bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain natriuretic peptide as a predictor of heart failure in patients with permanent pacemaker
Authors: Jelic Vera , Milasinovic Goran , Pavlovic Sinisa , Kanjuh Vladimir , Zivkovic Mirjana
Published: July 2008

Introduction: Brain natriuretic peptide (BNP) has a role in control of cardiovascular and renal functions. Objective The objective was to assess the predictive value of BNP levels for development of heart failure in patients with permanent pacemakers. Method In patients with implanted DDD pacemakers, BNP levels were measured at rest and after exercise testing, on DDD and VVI modes. There were 42 patients (25 males; 59.5%), without symptoms or signs of coronary disease or heart failure, and with normal echocardiograms. According to BNP levels, the patients were divided into three groups: with BNP levels lower than 80 pg/ml, BNP ranging from 81-150 pg/ml, and BNP levels over 151 pg/ml. Results In the first group (27 patients), BNP levels were significantly higher on VVI compared to DDD mode, both at rest and after exercise (p<0.01), with all BNP levels within normal range. In the second group (5 pts), BNP levels at rest were also significantly higher on VVI than on DDD mode, p<0.05. After exercise, these values were also higher on VVI compared to DDD mode, but without statistical significance. The third group (10 pts) as a whole had higher BNP values on VVI compared to DDD mode, with no statistical significance. In patients from this group who later developed heart failure, BNP levels were found to be significantly lower on DDD as opposed to VVI mode at rest, p<0.05, and even higher significance was found after exercise, p<0.01. After 6-year follow-up, 2 out of 5 patients from the second group developed dilated cardiomyopathy, and 8/10 patients in the third group experienced heart failure with LV EF 34.1?10%, LV EDD 6.1?0.42 cm, LV ESD 4.8?0.45 cm. Five of these patients died within the follow-up period. Conclusion The increased BNP levels can be valuable for early screening of patients with higher risk of heart failure. In patients with increased BNP at the time of pacemaker implantation, DDD pacing is a modality of choice.
The evaluation of hemodialysis adequacy during the use of different dialysis membranes
Authors: Stasevic Zvonimir , Subaric-Gorgieva Gordana , Krcmarevic Jelica , Stolic Radoica , Trajkovic Goran
Published: July 2008

Introduction: Hemodialysis efficacy that significantly influences morbidity and mortality of patients can be evaluated by different widely used indices of adequacy. Objective The aim of the study was to evaluate the adequacy of hemodialysis in the group of patients on maintenance hemodialysis and to examine the influence of different dialysis membranes on the indices of adequacy and frequency of symptoms and complications developing during dialysis treatment. Method The study involved 14 patients dialyzed in three successive months with three different types of dialyzers: E3 (Hemomed) - cuprophane membrane, 1.3 m2, F6 (Hemomed) - polysulfone membrane, 1.3 m2, CM23 (Zdravlje) - cuprophane membrane, 1.25 m2. Each type of dialyzers was used during one month, meaning during 12 successive 4-hour hemodialyses. Results Mean value of Kt/V index was 1.39?0.21 for E3 dialyzer, 1.18?0.24 for F6 dialyzer and 1.44?0.25 for CM23 dialyzer. The difference between the indices was statistically significant (p<0.05). Mean protein catabolic rate (PCRn) ranged between 1.6 and 1.7 and no significant difference was found between the dialyzers used. The frequency of hypertension episodes was similar during the hemodialysis with different dialyzers, but the incidence of different symptoms and hypotension episodes was significantly lower during hemodialysis with polysulfone membrane. Conclusion Hemodialysis with three examined types of dialyzers enabled acceptable dialysis adequacy. Dialyzers with cuprophane membrane enabled significantly higher Kt/V index, but the incidence of symptoms and hypotension was significantly lower during hemodialysis with polysulfone membrane.
Factors influencing the development of avascular necrosis in non-operative treatment of the acute slipped capital femoral epiphysis
Authors: Slavkovic Nemanja , Vukasinovic Zoran , Slavkovic Slobodan
Published: July 2008

Introduction: The acute slipped capital femoral epiphysis can result in development of avascular necrosis of the femoral head which is very difficult condition to treat. Orthopedic surgeon can influence the development of avascular necrosis. Objective The main objective in our study was to identify factors influencing the development of avascular necrosis in nonoperative treated patients for the acute slipped capital femoral epiphysis. Method A total of 53 patients and 59 hips treated for the acute slipped capital femoral epiphysis at the Institute for Orthopedic Surgery "Banjica" between 1968-2004 were studied. Necessary data were obtained from the accurate medical records. Results Avascular necrosis of the femoral head was diagnosed in 8 patients (13.56%). Six of them (75%) were treated by manipulative reduction in general anesthesia and spica cast immobilization. Fischer test, used for statistical data processing, found significant difference between two non-operative methods of treatment (p=0.0008). Conclusion Higher-degree epihyseal displacement as well as complete separation of the physis and metaphysis were found to be the risk factors of avascular necrosis. Every manipulation with the affected hip was also associated with higher percentage of avascular necrosis of the femoral head.
Forensic expertise of the injury severity in fatally injured car-occupants
Authors: Nikolic Slobodan , Atanasijevic Tatjana , Popovic Vesna , Babic Dragan
Published: July 2008

