Prevalence of anencephaly in the region of Rijeka, Croatia.

This retrospective study determines the prevalence of anencephaly in the region of Rijeka, Croatia. Records of all spontaneous and therapeutic abortions terminated in medical institutions, all fetuses weighing more than 500 g or more than 22 weeks gestation (whether the product of abortion, therapeutic termination, stillborn or liveborn) and infants who died in the first year of life in the region of Rijeka, Croatia, during the 1963-2000 period were reviewed. There were 135,451 births; 22 of them were anencephalics (19 stillborn), which comprises 0.2% of all births and 2.1% of stillbirths. Annual prevalence of anencephaly varied in range from 0.00 to 7.42 per 10,000 births. In two cases pregnancy was electively terminated after ultrasonographic diagnosis of anencephaly. Fifteen anencephalics were female, six were male, and in one case sex was undetermined due to aplasia of genital organs. Associated congenital malformations were detected in 18 anencephalics. The importance of establishing national and international registers of congenital malformations in all countries is stressed. The authors suggested that the setting of obligatory reporting of all congenital malformations would be the first step toward this practice in Croatia, as well as in other developing countries.

Technical note: simple vibroacoustic foetal stimulator.

PRIMARY OBJECTIVE: To build and test a simple vibroacoustic foetal stimulator. RESEARCH DESIGN: A vibroacoustic foetal stimulator was constructed and subjected to bench testing. Clinical trial was carried out in comparison to an electro laynx. MAIN OUTCOME AND RESULTS: Screening specificity of 98% and 100% sensitivity was achieved, with no decrease in specificity due to user's maladjustments. The device was characterized by simple use, maintenance and disinfection. CONCLUSIONS: The device is a good screening instrument for foetal health in prenatal care, despite its simplicity and low price.

[The effect of maternal smoking on pregnancy outcome]. / Utjecaj majcina pusenja na ishod trudnoce.

The aim of the study was to determine the influence of smoking on the pregnancy outcome. The retrospective study was based on the original database made at the Department of Gynecology and Obstetrics, Medical School, University of Rijeka, in the period between 1987 and 1997. In the mentioned period we analysed 37,417 total singleton births out of which there were 1,685 (4.5%) preterm and 35,732 (95.5%) term births, as well as 1,739 (4.6%) hypotrophic and 35,678 (95.4%) eutrophic newborns. The analysis of smoking during the whole pregnancy on the gestation outcome was performed in 9,895 (26.4%) parturient smokers and 27,522 (73.6%) parturient nonsmokers (control group). The frequency of preterm and/or term delivery, intrauterine fetal growth retardation, Apgar score, birth weight, as well as morbidity and perinatal mortality, were analysed in both groups. The frequency of preterm deliveries was 5.4% (n = 529) in parturient smokers and 4.2% (n = 1,156) in parturient nonsmokers. This difference is statistically significant (p < 0.001). The frequency of hypotrophic newborns born to parturient smokers (n = 631 or 6.4%) was statistically significantly higher (p < 0.001) compared to the frequency of hypotrophic newborns (n = 1,108 or 4.0%) born to parturient smokers. The obtained results point to the importance of chronic smoking during pregnancy as a risk factor in the development of maternal and/or fetal complications.

Zinc levels in human milk and umbilical cord blood.

Zinc levels were determined in human milk and umbilical cord blood samples collected in the Rijeka Clinical Hospital during the period from September 1995 to January 1996. The average concentrations of zinc were 4.98 +/- 2.53 mg/l in breast milk (range: 1.69-11.60 mg/l) and 1.18 +/- 0.21 mg/l in umbilical cord blood (range: 0.87-1.91 mg/l). Results of group comparisons regarding mothers' age, parity, residence and smoking habits indicate that parity affected Zn levels in both, breast milk and umbilical cord blood, with higher content found in primiparae. Younger mothers (aged < or = 25 years) also had higher levels of Zn in breast milk compared to those whose age was > 25 years. Residence and smoking habits did not seem to have any impact on Zn concentrations in biological tissues studied. A weak association between umbilical cord blood Zn levels and anthropometric measurements of newborns, like birthweight and head circumference, is also observed.

Fetal biophysical profile and vibratory acoustic stimulation in high-risk pregnancies.

