bluuebunny/crossref_metadata_2025 huggingface dataset:
Suicide in the military environment
Authors: Cabarkapa Milanko , Panic Milivoj
Published: December 2010

Suicide of soldiers has its own specifics, because not only it represents the tragedy for the individuals and their family, but also has great psychological effect on social environment and military unit in which it occurs. Suicide can be caused by variety of factors, as reported in the literature. The case reviewed in this article presents multilateral determination of suicide, with particular stress on the character of each individual and social interaction of soldiers. Psychological complex of basic inferiority, low educational level, family problems, and poor integration into military unit could be considered the leading determinants of this suicide. This emphasizes the importance of certain preventive measures such as more rigorous psychological selection for specific military duty, and the education of non-commissioned officers for better recognition and understanding of pre-suicidal syndrome.
Rare forms of panniculitis: subcutaneous sarcoidosis and panniculitis associated with dermatomyositis
Authors: Basanovic Jelena , Brasanac Dimitrije , Zivanovic Dubravka , Nikolic Milos
Published: December 2010

Panniculitides represent heterogenous group of disorders involving subcutaneous fat tissue, and are etiologically related to different causes including systemic diseases. Two female patients having subcutaneous sarcoidosis and panniculitis associated with dermatomyositis are presented in this paper. The first patient, (38 years of age), was with the nodes on forearms and lower legs, which occurred one month after hypophysectomy for adrenocorticoscopic (ACTH)-secreting pituitary adenoma, and showed histopathologically confirmed epithelioid, noncaseating granulomas in the subcutaneous fat tissue. Laboratory and radiographic findings were normal with the exception of positive rheumatoid factor and incompletely developed cysts in proximal phalanges of the hand. The second patient (56 years of age), was with subcutaneous nodes on the upper arm and the lateral chest wall, which were noticed several months after the diagnosis of dermatomyositis. Histopathological examination showed lobular pannicilitis with hyaline fibrosis and plasmocytic-lymphocytic infiltrate.
Frequency and colonization rate of intravascular catheters
Authors: Tomanovic Branka , Mirovic Veljko
Published: December 2010

Clinical signs are not sufficiently reliable for establishing diagnosis of intravascular catheter-related infection. Therefore, microbiological confirmation, based on the culture of the catheter tip after its removal, is necessary in diagnosing the infection. The aim of this study was to determine the frequency and the degree of microbial colonization of intravascular catheters (IVK), and the risk for the onset of sepsis, by using qualitative, semiquantitative (roll plate) and quantitative (vortexing) catheter culture techniques. During the period April 2001 December 2002, 289 intravascular catheters were cultured. A total of 284 microorganisms were isolated from 217 (75%) culture-positive catheters. The frequency of isolation of some organisms was the following coagulase-negative staphylococci (CNS) 41%, Staphylococcus aureus 19% Enterococci spp 6%, other Gram-positive microorganisms 9%, Gram-negative microorganisms 21%, and fungi 4%. In 35 catheters, cultures were polymicrobial; two microorganisms were found in 25 cultures and three were found to be in 10 cultures. There were 122 (46%) intravascular catheters which were found significantly colonized. A high rate of positivity and a high rate of S. aureus isolates and Gram-negative bacteria indicate the need of establishing the exact microbiological diagnosis of these infections, and the rigorous undertaking of adequate control and preventive measures.
Mortality from endometrial cancer in female population of Belgrade
Authors: Pantovic Vesna , Jarebinski Mirjana , Pekmezovic Tatjana , Knezevic Anita , Kisic Darija
Published: December 2010

Data about mortality from malignant tumors of endometrium were analyzed in the Belgrade area during the period 1975-2000. The obtained results showed that the average percentage of endometrial cancer in mortality structure from all the cancers of female population was 2.65%. During the observed 26-years period, malignant tumors of endometrium constituted 17.38% of all the tumors of gynecological localization. The standardized mortality rate in 1975 (population worldwide used as a standard) 7.06/100 000 population while in 2000 it was 1.78/100 000 population, respectively, which showed almost fourfold mortality decline during the observed period (y=4.72-0.16x). A trend of declining risk of dying from endometrial cancer was present in all the age groups. The obtained results indicated that in the observed period the average mortality rates ranged from 0.14/100 000 population in females aged up to 34 years (y=0.30-0.01x), and reached the highest value in females aged 65-74 years (14.57/100 000; y=23.43-0.66x), and 75 years of age and over (19.62/100 000; y=31.17-0.85x).
Posttraumatic stress disorder in bosnian war veterans: Analysis of stress events and risk factors
Authors: Kuljic Blagoje , Miljanovic Bozidar , Svicevic Radoslav
Published: December 2010

The aim of this study was to determine the incidence of Post-Traumatic Stress Disorder (PTSD), the characteristics of stress-related events, and the risk factors for the development of PTSD. The total patient sample consisted of 100 Bosnian war veterans. Watson?s PTSD module was used in establishing PTSD diagnosis. Patients fulfilled the following questionnaires: personal data form, Posttraumatic Symptom Scale PTSS-10 (Holen), Impact of Event Scale (Horowitz), Life Event Scale, and Eysenck Personality Inventory. PTSD was diagnosed in 30% of the examined patients. Larger number of stress-related events, particularly of those regarded as life-threatening, wounding/death of a close person, and material losses were more frequent in persons with PTSD. The risk factors for the development of PTSD in this study were: age (30-40), marital status (married), lower level of education, the front-line combat exposure, neurotic manifestations, family problems in childhood, and neuroticism.
Uloga nuklearne medicine u transplantaciji bubrega
Authors: Jaksic Emilija , Beatovic Slobodanka , Han Ruben
Published: December 2010

