Prognostic value of a decrease in mean platelet volume, platelet distribution width, and platelet-large cell ratio for major adverse cardiovascular events after myocardial infarction without ST-segment elevation: An observational study

The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated with clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 h after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66–0.99, p = 0.049) and overall survival rate (OR 0.95, 95% CI = 0.91–0.99, p = 0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI = 0.24–0.72, p = 0.002) and a lower survival rate (OR 0.32, 95% CI = 0.12–0.90, p = 0.03) than patients who had a decrease in PDW < 9.9%. In the Kaplan–Meier analysis using log-rank test, patients who had a decrease in PDW < 9.9% had an increased risk for MACEs (p = 0.002) and lethal outcomes (p = 0.002). However, a decrease in MPV or P-LCR did not have prognostic value. A decrease in PDW < 9.9% measured 24 h after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients

Age characteristics of the larynx in infants during the first year of life

Background and Purpose: Investigations of the larynxes in thyrty infants during the first year of life of both sexes, randomized trial, were performed by morphological and histologic analysis. Morphometric parameters of the larynx as: length (anterolateral parameter), width (transverse parameter) and thickness (anteroposterior parameter) were determined. These parameters determine the size and shape of the larynx. The repciprocal relation parameters which determinate size of the larynx in infants and the body length are in high correlation. Therefore, the equation for calculating the size of the larynx out of the body heght was founded. Histologic characteristics of the laryngeal cartilage are constant. They indicate evident changes, that are the basis for approximate determination of a child’s age. Materials and Methods: The organs of the infants were taken from pathoanatomical autopsies. None had changes in the respiratory system. The major methods of the investigatio were anatomical macrodissection, morphological and histologic analysis and statistics. Results: The average body length in infants was 540 ± 20 mm (54 ± 2cm) and the average larynx length was 11.9± 0.3 mm. There was a correlation between these parameters p ‹ 0.01 (r = 0.75). The average value of the width of the larynx in infants was 17.7±0.5 mm. The width of the larynx was in correlation with the body length p ‹ 0.01 (r=0.79). The average value of the thickness of the larynx was 12.6±0.4 mm. This parameter was correlated with the body length p < 0.01 (r = 0.82). Histological analyses results of our investigation, cartilage of the larynx in infants, show that hyalin structure is the result of age changes. Conclusion: Quantitative anatomical knowledge on the larynx in the pediatric population are necessary for the clinical orientation, particularly for choosing a suitable endotracheal tube. Size of the larynx in prematures, neonates and small children, constantly follows the external body dimensions, particularly the body height, that is confirmed by the correlation factor in its highest value. They indicate evident changes, that are the basis for approximate determination of a child’s age. Hyalin structure is in correlation to the children’s age

Age characteristics of the larynx in infants during the first year of life

Background and Purpose: Investigations of the larynxes in thyrty infants during the first year of life of both sexes, randomized trial, were performed by morphological and histologic analysis. Morphometric parameters of the larynx as: length (anterolateral parameter), width (transverse parameter) and thickness (anteroposterior parameter) were determined. These parameters determine the size and shape of the larynx. The repciprocal relation parameters which determinate size of the larynx in infants and the body length are in high correlation. Therefore, the equation for calculating the size of the larynx out of the body heght was founded. Histologic characteristics of the laryngeal cartilage are constant. They indicate evident changes, that are the basis for approximate determination of a child’s age. Materials and Methods: The organs of the infants were taken from pathoanatomical autopsies. None had changes in the respiratory system. The major methods of the investigatio were anatomical macrodissection, morphological and histologic analysis and statistics. Results: The average body length in infants was 540 ± 20 mm (54 ± 2cm) and the average larynx length was 11.9± 0.3 mm. There was a correlation between these parameters p ‹ 0.01 (r = 0.75). The average value of the width of the larynx in infants was 17.7±0.5 mm. The width of the larynx was in correlation with the body length p ‹ 0.01 (r=0.79). The average value of the thickness of the larynx was 12.6±0.4 mm. This parameter was correlated with the body length p < 0.01 (r = 0.82). Histological analyses results of our investigation, cartilage of the larynx in infants, show that hyalin structure is the result of age changes. Conclusion: Quantitative anatomical knowledge on the larynx in the pediatric population are necessary for the clinical orientation, particularly for choosing a suitable endotracheal tube. Size of the larynx in prematures, neonates and small children, constantly follows the external body dimensions, particularly the body height, that is confirmed by the correlation factor in its highest value. They indicate evident changes, that are the basis for approximate determination of a child’s age. Hyalin structure is in correlation to the children’s age

