bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and characteristics of endometrial polyps in patients with abnormal uterine bleeding
Authors: Djordjevic Biljana , Milosevic Jelena , Stanojevic Zorica
Published: December 2010

Background/Aim. The prevalence of endometrial polyps (EPs) in the general female population is about 24%. Abnormal uterine bleeding is frequently the presenting symptom of EPs. The aim of this study was to determine the prevalence and characteristics of EPs in patients with abnormal uterine bleeding. Methods. The prevalence and characteristics of EPs were investigated in 961 patients with abnormal uterine bleeding who underwent dilatation and curettage between January and December 2006. Regarding histopathological features of EPs (presence of atypical hyperplasia or endometrial carcinoma), patients were divided into two groups: group A - patients who had EPs and EPs with hyperplasia without atypia (n = 204) and group B - patients who had EPs with atypical hyperplasia and EPs with carcinoma (n = 7). Results. In 211 (21.94%) patients EPs were found with abnormal uterine bleeding. Histopathologically, there were 175 (82.94%) EPs, 29 (13.74%) EPs with hyperplasia without atypia, 5 (2.37%) EPs with atypical hyperplasia, and 2 (0.95%) EPs with endometrial carcinoma. Contrary to the patients with EPs and EPs with hyperplasia without atypia (group A), patients who had EPs with atypical hyperplasia and EPs with carcinoma (group B) were older (p < 0.05), and more commonly postmenopausal (p < 0.05) and with hypertension (p < 0.05), all of statistical significance. Conclusion. The prevalence of endometrial polyps in patients with abnormal uterine bleeding according to our data was 21.95%. Atypical hyperplasia and endometrial carcinoma were rarely confined to a polyp. Older age, postmenopausal period and hypertension may increase the risk of premalignant and malignant changes in endometrial polyps.
Pediatric health-related quality of life instrument, Part I: General guidelines for selection
Authors: Stevanovic Dejan
Published: December 2010

 Ubrzan razvoj koncepta kvaliteta zivota u pedijatriji omogucio je razvoj velikog broja upitnika za njegovu procenu. Odabir pravog upitnika zahtevan je i slozen proces i svi koji ce ga koristiti moraju pri selekciji da obrate paznju na niz zahteva. Selekciju odredjuju precizno postavljen cilj, adekvatan dizajn procene (ili dizajn studije), odredjene karakteristike ispitanika i karakteristike upitnika. Ovi koraci, sa svim svojim elementima, znacajno su zavisni i medjusobno povezani. Ukoliko neki od njih bude izostavljen, neadekvatan upitnik moze biti znacajan izvor greske u proceni kvaliteta zivota, a narocito u poredjenju podataka dobijenih iz drugih izvora. Stoga, vazno je razumeti da kombinacija ovih atributa odredjuje populaciju za procenu, nacin i tip procene, rezultate i zakljucke procene, a ne samo upitnik za merenje kvaliteta zivota.
Stem cells use in the treatment of neurologic disorders: Has the future already arrived?
Authors: Obradovic Dragana , Balint Bela , Dincic Evica , Raicevic Ranko , Obradovic Slobodan , Toncev Gordana , Kostic Vladimir
Published: December 2010

 Buducnost celijske terapije u lecenju neuroloskih bolesti je pocela. Ostaju vazna pitanja na koja odgovor mogu dati samo dobro osmisljene medjunarodne studije, a ticu se vrste celija, nacina njihovog umnozavanja i aplikacije, kao i optimalnog vremenskog okvira za ovakvu vrstu lecenja.
Granular-cell tumor: A rare variant of mammary tumor
Authors: Ilic Ivan , Randjelovic Pavle , Ilic Ratko , Djordjevic Lidija , Radojkovic Danijela
Published: December 2010

Background. Granular cell tumor (GCT) is a rare variant of mammary tumor beset with diagnostic dilemmas that may be resolved by using numerous, very complex, enzymohistochemical and immunohistochemical methods. Case reports. We reported three female patients 16, 21 and 65 years old, operated on for mammary tumor at the Surgical Clinic of the School of Medicine in Nis, over the period of thirty years, 1977 to 2007. During this period 14.022 mammary tumors were diagnosed, including these three cases. These tumors had benign characteristics, without associated tumors in other localizations. A typical histological feature of GCT was a granular cytoplasm in large ovoid cells, organized like nests or like a trabecular arrangement. The tumors were analyzed by sets of histochemical, enzymohistochemical, immunohistochemical methods as well as ultrastructural examination. Protein, S-100 neuron-specific enolase and vimentin expressed a diffuse and intensive immunohistochemical activity, while expression of estrogen and progesterone receptors, as well as HER-2 oncoprotein was negative. The ultrastructural analysis confirmed that the tumor cells were enriched by lysosomes and consequential disorganization of cytoplasm. Conclusion. The reported enzymo- and immunohistochemical combined methods provide a precise diagnosis and confirm the GCT's neural origin, which has been disputed for years.
Pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
Authors: Ciric Zorica , Stankovic Ivana , Rancic Milan , Pejcic Tatjana , Radovic Milan
Published: December 2010

