bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative factors influencing the early results of infrainguinal limb salvage procedures
Authors: Cinara Ilija , Davidovic Lazar , Markovic Miroslav , Kuzmanovic Ilija , Koncar Igor
Published: July 2008

Introduction: The early results of 59 patients treated surgically for critical limb ischemia at the Institute of Cardiovascular Diseases were analyzed. Research was performed in a prospective manner, as an acute study, lasting for three months. Objective Our focus was on primary and secondary patency rate, and graft efficacy (quality accomplished by graft patency, improvement of clinical status of the leg, and quality of life). Method The influence of each variable on the outcome was analyzed (descriptive: sex, comorbidity, risk factors, clinical stage of disease, angiographic verification of pedal arch, previous vascular procedures; and numerical: gender, preoperative Doppler index, angiographic score by Bollinger), as well as their predictive value. Inferential statistics was used for establishing the significance of influence, and univariate regression analysis for predictive values. Results No influence of variables on the outcome was evident in the first three months, and their predictive value was not important considering the graft patency rates and efficacy (except for preoperative clinical status affecting the graft efficacy, presence of pedal arch, affecting both primary and secondary patency rates and graft efficacy, and finally Doppler index affecting the secondary patency rates). Conclusion When the surgeon needs to give an early prediction of graft destiny, he can rely on preoperative clinical status, earlier vascular operative procedures, presence of pedal arch, and values of Doppler index (in case of reintervention).
Comparison of three diagnostic methods to confirm Helicobacter pylori infection
Authors: Opavski Natasa , Spuran Milan , Djukic Slobodanka , Mijac Vera , Ranin Lazar
Published: July 2008

Introduction: Helicobacter pylori induces gastric inflammation in host and such gastritis increases the risk of gastric and duodenal ulceration as well as adenocarcinoma. Because peptic ulcer disease is the major cause of morbidity, accurate diagnosis of H. pylori infection is very important. Unfortunately, there is no gold standard among diagnostic tests for Helicobacter infections. If gastroscopy is performed, histopathology and urease test are the most often used. Still, culturing of this bacterium is essential for drug susceptibility testing and analysis of virulence factors. Objective The aim of this study was to compare three diagnostic procedures - histopathology, urease test and culture, which are used to verify H. pylori infection. Method Three pairs of gastric mucosal biopsy specimens were collected from each of 28 dyspeptic patients undergoing endoscopy. Nineteen patients were not pretreated with antibiotics, while nine had received eradication therapy earlier. One pair of biopsy specimens was used for histopathologic examination, the second for urease test and the third was simultaneously cultured on nonselective and selective solid media. Isolate was identified as H. pylori on the basis of colony morphology, morphological properties and biochemical tests. Results In 14 out of 28 patients, H. pylori infection was confirmed on the basis of results of all diagnostic procedures. The concordance of these three methods was very good, because the results of histopathology, urease test and culture corresponded in 26 from 28 patients. Conclusion The conclusion of our study is that culture, as the method with high degree of concordance with other two procedures and the only that can give information on drug susceptibility of Helicobacter, is recommended for diagnosis of Helicobacter pylori infection along with histopathology and urease test.
The value of corticotropin-releasing hormone (CRH) test for differential diagnosis of Cushing’s syndrome
Authors: Penezic Zorana , Zarkovic Milos , Vujovic Svetlana , Ivovic Miomira , Beleslin Biljana , Ciric Jasmina , Drezgic Milka
Published: July 2008

Introduction: Diagnosis and differential diagnosis of Cushing?s syndrome (CS) remain considerable challenge in endocrinology. For more than 20 years, CRH has been widely used as differential diagnostic test. Following the CRH administration, the majority of patients with ACTH secreting pituitary adenoma show a significant rise of plasma cortisol and ACTH, whereas those with ectopic ACTH secretion characteristically do not. Objective The aim of our study was to assess the value of CRF test for differential diagnosis of CS using the ROC (receiver operating characteristic) curve method. Method A total of 30 patients with CS verified by pathological examination and postoperative testing were evaluated. CRH test was performed within diagnostic procedures. ACTH secreting pituitary adenoma was found in 18, ectopic ACTH secretion in 3 and cortisol secreting adrenal adenoma in 9 of all patients with CS. Cortisol and ACTH were determined -15, 0, 15, 30, 45, 60, 90 and 120 min. after i.v. administration of 100?g of ovine CRH. Cortisol and ACTH were determined by commercial RIA. Statistical data processing was done by ROC curve analysis. Due to small number, the patients with ectopic ACTH secretion were excluded from test evaluation by ROC curve method. Results In evaluated subgroups, basal cortisol was (1147.3?464.3 vs. 1589.8?296.3 vs. 839.2?405.6 nmol/L); maximal stimulated cortisol (1680.3?735.5 vs. 1749.0?386.6 vs. 906.1?335.0 nmol/L); and maximal increase as a percent of basal cortisol (49.1?36.9 vs. 9.0?7.6 vs. 16.7?37.3 %). Consequently, basal ACTH was (100.9 ?85.0 vs. 138.0?123.7 vs. 4.8?4.3 pg/mL) and maximal stimulated ACTH (203.8 ?160.1 vs. 288.0?189.5 vs. 7.4?9.2 pg/mL). For cortisol, determination area under ROC curve was 0.815?0.083 (CI 95% 0.652-0.978). For cortisol increase cut-off level of 20%, test sensitivity was 83%, with specificity of 78%. For ACTH, determination area under ROC curve was 0.637?0.142 (CI 95% 0.359-0.916). For ACTH increase cut-off level of 30%, test sensitivity was 70%, with specificity of 57%. Conclusion Determination of cortisol and ACTH levels in CRH test remains reliable tool in differential diagnosis of Cushing?s syndrome.
Tubular kidney function in patients with type 2 Diabetes mellitus, microalbuminuria and proteinuria
Authors: Vlatkovic Vlastimir , Stojimirovic Biljana , Obrenovic Radmila , Nogic Spomenka
Published: July 2008

