bluuebunny/crossref_metadata_2025 huggingface dataset:
Do stone size and impaction influence therapeutic approach to proximal ureteral stones?
Authors: Radulovic Slobodan , Vuksanovic Aleksandra , Milenkovic-Petronic Dragica , Vavic Bozo
Published: December 2010

Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.
Multiple gigantic renal cysts
Authors: Zivkovic Sladjana , Pavlovic Svetlana , Ciric Slobodan
Published: December 2010

Introduction. Cystic renal lesions are very heterogeneous lesions which differ in ethiopathogenesis, morphological and clinical manifestations, and also in evolution and therapy. Classification of cystic lesions is complex, symptomatology is poor, and diagnosis is based on complete radiological diagnostic procedures. Case report. We presented a 20-year old patient with mild subjective symptoms. Objectively, he was without positive clinical signs and changes in biochemistry of blood. Using ultrasonography (US) multiple serous simple cysts were found in both kidneys. Using computed tomography (CT) multiple serous cysts were found, without changes in cystic walls, with preserved renal parenchyma and without cystic changes on other parenchymatous organs. Conclusion. Although renal cystic lesions are frequent in adult population, this is a rare example of a young adult man with simple, gigantic, serous cysts which do not produce clinical manifestations nor functional renal difficulty so far.
Residual monomer content determination in some acrylic denture base materials and possibilities of its reduction
Authors: Kostic Milena , Krunic Nebojsa , Nikolic Ljubisa , Nikolic Vesna , Najman Stevo , Kocic Jelena
Published: December 2010

Background/Aim. Polymethyl methacrylate is used for producing a denture basis. It is a material made by the polymerization process of methyl methacrylate. Despite of the polymerization type, there is a certain amount of free methyl methacrylate (residual monomer) incorporated in the denture, which can cause irritation of the oral mucosa. The aim of this study was to determine the amount of residual monomer in four different denture base acrylic resins by liquid chromatography and the possibility of its reduction. Methods. After the polymerization, a postpolymerization treatment was performed in three different ways: in boiling water for thirty minutes, with 500 W microwaves for three minutes and in steam bath at 22? C for one to thirty days. Results. The obtained results showed that the amount of residual monomer is significantly higher in cold polymerizing acrylates (9.1-11%). The amount of residual monomer after hot polymerization was in the tolerance range (0.59- 0.86%). Conclusion. The obtained results denote a low content of residual monomer in the samples which have undergone postpolymerization treatment. A lower percent of residual monomer is established in samples undergone a hot polymerization.
Sentinel lymph node biopsy in breast neoplasms
Authors: Visnjic Milan , Kovacevic Predrag , Djordjevic Goran
Published: December 2010

Background/Aim. Sentinel node (SN) is the first draining node from the malignant tumor site. In the last decade, sentinel node biopsy (SNB) has been introduced as an alternative to axillary dissection in breast cancer. In patients with negative SNB (sentinel node uninvolved with malignancy) axillary dissection is not recommended. The aim of this stady was defining the indications for SNB, and SNB principles, as well as the survey of our first experiences. Methods. In the period from 2004 to 2008, we performed 78 SNBs in 75 patients (72 females, 3 males) with breast cancer. Indications for SNB were T1-2 and N0 lesions according to TNM classification (Tumor, Nodus Methastasis). In all cases, lymphoscintigraphy was done first, and then SNB with double contrast (methylen blue and technetium - Tc-99). In 57 (73%) cases, one SN was confirmed, and in 21 (26.9%) 2 nodes. Results. In 58 (74.3%) SNB, SN pathohistology was negative, i.e. there were no cancer metastases. In this group of patients, axillary dissection was not done in 47 (81%) SNB. In the remaining 11 (18.9%), lymphonodal dissection level I and II was done after SNB, regardless of the presence or no presence of metastases within SN. All the cases were monitored from six months to one year of the operation and disease progression was not observed. Conclusion. Sentinel node biopsy is an acceptable method of breast cancer diagnosis and a good alternative to lymphonodal dissection if there are no metastases within SN. The technique is relatively simple, but requires team work of experienced specialists: surgeons, nuclear medicine specialists and anesthesiologists. Our first experiences suggest a high degree of reliability of the method in selected patients and with well trained team of doctors.
Correlation between antibiotic consumption and bacterial resistance as quality indicator of proper use of these drugs in inpatients
Authors: Velickovic-Radovanovic Radmila , Petrovic Jasmina , Kocic Branislava , Antic Snezana , Randjelovic Gordana
Published: December 2010

