bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of inflammation in arteriosclerotic plaque destabilization and rupture
Authors: Tatic Vujadin , Kanjuh Vladimir , Rafajlovski Sasa , Kostic Kristina , Suscevic Dusan
Published: December 2010

Introduction. Although Rudolf Virchow considered arteriosclerosis an inflammatory disease in his book Cellular Pathology published in 1858, the opinion that it was a degenerative arterial disease as a civilization disease prevailed. Nowadays, a great attention has been paid to the inflammatory process in the pathogenesis of arteriosclerosis and particularly in the destabilization and rupture of plaque. Aim. To find out whether T and B lymphocytes, lipid macrophages, vascular smooth muscle and mast cells as well as plaque destabilization and rupture are present in ruptured arteriosclerotic plaque in the coronary arteries. Methods. Histochemical and immunochemical analyses of 68 ruptured arteriosclerotic plaques from the coronary arteries were performed. Microscopic examination revealed the presence of inflammation elements in all of them. The following histochemical and immunochemical methods were applied: Masson's trichrome, actins, vimentin, CD3, CD43, CD68, CD20, CD45 and chlorine acetyl esterase. The control group included 10 arteriosclerotic plaques from the coronary arteries with fibrous cap, but without inflammation cells. Results. Rupture of the arteriosclerotic plaque fibrous cap, with thinned and torn collagen fibers, was found in all of the 68 arteriosclerotic plaques. In 57 out of 68 analysed plaques, the increased number of T-lymphocytes, lipid macrophages, vascular smooth muscle and mast cells particularly on the plaque rupture site were found. In the remaining 11 specimens, mast cells were present in a somewhat smaller number. In the control group with the stable plaque, inflammation cells were not observed. Conclusion. Our results pointed out that the inflammatory elements, which might exert an effect upon the arteriosclerotic plaque destabilization, and rupture had been present in the ruptured arteriosclerotic plaque.
Sekundarna depresija kod alkoholicara - klinicki znacaj
Authors: Mandic-Gajic Gordana
Published: December 2010

 Sekundarna depresija u ranoj apstinenciji moze znacajno da utice na tok i ishod lecenja alkoholicara. Ona smanjuje kognitivne sposobnosti alkoholicara i njihovu saradnju pri lecenju uz mogucnost pojave teske depresije, suicida i recidiva. Grupa depresivnih alkoholicara je relativno mala subpopulacija primarnih alkoholicara, ali klinicki je vrlo znacajna. Pored redovnog programa za lecenje alkoholizma, ova grupa zahteva poseban terapijski pristup za depresiju sa kombinacijom farmakoterapije i psihoterapije. Prilikom prijema alkoholicara na lecenje bilo bi potrebno da se u rutinsku klinicku praksu uvede skrining na depresiju uz ponovnu dijagnosticku procenu posle cetiri nedelje radi distinkcije alkoholom indukovane depresije od sekundarne depresije. Lecenjem bi trebalo obuhvatiti ne samo sekundarnu depresiju teskog vec i depresiju umerenog i blagog stepena. Lecenje sekundarne depresije moglo bi popraviti ishod terapije alkoholizma i doprineti sprecavanju recidiva alkoholizma.
Nephronophthisis and medullary cystic kidney disease complex
Authors: Stanisic Marijana , Hrvacevic Rajko , Paunic Zoran , Petrovic Stanko
Published: December 2010

Background. Nephronophthisis and medullary cystic kidney disease complex refers to the genetic heterogeneous group of inherited tubulointerstital nephritis. Nephronophthisis comprises at last 3 clinical manifestations, has the autosomal recessive pattern of inheritance, appears early in life and is the most frequent inherited kidney disease that causes terminal renal failure in childhood, while medullary cystic kidney disease has the autosomal dominant pattern of inheritance, is less frequent, and terminal renal failure appears later in life. These two forms have similar clinical and morphological findings but extrarenal manifestations, the median ages of occurrence of terminal renal failure, and siblings presence help us distinguish these diseases. Case report. In this article we illustrated the case of a 20- years old patient with the suspicion of having complex nephornophthisis and medullary cystic kidney disease based upon mild renal failure, seen in routinely taken laboratory findings and bilateral cysts in corticomedullary region of the kidneys verified on abdominal ultrasound examination. Conclusion. This disease should rise suspicion in children or adolescents with progressive renal failure, a typical clinical manifestation, blood and urine samples results, bilateral cysts in the corticomedullary region of the kidneys seen during ultrasound examination of the kidneys and family inheritance.
Renal scintigraphy in children with urinary tract infections
Authors: Ajdinovic Boris , Krstic Zoran , Dopudja Marija , Jaukovic Ljiljana
Published: December 2010

