bluuebunny/crossref_metadata_2025 huggingface dataset:
The results of the treatment of right ventricle myocardial infarction
Authors: Rafajlovski Sasa , Orozovic Vjekoslav , Radjen Goran , Ristic-Andjelkov Andjelka
Published: December 2010

Aim. To present the results and experience in diagnosing and treating of patients with acute right ventricle infarction, during the period of hospitalization of one month, with adjuvant analyses of the obtained results in the period of fifteen years. Methods. Acute right ventricle infarction porved clinicaly, enzymologicaly, by ECG, echochardiographically or scintigraphically we treated with thrombolitic therapy within first six hours after admittion, with salvaged PTA in case of the cardiogenic shock or AV block II??III? despite of thrommbolitic therapy, or with postponed PTA within first month of intrahospital treatment. Results. In the period from 1990 to 2004, 3 225 patients of both sexes were treated for acute myocardial infarction at the different localization in patients' at the mean age of 53.7 ? 5.8. One-hundredthirty - nine (43.9%) patients were treated with thrombolitic therapy according to the speed up protocole. Heparin was administered to 160 (50.7%) patients with water load, and 17 (5.4%) patients had the primary percutaneous transluminal coronary angioplasty (PPTCA), so that the mechanical blood flow could be established, by the implantation of a stent when necessary. In 316 patients with right ventricle infarction, 58 (18.3%) had postponed and salvaged percutaneous transluminal coronary angioplasty (PTCA). Twenty-two (15.8%) patients had thrombolitic therapy, whereas 36 (22.5%) patients were treated with heparin. We had a successful balloon dilatation in 21 (36.2%), whereas 32 (55.2%) patients had 1?3 intracoronary stents inplanted, depending upon the necessity, and 5 (8.6%) patients from this group were sent to surgical intervention. In the group of 214 (67.7%) patients treated with heparin or thrombolitic therapy combined therapy, with PTCA, 12 (5.7%) patients died, whereas in the group of 124 (39.3%) patients treated only with heparin 26 (16.2%) patients died, statistically significant difference (p < 0.001, ?2 = 18.423). Was noticed n the group of 1 204 patients with inferoposterior infarction, 122 (10.1% ) patients died. In the group of 316 patients with right ventricle infarction, 38 (12%) died. In the group of 888 control patients with inferoposterior infarction, but without right ventricle infarction, 84 (9.4%) patients died. In the group of 2 021 patients (62.2%) with anterior infarction, 248 (12.3%) died. Conclusion. The obtained results showed that the patients with right ventricle infarction, due to the great expansion of necrosis and the involvement of the inferoposterior wall of the left ventricle, as well as the ischemia of sinus and AV nodes, were the patients of a high risk. That was why it was essential to do urgent widening of the artery to reestablish blood flow either by using drugs or by means of mechanical methods.
Delayed epidural hematoma after mild head injury
Authors: Radulovic Danilo , Janosevic Vesna , Rakic Miodrag , Djurovic Branko , Slavik Eugen , Lakicevic Novak
Published: December 2010

Background. Traumatic delayed epidural hematoma (DEH) can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a ?massive? epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.
Solid-pseudopapillary tumors of the pancreas
Authors: Mirkovic Darko , Karamarkovic Aleksandar
Published: December 2010

Background. Solid-pseudopapillary tumors of the pancreas (SPT) is a very rare lesion. We presented the clinical and pathological characteristics of this tumor and reviewed the literature. Case report. We analyzed the treatment of the two female patients, aged 21 and 37 years, with this tumor. The first female patient had the tumor without involvement of the surrounding organs. The second female patient had the tumor with a high grade of malignancy which invaded blood vessels. We performed in both patients splenohemipancreatectomy, and then we reported the pathological characteristics of the tumors. We didn't find recidive in the observed postoperative follow-up of 4, and 6 years, respectively. Conclusion. SPT is a rare tumor of the pancreas that is diagnosed primarily in young women. The prognosis after surgical treatment was excellent. The histopathological analysis is the main procedure in establishing diagnosis, regardless the most recent diagnostic procedures.
Distal renal tubular acidosis as a cause of osteomalacia in a patient with primary Sjögren's syndrome
Authors: Jovelic Aleksandra , Stefanovic Dusan
Published: December 2010

Background. One half of the patients with primary Sj?gren?s syndrome has extraglandular manifestations, including renal involvement. The most frequent renal lesion is tubulo-interstitial nephritis, which manifests clinically as distal tubular acidosis and may result in the development of osteomalacia. Case report. In a 29 - year-old female patient, with bilateral nephrolithiasis, the diagnosis of primary Sj?gren?s syndrome, tubulo-interstitial nephritis, distal renal tubular acidosis, and hypokalemia were established. She was treated for hypokalemia. Two years later she developed bone pains and muscle weakness, she wasn?t able to walk, her proximal muscles and pelvic bones were painful, with radiological signs of pelvic bones osteopenia and pubic bones fractures. The diagnosis of osteomalacia was established and the treatment started with Schol?s solution, vitamin D and calcium. In the following two months, acidosis was corrected, and the patient started walking. Conclusion. In our patient with primary Sj?gren?s syndrome and interstitial nephritis, osteomalacia was a result of the long time decompensate acidosis, so the correction of acidosis, and the supplementation of vitamin D and calcium were the integral part of the therapy.
Visual acuity after trabeculectomy
Authors: Buzarovska-Blazevska Karolina , Jordanova-Dimovska Vesna , Vukosavljevic Miroslav , Dzajkovska Elena
Published: December 2010

