bluuebunny/crossref_metadata_2025 huggingface dataset:
Diet and gastric cancer
Authors: Sipetic Sandra , Tomic-Kundakovic Sladjana , Vlajinac Hristina , Jankovic Slavenka , Marinkovic Jelena , Maksimovic Jadranka
Published: December 2010

The aim of this case-control study, conducted in Serbia during the period 1998-2000, was to investigate whether diet was associated with the development of gastric cancer. The case group consisted of 131 patients with histologically confirmed gastric cancer, and the control group of 131 patients with orthopedics diseases and injuries. Cases and controls were individually matched by age (?? 2 years), gender, and place of residence. On the basis of multivariate logistic regression analysis, following factors were found as independent risk factors for gastric cancer: more frequent consumption of high-fat milk [Odds ratio (OR) =1.45, 95% confidence interval (CI) = 0.99-2.16]; mutton, lamb and/or calf meat (OR = 2.46, 95% CI = 1.11-5.47), sugar (OR = 2.13, 95% CI = 1.43-3.18), semi-white bread (OR = 2.09, 95% CI = 1.25-3.50), and salting food (OR = 5.72, 95% CI = 2.63-12.42). Factors found as protective were: more frequent consumption of margarine (OR = 0.41, 95% CI = 0.25-0.69), ?other? cheeses (OR = 0.47, 95% CI = 0.29 - 0.77), and fish (OR = 0.39, 95% CI = 0.19-0.76).
Current treatment of cardiogenic shock
Authors: Gligic Branko , Romanovic Radoslav
Published: December 2010

 S obzirom na izneto moglo bi se zakljuciti da je letalitet kod bolesnika sa kardiogenim sokom i dalje visok i iznosi od 50 do 80%. Patofiziologija soka ukljucuje jednu spiralu koja je okrenuta nadole. Ishemija izaziva miokardnu disfunkciju, koja zatim pogorsava ishemiju podrucja nefunkcionalnog, ali vijabilnog miokarda, a to doprinosi razvoju kardiogenog soka. Kljuc za uspeh je dobro organizovan pristup, brza dijagnoza i promptna terapija za odrzavanje arterijskog krvnog prtiska i minutnog volumena. Smanjenju smrtnosti doprinosi hitna srcana kateterizacija i revaskularizacija sa angioplastikom ili koronarnom operacijom i to je mozda sada jedina standardna terapija. U bolnicama koje ne primenjuju direktnu angioplastiku bila bi pozeljna hemodinamska potpora intraaortnom balon pumpom i tromboliticka terapija sa brzim transportom u ustanove koje mogu da urade PKA ili urgentnu revaskularizaciju miokarda, jer to u mnogome dovodi do smanjenja mortaliteta.
Autologous pluripotent progenitor cells in the treatment of ischemic heart disease
Authors: Obradovic Slobodan , Rusovic Sinisa , Dincic Dragan , Gligic Branko , Baskot Branislav , Balint Bela , Stamatovic Dragana , Romanovic Radoslav , Ristic Andjelka , Trifunovic Zoran
Published: December 2010

 Studije na zivotinjama i prva klinicka iskustva na ljudima pokazuju da nakon primene progenitornih celija mioblasta ili poreklom iz kostne srzi dolazi do poboljsanja srcane funkcije. Pomenute metode jos nose sa sobom veoma veliki broj pitanja. Da li je zaista moguce regenerisati miokard ?nekim? novim mioblastima, za koje se ocekuje da se diferenciraju u patoloskim uslovima u plemenito visoko diferentovano, funkcionalno tkivo miokarda? Kada je u pitanju ishemijska bolest srca ne treba zaboraviti osnovni problem - koronarnu insuficijenciju, koja se samom kardiomioplastikom ne resava. Kombinacija revaskularizacionih procedura sa celijskom kardiomioplastikom je sine qua non za prezivljavanje i transplantovanih celija. Da li je veca debljina oziljka na miokardu i njegova elasticnost dovoljna korist da bi se ove celije transplantovale kod bolesnika sa teskim oziljnim promenama na srcu? Koji su bolesnici pravi kandidati za ovaj vid terapije, koji je optimalan broj mioblasta koji treba transplantovati i koji je najbolji nacin za transplantaciju? Ovo su samo neka od ozbiljnih pitanja na koje je sada tesko dati odgovor. Sa druge strane, transplantacija progenitornih celija iz kostne srzi ili njihova mobilizacija faktorima rasta u perifernu krv su metode za pospesivanje arteriogeneze i angiogeneze, koja moze biti veoma brza i efikasna u smislu spasavanja ugrozenog miokarda u akutnim koronarnim sindromima, a dovoljna u sprecavanju ishemije kod teskih hronicnih koronarnih bolesnika. Visednevna primena faktora rasta omogucava dugotrajnu mobilizaciju velikog broja progenitora mezenhimskih celija iz kostne srzi, tj. pospesuje proces koji se i inace dogadja pod uticajem ishemije i nekrozom potaknutane imunske reakcije. Medjutim, koje faktore rasta, kada i u kojoj dozi, treba dati za mobilizaciju endotelnih i mioblastnih progenitora? Da li neki od njih mogu da pospese reperfuziono ostecenje miokarda? Koliko dugo treba primenjivati takvu terapiju? Da li je treba dati samo bolesnicima sa no reflow fenomenom? Dakle, brojna su pitanja koja se namecu i kada je u pitanju ovaj vid celijske terapije. U svakom slucaju dosadasnja istrazivanja otvaraju nove puteve i potrebne su vece, dobro kontrolisane randomizovane studije koje ce lagano da odgovaraju na jedno po jedno od pomenutih pitanja! Kardiologija se spusta na novi nivo, nivo osnovnih bioloskih procesa, diferencijacije, regeneracije, gensku terapiju, terapiju koja je usmerena na razvijanje mikrocirkulacije. Kao i u svemu ranije, bice potrebno puno godina da osetimo korist od istine za kojom tragamo.
Possibility of management of lower leg war burns with free flaps
Authors: Panajotovic Ljubomir , Kozarski Jefta , Krtinic-Rapaic Snezana , Stanojevic Bojan
Published: December 2010