Background/Aim. Antibiotics are the most frequently used medications in Serbian hospitalized patients. Information about antibiotic utilization and sensitivity among inpatients in Serbia is scanty, and there are no available publications on the topic. The aim of this study was to investigate the correlation between antibiotic use and bacterial resistance in the Clinical Center Nis, one of the biggest hospitals in Serbia. Methods. The data on antibiotics use in inpatients were obtained from the database of the Department of Pharmacotherapy and expressed as defined daily doses per 100 bed-days (DBD), during 2003-2007. Bacterial resistances were given as percentages of resistant isolates. Results. During the investigation period, the overall consumption of antibiotics had a significant decrease in 2007, by 22.99% (62.23 : 47.92 DBD; p < 0.05). The most frequently used antibiotics were cephalosporins, followed by penicillin's, aminoglycosides and quinolones. Hospital aminoglycosides consumption was reduced in 2007 to 59.9% (13.4 : 5.53 DBD) while the resistance to amikacin was reduced from 40.88% to 32.1%. However, utilization of ciprofloxacin had a significant increase in 2007 (120.7%). There was an alarming increase in the level of resistance to ciprofloxacin in our hospital (from 13.5% to 28.3 % in Escherichia coli and from 11.1 to 30.09% in Proteus mirabilis). Reduction of E coli resistant to amoxicillin+clavulanic acid correlated significantly with their utilization, while the resistance for all isolates decreased from 52.16% to 24.40%. Conclusions. These results confirm an association between the use of antibiotics and the prevalence of resistance. This methodology could provide good quality indicators of rational drug use and serve for local monitoring of antibiotics use and resistance, as well as for external comparison.
Effects of epidural anesthesia on I and II delivery stage and on a newborn
Authors: Cutura Nedjo , Soldo Vesna , Curkovic Aleksandar , Tomovic Branko , Mitrovic Tanja
Published: December 2010

Background/Aim. Epidural anesthesia (EA) is the most efficient method of pain reduction and its total elimination during delivery. The aim of this study was to establish an influence of EA on the first and the second part of delivery process, frequency of vacuum extractor and forceps appliance, and the effect of EA on the newborn. Methods. A total of 360 patients with EA were analyzed at delivery and 1 130 controls without EA. Both groups had vaginal delivery. In both groups deliveries were stimulated by 10 IU of oxytocin in 500 mL of crystalloid solvent, with 15-20 drops per minute. As anaesthetic, Bupivacain (0,25% or 0, 125%) was used by the 18 G catheters Braun and Wigon. Level of application was L2-L3 part of spine. Results. The results of this study indicate that deliveries with EA were shorter in duration, but also had much more vacuum extractor and forceps appliance (over 2.5 times) than those without EA. Apgar score was significantly higher in the experimental group with multiple deliveries. However, there was no significant deference between average Apgar score of newborns of patients with EA and that of newborns of patients without EA. Conclusion. Application of EA decreases duration of delivery, and has no any adverse effects on newborns.
Thrombocyte aggregation, endothelial dysfunction and acute myocardial infarction
Authors: Pavlovic Predrag , Tavcioski Dragan , Stamenkovic Emina
Published: December 2010

 Akutni infarkt miokarda u razvijenim i srednje razvijenim zemljama jedan je od najcescih uzroka mortaliteta i morbiditeta, pa poznavanje patofiziologije ateroskleroze i aterotromboze predstavlja najveci izazov savremenoj medicini. Najcesci uzrok AIM je ateroskleroza epikardnih koronarnih arterija sa posledicnom rupturom i/ili erozijom aterosklerotskog plaka, nastajanjem intrakoronarne tromboze i prekida cirkulacije arterijske krvi u predelu irigacije infarktne arterije. Sklonost ka aterosklerozi ne znaci po pravilu i sklonost ka trombozi, i obrnuto. Mnogobrojni faktori rizika od ishemijske bolesti srca modifikuju funkciju hemostaznog sistema, remete ravnotezu izmedju proagregatornih i antiagregatornih, prokoagulantnih i antikoagulantnih, profibrinolitickih i antifibrinolitickih mehanizama. Na taj nacin genetski uslovljena sklonost ka trombozi potencira se faktorima rizika, sto zajedno vodi ka aterotrombozi i akutnom koronarnom sindromu. Fizicko opterecenje je jedan od faktora rizika od ishemijske bolesti srca. Efekat zavisi od vrste opterecenja, duzine trajanja i stepena utreniranosti bolesnika. Umerena fizicka aktivnost kroz duzi vremenski period ima protektivni znacaj kod bolesnika sa ishemijskom bolescu srca, jer poboljsava funkciju endotela, smanjuje oksidativni stres na nivou endotela, smanjuje broj i aktivnost trombocita kao i aktivnost mnogih faktora koagulacije i na taj nacin smanjuje ucestalost ponovnih koronarnih dogadjaja. Nasuprot tome, akutna fizicka aktivnost dovodi do izrazenog prokoagulantnog stanja sto na terenu disfunkcije endotela i specificnosti hemostaznog sistema moze provocirati ponovnu koronarnu trombozu.
The incidence of difficult intubation in 2 000 patients undergoing thyroid surgery: A single center experience
Authors: Kalezic Nevena , Milosavljevic Radoje , Paunovic Ivan , Zivaljevic Vladan , Diklic Aleksandar , Matic Danica , Ivanovic Branislava , Neskovic Vojislava
Published: December 2010

