bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the degree of clinical rheumatoid arthritis activity based on the concentrations of cytokines TNF-alpha, IL-12, IL-15, and IL-18 in serum and synovial fluid
Authors: Petrovic-Rackov Ljiljana
Published: December 2010

Bacground/Aim. Experimental in vitro and in vivo investigations in a mouse model have proved that TNF-alpha, IL-12, IL- 15 and IL-18 participate in the pathogenesis of erosive inflammatory arthritis. The aim of this research was to determine the clinical significance of cytokines in the evaluation of the activity of rheumatoid arthritis (RA). Methods. Inside a 4-year period we followed-up 64 patients with RA as newly occurred or in the phase of worsening. We observed the clinical manifestation of the disease upon wluch we divided the patients in to 3 groups: the patients with low active RA, patients with moderate active RA, and the patients with wild active RA. The control group (n = 25 patients) included the patients with osteoarthrosis (OA), and arthritis of the knee. In the samples of serum of all of the patients the concentrating of cytokines TNF-alpha, IL-12, IL-15, and IL-18 were determined using the immunoenzymatic methods in mice for human interleukines. By comparing the concentrations in 30 patients with the high, 14 patients with moderate, and 20 patients with the mild activity of RA it was determined that the patients with the high degree of the disease activity, had significantly high (p < 0.01; p < 0.05) concentrations of the examined cytokines in blood and synovial fluid as compared to the patients with the moderate and mild active disease. There was a relationship (p < 0.01) between the concentrations of cytokines in blood and synovial fluid with the quantity of the Disease Activity Score in 28 joints. Conclusions. Cytokines concentrations could be good indicators of the degree of the general activity of RA. This research could contribute to the interpretation of insufficiently well known views of the pathogenesis role and significance of citokines in an active disease.
Dynamic changes in calcium and phosphate plasma concentrations in the patients on peritoneal dialysis
Authors: Jovanovic Natasa , Lausevic Mirjana , Stojimirovic Biljana
Published: December 2010

Background/Aim. The disturbances of active forms of vitamin D synthesis and disturbances in calcium and posphate metabolism develop early in chronic renal failure, when creatinine clearance is about 30 ml/min. Chronic hemodialysis and peritoneal dialysis only partially correct the biochemical environment of patients on chronic renal replacement therapy because of end-stage renal disease. These dialysis modalities can?t significantly affect the endocrine disturbances of chronic renal failure and they have minimal modulatory effect. The management of disturbed calcium (Ca) and phosphate (P) metabolism and the maintainance of Ca ? P product below 4.4 mmol/l thanks to the use of dialysate solutions with the appropriate calcium concentration and the careful dosage of phosphate binders, calcium and active vitamin D metabolits, are extremely important for the prevention of renal osteodystrophy, secondary hyperparathyroidism as well as low-bone turnover disease. The aim of the study was to analyze the plasma levels of calcium, phosphate, albumin, alkaline phosphatase and parathormon (PTH) in 58 patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) from March to August 2003. The use of phosphate binders and the substitution with active vitamin D metabolits were also analyzed. Methods. We examined 58 patients, 30 males and 28 female, mean-age 52 years (range, 26-78 years), affected by end-stage renal disease of the different leading cause. The average time on peritoneal dialysis program was 20 months (2-66 months). Most of the patients were treated by CAPD, while only few of them performed automatic, cyclic or intermittent peritoneal dialysis. Most of the patients used a dialysate with 1.75 mmol/l calcium concentration. Results. The study showed that our patients on chronic CAPD program during several months had normal calcemia, phosphatemia and the level of alkaline phosphatase, and that they had Ca ? P product in the recommended range. PTH serum level ranged from 16 to 490 pg/l in our patients. Conclusion. The study showed that a balanced diet and a correct dosage of phosphate binders, as well as a careful substitution with active vitamin D metabolits render a good control of calcium and phosphate serum balance, as well as an effective prevention of renal osteodystrophy development in the patients on chronic peritoneal dialysis treatment.
Significance of the inital cytomorphological and immunocytochemical findings and the correlation with the international prognostic index for the survival in patients with non-Hodgkin’s lymphoma
Authors: Mihaljevic Biljana , Nedeljkov-Jancic Ruzica , Cemerikic-Martinovic Vesna
Published: December 2010

Background/Aim. Fine-needle aspiration biopsy is a quick, economical, and safe initial method in managing a patient with suspected lymphoma. According to a few reports on this preoblem, the aim of this study was to compare histological findings to cytomorphological ones in needle aspirates. We also compared these findings to the overal survival (OS) time. Methods. We analyzed the fine-needle aspiration biopsies of peripheral lymph nodes, and the International Prognostic Index (IPI) in 81 patients with non-Hodgkin?s lymphoma (NHL). We put these findings into correlation with OS time. Results. According to the International Working Formulation (IWF) criteria, the dominant cell population was as follows: 18 patients had the small cell population, 21 patients had small cleaved cells, 18 patients had the mixed cell population, 21 patients had large cell population, 2 patients had Burkitt lymphoma type, and 1 patient had the dominant lymphoblasts. On presentation, 32 patients had a low IPI index, 32 patients had a low intermediate, and 17 patients had a high intermediate IPI. We confirmed the statistical significance (Kaplan-Mayer) of cytomorphology (p = 0.013) and IPI index (p = 0.016) for survival time. During a 48-month follow-up, OS was 37.2 months for the patients with the dominant small cells, and 32 months for the patients with small cleaved cells (PH equivalent to indolent NHL). For the patients with the dominant mixed cell population, large cell population and Burkitt limphoma cell, OS were 17, 14.4, and 9.3 months, respectively (PH equivalent to aggressive NHL). Patients with low IPI had the highest OS, 36 months for the low intermediate and only 11.6 months for the high intermediate IPI index. Conclusion. We concluded that an initial cytological and clinical profile of patients with NHL, might give a quick and relevant information for planning an adequate therapy.
Benign paroxysmal torticollis in infancy
Authors: Dimitrijevic Lidija , Colovic Hristina , Zivkovic Vesna
Published: December 2010