Background/Aim. In this study we compared the two groups of glaucoma patients who had underwent trabeculectomy, with or without intraoperative application of antimetabolite 5-Fluorouracile (5 FU). Methods. We followed up 50 glaucoma patients (group I) in a four-years period after trabeculectomy alone (antimetabolites were not applied), and 50 patients in whom antimetabolite 5 FU was applied (group II). We followed up intraocular pressure (IOP), visual acuity (VA), lens transparency, optic disc changes, visual fields (VF perimetry).The IOP at the time of the surgery, and the period of the treatment before the surgery were the important data for the follow-up. Results. The results that we got in the first group were: in 8 patients (16%) there was no change of VA, and of optic disc with a mild VF deterioration; in 18 patients (33%) the worsening of VA by 1 Snellen line (3 years after the surgery) with no change of the disc and a mild VF progressing; in 10 patients (20%) VA decreased by 2 Snellen lines with the progressive VF changes and cataract appearance, (cataract and VA worsening appeared mainly 3 years after the surgery); in 6 patients (12%) by 3 Snellen lines, and in 4 patients (8%) by 4 Snellen lines. In 4 patients (8%), the highest worsening of VA - (0.2) and the best (0.9) at the time of the surgery were observed. The VA ranging from 0.4-0.6 at the time of the surgery yielded the longest preservation of vision. In the group II (5 FU applied intraoperatively): in 5 patients (10%) there was no change of VA and of optic disc with a mild VF deterioration; in 20 patients (40%) the worsening of VA by 1 Snellen line, with no change of the disc and a mild VF progressing. In 14 patients (28%) VA decreased by 2 Snellen lines with the progressive VF changes and cataract appearance; in 7 patients (14%) by 3 Snellen lines, and in 4 patients (8%) by 4 Snellen lines. Conclusion. All of the checked parameters were better in the group II of the patients, (5 FU applied intraoperatively). Also, in the group of the patients with the longest treatment before the surgery and with the good VA, and in the patients with the shorter treatment and with the bad VA, the quickest progression of the vision lost was observed. The best preservation of VA was recordered in the patients with a mild IOP, and in those who had not been treated more than 1 or 2 years with the drops before the surgery. The VA ranging from 0.4-0.6 at the time of the surgery allowed the longest preservation of vision.
Influence of orlistat therapy on serum insulin level and morphological and functional parameters of peripheral arterial circulation in obese patients
Authors: Hajdukovic Zoran , Jovelic Aleksandra , Zivotic-Vanovic Mirjana , Radjen Slavica
Published: December 2010

Background/Aim. Insulin resistance is related to accelerated atherosclerosis, whereas weight loss is associated with the increasing insulin sensitivity, the improvement of functional and the morphological parameters of arterial circulation, and the reduction of cardiovascular morbidity and mortality. The aim of our study was to evaluate the influence of orlistat treatment on serum insulin level and functional and morphologic parameters of peripheral arterial circulation. Methods. We conducted a prospective, randomized, double ? blind, placebo ? controlled study. Thirty patients with body mass index over 30 kg/m2 normotensive, nonsmokers, without clinically manifested cardiovascular disease or diabetes were randomly assigned either orlistat (120 mg, 3 times daily; n = 20) or placebo (n = 10) in a double ? blind manner. All of the patients were on individually calculated hypocaloric diet. The follow-up period was 24 weeks. Arterial pressure, fasting serum glucose and insulin level, triglycerides, total cholesterol and low density lipoprotein-cholesterol were determined at the beginning, following 3 and 6 months. Also, the intima ? media thickness of right superficial femoral artery and the mean blood flow velocity were determined with ultrasonography. Results. Inside the period of 3 and 6 months, there were the greater reductions of body mass index, arterial pressure, fasting glucose and insulin level, total cholesterol, low density lipoproteins, as well as the greater reductions of mean velocity blood flow and peripheral pulse pressure in the orlistat group vs the placebo group (p < 0.01). Greater reductions in the waist circumference and intima ? media thickness were registered following 6 months in the orlistat vs the placebo group (p < 0.01). Conclusion. In the group of obese patients orlistat therapy reduced risk factors, serum insulin level and improved early arterial functional changes as assessed with the reductions of the mean velocity blood flow and peripheral pulse pressure following 3 months. The regression of morphological changes, as assessed with the reduction in intima ? media thickness, was feasible over the six ? month period.
Frequency of metastatic tumors in the heart
Authors: Rafajlovski Sasa , Tatic Vujadin , Ilic Srbislav , Kanjuh Vladimir
Published: December 2010