Background/Aim. To determine the incidence of abnormal Technetium Tc 99m Dimercaptosuccinic Acid (Tc99m DMSA) renal scintigraphy findings in the children with urinary tract infection (UTI), and to evaluate the difference between the children with UTI and vesico-ureteral reflux (VUR), and the children with UTI without VUR. Methods. Tc99m DMSA renal scintigraphy was performed in 170 children with UTI, mean age 7.07 years (1 month to 14 years, 137 were girls and 33 were boys). In 88 of the children, VUR was proved by micturating cystouretherography (MCU), while in 82 VUR could not be detected by MCU. VUR was graded in accordance with MCU recommended by the international study of VUR. In 13 of the children the grade of VUR was grade I, in 30 was grade II, in 23 grade III, in 17 grade IV, while the grade V was in 5 of the children. Findings of Tc99m DMSA renal scintigraphy were classified as: 1 - normal, 2 - probably normal, 3 - equivocal, 4 - probably abnormal, and 5 - abnormal. The degree of the significance of the difference of the findings was estimated using ?2, taking p < 0.01 as the limit of statistical significance. Results. Of the total number of 170 studied children, the abnormal findings were detected in 30% (51/170), normal findings in 62% (106/170), and equivocal in 8% (13/170). In the children with UTI and VUR, the incidence of abnormal findings was 49% (43/88), of normal 43% (38/88), and of equivocal findings 8% (7/88). All the children with VUR grade V had the abnormal findings (the incidence of the abnormal findings was 100%). In the children with VUR grade IV, the abnormal findings were 71%. In the children with VUR grade I, 77% of the findings were normal, in the children with VUR grade II, 53% of the findings were normal and in the children with VUR grade III, 30% of the findings of renal scintigraphy were normal. In the children with UTI without VUR, the incidence of abnormal findings was 10% (8/82), of normal findings 83% (68/82), and of equivocal findings 7% (6/82). The incidence of abnormal findings was significantly higher in the children with UTI and VUR than in those with UTI without VUR (p < 0.01). Also, the incidence of the abnormal findings was higher in the children with VUR grades IV and V than in the children with VUR grade I (p < 0.01). Conclusion. DMSA renal scintigraphy in the children with ITU revealed the abnormal findings in 30% of the cases. The incidence of the abnormal findings was significantly higher when VUR was present, as well as if the grade of VUR was higher. Our results confirmed that Tc99m DMSA renal scintigraphy was a very important technique in the evaluation of the children with ITU.
Use of extratransference interpretation in psychoanalytic psychotherapy
Authors: Jojic Boris
Published: December 2010

Background. In psychoanalytic psychotherapy, the transference analysis takes the central position of the work. The work in the extratransference sphere and experience in a professional practice with extratransference interventions have not been reported much in the literature. Extratransference sphere includes less transferring relation to a psychotherapist, transference to other objects, or may refer to the external reality rather than the psychic reality or fantasy. Case report. We pointed out extratransference interventions. We demonstrated an application of a genetic interpretation and reconstruction, too, which could restore and establish the connections between the past and the present, in order to understand the influences of the current reality and the past, and helping us, further, to resolve the infantile conflicts. Conclusion. Interpretation of extratransference situations takes an important part of an analytical work and it is an essential category of the interpretation. Analytic understanding should include transference and extratransference spheres, fantasy and reality, past and present. Working with neurotic patterns and character resistance needs an optimal choice of intervention in the given moment of the analytic process. Extratransference interventions are an essential category of intervention, irreplaceable for its effectiveness in the analytic process.
Correlation between findings of echosonography and endoscopic retrograde cholangiopancreatography examination in chronic pancreatitis patients
Authors: Alempijevic Tamara , Kovacevic Nada , Djuranovic Srdjan , Krstic Miodrag , Ugljesic Milenko
Published: December 2010

Background/Aim. Chronic pancreatitis is defined as an amount of chronic inflammatory lesions that lead to the destruction of pancreatic tissue and fibrosis development, whereas the later stages of the illness are characterized by the destruction of the endocrine portion of the organ. Although the results of different studies are abundant, chronic pancreatitis still remains enigmatic, both in its diagnostic and therapeutic aspect. To test the correlation between the findings of echosonography and endoscopic retrograde cholangiopancreatography (ERCP) examination in chronic pancreatitis patients. The observed degree of correlation may serve for the validation of echosonography as a diagnostic tool in chronic pancreatitis patients. Methods. We collected and analyzed data on morphological features in chronic pancreatitis patients revealed by echosonography as well as endoscopic retrograde cholangiopancreatography. Results. 35 patients 34?73 years of age were included in this study. In 60% (21 subject) history was subjective for alcohol abuse. significant correlation has been found between alcohol abuse and chronic pancreatitis (?2 = 6.896; p < 0.05). Correlation between groups of chronic pancreatitis patients diagnosed by echosonography and endoscopic retrograde cholangiopancreatography was highly significant (p = 0.799; p < 0.01). Conclusion. Echosonography was proved to be a suitable first choice imaging method for the examination of patients when chronic pancreatitis was suspected. Echosonography might provide conclusive information on the morphology of pancreatic canalicular system, as well as on the state of pancreatic parenchyma.
Unerupted lower third molar as a cause of acute infection in soldiers
Authors: Matijevic Stevo , Marjanovic Marjan
Published: December 2010