Background. Benign paroxysmal torticollis (BPT) is an episodic functional disorder of unknown etiology, characterized by the periods of torticollic posturing of the head, that occurs in the early months of life in healthy children. Case report. We reported two patients with BPT. In the first patient the symptoms were observed at the age of day 20, and disappeared at the age of 3 years. There were 10 episodes, of which 2 were followed by vomiting, pallor, irritability and the abnormal trunk posture. In the second patient, a 12-month-old girl, BPT started from day 15. She had 4 episodes followed by vomiting in the first year. Both girls had the normal psychomotor development. All diagnostical tests were normal. Conclusion. The recognition of BPT, as well as its clinical course may help to avoid not only unnecessary tests and the treatment, but also the anxiety of the parents.
Epidemiological characteristics of nosocomial bloodstream infections and their causes
Authors: Suljagic Vesna , Mirovic Veljko
Published: December 2010

Background/Aim. Nosocomial bloodstream infections (BSI) contribute to grater morbidity and mortality rates, as well as to increasing length of hospital stay and health care costs. All patients with nosocomial BSI identified during the one-year period were studied to identify microbiological factors associated with these infections. Methods. A one-year prospective cohort study was performed in patients in intensive care units (ICU), and non- ICU patients. The patients were identified by active surveillance and positive blood cultures during the study period. The definitions of nosocomial BSI of the Center for Diseases Control and Prevention, Atlanta were used. Hospital laboratory detected growth in blood cultures, identified organisms, and performed susceptibility testing were in according with the American National Committee for Clinical Laboratory Standards. Results. The incidence of nosocomial BSI was 2.2 per 1 000 admission in non-ICU and 17.4 per 1 000 admission in ICU patients. The 28- day crude mortality rate was 44.9%. There were 60.3% primary nosocomial BSI. Gram-negative organisms accounted for 50%, gram-positive organisms accounted for 44.9%, and 4.1% were caused by fungi. The most common pathogens were coagulasenegative staphylococci (21.4%), Staphylococcus aureus (14.3%), Klebsiella spp. (13.3%), Pseudomonas aeruginosa (8.2%), Acinetobacter spp. (7.1%). Methicillin resistance was detected in 64.3% of S.aureus and 100% of coagulasa-negative staphylococci. Vancomycin resistance in enterococci and staphylococci was not deteced. The proportion of ceftazidim resistance among K.pneumoniae isolates was 92%. Conclusion. This study might help to better understanding not only the characteristics of BSI, but also the featares of their causes, primarily the resistance of coagulase-negative staphylococci and S. aureus to methicillin, and of K. pneumoniae to ceftazidime.
Nosocomial infections in the intensive care units
Authors: Jovanovic Biljana , Mazic Natasa , Mioljevic Vesna , Obrenovic Jelena , Jovanovic Snezana
Published: December 2010

Background/Aim. The risk for nosocomial infections (NIs) is 5-10 times higher in patients hospitalized in the Intensive Care Units (ICUs) than in patients staying in other wards. The higher incidence rates of NIs in the ICUs may be explained by the fact that the patients in the ICUs have more severe underlying disease, and are exposed to the invasive diagnostic and therapeutical procedures. The unreasonable use of antibiotics leads to the selection of multiresistant agents, which have been increasingly recorded as the NIs causative agents. The aim of this study was to investigate the characteristics of NIs in the ICUs in the period January-June 2005. Methods. The study of incidence was performed in accordance with the methodology of the Centers for Diseases and Prevention. Any infections in the patients hospitalized in the ICUs in the period from January to June 2005 were registered. The results both from medical documentation and from the direct contacts with the medical personnel were analyzed. The samples were tested using standard methods in the microbiological laboratory. Results. The incidence rates of NIs patients ranged from 1.5 to 40.8, and the incidence rates of infections were 1.5 to 65.6 per 1 000 patient?s days. Out of the total number of NIs, urinary infections accounted for 44.6%, blood infections for 37.6%, and surgical site infections for 16.9%. Conclusion. The most frequent cause of nosocomial urinary infections was Klebsiella, of nosocomial sepsis - coagulase ? negative staphylococci, and of surgical site infections - Staphylococcus aureus.
Failures and complications of thoracic drainage
Authors: Djordjevic Ivana , Stanic Vojkan , Nestorovic Milica , Vulovic Tatjana
Published: December 2010