Introduction. Secondary or metastatic tumors in the heart occur more frequently than primary ones, and, according to the published series, their frequency found in autopsic material ranges from 1.6% to 20.6%. Metastatic tumors in the heart are rarely clinically symptomatic, and, therefore, they are rarely diagnosed within the lifetime. They are mostly diagnosed at autopsy. The aim of this study was to analyze the frequency of metastatic tumors of the heart, their primary localization, as well as the localization of the metastases found in the autopsic material within the period 1972?2004. Metods. During the autopsy of the patients died of metastatic tumors, we microscopically and macroscopically analyzed all the organs and tissues to determine the metastases of primary tumors in other organs, especially in the heart and pericardium. Results. Within the period from 1972?2004, 11 403 autopsies were performed. In 2 928 (25.6%) out of 11 403 autopsies, the presence of malignant tumor was diagnosed, and in 79 (2.7%) of these cases, metastasis of the heart was found out. Only in 5 of the cases, the presence of metastasis in the heart was diagnosed during the lifetime. The most frequent metastases in the heart were caused by pulmonary carcinoma (18 cases), leukemia and malignant lymphoma (8 cases, each), then pancreatic and breast carcinoma, while the metastases of other carcinomas were rather rare. In 40 (60.76%) cases, the metastasis was localized in the myocardium, but more often in the left ventricle, in 24 (30.38%) cases in the pericardium, in 4 cases in the epicardium and in the 3 of them in the mitral and tricuspid valve. Only in one case of renal carcionoma, metastasis was found in the right atrium and it occurred by spreading (dissemination) through the lumen of the inferior vena cava. Conclusion. Metastatic tumors of the heart are rather rare, and rarely clinically symptomatic, and, thus, rarely diagnosed during life. The methods of choice for the diagnosis of the metastasis in the heart are echocardiography, computerized tomography, magnetic resonance imaging, cytological analysis of the pericardial effusion and biopsy. The treatment includes surgery, chemotherapy and radiotherapy.
Influence of proteinuria on the lipoprotein (a) metabolism disorder
Authors: Petrovic Dejan , Obrenovic Radmila , Stojimirovic Biljana
Published: December 2010

Background/Aim. Proteinuria causes lipid metabolism abnormalities. The aim of the present study was to examine the influence of proteinuria on the lipoprotein (a) metabolism disorder. Methods. The study included 60 patients of the male-famele ratio (M : F = 32 : 28), mean age 37.15?9.85 years with, the average endogenous creatinine clearance 86.27?19.81 ml/min, and the average body mass index (BMI) 24.18?2.23 kg/m2. Regarding the level of glomerular proteinuria, the patients were divided into four groups. The first (control) group, with proteinuria levels less than 0.25 g/24h, included 15 patients (M : F = 6 : 9), mean age 34.66?4.82 years, the mean clearance of endogenous creatinine 99.70?12.94 ml/min, and mean BMI 23.28?3.50 kg/m2. The second group, with proteinuria between 0.25 and 1.0 g/24 h, includ 15 patients (M : F = 9 : 6) with primary glomerulonephritis, mean age 37.87?9.65 years, the mean clearance of endogenous creatinine 82.85?18.48 ml/min, and mean BMI 23.83?1.57 kg/m2. The third group include 15 patients (M : F = 8 : 7) with primary glomerulonephritis, with proteinuria between 1.0 and 3.0 g/24 h, mean age 35.67?13.29 years, the mean clearance of endogenous creatinine 82.85?18.48 ml/min, and mean BMI 23.83?1.57 kg/m2. The fourth group, with proteinuria higher than 3.0 g/24 h, included 15 patients (M : F = 9 : 6) with primary glomerulonephritis, mean age 40.40?9.75 years, the mean clearance of endogenous creatinine 80.16?20.80 ml/min, and mean BMI 24.83?1.44 kg/m2. In order to assess the influence of proteinuria on the lipoprotein (a) metabolism abnormalities we investigated 24-hour proteinuria, the colloid osmotic pressure (COP) of plasma, and the serum concentration of lipoprotein (a). The results were statistically analyzed using ANOVA, Kruscal-Wallis test, Mann-Whitney U test, ?2 test and Spearman test. Results. Statistically, the patients with proteinuria over 3.0 g/24 h had the significantly higher values of lipoprotein (a) in serum as compared to the control group, and the patients with proteinuria about 0.25-1.0 g/24 h. The patients with proteinuria between 1.0-3.0 g/24 h had the statistically significantly higher values of lipoprotein (a) in serum than the control group (proteinuria < 0.25 g/24 h). There was a highly statistically significant negative correlation between serum albumin concentration, COP and the concentration of lipoprotein (a) in serum. There was a highly statistically significant positive correlation between 24-hour proteinuria and the concentration of lipoprotein (a) in serum. Conclusion. Proteinuria leads to the deterioration of lipoprotein (a) abnormalities.
Prolonged survival of a female patient with total pelvic exenteration
Authors: Ignjatovic Dragan , Jevtic Miodrag , Mirkovic Darko
Published: December 2010

Background. To present a female patient who lived 5 years after total pelvic exenteration (TPE). Case report. The female patient underwent TPE due to retrovesicovaginal fistula as a consequence of locoregional irradiation after the operation for the malignoma of the vaginal part of the uterus. In the formation of Bricker conduit, the ureter antireflux was achieved by the application of the ?tobacco sack muff? made of the intestines around the ureter. By the use of this technique, the occurrence of pyelonephritis, as the leading cause of death in such patients, was prevented. Conclusion. TPE is a hope for significantly prolonged survival of patients with advanced pelvic malignomas, or with a postirradiatiation fistula.
Metabolic syndrome and central retinal artery occlusion
Authors: Kosanovic-Jakovic Natalija , Petrovic Lidija , Risimic Dijana , Milenkovic Svetislav , Matic Danica
Published: December 2010

