Craniocerebral war missile injuries: clinical and radiological study.
In this study we reviewed the initial clinical and radiological management and early outcomes of 176 consecutive patients from the war in Croatia.
Brain↗
Biomedical subjects
Z Dujić
Publications and source records attributed to Z Dujić.
Blood gases and sex hormones in women with and without genital descensus.
BACKGROUND: Abnormalities in connective tissue and spirometric disorders have previously been found in women with genital descensus. OBJECTIVE: To evaluate the association of descensus and respiratory function. METHODS: The blood gases and sex hormones were measured in 130 women scheduled for surgical correction of descensus and 60 matched women without descensus. All subjects were nonsmokers and without past or present cardiorespiratory disease. RESULTS: Women with descensus had a lower pH (7.39+/-0.04 vs. 7.41+/-0.04, p = 0.01), lower arterial tensions of oxygen (12.7+/-12. vs. 14.1+/-0.9 kPa, p = 0.003) and carbon dioxide (5.1+/-0.4 vs. 5.3+/-0.3 kPa) but a higher hemoglobin concentration (141+/-11 vs. 132+/-9 g/l) and a higher serum progesterone in the follicular phase of the cycle (3.1+/-4 vs. 1.5+/-1 ng/ml, p = 0.03). In 39 (30%) women with descensus, the arterial carbon dioxide tension was below 4.9 kPa. All subjects ventilated more in the luteal compared to the follicular phase of the cycle. In women with descensus, the hemoglobin concentration increased with decreasing arterial oxygen tension (p = 10(-4)) and with decreasing pH (p<10(-3)). CONCLUSION: Women with descensus frequently hyperventilate and, compared with women without descensus, have a lower arterial oxygen tension, increased hemoglobin concentration and slightly lower pH.
Carbon Dioxide↗
Pyelolithotomy improves while extracorporeal lithotripsy impairs kidney function.
PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) causes acute depression of kidney function, which chronically returns to baseline levels. This sequala could indicate chronic regression of acute lesions or a balance between lesions and relief of obstruction. We compared changes in kidney function 1 week and 3 months after ESWL and pyelolithotomy. MATERIALS AND METHODS: A group of 17 women and 13 men 28 to 71 years old with 0.6 to 3 cm. stones received 1,800 to 3,200 shock waves by an electromagnetic lithotriptor. Another group of 21 women and 9 men 35 to 76 years old with 2.5 to 3.8 cm. stones underwent Gil-Vernet intra-sinus pyelolithotomy. Split renal plasma flow, glomerular filtration rate and mean parenchymal transit times of nonreabsorbable filtrate solutes were measured by dual gamma camera renography, and plasma clearances of 99mtechnetium diethylenetriaminepentaacetic acid and 131orthoiodohippurate acid. RESULTS: ESWL caused acute deterioration and chronic restoration of baseline parameters of the treated kidney, and small but sometimes irreversible damage to plasma flow to the untreated kidney, especially in obese patients. In contrast, pyelolithotomy acutely and chronically improved function of the treated kidney, and normalized parenchymal transit times of radiotracers. CONCLUSIONS: ESWL does not achieve substantial improvements in kidney function, which can be achieved by other methods of stone removal.
Adult↗
Triggers of acute myocardial infarction regarding its site.
We have studied the incidence of possible triggers of the myocardial infarction regarding its site in 750 patients with anterior and 731 patients with inferior infarction. Infarctions occurred most frequently without recalling any triggering activity, especially in patients with anterior infarction (67 vs. 44%). Physical effort as the possible precipitator was also more frequent in anterior infarctions (22 vs. 16%). However, the onset of inferior infarction was more frequent during meteorological stress (9 vs. 2%), emotional stress (10 vs. 3%), after overeating (13 vs. 3%) and nicotine abuse (6 vs. 1.5%). These triggers were independent and highly significant (P < 0.02 in each case) discriminators of the site of myocardial infarction. Bimodal circadian rhythm, with primary peak between 6 and 9 h a.m. and the secondary peak between 3 and 6 p.m. was observed in patients which did not recall any triggering activity, and this was more pronounced in patients with inferior infarction. These results support the hypothesis that the influence of the vegetative tone is most pronounced in the onset of myocardial infarction of inferior wall.
Circadian Rhythm↗
Spirometric disorders in women with genital descensus.