Introduction: Diabetes melitus (DM) and hypertension are the most frequent causes of kidney function damage. Many different tests are developed to detect reversible functional kidney changes (detection of microalbuminuria and selective urinary enzymes). Objective The aim of our study was to examine tubular kidney function in type 2 DM patients with different proteinuria levels, and to compare these results with healthy people. Method The patients with type 2 DM and creatinine clearance >80 ml/min were included in the study. According to the levels of proteinuria, the patients were classified in three groups: group I - patients with proteinuria <300 mg/24 h, and no microalbuminuria; group II - the patients with proteinuria <300 mg/24 h and microalbuminuria >20 mg/24 h; and group III- the patients with proteinuria >300 mg/24 h. The control group consisted of healthy subjects. Results The study revealed that in type 2 DM patients and normal global kidney function, fractional excretions of sodium, potassium, and phosphates as well as renal phosphate concentrations were not adequately sensitive markers to detect damage in tubular kidney function in DM. There were some changes of urate fractional excretion in these patients: this value was significantly lower in patients with microalbuminuria compared with those with proteinuria >300 mg/24 h, as well as in the control group (p<0.05). Hormone dependent tubular kidney activity, urinary osmolarity, and urea fractional excretion in all patients were within normal ranges. Conclusion It is evident that routine laboratory analyses are not sensitive markers to detect early changes of kidney function in type 2 DM.
Factors mediating the depression in the adult obese outpatients
Authors: Gudelj-Rakic Jelena , Davidovic Dragana , Avramovic Dusan , Backovic Dusan , Jorga Jagoda
Published: July 2008

Introduction: The prevalence of obesity is rising to epidemic proportions at the alarming rate in both developed and underdeveloped countries around the world. Current prevalence data from individual national studies suggest that the obesity prevalence in the European countries ranges from 10% to 20% for men, and 10% to 25% for women. Health consequences of obesity imply both a number of fatal and non-fatal health problems (out of which the most common are cardiovascular problems, non-insulin dependent diabetes mellitus, cancers), and also a wide spectrum of psychological consequences from diminished self-esteem to clinical depression. Causal relationship between obesity and many chronic diseases is evidence- based. At the same time, there are marked differences in research data regarding causal obesity-depression relationship. Several studies have found no direct association between obesity and depression, while in others the prevalence of depression in obese patients was up to 50%. Gender, obesity grade, socioeconomic status and asking for professional help are named as moderators and mediators of this relationship. Among recommended screening methods, BDI-II is the most frequently used in the adult outpatient departments. Objective The aim of the study was to determine possible risk factors of depression in adult obese patients treated for obesity. Gender, obesity and education level as well as marital status were analyzed as possible moderators of depression-obesity relationship. Method The research included 267 patients, 38.0?14.6 years of age, who referred to the Outpatient Nutrition Department for dietetic consultation or nutritional medical therapy. Nutritional status was assessed by BMI (kg/m?), calculated from measured values of body weight and height according to WHO recommendations. An estimate of the existence and/or depression level was investigated by Beck Depression Inventory - self administered questionnaire recommended for use in Serbian population. Results The results revealed higher average BDI score values in obese patients (F(267,1)=6.014, p=0.015) in comparison to their non-obese counterparts. In addition, the percentage of depressive obese patients was significantly higher (55.1%, ?2 (267.1)=22.64, p<0.001). There was significant correlation of BMI and BDI scores (r=0.246, p<0.001). The number of women with depression was significantly higher in comparison to men (?2 (267.1)=4.261, p=0.039).Women also had higher average BDI score (p = 0.003). MANOVA showed that BDI score was influenced by gender (F(267.1)=8.936, p=0.030) and nutritional status ( F(267.1)=6.115, p=0.014), but combined effect of the abovementioned moderators was not significant. Conclusion Depression is ten times more frequent in obese patients undergoing the obesity treatment vs. general population and, therefore, screening for depression is needed. Special attention should be paid to women and more obese patients due to higher incidence of depression in these groups.
Malignant diseases in medicolegal practice
Authors: Bogdanovic Ljiljana , Savic Slobodan , Basta-Jovanovic Gordana
Published: July 2008

