bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebrospinal fluid and plasma concentration of soluble intercellular adhesion molecule1, vascular cell adhesion molecule1 and endothelial leukocyte adhesion molecule in patients with acute ischemic b
Authors: Selakovic Vesna , Colic Miodrag , Jovanovic Marina , Raicevic Ranko , Jovicic Aco
Published: December 2010

Background. Leukocyte migration into the ischemic area is a complex process controlled by adhesion molecules (AM) in leukocytes and endothelium, by migratory capacity of leukocytes and the presence of hemotaxic agents in the tissue. In this research it was supposed that in the blood and cerebrospinal fluid (CSF) of patients in the acute phase of ischemic brain disease (IBD) there were relevant changes in the concentration of soluble AM (sICAM-1 sVCAM-1 and sE-selectin), that could have been the indicators of the intensity of damaging processes in central nervous system (CNS). Methods. The study included 45 IBD patients, 15 with transient ischemic attack (TIA) 15 with reversible ischemic attack (RIA), and 15 with brain infarction (BI) of both sexes, mean age 66?7. Control group consisted of 15 patients with radicular lesions of discal origin, subjected to diagnostic radiculography without the signs of interruption in the passage of CSF. Changes of selected biochemical parameters were determined in all patients in frame 72 hours since the occurence of an ischemic episode. Concentrations of soluble AM were determined in plasma and CSF by ELISA. Total number of leukocytes (TNL) in peripheral blood was determined by hematological analyzer. Results. The results showed that during the first 72 hrs of IBD significant increases occured in TNL and that the increase was progressive compared to the severeness of the disease. Significant increase of soluble AM concentration was shown in plasma of IBD patients. The increase was highest in BI somewhat lower in RIA and the lowest in TIA patients compared to the control. In CSF concentrations of sICAM-1, sVCAM-1 and sE-selectin demonstrated similar increasing trend as in plasma. Conclusion. TNL, as well as the soluble AM concentrations in plasma and CSF, were increased during the acute IBD phase and progressive in relation to the severeness of the disease, so that they might have been the indicators of CNS inflammatory reaction intensity. Furthermore, the results indicated their role in IBD pathogenesis and offered the possibility of researching the application of antagonists and/or activity modulators of some of them in IBD therapy.
Aktuelni problemi u primeni misicnih relaksanata u klinickoj praksi
Authors: Konstantinovic Slavko , Balkanov Trajan
Published: December 2010

 U savremenoj anestezioloskoj praksi koriste se dve vrste misicnih relaksanata. Prema mehanizmu dejstva dele se na depolarizujuce i nedepolarizujuce, a prema duzini dejstva one sa kratkotrajnim (npr. sukcinilholin i mivakurijum), srednje dugim (atrakurijum, rokuronijum) i dugotrajnim dejstvom (npr. pankuronijum). Svi zauzimaju znacajno mesto, jer se kratkotrajni primenjuju za indukciju u anesteziju i kratke hirurske intervencije, a dugotrajni za odrzavanje misicne relaksacije u toku dugotrajnih hirurskih intervencija. Ispoljavaju neka nezeljena dejstva koja terapijski efekti daleko nadmasuju, sto omogucava efikasnu i bezbednu primenu.
Papular-purpuric "gloves and socks" syndrome caused by parvovirus B19
Authors: Pavlovic Milos
Published: December 2010

This paper presents a 15-year-old boy with an acute febrile illness accompanied by purpuric and papular lesions located mostly on the dorsal areas of his hands and feet with the additional changes on his knees and elbows. Serologic studies confirmed the acute infection by parvovirus B19. Apart from mild leukocytosis there were no other abnormalities in hematologic and laboratory findings. The diagnosis of papular-purpuric "gloves and socks" syndrome (PPGSS) was made. Cutaneous changes completely resolved two weeks later. Herein the patient's condition was described together with a brief overview of the PPGSS literature concerning this relatively rare viral exanthema.
Early results of the use of oblong S-ROM cementless acetabular component
Authors: Popovic Zoran , Pokimica Ljubomir , Starcevic Srdjan , Rajovic Jovo
Published: December 2010

Massive deficiency of acetabular bone stock is a challenging problem in the increasing number of patients who need a revision of the failed hip arthroplasty. Oblong acetabular cup has been presented as an alternative reconstruction technique for hips with extensive acetabular bone loss. The aim of this study was to present our results with the use of a bilobed acetabular component inserted during revisional surgery, to define indications, and to introduce this method into our orthopaedic practice. Seven patients underwent revisional hip arthroplasty with a cementless oblong acetabular component between September 2000 and June 2002. Six patients underwent revisional hip arthroplasty, and in one primary hip arthroplasty by oblong acetabular component was performed because of bone defect of acetabulum after gunshot fracture. The average follow up was thirteen months. Radiographic analysis in all patients demonstrated stable bone incorporated acetabular component with the restored hip. All the patients walked with full weight bearing and were without pain. On the basis of our experience we find this method statisfactory in certain types of bone defefects of acetabulum, and that it provides stable reconstruction of acetabulum with the correction of hip joint.
Obelezavanje puta limfnog sirenja melanoma i biopsija strazarskih limfnih zlezda
Authors: Panajotovic Ljubomir
Published: December 2010

