bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconstructive surgery of idiopathic hypertrophic cardiomyopathy, systolic anterior motion and severe mitral regurgitation
Authors: Stojanovic Ivan , Vukovic Milan , Neskovic Vojislava , Babic Milan , Zlatanovic Miroljub , Bojovic Zeljko
Published: July 2008

Hypertrophie obstructive cardiomyopathy (HOCM) is an idiopathic disease frequently associated with systolic anterior motion (SAM). The anterior leaflet of mitral valve is sucked by Ventury effect into the left ventricle outflow tract making subaortic stenosis more severe and producing mitral insufficiency at the same time. Septal myectomy along with mitral valve replacement has been the treatment of choice for a long time. An understanding of pathoanatomy and hemodynamics of the disease has opened possibility for total reconstructive treatment of both subaortic stenosis and mitral insufficiency in such patients. This is a case report of 50-year-old male with severe subaortic stenosis (136/70 mmHg) due to HOCM and SAM along with grade IV mitral insufficiency. Septal myectomy was performed. Mitral insufficiency was managed by reducing the height of posterior cusp along with remodeling of mitral annulus by Carpentier-Classic ring. In that way, subaortic obstruction was reduced to 30.9/10 mmHg while mitral insufficiency was lowered to negligible level. The patient was discharged from hospital with sinus rhythm eight days after the surgery.
Leiomyoma in pregnancy: Echosonographic mimicry
Authors: Nikolic Rajko , Puzigaca Zarko , Mladenovic Aleksandra
Published: July 2008

Leiomyoma is the most common tumor viewed by echosonography of the uterus. This report presents pregnancy with calcified leiomyoma of the uterus which simulated the head of the fetus, what was verified by echosonography. Woman, nullipara, 41 years old, in week 21 of pregnancy, was referred for echosonographic evaluation. Biochemical screening for Down syndrome, performed in week 17 of pregnancy, was positive. Fetal karyotype, obtained by amniocentesis, was normal (46 XX). In the case presented herein, diameter of leiomyoma was 48 mm, being equal to the diameter of the fetal head in 21st week of pregnancy. Due to calcifications on the surface of leiomyoma which were viewed on echosonography in the form of hyperechogenic border, this tumor looked like a head of the fetus. This echosonographic finding of two fetal heads in a single pregnancy was remarkable even for a gynecologist experienced in echosonographic examination.
Magnetic resonance imaging of the breasts: Clinical practice and further development
Authors: Milosevic Zorica , Spasic Nenad
Published: July 2008

Magnetic resonance imaging (MRI) of the breasts was introduced in clinical practice over 10 years ago. The method is based on visualization of morphology of the lesion and pathophysiology of their vascularization. It is useful complementary method to mammography and breasts ultrasound, with potential to detect clinically or mammography occult lesions. Compared to the conventional visualization methods, MRI of the breasts is more sensitive, although specificity of the method is lower than sensitivity. The indications for MRI of the breasts are: differentiation between recurrent malignant disease and postoperative or post irradiation changes, local cancer staging in preoperative planning, breasts implants, axillary metastases with occult primary tumor and cases with inconclusive conventional imaging. The limitations of MRI of the al Bezanijska kosa, Belgrade breasts are: low sensitivity for in situ carcinomas, false negative results for 10% carcinomas and hormone-induced false positive results. The further development of the method includes: breasts cancer screening in the patients with high risk, monitoring of the effects of neo-adjuvant chemotherapy, MR-guided biopsy and new contrast agents.
Correction for near vision in pseudophakic patients
Authors: Dujic Mirjana , Misailovic Katarina , Kovacevic Milena , Babic Dragana
Published: July 2008

Objective of the study was to show the mean values of correction for near vision and to discuss the presbyopic correction in pseudophakic patients. Setting was the Eye department where authors work. Inclusion criteria for 55 patients were native or corrected distant vision of 0.8-1.0 on Snellen's chart; 0,6 on Jagger's chart for near vision; round pupil and good position of the implant. Biometry of the anterior chamber depth with Alcon biophysics during distant and near vision was performed in our study. ?Hi square" test was carried out and it was concluded that patients younger than 59 years (41 eyes) had median correction of +2.0 dsph, while patients older than 60 years (36 eyes) had correction of+3.0 dsph, but it was not statistically significant. There was no statistically significant difference of the correction between pseudophakic (41) and phakic (19) eyes in patients younger than 59 years. The anterior movement of the IOL was 0.18 mm in the younger group and 0.15 mm in the older group. With good IOL movement and new materials which could have changeable refractive power, the problem of pseudophakic correction for near vision might be solved.
Open wedge osteotomy and callus distraction by means of the external fixator in distal femur and proximal tibia in knee arthrosis with valgus and varus deformity
Authors: Milenkovic Sasa , Mitkovic Milorad , Radenkovic Mile , Stanojkovic Miodrag , Micic Ivan , Karalejic Sasa
Published: July 2008

