In this report of two new cases of liver angiosarcoma (ASL) among plastic industry workers, the authors present the history and perspectives of this problem. The first cases of ASL have been registered since 1974, and in 1984, the European register of angiosarcoma was founded. In this register, 11 cases of ASL and one case of haemangiopericytoma have been registered from Croatia, all from a single plastics plant near Split. Two new cases of ASL (in retired autoclave cleaners, who were exposed to a concentration of 500-1000 ppm vinyl chloride monomer (VCM) during the working process) in the same plant are represented. They were detected with combined techniques of ASL detection, and both are still alive. The diagnoses have been histologically confirmed: one of them was surgically treated with segmental liver resection. The appearance of new cases of ASL confirms the perspective presented in the last report by the same authors.

Adult↗

PubMedDate not supplied

[Role of wrist instability in the onset of pseudoarthrosis of the scaphoid bone].

INTRODUCTION: The most common fracture involving the wrist is a fracture of the scaphoid bone. Fracture of the scaphoid most frequently occurs in young adult male and usually involves the wrist of the scaphoid. There is a universal agreement that the majority of these fractures will heal if immobilized property and for a long period of time [1, 2]. In the treatment of these fractures much attention has been payed to bone damage and not to associated ligament injury. It is reported that the incidence of nonunion of scaphoid fractures is ten per cent and that the frequency of this complication remains essentially unchanged [3, 4]. Failure to improve the outcome suggests that the mechanisms and causes of this complication are poorly understood. Explanations of nonunion or delayed union of scaphoid bone are: poor initial treatment or even no treatment [3], delayed diagnosis [5], fragments displacement [5-8], improper immobilization [9], site and direction of the fracture [3] and wrist instability [8, 10]. AIM: The study was undertaken to analyse the influence of carpal instability on the development of scaphoid nonunion. METHOD: The study concerned 40 patients with painful nonunions of the scaphoid bone. Duration of nonunion was 1.43 year. There were 37 (92%) male and 3 (8%) female patients. Site and direction of the fracture, initial treatment and carpal collaps were analysed. Data processing was done for all examined patients (Table 1). RESULTS: Dominant hand was involved in 24 (60%) patients and nondominant hand in 16 (40%) subjects. Carpal collaps was present in 68% of patients. There were 14 (35%) untreated patients (Graph 1). Untreated fractures were statistically insignificant regarding the intensity of carpal collaps (p = 0.101; p > 0.05). The physical examination usually revealed focal tenderness, a palpable click with ulnar deviation, abnormal antero-posterior mobility with passive range of motion or a combination of these findings. Standard X-rays evaluated fracture location and carpal instability or collaps. There were 14 (35%) proximal third located fractures and 26 (65%) in the middle third of wrist (Graph 2). There was no statistically significant correlation between location of the fracture and presence of carpal collaps (p = 0.081; p > 0.05). DISCUSSION: There were 35 per cent overlooked fractures. Delay in diagnosis of a scaphoid fracture has been suggested as a significant factor in the development of nonunion [5, 7]. However, in our series of nonunions, non treatment does not occur frequently enough to be the critical factor. Most series report about 2/3 of nonunions occurring at the wrist [7, 9]. Our series shows a similar distribution, arguing against site as a critical factor. There appears to be a nearly uniform rate of nonunion in most of the reported series [7, 15, 16], regardless of the position of the wrist, whether or not the thumb was immobilized. Evidence of ligamentous injury in our series led us to conclude that scaphoid nonunion is consistently associated with carpal instability pattern. In our series 68% of nonunions associated with carpal collaps were present. We found no statistically significant correlation between carpal collaps and nontreated fractures or location of fracture site. Therefore, we concluded that carpal collaps was consistently present and, thus the critical factor in wrists with ununited scaphoid fractures.

Adolescent↗

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[Incidence and severity of degenerative changes in the wrist in pseudoarthrosis of the scaphoid bone]].