Introduction: In many cases of natural death (so-called obscure natural death), medicolegal assessment and elucidation are required. Although malignant tumors may be the cause of obscure natural death, their forensic significance has not been particularly studied in our population. Objective The objective of the study was to provide a general report on medicolegal importance of malignant diseases. Method Autopsy material of the Institute of Forensic Medicine, Belgrade, from 1990 to 2000, was analyzed. The data were obtained from autopsy records, investigation reports, family members of the deceased and available medical documentation. Results The malignant tumor was the cause of death in 81 cases (0.69% out of a total of 11771 autopsies), in 52 males and 29 females, respectively. The incidence of malignant diseases increased with age. The most frequent cause of death was the lung cancer - diagnosed in 33 cases (40.7% out of 81), with somewhat higher percentage in females (41.4%) than in males (40.4%), but this difference was not statistically significant (?2 =0.13; p>0.05). Other locations of malignancies were less frequently found: brain (7 cases), colon (6), stomach (5) and pancreas (4). In 67 cases, widespread tumor with metastases was identified as an immediate cause of death, in 8 cases there was a hemorrhage from eroded blood vessels, and in 6 cases peritonitis due to gastric or intestinal leakage into the abdominal cavity at the site of wall perforation. In 61.7% cases, fatal tumor was not diagnosed during the life, and was recorded more frequently in female group (75.9%) than in males (53.8%), but this difference was not statistically significant (?2=2.71; p>0.05). In most cases of lung cancer (22 or 66.7% out of 33), which was predominant type in the analyzed sample, malignancy remained unrecognized during the life. Conclusion The most important medicolegal problems regarding fatal malignant diseases are associated with exclusion of violent death in cases that are characterized as obscure (suspicious) natural death, as well as assessment of possible legal responsibility of medical staff in cases in which malignant tumor has not been diagnosed during the life.
Enteropathy associated T-cell lymphoma
Authors: Bakrac Milena , Bonaci-Nikolic Branka , Colovic Natasa , Simic-Ogrizovic Sanja , Krstic Miodrag , Colovic Milica
Published: July 2008

Enteropathy associated T-cell lymphoma (EATCL) is a high grade, pleomorphic peripheral T-cell lymphoma with usually cytotoxic phenotype. This is a case report of three patients with EATCL. The first patient was 50 year-old woman with four year history of gluten sensitive enteropathy (GSE). Diagnosis of lymphoma was confirmed after the resection of the jejunum (small intestine obstruction). Pathohistological (PAS, Reticulin, Giemsa) and immunohistochemical (anti-LCA, anti-CD20, anti- CD45RO, anti-CD3) methods revealed the diagnosis of EATCL: CD45RO+, CD3+. After the third cycle of chemotherapy, the disease progressed with massive lung infiltration. Patient died due to complications of bone marrow aplasia. The second patient was 23 year-old woman with long earlier history of GSE. She presented with the acute renal failure. According to established diagnosis of tubulointerstitial nephritis, she was treated with pulse doses of steroid therapy. After temporary improvement, she had dissemination of the disease. On MRI, small intestinal wall was thickened, and abdominal lymph nodes were enlarged with extraluminal compression of common bile duct. Laparotomy with mesenterial lymph node biopsy and consecutive pathohistological and immunohistochemical analyses revealed the diagnosis of EATCL. The patient received chemotherapy, but she died with signs of pulmonary embolization. The third patient was 53 year-old woman without previous history of GSE. Diagnosis of EATCL was revealed after the resection of jejunum because of small intestinal obstruction. She received two cycles of chemotherapy, but she died with signs of disease progression. IgA antiendomysial antibodies were detected in the serum of all patients. The overall survival of patients was 7 months. The possibility of lymphoma rising in patients with clinical progression of GSE despite gluten free diet must be kept in mind.
Intrapartal resection of the bicornuete uterus for placenta membranacea percreta
Authors: Sparic Radmila , Kadija Sasa , Tadic Jasmina , Dokic Milan , Milenkovic Vera
Published: July 2008

Placenta membranacea is a rare anomaly characterized by failure of villous atrophy during early gestation, and 30% of cases involve some form of placental adherence. Placenta percreta is infrequent, but life-threatening condition. Antenatal diagnosis of these placental anomalies is very difficult, but essential for reduction of the number and extent of possible complications. A 19-year-old primigravida was referred to us with 31- week pregnancy complicated by preeclampsia. Upon admission, ultrasound scan revealed eutrophic fetus in breech presentation, without any signs of retroplacental clot. At laparotomy, hemoperitoneum without any trophoblastic tissue emerging to the peritoneal cavity was found and placental abruption with uteroplacental apoplexy was suspected. In addition, unicervical symmetric bicornuate uterus with pregnancy in the left uterine horn was found. The lower segment uterine section was performed and 1800 grams live baby was delivered. Delivery of the placenta was unusually difficult. It was very large and densely adherent to the posterior uterine wall, which appeared to be composed of serosa in that area only. After removal of placenta, the hemorrhage could not be controlled, and resection of the left uterine horn was performed. Placenta accreta, increta and percreta ought to be considered in all cases of uterine anomalies in pregnancy and in cases of prenatal diagnosis of placenta membranacea.
The influence of respiratory pattern on heart rate variability analysis in heart failure
Authors: Zamaklar-Trifunovic Danijela , Seferovic Petar , Petrovic Milan , Zivkovic Mirjana , Vukomanovic Goran , Milic Natasa , Ristic Arsen , Zdravkovic Marija
Published: July 2008

