Rapid, effective, and long-lasting behavioral recovery produced by microsutures, methylene blue, and polyethylene glycol after completely cutting rat sciatic nerves.

Behavioral function lost in mammals (including humans) after peripheral nerve severance is slowly (weeks to years) and often poorly restored by 1-2-mm/day, nonspecifically directed outgrowths from proximal axonal stumps. To survive, proximal stumps must quickly repair (seal) plasmalemmal damage. We report that, after complete cut- or crush-severance of rat sciatic nerves, morphological continuity, action potential conduction, and behavioral functions can be consistently (>98% of trials), rapidly (minutes to days), dramatically (70-85% recovery), and chronically restored and some Wallerian degeneration prevented. We assess axoplasmic and axolemmal continuity by intra-axonal dye diffusion and action potential conduction across the lesion site and amount of behavioral recovery by Sciatic Functional Index and Foot Fault tests. We apply well-specified sequences of solutions containing FDA-approved chemicals. First, severed axonal ends are opened and resealing is prevented by hypotonic Ca²âº-free saline containing antioxidants (especially methylene blue) that inhibit plasmalemmal sealing in sciatic nerves in vivo, ex vivo, and in rat B104 hippocampal cells in vitro. Second, a hypotonic solution of polyethylene glycol (PEG) is applied to open closely apposed (by microsutures, if cut) axonal ends to induce their membranes to flow rapidly into each other (PEG-fusion), consistent with data showing that PEG rapidly seals (PEG-seals) transected neurites of B104 cells, independently of any known endogenous sealing mechanism. Third, Ca²âº-containing isotonic saline is applied to induce sealing of any remaining plasmalemmal holes by Ca²âº-induced accumulation and fusion of vesicles. These and other data suggest that PEG-sealing is neuroprotective, and our PEG-fusion protocols that repair cut- and crush-severed rat nerves might rapidly translate to clinical procedures.

[Eleven years of registration of congenital anomalies in Croatia associated with the EUROCAT international project]. / Jedanaestogodisnje registriranje kongenitalnih anomalija u Hrvatskoj u sklopu medunarodnog projekta EUROCAT.

Results of the eleven-year registration of congenital anomalies in Croatia are presented. Zagreb Registry as a part of international EUROCAT (European Registration of Congenital Anomalies) project covers four regional centers (Varazdin Rijeka, Pula and Koprivnica). The ascertainment, calculation of prevalence rates and statistical methods are based on EUROCAT method of investigation. Mean prevalence rate of 18.86/1000 births (1228 children with congenital anomalies per 65,100 births) was registered in the 1983-1993 period. The most frequently registered anomalies were congenital heart diseases, a heterogenous group of limb defects, oral clefts, central nervous system anomalies and chromosomal aberrations. The most frequent structural anomalies expressed as rates per 1000 births are ventricular septal defect (1.8), cleft lip +/- palate (1.1), atrial septal defect (0.8) polydactyly (0.8) and limb reduction defects (0.5). Statistical analysis shows a fluctuation of Down's syndrome prevalence rates during the monitored period. Statistically significant differences (p < 0.01) in prevalence rates among four regions of Croatia were established. The prevalence rates of marker anomalies (Down's syndrome, polydactyly, oral clefts) are tenfold higher compared to routine statistical data of Republic of Croatia. Acquired experience, collaboration and results obtained in this project represent a good basis for more rational planning of medical care and further investigation of this significant medical and public health problem.

The need and value of routine screening of all pregnant women for hepatitis B surface antigen.

A prospective study was performed to determine whether the risk factor for hepatitis B, proposed by Centers for Disease Control (CDC), USA, are reliable predictors for the hepatitis B surface antigen (HBsAg) carrier state in an obstetric population. In the period between January 1, 1991 and December 31, 1992, all pregnant women from geographically defined areas of the Istrian and Rijeka districts were routinely screened for hepatitis B surface antigen (HBsAg). Among 10,627 pregnant women, 107 (1%) HBsAg positive cases were registered. History risk factors recommended by CDC were recorded in 46 (43%) out of 107 HBsAg positive women. The other 61 subjects had no recognizable risk factors. The screening of pregnant women for HBsAg only on the basis of the CDC recommended history guidelines, would have left 57% of our HBsAg positive mothers undetected and therefore their children unvaccinated against hepatitis B infection. Our results confirmed the need and value of the new CDC recommendations about routine prenatal screening of all pregnant women for HBsAg until hepatitis B vaccine is included in the scheme of compulsory vaccination of all newborns.

[Congenital central paralysis of the facial nerve in a newborn infant]. / Kongenitalna centralna pareza zivca facijalisa u novorodenceta.

A case of congenital paresis of the supranuclear facial nerve on the left side in a newborn is presented. His mother has also congenital central facial nerve paresis and for this reason the same anomaly in the newborn was considered to be due to a genetic defect in the intrauterine development. No other lesions in the pyramidal tract were observed. At the infant's birth, a mild form was found of the partial pneumothorax which spontaneously disappeared. The authors suggest a multidisciplinary approach in the study of congenital facial nerve lesions.