Ivan Krajnc

Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart.

Classic anatomical dissection of 150 hearts from adults aged 18–80 years was performed. The sinoatrial (SA) node artery was most frequently a large atrial branch of the right coronary artery (63%), arising at a mean distance of 1.2 cm (range 0.2–2.2 cm) from its beginning, with a mean external diameter of 1.7 mm (range 1–3 mm). In 37% of cases the SA node artery was a branch of the left coronary artery or one of its branches, with an initial mean external diameter of 2.2 mm (range 2–3 mm). The origin of the SA node artery was not related to coronary arterial dominance. The atrioventricular (AV) node artery was the first and longest inferior septal perforating branch of the right (90%) or left (10%) coronary artery, arising from the U- or V-shaped segment of the corresponding artery at the level of the crux cordis. Mean external diameter was 2 mm (range 1–3.5 mm). The origin of the AV node artery was dependent on coronary arterial dominance. Identification of the anatomical variants of the arterial blood supply to the SA and AV nodes may help in overcoming potential difficulties in treating arrhythmias and in mitral valve surgery.

Quality of life and the effect on social status among Slovenian women after breast cancer treatment.

This study investigated whether the type of surgical procedure used to treat breast cancer (mastectomy versus breast-conserving lumpectomy) had any effect on the quality of life and social status of women. The prospective analysis included 382 women newly diagnosed with non-metastatic breast cancer who had undergone a surgical intervention for breast carcinoma at our institution: 198 patients had undergone mastectomy with axillary lymphadenectomy and 184 patients had undergone breast-conserving lumpectomy with local axillary lymphadenectomy. The post-mastectomy women reported significantly more financial problems, a lowered social status and more physical symptoms compared with the breast-conserving post-lumpectomy patients. The patients that underwent lumpectomy were more satisfied with their body image and their sexual life. Since the adverse financial effects of wage loss can significantly decrease a patients quality of life, this study indicates that postmastectomy patients in particular need to be protected more effectively against a decline in their social status.

Anatomical Variations of the Coronary Sinus Ostium Area of the Human Heart

Classic anatomical dissection of 150 heart specimens from adults aged 18–80 years was performed. The Thebesian valve was absent in 20% of cases and, in these, 4% had a large ostial valve of the middle cardiac vein in front of the coronary sinus ostium. Fibres of Chiari were found in 10% of cases. Ostia of the middle cardiac vein, posterior veins of the left ventricle, small cardiac vein and deep cardiac veins were present in the distal 10 mm of the coronary sinus. Some samples had ostial and/or parietal valves or antivalves that sometimes contained muscular fibres. Distal accessory parietal valves (2%) and antivalves (1%) of the coronary sinus wall were found at a distance of 4–7 mm from its ostium. The frequency and variability of anatomical structures in the area of the coronary sinus ostium probably influence the haemodynamics of this area. Knowledge of and being able to identify these anatomical variations may help in identifying and overcoming potential difficulties in treating arrythmias and in cardiosurgery.

Complete mapping of lateral and medial sural artery perforators: Anatomical study with Duplex-Doppler ultrasound correlation

INTRODUCTION The precise vascular anatomy of posterior lower leg skin is not well understood. Despite being a potential donor site for sural artery perforator flaps, this region is rarely used and underestimated. The aim of this study was to provide exact preoperative planning for medial and lateral sural artery perforator flap harvest. METHODS An anatomical study on 16 cadaveric lower legs was performed to determine the number and location of all medial and lateral sural artery perforators in relation to five fixed points (medial and lateral maleolus, calcaneus, medial and lateral condyle). A Duplex study on 32 lower legs determined the number and location of dominant medial and lateral sural artery perforators in relation to same anatomical points. Results of the two studies were correlated. RESULTS A total of 234 perforators were found in the anatomical (134) and Duplex studies (100). A dominant lateral sural artery perforator was found in 9.4% of all lateral perforators in 31% of dissected legs. A dominant medial sural artery perforator was found in 37% of all medial perforators in 94% of legs. The difference in the number of dominant medial and lateral perforators was significant (p < 0.001) in the anatomical study, while no significant difference was found in the Duplex study (p = 0.920). CONCLUSION The anatomical study showed relative unreliability of sural region regarding number of dominant perforators. Therefore, harvest of medial and particularly lateral sural artery perforator flap is unsafe without preoperative perforator mapping. No significant difference in location of dominant perforators was found between Duplex and anatomical studies. Duplex proved reliable for planning of sural artery perforator flaps due to high precision in detecting location of dominant perforators.