Introduction. Autonomic dysfunction is present early in the course of heart failure, and has a direct role on deterioration of cardiac function and prognosis. Heart rate variability (HRV) estimates sympathovagal control of heart frequency. The influence of respiratory pattern on HRV is clinically important. Breathing disorders are common in heart failure and highly affect HRV and autonomic evaluation. It was previously shown that slow and deep breathing increased parasympathetic tone, but effects of this respiratory pattern on HRV were not evaluated. Objective. The aim of the study was to estimate effects of slow and deep breathing (SDB) on HRV in heart failure patients. Method. In 55 patients with heart failure (78% male, mean age 57.18?10.8 yrs, mean EF=34.12?10.01%) and 14 healthy controls (57.1% male, mean age 53.1?8.2 yrs), short term HRV spectral analysis was performed (Cardiovit AT 60, Schiller). VLF, LF, HF and LF/HF were determined during spontaneous and deep and slow breathing at 0.1 Hz (SDB). Results. LF, HF and LF/HF significantly increased during SDB compared with spontaneous breathing both in controls (LF 50.71?61.55 vs. 551.14?698.01 ms2, p<0.001; HF 31.42?29.98 vs.188.78?142.74 ms2, p<0.001 and LF/HF 1.46?0.61 vs. 4.21?3.23, p=0.025) and heart failure patients (LF 27.37?36.04 vs. 94.50?96.13 ms2, p<0.001; HF 12.13?19.75 vs. 41.58?64.02 ms2, p<0.001 and LF/HF 3.77?3.79 vs. 6.38?5.98, p=0.031). Increments of LF and HF induced by SDB were significantly lower in patients than healthy controls. Heart failure patients had lower HRV compared to healthy controls both during spontaneous breathing and SDB. During spontaneous breathing, only HF was significantly lower between healthy controls and patients (p=0.002). During SDB VLF (p=0.022), LF (p<0.001) and HF (p<0.001) were significantly lower in heart failure patients compared to controls. Conclusion. These data suggest that SDB increases HRV both in healthy and heart failure patients; the highest increment is in LF range. Differences in spectral profile of HRV between healthy controls and heart failure patients become more profound during SDB. Controlled respiration during HRV analysis might increase sensitivity and reliability in detection of autonomic dysfunction in heart failure patients. .
Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade
Authors: Sparic Radmila , Dokic Milan , Argirovic Rajka , Kadija Sasa , Bogdanovic Zorica , Milenkovic Vera
Published: July 2008

Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections) and 91 postpartum hysterectomies (70 or 76.92% after cesarean section) in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections) and 64 hysterectomies (39 or 60.94 % after cesarean section). The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .
Variations in the concentration of total human milk proteins in the first month of lactation
Authors: Mladenovic Marija , Radlovic Nedeljko , Lekovic Zoran , Ristic Dragana , Radlovic Petar , Gajic Milan , Djurdjevic Jelena
Published: July 2008

Introduction. Human milk proteins are maximally adapted to physiological needs of a neonate. Thus, depending on the speed of the neonatal growth and development, the content of milk proteins changes, both in quantity and quality. Objective. The study was conducted in order to determine variations of total protein concentrations in milk in the first and third lactation week in lactating mothers of term and preterm neonates. Also, we analyzed the influence of the mode of delivery, neonatal Apgar score and parity on the concentration of human milk proteins in both lactation phases. Method. The study aims were evaluated on the sample of 48 women, of whom 33 were mothers of term neonates and 15 of neonates born between the 34th to 37th gestational weeks. Total protein level of the lactation milk from the middle phase was determined using the standard laboratory method (Lowry et al., 1951), and the obtained differences were analyzed by t-test. Results. Total protein concentration in term colostrum was 17.60-45.17 g/l (X=24.71?5.19), while in preterm colostrum it was 28.39-73.30 g/l (X=39.17?11.08). The total protein level of mature milk in women who had term delivery was 11.90-22.11 g/l (X=16.39?2.96), while in women who had preterm delivery it was 14.50-44.19 g/l (X=23.25?8.96). The obtained results indicated that total protein concentration in women who had preterm delivery was significantly higher than that of women who had term delivery, both in the colostral and mature phase of lactation. (p<0.01). Also, the difference in the protein concentration was statistically highly significant (p<0.01) in the colostral and mature phase of lactation, both in women who had term and preterm delivery. Variations in the total protein level of human milk were not significant, depending on the prematurity stage, the mode and severity of delivery and parity, both in the first and third week of lactation. Conclusion. Our results show that total protein concentration in human milk was significantly higher in the first than the third week of lactation. In both lactation phases, milk protein content was higher in women who had preterm delivery than those having had term delivery. The influence of prematurity stage, the mode and severity of delivery and parity on the total milk protein level was not significant. .
Importance of transport in prehospital treatment of children with craniocerebral injuries
Authors: Stanic-Canji Danica , Popovic Nada , Draskovic Biljana
Published: July 2008