Various methods can be applied for treatment of knee deformity. One of them is open wedge osteotomy and callus distraction by means of the external fixator. This paper presents the results of treatment of 16 patients with knee arthrosis associated with varus and valgus deformities (10 varus and 6 valgus deformities). Open wedge osteotomy of the varus deformity was performed in the proximal tibia, and in case of the valgus deformity in the distal part of the femur. The patients who were operated on had a knee varus larger than 10 degrees and a knee valgus larger than 12 degrees. Prior to open wedge osteotomy and application of the external fixator, knee arthroscopy was performed (meniscectomy, cartilage drilling and shaving, debridement, the extraction of loose bodies). After one-year follow-up, the final outcome of the treatment was positive in all patients. The treatment alleviated the pain in these patients. The method is minimally invasive and relatively easily applied. Mitkovic's external fixator type M20-CD-V allows for continuous callus distraction with simultaneous correction of the varus or valgus knee deformity.
Floating spleen with chronic torsion of the pedicle causing splenomegaly and secondary hypersplenism
Authors: Colovic Radoje , Boskovic Darinka , Grubor Nikica , Colovic Natasa
Published: July 2008

If the spleen is not fixed within the left subphrenic space, it gradually passes into the lower abdomen, where is much more exposed to trauma. Torsion of the splenic pedicle can also occur, causing the infarct necessitating an immediate surgery. Venous stasis causes splenomegaly and sometimes secondary hypersplenism. The authors present 16.5-year old girl with torsion of the splenic pedicle of floating spleen for 720?: in spite of that, the patient had neither splenic infarct nor splenic vein thrombosis, possibly due to thrombocytopenia, but she had splenomegaly and secondary hypersplenism with pancytopenia causing bleeding, sideropenic anemia and mild jaundice. After treatment with iron, the patient underwent splenectomy which resulted in almost immediate rise of the number of all blood cells, and even thrombocytosis. The authors suggest early surgical treatment of the floating spleen, preferably splenopexy, before development of severe complications when splenectomy had to be performed in the majority of patients. Accessory spleens, if present, should be saved.
Ovarian cancer after in vitro fertilization
Authors: Milenkovic Vera , Sparic Radmila , Dokic Milan , Petkovic Spasoje , Atanackovic Jasmina
Published: July 2008

There is serious concern about cancer risk in women undergoing ovarian stimulation treatment for infertility and long-term safety of these procedures. Association between fertility drugs and ovarian cancer is still controversial. A 30-year-old woman was referred to our institution with the initial diagnosis of an adnexal tumor after in vitro fertilization. Her history revealed adnexectomy for mucinous cystadenofibroma of the left ovary eight years ago, and cystectomy due to cystadenoma of the right ovary three years ago. At admission, the most remarkable findings were high temperature and elevated white blood cell count and erythrocyte sedimentation rate. Broad spectrum antibiotic treatment was initiated. Six days after admission, the patient was feverish, with temperature up to 38?C, and evident signs of the acute abdomen. Immediate laparotomy was performed and multilocular right adnexal tumor 150x130x100 millimeters in size was identified. The right salpingo-oophorectomy was carried out. Pathological diagnosis was mucinous ovarian adenocarcinoma. Eighteen days later, radical surgery was performed. After the surgery, chemotherapy was applied. There is an urgent need for clear interpretation of the association between fertility drugs and subsequent higher ovarian cancer risk. Lacking conclusive evidence, an increased risk of ovarian cancer has been reported and more recently disputed. Higher ovarian cancer risk may be serious and even life-threatening complication for women undergoing ovarian stimulation.
Current diagnosis and treatment of the osteoarticular tuberculosis
Authors: Lesic Aleksandar , Bumbasirevic Marko , Savic Branislava , Cobeljic Goran , Pesut Dragica
Published: July 2008

In 1993, tuberculosis was recognized as global medical problem by WHO. Recurring flare-up of this disease was triggered by difficult socioeconomic situation of the countries in transition, current development of immunocompromising diseases, and some other factors have contributed, too. The osteoarticular tuberculosis has been always postprimary and localized form of the disease, which, due to certain similarity to some other osteoarticular diseases, has been challenge for orthopaedic surgeons both from diagnostic and treatment aspects. Bacteriological diagnostics has had a limited value due to application of recommended tuberculostatic medication before obtaining specimens from bones or joints; and, on the other hand, rapid bacteriological methods, because of their expensive equipment, could be carried out in large mycobacteriology laboratories only. New visualizing methods, CT and MRI, have been particularly important for detection and monitoring of tuberculosis process in the spine during the early stage of the disease, what is impossible to achieve with native radiograms. Programmed administration of tubercuiostatic drugs both in non-operative and surgical treatment has been proven necessary.
Can outstanding research be done under less than ideal conditions?
Authors: Igic Rajko
Published: July 2008

