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.

Acute acalculous cholecystitis in patients with surgical acute renal failure.

Acute acalculous cholecystitis (AAC) developed in 11 (7.7%) of 143 patients with surgical acute renal failure (ARF) who had no prior biliary tract disease. The cause of this potentially fatal complication is multifactorial and include trauma, previous surgery, sepsis, intermittent positive pressure ventilation, total parenteral nutrition, multiple transfusions, hypotension, and opiate sedation. The diagnosis of AAC was based on clinical suspicion, ultrasound scanning, and laboratory tests (leukocyte count, liver enzymes, bilirubin and C-reactive protein). All our ARF patients with AAC were receiving antibiotics at the time of diagnosis. Five patients were treated conservatively and six underwent cholecystectomy. The mortality rate in our ARF patients with AAC was 45.5%, and was not significantly different from than in ARF patients without AAC. The diagnosis of AAC should be made early, and judicious management (conservative or surgical) decreases its role as a contributory factor to the mortality in ARF patients.

Computed tomographic imaging to determine the frequency of anatomical variations in pneumatization of the ethmoid bone.

The present study was performed on axial and coronal CT scans of 212 patients. Scans were analyzed by an anatomist and a radiologist for the presence of Haller's cells, agger nasi cells, Onodi's cells and pneumatized crista galli. Results demonstrated the presence of Haller's cells in 21.2%, Onodi's cells in 10.4% and pneumatized crista galli in 2.4% of patients. A pneumatized anterior clinoid process was found in 0.5% of the patients. The data obtained in our study were compared with those reported in other anatomic and radiologic studies.

Topoanatomic relations of the ophthalmic artery viewed in four horizontal layers.

In the present paper we have studied the gross anatomy of the ophthalmic artery in 200 human cadaver dissections viewed in four horizontal layers. The ophthalmic artery can be divided into the origin, intracranial, intracanalicular and intraorbital parts. The most common origin of the artery was from the medial half of the anterior side of the internal carotid artery (ICA) in its upper curve (52%), followed by the medial half of the superior side (44%), and in only 4% from the medial side of the upper curve of the ICA. We have examined the topographic anatomy of the ophthalmic artery in detail, and found a rare anastomosis of the ophthalmic artery with the frontal branch of the middle meningeal artery.

Osteogenic protein-1 (bone morphogenetic protein-7) reduces severity of injury after ischemic acute renal failure in rat.

We have shown that osteogenic protein-1 (OP-1) (bone morphogenetic protein-7) is responsible for the induction of nephrogenic mesenchyme during embryonic kidney development. Gene knock-out studies showed that OP-1 null mutant mice die of renal failure within the first day of postnatal life. In the present study, we evaluated the effect of recombinant human OP-1 for the treatment of acute renal failure after 60 min bilateral renal artery occlusion in rats. Bioavailability studies in normal rats indicate that approximately 1.4 microg OP-1/ml is available in the circulation 1 min after intravenous administration of 250 microg/kg, which then declines steadily with a half life of 30 min. About 0.5% of the administered OP-1 dose/g tissue is targeted for OP-1 receptors in the kidney. We show that OP-1 preserves kidney function, as determined by reduced blood urea nitrogen and serum creatinine, and increased survival rate when administered 10 min before or 1 or 16 h after ischemia, and then at 24-h intervals up to 72 h after reperfusion. Histochemical and molecular analyses demonstrate that OP-1: (a) minimizes infarction and cell necrosis, and decreases the number of plugged tubules; (b) suppresses inflammation by downregulating the expression of intercellular adhesive molecule, and prevents the accumulation and activity of neutrophils; (c) maintains the expression of the vascular smooth muscle cell phenotype in pericellular capillaries; and (d) reduces programmed cell death during the recovery. Collectively, these data suggest that OP-1 prevents the loss of kidney function associated with ischemic injury and may provide a basis for the treatment of acute renal failure.

[Pneumatization of the middle nasal turbinate: a CT study]. / Pneumatizacija srednje nosne skoljke: CT prikaz.

