bluuebunny/crossref_metadata_2025 huggingface dataset:
Acrokeratosis paraneoplastica Bazex syndrome associated with esophageal squamocellular carcinoma
Authors: Medenica Ljiljana , Gajic-Veljic Mirjana , Skiljevic Dusan , Pesko Predrag
Published: December 2010

Background. Acrokeratosis paraneoplastica Bazex (APB) is a very rare disease in the group of obligate paraneoplastic dermatoses, associated mostly with squamous cell carcinoma of the upper aerodigestive tract and metastatic cervical lymphadenopathy. The disease is characterized by violaceous erythemosquamous changes on the acral regions. This entity was first reported by Bazex in 1965. About 160 cases have been presented so far. Case report. We presented a patient with a three-month history of violaceous erythema, edema, erosions and scaling on the acral regions, elbows and knees and severe nail dystrophy. When the diagnosis was established, he did not have any symptom of internal malignancy. Esophagogastroscopy revealed ulcerovegetant lesion of the esophagus, while histology showed squamocellular invasive carcinoma. Surgical tumor removal resulted in significant improvement of skin changes in 15 days. Unfortunately, four months later, extensive skin lesions pointed to metastasis of squamous cell carcinoma. Conclusion. Skin changes can precede a few years the first manifestations of neoplasia. The course of the disease in our patient proved that APB is a specific marker of underlying malignancy.
Adverse effects of long term, continual administration of high doses of albendazole in the treatment of echinococcal disease
Authors: Jevtic Miodrag , Mikic Dragan , Arsic-Komljenovic Gordana , Stankovic Nebojsa , Ristanovic Elizabeta , Sjenicic Goran , Janicijevic-Hudomal Snezana
Published: December 2010

Background/Aim. Modern treatment of cystic echinococcosis, except for surgical treatment and percutaneous drainage of cyst considers also administration of albendazole as a type of individual therapy. However, clinicians fear of the serious adverse effects of high doses of albendazole, first of all the elevation of serum transaminases activity, very frequently results in subdosing of albendazole and wrong conclusions its efficacy and safety. The aim of this study was to investigate adverse effects of a longterm, continual administration of high doses of albendazole in the treatment of patients with echinococcal disease. Methods. A total of 42 patients (mean age 40.4 ? 18.3 years) with echinococcal disease were included in the study. They were treated with continual administration of high doses of albendazole within the period of 4 to 6 months. The subgroups of 27 and 15 patients were treated with 15-20 mg/kg/day and with 21-25 mg/kg/day albendazole, respectively. The patients in the control group (18 with surgical treatment, 6 with percutaneous drainage of cyst) were treated with 800 mg albendazole per day (< 15 mg/kg body weight) in the cycles of 28 days (1-3 cycles) and a two-week pause between them. Results. In the study group adverse effects of albendazole were registered in 20 (47.6%), whereas in the control group in 6 (30.0%) of the patients. In both subgroups elevated activity of serum transaminases were found more frequently in the study group compared to the control one (35.7% vs 25%, p < 0.05), especially in the patients who were treated with higher doses of albendazole. The patients in the study group, compared to the patients in the control group had significantly higher mean activity of serum alanin aminotransferase in the course of the second and third month of the therapy (p < 0.05). Administration of albendazole due to adverse effects was stopped in 3 (7.1%) of the patients in the study group. Two (4.8%) of them had a very high activity of serum transaminases and one had a muscle pains and high activity of serum creatine kinase. After the interruption of the therapy we documented a normalization of serum enzyme levels in all the patients. Conclusion. Longterm, continual administration of high doses of albendazole in the patients with echinococcal disease results in significant elevation of serum transaminases activity, compared to the patients treated with albendazole in the cycles, but in the majority of the patients serum transaminases activity was normalizated by the end of a 6-month period.
Pediatric health-related quality of life instrument, Part II: General guidelines for translation and cultural adaptation
Authors: Stevanovic Dejan
Published: December 2010

 Prenosenje koncepta kvaliteta zivota iz jednog u drugi kulturoloski okvir slozen je proces i obuhvata vise etapa od pripreme do krajnjeg izvestaja o prevodjenju. Smernice za prevodjenje i adaptaciju upitnika o kvalitetu zivota u pedijatriji, kao i za njihovo koriscenje u unakrsnim kulturoloskim studijama ne postoje. Stoga, potrebno je detaljno istrazivanje ovog koncepta u raznim kulturoloskim okvirima, kako bi bile postavljene prave preporuke. Precizno izvedeno prevodjenje i kulturoloski senzitivna adaptacija predstavljaju proces kojim se verodostojno originalni upitnik prebacuje u drugi kulturoloski okvir, kako bi mogao da sluzi istoj svrsi. Samo pazljivo izvedena verzija originala, koja ce naknadno biti psihometrijski proverena i verifikovana, moze da meri na pravi nacin ono za sta je namenjena.
Preparation and testing of solutions for organ perfusion and preservation in transplantation
Authors: Antunovic Mirjana , Aleksic Dragana
Published: December 2010