BACKGROUND: We hypothesized that abnormalities in connective tissue, found in women with genital descensus, could impact their pulmonary function. METHOD: Therefore we compared lung flows and volumes between women with (n = 100) and without (n = 100) descensus. RESULTS: Patients exhibited highly significant decrements in all expiratory flows, especially in the peak expiratory flow (-35%) and other flows at large lung volumes. The forced vital capacity and forced expired volume at 1 second, but not their ratio, were also decreased (-16% and -17%, respectively). These differences were exaggerated in postmenopausal subjects and in patients with third degree of descensus, but did not depend on the presence of stress incontinence. Lung flows and volumes did not change between follicular and luteal phase of the cycle, either in patients or in controls. The forced vital capacity decreased with increasing years past the menopauses in patients (65 +/- 10 ml per year), but not in controls. CONCLUSION: In women with genital descensus deteriorations in lung ventilatory function were observed in association with the presence and duration of postmenopauses.
Adult↗
Early intracranial infections after brain missile injuries--the role of computer tomography in diagnosis and treatment.
During the war in Croatia, from August 1991 until December 1994, 138 soldiers were treated at the Split University Hospital for different brain injuries inflicted by missiles. Nine of these 138 patients developed intracranial infection. This retrospective study reports on the outcome of these 9 intracranial infections caused by penetrating missile head injuries. In case of clinically suspected infection, computerized tomography scan was obtained at two time points during the course of infection in the same patient. Scans were obtained with and without contrast media, 7 to 14 days after the injury and the 4 weeks later. The role of computerized tomography in the detection and follow-up of various intracranial infections and long-term consequences were evaluated.
Adult↗
Increase of lung transfer factor in early sarcoidosis.
Dynamic spirometry and the lung transfer factor for CO (TLCO) were determined in 41 non-smoking patients with sarcoidosis before and after steroid treatment. Dynamic spirometry revealed usual stage-dependent restrictive and/or obstructive abnormalities; only maximal expiratory flow rate at 75% FVC (MEF75) was significantly increased after steroid treatment in stage 2 patients. The new finding is that TLCO was increased in stage 1 [on average 21% above the predicted values (p.v.)], but it was decreased in stage 2 (11% below p.v.) and stage 3 (27% below p.v.). The increase in TLCO in stage 1 was predominantly caused by an increase in TLCO membrane component (Dm) (33% above p.v.), while the pulmonary capillary blood volume (Vc') increased less (19% above p.v.). Steroid treatment significantly reduced TLCO, Dm and Vc' in stage 1 (for 14, 17 and 18% of the respective baseline values), whereas it caused TLCO and Dm increases in stage 2 (for 8 and 10% of the respective baseline values). In conclusion, a TLCO in pulmonary sarcoidosis may not only be decreased in its advanced stages, but also exhibit increased values, which appeared related to the subclinical inflammatory reaction in the stage 1 patients.
Adult↗
Gated versus first-pass radioangiography in the evaluation of left-to-right shunts.
Excluding regurgitant ventricles and multiple shunting, left-to-right shunts of the central circulation can be evaluated from the difference between the right ventricular stroke counts (SCRV) and the left ventricular stroke counts (SCLV), which are obtained from gated radioangiography. The pulmonary-to-systemic flow ratio (QP/Qs) is equated to SCRV/SCLV in atrial shunts and to SCLV/SCRV in ventricular and ductal shunts. In this paper, the potentials of the stroke count method have been compared to the gamma fit first-pass technique, incorporating the recent refinements in ductal shunts and deconvolution of the pulmonary curve. In 17 patients with left-to-right shunt, the stroke count method and the gamma fit method correlated moderately with oximetry (r = .71 and .87), respectively. The gamma variate method appeared superior in the detection and estimation of small shunts, whereas when QP/Qs was two or larger, the stroke count method yielded closer agreement with oximetry data.
Adolescent↗
Deconvolving out indicator smearing in the right ventricle facilitates left-to-right shunt quantitation.