Background/Aim. The incidence of difficult intubation (DI) is 1-10%, and DI leading to inability to intubate occurs in 0.04% of the population. The aim of this study was to evaluate the incidence of DI in thyroid surgery and to assess possible correlation of difficult tracheal intubation with sex and primary diagnosis. Methods. We studied 2 000 consecutive patients (1 705 females) scheduled for thyroid surgery who were assessed for DI prior to general anesthesia, with respect to primary disease diagnosis and sex. Patients were divided into four groups: patients with nodal goiter (group A), polynodal goiter (group B), hyperthyroidism (group C) and thyroid carcinoma (group D). Difficult intubation was predicted using the scoring system which included 13 parameters ranged from 0 to 2. Additive score > 5 was accepted as a predictor of DI. True DI was defined as impossible visualization of glottis with direct laryngoscopy (grade III and IV). Results. Difficult intubation was observed in 110/2 000 patients (5.5%). The incidence of DI was higher in males (26/295, 8.8%) then females (84/1 705, 4.9%) (p < 0.01). The incidence of DI was highest in the group B (6.2%). Extremely DI occurred in 15/2000 patients (0.75%), the most of them in the group C (1.1%). Sensitivity of used scoring system was 91.8% and specificity 86.5%. Conclusions. The incidence of DI was highest in patients with polynodal goiter but extremely DI was present mostly in patients with hyperthiroidism. Men seem to be at higher risk for DI than women. Scoring system used in this study for prediction of DI may be useful in this patient population.
Estimation of 99mTc-ciprofloxacin accumulation indexes in bone and joint bacterial infections
Authors: Pucar Dragan , Jankovic Zoran , Dugonjic Sanja , Popovic Zoran
Published: December 2010

Background/Aim. 99mTc-ciprofloxacin is a radiopharmaceutical preparation sintetized to improve diagnostic accuracy of bacterial infections in human tissues. It is mostly applied in diagnosis of bone and joint infections. Many papers have confirmed its sensitivity to infection, but newer papers argued its specificity. The aim of this study was to compare the results of visual analysis of scintigrams to semiquantitative calculations of accumulation indexes with the assumption that calculation of indexes would improve the specificity for bone and joint infections. Methods. We examined 40 patients, 25 with confirmed bone and joint bacterial infections and 15 patients with bone and joint diseases without bacterial infection. Scintigraphy was performed 5 minutes, 1, 4 and 24 hours after intravenous (iv) injection of 99mTc-ciprofloxacin. Scintigrams were analyzed visually and by calculation and comparation of accumulation indexes values. Results. Visual sensitivity was 94%, but specificity only 47%. Index calculation achieved much higher specificity (100% after 1, 4 and 24 hours for cut off value of 1.50). All basic index values (5 min) in the patients with infections increased in 24 hours. In 8 patients without infection occurred a slight increase and in 7 patients decrease of basic index values. Conclusion. Calculation of accumulation index values is needed in the use of 99mTc-ciprofloxacin scintigraphy as it is the only way to improve specificity for bacterial bone infections. Visual interpretation of results is sensitive, but not specific due to accumulation of the drug in a high percent of non infected bone and joint lesions.
Denonvilliers' advancement flap in congenital alar rim defects correction
Authors: Novakovic Marijan , Baralic Ivanka , Stepic Nenad , Rajovic Milica , Stojiljkovic Vladimir
Published: December 2010

Background. Alar rim defects are mostly acquired, resulting from burns, traumas or tumor excision. Sometimes they can accompany craniofacial clefts. However, isolated congenital alar defects are extremely rare. Case report. We presented two cases of congenital isolated alar cleft. The defect was closed by the use of an advancement flap, the technique described by Denonvilliers. We achieved both symmetry and appropriate thickness of the nostrils. Skin color and texture of the alar rim were excellent, with scars not excessively visible. Conclusion. Denonvilliers' z-plasty technique by using advancement flap provides both functionally and aesthetically satisfying outcome in patients with congenital alar rim defects.
Risk factors for the occurrence of cardovascular system diseases in students
Authors: Stojanovic Dusica , Visnjic Aleksandar , Mitrovic Vladimir , Stojanovic Miodrag
Published: December 2010

Background/Aim. Cardiovascular diseases are a leading cause of death in the majority of developed, as well as in many developing countries. The aim of this study was to determine cardiovascular risk factors in student population and to suggest possible measures for prevention. Methods. The study was carried out during 2007-2008 at the School of Medicine, University of Nis. It included 824 students in their final year (220 males, 604 females). Results. There was no significant difference in prevalence of hypertension among the male (1.81%) and female students (0%). The prevalence of obesity (Body Mass Index - BMI > 30 kg/m2) was significantly higher (p < 0.001) in the male (7.27%) than in the female population (1.32%). Abdominal obesity was also more frequently encountered (p < 0.01) in the male (9.09%) than in female population (1.32%). Every fourth student smoked cigarettes with no significant difference between the male and female students. Alcohol consumption was a significantly higher problem (p < 0.001) in the male population (18.18%) than in the female one (2.65%). Physical inactivity was more often found (p < 0.001) in the female students (65.56%), than in male ones (36.36%). By the bivariate correlation of cardiovascular risk factors, it was determined that in the male student population systolic blood pressure correlated significantly with diastolic blood pressure, BMI and waist size, whereas age correlated with sistolic blood pressure, waist size and smoking. In the female students sistolic blood pressure correlated with diastolic blood pressure, BMI and waist size; diastolic blood pressure correlated with BMI and physical inactivity; cigarette smoking correlated with alcohol consumption and age. Conclusion. Cardiovascular risk factors are present in the final-year students of the School of Medicine, University of Nis. It is necessary to insist on decreasing obesity prevalence, cigarette and alcohol consumption, and on increasing physical activity of students in order to prevent cardiovascular diseases.
Fatal diquat intoxication
Authors: Jovic-Stosic Jasmina , Babic Gordana , Todorovic Veljko
Published: December 2010

