ON THE PLACEMENT OF APRON DOSEMETERS AND DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY PROCEDURES: PRELIMINARY RESULTS

Personnel involved in interventional practices are likely to be exposed to higher radiation doses than other workers in the medical field. Personnel monitoring and radiation protection measures play a crucial role in keeping these doses below the limits. EURADOS (European Radiation Dosimetry Group) Working Group 12 performed a series of investigations showing how the complexity of the scattered field reaching the operators can influence the doses to the operators. The present work was aimed at determining the possible effects on the registered doses of the scattered field and the actual position of a dosemeter on apron. This study has been performed through Monte Carlo simulations and it was validated through measurements. It does not claim to identify the 'best' position for the dosemeter, but to assess the variability of its response, showing how a variability of the order of +/- 30% to 40 should be taken into account.

Control of SrO buffer-layer formation on Si(001) using the pulsed-laser deposition technique

The overview of optimal parameters for deoxidation of the Si(001) surface using SrO and a pulsed-laser deposition method.

Supracondylar missile fractures of the femur

We present the results of the surgical treatment of 50 supracondylar missile fractures of the femur in 48 patients wounded in the territory of the former Yugoslavia in the period June 1991-October 1995. The injuries were caused by bullets in 28 (58.3%) patients and by fragments of mines or other explosive devices in 20 (41.7%) patients. In nine (18.0%) missile supracondylar fractures there were associated fractures of articular surfaces in the knee-joint. Neurovascular bundle injuries were present in 19 (38.0%) and vascular injuries alone in 17 (34.0%) limbs. Bone fragments were stabilized by external fixation in 43 (86.0%) and by plaster of Paris in five (10.0%) limbs. Primary reconstruction of large blood vessel was necessary in 16 (32.0%) limbs. In total eight (16.0%) above knee amputations were done. Coverage of soft tissue defects was required in 19 (38.0%) limbs. Early and late postoperative complications occurred in 26 (52.0%) limbs. Additional surgical procedures were necessary in 15 patients. Definitive results showed a large number of limb shortenings, nerve paralyses and contractures of the knee-joint.

[Primary liposarcoma of bone]

A case of 75-year-old man with extremely rare primary liposarcoma of the bone was presented. Stains for lipid, Sudan III, Sudan IV, and Oil Red "O", demonstrated the presence of intracellular lipid in the lipoblasts. Similarly, the S-100 immunoreactivity and electron microscopic findings of tumor cells confirmed the diagnosis of liposarcoma. Histochemical stains for PAS, Alcian-blue, mucikarmin, Toluidin-blue and Coloidal Iron were negative.

Interactive visualization of 3D fields and images on inexpensive workstations using VRML

The visualization of volumetric medical images and static or time-dependent vector fields is performed on personal computers over the Web using an interactive 3D interface based on VRML and Java. The VRML client obtains field information and the surface models of examined objects from a server accessible over the Internet. Various virtual tools enable radiologists and referring physicians to visualize and manipulate complex data sets using a simple interface on low-cost computers.

Primary surgical treatment of war injuries of major joints of the limbs

We present the results of primary surgical treatment of war injuries of major joints in 339 patients, wounded in the territory of the former Yugoslavia in the period June 1991-October 1995. The total number of surgically treated joints was 358. The injuries were inflicted by the fragments of explosive devices in 176 (51.9%) patients and by bullets in 125 (36.9%) patients. A single wound was present in 160 (47.2%) and several wounds in 176 (51.9%) patients; 276 (77.1%) patients had injuries of articular bone. The most frequently injured joints were knee joint 167 (46.6%) and elbow joint 72 (20.1%). Associated neurovascular injuries were present in 68 (18.9%) patients. Postoperative bone fragment stabilization was required in 254 (70.9%) joints. Stabilization was by plaster of Paris in 148 (58.2%) and external fixation in 85 (33.4%) patients. Postoperative course was uneventful in 262 (77.3%) while postoperative complications occurred in 77 (22.7%) patients. Amputations were performed in 15 (4.4%) patients. After the primary surgical treatment 254 (74.9%) patients were discharged and directed to rehabilitation or home care and 81 (23.9%) patients required additional reconstructive surgery for bone and soft tissue defects.