INTRODUCTION: In patients with symptomatic scaphoid nonunion there was an increased evidence of progressive osteoarthrosis expressed as instability of the wrist [1, 2]; it is defined as a scapholunate angle of more than 70 degrees or a radiolunate angle of more than 10 degrees. Intercarpal instability causes unnatural joint movement of the wrist. This disorganization of the wrist mechanism associated with hypermobility of the schapoid bone induces degenerative changes [3]. Arthritic changes begin at the distal scaphoid-radial styloid joint and later progress to the capitolunate joint. A similarity was noted with rotatory instability of the scaphoid bone associated without fracture [2]. If mid-carpal joint exists the joint becomes unstable, the lunate rotates backwards and carpal bones show the so-called concertina deformity [4] or dorsal intercalated segment instability pattern [5]. AIM: We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. METHOD: In this study 40 patients with painful nonunion of the scaphoid bone were analysed. Duration of nonunion was 1.43 year (range from 8 months to 15 years). Roentgenograms of the hand were done in anteroposterior, lateral and oblique projections. Fracture location and configuration were determined as described by Russe. Instability was determined by measuring the scapholunate and radiolunate angle in the lateral roentgenogram. Scapholunate angle more than 70 degrees and radiolunate angle more than 10 degrees were considered abnormal. To asses the amount of carpal collapse the carpal index was determined as described by Youm [6]. Abnormal value was 0.50 or less (normal value: 0.54 +/- 0.03). Four roentgenographic groups were established based on the extent of degenerative changes [7]. Group I showed no sign of degenerative changes. Group II had sclerotic lesions in fracture margins with or without a cystic formation. Group III showed lesions of radioscaphoid arthritis, including joint-space narrowing and pointing the radial styloid. Group IV had lesions of generalized arthritis of the wrist. RESULTS: Duration of nonunion was not in correlation with development of osteoarthritic changes (p = 0.644, p > 0.05) (Table 1). Progressive degenerative changes correlated well with radiolunate angle (p = 0.398, p < 0.05), capitolunate angle (p = 0.381, p < 0.05) and carpal index (p = 0.392, p < 0.05) (Table 2). The average values of intercarpal angles increased with progression of osteoarthritic changes (Table 3). There were 14 (35%) proximal third located fractures and 26 (65%) in the middle third or waist. There was a statistically strong correlation between location of the fracture in proximal third and presence of degenerative changes (p = 0.341, p < 0.01) (Table 4). Intensity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p = 0.665, p > 0.05). DISCUSSION: In our study the most significant factors associated with arthritis were instability of the wrist and fracture location at the proximal third of the scaphoid bone. Mack [7] reviewed forty-seven symptomatic nonunions of the scaphoid and found a correlation between the presence of arthritis and the duration of nonunion. Also, he concluded that instability of the wrist can occur as late phenomenon in previously stable nonunion. Similar results were noted by Ruby [8] in his series. Conclusion of these authors was that the incidence of degenerative changes increased with the time after fracture of the scaphoid bone occurred [8-12]. We demonstrated that in untreated fractures associated with carpal instability, arthritis developed much earlier. Fourteen (35%) patients in our study were not treated and 92.8% belonged to Group II and Group III, with average time of nonunion duration of 27.2 months. Lunate dorsiflexion is a useful guide to carpal instability. In our experience the lunate silhouette is easily visualized on a lateral roentgenogram even in the presence of degenerative arthritis. There is a high probability that degenerative changes will occur. We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.

Disease Progression↗

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[Biomechanics of the meniscus of the knee joint and its characteristics].

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Biomechanical Phenomena↗

PubMedDate not supplied

[The effect of meterological factors on the manifestation of myocardial infarct in the coastal region of central Dalmatia].

The influence of mediterranean climate on the onset of myocardial infarction (MI) was investigated. The study comprised 1306 MI patients from the coastal part of Middle Dalmatia admitted to the two hospitals in Split in 1981-1987 period. Myocardial infarction incidence during south-wind was significantly greater then during north-wind (chi 2 = 5.6; < 0.05) as well as during all non-south-wind days (chi 2 = 11.6; p < 0.001). The coefficients of partial correlation show mild but still significant connection of MI incidence with increased air temperature (rt = 0.064; p < 0.05) and relative humidity (rh = 0.064; p < 0.05). Cross-correlation with shift also revealed mild connection of MI incidence with increased temperature within four days before and on the day of incident (r = 0.023-0.034; p < 0.05). The analysis of synoptical situations in the days with greatest number of MI's (4 to 6) ascertained the characteristics of unstable weather when passing atmospheric front caused a change in the type of weather. The results suggest that coronary patients should stay at home during the south-wind passing atmospheric front, avoid physical stress and take more often antianginal drugs.