Free flaps are used in the surgical treatment of burns for wound closure where the burn is too deep, and in case, when after necrotic tissue excision, the bones, tendons, nerves, and blood vessels remain bare. Covering of the exposed structures is commonly performed in the primary delayed, or in the secondary wound treatment. The possibilities of covering the defects of the lower leg with local flaps are limited. Free flaps are used when all the possibilities of the other reconstructive procedures have been exhausted. The defect of the soft tissue of the lower leg was covered with free flaps in the injured soldiers with deep burns, treated at the Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade. In one patient the wound closing was performed immediately after excision of necrotic tissues, and in the other two in the secondary management. The application of free microvascular flaps enabled the closure of large post excision defects of the lower leg in one operation. Our experience in the treatment of these soldiers point to the possibility of coverage of the exposed deep structures with free flaps as early as possible.
Ménétrier's disease associated with ulcerative collitis
Authors: Mirkovic Darko , Doder Radoje , Ilic Srbislav , Mitrovic Miroslav , Ignjatovic Mile
Published: December 2010

In this paper a 21 year old patient was presented with M?n?trier's disease, associated with ulcerative colitis. The first symptoms of ulcerative colitis occured at the age of eleven, since when the patient has been conservatively treated several times because of the exacerbations of the desease. During control examinations presence of polipoid changes in stomach was discovered by upper endoscopy. Gastrectomy was suggested because the patient had excessive anemic syndrome which required weekly substitutional therapy with deplasmatic eritrocytes, as well as hypoproteinemia, while multiple polipoid changes suspect for malignancy were gastroscopically identifided. Patient accepted surgical treatment, and was transfered to the Clinic of Surgery. Total gastrectomy was performed, and patohystological finding confirmed M?n?trier's desease. After two weeks, the patient was released from the hospital in good general condition, with regular clinical and laboratory findings.
The problem of calcified ascending aorta during aortocoronary bypass
Authors: Nezic Dusko , Knezevic Aleksandar , Cirkovic Milan , Petrovic Branko , Jovic Miomir , Kolar Jovo , Birovljev Sinisa , Jakovljevic Miroslav
Published: December 2010

Heavily calcified ascending aorta significantly increased morbidity and lethality during open-heart surgery. Cannulation and clamping (partial or total) of severely atherosclerotic ascending aorta can easily cause damage and rupture of aortic wall, with consequential distal (often fatal) embolization with atheromatous debris (brain, myocardium). From June 1998. until June 2000, 11 of 2 136 (0.5%) patients who underwent coronary artery bypass grafting were with the severe atheromatous ascending aorta. The site of cannulation was in the aortic arch in three patients (aorta was occluded with Foley catheter in one case, and single clamp technique was used in the other two cases). The femoral artery was the cannulation site in other five cases. Profound hypothermia, ventricular fibrillation, and circulatory arrest, with no cross-clamping or cardioplegia, were used in three patients. Two patients were operated on with extracorporeal circulation, one in normothermia, on the beating heart, the other in moderate hypothermia, on fibrillating heart. In three patients myocardial revascularization was performed on the beating heart, in normothermia, without extracorporeal circulation. Postoperative course was uneventful in all 11 patients. Neither atheroembolism in the peripheral organs, nor atheroembolism of the extramities occurred. The proposed surgical approaches have the potential to reduce the prevalence of stroke and systemic embolization associated with coronary artery bypass grafting in patients with heavily calcified ascending aorta. This result was achieved due to the applied modifications of standard cardiosurgical technique.
Histopathological and immunocytochemical changes in the liver of patients with chronic hepatitis C
Authors: Jovanovic Maja , Konstantinovic Ljiljana , Katic Vuka , Ciric Slavisa , Kostic Velimir , Jovanovic Branislav
Published: December 2010

