bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of nuclear Ki-67 antigen in prostatic high grade intraepithelial neoplasia and prostatic carcinoma
Authors: Jankovic-Velickovic Ljubinka , Djordjevic Biljana , Rancic Gorana , Marjanovic Goran
Published: December 2010

Background/Aim. Prostatic intraepithelial high grade neoplasia (PINHG) is accepted as preneoplastic lesion in prostatic carcinoma. One of the fundamental events in early oncogenesis is the disruption of proliferative activity. One of the numerous regulatory proteins is Ki-67 expressed in all proliferating cells. Index Ki-67 is considered to have prognostic significance. The aim of the study was to compare the level of proliferation in hyperplastic epithelium, prostatic carcinoma (Gleason score > 6) and PINHG. Methods. Micromorphological examination was done in 85 patients. Pathohistological analysis was performed on standard histologic specimens with the estimation of Gleason score and the presence of PINHG in its surroundings. Nuclear proliferative activity was analyzed immunohistochemically in 19 cases, using a monoclonal anti-Ki-67 antibody. Results. PINHG was found in prostatic carcinoma surrounding in 30% of the patients. In hyperplastic epithelia Ki-67 proliferative activity was 1,08, in PINHG 2,25 (p < 0,05), while in prostatic cancer, Ki-67 index was 17,64. Proliferative activity in prostatic carcinoma was significantly higher than in PINHG (p < 0,001) and hyperplasia (p < 0,001). Conclusion. This study confirmed that high grade PIN lesion predominately appears in the surrounding of poor or moderately differentiated prostate carcinoma, and that it represents progressive disorder of proliferation in preneoplastic and neoplastic prostatic epithelium. .
Extravesical diverticulectomy: A surgical technique for managing a giant bladder diverticulum
Authors: Milovic Novak , Bancevic Vladimir
Published: December 2010

Background. Bladder diverticulum may be congenital and acquired. Iatrogenic bladder diverticulum is classified in a special group. Indications for surgery are: persistent or recurrent urinary infection, the presence of a stone in a diverticulum, development of tumor in a diverticulum cavity, the lower urinary tract symptoms and voiding symptoms and vesicoureteral reflux due to diverticulum or ureteral obstruction. Case report. We presented a patient with a giant bladder diverticulum. Transurethral bladder catheterisation was performed because of urine retention. Secondly, transurethral prostate resection solved subvesical obstruction. The third step was open, extravesical diverticulectomy. Post-operative course was without complications. Three months after the surgery, control intravenous urography revealed normal findings. Conclusion. We believe that the three-steps treatment of a giant bladder diverticulum significatntly contributed to the decreasing of postoperative complications. .
Cardiac rhabdomyosarcoma
Authors: Damjanovic Miodrag , Tomasevic Miloje , Djordevic-Radojkovic Danijela , Koracevic Goran , Jankovic Ruzica
Published: December 2010

Background. Primary malignant cardiac tumors are rare entities and rhabdomyosarcoma accounts 20% of these lesions. Case report. We presented a female patient with loss of appetite and loss of weight. She also had symptoms of heart failure and bilateral pleural effusions. A mobile tumor in the left heart with the entrance from the left atrium to left ventricle during diastole was seen by transthoracic echocardiography. The tumor was extirpated in total, histologic diagnosis was rhabdomyosarcoma, and the patient died after 6 months. Conclusion. Primary malignant cardiac tumors can simulate heart failure or systemic disorders. Cardiac rhabdomyosarcomas have a poor prognosis with the average survival of 6 months after the occurrence of symptoms and making a diagnosis. In cardiac insufficiency, differential diagnostics should be used to consider cardiac tumors that could be with certainty confirmed or excluded by echocardiography.
Urological complications after radical hysterectomy: Incidence rates and predisposing factors
Authors: Likic-Ladjevic Ivana , Kadija Sasa , Ladjevic Nebojsa , Stefanovic Aleksandar , Argirovic Rajka , Petkovic Spasoje , Petronijevic Milos , Vrzic-Petronijevic Svetlana
Published: December 2010

Bacground/Aim. Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. Methods. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient?s age; the International Federation of Ginecology and Obstetrics (FIGO) stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. Results. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentioned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal fistuls had abscess of vaginal cuff. Conclusion. The stage of the disease seem to be the most significant factor in the development of intraoperative ureter and bladder injuries. The stage of the disease, intraoperative bladder injury, diabetes mellitus and postoperative infection of surgical site are the most significant factors in the development of postoperative fistuls. .
Mycophenolate mofetil combined with steroids: New experiences in the treatment of idiopathic retroperitoneal fibrosis
Authors: Obrencevic Katarina , Jovanovic Dragan , Kovacevic Zoran , Hrvacevic Rajko , Ignjatovic Ljiljana , Mijuskovic Mirjana
Published: December 2010