Introduction. In initial, prehospital, phase of treatment of the injured pediatric patient, transport plays an important role. Objective. The aim of this study was to determine the influence of an adequate transport on the survival rate and final outcome of patients with craniocerebral injuries. Method. This study is a clinical, partly prospective, partly retrospective study that includes 60 patients with isolated craniocerebral injuries, aged up to 17 years, and with Glasgow Coma Scale under 8, that did not require surgical treatment. The patients were divided in two groups each with 30 patients. The first group included patients that had adequate prehospital treatment. The second group included patients that had improper prehospital treatment. In both groups the emphasis was on the transport as an important step in initial treatment. Results. There was a statistically significant difference in respect to the mode of transport. In group I there was a greater number of patients transported by specialized emergency vehicles (93.3%) compared to the group II. There was also a difference regarding the time that had elapsed from the moment of injury to the moment of arrival to the hospital - a significantly shorter time in group I. In a group of patients that survived, a greater percentage of patients had been transported by specialized emergency vehicles compared to the group of patients that did not survive. Conclusion. Adequate transport improves the survival rate of the patients with craniocerebral injuries. Also the time that has elapsed from the moment of injury to the moment of arrival to the hospital also influences the survival rate, but the final outcome, too. Transport of pediatric patients is globally neglected. Transport of unstable, critically ill and injured patients accompanied by inexperienced and unspecialized staff is followed an increased mortality rate. .
Mucinous cystadenoma of pancreatic head with focal malignant alteration in a 52-year old man
Authors: Colovic Radoje , Micev Marjan , Radak Vladimir , Grubor Nikica , Stojkovic Mirjana , Colovic Natasa
Published: July 2008

Mucinous cystadenomas of the pancreas are rare tumors appearing usually within the body and the tail of the pancreas in a young and middle-aged women. They rarely communicate with the pancreatic duct and occasionally may become malignant. The authors present a patient with a number of rare features. In a 52 year-old male, we did a radical pylorus-preserving cephalic duodenopancreatectomy for a mucinous cystadenoma within the head of the pancreas, which perforated into the main pancreatic duct causing chronic obstructive pancreatitis having few foci of malignant alteration. The postoperative recovery was uneventful, but three months later the patient died due to exacerbation of the underlying serious heart disease. .
Corticosteroid therapy in Henoch-Schönlein gastritis
Authors: Pavlovic Momcilo , Radlovic Nedeljko , Lekovic Zoran , Berenji Karolina , Novak Arpad
Published: July 2008

Introduction. Henoch-Sch?nlein purpura (HSP) is the most common vascular disease of childhood. It is a multisystem disease most commonly affecting the skin, joints, gastrointestinal tract, and kidneys, but other organs may be affected, too. Gastrointestinal involvement occurs in approximately 65-90% of patients, ranging from mild symptoms such as abdominal pain, nausea, and vomiting, to more severe manifestations such as gastrointestinal bleeding and intussusception. In most cases, HSP spontaneously resolves without treatment. The use of corticosteroids is controversial and usually reserved for severe systemic manifestations. Some authors suggest that the abdominal pain and gastrointestinal hemorrhage of HSP may respond to steroids, with some suggesting that there is a benefit in their use and describing a regimen. Case outline. This is a case report of HSP in a fourteen year-old boy with abdominal pain and hematemesis. Upper endoscopy showed an edematous and erythematous change in the body of the stomach and purpuric lesions in the duodenum, while multiple erosions were found in the antral area. Parenteral corticosteroid therapy with gastric acid secretion inhibitor administration led to regression of gastrointestinal symptoms on the seventh day, with relapses on the fourth and sixth day. Peroral administration of corticosteroids and gradual decrease of daily doses started on the eighth day of abdominal symptoms. New purpuric skin rashes appeared during six weeks. Conclusion. Corticosteroid therapy with gastric acid secretion inhibitors showed a positive effect in our patient with a severe form of HSP accompanied by abdominal pain and gastrointestinal hemorrhage. .
Cardiac tamponade due to rupture of healed and sealed aortic intimomedial tear: Case report
Authors: Nikolic Slobodan , Atanasijevic Tatjana , Popovic Vesna
Published: July 2008

Introduction: The healed and sealed intimomedial aortic tears showed clearly defined edges and U-shaped defect of the tissue extending from intima into the media of a varying depth, filled by paler tissue with smooth surface. These tears can be solitary or multilocular, localized in different parts of the aorta, followed by limited intramural incomplete dissection. They can be provoked by diseases or injury. This part of the aortic wall filled with scar tissue is very vulnerable and could be the site of new rupture, followed by tamponade or fatal internal bleeding. Case outline. In this paper, we report a case of unexpected unknown death of a young male, 26-years-old, found on the ground, near his car. At autopsy, we established the old healed and open intimomedial tear on the posterior wall of the ascending aorta, with a remaining little dissection flap. This part of the wall with scar tissue was ruptured, causing bleeding in the pericardial sac, and tamponade. Histologically, the early stage of cystic medial degeneration was recognized. There were no injuries of the skin, soft tissue and bones. Conclusion. In the paper, we discussed the manner of death in this case, as well as the medicolegal implications. .
Myocardial infarction and nocturnal hypoxaemia
Authors: Pencic Biljana , Dekleva Milica , Celic Vera , Rasic Zorica
Published: July 2008