Aged↗

PubMedDate not supplied

[Controlled comparison of nicardipine and propranolol in the treatment of arterial hypertension].

A randomized collective comparative study between nicardipine (N) and propranolol (P) was conducted over a period of 7 weeks in thirty hypertensive patients of both sexes, aged from 20 to 65 years, with the diastolic pressure over 100, but below 120 mmHg. Thirteen examinees were given N (60-120 mg daily) and seventeen P (120-240 mg daily); the groups were comparable according to a series of relevant parameters. In the placebo-period the mean arterial pressure (MAP) was slightly lowered, by 4.4% (p greater than 0.20). MAP was, however, considerably lowered already at the end of the second week of active treatment both in the N group (from 135.1 +/- 7.4 to 116 +/- 10.8 mmHg, or by 19.1%; P less than 0.01), as well as in the P group (from 131.6 +/- 8.1 to 117 +/- 9.1 mmHg, by an average of 11.1%; P less than 0.05). The values continued to decrease, and at the end of the seventh week of the study MAP averaged 108.5 +/- 6.5 mmHg (-19.7%; P less than 0.01) in the N group, while it was 109.7 +/- 9.1 mmHg (-16.6%; P less than 0.01) in the P group. The heart rate became considerably slower in the P group only, from the initial 84.5 +/- 9.2 to 66.9 +/- 2.7 beats per minute at the end of the seventh week (-20.8%; P less than 0.01), but it was unexpectedly, although not significantly lowered also in the N group, from the initial 78.3 +/- 6.5 to 74.2 +/- 4.0 beats (-5.2%; P greater than 0.20).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗

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[The role of the diagonal ear lobe crease in the clinical evaluation of coronary risk].

Two hundred and forty-three prospective patients (143 with proved coronary heart disease and 100 without coronary disease) were analysed for the presence or absence of ear lobe crease, a possible aural sign of coronary artery disease. The crease was present in 72.7% of the coronary and 48% of the noncoronary examinees (p less than 0.001). The crease was more prevalent in older (greater than 50) than in the younger patients. The positive predictive value of this sign averages 70% and the negative one 60%.

Coronary Disease↗

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[The time interval from the onset of myocardial infarct to arrival in the coronary unit in the area of Split].

The time interval from the initial symptoms of myocardial infarction to the coronary care unit admission in patients treated at the Department of Internal Medicine, University Hospital "Firule", Split, and Military Hospital, Split, between 1 January 1981 and 31 December 1987, vas analysed. The average duration of this delay was 14.8 +/- 11.6 hours (range 2-72 hours). It is concluded that this interval should be substantially reduced in order to decrease the actual coronary heart disease death rate.

Coronary Care Units↗

PubMedDate not supplied

[Characteristics of diurnal rhythm in the development of myocardial infarct: risk in the morning hours].

The onset of precordial pain was assessed in all the patients admitted to the Clinical Hospital "Firule" and the Military Hospital, Split, during a six-year period (1981-1986) with acute myocardial infarction (n = 1304). According to the time of onset, all the subjects were stratified in three-hour intervals. The large majority of initial symptoms was registered between 7 and 10 a.m. (372 or 28.53% of all; chi 2 = 317, P less than 0.001). The results of this and other studies of circadian rhythm in coronary events points out to the high risk of morning hours, suggesting specific preventive measures, including pharmacological and life-style interventions.

Circadian Rhythm↗

PubMedDate not supplied

[Characteristics of patients with acute myocardial infarction treated in Split 1982-1992].

