Concentration and mobility of trace elements (Li, Ba, Sr, Ag, Hg, B) and macronutrients (Ca, Mg, K) in soil-orchid system on different bedrock types.

The mobility of chemical elements in the soil-orchid system has been poorly studied. The aim of this study is to evaluate the uptake and mobility of several trace (Li, Ba, Sr, Ag, Hg, and B) and macronutrients (Ca, Mg, and K) in the orchid Anacamptis morio (L.) R.M.Bateman, Pridgeon & M.W.Chase from soils in western Serbia. The sampling sites are characterized by three different bedrock types-cherts, limestones, and serpentines, which are the source of the significant chemical differences in the elemental status of the soil and plant tissues. The four-step Community Bureau of Reference sequential extraction procedure was used to determine the distribution of fractions and predict their potential phytoavailability. The orchid and soil samples were analyzed for total elemental content analysis using ICP-OES. The greatest potential for plant availability was determined for Ba and Sr, representing about 80% of the total soil content. More than 40% of Li in the soils was found to be potentially phytoavailable. Significant correlations were found between the total content of Li, B, and Sr in soils. Between 38 and 60% of Li content and more than 80% of Ba and Sr content were determined to be potentially phytoavailable by sequential analysis. The highest bioconcentration factor (> 1) was determined in the case of B and Sr for all orchid organs, while translocation factor for Li was highest in tubers and leaves. The studied elements were mainly stored in tubers and roots, indicating the exclusion strategy of A. morio as a metal tolerance mechanism. The data obtained showed significant differences in metal content in soils and plants originating from sites with different parent materials, suggesting that bedrock type and associated soil properties are important factors that determine chemical element mobility and uptake.

The Phytoremediation Potential and Physiological Adaptive Response of Tamarix tetrandra Pall. Ex M. Bieb. during the Restoration of Chronosequence Fly Ash Deposits.

The challenging process of identifying and selecting plant species suited to the phytoremediation of fly ash (FA) dumps involves studying their functional properties and physiological response to a deficit of essential elements and toxicity from heavy metal(loid)-induced oxidative stress. We hypothesised that Tamarix tetrandra has high potential to be used for the phytoremediation of FA deposit sites thanks to its secretion strategy and antioxidative system. In this study, this hypothesis was examined by determining the bioconcentration and translocation factors for As, B, Cr, Cu, Mn, Ni, Se and Zn at the FA disposal lagoons at the 'Nikola Tesla A' thermal power plant in Obrenovac, Serbia, three (lagoon L1) and eleven (lagoon L2) years after the phytoremediation process had begun, and by measuring parameters of photosynthetic efficiency and chlorophyll concentration, non-enzymatic antioxidant defence (carotenoids, anthocyanins and phenolics), oxidative stress (concentration of malondialdehyde-MDA) and total antioxidant capacity to neutralise DPPH free radical activity. Tamarisk not only showed the ability to phytostabilise As, Cr and Ni and to accumulate low-availability Mn, Zn and Cu, but also the potential to maintain the structural and functional integrity of cell membranes and stable vitality at L1 under multiple stress conditions due to the high synthesis of phenols and tolerance to increased salinity. However, toxic concentrations of B and Se in leaves induced oxidative stress in tamarisk at L2 (reflected in higher MDA content and lower vitality) and also decreased the synthesis of chlorophyll, carotenoids, anthocyanins and total antioxidant activity. In addition, the prooxidative behaviour of phenols in the presence of spin-stabilising metals from FA could also have resulted in their weaker antioxidant protection at L2. These findings indicate that the choice of tamarisk was justified, but only at the beginning of the phytoremediation process because its presence contributed to an improvement in the harsh conditions at FA deposit sites and the creation of more favourable conditions for new plant species. This knowledge can be of great importance when planning sustainable ash deposit site management worldwide.

An Assessment of the Phytoremediation Potential of Planted and Spontaneously Colonized Woody Plant Species on Chronosequence Fly Ash Disposal Sites in Serbia-Case Study.