Background/Aim. To record the frequency of infections as complications accompanying the unerupted lower third molars and to determine if there was a significant level of the relationship between the frequency and the severity of infections and the age of patients. Methods. This study included 100 soldiers of the Army of Serbia & Montenegro, with the unerupted third molars, of male sex, 18 to 25 years old, who were receiving clinical treatment. Results. In 73% of the patients the infection was caused with the unerupted lower third molars. The highest frequency of infection was observed in the group of 20?23 years of age (75.3%). Mild infection occurred in 49 (67.1%) of the patients. Conclusion. The frequency of infection was significantly higher in the older patients. Because of the high frequency of the infection recorded, the unerupted lower third molars should be surgically removed before the age of 20.
Possibility to predict the development of secondary depression in primary alcoholics during abstinence
Authors: Mandic-Gajic Gordana
Published: December 2010

Background/Aim. The relationship between alcoholism and depression is observed in clinical trials. The factors which could predict persistence of secondary depression after alcohol withdrawal are not enough explored on admission. The differences between depressed (DA) and non-depressed (NDA) alcoholics regarding the degrees of severity of withdrawal, severity of depression and the intensity of cognitive dysfunctions were explored on admission to investigate possibility of prediction of the development of secondary depression in alcoholics. Methods. A group of primary male alcoholics (n=86) was recruited during inpatient treatment. After 4 weeks alcoholics were divided in the DA group (n=43) and NDA (n=43) group according to the score on the Hamilton Depression Rating Scale (HAM-D). Clinical assessment of withdrawal, scoring on the Alcohol Dependency Severity Scale- ASD, and scoring on the Mini Mental Scale-MMSE were performed in all the participants on admission. The differences between the groups were tested by the Student's t-test. Results. The DA group showed the significantly higher severity of depression, higher levels of alcohol withdrawal symptoms and cognitive dysfunctions than the NDA group on admission. Conclusion. The specific group of depressive alcoholics was shown to be characterized by the higher severity of alcoholism and depression on admission, which could predict prolonged, secondary depression. Early detection and concurrent therapy of secondary depression could improve the treatment, and reduce the relapse of alcoholism.
Significance of the spatial reconstruction based on mathematical modeling in the surgical treatment of giant intracranial aneurysms
Authors: Nikolic Igor , Nagulic Mirjana , Antunovic Vaso
Published: December 2010

Background. The use of computer models for the 3- dimensional reconstruction could be a reliable method to overcome technical imperfections of diagnostic procedures for the microsurgical operation of giant intracranial aneurysms. Case report. We presented a case of successfully operated 52-year-old woman with giant intracranial aneurysm, in which the computer 3-dimensional reconstruction of blood vessels and the aneurysmal neck had been decisive for making the diagnosis. The model for 3- dimensional reconstruction of blood vessels was based on the two 2-dimensional projections of the conventional angiography. Standard neuroradiologic diagnostic procedures showed a giant aneurysm on the left middle cerebral artery, but the conventional subtraction and CT angiography did not reveal enough information. By the use of a personal computer, we performed a 3-dimensional spatial reconstruction of the left carotid artery to visualize the neck of aneurysm and its supplying blood vessels. Conclusion. The 3-dimensional spatial reconstruction of the cerebral vessels of a giant aneurysm based on the conventional angiography could be useful for planning the surgical procedure.
Acute serous meningitis in a patient with erythema infectiosum
Authors: Canovic Predrag , Ravic-Nikolic Ana
Published: December 2010

Bacground. Clinical manifestations caused by parvovirus B19 (PVB19) are various and depend on the age and immunity of an infected person. In children, the most frequent clinical manifestation of parvovirus B19 primary infection is erythema infectiosum (EI). Case report. In this case report we presented a 12-year-old patient with 2 clinical syndromes: erythema infectiosum and serous meningitis. Erythema infectiosum was manifested as fever, typical skin lesions (?slapped cheeks?), erythematous macules and papules confluent with reticular appearance on the extremities and the trunk. Serous meningitis had a mild course with an increased number of lymphocytes (120/ mm?) and the mildly increased level of proteins (0.75 g/l). The serological examination showed the presence of IgM and IgG antibodies against parvovirus B19 in serum, as well as in cerebrospinal fluid (CSF). The reduction of serum/CSF ratio of IgG antibodies was present. The symptomatic therapy was used in the treatment. The course and the prognosis were benign. Conclusion. Human PVB19, although non-specifically associated with CNS diseases could be an etiological factor that might cause serous meningitis. So, it should be considered in different diagnosis in patients with aseptic meningitis, especially during the outbreaks of erythema infectiosum.
Indirect blast rupture of the pancreas with a primary unperforated blast injury of the duodenum
Authors: Ignjatovic Dragan , Ignjatovic Mile , Jevtic Miodrag
Published: December 2010

Background. To present a patient with an indirect blast rupture of the head of pancreas, as well as with a blast contusion of the duodenum following abdominal gunshot injury. Case report. A patient with the abdominal gunshot injury was submitted to the management of the injury of the liver, gaster and the right kidney in the field hospital. The revealed rupture of the head of the pancreas and the contusion of the duodenum were managed applying the method of Whipple. Conclusion. Indirect blast injuries require extensive surgical interventions, especially under war conditions.
Treatment of severe spacticity in multiple sclerosis by continuous intrathecal baclofen
Authors: Peric Predrag , Antic Branislav , Dincic Evica , Obradovic Dragana , Arsic Stojanka
Published: December 2010