Background. The presence of lymphocytes within the liver parenchyma is related to immunologically mediated liver damage in chronic hepatitis C. The aim of the study was to make histological, histochemical, and immunocytochemical assessment of liver biopsy specimens in patients with chronic hepatitis C virus (HCV) infection. Methods. Biopsy specimens of 20 patients with chronic HCV disease were analyzed, using standard staining procedures to verify histologic liver lesions, as well as immunoenzymatic staining with monoclonal antibodies to detect CD4+ T-lymphocytes, B-lymphocytes, and macrophages. Results. Micromorphologic characteristics of chronic active viral hepatitis C were present in all the patients, differing, hower, by the level of their activity. Dominant changes were found within the portal space, consisting of mononuclear lympho-plasmocytic infiltration and macrophages. Immunocytochemical investigation of mononuclear and macrophageal infiltration showed the correlation between micromorphological findings and the degree of the activity. Conclusion. The presence of lymphocytic and macrophageal infiltration within the hepatic tissue directly correlated with the intensity of the liver damage. Analysis of the population of cellular infiltrate in the liver together with the monitoring of viremia level and the level of hepatocyte necrosis, could be useful tools for elucidation of the pathogenesis of chronic hepatitis C.
Posttraumatski stresni poremecaj
Authors: Samardzic Radomir , Spiric Zeljko
Published: December 2010

 Posttraumatski stresni poremecaj se razvija kao reakcija na izlaganje ekstremnom stresu. Oko trecine populacije, najmanje jednom u zivotu suocava se sa ekstremnim stresnim dogadjajima. Posledice PTSP su teske i obuhvataju skoro sve sfere zivota. Posebna komplikacija jeste pridruzena, odnosno komorbidna psihopatologija, sto terapijski proces cini slozenijim. Terapija kod ovog poremecaja se sprovodi kroz integrativni pristup, farmakoterapijom, psihoterapijom i psihosocijalnom terapijom i rehabilitacijom. Vazno je rano otkrivanje i dijagnostika ovog poremecaja, u cilju prevencije lose posttraumatske adaptacije i razvoja hronicne forme poremecaja.
Primary-localized-cutaneous-amyloidosis: Lichen amyloidosus
Authors: Mikic Dragan , Forcan Slobodan , Kostov Milos , Popovic Lidija , Brajuskovic Goran
Published: December 2010

This case report presented a female patient with primary-localized-cutaneous--amyloidosis in the form of lichen amyloidosus. Primary-localized-cutaneous--amyloidosis is a rare idiopathic dermatosis caused by abnormal deposition of amyloid composed primarily of degenerated keratin filaments. In order to establish the final diagnosis, detailed clinical and laboratory investigations were performed, with a particular emphasis on pathohistological analysis of skin specimens, special stains, and electron microscopy.
The choice of optimal radiotherapy technique for locally advanced maxillary carcinoma using 3d treatment planning system
Authors: Mileusnic Dusan
Published: December 2010

Aim. To compare the isodose distribution of three radiotherapy techniques for locally advanced maxillary sinus carcinoma and analyze the potential of three-dimensional (3D) conformal radiotherapy planning in order to determine the optimal technique for target dose delivery, and spare uninvolved healthy tissue structures. Methods. Computed tomography (CT) scans of fourteen patients with T3-T4, N0, M0 maxillary sinus carcinoma were acquired and transferred to 3D treatment planning system (3D-TPS). The target volume and uninvolved dose limiting structures were contoured on axial CT slices throughout the volume of interest combining three variants of treatment plans (techniques) for each patient: 1. A conventional two-dimensional (2D) treatment plan with classically shaped one anterior two lateral opposite fields and two types of 3D conformal radiotherapy plans were compared for each patient. 2. Three-dimensional standard (3D-S) plan one anterior + two lateral opposite coplanar fields, which outlines were shaped with multileaf collimator (MLC) according to geometric information based on 3D reconstruction of target volume and organs at risk as seen in the beam eye's view (BEV) projection. 3. Three-dimensional non-standard (3D-NS) plan: one anterior + two lateral noncoplanar fields, which outlines were shaped in the same manner as in 3D-S plans. The planning parameters for target volumes and the degree of neurooptic structures and parotid glands protection were evaluated for all three techniques. Comparison of plans and treatment techniques was assessed by isodose distribution, dose statistics and dose-volume histograms. Results. The most enhanced conformity of the dose delivered to the target volume was achieved with 3D-NS technique, and significant differences were found comparing 3D-NS vs. 2D (Dmax: p<0,05 Daver: p<0,01; Dmin: p<0,05; V90: p<0,05, and V95: p<0,01), as well as 3D-NS vs. 3D-S technique (Dmin: p<0,05; V90: p<0,05, and V95: p<0,01), while there were no differences between 2D vs. 3D-S technique. 3D-S conformal plans were significantly superior to 2D plans regarding the protection of parotid glands, and the additional improvement of dose conformity was achieved with 3D-NS technique. 3D-NS technique resulted in the decrease of Dmax for ipsilateral retina compared with 3D-S technique, while the level of Dmax for optic nerve was increased (within an acceptable range) with 3D-NS technique. Conclusion. In this study, 3D planning of radiotherapy for locally advanced maxillary sinus carcinoma with noncoplanar fields, which number did not exceed the number of fields for conventional arrangement enabled conformal delivering of the adequate dose to the target volume with the improved sparing of adjacent uninvolved healthy tissue structures.
Predictive significance of residual ischemia proved by dobutamine stress: Echocardiography test in patients early after the first uncomplicated myocardial infarction
Authors: Karanovic Nevena , Todorovic Lazar , Perisic Zoran , Pavlovic Milan
Published: December 2010

