This article highlights the concept, history and development of fetal medicine. The first attempts of fetal medicine date from the stone age and have continued throughout the medieval and modern ages. Attempts to influence fetal health and pregnancy outcome at first were purely theoretical and passive, limited by ignorance, fear, and religion. With the development of the medical sciences, the role of the obstetrician became more active. Today, not only obstetricians, but many other experts in the field of antenatal care as well, deal with the great number of medical and technological advances. The limitations arising today are mainly ethical. The main question that still has not been answered is to what extent the physician is allowed to interfere with the process of fetal development and pathology, based upon real fetal and maternal benefit. In order to answer this question and to coordinate many activities by different experts in this field, an international society antitled The Fetus as a Patient was formed in 1985. Croatian experts have played a leading role in this concept.
Six young female patients suffering from recurrent uveitis, all of them HLA B-5 positive, were followed-up 2-7 years (mean 4.5 years). Anterior hypopyon uveitis was present in two patients, retinal vasculitis in all, exudative recurrent retinal detachment in two, resulting in phthysis in one patient. Complete clinical work-up as well as serology were within normal limits. The effect of the corticosteroid therapy applied in all patients was dubious, while Cyclosporine gave only temporary relief in one patient. Promising vitreoretinal surgery was suggested to one patient.
Clinical and morphological findings of lymph nodes in 150 consecutive untreated non-Hodgkin lymphoma (NHL) patients were retrospectively studied. One hundred and fifteen (77%) patients had B-NHL and 35 (23%) T-NHL, 96 (64%) patients had NHL low grade malignancy and 54 (36%) NHL of high grade malignancy according to the Kiel classification. Lymph nodes exceeding 2 cm in diameter (p less than 0.05), hepatomegaly (p less than 0.05), splenomegaly (p less than 0.05), and the duration of lymphadenopathy for more than 6 months preceding diagnosis (p less than 0.01) were significantly more common in low than high grade malignancy of NHL patients. Febrile episodes at the diagnosis were significantly more common in high than in low grade malignancy of NHL patients (p greater than 0.05). Lymph nodes exceeding 2 cm in diameter (p less than 0.05) in B-NHL, and lymph nodes above the diaphragm (p less than 0.05) and skin infiltration (p less than 0.001) were more common in T-NHL than in B-NHL patients. At the diagnosis low grade NHL patients have significantly more often splenomegaly, hepatomegaly, large palpable lymph nodes, and long lasting lymphadenopathy before diagnosis. High grade malignancy NHL patients have more often general symptoms, B-NHL patients have more often large palpable lymph nodes, T-NHL patients have more often skin infiltration and lymph nodes above the diaphragm. Precise clinical characterization of patients in addition to pathohistological diagnosis are very important in this highly variable disease.
The study deals with the investigation results of psychodynamic factors relevant to the explanation of criminal behaviour. The research has been carried out on a sample of ten subjects sent to forensic psychiatric examination through court order, in order to evaluate their accountability and to suggest possible treatment. The sample included the diagnostic category of personality disorders only. Persons with psychotic disturbances, alcohol and drug addicts, mentally retarded and delinquents with organic-cerebral damage were not taken into consideration. The method of studying individual cases by means of psychodynamically oriented analysis of the subjects' development and other available data have been applied. The obtained results suggest that socialization defects, located in pregenital development phase are basis for criminal behaviour. The defects are due to badly disturbed object relations mainly in the oral and anal phase of development. In the subjects, narcissistic personality disorders can be diagnosed, while neurotic symptoms are present in a smaller degree. Criminal behaviour of these people can best be understood in the context of the theoretical concept of early narcissistic configurations actualization: grandiose self and idealized image of parental figures. In such cases the release of aggressiveness has been provoked, as a rule, by immediate endangerment of the self and by uncertain sexual identity. Unconscious feeling of guilt and need for selfpunishment appears often as criminal action driving forces. In all the subjects, structural disturbances in ego and superego formation were diagnosed. Greater integration of psychoanalytic knowledge into the theory and praxis of forensic psychiatry imposes itself as an indispensable basis for the reforms which are already under way and which are excepted in the future development of forensic psychiatry.