Background/Aim. Idiopathic retroperitoneal fibrosis (IRF) is an uncommon disease characterized by a retroperitoneal fibrotic tissue that often involve the ureters, leading to the obstructive nephropathy and variable impairment of renal function. Findings strongly suggest an autoimmune etiology. Surgery, medical treatment with immunosuppressive drugs, or a combination of both are proposed. The optimal treatment has not been established yet. The aim of this study was to present our experience with combined immunosuppressive therapy of IRF, steroids (S) and mycophenolate mofetil (MMF). Methods. We prospectively followed four patients with IRF from January 2004 to December 2006. Three patients had an active disease with bilateral hydronephrosis. In the two of them acute renal failure was presented, and ureteral catheters were inserted in one in order to manage ureteral obstruction. One patient has came to our unit with a relapse of IRF and incipient chronic renal failure after the prior therapy with ureterolysis and immunosuppressive drugs (azathioprine and tamoxifen). All patients received steroids and MMF. Two patients were treated with intravenous methylprednisolone pulses (250 mg each), for three consecutive days, followed by oral prednisone 0.5 mg/kg/day. The other two patients received oral prednisone at the same dose. Prednisone was gradually tappered to a maintenance dose of 10 mg/kg/day. Simultaneously, all patients received MMF, initially 1 g/day with the increase to 2 g/day. Results. After four weeks of the therapy all symptoms disappeared, as well as a hydronephrosis with a decrease of erythrocyte sedimentation rate and Creactive protein (CRP) to normal level in all patients. Three patients remain in remission untill the end of the follow up. One patient had a relapse because of stopping taking the therapy after six months. He was treated by oral prednisone 0.5 mg/kg/day, which was gradually decreased. After twelve weeks hydronephrosis disappeared and CRP returns to the normal level. Conclusion. The combination of steroids and mycophenolate mofetil led to the remission of IRF with a strong and quick immunosuppressive effect. It also provided avoiding the long-term use of high steroid dose and surgical procedures. .
Effect of tadalafil on erectile dysfunction in male patients with diabetes mellitus
Authors: Popovic Srdjan , Nale Djordje , Dabetic Marija , Matanovic Dragana , Dimitrijevic-Sreckovic Vesna , Milic Gordana , Gostiljac Drasko , Vujovic Svetlana , Antonijevic Nebojsa , Nisic Tanja , Djordjevic Predrag
Published: December 2010

Background/Aim. During the first 10 years over 50% of diabetes patients develop erectile dysfunction (ED). It is more severe and resistant to therapy than in male patients with normal glucoregulation. The purpose of this pilot study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with diabetes mellitus (DM), together with moderate to severe ED. Methods. The study included 30 male patients with diagnozed type 1 or type 2 DM together with ED. ED was estimated through the International Index of Erectile Function (IIEF-6), Sexual Encounter Profile (SEP) questionnaire and prostaglandin test, at the beginning of the research and three months after the 20 mg tadalafil therapy initiation, once a week (on Fridays). Glycosylated haemoglobin in blood (HbA1c) values were also monitored. According to the ED severity (IIEF values at the beginning of the therapy) the patients were divided into 2 groups. The previous experience with sildenafil citrate (Viagra) and prostaglandin E1 intracavernous therapy was recorded. Results. Tadalafil significantly improved ED (p < 0.001) for 7.40 points of the IIEF score, i.e. for 58% and 60% towards SEP2 and SEP3 questionnaire, respectively. Compared to the previous ED therapy subjectively better tadalafil experience was recorded. Each group experienced a significant improvement in IIEF score (p < 0.001), more significantly in the group 2 (8.26?1.49 points) compared with the medium improvement in the group 1 (6.27?1.35 points). After three months HbA1c values decreased for 2.26?1.62 (p < 0.001). Conclusion. Tadalafil is an effective tool for treating ED in diabetes patients. In some situations tadalafil application could replace prostaglandin test. The sexual sphere motivation leads to the improvement of glucoregulation in DM patients. .
Seven steps of gradual cessation of smoking: An example from India
Authors: Narayan-Srivastava Govind
Published: December 2010

Background/Aim. One sixth of smokers in the world live in India. The National Family Health Survey showed that individuals with no education were 2.69 times more likely to smoke and chew tobacco than those with postgraduate education. Whether the physicians' interaction with public can cause the smoking cessation or habit by detailing the harmful effects as well as benefits of cessation without any withdrawal effects? Our aim was, therefore, to help people to stop smoking step by step. Methods. The study was conducted at the University Student Health Care Centre, Banaras Hindu University, Varanasi, India, from June 2004 to February 2005. A total of 1 200 students smokers (graduate, post graduate or research scholars) participated. They were from 17 to 32 years old (mean age, 26 years). All were male sex. Each and every student was explained in details risks and hazards, and benefits of cessation, focusing this latter on immediate and substantial benefits at any sex and age; their every question and quarries were explained. All were told that either they should stop smoking immediately or minimized step by step. The seven steps were explained to them. Results. The smoking duration was one year and more in all the participants ranging from one to 15 years; the average period of smoking was five years and six months; the number of smoked cigarettes per day was 12 on average (5?20). In 450/1200 (37.50%) students, either of any family members were smoking while 200 (16.66%) students have been inspired from their friends. The majority of 780/1200 (65%) gave-up smoking at any step as advised. The followup could not be done in 80/1200 (6.6%) students who did not report at any of the stages. Finally, 340/1200 (28.0%) students either reduced the number or failed to give-up smoking. Conclusion. The results of the study are very encouraging. Such interaction type of doctors with smokers will not only help to the concerned person but also to the society. .
Ecthyma gangrenosum in a patient with non-Hodgkin lymphoma
Authors: Colovic Natasa , Grubor Nikica , Tanasilovic Srdjan , Colovic Radoje
Published: December 2010

