Combat eye injury: laser photocoagulation prophylaxis of retinal detachment.

Traumatic retinal detachment can occur in combat eye injuries and has numerous complications. We presume that the incidence would be much higher if we omitted to perform argon laser prophylactic treatment in cases of (1) traumatic retinal rupture, (2) retained retinal foreign body (before and after surgery), and (3) vitreoretinal proliferation with or without sector traction detachment. In these cases we performed a modified method of blockade with confluent, two-row laser spots, which proved to be more efficient clinically and formed stronger retina-choroid adhesions in experimental studies. In a total of 78 performed laser coagulations, retinal detachment occurred in three, all of them with already present traction retinal detachment.

[Vitreoretinal proliferation as a cause of tractional retinal ablation after severe perforating injury]. / Vitreoretinska proliferacija kao uzrok trakcionih ablacija retine posle teskih perforativnih povreda.

The main idea of this paper was to investigate the influence of proliferative reaction in vitreous body, in case of serious injuries of the eyeball on the development of complications. It was shown that the presence of hemophthalmia which intensified PVR process and anteroposterior traction influenced the intensity of PVR and also the development of retinal ablation. The complete perforation of the posterior wall of the eye ball (duplex perforation) with the small foreign body would produce bigger scar on the posterior wall than in case of singular perforations, which would usually be enough to control anteroposterior traction towards vitreous body and prevent retinal ablation.

[Photocoagulation in the prevention of retinal detachment in perforating injuries of the eye caused by warfare]. / Fotokoagulacija u profilaksi ablacije retine prilikom ratnih perforativnih povreda oka.

Main indications for application of photocoagulation in the prevention of retinal detachment in penetrating eye war injuries were presented. Photocoagulation was performed when intrabulbar foreign body was present, before its extraction and in the cases of traumatic ruptures of sectorial traumatic tractional retinal detachment. Modified photocoagulation by argon laser, with linked spots in two rows was used since it was shown to be clinically the most suitable.

[Analysis of treatment of perforating ocular injuries during warfare in Bosnia-Herzegovina]. / Analiza lecenih ratnih perforativnih povreda oka sa bosansko-hercegovackog ratista.

The analysis of 210 patients with penetrating eye injuries was performed. The age of the majority of injured was 20-30 (40%). Most injuries were caused by explosive devices (80%). Entering wounds were found on the cornea in 66.19%, on the sclera in 21.42% and on the limbus in 12.38% of the cases. Traumatic cataract was found in 45.72%, hemophthalmus in 53.33%, detachment of the retina in 40%, intrabulbar foreign body in 51.42%, prolapse of the iris and uvea in 36.19%, and endophthalmitis and hypopyon in 11.42% of the cases. Visual acuity after the operation was more than 0.10 in 37.89% of the cases. The basic principles of the treatment of penetrating eye war injuries were discussed.

[Surgical treatment of paralytic convergent strabismus using a modification of Jensen's method]. / Hirursko lecenje paraliticke konvergentne razrokosti modifikovanom metodom po Jensenu.

Surgical treatment of paralytic convergent strabismus using the modified Jensen's is method was performed in 35 patients. The full success (orthophoria) was achieved in 51.5% and satisfying (approximately orthophoria) in 25.7% of cases. The six-year follow up of patients showed that surgical effect was permanent in 71.4% of cases. The most common cause of paralytic convergent strabismus has been trauma (71.4%), and, that, traffic accidents in 45.7%. According to communications and available literature this modified treatment of paralytic convergent strabismus for the first time in Yugoslavia has been applied in the Military Medical Academy.

[Methods and results of Nd YAG laser capsulotomy in pseudophakia]. / Metodologija primene i rezultati Nd YAG laser-kapsulotomije kod pseudofaka.

Methods and results in the use of Nd-YAG laser in capsulotomy (membranoectomy) of secondary cataracts in pseudophakia are presented. The specificity of this procedure is the closeness of the implanted artificial lens to the site of laser effects.

[The adenohypophyseal gonadotropins in patients with anorexia nervosa]. / Funkcija gonadotropina adeno-hipofize u bolesnica s anoreksijom nervozom.

In 13 patients with anorexia nervosa (AN), secondary amenorrhoea lasting eight to 25 months and the loss of body weight more than 25% were found. Estradiol concentrations (E2) were significantly lower in patients with anorexia nervosa than in nine patients in the control group (21.4 +/- 9.2 vs 96.5 +/- 25.8 pg/ml, p less than 0.01). LH concentrations were also significantly lower in AN than in the control group (6.8 +/- 3.2 vs 12.3 +/- 4.5 IU/L, p less than 0.01). A similar relationship was found in the FSH concentration (5.2 +/- 2.0 vs 9.4 +/- 3.5 Iu/L, p less than 0.05). A 100 ug LH-RH i.m. administration produced a significant rise of the LH concentration and a slightly smaller one of FSH in comparison with the basal concentrations, with a maximum rise after 60 minutes (LH after 60 minutes 76.4 +/- 16.5 IU/L, and FSH 24.0 less than 5.6 IU/L).

Ultrasonography in the detection of cervical incompetency.