Great scientific discoveries rarely originate from small and poor countries. However, the lives and achievements of three Yugoslav scientists who were active in the biomedical sciences, Laza K. Lazarevic (1851-1891), Ivan Djaja (1884-1957), and Pavao Stern (1913-1976), serve as an example of success in this environment. These scientists, as well as the majority of other successful investigators in small and poor countries, were trained in foreign and developed countries and, upon return, were given the freedom to start a self dependent research program. They overcame many obstacles, including wars and civil unrests, to contribute significantly to certain medical fields. It is interesting that although a Jew, Stern was allowed to work during the World War II in Zagreb, which became capital of the so-called Independent State of Croatia, a puppet state under German control. Perhaps his good name among pharmacologists helped him to keep position during this tough period. Nowadays, new technologies requiring for biomedical research are rather expensive, and poor countries cannot afford to finance many scientists. Thus, selection of the most productive researchers is the challenge for those who finance scientific work.
St. Luke and his cult as holy healer of the Serbs
Authors: Mitrovic Zorica , Markovic Ljiljana , Nenadovic Maja
Published: July 2008

Most school doctors, who lived in the period of Early Christianity from 1st to 4th century A.D. and who were canonized saints, have been known, up to these days, among people and in scientific and medical circles as Holy Healers. It is understood that only exclusively educated medical experts, trained to heal professionally and prepare medicines are considered Holy Healers. Out of all Holy Healers, St. Kosma and Damian, St. Panteleimon, St. Luke, etc., are highly respected by our people. St. Luke (1st century A.D.) is specially honored by Serbian nation. His relics were taken to Smederevo in 1453 and then the town became ?the place of many cures and new healing spot". Out of these relics, only the foot of St. Luke was preserved in a very good condition and it remained in the possession of the Serbian Orthodox Church. In old documents written in old Greek and clerical-slavic language, St. Luke is glorified as ?reliable doctor both for soul and body..." St. Luke is respected as a protector of medicine and pharmacy, doctors and pharmacists, and patients, as well as many families (family patron of the Serbs), even of the whole regions. Many chemist's shops and hospitals are named by this Saint, what is the confirmation that his cult and recognition of his personality and his work are still present in our milieu.

 This article has been retracted. Link to the retraction 10.2298/SARH1010674U
Graphospasm - clinical presentation, etiology and the course of disease: Analysis of 30 cases
Authors: Kacar Aleksandra , Svetel Marina , Jovic Jasmina , Pekmezovic Tatjana , Kostic Vladimir
Published: July 2008

INTRODUCTION Dystonia, as prolonged, involuntary muscle contraction, causes torsion, repetitive movements and abnormal body position. In so far only a part of body is affected by dystonic movement, it is the question of focal dystonia, which is called writer's cramp if the arm is involved. OBJECTIVE The objective of the study was to present the specific clinical features of patients with task-specific dystonia, who were diagnosed, treated and followed up at the Institute of Neurology, Clinical Center of Serbia, Belgrade. MATERIAL AND METHODS In the period 1995-2003, 30 patients with task-specific dystonia were treated at the Institute of Neurology, CCS, who met the adopted criteria for diagnosis. The severity of the diseases was tested by estimating the ability of patient to write the test sentence per time unit, as well as by means of scale for measuring different disabilities, ranging from 0-16 (Marsden-Fahn). Depression, anxiety and obsessiveness were tested by Beck's scale, Hamilton's depression and anxiety scale and Mousdly's obsessiveness scale. Thorough questionnaire focused on clinical details was also used. Besides descriptive statistics, data processing included analysis of variance and Kruskal-Wallis's test. RESULTS Thirty patients with diagnosis of task-specific dystonia were analyzed. At the onset of the disease, mean-age was 34.1 years (SD=11.4; 13-58), while the duration of disease at the moment of the examination was 10.3 years (SD=10.6; 1-39). There were 20 males and 10 females (sex ratio 2:1). None of the patients reported any history of trauma of subsequently affected region before the development of discomforts. Twelve patients used their hands for a long time during their professions (writing, playing the instrument, type-writing, etc.). Eight patients were typists (26.6%), four were musicians (13.3%), while the rest of cases (18) had some other occupations that did not necessarily imply long-term use of hands (office worker, engineer, physician, mechanical technician, etc.). Twelve patients had simple task-specific dystonia (type I) (40%), ten cases manifested progressive diseases (type II) (33.3%), while the others suffered from dystonia that was present at rest (type III). Two patients had positive family history. DYT 1 mutation was verified in one of them. Depression, anxiety and obsessiveness were not verified in our patients. Type of writer's cramp was not in correlation with any of the tested parameters except with the age at the onset of the disease, severity of disease according to Marsden's scale and degree of disability.
Cochlear implant application with postlingually deaf patients
Authors: Kosanovic Rade , Ivankovic Zoran , Stojanovic Sandra
Published: July 2008

Through last several decades, cochlear implant has been fully recognized for treatment of profound hearing loss. Modern technology development enabled unimagined possibilities in technical qualities of the device, as well as development of usable coding strategies, which led to extraordinary results of patient rehabilitation. It is well known that postlingually deaf implanted patients show better results than prelingually deaf implanted patients. This is to be understood, concerning the fact of matured hearing paths and centers of CNS, presence of developed speech in patients postlingually deaf, contrary to prelingually deaf patients in whom the development of hearing paths and centers is yet to be established only after cochlear implantation. Accordingly, this is a case report of male adult patient B.D. who was implanted because of complete deafness following the application of gentamicin. The results of implantation were excellent and fully justified the choice of the patient for CI application.
Solid-cystic-pseudopapillarytumor of the pancreas - case report
Authors: Karamarkovic Aleksandar , Micev Marjan , Culafic Djordje , Popovic Nada , Djukic Vladimir
Published: July 2008