The aim of the study was to answer the question whether the serum level and the urine level of N-acetyl-beta-D-glucosaminidase (NAG) could be the indicator of liver and kidney lesions, and the indicator of the stage of the lesions, in cases of endotoxemia and endotoxin shock. The authors performed the experiment using 60 rabbits as experimental animals. The animals were divided into six groups (10 rabbits in each group); control animals received an equal volume (1.0 ml/kg of body weight) of physiological saline solution. Endotoxin (Lipopolysaccharide E. coli 055 B-5) in doses of 20, 40, 60, 80, and 100 micrograms/kg of body weight were administered in a single intravenous injection to each animal of I-V experimental groups. Using endotoxin in that dose of application, the authors provoked different stages of endotoxemia on the rabbits in the first four experimental groups, and the endotoxin shock on the rabbits of the fifth experimental group. After 18 hours, the rabbits were decapitated, and the levels of NAG in serum, urine, kidney and liver tissues determined. The results showed that the serum increase of NAG activity is caused not only by the lesions of kidney parenchyma, but by the lesions of liver parenchyma too, in the cases of endotoxemia and endotoxin-produced shock; the increase is statistically significant. Urine increase of NAG activity is significant even in cases in which the authors administered very low doses of endotoxin (20 micrograms/kg of body weight), so it can be said that urine NAG activity is a very good indicator of early kidney parenchyma lesions. But, the urine increase of NAG activity is (absolutely) in correlation with the dose of administered endotoxin, so it can be said that urine activity of NAG is the indicator of stage of kidney lesions in cases of endotoxemia and endotoxin-provoked shock.
This paper presents the epidemiological study of respiratory viral infections in Croatia from 1 September 1986 till 31 August 1987. A total of 527 patients with acute respiratory diseases were examined. Their nasopharyngeal secretion and/or throat swab were taken and the viruses were demonstrated by the method of direct viral diagnosis (isolation and rapid immunofluorescent detection). This 12-month study on acute respiratory infections in Croatia in 1986/1987 shows that viruses were the agents in 47.2% of these infections. Out of a total of 527 patients with acute respiratory disease, 177 patients had RSV (prevalence 33.6%), 40 adenovirus (prevalence 7.6%), 18 enterovirus (prevalence 3.4%), 12 parainfluenza (prevalence 2.3%), 8 herpes simplex virus (prevalence 1.3%) and 3 influenza virus (prevalence 0.6%) infection; (9 patients had mixed infections with two viruses). Viral etiology was proved in 44.0% of upper respiratory tract infections, 86.5% of bronchiolitis, 63.3% of pneumonia, 57.5% of bronchitis, and 33.3% of croup. The epidemical wave of RSV infections started in October 1986 and lasted for the next 7 and a half months with a peak in December 1986. Infections with parainfluenza occurred in November 1986 and subsided in March 1987 with a peak in December 1986. An epidemic of adenovirus occurred in two waves and lasted throughout 9 months. Enteroviruses caused infections during the fall and at the beginning of the winter 1986 but also again in the spring 1987.
The authors present the frequency of urinary tract infections in hospitalised infants. A retrospective study of infants hospitalized during a five year period, from 1979-1983 was made. The average frequency for the mentioned period was 12%, all of which were bacterial infections. In 70.7% of patients we diagnosed cytopyelonephritis. Girls prevailed among the patients with urinary tract infections, even in the neonatal period. Vesicoureteric reflux was confirmed in 36.5% children. The results of this study show that the symptoms of urinary tract infections in infancy are not specific. As the frequency of cytopyelonephritis and vesicoureteric reflux was high it emphasizes the significance of early diagnosis. In every febrile child, diagnosis of urinary tract infections should be suspected.
The authors have analysed the mortality of malignant haemopathies in Yugoslavia from 1978 to 1987. The standardized rate of mortality among all malignant haemopathies was from 6.5 to 7.2%000. These rates were higher in males (7.8-8.8%000), than in the females (4.8-5.9%000). The mortality of this group of malignant tumors shows a decreasing tendency, which is more evident in females than in males. Since Hodgkin's disease and lymphoid leukemia participate with about 50% in the structure of mortality from all malignant hemopathies, and for that reason, mortality from these two diseases is especially analysed. The standardized rate of mortality from Hodgkin's disease was between 1.7-2.5%000 (males 2.1-3.2%000; females 1.3-2.0%000). Mortality from this malignant haemopathy has a tendency of decreasing, which is approximately of the same intensity in both sexes. Mortality from lymphoid leukemia in the period between 1978 and 1987 was from 0.7 to 1.2%000 (males 0.9-1.7%000; females 0.5-1.0%000). The mortality trend from lymphoid leukemia shows a similar slight decrease in males and females.