Background/Aim. Chronic obstructive pulmonary disease (COPD) irreversibly damages pulmonary function leading to disorder of arterial blood gases, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2), appearance of dyspnea, and decrease of physical condition. The aim of this study was to establish if medical treatment and respiratory rehabilitation in COPD used simultaneously lead to the greater improvement of PaO2, PaCO2 and physical condition and decreaseing dyspnea than medical treatment alone. Methods. A total of 60 patients divided into three groups according to the severity of obstruction (mild - I, severe - II, very severe - III) were tested. Each group had the two subgroups of patients - first one with those treated both with medical treatment and respiratory rehabilitation (A) and the second one with the patients treated only with medical treatment (B). The treatment took 21 days. The measurements of PaO2 and PaCO2) intensity of dyspnea at rest and exercise (10 - point Borg Category Scale), and physical capacity (Six-Minute Walk Test - 6MWT) were done on the first and on the last day of testing. Results. The results showed that all of the patients who were treated with the combination of medical treatment and respiratory rehabilitation had significantly higher increase in the values of PaO2 (I - p < 0.01; II - p < 0.05; III - p < 0.01), score of Borg's scale (I - p < 0.05, p < 0.001; II - p < 0.05, p < 0.001; III - p < 0.001, p < 0.001) and 6MWT (I - p < 0.001; II - p < 0.001; III - p < 0.001), and that statistically significant increase of the values of PaCO2 (p < 0.05) had only the patients with very severe COPD treated with the combination of drugs and respiratory rehabilitation. Conclusion. Based on the obtained results we conclude that using respiratory rehabilitation in combination with pharmacological treatment of COPD gives statistically higher improvement of values of PaO2 and PaCO2, and physical condition, and also leads to decrease of intensity of dyspnea than using just drug therapy.
Stem cell harvesting protocol research in autologous transplantation setting: Large volume vs. conventional cytapheresis
Authors: Balint Bela , Ljubenov Marika , Stamatovic Dragana , Todorovic Milena , Pavlovic Mirjana , Ostojic Gordana , Jocic Miodrag , Trkuljic Miroljub
Published: December 2010

Background/Aim. The use of peripheral blood as a source of hematopoietic stem cells (SCs) is progressively increasing and has nearly supplanted bone marrow transplantation. Interpatient variability in the degree and kinetics of SC mobilization into peripheral blood is an expected event after conventional chemotherapy-based treatment, followed by sequential administration of recombinant granulocyte-colony- stimulating factor (rHu-CSF). In this study, specific factors associated with the application of two different SC-harvesting approaches, including the use of large volume leukapheresis (LVL) vs. repetitive conventional apheresis (RCA), were analyzed. The basic goal of the study was to evaluate the influence of apheresis protocol (collection timing, processed blood volume and cell yield) upon the clinical outcome of transplantation. Methods. Results obtained by LVL (76 pts) and RCA (20 pts - control group) were compared. The SC mobilizing regimen used was cyclophosphamide (4-7 g/m2) or polychemotherapy and rHuG-CSF 10-16 ?g/kg of body mess (bm) per day. Cell harvesting was performed using COBE-Spectra (Caridian-BCT, USA). The volume of processed blood in LVL setting was ? 3.5 - fold of the patient's circulating blood quantity (ranged from 12.7 to 37.8 l). All patients tolerated well the use of intensive treatment, without any side or adverse effects. Our original controlled-rate cryopreservation was carried out with 10% dimethyl sulfoxide (DMSO) using Planer R203/200R or Planer 560-16 equipments (Planer Products Ltd, UK). Total nucleated cell (NC) and mononuclear cell (MNC) counts were examined by flow cytometry (Advia-2120 Bayer, Germany; Technicon H-3 System, USA). The CD34+ cell surface antigen was investigated by the EPICS XL-MCL device (Coulter, Germany). Results. Performing LVL-apheresis, high-level MNC and CD34+ cell yields (7.6?4.6 ? 108/kg bm and 11.8?6.5 ? 106/kg bm, respectively) were obtained. As a result, rapid hematopoietic reconstitution ("graft-healing") - on the 9.4th and 12.4th day for granulocytes and platelets, respectively was achieved. Using repetitive conventional apheresis (2-3 procedures), the total MNC count was high (8.2?7.0 ? 108/kg bm), but the total CD34+ yield was lower 10.8?9.9 due to inferior CD34+ vs. MNC ratio. Conclusion. The results obtained suggest that well-timed LVL-apheresis increased SC-yield in cell harvest, resulting in faster bone marrow repopulation and hematological reconstitution, as well as better overall clinical outcome of transplantation. These results necessitate additional examinations of CD34+ subsets ratio in cell harvest.
Transcranial parenhymal sonography in the diagnosis of Parkinson's disease
Authors: Mijajlovic Milija , Petrovic Igor , Stojkovic Tanja , Svetel Marina , Stefanova Elka , Kostic Vladimir
Published: December 2010

Bacground/Aim. Modern ultrasound systems allow highresolution transcranial sonography (TCS) of the brain structures. Enlargement of the echogenic signal (hyperechogenicity) of the substantia nigra (SN) has been reported as a highly characteristic finding in idiopathic Parkinson's disease (PD) and is thought to reflect increased amounts of iron, bound to proteins other than ferritin, in the SN in the course of neurodegeneration. The aim of our study was to investigate the prevalence of the SN hyperechogenicity in PD patients, as well as its possible clinical correlates. Methods. The study comprised 103 consecutive PD patients and 50 healthy age-matched controls. For TCS examination a color-coded, phased array ultrasound system equipped with a 2.5 MHz transducer was used (ESAOTE Technos MP, Italia). The examination was performed through a preauricular acoustic bone window with a penetration depth of 16 cm and a dynamic range of 45-50 dB. The SN was identified within the butterfly shaped structure of the mesencephalic brainstem, with scanning from both temporal windows. Results. The SN hyperechogenicity was identified in 95 out of 103 examined PD patients (92%), which was marked in 60 (63%), and moderate in 35 patients (37%). Median SN echogenic size was larger contralateral to the clinically more affected side of the body. Unilateral SN hyperechogenicity was also found in 5 out of 50 healthy controls (10%). No ventricular enlargements were notified in our study. Conclusion. Our study demonstrated SN hyperechogenicity in more than 90% of PD patients. In adult subjects without neurological symptoms, the TCS finding of at least unilaterally marked SN hyperechogenicity indicates a subclinical functional impairment of the nigrostriatal dopaminergic system. .
Asymptomatic renal damages in persons with chronic professional exposure to elementary mercury low concentrations
Authors: Djuric Stevan , Jovanovic Dragan , Hrvacevic Rajko , Kovacevic Zoran , Konjevic Marija
Published: December 2010