 Biopsija limfnih zlezda strazara je postupak koji, uz relativno nizak morbiditet, daje precizne podatke o stanju regionalnog limfonodalnog basena bolesnika sa melanomom koze. Stanje regionalnih limfnih zlezda je kljucni prognosticki parametar, veoma bitan za planiranje daljeg lecenja. Za uspesnu identifikaciju i histopatolosku obradu SLN neophodna je saradnja hirurga, nuklearnog radiologa i histopatologa. Dijagnostikovanjem okultnih metastaza u regionalnim limfnim zlezdama identifikuju se bolesnici kojima treba uciniti kompletnu limfonododisekciju, kao i oni koji mogu imati koristi od primene adjuvantne antitumorske terapije. Uvodjenjem ovog postupka dilema izvodjenja ili ne ELND vise ne postoji. Tehnicki i kadrovski zahtevi medjutim, jos uvek je ne svrstavaju u rutinske standardne postupke u lecenju melanoma. Pronalazenje mikrometastaza u regionalnim limfnim zlezdama menja stadijum bolesti u kome je bolesnik do tada bio (migracija stadijuma, Will Rogers fenomen). Novim klasifikacionim sistemom definise se klinicki i patoloski stadijum bolesti (14, 114). Ukoliko su regionalni limfonodusi ispitivani klinickim i/ili radioloskim postupcima, moze se govoriti o klinickom stadijumu bolesti. Za odredjivanje patoloskog stadijuma neophodna je histoloska evaluacija limfnih zlezda dobijenih bilo selektivnom bilo elektivnom limfadenektomijom. SLNB se smatra jednim od najvecih napredaka u terapiji melanoma u zadnjoj deceniji XX veka (4, 111). Ocekuje se da ce postati standard u lecenju bolesnika sa klinicki negativnim limfnim zlezdama (99, 111, 112), posebno sa usvajanjem novog sistema za odredjivanje stadijuma koze (14, 114, 115).
Fulminant hepatitis B
Authors: Djokic Milomir , Begovic Vesna , Rajic-Dimitrijevic Radmila , Aleksic Rada , Popovic Svetlana , Hristovic Dejan
Published: December 2010

Fulminant hepatitis, or fulminant hepatic failure, is defined as a clinical syndrome of severe liver function impairment, which causes hepatic coma and the decrease in synthesizing capacity of liver, and develops within eight weeks of the onset of hepatitis. Several independent factors influence the survival of patients: age, the cause of liver disease, the degree and the duration of encephalopathy in relation to the onset of the disease, and the prevention of complications. Over the years many intensive treatments have been practiced. Liver transplantation is expensive, and patients who survive transplantation require life-long immunosupression, clinical care and complications management. Without transplantation fulminant hepatitis and hepatic failure might be completely recovered spontaneously, and the patient could expect a normal life. Two cases of fulminant B hepatitis with intensive care treatment, and their survival despite unfavorable prognosis are presented in this paper. The menagement of patients with fulminant hepatitis required intensive monitoring and therapeutic measures, including corticosteroids. The prognosis for survival without transplantation in fulminant hepatitis is limited by the measures of medical treatment and new specific therapeutic modalities which must be developed through basic research.
Plastic surgery in the treatment of primary melanoma of the skin
Authors: Panajotovic Ljubomir , Kozarski Jefta , Krtinic Snezana , Stanojevic Bojan
Published: December 2010

Surgery is still the most effective treatment modality of skin melanoma. The margins of excision are determined by the thickness of primary tumor. From January 1999 to December 2001, 99 patients (57 male and 42 female, of the average age 55), were surgically treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy. The most usual localization of the primary tumor was the back (23.23%), followed by the forearm, and the lower leg. Regarding the clinical type of the melanoma, nodular melanoma dominated (62.62%). Microscopic staging of the melanoma (classification according to Clark and Breslow), showed that the majority of patients already suffered from the advanced primary disease, which called for radical excision and the choice of reconstructive methods in the closure of post-excision defects. The reconstructive plastic surgical methods enabled the closure of post-excision tissue defects, regardless of their size, structure, and localization. During the closure of post-excision defects, direct wound closure or split skin draft was performed in 76.76% of patients. Flaps were applied in 19.19% of patients with the primary melanoma of the head, face foot, and hand. The sufficiency of the available reconstructive procedures makes plastic surgery irreplaceable in the surgical treatment of the primary melanoma of the skin.
Impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias in the late hospital phase of the acute myocardial infarction: Relation with the long-lasting left ventricle remodeli
Authors: Otasevic Petar , Neskovic Aleksandar , Popovic Zoran , Vlahovic Alja , Vukovic Milan , Borzanovic Branislava , Popovic Aleksandar
Published: December 2010