In this study, the potential of planted (Tamarix tetrandra Pall. ex M.Bieb. and Robinia pseudoacacia L.) and spontaneously colonized (Amorpha fruticosa L. and Populus alba L.) woody species for the phytoremediation of potentially toxic trace elements (TEs) such as As, B, Cr, Cu, Mn, Ni, Se, and Zn, from the chronosequence fly ash (FA) deposit lagoons (L1 and L2) at the 'Nikola Tesla A' Thermal Power Plant (TENT-A) in Serbia were analyzed. The differences in the pseodototal and bioavailable (DTPA-extractable) concentrations and mobility (AR index) of TEs in FA at the examined lagoons are a result of the time-conditioned influence of weathering (3 and 11 years respectively) and vegetation development on changing the basic physical and chemical properties of FA (texture, pH, EC, CEC, C, N, and bioavailable P and K) and its toxicity. This resulted in differences in the concentration of TEs in the roots and leaves of the examined plants at L1 and L2. All examined species accumulated Cr the most in the root (BAF > 1 and TF < 1), which suggests that they are good stabilizers of this element. Biological indices for As (BAF > 1 and TF < 1) identified T. tetrandra and A. fruticose as good stabilizers of As. P. alba stood out as accumulating the highest levels of B, Ni, and Zn, T. tetrandra the highest levels of Cu, Mn, and Se, and R. pseudoacacia the highest levels of As and B in leaves (BAF > 1; TF > 1), which makes them good extractors of these elements from the FA at TENT-A. However, due to toxic concentrations of As, B, Se, and Zn in their leaves, they are not recommended for the phytoremediation of the investigated lagoons through the process of phytostabilization. Under conditions of elevated total Cu and Ni concentration in FA, the content of these elements in the leaves of A. fruticosa at both lagoons were within the normal range. This, in addition to a good supply of essential Zn, the stabilization of As and Cr in the roots, an increase in BAF, and a decrease in TF for B with a decrease in its mobility in ash over time, singles this invasive species out as the best candidate for the phytostabilization of TEs in FA at the TENT-A ash deposit site.

Phytoremediation Potential, Photosynthetic and Antioxidant Response to Arsenic-Induced Stress of Dactylis glomerata L. Sown on Fly Ash Deposits.

Arsenic (As) from coal fly ash can be released into soil/groundwater, presenting a global threat to the environment and human health. To overcome this environmental problem, phytoremediation represents an urgent need, providing 'green' cleanup of contaminated lands. The present study focused on As concentrations in fly ash and plants, evaluation of phytoremediation potential of Dactylis glomerata sown on fly ash deposits together with its photosynthetic activity, and oxidative and antioxidative response to As stress. Field research was carried out on fly ash deposits at the thermal power plant "Nikola Tesla", Obrenovac (TENT-A, Serbia) and the control site. Fly ash is characterized by alkaline pH reactions, small amounts of organic matter, a large amount of available phosphate, and total and available As concentrations. Results in this study indicate that phosphate application can ameliorate As toxicity, uptake and root-shoot transport. Furthermore, D. glomerata can be considered as good As phytostabilizator, because it retains more As in roots than in leaves. Excess As in leaves decreases photosynthetic efficiency (Fv/Fm) and concentrations of chlorophylls, carotenoids, and anthocyanins, whereas high content of malondialdehyde (MDA) can be a signal for biosynthesis phenolics and ascorbic acid, providing cellular redox homeostasis and recovery of photosystem II (PSII) photochemistry. In the roots, low oxidative stress under high concentrations of As is related to intense antioxidant biosynthesis. Taken together, the results in this study indicate a high adaptive potential of D. glomerata to As stress. These findings may suggest that physiological and metabolic tools can be used as a way forward in the 'real field' scenario, phytomanagement of fly ash and ecosystem services providing sustainable phytoremediation of As-contaminated sites around the globe.

Oxidative stress induced by chlorpromazine in patients treated and acutely poisoned with the drug.

Background/Aim: Although chlorpromazine (CPZ) is an antipsychotic drug widely used in clinical practice for a long time, its mechanism of action has not been entirely defined. An extremely difficult managing of patients acutely poisoned with CPZ is additional reason for detailed studying its toxicity mechanisms. In this clinical study, we investigated whether the oxidative stress (OS) mediates CPZ toxic effects in the exposed patients. Methods: The patients were organized into 3 groups: the T-group - hospitalized patients receiving therapeutic doses of 75-150 mg CPZ/day; the overdosed group, divided into two subgroups: the group M and the group S - mildly (CPZ serum concentration: 0.21 ± 0.05 mg/L) and severely (CPZ serum concentration: 2.66 ± 0.25 mg/L) poisoned patients, respectively, and the group C (control group of healthy volunteers). Oxidative stress parameters [total antioxidative status (TAS) and malondialdehyde (MDA) in plasma)] and superoxide dismutase (SOD) activity in erythrocytes were measured spectrophotometrically, and CPZ concentrations in serum were monitored chromatographically. One set of measurements was performed in the group C and T, whereas two sets of measurements (after 24 hours and 48 hours) were done in the poisoned patients, groups M and S. Results: A decrease of TAS and increase of SOD activity were obtained in both subgroups of the poisoned patients, compared to the controls and the group receiving therapeutic doses of CPZ. A significant increase of MDA was achieved in severely poisoned patients, compared to all other groups. Conclusion: Changed oxidative stress parameters in patients poisoned with chlorpromazine indicate involvement of oxidative stress in the toxicity mechanism(s) of chlorpromazine.