Background/Aim. Any forms of mercury have toxic action on the majority of organs, especially kidneys. The major source of professional exposure to mercury are departments for the production of chlorine which use mercury as catode. The aim of the study was to prove that chronic exposure to elementary mercury low concentrations could cause asymptomatic damages of the kidneys. Methods. A total of 40 workers from the factory "HIP Petrohemija" Pancevo, of the mean age 45?8 years, who were exposed to the effects of mercury for more than 20 years within the production procedure, and 20 workers from the factory "Panonijaplast" Pancevo, of the mean age 44?7 years, who were not exposed to mercury nor to other nephrotoxic agents, were submitted to laboratory analysis, renal function testing, and determination of mercury concentration in urine. Mercury concentration was also measured in the air of working premises of the factory. Results. The performed measurements confirmed that the concentrations of mercury at any tested working place in the Department of Electrolysis were not more than the maximally permitted concentration for an 8-hour exposition. In the exposed group (40 examinees) 75% of the examinees had mercury in urine in the concentration < 0.1 ?mol/l, while in 25% of them it was 0.1-0.75 ?mol/l. In the control group (20 examinees) all of the examinees showed to have < 0.1 mol/l mercury in urine. There was determined a positive corelation between the concentration of mercury in urine and the value of ?2-microglobulin (p < 0.05), as well as between the corrcentration of mercury in urine and ?GT activity (p < 0.05), and between the concentration of mercury in urine and the value of retinol-binding protein (p < 0.01). Conclusion. In 25% of the examinees excretion of mercury was significantly higher than in the control group. The frequency of asymptomatic renal tubular lesions and dysfunction of moderate extent were found to be higher in the exposed group than in the control one.
Diabetes mellitus: A risk factor for the development of osteoporosis
Authors: Vuksanovic Miljanka , Djurica Snezana , Zerajic Branka
Published: December 2010

 Osteoporoza je vazan zdravstveni problem. Prisutan je kod svake trece zene u postmenopauzi i povezuje se sa znacajnim morbiditetom i mortalitetom. Zene sa dijabetesom u postmenopauzi imaju povecan rizik od preloma kuka nego zene koje nisu dijabeticari, tako da strategija prevencije osteoporoze kod svih bolesnika sa dijabetesom ima smisla, narocito kod zena obolelih od dijabetesa. Dokazi da populacija starih sa dijabetesom ima povecan rizik od fraktura kosti daju novi podsticaj za dalja istrazivanja fokusirana na kost i dijabetes. Ona bi trebala da razjasne uticaj razlicitih aspekata dijabetesnog metabolizma, poboljsanja kontrole glikemije i uticaja lecenja dijabetesa na kosti. Odredjivanje (procena) kvaliteta kosti ukljucivala bi standarde merenja BMD, kao i razvoj novih pristupa merenju glikoziliranog kolagena. Bolje shvatanje i sagledavanje uticaja dijabetesa na kost povecava mogucnost ocuvanja kosti i preveniranja pojave fraktura kod osoba sa dijabetesom. Takodje, neophodno je ustanoviti optimalni izbor ispitivanih biohemijskih markera i napraviti standardizaciju merenja kostane mase kod obolelih od dijabetesa. U klinickoj praksi pristup bolesniku sa dijabetesnom osteopatijom trebalo bi da bude individualan, prema stanju promena i profilu rizika, a da dijagnostikovanje i terapijski postupci postanu rutina.
Nocturia and benign prostatic hyperplasia
Authors: Laketic Darko , Laketic Vesna
Published: December 2010

Background/Aim. Nocturia often occurs in patients with benign prostate hyperplasia (BPH). The aim of the study was to investigate the frequency of nocturia in patients with BPH. Nocturia and other factors associated with it were also investigated. Methods. Forty patients with the confirmed diagnosis of BPH were studied. Transurethral and transvesical prostatectomy were performed in all the patients. Symptoms were evaluated with the International Prostate Symptom Score before, as well as three and six months after the surgery. All the results were compared with the control group. Results. There was no statistically significant difference between the patients before and after the surgery regarding nocturia. There was, however, a statistically significant difference between the operated patients and the control group regarding nocturia, as well as a statistically significant correlation between noctruia and the age of the patients in both the investigated and the control group. A correlation also existed between nocturia and the prostatic size. Conclusion. There was no statistically significant improvement in symptoms of nocturia after the surgery. It is necessary to be very careful in decision making in patients with nonabsolute indiction for surgery and isolated bothersome symptom of nocturia. Age of a patient should also be considered in the evaluation of favorable result of the surgery because of a significant correlation between noctura and the age of a patient.
Low-level laser efficiency in the therapy of chronic gingivitis in children
Authors: Igic Marija , Kesic Ljiljana , Apostolovic Mirjana , Kostadinovic Ljiljana
Published: December 2010