Background. The accumulation of risk factors for central retinal artery occlusion can be seen in a single person and might be explained by the metabolic syndrome. Case report. We presented the case of a 52-year-old man with no light perception in his right eye. The visual loss was monocular and painless, fundoscopy showed central retinal artery occlusion and the laboratory investigation showed the raised erythrocyte sedimentation rate of 105 mm/h and the raised C-reactive protein of 22 mg/l. Specific laboratory investigations and fluorescein angiography excluded the presence of vasculitis, collagen vascular diseases, hypercoagulable state and antiphospholipid syndrome. Conclusion. The patient met all the five of the National Cholesterol Education Program (NCEP) criteria for the metabolic syndrome: hypertension, abnormal lipid profile, abnormal glucose metabolism, obesity and hyperuricemia. Measurement of C-reactive protein is useful for the assessment of therapeutic systemic effect on any abnormality in the metabolic syndrome. Individual therapy for all risk factors in the metabolic syndrome is necessary to prevent complications such as cardiovascular, retinal vascular diseases and stroke.
High doses of immunoglobulin g in the therapy for severe forms of myasthenia gravis and Guillain-Barré syndrome
Authors: Lavrnic Dragana , Romic Marija , Kacar Aleksandra , Rakocevic-Stojanovic Vidosava , Stevic Zorica , Vujic Ana , Basta Ivana , Marjanovic Ivan , Bogdanovic Gradimir , Apostolski Slobodan
Published: December 2010

Background/Aim. High doses of immunoglobulin G (IVIG) have been recognized as a very important therapeutic modality in the treatment of neurological diseases. The aim of this report was to present our experience in the treatment of severe forms of myasthenia gravis (MG) and Guillain-Barr? syndrome (GBS). Methods. We analyzed the efficacy and safety of immunoglobulin G therapy in 53 patients with severe forms of myasthenia gravis, and 27 patients with very severe forms of Guillain-Barr? syndrome. Results. At the end of the follow-up period, a significant improvement was noticed in 47 out of 53 patients with myasthenia gravis ( 88.7%). In the group of 27 patients with severe forms of Guillain-Barr? syndrome an improvement was registered in 19 patients (70.3%). The side effects of this therapy were mostly mild, manifested as headache, myalgia, skin rash, adynamia, and other clinically insignificant effects. No severe side effects were recognized. Conclusions. Our study clearly demonstrated the high efficacy of IVIG therapy in the treatment of severe forms of myastehnia gravis and Guillain-Barr? syndrome.
Factors which influence postoperative mortality after hip fracture
Authors: Ristic Branko , Ristic-Ignjatovic Dragana , Milicic Biljana , Obradovic Zdravko
Published: December 2010

Background/Aim. One of the most significant predictors of mortality after hip fractures is cognitive impairment (dementia). The aim of this study was to report the results of a prospective study of the influence of some factors on sixmonth mortality in elderly patients with hip fractures. Method. The elderly patients with hip fracture were assessed on admission to the hospital using the measures of cognitive function, the mobility before the fracture, and physical comorbidity, the type of fracture and the place of the injury. Six months later, we checked how many of them were still alive. Results. We performed univariate and multivariate analyses in 132 patients and found that the most significant predictors of six-month mortality were dementia, comorbidity, and prefacture mobility. Conclusions. A comprehensive physical and mental health assessment of an elderly patient after hip fracture could predict mortality. A good examination of cognitive functioning could be very useful in choosing the optimal treatment for this type of patients.
Cervical lymphodenopathy: A single presentation of sarcoidosis
Authors: Celeketic Dusica , Nadaskic Ruzica , Krotin Mirjana , Cemerikic Vesna , Stojkovic Aleksandra , Trpkovic Andreja , Vukovic Vladimir
Published: December 2010

Background. Sarcoidosis is a chronic inflammatory disease, commonly found in lungs and hilar lymph nodes, but multiple organs could be involved. The diagnosis is based on specific pathohistology which should be always combined with clinical, radiological and laboratory findings. Case report. A patient initially presented with pneumonia, and treated with antibiotics, but with the general symptoms that persisted despite radiological resolution of lung infiltration was reported. The further diagnostic procedures revealed the presence of sarcoid granulomas in cervical lymph nodes. The peripheral lymph nodes are often affected in the early course of the disease, but it is difficult to distinguish if the illness is a sarcoid reaction to lung infection or a acute onset of sarcoidosis. Conclusion. The detection of sarcoid granulomas in cervical lymph nodes should be precisely analyzed for the presence of sarcoidal changes in other tissues, primarily in the lungs tissue. Early diagnosis of lung sarcoidosis is significant, especially in the light of the fact that the latest studies point out that the prednisone therapy, started immediately after the diagnosis has been made, renders positive effects also in asympthomatic patients in II and III phase of the disease.
Tumor marker CA-125 in adnexal inflammatory tumors
Authors: Nikolic Branka , Ardalic Daniela , Lazic Jelena
Published: December 2010