Background. To evaluate the long-term prognostic value of dobutamine stress-echocardiography (ECG) test for new coronary events (new episodes of angina pectoris, cardiac-related deaths, and reinfarctions) early after the first uncomplicated myocardial infarction. Methods. Dobutamine stress-echocardiography tests were performed in all of 104 patients 10-20 days after the first myocardial infarction. Patients were followed-up for 36 (29 ? 7) months. Kaplan-Meier cumulative survival curves were tested by Breslow test (Log Rank). Results. Two cardiac deaths (1.92%), nine nonfatal myocardial infarctions (8.65%), and three cases of recurrent angina pectoris (2.88%) occurred during the prospective follow-up. Cumulative survival curves showed that in patients with negative findings of dobutamine stress-echocardiography test, survival time without significant events was 35.31 months, while in the group with positive findings of dobutamine stress-echocardiography test it was 30.91 months (log Rank 7.22; p<0.01). Prognostic value of dobutamine stress-echocardiography test was analyzed by Cox regression model and was 2.92, meaning that the risk of significant events was 2.92 times higher in the group of patients with positive findings of dobutamine stress-echocardiography test. Conclusion. Patients with negative findings of dobutamine stress-echocardiography test were with significantly higher possibility of surviving without significant events in comparison with the patients in whom the findings of dobutamine stress-echocardiography test were positive. In combination with clinical signs and ECG results, the results of dobutamine stress-echocardiography test improved prognostic value in the patients with the first uncomplicated myocardial infarction, and in that way influenced the strategy of their further treatment.
Soluble CD4 antigens in the cerebrospinal fluid as a marker of lymphocytic infiltration of the central nervous system
Authors: Vrbic Miodrag , Vrbic Svetislav , Skoric Snezana , Mihailovic Vesna , Rankovic Zarko , Konstantinovic Ljiljana , Kostic Velimir , Krstic Milijanka , Jovanovic Maja
Published: December 2010

Early diagnosis of the central nervous system (CNS) infections is a precondition of their successful treatment. However, the essential standard examination of the cerebrospinal fluid (CSF) is sometimes neither specific enough to define their basic nature, nor sufficient to differentiate them from processes of non-infectious origin. Supposing that the released surface molecules of activated immunocompetent cells could better define the character of inflammatory reaction, the levels of soluble CD4 antigens (sCD4) were determined with enzyme-immunosorbent test in the CSF of the patients with various CNS diseases. In contrast to cerebrovascular insults toxic-metabolic, and other conditions in control group, detectable sCD4 concentrations in acute encephalitis (24 ? 11U/ml) were verified at the beginning of the disease, being also present in cytologically diagnosed normal CSF findings. They were significantly higher (p<0.05) compared to acute serous meningitis (13.5 ? 8 U/ml), while in purulent meningitis they were measurable only after the disease progression - in correlation with the disturbed brain system function. The obtained results suggested the significance of CD4 antigen levels in CSF as a sensitive and specific marker of lymphocytic infiltration of the brain parenchyma, the measurement of which could contribute to early identification of the CNS infections better understanding of their pathogenesis, and the assessment of the actual level of the destruction of neurons.
Cerebellar hemangioblastomas: A study of the immunoprofile of neoplastic stromal component
Authors: Tasic Desanka , Dimov Dragan , Kostov Milos , Ilic Srbislav , Dojcinov Dojcin , Jovanovic Milan , Stanojevic Goran , Dimov Irena
Published: December 2010

Background. Central nervous system hemangioblastomas (HBs) are uncommon highly vascularized tumors that are predominantly found in the cerebellum. They occur sporadically or in association with von Hippel-Lindau (VHL) disease. HBs are of unknown histogenesis, and the origin of stromal cells is still a subject of debate. The aim of this study was to investigate the immunoprofile of neoplastic stromal component, and to determine whether the profile of the expression of immunomarkers used can contribute to the elucidation of the histogenesis of HBs. Methods. A series of eight cerebellar HBs were histochemically examined for the detection of mast cells and immunohistochemically for the expression of factor VIII-related antigen (FVIII-RAg), CD34, vimentin, factor XIIIa (FXIIIa), S-100 protein, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE) neurofilaments (NF), synaptophysin, chromogranin, and somatostatin. Results. Mast cells were present in all hemangioblastomas, and were particularly abundant in one tumor. Immunohistochemically, intense reactivity for vimentin and NSE in the stromal cells was constantly seen. Immunoreactivity with S-100 protein and FXIIIa was variable, but generally many HBs stromal cells were negative for these markers. However, stromal cells were uniformly negative for FVIII-RAg in all HBs investigated. They were negative for CD34 GFAP, NF, synaptophysin, chromogranin, as well as somatostatin. GFAP-positivity of the occasional stromal type cells, located only peripherally, was interpreted as "pseudopositivity". Conclusion. The immunoprofile of neoplastic stromal component in this study suggested a possible origin from undifferentiated multipotential mesenchymal cells. High expression of NSE (glycolytic and hypoxia-inducible enzyme) in the HBs stromal cells might be related to the loss of the VHL protein function.
Interhospitalni i intrahospitalni transport kriticno povredjenih i obolelih
Authors: Filipovic Nikola , Surbatovic Maja , Stankovic Nebojsa , Jovanovic Krsta
Published: December 2010