Background. The impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias is not yet clarified. The aim of this study was to investigate the impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias, as well as long term association between complex ventricular arrhythmias and left ventricular remodelling, and their impact on five-year lethality. Methods. Ninety seven consecutive patients with first acute myocardial infarction (streptokinase was administered in 58 patients) underwent 24-hours Holter monitoring at discharge. Ventricular arrhythmias were classified according to Lown classification, and patients were grouped into the group with simple ventricular arrhythmias (Lown class 0 to 2), and the group with complex ventricular arrhythmias (Lown class 3 to 5). Echocardiography was performed at discharge, and six and twelve months after the infarction. Left ventricular volume indexes and ejection fraction was determined using Simpson's biplane formula. Results. In patients with complex ventricular arrhythmias left ventricular volume indexes were higher and ejection fraction was lower throughout the study, whereas wall motion score index was higher one year after the infarction. On the other hand, these variables were similar throughout the follow-up within the groups of patients with and without complex ventricular arrhythmias who received thrombolytic therapy. The incidence of complex ventricular arrhythmias was similar in thrombolysed and non-thrombolysed patients (11/58 vs. 5/39). There was no difference in five year lethality between patients with and without complex ventricular arrhythmias (4/16 vs. 13/81 patients). Conclusion. Our data indicated that left ventricular remodelling in patients with complex ventricular arrhythmias was not progressive after hospital discharge. The presence of complex ventricular arrhythmias was not associated with the increased five-year lethality, despite of more pronounced left ventricular remodelling. It occured that thrombolysis per se had no influence on the incidence of complex ventricular arrhythmias in the late hospital phase after the first acute myocardial infarction.
Metastatic melanoma of the skin: Surgical treatment
Authors: Panajotovic Ljubomir
Published: December 2010

 Bolesnici sa metastatskom diseminacijom bolesti imaju srednje prezivljavanje od oko 6 meseci. Bolesnici sa malim brojem metastatskih lezija i produzenim intervalom bez bolesti mogu imati korist od hirurske ekscizije. Ukoliko je izvodljiva, hirurgija udaljenih metastaza ima znacaja u palijativnom smislu radi redukcije simptomatologije koju njihova pojava daje kao i radi poboljsanja kvaliteta i produzavanja zivota. Samo se operacijom metastaza, ukoliko je to izvodljivo, moze znacajno produziti zivot bolesnika sa metastatskim melanomom. Oko 25% bolesnika u IV klinickom stadijumu mogu biti kandidati za operaciju, bilo samu ili u sklopu kombinovanog lecenja koje ukljucuje jos i sistemsku imuno, biohemijsku i radijacijsku terapiju. Napredak u imunoterapiji, biohemioterapiji i radioterapiji nije doneo znacajnije poboljsanje u lecenju bolesnika sa metastatskim melanomom. Hirursko je, za sada, jedino standardno lecenje ovih bolesnika, dok se svi ostali modaliteti terapije primenjuju kroz kontrolisane klinicke studije.
Microvascular free flaps in the management of war wounds with tissue defects
Authors: Kozarski Jefta , Panajotovic Ljubomir , Novakovic Marijan
Published: December 2010

Background. War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. Methods. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defects. The main criteria for the application of free flaps were: general condition of the wounded, size, localization, and structure of tissue defects. For the extensive defects of the tissue, as well as for severely contaminated wounds latissimus dorsi free flaps were used. For tissue defects of distal parts of the lower extremities, scapular free flaps were preferred. While using free tissue transfer for recompensation of bone defects, free vascularized fibular grafts were applied, and in skin and bone defects complex free osteoseptocutaneous fibular, free osteoseptocutaneous radial forearm, and free skin-bone scapular flaps were used. Results. After free flap transfer 16 (14,4%) revisions were performed, and after 8 unsuccessful revisions another free flaps were utilized in 3 (37,5%) patients, and cross leg flaps in 5 (62,5%) patients. Conclusion. The treatment of war wounds with large tissue defects by the application of free microvascular flaps provided shorter wound-closing period, earlier beginning of physical therapy, as well as the treatment of great number of patients with the extensive tissue defects in the conditions of massive influx of the wounded.
The effects of two-week program of individually measured physical activity on insulin resistance in obese non-insulin-dependent diabetes mellitus
Authors: Cizmic Milica , Zivotic-Vanovic Mirjana , Zivanic Slobodan , Dragojevic Radosav
Published: December 2010

It is well known that under the influence of regular, individually measured aerobic physical activity, it is possible to raise the biological efficiency of insulin by several mechanisms: by increasing the number of insulin receptors, their sensitivity and efficiency, as well as by increasing glucose transporters GLUT-4 on the level of cell membrane. The aim of this research was to examine whether decreased insulin resistance could be achieved under the influence of the program of individually measured aerobic physical activity in the 2-week period, in the obese type 2 diabetes patients with the increased aerobic capacity (VO2)max. In 10 type 2 diabetes patients 47.6 ? 4.6 years of age (group E), in the 14-days period, program of aerobic training was applied (10 sessions - 35 min session of walking on treadmill, intensity 60.8 ? 5.7% (VO2)max, frequency 5 times a week ), as well as 1 600 kcal diet. At the same time, other 10 type 2 diabetes patients 45.9 ? 5.5 years of age (group C) were on 1 600 kcal diet. Before and after this period the following was measured in both groups: insulin sensitivity (M/I) by the method of hyperinsulin euglycemic clamp, and (VO2)max by Astrand test on ergocycle. In contrast to the group C, in the second testing of E group subjects a significant increase was obtained in M/I (1.23 ? 0.78 vs. 2.42 ? 0.95 mg/kg/min/mU p<0.001, 96.75%) as well as the increase of (VO2)max (26.34 ? 4.26 vs. 29.16 ? 5.01 ml/kg/min p<0.05, 10.7%). The results had shown that 2-week program of aerobic training had had significant influence on the increased aerobic capacity and insulin sensitivity in the tested patients.
Technetium-99m scintimammography in the diagnosis of malignant breast tumors
Authors: Jaukovic Ljiljana
Published: December 2010

