artificial deformed skulls. The deformation was done with a circular bandaging which is graphically illustrated. Farkas (1973), Winkler (1979) and Schröter (1988) identified the same type of bandaging on skulls of the ethnic migration period. The anthropological examination identified 46 as male and 27 as female skeletons: 16 were determined as infants and juveniles. About 5 skeletons were indeterminable because of their bad state of preservation. There was a deficit of women and infants. The average lifespan was less than 33 years. The influence or the presence of other anthropological types was not identified. But there should be further proof why, for example these groups of Gepiden from Viminacium have disappeared relatively rapidly from the historical stage and the Balkan.

[Development of orthopedics and founding of the Clinic for Orthopedic Surgery and Traumatology in Novi Sad]. / Razvoj ortopedije i osnivanje klinike za ortopedsku hirurgiju i traumatologiju u Novom Sadu.

A study of the development of the orthopaedic surgery in Novi Sad from the antique times till 1980 when the Clinic for Orthopaedic. Surgery and Traumatology was established has been carried out. Development from Roman Times till the Second World War. The first material evidence of the surgical activities in this area originates from the epoch of the Roman Empire, when under the emperor Augustus (Augustus, 27 B.C.-14 A.D.), the northern border of the Empire was established and fortified on the river Danube. At that time on the place of the contemporary Petrovaradin Fortress, a small fortification with a permanent garrison, called Cusum, was built. As it was proved by excavation of the surgical instruments from the Roman time at the nearby Sremska Mitrovica (Sirmium) the surgery in the Roman legions was quite developed and it could be concluded that some forms of surgery and orthopaedics were practised in the antique Cusum as well. There is no reliable evidence about the health service in the area after the Roman era till the 1689 when Petrovaradin was finally sized by Austrian troops from the Turks, and when the first recorded hospital (Petrovaradin Military Hospital) in this region was founded. At that time on the northern shore of the river Danube a new settlement, developing later into the town of Novi Sad, was established. Surgery together with orthopaedics at that time were performed by the so-called "feldschers", and then by primitive, self-taught surgeons who were actually experienced barbers, while educated doctors started to practice surgery only in the 19th century when the first surgical department in Novi Sad was founded in the Great Town Hospital, and for years after that, the orthopaedics was practised by general surgeons. The foundation of the Anglo-Yugoslav Children's Hospital for Tuberculosis of the Bones and Joints at Sremska Kamenica in 1934 by Dr. Katherine S. Macphail, a great benefactress of our people, was of great importance for the development of orthopaedics in this area as it was the first orthopaedic hospital in the country. The first small unit for orthopaedics, as a part of the Surgical Department of the Novi Sad State Hospital, was established in 1937 and led by a surgeon, Dr. Nikola Pravdica. Development from the Second World War till the 1980. After the Second World War the Main Provincial Hospital with two surgical departments was established in Novi Sad. At the so-called Second Surgical Department led by Dr. Nestor Teodorovic a small unit for traumatology and orthopaedics was founded in 1946, which functioned as such till 1953. The first properly trained orthopaedic surgeon was Dr. Stojan Letic who passed the specialty exam in 1953 and was attached to the Second Surgical Department of the Main Provincial Hospital. The first independent Orthopaedic and Traumatologic Department, led by an experienced orthopaedic surgeon, Dr. Vladimir Razenj, was established in 1956. From 1959 till 1963 the department was led by Prim. Dr. Dobrivoje Gradistanac. In 1963 this department together with the former "English Hospital" at Sremska Kamenica were incorporated into the so-called Clinic for Surgical Diseases and divided in the Orthopaedic (led by Prof. Milenko Dosen) and separated Traumatologic (led by Prim. Stojan Letic) departments which existed as such till 1975 when they were integrated again into a single unit which evolved into the Clinic for Orthopaedic Surgery and Traumatology in 1980.

Transplantation of fresh-frozen menisci: an experimental study in dogs.

Transplantation of 25 fresh-frozen medial menisci was studied in 15 adult dogs. Before implantation, the allografts were deep-frozen and stored at -70 degrees C for 6 weeks to 18 months. The animals were killed 2 to 8 months postoperatively, and their knees and transplants were examined macroscopically and histologically. Complete healing of the allografts was found in 19 knees, incomplete in 3, and healing by massive fibrovascular tissue in 3 knees. Some shrinkage of the transplants taken 2 to 4 months after the surgery was observed; however, the 6- and 8-month specimens appeared grossly normal. Histologically, all transplants displayed a characteristic decrease in the number of cells, but this was significantly less pronounced in the 6- and 8-month specimens. Some degenerative alterations were found in all transplanted knees, but was obviously less pronounced in areas covered by the allografts and in the 6- and 8-month specimens. It is concluded that the transplantation of the fresh-frozen menisci could be successful; although the transplants are subjected to a remodeling process, they appear to function normally and protect the articular cartilage. The technique of conservation by freezing at -70 degrees C offers the advantage of an effective meniscal banking.

Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability.

One hundred thirty patients who had an injury of the triangular fibrocartilage complex (TFCC) with distal radioulnar joint (DRU) instability were treated operatively. The TFCC injury with DRUJ instability occurred as an isolated lesion in 20. After appropriate fracture stabilization, 86 patients were treated with closed reduction of the DRUJ and radioulnar transfixation with one to two Kirschner wires with the forearm in neutral rotation. In 19 patients the avulsed ulnar styloid was internally fixed, and the DRUJ supplemented with radioulnar transfixation. In 13 patients the ulnar styloid was internally fixed. In 12 patients with radial avulsion fractures the displaced bony fragment was percutaneously fixed with a Kirschner-wire. Postoperatively all the patients were immobilized in a long arm cast in neutral rotation for 6 weeks. The results were excellent in 95%, fair in 30, and poor in 5.

Healing of the articular disc of the wrist in dogs.

The healing potential of the articular disc of the wrist (antebrachiocarpal) joint was investigated in 30 adult dogs (35 joints). In 28 joints a complete section of the entire disc was carried out and sutured in 10; a partial lesion was made in 7. The dogs were killed at varying intervals from 2 weeks to 8 months and healing studied by naked eye inspection and histological examination. At 3, 6 and 8 months the tears in all specimens were completely healed by mature fibrous tissue containing fibrocartilaginous elements, whether or not they had been sutured. In peripheral areas the defect was filled by an ingrowth of young fibroblastic tissue arising from the synovium, whereas in the central areas the repair appeared to originate from neighbouring bone. We have demonstrated the ability of the mostly avascular disc to repair itself. Suturing did not enhance the healing process.

Allograft meniscus transplantation in the dog.

We studied transplantation of a fresh meniscus in 25 knees in 15 adult dogs. On 2 tables and with 2 surgical teams the medial menisci were explanted, exchanged and implanted into the opposite dog's knee. The animals were killed 4-12 months postoperatively, and the transplants were studied histologically. Complete healing in the host's capsular tissues was found in 18 knees, incomplete healing in 3, and healing by massive fibrovascular scar tissue in 4 knees. In the 4- and 5-month specimens the transplants were found to be narrower, thinner, and of changed color and consistency, while in the 8- and 12-month specimens most of the allografts appeared grossly normal. Histologically, the allografts had normal general microarchitecture, but a marked decrease in the number of cells. In the 8- and 12-month specimens the cells had increased but the number of cells in general was still less than in the controls. Although some degenerative changes of the medial tibial articular cartilage were noted in most knees, there were less changes beneath the allografted meniscus.

[Morphologic characteristics and static resistance of transplanted patellar ligaments after replacement of the cruciate ligaments in the knee--an experimental study in a dog]. / Morfoloske osobine i staticka otpornost autotransplantata ligamenta patele nakon zamene prednjeg ukrstenog ligamenta kolena--eksperimentalna studija u psa.

An experimental study on transplantation validity of patella's ligament, when transplanting front crossed ligament, was performed on 106 knees in 53 grown-up dogs. The investigation had three stages. Three months after the transplantation of the front crossed ligament with the medial third part of the patella's ligament animals were sacrificed and in one group the static resistance and the resistance to elongation, by using special tweezers (Alfred Amsler Co., Schafhausen, Switzerland), was investigated. The results showed that the patella's ligament is very suitable for transplantation because its resistance and strength were almost identical with the same parameters of intact front crossed ligament. Revascularization of the new ligament using Spaltenholz's technique was done in the second group, and three months after the operation, complete revascularization of transplants took place. The synovial membrane which covers the new ligament represents the main source of fresh blood vessels on one side, while similar process takes place along the bone tunnels where the new ligament was fixed. The new ligament histologic analysis carried out in the third group of experimental animals showed that after three months the transplant acquires the structure which is very similar to the front crossed ligament. The obtained results of the investigation show that the patella's ligament is a very good biologic material for transplantation of the crossed ligament.

Blood supply of the articular disc of the antebrachiocarpal joint in dogs.