Background. Successful treatment of severe spasticity represents an imperative of symptomatic therapy of multiple sclerosis (MS) due to a significant improvement of physical, psychic and social rehabilitation of MS patients, as well as a longterm cost savings for the additional treatments of conditions arising from uncontrolled severe spasticity. Continuous intrathecal administration of baclofen (ITB), using a subcutaneously implanted programmable infusion pump, is a minimally invasive, reversible method for the treatment of severe diffuse spasticity of the spinal origin. Case report. The first two cases in our country, treated by ITB due to severe spasticity caused by MS, were reported. Despite the local complications of surgical wound healing above the implanted components of the ITB-system in one patient, the optimal reduction of spasticity the with complete elimination of spastic pain was obtained in both patients. Conclusion. Our initial experiences confirmed ITB as a safe and effective therapeutical option for the treatment of intractable spasticity in patients with MS. Major prerequisites for this were adequate patient selection and good control of the basic disease. The use of the minimal invasive implantation technique and the experience in choosing of the adequate ITB-system components, could successfully prevent the occurrence of local complications related to the impaired healing of the ITB-system implantation site.
Intracranial menigioma manifested after delivery in a patient with Hodgkin's disease
Authors: Nagulic Mirjana , Tukic Ljiljana , Ilic Srbislav , Markovic Marko
Published: December 2010

Background. Intracranial meningioma is rarely reported in the patients treated for Hodgkin?s disease (HD), known to mainly occur in the area of radiation therapy. Case report. A 26-year-old woman with HD, and intracranial meningioma following the delivery, was presented. As we knew, a similar case had not been reported in the literature before. Three years prior the surgery for intracranial tumor, the patient had been started to be treated for HD of neoplasm stage I (NS I) type, by the use of the standard (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) BEA-COPP protocol. The remission of HD, achieved after 7 cycles, persisted over a 27-month-period up to the delivery. Within this period, the patient was without neurologic disorder, but with the obvious psychotic behavior, for which the patient was treated with haloperidol. Two days following the normal delivery, during the acute disorder of the consciousness, intracranial tumor was found. A complete bilateral meningioma (11.7 ? 8.3 ? 8.1 cm) of the frontal parietal zone was removed. Conclusion. there were no reliable signs of the use of an intensive hemotherapy in the reported case (alkylating cytostatics and topoisomerases inhibitors) which might have caused the proliferation of a benign solid tumor. The pregnancy was supposed to be the possible second risk factor for causing the growth of a meningioma. On the basis of the significant psychic disorders before the pregnancy, as well as upon the size of the operated on tumor, we concluded that the occurrence of intracranial meningioma could be regarded the parallel neoplastic disease or the second primary tumor.
Detection of free cancer cells in peritoneal cavity in patients surgically treated for gastric adenocarcinoma
Authors: Kostic Zoran , Cuk Vladimir , Bokun Radojka , Ignjatovic Dragan , Usaj-Knezevic Slavica , Ignjatovic Mile
Published: December 2010

Bacground/Aim. Peritoneal metastasis is a leading cause of therapeutic failure after an operative treatment of patients with gastric adenocarcinoma. Free cancer cells might induce or indicate an early peritoneal seeding with a subsequent peritoneal metastasis. The aim of this study was to determine the frequency of the presence of free cancer cells in the peritoneal cavity in the patients surgically treated for gastric adenocarcinoma, and its relation to certain clinical, operative and pathohistological parameters. Methods. Inside a period from April 2000, and April 2004, the total of 100 patients underwent intraoperative peritoneal lavage for cytological examination. Immediately after the laparotomy, 200 ml physiologic saline, heated to 37 ?C, was introduced into the abdominal cavity, manually dispersed and collected from the region around the gastric tumor and the pouch of Douglas. The nucleated cell layer was smeared on four glass slides for every patient and dyed with May-Gr?nwald-Giemsa stain. The cytological findings were defined as positive or negative according to the presence of cancer cells. The frequency of positive cytological findings was compared to the location and the diameter of the cancer, pathohistological type of carcinoma, pathohistological stage of the disease, lymph node and the liver and/or peritoneal metastases and the type of surgical procedure. Results. Free cancer cells were found in 24 (24%) of the patients, while in 76 (76%) of them cytological findings were negative. A statistically highly significant difference (p ? 0.001) in the frequency of positive cytological finding was found between the groups of patients with and without cancer invasion of serosa, with cancer diameters > 5 cm and ? 5 cm, in the stage of disease I, II and III, IV, with macroscopically present and without metastases, with resection and D2 lymphadenectomy and palliative procedure. Free cancer cells were statistically more frequently (p ? 0.05) detected in the patients with lymph nodes metastases comparing to the patients without lymph nodes involvement. The results of the univariate analysis showed that the cancer diameter > 5 cm, tumor invasion of serosa, pathohistological stage of the disease III and IV and macroscopically visible metastases were the most important risk factors for the free cancer cells detection. Conclusion. Peritoneal lavage cytology was shown to be a useful tool for the detection of the group of patients with greatest risk of peritoneal dissemination. The frequency of positive cytological findings was highly associated with the diameter of the tumor and the cancer invasion of serosa. Cytological examination of peritoneal lavage fluid improved the accuracy of staging and selection of patients who might have benefit from neoadjuvant chemotherapy.
Influence of metal-ceramic fixed dental restorations on the occurrence of discoloration of gingiva
Authors: Ristic Ljubisa , Ilic Srbislav , Zivanovic Aleksandar
Published: December 2010