Introduction. Ecthyma gangrenosum is a rare disease of the skin that causes the localized necrosis of the skin and subcutaneous fat tissue, leading to the multiple ulcerations surrounded by local hyperaemia. The ulcerations are usually localized in groins, and perianal area. In the majority of cases ecthyma is caused by a Pseudomonas aeruginosa sepsis. The disease usually appears in immunocompromized, most frequently hematological patients. Case report. We presented a 78-year-old woman who had been treated for non-Hodgkin lymphoma for the last 18 years. She had recently been given cytotoxics which led to neutropenia. The patient suddenly developed high fever, chill and diarrhea, followed by ecthyma gangrenosum cutaneous lesions in groins, axillas, right side of the neck and umbilicus. Pseudomonas aeruginosa and Proteus mirabilis, that were sensitive to several antibiotics were isolated. The treatment included rehydratation, antibiotics, surgical debridement and regular dressing with antiseptics. The healing of all lesions was achieved after sixteen weeks of the treatment. Conclusion. If haemorrhagic- necrotic lesions of the skin are developed in immunocompromised, usually haematologic patients, an Ecthyma gangrenosum has to be considered immediately, material for identification of a cause has to be taken, followed by immediate administration of antibiotics effective against Pseudomonas aeruginosa. Surgical debridement and other therapeutic modalities are to be considered in some patients. .
Significance of confirming Epstein-Barr virus nuclear antibody as tumor marker
Authors: Stosic-Divjak Svetlana , Djukic Vojko , Boricic Ivan , Racic Alek , Divjak Isidora , Krsmanovic Velibor
Published: December 2010

Backgrounnd/Aim. Study of the association between Epstein-Barr virus (EBV) and the tumors of the nasopharynx renders an opportunity to introduce causal treatment. Already have been proven the anti-EBV (anti-Epstein-Barr nucleus antigene) antibodies in the blood serum of the patients infected with EBV, while over 91% of the patients with nasopharyngeal malignant tumors also have a detectable anti-EBV marker. The aim of this research was to determine if there were anti-EBV antibodies in the serum of the patients with the already verified nasopharyngeal malignant tumors, and, if there were, to determine the quantitative ratio to the values in the serum of the healthy controls. Methods. The study involved 74 individuals in the period from 1994?2001 divided into four groups: group A counting 11 patients with undifferentiated carcinome of nasopharyngeal type (UCNT); group B counting 25 patients with UCNT Xray treated at least three years before the onset of the study; group C including 28 healthy subjecets (blood donors), and the group D with 10 patients with planocellular nasopharyngeal carcinoma. Serologic diagnostics of the patients serum was performed using the techniques of Reedman and Klein for the detection of anti-EBV antibodies in the serum. Results. The presence of the statistically significantly higher values of the mean geometric titer (MGT) of the anti- EBNA antibodies was determined in 36 patients with histologically verified UCNT as compared with the control groups including 10 patients with planocellular carcinomas of the nasopharynx and 28 blood donors. Presented were anti-EBNA titers with 95% confidence interval for any participants according to the Hoo clinical classification of nasopharyngeal tumors, as well as according to the fact if they had been radiotreated within the previous three years. Conclusion. The results of this study confirm the conclusions of the recent literature on the possible etiopathogenesis of nasopharyngeal tumors and the use of viral anti-EBNA antibodies as viral markers in the diagnostics of UCNT diseases. .
Effect of recasting on the elastic modulus of metal-ceramic systems from nickel-chromium and cobalt-chromium alloys
Authors: Mirkovic Nemanja
Published: December 2010

Background/Aim. Elastic modulus of metal-ceramic systems determines their flexural strength and prevents damages on ceramics during mastication. Recycling of basic alloys is often a clinical practice, despite the possible effects on the quality of the future metal-ceramic dentures. This research was done to establish recasting effects of nickel-chromium and cobalt-chromium alloys on the elastic modulus of metalceramic systems in making fixed partial dentures. Methods. The research was performed as an experimental study. Six metal-ceramic samples of nickel-chromium alloy (Wiron 99) and cobalt-chromium alloy (Wirobond C) were made. Alloy residues were recycled through twelve casting generations with the addition of 50% of new alloy on the occasion of every recasting. Three- point bending test was used to determine elastic modulus, recommended by the standard ISO 9693:1999. Fracture load for damaging ceramic layer was recorded on the universal testing machine (Zwick, type 1464), with the speed of 0,05 mm/min. Results. The results of this research revealed significant differences between elasticity modules of metal-ceramic samples in every examined recycle generation. Recasting had negative effect on the elastic modulus of the examined alloys. This research showed the slight linear reduction of elastic modulus up to the 6th generation of recycling. After the 6th recycling there was a sudden fall of elastic modulus. Conclusion. Recasting of nickelchromium and cobalt-chromium alloys is not recommended because of the reduced elastic modulus of these alloys. Instead of reusing previously recasted alloys, the alloy residues should be returned to the manufacturer. .
Epileptic seizures due to multiple cerebral cavernomatosis
Authors: Spasic Mirjana , Lukic Stevo
Published: December 2010

