[Urinary bladder incontinence after prostatectomy. Urodynamic evaluation and results of therapy]. / Inkontinencija mokrace nakon prostatektomije. Urodinamska evaluacija i rezultati lijecenja.

Forty-seven males referred due to postprostatectomy urinary incontinence (34 after transurethral resection of prostatic adenoma and 13 after open suprapubic adenomectomy) were retrospectively studied. Urodynamic evaluation identified 19 (40.4%) men with incontinence due solely to sphincter incompetence, and 19 (40.4%) men, in addition to sphincter incompetence, had urinary bladder dysfunction (unstable detrusor and/or reduced bladder compliance). Seven (14.8%) men had pure bladder dysfunction as the only cause of urinary incontinence. Two patients had normal urodynamic findings (N = 2; 4.2%). Men with urinary incontinence due only to sphincter incompetence were treated by insertion of artificial sphincter devices or condom catheter drainage (lack of artificial sphincters), while others were treated pharmacologically (imipramine, propantheline, oxybutynin or their combinations ... N = 25), or by augmentation cystoplasty using ileum after unsuccessful pharmacological treatment (N = 3). Out of 25 patients with pharmacological treatment, 21 were available for the final assessment of the treatment efficacy. Eleven (52.3%) patients were "socially continent" after the treatment. It is concluded that in the assessment of the cause of postprostatectomy urinary incontinence urodynamic evaluation is mandatory, and that the treatment should be based on the results of such studies. The role of bladder dysfunction as a cause of postsurgical urinary incontinence is again strongly emphasized.

[Brain death--modern concepts]. / Mozdana smrt--sadasnji nazori.

Traditional definition of death-cessation of heart function-became obsolete, because it was indisputably ascertained that brain function may be totally an irreversibly destroyed, while other parts of the body continue to live including the heart. So the definition of death switched from the heart to brain function--a brain stem dead patient becomes'' a corps with a beating heart "(ghostly aspects of the medical progress). Early recognition of brain death before the unavoidable cessation of circulation is the basis of organ(s) transplantation. The tests necessary to show that the brain stem is not functioning take only a few minutes to carry out, but the moral and legal responsibility for such a diagnosis is tremendous. The best safeguards against suspicion of error are well-written guidelines. Doctors involved with diagnosis of brain death must acquire clear and unambiguous criteria. The purpose of this presentation is to contribute to wider distribution of knowledge of brain death symptoms in our local situation where organ transplants, including the heart, have been achieved. During the year 1994, 296 patients were admitted into the neurological intensive care unit, 32 of them in respiratory arrest. Ten were considered as potential organ donors but nine died during observation. However, one transplantation was performed: heart, kidneys, and corneae were donated and used.

[Recurrent urinary infection as the first sign of neurogenic disease-- detrusor sphincter dyssynergia]. / Recidivni urinarni infekt kao prvi znak neurogene bolesti--detruzorsko sfinkterske disinergije.

In 35 patients with recurrent urinary tract infection and kidney disease, dysfunction of micturition mechanism was found. The causes of neurogenic disease include: trauma and spinal degenerative diseases as well as the development of chronic disorders of the spinal cord. These diseases are a predisposing factor in the development of lower tract infections. Studying the causes of kidney impairment we have indirectly come to the diagnosis of the basic neurogenic disease.

Hereditary antigen characteristics of blood in ischemic cerebrovascular accident.

In order to determine genetic differences between 50 examinees with ischemic cerebrovascular accident (iCVA) and those of comparative group, we have chosen 1883 persons from phenotypic healthy population divided into 5 different subgroups. The purpose of our investigation was exploring hereditary characteristics of antigenes linked to erythrocyte membrane. The highest discriminating value in genetic distance had MN and ABO genetic loci. The frequency of M antigen in stroke patients was 70% (in the comparative group 55%), N antigen had frequency 30% in patients with iCVA and 45% in the comparative group. The frequency of the blood group A in the patients with iCV was 32.68% and 27.16% in the comparative group. Blood group B had frequency in the patients 10.69% and in the comparative group 6.72%. O blood group had frequency in the patients 56.73% and in the comparative group 66.12%. Genetic distance between patients with iCVA and the comparative group were determined with gene frequencies, that was shown on the dendrogram. The dendrogram clearly shows that patients with iCVA are separated from all other comparative subgroups. The results of our investigation presented the highest discriminating value of MN and ABO genetic loci. The possibility of linkage between genetic loci for these erithrocyte antigenes (on the 4th and 9th chromosome) and genetic loci which determine iCVA cannot be excluded. Finally we consider that this method can support earlier identification of persons who belong to "high risk group for cerebrovascular disease".

[Neurologic and urodynamic characteristics of patients with Guillain-Barré syndrome]. / Neuroloske i urodinamske osobine u bolesnika s Guillain-Barréovim sindromom.

Neurologic and urodynamic aspects of five patients with Guillain-Barré syndrome are presented. Four patients were urodynamically investigated in the acute stage of neurological disease. All of them had complete urinary retention. Following moments causing urinary retention were determined: detrusor areflexia with the signs of urethral sphincter denervation in one patient, detrusor hyperreflexia with dyssinergia of the sphyncter in two patients and detrusor hyperreflexia with synergia of the sphincter in one patient. One patient was examined in the chronic stage of Guillain-Barré syndrome showing urodinamically detrusor hyperreflexia with synergia of sphincter.

[The role of thrombocytes in the development of ischemic cerebrovascular insult]. / Uloga trombocita u nastanku ishemickog cerebrovaskularnog inzulta.

Cerebrovascular diseases appear in 10 to 15% in the general mortality of population, so that they are in the third place on the list of death causes, after cardiovascular and malignant diseases. Having in mind particular importance of hemorrheological complex in the development and course of cerebrovascular accident, in the present work we investigated adhesion, aggregation and number of thrombocytes. Parallel to the evaluation of the above mentioned hemorrheological indicators, we investigated the degree of motor deficit and the severity of of consciousness disturbances. All the indicators were determined first within 24 hours after the onset of the disease, then after 72 hours, and finally during the 9th day of the disease. The same procedure was done in the control group and all the indicators were determined during the first day, the third day and the ninth day of investigation. The group of patients consisted of 20 men and 20 women. In the control group were included 20 men and 20 women. On the basis of our investigation of hemorrheological indicators, we came to the conclusion that the adhesion of thrombocytes is of particular importance in the diagnostics and further following of the course of the cerebrovascular accident. The aggregation of thrombocytes has only a relative value in the investigation of the course of the ischemic cerebrovascular accident, while the number of thrombocytes has not significance for the onset and course of the ischemic cerebrovascular disorder.