Background/Aim. Histidine-tryptophan-ketoglutarate (HTK) solution is the most frequently used solution for the preservation of abdominal organs by leading transplant centers worldwide. The aim of the study was to investigate whether it is possible to prepare this kind of perfusion solution in the hospital pharmacy. In the hospital pharmacy setting we prepared HTK preservation solution and tested its quality, and in accordance with the obtained results recommended its shelf-life. Methods. A multicomponent HTK solution was prepared following standardized aseptic procedures for sterile products. Components of HTK solution were dissolved in water for injection under aseptic conditions and the obtained solution was sterilized by bacteriological membrane filtration (0,22 ?m). The quality of the produced solution was examined using physical and physico-chemical methods and biological tests. Following pharmacopoeial regulations, we examined clarity, pH value, sterility and performed testing on pyrogens. The content of the amino acids histidine and triptophan was determined by using high pressure liquid chromatography (HPLC) method. The concentrations of chloride ions were investigated by retitration method. Atomic absorption spectrometry and ion-exchange chromatography with conductometric detection were used for determining the level of magnesium and calcium ions and the concentrations of sodium and potassium ions in HTK solution, respectively. Results. It was shown that the quality of the prepared HTK solution complied with the regulation demands. Also, pH value of the solution as a function of storage temperature, remained in the physiological range (pH 7.4). Conclusion. According to the obtained results of physico-chemical and biological testing it can be concluded that in the hospital pharmacy setting with the applied technological procedure, we can produce HTK preservation solution of the required quality. Keeping of HTK preservation solution in a refrigerator at 4?C warrants its shelf-life of six months. .
Influence of occupational exposure to low-dose ionizing radiation on the plasma activity of superoxide dismutase and glutathione level
Authors: Djurovic Branka , Spasic-Jokic Vesna , Djurovic Branislav
Published: December 2010

Background/Aim. During exposure to low-level doses (LLD) of ionizing radiation (IR), the most of harmful effects are produced indirectly, through radiolysis of water and formation of reactive oxygen species (ROS). The antioxidant enzymes - superoxide dismutase (SOD): manganese SOD (MnSOD) and copper-zinc SOD (CuZnSOD), as well as glutathione (GSH), are the most important intracellular antioxidants in the metabolism of ROS. Overproduction of ROS challenges antioxidant enzymes. The aim of this study was to examine if previous exposure to low doses of IR induces adaptive response by means of stimulation of intracellular antioxidant defense system. Methods. We investigated a group of medical workers occupationally exposed to IR (n = 44), 29 male and 15 female. The controls (n = 33) consisted of medical workers not exposed to IR, 23 male and 10 female. The examinees from both groups worked in the same environment and matched in crucial characteristics. All measurements were performed by a calibrated thermoluminiscent dosimeter type CaF2:Mn. SOD activity and GSH content were measured spectrophotometrically in the plasma of both groups of medical workers. Half of each blood sample was irradiated by 2Gy of ? radiation, dose-rate 0.45 Gy/min, and the distance from the source of 74 cm. Results. The dosimetry results indicate that occupational doses were very low. Our results confirmed significantly higher SOD activity in the exposed vs. unexposed workers (p < 0.00006). SOD activity after irradiation of blood samples failed to show a significant difference between the exposed workers and the controls (p = 0.905), even the difference in each group before and after the irradiation was significant. In blood samples of the exposed workers expression of enzymes after the irradiation, was not as high as in the controls, or even in the case of the exposed in nuclear medicine personnel, SOD activity was decreased. There were no significant differences in the content of GSH between the groups. Conclusion. Our results pointed out that occupational exposure to low doses of IR compromised mitochondrial function. During occupational exposure, the activity of antioxidant enzymes was increased as a protection against the increased production of ROS. After high-dose irradiation dysfunction of mitochondrial system was noticed, suggesting the break-down of antioxidant defense and failure of an adaptive response. Therefore, the "chronic oxidative stress" might reduce antioxidant defense in the case of accidental exposure to high doses of IR. It could indirectly increase the incidence of some other "free radicals' diseases" in occupationally exposed personnel. .
The influence of lithotripsy methods on the incidence of auxiliary procedures after ureteric stone desintegration
Authors: Radulovic Slobodan , Vuksanovic Aleksandar , Milenkovic-Petronic Dragica , Vavic Bozo
Published: December 2010