Background/Aim. Gingivitis is a frequent phenomenon in children considered to be a risk factor for the occurrence and progression of paradontal tissue disease. So, it is necessary not only to identify inflammation, but also to react in due time and adequately in order to avoid further disease spread and the beginning of periodontitis. The aim of this study was to determine the efficiency of a low-level laser application in the therapy of chronic gingivitis in children. Methods. The study a included hundred of children with permanent dentition suffering from chronic gingivitis. All the examinees were divided into two groups: group I - 50 examinees with chronic gingivitis, who underwent the basic therapy; group II - 50 examinees with chronic gingivitis, who underwent the basic therapy and also a therapy with a low-level laser. Evaluation of the condition of oral hygiene, the health of gingiva and periodontium were done using appropriate index before and after the therapy. Results. For the plaque index (PI) following results were obtained: in the group I PI = 1.94, and in the group II PI = 1.82. After the therapy in both groups PI was 0. In the group I sulcus plaque index (SPI) was 2.02 before the therapy and 0.32 after the therapy. In the group II SPI was 1.90 before the therapy, and 0.08 after the therapy. In the group I Community Periodontal Index of Treatment Needs (CPITN) was 1.66 before the therapy, and 0.32 after the therapy, and in the group II CPITN was 1.60 before the therapy, and 0.08 after the therapy. Conclusion. Chronic gingivitis in children can be successfully cured by the basic treatment. The use of a low-level laser can significantly improve this effect.
Impact of air pollution on the rate of hospital admission of children with respiratory diseases
Authors: Nikic Dragana , Bogdanovic Dragan , Stankovic Aleksandra , Nikolic Maja , Milosevic Zoran
Published: December 2010

Background/Aim. Numerous epidemiological studies have reported effects of air pollution on the prevalence of respiratory diseases in children. Association between air pollution and hospital admissions for respiratory diseases among children has not been investigated in our country yet. The purpose of this study was to examine impact of ordinary air pollutants (sulfur dioxide and black smoke) in concentrations regularly reported during monitoring on hospital admissions for respiratory diseases among children. Methods. We compared daily data of sulphur dioxide and black smoke concentrations in air with data of daily hospital admissions for respiratory diseases in children 0-14 years of age in two periods (1992-1995 and 2002-2005) in Nis, Serbia. Results. There were totally 4 283 and 3 842 hospital admissions for respiratory diseases in children in the first (1992-1995), and the second (2002-2005) period observed, respectively. The highest number of hospital admissions was registered in children aged 0-4 years, and the lowest one in children aged 10-14 years. Statistically significant influence of pollutants on the number of hospital admissions for respiratory diseases was observed in the period 1992-1995 in children aged 0-4 years. Overall, a 10 ?g/m3 increase in black smoke concentration was associated with a 3.95% (95% CI 1.29-6.67%) increase in the rate of hospital admission for respiratory diseases after three days, 4.50% (1.77-7.30%) after four days and 7.15% (1.21-13.44%) after seven days. A 10 ?g/m3 increase in sulphur dioxide concentration was associated with a 1.29% (0.03-2.56%) increases in the rate of hospital admission for respiratory illness after three days. Influence of air pollution on the number of hospital admissions in older groups of children, as well as in the period 2002-2005 was not statistically significant. Conclusion. Our study suggested that air pollution concentration measured during regular monitoring, out of episodes of pollution, appear to be risk for hospital admissions for respiratory diseases in children age 0-4 years.
SMART Control stents in femoropopliteal region
Authors: Jagic Nikola , Stamenkovic Dragan , Toncev Slavko , Petrovic Dejan , Miloradovic Vladimir , Milicic Biljana
Published: December 2010

Introduction/Aim. Occlusive disease of lower limb arteries have been so far traditionally best treated with bypass surgery, but we want to find minimally invasive approach that should be at least as good as conventional surgery, and hopefully better. The aim of this study was to evaluate SMART Control stents (Cordis, J&J) in Trans Atlantic Society Consensus (TASC) B and C femoropopliteal lesions during one-year follow-up. Methods. Retrospective nonrandomized analysis included forty arteries in consecutive 40 patients who were stented with SMART Control stents. Primary patency at 12-month verified with Duplex Ultrasound and Acute Brachial Index (ABI) as well as freedom from Target Vessel Revascularization (TVR) were primary endpoints. Results. Primary technical success at stent implantation was 100%. Mean ABI values were preprocedurally 0.50, postprocedurally 0.83, at one month 0.86, at six months 0.84, at one year 0.78. After one year 39 stents were patent (97.5%). Conclusion. Excellent performance of the stent from technical point of view and a midterm results in vessel patency, as well as the absence of need for TVR were achieved. Yet, life expectancy in this cohort group of patients demands longer follow up data to draw a definite sustained positive conclusion.
Use of mechanical ventilation in pediatric patients
Authors: Martic Jelena , Jankovic Borisav , Minic Predrag , Sovtic Aleksandar , Nikolic Ljubica , Ristic Snezana , Sarajlija Adrijan
Published: December 2010