Background. Technetium-99m (99mTc) tetrofosmin scintigraphy is a new imaging method for the diagnosis of various malignancies, such as lung, thyroid, and most frequently breast neoplasms. The aim of this study was to evaluate the diagnostic reliability of 99mTc-Tetrofosmin breast scintigraphy in the detection of malignant breast disease. Methods. 99mTc -Tetrofosmin scintimammography (SMM) was performed in 28 patients with 30 breast lesions suspicious for malignancy. Standard mammography (MM) was also done. After surgery, the results of SMM and MM were compared to definitive histopathological findings as the "gold standard". After intravenous injection of radiotracer, SMM was performed in prone and supine views of the thorax, using large field-of-view Gamma camera. Results. The results of SMM were interpreted visually and semiquantitatively, and evaluated as positive or negative. Sensitivity, specificity and accuracy, positive (PPV) and negative predictive value (NPV) were obtained in relation to histopathology. After comparing the results of SMM and MM, SMM was proved more sensitive (95% for SMM vs. 80% for MM), while the specificity of both methods was similar. Conclusion. The results of this study indicate that the contribution of SMM as a nuclear medicine procedure has its place in the diagnostic protocol for patients suspected of malignant breast cancer.
Significance of the determination of proinflammatory cytokines in the serum of polytraumatized patients with sepsis
Authors: Surbatovic Maja , Jovanovic Krsta , Vojvodic Danilo , Filipovic Nikola , Babic Dragan
Published: December 2010

Severe sepsis and trauma complicated with multiple organ dysfunction syndrome (MODS) are among the leading causes of death in intensive therapy units with mortality rate exceeding 50%. The outcome is not determined only by infection or trauma, but also by the intensity of immuno-inflammatory response, which is essential for host defence, but if uncontrolled leads to MODS. Pro-inflammatory cytokines (tumor necrosis factor-a -TNF-a, IL-1 IL-8, IL-12, IFN-g, etc) represent a part of this immuno-inflammatory response to an insult. The results of the clinical investigation of correlation between pro-inflammatory cytokines (IL-8, IL-12, TNF-a, IFN-g) the outcome (survivors, non-survivors), and the severity (systemic inflammatory response syndrome - SIRS - less severe, and MODS - more severe) in polytraumatised patients with sepsis are presented in this paper. Mean values of IL-8 were 1.3-fold higher in non-survivors (p<0.05), and 60-fold higher in MODS group (p<0.01). Mean values of IL-12 were 1.6-fold higher in survivors (p<0.01), while the values between SIRS and MODS group did not differ significantly; mean values of TNF-a were 3-fold higher in survivors (p<0.05), and 46-fold higher in MODS group (p<0.01). Mean values of IFN-g did not differ significantly between the two groups regarding the outcome and severity. The obtained results indicated that IL-8 was a reliable predictor of lethal outcome and MODS (p<0.01), IL-12 a reliable predictor of survival (p<0.05), and TNF-a a reliable predictor of survival (p<0.05) and MODS (p<0.01).
Carbamazepine for acute psychosis with eeg abnormalities
Authors: Ivkovic Maja , Damjanovic Aleksandar , Marinkovic Dragan , Paunovic Vladimir
Published: December 2010

Aim. To investigate the efficacy of carbamazepine as adjuvant drug therapy in acute paranoid psychosis with associated EEG abnormalities, compared to sole antipsychotic treatment. Methods. Eleven medication-naive patients diagnosed with acute paranoid psychosis with associated EEG abnormalities were divided into two treatment groups: sole fluphenazine group, with flexible dosing of 5-10 mg/day (n=6), and carbamazepine group (n=5) with the addition of carbamazepine (600 mg/day) to fluphenazine treatment. Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and EEG were assessed on the baseline and after 6 weeks of treatment. Paired and two-tailed t-tests were used for statistical significance. Results. All the patients showed significant improvement of mental state after 6 weeks of treatment with no significant differences in CGI, BPRS, and total SANS scores in relation to the therapy with carbamazepine. Nevertheless, after 6 weeks of the treatment, EEG findings were significantly better in carbamazepine group, in relation to the findings from the onset of the treatment, as well as in comparison to sole fluphenazine group. Conclusion. Although carbamazepine stabilized abnormal brain electrical activities it seemed that the associated EEG abnormalities were not significant for acute psychosis observed. These preliminary results suggested that there was no convincing evidence that carbamazepine was efficient as the augmentation of antipsychotic treatment for patients with both acute paranoid psychosis and EEG abnormalities.
Comparison of two different protocols for the induction of maturation of human dendritic cells in vitro
Authors: Colic Miodrag , Mojsilovic Slavko , Pavlovic Bojan , Vucicevic Dragana , Majstorovic Ivana , Bufan Biljana , Stojic-Vukanic Zorica , Vasilijic Sasa , Vucevic Dragana , Gasic Sonja , Balint Bela
Published: December 2010