Introduction/Aim. Localization of ureteric stones and the difference in disintegration success are the most important but not the only factors in choosing the first treatment approach to ureteric stones. The aim of the study was to investigate the incidence of auxiliary procedures after different ureteric stones lithotripsy modalities. Methods. In a prospective bicentric study 260 patients with ureteric stones were analyzed. The patients were divided into two groups: group I - 120 patients subjected to extracorporeal shock ware lithotripsy (ESWL) treatment and group II - 140 patients treated endoscopicly with ballistic lithotripsy using "Swiss" Lithoclast. Results. Endoscopic treatment of all distal ureteric stones was significantly more successful than ESWL, but not significantly more successful than ESWL regarding proximal ureteric stones except for stones larger than 100 mm2 that were significantly better treated with endoscopic method. There was no general significant difference in auxiliary procedures rate after lithotripsy between the two groups. In the group I auxiliary procedures were significantly more performed than in the group II after the lithotripsy of stones larger than 100 mm2, calcium-oxalat-monohydrate stones and highly significantly more performed after the treatment of stones located in the iliac ureteric portion and impacted stones. After the lithotripsy of lumbar ureteric stones and multiple stones situated in different ureteric portions additional procedures were highly significantly more necessary in the goup II than in the group I. Conclusion. Being significantly more successful comparing to ESWL, ureteric stone treatment with "Swiss" Lithoclast should be considered the first therapeutic option for all, especially impacted stones located in iliac and pelvic ureter. In spite of a statistically significant difference in success rate, ESWL should be performed as the first treatment option in all cases of lumbar stones as well as multiple stones located in different ureteric portion because of lower auxiliary procedures rate except for stones larger than 100 mm2 that should be primarily treated endoscopicly. .
Outcomes of ophtalmologic surgical procedures of esotropia in children and adolescents
Authors: Kljakovic-Avramovic Tamara , Vukosavljevic Miroslav , Avramovic Sinisa
Published: December 2010

Background/Aim. Esotropia is the most common manifestation form of strabism accompanied by refraction deviations and amblyopia. The aim of this prospective study was to present the outcomes of surgical treatment of esotropia in children and adolescents. Methods. Within the period from January 1st 2006 to February 1st 2007 at the Clinic for Ophtalmology, Military Medical Academy, Belgrade a total of 25 patients with esotropia (34 eyes) and previously corrected refraction anomaly and treated amblyopia were operated on. The patients were 4-19-year of age. All of the patients were submitted to a complete ophtalmologic and orthoptic examination prior to the surgery, and a month, three months and six months after the surgery. The surgery was performed under general anesthesia. Out of the total number of the patients nine were operated on both eyes, while 16 patients on one eye with amblyopia or frequent esodeviation. Nine patients were submitted to retroposition of the inner straight muscle, two to myectomy of the outer straight muscle, while in 14 of the patients a combination of retroposition and myectomy was performed. The patients were divided into three groups according to the preoperative angle at the distance and followed-up accordingly after the surgery. Deviation angle at the distance in the group I was 18-25 DP, in the group II 26-35 PD, while in the group III it was 36-60 PD. Results. The most numerous, group I (12 patients; 48%), a month following the surgery showed angle reduction by 55.58%, after three months 63.25%, and after six months 63.92%. The group II consisted of 8 patients (32%) showed angle reduction by 70.75% a month following the surgery, by 76% after three months, and by 79.12% after six months. The group III (5 patients; 20%) showed angle reduction by 72.20% a month following the surgery, 79.20 after three months, and 80.12% after six months following the surgery. Conclusion. The best postoperative outcomes after a month, three and six months were obtained in the group of patients with the highest esodeviation angle at the distance solved by the surgery on both eyes. Timely surgical treatment befell into major precondition for developing and maintaining the elements of binocular vision in the operated on patients. .
Caries risk estimation in children regarding values of saliva buffer system components and carboanhydrase activity
Authors: Surdilovic Dusan , Stojanovic Ivana , Apostolovic Mirjana
Published: December 2010

Background/Aim. One of the preconditions for efficacious systematic reduction of caries prevalence and prophylaxis is the determination of risks of this disease appearance. The aim of this study was to prove the significance of salivary carboanhydrase activity determination in estimation of caries risk in children. Methods. The study included 123 children of average age of 13.4?0.3 years and permanent dentition. The children were divided into two groups according to caries risk (low and high caries risk groups). Two samples of saliva - unstimulated and stimulated one were taken from each child. Salivary carboanhydrase activity, as well as pH value, bicarbonate and phosphate buffer levels were estimated in both group of saliva samples. Results. The investigation showed significantly higher carboanhydrase activity (p < 0.001) in both saliva samples in low caries risk group compared to high caries risk one. In children with low caries risk, both unstimulated and stimulated saliva show significantly higher bicarbonate and phosphate buffer concentrations (p < 0.001), as well as pH values. Conclusion. The lower caries incidence could be expected in children with high carboanhydrase activity and higher salivary buffer system parameters levels. The presented results suggest that salivary carboanhydrase activity represents the important marker of individual susceptibility for caries appearance in children.
Lung involvement in systemic connective tissue diseases
Authors: Plavec Goran , Tomic Ilija , Bihorac Sanela , Kovacevic Gordana , Pavlica Ljiljana , Cvetkovic Gordana , Sikimic Stevan , Milic Rade
Published: December 2010