Background/Aim. Major aims of mechanical ventilation (MV) in pediatrics mean the contribution to complete recovery of acute disorder or to establishing stability of previously long-term changed health condition. MV is used today in 16-46% of patients treated in pediatric intensive care units. The aim of this paper was to get insight into the presence of the disease and pathologic conditions and outcome of MV regarding previous health condition of pediatric patients. Methods. This retrospective study included 476 pediatric patients (beyond neonatal age) who underwent mechanical ventilation (MV). On the basis of previous health status the patients were classified in two groups: the group A consisted of 157 children with no previous chronic disease leading to MV and the group H comprised of 319 children who received MV due to worsening of previous chronic disease. Results. In both groups of pediatric patients there was significant predominance of younger age patients. Acute and chronic neurological disorders were the most frequent conditions requiring use of MV. Out of a total number (476) of the patients, 178 patients (37.4%) died. In the group A 17 patients (10.9%) died, while in the group H mortality rate was significantly higher (161 or 50.5% patients died; p < 0.01; RR 4.85; CI 3.1-7.6). Total duration time of MV in all the patients was 7 525 days, with 1 345 days (15%) accounted for the group A and 4 567 days (85%) for the group H. Mean MV duration was 7.48 (? 9.23) days for the patients in the group A which is significantly shorter in comparison to mean 21.8 (? 57.96) days for the group H patients (p < 0.001). Conclusion. These results point out significant contribution of MV to better outcome in pediatric patients with different acute disorders. Clear dominance of chronically ill children requiring mechanical ventilation due to acute worsening of their condition implies new complexity of problems regarding organization of pediatric intensive care and treatment.
Cardiovascular morbidity and mortality in patients treated with hemodialysis: Epidemiological analysis
Authors: Petrovic Dejan , Stojimirovic Biljana
Published: December 2010

Background/Aim. Cardiovascular diseases are the leading cause of death in patients treated with hemodialysis (HD). The annual cardiovascular mortality rate in these patients is 9%. Left ventricular (LV) hypertrophy, ischemic heart disease and heart failure are the most prevalent cardiovascular causes of death. The aim of this study was to assess the prevalence of traditional and nontraditional risk factors for cardiovascular complications, to assess the prevalence of cardiovascular complications and overall and cardiovascular mortality rate in patients on HD. Methods. We investigated a total of 115 patients undergoing HD for at least 6 months. First, a cross-sectional study was performed, followed by a two-year follow-up study. Beside standard biochemical parameters, we also determined cardiac troponins and echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction). The results were analyzed using the Student's t test and Mann-Whitney U test. Results. The patients with adverse outcome had significantly lower serum albumin (p < 0.01) and higher serum homocystein, troponin I and T, and LV mass index (p < 0.01). Hyperhomocysteinemia, anemia, hypertriglyceridemia and uncontrolled hypertension had the highest prevalence (86.09%, 76.52%, 43.48% and 36.52%, respectively) among all investigated cardiovascular risk factors. Hypertrophy of the LV was presented in 71.31% of the patients and congestive heart failure in 8.70%. Heart valve calcification was found in 48.70% of the patients, pericardial effusion in 25.22% and disrrhythmia in 20.87% of the investigated patients. The average annual overall mortality rate was 13.74%, while average cardiovascular mortality rate was 8.51%. Conclusion. Patients on HD have high risk for cardiovascular morbidity and mortality.
Botulinum toxin in the treatment of sialorrhea
Authors: Svetel Marina , Vasic Milan , Dragasevic Natasa , Pekmezovic Tatjana , Petrovic Igor , Kostic Vladimir
Published: December 2010

Background/Aim. Botulinum toxin-A (BTX-A) is known to block the release of acetylcholine from motor and autonomic nerve terminals and may significantly decrease saliva production when injected intraglandulary. The aim of this study was to evaluate effects of BTX-A injections in the treatment of disabling sialorrhea in various neurological disorders. Methods. This study included 19 consecutive patients with significant sialorrhea associated with various neurological disorders. Out of them 13 patients were with Parkinson's disease, two with pantothenate kinase-associated neurodegeneration, two with multiple system atrophy, one with Wilson's disease, and one patient with postoperative sialorrhea. Botulinum toxin-A (Dysport?, Ipsen Pharma) was injected into the parotid glands with (n = 7 patients) or without (n = 12 patients) ultrasound guidance. All the patients were scored before and after the treatment and in weekly intervals thereafter using the salivation item of the part II (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Results. Thirteen patients (68%) reported beneficial effect of BTX-A injection, while 6 of them (32%) had no response at all. The sialorrhea scores before and after the treatment were 3.1 ? 0.1 (range 2-4) and 1.8 ? 0.1 (range 0- 3), respectively (t = 5.636; p < 0.001). There was no difference in the magnitude of response between the groups with (t = 4.500; p = 0.004) and without (t = 3.674; p = 0.005) ultrasound control of injection sites. Adverse effects were registered in 5 patients (26%). Conclusions. Botulinum toxin-A injections to easily accessible parotid glands, without necessity for ultrasound guidance, are safe and efficaceous treatment for sialorrhea in different neurological disorders.
Predicting violence in veterans with posttraumatic stress disorder
Authors: Jovanovic Aleksandar , Lecic-Tosevski Dusica , Ivkovic Maja , Damjanovic Aleksandar , Jasovic-Gasic Miroslava
Published: December 2010

