Biomedical subjects
Publications and source records attributed to R Raicević.
We evaluated the effect of PTH on blood pressure in haemodialysed patients. The correlation was found between systolic, diastolic pressure and PTH. The results have shown that PTH might have the influence on regulation of arterial blood pressure in these patients.
The purpose of these studies was to assess the effect of 6 month calcidol treatment on Ca and PO4 metabolism in haemodialyzed patients. During 3 and 6 month on alpha calcidol therapy, there was significant increase of total and ionized Ca (p < 0.05; p < 0.01 respectively). After 6 months on alpha calcidol therapy there was significant decrease of alkaline phosphatase level (p < 0.05) and increase in bone density (up to 82%, p < 0.05). The study has shown that appropriate use of alpha calcidol could be effective in treatment of Ca and PO4 disbalance in haemodialyzed patients.
Most common complications of peritoneal dialysis are those related to anatomic defect of the abdominal wall and peritoneum. The aim of this investigation was to examine the frequency of congenital and acquired wall defects in patients on CAPD treatment causing complications. Fifty patients, 32 women and 18 men, on CAPD treatment for more than two years, were investigated. Most common was a defect in the anterior-lateral abdominal wall predisposing to hernias in 14% of patients. Umbilical and pericatheteral hernias were more common than other, with a mean time of 21 months for the appearance. Persistence of vaginal process of peritoneum related to scrotal oedema was documented in 4% of patients. Communication of peritoneal cavity with the abdominal ostium of tuba uterina was found not to be an important factor for peritonitis.
Peritonitis is a very serious complication in patients treated by CAPD. The frequent and grave episodes are the main cause for CAPD withdrawal. The effective prevention and adequate therapy of peritonitis are very important for a successful CAPD treatment. The aim of this study was to present our results of peritonitis therapy in CAPD patients using the following protocol: Vancomycin 1.0 g.i.p. immediately after the admission to the unit, 250 mg Ceftriaxon (Longaceph) after a bag exchange for seven days, and the 1.0 g Vancomycin. Using this protocol we treated 97 peritonitis episodes; 74 of them (80%) were treated successfully by this antibiotics combination. The clearness of peritoneal fluid was attained 1-3 days within 56.7% of cases, and 4-6 days within the 29.7% peritonitis episodes (86.4%). A common cause of peritonitis was Staphylococcus epidermidis episodes (28.4%), Staphylococcus aureus (13.5%), and in 39.1% episodes the cultures were sterile. Uneffective antibiotic application according to this protocol was found in cases of pseudomonas and fungal peritonitis. The mentioned antibiotic therapy had no effect in a small number of peritonitides provoked by S. epidermidis (8.7%) and S. aureus (13.0%) This required the application of a third antibiotic. It could be concluded that this antibiotic combination in treatment of peritonitis in patients on CAPD was very effective.
The estimation of CAPD efficacy presents a complex problem in the patients treated by this method. The most important parameters are: clinical indications, biochemical parameters, Kt/v, PCT, PET indexes, and others. Numerous factors may influence CAPD efficacy. Peritonitis, particularly the frequent episodes, significantly affects permeability and ultrafiltration capacity of the peritoneal membrane. The aim of this paper is to investigate the peritonitis incidence and its influence on some parameters of CAPD efficacy. Forty-four CAPD patients of both sexes, aged 55.7 +/- 13.5 yrs, dialysis duration 19.6 +/- 15 months, were studied. The influence of peritonitis incidence was studied using urea, creatinine, hemoglobin, hematocrit parameters and K t/v, PET indexes. Statistically significant low K t/v values were found in the patients who had four or more peritonitis episodes. Our results, as well as those in the literature, indicate that frequent peritonitis episodes significantly decrease the peritoneal membrane permeability.
In significant number of diabetic patients are observed numerous complications during the disease onset and course. One of the most frequent is diabetic polyneuropathy that can, during its course, assume such types and imitate various diseases that can by the intensity of revealance be prominent and couse significant differential-diagnostic difficulties, especially if some forms of polyneuropathy are more rarely considered. The patient with poorly regulated diabetes, in whom the couse of disturbances was unknown for the longer period of time was presented in this study. Leading clinical phenomenology indicated the signs of impairment of cauda equina roots and extensive diagnostic procedures had to be performed. However, just after the favorable response to the glycemia regulation and withdrawal of neurologic phenomenology it was concluded that the patient suffered from diabetic polyneuropathy with clear signs of autonomic nervous system involvement, as well as autonomic neuropathy at the some time, respectively.
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In order to determine diagnostic and prognostic value of long latency reflexes, blink reflex and somatosensory evoked potentials in patients with ischemic brain disease (IBD), examinations were done in 32 patients of both sexes with IBD, average age 44-76 years. First examinations were performed within first week of the onset of IBD and in majority of patients repeated after 3 and 6 months. Changes of electrophysiological characteristics compared with the degree of IBD, clinical presentation, localization, extent of infarction zone (measured by CT) and functional recovery where analyzed. Electrophysiological changes were predominantly associated with amplitude of physiological response and were in correlation with the degree of IBD, localization and the extent of infarction zone. Latencies were prolonged only in case of subcortical ischemic lesions. Correlation between functional recovery and electrophysiological changes was present only within the structures responsible for certain components of electrophysiological responses and localization of ischemic lesion. In conclusion, electrophysiological examinations are of high diagnostic and predictive value in IBD.
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The possibility of early prediction of ischemic brain disease (IBD) is extremely significant for the creation of the individually designed treatment program. The aim of this study was to determine the significance of hemispheric localization of ischemic brain lesion as possible factor for the early prediction of IBD outcome. The study included 170 patients with IBD, whose score of neurologic and functional impairment was determined after admission by using the standard scales. The values of hemorrheological parameters-erythrocyte sedimentation rate (ESR), fibrinogen and alpha 2 globulin were also determined, so as the extensity of ischemic lesion by CT and MR brain examinations. After the treatment, the score of neurologic and functional impairment was also determined and the degree of ischemic disturbance was estimated-transitory ischemic attack (TIA), reversible ischemic attack (RIA) and cerebral infarction. The lower scores were noticed for neurologic and functional impairment, meaning the more severe degree of ischemic disorder with ischemic lesion localization in right cerebral hemisphere (RCH), in acute stage and at the end of treatment. The higher values of ESR, slightly less of fibrinogen and alpha 2 globulin were revealed in the case of ischemic lesion localization in RCH, so as the higher frequency of RCH lesions in percentages connected with the more severe ischemic disorders. It was concluded that the ischemic lesion localization in RCH might be the predictor of poorer IBD outcome.
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