Background. Dendritic cells (DC) have been used for immunotherapy of malignant tumors, different kinds of infections, and other clinical conditions. For that purpose, optimal conditions for the generation of functionally mature DC in vitro are required. Two different protocols for the induction of maturation of monocyte-derived DC (MDDC) were compared in this study. Methods. MDDC were generated in vitro by cultivating adherent monocytes of healthy volunteers with granulocyte macrophage-colony stimulating factor (GM-CSF) and interleukin 4 (IL-4) during 6-days period. The immature DC thus prepared were induced to mature using two protocols. DC were stimulated for 2 days with lipopolysaccharide (LPS), or with a cocktail of proinflammatory mediators (PM) containing IL-1b, IL-6, tumor necrosis factor ? (TNF?), and prostaglandin E2 (PGE2), respectively. Phenotypic characteristics of MDDC and their endocytic activity were studied by flow cytometry. Allostimulatory activity of these cells was tested in the mixed leukocyte reaction (MLR), whereas the production of cytokines was determined by ELISA kits. Results. MDDC matured with PM (PM-DC) were predominantly non-adherent cells, while about 30% of LPS-matured DC were adherent cells. In comparison with LPS-DC, PM-DC expressed higher levels of CD86 and CD83, had lower endocytic activity, produced higher levels of IL-10 and lower levels of IL-12, and more strongly stimulated proliferation of allogeneic lymphocytes. Conclusion The protocol based on the combination of proinflammatory cytokines and PGE2 is better for the induction of maturation of human MDDC in vitro than the protocol using LPS alone.
R-MC46 monoclonal antibody stimulates adhesion and phagocytosis by rat macrophages
Authors: Gasic Sonja , Vucevic Dragana , Popovic Petar , Vasilijic Sasa , Colic Miodrag
Published: December 2010

Background. In our previous experiments it was shown that R-MC46 monoclonal antibody (mAb), produced at our Institute, stimulated homotypic aggregation of rat granulocytes and production of proinflammatory cytokines. The aim of this study was to examine antigen expression and function, recognized by R-MC46 mAb on macrophages. Methods. The expression of R-MC46 antigen on thymic and peritoneal macrophages was investigated using immunocytochemistry and flow cytometry methods. Its biochemical characterization was performed by Western blot. The ability of R-MC46 mAb to modulate adhesion and phagocytosis by macrophages was studied by using co-culture experiments with autologous thymocytes. Results. R-MC46 mAb stained thymic macrophages more strongly than peritoneal macrophages. After in vivo treatment of peritoneal macrophages with Pristane, a significant up-regulation of the R-MC46 antigen expression was observed. Western blot analysis showed that the mAb recognized a low molecular weight antigen of about 5.5 kDa. R-MC46 mAb significantly enhanced binding and phagocytosis of thymocytes by both thymic and peritoneal macrophages. These processes were completely blocked by WT.3 (anti-CD18) mAb. The stimulation of binding thymocyte to macrophages was higher with the use of thymic macrophages,while the phagocytosis of these cells was higher in the presence of peritoneal macrophages. Conclusion. R-MC46 mAb recognized a new molecule expressed by rat macrophages. The antigen is most probably involved in ?2 integrin-mediated adhesion and phagocytosis, as well as proinflammatory functions of macrophages.
Alcohol consumption, arterial blood pressure and general mortality rate: Twenty-years follow-up study
Authors: Jakovljevic Branko , Stojanov Vesna , Paunovic Katarina , Belojevic Goran , Radosavljevic Vladan
Published: December 2010

Background. Alcohol consumption has both adverse and beneficial effects on health and survival. The aim of this prospective study was to examine the association between alcohol consumption and arterial hypertension as well as general mortality rate. Methods. The study included 286 participants, middle-aged men and women examined in 1974, and again in 1994 during twenty years of follow-up (mean age at the beginning of the study 43.61?7.09 years). Alcohol consumption was assessed by the specific questionnaire. Consumption levels were grouped into three categories: rare drinkers (consuming less than 6 drinks a week), moderate drinkers, who consume 1-2 alcohol drinks a day and heavy drinkers (consumers of 3 or more drinks a day). Results. In both phases of the follow-up the lowest values of systolic and diastolic pressure were recorded in the group with moderate alcohol consumption, and the highest values in the group with excessive consumption. The observed differences were statistically significant. The general mortality rates were the highest among participants reporting excessive alcohol consumption (relative risk 3.2; 95% confidence interval 1.84-5.62), and among the abstainers (relative risk 1.8; 95% confidence interval 0.99-3.36), compared to the moderate consumption group. Conclusion. Analysis of the obtained results suggested the protective effect of moderate alcohol consumption on cardiovascular system.
Brown tumor of the maxilla in patient with secondary hyperparathyroidism
Authors: Jovic Nebojsa , Kozomara Ruzica , Stosic Srboljub , Brocic Miroslav , Hrvacevic Rajko , Ilic Srbislav
Published: December 2010