Anatomical Variations of Coronary Ostia, Aortocoronary Angles and Angles of Division of the Left Coronary Artery of the Human Heart

Classic anatomical dissection of 150 heart specimens from adults aged 18 − 80 years was performed. Anatomical variations were studied in: (i) the position of the ostium of the left coronary artery; (ii) the angle between the proximal segment of the left coronary artery and the longitudinal axis of the aorta and between the circumflex and the anterior descending branches; (iii) the angle between the anterior descending artery and the diagonal branches, and between the diagonal and circumflex branches in trifurcation of the left coronary artery; (iv) the position of the ostium of the right coronary artery in the right coronary sinus of Valsalva; (v) the angle between the initial part of the right coronary artery and the logitudinal axis of the aorta; and (vi) the position of the initial part of the left coronary artery relative to the coronary groove. Knowledge of and the ability to recognize and identify the variety of sites of origin of coronary arteries, aortocoronary angles and angles of division of the left coronary artery of the human heart may help to overcome potential difficulties in cardiosurgical procedures, such as aortic valve replacement and reinsertion of coronary arteries.

Anatomical peculiarities of the cavo-tricuspid isthmus in the human heart

SummaryThe cavo-tricuspid isthmus is the term for the part of the right atrium between the ostium of the inferior vena cava and its border – the Eustachian ridge on one side and the tricuspid valve on the other side. In this area lie the coronary sinus ostium with its Thebesian valve, the fibers of Chiari (10%), and ostia of the deep cardiac veins – the Thebesian veins in close relation to the coronary sinus ostium (35%). Pacing of the coronary sinus is very often used during the treatment of cardiac arrhythmias; radiofrequency catheter ablation in cases of permanent atrial tachycardia is successfully performed through the coronary sinus; during certain cardiosurgical procedures, cardioplegia is performed by retrograde perfusion of the myocardium through the coronary sinus. Knowing and recognizing certain anatomical peculiarities of the structures in this part of the right atrium may be interesting for clinical practice.

Accuracy of Intra-operative Frozen Section Analysis of Ovarian Tumours

During operative treatment for ovarian tumours assistance is frequently required to make decisions regarding malignancy status and the extent of the ensuing procedure. Intra-operative frozen section analysis may be useful, provided there is adequate acquaintance with the correlation between using frozen sections and permanent histopathological sections for diagnosis at the institution where the operation is being undertaken. This retrospective study aimed to determine this correlation. Findings from 131 intraoperative frozen sections were compared with the subsequent diagnosis from permanent histopathological sections for women with benign, borderline and malignant ovarian tumours at the Maribor Teaching Hospital (now the University Clinical Centre Maribor) between 1 January 1993 and 31 December 2001. Frozen-section findings corresponded to histopathological findings in 84.7% of cases, with 15.3% false-negative and no false-positive results. For benign, borderline and malignant ovarian tumours, sensitivity was 100.0%, 76.1% and 89.0%, respectively, and specificity was 90.6%, 90.6% and 100.0%, respectively. The majority of errors occurred in diagnosing mucinous borderline tumours. Precise preoperative diagnosis is extremely important in the treatment of ovarian tumours.

Thoraco-acromial artery perforator 'propeller' flap.

Axillary scar contracture following trauma presents a reconstructive challenge since the restoration of normal arm mobility along with acceptable aesthetic outcome is of utmost importance. We report the first successful use of a thoraco-acromial artery perforator pedicled flap, harvested and designed solely using the concept of free-style perforator flaps, for the reconstruction of axillary defect after excision of scar contracture in a patient previously affected by poly-trauma. The flap was based on two

E-health integration and interoperability based on open-source information technology

Th e fi rst relevant and frequently cited defi nition of Ehealth was published in 2001 [1]: “E-health is an emerging fi eld in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state of mind, a way of thinking, an attitude, and a commitment to networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology”. Although “E-health” is the generally accepted notation in the professional literature, the offi cial European bodies (Commission, Parliament, Council) use both “e-Health” and “eHealth”. In this introduction all three terms will be used intentionally in order to keep to the original notation when making references. Th e EU “offi cial” explanation of the term is presented on the European Commission (EC) Information Society portal [2]: “Th e term eHealth covers a range of technological areas. In the fast-moving world of ICT, diff erent names have been used for applications which are now seen as part of the eHealth fi eld. Th ese include medical informatics, telemedicine, health telematics, and ICTs for health”. Th e portal [2] also presents the wider point of view: “eHealth means Information and Communication Technologies tools and services for health. eHealth covers the interaction between patients and health-service providers, institution-to-institution transmission of data, or peer-topeer communication between patients and/or health professionals. Examples include health information networks, electronic health records, telemedicine services, wearable and portable systems which communicate, health portals, and many other ICT-based tools assisting disease prevention, diagnosis, treatment, health monitoring and lifestyle management. “eHealth systems provide patients with better information – on treatments, on their condition, and on improved standards of living – and make it simpler for healthcare professionals to access and share information, both general and patient-specifi c. Th e use of electronic patient records allows doctors to see much more of a person’s medical history than do paper fi les, which typically only include information on treatment in a single surgery or hospital. A patient’s condition can be monitored remotely, either freeing up a hospital bed which would have been required with previous monitoring equipment, or providing a better standard of care for the patient.” Th e EC Information Society provides in-depth information on the EU point of view. Th e “eHealth action plan, progress report 2005”, where the situation regarding eHealth development and application in EU member countries is investigated and the near future is envisioned, can be downloaded from the web page [2]. Th is paper aims to answer the following dilemma presented on the EC portal [2]: “Although ICTs have been revolutionising the healthcare sector in recent years, the EU has found that eff orts across the continent have been fragmented and could benefi t from improved cross-border coordination. eHealth tools and services have been widely introduced, but too often health authorities, hospitals, or doctors have chosen and implemented their own individual systems. If these systems are able to communicate with each other, the potential benefi ts they can bring to patients will increase signifi cantly.”

