Transcranial Doppler sonography for post-traumatic stress disorder.

Transcranial Doppler sonography (TCD) was used to examine the mean speed of blood circulation in 50 patients suffering from post-traumatic stress disorder (PTSD). The sonography was repeated 6 months after successful psychiatric treatment. Doppler sonography of Willis's circle blood vessels and vertebrobasilar flow was performed on healthy controls as well. All of the subjects in both groups were 20 to 43 years old and had not suffered from other diseases. Vasospasm of Willis's circle blood vessels was discovered in 62% of PTSD patients, which decreased to 22% after treatment. In the control group, it occurred in 8% of subjects. TCD examination of vertebrobasilar system blood vessels did not identify significant differences in blood circulation mean speed between controls and PTSD patients, regardless of whether they had or had not been treated. This research proved the value of TCD in discovering Willis's circle blood vessel vasospasm in PTSD patients, which suggests the inclusion of TCD in diagnosing PTSD. The value of TCD was affirmed in controlling treatment success, because after 6 months of psychiatric treatment, there were significantly fewer patients with Willis's circle blood vessel vasospasm.

Transcranial Doppler in smoking relapse prevention strategy.

Nicotine dependence is a progressive, chronic, relapsing disorder. Nicotine is the principal and most potent psychopharmacologically active component of tobacco smoke. Through activation of nicotine receptors in the central nervous system, nicotine can lead to tolerance and dependence. Cessation of smoking is followed by severe pathophysiologic withdrawal and by long-term craving. TCD measurement of cerebral blood flow velocity (BFV) and nicotine dependence degree measured by Fragestrom questionnaire was analyzed in relation to smoking relapse. This study includes 47 participants (25 females and 22 males) included in Breathe Free Plan To Stop Smoking in Non Smoking School in Zagreb. 12 month following the end of treatment participants were divided in three groups: continued abstinence, interrupted abstinence and non abstinence. High nicotine dependence combined with TCD pathological finding significantly discriminated successes and failures, suggesting that smokers with pathological TCD need specific therapeutic approach with more social support, individualized coping skills and cognitive restructuring. Measuring cerebral flow velocity by transcranial Doppler in smokers showed the practical validity in prediction of smoking relapse.

Haemodynamic changes in patients with whiplash injury measured by transcranial Doppler sonography (TCD).

The daily increasing number of cervical whiplash injuries presents ever-greater requirement for vertebrobasilar diagnostics. A cervical spine injury, which is quite frequent injury, may occur during a fall, or industrial, traffic, sport or war injury. Transcranial Doppler (TCD) sonography with Transcan 3-D EME device and 2 MHz probe was used for the assessment of vertebrobasilar circulation in patients with a whiplash injury of the cervical spine, that occurred mostly in car accident. This study includes 47 patients with clinically verified cervical spine trauma with x-ray evidence of no bone lesion. The patients were examined by TCD within a month, and then six months following the accident. The obtained values were compared to normal blood flow velocities and correlated with the severity of clinical picture. During the first month after the injury, statistically significant disturbances in the vertebrobasilar circulation were recorded, such as the increase in mean blood flow velocities in AVL (68%), AVR (62%) and BA (51%) (mostly as spasam). Six months later, normal findings were obtained in about 50% of the vessels, whereas in rest of the patients vasospasam persisted in one, two or all examined blood vessels. TCD of the vertebrobasilar circulation was found to be a very useful method in the diagnostics and follow-up of patients with a whiplash injury.

Osijek Health Center during the 1991-1992 war in Croatia.

To assess the effectiveness of health services in the city of Osijek during the 1991-1992 war in Croatia, we followed the changes in the utilization of health services, morbidity and mortality, and completion of a vaccination plan during the 2 years of the war. We used a retrospective analysis of data from the Osijek Health Center and the Osijek County Institute of Public Health. The organization of health care during the war followed the concept of integrated health care and the instructions of the Ministry of Health. Visits to primary health care physicians decreased considerably, with a concomitant increase in disease and mortality. The plan for mandatory vaccination was not completed because of the evacuation of preschool and school children. The war changed the mode of health care use, the disease and mortality structure, and the implementation of mandatory vaccination. However, timely education and preparation of the health services to the war situation resulted in an adequate provision of health care to the population.