 Znacaj uro-nefroloskih nuklearnomedicinskih metoda u ispitivanju presadjenog bubrega je u pravovremenom otkrivanju komplikacija i njihovom pracenju. Rezultati ovih ispitivanja imaju visestruk znacaj: - vazne su implikacije tih rezultata na klinicki stav, jer opredeljuju klinicara u cesto vitalnoj odluci izmedju konzervativne i radikalne terapije, - rezultati nuklearnomedicinskih ispitivanja omogucuju pracenje perfuzijske funkcijske i urodinamske reakcije presadjenog bubrega na lecenje, - imaju i prognosticki znacaj, jer omogucavaju da se predvidi stepen ocekivanog oporavka funkcije presadjenog bubrega posle lecenja.
Actinomycosis: A multidisciplinary approach to a clinical problem
Authors: Djokic Milomir , Begovic Vesna , Loncarevic Slobodan , Vulovic Rajko , Dimitrijevic Jovan , Popovic Svetlana , Aleksic Rada
Published: December 2010

Actinomycosis is caused by microorganisms of the Actinomyces species, found in the oral cavity, gastrointestinal and genital tract. Infection by Actimomyces species mainly causes chronic supurative disease of the oral cervico-facial, thoracic, and abdominal regions. Clinical manifestations have been described at every level, but the disease is relatively rarely diagnosed. The causative agent is considered to be an opportunistic pathogen associated with infection, trauma, surgical procedures, or associated with a neoplasm or foreign body. Symptoms include intermittent fever, weight loss abdominal or thoracic pain, pseudotumor and tumor masses, and local symptoms from the infected area. Pseudotumor and tumor masses are diagnosed by ultrasonography and computerized tomography. The diagnosis is confirmed by the presence of a causative agent in biopsy or surgically acquired samples. The treatment includes the administration of high doses of antibiotics (penicillin, amoxicillin, ceftriaxone) for at least 6-12 months, as well as surgical tretment. Penicillin is a drug of choice. This infection is often polymicrobial, so that antibiotic therapy should include agents that act against the associated pathogens. Treatment outcome and prognosis in these three cases were excellent, despite the prolonged course of the extensive disease.
Allergic granulomatous angiitis
Authors: Trifunovic Gordana , Plavec Goran , Tomic Ilija , Popovic Lidija , Stefanovic Dusan
Published: December 2010

Allergic granulomatous angiitis (AGA) - Churg-Strauss syndrome, is a rare autoimmune disease characterized by three distinct clinical phases prodromal, eosinophilic, and vasculitic, and most of respiratory symptoms and signs begin in the first two phases of the disease. Two female patients of different age, who fulfilled the diagnostic criteria for AGA, and were in different phases and with the different duration of the disease are presented. The first patient (24 years of age) was admitted to the hospital due to aggravation of asthma, heart failure, and polyneuropathy. The second one (45 years of age) was also hospitalized due to the worsening of asthma polyneuropathy, and fever. Both were treated continuously with glucocorticoids. The older patient also received a total of six pulse doses of cyclophosphamide. Satisfactory response to such a treatment was achieved in both cases.
Professional exposure to ionizing radiation and the occurrence of cataract
Authors: Djurovic Branka , Djurovic Branislav , Spasic-Jokic Vesna
Published: December 2010

Radiation cataract is one of ensuing effects of ionizing radiation, since its threshold dose under which it does not occur, and above which it shows dose dependency, has been observed. Clinical course of radiation cataract is identical for all the types of ionizing radiation and is very typical. Minimal dose for progressive cataract formation is determined by the type of radiation, i.e., its relative biological efficacy, dose, and the duration of the exposure period. Theoretically, threshold dose existence does not exclude the incidence of cataract formation under significantly smaller doses, as well. The aim of this study was to analyze the incidence of cataract formation among the medical staff professionally exposed to ionizing radiation. Neither of the diagnosed cataracts had typical morphology, nor was the correlation established between the dose, exposure time, and the cataract formation. All the diagnosed cataracts were described as premature, and therefore ionizing radiation was considered as a co-factor in premature cataract formation in the examined groups.
The frequency of resistance to antibiotics of most frequently isolated bacteria from blood cultures during the period 1997-2002
Authors: Mirovic Veljko , Tomanovic Branka , Konstantinovic Sonja
Published: December 2010