Background/Aim. The glycoprotein of a high molecular weight CA-125, which is not a specific tumor marker of ovarian cancer, is secreted by the endothelial cells of most pelvic organs. Endometriosis, inflammatory processes in the pelvic cavity, as well as some nongynecoligical malignant diseases, could be followed by the increased values of CA-125. Serial assessment of the values of CA- 125 makes it possible to avoid surgical treatment, and, by means of the used conservative treatment, to avoid malignant diseases not to be noticed. Methods. The study included 57 female patients hospitalized due to inflammable adnexal tumors. Besides following the values of serum CA-125 during and after the therapy, also performed were the transvaginal Doppler ultrasonography and the determination of the values of resistance index (RI). Results. In 27 patients (55.1%) the CA-125 values ranged from 38.8 U/ml to 794 U/ml, while in 30 of the patients they were within the range of normal. In this group of the patients, besides the increased values of CA- 125, also increased were the values of leucocytes (119/l ? 209/l), as well as the sedimentation rates (65?120) within the first hour. In all the 57 patients, transvaginal Doppler ultrasonography revealed the presence of adnexal tumor of inflammatory kind. The measured values of RI were within the range of 0.539?0.681. Eight of the patients were treated by the conservative - triple antibiotic therapy, while in 49 patients explorative laparotomy was performed. Hystorectomy was done in 12 of the patients, and one-side adnexectomy in 37 of them. Conclusion. The method for the assessment of CA-125 is simple and available which facilitates the monitoring of surgical, conservative or the combined therapy that is particularly significant in younger patients with inflammable adnexal tumor developed on the basis of endometrosis.
Foodborne disease outbreak among soldiers in Nis garrison associated with the consumption of coleslaw
Authors: Cekanac Radovan , Cobeljic Miloje , Opacic Dolores
Published: December 2010

Aim/Background. Large outbreaks of foodborne diseases are always focused by the general public who expect experts to rapidly explain both the causes of the disease and its growth. This article presents the results of the investigation of an outbreak of foodborne disease that has attracted much of the electronic and written media attention. Methods. The data on food items consumed by intoxicated and healthy soldiers were obtained by the adapted questionnaire during a field investigation performed on November 3-4, 2005. On the same occasion other relevant data were also collected. For microbiological investigations stool samples from the ill persons were collected, as well as food specimen and swabs from the working surfaces and utensils in the kitchen where the food had been prepared. Results. In the outbreak of foodborne disease, which started on November 2, 2005, and terminated on the next day, 103 ill soldiers were registered in 7 units scattered over 4 locations in the garrison of Nis. The attack rate varied in the affected units from 33 to 338?, with the mean value of 109.7?. The clinical course of the disease was predominantly light including vomiting, diarrhea and fever as the most frequent signs of illness. All the affected soldiers were hospitalized, treated with symptomatic therapy, and discharged fully recovered. By comparing dishes that had been consumed by the ill and the healthy persons before the beginning of the outbreak, the greatest statistical significance (p < 0.0001), and the only significant relative risk (RR = 3.43) were related to the consumption of the coleslaw served for lunch on November 1, 2005. In addition, two control groups with the total of 151 persons who had not consumed the coleslaws were identified no one of them was affected. An microbiological investigation did not reveal any bacterial enteropathogens. Conclusion. In the described foodborne disease outbreak a causative agent was not identified although coleslaw was the way of transmission probably secondarily contaminated by the improper hygiene practice during its processing.
Novel surgical procedure for the treatment of female stress urinary incontinence by using transobturator vaginal tape
Authors: Argirovic Rajka , Likic-Ladjevic Ivana , Boskovic Vladan , Berisavac Milica , Milenkovic Vera , Kadija Sasa
Published: December 2010

Introduction/aim: Current method in the treatment of female urinary incontinence implies the placement of tension-free suburethral vaginal tape, using a retropubic or transobturator approach. Considering numerous complications related to retropubic approach, we reported the results of transobturator procedure in prospective study. Methods. We used a non-absorbable polypropylene tape with the outside-in (Herniamesh) or in-outside (Johnson & Johnson) transobturator approach. Results. During the period from October 2004 to September 2005 the procedure was carried out in 10 patients. In only 2 cases urinary stress incontinence occurred as isolated problem managed with transoburator tape, whereas in 8 patients this procedure was associated with other operative gynecologic events. No perioperative complication was encountered. In 80% of the patients a satisfactory result was obtained, while one patient failed to demonstrate any amelioration, and the other developed subsequently urge incontinence. Conclusion. Transobturator tension-free vaginal tape represents a very simple, safe and, in the large percent of cases, successful procedure in the management of urinary stress incontinence, with rare perioperative complications.
Incidence of surgical site infections in the departments of orthopedics and traumatology
Authors: Maksimovic Jadranka , Markovic-Denic Ljiljana , Bumbasirevic Marko , Marinkovic Jelena
Published: December 2010