Background. Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4?0.9 % of people, and represent around 5% of all cerebrovascular malformations. They can be single or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. Ten to 30 % are associated with familial clustering. Case report. We presented the case of a 43-year-old man, admitted to the Emergency Department due to unprovoked seizure during the wide awake and everyday activities. Neurological examination was with no focal signs. A 32-channel standard digital EEG was without any significant changes of normal baseline activity. After sleep deprivation EEG showed multifocal, bilateral and asymmetric polyspikes and sharpwaves activity. Hyperventilation induced generalized epileptiform discharges. MRI scan demonstrated multiple small cavernous angiomas. Neuropsychological testing demonstrated a delayed memory impairment. Neurosurgery treatment was not recommended, and the therapy with valproate 1 250 mg/day had an excellent efficacy with no singnificant adverse effects. Conclusion. This patient considered as a rare case with multiple cavernomatosis highlights the importance of neuroradiological examination in adult patients with the first epileptic seizure but with no focal neurological signs. .
Incidence of locally invasive prostate cancer in patients with intermediate values of prostate-specific antigen
Authors: Cerovic Snezana , Jeremic Nebojsa , Brajuskovic Goran , Milovic Novak , Maletic-Vukotic Vinka
Published: December 2010

Background/Aim. Feasibility of radical prostatectomy (RP) in patients with locally invasive prostate cancer (PC) is assessed by the standard parameters such as the stage of the disease, serum prostate-specific antigen (PSA) and bioptic Gleason grade (GG). Intermediate values of PSA are important in predicting the local confines of the tumor, but can also be detected in more than 30% of patients with locally advanced PC. The aim of this study was to find out the incidence of locally advanced PC in the patients with intermediate serum PSA in whom RP had been performed. Methods. We used the biopsy cores and the tissue obtained after RP from 46 patients who had intermidiate PSA values which were defined as PSA from 2.6-10 ng/ml. In all the patients classical regional lymphadenectomy was performed. In all the patients, preoperative stage was determined according to the Partin tables (PT) from 2001. Results. In 52,17% of the patients biopsy GG was ?6, while it was 7 in 47.83% of the patients. Clinically localized disease (cT2b) was found in 86.96% of patients; other 13.04% of the patients had locally advanced PC. After RP, the incidence of localized PC was 47.83%, while the advanced disease was found in 52.17%. Metastasis in one or two regional lymph nodes (N1) was found in 10.87% of the patients with the advanced PC. According to PT, the expected incidence of positive lymph nodes should have been 8% for pT3 stage. Positive correlation between the assumed N1 stage according to PT and N1 stage in our radical prostatectomies was statistically significant (p = 0.012). Conclusion. In more than 50% of patients with intermediate values of PSA locally advanced disease can be expected after RP. The use of the Partin tables have an important predictive value in assessing the local confines of the cancer and metastasis in regional lymph nodes. .
Determination of factor Xa inhibition doses of low-molecular heparin, nadroparin and reviparin in urological patients
Authors: Pavlovic Svetlana , Zivkovic Sladjana , Koracevic Goran
Published: December 2010

Background/Aim. The inhibition of factor Xa (FX) by the use of low-molecular heparin (LMH) is important clinical procedure in patients with moderate and high risk for the developament of venous thromboembolism (VTE) and pulmonary embolism (PE). The aim of this study was to determine the level of inhibition of FXa by the use of prophylactic doses of LMH nadroparin-calcium and reviparine-sodium which were applied in urological patients with moderate risk for VTE and PE. Methods. The examination included 80 urological patients divided into 4 groups after urological, uroradiological and anesthesiological preoperative preparation and categorization of anesthesiological risk according to the ASA III classification. The first two groups, of 20 patients each, received the recommended doses of LMH in accordance with the preoperative risk, and an inhibition of FXa 48 hours after the surgical operation and four hours after the administration of LMH was determined. Heptest and homogenous anti-Xa test were used for monitoring of FXa inhibition. Since the obtained anti-Xa values were not satisfactory, two more groups were formed and given double the recommended doses. In these new groups, inhibition of FXa was in recommended range. Standard descriptive statistical parameters were used for describing the charateristics of the people from the formed groups. Results. All the patients examined were clinically estimated as patients of moderate risk, for VTE and PE. There were no statistically singificant difference in body weight of the patients who received nadroparin-calcium 0.3 ml and reviparine-sodium 0.25 ml and those who received their double doses, respectively. The level of FXa inhibition in the group in which the dose of nadroparin-calcium of 0.6 ml was applied was statistically significantly higher than in the group which received the dose of 0.3 ml (Mann-Whitney U test: Z = 5.416; p < 0.0001). The level of FXa in the group given reviparine-sodium 0.5 ml was significantly higher than in the group which received the half of this dose (Mann-Whitney U test: Z = 5.416; p < 0.0001). This research did not confirm a statistically significant difference in the levels of FXa inhibition in patients who received nadroparincalcium as VTE and PE prophilaxis in the dose of 0.6 ml and those who received reviparin-sodium 0.5 ml (in two doses of 0.25 ml) (Mann-Whitney U test: Z = 0.163; p > 0.05). Conclusion. According to biochemical monitoring, the recommended doses of LMH are insufficient for the prophylactic inhibition of FXa in urological pateints with moderate risk for VTE and PE, so the higher doses which inhibit FXa are recommended. .
Study on histogenesis of enterochromaffin-like carcinoid in autoimmune atrophic gastritis associated with pernicious anemia
Authors: Macukanovic-Golubovic Lana , Katic Vuka , Rancic Gorana , Milenovic Mladen , Marjanovic Goran , Golubovic Zoran
Published: December 2010