The normal vascular anatomy of the articular disc of 48 antebrachiocarpal joints was studied in 24 dogs (12 puppies and 12 adult animals) using an India ink vascular injection technique. It was found that the articular disc receives its blood supply mainly from the palmar and dorsal branches of the palmar interosseous artery. Branches of these 2 arteries arborise and give direct peridiscal vessels to the dorsal, proximal and palmar sides of the articular disc. The peridiscal vessels ramify and anastomose with one another to form a cup-shaped terminal peridiscal capillary plexus around the disc which ends at the peripheral parts of the disc in a series of terminal capillary loops. This leaves the major central segment of the disc without blood vessels. The proportion of vascularised to nonvascularised areas of the disc depends upon the age of the animals. In young puppies, the degree of vascular penetration into the disc is quite extensive, while in adult animals it ranges from 15 to 25% of the discal width; the considerably larger central area of the articular disc is thus avascular.

Detailed anatomy of the antebrachiocarpal joint in dogs.

A comparative study of the anatomy of the antebrachiocarpal (AC) articulation was carried out in 30 adult dogs with 60 joints. Although a considerable degree of similarity was found between the AC joint in dogs and the corresponding wrist joint in humans, a number of differences between these two homologous joints were also noted. The distal end of the ulna in dogs directly articulates with the ulnar carpal and accessory carpal bones forming a specialized antebrachiocarpal arrangement more adapted to running. The accessory carpal bone in dogs is a massive, long bone and is strikingly different from its homologue in humans, the pisiform bone. The joint between the accessory and ulnar carpal bones, which corresponds to the piso-triquetral joint in humans, is always connected with the AC joint, whereas in humans this communication could be found occasionally. The large radial carpal bone in dogs, characteristic for carnivores, corresponds to the fused scaphoid and lunate bones in humans, in whom this type of fusion is very rarely found. The palmar ulnocarpal and radiocarpal ligaments in dogs are distinctly intra-articular, whereas in humans these ligaments are intracapsular. One of the controversies of the AC joint in dogs is a structure located between the distal-most parts of the radius and ulna forming a strong bond between these two bones and a part of the antebrachial articular surface. It is cartilage-like and is composed of typical fibrocartilaginous tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

The blood supply of the human distal radioulnar joint and the microvasculature of its articular disk.

The arterial blood supply of the distal radioulnar joint was investigated in 35 upper extremities taken from 22 fresh cadavers (11 newborns and 11 adults using the India ink injection and tissue-clearing techniques according to Spalteholz). Microvasculature of the articular disk of the distal radioulnar joint was also performed in 35 articular disks taken from 22 fresh human cadavers, 11 newborn and 11 adults using the same technique. It was found that the general blood supply to the joint is received mainly from the palmar and dorsal branches of the anterior interosseous artery. These branches, after dividing at the proximal border of the pronator quadratus, arborize in a fanlike fashion around the joint and their small ramifications penetrate and vascularize the capsule and the articular disk from the palmar, dorsal, and medial sides. The terminal branches of the anterior interosseous artery reinforced by the posterior interosseous artery and a small branch of the ulnar artery give the direct peridiscal vessels to the palmar, medial, and dorsal margins of the articular disk, which arborize and anastomose with one another and form the terminal capillary networks that end at the peripheral segments of the disk in a series of terminal capillary loops, leaving the inner segments devoid of blood vessels. The posterior interosseous artery anastomoses at the distal part of the forearm with one of the terminal rami of the dorsal branch of the anterior interosseous artery and, in that way, contribute to the vascularization of the dorsal capsule of the distal radioulnar joint. The ulnar artery gives off a small branch that anastomoses with one of the terminal ramifications of the palmar branch of the anterior interosseous artery and contributes to the formation of a small arterial arch on the anteromedial side of the distal ulna, supplying the anteromedial capsule and the basistyloid area of the ulna. Both ulnar and radial arteries contribute to the vascularity of the joint through the collateral network of the palmar and dorsal carpal arches. In the articular disk, the major central portion of the disk is avascular and only its peripheral, palmar, medial, and dorsal margins are vascularized. The proportion of vascularized zone to avascular zone depends on the age of the subject and, in newborns, is approximately 33%. In adults, only 25% of the peripheral segments are vascularized.(ABSTRACT TRUNCATED AT 400 WORDS)

Histologic structure of the articular disk of the human distal radioulnar joint.

A histologic study of the structure of the articular disk of the distal radioulnar joint in humans was performed on 57 disks from 37 fresh cadavers that included fetuses and individuals up to age 65 years. The specimens were stained with hematoxylin and eosin, orcein, and Mallory and Mann-Dominici's methods, and studied with the light microscopy. It was found that the disks of adults were basically formed of the so-called fibrocartilagenous tissue composed of an intercellular substance in which there were interwoven wavelike collagen fiber bundles and between them three specific types of cells: (1) rather sparse fibrocytes mostly situated in dorsal and palmar margins, (2) predominant and constant chondroid cells dispersed throughout the disk, and (3) less-frequent real chondocytes distributed mostly in the central parts. This basic tissue is modified according to the age of the subjects and functional requirements. In fetuses and newborns, it is almost completely fibrous and very cellular, while in adults, it is more cartilaginous with significantly reduced cellularity. The structure of various parts of disks is adapted to the functional stresses exerted on them. In central parts exposed to pressure, the tissue is more cartilaginous, while peripheral, massive margins, subjected mostly to traction, are built in a ligamentlike pattern. The ulnar and carpal surfaces are adapted to the gliding movements of the ulna and carpus. It is concluded that the articular disk in humans, which is basically of fibrocartilagineous nature, is a dynamic structure biomechanically, predetermined and changing with aging.