Chest ultrasonography has been advocated as an effective tool for diagnosis and localization of pleural effusion. To determine if chest ultrasonography would be beneficial, when thoracocentesis was performed, 71 patients with suspected pleural effusion were evaluated. Two groups of patients were formed according to the presence of small or large suspected effusion ascertained by chest posteroanterior roentgenogram. Chest ultrasound was found very useful, both for establishing diagnosis of pleural fluid and for obtaining adequate fluid samples of small effusions. This technique had no such advantage during thoracocentesis of large effusions. During and after thoracocentesis, there were no complications in any group of patients. Authors concluded that ultrasound method seems to be very useful in choosing the optimal site for thoracocentesis, particularly of small effusions.
The results of karyotypic analysis of a new case of endometrial adenocarcinoma revealed in all analyzed diploid or near-diploid cells two chromosomes 1 of normal morphology and the presence of a marker or markers derived from chromosome 1. No other common chromosome marker was observed. Among a total of 25 endometrial adenocarcinoma cases reported in literature, including the case we reported, the most frequent chromosome abnormality-observed was trisomy and tetrasomy of the long arm of chromosome 1 which may represent a specific karyotypic change in at least one subtype of this tumor.
The aim of this study was to investigate in what way the outcome of treatment could be influenced by some traits of personality and its functioning, described in psychological literature as "ego strength". Here, one has to take into account the difficulties in studying the complex process of treatment involving numerous personality and environmental factors, which cannot be separated and observed, measured and assessed as isolated values. Therefore, conclusions about the influence of personality strength on the outcome of treatment have a relevant but not absolute significance. The authors presumed that one of the reasons for the unfavourable outcome of treatment was to be found in the alcoholic's personality system. They tested this presumption on samples of successfully and unsuccessfully treated alcoholics, who received the same treatment, and on a control group. As a measuring instrument for assessing the effectiveness of the personality system, Barron's Ego Strength Scale was used. The study showed that the group of unsuccessfully treated alcoholics had statistically significant lower scores on the ES scale, and that they differed from the successfully treated group. Between successfully treated alcoholics and the control group there were no statistically significant ES Scale differences. The study has indicated that it would be appropriate to use ES Scale before beginning the treatment of alcoholics. Thus in the treatment of those with lower scores, additional attention and activities could be devoted to other systems, those of family and work, within the general system of "man-environment", in order to compensate for the relative inadequacy of the personality system.
A follow-up study in cotton workers (35 female and 31 male) was performed ten years after the original cross-sectional study. The prevalence of byssinosis considerably increased during the follow-up study in female (22.9%; 42.9%) and in male (25.8%; 51.6%) workers. Similarly, the prevalence of almost all respiratory symptoms was significantly higher during the follow-up study than at the time of the initial study. Significant acute reductions of FVC and FEV1 during the work shift were recorded in both surveys. The mean annual decline in ventilatory capacity was greater than expected for both female (FVC: -0.036 L/year; FEV1: -0.059 L/year) and male workers (FVC: -0.059 L/year; FEV1: -0.068 L/year). The mean total airborne dust concentration was 3.95 mg/m3 with an average respirable dust concentration of 0.97 mg/m3. Our study demonstrated an association between exposure to cotton dust and increasing prevalence of respiratory symptoms and progressive impairment of ventilatory capacity.
The authors analysed and compared three groups of patients who had undergone surgery. In the first group of 72 patients with diabetes and cataract, intraocular lens implantation was carried out. In the second group of 96 patients with diabetes and cataract, cataract surgery was not followed by intraocular lens implantation. The third group of 100 nondiabetic patients, selected by random choice, had intraocular lens implanted after the cataract surgery. Retinal status, postoperative complications and visual acuity were the parameters analysed in correlation with the intraocular lens implantation. In the authors' opinion, the prognosis following cataract surgery and intraocular lens implantation in diabetic patients is good, if diabetic complications do not occur, particularly retinopathy and vitreal hemorrhage which impair the vision considerably. Intraocular lens can be implanted even in cases of maculopathy and preproliferative diabetic retinopathy, provided a thorough diagnostic evaluation has been performed (echography, fluorescein angiography). Laser photocoagulation procedure should also be carried out before surgery and repeated as long as the transparence of the lens enables it. The treatment should be resumed two weeks after the cataract surgery and intraocular lens implantation at the latest. Intraocular lens implantation is contraindicated in proliferative diabetic retinopathy, and especially iridal rubeosis, as the risk of neovascular glaucoma development is considerable.