Background/Aim. Autoimmune atrophic fundic gastritis induces the pernicious anemia (PA), as well as the changes in both epithelium and endocrine cells of gastric mucosa. The most important complications are: achlorhydria, hypergastrinemia, gastric cancer and enterochromaffin-like ( ECL) carcinoid. The aim of this study was to examine ECL carcinoid histogenesis in A-gastritis associated with PA. Methods. During the period from 2000?2006, 65 patients with PA and 30 patients of the control group were examined. Histopathological examination was done in endoscopical biopsies of gastric mucosa fixed in 10% formaldehyde. Paraffin sections were stained with classic hematoxylin-eosin (HE); histochemical AB-PAS (pH 2.5), cytochemical argyrophilic Servier-Munger?s and immunocytochemical PAP methods for G cell identification and chromogranin A antibodies - specific marker for neuroendocrine ECL cells. Both G and ECL cells were counted per 20 fields, of surface 0.0245312 mm2 by a field. Basal gastrin serum levels were also examined by using radioimmunoassay (RIA) method. The obtained results were statisticaly calculated by using Student?s t test. Results. Marked antral G cell hyperplasia associated with corporal ECL hyperplasia was found. ECL cell hyperplasia was of simplex, linear, adenomatoid type to the pattern of intramucous ECL cell carcinoid. An average number of G cells was statistically significant in the patients with PA as compared to the control group (p < 0.05) as well as an average number of ECL cells. Conclusion. We concluded that antral G cell hyperplasia accompanied by gastrinemia induces ECL hyperplasia and ECL corporal carcinoid in A-gastritis and that their histogenesis develops trough simple, linear and adenomatoide hyperplasia. .
Significance of biomarkers and surrogate endpoints in preclinical and clinical trials
Authors: Ilic Katarina , Kuntic Vesna
Published: December 2010

 Biomarkeri imaju siroku primenu u modernoj medicini i biologiji. Oni su promenili nacin dijagnostikovanja i klasifikacije bolesti, pracenja efekata terapije, odredjivanja toksicnosti, a imaju i sve vecu primenu u razvoju novih lekova. Karakteristike biomarkera odredjuju i njihovu primenu. Biomarkeri koji imaju malu moc predvidjanja korisnosti tretmana koriste se u ranim fazama razvoja lekova za preliminarni skrining. Biomarkeri velike prediktivne moci mogu biti upotrebljeni kao surogatni parametri u proceni efikasnosti i bezbednosti tretmana. Surogatni parametri validirani u klinickim istrazivanjima i prihvaceni od strane regulatornih agencija mogu biti korisceni i za registraciju lekova, narocito za ubrzanu registraciju antiinfektivnih lekova i hemoterapeutika. Medjutim, za registraciju antikancerskih lekova regulatorne agencije insistiraju na neophodnosti prospektivnih postmarketinskih studija da bi se dokazalo postojanje korelacije surogatnih parametara sa klinickom koristi od primenjenog tretmana. .
Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia
Authors: Svetel Marina , Vasic Milan , Tomic Gordana , Stankovic Predrag , Stojanovic Milena , Dragasevic Natasa , Dergenc Ranko , Vukasinovic Milan , Pekmezovic Tatjana , Petrovic Igor , Kostic Vladimir
Published: December 2010

Background/Aim. Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80?100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. Methods. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12?16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. Results. The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index ? (VHI) that was rated as rather significant one (t = 3.562; p = 0.006). Conclusion. Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.
Influence of the primary malignant tumor site on the incidence and features of metastatic ovarian tumors
Authors: Stanojevic Zorica , Djordjevic Biljana , Zivanovic Danijela
Published: December 2010