A simple algorithm is developed to enhance the resolution of components of multimodal pulmonary radiohistograms. Based on the assessed right ventricular ejection fraction (RVEF), it deconvolves out the effect of indicator smearing in the right ventricle on the heart rate samples of the pulmonary radiohistogram, ck. The output is the ideal curve, c'k = ck/RVEF--(1-RVEF).ck-1/RVEF, that would be obtained if RVEF equalled unity. Since the formula is not a recursive one, it does not suffer from error propagation pertinent to numerical deconvolution. Once RVEF is known, implementation of the algorithm is simple. If RVEF is not known accurately it may be replaced with its upper estimate, RVEFup > RVEF, yielding a partial deconvolution of the curve. When applied to studies of patients with left-to-right shunt the method improves the accuracy and lessens the interobserver variation of the Maltz-Treves method.
Adult↗
Increase of pulmonary diffusing capacity in systemic sclerosis.
Pulmonary function tests and chest radiographs of 29 non-smoking systemic sclerosis (SSc) patients were analysed, featuring an apparently paradoxic finding of an increased diffusing lung capacity for carbon monoxide (DLCO). Twenty-one patients (72%) had abnormal pulmonary function, 11 of them had restrictive disease (38%), six (21%) had isolated DLCO increase, four (14%) had isolated DLCO reduction, while two patients had obstructive disease (7%). Chest X-ray revealed interstitial abnormalities consistent with pulmonary fibrosis in all four patients with isolated DLCO reduction, in one obstructive patient and in six restrictive patients. In patients with DLCO increased steroid treatment significantly reduced DLCO (P < 0.05) and membrane DLCO component (Dm) (P < 0.05). Hitherto unobserved finding of DLCO increase in SSc patients was associated with shorter duration of SSc (P < 0.05), normal lung mechanics and roentgenogram (P < 0.05) and absence of pulmonary symptoms (P < 0.05). The findings that in some SSc patients DLCO increases suggest that DLCO might prove to be an early and sensitive indicator of acute pulmonary involvement.
Adult↗
Model for radionuclide evaluation of left-to-right ductal shunts.
A model for radionuclide evaluation of left-to-right ductal shunts was designed. It was a generalization of the standard Maltz-Treves method, accounting for the possibility that distribution of the shunt flow between the two lungs differs from that in the right ventricular (RV) output (Fs). This yields a new formulation in which the ratio of ductal flow to pulmonary flow (Fd/Fp) equals a weighted average of Fd/Fp obtained separately for the right lung (RL) and the left lung (LL), i.e. Fd/Fp = R(Fd/FpP)RL+ (1-R) (Fd/Fp)LL; where R is the fraction of the RV output going to the right lung. Separate shunt-flow ratios can be obtained by conventional analysis of the respective lung radiohistogram, while R can be determined from the upslopes of these curves. Formulas were derived rigorously from basic principles, so that the ultimate clinical validity of the method depends on radioangiographic assessment of R, (Fd/Fp)RL and (Fd/Fp)LL. Due to asymmetry of flows there is no true referent method for patients with ductal shunts. Therefore a simulation study, using quasi-real data, was utilized, yielding satisfactory performances of the algorithm: (Fp/Fs) calculated = 0.92 (Fp/Fs)stimulated +0.15 (r = 0.878).
Algorithms↗
Theoretical considerations on the validity of the Stewart-Hamilton principle in measuring cycle-averaged flows via histogram of indicator in the pulsating compartment.
It has been heuristically shown that the Stewart-Hamilton principle, adapted to external counting observables of system indicator histogram, A(t), its cycle-averaged equilibrium count rate, A(equ), and indicator volume of distribution in the body, V(body), is F/V(body) = A(equ)/integral of o infinity A(t)dt, where F is the cycle-averaged cardiac output. Since the method lacks the theoretical plausibility, it remained unclear whether it is an approximation and what conditions warrant its usability. This paper presents an exact derivation of the above equation. To fulfill it the generalizations of the stationary theory of indicator kinetics were set up that allowed for the conditions of pulsatile flows and volumes and the dependence of the distribution of transit times of indicator on the phase of the cardiac cycle. The assumptions utilized were that the tracer enters the compartment well mixed and convectively carried by the blood in concentrations that do not vary in the single cycle to a material extent. The method yields the cardiac output, even when the flow to a compartment is only a part of it, provided that the fraction of indicator that traversed the system equals the fraction of cardiac output that perfuses the compartment. It was shown that, when applied to a regurgitant ventricle, the method obtains the forward flow and that separate application of the method to each of the ventricles provides the theoretical basis for evaluation of the central-circulatory shunts.
Ductus Arteriosus, Patent↗
Non-stationary theory of blood-borne tracers.