Measurement of simple reaction time in antipsychotic treatment of patients with schizophrenia

ZusammenfassungHintergrundDie Rolle der einfachen Reaktionszeit wurde in der Fachliteratur umfangreich diskutiert. Zahlreiche Studien untersuchen die basische Reaktionszeit unter statischen Bedingungen, die sich auf eine Messung beziehen. Das Ziel der vorgelegten Studie war festzustellen, ob sich die einfache Reaktionszeit bei hospitalisierten Patienten mit einer schizophrenen Störung unter Behandlung mit Risperidone oder Olanzapine verändert.MethodenAn der achtwöchigen doppelblinden Pilotstudie nahmen 17 hospitalisierte Patienten mit akuter Exazerbation einer schizophrenen Störung (nach DSM IV Kriterien) und 20 gesunde Kontrollen teil. In der ersten Woche wurden die Patienten mit klassischen Antipsychotika behandelt. In der Folge wurden die Patienten in zwei Gruppen randomisiert und entweder mit Risperidone 4 mg/täglich oder Olanzapine 10 mg/täglich in konstanter Dosierung während der ersten Woche und in flexibilen Dosierungen während der restlichen sieben Wochen weiterbehandelt. Da keine Unterschiede zwischen den Reaktionszeiten bei mit Risperidone oder Olanzapine behandelten Patienten gefunden wurden, wurden beide Therapiegruppen in der statistischen Analyse vereint und mit der gesunden Kontrollgruppe verglichen. Psychopathologische Symptome wurden anhand von Positive and Negative Scale (PANSS) bewertet und extrapyramide Symptome anhand der Simpson Angus Scale und Abnormal Involuntary Movement Scale. Die Reaktionszeit wurde mit dem an einen Computer angeschlossenen Alpha Apparat ermittelt. Alle Bewertungen und messungen wurden während der medikamentösen Therapie viermal durchgeführt.ErgebnisseDie Reaktionszeit der Patienten war statistisch gesehen wesentlich länger als jene der gesunden Kontrollen (t1=17,11; p1<0,05). Nach acht Wochen der Behandlung verbesserte sich die Reaktionszeit der Patienten wesentlich, doch sie erreichte das Niveau der gesunden Kontrollen nicht (t4=28,18, p4<0,05). Die kürzere Reaktionszeit korrelierte weder mit der Verbesserung psychopathologischer Symptome noch mit der Verbesserung von extrapyramidalen Symptomen.SchlussfolgerungDie Ergebnisse der vorliegenden Studie weisen darauf hin, dass sich die einfache Reaktionszeit durch die Behandlung mit atypischen Antipsychotika verbessern kann.SummaryBackgroundThe role of simple reaction time in schizophrenia has been extensively reported to date in professional literature. However, most studies have examined basic reaction time under static conditions using a single measurement. The aim of the present study was to establish whether any changes occur in simple reaction time during treatment with risperidone or olanzapine in in-patients suffering a relapse of schizophrenia.MethodsSeventeen in-patients suffering acute relapse of schizophrenia (DSM IV criteria) and twenty matched, healthy controls participated in an eight-week, double-blind pilot study. The patients were treated with conventional antipsychotics for seven days after admission and were then randomised to the treatment arms with risperidone (4 mg/day) or with olanzapine (10 mg/day) at a fixed dosage in the first week and thereafter in flexible dosages for the remaining seven weeks. Since no differences were found between reaction times of patients treated with risperidone or olanzapine, the two treatment groups were merged in the statistical analysis before being compared with the normal controls. Psychopathological symptoms were assessed using the Positive and Negative Symptom Scale (PANSS) and extrapyramidal symptoms with the Simpson Angus Scale and Abnormal Involuntary Movement Scale. Reaction time was measured with the Alpha apparatus, connected to a personal computer. All assessments and measurements were conducted four times during the treatment phase of the study.ResultsThe reaction time of patients was significantly longer than that of the healthy controls (t1=17.11; p1<0.05). After eight weeks of treatment the reaction time of patients significantly improved but did not reach that of the healthy controls (t4=28.18, p4<0.05). Furthermore, the improved reaction time in the patients did not correlate with improvement of psychopathological symptoms or with improved extrapyramidal symptoms.ConclusionThe results of the study suggest that simple reaction time can improve during treatment with atypical antipsychotics.