Background/Aim. Ovary is the organ of the female reproductive system most commonly affected by metastases. The aim of the study was to determine the frequency and features of metastatic ovarian tumors (MOT) depending on the site of the primary malignant tumor. Methods. The study group consisted of 488 patients with histopathologically confirmed ovarian cancers treated at the Clinic of Oncology, Clinical Center Nis, in the period from 1 January 1998 to 31 December 2005. MOT were found in 41 patients. Regarding the site of the primary malignant tumor, those with secondary ovarian tumor were divided into two groups: group A - primary malignant tumor involving the genital organs (n = 30) and group B - primary malignant tumor of extragenital origin (n = 11). Results. MOT were confirmed in 8.40% (41/488) of the patients. Secondary ovarian malignancies were the consequence of endometrial carcinoma spreading in 73.17%, breast carcinoma in 19.51%, stomach carcinoma in 4.88% and colon carcinoma in 2.44% of the cases. No significant differences were found between the group A and group B by the factors of age, body mass index, parity and menopausal status. Contrary to the group A, metastatic tumors in the group B patients were more commonly asymptomatic (p < 0.001), bilateral (p < 0.05), with larger ovarian diameter (p < 0.05), associated with ascites (p < 0.001) and abdominal metastases (p < 0.01), all of statistical significance. Conclusions. Metastatic tumors made up 8.40% of ovarian neoplasmas. With non-genital primary tumors, secondary ovarian deposits were frequently asymptomatic, bilateral, associated with larger ovarian diameter, ascites and abdominal metastatic deposits, compared to malignant tumors of genital origin.
New bearings in pharmacotherapeutic strategies: Pharmacogenetics and gene therapy
Authors: Grbovic Leposava , Radenkovic Miroslav , Djokic Jelena , Gojkovic-Bukarica Ljiljana , Dragovic Gordana
Published: December 2010

 Slicno drugim, novim terapijskim konceptima i genska terapija je puno obecavala, ali za sada je jos u razvoju. Glavni izazov ostaje unosenje pravog gena na pravo mesto, u pravu celiju i obezbedjenje adekvatne ekspresije, uz minimalna nezeljena dejstva. Iako se najvise radi na virusnim vektorima, smatra se da buducnost genske terapije cine znatno bezbedniji nevirusni sistemi. Bilo je izvesnih promasaja u genskoj terapiji, sto je dovelo do sumnje i zabrinutosti u siroj populaciji. Medjutim, razvoj genske terapije je realnost, kao i cinjenica da ona ima svoje mesto u medicini. Vazno je istaci da genskoj terapiji treba pristupati sa izuzetno visokim stepenom naucne, strucne i eticke odgovornosti, jer se ne moze iskljuciti mogucnost genetskih manipulacija opasnih za ljudsko zdravlje.
Coexistence of Hashimoto's thyroiditis and papillary thyroidal carcinoma with papillary carcinoma of thyreoglossal duct
Authors: Cizmic Milica , Ignjatovic Mile , Cerovic Snezana , Ajdinovic Boris
Published: December 2010

Background. Simultaneous presence of Hashimoto's thyroiditis and papillary thyroidal carcinoma in thyroidal gland with papillary carcinoma association in thyroglossal duct is quite rare. The questions like where the original site of primary process, is where metastasis is, what the cause of coexisting of these diseasesis present a diagnostic dilemma. Case report. We presented a case of a 53-year old female patient, with the diagnosis of Hashimoto's thyroiditis and symptoms of subclinical hypothyreosis and nodal changes in the right lobe of thyroidal gland, according to clinical investigation. Morphological examination of thyroidal gland, ultrasound examination and scintigraphy with technetium (Tc) confirmed the existence of nonhomogenic tissue with parenchyma nodular changes in the right lobe of thyroidal gland that weakly bonded Tc. Fine needle biopsy in nodal changes, with cytological analyses showed no evidence of atypical thyreocites. Hashimoto's thyroiditis was confirmed on the basis of the increased values of anti-microsomal antibodies, the high levels of thyreogobulin 117 ng/ml and TSH 6.29 ?IU/ml. The operation near by the nodular change in the right lobe of thyroidal gland revealed pyramidal lobe spread in the thyroglossal duct. Total thyroidectomia was done with the elimination of thyroglossal duct. Final patohystological findings showed papillary carcinoma in the nodal changes pT2, N0 and in the thyroglossal duct with the presence of Hashimoto's thyroiditis in the residual parenchyme of the thyroid gland. After the surgery the whole body scintigraphy with iodine 131 (131I) did not reveal accumulation of 131I in the body, while the fixation in the neck was 1%. After that, the patient was treated with thyroxin with suppressionsubstitution doses. Conclusion. Abnormality in embrional development of thyroidal tissue might be the source of thyroidal carcinoma or the way of spreading of metastasis of primary thyroidal carcinoma from thyroid gland. The cause of this process is most probably a hereditary mutation in RET oncogenes.
Computer-assisted quantitative analysis of Ki-67 antigen in dysplasia: Associated lesions or masses in ulcerative colitis
Authors: Zivkovic Vesna , Petrovic Aleksandar , Djordjevic Biljana , Katic Vuka , Gligorijevic Jasmina , Pavlovic Voja , Krstic Miljan
Published: December 2010

