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The most common fracture involving the wrist is a fracture of the scaphoid bone. Fracture of the scaphoid most frequently occurs in young adult male and usually involves the wrist of the scaphoid. There is a universal agreement that the majority of these fractures will heal if immobilized property and for a long period of time [1, 2]. In the treatment of these fractures much attention has been payed to bone damage and not to associated ligament injury. It is reported that the incidence of nonunion of scaphoid fractures is ten per cent and that the frequency of this complication remains essentially unchanged [3, 4]. Failure to improve the outcome suggests that the mechanisms and causes of this complication are poorly understood. Explanations of nonunion or delayed union of scaphoid bone are: poor initial treatment or even no treatment [3], delayed diagnosis [5], fragments displacement [5-8], improper immobilization [9], site and direction of the fracture [3] and wrist instability [8, 10]. ⋯ There were 35 per cent overlooked fractures. Delay in diagnosis of a scaphoid fracture has been suggested as a significant factor in the development of nonunion [5, 7]. However, in our series of nonunions, non treatment does not occur frequently enough to be the critical factor. Most series report about 2/3 of nonunions occurring at the wrist [7, 9]. Our series shows a similar distribution, arguing against site as a critical factor. There appears to be a nearly uniform rate of nonunion in most of the reported series [7, 15, 16], regardless of the position of the wrist, whether or not the thumb was immobilized. Evidence of ligamentous injury in our series led us to conclude that scaphoid nonunion is consistently associated with carpal instability pattern. In our series 68% of nonunions associated with carpal collaps were present. We found no statistically significant correlation between carpal collaps and nontreated fractures or location of fracture site. Therefore, we concluded that carpal collaps was consistently present and, thus the critical factor in wrists with ununited scaphoid fractures.
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The war and break up of former Yugoslavia began in 1991. In May 1992 the United Nations imposed economic sanctions on Serbia and Montenegro which were suspended only in November 1995. The purpose of this study was to assess the effects of the war and UN sanctions on health of the population of Serbia without the provinces of Vojvodina and Kosovo. ⋯ In addition, bureaucratic hurdles of getting clearance from the UN added months of delay and made foreign companies unwilling to trade [5, 7]. The supply and distribution of drugs within the country was also irregular because communication lines were cut and local companies were not prepared to risk distributing drugs that nobody could pay for [7]. Higher than expected mortality in women aged 25-44 over the period 1991-1994 could be probably explained by their higher vulnerability (period of fertility) and the fact that the main burden of family survival was on them, so they had no time to think and to take care of their health. (ABSTRACT TRUNCATED)
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Hepatopulmonary syndrome (HPS) is defined by liver disease, hypoxaemia, increase of alveolar-arterial gradient, when inhaling room air, and intrapulmonary vascular dilatation. Pathoanatomical substrate of intrapulmonary vascular dilatation consists of dilated precapillary network, direct arterio-venous communication and dilated pleural blood vessels, "pleural spiders" [2]. Recently, hepatopulmonary syndrome gained clinical significance. Deterioration of arterial oxygenation in patients with liver disease indicates a very poor prognosis, because of which there are suggestions to classify hepatopulmonary syndrome as a new indication of liver transplantation [4]. ⋯ It is supposed that approximately 50% of patients with indication for liver transplantation have some form of arterial oxygenation disorder and 13-47% of these patients may have HPS [6, 7]. In our study, HPS was diagnosed in 18% of patients. We explain this high incidence by the fact that our study included the patients with advanced liver cirrhosis (stages Child's B and C). In studies performed up to date, there was neither correlation between biochemical liver function parameters and intrapulmonary shunts, nor any strong relation between severity of hepatic failure and degree of hypoxaemia [12, 13]. We noticed no correlation between hepatic functions (synthetic, excretory, transaminases) and PaO2 and/or intrapulmonary shunts. Some authors suggested that ventilation-perfusion disorder (Va/Q) is an important cause of hypoxaemia in
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Over last decades with modern approach to combined treatment of soft tissue sarcoma in children and adolescents, with effective systemic chemotherapy and adequate local control most frequently with conservative surgery and radiotherapy, or radiotherapy alone, results of treatment from 20% of a three-year overall survival to 75% were improved significantly. Nevertheless, combined treatment involves risk of acute radiation reactions and late side effects, so there is a need for precise radiotherapy planning with optimal schedule of fractionating, adequate radiation volume and optimal tumour dose. The purpose of our study was to evaluate the results of combined treatment of soft tissue sarcoma, role of radiotherapy in local control use of the optimal tumour dose and assessment of acute radiation reactions in an examined group of patients. ⋯ The tumour dose of 45 Gy was also used in four patients in CS IV, in two subjects for local control and in two as a palliative treatment. Seven patients in CS III received a tumour dose of 45 Gy, because the age of children, tumour site and tumour size permitted no higher tumour doses. That is when planning an adequate local therapy one must have in mind the initial tumour size, type of administered systematic chemo
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Severe ophthalmopathy with sight impairment and double vision due to a compressive optic neuropathy, extraocular muscle thickness and corneal exposure occurs in 3-5% of all patients with Graves' hyperthyroidism [1]. Steroids are the choice of treatment for ophthalmopathy in more than 50%, and with orbital radiotherapy or surgical decompression in more than 70% of cases [2]. In severe ophthalmopathy steroids are effective in more than 60% of patients [1, 3], but to be effective high dosage is necessary [1, 4-6]. High-dose intravenous steroid pulse therapy is probably preferable to oral steroids giving a better response with fewer adverse effects [6]. The aim of the study was to evaluate the efficacy of high-dose intravenous methylprednisolone pulse therapy followed by oral steroids in the treatment of patients with severe Graves' ophthalmopathy. ⋯ The best parameters of severity of the disease and of response to treatment are those related to assessment of optic nerve function, ocular motility and corneal status [6, 10]. In this series of 14 patients treated with high-dose steroids we found an improvement in visual acuity and color vision and normalization of visual fields, intraocular pressure, visual evoked potentials and fundal changes within a few days of treatment. Clinical activity score (CAS) was significantly and promptly reduced by therapy as most reports revealed [3, 5, 8]. CAS has a high predictive value for the outcome of treatment since it is based on signs of inflammation. The low score level, however, does not preclude a therapeutic success [9]. A mean value of proptosis was significantly reduced by thera