POSTOPERATIVE INFECTIONS AFTER POSTERIOR SPONDYLODESIS OF THORACIC AND LUMBAL SPINE. SURGICAL SPINE INFECTIONS

Background: Postoperative infection after posterior spondylodesis of thoracic and lumbal spine is the most common complication, and a reason for revision surgery. Aim of this work is to analyze rate of postoperative spine infections at our institution, and to determine eventual risk factors. Subjects and methods: In our paper we analyze incidence of deep surgical infections after posterior spondylodesis, performed on our Spine department during last 5 years (September 1, 2008 – September 1, 2013). Including criteria were: posterior spondylodesis with transpedicular screws from Th1 to S2 due to different spine indications (injuries, degenerations, deformities, tumors), absence of local or general infection prior the index surgery, surgery performed by the same surgeon (MB). Excluding criteria were: needle procedures (kypho/vertebro-plasties, nerve root and faset blocades), anterior spine surgeries, cervical spine surgeries, and decompresive surgeries. Results: One hundred sixty five patients with 183 surgeries have been included in this study. Early surgical infection (within a month after the surgery) has appeared at five patients (2.7%). There have been no late surgical infections. Analyzing patients’ charts, we have found that Meticillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA) have caused infections in two patients, while Clebisiela pneumoniae ESBL has caused infection in one patient. Those five patients with infections have had further risk factors: long preoperative hospitalization at four patients, polytrauma, diabetes and advanced age at one patient, each. Three patients with postoperative infection had completely non-titanium surface of implants, and other two had about 20% of non-titanium implant surface, although vast majority of surgeries have been performed by implants whose surface was completely titanium alloy. Infections have appeared between 10-30 postoperative days. In two patients where revision surgeries (debridement, drainage, antibiotic according the species) had been performed in two weeks after appearance of infection, infections have been cured. In three patients where revisions had been postponed for longer than two weeks, additional surgeries (removal of implants) were necessary for curing the infections. Conclusions: This study presented that rate of infection, microbiological species and risk factors are similar to the other orthopedics procedures and other institutions. Early revision is preferable, since it effectively avoids implant removal

Morphometric Alteration of Femoral Condyles Due to Knee Osteoarthritis

Aim of this study was to estimate how knee osteoarthritis (OA) affects the shape of femoral condyles by comparing the radiuses of condylar curves between healthy and OA knees. Seventeen female and five male patients with established diagnosis of knee OA were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation and compared to referent values of healthy knees, after adjusting to body height. The average radiuses of condylar curves were between 52.6 ± 6.2 and 17.6 ± 3.5 mm medially, and between 43.3 ± 8.4 and 15.4 ± 3.7 mm laterally, for 0° and 90° femoral flexion contact points, respectively. The OA knees had longer curve radiuses medially and laterally at 0°, 10°, and 20° femoral flexion contact points in comparison to the healthy sample (P<0.001; t-test). Our results suggest that the shape of the femoral condyles in OA knees is changed. It should be aware not only in researching of OA etiology, but also in designing of knee endoprostheses, in a manner to achieve better individual sizing

Clinical and Radiological Morphometry of Posterior Parts of Thoracic and Lumbal Vertebras

The aim of this work is to measure clinically important dimensions of thoracic and lumbal vertebras. Charts of one-hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine between 01.01. 2008. and 31.3.2010. at the Department for Orthopedics and Traumatology, of the Sarajevo Clinical center were retrieved, and only 14 patients, with 46 vetrtebras and 89 pedicles have had complete documentation (clearly visible measured structures on X-ray and CT scans). Digitalized antero-posterior and latero-lateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height and width of the pedicle – PH, PW, axial and vertical cortico-cortical transpedicular distances – AL, VL, and interpedicular distance – IP. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and length scale on CT scans. Enlargement of those parameters, from T1 to L5 level was from 50 to 150%. This increasing was not always linear, sometimes there was even decreasing. For instance, the IP on second and third thoracic vertebra was shorter compared to the first thoracic vertebra. Pedicles from the third to the eighth thoracic vertebra were narrower compared to the second thoracic vertebra. The importance of this work is in to analyze the mentioned dimensions by methods available to the clinician. Every other in vivo measurement is impossible because of the excessive surgical approach, while preoperative CT scanning with a great number of slices per one millimeter for this purpose is not ethical

The Radiological Estimation of Vertebral Body Volumes on the Thoracic and Lumbal Spine: Radiological Estimation of Vertebral Body Volumes