Background/Aim. The aim of this study was to apply computer- assisted methodology in assessment of Ki-67 positivity in "adenoma-like" dysplasia associated lesions or masses (DALMs), and carcinoma in ulcerative colitis (UC), and to determine a new approach to grading of Ki-67 staining intensity. Methods. Immunohistochemical slides were quantitatively analyzed for estimation of proportion and intensity of Ki-67 positive-stained cells in a total of 50 "adenoma-like" DALMs (27 with low-grade dysplasia and 23 with high-grade dysplasia), and 17 adenocarcinomas associated with UC. The four grades of immunohistochemical staining intensity were established by an automated classification of nuclear optical densities. Results. The Ki-67 labeling index (LI) in low-grade dysplasia was significantly lower than in high-grade dysplasia, and carcinoma (p < 0.001). The Ki-67 LI of carcinomas was not significantly different from the value obtained in highgrade dysplasia (p > 0.05), however having the difference in percentage values of the moderate stained nuclei (p < 0.05). The overall average values of chromogene nuclear optical density, showed statistically significant differences between DALMs and carcinoma (p < 0.05), although not between normal mucosa and low-grade dysplasia (p > 0.05). Conclusion. The obtained results imply, according to the overall percentage of labeled nuclei, that high-grade dysplasia is very close to carcinoma, while there is the difference in the percentage of moderately stained nuclei. We showed that Ki-67 positivity have a different internal distribution which could be useful in analysing these lesions. These findings also, indicate the important biological differences between low-grade dysplasia and carcinoma in UC, and a low proliferative potential of the former. Automated image analysis permits an objective estimation of Ki-67 immunohistochemical staining in UCassociated dysplasia and carcinoma.
Class II malocclusion therapy using fixed orthodontic appliance
Authors: Skufca Bojan , Jelenic Tatjana
Published: December 2010

Background. Depending on the indication, and the age of a patient, class II division I malocclusion can be treated by a fixed or mobile orthodontic appliance, with or without teeth extraction. Case report. A treatment of a male patient, 15 years old, with dentoalveolar class II division I was described. On the base of clinical findings, study case analysis, analysis of orthopan and profile cephalogram, there were class II division I with protrusion of frontal teeth and mild crowding in lower jaw assessed. The patient was treated by fixed orthodontics appliances (SWA Roth .022") in both jaws for 18 months, with the retention period of the same length. Conclusion. Fixed ortodontic appliances are necessary when bodily movement of the teeth is indicated - in this case for cuspids distalization and retraction of incisors.
Identification of residual ischemia in the occluded coronary artery irrigation area using myocardial perfusion scintigraphy
Authors: Baskot Branislav , Obradovic Slobodan , Gligic Branko , Rafajlovski Saso , Markovic Ljuba , Pavlovic Miodrag
Published: December 2010

Background. Inspite the indisputable significance of coronarography, the implications of a revealed stenosis - and how close it is to occlusion could vary in regard to its physiological importance. Myocardial perfusion scintigraphy (MPS) possibility to prove and objectivise the presence of ischemia and myocardial viability within an occlusion found coronarographically is especially significant since it makes possible to the clinician to choose an adequate therapy. Case report. We reported a 43- year-old male patient who had been hospitalized to another institution due to acute myocardial infarction (AMI) of posterolateral localisation. Following the acute AMI stage the ergometric test per Bruce protocole was performed, negative to ischemic heart disease, while multislice computed tomography showed no significant changes on the coronary arteries. The performed one-day-protocole MPS showed a massive area of residual ischemia within myocardial infarction (MI) type culprit lesion of the posterolateral zone starting from the subapical level to the basal cross-section. According to the MPS findings coronarography was indicated due to a revascularisation assessment. The performed coronarography revealed an occlusion of the circumflex coronary artery (CCA) right after the division of obtuse branch (OB) that presented discretely in the distal parts from the homo- and heterocolaterals. The distal portion of CCA presented discretely out off the right coronary artery (RCA). Echocardiography confirmed an ejection fraction of 50% with hypokinesia of inferior and posterior walls, as well as the septum, showing a mild reduction of the general contractility. Flows through confluences were well. A month after MI a percutane coronary intervention (PCI) was performed with the implantation of a drug-releasing stent (Taxus). Early after PCI (within two weeks) a control MPS was done to evaluate the effects of the therapy giving the normal findings of myocardial perfusion. Conclusion. Determination and identificantion of vivid but ischemic myocard of culprit lesion type in the occluded artery irrigation zone enable making choice of the best therapy for a patient.
Surgical treatment of war posttraumatic pleural empyemas
Authors: Cvijanovic Vlado , Stanic Vojkan , Ristanovic Aleksandar , Gulic Bojan , Kovacevic Snezana
Published: December 2010