Background. Since the introduction of diquat in agriculture practice in 1960's, about 40 cases of poisoning have been described in detail in medical literature. Case report. We presented two cases. A case one, a 35-year-old, previously healthy, woman ingested 14% diquat solution. The poisoning had fulminant course, consisted of severe stomachache, vomiting, cardiocirculatory shock, respiratory failure and cardiac arrest 20 hours post-ingestion. Autopsy revealed myocardial infarction, bronchopneumonia and incipient renal damage. A case two, a 64-year-old man developed severe gastroenteritis, corrosive lesions of mucosal surfaces, acute renal injury, arrhythmias, brain stem infarction and bronchopneumonia. The diagnosis of diquat poisoning was made retrospectively upon the clinical picture and identification of pesticides he had been exposed to. The patient died 18 days post-exposure. The most prominent findings on autopsy were pontine hemorrhage and infarction, bronchopneumonia, left ventricle papillary muscle infarction and renal tubular damage. Conclusion. Cardiocirculatory disturbances led to fatal complications, the heart and brain infarction. We pointed out the heart as one of the most severely affected organs in diquat poisoning.
Preoperative echocardiographic parameters influencing quality of life five years after coronary artery bypass graft surgery
Authors: Zdravkovic Marija , Ristic Miljko , Milic Natasa , Zdravkovic Darko , Krotin Mirjana , Randjelovic Tomislav
Published: December 2010

Background/Aim. Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life has not been still implemented in everyday work and preoperative echocardiographic factors affecting the quality of life in patients undergoing coronary artery bypass graft surgery have been poorly documented. The aim of this study was to evaluate echocardiographic parameters influencing quality of life following coronary artery bypass graft surgery and its correlation with widely used Parsonnet score. Methods. A total of 449 consecutive patients with myocardial revascularization, operated during 1999 and 2000 were enrolled in this retrospective-prospective study. The patients with comorbidities were excluded as well as those with in complete myocardial revascularization. A group of 180 patients who accepted to participate in quality of life evaluation was followed for 60 months. The quality of life was evaluated using a questionnaire SF-36. Results. The mean patients' age was 57.8 ? 7.8 years, 79.4% were males. A 5-year survival was 84.2%. The mean number of risk factors was 3.4 ? 1.0. Most of the patients were in New York Heart Associatiation (NYHA) II class (104 of them or 59.4%), 61 of them (34.9%) in NYHA III class and only 10 patients or 5.7% of them were in NYHA IV class. The mean End-Diastolic Diameter (EDD) was 55.3 ? 5.6 mm, mean End- Systolic Diameter (ESD) 38.7 ? 5.6 mm and mean ejection fraction (EF) 51.7 ? 9.6%. Left atrium dilatation (p < 0.001), as well as left ventricle dilatation (p < 0.001), low left ventricle ejection fraction (p < 0.001), multisegmental disorders of contractility (p < 0.001), and severe mitral regurgitation (p < 0.001) were in negative correlation with almost all dimensions of quality of life. ROC analysis showed that left ventricle EDD of 54.5 mm can be used as good cut-off value for prediction of optimal quality of life, with sensitivity of 57% and specificity of 70% (RR = 1.386), left ventricle ESD of 37.5 mm with sensitivity of 65% and specificity of 57% (RR = 0.855) and left ventricle EF of 50% with sensitivity of 61% and specificity of 70% (RR = 0.916). Conclusion. Echocardiographic parameters, that can easily be obtained preoperatively, have strong predictive value not only in postoperative survival, but also in determination of the quality of life of the patients five years after coronary artery bypass graft surgery.
Reliability of the thyroid stimulating hormone receptor antibodies level determination in diagnosing and prognosing of immunogenic hyperthyroidism
Authors: Aleksic Aleksandar , Aleksic Zeljka , Mitov Vladimir , Jovic Miljan
Published: December 2010

Background/Aim. Graves disease (GD) is defined as hyperthyroidism with diffuse goiter caused by immunogenic disturbances. Antibodies to the thyroid stimulating hormone (TSH) receptors of thyroid gland (TRAb) have crucial pathogenetic importance in the development and maintenance of autoimmune hyperthyroidism. The aim of this study was to identify sensitivity, specificity, positive an negative predictive value of TRAb level in sera of patients with GD as well as to estimate significance of TRAb level for remission and GD relapses occurrence. Methods. We studied prospectively and partly retrospectively 149 patients, 109 female and 40 male patients, 5-78 years old, in the period 1982-2007. There were 96 patients with GD. The control group consisted of 53 patients, 21 with hyperthyroidism of second etiology and 32 patients on amiodarone therapy, with or without thyroid dysfunction TRAb was measured by radioreceptor assay (TRAK Assay and DYNO Test TRAK Human Brahms Diagnostica GMBH). Results. According to the results the sensitivity (Sn) of TRAb test was 80%, specificity (Sp) 100%, positive predictive value (PP) 100% and negative predictive value (NP) 83%. Also, the Sn of hTRAb test was 94%, Sp 100%, PP 100% and NP 94%. Our results show that an increased level of TRAb/hTRAb at the beginning of the disease and the level at the end of medical therapy is associated with an increased number of GD relapses and a shorter remission duration. Conclusion. Detection and measurement of TRAb in serum is a very sensitive method for diagnosing GD and very highly specific in vitro method for differential diagnosis of various forms of hyperthyroidism. Clinical significance of differentiating various forms of hyperthyroidism, using this in vitro assay, lays in adequate therapeutic choice for these entities.
The quality of life of lumbar radiculopathy patients under conservative treatment
Authors: Boskovic Ksenija , Todorovic-Tomasevic Snezana , Naumovic Nada , Grajic Mirko , Knezevic Aleksandar
Published: December 2010