Brown tumor or parathyroid osteopathy is a kind of bony lesion caused by hyperparathyroidism. It appears as an expansive osteolytic lesion mostly in mandible, ribs, pelvis and femur, but rarely in the upper jaw. Bone resorption is the result of osteoclastic activity due to an increased activity of parathyroid hormone. A 25-years-old male patient was operated on due to clinicaly and radiographicaly obvious maxillary tumor and increased values of parathyroid hormon (PTH - 1 050 ng/l). The level of calcium in blood was normal (Ca 2.34 mEq/L). The patient was dialyzed for years because of the chronic renal failure. Histopathologic analysis confirmed brown tumor, that appeared as bony lesion of secondary hyperparathyroidism due to the chronic renal failure. The operation of the upper jaw had been performed before parathyroidectomy, due to an excessive growth of tumor followed by heavy epistaxes. The subsequent parathyroidectomy was followed by the regression of remaining bony lesions.
Infective endocarditis of a rare etiology: Serratia marcescens
Authors: Djokic Milomir , Milanovic Milomir , Begovic Vesna , Ristic-Andjelkov Andjelka , Tomanovic Branka
Published: December 2010

Infective endocarditis (IE) is a unique diagnostic and therapeutic challenge. It is a severe disease, fatal before penicillin discovery. Atypical presentations frequently led to delayed diagnosis and poor outcome. There was little information about the natural history of the vegetations during medical treatment or the relation of morphologic changes in vegetation to late complications. Application of a new diagnostic criteria and echocardiography, increased the number of definite diagnosis. Trans-thoracic and trans-esophageal echocardiography had an established role in the management of patients with IE. The evolution of vegetation size, its mobility, and consistency, the extent of the disease, and the severity of valvular regurgutation were related to late complications. With therapeutic options including modern antibiotic treatment and early surgical intervention IE turned out to be a curable disease. Reduction in mortality also depended on prevention. Antibiotic prophylaxis of IE was important, but low mortality was also the result of early treatment, especially in the event of early recognition of symptoms and signs of the disease.
Cognitive-behavioral therapy of conversion aphonia
Authors: Kuljic Blagoje
Published: December 2010

Although a common disease, conversion disorder still calls attention in the clinical practice. A case of conversion disorder, diagnosed as a psychogenic aphonia that persisted for a week, was reported in this paper. A 21-year-old woman developed symptoms after breaking off a long-lasting relationship with her boy-friend. History revealed that she was introvert with high neuroticism and communication problems. Cognitive-behavioral therapy was used. After the positive reinforcement in the therapy of her aphonia, assertion training for the development of communication skills was performed. In the end, cognitive restructuring was used to prevent relapse in regard to her actual life situation of being a refugee preparing for immigration to Australia.
Detection of Helicobacter pylori in gastric biopsy and resection specimens
Authors: Babic Tatjana , Basic Hakija , Selimovic-Miljkovic Biljana , Kocic Branislava , Tasic Gordana
Published: December 2010

Aim. To compare the sensitivity of detecting H. pylori in gastric biopsy and resection specimens using modified Giemsa stain and immunohistochemistry, using a commercially available anti-H. pylori antibody (Dako, Denmark). Methods. Gastric antral biopsy specimens showing chronic gastritis (28 cases) together with tissue blocks from gastrectomy specimens for duodenal ulcer (2 cases) were stained with modified Giemsa and immunoenzymatic alkaline phosphatase - anti-alkaline phosphatase (APAAP) method, and were carefully examined for the presence of H. pylori. Results. Using a modified Giemsa stain, the spiral shaped bacteria of H. pylori stained blue, were attached to the brush border of the gastric foveolar epithelial cells. However, the specificity of modified Giemsa stain depended on the morphological appearance of H. pylori. The specificity of immunostaining permitted detection of low numbers or even single organisms. In all cases bacteria were more prominent and easier to detect in immunostained preparations. H. pylori was identified in 22 (73.3%) of 30 sections stained with modified Giemsa stain, but it could be identified with greater frequency in sections stained with APAAP, in 27 (90%) of 30 sections. Conclusion. Immunohistochemical identification of H. pylori was better than Giemsa stain for detecting that organism.
The level of the sciatic nerve division and its relations to the piriform muscle
Authors: Ugrenovic Sladjana , Jovanovic Ivan , Krstic Vladislav , Stojanovic Vesna , Vasovic Ljiljana , Antic Svetlana , Pavlovic Snezana
Published: December 2010

Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome). The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities) which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases). In the remainder of the cases the sciatic nerve division was high (27.5% of the cases) in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases), while in 8 lower extremities (4% of the cases) the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases) and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases) common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases), must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.
Factor V Leiden, FII G20210A, MTHFR C677T mutations as risk factors for venous thrombosis during pregnancy and puerperium
Authors: Djordjevic Valentina , Rakicevic Ljiljana , Spasic Milos , Miljic Predrag , Mikovic Danijela , Kovac Mirjana , Radojkovic Dragica
Published: December 2010