Introduction: There is an increased risk of cardiovascular morbidity and mortality in patients with nocturnal intermittent hypoxaemia. Objecive. The aim of this study was to evalute the influence of nocturnal hypoxaemia on ventricular arrhythmias and myocardial ischaemia in patients with myocardial infarction (MI). Method. We studied 77 patients (55.8?7.9 years) with MI free of complications, chronic pulmonary diseases, abnormal awake blood gases tension. All patients underwent overnight pulse oximetry and 24-hour electrocardiography. Patients were divided into two groups according to nocturnal hypoxaemia. Total number of ventricular premature complex (VPC); maximal VPC/h; incidence of VPC Lown class>2 and occurrence of ST-segment depression were analyzed for nocturnal (10 PM to 6 AM), daytime (6 AM to 22 PM) periods and for the entire 24 hours. Results. Both groups were similar in age, gender, standard risk factors, myocardial infarction size and did not differ in VPC during the analyzed periods. The number of nocturnal maximal VPC/h was insignificantly greater in group 1 (with hypoxaemia) compared to group 2 (without hypoxaemia), (p=0.084). Maximal VPC/h did not differ significantly either for daytime or for 24 hours among the groups. Nocturnal VPC Lown>2 were significantly more frequent in group 1 (25% vs 0%, p=0.002). The incidence of VPC Lown>2 was similar during the daytime, and during 24 hrs in both groups. Occurrence of ST-segment depression did not differ between groups 1 and 2. Conclusion. Nocturnal hypoxaemia was associated with complex nocturnal ventricular arrhythmias in patients with MI. .
The influence of direct intramuscular corticosteroid therapy on parameters of venous circulation in hypoxaemic fetuses
Authors: Babovic Ivana , Plesinac Snezana , Opalic Jasna , Plecas Darko , Ljubic Aleksandar
Published: July 2008

Introduction: The influence of glucocorticosteroid therapy on fetal lung maturation is evident but little is known about its effects on parameters of fetal venous circulation. Objective. The aim of the study was to assess the influence of direct intramuscular (i.m.) fetal corticosteroid therapy (CST) on parameters of fetal venous circulation which indicates a degree of fetal hypoxia. Method. The prospective study was conducted at the Institute of Gynaecology and Obstetrics during 2001. We evaluated the influence of direct i.m. fetal single dose dexamethasone (2 mg/ kg estimated fetal weight by sonographic examination) on foetal ductus venosus (DV) and vena cava inferior (VCI) velocities in 49 fetuses 24 hours before and after therapy. Results. There is positive correlation with the statistical significance in systolic/diastolic ratio (S/D) in DV before and after the corticotherapy r=0.366; p=0.018. Reverse flow during contraction of the right atrium in DV was found in 55.6% of fetuses after CST. Reverse flow during the contraction of the right atrium in VCI was found in 3 fetuses before CST and in 4 fetuses after CST. We found positive correlation without statistical significance between the vena cava pre-load indices before and after CST (r=0.127; p= 0.428). There is positive correlation with the statistical significance between systolic flow in VCI before and after CST (r=0.478; p=0.002). Conclusion. Corticosteroid therapy influences parameters of fetal venous circulation. Its influence depends on duration of fetal hypoxia. The parameters of fetal venous circulation can be a predictor of the perinatal outcome. .
Primary abductor hip contracture as diagnostic, prognostic and therapeutic problem in child hip pathology
Authors: Pajic Milos , Vukasinovic Zoran
Published: July 2008

Coxa obliqua represents a special functional entity in the pathology of the child hip. Authors have confirmed the results of S.L. Weissman and B. Strinovic which claimed that the abductor contracture of the hip was a primary congenital condition that developed as a result of intrauterine malposition, leading later to the contralateral adductor contracture. Critical period for the development of complications was between 6 and 8 month after birth, adductor contracture might keep persisting together with the development of acetabular dysplasia, and later on with ipsilateral subluxation. This malformation has usually been diagnosed within 3 and 6 months of age. It could be connected with some other signs of malposition, such as plagiocephaly, torticollis or infantile thoracic C scoliosis. For the diagnosis of coxa obliqua, the examination of hips in the prone position was very important and the ultrasonic and radiological examinations were crucial. The applied treatment used to be exclusively physical rehabilitation. Wide diapering has been contraindicated. In this study, we included 2,500 newborns, 1,300 boys and 1,200 girls (5,000 hips). In 22 cases of coxa obliqua (10?), the excellent results were obtained in 96% of cases. In two unsuccessfully treated cases, a contralateral dysplasia developed, and in one untreated, subluxation. The authors are advocating a systematic and early detection and treatment of the primary coxa obliqua. .
IgG serum antibody responses in suspected liver cystic echinococcosis patients
Authors: Radonjic Ivana , Dzamic Aleksandar , Arsic-Arsenijevic Valentina , Djukic Slobodanka , Mitrovic Sanja
Published: July 2008