Solid-cystic-pseudopapillary tumor (SCPT) of the pancreas, described by Frantz (1959), is a very rare clinical pathologic entity with relatively low grade malignant potential. The tumor is more frequent in the body and tail of the pancreas. The majority of patients are young females. About 60% of patients are asymptomatic. Complications such as rupture, bleeding or secondary infections are rare. Metastases of the tumor and local recurrence after surgical treatment are also rare. Prognosis is excellent after complete surgical removal. It is difficult to make a preoperative diagnosis of pancreatic SCPT. The exact diagnosis is based on histological findings. Differential diagnosis should consider pancreatoblastoma, non neoplastic cysts, pancreatic pseudo-cysts and hydatid cyst. This is a case report of 39-year old woman who was admitted to our institution with abdominal discomfort and palpable abdominal mass in the upper abdomen. US and CT scan revealed round neoformation of 60 mm in diameter located in the body of the pancreas. Imaging features were not specific enough to allow for precise diagnosis. Curative R0 left spleno-hemipancreatectomy was performed. Histology of the resected specimen revealed solid and cystic-pseudopapillary tumor of the pancreas. The patient was discharged on postoperative day 7 in a good condition. The patient is well 48 months after the operation, with no impairment of pancreatic endocrine or exocrine function.
Hydatid cyst of the pancreas
Authors: Colovic Radoje , Grubor Nikica , Radak Vladimir , Colovic Natasa , Stojkovic Mirjana
Published: July 2008

Hydatid cyst of the pancreas is rare. During the last 30 years, less than 40 cases have been reported in journals on Medline. This is a case report of a 35-year old woman with 2-year history of epigastric pain in whom an ultrasound and computed tomography showed the cyst of the body and tail of the pancreas 6x7 cm in diameters, which was supposed to be hydatid one. During surgery, an isolated hydatid cyst of the pancreas was found without communication with the pancreatic duct. The content of the cyst was removed, and pericyst was partially excised and drained. The recovery was uneventful and the patient has remained symptom free so far. Although rare, hydatid cyst should be considered in the differential diagnosis of the cystic lesions of the pancreas, particularly in patients coming from endemic areas and without history of pancreatitis.
Concept of „long centric"
Authors: Martinovic Zeljko , Obradovic-Djuricic Kosovka , Teodorovic Nevenka , Zivkovic Rade
Published: July 2008

The objective of this paper was to show the historical perspective of the ?long centric" occlusal concept and its importance in the modern dentistry, especially from the gnathological aspect. The ?long centric" concept represents therapeutic modality used in modern dentistry and occlusal adjustment in all patients showing differences in strong and weak closure of the lower jaw starting from the position of physiological rest/long centric" concept is applied only for anterior teeth and occlusal movements from rather than toward the center. Whenever the ?long centric" parameters are not adequate, occlusal disturbance, resulting from the ?wedge" effect during the initial closure of the lower jaw, is present. Different degrees of abrasion or hypermobility of the teeth are often the result of the above-mentioned occlusal disturbances and can potentially trigger bruxism and malfunction. Modus procedendi should be the regular approach of every dentist to any occlusion, because only the built-in ?long centric" efficiently contributes to the occlusal stability of the anterior portion of the dentition. All occlusions should be routinely tested regarding their need for ?long centric", especially when the extensive therapeutic interventions (conservative, prosthetics) of the occlusal complex are required.
Legal status of persons with mental illness in Serbia
Authors: Jovanovic Aleksandar
Published: July 2008

In this study, legal status of the mentally ill has been discussed in the context of Serbian legislation. The topics covered are the following: 1) the admission of persons with mental illness to psychiatric institution, 2) general (legal) competence, 3) marital relations of persons with mental illness, 4) legal definitions of sanity and security measures of medical character. Serbia still has no general law on mental health which would be in accordance with European standards, and the existing legislation which deals with the rights of persons with mental illness is, to a large extent, incomplete and obsolete. The author appeals for passing the law on mental health which should: a) follow modern trends in psychiatry concerning the protection of human rights with the basic goal to protect society and mentally ill persons, b) to protect the professional and moral integrity of psychiatrists, c) to provide ethically and professionally acceptable authorization for the use of force, if necessary, in order to prevent criminal acts and/or self-injuries in patients suffering from severe psychical disorders, d) to conceptualize forensic psychiatric treatment (the security measures, corrective psychiatry) and the programs of rehabilitation as an integral part of the community mental health protection system.
Secanje na Prvi kongres srpskih lekara i prirodnjaka - povodom stogodisnjice
Authors: Pavlovic Budimir
Published: July 2008

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70 Years of English-Yugoslav children hospital for osteoarticular tuberculosis in Sremska Kamenica
Authors: Mikic Zelimir , Lesic Aleksandar
Published: July 2008