Background/Aim. Frequent expression of negative affects, hostility and violent behavior in individuals suffering from posttraumatic stress disorder (PTSD) were recognized long ago, and have been retrospectively well documented in war veterans with PTSD who were shown to have an elevated risk for violent behavior when compared to both veterans without PTSD and other psychiatric patients. The aim of this study was to evaluate the accuracy of clinical prediction of violence in combat veterans suffering from PTSD. Methods. The subjects of this study, 104 male combat veterans with PTSD were assessed with the Historical, Clinical and Risk Management 20 (HCR-20), a 20-item clinicianrated instrument for assessing the risks for violence, and their acts of violence during one-year follow-up period were registered based on bimonthly check-up interviews. Results. Our findings showed that the HCR-20, as an actuarial measure, had good internal consistency reliability (? = 0.82), excellent interrater reliability (Interaclass Correlation ICC = 0.85), as well as excellent predictive validity for acts of any violence, non-physical violence or physical violence in the follow-up period (AUC = 0.82-0.86). The HCR-20 also had good interrater reliability (Cohen's kappa = 0.74), and acceptable predictive accuracy for each outcome criterion (AUC = 0.73-0.79). Conclusion. The results of this research confirm that the HCR-20 may also be applied in prediction of violent behavior in the population of patients suffering from PTSD with reliability and validity comparable with the results of previous studies where this instrument was administered to other populations of psychiatric patients.
Dopa-responsive dystonia
Authors: Djuric Gordana , Svetel Marina , Dzoljic Eleonora , Kostic Vladimir
Published: December 2010

Backgrround/Aim. Dystonia is considered to be a prolonged involuntary contractions of the muscles leading to twisting, repetitive movements or irregular postures. Etiologically, it could be classified as primary and secondary dystonia. Dopa-responsive dystonia (DRD) belongs to a group of primary dystonia. The aim of this study was to detect the presence of gene GCH-I mutation in our population in patients with dopa-responsive dystonic dyskinesia and to analyze clinical specificity of the affected. Methods. Out of the group of patients with dystonia of different distribution four patients were separated whose clinical picture indicated the diagnosis of DRD. Two patients had a positive family anamnesis while the other two were sporadic. Genetic analysis was performed by the use of a standard protocol, which included PCR amplification and DNK sequencing according to the method of Senger and autoradiografy. Results. In the patients from the family DRD-1 new hetaerazygote point mutation 520G?A in 4-m exson gene GCH-I was revealed. First symptoms of the disease showed in the age of seven by the torsion of the left foot, progressively advanced and got into the evolution of numbness in the legs, aggravated gait, tending to worsen in the evening, and the therapy with levodopa (500 mg) produced a dramatic effect. The second mutation in the female patient from the family DRD-2 was homozygote deletion in1-m intron gene GCH-I (IVS1-85delA). Unwilling torsion of the foot, feeling of weakness in the lower extremities (that caused falling without loss of the consciousness) were clinical demonstrations of the disease. The application of levodopa (300 mg) caused regression of the symptoms of the disease. Hetaerazygote deletion of adenine in the position 209 in the first exon (209del A) was identificated in the patient DRD-3 with negative family anamnesis, in who in the age of ten the torsion of the foot inside occurred for the first time following by trembling of both the left and right legs at rest; after a few years, tremor of hands also appeared, which became worse in stressful situations. The father of the patient was an asymptomatic bearer of mutation. The fourth mutation in gene GCH-I was found in I exon gene GCH- I, 208delA. The disease was started by torsion of the left foot, progressing easily, and worsening in the evenings, but at the age of 30, moving became harder, fatigue and pain in muscles, increased and at the age of 40 the patient recognized the change of speech. The application of levodopa (300 mg/daily) made the patient feel better and walk independently. Conclusion. The study presented four patients with genetic confirmation of the diagnosis of dopa-responsive dystonia. This entity is very significant in differential diagnostics of both early dystonia (< 26 years) and early parkinsonism (< 40 years) since it can be successfully managed by applying relatively low doses of levodopa over a long period of time.
Significance of herbal drugs legislation for their rational use
Authors: Cupara Snezana , Jankovic Slobodan
Published: December 2010

 Kvalitet i bezbednost upotrebe biljnih preparata ostaju i dalje prioritet koji treba zakonski urediti na svetskom nivou. Za registraciju biljnog preparata kao leka postoje isti zahtevi kao i za registraciju drugih lekova u pogledu dokumentacije koja treba da sadrzi predklinicka i klinicka ispitivanja. Ovakva ispitivanja vrlo su zahtevna, a kako slozenost molekulske gradje, cak i jednokomponentnih biljnih preparata, ometa utvrdjivanje jedinstvenih kriterijuma za jasno pracenje njihovih terapijskih efekata, ispunjavanje zahteva za registrovanje biljnih preparata kao lekova u praksi jos uvek je izazov i za naucnike i za proizvodjace.
Endoscopic middle meatal antrostomy in treatment of maxillary sinus mucoceles
Authors: Peric Aleksandar , Milojevic Milanko , Ljubicic Aleksandar , Sotirovic Jelena
Published: December 2010