Background. Venous thrombosis is the most common cause of obstetric morbidity and mortality during pregnancy and puerperium. The incidence of pregnancy associated venous thrombosis varies from 1 in 1000 to 1 in 2000 deliveries. Factor V G1691A (FV Leiden), FII G20210A and MTHFR C677T mutations are the most common genetic risk factors for thromboembolism. The aim of this study was to establish the presence of these risk factors in a group of women with an episode of deep venous thrombosis during pregnancy or puerperium. Methods. The study was carried in a group of 45 women with the first episode of deep venous thrombosis during pregnancy or puerperium. The patients with antiphospholipid antibodies, antithrombin III, protein C or protein S deficiency, and autoimmune and malignant diseases were excluded from the study. FV Leiden, FII G20210A, and MTHFR C677T mutations were detected by polymerase chain reaction, followed by digestion with specific restriction enzymes. Results. Twenty heterozygous carriers of the FV Leiden mutation and one homozygous carrier were detected, which represents the frequencies of 44.4% and 2.2%, respectively. For the FII G20210A mutation, six heterozygous carriers were identified, giving the frequency of 13.3%. The MTHFR C677T mutation was observed in 31 patients (22 heterozygous and 9 homozygous carriers) which represents the frequencies of 48.9% and 20%, respectively. Conclusion. Our study suggested that the obligatory testing for FV Leiden and FII G20210A mutations was strongly recommended in women with history of venous thrombosis during pregnancy and puerperium. We found a slight effect of MTHFR 677T allele, but it should be considered in association with other risk factors.
Use of high-dosage chemotherapy with autologous hematopoietic stem cell transplantation as a first-line therapy for the patients with poor-prognosis testicular tumors
Authors: Marjanovic Slobodan , Cerovic Snezana , Brajuskovic Goran
Published: December 2010

Background. High-dose chemotherapy followed by hematopoietic stem cell support can be used as a first-line treatment in patients with germ-cell tumor (GCT) with poor prognosis. Long-term survival rate is attained in 50% of these patients. The aim of this paper was to present the experience at the Department of Hematology, Military Medical Academy, with high-dose cytostatic therapy as first-line chemotherapy in GCT patients with poor prognosis. Methods. Between 1997 and 2003, five patients with high-risk germ-cell tumors were treated with high-dosage chemotherapy followed by an autologous stem cell transplantation. All the patients were with non-seminomatous germ-cell tumors with mixed histology, and one was with extragonadal retroperitoneal germ-cell tumor. Results. The follow-up period ranged from 8 to 33 months. Three patients achieved complete remision, two patients only partial remision, and one was not followed-up. One patient was with residual tumor resection, using retroperitoneal lymphadenectomy, after autologous stem cell transplantation. All the patients were treated according to standard protocols. Conclusion. Early high-dose chemotherapy associated with hematopoietic stem cell support as a first-line treatment in the patients with germ-cell tumor with a poor prognosis, represented an efficient treatment modality.
Therapy of acute hepatitis C infection
Authors: Djokic Milomir , Begovic Vesna
Published: December 2010

Background. Hepatitis C viral infection is a major cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. The progression of acute to chronic infection occurs in 50-90% of cases. There is no standard therapy for acute HCV infection. Comparative studies are required to verify the optimal doses, dosage schedules and the treatment duration, and to establish the optimal treatment for acute hepatitis C. Recent reports have demonstrated that early application of interferon alpha was a treatment of choice for acute HCV infection. The addition of ribavirinin in the treatment of acute HCV infection, and HCV genotype, did not improve the end-of treatment responses. It is important to consider the treatment of acute HCV infection before it progresses to chronic state. Case Report. Beneficial effect of interferon therapy in a patient with acute hepatitis C is presented. Early treatment with 3 MIU interferon alpha, three times a week, within six-months, resulted in the normal serum aminotransferases, and good virological response in our patient. Conclusion. Interferon therapy significantly increased the probability of obtaining normal serum aminotransferases and undetectable HCV RNA, following acute HCV infection.
Bcl-2 and Bax interaction in B-lymphocytes of peripheral blood in patients with chronic lymphocytic leukemia
Authors: Brajuskovic Goran , Orolicki-Vukosavic Slobodanka , Cerovic Snezana , Usaj-Knezevic Slavica , Marjanovic Slobodan , Romac Stanka
Published: December 2010