Background/aim: Besides infections of urinary tract and pneumonias, as well as blood infections, surgical site infections (SSI) represent one of the most common localization of hospital infections. The aim of this study was to determine the incidence of SSI in the departments of orthopedics and traumatology as well as the SSI incidence in relation to the ASA score, surgical site contamination class and NNIS index. Methods. A prospective cohort study followed daily all the surgical patients hospitalized over 48 hours in the Institute for Orthopedic Surgery and Traumatology, Clinical Center of Serbia, as well as 30 days after the discharge, during the period between February 1 to July 31, 2002. The patients were examined and their diagnoses made according to the definition of hospital infections, i.e. upon clinical and/or laboratory analyses, using concurrently the ASA score, surgical site contamination class and NNIS index. Results. Out of 227 surgical patients, 60 were diagnosed with SSI during their hospitalization, while 3 of the patients developed SSI after the discharge. The incidence of SSI was 22.7% (95% CI = 17.8?27.6). In the patients with good health condition, i.e. ASA ? 2, the incidence of SSI was 18.3% (43/235) and in those with ASA > 2, it was 47.6% (20/42) (?2 = 17.4; p < 0.001). The incidence of SSI was 13.5% (25/185) in the clean wounds, 11.6% (5/43) in purely contaminated, while it was much higher in the contaminated 65.5%; (19/29) and soiled 70.0%; (14/20) wounds (?2 = 67.6; p < 0.001). The incidence of SSI in relation to NNIS was 8.1% (13/161) in the patients with score 0, then 36.4% (32/88) in the patients with score 1, and 64.3% (18/28) in the patients with the scores 2 and 3 (?2 = 57.3; p < 0.001). The patients with SSI stayed in the departments of orthopedics and traumatology approximately 1.8 times longer than the patients without SSI (t = 5.3; DF = 275; p < 0.0019. Conclusion. It is important to emphasize the need for constant epidemiological surveillance of SSI and the implementation of preventive measures in Serbia.
Significance of ultrasonography of the terminal ileum in moderate Crohn's disease
Authors: Lukic-Kostic Leposava , Jovic Jasna , Sekulovic Slobodan
Published: December 2010

Background/aim: Crohn's disease (CD) is a chronic granulomatous inflammatory disease of unknown etiology, involving any part of the gastrointestinal tract, and frequently followed by extra intestinal manifestations. The use of ultrasonography plays a significant role in diagnosing this disease, as well as in monitoring the effects of the therapy. The aim of this study was to assess the use of ultrasonographic diagnostics in the patients with moderate serious and the mild form of CD. Methods. The study involved 30 patients both sexes with CD of moderate form determined using the standard diagnostics, according to the Crohn's Disease Activity Index - CDAI ranging from 220?400. The patients were divided into two groups with CDAI > 320 (Ia), and CDAI between 220 and 320 (Ib), respectively. The Control group was made of 19 patients with the mildly active stage of the disease and the CDAI values in the range from 100?220. The patients were submitted to an ultrasonographic examination of the terminal ileum affected with CD in order to determine the length of the affected segment of intestine, the thickness of the wall, the changes of the structure of the wall, the changes of the surrounding mesenterium with the enlarged lymph nodes. CD complications, abscesses, and enteroenteral fistulas were investigated, too. Results. The comparison of the ultrasonographic findings of the three groups revealed that more serious clinical laboratory image of CD significantly correlated with the higher length of the affected segment (p < 0.001), higher thickness of the wall (p < 0.001), the higher number and the larger lymph nodes of the mesenterium (p < 0.001). Only the most serious patients were found to have abscess of the ileocecal area (Ia ? 40%). There was no difference found between the groups regarding the occurrence of enteroenteral fistulas. Conclusion. Considering the obtained results and data from the literature, it could be concluded that an ultrasonographic examination of the ileocecal area plays an important role in the diagnostic procedure in the management of a patient with CD. Of particular significance is the possibility to use this examination in monitoring the effects of the therapy in patients with CD.
Histopathology of chronic hepatitis C in relation to virus genotype
Authors: Delic Dragan , Nesic Zorica , Prostran Milica , Boricic Ivan , Tomanovic Nada , Cutovic Milisav , Dokic Ljubisa , Simonovic Jasmina , Svirtlih Neda
Published: December 2010

Background/aim: The natural history of hepatitis C virus (HCV) infection is variable and the factors determining the course of the illness are unclear. There are geographical variations in the distribution of different HCV genotypes, and some of them are related to the specific infection routes. Regarding our country, the dominant genotype is genotype 1b. It is unclear and still remains a question whether the distinct histopathological manifestations are related to the particular genotypes of HCV. Thus, the aim of this study was to determine whether the distinct histopathological manifestations of HCV infection might be in relation to the individual virus genotype. Methods. In this study we examined 126 patients with chronic HCV infection regarding the histopathological features, demographic data, and virus genotype. The observed groups of patients were predominantly infected with HCV genotypes 1b and 3a. Results. In this study we found that the patients infected with HCV genotype 1b had more frequently moderate or severe necroinflammatory activity of the disease, significantly higher grading score as compared with other genotypes (p < 0.0001). A higher degree of fibrosis was, also, more common in the patients infected with genotype 1b of HCV as compared with other genotypes (p < 0.05). There were no significant correlations between the necroinflammatory activity of the disease and the stage of fibrosis in 1b, 4 and mixed genotypes. Conclusion. The present data support the hypothesis that distinct genotypes of HCV are associated with the particular histopathological manifestation of the disease.
Supraselective embolization as a method for the management of renal vascular injuries
Authors: Milovic Novak , Bancevic Vladimir , Jakovljevic Olivera , Paunic Zoran
Published: December 2010