Introduction: There is no specific injury among fatally injured frontal car-occupants in frontal car collisions, used in forensic expertise. We tried to point out the usefulness of the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) for the expertise in such cases. Objective Analyzing the severity of body region injuries and total injury severity of deceased car occupants, to point out their importance in forensic expertise. Method Retrospective autopsy study was performed. Autopsy records of all deceased car-occupants in frontal car collisions were analyzed in order to establish the severity of injuries in body regions (AIS) and total severity of injuries (ISS). Statistical analysis was performed using the chi-square test, t-test, and logistic regression, with significance set at p<0.05. Results A total of 500 cases were analyzed: 282 car-drivers and 218 front car-passengers, average age of 41.48?15.31 and 39.78?16.93. There were 401 males and 99 females. The most injured body region was head with neck: AIS=3.50?2.48, for car-drivers, and AIS=3.54?2.50, for front car-passengers, as well as thorax: AIS=3.63?2.16 car-drivers, and AIS=3.37?2.14, for front car-passengers. More severe injuries of head (AIS?4) suggested that deceased was a front car-passenger (Wald =13.27; p=0.04). More severe injuries of thorax and abdomen (AIS?5) indicated that deceased was a car-driver (Wald=5.72; p=0.02, and Wald=8.23; p=0.01, respectively). The injury severity of the face and limbs were useless in such expertise (Wald=1.72; p=0.19, and Wald=0.89; p=0.34, respectively). An average ISS was 57.31?20.16 for car-drivers, and 54.54?21.01 for front car passengers. The ISS value was useless in expertise (t=1.50; p=0.13, and Wald=2.24; p=0.13). Conclusion As the injury of the head is more severe, the deceased is more likely to be the front car-passenger. Severe thoracic and abdominal injuries are more characteristic for cardrivers. A total injury severity is useless for forensic expertise in cases of fatally injured in car collisions.
Chylopericardium as a complication of cardiac surgery: Report of two cases and review of the literature
Authors: Velinovic Milos , Vranes Mile , Kocica Mladen , Djukic Petar , Mikic Aleksandar , Vukomanovic Vladislav , Kacar Sasa , Putnik Svetozar , Divac Ivan , Markovic Dejan , Seferovic Petar , Ristic Arsen
Published: July 2008

Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with chylopericardium was diagnosed perioperatively (implantation of artificial aortic - St. Jude No 21 and mitral valve - St. Jude No 29). Etiology of pericardial effusion was established by Sudan III staining of punctate specimen obtained by subxiphoid pericardial puncture. Probable cause of chylopericardium was the lesion of ductus thoracicus during cross-clamping of the superior caval vein with a Cooley clamp. Initial treatment included diet rich in medium-chain triglycerides which resulted in resolution of the effusion. During five-year follow-up, there were no recurrences of pericardial effusion. The second patient was female, 21 years old, with chylopericardium after partial pericardiectomy performed because of the chronic severely symptomatic pericardial effusion, resistant to other forms of treatment. Pericardiocentesis provided 650 ml of yellowish fluid with a high concentration of cholesterol (3.2 mmol/l), triglycerides (16.6 mmol/l), and proteins (64.7 g/l), which verified chylopericardium, most probably as a consequence of the lesion of ductus thoracicus during partial pericardiectomy. Diet rich in medium-chain triglycerides failed to decrease the effusion, after two weeks of treatment (daily secretion 250-350 ml). Lymphography revealed lesion of ductus thoracicus, most probably at Th9/Th10 level, with no direct visualization of extravasal accumulation of contrast media. Surgical ligation of ductus thoracicus was performed through the right thoracotomy. However, postoperative secretion increased to 1000 ml/day. Patient underwent redo surgery comprising the ligation of lymphatic vessels, guided by extravasation of intraoperatively iwected methylene-blue indicator. During one-year follow-up, there were no recurrences of pericardial effusion. In conclusion, intraoperative lymphography significantly contributed to successful surgical treatment of patients with chylopericardium.
Antioxidant status in type ii diabetes mellitus patients with or without microvascular complications
Authors: Kostic Nada , Caparevic Zorica , Ilic Sanja
Published: July 2008