Background. Adverse effects of dental cast alloys on the health of patients are the problem in clinical practice. The aim of this paper was to describe the case of a patient with discolorated gingivae in the presence of fixed dental restorations and used diagnostic and therapeutic procedures. Case report. A 30-year old patient, presented with the complaints about unsatisfactory esthetic of his fixed dental restorations. He complained about the greyish discoloration of gingivae, inappropriate color of the crowns, and a larger space between the central incisors. Both discolorated and normal gingivae around the fixed dental restorations were taken by excision and the samples of gingivae were examined histopathologically, and by using the Atomic Absorption Spectrophotometry test (AAS). Histopathological examination of the discolorated gingivae showed the presence of non-specific inflammation with a foreign body. AAS revealed the presence of various metals in the samples and the higher metal contents in the samples of discolorated gingivae as compared with the samples of normal gingivae. New metal-ceramic crowns were made for the patient. Conclusion. A main cause of greyish discoloration of gingivae was presence of a metal in gingival tissue. After the excision of discolorated gingivae old metalceramic crowns should be replaced with new crowns.
Did a reform strategy in drug management improve doctors’ prescribing habits in Montenegro: The example for the cardiovascular drugs
Authors: Duborija-Kovacevic Natasa , Tomic Zdenko
Published: December 2010

Background/Aim. A comprehensive reform strategy in drug management has been applying for a few years in Montenegro in order to promote a rational use of drugs. The reform strategy covered: an information system named ?The Control of Distribution and Use of Drugs?, a new List of Essential Drugs (that are reimbursed by the Republic Fund for Health), legislative and regulatory measures in order to establish a better control of drug prescribing and more efficient processing of the prescriptions. The aim of this study was to evaluate the effects of the reform strategy on the doctors' prescribing habits and the subsequent use of cardiovascular drugs within the outpatient setting of Montenegro. Methods. A retrospective-prospective pharmacoepidemiologic study included a sample of 100% of cardiovascular drugs that were taken with prescription from state pharmacies during 2000 and 2004. The results were presented by the number of defined daily doses (DDD) per 1000 inhabitants per day. All the drugs were classified according to the uniform anatomical-therapeutic-chemical (ATC) classification of the drugs. The Wilcoxon test for matched pairs was used in order to calculate the significance of difference in cardiovascular drugs utilization before and after the introduction of new measures. Results. Although prescribing and the resulting outpatient use of cardiovascular drugs (ATC group C) that were reimbursed by the Republic Fund for Health was increased approximately by 13% in 2004 in comparison with 2000 (67.98 vs. 60.17 DDD/1000 inh./day), we did not find a statistically significant difference (p > 0.05). Prescribing of ACE inhibitors (C09A) increased approximately by 45% during the investigated period (15.30 vs. 22.17 DDD/1000 inh./day). The selection of drugs was also altered: cilazapril, ramipril and quinapril were left out, captopril and enalapril were more prescribed, and a newly-included fosinopril was prescribed mostly (31.5%). Calcium-channel blockers (C08) were prescribed 33.7% more (7.12 vs. 9.52 DDD/1000 inh./day), mostly because of seven times higher prescribing of amlodipine in 2004. Pentaerythritol tetranitrate was left out, but isosorbide dinitrate and isosorbide mononitrate were prescribed more frequently. High-priced atorvastatin was replaced with the older simvastatin, that was prescribed three times more. Conclusion. The reform strategy in drug management mostly improved the doctors' prescribing habits and the subsequent use of cardiovascular drugs within the outpatient setting. For the most part, the noticed changes were in accordance with the actual recommendations, but some cases need additional measures. Regulatory policy, however, could not compensate for the continual education of doctors that prescribe drugs.
Successful lamivudine therapy for chronic hepatitis B in the family
Authors: Nozic Darko
Published: December 2010

Background. Hepatitis B virus infection is a global public health problem since it is a leading cause of liver cirrhosis and hepatocellular carcinoma. An optimal treatment is needed to reduce mortality. Current therapies for chronic hepatitis B include standard and pegilated interferon-alfa and nucleoside and nucleotide analogies, primarily lamivudine and adefovir. Each of the therapies, however has various limitations. Case report. In this paper we presented a father and his daughter with chronic hepatitis B, successfully treated with lamivudine. Conclusion. In the linked cases of chronic hepatitis B, the choice of antiviral medicine in some patients could also be made on the basis of its efficacy in the persons previously treated with it, even without determining virus genotype.
A perspective in epidemiology of suicide in Japan
Authors: Yamamura Takehiko , Kinoshita Hiroshi , Nishiguchi Minori , Hishida Shigeru
Published: December 2010