The aim of this study was to determine the frequency of resistance to antibiotics of the most frequently isolated bacteria from blood cultures of hospitalized patients during the period 1997-2002. The resistance to antibiotics was determined by disk diffusion method according to National Committee for Clinical Laboratory Standards procedures. The majority of staphylococci isolates were resistant to methicillin, and the proportion of methicillin-resistant Staphylococcus aureus was stable (76.8-81.6%), during the follow-up period. None of the staphylococci isolates were resistant to vancomycin, but there was a very high incidence of high-level resistance of enterococci to aminoglycosides (47.2-72.2%). In 1998, only one strain among enterococci was resistant to vancomycin (Enterococcus faecium, VanA fenotype). Enterococcus spp isolates expressed variable frequency of resistance to ampicillin (15-40.1%) during the follow-up period. Among Enterobacteriaceae there were no isolates resistant to imipenem, but dramatic increase of the resistance to ceftriaxone was found from 35.9% in 1997 to 95.9% in 2002 (p<0.001). Extended spectrum beta-lactamases production was found in all the species of enterobacteria isolates. Resistance to imipenem was observed in Acinetobacter spp isolates in 2002 for the first time. Pseudomonas spp isolates expressed high and very variable resistance to all antibiotics tested during the follow-up period.
Transitional type of Castleman's disease manifested as the POEMS syndrome
Authors: Tomic Ilija , Plavec Goran , Tasic Olga , Ristanovic Aleksandar , Cvijanovic Vlado
Published: December 2010

Background. Castleman?s disease is an atypical lymphoproliferative disorder characterized by angiofollicular hyperplasia of lymph nodes. Histologically it can be classified into a hyaline-vascular type, plasma-cell type, and transitional (mixed-cell) type, while clinically localized type has been classified as unicentric, or generalized (multicentric) form of the disease. Case report. This paper presents a 21 years old male patient with multicentric Castleman?s disease, a transitional (mixed-cell) type. The disease was manifested by fever, generalized enlargement of peripherial lymph nodes, breast glands enlargement, hyperemia of the face, and weakness of the lower extremities. We found mediastinal lymphadenopathy, pleural and pericardial effusions, sensorimotor peripherial neuropathy and polyclonal hypergammaglobulinemia. The simultaneous presence of these manifestations of the disease (sensomotor peripheral neuropathy, lymphadenopathy, effusions endocrinopathy, polyclonal gammaglobulinemia and skin changes) is indentified as POEMS syndrome. The diagnosis of Castleman?s disease was based on the results of histopathologic analysis of mediastinal lymph node biopsies after thoracotomy. The patient was treated with corticosteroids (prednisone 80 mg daily for 2 weeks followed by 60 mg daily). A partial response was achieved after 4 months of treatment. Conclusion. A transitional type of multicentric Castleman?s disease may be present itself as POEMS syndrome. The effect of corticosteroid therapy in this form of the disease is unpredictable.
Subcutaneous emphysema as a complication of tooth extraction
Authors: Vacic Aca
Published: December 2010

Subcutaneous emphysema is a rare complication in dentistry, which may lead to diagnostic errors and inadequate therapy. A 17 years old female patient, in whom the separation of tooth roots was performed by the use of air-powered drill during the extraction of the first right lower molar, is presented in this paper. During the intervention, swelling of the right half of the face and the lower eyelid suddenly occurred, accompanied with simultaneous feeling of choking, and pressure in the neck and chest. Because of the suspicion of the allergic reaction, the patient was administered antihistaminic agent, together with parenteral corticosteroid, and was sent to an institution where she was treated as an in-patient. During hospitalization, subcutaneous emphysema of the face and neck was diagnosed by physical and x-ray examination. The emphysema completely disappeared after the use of oxygen and antibiotics.
The role of magnetic resonance imaging in the diagnosis of postoperative spondylodiscitis
Authors: Stosic-Opincal Tatjana , Peric Vesna , Grujicic Danica , Gavrilovic Svetlana , Golubicic Ivana
Published: December 2010

Background. Spondylodiscitis, discitis associated with vertebral osteomyelitis may follow disc-removal surgery. A targeted successful treatment of spinal infections requires clinical and laboratory data that are completed by the contribution of imaging procedures. Neuroimaging provides precise information on correct topography, localization, propagation, and differential diagnosis of spinal infectious lesions. The aim of this study was to present magnetic resonance imaging (MRI) findings in patients with postoperative spondylodiscitis. Methods. MRI was performed in 6 patients aged 29-50, with clinically suspected postoperative spondylodiscitis. Initial examination was performed 3-8 weeks after surgery and 3, 6, or 12 months after the treatment by antibiotics. Patients underwent MRI on a 1T imaging unit (Siemens, Magnetom-Impact), including sagittal T1W and T2W images and axial T1W images before and after the administration of gadolinium contrast medium. Results. MRI findings included: significantly decreased signal intensity with the loss of distinction between vertebral body and intervertebral disc space on T1W, increased signal intensity in the adjacent vertebral body and end-plates on T2W, contrast enhancement of vertebral body and disc space and paravertebral soft tissue changes. Follow-up examinations performed 3, 6, or 12 months after the treatment showed less abnormal signal intensities on both T1- and T2-weighted images. Conclusion. Postoperative spondylodiscitis is a rare but severe complication of lumbar disc surgery. Since conventional imaging techniques are not reliable for detecting spondylodiscitis in its early stages, MRI is of great significance in the diagnosis of postoperative spondylodiscitis.
Morphological changes in aorto-coronary vein graft: The analysis of autopsy and biopsy material
Authors: Tatic Vujadin , Kanjuh Vladimir , Rafajlovski Sasa , Suscevic Dusan , Ilic Radoje
Published: December 2010