Introduction. Lipid peroxidation and antioxidant systems are important factors affecting the metabolism of lipoproteins in diabetes mellitus. Objective. The aim of this study was to investigate the lipid and antioxidant parameters in type II diabetes mellitus patients, and also to determine the effect of diabetic complications on these parameters. Method. Lipid status, Oxidized LDL cholesterol, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and plasminogen activator inhibitor (PAI-1) levels in plasma of 50 type II diabetic patients were measured with commercially available kits. Results. The results showed only statistically significant higher levels of triglycerides (3.12?3.9 mmol/l) in diabetics compared with the controls. Ox-LDL cholesterol (84.7?16.9 mmol/l) and SOD activities (913.4?120.3 U/gHb) in type 2 diabetes mellitus were higher than those of the controls, but there was no statistical significance. On the other hand, in patients with diabetes mellitus and complications, LDL cholesterol, PAI-1, SOD and GSH-Px activities were higher but not significantly than those without complications. Triglycerides and Ox-LDL cholesterol were lower in the group of diabetic patients with complications in comparison to the group without complications. Conclusion. These results indicate that antioxidant status may be affected in type II diabetic patients and that the rise in some enzyme activities could be a compensatory mechanism to prevent tissue damage. Our results suggest that the rise in PAI-1 in type II diabetics with complications may be a good marker of vascular endothelial dysfunction.
Self-management program in treatment of asthma
Authors: Milenkovic Branislava , Bosnjak-Petrovic Vesna
Published: July 2008

Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30) or to conventional treatment (Group B, n=30), with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist), courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p<0.05), unscheduled visits to ambulatory care facilities (p<0.005), days off work (p<0.0001), courses of oral prednisolone (p<0.001) and antibiotics (p<0.05). At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work), but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. Conclusion. These results suggest that peak-flow based self management is more effective than traditonal treatment in mild and moderate persistent asthma. .
Health habits, attitudes and behavior towards oral health of children with epilepsy
Authors: Jovanovic Svetlana , Gajic Ivanka
Published: July 2008

Introduction: Children suffering from epilepsy are high at risk of oral diseases primarily due to their underlying medical condition which can have an impact on the maintenance level of oral hygiene, but also due to adverse effects of antiepileptic drugs. Objective. The aim of this paper was to identify habits, attitudes and behavior of children with epilepsy and parents in respect to oral health. Method. The experimental group consisted of 50 children with epilepsy, 24 boys and 26 girls, 7-14 years old, mean age 11.2?2.2 years. The control group consisted of healthy children, matched by age and gender. The instruments of investigation consisted of the structured interview of children and parents concerning oral health habits, attitudes and behavior. We used medical records of children with epilepsy as a source of information on their diagnosis, duration of the illness and current therapy. Statistical analysis was performed by chi-squared test, nonparametric correlation, Wilcoxon?s signed rank test and logistic regression. Results. Results showed that more children with epilepsy and their parents had inappropriate habits and attitudes towards oral health, as well as nutrition habits (p<0.001). Compared to healthy controls, children with epilepsy washed their teeth less often and shorter, they had less knowledge about causes of oral diseases and about influence of oral diseases on general health, and they had worse self-rating of teeth and gum condition. In addition, significantly more children with epilepsy used an incorrect technique of teeth brushing (p<0.001). Characteristics of children?s epilepsy and educational degree of parents had no influence on these differences. Conclusion. Study results showed that children with epilepsy and their parents had worse habits, attitudes and behavior towards oral health than healthy controls and their parents. This difference can be explained primarily by worse parental estimation of oral health and behavior towards oral health in comparison to parents of healthy controls. .
Angiosome of the fibular artery as anatomic basis for free composite fibular flap
Authors: Manojlovic Radovan , Milisavljevic Milan , Tabakovic Dejan , Cetkovic Mila , Bumbasirevic Marko
Published: July 2008

Introduction. The free osteoseptocutaneus fibular flap is, anatomically, an angiosome of the fibular artery. Knowledge of detailed topography anatomy of the fibular artery and its branches is necessary for successful creation and elevation of the flap. Objective. The aim of the study was to determine topography of the tissue of the leg supplied only by the fibular artery, to describe topography relations of the branches of the fibular artery, their number, anastomoses, vascular plexus and the way of vascularization of the skin, muscle and bone tissue. Method. The popliteal artery was cannulated in 15 cadaveric legs, flushed with ink and then with 10% ink-gelatin. Fixation of tissue was performed with formalin and then micropreparation of the side branches of the fibular artery was performed. Also, two corrosive models were made. Localization of foramen nutrition was determined by measuring 50 fibulas. Results. The skin supplied by the fibular artery forms distal two thirds of the lateral-posterior aspect of the leg. Vascularization of the skin arises from the side branches of the fibular artery forming a rich fascia plexus at the deep fascia level. From 3 up to 7 side branches of the fibular artery are incorporated in the fascia arterial plexus and can be separated as septocutaneus and myocutaneus, according to topography relations. The nutritive artery enters the fibula cortex at a spot that, measured from the top of the fibula, lies in the area between 32% and 65% of the whole length of the fibula. Periosteal circulation of the fibula originates from the short side branches of the fibular artery that anastomoses at the periosteum level. Conclusion. The axial line of flap has to be marked 2 cm posterior to the line from caput fibulae to malleolus lateralis. Numerous anastomoses between the side branches of the fibular artery in the fascia plexus enable good circulation of the skin even when some of the branches are not included in the flap. The middle third of fibula has to be used as bone graft because of localization of the foramen nutrition. .
Compliance with hypertension guidelines in general practice in Slovenia
Authors: Petek-Ster Marija , Kersnik Janko , Svab Igor
Published: July 2008