Anatomic variations of the middle turbinate may be an important factor in the pathogenesis of inflammatory processes of the paranasal sinuses. A detailed analysis of coronal and axial plane CT scans of the paranasal sinuses obtained from 120 patients was performed. Paradoxical curve of the middle concha was detected in 24.2% of patients. Pneumatized middle turbinate was found in 42.5% and "true" concha bullosa in 8.3% of patients. Bilateral concha bullosa was found in 1.7% of patients.

Regeneration of articular cartilage defects in rabbits by osteogenic protein-1 (bone morphogenetic protein-7).

Osteogenic protein-1 (OP-1, BMP-7), a member of the transforming growth factor-beta family, induces cartilage and bone formation when implanted at intra and extraskeletal sites in vivo. The human OP-1 gene has been cloned and biologically active recombinant OP-1 homodimers have been produced. In the present study, the authors investigated the influence of OP-1 on healing of full-thickness articular cartilage defects, made by drilling two adjacent (phi 3mm) holes through articular cartilage of NZW rabbit knee joint were dissected and examined histomorphometrically. Results indicated that OP-1 induced articular cartilage healing and regeneration of the joint surface which contained cells resembling mature joint chondrocytes. These data imply a new strategy for biological repair of damaged joint surfaces in humans.

Differences between male and female breast cancer. II. Clinicopathologic features.

The aim of this study was direct comparison of clinicopathologic features in male and female breast cancer patients. The study included 100 male and 500 female patients with pathohistologically confirmed breast cancer, who were treated at the University Hospital for Tumors in Zagreb, Croatia, between 1970 and 1990. The results revealed significant sex-related differences in the following characteristics: patients age at diagnosis (36% vs. 66% below the age of 60, respectively, p < 0.001), delay in treatment (29% vs. 58% within the first 3 months, p < 0.001), tumor size (45% vs. 58% up to 5 cm, p < 0.001), number of affected regional lymph nodes (74% vs. 87% up to 5 nodes, p < 0.01), TNM-stage distribution (49% vs. 56% in stages I-II, p < 0.001), estrogen receptor values (69% vs. 32% > 10 fmol/mg protein, p < 0.001) and progesterone receptor values (67% vs. 48% > 10 fmol/mg protein, p < 0.05). No significant sex-related differences in breast cancer patients were found regarding histologic grade of malignancy (males: grade I-36%; II-34%; III-30%; females: grade I-33%; II-36%; III-31%), affected breast (left in 58% males vs. 50% females), and type of surgical treatment (modified radical mastectomy in 64% male vs. 61% female patients). This study confirmed the well-known facts that male breast cancer develops at an older age and with a much higher proportion of positive tumor hormone receptors. Furthermore, the authors found the male patients in Croatia to be insufficiently informed about the possibility of breast cancer development in male sex, which resulted in a significantly prolonged treatment delay and, consequently, higher TNM stage of the disease, bigger tumors and more affected lymph nodes at the time of diagnosis in comparison to female patients.

Differences between male and female breast cancer. III. Prognostic features.

The aim of this study was direct comparison of prognostic features in male and female breast cancer patients. The study included 100 male and 500 female patients with pathohistologically confirmed breast cancer, who were treated at the University Hospital for Tumors in Zagreb, Croatia, between 1970 and 1990. Stage-adjusted univariate analysis of differences in five-year overall survival revealed similar prognosis in both sexes when the disease was in TNM-stages I and II (males: 95% and 80%; females: 90% and 79%, respectively). However, the study showed that in TNM stages III and IV, male patients had a significantly worse five-year overall survival (males: 39% and 5%; females: 61% and 27%, respectively; p < 0.05). The impact of ten clinicopathologic characteristics on survival in males and females was also analyzed through the multivariate statistical analysis, in this case by multiple regression. Analyzed characteristics included patient age at diagnosis, delay in treatment, tumor size, number of affected lymph nodes, TNM-stage, histologic grade, affected breast, estrogen and progesterone receptor values, and type of surgery. An extremely intriguing finding was that the percent of survival variance explained by ten selected predictors (R2) amounted to as much as 78.7% in males, in comparison to only 23.1% in females. Three predictors that explained most of the survival variance in males were TNM-stage (21.0%), number of affected lymph nodes (19.5%) and delay in treatment (16.2%). The most important corresponding prognostic factors in females were number of affected lymph nodes (12.7%), histologic grade (6.6%) and tumor size (5.9%). The authors concluded that, from the prognostic point of view, male and female breast cancer represent two quite different diseases: in males, the outcome can be very precisely predicted from the basic clinicopathologic characteristics of the disease, while in females there is probably a wide spectrum of other factors with a significant influence on the prognosis, which require additional studies.