Background/Aim. The quality of life of lumbar radiculopathy patients conditioned by their health status is a result of both their subjective perception of the disease and their objective health status. The aim of this study was to evaluate the quality of life of lumbar radiculopathy patients under conservative treatment by means of generic and another lumbar syndrome specific questionnaires. Methods. A total of 50 patients (33 males, 17 females average age 46.1 years,) under conservative treatment in a hospital over four weeks were included in the study. They were interviewed using two questionnaires: the SF36 (Short form (36) Health Survey) generic questionnaire measuring eight domains of their quality of life summarized into two main ones (i.e. overall physical and overall mental health), and the lumbar syndrome specific North American Spine Society - Low Back Pain Outcome Instrument (NASS LBP), a questionnaire measuring four domains (functional limitations, motor and sensitive neurological symptoms, expectations from the treatment and satisfaction with it). Results. The values of physical health domain was low as 31.1 at the beginning of the treatment, were rising over the following six months and dropped insignificantly after four years (42.1/48.7 /47.0) The mental health values (47.2) did not alter as compared to that of the general population. A values of the quality of life stabilized within six months. The neurological symptoms domain did not correlate with other value scales and domains. Conclusion. The quality of life of lumbar radiculopathy patients was impaired only from its physical aspect, but after conservative treatment it improved over the following six months. After four years there is an insignificant drop of all quality of life values, indicating a need for a longer term monitoring of there patients.
Acute renal failure in premature neonates
Authors: Doronjski Aleksandra , Stojanovic Vesna , Spasojevic Slobodan , Kovacevic Branka , Pavlovic Vesna , Nikolic Marko , Savic Radojica
Published: December 2010

Background/Aim. Hemodynamic stress is the leading cause of acute renal failure (ARF) in premature neonates. Incidence of ARF in this population is between 8 and 24%. The aim of this study was to determine the frequency of presence of ARF in premature neonates, as well as its impact on their survival. Methods. A retrospective study of 114 premature neonates [(gestational age, GA less than 37 gestation weeks (gw)] admitted to the Intensive Care Unit (ICU) at the Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina in 2007 was conducted. Serum creatinine, urea and bilirubine were determined on the 3rd day of life in 65 newborns who met inclusion criteria. ARF was diagnosed in 16 newborns (n=16/65; 25%). Results. The premature neonates with ARF had significantly lower GA [<28 gw - 8/16 (50%) vs. 5/49 (10%); p < 0.05], birth weight (BW) (1 265 g vs. 1615 g; p < 0.05) and systolic blood pressure (43.37 mm Hg vs. 52.7 mmHg; p < 0.05) than ones without ARF. Non-olyguric ARF was diagnosed in 62% of newborns with ARF (n=10/16), while the rest had the olyguric type (n = 6/16; 38%). Twenty-five percent of premature neonates with ARF (n = 4/16) died in contrast to 10% of premature neonates without ARF (n = 5/49). ARF was treated conservatively in all but 3 cases when peritoneal dialysis was performed. Renal function has recovered completely in all of the survivors. In order to determine their predictivity in relation to ARF, following parameters were analyzed: GA, BW < 1 500 g, presence of concomitant sepsis and intracranial hemorrhage grade III/IV. BW < 1 500 g demonstrated the highest sensitivity (se 0.75), while GA < 28 gw, sepsis and intracranial hemorrhage grade III/IV showed high specificity (sp = 0.90, 0.89 0.88, respectively). Conclusion. Acute renal failure frequently occurs in population of premature neonates and requires meticulous fluid and electrolyte balance, especially in the case of low birth weight and extreme immaturity.
Nosocomial infections prevalence study in a Serbian university hospital
Authors: Ilic Milena , Markovic-Denic Ljiljana
Published: December 2010

Background/Aim. Nosocomial infections (NI) are a serious health problem resulting in an enormous burden of excess morbidity and mortality rates, and health care costs. The aim of this study was to assess the prevalence of NI and to identify groups of patients at special risk for NI in the University Clinical Center, Kragujevac, Serbia. Methods. A period prevalence study design was used in this study. A survey of NI included all patients hospitalized in all departments in the University Clinical Center, Kragujevac. Results. Among 764 patients surveyed, the global prevalence rate of patients with at least one NI was 6.2% (95%CI = 5.6-6.8), while the prevalence of NI was 7.1%. The most frequent infections were surgical site infections (14.1%; 95%CI = 12.9-15.3), followed by pneumonia (2.3%; 95%CI = 2.1-2.5) in surgical patients. In medical wards, the most common NI were skin and subcutaneous tissue infections (1.6%l 95%CI = 1.4-1.8), and urinary infections (1.4%; 95%CI = 1.3-1.5). Overall, 85.1% NI were culture-proven; the leading pathogens were Pseudomonas species (40.0%), followed by Staphylococcus species (25.0%), Escherichia coli (22.5%), Proteus mirabilis (17.5%) and Klebsiella-Enterobacter (12.5%). Multivariate logistic regression analysis identified 3 risk factors independently associated with NI appearance: hospital stay ? 8 days (p = 0.0015), urinary catheter (p = 0.0022) and antibiotic use (p < 0.001). Conclusion. This study showed that NI are a serious health problem in our hospital. The most common infections were surgical site infections, followed by skin and subcutaneous tissue infection and urinary tract infections. Nosocomial infections were most common in patients in urological and orthopedic departments, and then in intensive care units. Prolonged hospital stay, urinary catheter and antibiotic exposure were risk factors independently associated with NI appearance.
Cardiac troponin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury
Authors: Simovic Aleksandra , Knezevic Jasmina , Igrutinovic Zoran , Stojanovic Nadezda , Kocic Sanja
Published: December 2010

