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Biomedical subjects

S Milutinović

Publications and source records attributed to S Milutinović.

At least 19 recordsLinked to original sources
PubMed1998

Features of uremic neuropathy in long-term dialysis.

In order to assess the influence of long term hemodialysis on progression of uraemic neuropathy (UN), 16 different electroneurographic (ENG) parameters on 158 dialysis patients were performed. The ENG parameters were compared in three groups of patients of different dialysis age. Group I: high dialysis age (HDA) comprising of, 31 patients being more than 10 years on dialysis; Group II: intermediate dialysis age (IDA) comprising of 53 patients between 5 and 10 years on HD and group III: low dialysis age (LDA) comprising of 74 patients being less than 5 years on dialysis. The influence of sex and age was also analyzed. All sixteen tested parameters were altered in uremic patients when compared to 140 healthy controls (p < 0.01). HDA pts compared to LDA pts and the older group versus the younger had 11 and 9 out of 16 ENG parameters significantly worsened, respectively (p < 0.01). The most profound and reproducible lesion was in prolongation of evoked potential of tibialis posterior and peroneus nerve (FWt, HWt, FWp). HDA, especially after 10 yrs and the age but not the sex is clearly associated with a further progression of UN. However, for unknown reasons, the progression of UN in dialyzed patients is not followed by a parallel worsening of clinical symptoms (p > 0.05).

Action Potentials↗
PubMed1995

[The beginnings of otorhinolaryngology in Bosnia and Herzegovina and its development in Sarajevo].

The first ENT Department in Bosnia and Herzegovina was established in Sarajevo by Dr. Zarko Prastalo in 1923, as a part of the Surgery Clinic, with 10 beds. The next year (1924) ENT got its own operation theatre, 30 beds more and a new localization. In that period there was only one ENT specialist, Dr. Zarko Prastalo. Three years after some new doctors started the specialization in ENT. By the year 1946 the ENT Department became a University clinic with 7 doctors on duty, the Clinic became an educational centre. To the year 1992, 112 ENT specialists were educated in the ENT Clinic in Sarajevo. Later in time, after Dr. Zarko Prastalo, Dr. Ivo Herlinger, Dr. Josip Gerc and Dr. Emilija Bac became known ENT specialists. The new scientific and operation techniques came to the ENT Clinic, the first chelognapalato schisis was in 1936, done by Dr. Josip Gerc. The first ear operation using operation microscope and microinstruments was performed in 1962, while the first laryngo-micro-operation in 1971. Since 1965 th worked with the Maxilofacial Surgery, together, but in 1972 they moved to the stomatologic Clinic, With the development of the clinic, 10 our patient departments (ambulances) were established in Sarajevo. As for now, during the war, there are 101 beds, 13 ENT specialists. Dr. Sejo Sebić was killed in 1992 by the aggressor.

Bosnia and Herzegovina↗
PubMed1994

[Management of soft-tissue defects related to war injuries].

The paper analyzed our experiences with repairing the skin defects in 120 wounded patients in the first war year. After primarily surgical observations patients were hospitalized in the ORL clinic for a further care. Most of wounds were by artillery projectiles. Extensivity, intensivity and primary contamination are three characteristics of war wounds that makes problems in definitely repairing of defects. This is because of the secondary repair 67.80% defects. Spontaneous reepithelization is noticed in 14.80% defects. By direct sutures we closed 16.00%, free skin tissues grafts 23.26%, used various techniques of rotation and transposition flaps 46.52% defects. Correct plastic reconstructive planning and active physical-chemical preoperative treatment eliminated big postoperative complications.

Adult↗
PubMed1994

[Care of war injuries of the nasal apparatus].

Prominent position of nose and paranasal sinuses (nose complex) is one of the most percentage of war injuries (37.00% of ORL region). Unfortunately, these wounds are badly observed. So late we have big functional and aesthetical disorders. Using simple methods like inspection, palpation, rhinoscopy and some radiologic examination we could have a good information about kind and lesion extension. It is very important in operating planning. This paper is retrospective analyses of nose complex war injuries in a first 12 months of aggression. They are open nonpenetrans in less than a half cases and high percent of isolated injuries (42.60%). Most of them are from artillery projectiles.

Adult↗
PubMed1993

Ticlopidine improves dialysis clearance of solutes in uremic patients by reducing blood clotting in dialyser fibers.