 Transport kriticno obolelih i povredjenih je klinicka situacija ciji su potencijalni rizici od komplikacija i slozenost veoma potcenjeni. Da bi se smanjio rizik od eventualnih komplikacija, oprema mora biti standardizovana (monitor za kardiovaskularnu i respiratornu funkciju defibrilator, transportni ventilator), a tim za transport uvezban. Mora postojati inter- i intrahospitalna koordinacija da bi se intenzivna terapija kriticno p/o mogla sprovoditi tokom transporta kao da je bolesnik u jedinici intenzivne terapije. Ovaj savremeni pristup transportu kriticno p/o poznat je kao portabilna intenzivna terapija (3).
Diagnosis of multiple myeloma on based the material obtained by fine needle aspiration biopsy of the lungs
Authors: Bokun Radojka , Tatomirovic Zeljka , Skuletic Vesna , Plavec Goran , Ristic Labud , Stefanovic Dara
Published: December 2010

The patient presented in this paper was admitted to the hospital for the evaluation of radiologically revealed shadow in both lungs. In the course of diagnostic procedures, fine needle aspiration biopsy of the intrathoracic mass was performed. Cytologic analysis of the smear was performed because of clinical suspicion of plasma cell proliferative disease that was confirmed by bone marrow aspiration. Thus, the cytologic finding of intrathoracic lesion preceded the diagnosis of multiple myeloma.
Presence of interleukin-8 and the IL-1 receptor antagonist in the cervical mucus of fertile and infertile women
Authors: Kataranovski Milena , Radojcic Ljiljana , Prokic Vera , Vojvodic Danilo
Published: December 2010

Background. Cytokines are involved in almost every aspect of reproduction and recent studies suggested a relationship between cytokines and male/female infertility. In the present study, the levels of interleukin-8 (IL-8) and interleukin-1 receptor antagonist (IL-1Ra) were determined in the cervical mucus of fertile and infertile women. Methods. Groups of patients were formed according to the results of the standard procedure for infertility investigation, including postcoital test and the presence of antispermatozoid antibodies in the sera of both partners and in seminal plasma, by mixed antiglobulin reaction (MAR) test and Kibrick agglutination test. IL-8 and IL-1Ra levels were determined in solubilized (ultrasonographic sonicaton) cervical mucus sampled in the midcycle by commercial ELISA kits and expressed as pg/mg proteins. Results. The groups were designated as fertile (n=20) and infertile (n=48). The latter was divided into two subgroups, one consisting of infertile women with positive postcoital test and without antispermatozoid antibodies (n=30), and the other designated as infertile women with negative postcoital test (n=18). This subgroup was composed of women with negative postcoital test and without antibodies (n=10) and the women with negative postcoital test with antibodies (n=8). Similar levels of IL-8 and IL-1 Ra were noted in the cervical mucus of in fertile women and women with positive postcoital test and without antispermatozoid antibodies. A tendency of decrease (p=0,052) and significant decrease in IL-8 levels (p<0.05) was noted in negative postcoital test group and negative postcoital test group without antibodies respectively, compared to the levels in the fertile examinees. A significant rise in IL-1Ra levels (p<0,05) was detected in the mucus of negative postcoital test group with further increase in negative postcoital test group with antibodies (p<0.02). Conclusion. Changes in IL-8 and IL-1 Ra levels in the cervical mucus of infertile patients with negative postcoital test suggested the existence of the relatinship between cervical cytokines and infertility in these women.
Morphometric variability of precuneus in relation to gender and the hemisphere of human brain
Authors: Spasojevic Goran , Malobabic Slobodan , Suscevic Dusan , Miljkovic Zeljka
Published: December 2010

Precuneus, a quadrangular gyrus of the medial surface of the human parietal lobe, is bound by three primary brain sulci and by superior hemispheric border. Precise encephalometric data about precuneus are important in the studies of brain lateralization, sex dimorphism, and brain functions in general. In this study, total and visible (exstrasulcal) surface area of the precuneus were measured on 50 brains of the adult persons (31 male, and 29 female), together with the investigation of its relationship to the side (left/right) and gender (sex dimorphism). The average total surface area of the precuneus was 16.07 cm2 on the right (males 16.44 cm2, females 15.27 cm2), and 15.44 cm2 on the left (males 15.67 cm2, females 14.62 cm2). The average visible (extrasulcal) surface area of cortex of precuneus was 9.97 cm2 on the left (males 10.75 cm2, females 8.91 cm2), and 9.38 cm2 on the right (males 10.25 cm2, females 8.19 cm2). Exstrasulcal surface area of the left precuneus was larger, by 0.59 cm on the average, which was not statistically significant. Total surface area of precuneus of males was significantly larger on the right (16.44 cm2) (p<0.01) than on the left (15.67 cm2). In females it was also larger on the right (15.27 cm2) than on the left (14.62 cm2), but with no statistical significance. Visible (exstrasulcal) surface area of both, (left and right precuneus of males) was highly significantly larger in comparison with the females (p<0.001). The obtained results and other facts suggested that sex dimorphism of human brain, including precuneus, was present, but not always easily observable studied or proven in all the details.
Myocardial perfusion scintigraphy in identification and localization of individual coronary lesions
Authors: Baskot Branislav , Jankovic Zoran , Markovic Milic , Spaic Rajko
Published: December 2010