Introduction. Compliance with hypertension guidelines in clinical practice is generally poor, but there was no data about compliance with any guidelines in general practice in Slovenia. Objective. Our aim was to find out whether general practitioners in Slovenia managed their hypertensive patients according to the national guidelines, based on 1999 WHO/ISH guideline recommendations. Method. 42 family physicians registered all patients with the diagnosis of arterial hypertension among 300 consecutive regular office visits. We used data about blood pressure management from paper medical records. Results. We collected data from 2752 patients with hypertension; the mean age was 64.1 years (SD = 12.4 years, from 21 to 97 years). All elements of the minimal diagnostic program in the last five years were performed in 23.8% of the patients. In 1809 (65.7%) patients, whose cardiovascular risk was estimated, the minimal diagnostic program was performed more frequently (p<0.001). Non-pharmacological measures were performed in 1210 (47.0%) patients. 2649 (97.6%) patients had drug therapy in accordance with the guidelines. Follow-up in accordance with the guidelines was performed in 1492 (55.3%) patients. Only 256 (9.3%) patients were managed completely according to the guidelines and only 347 (15.5%) of study population reached the target values of blood pressure. Conclusion. The impact of hypertension guidelines on patients? management in everyday primary care appears marginal. More emphasis should be placed on the efficient implementation of the guidelines. .
Danon disease: A case report and literature overview
Authors: Catovic Suad , Otasevic Petar
Published: July 2008

Danon disease, a rare glycogen storage disease, is a dominant X-linked disorder. It is due to mutation in gene for lysosome-associated membrane protein 2 (LAMP 2). The LAMP 2 gene is located on Xq24, and its mutation causes primary deficiency of LAMP 2 and myocyte hypertrophy by accumulations of vacuoles containing glycogen. Danon disease is clinically characterized by the triad of hypertrophic cardiomyopathy (HCM), proximal myopathy and mental retardation. Myopathy and mental retardation can be absent, and cardiomyopathy is usually hypertrophic. This is a case report of the patient with genetically confirmed Danon disease and mixed cardiomyopathy, but without myopathy and mental retardation. ECG showed typical Wolff-Parkinson-White (WPW) pattern while echocardiography demonstrated hypertrophy and dilatation of all cardiac chambers with impaired systolic and diastolic function. Male sex, early onset of symptoms, massive hypertrophy of the myocardium and ventricular preexcitation indicate a genetic basis for HCM. Therapeutic measures, except heart transplantation, do not improve prognosis substantially. Only an accurate diagnosis in patients with unexplained HCM helps in establishing of the appropriate treatment strategies and adequate genetic consultation. .
Newborn hearing screening
Authors: Babac Snezana , Djeric Dragoslava , Ivankovic Zoran
Published: July 2008

Introduction: Prevalence of sensorineural hearing loss is 1-3 per 1,000 newborns. Transient evoked otoacoustic emission (TEOAE) and automated auditory brain stem responses (AABR) are most frequently used methods in newborn hearing screening programmes. Objective. The aim of this study was to examine hearing function in newborns with and without risk factors for hearing loss. We investigated accuracy and feasibility of two automated technologies: transient otoacoustic emissions (TEOAE) and auditory brain stem response (AABR) in early detection of hearing loss. Method. In prospective study, 907 newborns were tested on both ears with transient evoked otoacoustic emissions (TEOAE). If results were "refer", we performed automated brain stem response (AABR). Two stage screening protocols were used with two screening technologies (TEOAE, AABR). Results. Results showed screening pass of 86.3% of the newborns in the first protocol and 99.3% in the second. Six (0.7%) newborns had positive screening results for hearing loss. They were referred for additional audolologic tests (otoacoustic emissions, tympanometry, and auditory brain stem response) to confirm or exclude hearing loss. Audiologic examination was performed up to the third month of life. We confirmed unilateral sensorineural hearing loss in two babies. Average test time per ear was 21.3?19.4 s for TEOAE and 135.3?67.9 s for AABR. Conclusion TEOAE, AABR tests are confidential, noninvasive and feasible methods and can help to detect hearing impairment.
The influence of age and the beginning of menopause on the lipid status, LDL oxidation, and CRP in healthy women
Authors: Caparevic Zorica , Kostic Nada
Published: July 2008