Ticlopidine, a platelet aggregation inhibitor was tested, in a double blind comparative cross-over study versus placebo, in 51 dialysed uremic patients who had increased dialyser blood clotting (> 25 fibers clotted/dialyser). At the end of a 7-day treatment period with 250 mg daily, the clearance of urea, creatinine and phosphate was determined at 30 and 210 minutes of dialysis, as well as the number of fibers clotted at the end of dialysis. Ticlopidine improved dialyser clearances for urea, creatinine and phosphate from 165 +/- 41 to 182 +/- 35 (p < 0.01), 135 +/- 37 to 143 +/- 35 (p < 0.05), and 120 +/- 36 to 130 +/- 35 (p < 0.05) ml/min, respectively, at 30 min of HD and a similar effect was seen after 210 min of dialysis. The number of dialyser fibers clotted after dialysis was reduced by ticlopidine therapy from 110 +/- 48 to 15 +/- 8 (p < 0.01). Ticlopidine reduced the initial dialysis-induced drop in leucocyte count by 20% (p < 0.05); no change in platelet or erythrocyte count was observed. Two out of 51 patients experienced an adverse reaction from ticlopidine (cutaneous haematoma and minor gingival bleeding). We conclude that ticlopidine is an efficient and safe drug for dialysed uremic patients since it can reduce blood clotting and thereby increase dialysis efficiency.

Adolescent↗
PubMed1993

The role of sympathetic dysfunction in blood pressure regulation in uremic patients treated by continuous ambulatory peritoneal dialysis.

The role of autonomic nervous system dysfunction in the regulation of arterial blood pressure in 4 male and 10 female uremic patients, age 35-65 years (57 +/- 9 years), treated by continuous ambulatory peritoneal dialysis (CAPD) for 6-40 months (20 +/- 12 months), was studied. The integrity of the entire autonomic reflex arc was checked using Valsalva's test and the orthostasis challenge test. In parallel, efferent sympathetic function was tested with the handgrip test. A significantly decreased Valsalva ratio was found in 7 patients (50%), and it was normal in only 2 patients (14%). The handgrip test was subnormal in 5 patients (36%) and abnormal in 7 patients (50%). On the contrary, the orthostatic challenge test showed normal compensatory reaction in 10 patients (72%). The evaluation of three autonomic tests showed combined (afferent + efferent) lesion in 6 patients (43%), predominant afferent lesion in 3 patients (21%), and in 3 patients predominant efferent lesion. In 2 patients (14%) there was no end-organ response. Despite significant autonomic nervous system dysfunction in uremics on CAPD, as demonstrated by these results, blood pressure regulation in the supine and upright position was adequate in most patients (72%), indicating a relatively greater role of other blood pressure-regulating factors.

Adult↗
PubMed1992

Phagocytic function in patients with recurrent urinary tract infections.

Phagocytes play an essential role in the host's defence against uropathogenic bacteria which are mostly extracellular pathogens. The functional capacity of peripheral blood phagocytes (predominantly polymorphonuclears, PMN) was investigated in 47 patients (urethrocystitis, acute or chronic pyelonephritis) and in healthy persons. The random mobility of phagocytes was determined by measuring their spontaneous migration from a capillary tube. Using radioactively labelled sheep erythrocytes as targets and the phagocytes as effector cells, ingestion, digestion and extracellular cytotoxicity were determined. All the four phagocytic functions in patients were significantly lower than in healthy controls, especially in patients with chronic pyelonephritis. These results link reduced phagocytosis by blood phagocytes with recurrent urinary tract infections (UTI). Whether the defect is primary or secondary to infection (and only transient) should be the object of further studies.

Adult↗
PubMed1991

The effect of guanidino substances from uremic plasma on insulin binding to erythrocyte receptors in uremia.

We have studied insulin binding to erythrocyte receptors in a group of 25 nonobese, nondiabetic uremic patients undergoing maintenance hemodialysis for 2-54 months and 14 healthy controls. Erythrocytes of predialyzed uremics bind significantly less insulin than control erythrocytes (p less than 0.01). Dialysis resulted in a rapid increase of insulin binding (p less than 0.001). The concentrations of plasma insulin and glucose remained essentially unchanged during 5-hour hemodialysis and did not significantly differ from the control values. The down regulation of insulin receptors in undialyzed patients in the presence of normal plasma insulin concentration indicates that factors other than insulin itself could be responsible for insulin receptor activity during uremia. The results demonstrated that creatinine, creatine and glycocyamine have a direct suppressive effect on insulin binding of postdialyzed plasma (p less than 0.05) in concentration of 1 mmol/l. This suggested that specific uremic toxins could play an important role in the mechanisms of altered insulin binding during hemodialysis. Despite the high concentration of these compounds in blood of uremics, the only common feature for these compounds is the presence of the guanidino group in the molecule.

Adult↗
PubMed1987

[Dihydroergotamine in the treatment of patients with symptomatic hypotension during regular hemodialysis].