The development of orthopedic surgery in Novi Sad and Voivodina is related to the name of Dr. Katherine MacPhail, a Scottish physician, who came to Serbia during the World War I, where she worked with her mission in Belgrade and Kragujevac. After the war, she remained in Serbia and, in 1921, founded the first children's, co-called English-Serbian Hospital; then, in 1934, established English-Yugoslav Children's Hospital for Treatment of Osteoarticular Tuberculosis in Sremska Kamenica, which was open until 1941. After the end of World War II, as early as in 1947, Dr. MacPhail returned to Sremska Kamenica, where she reactivated the hospital. After the nationalization of the hospital, she left for Scotland, but the hospital kept working, first under the supervision of the Belgrade Clinic for Orthopedic Surgery and Traumatology, and then as a ward of the Clinic for Orthopedic Surgery and Traumatology of the Novi Sad School of Medicine, until 1992, when it was closed.
Abscess of the spleen
Authors: Grubor Nikica , Colovic Radoje , Colovic Natasa , Radak Vladimir
Published: July 2008

Splenic abscess is a rare disease but with increasing frequency. The authors present 9 patients with splenic abscess treated at the Institute of Digestive System Diseases, Clinical Centre of Serbia, in a period from January 1, 1986 to May 15, 2004. Splenic abscess was the complication of septic endocarditis in 4, trauma in 2, dental infection in 1, while in 2 cases it was the complication of chemotherapy in myeloproliferative disorders. All 9 patients had fever, 7 - abdominal pain, 4 - left shoulder pain, and 1 patient had nausea and vomiting. Higher white blood count was found in 6 patients, pleural effusion in 4, elevated left hemidiaphragm in 1 and basal pneumonia in 1 patient as well. Ultrasonography and CT were the most reliable diagnostic procedures. CT was superior in diagnosis of multiple small abscesses. Culture of the pus recovered the Enterococcus in 3 cases, Streptococcus a hemolyticus in 1, Staphylococcus epidermidis and Candida albicans in 1, Staphylococcus aureus, E. Coli and Candida albicans in 1, Staphylococcus aureus and Salmonella enteritidis in 1 case. Eight patients underwent splenectomy and 1 was cured by combined antibiotics in high doses. One patient died postoperatively due to septic endocarditis that had been present before surgery. The authors believe that splenectomy and antibiotics administered according to drug susceptibility test as well as management of underlying disease are the method of choice for splenic abscess treatment. Conservative antibiotic treatment is indicated in selected cases only.
Relation of pathoanatomic substrate and incidence of bacterial infection in the acute biliary pathology
Authors: Karamarkovic Aleksandar , Popovic Nada , Bajec Djordje , Jeremic Vasilije , Djukic Vladimir , Radenkovic Dejan , Bumbasirevic Vesna , Gregoric Pavle
Published: July 2008

Acute biliary diseases have become the most common indication for major abdominal surgery. We investigated 60 patients who underwent surgery for the acute biliary diseases, within 48 hours from the onset of the illness (group I), and over longer preoperative interval (48 h up to 5 days) (group II). Surgical specimen (gallbladder) was histologically examined. Samples for microbiological exams were obtained from gallbladder, common bile duct, Lund's node, gallbladder bed and peritoneal cavity. Positive bile cultures were found in 43% of group I, and in 70% of group II (p<0.05). Microbiological analysis revealed 13 different species, mostly Gram negative aerobic rods (69%). The incidence of bacteriobilia was in correlation with HP of lesions (79% in the acute and 18% in chronic lesions; p<0.01), what testified the importance of time interval and role of bacterial factor in the acute biliary pathology. Septic complications strictly occurred in patients with positive biliary findings. Early surgical treatment eliminates focus, and stops further development of intraabdominal and systemic septic complications. Correlation between bacteriobilia and septic sequelae calls for prophylactic use of antibiotics.
Acute sciatic neuropathy: "Saturday night palsy"
Authors: Manigoda Miodrag , Dujmovic-Basuroski Irena , Trikic Rajko , Drulovic Jelena
Published: July 2008

This is a case report of 25-year old, unemployed male, admitted to hospital due to acute onset of the left foot drop, subsequent walking difficulty and numbness of the left calf and foot. Symptoms began after prolonged sleep with previous heroin abuse by sniffing. During neurological examination, mild weakness of knee flexors, moderate weakness of plantar flexors and paralysis of foot dorsiflexors, together with hypesthesia of the left calf, foot and fingers, predominantly in the innervation area of common peroneal nerve on the same side, were observed. The electrophysiologic examination revealed predominant involvement of peroneal division within the sciatic nerve, together with recorded conduction block indicating the compression as possible mechanism of nerve injury. The patient was administered corticosteroid therapy during two months, what resulted in almost complete recovery. The peculiarity of this case report is in the presence of the sciatic nerve "Saturday night palsy" with possible effect of former heroin abuse.
Biliary mucinous cystadenoma of the liver with focal malignant alteration
Authors: Colovic Radoje , Grubor Nikica , Micev Marjan , Colovic Natasa
Published: July 2008