Background. Patients with implanted aortic coronary grafts have different survival time, which raises the question why the efficacy of graft implants is so poor. The aim of this study was to present the results of the analysis of morphological changes in the vein grafts taken after the death of patients who died after surgery in different time intervals, as well to present the analysis of the grafts obtained after surgical reintervention. Methods. The total number of 656 grafts of 308 dead patients was analyzed, as well as 76 grafts from 40 patients who underwent surgical reintervention. According to the duration of the graft since surgical intervention until death, all the analyzed changes were divided into two groups: a) early changes and complications, and b) late changes and complications in aorto-coronary vein grafts. Results. After the autopsy, 518 vein grafts from the first group were evaluated histopathologically. Changes were found in the form of small or large areas with peeled endothelium in 266 grafts, with the insudation of fibrin and thrombocytes in such places, subendothelial edema, and occlusive thrombosis of the graft lumen. Significant stenosis, which occurred distally from the anastomoses, was present in 118 grafts without changes in the walls of the graft, and there was significant narrowing of the graft lumen in 134 vein grafts due to intimal hyperplasia. In the second group, 138 grafts were histopathologically analyzed after autopsy. Significant hyperplasia was present in 117 grafts with the migration of smooth muscle cells from media into intima, and in 21 grafts there were atheromatous plaques. In 120 veins analyzed before the graft implantation, the lesion or the lack of endothelium was found, as well as the penetration of fibrin and blood elements and intimal hyperplasia. In 46 veins analyzed before the graft implantation, significant intimal hyperplasia with the elevated number of smooth muscle cells was found. Conclusion. The most frequent lesions in the grafts were the lesions of the endothelium, which caused thrombosis formation and lumen occlusion. Intimal hyperplasia in patients with longer survival time occurred due to the migration of smooth muscle cells from the media, or due to the formation of atherosclerotic plaques, which caused graft lumen stenosis or thrombosis.
Botulinum toxin A in the treatment of anal fissure
Authors: Stankovic Nebojsa , Mirkovic Darko
Published: December 2010

Background. This paper presents our first experience in the treatment of primary anal fissure by injection of botulinum A toxin into the internal sphincter. Methods. The study group of the retrospective study included 12 outpatients (8 females and 4 males), mean age 42 (range 18-60). During the period 2000-2003, after unsuccessful conservative treatment, patients were treated with the injections of botulinum A toxin, 100 units on both sides of the anal fissure laterally into the internal anal sphincter (50 units on either side). The patients were clinically evaluated 3, 7, and 30 days, and 3 and 6 months after the treatment. Results. Three fissures had healed after a month, and seven after 3 months. Two remained unhealed, but asymptomatic. There was no incontinence of flatus or faeces after 3 months of the treatment. After temporary healing, two fissures relapsed after 6 months, and these patients had the adequate tonus of the anal sphincter muscles. Except for the temporary incontinence, there were neither other side-efects, nor serious complications. Conclusion. Injection of botulinum A toxin achieved good results in the treatment of anal fissure. The appropriate use makes this method safe as an alternative to surgical treatment of anal fissure.
Umbilical metastasis (Sister Mary Joseph's nodule) diagnosed by fine-needle aspiration
Authors: Tatomirovic Zeljka , Bokun Radojka , Skuletic Vesna , Ilic Srbislav , Roganovic Branka , Milutinovic Dragan
Published: December 2010

Sister Mary Joseph?s nodule is the eponym for metastatic involvement of the umbilicus. This less common entity is the sign of disseminated malignant disease, mainly of digestive and gynecologic origin, and is associated with a poor prognosis. A case of Sister Mary Joseph?s nodule in a 76-year-old woman in whom the umbilical metastasis was the first sign of malignant disease in presented. The diagnosis of metastatic adenocarcinoma was established by fine needle aspiration cytology of the umbilical nodule. Radiological and ultrasonographic investigation disclosed carcinoma of the gallbladder with pancreas, stomach, and colon invasion as well as peritoneal dissemination. The diagnosis was confirmed by exploratory laparatomy and histological examination of the excised umbilical nodule.
A well-differentiated liposarcoma co-existent with leiomyoma
Authors: Stojsic Zorica , Bacetic Dragoljub , Radevic Bozina , Vasiljevic Jovan
Published: December 2010

Background. The coexistence of a well-differentiated liposarcoma (atypical lipomatous tumor) and benign smooth muscle component in a single soft tissue neoplasm is extremely rare. Case report. Histologic and immunohistochemical characteristics of tumor, which represented the reccurence of a retroperitoneal atypical lipoma in a 50-year-old female patient are presented in this paper. The tumor represented the recurrence of a retroperitoneal atypical lipoma. Lipomatous component consisted of a mixture of lipoma-like and sclerosing variant of well-differentiated liposarcoma. Characteristically, the heterologous smooth muscle differentiation was manifested as a macroscopically visible nodular growth in the form of a leiomyoma within the adipocytic component. It consisted of intersecting fascicles of spindle cells, which lacked mitoses and significant atypia, and were immunopositive for smooth muscle markers. Conclusion. This case of well-differentiated liposarcoma with benign smooth muscle is the first reported tumor of retroperitoneal localization. It is also the first one to exhibit the heterologous smooth muscle component as a distinct leiomyoma.
Potential role of cholesterol in distinguishing malignant from benign pleural effusion
Authors: Plavec Goran , Tomic Ilija , Nidzovic Natasa , Radojcic Branko , Acimovic Slobodan , Bokun Radojka
Published: December 2010

