Supplementation with L-arginine affects its metabolizing pathways in rat liver subjected to bile duct ligation.

Liver cholestasis is known to accompany several major liver disorders and is adequately mimicked in rats by ligation of the bile duct (BDL). L-arginine is a semi-essential amino acid which is involved in several important metabolic pathways that are significantly affected during cholestasis. This study was conducted in order to contribute to the understanding of the enrolment of L-arginine supplementation in cholestatic liver function. This was carried out by estimation of serum and liver tissue arginase activity, along with liver tissue citrulline, nitric oxide (NO) and polyamine concentrations. Rats subjected to BDL were treated for nine days with L-arginine (150 mg/kg) or remained without any treatment. Animals from two control groups were either subjected to medial laparotomy (sham/opened group) or were without any surgical treatment and received only L-arginine. Application of L-arginine prevented a significant increase in plasma bile acid and bilirubin concentrations, as well as enzyme biochemical markers that were increased after BDL. It is worth mentioning that L-arginine was able to cause a decrease in arginase activity and liver tissue NO concentrations that were found to be significantly altered during cholestasis. On the other hand, the changes occurring in the concentration of liver polyamines (putrescine, spermidine and spermine) and the activity of polyamine metabolizing enzymes were not notably affected by the administered L-arginine. The results of the present study revealed that exogenous L-arginine was able to ameliorate or prevent changes occurring in its metabolism in liver during cholestasis.

Maxillofacial war injuries during the war in former Yugoslavia.

War wounds of the maxillofacial region occur in 5-17% of casualties. In the Clinic for Maxillofacial Surgery of the Military Medical Academy, during the war in former Yugoslavia, 482 casualties with dominant wounds in the maxillofacial region were treated. The outcome of the treatment depended on the quality and speed of the first aid and general medical aid, as well as on qualified specialist treatment. Specificity of the management of the war wounds of maxillofacial region includes: minimal debridement of soft tissues, removal of only deperiosted fragments of bony tissues, valid reconstruction of bony and soft tissues defects, correct immobilization, antitetanus prophylaxis, adequate antibiotic therapy, as well as permanent and very meticulous postoperative care.

The treatment of traumatic facial bones and jaw fractures in the period 1972-1996.

During the last twenty-five years, in the period from January 1, 1972 to December 31, 1996, 1006 injured with facial and jaw fractures have been treated at the Clinic for Maxillofacial Surgery of the Military Medical Academy--91.05% of the injured were males and 67.98% belonged to the age group between 11 and 30. The most frequent etiologic factors were traffic accidents (46.42%) and fights (38.07%). Isolated fractures of mandible were found in 51.09% of the injured. In 70.57% of the treated the surgery was used for adequate reduction, osteosynthesis and stabilization of bone fragments, and 29.34% of the injured were treated conservatively, which involved the manual reduction and intermaxillar immobilization. The post-operative complications were observed in 51 (5%) of the injured.

Monocortical osteotransplant of the iliac bone in reconstruction of mandibular gunshot defects.

In the Clinic for Maxillofacial Surgery of Military Medical Academy, 134 injured with mandibular defects were treated, as well as a significantly larger number of injured from the territory of former Yugoslavia, with dominant injuries of the head and neck regions. Until June 1994, smaller defects were treated using bicortical osteotransplant of the iliac bone. Due to its only partial successfulness in reconstruction of mandibular defects, monocortical osteotransplant of the iliac bone was selected for reconstruction of the mandibular defects and the results were much better compared to the other free osteotransplants.

Vascularized fibular graft in the reconstruction of posttraumatic mandibular defects.

The results of the use of the vascularized fibular graft for the reconstruction of posttraumatic defects of the mandible are presented. Different surgical procedures were applied in reconstruction of the mandibular defects in 120 wounded. In the last four years vascularized fibular graft was used in 11 mandibular reconstructions. Taking into account the survival rate of 100%, long vascular pedicle, strength, length and the possibilities of adaptation of the bone make this graft suitable for mandibular reconstruction. The functional and esthetic results obtained by the use of this graft were satisfactory, with minimal donor site morbidity.

Facial nerve injuries and its treatment.

Twenty four patients with traumatic interruption of the conductivity of the facial nerve were treated in the period 1991-1996 at the Clinic for Maxillofacial Surgery. After topographic orientation about the site and level of the injury, the reconstruction of the nerve using nerve grafts was performed in all patients. The results were satisfactory.

Bimaxillary osteotomies in correction of dentofacial deformities.

In 342 patients with dentofacial deformities cephalometric analyses were preoperatively performed. A study of occlusion on cast models as the simulated new position of the facial soft tissues was done on the photographs. Surgical treatment using bimaxillary osteotomies for correction of dentofacial deformities was done in 38 patients: 31 with prognathism and maxillary hypoplasia, 5 with facial asymmetry and laterognathism and in 2 with otomandibular dysostosis. The LeFort I type osteotomy was used for the upper jaw and Obwegeser technique for the lower jaw. Intermaxillary and circumzygomatic immobilization were removed 8-10 weeks after the operation. After that, the patients retained the individual chin traction from 2 to 3 months. The complete relapse occurred in one patient and prolonged loss of the mandibular nerve sensibility in one.

