Kinking, coiling and diameters of vertebral artery first segment and their relationships to sex and side.

INTRODUCTION: Recent information on tortuosity in the prevertebral (V1) segment of the vertebral artery is based on case reports rather than systematic data on its presence, types, diameters, and sex- or left-right differences.

Memory efficiency in patients with drug-resistant epilepsy.

OBJECTIVE: To evaluate memory in patients with drug-resistant epilepsy. METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935). CONCLUSION: Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

The Impact of Thrombolytic Therapy on Anxiety, Depression and Quality of Life of Patients with Acute Ischemic Stroke.

BACKGROUND: It is well established that thrombolytic therapy improves the functional recovery by reducing disability measured as National Institutes of Health Stroke Scale (NIHSS) and Rankin score in patients with ischemic stroke. However, the role of alteplase treatment on anxiety and depression in those patients is less clear. Therefore, the aim of this study was to determine whether patients treated with thrombolytic therapy had a better quality of life, less anxiety and depression compared to patients who were not treated with thrombolysis. SUBJECTS AND METHODS: In this "single canter study" 60 patients with acute ischemic stroke were divided into two groups: alteplase treated (AT) group, and not treated (NT) group. The sociodemographic data including gender, age, marital status, education, employment, financial status, place of residence, refugee status were collected at the beginning of study. The NIHSS score and modified Rankin score (mRS) were performed on admission and at discharge from hospital. Six months following discard from hospital the Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI) and the Short Form 36 quality of life (SF-36 QoL) were performed. RESULTS: There were no differences in mean NIHSS and mRS at admission to hospital between the groups. At discharge from hospital patients in AT group had significantly lower NIHSS and mRS than patients in NT group. In post-stroke period the patients from AT group had significantly less anxiety and depression than patients from NT group (BAI in AT 6.4+4.17 vs BAI in NT 14.27+7.01 and BDI in AT 9.20+6.61 vs BDI in NT 18.0+7.49). Patients in AT group had significantly better SF-36 QoL score in all components than NT group. CONCLUSION: The results of this study showed that thrombolytic therapy reduced the intensity of anxiety and depression and improves the quality of life of patients six months after ischemic stroke.

Post-trauma cardiovascular risk factors and subclinical atherosclerosis in young adults following the war in Bosnia and Herzegovina.

Background: Risk of cardiovascular disease (CVD) has been associated with stress from serving in a war, but it has not been established whether children who experience war-related stress are at increased CVD risk. Objective: This study aimed to compare CVD risk factors in young adults according to whether they experienced traumatic events as children during the 1990-1995 war in Bosnia and Herzegovina, and whether those exposed to trauma have evidence of subclinical atherosclerosis. Method: We examined 372 first-year medical students who were preschool children during the war (1990-1995) (average age 19.5 ± 1.7 years, 67% female) in 2007-2010. They completed the Semi-Structured Interview for Survivors of War. CVD risk factors and carotid intima-media thickness (CIMT) measurements were obtained and compared in individuals with and without trauma. We also examined whether increased CIMT was independently associated with trauma after adjustment for other risk factors. Results: From multiple logistic regression, only elevated triglycerides (> 1.7 mmol/l) were associated with a 5.2 greater odds of having experienced trauma. The mean CIMT of subjects with trauma was greater than that of non-trauma-exposed subjects (0.53 mm vs 0.50 mm, p = 0.07). Moreover, trauma was independently associated with higher CIMT (difference = 0.036 mm, p = 0.024) after adjustment for CVD risk factors. Conclusions: We show that most CVD risk factors are associated with post-war trauma in young adults, and, if present, such trauma is associated with higher triglycerides and higher levels of CIMT in multivariable analysis.