Cholesterol and carcinoembryonic antigen (CEA) levels in pleural effusion and sera, were measured in 199 patients with pleural effusions of various origins. Malignant cause was found in 93, and nonmalignant in 106 patients. Mean cholesterol level in sera of patient with malignant disease was 5.0 ? 0.93mmol/L, and in nonmalignant group 4.34 ? 1.32 mmol/L. The difference was not statistically significant. Mean cholesterol level in nonmalignant pleural effusions was higher thAn those in malignant (2.51 ? 1.23 mmol/L; and 2.28 ? 1.06 mmol/L), but the difference was also not significant. Average pleural fluid/serum cholesterol ratio (HolI/S) in nonmalignant group was 0.61 ? 0.32 and in malignant group 0.46 ? 0.22. The difference between those mean values was significant. Higher ratio, at the cut off value of 0.5 was found in 79/106 and in 25/93 malignant patients. Calculated sensitivity was 75%, specificity 73%, positive predictive value 76%, negative predictive value 65% and accuracy 69%. Significant negative correlation between Holi/S and pleural fluid CEA was found (p<0.05). It was assumed that pleural fluid/serum cholesterol ratio lower than 0,5 could be of great benefit, as an additional test in the differentiation of malignant from benign pleural effusion.
Correlation between echo morphological carotid plaque characteristics and neurological symptoms
Authors: Brajovic Milan
Published: December 2010

A group of 72 patients with 111 asymptomatic carotid stenoses (ACS), mean age 65.42 ? 9.21 and of 36 patients with 58 symptomatic carotid stenoses (SKS), mean age 67.63 ? 8.79 were analyzed prospectively during a three-years follow-up period. All patients underwent color duplex scan sonography (CDS), carotid arteriography, computed tomography scan (CT), and neurological examination. The aim of the study was to analyze correlation between echo plaque morphology (degree and plaque quality) and neurological symptoms and objective neurological disorders, as well as value of CDS method to appreciate carotid stenosis characteristics. The results analysis showed significantly higher ACS in the group of 30-49% stenoses, but significantly higher SCS in the group of 70-89% and more than 90% stenoses. Fibrous plaque was more frequent in the ACS group, while exulceration and mix plaque were more frequent in the SCS group. Significantly higher number of clinical CVI cases, deaths, and ischemic lesion registered during CT were reported in the SCS group than in the ACS group. CDS showed 92% sensitivity, 90% specificity, and 92% diagnostic accuracy in the assessment of stenosis growth. Morphological characteristics of carotid plaques, significantly correlated with neurological disorders, were stenoses more than 70%, plaque exulceration, mix plaque, and plaque stenoses more than 50%.
Treatment of 36 cases of thrombotic thrombocytopenic purpura
Authors: Suvajdzic-Vukovic Nada , Pandurovic Radmila , Rajic Zoran , Milosevic Rajko , Bogdanovic Andrija , Lazarevic Vladimir , Elezovic Ivo , Colovic Milica , Budisin Zivko , Savic Nebojsa , Vucelic Dragica , Vavic Natasa , Boskovic Darinka
Published: December 2010

Thirty-six patients (pts.) with thrombotic thrombocytopenic purpura (TTP) were treated between May 1990 and May 2003. There were 31 women and 5 men; the average age was 37 years. Twenty-five cases were idiopathic and 11 secondary (3 infection - related, 5 occurred during pregnancy and 3 were drug - associated). The mean lag period between the first symptoms and the diagnosis was 8.5 days (in 14 pts. ? 5; in 22 > 5). On diagnosis neurological symptoms were present in 31, bleeding in 33, fever in 21 and renal impairment in 27 patients. The mean hemoglobin was 67.5 g/L, the mean platelet count was 10?109/L, and the mean reticulocytosis was 17%. The mean serum LDH was 1457 IU. Treatment included plasma exchange (PE) in 24 pts. and only plasma infusions in 12 pts. There were 24 complete responders (20 on PE) and 12 deaths (4 on PE); PE significantly improved survival (p<0.01). There were 5 treatment-related complications due to the infection and bleeding, 17 exacerbations and 4 relapses. The mean time delay before the onset of symptoms and the treatment initiation lasted for 9 days suggesting the poor disease recognition; the mean time delay from diagnosis to PE institution was 6 days, indicating postponed PE. The mean treatment duration in all patients was 18 days; the mean number of PE cycles needed for the platelet count stabilization was 9. Good prognostic indicators of survival were: the longer prodromal period (>5 days), the secondary form of TTP and the absence of coma at presentation. The use of PE significantly improved survival. TTP is a severe disorder requiring early recognition and diagnosis in general medical care facilities, which should lead to the timely treatment with PE.
Spectral analysis of heart period variability in anorexia nervosa
Authors: Platisa Mirjana , Gal Vera , Damjanovic Svetozar
Published: December 2010

The aim of this study was to investigate the response of autonomic cardiac control to postural change using spectral analysis, in patients with anorexia nervosa. Spectral components of total variability as well as of low and high frequencies were analyzed for 17 anorexic patients with mean body mass index (14.9 ? 1.9) kg/m2 and for 9 healthy age-matched women with body mass index (20.3 ? 1.7) kg/m2, in supine and standing postures. During standing posture, increased heart rate in all subjects was accompanied by the decrease in total variability and high frequency spectral powers. In supine posture, anorexic patients demonstrated the reduced low frequency spectral power. Compared to control women, during standing posture anorexic patients showed higher heart rate, reduced total variability and high frequency spectral powers. Statistically significant correlation was noticed between body mass index and spectral power of low frequency in both supine and standing posture. Alterations in autonomic cardiac control induced by anorexia nervosa could be estimated by spectral analysis of heart period variability.
Proliferative activity of myeloma cells determined by Ki-67 antibody: Biological and clinical significance
Authors: Markovic Olivera , Marisavljevic Dragomir , Cemerikic Vesna , Vidovic Ana , Bakrac Milena , Perunicic Maja , Suvajdzic Nada , Colovic Milica
Published: December 2010