Background: Renal injuries are most often caused by traumatic injuries, but they can also be induced iatrogenically, during renal biopsy, percutaneous nephrostomy or lithotripsy. Vascular renal injuries may be treated by embolization, nonsurgical or surgical methods. Case report. In this paper we presented a high-risk patient with poor outcome of an open surgery threatment and a prior attempt of embolization, with gross haematuria caused by traumatic renal arterio-venous (AV) fistula and pyelocalical injury who was managed by supraselective embolization of the irrigating arterial vessel. Conclusion. Supraselective embolization is a first choice method for the treatment of low grade renal vessel injuries. Even patients with the most severe renovascular lesions and major renal destruction (a grade IV injury) can be treated nonsurgically with supraselective embolization, with an excellent chance to preserve the maximal amount of functional renal parenchyma. This method is rapid, effective, tissue preserving, and likely to reduce morbidity and mortality.
Manifestations of somatic disturbances in early postmenopause in women after physiological and surgical menopause
Authors: Nincic Dejan , Zikic Dragan , Ivkovic-Kapicl Tatjana , Mastilovic Katarina
Published: December 2010

Background/Aim. The most common secondary manifestations of menopause are clinical manifestations of estrogen deficiency. They could be early and late. The aim of this study was to compare manifestations of somatic disturbances in early postmenopause in women after physiological and surgical menopause. Methods. This prospective study included 60 women, age 41-55 years, divided into two groups: physiological (30 of them) and surgically induced menopause. For every subject a special evidence list, consisting of the disease history questions, physical and gynecology examination as well as dates about physiological variables (arterial tension, height, weight, and body-mass index) and laboratory examination was formed. The values of arterial blood pressure, body height, body mass, body mass index (BMI), and lipid status were determined and gynecological examinations were performed in each patient. Results. The most frequent symptoms in both groups were vasomotor ones. Headache was the more intensive sign in the group after induced menopause. Extra systolic heart excursion was a common symptom in both study groups. Arterial tension, regardless of the type of menopause, was in the physiological range. The frequent organic signs of menopause, more intensive in the group after induced menopause, were genitourinary and skin atrophy. An analysis of the BMI showed that the women in both groups were obese (BMI > 25). The lipids analysis confirmed the predomination of hyperlipoproteinemia type IIa in the group with physiologic menopause and type IIb after induced menopause. Conclusion. The dominant signs of menopausal syndrome were vasomotor and bone-joint symptoms, more frequent in the group after induced menopause. There were no statistically significant differences between the study groups according to the genitourinary atrophy and other signs of aging. Menopausal hormonal changes, regardless of the way of menopause developing, increase the risk for hyperlipoproteinemia. The frequency of somatic signs in early post menopause is typically higher after induced menopause. More intensive follow-up in patients after surgical removing of the ovaria is necessary in order to improve the quality of life in these patients.
Morbus gaucher: A report of two cases
Authors: Djokic Milomir
Published: December 2010

Backround. Clinical features of inherited glucocerebrosidase deficiency were first described by Phillippe Charles Ernest Gaucher, French physician (1854-1918). Deficiency of glucocerebrosidase leads to the accumulation of the lipid glucocerebroside within the lysosomes of the monocyte macrophage system. Lipid-laden cells, known as Gaucher cells, lead to hepatosplenomegaly, multiorgan dysfunction and sceletal deterioration. Case report. We reported a 36- year-old male and a 42-year-old female admitted for the clinical examination due to hepatosplenomegaly. The Clinical diagnosis was provided by a bone marrow examination and demonstration of the characteristic Gaucher cells. Both of the patients had type I Gaucher's disease (a mild form of the disease), which is distinguished by the lack of central nervous system involvement and striking phenotypic variation. We had not a possibility of testing ?-glucocerebrosidase activity in peripheral leukocytes (a definitive diagnosis of Gaucher's disease). Also, enzyme replacement therapy had not been available in our country. Conclusion. Althoungh rare, Gaucher's disease is also present in our country. Both molecular genetic, and the enzyme ?-glucocerebrosidase activity testing in peripheral leukocytes are needed for the definitive diagnosis of this disease.
Use of estrogen replacement therapy in menopause: Secondary prevention of osteoporosis
Authors: Djurica Snezana
Published: December 2010

 Osteoporoza je socioekonomska kategorija cak i u bogatim drustvenim zajednicama. Troskovi lecenja osteoporoze daleko nadmasuju cenu i preventive i dijagnostike zajedno. To je razlog da se, primenom estrogena ili selektivnih modulatora receptora za estrogene vec u ranoj menopauzi, spreci nastanak i ispoljavanje osteoporoze. Selektivni modulatori receptora za estrogene umanjuju vazomotorne i neuroendokrine poremecaje u menopauzi, poboljsavaju kvalitet zivota, povoljno deluju na metabolizam lipida i stanje kardiovaskularnog sistema, bezbedni su u odnosu na karcinogenezu, sprecavaju nastanak osteoporoze u menopauzi i smanjuju rizik od preloma. Znacajno bolji su u odnosu na prethodne oblike nadoknade hormona u menopauzi, ali nisu bezbedni u pogledu karcinoma endometrijuma (tamoksifen), cerebrovaskulnih insulta (tamoksifen) i tromboza dubokih vena (tamoksifen, raloksifen).
Malt lymphoma of the parotid salivary gland
Authors: Krasic Dragan , Radovic Predrag , Buric Nikola , Cosic Andrija , Katic Vuka
Published: December 2010