Antecedentes: El riesgo de enfermedades cardiovasculares (ECV) ha sido asociado con el estrés del servicio en la guerra. No está establecido si los niños que han experimentado estrés relacionado a la guerra tienen un riesgo aumentado de ECV. Comparamos los factores de riesgo de ECV en adultos jóvenes, en función de si experimentaron eventos traumáticos en la niñez durante la guerra de 1990­1995 en Bosnia-Herzegovina, y si aquellos expuestos a trauma tienen evidencia de ateroesclerosis subclínica.Métodos: Examinamos a 372 estudiantes de medicina de primer año, quienes eran niños preescolares durante la guerra (1990­1995) (edad promedio 19.5±1.7 años, 67% mujeres) en 2007­2010. Completaron la Entrevista Semiestructurada para Sobrevivientes de Guerra. Se obtuvieron mediciones de factores de riesgo cardiovascular (ECV) y de Grosor Carotídeo de la Intima Media (CIMT por su sigla en ingés), se compararon en personas con y sin trauma y se examinó además si el incremento de CIMT se asociaba independientemente con trauma luego de ajustar por otros factores de riesgo.Resultados: De la regresión logística múltiple, sólo la elevación de triglicéridos (> 1.7 mmol/L) se asoció a una probabilidad 5.2 veces mayor de tener trauma. La CIMT promedio de los sujetos con trauma fue mayor (0.53 mm vs 0.50 mm, p=0.07) que la de los sujetos no expuestos a trauma. Más aún, el trauma estaba independientemente asociado con mayor CIMT (diferencia=0.036 mm, p=0.024) luego del ajuste por otros factores de riesgo de ECV.Conclusiones: Mostramos que la mayoría de los factores de riesgo de ECV estaban asociados con el trauma post-guerra en adultos jóvenes, pero si estaba presente, el trauma se asocia a mayores niveles de triglicéridos y de CIMT en los análisis multivariable.

Efficacy and Safety of Low-Dose Versus Standard-Dose Alteplase Regimens in Patients with Acute Ischaemic Stroke.

BACKGROUND: The use of intravenous recombinant tissue plasminogen activator, alteplase, at a dose of 0.9 mg/kg is an effective treatment for patients with acute ischaemic stroke; this dose is also associated with high intracerebral haemorrhage rates. The aim of this study was to evaluate whether the low-dose alteplase treatment is as effective and safe as the standard-dose regimen. SUBJECTS AND METHODS: This was a retrospective, single-centre study, and data were collected from the Hospital Stroke Registry. Based on the severity of stroke and the risk of intracerebral haemorrhage, patients were divided into two groups according to the alteplase doses given; the low-dose (0.6 mg/kg) group (n=45) and the standard-dose (0.9 mg/kg) group (n=165). Ninety-day outcomes measured as modified Rankin score and National Institute for Health Stroke Scale (NIHSS) score, as well as symptomatic intracerebral haemorrhage and mortality rates were analysed. RESULTS: The standard-dose group had a slightly more favourable outcome (Rankin score 0-2) at 90 days after alteplase treatment than the low-dose group (64.24% vs. 53.33%), but the difference was not significant. The total intracerebral haemorrhage rate and mortality rate at 90 days were higher in the standard-dose group than in the low-dose group (21.2% vs. 13.3% and 6.1% vs. 0.0%, respectively), but these differences were not statistically significant. CONCLUSION: The low-dose alteplase treatment applied to the patients with high intracerebral haemorrhage risk had comparable efficacy and safety profile to the standard-dose regimen.

Ego Defence Mechanisms in Patients with Epilepsy.

BACKGROUND: In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS: We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS: Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION: Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.

The expression and significance of p53 protein and Ki-67 protein in pterygium.