Background/Aim. According to the information about deaths from any causes, provided by the vital statistics based on the WHO Member Countries mortality and morbidity, suicide rate in Japan has been ranking high among the causes of death. The number of suicides goes on increasing every year in Japan. In fact, suicide rates per 100 000 population have already reached the sixth place among the leading causes of death. The aim of this study was to perform epidemiological surveys of suicide rates, obtained from the official vital statistics provided by the WHO on mortality and morbidity during several past decades in Japan. Methods. Completed suicide data were collected via the vital statistics by the Health, Labor and Welfare Ministry (MHLW), Japan and the attempted suicide data were extracted from the Annual Report of the Ambulance and Rescue Activities by the Fire Prevention and Control Office (FPCO) in Kobe City. The data were examined on the basis of social factors including economic trends, gender differences, modus operandi of suicide, age group, and physical and mental disorders in suicidal behavior and compared to international data. Results. Male suicide rates have gradually increased with the four temporal steep risings during the 20th century, while those of females have generally reached the stabilization with no fluctuations. Suicides are not always under the influence of economic trends in Japan. Suicide rate was the highest in the Akita and Iwate prefectures, known for the low population density. Suicide rate increases with aging, reaching a peak in the age of 80 and over. The trends of completed suicide rates are elevating by males about twice the suicide rate of females which keeps on stable. On the other hand, female attempted suicide rates greatly increase from two to five times more than those in males which are generally close to the constant. The majority of suicides are caused by their physical and/or mental disorders including typical depressive states. Suffocations/hangings are the most common methods used to commit suicide by both sexes. Utilities and interactions among these several components were considered, as well as a perspective of suicidal behavior. Conclusion. In order to prevent suicide and avoid the worst tragedy for a family, it is an essential requirement to collect and analyze any information concerning suicide victims.
Exposure to sun radiation as a risk factor for the occurrence of basal cell carcinoma in the Montenegrian population
Authors: Maksimovic Natasa , Raznatovic Milena , Marinkovic Jelena , Jankovic Janko
Published: December 2010

Backgound/aim: Basal cell carcinoma (BCC) is the most frequent form of carcinomas in the whites. Among the environmental factors, the most important risk factor for its occurrence is the exposure to sun radiation. The aim of this study was to assess the role of the sun radiation in the development of basal cell carcinoma BCC in the Montenegrian population. Methods. A case-control study was conducted in a period from 2002-2003. The study group included 100 histopatologically confirmed cases with BCC, while the control group included 100 patients from the same population, who did not present skin cancer and who were individually matched with the cases from the study group by sex and age (? 5 years). All the participants were interviewed using an epidemiological questionnaire. For statistical analysis, the ?2 test and univariate logistic regression analysis were used. Results. The risk for development of BCC was increased in the persons: that always had burns with no tan during the exposure to sunlight (OR = 1.75; 95% CI = 1.20-2.55; p = 0.003); that developed sunburns after two hours of the exposure to sunlight (OR = 3.72; 95% CI = 2.39-5.79; p < 0.001) that kept light tan or remained without changes in childhood and adolescence after the repeated exposures to sunlight (OR = 2.92; 95% CI = 1.89-4.52; p < 0.001) that often had severe and painful sunburns (OR = 4.48; 95% CI = 2.74-7.33; p < 0.001). Conclusion. Our study confirmed the significance of sunlight exposure for the development of BCC.
Significance of the determination of doppler sonography haemodynamic indices for the assessment of distal perfusion in patients with critical ischemia of lower limbs
Authors: Cizmic Milica , Kronja Goran , Ajdinovic Boris , Pucar Dragan
Published: December 2010

Background/Aim: The perfusion of tissue, especially the muscles of the lower limbs (LL), implies the blood flow that carries enough nutrition, energy materials and oxygen. The aim of this study was to determine whether the decreased Doppler sonography parameters, resistance index (RI), and pulsatility index (PI) were significant as indicators of irreversible ischemia of LL. Methods. In 40 patients (mean age 66?14.9 years, 21% women and 79% men) with the signs of critical ischemia of LL, Lariche-Fontaine class III and IV, we performed contrast angiography of the LL arteries, and perfusion scintigraphy of LL using, thallium-201, while we performed Doppler sonography to determine resistance index (RI), as well as pulsatility index (PI). After that, all the patients were treated with vasodilatation using Bergmann's solution within a 10-day period. Following that, all the patients underwent the determination of haemodynamic indices RI and PI applying the methods of Doppler sonography. The obtained values of RI and PI indices revealed no clinical recovery which suggested the irreversibility of critical ischemia (unsuccessful therapy in 100% of the patients), and clinical recovery which suggested the reversibility of the disease (unsuccessful therapy in 80% of the patients). Results. The obtained values of PI = 0-0.3 and RI = 0-0.25 for the examined LL arteries were the indicators of irreversible ischemia. A significant correlation between the values of RI in the distal parts of a. tibialis anterior and posterior was proved, as well as between the decreased perfusion of LL determined by tallium-201 (p < 0.05, r = 0.43), and a tibialis anterior (p = 0.05, r = 0.38). There was, however, no statistically significant correlation between the angiographic values and perfusion scintigraphy of LL. Conclusion. The obtained values of haemodynamic RI and PI indices should be a novel approach for introducing a new criteria for the assessment of reversible and irreversible critical ischemia of LL using the method of Doppler.
Use of free microvascular flaps in the management of the head and neck defects
Authors: Nikolic Zivorad , Jeremic Jelena , Milosavljevic Radoje
Published: December 2010