In 80 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix and the thickness of the anterior wall of a lower uterine segment have been evaluated ultrasonically. We have also measured the width of the endocervical canal and studied the prolapse of fetal membranes (with fetal parts) into the endocervical canal. We evaluated these same parameters in 80 healthy pregnancies. The length of the cervix, the thickness of the anterior wall of a lower uterine segment, and the width of the endocervical canal were followed longitudinally in the patients from the 10th to the 36th gestation week. No statistically significant differences between age groups were found. In four age groups at risk for cervical incompetency, cervical lengths and wall thickness were significantly different (p less than 0.001) from those in comparable controls. Forty-five percent of the patients in the at-risk group, with cervical cerclage, delivered at 37.3 (range: 32 to 41) weeks and 6.25% of pregnancies ended in abortion when the amniotic membrane herniated into the cervical canal, with or without some part of the fetus.

[Results of terminal salpingostomy and fimbrioplasty in distal occlusion and tubal phimosis]. / Rezultati terminalne salpingostomije i fimbrioplastike kod distalne okluzije i fimoze tuba.

Terminal salpingostomy and fimbrioplastics were performed in 108 patients by conventional surgical technique: 78 had bilateral occlusion of the abdominal orifice of the uterine tube with hydrosalpinx, 21 unilateral distal occlusion coupled with stenosis and perisalpingitis on the other side, and 9 bilateral stenosis and perisalpingitis. In all patients other causes of sterility were excluded. The duration of their sterility lasted 2-15 years, while their age ranged from 21 to 40 years. In 96 out 108 patients laparoscopy was applied immediately before operation. Out of 108 surgically treated patients, 22 conceived and gave birth to a child (20%), 2 had abortion (0.92%), and 7 conceived outside the uterus (3.7%). In 72 patients who did not conceive six months after operation, control hysterosalpingography was applied; it showed that 58 patients had one or both tubes unobstructed (80.5%), while bilateral reocclusion was found in 14 patients (19.4%). Hydrotubation was performed by a mixture of antibiotics and hydrocortisone 3-5 days following operation.

[The frequency of premature labor before and after administering beta-sympathomimetics in clinical practice]. / Ucestalost prematurnih porodaja prije i nakon uvodenja beta-simpatikomimetika u klinicku upotrebu.

From 1971 to 1975, when beta sympathicomimetics were not used, from total 13 561 deliveries 6.06% were preterm deliveries. In years 1976-1980, when these tocolytics are routinely used from total 15 242 deliveries 5.24% were preterm deliveries. Significance is statistically characteristic, p = = 0,01. In the anamnesis of all parturients in both periods, frequency of factors which effect on the rate of preterm deliveries is equal.

[Comparison of hysterosalpingographic and laparoscopic findings in tubal factor of sterility (author's transl)]. / Komparacija histerosalpingografije i laparoskopije kod tubarnog faktora neplodnosti.

Hysterosalpingographic and laparoscopic findings in 116 sterile women with the ovulatory cycle and the fertile spermiogram of their husbands were compared. Laparoscopy was performed in 65 patients in whom hysterosalpingography (HSG) revealed the occlusion of one or both tubes localized at the abdominal orifice, then in 23 women with unobstructed tubes and pertubal adhesions, and in 28 women in whom HSG findings were normal and who did not conceive at least 6 months after HSG. In 69% of cases the results of both methods were similar, whereas in 31% of cases laparoscopic findings, 18 laparoscopic findings showed significant by hysterosalpingography. Out of 28 normal HSG findings, 18 laparoscopic findings showed significant pathologic tubal changes. In unilateral occlusions HSG revealed peritubal adhesions in unobstructed tubes in 4 cases and laparoscopy in 18 out of 24 cases along with the agglutination of the fimbria and periovarian adhesions. In the whole group of the women examined, HSG revealed periadnexal adhesions in 39 (33%) and laparoscopy in 69 cases (59%).

[Yellow body function in bromocryptine induced early pregnancy in patients with hyperprolactinemia (author's transl)]. / Funkcija zutog tijela u ranoj trudnoci induciranoj bromokriptinom u bolesnica s hiperprolaktinemijom.

In six patients estrogens and gonadotropins were low and the prolactin concentration was increased (36-128 micrograms/l). Amenorrhea in all patients lasted 8-60 months, while galactorrhea was observed in five patients. By the X-ray of the sella turcica and neurologic and ophthalmologic examinations no signs of an intrasellar expansive process were revealed. The progesterone test was negative in four patients and the clomiphene test in all six patients. The LH-RH test (100 micrograms i. m.) showed the increased LH and FSH concentrations in all six patients. They all became pregnant in the course of the bromocryptine treatment (5-7.5 mg daily). Pregnanediol and prolactin concentrations were recorded every 14 days in the first 16 weeks of pregnancy, both in six patients and in eleven controls with spontaneous pregnancy. The pregnanediol concentrations proved somewhat higher in the control group than in patients having become pregnant under the bromocryptine therapy, but the differences are not statistically significant. However, the prolactin concentrations were significantly lower in controls than in pregnant women with the hyperprolactinemic anovulatory syndrome (p less than 0.01) in the sixth to the twelfth week of pregnancy.