Background/Aim. Myocardial cell lesion in newborns may be clinically occult. In recent years there has been shown growing interest in the use of cardiac troponin-I (cTnI) in relation to perinatal asphyxia and hypoxic myocardial lesion. The aim of this study was to determine a relationship between high cTnI levels and outcome in critically ill newborns with perinatal asphyxia. Methods. In this study 78 patients were divided into three groups. The group I included 39 newborns (15 term and 24 preterm) with perinatal asphyxia, with no deaths, only full or partial (with some neurological sequels) recovery. The group II included 10 newborns (6 preterm and 4 term), with perinatal asphyxia who died, with critical cardio-respiratory problems and multiorgan dysfunction. The group III included 29 healthy term newborns. A level of cTnI in all three groups was measured within 24-48 hours after delivery. Results. A statistically significant higher value of cTnI (0.082 ?g/l ? 0.166) was found in group I than in the group III (healthy newborns). In the group I, 21/39 newborns required respiratory and 16/39 required pressure support. In the group II, the largest average value of cTnI of 0.425 ? 0.307 was found. All of the newborns in the group II required respiratory and pressure support. In the group III the lowest average value of cTnI (0.0186 ?g/L ? 0.0286) was found. Conclusions. High cTnI levels could be used as markers of perinatal asphyxia and even as predictors of future outcomes and/or mortality.
Liver actinomycosis mimicking liver tumor
Authors: Culafic Djordje , Lekic Nebojsa , Kerkez Mirko , Mijac Dragana
Published: December 2010

Background. The liver actinomycosis is a rare disease associated with complex differentiation from the liver metastases or hepatocellular carcinoma. Case report. A 50-year old immunocompetent female patient was admitted to the Surgical Department in an exhausted condition, with dyspnea, significant weight loss and intermittent fever in the recent two months. Diagnostic procedures that followed, including abdominal ultrasound and computed tomography led us to the diagnosis of metastatic liver disease of unknown etiology with pleural and pericardial effusion. Intraoperatively, the presence of liver pseudotumor without malignancy in the liver was confirmed. Histological examination confirmed the diagnosis of liver actinomycosis. Prolonged treatment with high dose penicillin was performed and all signs and symptoms resolved completely without further problems. The control abdominal ultrasound finding was normal. Conclusion. Liver actinomycosis has a nonspecific presentation, often mimicking liver tumor. A timely diagnosis as well as a combined surgical and antibiotic therapy is necessary in the treatment of patients with primary disease and prevention of complications.
Cardiovascular screening of athletes
Authors: Stajic Zoran , Mijailovic Zdravko
Published: December 2010

 Sprovodjenje kardiovaskularnog skrining programa ima za cilj smanjenje ucestalosti iznenadne srcane smrti kod sportista. Potrebno je doneti nacionalne preporuke koje bi trebalo da jasno definisu obim, organizaciju i sprovodjenje skrininga i redovnih sistematskih pregleda sportista. U medjuvremenu, dok se ne donesu posebne nacionalne preporuke, smatramo da je neophodno da se svi klinicki lekari koji se bave sportskom medicinom detaljno upoznaju sa vazecim evropskim i americkim preporukama, a za prakticnu primenu u svakodnevnoj rutinskoj klinickoj praksi predlazemo primenu modifikovanog americko-evropskog skrining programa koji bi se sastojao od 12 tacaka iz americkih preporuka (navedeno u tabeli 2) i obaveznog 12- kanalnog EKG-a.
Severe form of Legionnaires' disease in an immunocompetent patient
Authors: Andrijevic Ilija , Matijasevic Jovan , Povazan Djordje , Kojicic Marija , Batranovic Uros
Published: December 2010

Background. Legionnaires' disease (LD) is a pneumonia caused by Legionella pneumophila (LP). The disease occurs more often in immunocompromised persons and can be manifested by severe pneumonia, multiple organ failure and has a high mortality. Case report. Immunocompetent patient, male, 53- year old, with severe form of LB had fever, cough, weakness and diarrhea as the initial symptoms of the disease. Laboratory results showed increased number of leukocytes, increased values of acute phase proteins, liver enzymes and hyponatremia. Computed tomography of the chest showed the marked inflammatory lesions on both sides. Pathohystological analysis of the samples retrieved by bronchoscopy pointed to a pneumonia, and diagnosis of LD was confirmed by positive urine test for LP antigen. Later, the disease was complicated by acute adult respiratory distress syndrome (ARDS). Treatment with antibiotics (erythromycin, rifampicin, azithromycin) combined with ARDS treatment led to a clinical recovery of the patient together with complete resolution of inflammatory lesions seen on chest radiography. Conclusion. In severe pneumonias it is necessary to consider LD in differential diagnosis, perform tests with aim of detecting LP and apply adequate antibiotic treatment in order to accomplish positive outcome of the therapy and prevent complications.
Anterior tibial muscle hernia: Reconstruction with periosteal patch plasty
Authors: Maric Dusan , Madic Dejan , Maric Dusica , Stankovic Milan , Smajic Miroslav
Published: December 2010