Background/Aim. Thoracic drainage is a surgical procedure for introducing a drain into the pleural space to drain its contents. Using this method, the pleura is discharged and set to the physiological state which enables the reexpansion of the lungs. The aim of the study was to prove that the use of modern principles and protocols of thoracic drainage significantly reduces the occurrence of failures and complications, rendering the treatment more efficient. Methods. The study included 967 patients treated by thoracic drainage within the period from January 1, 1989 to June 1, 2000. The studied patients were divided into 2 groups: group A of 463 patients treated in the period from January 1, 1989 to December 31, 1994 in whom 386 pleural drainage (83.36%) were performed, and group B of 602 patients treated form January 1, 1995 to June 1, 2000 in whom 581 pleural drainage (96.51%) were performed. The patients of the group A were drained using the classical standards of thoracic drainage by the general surgeons. The patients of the group B, however, were drained using the modern standards of thoracic drainage by the thoracic surgeons, and the general surgeons trained for this kind of the surgery. Results. The study showed that better results were achieved in the treatment of the patients from the group B. The total incidence of the failures and complications of thoracic drainage decreased from 36.52% (group A) to 12.73% (group B). The mean length of hospitalization of the patients without complications in the group A was 19.5 days versus 10 days in the group B. The mean length of the treatment of the patients with failures and complications of the drainage in the group A was 33.5 days versus 17.5 days in the group B. Conclusion. The shorter length of hospitalization and the lower morbidity of the studied patients were considered to be the result of the correct treatment using modern principles of thoracic drainage, a suitable surgical technique, and a careful follow-up of the patients.
Resorption and tolerance of the high doses of ferrous sulfate and ferrous gluconate in the patients on peritoneal dialysis
Authors: Lausevic Mirjana , Jovanovic Natasa , Ignjatovic Svetlana , Grujic-Adanja Gordana , Stojimirovic Biljana
Published: December 2010

Background/Aim. Iron supplementation plays a crucial role in peritoneal dialysis (PD) patients. Oral iron substitution is more convenient than intravenous therapy in PD patients, but impaired absorption and adverse effects may be limiting factors for oral treatment. The aim of this study was to compare the absorption and side effects of high doses ferrous sulphate and ferrous gluconate in PD patients. Methods. Blood samples were taken from 29 PD patients at baseline, as well as 2, 4 and 8 hours after oral intake of 4 ferrous sulphate tablets (containing 105 mg elemental iron per tablet). The test was repeated using 8 ferrous gluconate drinkable ampoules (containing 50 mg elemental iron per ampoule). Results. The maximal increase in serum iron level during the test with iron sulphate was 113.51?103.37% versus the initial values of 183.87?37.38% during the ferrous gluconate test. The maximal values of serum iron after the intake of ferrous sulphate were 26.23?9.95 ?mol/l versus 30.97?8.65 ?mol/l after the intake of ferrous gluconate. There was a statistically significant difference between these two groups. Six patients showed an increase in serum iron of more than 300% after a high ferrous gluconate dose, while in 15 of the patients serum iron increased between 100% and 300%, and in 8 of the patients serum iron levels increased by less than 100%. Side effects occurred more frequently after the intake of ferrous sulphate than ferrous gluconate. Conclusion. High doses of oral iron were well absorbed and tolerated in PD patients. Ferrous gluconate was better absorbed and tolerated than ferrous sulphate, thus we recommend it for oral iron supplementation in PD patients.
Influence of the myocardial bridging phenomenon on the myocardial structure and the coronary arteries wall structure changes
Authors: Tomanovic-Kokovic Jelena , Teofilovski-Parapid Gordana , Oklobdzija Mirjana , Kanjuh Vladimir , Kovacevic Slobodan , Parapid Biljana , Kokovic Vladimir
Published: December 2010

Background/Aim. Our research was performed to evaluate the influences of the myocardial bridging of coronary arteries on the myocardial and coronary arteries wall structure changes, that could be a reason for multiple heart malfunctions. Methods. We analyzed the autopsy material, collected during a five-years period, and especially the group of 575 cases with the major aim to diagnose mors naturalis. In all cases with the presence of myocardial bridge over the arterial coronary wall revealed at autopsy, samples were taken for microscopic verification and examination. Results. We found myocardial bridges over the coronary arteries or their major branches in 27 of the cases (4.70%). We believe that myocardial bridges compromise coronary perfusion by cyclic compression of the overbridged vessels, and that it could be the initial factor in the pathogenesis of arteriosclerotic degeneration processes on the coronary artery wall. We found different grades of arteriosclerotic changes in 88.89% of the cases, as well as fibrosis of myocardium in 88.89% and lipomatosis in 66.67% of the cases with the present myocardial bridges. Conclusion. Our results suggested that myocardial bridging of coronary arteries and/or their branches was the pathological and even lethal phenomenon that deserves more intensive clinical evaluation.
Importance of personality traits and psychosocial factors for the development of coronary heart disease
Authors: Jovanovic Dragana , Jakovljevic Branko , Paunovic Katarina , Grubor Dusan
Published: December 2010