Although cardiac mechanical activity causes periodic fluctuations of the regional volumes and flows through the cardiac chambers and great vessels, hitherto, the developed theory of blood-borne tracers has rested upon stationarity of flow, volume and distribution of transit time. Allowing for an arbitrary indicator injection, a more general theory is presented that accounts for periodic changes in the transport laws, flows and volumes of the system. When indicator particles are not thoroughly mixed with the entering blood, the intracycle changes violate most of the stationary equations. However, assuming complete mixing of indicator at the system inlet, in concentrations that do not change during the single cycle, this enables generalized counterparts of some of the most important stationary relations to be established. The difference between the indicator mean transit time calculated from the stationary assumptions and the one which allows for periodic kinetics is illustrated in radioangiographic assessment of the left ventricular ejection fraction.
Blood Volume↗
About mechanisms of prostaglandin E1 induced deterioration of pulmonary gas exchange in COPD patients.
Prostaglandin E1 (PGE1) has been reported to attenuate COPD-related pulmonary hypertension and to slightly lower the arterial oxygen tension (PaO2). In order to infer the involved mechanisms, the effects of intravenous infusion of PGE1 on pulmonary haemodynamics, diffusing lung capacity for CO (DLCO), membrane diffusing capacity (Dm), pulmonary capillary blood volume (Vc), physiological shunt (Qps/Qt), arterial blood gases and other lung functional indices were evaluated in 20 COPD patients with pulmonary hypertension and, excluding right catheterization, in 14 control subjects. The examines were studied at baseline and during infusion of 20-30 ng kg-1 min PGE1 or placebo. In control subjects PGE1 only caused systemic arterial pressure decrease (-17.8%). In COPD patients, as expected, PGE1 increased cardiac index (16.2%), but decreased systemic arterial pressure (-21.2%), pulmonary arterial pressure (-27.9%), pulmonary vascular resistance (-45.4%) and PaO2 (-10.4%), worsening their hypoxaemia. However, the effect of PGE1 on DLCO was an increase (11.9%), due to an increase in Vc (15.2%) and less markedly in Dm (4.9%). Physiological and anatomical shunts were increased with PGE1 (20.2% and 14.8%) and the overall ventilation/perfusion ratio decreased from 0.89 to 0.79. Decrements in PaO2 correlated with increments in Qps/Qt (r = 0.86). In conclusion, in COPD patients studied, PGE1 increased DLCO, which compensated for the deleterious effect of increased cardiac output on alveolar-capillary gas equilibration. Therefore, worsening of hypoxaemia during PGE1 infusion was related with increased right-to-left shunt and deterioration of ventilation-perfusion relationship.
Alprostadil↗
High resolution pulmonary computed tomography scans quantified by analysis of density distribution: application to asbestosis.
A new method for quantitative evaluation for high resolution computed tomography (HRCT) of the lungs was developed by assessment of the distribution of radiological densities within the lung slices. To enable effective reduction of data and improve the sensitivity of detection of abnormalities, the density distributions were analysed by curve fitting through the gamma variate model. The output of two variables proved most representative: the most frequent density (Hoansfield units; HU) and width of distribution (HU). The method was applied to seven patients with early asbestosis (positive histological finding and International Labour Office (ILO) profusion score up to 0/1), 15 patients with advanced stage of asbestosis (positive histological finding and ILO score above 1/2), and 13 normal controls. All patients with early asbestosis had isolated reduction of diffusing lung capacity to carbon monoxide (DLCO), whereas all patients with advanced asbestosis had reduced DLCO and restrictive disease; two of them also had an obstruction pattern. The most frequent densities were significantly greater in the advanced asbestosis group (-567 HU) when compared with both the early asbestosis group (-719 HU; p = 2 x 10(-6)), and controls (-799 HU; p = 0), and they also discriminated significantly between the early asbestosis group and controls (p = 0.0002). Significantly stronger linear correlations were established between DLCO and the most frequent densities (r = 0.86) than between DLCO and HRCT score (r = 0.57) or ILO score (r = 0.34). It is concluded that fitting the curve of the density distribution enables a more objective assessment of HRCT pulmonary scans, especially in the early stage of asbestosis.
Adult↗
Effect of a single air dive on pulmonary diffusing capacity in professional divers.