Background/aim: In the field of contemporary head and neck reconstructive surgery, free vascularized tissue transfer is becoming a gold standard. The aim of this study was to review our clinical results and experience, with use of free microvascular flaps and compare them with the recently published patient series. Methods. During the period from 2001 to 2005, 37 patients underwent microsurgical reconstruction after the tumor ablation in the region of head and neck. Flap viability was monitored intraoperatively with the Ackland test and postoperatively by the clinical observation and mini-Doppler test. Results. The overall success rate was 83.8%. The complications that appeared were: one complete flap necrosis due to venous thrombosis, and five late flap ischemic necroses, in the period from the 10th to 14th postoperative day. Conclusion. Free flap reconstruction of the head and neck is a surgical technique that provides the reconstruction of complex and extensive defects, that could not be performed by using local or regional flaps.
Determination of the delivered hemodialysis dose using standard methods and on-line clearance monitoring
Authors: Vlatkovic Vlastimir , Stojimirovic Biljana
Published: December 2010

Background/aim: Delivered dialysis dose has a cumulative effect and significant influence upon the adequacy of dialysis, quality of life and development of co-morbidity at patients on dialysis. Thus, a great attention is given to the optimization of dialysis treatment. On-line Clearance Monitoring (OCM) allows a precise and continuous measurement of the delivered dialysis dose. Kt/V index (K = dialyzer clearance of urea; t = dialysis time; V = patient's total body water), measured in real time is used as a unit for expressing the dialysis dose. The aim of this research was to perform a comparative assessment of the delivered dialysis dose by the application of the standard measurement methods and a module for continuous clearance monitoring. Methods. The study encompassed 105 patients who had been on the chronic hemodialysis program for more than three months, three times a week. By random choice, one treatment per each controlled patient was taken. All the treatments understood bicarbonate dialysis. The delivered dialysis dose was determined by the calculation of mathematical models: Urea Reduction Ratio (URR) singlepool index Kt/V (spKt/V) and by the application of OCM. Results. Urea Reduction Ratio was the most sensitive parameter for the assessment and, at the same time, it was in the strongest correlation with the other two, spKt/V indexes and OCM. The values pointed out an adequate dialysis dose. The URR values were significantly higher in women than in men, p < 0.05. The other applied model for the delivered dialysis dose measurement was Kt/V index. The obtained values showed that the dialysis dose was adequate, and that, according to this parameter, the women had significantly better dialysis, then the men p < 0.05. According to the OCM, the average value was slightly lower than the adequate one. The women had a satisfactory dialysis according to this index as well, while the delivered dialysis dose was insufficient in men. The difference between the women and the men was significant. Conclusion. The application of OCM has shown that it is the most rigorous parameter for the assessment of adequacy and that its regular use would contribute to increasing of the delivered dialysis dose and improvement of the treatment quality.
Analysis of loss of heterozygosity of the tumor suppressor genes p53 and BRCA1 in ovarial carcinomas
Authors: Petrovic Bojana , Perovic Milica , Novakovic Ivana , Atanackovic Jasmina , Popovic Branka , Lukovic Ljiljana , Petkovic Spasoje
Published: December 2010

Background/aim: Among the genes involved in ovarian carcinogenesis, there has been increased interest in tumor-suppressor genes p53 and BRCA1. Both of the genes make control of cell cycle, DNA repair and apoptosis. The p53 is a "genome guardian" inactivated in more than 50% of human cancers, while BRCA1 mutations are found mostly in breast and ovarian cancer. The aim of this investigation was to establish the frequency of loss of heterozygosity (LOH) in the regions of the genes p53 and BRCA1 in ovarian carcinomas, and to analyze the association of LOH with the disease stage and prognosis. Methods. We analyzed 20 patients with a confirmed diagnosis of epithelilal ovarian carcinoma. DNA for molecular-genetic analysis was extracted from the tumor tissue and blood as normal tissue of each person. Microsatellite markers of the regions of genes p53 and BRCA1 were amplified by PCR method. The determination of allelic status of microsatellites and detection of LOH was performed after PAA gel electroforesis. Results. Both of the analyzed microsatellite markers were informative in 13/20 (65%) cases. In the region of gene p53, LOH was established in 4/13 (30.7%) tumors. One of them had histological gradus G1, one had gradus G2, and two of them had gradus G3, while all were with the International Federation of Gynecology and Obstetrics (FIGO) IIIc stage. In the region of gene BRCA1, LOH was detected in 5/13 (38.5%) tumors. Four of them had histological gradus G2, and one had gradus G3, while by the (FIGO) classification one was with stage Ib, one was with stage IIIb, while the three were with stage IIIc. LOH in both of the analyzed regions was detected in one tumor (7.7%), with histological gradus G3 and the FIGO IIIc stage. Conclusion. The frequency of LOH in epthelial ovarian carcinomas was 30.7% and 38.5% for p53 and BRCA1 gene regions, respectively. Most of tumors with LOH had histological gradus G2 or G3, and the clinical FIGO stage IIIc, suggesting the association of this occurrence with a later phase of the disease.
Abdominal compartment syndrome caused by ruptured abdominal aortic aneurysm in vena cava
Authors: Music Davor , Radevic Bozina , Batricevic Goran , Filipovic Aleksandar
Published: December 2010