Biliary mucinous cystadenoma of the liver is a rare tumor that develops almost exclusively in women. Its typical localization is near the hepatic hilus. It may become malignant, and therefore careful histological examination of the entire resected specimen is mandatory. Incomplete excision results in recurrence and occasionally in malignant alteration. The authors present a 66-year old woman who presented with the right upper abdominal pain and occasional vomiting, and who was diagnosed with cystic lesion of the right lobe of the liver. The lesion was totally excised by an open operation. It was filled with mucinous viscous fluid and there was proliferation in one part of the internal surface. The cystic lesion communicated with the common hepatic duct through a tiny duct (above the cystic duct), but in spite of that, it did not contain bile. Histological examination showed mucinous cystadenoma with focal malignant alteration. After the uneventful recovery, the pain and vomiting were eliminated and she has remained symptom free so far.
Screening methods of ovarian cancer in adults
Authors: Milenkovic Vera , Sparic Radmila , Atanackovic Jasmina
Published: July 2008

Ovarian cancer is associated with high mortality rate which has improved a little despite therapeutic advances. It causes more deaths than combined cervical and uterine cancer. High mortality is believed to be a direct result of already advanced stage at the time of diagnosis. Survival is excellent in case of early stage disease but poor in late stage disease, regardless of histology. The goal of screening for ovarian cancer is restricted to detection of asymptomatic early stage disease, as precursor lesions of ovarian cancer have not been identified. At present, there is no reliable method of ovarian cancer screening which has been shown to reduce mortality from ovarian cancer. Therefore, routine screening of women in general population can not be currently advised. Screening should be limited to high-risk population and subjects participating in research projects as long as the results of current studies are available.
Pathophysiological aspects of severe acute pancreatitis-associated lung injury
Authors: Surbatovic Maja , Jovanovic Krsta , Radakovic Sonja , Filipovic Nikola
Published: July 2008

Acute pancreatitis is an inflammatory process which occurs in severe form in 20% of all patients, out of whom 1596-25% will die. The incidence of severe acute pancreatitis-associated lung injury (APALI) varies from 15% to 55% and its severity varies from mild hypoxemia to acute respiratory distress syndrome (ARDS). Acute lung injury (ALI) and ARDS are the most significant manifestations of extra abdominal dysfunctions in severe acute pancreatitis with mortality rate as high as 60% in the first week of the onset of illness. Different pathophysiological mechanisms of severe acute pancreatitis-associated lung injury have been described. The role of enzymes, adhesion molecules, neutrophils, fibronectin and various inflammatory mediators has been emphasized. Mechanism of the acute lung injury associated with the acute pancreatitis is very complex and has not been clear yet. There is no specific therapeutic procedure and mortality rate is very high. Therefore, further studies are necessary to address this acute and growing problem in intensive medicine.
Making a diagnosis of different lesions of vocal fold mucosa by contact endoscopy: The first usage in our clinical practice
Authors: Jovanovic Milan , Perovic-Jovanovic Jelena , Milenkovic Sanja
Published: July 2008

During laryngomicroscopy, the superficial layers of vocal fold epithelium can be examined in vivo and in situ by contact endoscopy. Methylene blue is applied initially to stain the epihelial cells of the vocal folds. When in contact with mucosal tissue, this endoscope provides 60 and 150 times magnification and clear visualization of cellular patterns of the superficial epithelial layers. For the first time in our laryngological clinical practice, we confirmed a number of previously established parametars such as regularity and arrangement of the epithelium, nucleus contour, and nucleus-cytoplasm ratio, what all enable recognition and easy evaluation of different clinical conditions such as chronic laryngitis, Reinke.s edema, papiloma dyspiasia or vocal fold carcinoma. The advantage of con- tact endoscopy in vivo and in situ allows for detailed scan and mapping of all cell changes of the whole mucosa surface. All these features definitely classify the contact endoscopy into additional diagnostic methods in laryngology.
Radiographic signs of scaphoid union after bone grafting: The analysis of inter-observer agreement and intra-observer reproducibility
Authors: Miric Dragan , Vuckovic Cedo , Djordjevic Zoran
Published: July 2008