[Patellar height in patients with chondromalacia]. / Visina patele u obolelih od hondromalacije.

A radiogrametric assessment of the patellar height performed by three measurement methods, in the lateral views of radiograms of 136 patients with chondromalacia of the patella was aimed at the establishment of certain parameter values in the studied population and the assessment of the influence the altered patellofemoral ratio has upon the onset of the disease. The results of the study verified the remarkable advantages of the method by Insall and Salvati for the measurement of the patellar height and showed a significant involvement of patellofemoral incongruity in the development of chondromalacia, since in 15-16% of the cases the patella was not properly placed.

Operative treatment of the large post-traumatic subcutaneous haematoma or bursa.

A study of the large subcutaneous haematoma or bursa was carried out in 85 adult patients who were mostly injured in traffic accidents as pedestrians hit by automobiles or in motocycle accidents. The lesions, mostly located at trochanteric and lumbosacral regions, were produced by direct, tangential traumatic forces splitting the subcutaneous fat from the fascia and creating a massive haematoma which was subsequently transformed into a real bursal cyst, resistant to the conventional methods of treatment. As the results of conservative measures were unsatisfactory in 74 per cent of cases, a simple operation has been developed, consisting of excision of the bursal wall and inserting cutaneofascial sutures to allow complete elimination of any dead spaces where tissue fluids could re-accumulate. As the results of this operation were favourable in 95 per cent of cases, it is recommended for the management of this condition.

[Early functional and anatomic results after total condylar knee prosthesis implantation]. / Rani funkcionalni i anatomski rezultati nakon ugradnje totalne kondilarne endoproteze kolena.

The results of total knee replacement in 30 patients have been analyzed. Total knees were implanted during 1990, and the shortest follow-up time after the operations amounted to 6 months. All 30 total condylar prosthesis were of Insall-Burstein posterior stabilized design. The average age of the operated patients was 61 years. Osteoarthritis caused serious knee damage in 21 patients and was the indication for the operation; in 7 patients it was rheumatoid arthritis; in 1 patient synovitis villonodularis; and severe posttraumatic osteoarthrosis in 1 patient. In 18 patients axial knee deformity was noted prior to operation in the sense of valgus or varus. The continuous passive motion machine was used in the postoperative treatment of all patients. Clinically acceptable results were obtained in 90%. Wound healing complications were noted in 2 patients. Full axial deformity correction was achieved in all the patients with a full extension and flexion of over 90 degrees in the operated knees. Preliminary results after the implantation of this type of prosthesis are very encouraging and justify it's further routine use.

[The size and suitability of blood vessels for transplantation into the knee of the dog]. / Velicina i podobnost krvnih sudova kolena u psa za transplantacione zahvate.

An investigation of the size and suitability for the transplantation procedures of the knee blood vessels was made in 20 adult dogs with 40 extremities using the technique of injection of the arterial network through the femoral artery with the mixture of the methacrylic resin (SIGMAL R "Galenika", Belgrade) and the red ink. When the polymerisation of injected methacrylic resin was completed the specimens were exposed to either chemical or biological maceration of the tissues. Thirty-five specimens were chemically macerated using either 30% solution of hydrochloride acid or 40% potassium hydroxide. With this method bones were also destroyed and only the methacrylic vascular cast remained unaffected. Five specimens were exposed to the biological maceration using the insects (Dermestes vulpinus). This method proved to be better as the bones elements were not destroyed which allowed more precise study of vessel relations and topography. Calibre of the arteries was measured using the micromethod MEBA (Zagreb) with the accuracy of 0.01 mm. The main arterial vessels of the knee joint on the medial side are aa. saphena, genus descendes (branches of the femoral artery, then a. genus descendens (branches of the femoral artery, then a. genus medialis (branch of the popliteal artery), and on the lateral side are a. caudalis femoris distalis, (branch of the femoral artery), a genus lateralis (branch of the popliteal artery) and recurrent branches of the a. tibialis cranialis. Calibre of the femoral and popliteal arteries was over 2 mm which means that they are suitable for macrosurgical sutures, while the calibre of all other arteries was under 2 mm, and it is concluded that they are suitable only for microsurgical sutures.