[Epidemiology of Crohn's disease in the Rijeka-Istra region]

The incidence and prevalence of Crohn's disease in Rijeka and Istra, the western part of Croatia with 575,000 inhabitants, were investigated for the period 1973-1994. A total of 197 patients were diagnosed. This gave an annual incidence of 0.34/10(5) in 1973 and 3.47/10(5) in 1994. These data suggest that incidence of Crohn's disease in our region is similar to that reported in northern Europe. The most frequent age groups affected were 15-25 and 50-60 years old. 54% of the patients were younger than 30 years. The small bowel was involved in 49.7% of the patients, the large bowel in 23.3%, and both small and large bowel in 25.8%. At the time of diagnosis 85.8% of patients had abdominal pain, 84.2% diarrhea, 71.6% significant weight loss. All forms of intestinal and extraintestinal complications were observed. Surgery was required in 25.5% patients. No patient developed a malignancy of the gastrointestinal tract. One patient had a cancer of uterus and one a cancer of vulva. The diagnosis was based on clinical features in combination with endoscopic and radiologic findings, and in most patients it was also supplemented by histologic examination. The mean interval from the symptom onset to diagnosis was 1.9 years. The positive family history among relatives was found. In Crohn's disease there was no dose-response relation between smoking and disease. The relationship should be further explored because of the potential for other therapeutic approaches in this disease.

Subtrochanteric missile fractures of the femur

The treatment results of subtrochanteric missile fractures of the femur in 41 casualties are analyzed. The wounds were inflicted by infantry weapon missiles in 29 (70.7%) and by fragments of mine or explosive devices in 12 (29.3%) casualties. The associated neurovascular bundle injuries were present in 11 (26.8%) patients. Fracture stabilization was done by external fixation in 25 (62.5%): group A; and by plaster of Paris in 15 (37.5%) patients: group B. The postoperative period was uneventful in 14 (35.0%) and early or late complications occurred in 26 (65.0%) patients. Bone infection developed in six (15.0%) and fractures did not heal in four (10.0%) patients. Complications were present in 13 (52.0%) patients from group A and in 13 (86.7%) patients from group B. Delayed fracture healing and fracture nonunion were present in group A and contractures of large joints in group B. Subtrochanteric missile fractures of the femur present very severe injuries where the treatment is followed by a very high percentage of complications. External fracture fixation in this region facilitates the care, stability, early covering of soft tissue defects and early physical therapy.

[Rigid osteosynthesis with the AO plate and Phemister's spongioplasty in secondary treatment of diaphyseal gunshot fractures]

In prospective study, in 160 injured with diaphyseal gunshot fractures (DGF), in secondary treatment phase, there were applied rigid osteosynthesis by AO plate and spongioplasty with iliac graft by Phemister assuming that this method would provide good functional results. The average age of injured was 32.25 years, and average postsurgical follow-up period was 32.5 months. The fracture healing was achieved in 93.7% injured while pseudoarthrosis developed in 6.25%. Osteomyelitis, as the second significant complication, appeared in 8.12% cases. Good functional results were achieved in 55.62%, satisfying in 36.25% while the poor result was noticed only in 8.12% cases. The applied method in DGF treatment proved to be very successful, it led to faster fracture healing, shortening of hospitalization time of the injured with better functional results and less complications compared to the other treatment methods in the secondary phase.

[Chondrosarcoma and hemipelvectomy]

Unlike osteosarcoma and Ewing's sarcoma chondrosarcomas are primarily surgically managed as they are resistant to chemo- and radio-therapy. A female patient, aged 36 years, was operated in 1992 for pelvic chondroma; a year later she was reoperated due to local recurrence, and diagnosis of chondrosarcoma was established. Because of tumour regrowth she was referred to our institution for hemipelvectomy. The operative team consisted of and orthopaedic surgeon, an urologist, and a general surgeon. A (large) tumour was completely removed. The patient's recovery was rapid, and she is now able of controlling urination and defecation. This kind of operation is extensive and traumatic, but it is useful in appropriately selected cases.

[Risk factors for stroke in young people]

