Endoscopically assisted latissimus dorsi flap harvesting and breast reconstruction in young female with Poland syndrome

We will describe a second phase of breast reconstruction on a young girl suffering from Poland syndrome. She has the breast, pectoralis major and minor muscle aplasia on the right side. She has no other deformities. The best result is achieved by combining latissimus dorsi flap and a silicone implant, and even better aesthetic result is accomplished with endoscopically assisted latissimus dorsi harvesting. Purpose of this operation is to correct the chest asymmetry and to accomplish good aesthetic result.     

Risk behaviors for getting HIV infection among the Croatian men who have sex with men in 2007

This survey was conducted with the aim of obtaining the information on the sexual risk behavior of Croatian men who have sex with men (MSM) two years after the first research. There was total of 820 respondents recruited at seven frequent meeting places of Croatian MSM in Zagreb and Rijeka, as well as one gay-oriented web-site. The overall response rate was 17.6% which is 1.4 percentage point less than it was two years ago. The rate of condom use during last anal intercourse was 53.2% and 69% of those who used a lubricant had chosen a correct water-based product which is increase of 15% comparing to the last research. Only 27% of those who had also had sex with women (MSM/MSW) during last 12 months regularly used protection. The results of this research suggest that there are trends in declining of some risk behaviors among Croatian MSM but there is a lot of space for focused and effective prevention activities on increasing the risk perception and reducing risk behaviors.     

Clinical utility of red cell distribution width in alcoholic and non-alcoholic liver cirrhosis

Red blood cell distribution width (RDW) is a measure of the variation of red blood cell width that is reported as apart of standard complete blood count. Red blood cell distribution width results are often used together with mean corpuscular volume (MCV) results to figure out mixed anemia. The aim of our study was to compare the values of RDW in alcoholic and non-alcoholic liver cirrhosis and to determine if RDW follows the severity of disease according to Child-Pugh score. We retrospectively analyzed 241 patients (176 men and 65 women) with liver cirrhosis and anemia, defined as a hemoglobin value < 130 g/L in men and < 120 g/L in women, which were hospitalized in our Division in a period between 2006 and 2008. Patients were divided in two groups; in first were patients with alcoholic liver cirrhosis, and in second with non-alcoholic cirrhosis. Severity of disease was determined according to Child-Pugh score. Red blood cells distribution width Normal reference range is 11-15%. Alcoholic liver cirrhosis had 204 patients (85%) while non-alcoholic cirrhosis had 37 patients (15%). In group of alcoholic cirrhosis the average RDW was 16.8%. In relation to severity of disease the average RDW for Child-Pugh A was 16.80%, for Child-Pugh B was 16.92%, for Child-Pugh C was 17.10%. In the group of non-alcoholic cirrhosis the average RDW was 16.73% and in relation to severity of disease for Child-Pugh A was 16.25%, for Child-Pugh B 17.01% and for Child-Pugh C was 16.87%. We didn't find statistically significant difference of RDW between alcoholic and non alcoholic cirrhosis (p > 0.05) and we didn't proved any statistically significant increase of RDW in relation to severity of disease in group of alcoholic cirrhosis (p = 0.915) nor in group of patients with non-alcoholic cirrhosis (p = 0.697). Our study showed that RDW had not any clinical value in differentiation of anemia neither in alcoholic and non-alcoholic liver cirrhosis nor in severity of liver disease.     

Tremor, seizures and psychosis as presenting symptoms in a patient with chronic lyme neuroborreliosis (LNB)

Lyme borreliosis is a multisystem disorder caused by Borrelia burgdorferi (Bb). Neurological symptoms such as lymphocytic meningoradiculoneuritis (Bannwart's syndrome), cranial neuritis (II,III,IV,V,VI), encephalitis, transverse myelitis are found in about 10% of cases during the second phase of the disease. In the chronic stage, many months or years after the initial infection, other neurologic complications may occur, such as encephalomyelitis, epileptic crises, cognitive impairment, peripheral neuropathy and psychiatric disturbances such as depression, anxiety, panicc attacks, catatonia, psychosis etc. Some patient continue to experience symptoms of fatigue, insomnia or psychiatric disorder in the post borrelia syndrome. We describe here a patient with a triad of unusual symptoms in chronic LNB including tremor, seizures and psychosis. Standardized medical interview, neurologic examination, neuroimaging, serum and CSF serology as well as EEG and EMNG evaluation were performed. The patient was treated with intravenous ceftriaxone and doxycycline and responded with rapid clinical and functional improvement.Newertheless, he suffered from multiple systemic and neurologic sequelas that influenced his daily activities in post treatment period. Emphasis is placed on the atypical onset and evolution, the difficulties encountered in formulating diagnosis, early treatment and the uncertainties concerning the sequelae after treatment. In patients with non-specific long lasting symptoms in the absence of overt clinical signs suggesting CNS involvement, routine treatment with i.v. ceftriaxone is not to be encouraged.     

Displacement of a mandibular incisor--an infrequent complication of mandibular fracture

A case of a mandibular fracture with an unusual complication is reported. A 13-year-old boy was admitted four years after conservative treatment of a symphyseal fracture. He complained of recurrent swelling. A radiographic evaluation showed a horizontally laid permanent mandibular left lateral incisor (PMLLI) that had probably slid into the fracture line and provoked repetitive infection episodes. After a surgery, a clinical and radiological analysis showed satisfactory healing.     