Background/Aim. Systemic connective tissue diseases (SCTD) are chronic inflammatory autoimmune disorders of unknown cause that can involve different organs and systems. Their course and prognosis are different. All of them can, more or less, involve the respiratory system. The aim of this study was to find out the frequency of respiratory symptoms, lung function disorders, radiography and high-resolution computerized tomography (HRCT) abnormalities, and their correlation with the duration of the disease and the applied treatment. Methods. In 47 non-randomized consecutive patients standard chest radiography, HRCT, and lung function tests were done. Results. Hypoxemia was present in nine of the patients with respiratory symptoms (20%). In all of them chest radiography was normal. In five of these patients lung fibrosis was established using HRCT. Half of all the patients with SCTD had symptoms of lung involvement. Lung function tests disorders of various degrees were found in 40% of the patients. The outcome and the degree of lung function disorders were neither in correlation with the duration of SCTD nor with therapy used (p > 0.05 Spearmans Ro). Conclusion. Pulmonary fibrosis occurs in about 10% of the patients with SCTD, and possibly not due to the applied treatment regimens. Hypoxemia could be a sing of existing pulmonary fibrosis in the absence of disorders on standard chest radiography.
Prognostic significance of acute bundle branch block in patients with acute myocardial infarction
Authors: Mijailovic Vuk , Mrdovic Igor , Ilic Marina , Asanin Milika , Srdic Milena , Rajic Dubravka
Published: December 2010

Background/Aim. Acute bundle branch block (ABBB) presence is associated with the increasing mortality of patients with acute myocardial infarction (AMI). The aim of this study was investigate ABBB influence with respect to in-hospital (IN) and long-term mortality in patients with AIM, as well as total mortality in follow-up, the presence of in-hospital congestive cardiac insufficiency (CCI) and the presence of CCI at follow-up. Methods. This study included 606 consecutive patients with AMI. A total of 415 (68.5%) were males and 191 (31.5%) females, mean age 64.0?11.9. After the dismissal the patients underwent 18-month follow-up period. Results. Acute bundle branch block was registered in 44 patients (7.2%), out of which 15 patients (2.4%) had the left (L) ABBB and 29 patients (4.8%) had the right (R) ABBB. The patients with ABBB showed higher proportion of IH CCI (Killip III and IV) and hypotension compared with the control group (patients without ABBB). In the group of patients with ABBB ?-blockers, statins, aspirin and ACE-inhibitors were less applied. All the three ABBB groups exhibited an increased IH mortality (ABBB 47.7% vs 11.2%, p < 0.01, ARBBB 55.1% vs 11.2% p < 0.01, ALBBB 33.3% vs 11.2%, p < 0.01). Follow-up mortality of the patients with ABBB and ALBBB was higher in comparison with the control group (log-rank p = 0.046 and log-rank p = 0.01, respectively), whereas the group with ARBBB did not show any differences (log-rank, p = 0.59). Conclusion. The patients with ABBB AMI are a risk group of patients that commonly exhibit both early and remote CCI accompanied by high mortality. That is the reason why this sub-group of AMI patients should receive an urgent diagnostics followed by aggressive therapeutic treatment.

 This article has been retracted. Link to the retraction 10.2298/VSP0901074U
Patterns of lipofuscin accumulation in ganglionic nerve cells of superior cervical ganglion in humans
Authors: Zivkovic Vladimir , Stefanovic Natalija , Djurovic-Filipovic Tatjana , Pavlovic Snezana , Stojanovic Vesna , Bakic Mirjana , Kundalic Braca , Pavlovic Miljana
Published: December 2010

Background/Aim. Considering available literature lipofuscin is a classical age pigment of postmitotic cells, and a consistently recognized phenomenon in humans and animals. Lipofuscin accumulation is characteristic for nerve cells that are postmitotic. This research was focused on lipofuscin accumulation in ganglionic cells (GC) (postganglionic sympathetic cell bodies) of superior cervical ganglion in humans during ageing. Methods. We analysed 30 ganglions from cadavers ranging from 20 to over 80 years of age. As material the tissue samples were used from the middle portion of the ganglion, which was separated from the surrounding tissue by the method of macrodissection. The tissue samples were routinely fixed in 10% neutral formalin and embedded in paraffin for classical histological analysis, then three consecutive (successive) sections 5 ?m thick were made and stained with hematoxylin and eosin method (HE), silver impregnation technique by Masson Fontana and trichrome stain by Florantin. Results. Immersion microscopy was used to analyse patterns of lipofuscin accumulation during ageing making possible to distinguish diffuse type (lipofuscin granules were irregularly distributed and non-confluent), unipolar type (lipofuscin granules were grouped at the end of the cell), bipolar type (lipofuscin granules were concentrated at the two opposite ends of a cell with the nucleus in between at the center of a cell), annular type (lipofuscin granules were in the shape of a complete or incomplete ring around the nucleus) and a cell completely filled with lipofuscin (two subtypes distinguishing, one with visible a nucleus, and the other with invisible one). Even at the age of 20 there were cells with lipofuscin granules accumulated in diffuse way, but in smaller numbers; the GC without lipofuscin were dominant. Growing older, especially above 60 years, all of the above mentioned patterns of lipofuscin accumulation were present with the evident increase in cells completely filled with lipofuscin, but cells without lipofuscin were also present even in the oldest persons. Conclusion. Lipofuscin is present in all periods of ageing with a different intensity of accumulation. GC without the pigment, diffusely distributed, as well as very rare cells with a unipolar type of lipofuscin distribution are characteristic for the age of 20- 60 years. In the age above 60 years, except the cells without pigment and diffuse accumulation type, there are also bipolar and annular types and forms in which cells are completely filled with lipofuscin granules.
Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction
Authors: Knezevic Bozidarka , Nikolic Goran , Dragnic Sinisa , Music Ljilja , Boskovic Aneta
Published: December 2010

Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS) are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI) centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.
Histopathological characteristics and coexpression of p53 and p16INK4a proteins in renal cancer
Authors: Zivkovic Sladjana , Kostov Milos , Pavlovic Svetlana , Mijovic Zaklina
Published: December 2010

Background/Aim. Renal carcinoma represents histologically heterogeneous group of malignant tumors, with various clinical aggressiveness. The frequency of p53 mutation in primal renal carcinoma is rare, although there are information about its heterogeneous accumulation. The loss of protein p16 expression in primal renal carcinoma is detected in 20-30% of the cases. The aim of this paper was to determine frequency of mutated protein p53 and expression of protein p16INK4a in renal carcinoma, to analyze their correlative relation and relation with the examined clinicopathological parameters. Methods. The examination included 12 patients (66.7% men, 33.3% women), with patohistologically verified renal carcinoma. Expression of mutated form of protein p53 and protein p16 was determined in tissue samples, by immunohistochemical analysis using of mice monoclonical antibodies produced by DAKO, Denmark. Results. In 9 (75%) of the cases was detected mutated protein p53, of whom 66.6% had higher histological gradus of tumor (G3-4) and higher pathological stadium of the disease (pT3a-b) at the same time. In 7 (58.3%) and 5 (41.7%) of the cases expression of protein p16, the loss of expression of protein p16 were detected respectively. A statistically significant positive correlation was determined between pathological stadium of disease (TNM) and the degree of tumor differentiation (G) (? = 0.834; p < 0.001), as well as between TNM and mitotic index (? = 0.622; p = 0.031). Conclusion. A mutated form of protein p53 exists in 75% of the cases with the renal carcinoma and 66.6% of then have higher histological gradus of tumor and higher stadium of tumor disease at the same time. Coexpression of mutated protein p53 and protein p16INK4a in renal carcinoma is not statistically significant and it is not in correlation with clinicopathological parameters. Immunohistochemical analysis of mutated protein p53 in renal carcinoma can have predictive significance.
Serous microcystic adenoma of the head of the pancreas causing an obstructive jaundice
Authors: Colovic Radoje , Grubor Nikica , Micev Marjan , Rankovic Vitomir , Matic Slavko , Latincic Stojan
Published: December 2010

Background. Serous microcystic adenoma is a rare benign tumor of the exocrine pancreas originating from the ductal system and composed of a large number of small cysts covered by cuboid cells, filled with clear serous fluid and separated with fibrocolagenous stroma. Most frequently it appears in women in 7th and 8th decades, in the distal pancreas. It shows a very low malignant potential. In 2/3 of patients symptoms are uncharacteristic and in 1/3 they are absent. When localized within the head of the pancreas it rarely causes an obstructive jaundice. Case report. We presented a 61-year-old female patient who for months had had mild and nonspecific abdominal symptoms developing to progressive obstructive jaundice. At surgery we revealed a rather large policystic mass of the head of the pancreas causing not only obstructive jaundice but also a venous stasis by compression and dislocation of the portomesenteric vein. The tumor was removed with pylorus preserving cephalic duodenopancreatectomy (Whipple's procedure modified by Longmire-Traverso). Histology confirmed serous microcystic adenoma of the pancreas. The postoperative recovery was uneventful and preoperative symptoms disappeared. Conclusion. Although very rare, serous microcystic adenoma might appear within the head of the pancreas and has to be taken into consideration in differential diagnosis of cystic lesions of the head of the pancreas. Very rarely the tumour might cause obstructive jaundice. Surgical resection, which might be demanding, leads to complete recovery.
Giant paraovarian cyst in a child complicated with torsion
Authors: Kostov Milos , Mijovic Zaklina , Mihailovic Dragan
Published: December 2010