Introduction: Atherogenic lipid profile is an important risk factor in development of atherosclerosis in menopausal women. High level of small dense LDL, that is more susceptible to oxidation, and high levels of inflammatory markers are also associated with an increased risk for development of atherosclerosis. Objective. The aim of this study was to investigate the relationship between lipid profile, oxidized LDL (Ox-LDL) and C-reactive protein (CRP) as inflammatory reaction in healthy women dependent on age and menopause. Method. The study included a group of clinically healthy women (total of 97 women). Group 1: 15 women younger than 45 years; group 2: 62 women between 46 and 55 years, group 3: 20 women between 56 and 65 years, group of menopausal women (73) and group of premenopausal women (24). None of the women had history of obesity, diabetes mellitus, cerebrovascular, ischaemic heart disease, and hypertension. Lipid profiles were measured by enzymatic methods. Ox-LDL was measured by using a specific monoclonal antibody, mAb4E6. CRP was measured using hemiluminiscent methods (Immulite-DPC). Results. Results showed significantly higher levels of total cholesterol (p<0.01) and LDL cholesterol (p<0.01) in women over 56 years compared with women younger than 45 years. We also found similar results in menopausal women. Levels of Ox-LDL (p<0.05) and CRP (p<0.01) showed significantly higher levels in women over 56 years. In menopausal women, we found significantly higher levels of CRP (p<0.05). There was no significant difference in the levels of oxLDL between the menopausal and premenopausal women. Levels of triglycerides and HDL cholesterol were not different among groups. We found that 51% women had levels of HDL cholesterol lower than 1.3 mmol/L. In all groups of women, we found positive correlation among age, Ox-LDL (p<0.01) and CRP (p<0.01). Ox-LDL also positively correlated with CRP (p<0.01). Conclusion. In healthy women older than 56 as in menopausal women, we found significantly higher levels of LDL cholesterol and inflammatory markers. These results suggest that strategies of primary prevention in women are needed to reduce the risk of developing cardiovascular disease.
Distal splenorenal shunt with partial spleen resection
Authors: Gajin Predrag , Radevic Bozina , Nenezic Dragoslav , Ilijevski Nenad , Jesic-Vukicevic Rada , Radak Djordje
Published: July 2008

Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren) with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren) with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years) who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years) that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%), while in the second group there were 13 patients with splenomegaly (68%). Before surgery, the mean platelet count in the first group was 51.6?18.3x109/l, to 118.6?25.4x109/l postoperatively. The mean platelet count in the second group was 67.6?22.8x109/l, to 87.8?32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05). Comparing the postoperative platelet count between the first and second group, we found that there was a very significant statistical difference, too (p<0.01). Conclusion. Distal splenorenal shunt (Warren) with partial spleen resection is a very reliable surgical technique in treatment of hypersplenism and decompression of oesophageal varices caused by portal hypertension and has advantage in treatment of hypersplenism over the distal splenorenal shunt method. .
Gilbert’s syndrome in children: Our experience
Authors: Radlovic Nedeljko , Lekovic Zoran , Mladenovic Marija , Ristic Dragana , Radlovic Vladimir , Lekic Vojislav , Vuletic Biljana , Djurdjevic Jelena , Gajic Milan
Published: July 2008

Introduction: Gilbert?s syndrome represents the most frequent hereditary disorder of bilirubin metabolism. It occurs in 2-7% of subjects in general population, and is manifested by mild unconjugated hyperbilirubinaemia of benign nature. Objective. The study was conducted in order to analyse our experience related to the circumstances of disclosure, age at onset and sex distribution of Gilbert?s syndrome in children. Method. The diagnosis of Gilbert?s syndrome was based on the findings of mild unconjugated hyperbilirubinaemia in the absence of haemolysis and organic liver disease, as well as significant increase of bilirubin unconjugated fraction in serum after a 3-day hypocaloric diet (400 kcal/daily). Results. Of 58 subjects with Gilbert?s syndrome, there were 40 (68.97%) boys and 18 (31.03%) girls, indicating a 2.22 fold higher incidence of boys than girls. The age at diagnosis of the disorder was similar in boys and girls, and was 12.2-18 (X=14.71?1.55) years for boys and 10.5-16.4 (X=14.38?2.10) years for girls (p>0.05). Except for 3 girls aged below 12 years, in all other patients the diagnosis was made after that age; in 20, between age 12 and 14 years and in 14, between age 14 and 16 years, while in 10 patents, it was made at age between 16 and 18 years. In 20 (34.48%) subjects, hyperbilirubinaemia was disclosed on routine paediatric examination, in 19 (32.76%) when differentiating the cause of recurrent or acute abdominal pain, in 17 (29.3%) during febrile condition and in 2 during insufficient caloric intake. The values of unconjugated bilirubinaemia, both before a hypocaloric test and after a 3-day energy deprivation, were higher in boys than girls, but this difference was statistically significant only after the 3-day hypocaloric diet in age group between 16 and 18 years (p=0.038). Also, no significant difference was found in bilirubinaemia level between the different age groups either in boys or girls. Conclusion. According to our findings, in children, Gilbert?s syndrome is manifested only in puberty, and 2.22 times more often in boys than girls. It is most frequently revealed during a routine pediatric examination, as well as when investigating the cause of abdominal pain and fever. A significantly higher level of serum bilirubin in boys as related to girls is registered only after a hypocaloric diet in age group between 16 and 18 years. .
New international classification of functioning, disability and health
Authors: Stucki Gerold , Maksimovic Milos , Davidovic Dragana , Jorga Jagoda
Published: July 2008