Background. Chronic lymphocytic leukemia (CLL) is a neoplastic disease characterized by the accumulation of morphologically mature monoclonal CD5+ B cells in the early phase (G0/G1) of the cell cycle. The accumulation of neoplastically transformed B-lymphocytes (CLL cells) is primarily the consequence of apoptosis blocking in these cells. Bcl-2 proteins are well-known modulators of this process. Some of these proteins are anti-apoptotic while the others are pro-apoptotic. All contain at least one of the four conserved regions called the Bcl-2 homologous domains (BH1-BH4). Evidence indicates that Bcl-2 and Bax form homo- and heterodimers. The anti-apoptotic effect of Bcl-2 protein is based on its ability to bind Bax protein in the heterodimer form, and thus to block the forming of Bax/Bax proapoptotic homodimers. The ratio of Bcl-2/Bax represents the cell autonomous rheostat which determinates the type of the cell reaction to an apoptotic stimulus. Methods. The aim of this study was to determine the level of interaction between these two proteins in CLL cells using the co-immunoprecipition method. The study included the analysis of 20 peripheral blood specimens from 20 patients with CLL, and 20 peripheral blood specimens from healthy persons, who were in the control group. Specimens were precipitated with the monoclonal antibody for Bcl-2 protein, and immunoblotted with the palyclonal antibody for Bax protein (IP: Bcl-2/WB:Bax). At the same time, specimens were precipitated with the polyclonal antibody for Bax protein, and immunoblotted with the monoclonal antibody for Bcl-2 protein (IP: Bax/WB:Bcl-2). The intensity of Bcl-2 and Bax protein's binding compared to the control samples of the peripheral blood from healthy persons, was increased in CLL cells. Results. IP: Bax/WB: Bcl-2 showed a high level of ?free? Bcl-2 protein which was not bound in the heterodimer form to Bax protein. Simultaneously IP: Bcl- 2/WB: Bax showed that a higher quantity of Bax protein was bound in the heterodimer form to Bcl-2 protein as opposed to the quantity of pro-apoptotic Bax protein potentially bound in the homodimer form. Conclusion. Further studies involving larger groups of patients are necessary to explore the potential significance of the Bcl-2/Bax protein ratio as a prognostic parameter in the CLL treatment.
Cigarette smoking in military pilots and intima-media thickness of the carotid arteries
Authors: Jovelic Stojan , Hajdukovic Zoran , Jovelic Aleksandra , Radjen Slavica
Published: December 2010

Background. It is well known that smoking is associated with an increase in arterial wall thickness. However, most studies of this problem have been undertaken in age and sex heterogeneous groups, as well as in patients with already present other conventional risk factors. The aim of this study was to assess the effect of cigarette smoking on arterial wall thickness of the common carotid artery in asymptomatic pilots. Methods. The imaging of intima?media thickness of the posterior wall of the distal 1 cm of both common carotid arteries was performed using a B mode ultrasound device, in 39 pilots (37.05 ? 6.66 years), for whom smoking was the single cardiovascular risk factor. Comparisons were made with 49 non-smokers (35.12 ? 7.39 years). Results. The posterior walls of both common carotid arteries were thicker in smokers (left, p < 0.05; right, p > 0,05). Intima-media thickness was significantly lower on the right side than on the left side in both smokers and nonsmokers (p < 0.01). Conclusion. Cigarette smoking as the single cardiovascular risk factor was associated with the wall thickness of the carotid arteries in our study. This finding indicated that early atherosclerosis was already present in pilots - smokers entering middle age.
Biochemical, pharmacological, and toxic effects of n-metil 3,4-methylenedioxyamphetamine - "ecstasy"
Authors: Malicevic Zivorad , Ninkovic Milica , Vasiljevic Ivana , Selakovic Vesna , Jovanovic Marina
Published: December 2010

 Navedeni podaci ukazuju da ?ekstazi? nije, kako se to posebno medju omladinom smatra, laka, bezopasna i zabavna droga. Obilje nezeljenih psihickih, neuroloskih, hepatickih, bubreznih, kardiovaskularnih i drugih toksicnih efekata pokazuje samo da oni nisu dobro procenjeni, a najopasnije je sto se desavaju pri upotrebi uobicajenih prosecnih doza ove droge. Uzivaoci u vecini slucajeva prelaze preko nezeljenih efekata MDMA i veoma lako se vracaju omiljenoj piluli, ali vremenom nezeljeni efekti postaju naglaseniji. U pokusaju da savladaju depresivnost, anksioznost i bezrazlozni zamor uzivaoci "ekstazija" obicno posezu za alkoholom ili drugim tezim narkoticima, cime posle privremenog "poboljsanja" stanje postaje jos teze, a put u tesku narkomaniju postaje sasvim izvestan. Usled nepoznavanja stvarne toksicnosti "ekstazija" zdravstveni radnici svih profila moraju uloziti napor i javnost upoznati sa stvarnim cinjenicama, posebno mlade koji iz neznanja i pomodarstva koriste "ekstazi".
Gangrene of the right colon after blast injury caused by abdominal gunshot wounds
Authors: Ignjatovic Dragan , Misovic Sidor , Jevtic Miodrag
Published: December 2010

Aim. To present a patient with an indirect secondary nonperforating blast injury of the right colon following abdominal gunshot injury, which led to necrosis and the right colon gangrene, and was surgically managed. Case report. A 26-year-old male was shot in the abdomen by four projectiles causing the secondary indirect blast injury of the right colon that turned into gangrene after 24 hours. Two days after admission, laparotomy was performed, but the primary anastomosis was not done because of the stomach and pancreatic injury, and the resection of the colon with terminal ileostomy was done instead. Three months later, the reconstruction of the colon was performed using ileocolotransverso-terminolatetral anastomosis. Conclusion. Secondary blast injuries should be anticipated in gunshot injuries, and could be expected to any organs, particularly the air filled ones.