A series of drawings of a patient with schizophrenia-like psychosis associated with epilepsy: captured illustration of multifaced self- expression.

INTRODUCTION: Drawings may give an insight into the complex mental process, however they have been underutilized in patients with psychosis associated with epilepsy. CASE REPORT: A 33-year-old, right handed female, diagnosed with schizophrenia-like psychosis associated with epilepsy, was treated in the Day Unit due to psychosocial rehabilitation. Besides other treatments, the patient underwent group analysis of drawings once a week. Qualitative analysis of the form and content of drawings made by free associations were performed. The varying of size and motives with vivid colours and the curve of perspective were documentated in three figures, followed by the last drawing which was without such elements. CONCLUSION: A series of drawings of patients with psychosis associated with epilepsy is needed to record a possible variations and disturbance of the immediate mental process. Group sessions may additionally contribute to diminish stigma and enhance psychosocial reintegration.

Bridging psychological barriers between the child and the father after his returning from the war: Could group art therapy help?

Introduction: War veterans with chronic post-traumatic stress disorder (PTSD) have poorer family and parenting functioning, but little research has focused on these impairments. Case report: This paper presented how the series of drawings and the group art therapy process enhanced bridging the psychological barriers of a 33-year-old male PTSD war veteran to engagement with the child. After two years of deployment he returned home and suffered mostly from PTSD numbness and avoidance symptoms. The veteran had the family readjustment difficulties and felt guilty for being detached from his 3-year-old son. He under-went integrative treatment in the Day Unit Program. The drawings series were made by free associations. Clinical observations and group discussions were recorded in the group art therapy protocols. The presented patient got gratifications and support from the group members for his illustration of popular cartoon heroes, and decided to draw Mickey Mouse at home. On the next session he shared his satisfaction for bridging the gap between him and his son, having done the same drawings with his son at home. Beck's depression inventory (BDI) was used for self-rating of depression and a reduction of BDI score from 18 to 6 during the treatment course was recorded. Conclusions: Series of drawings illustrated shift from war related past toward current family life of the war veteran. Group art therapy gave him gratification and support with hope and a sense of belonging, thus facilitated his parenting readjustment.

Re-evaluating disability assessment in war veterans with posttraumatic stress disorder.

Background/Aim: Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. Methods: The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans' military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale ­ CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. Results: There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. Conclusion: The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.

Posttraumatic stress disorder and art group therapy: Self-expression of traumatic inner world of war veterans.

Background/Aim: Art therapy and drawings may serve as alternative means of expression and release from trauma among veterans diagnosed with posttraumatic stress disorder (PTSD). Methods: The retrospective clinical study of drawings of war veterans was performed. A total of 89 war veterans met the Diagnostics and Statistical Manual of Mental Disorders (DSM-IV) PTSD criteria and were consecutively admitted to the Day Hospital during 5 years. Art group therapy as part of integrative treatment was performed once a week. The group was open and heterogeneous. Qualitative analysis of drawings content and group protocols were obtained. The drawings were made by free associations. War related themes were explored and descriptive statistics were applied. Results: The most frequent type of common themes of combat stress presented battle and witnessing wounded and killed combatants. Less frequent were themes of graves, destroyed cities and broken trees. The veterans preferred black and red colors with association to death, blood, wounds and destroyed objects. Conclusion: Drawing could provide a unique, complex, visual illustration of war traumatic experiences and memories of posttraumatic stress disorder veterans. Art group discussion might enhance war veterans' verbal expression due to group support in safe setting. As adjuvant psychotherapy, art group therapy could enrich awareness and the ability of clinicians to treat hard posttraumatic stress disorder symptoms related to uncovered war trauma.