The aim of this study was to evaluate the accuracy of myocardial perfusion scintigraphy with technetium-99m tetrofosmin by single-photon emission computed tomography (SPECT), using one-day protocol in the identification and localization of individual stenosed coronary vessels. Sixty-eight patients with suspected coronary artery disease (CAD) were studied. In thirty of them coronary angiography showed significant stenosis (?50%). Nine patients were with one-vessel disease, 11 were with two-vessel disease, and 10 were with three-vessel disease. All the patients were administered two i.v. injections of 99mTc tetrofosmin, one at peak pharmacologic exercise (1-3 min after i.v. administration of dipiridamol 0.56 mg per kg during 4 min) 370 MBq, and the other 740 MBq at rest 3 hrs after the exercise test (acquisition was obtained 15-30 min after injections for both studies). Overall sensitivity, specificity, and diagnostic accuracy in the identification of individual stenosed coronary vessels were 90%, 86%, and 88%, respectively. Sensitivity, specificity, and accuracy in each of the individual vascular territories were not significantly different: LAD (96% 64%, and 75%), ACx (73%, 100%, and 94%), RCA (95%, 93%, and 94%). The results of this study demonstrated one-day 99mTc-tetrofosmin SPECT scintigraphy to be suitable and accurate technique for the identification and localization of individual stenosed coronary vessels, as well as a highly sensitive method in the recognition of one- and multiple-vessel diseases of coronary arteries.
Disturbances of protein c activity in abdominal sepsis: Diagnostic and predictive importance
Authors: Karamarkovic Aleksandar , Mirkovic Darko , Stankovic Nebojsa , Nikolic Valentina , Jeremic Vasilije , Radenkovic Dejan , Stefanovic Branislav
Published: December 2010

Background. Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, more than one third of patients still die of severe secondary peritonitis. Clinical difficulties in the treatment of abdominal sepsis were related to inherent problems of limited clinical signs and the rapid spread of infection. An inflammatory process is often well under way before the presence of clinical signs and symptoms of sepsis. The aim of this prospective study was to assess diagnostic and prognostic significance of protein C in abdominal sepsis. Methods. Twenty-two patients with severe intraabdominal infections with sepsis syndrome were treated surgically as compared to 15 patients with hernia repair (control group). During the study, the following parameters were analyzed daily: protein C, AT III, plasminogen, alfa-2 antiplasmin, HMWK, C5a and C5-B9 complement, C1-inhibitor, CRP. Results. The mean APACHE II score was 17 points, with actual mortality rate of 23%. Each parameter evaluated in the abdominal sepsis group differed from the one evaluated in the control group to a great extent (p=0.001). The results and multivariate regression statystical analysis confirmed the following parameters as sensitive biological markers of septic cascade (p?0.0001-0.026): protein C, AT III, HMWK, C1-inhibitor and C5-B9 complement. According to the results the low level of protein C consistently correlated with disease severity and suggested the development of septic shock and poor outcome. Conclusion. Early diagnosis of plasma proteolytic disturbances was very important, from the diagnostic and predictive point of view, in abdominal sepsis. According to the results protein C was the most significant marker of sepsis and early predictor of the outcome of septic complications during severe intraabdominal infections (r=0.761; p=0.0001).
The most often causes of odontogenic maxillary sinusitis
Authors: Racic Alek , Dimitrijevic Milovan , Djukic Vojko
Published: December 2010

In the period 2000-2002, 40 patients with odontogenic sinusitis were examined at the Institute for ENT and Maxillofacial Surgery, Clinical Centre of Serbia. Oroantral communication was detected in 40% of the patients, oroantral fistula in 35%, sinus foreign bodies in 15% and other conditions in 10% of the cases. The extraction of the upper lateral teeth was the cause of odontogenic sinusitis in 65% of the cases. Given the specific tooth, the first upper molar was the most often cause of the condition, i.e., in 40% of cases. Odontogenic sinusitis as the complication of the oral cavity surgery was found in 85% of the patients.
War liver injuries
Authors: Stankovic Nebojsa
Published: December 2010

Aim. To provide a retrospective analysis of our results and experience in primary surgical treatment of subjects with war liver injuries. Methods. From July 1991 to December 1999, 204 subjects with war liver injuries were treated. A total of 82.8% of the injured were with the liver injuries combined with the injuries of other organs. In 93.7%, the injuries were caused by fragments of explosive devices or bullets of various calibers. In 140 (68.6%) of the injured there were minor lesions (grade I to II), treated with simple repair or drainage. There were complex injuries of the liver (grade III-V) in 64 (31.4%) of the injured. Those injuries required complex repair (hepatorrhaphy, hepatotomy, resection debridement, resection, packing alone). The technique of perihepatic packing and planned reoperation had a crucial and life-saving role when severe bleeding was present. Routine peritoneal drainage was applied in all of the injured. Primary management of 74.0% of the injured was performed in war hospitals. Results. After primary treatment, 72 (35.3%) of the injured were with postoperative complications. Reoperation was done in 66 injured. Total mortality rate in 204 injured was 18.1%. All the deceased had significant combined injuries. Mortality rates due to the liver injury of the grade III, IV and V were 16.6%, 70.0% and 83.3%, respectively. Conclusion. Complex liver injuries caused very high mortality rate and the management of the injured was delicate under war circumstances (if the injured reached the hospital alive). Our experience under war circumstances and with war surgeons of limited knowledge of the liver surgery and war surgery, confirmed that it was necessary to apply compressive abdominal packing alone or in combination with other techniques for hemostasis in the treatment of liver injuries grade III-V, resuscitation and rapid transportation to specialized hospitals.
External skeletal fixation of the tibial shaft fractures
Authors: Milenkovic Sasa , Mitkovic Milorad , Radenkovic Mile
Published: December 2010

Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitkovic?s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16?84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitkovic?s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.
Comorbidity of posttraumatic stress disorder and mild closed head injury in war veterans: Endocrinological and psychological profiles
Authors: Spiric Zeljko , Samardzic Radomir
Published: December 2010

Aim. To determine the degree of psychological and endocrinological changes in war veterans with the diagnosis of Chronic Posttraumatic Stress Disorder (PTSD) regarding presence/absence of comorbid mild closed head injury (mCHI) caused by explosive devices. Methods. Two groups of PTSD inpatients, with (n = 37), and without (n = 86) sustained blast trauma followed by mCHI were formed during the psychiatric treatment. Participants were interviewed by experienced clinicians who used the PTSD Interview (PTSD-I). In addition, patients completed the Symptom Checklist-90-Revised (SCL-90-R). Serum levels of ten hormones were assessed: triiodothyronine, thyroxine, thyrotropin-stimulating hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and insulin, by radioimmunoassays and hydrocortisone, growth hormone and testosterone by fluoroimmunoassays. Results. Veterans with comorbid mCHI and PTSD showed significantly higher level of amnesia for traumatic event as well as of somatization on the SCL-90-R. Significant differences of hormone levels were not found. Conclusion. The results didn't support the hypothesis on specific PTSD subgroup characterized by history of mCHI and consecutive postconcussion syndrome. The absence of differences in levels of hormones indicated the dominant role of psychogenic trauma in the etiology of hormone disbalance in chronic PTSD. Amnesia for traumatic event in war veterans with comorbid PTSD and mCHI was easily explained by neurogenic peritraumatic amnesia due to the blast trauma, but it did not affect either quality of intensity or posttraumatic symptoms as well as endocrinological parameters.
War, traffic and iatrogenic injuries of D3 duodenal segment
Authors: Ignjatovic Dragan , Cuk Vladimir , Misovic Sidor
Published: December 2010

Background. Injuries of the duodenum at the level of aortomesenteric clamp (segment D3) are with a high incidence of death due to the development of fistula and peritonitis. In three successfully managed cases, we applied the biliary surgery method. Case reports. All three cases were with the injuries of D3 duodenal segment. The first patient suffered from the blast perforation of duodenum at the level of the aortomesenteric clamp which occurred at the 7th day after the injury. The second patient suffered from the duodenal injury caused in a traffic accident. The third patient suffered from an iatrogenic injury at the beginning of D3 duodenal segment inflicted during ureterolithotomy. The described surgical procedure included basically the suture to narrow the site of the injury, then lateroterminal anastomosis with the Roux-en-Y jejunal flexure and, finally, the placement of a silicone prosthesis starting from the duodenum through the site of injury and the Roux-en-Y out. Octreotide and the total parenteral nutrition were administered to the patients postoperatively. Conclusion. The use of the releasing silicone prosthesis in all three patients provided the repair of the site of the injury with anastomosed Reux-en-Y jejunum.
Agranulocytosis induced by metamizole and its management with granulocyte growth factor
Authors: Celeketic Dusica , Trpkovic Andreja , Cvetkovic Zorica
Published: December 2010

Drug-induced agranulocytosis was defined as a severe selective neutropenia caused by an unexpected drug reaction. Metamizole was the most common nonopioid analgesic drug associated with agranulocytosis. It was also associated with combined blood dyscrasias and other severe immunologic disorders. The risk of agranulocytosis by metamizole seemed to be considerably higher than estimated formerly. Modern management with broad-spectrum antibiotics and haematopoietic growth factors reduced the mortality in those patients. Two cases of agranulocytosis caused by metamizole were reported.
Effects of adenoidectomy and immediate orthodonthic treatment on jaw relations and naso-respiratory rehabilitation
Authors: Milic Jasmina , Nikolic Predrag , Novakovic Svetlana
Published: December 2010