INTRODUCTION The diagnosis of radiological union of scaphoid bone after bone grafting requires clear evidence of bony trabeculae traversing the graft from the proximal to the distal pole on at least two of four standard scaphoid views. This sign is the only objective assessments of union. Radiographs of the scaphoid taken 18 weeks after operation, however, can be difficult to interpret. This fact led us to question whether radiographs of scaphoid at 18 weeks provide reliable and objective indication of union. OBJECTIVE Our study was, therefore, designed to determine the reliability of the radiographic diagnosis of scaphoid union after bone grafting by testing the degree of inter-observer agreement and reproducibility. METHODS Out of 30 sets of the scaphoid bone radiographs after bone grafting taken 18 weeks after operation, 15 of good quality were selected. Each set included four views: postero-anterior, lateral, semi- pronated and semi-supinated. Seven observers were tested: three orthopedic consultants, three residents and one consultant in radiology. Each was presented with 15 sets of radiographs designated from 1 to 15 and each was asked to answer the question: "Are there trabeculae crossing the fracture site?" Possible answers were 'yes' or 'no'. Eight weeks later, the same 15 sets of radiographs were marked in alphabetic order from A to K and presented to the same seven observers. Data was then analyzed and expressed in terms of interobserver agreement in pairs and intra-observer reproducibility. Calculation was done by kappa statistics so that the degree of disagreement was taken into account and allowance was made for chance agreement. Kappa values can vary from -1.0 (complete disagreement) through 1 (chance agreement) to +1 (complete agreement). RESULTS For all 15 sets of radiographs, the degree of agreement between each pair of observers was illustrated in Table 2. It demonstrated the level of agreement between each pairs of seven observers. The overall median kappa coefficient for inter-observer agreement was 0.46. This value corresponded to ?moderate" strength of agreement. Median kappa coefficient for consultant was 0.62, but median kappa coefficient for residents was 0.43. The degree of agreement between the opinions of each observer at his first and at his subsequent reviews of the same set of radiograph after 8 weeks was presented in Table 3. The overall median Kappa coefficient for the intraobserver agreement for all seven observers was 0.54. The ability of seven observers to reproduce their own opinion regarding trabeculae crossing the fracture line was poor to use it for assessment of bone union. CONCLUSION Our conclusion is that radiographs taken 18 weeks after scaphoid grafting cannot be reliable and reproducible for assessment of bone union.
Epidemiological characteristics of hip fractures in Belgrade from 1990 to 2000
Authors: Lesic Aleksandar , Jarebinski Mirjana , Pekmezovic Tatjana , Spasovski Dusko , Bumbasirevic Marko
Published: July 2008

The objective of this study was to estimate the incidence of hip fractures in Belgrade for the period 1990-2000, and to determine distribution of fractures according to sex, age, and causes of injuries. Data based on medical records of the National Health Service in Belgrade were collected from all orthopedic hospitals and departments in Belgrade. A total number of 8904 hip fractures were included in the analysis, out of which 64.7% occurred in women. During the survey period, the estimated average annual incidence rate of hip fractures was 51.7/100 000 (95% Cl= 48.1-55.4); 66.2/100 000 (95% Cl= 60.8-72.1) in women and 35.3/100 000 (95% Cl= 31.4-40.1) in men, respectively. In the age group s50 years, the incidence rates standardized by the 1985 US population were 228 and 96 per 100 000 female and male population, respectively. An exponential increase in the incidence of hip fractures with age was observed in both sexes, especially in women. The number of trochanteric fractures was 4718 (53.0%), compared with 4186 (47.0%) cervical fractures. Observation at three time points, in 1990,1995,2000, indicated the pronounced increase of trochanteric fractures in women and less distinctive in men. Fall on the flat ground resulted in 70.3% of hip fractures among persons aged 50 years or older, and traffic accidents were recorded as the major cause in 59.7% of patients under 50 years of age.
Renal transplantation again at the University children's hospital of Belgrade
Authors: Peco-Antic Amira , Krstic Zoran , Kostic Mirjana , Kruscic Divna , Jovanovic Olga , Smoljanic Zeljko , Spasojevic Brankica , Babic Dragan , Boric Zivko
Published: July 2008

After a 15-year break, pediatric renal transplantation restarted again at the University Children's Hospital of Belgrade. Owing to this, best relationship between the number of new patients with terminal renal failure and those with functioning graft has been recently achieved, and mortality of children with terminal renal failure has been decreased to zero. The aim of this paper was to show the recent results achieved in pediatric renal transplantation at the University Children's Hospital in Belgrade. During the period from June 2001 till June 2003,10 patients, 6 boys and 4 girls, aged 5 to 15 years (9.5? 3.8) underwent transplantation of kidney harvested from a live matched donor. Out of these, two patients underwent pre-emptive transplantation. Urine from the graft started immediately after anastomosis was performed, while serum creatinine normalized after 15 to 120 hours. Daclizumab was the most commonly used as immunosuppressive induction agent, but the maintenance immunosuppressive therapy consisted of Imuran or Mycophenolate Mofetil (MMF), Neoral or Tacrolimus (FK 506) and prednisone. At the end of follow up, after 18.7?8.4 months, nine patients had normal, and one patient slightly decreased renal graft function. Growth after transplantation and nutritional status were improved in all patients, and all of them achieved complete psychosocial rehabilitation. These results showed that the University Children's Hospital in Belgrade fulfilled all necessary conditions to become a specialized Center for Pediatric Renal Transplantation.
Pathohistological characteristics of myelodysplastic syndromes: Diagnostic and prognostic significance
Authors: Marisavljevic Dragomir , Cemerikic Vesna , Rolovic Zoran , Boskovic Darinka , Colovic Milica
Published: July 2008