[Blood autotransfusion in head and neck surgery]. / Primena autotransfuzije krvi u hirurgiji glave i vrata.

Autotransfusion as a method of blood compensation after multilative surgical operation in cases of malignant neoplasm of the maxillofacial region, was introduced in our clinical practice in 1989, and up to now we have performed it in a group of 23 patients. It has been known that an autotransfusion depends on the patients' general health situation, hemoglobin level, hematocrit and iron concentration in serum. We exfused at least three days before operation 450 ml of blood from each patient. The blood was taken into plastic bags and kept in the refrigerator at the temperature of +4 degrees C. The decrease of serum iron concentration was approximately 54.26% in all tested patients that demanded the substitution therapy with iron together with vitamin C before and after surgery. There was neither prolongation of postoperative treatment nor complications associated with this method of post-operative blood loss compensation. Based on obtained results we could conclude that the best method of inter- and postoperative blood compensation was autotransfusion, taking care about factors which could limit the possibilities of its applications.

[Motivation in patients for surgical treatment of prognathism using bimaxillary surgery]. / Motivisanost pacijenata za hirursko lecenje progenije primenom bimaksilarne hirurgije.

A postoperative survey was conducted to evaluate the motivation of twenty three patients following surgical correction of mandibular prognathism. The operative technique of bimaxillary surgery was applied to all patients. The major reason for surgery was esthetics. Majority of patients were informed about surgery by their family dentists, and almost all of them were satisfied and stated that their expectations were fulfilled.

[Large dermoid cysts of the mouth floor]. / Velike dermoidne ciste poda usta.

Dermoid cysts of the mouth floor are very rare. The incidence of these cysts is up to 3.6% of all cysts in the oral cavity. The article presents the material from the Clinic of Maxillofacial Surgery MMA. Eleven cases of large dermoid cyst are discussed. All of them were removed completely and no recurrence developed in longer period of time postoperatively.

[Fractures of the zygomaxillary complex: indications for exploration and reconstruction of the orbital floor]. / Frakture zigomatikomaksilarnog kompleksa: indikacije za eksploraciju i rekonstrukciju poda orbite.

Within the period of 11 years 132 patients with fractures and dislocations of the zygomatic maxillary complex have been treated at the Clinic of Maxillofacial Surgery of the M.M.A. In all cases the Converse-Valentine method was used which provided good reposition and fixation of fragments in the correct anatomic position as well as insight into the state of the orbital floor. In 75 operated patients (56.81%) it was necessary to reconstruct the orbital floor by osteo or allotransplants. The results have pointed out the necessity of operative reposition and fixation of fragments on three typical sites as well as the necessity of exploration of the orbital floor in order to prevent diplopia, sensibility disorders as well as traumatic neuralgia.

[Ultrasound as a diagnostic aid in maxillofacial surgery]. / Ultraschall als ein diagnostisches Hilfsmittel in der Kiefer-Gesichts-Chirurgie.

Ultrasonography is a relatively new diagnostic aid in maxillofacial surgery. It can be used in maxillofacial surgery in three modifications: Doppler sonography, A-scan sonography, B-scan sonography. As clinicians we wanted to determine what contribution ultrasound examination has made to the diagnosis of superficial maxillofacial masses, when compared with clinical examination, intraoperative findings and with other methods of investigations. Since 1985 B-scan sonography has been performed in the examination of congenital, inflammatory and neoplastic masses of the head and neck on more than 1500 patients. The ultrasound examination was performed in the Department of Radiology by radiologists. The value of the ultrasound findings varied depending on the soft tissue lesions which were examined and the experience of the radiologists who performed the examination. The advantages of the diagnostic ultrasound are in being noninvasive, without any known deleterious biological effect, rapid, painless, inexpensive and easily reproducible. Ultrasonography is a procedure which nowadays is routinely performed in our department for the preoperative evaluation of our cancer patients and postoperative follow-up as well as for the patients with inflammations, diseases of the salivary glands and soft tissue swellings.

[Secondary occlusal traumatism. 1. Histopathological changes of periodontal tissues in experimental occlusal traumatism]. / Sekundarni okluzioni traumatizam. Histoloske promene periodoncijuma eksperimentalnih zivotinja.

Six and nine months after the experimental occlusal traumatism, the following histopathological changes of periodontal tissues were observed: --Disorganisation and necrosis of the collagen fibers, abundant cellular infiltration and dilatation of the blood vasels of the periodontium; --The periodontal space was enlarged. Directions of principal collagen fibers was changed. This was especially visible in the region of transeptal fibers; --The observed periodontal changes were correlated with the duration of inflammation and occlusal trauma. The longer these factors persisted the more extensive these periodontal changes occurred.