In this study we analyzed proliferative activity of myeloma cells and a possible correlation with selected clinical data, histological features and survival in 59 patients with newly diagnosed multiple myeloma (27 females and 32 males, mean age 62 years). Imunohistochemical method was applied using Ki-67 antibody on B5-fixed and paraffin-embedded bone marrow specimens to evaluate growth fraction of myeloma cells. Clinical staging was done according to the Durie-Salmon classification (4 patients had stage I disease, 16 patients stage II and 39 patients stage III). The number of Ki-67+ myeloma cells ranged from 1% to 36% (mean value 7%). In 39 of 59 patients (66.1%) number of Ki-67+ cells was less than 10% (cases with low proliferative index). Ki-67 expression significantly correlated with the clinical stage, ?2-microglobulin level, plasma cell morphology, volume of myeloma infiltration and the extent of osteolytic lesions. Patients with increased proliferative index (Ki-67+cells ?10%) showed a significantly shorter survival compared to those with low proliferative index (14 months vs. 36 months, p = 0.023). However, this difference was not shown in multivariate analysis, particularly due to the high correlation between proliferative activity and plasma cell morphology and the volume of myeloma infiltration.
Ischemic preconditioning
Authors: Ristic-Andjelkov Andjelka , Baskot Branislav , Damjanovic Milorad , Rafajlovski Sasa
Published: December 2010

Background. Ischemic preconditioning is a phenomenon during which myocardium, subjected to brief episodes of ischemia followed by reperfusion, tolerates better the subsequent, more prolonged episode of this ischemia, thus reducing the infarction size substantially. Case report. Two patients with acute left anterior descendent artery occlusion received fibrinolytic therapy (alteplase) within 6 hours of the onset of chest pain, but developed myocardial infarctions of different sizes. The first patient, without the history of preinfarction angina, developed large anterior infarct, because there was no time either for ischemic preconditioning or for the coronary collateral vessels development. In the second patient, with 4-day history of preinfarction angina, the more favorable outcome was seen he developed smaller apical necrosis, with the great degree of myocardial viability in the infarct-related area. Conclusion. Ischemic preconditioning in patients with acute myocardal infarction results in the reduction of mortality, infarction size, as well as in the frequency of malignant arrhythmias.
Genetic alterations in B-cell non-Hodgkin's lymphoma
Authors: Magic Zvonko , Novkovic Tamara , Cikota Bojana , Tasic-Radic Olga , Tarabar Olivera , Stamatovic Dragana
Published: December 2010

Background. Although the patients with diagnosed B-NHL are classified into the same disease stage on the basis of clinical, histopathological, and immunological parameters, they respond significantly different to the applied treatment. This points out the possibility that within the same group of lymphoma there are different diseases at molecular level. For that reason many studies deal with the detection of gene alterations in lymphomas to provide a better framework for diagnosis and treatment of these hematological malignancies. Aim. To define genetic alterations in the B-NHL with highest possibilities for diagnostic purposes and molecular detection of MRD. Methods. Formalin fixed and paraffin embedded lymph node tissues from 45 patients were examined by different PCR techniques for the presence of IgH and TCR ? gene rearrangement; K-ras and H-ras mutations; c-myc amplification and bcl-2 translocation. There were 34 cases of B-cell non-Hodgkin?s lymphoma (B-NHL), 5 cases of T-cell non-Hodgkin?s lymphoma (T-NHL) and 6 cases of chronic lymphadenitis (CL). The mononuclear cell fraction of the peripheral blood of 12 patients with B-NHL was analyzed for the presence of monoclonality at the time of diagnosis and in 3 to 6 months time intervals after an autologous bone marrow transplantation (BMT). Results. The monoclonality of B-lymphocytes, as evidenced by DNA fragment length homogeneity, was detected in 88 % (30/34) of B-NHL, but never in CL, T-NHL, or in normal PBL. Bcl-2 translocation was detected in 7/31 (22.6%) B-NHL specimens, c-myc amplification 9/31 (29%, all were more than doubled), K-ras mutations in 1/31 (3.23%) and H-ras mutations in 2/31 (6.45%) of the examined B-NHL samples. In the case of LC and normal PBL, however, these gene alterations were not detected. All the patients (12) with B-NHL had dominant clone of B-lymphocyte in the peripheral blood at the time of diagnosis while only in 2 of 12 patients MRD was detected 3 or 6 months after BMT. Conclusion. Because it is quick and simple, PCR analysis of clonal IgH rearrangements is very useful when diagnostic assistance is required. This technique is also very efficient for tracking minimal residual disease in lymphomas and leukemia's and for monitoring clonal evolution in acute and chronic lymphoblastic leukemia's and lymphomas. The presence of other genetic alterations, which we detected, should serve as an additional prognostic or predictive factor in the patients with B-NHL.
Arrhythmias and conduction abnormalities in children after repair of tetralogy of Fallot
Authors: Kuzevska-Maneva Konstandina , Kacarska Rozana , Gurkova Beti
Published: December 2010