INTRODUCTION Pathohistological (PH) analysis is recommended as basic diagnostic procedure during the investigation of myelodysplastic syndromes (MDS). AIM The aim of this paper was to investigate diagnostic and prognostic significance of bone marrow PH features in patients with MDS, and its relation to cytoiogical characteristics of bone marrow aspirate. METHODS Cellularity, disorder of marrow histotopography, quantity of hematopoiesis lineages, cellular atypia, the amount of myeloblasts, and stromal changes were particularly analyzed in trephines of 236 patients with primary MDS. RESULTS In most cases (78.4%) hypercellular bone marrow was observed, although in 10.2% patients hypocellular subtype of MDS was diagnosed. Erythropoiesis dislocation was present in 64.7% patients, dislocation of MK-poiesis in 50.9% patients, while 61.3% had dislocation of granulopoesis (so-called ALIP phenomenon). In most cases three lineage hyperplasia was present, while relative hypoplasia of E- and MK-lineage was found in1/4 cases, each, particularly in advanced MDS. Morphological features of dyseritropoiesis and dysmegakaryocytopoiesis were present in 42.5% and 75.7% cases, respectively. Different stages of reticulin and collagen fibrosis were observed in 55.5% patients, while 7.6% had hyperfibrotic subtype of MDS. Comparative analysis of cytoiogical and histological features of MDS bone marrow showed positive correlation between two methods only in respect of estimation of eritropoiesis quantity, presence of dismegakaryocytopoiesis and ?reactive" cells. The univariate analysis showed that MK- and G-lineage dislocation, quantity of E- and G-lineage, and presence of dysmegakaryocytopoiesis, were prognostic indicators for short survival and evolution of the disease in MDS patients. However, multivariate analysis showed that only G-lineage dislocation was independent prognostic variable for survival in MDS cases. CONCLUSION PH analysis is irreplaceable diagnostic procedure during MDS investigation, since it provides reliable information of cellularity, architectural disorganization, number of megakaryocytes and alterations of marrow stroma. In addition, PH analysis provides numerous important prognostic information.
Munchausen syndrome by proxy
Authors: Jovanovic Aleksandar , Popovic Vesna , Savic Slobodan , Alempijevic Djordje , Jankovic Nada
Published: July 2008

This review deals with bibliography on Munchausen syndrome by proxy (MSbP). The name of this disorder was introduced by English psychiatrist Roy Meadow who pointed to diagnostic difficulties as well as to serious medical and legal connotations of MSbP. MSbP was classified in DSM-IV among criteria sets provided for further study as "factitious disorder by proxy", while in ICD-10, though not explicitly cited, MSbP might be classified as "factitious disorders" F68.1. MSbP is a special form of abuse where the perpetrator induces somatic or mental symptoms of illness in the victim under his/her care and then persistently presents the victims for medical examinations and care. The victim is usually a preschool child and the perpetrator is the child's mother. Motivation for such pathological behavior of perpetrator is considered to be unconscious need to assume sick role by proxy while external incentives such as economic gain are absent. Conceptualization of MSbP development is still in the domain of psychodynamic speculation, its course is chronic and the prognosis is poor considering lack of consistent, efficient and specific treatment. The authors also present the case report of thirty-three year-old mother who had been abusing her nine year-old son both emotionally and physically over the last several years forcing him to, together with her, report to the police, medical and educational institutions that he had been the victim of rape, poisoning and beating by various individuals, especially teaching and medical staff. Mother manifested psychosis and her child presented with impaired cognitive development, emotional problems and conduct disorder.
Resynchronisation therapy in patients with heart failure: Our results
Authors: Milasinovic Goran , Jelic Vera , Petrovic Milan , Calovic Zarko , Savic Dragutin , Pavlovic Sinisa , Zivkovic Mirjana , Kanjuh Vladimir
Published: July 2008

INTRODUCTION. Resynchronisation therapy with biventricular permanent pacing stimulation is one method of treating patients with systolic heart failure, with echocardiograph signs of ventricular asynchrony and a prolonged QRS of longer than 120 milliseconds. This method has been accepted in most medical centers around the world and was instigated in our Pacemaker Centre in December 2001, 3 months after FDA approval for human use. OBJECTIVE. The aim of the study was to present this new procedure and the results obtained from our own group of patients. METHOD. A multi-site, biventricular pacemaker, with a special electrode for left-half heart stimulation was implanted in the coronary sinus of 17 patients who had suffered systolic heart failure (12 male and 5 female, average age 59.9 years). For all of them, the duration of the QRS interval was longer than 120 ms, with left bundle branch morphology, and an ejection fraction below 30%. All the patients were NYHA class II or III. Prior to and after the implantation, a 12-channel ECG and ECHO were carried out, a b-minute hall walk test was performed, additionally, the total walked distance on a flat surface was measured, the general condition of the patient was evaluated, the number of medications being taken was noted, as was the number of days of hospitalization. RESULTS. The average time from diagnosis to implantation was 22 months, and the average post-operative follow-up was 14 months. Two of the patients died 10 and 7 months after the implantation, due to a new myocardial infarction and refractory heart failure. In addition, one patient did not show any improvement after the implantation of the multi-site pacemaker (there were three "non-responder" patients). All the other patients felt much better: decreased NYHA class for I - II class, increased left ventricle ejection fraction, reduced use of diuretics, increased b-minute hall walk distance and general walk distance on a flat surface, and decreased number of days of hospitalization. CONCLUSION. Resynchronisation heart failure therapy in the majority of patients with systolic left ventricular dysfunction and a prolonged QRS interval considerably improves cardiac function, in addition to reducing symptoms and hospital stays.