The WHO International Classification of Functioning, Disability and Health (ICF) provides a coherent view of health from a biological, individual and social perspective. This view may be defined both as multi- and interdisciplinary management of one?s functioning and health. This new classification is currently being assessed in multiple centers in 32 countries, on 12 health conditions. The Institute of Hygiene and Medical Ecology, School of Medicine, University of Belgrade, is one of them, serving as the centre where the classification is being tested in obese population. The objective of this paper is to provide information needed for further development and practical application of this classification in various health conditions. The new language of ICF is an exciting landmark event for preventive medicine and rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multiprofessional communication and improve communication between patients and health professionals. .
Significance and specificity of vascular anastomosis in liver transplantation: Our experience
Authors: Nenezic Dragoslav , Tasic Nebojsa , Ilijevski Nenad , Radak Djordje
Published: July 2008

Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. Results Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. Conclusion The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation.
Home-based exercise training in chronic obstructive pulmonary disease
Authors: Milenkovic Branislava , Zizic-Borjanovic Slavica , Borjanovic Srdjan , Rebic Predrag
Published: July 2008

Introduction The role of rehabilitation programmes in chronic obstructive pulmonary disease (COPD) patients is to lower dyspnoea, improve exercise tolerance and quality of life. Objective We have developed a short-course, home-based, rehabilitation programme of physical exercise for lower limb muscles, based on walking at patients? fastest pace. The aim of the study was to investigate the effectiveness of such a programme regarding the exercise tolerance, pulmonary functions and quality of life. Method Twenty-nine individuals with stable COPD (22 males, 7 females), with a mean age of 59.6?8.9 years participated in the study. Subjects were assessed before and after the 8-week rehabilitation programme using the six-minute walking test (6MWT), Borg breathlessness score, oxygen saturation, St. George?s Hospital Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Scale (HADS) and spirometry. Results The 6MWT distance improved significantly from 337 to 362 m, representing 8.3% (25 m) improvement over baseline. SGRQ activity, impact and total scores improved significantly after the rehabilitation programme (p<0.01) and quality of life, too. Anxiety and depression scores were significantly lower than the baseline (p<0.01), as well as dyspnoea sensation (p<0.01). Pulmonary function improved after an eight-week exercise programme, too (p<0.01). Conclusion This short-term and simple home-based exercise programme improved health status in COPD. It also improved exercise tolerance, breathlessness sensation and quality of life in COPD patients.
Chromosomal rearrangements as the cause of habitual abortions
Authors: Petrovic Bojana , Ljubic Aleksandar , Micic Miroslava
Published: July 2008

Introduction Habitual abortion is a spontaneous abortion occurring in three or more successive pregnancies with no intervening pregnancies. Chromosomal aberrations account for approximately 50% of fetal losses prior to 15 weeks. Objective The aim of this study was to determine the role of chromosomal rearrangements in etiology of habitual abortions in couples with a normal karyotype. Method We analyzed the karyotype of placental tissue, taken from spontaneously aborted fetuses from couples with normal karyotype and habitual abortions. The women tested were divided into two groups. In the first group, there were 23 women below 35, and in the second, 13 women above 35 years of age. Tissue samples were obtained from the abortions and processed using standard techniques. All specimens were G-banded using trypsin-Giemsa stain. Sixteen metaphase cells were analyzed for their chromosome constitution in each sample. For statistical analysis, we used ?? test. Results From 36 analyzed cases, there were 17 (47.2%) with an abnormal chromosomal constitution and 19 (58.2%) with a normal chromosomal constitution. Trisomy 16 was detected in 4 cases. Among sex chromosomal aberrations, only monosomy X was found in 3 cases. Two cases of triploidy and two cases of trisomy 8, 18 and 21 were detected. Trisomy 12 and trisomy 13 were found in one case each. In group of women under 35 (I group), the percentage of chromosomally abnormal fetuses was 34.8%, while in the group of women above 35 (II group), that percentage was 69.2, but there was no statistically significant difference between groups I and II (??=3.01< ??(1 and 0.05)=3.841). Conclusion Hereditary base defects are a significant cause of spontaneous abortions in early pregnancy. Detection of chromosomal abnormalities provides the opportunity to plan further treatment of reproduction disorders.
Slow release tramadol in the initial treatment of moderate to severe cancer pain: Open, multicentric clinical trial
Authors: Bosnjak Snezana , Bozovic-Spasojevic Ivana , Boskov Nedeljka , Vjetrov Sofija , Sumarac Ljubisa , Parezanovic Aleksandra , Susnjar Snezana , Marinkovic Zorica , Radovic-Tosovic Snezana
Published: July 2008