Background. A variety of benign cyst may occur in and around the ovary and broad ligament and may simulate serous cystadenomas. The majority of broad ligament and paraovarian epithelial tumors are serous neoplasms of low malignant potential and presented with a pelvic mass with or without ascites or pain, but without involvement of the ovary. Ovarian torsion and paraovarian serous cystadenoma are rarely reported. Case report. We presented a case of giant paraovarian cyst in an 14-year-old girl, with characteristics of serous cystadenomas grossly and microscopically, and complicated with double adnexal torsion. A computed tomography scan showed large hypodense cystic mass (measuring 30 ? 26 ? 12 cm), occupying the whole abdominal cavity, with no adhesion to the surrounding organs. Conclusion. Precise clinical data as well as pathological examinations based on immunohistochemical stainings were important in making the diagnosis. These rare cystic lesions of para/mesoovarian location in children and their unclear histogenesis might be a histopathological diagnostical problem.
Nonoclusive thrombosis of mechanical mitral valve prosthesis caused by inadequate treatment of anticoagulant therapy resistance
Authors: Ivanovic Branislava , Vujisic-Tesic Bosiljka , Simic Dragan , Cvetkovic-Matic Danica
Published: December 2010

Background. Oral anticoagulants have been used in the prevention of thromboembolic complications for over six decades. A rare, but possible problem in the application of these medications could be resistance to them. Case report. We presented a patient with nonocclusive thrombosis of the mechanical mitral prosthesis due to inadequately treated resistance to peroral anticoagulant therapy. Resistance to oral anticoagulant medications was proven by an increased dosage of warfarin up to 20 mg and, after that, acenokumarol to 15 mg over ten days which did not lead to an increase in the international normalized ratio (INR) value over 1.2. On the basis of information that she did not take food rich in vitamin K or medications which could reduce effects of oral anticoagulants, and that she did not have additional illnesses and conditions that could cause an inadequate response to anticoagulant therapy, it was circumstantially concluded that this was a hereditary form of resistance. Because of the existing mechanical prosthetics on the mitral position, low molecular heparin has been introduced into the therapy. The patient reduced it on her own initiative, leading to nonocclusive valvular thrombosis. Conclusion. When associated complications like absolute arrhithmia does not exist, the finding of resistance to oral anticoagulant agents is an indication for the replacement of a mechanical prosthetic with a biological one which has been done in this patients.
An outbreak of trichinellosis in a military unit
Authors: Radosavljevic Vladan , Cekanac Radovan , Mercep Milan , Jakovljevic Branko
Published: December 2010

Background/Aim. In December 2001, an outbreak of trichinellosis spreaded in a military unit. The aim of this paper was to show possibilities and consequences of trichinellosis infestations in military units during peace time, as well as to improve knowledge and awareness of medical corps personnel, commanders and soldiers about this disease. Methods. A descriptive and analytical epidemiological models were used to find out a source of outbreak and to identify the ways of its transmission. Results. This outbreak was caused by the contaminated raw smoked sausage which had not undergone health inspection and brought from civilians to a military unit. Thirty-eight persons were exposed, twenty-one affected and hospitalized. The most frequent symptoms reported were fever (76.2%), myalgia (76.2%), palpebral edema (42.8%), face edema (19.0%) and diarrhea (14.3%). Test for indirect immunofluorescence was positive in 14.3% and ELISA test was positive in 28.6% of the patients. Eosinophilia was present in 85.7% of the affected. IgE values were increased in 28.6% and CPK values were increased in 61.9% of the diseased. All of the 17 exposed undiseased had negative laboratory analyses for trichinellosis. Conclusion. We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs. A well-tuned, fast-reacting epidemiological monitoring system has to be obligatory.
Endovascular treatment of carotid-cavernous fistula type A with platinium coils
Authors: Culafic Slobodan , Juszkat Robert , Rusovic Sinisa , Stefanovic Dara , Minic Ljubodrag , Spaic Milan
Published: December 2010

Background. Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. Case report. This paper presents a 44-year old male patient with carotidcavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. Conclusion. Embolization of complex carotidcavernous fistula type A was successfully performed with platinum coils by endovascular approach.
Atipical immunophenotype in a littoral cell angioma
Authors: Colovic Radoje , Suvajdzic Nada , Grubor Nikica , Colovic Natasa , Terzic Tatjana
Published: December 2010

Background. Littoral-cell angioma (LCA) is a recently described benign vascular tumor of the spleen, whose imaging and pathologic characteristics have been discussed only by a few authors. The tumor is characterized by a mixture of papillary and cystic areas lined by neoplastic cells deriving from normal splenic lining - littoral cells. The neoplastic LCA cells express both endothelial and histiocytic antigens associated with CD8 negativity, compared with the normal endothelium of the venous sinuses of the spleen red pulp that only expresses endothelial antigens and CD8 positivity. Therefore, the typical and characteristic immunohistochemical pattern of the LCA is as follows: CD31, CD68, CD163, CD21, FVIII antigen positive; CD34, CD8 negative. Case report. We reported a 60-year-old male with moderate nodular splenomegaly with one large hypoechogenic solid lesion and mild thrombocytopenia in whom the diagnosis of LCA was made after the elective splenectomy. Namely, histopathological and immunohistochemical data allowed a final diagnosis of classical LCA in spite of CD21 negativity. As far as we know this is the first reported CD21-negative LCA patient. Histological specimens were presented and differential diagnoses discussed. Conclusion. Littoral-cell angioma is a very rare benign splenic neoplasm that should be considered in the differential diagnosis of multinodular splenomegaly, particularly if the patient has the signs of hypersplenism.
Mesoatrial shunt in Budd-Chiari syndrome
Authors: Mirkovic Darko , Stankovic Nebojsa , Jevtic Miodrag , Mitrovic Miroslav , Jovanovic Milan
Published: December 2010