Background/Aim. Numerous studies have provided clear and convincing evidence that psychosocial factors contribute to the pathogenesis and expression of coronary heart disease (CHD). These factors have been related to the following psychosocial domains: personality factors and character traits, depression, anxiety, social isolation and chronic life stress. The aim of this study was to estimate the influence of personality traits and psychosocial risk factors for the development of coronary heart disease. Methods. The investigation was conducted as observational cross-sectional (case-control) study. Based on medical records all subjects were divided into two groups: the group of patients with CHD (61 participants), and the control group of 41 healthy participants. All participants fulfilled the Eysenck Inventory Questionnaire, Paykel stress scale and Bortner scale of A-B self-estimation. Results. The participants with CHD were shown to have lower education than healthy participants, but were comparable by gender, age and place of residence. According to the Bortner scale, most participants with CHD expressed type A personality, whereas most healthy participants expressed types B and AB. The patients with CHD achieved higher scores on the Paykel stress scale of life events, and they had the higher level of neurotic and psychotic tendencies, as well as the lower level of extroversion compared to the healthy participants. Multivariate logistic regression model identified chronic stress (odds ratio 1.018; 95% confidence interval 1.007?1.028) as an important predictor for the occurrence of coronary heart disease, when adjusted for age, gender, nourishment and blood pressure. On the other side, the lower risk for the occurrence of CHD was observed among the participants who had the higher level of extroversion (odds ratio 0.859; 95% confidence interval 0.636?0.902). Conclusion. Chronic stress and introversion can be considered important risk factors for the development of coronary heart disease, independent of other predictors such as obesity and hypertension, supporting the biopsychosocial model of the occurrence of coronary heart disease.
Possibilty of the lower third molar eruption: Radiographic analysis
Authors: Nedeljkovic Nenad , Stamenkovic Zorana , Tatic Zoran , Racic Alek
Published: December 2010

Backgraund/Aim. To assess the possibility of the eruption of the lower third molar on the basis of the measured parameters: retromolar space, mesiodistal crown width of a molar and the third molar angulation. Methods. The investigation included 104 patients both sexes (43 boys, and 61 girls), 16 to 25 years old (meanage, 18 years). It was performed using the orthopanthomographic radiographs analysis of those patients. Each radiograph was covered by tracing paper, and the contoures of the followiny anatomic details were drawn: a) the crown and root contours of third molars, upper and lower central incisors, distal molars in occlusion, anterior edge of ramus mandible, b) lines: 1. the occlusal plane, 2. the line of retromolar space, 3. the mesiodistal crown width of third molar, 4. the axial shaft of the third molar and the distal angle between occlusal plane and the axial shaft of the third molar. The values were measured with an orthodontic caliper: the diameter of retromolar space, diameter of mesiodistal width, the value of distal angle between occlusal plane and axial shaft of molar. Results. A favourable angulation of the lower third molar (more than 60?) was found in, boys (left 27.90%, right 32.55%), girls (left 39.34%, right 37.77%). A favourable relationship between the diameters of mesiodistal width of the third molar and retromolar space was found in, boys, (left 13.59%, right 16.27%), girls, (left 8.19%, right 14.75%). A favorable relationship between the diameters of mesiodistal width of the third molar and the retromolar space and the angulation was found in boys, (left 9.30%, right 11.62%), girls, (left 6.56%, right 9.83%). Conclusion. There was not any statistically significant difference found between the relation of the retromolar value, third molar mesiodistal diameter, or of the third molar angulation to the left and the right side nor of their mutual relations in comparing boys and girls. A favorable prognosis was found in 9.33% of the patients.
Infection and inflammation in sepsis
Authors: Surbatovic Maja , Filipovic Nikola , Slavkovic Zoran , Radakovic Sonja
Published: December 2010

 Uprkos najmodernijim merama suportivne terapije MODS, koji se cesto javlja kod bolesnika sa sepsom, nosi sa sobom visok mortalitet od preko 50%. Zbog toga istrazivanja imunskog odgovora, pro- i antiinflamatornih citokina kod bolesnika sa sepsom imaju veliki znacaj u razumevanju patofiziologije i primene imunomodulacije u terapijske svrhe.
Early complications following radical surgical treatment of patients with gastric adenocarcinoma
Authors: Kostic Zoran , Cuk Vladimir , Ignjatovic Mile , Usaj-Knezevic Slavica
Published: December 2010

Background/Aim. Surgical treatment of patients with gastric adenocarcinoma means the total excision of a tumor and the pathways of its spreading with the risk of operational complications as low as possible. The aim of this study was to evaluate the type and frequency of early postoperative complications and mortality after a radical surgical treatment of patients with gastric adenocarcinoma. Methods. Complication rates and postoperative mortality were studied in 70 consecutive patients in whom a radical surgical procedure, gastrectomy (total or subtotal) with D2 lymphadenectomy, was performed. In the early postoperative period, the frequencies of general and specific complications were detected. The frequencies of complications were compared between the groups of patients according to the defined clinical, operative and pathohistological paramethers. Results. The overall morbidity and mortality rates were 27.14% and 5.71%, respectively Pancreatic fistula in five, and pleural effusion in three patients were the most frequently registered complications. Three of four deaths occured in patients older than 70 years, with the stage III and IV of the disease, and in all of them total gastrectomy with splenectomy was performed. A statistically significant difference (p < 0.05) in complication rates was found between the groups of patients with and without splenectomy and with the tumors > 5 cm and ? 5 cm. Conclusion. Radical surgical treatment of patients with gastric adenocarcinoma might be done with an acceptable morbidity and mortality if it is performed by the surgeons with the experience in D2 lymphadenectomy technique. A diameter of the tumor > 5 cm, and splenectomy, and/or splenopancreatectomy are the most important risk factors for the occurrence of complications and modifications of D2 lymphadenectomy technique with limited indications for splenic and/or pancreas resection can improve treatment results. An individual approach and the appropriate selection of the surgical procedure are necessary in patients older than 70 years.
Endophthalmitis in war and peace penetrating eye injuries
Authors: Vukosavljevic Miroslav , Slavkovic Zoran
Published: December 2010