Introduction The analgesic efficacy of slow release tramadol in the titration phase of treatment of moderate to severe cancer pain has been demonstrated in clinical trials. Objective The aim of the study was to evaluate this treatment strategy in routine daily practice. Method This was a prospective, non-randomized, open, multicentric, phase IV two-week study. Each patient received 100 mg slow release tramadol orally, twice a day. Patients were allowed to take 20 drops (50 mg) of tramadol as needed for breakthrough pain. The pain intensity and tramadol tolerability were recorded every day for the previous 24 hours, in the first week and at the end of the study. Pain relief and the impact of pain on sleep were evaluated on the 8th and 15th day. Results The study included 46 patients with metastatic malignant disease. The total of 46 patients completed the first week of treatment, and 33 patients completed the whole study. At the end of study, the intensity of pain was significantly reduced from 6.75 to 3.03 on numerical scale (NS 0-10) (p<0.001). At the end of study, 60.6% of patients graded the severity of pain as maximally mild on a verbal scale. The pain relief significantly improved from 25.75 to 71.81 on a numerical scale (NS 0-100) (p<0.001). The impact of pain on sleep was significantly reduced from 51.51% to 10.61% on a numerical scale (NS 0-100) (p<0.001). There were no differences in the drowsiness/confusion, nausea, vomiting, dizziness, loss of appetite and constipation, from the beginning to the end of treatment. Conclusion Tramadol slow release was effective in the titration phase of treatment of moderate to severe cancer pain with good tolerability.
Ultrasonography findings of liver in textile workers for diagnosing nonalcoholic fatty liver disease
Authors: Marovic Dragana
Published: July 2008

Introduction Ultrasonography, as a non-invasive method, has the advantage over other imaging methods in the investigation of nonalcoholic fatty liver disease (NAFLD), related to risk factors. Objective The aim of the study was to present the value of ultrasound imaging of fatty liver during a routine checkup of the selected working population. Fatty liver was related to obesity and hyperlipidaemia, excluding alcohol and diabetes mellitus. Method 120 textile workers were examined by ultrasound; blood cholesterol and triglycerides were measured in the meantime. Ultrasonography finding in the liver was normal echogenicity or "bright" hyperechogenicity (fatty liver). Five subgroups of examinees were formed using three risk factors for fatty liver: Body Mass Index (BMI), blood cholesterol and triglycerides. Results Ultrasonographic appearance of the liver was normal in 55% of examinees, while 45% had fatty liver. The highest incidence of fatty liver (70%) was in the first subgroup with the highest risk (elevated BMI, elevated cholesterol and triglycerides). The highest incidence of normal liver (85%) was in the fifth subgroup without risk factors (normal BMI, normal blood cholesterol and triglycerides). Incidence of fatty liver between subgroups was very different with high statistical significance. Conclusion Increased fat accumulation in the liver may be diagnosed with ultrasonography and related to risk factors for nonalcoholic fatty liver disease (NAFLD), such as obesity and hyperlipidaemia.
Echocardiographic evaluation of ventricular septal defect haemodynamics
Authors: Miranovic Vesna
Published: July 2008

Introduction Ventricular septal defect (VSD) is an opening in the interventricular septum. 30-50% of patients with congenital heart disease have VSD. Objective The aim of the study was to determine the dependence of the left ventricular diastolic dimension (LVD), left ventricular systolic dimension (LVS), shortening fraction (SF), left atrium (LA), pulmonary artery truncus (TPA) on the body surface and compare their values among experimental, control and a group of healthy children. Values of maximal systolic gradient pressure (Pvsd) of VSD were compared with children from one experimental and control group. Method Children were divided into three groups: experimental (32 children with VSD that were to go to surgery), control (20 children with VSD who did not require surgery) and 40 healthy children. Measurements of LVD, LVS, SF, LA, TPA were performed in accordance to recommendations of the American Echocardiographic Association. The value of Pvsd was calculated from the maximal flow velocity (V) in VSD using the following formula: Pvsd=4xV? (mm Hg). Results For children from the experimental group, the relationship between the body surface and the variability of the LVD was explained with 56.85%, LVS with 66.15%, SF with 4.9%, TPA with 58.92%. For children from the control group, the relationship between the body surface and the variability of LVD was explained with 88.8%, LVS with 72.5%, SF with 0.42%, PA with 58.92%. For healthy children, the relationship between the body surface and the variabilitiy of the LVD was explained with 88.8%, LVS with 88.78%, SF with 5.25% and PA with 84.75%. There was a significant statistical difference between average values of Pvsd in the experimental and control group (p<0.02). Conclusion The presence of the large VSD has an influence on the enlargement of LVD, LVS, SF, TPA. The enlargement of the size of the pulmonary artery depends on the presence of VSD and there is a direct variation in the magnitude of the shunt. There is a relationship and significant dependence of the LVS and LVD on the body surface. There is no statistically significant dependence between SF and body surface.
Posterior cusp enlargement in mitral valve reconstructive surgery for restrictive valve insufficiency: Case report
Authors: Stojanovic Ivan , Jovovic Ljiljana , Vukovic Milan , Trkulja Ljiljana , Bojovic Zeljko
Published: July 2008