Background. Budd-Chiari syndrome (BCS) represents partial or total occlusion of the hepatic veins with or without simultaneous obstruction of vena cava inferior (VCI). The symptoms of BCS are abdominal pain, hepatomegaly, ascites, varices of the abdominal wall, sometimes bleeding from the upper part of gastointestinal tract (GIT), lower limbs swelling and jaundice. Primary BSC is a relatively rare condition occurring in one per 100 000 of the population worldwide. Case report. A male patient, 25-year-old, facing tooth postextraction complications, was presented with acute BCS. On admission, physical examination revealed pale-grayish complexion, more pronounced veins over the thorax and abdomen, ascites, enlarged liver rising 8 cm below the right costal arch and having a minor pleural effusion by the right side. The patient was submitted to Doppler sonography and computed tomography (CT) that verified the right leg deep veins thrombosis, as well as the presence of a thrombus in the intrahepatic portion of the VCI. Multislice computed tomography (MSCT) showed occlusion of hepatic veins (Budd-Chiari syndrome) and thrombosis of the VCI in the retrohepatic part 6 cm long. Also, increased values of transaminases and gamma GT and reduced values of albumines and serum ferrum were registered. Molecular examination revealed Factor V Leiden mutation - heterozygote. After preoperative preparations a mesocaval shunt was made using Gore- Tex ring graft of 12 mm. Intraoperatively, the blue enlarged liver was found with almost black zones of tense capsule. After a graft making, liver congestion decreased followed by the change of colour and volume. Within postoperative course metabolic and synthetic liver functions were obvious. Conclusion. In patients with BCS medicamentous treatment does not yield adequate results, but even causes worsening of general condition. Surgical therapy in the presented patient was performed timely regarding the stage of the disease due to which irreversible liver changes were prevented while decompression of the portal system provided time overbridging up to liver transplantation.
Quantitative analysis of lamellar bodies in amniotic fluid as fetal pulmonary maturity indicator
Authors: Ljubic Vesna , Radunovic Nebojsa , Stefanovic Aleksandar , Opalic Jasna
Published: December 2010

Background/Aim. Although lamellar bodies have been the center of interest over the last years, the published results of fetal pulmonary maturity determination according to their concentration in amniotic fluid are controversial. The aim of this study was to determine the significance of lamellar bodies, as well as the ratio lecithin/sphingomyelin (L/S) in amniotic fluid for the assessment of fetal pulmonary maturity. Methods. This prospective 2-year study included 102 female examinees, ranging from 17 to 44 years of age, in whom lamellar bodies concentrations in amniotic fluid were determined to check the efficacy of the applied therapy for obtaining arteficial fetal pulmonary maturity. The shake test was applied as a comparative test for determining a quantitative L/S ratio. To determine a fetus maturity and development stage we followed up biparietal diameter, abdominal circumference, femure length, ponderal index at birth and body mass. Results. Out of a total of 102 amniocenteses within a period from 26th to 40th gestation week only 70 results were considered due to 32 unknown neonatal outcomes. Biparietal diameter was 224-362 mm, femur length 56 - 78 mm, ponderal index 1.22-2.84, fetus body mass 1300- 4 350 g. There was found a significant relation between gestation age and lamellar bodies concentration (R = 0.396398, p < 0.01), as well as between gestation age and the ratio L/S (R = 0.691297, p < 0.01). Also, there was a significant correlation of lamellar bodies concentration to the ratio L/S determined (R = 0.493609, p < 0.01). Conclusion. Determination of lamellar bodies concentration values is a reliable method to confirm fetal pulmonary maturity.
Implication of late diagnosis for survival of patients with colorectal carcinoma
Authors: Zdravkovic Darko , Bilanovic Dragoljub , Randjelovic Tomislav , Zdravkovic Marija , Toskovic Borislav
Published: December 2010