Three thousand three hundred and fifty-two patients (70% males and 28% females) were hospitalized and treated in Split for acute myocardial infarction (hospital mortality 20%) between 1982-1992. The number of these admissions has been constantly rising from 226 in 1982 to 397 in 1992. Over 45 years of age were 3043 (90.8%) of the patients (70% males and 30% females), while 309 of them (9.2%) were under 45 (93% males, 7% females). The lethality rate was 21% in the first and 8% in the second subgroup. In patients over 45 inferior myocardial infarction was found in 35%, and in patients under 45 in 49%. In the older group there were 40% smokers, 42% hypertensives and 39% hypercholesterolemics, while there were 75% smokers, 35% hypertensives and 33% hypercholesterolemic patients in the younger age group. The results show that the number of patients treated for acute myocardial infarction in the Split region is constantly increasing (p < 0.001). In patients under 45 years of age there is significantly higher inferior infarction prevalence (p < 0.001); a larger percentage of males (p < 0.001) and smokers (p < 0.001), and lower percentage of hypertensives (p < 0.001) and hypercholesterolemic patients (p < 0.05) was observed, as well as lower hospital mortality rate (p < 0.001).

Croatia↗

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[Meteorologic effects and thrombocyte aggregation in patients with myocardial infarct living in the coastal region of central Dalmatia].

The circulating platelet aggregates were measured in 90 patients admitted to the Clinical Hospital Split because of myocardial infarction developed in the costal region of Middle Dalmatia. They were divided into three groups, each consisting of 30 patients affected by coronary incident developed during the three most characteristic weather types in the region: sirocco, bora and calm weather. All the patients have had elevated values of circulating thrombocyte aggregates, but the patients in the sirocco group exhibited significantly higher values (34.77% +/- 11.67%) than the patients in both bora (27.93% +/- 11.72%; p < 0.05) and the calm weather groups (23.5% +/- 10.62%; p < 0.01). In the control group of 10 healthy examinees the values of circulating platelet aggregates were within normal range during all the three weather types (5.85% +/- 0.70%, 5.24 +/- 0.51% and 5.18 +/- 0.59%, in case of sirocco, bora and calm weather, respectively). The three groups were not significantly different regarding the values of creatinine kinase, which means that the infarct size was not the probable cause of the observed differences in platelet aggregability. Taking into account our previous finding of increased incidence of coronary events during sirocco, these results suggest that increased platelet aggregability is a contributing factor to the risk of myocardial infarction during such a weather.

Adult↗

PubMedDate not supplied

[Anterior septal myocardial infarct impairs cardiovascular function more than inferior septal myocardial infarct].

The functional ability, expressed as percentage of expected oxygen uptake, measured on the tread-mill according to the Bruce protocol, was assessed in 30 patients with anteroseptal, and in 30 patients with inferior myocardial infarction (MI), 4 months after the incident. In comparison to those with inferior MI, the patients with anteroseptal localization exhibited significantly lower values of functional ability (68.37% +/- 14% versus 75.63% +/- 11%, p < 0.05), significantly higher activities of creatine kinase (CK: 894.7 +/- 441 versus 603 +/- 330 IU, p < 0.01), significantly lower left-ventricular ejection fraction (53% +/- 6.4% versus 58.7% +/- 6.3%, p < 0.01) and higher negative correlation between CK and functional ability (r -0.85 versus r -0.72). In conclusion, anteroseptal infarction is associated with a greater decrease in functional ability then the inferior one, which is partly due to more extensive necrosis with greater deterioration in left ventricular contratility; the mere site of infarction is probably also a contributing factor.

Exercise Test↗

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[Association of platelet aggregation with the extent of myocardial infarction].

The aim of this study was to evaluate the association between the type of myocardial infarction (MI) and the circulating platelet aggregates [circulating aggregates of thrombocytes (CAT)]. The size of MI was assessed by the maximal values of creatine-kinase (CK). In 80 patients in the acute phase of MI the values of CAT and CK were manifold increased, mostly in 30 patients with anteroseptal MI (CAT 34.1 +/- 8.3%, CK: 920 +/- 340 IU), less markedly in 30 patients with inferior MI (CAT: 25 +/- 6.7%, CK: 739 +/- 263 IU) and in 20 patients with non-Q-wave MI (CAT: 20.7 +/- 1.9%, CK 518 +/- 224 IU). The differences between the groups were significant (p < 0.05). There was a significant linear correlation between CAT and CK in anteroseptal MI (r = 0.57, p < 0.01) and in inferior MI (r = 0.54, p < 0.01), but not in non-Q-wave MI (r = 0.15, p > 0.05). The results are concordant with the hypothesis that thrombotic event contributes more significantly to the pathogenesis of transmural acute myocardial infarction.

Adult↗