Background/Aim. Mucocele of a paranasal sinus is a benign non-neoplastic condition characterized by cystic expansion and distension of the sinus cavity by retained mucoid secretions. Etiology is unknown. The purpose of this study was to estimate the efficiency of the endoscopic middle meatal antrostomy (MMA) as a treatment modality in patients with maxillary sinus mucoceles. Methods. This retrospective study involved 11 patients with maxillary sinus mucoceles/pyoceles treated endoscopically in the Clinic for Otorhinolaryngology of Military Medical Academy, Belgrade over a 3-year period (2005-2007). The presented symptoms and signs, radiological and pathohistological findings and surgical treatment were reviewed. Results. There were four females and seven males, age 22 to 65 years (mean 33 years). Two patients were with allergic rhinitis. All the patients complained of nasal obstruction, ten had facial pain, seven had nasal discharge, five had cheek pressure, and four had epiphora, and four had headaches. On endoscopic nasal examination, the medial wall of the maxillary sinus was bulging in ten patients. Purulent drainage was seen in eight patients, septal deviation in ten, and polyps were found in two of the patients. The MMA and marsupialization of the mucocele were performed in all the patients. On histopathological examination, the mucocele wall showed a lining composed of respiratory epithelium. Postoperative follow-up ranged between 8 and 44 months (in six patients, it ranged from 24 to 44 months). No patients required revision surgery. Conclusion. The MMA with mucocele marsupialization abolishes middle meatal obstruction and establishes better drainage and ventilation of the maxillary sinus and restitution of its mucosa.
Determination of carbamazepine in serum and saliva samples by high performance liquid chromatography with ultraviolet detection
Authors: Djordjevic Snezana , Kilibarda Vesna , Stojanovic Tomislav
Published: December 2010

Background/Aim. Carbamazepine is antiepileptic drug widely used for the treatment of epilepsy. Due to low therapeutic index of carbamazepine there is a need for routine measuring its concentrations in biological fluids. The aim of the study was to describe a method for concomitant determination of carbamazepine in the serum and saliva. Methods. Separation of the drug from matrix is achieved by reversedphase chromatography on a C18 column, with a mobile phase of methanol-water-acetic acid (65:34:1) at a flow-rate of 1.0 ml/min. Detection was effected by ultra-violet absorption at 285 nm. The total run time was 5 min. Samples were prepared by alkaline extraction (pH 10) using chlorophorm. Results. Calibration curves were in the range 0.1-5 ?g/mL for serum and saliva samples. Mean recoveries of spiked serum and saliva were 97.59 and 92.30%, respectively. Limits of detection (LOD) of carbamazepine in serum and saliva were 0.166 and 0.178 ?g/mL, respectively. Limits of quantification (LOQ) in the serum and saliva were 0.237 and 0.226 ?g/mL, respectively. The method precision was carried out with coefficient of variation of 2.10% and 4.03% for the serum and saliva, respectively. The obtained data showed that there was a strong correlation between saliva and serum concentrations (r = 0.9481, p < 0.001). Conclusion. The method described here is rapid, precise, accurate and simple, and can be used for quantitative determination of carbamazepine in human serum and saliva after therapy applying. Saliva samples could be used as an alternative matrix for therapeutic drug monitoring of this antiepileptic drug.
Echocardiographic estimation of acute haemodynamic response during optimization of multisite pace-maker using different pacing modalities and atrioventricular delays
Authors: Salinger-Martinovic Sonja , Perisic Zoran , Milic Dragan , Apostolovic Svetlana , Tomasevic Miloje , Kostic Tomislav , Bozinovic Nenad , Stanojevic Dragana
Published: December 2010

Background/Aim. Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in symptoms, quality of life and prognosis in patients with severe heart failure and intraventricular conduction delay. Different pacing modalities produce variable activation patterns and may be a cause of different haemodynamic changes. The aim of our study was to investigate acute haemodynamic changes with different CRT configurations during optimization procedure. Methods. This study included 30 patients with severe left ventricular systolic dysfunction and left bundle branch block with wide QRS (EF 24.33 ? 3.7%, QRS 159 ? 17.3 ms, New York Heart Association III/IV 25/5) with implanted CRT device. The whole group of patients had severe mitral regurgitation in order to measure dP/dt. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left and right ventricular pre-ejection intervals (LVPEI and RVPEI), interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 170.5 ? 24.6 to 145.9 ? 9.5 (p < 0.001), RVPEI from 102.4 ? 15.9 to 119.8 ? 10.9 (p < 0.001), IVD from 68.1 ? 18.3 to 26.5 ? 8.2 (p < 0.001) and dP/dt from 524.2 ? 67 to 678.2 ? 88.5 (p < 0.01). Conclusion. In patients receiving CRT echocardiographic assessment of the acute haemodynamic response to CRT is a useful tool in optimization procedure. The variability of Doppler parameters with different CRT modalities emphasizes the necessity of individualized approach in optimization procedure.
Gastroesophageal reflux disease correlation with posterior laryngitis
Authors: Dimitrijevic Milovan , Beljin Vera , Petrovic Vladan , Djukic Vojko
Published: December 2010

Background/Aim. Over the last years numerous studies have been performed dealing with mutual relations among gastroesophageal reflux disease (GERD) and numerous diseases of the upper airways. The aim of the present study was to establish possible causal relationship between GERD and posterior laryngitis (PL). Methods. The study included 103 patients with gastrointestinal complaints. Diagnostic procedure included a medical history, gastroscopy and laryngeal directoscopy. The obtained data processed using classic methods of the descriptive statistics, as well as Pearson's chi-square test, Student's t test, rank sum test and Fisher's parametric analysis of variance. Results. Out of the total number of 103 examined patients, 33 (32%) were diagnosed with PL, while GERD was diagnosed in five of the examined patients all belonging to the PL group (15% of the patients with PL). In the remaining patients, PL was caused by other factors. All the patients with GERD had PL and globus sensation while 80% of GERD patients had prominent symptom of pain. Conclusion. The results of the study are indicative of the causal relationship between GERD and PL.
Treatment of vesicouretheral reflux in pediatric patients
Authors: Grebeldinger Slobodan , Radojcic Branka , Meljnikov Igor , Balj Svetlana
Published: December 2010