Background/Aim. Posttraumatic pleural empyema is the most frequent septic complication of the thoracic penetrating war injuries. Surgical treatment used to be based on the experience gained in the treatment of parapneumonic empyema, the most frequent empyema, and used to be favored the pleural drainage until the nineties of the last century. Thoracotomy and decortication was performed in case of drainage failure, in early chronic phase, 4-6 weeks after injury. The aim of this study was to emphasize the necessity of different surgical approaches in the treatment of this disease which is based on the different pathophisyology of posttraumatic and other sorts of empyema. Also, to recommend on the basis of the surgical treatment results, early decortication as better method in the treatment of this septic complication. Methods. In the period between September 1991-June 1999. 1 303 thoracic injures were surgically treated. There were 1 117 penetrating injures with 675 dominant thoracic injures, and 442 thoracic injures as the following ones. In 59 (5.3%) injured people raised posttraumatic empyema (PET). The patients were divided into the groups with early and late decortications regarding the interval between the injury and the surgical treatment. Almost all the patients sustained this complication in various periods before the admittance to the hospital. Surgical treatment efficiency of early and late decortication was analyzed on the basis of perioperative and postoperative study parameters and analyzing postoperative complications. Results. Thoracotomy and decortication were performed in 46 (78%) injured patients with post traumatic pleural empyema while only 13 (22%) injured patients were successfully treated for this septic complication with drainage procedures. This study proved that there were in the group with early decortications lesser intra and postoperative blood loss, duration of operation was shorter as well as febrile postoperative period. In this group, also, hospitalization was shorter and with lesser complications. Conclusion. The obtained results showed that thoracotomy and decortication should be done as early as possible in patients, not later than two weeks after the injury.
Clinic-pathological characteristics of colonic carcinoma in relation to localization and histologic type
Authors: Zivkovic Vesna , Katic Vuka , Djordjevic Biljana , Krstic Miljan , Pejovic Svetlana , Petrovic Aleksandar
Published: December 2010

Background/Aim. A significant increase in colonic carcinoma has been analyzed in numerous clinic-pathological studies and genetics models. The aim of this study was to determinate the differences in clinic-pathological parameters of colonic carcinoma regarding localization and histological type. Methods. The study enrolled 124 patients who had undergone surgery for colorectal carcinoma at the Clinic of Surgery in the town of Nis within 2005. Paraffin sections were stained with Hematoxilin-eosin (H&E), High iron diamine-Alcian blue (HID-AB) (pH-2.5) and Alcian blue-Preiodic arid Shiff (AB-PAS) (pH-2.5) methods. From pathological report we used data regarding: localization (right or left colon), histological type, histological grade, and parameters which determinate the tumor stage. Results. The total number of patients with right-sided colonic carcinoma was 40 (32.36%) and 84 (67.74%) with left-sided colonic carcinoma. Histopathologically, 96 (77.42%) adenocarcinomas and 28 (22.58%) mucinous adenocarcinomas were verified. There were no statistically significant differences between the right-sided and left-sided colonic carcinoma regarding sex, age, histological grade and tumor stage (p > 0.05). Mucinous adenocarcinomas was statistically significantly more frequent in right-sided colon (35.00%) than in left-sided colon (16.67%) (p < 0.05). There were no statistically significant differences between adenocarcinomas and mucinous adenocarcinomas regarding sex and disease stage. In younger patients the percentage of mucinous adenocarcinomas (28.57%) compared to nonmucinous ones (11.46%) was significantlly higher (p < 0.05) than in older patients. Mucinous adenocarcinomas had statistically significantly more frequently poor differentiation in comparison to adenocarcinomas (46.43% versus 9.37%, p < 0.001). Conclusion. According to the presented results it can be concluded that the lower grade of differentiation of the colon adenocarcinoma and mucinous secretion are significantly often present in younger patients.
Echocardiographic findings of mitral valve prolapse
Authors: Ristic-Andjelkov Andjelka , Miladinovic Zorica , Rafajlovski Saso , Ratkovic Nenad
Published: December 2010

 Prolaps mitralnog zalistka predstavlja najcescu urodjenu srcanu manu kod odraslih osoba. Ehokardiografski nalaz ima kljucnu ulogu prilikom postavljanja dijagnoze, ustanovljavanja lokalizacije zahvacenih segmenata i procene obima bolesti. Takodje, omogucuje identifikaciju bolesnika sa najvecim rizikom za pojavu komplikacija i daje kljucne podatke pri donosenju odluke o rekonstrukciji mitralnog zalistka.
Female genital tuberculosis: A disease seen again in Europe
Authors: Pesut Dragica , Stojsic Jelena
Published: December 2010

Background. Dramatic worsening of epidemiological situation with tuberculosis (TB) in the world has made extra- pulmonary tuberculosis actual again. Female genital TB is very rare, but each case still remains a serious medical problem. Case report. A 23-year-old human immunodeficiency virus (HIV) seronegative woman with two-month duration amenorrhea underwent surgery due to lower abdominal mass simulating a left ovary carcinoma, suggested by ultrasound examinations. During sampling, we found a mass of round, up to 3 mm, necrotizing nodules, diffuse in the uterus, ovarian and tubarial surfaces, in cervical and endometrial mucosa, and even in myometrium and fat omental tissue. No tumor mass was found. Microscopically, the tissue samples from all reproductive organs and omentum contained numerous tuberculous caseating granulomas. Mycobacteria were identified by Ziehl-Neelsen method. Antituberculosis treatment had been completed. Conclusion. In the differential diagnosis of an ovarian tumor and ascites TB should always be considered. It should also be suspected in recent Mycobacterium tuberculosis infection in younger women with amenorrhea, either HIV-seropositive or not.