Aim. To find out types and frequency of cardiac arrhythmias and conduction abnormalities in the group of children who underwent surgery for tetralogy of Fallot (TOF). Methods. Fortysix pedicatric patients who underwent a complete repair of TOF at the age of 1 to 13 (mean 2.89 ? 2.36) were studied. Thirty-eight (82.60%) had total correction and 8 (17.40%) had palliative operation first, and total correction afterwards. Twenty-four-hour Holter ECG monitoring was performed in all 46 pediatric patients aged from 1 to 16 yrs (mean 6.48 ? 4.04) after surgery as follows: in 1 patient (2.17%) after a year, in 20 patients (43.47%) after 2 to 5 years and in 25 patients (54.34%) after 5 years. Mean age of patients on Holter monitoring was 9.25 ? 4.39 (range 4?19). Twenty of them (43.47%) were girls and 28 (56.53%) were boys. All the patients were evaluated by standard methods (clinical signs, clinical findings, ECG before surgery, ECG before Holter monitoring and 2D Doppler echocardiography. Results. Types of heart rhythm found out by Holter monitoring were: sinus nodus dysfunction in 1 child (2.17%), significant premature atrial contraction (PAC) in 8 (17.39%), supraventricular paroxysmal tachycardia in 3 (6.53%), transient nodal rhythm in 2 (4.34%), premature ventricular contraction (PVC) Lown grade I-III in 9 (19.56%) and Lown grade IV in 2 (4.34), atrioventricular (AV) block grade I in 2, right bundle branch block (RBBB) in all 46 (100%) and RBBB + left anterior hemiblock (LAH) in 4 (8.96%). There was no presence of atrial flutter, ventricular tachycardia or complete AV block. None of them experienced sudden death. Using cross procedure statistical methods, it was found that all the patients with PVC had right ventricular dilatation. There was no relation of other types of arrhythmia found on Holter monitoring to the other parameters from echocardiography, neither to the other standard methods. Children did not need the pace-maker, but 36.95% of the them required antiarrhythmic drugs. Conclusion. Twenty-four hour Holter ECG is a noninvasive and very sensitive method for discovering heart rhythm disturbances in children after the repair of tetralogy of Fallot, especially in asymptomatic patients. The patients after the repair of this congenital heart disease needed a long-term follow-up for early recognition of serious heart rhythm disturbances and their treatment.
Evaluation of absolute volume of human fetal kidney's cortex and medulla during gestation
Authors: Vlajkovic Slobodan , Dakovic-Bjelakovic Marija , Cukuranovic Rade , Popovic Jasmina
Published: December 2010

Background. Human fetal kidney is quite different from the mature kidney, both macroscopically and hystologically. Lobulated surface of the human fetal kidney reflects its inner organization. Aim. To determine the fetal kidneys' volume according to the gestational age, to establish periods of their maximal and minimal growth and to compare these values for various gestational ages. Methods. Forty five human fetal kidneys aged from IV to X lunar months were analyzed. Kidneys were divided into nine groups according to their gestational age. The volumes of cortex and medulla were determined using stereological methods. The results were statistically analyzed and the periods of significant growth of these structures were marked. Results. Fetal kidney's cortex and medulla grew continually with a very high coefficient of linear correlation with crown-rump length. The cortex/medulla ratio was minimal in the first half of V lunar month, when medulla grew most rapidly and it was maximal immediately before birth, when cortex achieved its maximum. Conclusion. This study was an effort to provide some parameters which would help in the future investigations of the development of human fetal kidney.
Predictive factors of psychosomatic reactions during air raids
Authors: Samardzic Radomir , Spiric Zeljko
Published: December 2010

Background. Civilian population of Yugoslavia was exposed to massive stressors of air raids by NATO in 1999. The aim of this study was to investigate somatic complaints and their predictive factors during stresses of air raids. Methods. Random sample of 434 subjects, consisting of 139 inhabitants of several Belgrade municipalities and 295 employees of Military Medical Academy, were assessed in the cross-sectional study. The basic factors of interest were stress severity, variables of personality and habits and behavior relevant for somatic complaints. Self-report of stress severity and the most common somatic complaints were performed by Questionnaire specially designed for this purpose and personality evaluation by EPQ-38. Multiple regression analysis was used to determine the influence of predictors on dependent variable (psychosomatic symptoms). Results. Personality was the most important predictor that explained 29% of variance in somatic symptoms (with the strongest impact of neuroticism); 11% was explained by habits and behavior and only 1% of variance by stress. Conclusion. The finding that personality had higher impact on stress reaction outcome could be important for preventive and therapeutic aspects of stress reactions.
Timusne celije dadilje - specijalizovana mikrosredina timusa
Authors: Vucevic Dragana , Colic Miodrag , Gasic Sonja , Vasilijic Sasa
Published: December 2010