BACKGROUND/AIM: Pterygium is considered to be a degenerative disease of the conjunctiva, however, the presence of tumor markers in pterygium reinforces the hypothesis that this lesion is similar to tumor. Inactivation of p53 function removes an obstacle to increased proliferation. Factors affecting the prevalence of p53 expression in pterygium deserve investigation. The aim of the study was to investigate the expression of p53 and Ki-67 proteins in pterygium and normal conjunctiva, the effects of gender and age on p53 expression, and the relationship between the expression of p53 and Ki-67 proteins. METHODS: A total of 34 samples of pterygium and 34 samples of the normal conjunctiva were analyzed. The samples were studied by immunohistochemistry using antibodies against p53 and Ki-67. RESULTS: Totally 15 (44%) samples of pterygia were p53 positive. Correlations between the expression of p53 protein and sex, and age were not established. The number of Ki-67 positive cells in pterygium (9.74%) was significantly higher than the number of Ki-67 positive cells in the normal conjunctiva (1.74%), (P = 0.001). Between the expression of p53 protein and Ki-67 protein in pterygium there was a significant positive correlation (p = 0.000). CONCLUSION: The prevalence of p53 positive samples of pterygium was 44%. The influence of sex and age on p53 protein expression in pterygium was not found. The increased proliferative acivity was present in the epithelium of pterygium. The expression of Ki-67 protein is associated with the expression of p53 protein in pterygium. The findings of our study support the thesis of pterygium as tissue growth disorder.

IMMUNOHISTOCHEMICAL EXPRESSION OF P16INK4a IN INFLAMMATORY, PRENEOPLASTIC AND NEOPLASTIC CERVICAL LESIONS.

INTRODUCTION: High-risk human papilloma viruses play a main role in the development of cervical dysplasias and carcinomas. p16INK4a can be considered as a surrogate marker of active high-risk human papillomaviruses infection in dysplastic and neoplastic cells of the cervix. This study was aimed at determining the presence and level of pl6INK4a expression in inflammatory, preneoplastic and neoplastic lesions of the cervix. MATERIAL AND METHODS: The study was performed on 109 samples of cervical biopsy. Cervical cancer was diagnosed in 36 patients, 34 patients had a preneoplastic change (dysplasia) in stratified squamous cervix epithelium and a nonspecific inflammatory process was found in 39 patients. In all samples, immunohistochemical analysis using antibodies to pl6INK4a was performed. RESULTS: The expression of pl6INK4a was verified in all cases of cervical cancer (100%), in 67.65% of dysplastic cervical lesions and in 38.5% of inflammatory lesions. A statistically highly significant difference was found in the presence and level of expression among neoplasic, dysplastic and inflammatory lesions of the cervix (χ2 = 76.02, p <0.001). The expression was more frequent and had a higher level in neoplastic and high grade dysplastic lesions compared to expression in inflammatory lesions and low grade dysplasias. CONCLUSION: The analysis of the presence of pl6INK4a can differentiate non-neoplastic, high grade preneoplastic and neoplastic changes of the cervix. The use of pl6INK4a in interpreting borderline lesions of the cervix can enable a rational theraDeutic treatment of patients.

Neurosurgical procedure for treatment of traumatic subdural hematoma with severe brain injury: a single center matched-pair analysis.