Correlation and characteristics of self-rating and clinically rating depression among alcoholics in the course of early abstinence.

BACKGROUND/AIM: Depression is an alcoholism relapse risk factor, but frequently stays underdiagnosed among treated alcoholics. The correlation and characteristics of self-reported and clinically assessed depression in the course of early alcohol abstinence were explored. METHODS: A total of 100 inpatient, primary male alcoholics (20-60 years) diagnosed according to Classificaton of Mental and Behavioural Disorders (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were recruited consecutively. The Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) were scored on admission (Tl), after 4 weeks (T2) and after 8 weeks (T3). Student's t-test, repeated measures ANOVA and Pearson's correlation between the scores were done (p <0.05). Factor analyses of symptoms were performed. RESULTS: On HDRS Tl, T2, T3 90,7%, 39.5%, 17.4% alcoholics were depressive, respectively. The mean HDRS vs BDI scores on T1, T2 and T3 were 15.16 ± 6.34, 7.35 ± 4.18, 4.23 ± 2.93 vs 14.20 ± 9.56, 8.14 ± 7.35, 5.30 ± 4.94, respectively. Depression severity significantly lowered in the course of abstinence (ANOVA). The HRDS and BDI correlations on Tl, T2 and T3 were significant (r1 = 0.763, r2 = 0.684, r3 = 0.613 respectively). Dysphoric mood, anxious, vegetative and cognitive HDRS subscales on Tl, T2 and T3 were detected, but not BDI factors, thus BDI symptoms were analysed. CONCLUSIONS: The majority of alcoholics had depression on admission. A predominant mild-degree with a significant lowering of depression severity and positive significant correlations between HRDS and BDI scores in the course of abstinence were detected. The dysphoric mood on the HDRS subscale, and self-blame, anhedonia and guilt BDI symtoms were most prominent and persisted. The BDI could be a useful tool not only for routine screening and reassessment of depression, but also for exploring emotional content during early abstinence and planning tailored integrative therapy and relapse prevention for alcoholics.

Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital.

INTRODUCTION: The schizophrenics are frequently disinterested and resistant to standard care. CASE REPORT: We presented clinical observations of group art therapy of two schizophrenic patients during integrative therapy in Day Hospital. We modified the original "Synallactic collective image technique" (Vassiliou G, Vassiliou V.). The group is open, heterogeneous, meets once a week and discusses on exhibited drawings, drawn by free associations. The patients' drawings and group protocols showed clinical improvement by lowering depressive themes, more human figures and self-confidence. The obvious severity of markedly impairment on Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scales on admission with minimal improvement at discharge was rated. CONCLUSION: Group art therapy enables visual expression of emotions, perceptions and cognitions, develops creative potentials and support within the group, thus facilitating the integrative therapeutic process of schizophrenics. It may be useful adjunctive therapy for schizoprenic patients.

Phytotherapy in medieval Serbian medicine according to the pharmacological manuscripts of the Chilandar Medical Codex (15-16th centuries).

The Chilandar Medical Codex is the most significant and best preserved medieval Serbian manuscript and collects together documents on European medical science from the 12th to 15th centuries. It represents the best-known and most complete example of a large collection of medical manuscripts from the Salerno-Montpellier school, written in the vernacular - something which does not exist among the majority of European nations. This paper presents the section of the Codex that deals with phytotherapy, which is contained within the pharmacological manuscripts. An analysis of their contents shows that out of a total of 167 recorded substances, 135 are of plant origin (81%), 13 animal origin (7.7%) and 19 inorganic (11.3%). The recorded plant species are categorised into 63 families, of which the most frequent are: Apiaceae (8.1%), Lamiaceae (8.1%), Asteraceae (5.9%), Rosaceae (5.9%) and Fabaceae (4.4%). All possible plant parts were used in treatments: the whole plant (6%), underground parts (13.7% - root, rhizome, bulb) and aerial parts (80.3% - stem, leaf, flower, buds, fruit, seeds). Of the plants quoted, the following are mentioned most frequently: Vitis sp. (120), Rosa canina (55), Olea europaea (45), Pistacia lentiscus (25), Saccharum officinarum (23), Artemisia absinthium (16) and Foeniculum vulgare (15). The contents of the pharmacological manuscripts of the Chilandar Medical Codex point to the sound contemporary knowledge of the diversity of plant species, their origins, habitat types, the levels of their healing powers, and when and how to gather them and prepare them, as well as the recommended dose for the treatment of specific illnesses. As these manuscripts contain not only common, lay terms for the plants, but also scientific, botanical ones, we can consider them the precursor to Serbian botany. Based on its contents and the way in which they are presented, it can be viewed not only as the first Serbian pharmacopeia, but first Slavic pharmacopeia, too, because similar manuscripts written in the vernacular did not exist during that period among the other Slavic nations, or even most European nations.