Background/Aim. Vesicouretheral reflux (VUR) is an inherited abnormality of the urinary tract caused by dysfunction of vesicouretheral junction frequently accompanied by recurrent urinary infection. The optimal treatment method of VUR is still controversial. The aim of the study was to analyze medical charts of children with VUR with special focus on the results of endoscopic treatment with Deflux. Methods. This retrospective study analyzed the medical charts of all children diagnosed with VUR at the Institute for Children and Youth Health Care of Vojvodina, in five years period. The analyzed data were: age, gender, grade, bilateral or unilateral presence of reflux, distribution to the sides of the body, urinary tract infections, associated anomalies and complications of VUR, treatment methods and the success rate of endoscopic correction with Deflux. Data processing was performed using the standard statistical methods. Results. The study included 167 patients (101 females and 66 males) with 231 refluxing ureters. The patients age at diagnosis was 1 month to 18 years (mean 4.6 years). Frequencies of different grades of VUR at initial investigation were: 17%, 27%, 22%, 21% and 13% for grades I to V, respectively. VUR was unilateral in 103 patients (left in 65 and right in 38), and bilateral in 64. Urinary tract infections were present in 78.4% of patients, reflux nephropathy in 38.3%, hypertension in 3.0%, chronic renal insufficiency in 4.8%, associated anomalies in 39.5% of patients. The treatment method was recorded in 154 cases. Medically were treated 80 patients, and surgically 74. Endoscopic injection of Deflux was carried out in 59 patients. From 79 ureters treated, five had grade I reflux, 11 grade II, 23 grade III, 27 grade IV, and 13 grade V. In 46 patients Deflux injection was carried out once. A second injection was required in eight, and third injection in five patients. Reflux was absent in 42 of the treated patients (71.2%) and 15 patients (25.4%) had a decreased grade of reflux after the treatment. Overall success rate was 96.6%. Conclusion. Endoscopic subureteral injection of Deflux is a minimally invasive method for VUR treatment in pediatric patients.
Unilatelaral iris plateau syndrome after the use of ecstasy
Authors: Jovanovic Predrag , Hentova-Sencanic Paraskeva , Zoric Lepsa , Petrovic Maja , Trenkic-Bozinovic Marija
Published: December 2010

Bacground. Courmon street name for 3,4-Methylenedioxymethamphetamine (MDMA) is ecstasy. This widely abused 'recreational' drug causes both an increased release of monoamine neurotransmitters, including serotonine and dopamine, and an increased reuptake inhibition of serotonin. As a consequence, mydriasis and increased intraocular pressure (IOP) in predisposed patients occur. We present herein a rare case of acute increased IOP after use of ecstasy. Case report. A female patient, aged 38 years, visited doctor complaing of a decreased vision acuity and severe pain in the left eye and in the left part of the head. The initial treatment was urgent antiglaucomatous therapy followed by withdrawal of subjective problems of the patient and improvement of objective finding. History taking procedure reveled that just before the onset of the pain the patient had used ecstasy and had had similar 'experience' 6 years ago after cocaine snorting. She had not been to a doctor although she had experienced sporadic migrenous pain. Previous medical records excavation of revealed optic disk (cup-to-dise C/D=06), Bjerum arcuate scotoma and iris plateau with narrow chamber angle (Scheie II- III) so the diagnosis was a rare unilateral iris plateau syndrome of the left eye. Although the patient was given some pieces of information about the dangerous and possible deadly consequences of psychoactive substance abuse, she has not continue the treatment. Conclusion. Ecstasy abuse might cause a complete loss of vision, thus medicametous and surgical treatment are obligatory.
Arthroscopic findings after shoulder dislocation
Authors: Medenica Ivica , Radunovic Aleksandar , Madzarac Dragan , Zoric Miodrag , Bokonjic Dubravko , Stojkovic Bratislav
Published: December 2010

Background/Aim. Recurrent instability of the shoulder joint is frequently difficult to differentiate from diseased or injured rotator cuff or tendon of the forearm flexor (m. biceps brachii). Shoulder joint arthroscopy has been only recently introduced into instable shoulder joint lesion examination. The aim of this study was to present and analyze an arthroscopic finding on instable shoulder joint in order to determine causes and mechanisms of instability, as well as principles of surgical treatment. Methods. Arthroscopy of the shoulder joint was performed in 158 patients with at least one documented shoulder joint dislocation. These patients were divided into two groups. The group I included the patients with one to three dislocations, while the group II those with more than three dislocations. Preoperative diagnosis was based on anamnestic data and clinical examination using specific tests, and on the diagnosis of shoulder joint using radiography or computed tomography. Results. Out of the total number of the patients 138 (87.34%) had injury of the anterior patellar brim, 119 (75.32%) had failure of the anterior capsule, 126 (79.75%) had compressive cartilage injury of the posterior part of the head of the upper arm bone (Hill-Sachs lesion), 102 (64.56%) had insufficiency of glenohumeral tendon, 11 (6.96) had complete cut of the rotator cuff, 23 (14.56%) had injury of the posterior patellar brim, 12 (7.59%) had injury of the upper anterior-posterior patellar brim (SLAP). Conclusion. According to the obtained results it could be concluded that there is no a unique injury that leads to shoulder joint instability. It is necessary to point out to the significance of anamnesis and clinical examination in making diagnosis. Arthroscopic diagnostics is indicated in clinically unreliable findings as an additional method for determining operative treatment.