Background/Aim. Nowadays, eye injuries are a leading cause of one-eye disease or blindness worldwide. The aim of this study was to comparatively analyze the frequency of endophthalmitis following war and peace eye injuries. Methods. All the patients went through the detailed ophthalmologic examinations, prophylactic antibiotic treatment, and pars plana vitrectomies (VPP), or other required surgical interventions. Results. Inside the period from 1991 to 1998, 647 patients with eye injuries were hospitalized, out of which 500 with penetrating eye injuries. In the period 1999?2004, 611 patients with eye injuries, were treated, out of which 297 had penetrating eye injuries. Out of 500 patients with war penetrating eye injuries, in 286 of the cases intrabulbar foreign bodies (IFB) were detected. The signs of endophthalmitis were observed in 26 eyes (5.2%) at admission. Out of totally 297 peace penetrating eye injuries, 196 (66%) were IBF. In 25 eyes (8.4%) endophthalmitis was observed. Conclusion. In our study, the frequency of posttraumatic endophthalmitis following penetrating war eye injuries was relatively low, even lower than the frequency of endophthalmitis following peace eye injuries.
Microprocessor-controlled vs. "dump-freezing" platelet and lymphocyte cryopreservation: A quantitative and qualitative comparative study
Authors: Balint Bela , Vucetic Dusan , Draskovic Biljana , Vojvodic Danilo , Brajuskovic Goran , Colic Miodrag , Trkuljic Miroljub
Published: December 2010

Background/Aim. Thermodynamical and cryobiological parameters responsible for cell damages during cryopreservation (cryoinjuries) have not yet been completely explained. Thus, freezing procedures should be revised, exactly optimized to obtain an enhanced structural and functional recovery of frozen- thawed cells. The aim of this study was to compare microprocessor- controlled (controlled-rate) with the compensation of the released fusion heat and ?dump-freezing? (uncontrolled- rate) of the platelet and lymphocyte cryopreservation efficacy. Methods. Platelet quantitative recovery (post-thaw vs. unfrozen cell count), viability (using hypotonic shock response - HSR), morphological score (PMS), ultrastructural (electron microscopy) properties and expression of different surface antigens were investigated. In lymphocyte setting, cell recovery and viability (using trypan blue exclusion test) as well as functionality (by plant mitogens) were determined. Controlled- rate freezing and uncontrolled-rate cryopreservation were combined with 6% (platelets) and 10% (lymphocytes) dimethyl sulfoxide (DMSO). Results. Platelet recovery and functionality were superior in the controlled-rate system. The majority of surface antigen expression was reduced in both freezing groups vs. unfrozen cells, but GP140/CD62p was significantly higher in controlled-rate vs. uncontrolled-rate setting. Controlled- rate freezing resulted with better lymphocyte recovery and viability (trypan blue-negative cell percentage). In mitogen-induced lymphocyte proliferative response no significant intergroup difference (controlled-rate vs. uncontrolled-rate) were found. Conclusion. The data obtained in this study showned the dependence of cell response on the cryopreservation type. Controlled-rate freezing provided a superior platelet quantitative and functional recovery. Lymphocyte recovery and viability were better in the controlled-rate group, although only a minor intergroup difference for cell proliferative response was obtained.
Characteristics of decision-making process during prescribing in general practice
Authors: Djordjevic Natasa , Jankovic Slobodan
Published: December 2010

Background/Aim. The process of prescribing decision-making by general practitioners requires numerous consultations in order to obtain maximal effects, minimal risks, and cost-effectiveness with the full appreciation of a patient's right to choose. The aim of our study was to describe the process of decision-making by general practitioners who decide on the treatment for an individual patient, and to relate the scope and nature of this process to the quality of the outcome of the decision. Methods. The study involved 53 general practitioners who worked in the Health Center, Kragujevac at the time of investigation (September-December 2002.). General practitioners made prescribing decisions, thinking aloud, for five patients with urinary tract infections (n = 2), or stomach complaints (n = 3). The resulting 265 transcripts were analyzed to determine the scope and nature of the decision-making processes. Differences in prescribing were related to the case or the practitioners? working experience, and to their educational background. Results. Our results showed that the more years of practice the practitioners had the less treatments they prescribed, and the less additional aspects before prescribing they considered. The doctors with less experience, in most of the cases, considered the core aspects, while those with more experience more often considered the contextual and habitual aspects. Educational background of the general practitioners, and the type of a considered disease, had an influence on the decision-making process. The most optimal method for decision-making (marked as type F) was mostly used by the practitioners with the least experience, while the those with more experience mainly made their decisions in the ways considered the least acceptable. The optimal method for decision-making process does not necessarily provide the optimal therapy, so the least acceptable decision-making might not result in an inappropriate treatment. Conclusions. The observed prescribing decisions were mostly in disagreement with the Good Clinical Practice. Our study pointed out the need for the obligatory continuation of medical education of general practitioners in decision-making process during prescribing.
Distraction osteogenesis in the treatment of facial and mandibular deformities
Authors: Jovic Nebojsa
Published: December 2010