[Gender differences in victims of war torture: types of torture and psychological consequences].

BACKGROUND/AIM: Torture for political reasons is an extreme violence in interpersonal relations resulting in not only acute psychiatric disorders but also very often in very severe and far reaching negative consequences for the overall psychosocial functioning of a victim. The aim of this study was to investigate gender differences in types of torture and psychological consequences in subjects who experienced war torture. METHODS: A sample (410 men and 76 women) included clients of "Centre for rehabilitation of torture victims--IAN, Belgrade" who experienced torture in prisons and concentration camps during civil wars in ex-Yugoslavia 1991-1995 and 1999. Types of Torture Questionnaire with 81 items was used for collecting data about forms of torture. Symptom Checklist 90-Revised (SCL-90-R) was used for assessing type and intensity of psychological symptoms, and Impact of Event Scale (IES) was used to estimate posttraumatic complaints. RESULTS: A gender difference was found for 33 types of torture: 28 more frequent in men, and 5 in women. Factor analysis of torture types revealed three factors explaining 29% of variance: "common torture", "sadistic torture", and "sexual torture". Discriminant analysis revealed significant gender difference concerning the factors. "Common torture" and "sadistic torture" were more prominent in men, and "sexual torture" was more present in women. Higher scores on depression, anxiety, somatization, interpersonal sensitivity and obsessive-compulsive dimensions on SCL-90-R were found in women. General score and scores of subscales (intrusion and avoidance) on IES were significantly higher in women. CONCLUSION: Women exposed to war torture experienced less torture techniques and shorter inprisonment than men, but had more frequent and severe symptoms of posttraumatic stress disorder and other psychological symptoms. Gender differences in posttraumatic symptomatology can not be explained exclusively by gender differences in types of torture found in this study.

The potential of Festuca rubra and Calamagrostis epigejos for the revegetation of fly ash deposits.

Two grass species, Festuca rubra (sown) and Calamagrostis epigejos (naturally recolonised), were studied at two fly ash deposit lagoons, weathered 5 (L1) and 13 years (L2). Both species were assessed in terms of their invasive ability, photosynthetic efficiency, trace elements accumulation, and damage symptoms, while the characteristics of the habitat were assessed in terms of trace element content, and the pH and EC of the ash. In the ash weathered for 5 and 13 years, B and Mn concentrations fell within the normal range for soils, while there was an As, Mo and Cu excess, and Se and Zn deficit. There was no difference in the photosynthetic efficiency (ns) of the C. epigejos populations at the different-aged ash lagoons, but differences were found between the populations of F. rubra (P<0.001). F. rubra displayed damage symptoms, in the form of leaf tip chlorosis and necrosis, and wilting seedlings--a result of B accumulation in toxic concentrations and a Cu and Mn deficit. After 13 years the sown F. rubra remained over 9.5% of the ash lagoon's area (L2), while over the same period the naturally recolonised C. epigejos had overgrown 87.5% of the area. The greater colonisation and survival potential of C. epigejos is a result of multiple tolerance to the conditions at ash deposits and of the competitive ability of this species to dominate the colonised habitat. Therefore, characteristics of naturally colonised species can be used for modelling future actions of biological restoration of fly ash deposits aimed at binding the ash with minimal investment (the short-term aim), and for providing conditions for revegetation, and shortening the successive phases in the revegetation of ash deposits after the closure of thermal plants (the long-term aim).

Pain syndromes after missile-caused peripheral nerve lesions: part 1--clinical characteristics.