[Cervical factor in sterile couples with an ovulatory cycle normospermia and patent tubes]. / Cervikalni faktkor u sterilinih brakova s ovulacijskim ciklusom, normozoospermijom i prohodnim tubama.

In 54 sterile married couples with a normal biophasic cycle, passable tubes, and normozoospermia, the properties of the cervical mucus were investigated. The biphasic cycle was determined according to the basal temperature curve, in which the hyperthermal phase lasts 12 days or more, the concentration of pregnanediol in the urine on the 22nd day of the cycle (6.4 mg/24h), estrogen on the 12th day of the cycle (78.4 micrograms/24h), and the LH concentration on the 13th day of the cycle (58.3 U/l). A positive crystallization test was found in 12 out of 54 patients and the postcoital test in 8 out of 54 patients. In 31 patients with the clinical symptoms of colpitis and cervicitis the culture of the cervical secretion showed pathogenic bacteria in 24 patients. Eighteen patients were subjected to conization previously. A positive crystallization test and a normal postcoital test were found only in 14 out of 17 patients following conization but in not single patient with cervicitis. After antibiotic therapy and stimulation with estrogens a restitution of the function of the cervical mucosa was observed in 25 patients, while 12 patients became pregnant. Inflammation proved to impair the normal function of the cervical mucosa, and if lasting long, it can lead to irreversible changes. Also surgery in cervix can result in the destruction and reduction of cervical glands and should therefore be strictly medically indicated and carefully performed, especially in nulligravidae.

[Improved pregnancy rates with ovulation stimulation using clomiphene and the effect of conjugated estrogens on the cervix]. / Poboljsanje stope zanosenja pri poticanju ovulacije clomiphenom ucinkom konjugiranih estrogena na cerviks.

From a larger group of women treated which clomiphene 25 patients were selected who failed to conceive in spite of an indirect evidence of the ovulatory response and adequate luteal phase. Seventeen of them, who showed a distinct suppression of preovulatory reaction according to a modified cervical score, were treated with combined clomiphene and conjugated estrogens. The cervical score, the cycle pattern and the pregnancy rate were compared with the results of the previous treatment. The improvement of the cervical score was noted in 74.4% of patients, 6 women became pregnant, and the pregnancy rate related to the number of ovulatory cycles was 13.9%. Criteria for the treatment presented are discussed.

Amenorrhea following oral contraception.

In 21 patients with amenorrhea after taking oral contraceptives, the urinary excretion of estrogens and the plasma concentrations of LH, FSH and prolactin were determined. In five of these women the amenorrhea was accompanied by galactorrhea. Ten of the 21 patients had had origomenorrhea before contraceptive therapy. The progesterone test was negative in 9 patients and clomiphene test was negative in 10 patients. The urinary excretion of estrogens and plasma LH and FSH values were low normal while the prolactin concentration in group A (amenorrhea without galactorrhea) amounted to 12.8 +/- 2.4 micrograms/l of plasma and in group B (amenorrhea with galactorrhea) to 85.4 +/- 15.8 micrograms/l (p < 0.01). The pituitary response to 100 micrograms synthetic LH-RH i.m. was similar to that found in the early follicular phase of the ovulatory cycle and showed that the pituitary was capable of synthesizing and secreting LH and FSH. Two of the three women from group A who wanted to become pregnant conceived under the therapy with Clomid and HCG. In all women from group B, in response to Parlodel (bromocriptine) therapy administered in 5-mg dose daily, the plasma concentration of prolactin decreased to a normal level, galactorrhea ceased within 15-62 days, and menstruation resumed within 38-75 days. In three women it is very probable that the cycle became biphasic, and a previously clomiphene negative patient became a clomiphene responder.

[Endocrinological aspect of galactorrhea and lactation in relation to the cytology of breast secretion]. / Endokrinoloski aspekt galaktorije i laktacije uz citoloski pregled eksprimata dojki.

The concentration of prolactin in the plasma and the cytologic smears of the mammary extraction were analysed in 67 patients with galactorrhea. In 38 patients galactorrhea was couple with amenorrhea. Out of 67 patients with galactorrhea, 32 had hyperprolactinemia (68.6 +/- 14.4 ng/ml) along with low estrogen (14.6 +/- 3.8 ug/24 hours) and aonadotropin (FSH 6.2 +/- 2.0, LH 8.5 +/- 2.6 mIU/ml) values. In 48 out of 67 patients galactorrhea seceded under the therapy of Parlodel (bromocriptine). Out of 13 patients waiting pregnancy, 9 showed a restitution ofa the ovulatory cycle and 2 became pregnant. In the group of parturients it proved possible to suppress ablactation by estrogenic-and androgenic preparations (Ablacton) without a decrease in the prolactin concentration, while Parlodel brought about ablactation with a decrease of the prolactin concentration to normal values as early as 24 hours following the application of its first dose. In 6 patients with hyperprolactinemia and low estrogaen and gonatropin values an increase in the concentration of LH and FSH after 100 micrograms LH--RH i. m. was observed. In the cytologic smears of the mammary excretion there were no atypical or malignant cells.