Introduction According to Carpentier classification, group III of mitral insufficiency is caused by the restrictive motion of the mitral valve. A rheumatic process and a coronary disease are the main causes. It is very important to examine the valve precisely, to define deformities and aetiology in order to make such a valve functional. In rheumatic disease, fibrosis and degeneration deform the entire mitral apparatus. A surgical principle is to re-establish mobility and pliability of the apparatus taking care of the functional anatomy at the same time. Cusp enlargement, chordal mobilization and ring remodeling are just some of the numerous surgical techniques that could be performed in these patients. Case outlineA 55-year old female patient was admitted to hospital with severe mitral regurgitaion. She belonged to NYHA, functional stage 2. Echocardiography revealed that both cusps, mostly posterior, were of reduced size and mobility, resulting in grade 3 regurgitation. We performed posterior cusp enlargement by using autologous pericardium treated in 0.6% of glutaraldehyde solution. Annulus remodeling was done using size 27 flexible Duran ring. Control echocardiography found trivial regurgitation. The patient was discharged on 12th postoperative day in sinus rhythm. Conclusion Surgical reconstruction of the rheumatic mitral valve back to the functional state is a demanding procedure, which, however, provides certain benefit for the successfully treated patient.
Ancient Greek in modern language of medicine
Authors: Markovic Vera
Published: July 2008

In order to standardize language of medicine, it is essential to have a good command of ancient Greek and Latin. We cannot deny a huge impact of ancient Greek medicine on medical terminology. Compounds of Greek origin related to terms for organs, illnesses, inflammations, surgical procedures etc. have been listed as examples. They contain Greek prefixes and suffixes transcribed into Latin and they have been analyzed. It may be concluded that the modern language of medicine basically represents the ancient Greek language transcribed into Latin.
Malignant diseases as suicidal motives
Authors: Bogdanovic Ljiljana , Savic Slobodan , Basta-Jovanovic Gordana
Published: July 2008

Introduction Suicide is a conscious and intentional destruction of one?s own life, which occurs as a result of mutual influence of a person?s disposition and motives (facts inspiring the commitment of suicide). It is well known that various diseases, including malignancies, could be important and in some cases the only motive for committing suicide. Objective The purpose of the study was to analyze in detail suicides of persons whose only motive was an established malignant disease. Method The analysis was performed using the autopsy material of the Institute of Forensic Medicine, School of Medicine, University of Belgrade, during the period from 1990 to 2004. The reports on performed medico-legal autopsies were used, as well as history data obtained from the family members of suicidal persons, investigation reports and the available medical documents. Results In 1931 cases there was established suicidal nature of a violent death. Neoplasms were the suicidal motive in 37 persons (1.9%). The basic characteristics of the analyzed sample were predominance of males (26:11, ratio 2.4:1), the age of over 70 years and the highest incidence of malignant lung and breast tumors. Almost all cases were the persons who underwent treatment for malignant neoplasms over a longer period of time. During 19 autopsies (51.3% out of 37), a progressive phase of malignancy was established, i.e. metastases. The data on prior oral announcement of suicide intention were obtained for 70.3% (26 cases), and on previous suicidal attempts only for 13.5% (5) cases. In the majority of cases (78.4%) the place of committed suicide was the person?s home. In 16 cases (43.2%) the suicide was committed with a firearm. Hanging as a manner of destroying one?s own life was chosen by 12 persons (32.4%), while other ways were less frequently used. Conclusion Although malignancies were not present with high incidence as a suicidal motive in our analyzed sample, such cases require particular care of health workers in order to enable the application of adequate measures in the prevention of suicides in persons with malignant diseases. The suicide analyses performed so far indicated that a malignant disease was the motive. Doctors have to show maximal interest for the patient. Prevention is crucial, so the patient should be provided with such surroundings in which the person will not feel alone and abandoned.