 Prikazani protokoli lecenja i kriterijumi uspesnosti svakako ce zahtevati dalje izmene i dopune, ali se mogu koristiti u buducim klinickim studijama u cilju obezbedjivanja objektivnih podataka. Buduci pravci razvoja kraniofacijalne OD ukljucuju: uticaj faktora rasta na OD, uticaj OD na kraniofacijalni skelet u procesu rasta, usavrsavanje tehnike osteotomije putem endoskopije, razvoj minijaturnih multidirekcionih distrakcionih uredjaja koji omogucavaju interceptivnu OD i modifikaciju i usavrsavanje protokola lecenja putem kraniofacijalne OD.
Association of Helicobacter pylori infection with nodular antritis and follicular gastritis
Authors: Tomasevic Ratko , Golubovic Gradimir , Kiurski Miroslav , Stankovic Dragana , Doder Radoje , Pavlovic Aleksandar
Published: December 2010

Introduction. Helicobacter pylori (H. pylori) infection is known to be the must common cause of chronic gastritis having some endoscopic and pathologic characteristies as determinated by the Sydney System for Gastritis Classification. The aim of our case report was to point out the relationship between an endoscopic finding of nodular antritis and the presence of H. pylori infection and active chronic gastritis. Case report. Our patient underwent upper gastrointestinal endoscopy for dyspeptic complaints and was diagnosed as having nodular antritis, but also underwent urease test and hystopathologic examination of antral mucosa, to determine the presence and density of H. pylori infection and the presence and severity of gastritis. After a course of anti H. pylori treatment, dyspepsia improved and new biopsy specimens obtained two months and six months afterwards revealed no pathological findings. Conclusion. The case report supported the association of H. pylori infection of lymphoid follicles with nodular gastric mucosis.
Expression of Bcl-2 protein and the amplification of c-myc gene in patients with chronic myeloid leukemia
Authors: Strnad Milica , Brajuskovic Goran , Strelic Natasa , Zivanovic-Todoric Biljana , Tukic Ljiljana , Stamatovic Dragana
Published: December 2010

Background/Aim. Chronic myeloid leukemia (CML) represents a malignant myeloproliferative disease developed out of pluripotent hematopoietic stem cell that contains the fusion bcr-abl gene. Disorders that occur in the process of apoptosis represent one of the possible molecular mechanisms that bring about the disease progress. The aim of our study was to carry out the analysis of the presence of the amplification of the cmyc oncogene, as well as the analysis of the changes in the expression of Bcl-2 in the patients with CML. Methods. Our study included 25 patients with CML (18 in chronic phase, 7 in blast transformation). Using an immunohistochemical alkaline phosphatase-anti-alkaline phosphatase (APAAP) method, we analyzed the expression of cell death protein in the mononuclear bone marrow cells of 25 CML patients. By a differential PCR (polymerase chain reaction) method, we followed the presence of amplified c-myc gene in mononuclear peripheral blood cells. Results. The level of the expression of Bcl-2 protein was considerably higher in the bone marrow samples of the patients undergoing blast transformation of the disease. The amplification of c-myc gene was detected in 30% of the patients in blast transformation of the disease. Conclusion. The expression of Bcl-2 protein and the amplification of c-myc gene are in correlation with the disease progression.
Effects of tibolone on the risk factors for cardiovascular diseases in postmenopausal women
Authors: Jeremic Katarina , Lazovic Gordana , Tulic Ivan , Gojnic Miroslava , Stojnic Jelena , Jeremic Jelena
Published: December 2010

Background/Aim. Tibolone is a preparation that belongs to the group of steroidal substances. The effects of the use of the use of tibolone are the consequence of the activities of its metabolities, considering that their hormonal activity depends on the type of tissue in which they develop. The aim of this study was to evaluate the influence of the use of tibolone on risk factors for the development of cardiovascular diseases in postmenopausal women. Methods. A prospective observational stady included 94 patients who had the concentration of l7? estradiol < 50 pg/ml, and who was in menopause more than a year. Out of the total number of patients, 63 accepted to receive tibolone 2.5 mg daily (tibolone group), while 31 of the patients refused to take tibolone (control group). We measured the concentration of lipids (cholesterol, LDL cholesterol, HDL cholesterol, triglicerides), antitrombin III, fibrinogen, and C-reactive protein, before and after the treatment within a 6-month period. Then, we compared the difference between the values of concentrations and tested the statistical significance of the difference. We also evaluated the changes of values in the concentrations of the examinated parameters inside a 6-month period in the control group. Results. In 31 patients of the control group, from the control group there were no significant changes in the values of the defined parameters as compared to their initial values after six months. But there were changes of statistical significance (p < 0.001) in values of the concentrations of the exeminated parameters before and after the treatment in the tibolone group. In fact, we recorded decreases in the total cholesterol by 17.8%, HDL cholesterol by 27%, LDL cholesterol by 4% (without statistical significance p > 0.05) and triglicerids by 35%. There were no statistical differences in the concentrations of antitrombin III, fibrionogen, and C-reactive proteine in the tibolone group before and after the treatment. Conclusion. The use of tibolone dose decrease the concentration of the total cholesterol, triglicerides, HDL cholesterol, without a significant decrease of LDL cholesterol. Also, the use of tibolone does not have any significant effect on the concentrations of antitrombin III, fibrinogen and C-reactive proteine. The number of serum parameters measured in this study was limited, thus that was the reason to discuss only about the metabolism of lipids in the patients from the tibolone group. The final conclusion about the risk for cardiovascular diseases in the patients on tibolone, howerer, reqnires were extensive further clinical exeminations.
Liver damage caused by hepatitis C viral infection and ethyl alcohol consumption
Authors: Kostic Velimir , Jovanovic Maja , Konstantinovic Ljiljana , Kostic Emina , Mihailovic Vesna
Published: December 2010