Background/Aim. Colorectal cancer (CRC) is one of the most frequent diseases and early diagnosis has a potential role to improve survival. The aim of this study was to analyze influence of delay in diagnosis on survival in patients with colorectal cancer. Methods. A total of 119 patients with pathohystological diagnosis of CRC were included in the study. They were operated at our Department for Surgery from 2000 to 2002. They were divided into two groups according to the duration of symptoms: early operated patients - EOP (symptoms were presented for 3 months) and late operated patients - LOP (duration of symptoms was more than 3 months). Follow-up period was 5 year. Results. Weight loss, intermittent abdominal pain and anorexia were more frequent in LOP (p < 0.01). Young age, blood in stool, and tumor localized in rectum were dominant characteristics in EOP (p < 0.05). Overall delay in diagnosis was 2.19 ? 0.79 months in EOP and 11.37 ? 5.68 months in LOP. There was highly statistically significant difference between these two groups (p < 0.01). Overall survival was 44.75%. Five years survival was 65.9% in the group of EOP and 26.5% in the group of LOP (?2 = 28.16, p < 0.01) Weight loss was dominant characteristics in the patients who did not survive five years (?2 = 14.26, p < 0.01). A period of 2 months in delay in diagnosis is 'cut-off' value in prediction of death (sensitivity of 75.5% and specificity of 90.3%). Conclusion. A delay in diagnosis and stage of the disease are highly significant factors of patients with CRC survival. In everyday medical practice higher importance should be put on weight loss, intermittent abdominal pain, change in bowel habits, as well as on syderopenic anaemia.
Pharmacodynamic and pharmacokinetic effects of flumazenil and theophylline application in rats acutely intoxicated by diazepam
Authors: Segrt Zoran , Djordjevic Snezana , Jacevic Vesna , Kilibarda Vesna , Vucinic Slavica , Jovic-Stosic Jasmina , Potrebic Olivera , Vukcevic-Perkovic Natasa
Published: December 2010

Background/Aim. The majority of symptoms and signs of acute diazepam poisoning are the consequence of its sedative effect on the CNS affecting selectively polisynaptic routes by stimulating inhibitory action of GABA. The aim of the present study was to examine the effects of combined application of theophylline and flumazenil on sedation and impaired motor function activity in acute diazepam poisoning in rats. Methods. Male Wistar rats were divided in four main groups and treated as follows: group I - with increasing doses of diazepam in order to produce the highest level of sedation and motor activity impairment; group II - diazepam + different doses of flumazenil; group III - diazepam + different doses of theophylline; group IV - diazepam + combined application of theophylline and flumazenil. Concentrations of diazepam and its metabolites were measured with LC-MS. The experiment was performed on a commercial apparatus for spontaneous motor-activity registration (LKBFarad, Sweden). Assessment of diazepam- induced neurotoxic effects and effects after theophylline and flumazenil application was performed with rotarod test on a commercial apparatus (Automatic treadmill for rats, Ugo Basile, Italy). Results. Diazepam in doses of 10 mg/kg and 15 mg/kg produced long-time and reproducible pharmacodynamic effects. Single application of flumazenil or theophylline antagonized effects of diazepam, but not completely. Combined application of flumazenile and theophylline resulted in best effects on diazepaminduced impairment of motoric activity and sedation. As a result of theopylline application there was better elimination of diazepam and its metabolites. Conclusion. Combined application of flumazenil and theophylline resulted in the best antidotal effects in the treatment of diazepam poisoned rats. These effects are a result of different mechanisms of their action, longer half-life of theophylline in relation to that of flumezenil and presumably the diuretic effect of theophylline.
Influence of dietary glycemic index and glycemic load on the occurrence of ischemic heart disease
Authors: Nikolic Maja , Nikic Dragana , Petrovic Branislav , Rancic Natasa , Arandjelovic Mirjana
Published: December 2010

Background/Aim. There are no recommendations for the dietary intake of carbohydrates compared with the dietary intake of lipids in patients with ischemic heart disease (IHD). The aim of the study was to assess the influence of high dietary glycemic load (GL) on the occurrence of IHD. Methods. The case-control study was carried out between 2003 and 2004. The study group consisted of 290 patients with IHD hospitalized in the Clinical Center in the town of Nis. There were 290 controls admitted to the same medical institution as cases for a wide spectrum of acute conditions unrelated to known or potential risk factors for IHD. The data about risk factors for IHD were collected by the epidemiological questionnaire. The data about nutrition were collected by administered food frequency questionnaire. A total GL for each patient was calculated by the international tables and the standard for the glycemic index (GI) was used. Standard anthropometric measurements were applied. A total level of lipids and cholesterol was determined, too. Multivariate odds ratios (OR) and 95% confidence intervals were obtained by multiple logistic regression models. Statistical analysis was performed with Epi Info Programme (Version 6.04) and with the SPSS for Windows (Release 8.0). Results. The patients with IHD had statistically significantly different intake of carbohydrate compared with the patients of the control group but the risk of IHD occurrence was not associated with the total intake of carbohydrate. The total average GL in the patients of the study group was statistically significantly higher compared with the patients of the control group (p < 0.05) and a high GL was independent risk factor for IHD (OR = 1.99). Conclusions. In prevention of IHD it is recommended to intake food with lower GI, for example vegetables and fruit.