Spatial and temporal measurements of eye movement in children with dyslexia

This paper presents the first reading data in Croatian collected with an eye-tracking device. The eye-tracking method allows for research into two crucial levels underlying reading: the visual and the cognitive. The aim of this paper is to show the differences in eye movements in children with dyslexia using the principles of cognitive-control view. Despite the well-known definitions and vast literature on dyslexia, the neural basis of dyslexia varies greatly on the individual level. The three children studied in this paper were tested behaviorally using set of language tests for language behavior assessment on all language levels: phonology, morphology, syntax, lexicon and pragmatics. Two children had low scores on most language tests, and all three children had poor reading and writing level. Each of the children had to read two texts silently while their eye movements were recorded by means of an infrared eye-tracking system. We analyzed the number, position, and duration of fixations and the number and position of regressive (or back) saccades. Our results show intergroup differences (between a typically developing child and the three children with dyslexia), and intragroup differences (among all three children with dyslexia). The great number of fixations, longer duration of fixations, and great number of regression saccades are the main features that differentiate the children with dyslexia form the typically developing child. The only difference found between language and visual subtypes of dyslexia was a shorter duration of fixations for the child with a visual processing disorder.     

Distribution of major brain gangliosides in olfactory tract of frogs

Gangliosides are major cell-surface determinants in the central nervous system (CNS) of vertebrates, found both in neuronal and glial cell membranes. Together with cholesterol and glycosylphosphatidylinositol (GPI) - anchored proteins, gangliosides are involved in organization of plasma membrane microdomains. Based on biochemical studies, frog brain was previously described as having low quantities of gangliosides and their distribution pattern in specific brain regions was unknown. Using highly specific monoclonal antibodies generated against four major brain gangliosides (GM1, GD1a, GD1b and GT1b), we examined the distribution of these molecules in CNS of four different species of frogs (Rana esculenta, Rana temporaria, Bufo bufo and Bufo viridis). We also studied the distribution of myelin- associated glycoprotein (MAG), an inhibitor of axonal regeneration, which is a ligand for gangliosides GD1a and GT1b. Our results show that ganglioside GDla is expressed in neurons of olfactory bulb in all studied animals. In the brain of Rana sp., GD1a is expressed in the entire olfactory pathway, from olfactory bulbs to amygdala, while in Bufo sp. GD1a is restricted to the main olfactory bulb. Furthermore, we found that most of myelinated pathways in frogs express MAG, but do not express GD1a, which could be one of the reasons for better axon regeneration of neural pathways after CNS injury in amphibians in comparison to mammals.     

Gaze differences in processing pictures with emotional content

The International Affective Picture System (IAPS) is a set of standardized emotionally evocative color photographs developed by NIMH Center for Emotion and Attention at the University of Florida. It contains more than 900 emotional pictures indexed by emotional valence, arousal and dominance. However, when IAPS pictures were used in studying emotions with the event-related potentials, the results have shown a great deal of variation and inconsistency. In this research arousal and dominance of pictures were controlled while emotional valence was manipulated as 3 categories, pleasant, neutral and unpleasant pictures. Two experiments were conducted with an eye-tracker in order to determine to what the participants turn their gaze. Participants were 25 psychology students with normal vision. Every participant saw all pictures in color and same pictures in black/white version. This makes 200 analyzed units for color pictures and 200 for black and white pictures. Every picture was divided into figure and ground. Considering that perception can be influenced by color, edges, luminosity and contrast and since all those factors are collapsed on the pictures in IAPS, we compared color pictures with same black and white pictures. In first eye-tracking IAPS research we analyzed 12 emotional pictures and showed that participants have higher number of fixations for ground on neutral and unpleasant pictures and for figure on pleasant pictures. Second experiment was conducted with 4 sets of emotional complementary pictures (pleasant/unpleasant) which differ only on the content in the figure area and it was shown that participants were more focused on the figure area than on the ground area. Future ERP (event related potential) research with IAPS pictures should take into consideration these findings and to either choose pictures with blank ground or adjust pictures in the way that ground is blank. For the following experiments suggestion is to put emotional content in the figure area and to use different non complementary pictures to see if there is difference between different emotional categories.     

Stimulation of functional vision in children with perinatal brain damage

Cerebral visual impairment (CVI) is one of the most common causes of bilateral visual loss, which frequently occurs due to perinatal brain injury. Vision in early life has great impact on acquisition of basic comprehensions which are fundamental for further development. Therefore, early detection of visual problems and early intervention is necessary. The aim of the present study is to determine specific visual functioning of children with perinatal brain damage and the influence of visual stimulation on development of functional vision at early age of life. We initially assessed 30 children with perinatal brain damage up to 3 years of age, who were reffered to our pediatric low vision cabinet in "Little house" from child neurologists, ophthalmologists Type and degree of visual impairment was determined according to functional vision assessment of each child. On the bases of those assessments different kind of visual stimulations were carried out with children who have been identified to have a certain visual impairment. Through visual stimulation program some of the children were stimulated with light stimulus, some with different materials under the ultraviolet (UV) light, and some with bright color and high contrast materials. Children were also involved in program of early stimulation of overall sensory motor development. Goals and methods of therapy were determined individually, based on observation of child's possibilities and need. After one year of program, reassessment was done. Results for visual functions and functional vision were compared to evaluate the improvement of the vision development. These results have shown that there was significant improvement in functional vision, especially in visual attention and visual communication.