Introduction: Cystic echinococcosis is a parasitic zoonosis caused by a tapeworm Echinococcus granulosus. Liver infection is the most common form of human echinococcosis. Diagnosis of liver echinococcosis could be made by different methods. It is very important to have good anamnesis and epidemiological evaluation, clinical status and clinical investigations such as X-ray examination, ultrasonography, nuclear magnetic resonance, computerized tomography, laboratory analysis and serology. Different serologic tests could be used for diagnosis of echinococcosis: complement fixation test, immunoelectrophoresis, indirect haemagglutination, latex agglutination, indirect fluorescence test and enzyme immunoassays sush as ELISA test. Objective. The aim of this study was to investigate anti-E. granulosus antibodies by ELISA test as a complementary laboratory method in the diagnosis of human echinococcosis. Method. In this study, we investigated 212 patients of suspected liver cystic echinococcosis. ELISA test was used for detection of whole anti-E. granulosus IgG antibodies specific for AgB. Results. Out of 212 patients, in 26 (12.26%) patients echinococcosis was confirmed by ELISA test. In 7/26 patients who had data about the ultrasonographic morphological type of cyst according to Gharbi, high values of seropositivity were found. Borderline values were found in 15/212 (7.08%) patients. In three patients with borderline values, second sera samples were examined after 18-22 days. In one patient, the test showed the same value, in the second patient echinococcosis was confirmed while in the third, the test showed a negative value. In 171 (80.66%) patients, anti-Echinococcus antibodies were not found by ELISA test. Conclusion. It has already been known that serological investigation has some limitations, but detection of specific antibodies remains an indispensable mark in evaluation of suspected liver cystic echinococcosis patients. .
Effects of nonlinear error correction of measurements obtained by peak flowmeter using the Wright scale to assess asthma attack severity in children
Authors: Stamatovic Dragana , Bokan-Erdeljan Nada
Published: July 2008

Introduction: Monitoring of peak expiratory flow (PEF) is recommended in numerous guidelines for management of asthma. Improvements in calibration methods have demonstrated the inaccuracy of original Wright scale of peak flowmeter. A new standard, EN 13826 that was applied to peak flowmeter was adopted on 1st September 2004 by some European countries. Correction of PEF readings obtained with old type devices for measurement is possible by Dr M. Miller?s original predictive equation. Objective. Assessment of PEF correction effect on the interpretation of measurement results and management decisions. Method. In children with intermittent (35) or stable persistent asthma (75) aged 6-16 years, there were performed 8393 measurements of PEF by Vitalograph normal-range peak flowmeter with traditional Wright scale. Readings were expressed as percentage of individual best values (PB) before and after correction. The effect of correction was analyzed based on The British Thoracic Society guidelines for asthma attack treatment. Results. In general, correction reduced the values of PEF (p<0.01). The highest mean percentage error (20.70%) in the measured values was found in the subgroup in which PB ranged between 250 and 350 l/min. Nevertheless, the interpretation of PEF after the correction in this subgroup changed in only 2.41% of measurements. The lowest mean percentage error (15.72%), and, at the same time, the highest effect of correction on measurement results interpretation (in 22.65% readings) were in children with PB above 450 l/min. In 73 (66.37%) subjects, the correction changed the clinical interpretation of some values of PEF after correction. In 13 (11.8%) patients, some corrected values indicated the absence or a milder degree of airflow obstruction. In 27 (24.54%) children, more than 10%, and in 12 (10.93%), more than 20% of the corrected readings indicated a severe degree of asthma exacerbation that needed more aggressive treatment. Conclusion. Correction of PEF values obtained by peak flowmeters with traditional Wright scale shows a possibility of overtreatment in younger or short stature children and undertreatment in older or taller ones if we use old type of metres. The correction of peak flowmeter for non-linear error is a prerequisite in the application of asthma guidelines in PEF measurements. .
Association between socio-economic status and sexual behavior of adolescents
Authors: Vukovic Dejana , Bjegovic-Mikanovic Vesna
Published: July 2008

Introduction: Numerous studies have emphasized the importance of contextual factors as determinants of sexual behavior of adolescents. It has been found that lower socioeconomic status is associated with risky sexual behavior. Sexual behavior is individual but develops under strong influence of cultural and other influences. Objective. The aim of this study was to investigate the association of family?s socioeconomic status and risky sexual behavior of adolescents in Belgrade. Method. Self-administered questionnaire was used in secondary schools in Belgrade, and 1,782 adolescents attending first grade filled the questionnaire. For the analyses of predictors of risky sexual behavior, multiple logistic regression was used. Results. Parents? occupations did not show significant association with any of analyzed behaviors. Adolescents who received weekly disposable money above average were 2.5 times more likely to ever have had sexual intercourse, and if sexually active were more likely to use contraception. Perceived family?s wealth was a significant predictor of ever having sex (OR=1.9; CI 1.2-2.8) and not using contraception (OR=4.3; CI 1.2-15.0). Conclusion. Socioeconomic status is associated with sexual behaviors of adolescents. Fifteen-year olds who perceive their families as wealthier are more likely to ever have had sex and not use any kind of contraception. Adolescents with higher weekly income are more likely to ever have had sex and use contraception than their counterpats with less weekly disposable money. .
Benign solitary fibrous pleural tumor and hypoglycaemia
Authors: Milenkovic Branislava , Stojsic Jelena , Dudvarski Aleksandra , Bosnjak-Petrovic Vesna , Ercegovac Maja
Published: July 2008