TGF-beta and basement membrane matrigel stimulate the chondrogenic phenotype in osteoblastic cells derived from fetal rat calvaria.

Primary cultures of fetal rat calvarial cells contain a spectrum of osteogenic phenotypes including undifferentiated mesenchymal cells, osteoprogenitor cells, and osteoblasts. We recently demonstrated that rat calvarial osteoblast-like cells grown on basement membrane undergo profound morphological changes resembling a canalicular network in bone. In the present study, we examined the effect of reconstituted basement membrane Matrigel on chondroblastic versus osteoblastic differentiation of different cell subpopulations obtained by five consecutive enzymatic digestions of rat calvarial cell populations. We found that the appearance of canalicular cell processes decreased with the later digests. When cells from the fourth and fifth digest were grown on top of Matrigel for 7 days, the majority of the cell aggregates displayed chondrocytic characteristics but none of the cells became hypertrophic. When individual chondroblastic cell aggregates were subsequently transferred from Matrigel to plastic, they started expressing types I and X collagens, alkaline phosphatase, and osteocalcin. Within the next 7 days (days 8-14 of the experiment), the majority of cells increased in size, and at day 17 on plastic (day 24 of the experiment) mineralized bone nodules formed. The chondroblastic differentiation of calvarial cells grown on Matrigel could be inhibited by a specific transforming growth factor-beta 1 (TGF-beta 1) but not by a TGF-beta 2 antibody. Addition of recombinant TGF-beta 1 to similar cultures promoted the appearance of chondroblastic cell aggregates. The cartilage phenotype could not, on the contrary, be promoted by growing the cells on other extracellular matrices such as a collagen I gel. We suggest that TGF-beta 1 in concert with the basement membrane extracellular matrix induces chondroblastic differentiation of rat calvarial osteoprogenitor cells.

[4 cases of Richner-Hanhart syndrome (tyrosinemia type II) with neurological symptomatology in a Yugoslav family]. / Vier Fälle von Richner-Hanhart-Syndrom (Tyrosinämie Typ II) mit neurologischer Symptomatologie in einer jugoslawischen Familie.

Findings are described in four cases of Richner-Hanhart syndrome in a Yugoslavian family; this disorder is transmitted as an autosomal recessive trait. This family was first reported in 1963. Now tyrosinemia and tyrosinuria can be found in all cases, and neurological symptoms are also present in all cases, whereas earlier only one of them had these symptoms. In the meantime, the lesions on the soles of the feet have been totally excised in three cases, partially in one, and split thickness grafts from the normal skin have been applied. The palmar lesions were treated in the same manner in two cases. The possibilities for surgical treatment of this very painful, inherited form of dermatosis and their consequences are discussed. Surgical treatment is recommended for palmar lesions, but not for the plantar form. The pathogenesis of the dermatologic manifestations in this rare metabolic disease is briefly discussed.

[Epidermodysplasia verruciformis-like genodermatosis with changes in the nails]. / Epidermodysplasia verruciformis-ähnliche Genodermatose mit Veränderungen der Nägel.

Nine cases of genodermatosis are described, in which the clinical symptoms and light-microscope findings resembled those in epidermodysplasia verruciformis (Lewandowsky-Lutz disease). All had alterations of the fingernails and toenails. Viruses were not found in a excised skin lesions or in the fingernail clipping from the patients. The mode of inheritance of the dermatosis seems to be X-chromosomal and dominant. It is the opinion of the authors that this dermatosis is separate entity from epidermodysplasia verruciformis.