The risk factors of stroke in young adults and in the whole population are the same in general, but there are some special risk factors in young adults. They are congenital or early acquired diseases which are complicating with early stroke. We studied the risk factors of cerebrovascular insults in 150 patients, 20-49 years old (Table 1). This was 26.04 percent of all patients that were hospitally treated in the urgent neurological department over one year. However, twenty years ago, this percent was 20.20 [2]. We found that arterial hypertension was dominant both among young adults (47.99 percent) and in the whole population (Table 2) [1-3]. Essential hypertension was the most frequent, and renal and thyreotoxical hypertensions were rare. The atherogenic level of low density and high density lipoproteins (LDL/HDL) was present in 14.66 percent of young adult patients [3]. Diabetes mellitus, a known risk factor of stroke, was found in 5.33 percent of our studied patients, especially in the juvenile form [1-3]. Besides juvenile diabetes mellitus, we found other risk factors that were characteristic of young adults: systemic lupus erythematosus (3.33 percent), which began at an early vital age, and numerous cerebrovascular complications appeared during the first five years of illness [7]. In this group of young adults, we found no other type of vasculitis, which also can be a risk factor of stroke. Great risk factors of stroke in young adults were arterial-venous malformation, brain aneurysm and congenital muscular hypoplasia of the carotide and middle caliber cerebral arteries-multiple progressive intracranial arterial occlusion or Nishimoto Takeuchi disease or Moya Moya disease, which were found in 3.99 percent of our patients. These diseases were complicated by cerebrovascular haemorrhagic or ischaemic insults over the young vital period [9]. The similar was with congenital or early acquired (rheumatic fever) heart valve defects (3.99 percent in our group), with early cerebrovascular complications due to cardiogenic thromboembolism mechanisms [10]. In 2 percent of patients the stroke was the consequence of anticoagulant therapy. These were the patients with operated heart valve defects (haemodynamic risk factor was eliminated, but haemorrheological risk factor was evident) [2, 3]. Also, disturbances of cardiac rhythm were risk factors of stroke in 2 percent of our patients. The mechanism of stroke originated is cardiogenic thromboembolism or global hypotension and the following ischaemia in the border brain zone [11]. All these risk factors were present in a relatively small number of patients, but they were "strong" risk factors of stroke, especially in young adults. On the other hand, there were nicotinism, alcoholism and obesity. They were present in a greater percent (25.33; 15.66; 18.66 percent), but their influence was slow and indirect by haemorrheologic mechanism (the increasing aggregation of platelets, reduced flexibility of red and white blood cells, changed prostacycline-prostaglandin relation in endothelial and blood cells, viscosity of blood, LDL/HDL) [2, 3, 12, 13]. A prolonged psychogenic stress (8.66 percent in our group) was, also, a risk factor of stroke. It induced increase in catecholamine level, arterial hypertension, constriction of blood vessels, endothelial cell damages, increased aggregation of platelets, changed prostacycline-prostaglandin relation, metabolism of lipids and polysaccharides) [2, 3]. We found no abuse of ephedrine [16] or cocaine [15] as risk factors of stroke in our group, although it was described in litterature. Also, we found no postoperative thromboemolism (foramen ovale apertum). Ischaemic cerebrovascular insults dominated (77.34 percent) in our group of patients. In one article (Canada) [17] haemorrhagic insults were dominant in young adults. In our opinion, the number of our patients was not adequated, as haemorrhagic stroke is also treated in neurosurgical departments. The mor

[The effect of captopril on the development of adriamycin nephropathy in rats with spontaneous arterial hypertension]

The effects of captopril on morphologic changes and clinical course of adriamycin (ADR) nephropathy in spontaneously hypertensive rats (SHR) were examined. After ADR infections rats were divided into two groups: ADR-C group (n = 20) given captopril (60 mg/kg per day) and ADR group (n = 19) receiving no antihypertensive treatment. SHR were examined every 6 weeks. Captopril normalized systemic blood pressure, but failed to prevent proteinuria. It slowed down renal function deterioration in the early stage of ADR nephropathy (weeks 6 and 12), but at the end of the study both groups had the same degree of renal failure irrespectively of whether blood pressure was well controlled with captopril or hypertension persisted. Captopril slowed down mesangial expansion in the early stages of ADR nephropathy, but at the end of the study there was no statistically significant difference between these two groups. Treatment with captopril also reduced the development of glomerular sclerosis.

[The duration of surgical procedures as a factor in the development of postoperative osteomyelitis]

In the period from January 1st, 1969, to December 31st, 1988, 585 osteosyntheses of the closed bone fractures of lower limbs were performed at the Orthopedic department at the Military Hospital in Nis. At the same period 25 postoperative osteomyelitis were registered, i.e., 4.27%. The average duration of osteosynthesis in the tested group of patients was 84.6 minutes, and 54 minutes in control group. The difference of the average duration of osteosynthesis between groups was significant. The type and size of metal implants did not directly affect the evolution of postoperative bone infection unless the correct implantation was done and unless they were made of standardized leaguers.

[Tuberculous inflammation of the synovial membrane]

Four patients with tuberculous synovitis of the large joints are reported in whom primary tuberculous process has not been confirmed as a possible foci of spreading of the acidoresistant bacilli. The authors, describing in details the histologic picture of tuberculous synovitis, point out the importance of an early biopsy of the synovial membrane and obligatory microbiological confirmation of the established diagnosis.

[Surgical treatment of recurrent anterior shoulder dislocation using the Bazy-Savić method. 40 years' experience]

The fourty-year experience in the treatment of 328 patients with recurrent anterior shoulder dislocations using the Bazy-Savić method has been presented. Reintervention due to recurrent dislocation was performed in 12 (3.6%) patients. During a ten-year period questionnaires were sent to 105 operated patients and 76 patients replied. Satisfactory results were achieved in 69 (90.7%) patients.

[Autologous spongious iliac bone graft in the treatment of ununited diaphyseal fractures of the long bones]

In the treatment of ununited diaphyseal fractures the authors stick to three basic principles: rigid fragment stabilization, reduced fracture split and osteogenous stimulus addition. A multiple autologous spongious iliac bone graft was used as an ostogenous stimulus. This method was applied in 47 patients within the period 1978-1987. Healing occurred in 45 (95.7%) patients. Calus leading to healing has a form of external overbridging calus.