Background/Aim. Hepatitis C virus infection (HCV) is a complex disease, most commonly chronicle (80-85%). The aim of this research was to determinate the level of the liver damage in the patients cansed by HCV in conjunction with consuming ethyl alcohol. Methods. The research included 15 patients with chronic HCV infection supported by the misuse of ethyl alcohol, as well. The diagnosis of C infection hepatitis was proved using the ELISA test and PCR method. Results. The results of the study showed the liver damage by both HCV infection and ethyl alcohol, which was verified by the presence of biochemical changes and patohystological processing of the patients (liver biopsy and prosection). Patohystological changes were at the level of liver cirrhosis and carcinoma (2 patients). There was a signficant difference between the two subgroups (p < 0.001) regarding the examined values ?-GT, PLT and PTV. The basic therapeutic procedure was to introduce this category of patients into alcohol abstinence, and, in a few patients, to apply the antivirus therapy, as well. Conclusion. Based on the number of the examined patients (n = 15), we could conclude that a prolonged ethyl alcohol misuse with the presence of HCV infection was in a correlation with the liver disease progression.
Human ehrlichiosis
Authors: Djokic Milomir , Curcic Petar , Nozic Darko , Lako Branislav , Begovic Vesna , Rajic-Dimitrijevic Radmila , Hristovic Dejan
Published: December 2010

Background. Human ehrlichiosis is a newly recognized disease. It is a tick-borne disease caused by several bacterial species of the genhus Erlichia. These are small gram-negative pleomorphic cocci, that are obligatory intracellular bacteria. Tick Ixodes is the principle vector in Europe, and Amblyomma americanum in the United States. Bacterial organisms replicate in a tick, and are transmited from infected cells in a vector to the blood cells of animals or humans. Human ehrlichiosis is a name for a group of diseases caused by different species of Ehrlichia. One of them is the disease named human monocytic ehrlichiosis, caused by Ehrlichia chaffeensis, and the other is a human granulocytic ehrlichiosis caused by Anaplasma phagocytophilia. Case report. We reported a 23-year-old patient admitted for the clinical treatment with the symptoms of high febrility (above 40 ?C), headache, vomiting, general weakness and exhaustion, but without data on a tick bite. The patient was treated with trimetoprim-sulfamethoxazole for a week when Ehrlichia chaffeensis was confirmed by the immunofluoroscence test, and the therapy contimed with doxacyclin. Conclusion. Human ehrlichiosis is also present in our country, so this disease should be considered everyday, especially in infectology practice.
Relation between both oxidative and metabolic-osmotic cell damages and initial injury severity in bombing casualties
Authors: Vuceljic Marina , Zunic Gordana , Romic Predrag , Jevtic Miodrag
Published: December 2010

Background/Aim. We have recently reported the development of oxidative cell damages in bombing casualties within a very early period after the initial injury. The aim of this study, was to investigate malondialdehyde (MDA), as an indicator of lipid peroxidation, and osmolal gap (OG), as a good indicator of metabolic cell damages and to assess their relationship with the initial severity of the injury in bombing casualties. Methods. The study included the males (n = 52), injured during the bombing with the Injury Severity Score (ISS) ranging from 3 to 66. The whole group of casualties was devided into a group of less severely (ISS < 25, n = 24) and a group of severely (ISS ? 26, n = 28) injured males. The uninjured volunteers (n = 10) were the controls. Osmolality, MDA, sodium, glucose, urea, creatinine, total bilirubin and total protein levels were measured in the venous blood, sampled daily, within a ten-day period. Results. In both groups of casualties, MDA and OG levels increased, total protein levels decreased, while other parameters were within the control limits. MDA alterations correlated with ISS (r = 0.414, p < 0.01), while a statistically significant correlation between OG and ISS was not obtained. Interestingly, in spite of some differences in MDA and OG trends, at the end of the examined period they were at the similar level in both groups. Conclusion. The initial oxidative damages of the cellular membrane with intracellular metabolic disorders contributed to the gradual development of metabolic-osmotic damages of cells, which, consequently caused the OG increase. In the bombing casualties, oxidative cell damages were dependent on the initial injury severity, while metabolic-osmotic cell damages were not.
Immunohistochemical analysis of α-SMA and GFAP expression in liver stellate cells
Authors: Tomanovic Nada , Boricic Ivan , Brasanac Dimitrije
Published: December 2010