Introduction: Solitary fibrous tumors of the pleura are uncommon and discovered fortuitously or in patients with non-specific respiratory symptoms. When associated with hypoglycaemia, they are commonly referred to as Doege-Potter syndrome. Case outline. A 68-year old woman presented with a large pleural mass. She had a long history of headache and decreased consciousness with one-year worsening dyspnoea and right-sided chest pain. The chest X-ray revealed an enormous opacity occupying almost the entire right hemithorax. Endocrine tests showed an extremely reduced glucose level and blood concentration of insulin, C-peptide, glucagon, growth hormone and catecholamines within normal range. After fine-needle aspiration, by histological and immunohistochemical analysis, a benign solitary fibrous pleural tumor was diagnosed. Although surgical resection of such a huge tumor with hypoglycaemia is usually curative, our patient declined surgery and opted for conservative treatment with intravenous glucose. Conclusion. Clinicians should be aware of this rare, but important cause of hypoglycaemia and exclude a fibrous pleural tumor in the assessment of their patients. .
Stromal tumor of duodenal autonomous nerves (plexosarcoma)
Authors: Colovic Radoje , Micev Marjan , Radak Vladimir , Grubor Nikica , Colovic Natasa , Latincic Stojan
Published: July 2008

Gastrointestinal tumors arising from autonomous nerves of Meisner?s or Auerbach?s plexus (plexomas and plexosarcomas) are rare tumors in only 87 cases described in the literature up to 2001. We present a very rare case of gastrointestinal stromal tumor (plexosarcoma) of the third and fourth portion of the duodenum, 130x98x87 mm in diameter, arising from its back wall, with central necrosis of the well circumscribed tumor, which communicated with the duodenum through an ulceration of 15x7mm in diameter, spreading towards the great vessels of the retroperitoneum. It was gradually and carefully removed, together with 17 cm of the duodenum and few centimeters of the jejunum with end-to-end duodenojejunostomy below the Vater?s papilla. During the removal of the tumor, the superior mesenteric artery, being within the tumor?s capsule, was accidentally ligated but not transsected. In spite of the removal of the ligature, the artery became thrombosed due to damage of the intima by ligature so that it had to be resected and reanastomosed. After otherwise uneventful recovery, except for a mild pus discharge through the drain, not far from the arterial anastomosis, the patient suddenly started bleeding on the 13th day after surgery. At emergency reoperation, a rupture of the mesenteric artery above the thrombosed anastomosis was found. In spite of absence of the arterial pulsation within the mesentery, the bowel looked vital and the back flow from the artery was satisfactory. The arterial rereconstruction was not possible, so the artery was ligated. The postoperative recovery was surprisingly uneventful. The patient was discharged ten days after surgery and has stayed symptom-free so far. .
Camptomelic dysplasia: A case report
Authors: Kos Radmila , Medjo Biljana , Grkovic Slobodanka , Nikolic Dimitrije , Sajic Silvija , Ilic Jelena
Published: July 2008

Campomelic/camptomelic dysplasia is a very rare, severe osteochondrodysplasia characterised by severe skeletal and nonskeletal malformations and lethal outcome mainly in neonatal period. Characteristic abnormality by which the syndrome got its name is short, bowed long bones of lower extremities, most often of femur, manifested by short and bowed legs. Skin dimpling on tibial anterior side is another prominent characteristic of this syndrome. Severe cases are inherited by autosomal dominant trait, by mutation Sox9 gene on chromosome 17, with lethal outcome in the first days of life. Less severe forms of the disease are due to balanced translocation t (13;17) with life span up to the third decade of life. A majority of karyotypic males present as phenotypic females. We report a case of a female neonate, without consanguinity between parents, with characteristic signs of camptomelic dysplasia with short birth length of 46 cm, macrocephaly (head circumference 39 cm), dolichocephaly, hydrocephalus, short trunk and legs. Narrow rib cage, bowed lower extremities, short hand and foot phalanges, nail hypoplasia were noticed. Anterior fontanelle was enlarged, high forehead, face small and flat, hypertelorism, low nasal bridge, micrognathia, low set ears, cleft palate, were found. Characteristic skin dimpling on anterior side of tibia was present on both legs. Bone X-ray studies presented the following changes: anterior bowing of shortened femurs, hip dislocation, cervical vertebrae, scapulas, eleven pairs of slender ribs. Hip luxation. Karyotype was normal for a female, 46 XX. Respiratory insufficiency was present since birth, exacerbated, and led to lethal outcome in the second day of life, as described in the majority of these patients. .
Erythromycin in therapy of cyclic vomiting syndrome
Authors: Pavlovic Momcilo , Radlovic Nedeljko , Lekovic Zoran , Berenji Karolina
Published: July 2008

Cyclic vomiting syndrome is an insufficiently understood disorder which manifests itself in stereotypical episodes of vomiting with no detectable organic cause. Considering its unknown aetiology, drugs borrowed from various medication classes are applied in the therapy of this disorder, with variable success. Among other medicaments, erythromycin is also used in treatment of cyclic vomiting syndrome. This is a case study in which the application of erythromycin led to the prevention of attacks of cyclic vomiting syndrome. Our case report presents how periodical erythromycin therapy in two-week intervals at expected attack periods in a girl led to disappearance of cyclic vomiting. Adverse effects of erythromycin did not show up.