OBJECTIVES: To determine the influence of the non-stress test (NST) on the efficiency of the fetal biophysical profile (FBP) and to test the clinical usefulness of the FBP and its combination with vibratory acoustic stimulation (VAS) in managing high-risk pregnancies. METHODS: One hundred twenty fetuses of preeclamptic patients were included in a prospective study. Five standard variables of the FBP were observed ultrasonically following NST. In cases of non-reactive NST, external VAS was applied and the FBP score calculated and compared with the FBP score before VAS. RESULTS: Of 120 calculated FBPs, 102 (85%) had normal profile scores before VAS and 104 (86.7%) after VAS. No statistically significant difference was found. The sensitivity, specificity, and positive and negative predictive values of the FBP score in predicting poor perinatal outcome were 94.7%, 94.4%, 75% and 99%, respectively. VAS produced a high conversion (58.8%) of non-reactive NST to reactive fetal heart rate pattern. The false-negative rate of the FBP score was 9.8 per 1000, which did not increase after VAS. CONCLUSIONS: The efficiency of the FBP score was not significantly improved by VAS, although a high conversion of non-reactive to reactive NST was produced. The FBP with its three 'acute biophysical variables' was found to be an accurate method of antepartum assessment even without an NST. The low incidence of perinatal complications among patients with normal FBP scores, permits the conservative management of preterm high-risk pregnancies.

[Evaluation of the quality of life of disabled workers based on the most frequently used type of health care]. / Procjena kvalitete zivota invalida rada na osnovi koristenja najcescih oblika zdravstvene zastite.

An investigation was conducted among the dock workers from the port of Rijeka, where disabled workers made 13.1% of the total number of the employed. The most common causes of disablement were musculo-skeletal and connective tissue diseases (27%), injuries (20%) and diseases of the nervous and circulatory systems (13%). Chronic diseases in these workers whose mean age was 43.8 years were twice as frequent as in other workers (mean age 39.7 years). The average working span of disabled workers was 12.2 years, compared to 8.9 years of the rest of the working population. Analysis showed that in the year after disability assessment, workers with reduced working capacity visited their physicians 2.1 and specialists 1.7 times less often than the other workers. In general, the rate of absenteeism in the year following the assessment of disability was reduced 3.5 times. All the differences were very significant, (P < 0.01). Results lead to the conclusion that medical and social rehabilitation of disabled workers as well as their integration into the working environment were very successful, which undoubtedly had a positive impact on the quality of their life.

[Fetal death in the 20th to the 36th week of pregnancy]. / Smrtnost ploda u trudnoci od 20. do 36. tjedna.

In the period from 1986 to 1988, intrauterine fetal deaths from 20-36 weeks of gestation and 500 gm and more birth weight were analysed in a prospective study from the clinical and pathomorphological point of view. There were 57 such fetal deaths or 7.96% of the total number of 716 births till the 36th week of gestation, while 42.4% of women with the intrauterine fetal loss were cigarette smokers during pregnancy vs. 29.1% of such women among all those who gave birth during the same period. Smokers faced a relative risk of 1.8 for the fetal loss between the 20th and the 36th week of gestation. From the clinical standpoint, the cause of death was presumed in 40 or 71.4% of cases, while only in 24 or 42.1% of autopsies could the pathomorphological disorder be considered the cause of the intrauterine death. In 47 or 82.5% of cases, the observed pathomorphological disorders of the placenta, fetal membranes or the umbilical cord could also have contributed to the fetal death. Most often, i.e. in 20 or 35.1% of cases, chorioamnionitis was diagnosed and in 13 (22.3%) cases disorders of the placental circulation. In 7 cases (12.3%) neither clinical nor pathomorphological potential cause of death could be found. From the health care point of view it is important to find out those risk factors of fetal mortality which are preventable. Smoking during pregnancy could be the most preventable risk factor of fetal death.

[Changes in the anterior segment of the eye in workers in the coke manufacturing industry]. / Promjene prednjeg segmenta oka u radnika u proizvodnji koksa.

An investigation carried out of eye disorders in workers employed in the manufacture of coke demonstrated a high percentage of changes in the anterior segment of the eye. Registered symptoms such as conjunctival hyperemia, pinguecula, pigmentation and conjunctivitis were most probably connected with specific work and exposure to coal dust and irritants. In workers exposed for less than two years there were no changes in lacrimal secretion. In those working for 2-7 years excessive hypersecretion dominated, and after a longer period of exposure the majority of workers had hyposecretion.

[Lacrimal hyposecretion in women working with video terminals]. / Hiposekrecija suza kod radnica na videoterminalu.