Background. Abdominal compartment syndrome (ACS) is a rapid increase in intra-abdominal pressure associated with multi-organs dysfunction. It is caused mostly by abdominal bleeding und massive volume compensation. Case report. We reported a 76-year-old patient admitted to the hospital with aortic abdominal aneurysm, 13.7 cm in diameter, ruptured in vena cava, which caused intraabdominal hypertension, the liver and kidney dysfunction, as well as circulation, respiration and metabolic disorders. Intraabdominal pressure was measured by bladder manometry. Central venous pressure and systemic arterial pressure were monitored continuously. Clinical signs were thrill and typical abdominal bruit. Aorto-caval fistula was diagnosed by the use of contrast computerized tomography. Caval endoaneurysmatic suture and aortobiiliac bypass with 18 ? 9 mm Dacron prothesis were performed. Haemodynamic changes were mostly corrected during the surgery. The complete correction of haemodynamics, liver, kidney, respiration and metabolic changes was established in the next few weeks. Conclusion. The ACS was caused by rupture of abdominal aortic aneurysm in vena cava followed by edema of the abdominal organs, retroperitoneum, abdominal wall and ascites. Caval endoaneurysmatic suture and aortobiiliac bypass with 18 ? 9 mm Dacron prothesis solved aortocaval fistula as well as all the organs and metabolic dysfunctions caused by ACS.
Clinical characteristics of multiple system atrophy in Serbian population
Authors: Nesic Nada , Svetel Marina , Pekmezovic Tatjana , Ribaric Ksenija , Dragasevic Natasa , Kostic Vladimir
Published: December 2010

Background/Aim. Mulstiple system atrophy (MSA) is a neurodegenerative central nervous system disorder, characterized by any combination of extrapyramidal, cerebellar, pyramidal or autonomic disturbance. The aims of our study were to define clinical characteristics of MSA patients in our population, to account for neuroradiological and electrophysiological profile of the disease and to evaluate one-dose levodopa response. Methods. We have diagnosed 29 patients as MSA, with disease duration from the first symptom 5 years on average on examination. The examinating procedure included an anamnesis and complete neurological investigations, as well as neurootological and neuroradiological examinations. The study included the patients of the Institute of Neurology of the Clinical Center of Serbia in the period of 1996-2001, who completed both clinical and diagnostic criteria for a possible and probable MSA. Results. Autonomic disturbances were documented in 93.1%, whereas extrapyramidal symptoms were seen in additional 89.3% with symmetrical onset in 60%. Levodopa response was poor or moderate. Cerebellar signs were present in 63%, while pyramidal signs occured in 78.7%. There was no a cognitive deterioration (MMSE > 24). CT scan and MRI showed cerebellar and brainstem atrophy, as well as diffuse cortical atrophy. Conclusion. Failure of additional diagnostic procedures to distinguish MSA patients required a precise understanding of their clinical specificities. Our results support this statement.
Therapeutic value of serum uric acid levels increasing in the treatment of multiple sclerosis
Authors: Toncev Goran
Published: December 2010

Background/Aim. Uric acid was successfully used in both, prevention and treatment of the animal model of multiple sclerosis (MS). Recently it has been shown that inosine, a ribosylated precursor of uric acid, might be used to elevate serum uric acid levels in MS patients. The aim of this study was to evaluate the safety and efficacy of oral inosine as a single drug treatment in patients with MS. Methods. We administered inosine orally to 32 MS patients from 2001-2004 year at doses from 1-2 g daily (given twice) depending on the pretreatment serum uric acid levels. The mean follow-up interval was 37.69?6.55 months. The other 32 MS patients, without any treatment except for a relapse period (matched by age, sex, duration of disease and functional disability), were used as controls. The follow-up interval of these patients was 36.39?2.68 months. The neurological disability was evaluated by the Expanded Disability Status Scale score (EDSS). Results. During the observed period the treated MS patients were found to have the lower relapses rate than the non-treated MS patients (Chi-square test, p=0.001). None of the patients have showed any adverse effect of inosine treatment. The non-treated MS patients were found to have a higher increasing in the mean EDSS score than the treated ones (two-way ANOVA repeated measures/factor times, p=0.025). Conclusion. Our results suggested that the treatment approaches based on the elevation of serum uric acid levels might prove beneficial for some MS patients.
Bilobular pancreas: another variant of the divided pancreas?
Authors: Zivanovic Dragana , Perisic Vojislav
Published: December 2010

Background. Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. Case report. We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. Conclusion. The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.