This prospective study was carried out on 33 patients with clinically, serologically and ultrasonographically confirmed amoebic liver abscess. All patients were randomly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage. Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape, usually hypoechogenic content with specific dorsal sonic enhancement, and in the majority of cases, location near liver capsule. Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment. The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses.
The influence of HLA-B27 antigen on clinical, radiological and laboratory features of rheumatoid arthritis (RA) was studied. The group with B27 antigen comprised: 4 males and 20 females aged 28 to 71 and a group of patients free from B27 antigen consisted of 2 males and 21 females aged 26 to 69. RA patients possessing the B27 antigen did not differ regarding the age of the onset of disease, the distribution of affected joints during the follow-up (3-10 years), the development stages of the disease and the presence of rheumatoid factor when compared with B27 negative RA patients. The arthritis of the radiocarpal joints (p less than 0.01) was significantly more often the first sign of the disease in patients with B27 antigen. In these patients low back pain and morning stiffness in the low back were twice as frequent as they were in patients not possessing this antigen. The clinical pattern of the affected spine was also found more frequently in B27 carriers (p less than 0.05). B27 positive RA patients showed also the clinical pattern of sacroiliitis (SI) (p less than 0.05) and x-ray SI (p less than 0.01) significantly more often than the patients free from this antigen. In addition, symmetric arthritis of the peripheral joints was more often diagnosed in patients free from B27 antigen.
The authors deal with uveitis and cataract from two aspects. The occurrence of uveitis was analysed both before cataract surgery and postoperatively. The authors found in their material that uveitis occurred before cataract surgery in 1.8% and postoperative uveitis in 1.2% of cases. Special emphasis is put on the occurrence of postoperative complications in such eyes and the indications for the IOL implantation in uveitis patients.
The effect of intranasally administered (DesGly9-Arg8) vasopressin (DGAVP) on certain aspects of cognitive functions of alcoholic patients was studied. The investigation was carried out in 103 chronic alcoholic patients. None of the patients suffered from Korsakoff's syndrome, portal encephalopathy or brain damage of other etiology. The trial was double-blind, placebo controlled. Psychological testing, which included certain aspects of attention, short-term and long-term memory and spatial orientation, was carried out on the day before (baseline measurements), on the last day (II), and seven days after the last administration of DGAVP (III). No treatment effect of DGAVP was observed. The results show that investigations with humans are infinitely more complex than those with animals, since a number of physiological and socio-psychological factors must be controlled. In this study of alcoholics two such factors: 1) duration of abstinence and 2) adaptation to test situation were identified.
A combination of 2 or 3 tumor markers was determined in the serum of 478 patients with malignant tumors. In 195 out of 213 patients with differentiated thyroid cancer and without relapse or metastases, the Tg concentration has undetectable. In 9 patients with nonfunctioning thyroid metastases the Tg level was correlated with the progress of the disease or the success of the treatment. In 114 patients with gastrointestinal cancer CA 19-9, TPA and IAP were measured simultaneously. The highest discrepancies between patients with relapse or metastases (increased values in 1/2 of patients) and patients without relapse or metastases (increased values in 1/4 of patients) were given by CA 19-9. In the serum of 90 patients with breast cancer increased CA 15-3 values were found in 2/3 of patients with relapse or metastases and in 1/4 of patients without signs of tumor. A combination of universal tumor markers TPA and IAP had no value in monitoring 26 patients with melanoma.
The authors' experience with surgical complications following kidney transplantation is presented. From 1973 till May 1990, 136 transplantations were performed, out of which 21 before and 117 after 1983. Surgical complications occurred in 20 patients, thus reaching the incidence of 14.5% which corresponds with the incidence reported by other institutions. The incidence of vascular complications was 5.0%, of urological 4.3%, of lymphatic 1.4%, of wound infections 2.2%, and of graft ruptures 1.4%. Urological and vascular complications made for 65% of all the surgical complications which in 40% resulted in the loss of the graft. Out of the total number of the lost grafts, surgical complications were responsible in 28.1%.