Decompressive craniectomy (DC), an auxiliary neurosurgical invasive procedure, has been a part of the treatment regimen for severe brain injury (SBI). Today DC is the standard of care in patients with middle cerebral artery infarction. Our previous positive research results about effectiveness of DC procedure when applied to a specific group of SBIlpatients have made a solid base for a clinical evaluation of DC technique application to patients with isolated SBI with traumatic subdural hematoma (TSDH), despite controversies regarding clinical benefit of DC technique when applied to STBI patients. A matched-pair analysis has been performed to compare long-term clinical outcomes in patients with and without the DC technique applied. This study has encompassed 150 consecutive STBI patients with TSDH, aged between 18 and 82 years. One hundred patients had required application of DC procedure, while remaining 50 patients represented a matched control group in which the DCprocedure had not been applied. The control group match was conducted on the basis of epidemiological and potential prognostic factors, such as age, gender, DC surface area and Glasgow Coma Score (GCS). The main reason for occurrence of STBI with TSDH was traffic accidents, with sex ration 2:1 (male/female), while 2/3 of patients were aged between 26 and 40 years. Mortality rate of 18% had occurred in the group of patients in which DC procedure was applied early in the first 24 hours after the injury, while mortality rate of 54% had occurred in the group of patients in which DC procedure was applied later than 24 hours after the injury, in comparison to mortality rate of 35% that had occurred in the control matched group of patients. Also, better control of intracranial pressure (ICP) had occurred in patients in which a DC surface was made larger than 40ccm. In addition, less computed tomography (CT) scans were made as a follow up care procedure in patients in which DC procedure was performed and especially if DC procedure had been performed within 24 hours after the injury. However, regardless of many positive results that an early application of DC procedure has had on SBI patients with TSDH, an expected increase in immediate or delayed complications had occurred, for example we had recorded an increased number of encefalocele. Significantly better outcome of clinical recovery with less cases of morbidity and deaths had occurred in patients in which TSDH was removed with the DC technique within 24 hours after the time of injury and also if a DC surface had had size over 40 ccm, in compari- son to the group of patients that had TSDH removed with DC technique within longer period of time than 24 hours after the time of injury and also better than the control group.

Hemorrhagic complications of thrombolytic therapy.

Stroke is the most frequent neurological disorder, and the most common cause of severe disability compared to other diseases. Recombinant tissue plasminogen activator (rt-PA) is the only approved specific therapy for acute ischemic stroke. Hemorrhage is a significant complication of thrombolytic treatment. This study, which included a hundred patients (52 male and 48 female), was aimed at assessing the safety according to our experience with 100 thrombolytic treatments for stroke. The death rate related to hemorrhage after thrombolysis was 3%. The frequency of hemorrhagic events (hemorrhagic infarctions type 1 and 2, parenchymal hematomas type 1 and 2) was 16%. The study results have shown that the intravenous recombinant tissue plasminogen activator (rt-PA) therapy is safe.

Vascular dementia: clinical and neuroradiological correlation.

All stroke patients admitted to Banjaluka Clinical Centre during one year were evaluated by the standard protocol during the hospitalization and three months after the stroke. It included clinical, functional and neuropsychological examination and neuroimaging. Dementia was diagnosed according to the criteria of National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences. Demographic and clinical variables were examined. After the exclusion of the patients who died (n = 139) and those who refused to be interviewed during the 3-month follow up (n = 52) and those with pre-stroke dementia (n = 22), a total of 273 (58.8%) patients underwent neuropsychological examination 3 months after the stroke. Forty-nine (19.52%) of them met the criteria for vascular dementia. The predictors of vascular dementia were age, atrial fibrillation, cognitive and functional impairment on admission and functional outcome, subcortical lacunar infarctions, leukoaraiosis, multiple and bilateral brain lesions. Dementia is frequent after stroke and it cannot be determined by a single factor. A combination of several factors increases the critical threshold for cognitive decline.

Expression of vascular endothelial growth factor in melanocytic nevi.

Melanocytic nevi represent a benign neoplastic proliferation of melanocytes. The level of vascular endothelial growth factor expression in these proliferations is low in most cases; whereas an increased expression of this factor may be an indicator of pre-neoplastic changes in melanocyte lesions. We performed a semi-quantitative assessment of the level of vascular endothelial growth factor expression (score 0 to 3) on samples taken from 34 patients with benign melanocyte alterations of the skin. Melanocytic nevi showed an expression of vascular endothelial growth factor in 79.41% of the cases. The low level of expression (score 1) was seen in 70.59% cases. The results showed no statistically significant difference in the presence and level of vascular endothelial growth factor expression in relation to the following morphological parameters: histological type, a defect in the surface, density of inflammation infiltrate, mitotic index, growth phase and cell type.

Our experience with thrombolytic therapy -- preliminary report.

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.

Functional outcome after thrombolytic therapy.

In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score > or=90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score < or =2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a 'door-to-needle' time of less than 60 minutes and emphasize that 'time is brain'.