 Vise od dve decenije nakon prvog opisa, TNC su i dalje velika nepoznanica i potrebno je jos mnogo istrazivanja pre nego sto budemo bili u mogucnosti da definisemo preciznu ulogu ovih celija u razvoju T-limfocita. Mnoga od dosadasnjih saznanja ukazuju da se timociti u kontaktu sa TNC nalaze na prekretnici u svom razvojnom putu: ili ce biti uklonjeni indukcijom apoptoze ili ce nastaviti svoj razvoj i dalje sazrevanje. Brojna pitanja su za sada bez odgovora, a medju njima su dva posebno intrigantna. Koja je razlika izmedju timocita koji se vezuju za TNC i onih koji to ne cine? Koja je razlika izmedju populacije adherentnih timocita koji su selektivno internalizovani i onih koji su iskljuceni iz procesa internalizacije? Buduca istrazivanja kretanja timocita ka, unutar i van TNC ce verujemo pruziti dragocene informacije o ovoj fazi u razvoju T-limfocita. Nezavisno od toga sta ce buducnost pokazati o pravoj ulozi TNC, jedinstven kompleks koji ove celije formiraju sa timocitima je vrlo neobican, uzbudljiv i zagonetan bioloski fenomen.
Intraorbital wooden foreign body, diagnosed by NMR and ultrasonography, and extirpation by cranio-orbital approach
Authors: Nagulic Mirjana , Ilic Bozidar , Nikolic Igor
Published: December 2010

Aim. The case of the phlegmon of the left orbit associated with ophtalmoplegia and blindness in a 16-years old boy was presented. It was caused by the penetrafion of the wooden foreign body under unknown circumstances. Case report. Repeated CT scans did not reveal the presence of the foreign body before MR imaging and ultrasonography. The removal (43 ? 8 mm) was done one month after the injury by osteoplastic orbitotomy, using microsurgical technique. Three months later the signs of inflammation and eye protrusion withdrew. Motility of the left upper lid and eye were normal. Conclusion. MR imaging and ultrasonography were decisive in the diagnose of organic foreign body in the orbit.
Liver hydatid disease: Morphological changes of protoscoleces after albendazole therapy
Authors: Stankovic Nebojsa , Ignjatovic Mile , Nozic Darko , Hajdukovic Zoran
Published: December 2010

Background. Postoperative recurrence of the liver hydatid disease befalls approximately 10?30% of patients. Preoperative or postoperative therapy with albendazole in single therapeutic protocol (800 mg/d, within 28 days) indicated the need to evaluate the hydatid cyst liquid protoscoleces viability. Morphological changes of protoscoleces following the treatment with drugs are not well known. Aim. To estimate the viability of protoscoleces after preoperative or postoperative albendazole therapy, and their ability for cystic metamorphosis. Methods. A prospective, randomized clinical trial included 30 patients with liver hydatid disease, treated with albendazole and surgically (I group), and 30 patients in the control group treated only surgically (II group). The concentration of albendazole and its active metabolite albendazole sulphoxide in the cysts contents were determined using HPLC. Estimation of protoscoleces viability was based on the established micromorphologic criteria, and compared between the patients treated with albendazole, and the patients treated only surgically. Biological assessment of the viability was performed on protoscoleces with uncertain signs of the disturbed viability (unchanged structure, evaginated, without movements) using intraperitoneal injection of 1 ml of protoscoleces prepared suspension to AO type of rats. Results. The concentration of albendazole in cysts' contents ranged from 0 to 64.9 ?g/ml, and of its active metabolite from 0.5 to 40.8 ?g/ml. The presence of fully viabile protoscoleces in the albendazol treated patients was significantly lower than in the control group. A significant difference was noticed in the presence of disintegrated protoscoleces without movements in the albendazol treated group, compared to the control group. Biological assessment of the viability showed incapability of these protoscoleces for cystic metamorphoses. Conclusion. Low viability of parasites due to medicamentous therapy is very useful and important to surgeons, because the fertility of cysts is lower, and the risk of the disease recurrence is reduced.
Resistance of catheter-associated urinary tract infections to antibacterials
Authors: Verhaz Antonija , Skrbic Ranko , Rakita-Music Mirjana
Published: December 2010

Introduction. Catheter-associated urinary tract infections (CAUTI) are the most common nosocomial infections. The worldwide data show the increasing resistance to conventional antibiotics among urinary tract pathogens. Aim. To evaluate the adequacy of initial antimicrobial therapy in relation to the antimicrobial resistance of pathogens responsible for CAUTI in Clinical Center of Banja Luka. Methods. A retrospective study on major causes of CAUTI, antibiotic resistance and treatment principles was conducted at four departments of the Clinical Center of Banja Luka from January 1st, 2000 to April 1st, 2003. Results. The results showed that 265 patients had developed CAUTI. The seven most commonly isolated microorganisms were, in descending order: E. coli (31.0%), Pseudomonas aeruginosa (13.8%), Proteus mirabilis (12.9%), Gr. Klebsiella-Enterobacter (12.3%), Enterococcus spp. (5.2%), Pseudomonas spp. (4.3%), Serratia spp. (4.0%). The most common pathogens were highly resistant to ampicillin (64?100%), gentamycin (63?100%), and trimethoprim-sulfamethoxazole (68?100%), while some bacterias, like Pseudomonas aeruginosa and Serratia spp. showed rates of ciprofloxacin resistance as high as 42.8% and 72.7%, respectively. In 55.5% of the cases, the initial antibiotic therapy was inadequate, and was corrected latter on. There were no standard therapeutic protocols for this type of nosocomial infections. Conclusion. The results of this study emphasized an urgency of the prevention and introduction of clinical protocols for better management of CAUTI. Treatment principles should better correspond to the antibiotic sensitivity of uropathogens.