Aim. To determine if adenoidectomy itself could provide spontaneous relation of the transverse growth of jaws as well as an adequate mode of breathing or if there is a need for an additional orthodontic treatment to solve the problem. Methods. The study included one hundred and one patients aged 6-17 yrs., divided into three groups: group K - patients with oral respiration caused by adenoidal enlargement; group 1 - patients with adenoidectomy done 5 or more years before; group 2 - patients with orthodontic treatment done immediately after adenoidectomy. Transverse occlusion relation, the frequency of crossbite, and the intensity of nasal respiration were measured in all three groups of patients. Results. The obtained results have shown that in the patients with adenoidal enlargement and oral respiration, there was an evidence of maxillary width reduction as opposed to mandibular width. Of the patients, 14% were with unilateral or bilateral crossbite. In the patients with adenoidectomy done 5 or more years before, transverse maxillary growth compared to mandibular one in the region of the front width, showed statistically significant increase (p < 0.05) as opposed to the patients with adenoidal enlargement. The effect of adenoidectomy on transverse maxillary growth was not satisfactory anyway, which was also indicated by the increase of frequency of crossbite in 24% of the patients with adenoidectomy done 5 or more years before. In operated on and in the patients one month after orthodontic treatment, transverse maxillary growth compared to mandibular growth in all the regions of both front and back width, there was statistically highly significant increase (p < 0.01) as opposed to the patients with adenoidal enlargement and adenoidectomy done many years before. Significant maxillary and mandibular transverse relation was obtained without the presence of crossbite. Nasal respiration prevailed. Conclusion. Orthodontic therapy one month after adenoidectomy was necessary for solving the orthodontic problems caused by adenoidal enlargement and significantly contributed to the rehabilitation of nasal respiration.
Morphometric analysis of neurons from the marginal and substantia gelatinosa layers of human spinal cord: Classification according to laminar organization
Authors: Milosevic Nebojsa , Ristanovic Dusan , Stankovic Jovan , Nedeljkov Vladimir
Published: December 2010

The main goal of morphometric analysis of neuronal images, except for getting information about their geometry and dendritic branching patterns, is their classification based on laminar organization. The majority of contemporary techniques for image analysis are based on the application of fractal theory, which has some limitations on results analysis. For that reasons, the new, mostly nonfractal techniques for image analysis had been designed in the past few years. This study shows the analysis of morphometry of the human spinal cord neurons from the marginal (lamina I) and substantia gelatinosa (laminae I-II). For the analysis of neuron images two techniques of morphometric analysis were used: box-counting method as a mainly used technique for fractal analysis, and circle-counting method as a newly designed technique for measuring the length of dendrites. The use of these methods for neurons of the mentioned regions of human spinal cord showed that circlecounting method had given more accurate results than fractal analysis method. When the proposed method was used for the analysis of neuronal images, it was possible to classify neurons according to their laminar position.
Significance of iron reduction for the therapy of chronic hepatitis C
Authors: Nozic Darko , Balint Bela , Stankovic Nebojsa , Dimitrijevic Jovan , Neskovic Gorana
Published: December 2010

Background. It has been established that many patients with chronic hepatitis C have elevated serum iron, feritin levels and iron deposits in the liver. Therefore, the liver damage due to hepatitis C virus may be aggravated with iron overload. In many studies higher levels of iron in the blood and the liver were connected with the decreased response to interferon-alfa therapy for chronic viral hepatitis C. Recent introduction of pegylated interferons plus ribavirin has improved the therapeutic response, so it is now possible to cure more than 50% of the patients. Case report. Three patients with chronic hepatitis C and iron overload were presented. Iron reduction therapy using phlebotomy or eritrocytapheresis with plasmapheresis was done at different times in regard to specific antiviral therapy or as a sole therapy. Conclusion. It has been shown that iron reduction, sole or combined with antiviral therapy, led to the deacreased aminotransferase serum activity and might have slow down the evolution of chronic hepatitis C viral infection.
Stunned myocardium
Authors: Ristic Andjelka , Damjanovic Milorad , Baskot Branislav , Matunovic Radomir
Published: December 2010

Background. Stunned myocardium is a state of delayed recovery of regional contractility after a transient period of ischemia followed by reperfusion. Case report. A 67-year-old patient was admitted to our hospital with acute anterior myocardial infarction, and treated using percutaneous transluminal coronary angioplasty (PTCA) within acute disease stage. Reversible myocardial dysfunction persisted after ischemia following the return of normal perfusion. Abnormal resting wall motion with augmentation of contractility at low and high doses of dobutamine characterizes the stunned myocardium and reflects the normal blood flow reserve, characteristic for these postischemic, reperfused segments. SPECT (Single Photon Emission Computerized Tomography) with Tc 99 and dipyradamole showed normalization of perfusion defects in the apical region. Theree months after the infarction and PTCA, contractility was almost completely recovered. Conclusion. Stunned myocardium recovery lasted from few weeks to few months. Control ultrasonography as well as SPECT showed normalization of systolic function of the left ventricle in the viable segments registered at previous examinations.
Acute leg compartment syndrome after exertion
Authors: Misovic Sidor , Kronja Goran , Ignjatovic Dragan , Tomic Aleksandar
Published: December 2010

A case of a 22-year old soldier, with a history of pain in the leg during heavy exercise, which desisted at rest, was presented. One day before admission, the patient had felt an extreme exertion-induced pain in his right leg which had not lessened at rest. At the same time, the patient noticed persistent severe leg edema. On physical examination, the intracompartmental pressure was 62 mmHg (>30 mmHg). The patient was urgently operated on, and fasciotomy according to Mubarak was used. At second surgery, the debridement of the muscles of the posterior group of the leg, and the evacuation of hemathoma from the anterior and lateral group of the right leg muscles were perfomed. Postoperative recovery was uneventful. Fasciotomy wounds were closed within 14 days of the surgery. The complete physical treatment was done. Follow-up examinations 1, 3, and 6 months afterwards were satisfactory. The soldier completed his compulsory military service without any sequelae. Laboratory results were normal. Overlooked, unrecognized or surgically untreated compartment syndrome can cause severe damage, including even the loss of the extremity.