Background. Mucosa-associated lymphoid tissue (MALT) lymphoma was described for the first time in 1983 by Isaacson and Wright. It was classified into extranodal non-Hodkin's lymphomas of B-cell lymphocytes of the marginal zone of reactive lymphe follicles. It is characterized by both hyperplasia and colonization of plasmocytic, centrocytoid and monocytoid cells, by the infiltration of interfollicular and parafollicular parts of interstitium, as well as by the invasion of clusters of neoplastic lymphoid cells of the glandular epithelium, forming the pathognomic lymphoepithelial MALT limphoma lesions. Case report. In this paper we presented the two female patients, 59 and 75 years of age, with MALT lymphomas, associated with Miculicz's and Sj?gren's syndromes. The paper also underlined rather manymonth- long, indolent clinical course, evalution of both tumors, massive in size, as well as two-sided localization in the case of the Miculicz's syndrome. After the subtotal parotidectomy, using conservation of nerve facialis, the tissue blocks were fixed in 10% formaldehyde. The paraffine sections were stained by routine histochemical and an immunohistochemical method by using monoclonal antibodies for both B-cell and T-cell lymphomas, due to the verification of lymphoepithelial lesions. The MALT lymphoma diagnosis was based on the histological criteria and confirmed by an immunohistochemical method. After the surgical therapy accompanied by chemotherapy, the patients were controlled at regular intervals, and residual MALT lymphoma did not appear. Conclusion. MALT lymphoma is a rare tumor of the salivary glands, with the most frequent localization in the parotide gland. It had a slow clinical course, without metastases in both patients. The diagnosis was made pathohistologically and confirmed immunohistochemically. The surgical therapy was accompained by adjuvant chemotherapy.
Binocular responses and vertical strabismus
Authors: Risovic Dusica , Petrovic Lidija , Kosanovic-Jakovic Natalija , Misailovic Katarina , Stankovic Branislav , Eric-Marinkovic Jelena
Published: December 2010

Background/Aim. Elevation in adduction is the most common pattern of vertical strabismus, and it is mostly treated with surgery. The results of weaking of inferior oblique muscle are very changeable. The aim of this study was to evaluate binocular vision using sensory tests before and one and six months after the surgery. Methods. A total of 79 children were divided in two groups: the first, with inferior oblique muscle of overaction (n = 52), and the second with dissociated vertical deviation (DVD), and primary inferior oblique muscle overaction (n = 27). We tested them by polaroid mirror test (PMT), Worth test at distance and near, fusion amplitudes on sinoptofore, Lang I stereo test and Wirt-Titmus stereo test. We examined our patients before and two times after the surgery for vertical strabismus. Results. Foveal suppression in the group I was found in 60.5% of the patients before, and in 56.4% after the surgery. In group II Foveal suppression was detected in 64.7% of the patients before, but in 55.6% 6 months after the surgery with PMT. Worth test revealed suppression in 23.5% of the patients before, and in 40.7% after the vertical muscle surgery. Parafoveal fussion persisted in about 1/3 of the patients before the surgery, and their amplitudes were a little larger after the surgery in the group I patients. Lang I stereo test was negative in 53.9% before and 51.9% after the surgery in the group I, and in 48.2% of the patients before and after the surgery in the group II patients. Wirt-Titmus stereo test was negative in 74.5% of the patients before and in 72.9% after the surgery in the group I, but in the group II it was negative in 70.8% before and in 68.0% of the patients 6 months after the surgery. Conclusion. Binocular responses were found after surgery in 65.7% of the patients the group I and in 55.6% patients the group II. There was no significant difference between these two groups, but binocular responses were more often in the patients of the group I.
Recombinant factor VII (NovoSeven) in intraoperative blood saving during neurosurgical treatment of the brain arteriovenous malformation
Authors: Novak Vesna , Petrovic Budimir , Calija Branko , Mitov Ljiljana , Rancic Zoran
Published: December 2010

Background. Cerebral arteriovenous (AV) malformation causes, due to the increased blood flow through a malformation, a massive intraoperative bleeding complicating, so, surgical treatment. The use of intraoperative blood saving apparatus during surgery and a recombinant factor VII-a (NovoSeven) significantly reduce complications during surgical treatment. Case report. We reported a case of surgical treatment of the patient with AV malformation of IV stage according to the Spetzler-Martin scale, in the brain. Due to a possible heavy bleeding we used a apparatus for intrasurgical blood recovery, Cell Saver, Sequestra 1 000, Medtronic, U.S.A., and recombinant human factor VIIa (rFVIIa - NovoSeven, NovoNordisk, Denmark) to control bleeding and restore an adequate hemostasis. Conclusion. The use of an apparatus for intraoperative blood saving, as well as the NovoSeven preparation in the management of AV malformation of IV stage, showed to be successful.