Tests of vision and lacrimal secretion were performed as part of a general medical check-up among women employed at video-terminals in a bank. The tests were taken by three groups of 100 employees each. The first group consisted of full-time (eight hours) employees, the second of those working part-time (the time spent at a video-terminal daily was never less than two hours of continuous work) and a third group of control subjects having different clerical jobs but working in the premises with video-terminals. Diminished lacrimal secretion was most often present among full-time workers (20 per cent). A statistically significant difference in lacrimal secretion was observed between the first and the second group of examinees. There was no significant difference between the second group and the controls.

[Potassium diffusion potentials in fetal erythrocytes and leukocytes in umbilical cord blood]. / Kalijski difuzijski potencijal fetalnih eritrocita i leukocita iz krvi pupkovine.

The potential of the membrane erythrocytes and leucocytes from the fetal umbilical cord blood was studied in order to determine the vitality of cells. The membrane erythrocytes potential was analysed in 11 blood samples of normal deliveries and 3 blood samples of deliveries with the meconium amniotic fluid; the membrane leucocyte potential was examined in 16 blood samples of normal deliveries and 5 blood samples of deliveries with the meconium amniotic fluid. The method used was the indirect fluorescence spectroscopy and the cyanin dye DIO-C5-(3) as the extrinsic fluorescent probe. In deliveries with the meconium amniotic fluid, leucocyte and erythrocyte membranes continue maintaining the potassium potential. The reactions of erythrocytes and leucocytes to the addition of valinomycin are entirely different: in the leucocytes of fetuses with the meconium amniotic fluid the membrane is more polarized than in fetuses from normal deliveries, whereas in the erythrocytes of fetuses with the meconium amniotic fluid the membrane polarization is less pronounced.

[The effect of histamine and histamine H1 and H2 receptor blockers on the tone of the longitudinal muscles in the human appendix]. / Utjecaj histamina i blokatora histaminskih H1 i H2 receptora na tonus longitudinalne muskulature humanog apendiksa.

The aims of this study were to determine whether the effect of histamine on a smooth musculature of the human appendix is mediated by histamine H1-receptors only or whether histamine H2-receptors are involved, as well. The obtained results indicate histamine increases tonus in musculature; however, histamine H1-receptor antagonist (promethazine) decreases tonus. Histamine H2-receptor antagonist (cimetidine) has caused a mild increase in tonus of musculature what indicates that it has a certain intrinsic activity. By blocking histamine receptors with H1 and H2 antagonists which were used either separately or together before cumulative histamine concentrations, it has been concluded that histamine actions are exerted not exclusively by H1-receptors but also histamine H2-receptor antagonists can significantly decrease the tonicizing effect of histamine.

[The effect of prostaglandin F2 alpha and indomethacin on the musculature of the human appendix]. / Utjecaj prostaglandina F2 alpha i indometacina na muskulaturu humanog apendiksa.

In their research, the authors have tried to determine possible differences in effects of prostaglandin F2 alpha on longitudinal musculature tonus in normal and inflamed human appendix and the extent to which it is possible to react on prostaglandin effect by indomethacin. The obtained results indicate that PGF2 alpha increases tonus in human appendix musculature; however, the change is more pronounced in a normal appendix musculature. Even more, indomethacin prevents spasms caused by PGF2 alpha in musculature of both normal and inflamed appendix significantly. This indicates that, in addition to its influence on prostaglandin synthesis indomethacin also has another mechanism of activity, may be even at the level of prostaglandin receptors.

The chronotropic effect of histamine, prometasin and cimetidin on rat heart.

The effect of histamine, prometasin (the blocker of histamine H-1 receptor) and cimetidin (the blocker of histamine H-2 receptor) on the frequency of the isolated right atrium of rat was studied. Histamine, prometasin and cimentidin were applied cumulatively in concentrations of 5.4 X 10(-6) to 16.3 X 10(-3) mmol/l so that each new concentration was 3.3 times higher than the preceding one. The positive chronotropic effect of histamine was shown to be strongest with a concentration of 5.4 X 10(-3) mmol/l. Prometasin and cimentidine applied in increasing concentrations gave a negative chronotropic effect. Prometasin and cimetidin applied in a concentration of 5.4 X 10(-3) mmol/l before histamine, decreased the positive chronotropic effect of histamine to more than 60% no matter whether prometasin and cimetidin were applied alone or together. This finding suggests that the effect of histamine on rat heart is mainly realized via histamine H-1 and H-2 receptors and partly through releasing catecholamines from the adrenergic nerve terminal.