Introduction. Anterior tibial muscle hernia is the most frequent lower extremities muscle hernia. The aim of this paper was to present a possibility of a new surgical technique for anterior tibial muscle hernia reparation. Case report. We presented three cases of anterior tibial muscle hernia in adolescents. The cases were diagnosed clinically and ultrasonographycally. In all three cases reconstruction was done with periosteal patch plasty of fascial defect. Conclusions. Easy approachable, cheap, autologous material, periost, in the frame of periosteal patch plasty, could be one of the possible solutions in anterior tibial muscle hernia treatment.
Gender difference in hipolipemic and anti-inflammatory effects of statins in diabetics with coronary artery disease
Authors: Djindjic Boris , Rankovic Goran , Zivic Misko , Savic Todorka , Spasic Mirjana , Bubanj Maja
Published: December 2010

Background/Aim. Statins produce hipolipemic and pleotropic effects on markers of inflammation with stabilization of atheromatous plaque. The aim of this paper was to examine gender difference in hipolipemic and antiinflammatory effects of statins in patients with diabetes mellitus (DM) type 2 with coronary artery disease (CAD). Methods. Sixty dyslipidemic patients with DM type 2 were analyzed. Lifestyle modification and hipolipemic diet were applied in all patients divided into two groups: 30 patients with statins therapy (20 mg of simvastatin or equivalent dose of some other statins, during 3 months) and 30 patients without statins therapy. Estimation of obesity, quality of glicoregulation, and determination of inflammatory parameters: Creactive protein (CRP), fibrinogen, total and differential leukocyte count, intracellular adhesive molecules (ICAM-1), vascular adhesive molecule-(VCAM-1) and lipid profile (total cholesterol - TC, LDL-C, HDL-C, triglicerides - TG) were done. Results. Women with DM type 2 were more obese and had significant disturbances in lipid profiles, glicoregulation and inflammatory markers compared to men. Statins therapy significantly improved all lipid parameters and quality of glicoregulation in women, while there were only significant reduction of LDL-C and nonHDL-C in males. There were more significant reductions of inflammatory markers in women as compared to men with statins therapy. In the group without statins there was not such significant reduction. Concentration of ICAM-1 was the lowest in men on statins therapy, while there were no significant variability of VCAM-1 values between groups and genders. Conclusion. Women with DM type 2 and CAD have more prominent lipoprotein disorders and impaired glicoregulation with expression of enhanced proinflamatory state which could not be seen in men. Statins therapy exerts more favorable effects in women leading to stabilization of lipoprotein profiles, improvement of glicoregulation and reduction of inflammatory markers. More superior antiinflammatory effects of statins therapy in men were registered only in significant ICAM-1 reduction.
Evaluation of telemedicine systems for impacted third molars diagnosis
Authors: Duka Milos , Mihailovic Branko , Miladinovic Milan , Jankovic Aleksandar , Vujicic Biljana
Published: December 2010

Background/Aim. In the last twenty years significant advances have been made in the fields of information and telecommunication technology in health care applications, with a positive impact on the health care practice. The need for remote diagnosis and planning of interventions is of special importance in military health care, and health management of immobile persons, and those with special needs. In cases such as these, availability of specialist health care is mainly limited by geographic and financial factors. The aim of this study was to investigate practical usability of telemedicine approaches in everyday management of oral surgery patients in terms of reliability of established diagnosis and indications for oral surgery treatment of the third molars. Methods. Our experimental randomized study enrolled 432 randomly selected patients of both genders, aged 20 to 87 years, undergoing panoramic radiography for some reason in the Centre for Dental Radiography in Belgrade. In addition to radiography, photographs of the face and mouth cavity were taken. These images were uploaded to the web server specially dedicated to the study purposes, and then transmitted to teledentists, i.e. oral surgeons, who made remote diagnoses. Diagnostic agreement was determined by way of the Cohen's kappa coefficient, and diagnostic sensitivity (SE), specificity (SP), and effectiveness (EFF) were also established. Statistical significance was determined and comparisons performed by using the z-test, and testing of non-parametric characteristics by using the McNemar's ?2 test for p = 0.05 significance cut-off. Results. The results obtained by analyzed images and diagnostic assessment of the clinical diagnosis (kappa = 0.99, SE = 99%, SP = 99%, EFF = 99%, for 95% CI) indicate an almost complete diagnostic agreement. The differences in diagnosis were not statistically significant. Conclusion. Diagnostic assessment of the clinical diagnosis of impacted or semi-impacted third molars assisted by the telemedicine approach was equal to the real-time assessment of clinical diagnosis. Telemedicine, and teledentistry as its branch, represent the present and even more the future of this field of health care.
Reliability of Cobas Amplicor PCR test in detection of Mycobacterium tuberculosis in respiratory and nonorespiratory specimens
Authors: Lepsanovic Zorica , Savic Dejana , Tomanovic Branka
Published: December 2010