OBJECTIVE: To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries. METHODS: The prospective study included 326 patients with clinically significant pain syndromes including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Diagnostic procedures were analyzed, factors influencing the pain intensity were identified, and the patients' characteristics, pain characteristics, and other clinical symptoms and signs were compared between different types of pain syndromes. RESULTS: The rate of painful injuries ranged from 17.3 to 22.9% for mixed nerves and from 2.6 to 4.6% for motor nerves. Peripheral nerve block and sympathetic block were useful and safe adjuvant diagnostic procedures, obtaining pain relief in 66.7% of patients with neuralgic pain and in 90.1% of patients with complex regional pain syndrome Type II. Pain started 2.6 days after injury in patients with complex regional pain syndrome Type II and 11.9 days after injury in patients with painful nerve adhesions (analysis of variance, P < 0.001). Permanent pain was more frequent (79.1%) than paroxysmal pain, superficial pain was more frequent (55.2%) than deep pain, and burning pain was the most frequent pain descriptor (43.6%). Ten factors were found to significantly influence the pain intensity (binary logistic analysis), including three independent predictors (multivariate analysis): type of pain syndrome (P < 0.001), multiple nerve damage in the injury site (P = 0.022), and onset of pain in the first two days after injury (P = 0.031). CONCLUSION: Pain syndromes after missile-caused nerve injury differ significantly regarding time of pain onset, pain characteristics, and other symptoms and signs. The type of pain syndrome, multiple nerve damage, and early onset of pain are independent predictors of initial pain intensity. Although medical history and physical examination are the main diagnostic keys, nerve exploration preceded by a nerve block and sympathetic block are safe and useful adjuvant diagnostic procedures.

Pain syndromes after missile-caused peripheral nerve lesions: part 2--treatment.

OBJECTIVE: To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome. METHODS: The study included 326 patients with clinically significant pain syndromes, including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Treatment modalities included drug therapy, nerve surgery, sympatholysis, and dorsal root entry zone operation. Pain intensity was assessed before and after the treatment using a visual analog scale, and treatment outcome was defined as successful (pain relief >70%), fair (pain relief between 50 and 69%), or poor (pain relief <50%). The outcome was compared between different pain syndromes and different treatment modalities. RESULTS: A successful outcome was achieved in 28.6% of patients with deafferentation pain, in 76.9% of patients with complex regional pain syndrome Type II, and in 87.9 to 100% of patients with other pain syndromes (P = 0.002). Each type of pain syndrome required a specific treatment algorithm, but average pain relief was similar for all definitive treatment modalities (range, 81-88%; P > 0.05). Ten factors were found to significantly influence the treatment outcome, but only three factors were independent predictors of a successful outcome: type of pain syndrome (P < 0.001), severity of nerve injury (P < 0.001), and absence of pain paroxysms (P = 0.03). CONCLUSION: The treatment outcome of painful nerve injury depends on several factors, including the type of pain syndrome, severance of nerve injury, and absence of pain paroxysms. Drug therapy (carbamazepine, amitriptyline, or gabapentin) should be recommended, at least as a part of treatment, for patients with reinnervation pain, deafferentation pain, and complex regional pain syndrome Type II. Nerve surgery should be recommended for patients with posttraumatic neuralgia, either as the first treatment choice (acute nerve compression or intraneural foreign particles) or after unsuccessful pharmacological treatment (other causes of neuralgic pain).

[Possibility to predict the development of secondary depression in primary alcoholics during abstinence].

BACKGROUND/AIM: [corrected] The relationship between alcoholism and depression is observed in clinical trials. The factors which could predict persistence of secondary depression after alcohol withdrawal are not enough explored on admission. The differencies between depressed (DA) and non-depressed (NDA) alcoholics regarding the degrees of severity of withdrawal, severity of depression and the intensity of cognitive disfunctions were explored on admission to investigate possibility of prediction of the development of secondary depression in alcoholics. METHODS: A group of primary male alcoholics (n = 86) was recruited during inpatient treatment. After 4 weeks alcoholics were divided in the DA group (n = 43) and NDA (n = 43) group according to the score on the Hamilton Depression Rating Scale (HAM-D). Clinical assessment of withdrawal, scoring on the Alcohol Dependency Severity Scale-ASD, and scoring on the Mini Mental Scale-MMSE were performed in all the participants on admission. The differences between the groups were tested by the Student's t-test. RESULTS: The DA group showed the significantly higher severity of depression, higher levels of alcohol withdrawal symptoms and cognitive disfunctions than the NDA group on admission. CONCLUSION: The specific group of depressive alcoholics was shown to be characterized by the higher severity of alcoholism and depression on admission, which could predict prolonged, secondary depression. Early detection and concurrent therapy of secundary depression could improve the treatment, and reduce the relapse of alcoholism.