Since without prospective randomized studies it is not possible to have a clear attitude towards the importance of intracranial pressure monitoring, this study was aimed at examining the prognostic effect of the intracranial pressure monitoring and intracranial pressure oriented therapy in severe brain trauma patients, and at defining optimal intracranial pressure values for starting the treatment. Two groups of patients were treated in the study, one consisted of 32 patients undergoing intracranial pressure monitoring and the second group of 29 patients without intracranial pressure monitoring in the control group. The study was prospective with groups randomized. There were 53% survivals in the intracranial pressure monitored patients and 34% in the control group, with no significant difference in the survival rate between the two groups (chi2=2.11; p=0.15; p>0.05). The average intracranial pressure in the patients with intracranial hypertension who died was 27 mm Hg, while in the patients who survived the average intracranial pressure was significantly lower (Student's t test: t=2.91; p=0.008; p<0.01) and it was 18 mm Hg. We recommend starting intracranial pressure oriented therapy when the patient's intracranial pressure exceeds 18 mmHg during 2 hours of monitoring.
The hypoglossal artery is rarely described member of carotid-basilar family anastomoses. Together with a caudal end of the primitive internal artery, trigeminal, otic, and proatlantal intersegmental arteries, it represents the remnant of vascular channels' unsuccessful involution which function normally stops in human embryo with 12 to 14 mm crown-rump length. The persistence of hypoglossal artery alone is usually incidental and asymptomatic finding during the routine angiography, while during autopsies or surgical operations, its presence is frequently associated with other vascular or organic abnormalities and diseases. The aim of this review is to document the hypoglossal artery developmental morphology, as well as the normal anatomical and clinical aspects and better understanding of its persistence overall significance.
Serous retinal detachment is an unusual cause of visual loss in preeclampsia. We report the case of 24-years-old primipara with severe preeclampsia who developed bilateral serous retinal detachment a few hours after delivery. A few weeks after delivery there was spontaneous resorption of the subretinal fluid and complete resolution bilateral serous retinal detachment, with residual pigmentary changes of the retinal pigment epithelium. Visual acuity was normal in each eye. The management of retinal detachment as a complication in preeclampsia is conservative and the prognosis is usually good.
Pterygium internum (external eye layer) shows great recurrence tendency after surgical removal. Its etiology is still unclear and represents a significant problem. The main goal of our study was to explore the interrelationships of pathohistological characteristics of pterygium, namely presence of inflammation, vascularisation degree and fibrinoid changes and on the basis of their analysis to test the possibility of predicting its evolution and recurrence. The analysis was performed on the material taken from 55 patients surgically treated by the technique of Arlt. The specimens were stained using the classical histochemical methods: hematoxylin-eosin (HE), Masson's trichrome, Gomori's reticulin stain and PAS technique. Pterygium is mostly covered by conjunctival epithelium, while in the cap region shows morphology of modified stratified squamous epithelium of the cornea. Structural basis of the epithelium is composed of continuous basal lamina and continuous connective fibers underneath. This connective basis shows fibrinoid changes in the form of oval islets of different size, parallel to convexity of pterygium, or is in the form of unified focus. The number, caliber and the type of blood vessels showed excessive variability. Pathohistological analysis of morphological characteristics of pterygium is adequate basis for prediction of recurrences; as they present the biggest concern in treatment of this widely spread disease.
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