Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery ...and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage. We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lowerlimb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. Early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The aim of this study was to determine the pattern of myocardial infarction (MI) incidence with regard to age, gender, infarction site, and the most important risk factors. All 3,454 patients ...hospitalized in coronary care units of Clinical Hospital Split between 1989 and 1997 were analyzed. In the 3-year period preceding the war, from 1989 to 1991, 1,024 patients were hospitalized because of MI. During the 3 years of full war activities, from 1992 to 1994, there were 1,257 patients (significantly more; p < 0.05). And in the 3-year period after the war, from 1995 to 1997, there were 1,173 patients. In the war period, there were 151 (12%) patients younger than 45 years of age (p < 0.05); of that number, 143 (95%) were men (significantly more than in the other two periods; p < 0.05) and 8 (5%) were women. In the period preceding the war, there were 66 (6.5%) patients younger than 45 years: 60 (91%) men and 6 (9%) women. In the period after the war, those numbers were 88 (7.5%), 81 (92%), and 7 (8%), respectively. The patients younger than 45 years (305) more often had MI of an inferior than an anterior site (49% vs. 28%; p < 0.001), whereas there was no difference in patients older than 45 years (36% vs. 37%; p > 0.05). The patients older than 45 years had significantly greater hospital mortality (21% vs. 4%; p < 0.001) and were more likely to have hypertension (51% vs. 15%; p < 0.001) as well as hypercholesterolemia (54% vs. 14%; p < 0.001). Smokers prevailed among those younger than 45 years (75% vs. 51%; p < 0.001). The number of hospitalized patients with MI was greatest during the war period. It included a significant increase in the incidence in men younger than 45 years (12% vs. 7%; p < 0.05), with smoking as the most important risk factor, especially for infarctions of inferior sites.
We have studied the incidence of possible triggers of the myocardial infarction regarding its site in 750 patients with anterior and 731 patients with inferior infarction. Infarctions occurred most ...frequently without recalling any triggering activity, especially in patients with anterior infarction (67 vs. 44%). Physical effort as the possible precipitator was also more frequent in anterior infarctions (22 vs. 16%). However, the onset of inferior infarction was more frequent during meteorological stress (9 vs. 2%), emotional stress (10 vs. 3%), after overeating (13 vs. 3%) and nicotine abuse (6 vs. 1.5%). These triggers were independent and highly significant (
P<0.02 in each case) discriminators of the site of myocardial infarction. Bimodal circadian rhythm, with primary peak between 6 and 9 h a.m. and the secondary peak between 3 and 6 p.m. was observed in patients which did not recall any triggering activity, and this was more pronounced in patients with inferior infarction. These results support the hypothesis that the influence of the vegetative tone is most pronounced in the onset of myocardial infarction of inferior wall.
During 1981-1999, the breeding biology of the Great Reed Warbler was monitored at the 16.6 ha large system of discharge fish-ponds at Draga near Ig at Ljubljansko balje. 328 nests were found during ...the entire period. In the breeding season, I visited the fish-ponds 25 times on average per year. The annual breeding success oscillated between 24% and 86%, while in the entire period its average was 56%. The smallest distance between two occupied nests was 3 m. The majority of the nests were built in common reed Phragmites australis above the water level and only in two cases above solid earth; once it was built in great reedmace Typha sp. and once in rush Juncus sp. The nests were situated 55 cm above the water level on average and supported by 5-6 reed stalks. The average depth of the water under the nests was 64 cm. The average height of the nests was 11.8 cm, the average diameter 10.2 cm, and the average depth of the nest cup 7 cm. The first eggs were laid on May 3rd, the majority of them on May 15th. The average size of the 1,027 measured eggs was 22.8 x 16.4 mm, their average weight reaching 2.9 g. Most of the nests contained 5 eggs (2-6), or 4.8 on average. Only about 6% of the Great Reed Warbler pairs built the second nest as well. The number of eggs in the 27 second clutch nests was 2-5, or 3.4 on average. The hatched young weighed about 2.3 g, in three days they doubled this figure and after a week reached the weight of their parents. After 10-12 days, they left their nests, even before being able to fly. There were normally 4 or 5 (even 6) young in the nests, exceptionally a single chick (3.9 on average). The successfully fledged nests contained 3.7 chicks, or 2.2 young per all found nests. 655 chicks were ringed in their nests. Since 1989, the Great Reed Warblers breeding at Draga have been decreasing in numbers. The reasons for this state of affairs lie in the unsuitable mowing and the burning of reed, introduction of the plant-eating fishes (Ctenopharyngodon idella), artificially caused too low water level in the breeding period, and in the excessive disturbance caused by recreationists.
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