The aim of this study was to determine whether venous gas embolism after a single air dive, evaluated using precordial Doppler monitoring, was associated with alterations in spirometry, lung volumes, arterial blood gases, or pulmonary diffusing capacity for carbon monoxide (DLCO). Postdive time course monitoring of pulmonary function was undertaken in 10 professional divers exposed to absolute air pressure of 5.5 bar for 25 min in a dry walk-in chamber. The US Navy decompression table was followed. Venous bubbles were detected by precordial Doppler monitoring. Two types of decompression were used: air and 100% O2 applied for 21 min during decompression stops. Spirometry, flow-volume, and body plethysmography parameters were unchanged after the dive with air decompression (AD) as well as with O2 decompression (OD). A significant reduction in arterial PO2, on average 20 Torr, was found after the dive with AD. DLCO was decreased in all divers 20, 40, 60, and 80 min after diving with AD (P < 0.001), whereas it was not significantly decreased after diving with OD. Maximal DLCO decrease of approximately 15% occurred 20 min postdive. In AD diving, maximum bubble grade for each individual vs. maximum DLCO reduction correlated significantly (r = 0.85, P = 0.002), as well as DLCO vs. arterial PO2 (r = 0.64, P = 0.017). In conclusion, a reduction in pulmonary diffusing capacity is observed in parallel with the appearance of venous bubbles detected by precordial Doppler. We suggest that bubbles cause pulmonary microembolization, triggering a complex sequence of events that remains to be resolved. Measuring DLCO complements Doppler bubble detection in postdiving assessment of pulmonary function.
Adult↗
Association between asbestos-related pleural plaques and resting hyperventilation.
This study reports an association between pleural plaques and resting hyperventilation in a group of workers exposed to asbestos. Information on exposure level, pack-years of cigarette smoking, chest radiographs, ventilation parameters, single-breath diffusing lung capacity, and arterial gases were obtained for 344 workers. After the exclusion of 37 workers for isolated parenchymal fibrosis, combined pleuroparenchymal fibrosis, or diffuse pleural thickening, 55 subjects with isolated pleural plaques were evaluated against 252 no-plaque workers. A quantitative pleural score revealed mild pleural disease. Forty-four workers with plaques (80%) had hypocapnia induced by resting hyperventilation. The quantitative pleural score correlated significantly with the partial pressure of carbon dioxide in arterial blood (correlation coefficient = 0.7). A decrement in forced vital capacity was associated with plaques, whether controlled for age, smoking, and exposure or not. It was concluded that the resting hyperventilation observed in some asbestos-exposed subjects is related to the presence of mild pleural plaques and a restrictive disorder.
Adult↗
Lung diffusing capacity in a hyperbaric environment: assessment by a rebreathing technique.
A rebreathing method was developed for measuring diffusing lung capacity for carbon monoxide (DLCO) in a hyperbaric environment. Twenty two professional naval divers with normal lung function were included in the study. Significant correlations were found between rebreathing and single breath measurements for DLCO (r = 0.94; p less than 0.001; standard error of the estimate (SEE) = 0.66), alveolar volume (VA) (r = 0.79; p less than 0.005; SEE = 0.51), and DLCO/VA (r = 0.83; p less than 0.001; SEE = 0.11). In 17 divers, rebreathing DLCO (DLCOrb) was also measured at 20 minutes pre-dive, during the first decompression stop of the dive to 45 m for 25 minutes, and at 10 minutes post-dive. Compressed air diving was performed in a dry walk-in chamber and the United States Navy decompression table was followed. The pressure induced decrease in the rate of CO binding to haemoglobin was adjusted to normobaric conditions using a theoretical approach. Also, the presence of venous bubbles post-dive was detected by precordial doppler monitoring. A biphasic change in DLCO was noted: initially, DLCO was increased during the dive (p less than 0.005); this was followed by a post-dive decrease; DLCO/VA changed in a similar manner, as VA was only slightly altered. Only a small post-dive precordial doppler bubble grade was found. In conclusion, rebreathing DLCO measurement is a useful respiratory function test in the hyperbaric environment. It appears that an increase in D(L)CO during the compressed air dive is related predominantly to increased pulmonary capillary blood volume caused by increased negativity of the pleural pressure, hyperoxic pulmonary vasodilatation, and cardiorespiratory centralisation of the blood. The decrease in D(L)CO post-dive was only partially related to the presence of the venous bubbles detectable by doppler.
Adult↗