The aim of this work is to radiologicaly estimate the width, height and depth of bodies of thoracic and lumbal vertebras. Charts of one hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine, between 01.01.2008. and 31.3.2010. at the Department of Orthopedics and Traumatology - Clinical centre Sarajevo, were retrieved, and only 14 patients, with totally 46 vetrtebras have meet including criteria (clearly visible measured structures on X-ray and CT scans, and data about implants dimensions). Digitalized anteroposterior and laterolateral X ray, and transversal and sagital CT scans were basic inputs for measurement of height, width and depth of the vertebral body - CH, CW, CD. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and the length scale on CT scans. Enlargement of those parameters, from T1 to L5 spine level was from 60 to 100%, except the stagnation in the mid-thoracic region, and decreasing of corporal depth on the L5 vertebra (CD/L5), in comparison to the fourth vertebra (CD/L4). The clinical importance of this work is in estimation and comparison of dimensions of vertebral bodies measured on X ray and CT scans, as the basic inputs during surgical procedures of vertebroplasty and anterior spondilodesis

Clinical and Radiological Morphometry of Posterior Parts of Thoracic and Lumbal Vertebras

The aim of this work is to measure clinically important dimensions of thoracic and lumbal vertebras. Charts of one-hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine between 01.01. 2008. and 31.3.2010. at the Department for Orthopedics and Traumatology, of the Sarajevo Clinical center were retrieved, and only 14 patients, with 46 vetrtebras and 89 pedicles have had complete documentation (clearly visible measured structures on X-ray and CT scans). Digitalized antero-posterior and latero-lateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height and width of the pedicle – PH, PW, axial and vertical cortico-cortical transpedicular distances – AL, VL, and interpedicular distance – IP. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and length scale on CT scans. Enlargement of those parameters, from T1 to L5 level was from 50 to 150%. This increasing was not always linear, sometimes there was even decreasing. For instance, the IP on second and third thoracic vertebra was shorter compared to the first thoracic vertebra. Pedicles from the third to the eighth thoracic vertebra were narrower compared to the second thoracic vertebra. The importance of this work is in to analyze the mentioned dimensions by methods available to the clinician. Every other in vivo measurement is impossible because of the excessive surgical approach, while preoperative CT scanning with a great number of slices per one millimeter for this purpose is not ethical

Endothelin-1 Induced Vascular Smooth Muscle Cell Proliferation is Mediated by Cytochrome P-450 Arachidonic Acid Metabolites

Endothelins (ETs) are a family of three peptides (ET-1, ET-2, ET-3) that are implicated in the physiological control of vascular smooth muscle cell (VSMC) and myocardial contractility and growth. ET-1 is vasoactive peptide that acts via ET-A receptors coupling inducing vascular smooth muscle cell contraction. ET-1 is involved in the development and maintenance of hypertension. Aim of this study was to investigate whether ET-1 can induce vascular smooth muscle cell proliferation through arachidonic acid (AA) metabolites formed via cytochrome P-450 (CYP-450). VSMC proliferation was measured by [3H]thymidine incorporation in cultured cells treated by ET-1 (10 to l00 nmol/L) in presence of different inhibitors of CYP-450 (17-ODYA 5 μmol/L), lipoxygenase (LO) (baicalein 20 μmol/L) and cyclooxygenase (COX) (indomethacin 5 μmol/L). ET-1 (10 to 100 nmol/L) induced VSMC proliferation and this effect was attenuated by CYP-450 inhibitor (17-ODYA) and lipoxygenase (LO) inhibitor (baicalein) but not by cyclooxygenase (COX) inhibitor (indomethacin). CYP-450 and LO metabolites of AA, 20-hydroxyeicosatetraenoic acid (HETE) and 12-HETE increased [3H]thymidine incorporation in VSMC. Inhibitors of MAP kinase (PD-98059 50 μmol/L) and cPLA2 (MAFP 50 μmol/L) attenuated ET-1 as well as 20-HETE induced VSMC proliferation. These results suggest AA metabolites via CYP-450 mediates ET-1 induce VSMC proliferation

Laser Therapy of Painful Shoulder and Shoulder-Hand Syndrome in Treatment of Patients after the Stroke

The common complication after stroke is pain and dysfunction of shoulder of paralyzed arm, as well as the swelling of the hand. The aim of this study was to determine the effects of LASER therapy and to correlate with electrotherapy (TENS, stabile galvanization) in subjects after stroke. We analyzed 70 subjects after stroke with pain in shoulder and oedema of paralyzed hand. The examinees were divided in two groups of 35, and they were treated in the Clinic for Physical Medicine and Rehabilitation in Tuzla during 2006 and 2007. Experimental group (EG) had a treatment with LASER, while the control group (CG) was treated with electrotherapy. Both groups had kinesis therapy and ice massage. All patients were examined on the admission and discharge by using the VAS, DASH, Barthel index and FIM. The pain intensity in shoulder was significantly reduced in EG (p<0,0001), swelling is lowered in EG (p=0,01). Barthel index in both groups was significant higher (p<0,01). DASH was significantly improved after LASER therapy in EG (p<0,01). EG had higher level of independency (p<0,01). LASER therapy used on EG shows significantly better results in reducing pain, swelling, disability and improvement of independenc