Background/Aim. Liver stellate cells play an important role in hepatic fibrosis, and its progression to cirrhosis. These cells show immunoreactivity with different monoclonal antibodies amongst which the commonest are ?-smooth muscle actin (?-SMA) and glial fibrillary acid protein (GFAP). The aim of this study was to analyze stellate cell immunoreactivity for ?-SMA and GFAP in tissue sections showing the signs of chronic viral B-hepatitis and compare it with those without histopathological changes. Methods. We included 12 tissue samples showing chronic viral B hepatitis in the different stages of fibrosis and 7 tissue samples showing no histopathological changes. Immunohistochemical staining was performed using the streptavidinbiotin method. Results. There was a regular presence of ?-SMA immunoreactivity in tissue sections without histopathological changes in the portal tracts and also in liver parenchyma, while GFAP expression was noted in the periportal cavity. Tissue sections with the signs of chronic viral B hepatitis displayed very strong ?-SMA expression in the portal tracts. A statistical analysis showed a positive correlation between the degree of liver fibrosis and ?-SMA expression along the fibrous septa, whereas a negative correlation between the degree of liver fibrosis and ?-SMA expression was present in the portal zone. Conclusion. This study showed the existance of two different stellate cell subpopulations in liver tissue. Differentiation between them was possible on the basis of SMA/GFAP expression.
Gender differences in psychopathologic features of agoraphobia with panic disorder
Authors: Latas Milan , Mitrovic Mihajlo , Starcevic Vladan
Published: December 2010

Background/Aim. To examine gender differences in the major psychopathologic features in agoraphobia with panic disorder. Method. The study was conducted as a clinical study. The sample consisted of 119 patients, 32 men (26.9%) and 87 women (73.1%) with the basic diagnosis of agoraphobia with panic disorder. All the patients were evaluated with the clinical instruments suitable for the assessment of various clinical features associated with agoraphobia with panic disorder - questionnaires (the Hopkins Symptom Checklist 90, the Panic Appraisal Inventory, the Fear Questionnaire, the Beck Anxiety Inventory, and the Beck Depression Inventory), and the clinical rating scale (the Panic and Agoraphobia Scale). After the data collection, the sample was divided into two groups by the gender. Then the groups were compared. Results. There were no differences between the genders in the global psychopathologic features (the age at the onset of a disorder, duration of a disorder, severity and frequency of panic attacks, intensity of general psychiatric symptoms, intensity of general anxiety and depression). The women, however, reported a subjective perception of a more severe agoraphobic avoidance and males were significantly more likely than the females to anticipate the serious somatic consequences of panic attacks and worry about somatic health. Conclusion. There were a few gender specific psychopathologic features in patients with agoraphobia with panic disorder, so further studies would be necessary to come to a more precise conclusion.
Soft tissue myoepithelial carcinoma
Authors: Stojsic Zorica , Brasanac Dimitrije , Bacetic Dragoljub , Jankovic Radmila , Drndarevic Neda
Published: December 2010

Background. Myoepitheliomas are tumors composed predominantly or exclusively of myoepithelial cells, usually arising in salivary glands. Cutaneous/soft tissue localization is very rare, especially for the malignant myoepitheliomas. Case report. We presented a case of myoepithelial carcinoma involving subcutaneous adipose tissue of the left forearm in a woman aged 62 years. The tumor was composed of epithelioid and hyaline cell types, arranged in diffuse sheets, nests and loose clusters within hyalinized and myxoid matrix. The neoplasm displayed high-grade cytologic atypia with some cells having pleomorphic, hyperchromatic nuclei, and others showing vesicular nuclei, large nucleoli with scattered bizarre giant cells. High mean mitotic count of 7 mitoses/10 high power fields and extensive necrosis favored the diagnosis of malignancy. Immunohistochemical staining was positive for cytokeratin (AE1/AE3), epithelial membrane antigen, S-100 protein, glial fibrillary acidic protein, and vimentin. Conclusion. Considering the subcutaneous localization, myoepithelial immunophenotype and high-grade cytologic atypia the neoplasm was classified as a soft-tissue myoepithelial carcinoma.
Immunohistochemical analysis of angiogenesis in invasive ductal breast carcinoma with correlations to clinic pathological factor
Authors: Ivkovic-Kapicl Tatjana , Knezevic-Usaj Slavica , Panjkovic Milana , Mastilovic Katarina
Published: December 2010

Background/aim: Angiogenesis is the formation of new vessels from preexisting ones. The aim of our study was to determine the relevance of tumor-induced angiogenesis, its correlation with some of the commonly used clinical, pathological factors and the recent biological indicators, and metastatic potential of the tumor in a series of 120 patients with invasive ductal carcinoma of the breast. Methods. The identification of microvessels was performed immunohistochemically with factor VIII-related antigen. The microvessel count (MVC) was assessed at the invasive front of each carcinoma. The cases were divided into high-and low-microvessel density groups according to an average number of microvessels found in the multiple fields of the most vessel-dense part of each tumor. The nuclear immunohistochemical staining for hormone receptors, and the p53, and the membranous staining for cerbB-2 were evaluated. Results. There were significant correlations between a high MVC and a large tumor size, high histological grade, and c-erbB-2 protein over expression. There was no association between tumor angiogenesis, as assessed by the MVC, and the hormone receptors status, and the p53 protein expression. In the cases with a high MVC, there was a significant number of tumors with lymph node metastases. Conclusion. Our findings showed that a high MVC might point out an aggressive tumor phenotype. This might help to stratify patients for an appropriate therapy on an individual basis and, thus, offer the possibility of a more effectively tailored treatment program.