The efficacy and safety of dihydroergotamine (DHE, Ditamin) in the treatment of symptomatic hypotension in regularly dialysed patients were tested in comparison to placebo in a single-blind, randomised clinical trial. Ten adult uremic patients (5 men and 5 women) with acute hypotension during hemodialysis, at least once weekly associated with symptoms of cerebral hypoperfusion, were included into the study. The administration of DHE during hemodialysis in a dose of 10 micrograms/kg body weight intravenously resulted in an increase in blood pressure (BP) from 91 +/- 13 to 114 +/- 14 and from 60 +/- 12 to 78 +/- 11 mmHg for systolic and diastolic BP, respectively (p less than 0.01). The maximum effect on BP (systolic and diastolic) was achieved 15 to 30 min after DHE administration; thereafter a gradual decline of effect on BP was observed, the t1/2 of disappearance of effect being 46 min. The use of isotonic or hypertonic saline solution in the treatment of hypotension decreased under the administration of DHE from 1200 +/- 600 ml to 70 ml and from 34 +/- 28 to 10 +/- 17 ml per patient and dialysis, respectively (p less than 0.01). In spite of a higher ultrafiltration rate resulting in a greater body weight reduction after hemodialysis, the incidence of symptomatic hypotension decreased after DHE administration from 1.46 +/- 0.52 to 0.14 episodes per patient and dialysis (p less than 0.01). It may be concluded that the resistance of uremic patients to hypovolemic stress occurring during hemodialysis is markedly increased after intravenous administration of DHE in a dose of 10 micrograms/kg.

Adult↗
PubMed1985

Changes in insulin binding during hemodialysis in uremic patients.

To investigate factors responsible for altered insulin sensitivity in uremia, we studied 125I-insulin binding to erythrocytes in 20 uremic patients before and after dialysis. In uremic patients, predialysis binding was 50% lower in comparison with healthy controls (4.35 +/- 1.79 vs. 9.37 +/- 1.30%; p less than 0.01). Five-hour dialysis treatment resulted in a rapid increase in binding (on average to 55%; p less than 0.01). During the course of dialysis, binding to erythrocytes from 2 selected patients steadily increased in a time-dependent manner (on average 24%/h). The dialysis-induced increase in binding did not correlate with the changes in plasma insulin levels, but depended on the efficiency of dialysis as assessed by a relative decrease in plasma urea and creatinine. After an intravenous glucose load, the insulin-to-glucose ratio decreased in parallel with the increase in binding after dialysis. The results indicate that uremic plasma contains dialyzable substances which reversibly inhibit insulin binding, leading to altered insulin sensitivity.

Adult↗
PubMed1983

Inhibitor of insulin binding to erythrocytes in plasma of uremic patients.

Previously, we have shown that insulin binding (IB) to erythrocytes was decreased in uremic patients and that hemodialysis corrected the receptor defect. In the present study cross-incubation experiments were performed using uremic and control erythrocytes and plasma. Incubation of control erythrocytes with uremic plasma resulted in a 60% decrease in specific insulin binding, and progressive dilutions of uremic plasma revealed a parallel decrease in degree of inhibition suggesting the presence of an inhibitor of insulin binding in uremic plasma. Plasma obtained from uremic patients exhibiting lower IB to their erythrocytes was more potent in inhibition of IB to control erythrocytes, i.e. predialysis in comparison with postdialysis plasma. The alteration of IB was reversible since incubation of uremic erythrocytes with normal plasma restored IB towards normal values. Subjects having higher IB to their erythrocytes had more efficient plasma in restoring IB to uremic erythrocytes. The data indicate that alteration of insulin binding in uremia is mediated by dialysable plasma inhibitors. The possibility that humoral factors affecting binding of insulin to its receptors can in this way influence the sensitivity of peripheral tissues to insulin is considered.

Adult↗
PubMed1983

Improvement of insulin binding to erythrocyte insulin receptors in uraemia by haemodialysis.

Insulin binding to erythrocytes obtained from uraemic patients was determined using a radioreceptor assay. The binding was reduced by 50 per cent in 20 non-diabetic uraemic patients in comparison with 20 controls (4.7 +/- 1.79 vs 9.37 +/- 1.30 (mean +/- SD) p less than 0.01). During the course of haemodialysis insulin binding steadily increased in a time dependent manner in proportion to the efficiency of haemodialysis as assessed by relative decrease in plasma urea, uric acid or creatinine. Incubation of healthy donors' erythrocytes with uraemic plasma resulted in a dose dependent inhibition of insulin binding with a maximum of 40 per cent. These data indicate the presence of dialysable inhibitors of insulin binding in uraemic plasma.

Adult↗