Background/Aim. Traditional methods for detection of mycobacteria, such as microscopic examination for the presence of acid-fast bacilli and isolation of the organism by culture, have either a low sensitivity and/or specificity, or take weeks before a definite result is available. Molecular methods, especially those based on nucleic acid amplification, are rapid diagnostic methods which combine high sensitivity and high specificity. The aim of this study was to determine the usefulness of the Cobas Amplicor Mycobacterium tuberculosis polymerase chain reaction (CAPCR) assay in detecting the tuberculosis cause in respiratory and nonrespiratory specimens (compared to culture). Methods. Specimens were decontaminated by the N-acetyl-L-cystein- NaOH method. A 500 ?L aliquot of the processed specimen were used for inoculation of L?wenstein-Jensen (L-J) slants, a drop for acid-fast staining, and 100 ?L for PCR. The Cobas Amplicor PCR was performed according to the manufacturer's instructions. Results. A total of 110 respiratory and 355 nonrespiratory specimens were investigated. After resolving discrepancies by reviewing medical history, overall sensitivity, specificity, and positive and negative predictive values for CA-PCR assay compared to culture, were 83%, 100%, 100%, and 96.8%, respectively. In comparison, they were 50%, 99.7%, 87.5%, and 98%, respectively, for the nonrespiratory specimens. The inhibition rate was 2.8% for respiratory, and 7.6% for nonrespiratory specimens. Conclusion. CA-PCR is a reliable assay that enables specialists to start treatment promptly on a positive test result. Lower value for specificity in a group of nonrespiratory specimens is a consequence of an extremely small number of mycobacteria in some of them.
Mortality of patients with lone and idiopathic atrial fibrillation is similar to mortality in general population of Serbia
Authors: Potpara Tatjana , Grujic Miodrag , Marinkovic Jelena , Vujisic-Tesic Bosiljka , Ostojic Miodrag , Polovina Marija
Published: December 2010

Background/Aim. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in general population. The aim of the study was to compare all-cause mortality and cardiovascular mortality in patients with lone and idiopathic AF to correspondent mortality in general population of Serbia. Methods. A longitudinal observational study included the patients with nonvalvular AF as the main indication for inhospital and/or outpatient treatment in the Clinical Center of Serbia, during a period 1992-2007, if the latest date of first diagnosed AF was early January 2003; in that way, the total follow- up could last at least 5 years (minimum 1 year prospectively), or until death. Principles of oral anticoagulation, heart rhythm and frequency control during the study period were conducted according to the latest international guidelines for diagnosis and treatment of AF in the study period. Lone and idiopathic AF were defined as AF in patients without any underlying disease, younger than 60 years (lone AF) or older (idiopathic AF). To compare mortality of the study population with mortality of general population we used the standardized mortality ratio (SMR) and chi-square test with p < 0.05 as a level of statistical significance. Results. Out of 442 patients with AF and no underlying disease, aged 47 ? 12.6 years, with mean follow-up of 11.5 ? 7.2 years, 12 patients (2.7%) died: 7 patients of non-cardiovascular causes and 5 patients (1.1%) of cardiovascular death. When compared to the general population of Serbia, all-cause mortality and cardiovascular mortality in the patients with lone and idiopathic AF were not higher than in general population (p < 0.05). Conclusion. All-cause mortality and cardiovascular mortality of patients with lone and idiopathic AF are similar to all-cause mortality and cardiovascular mortality in general population of Serbia.
Comparative analysis of histopathological and clinical characteristics of pterygium
Authors: Dzunic Boban , Jovanovic Predrag , Zlatanovic Gordana , Veselinovic Dragan , Petrovic Aleksandar , Stefanovic Ivan
Published: December 2010

Background/Aim. Pterygium internum presents a significant epidemiological problem. Its etiopathogenesis is still unclear. After surgical removal it shows great tendency to recidives. The aim of this paper was to investigate connection between histopathological characteristics (inflammation presence, vascularization degree and fibrinoid changes) of pterygium and its clinical characteristics (duration, size, pterygium grade, presence of Fuchs' spots and recidives) and determine indicators for recidives prediction. Metods. We analyzed the material taken from 55 patients operated by Arlthi's method. The samples were colored by using standard histochemical methods: hematoxylin-eosin (HE), trichrome Masson painting, Gomora reticulin and PAS technique. Results. Pterygium was mostly covered by epithelium resembling conjunctival, while in the frontal cap region it showed the morphology of plate-layer cornea epithelium. The structural basis of the epithelium was composed of continuous basal lamina and continuous adhesive fibres underneath. This adhesive basis showed fibrinoid changes in the form of oval islands of various size, parallel to convexity of pterygium, or in the form of unified focus. The number, caliber and type of blood vessels showed a pronounced variability. Duration of pterygium and its size were in negative correlation with intensity of inflammation, without statistical significance. Pterygium with a longer period of develepment had negative correlation with the degree of vascularization (p > 0.05). The presence of Fuchs' spots showed a statitistically significant positive correlation with the degree of vascularization (p < 0.05). The intensity of fibrinoid changes was higher in pterygium with Fuchs' spots and in those which recurred (p > 0.05). Conclusion. Histopathological analysis of pterygium morphological shapes is a good basis for the prediction of recidives, which present the greatest problem in the treatment of this widely spread disease.