bluuebunny/crossref_metadata_2025 huggingface dataset:
White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health.
Authors: Bhopal R , Donaldson L
Published: November 2008

The request for scientifically appropriate terminology in research on race, ethnicity, and health has largely bypassed the term White. This and other words, such as Caucasian, are embedded in clinical and epidemiological discourse, yet they are rarely defined. This commentary analyzes the issue from the perspective of the epidemiology of the health of minority ethnic and racial groups in Europe and the United States. Minority groups are usually compared with populations described as White, Caucasian, European, Europid, Western, Occidental, indigenous, native, and majority. Such populations are heterogeneous, the labels nonspecific, and the comparisons misleading. Terminology that reflects the research purpose-for examples, reference, control, or comparison--is better (unlike White, these terms imply no norm, allowing neither writers nor readers to make stereotyped assumptions about the comparison populations. This paper widens the debate on nomenclature for racial and ethnic groups. Many issues need exploration, including whether there is a shared understanding among the international research community of the terms discussed.
The effect of WIC participation on small-for-gestational-age births: Michigan, 1992.
Authors: Ahluwalia I B , Hogan V K , Grummer-Strawn L , Colville W R , Peterson A
Published: November 2008

OBJECTIVE: This study examined the relationship between enrollment in the Special Supplemental Nutrition Program for women, Infants, and Children (WIC) and delivery of small-for-gestational-age infants. METHODS: WIC records were linked with birth certificates for 1992 full-term births; 41,234 WIC records and 18,34 non-WIC records were identified. Length of participation was defined by gestational age at enrollment. Logistic regression was used to examine the association between WIC participation and small-for-gestational-age births. RESULTS: Odds ratios for small-for-gestational-age birth decreased with increasing length of enrollment in WIC. CONCLUSIONS: Enrollment in WIC is associated with a lower prevalence of small-for-gestational-age deliveries.
A comparison of the effect of different bicycle helmet laws in 3 New York City suburbs.
Authors: Puder D R , Visintainer P , Spitzer D , Casal D
Published: November 2008

OBJECTIVES: This study was conducted to evaluate the effectiveness of 3 different bicycle helmet laws. METHODS: A direct observational study of nearly 1000 cyclists at 20 matched sites in each of 3 contiguous counties--Rockland and Westchester in New York and Fairfield in Connecticut--was carried out. Rockland's bicycle helmet law requires approved helmets for all cyclists regardless of age; Westchester's, by state law, requires cyclists younger than 14 years to wear helmets; and Fairfield's, also by state law, requires cyclists younger than 12 years to wear helmets when riding on highways. RESULTS: Rockland cyclists had the highest helmet use rate (35%), followed by Westchester (24%) and Fairfield (14%) cyclists. As a subgroup, teenagers used helmets least, a trend that was seen in all 3 counties. CONCLUSIONS: Our study suggests a positive effect of bicycle helmet legislation with no age limitation.
Ischemic stroke risk and passive exposure to spouses' cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group.
Authors: You R X , Thrift A G , McNeil J J , Davis S M , Donnan G A
Published: November 2008

OBJECTIVES: This study investigated the association between ischemic stroke risk and passive exposure to cigarette smoking. METHODS: Risk factors among 452 hospitalized cases of first-episode ischemic stroke were compared with 452 age- and sex-matched "neighbor-hood" controls. RESULTS: The risk of stroke was twice as high for subjects whose spouses smoked as for those whose spouses did not smoke (95% confidence interval = 1.3, 3.1), after adjustment for the subject's own smoking, heart disease, hypertension, diabetes, and education level. These results were confirmed when analysis was limited to those who never smoked. CONCLUSIONS: These findings provide evidence that spousal smoking may be a significant risk factor for ischemic stroke.
Weekly patterns of drug treatment attendance.
Authors: Svikis D S , Pickens R W , Schweitzer W , Johnson E , Haug N
Published: November 2008

OBJECTIVES: This study examined weekly patterns of drug treatment attendance in relation to date of welfare payment receipt and reason for treatment absence. METHODS: Treatment attendance by Medicaid-eligible pregnant women who were drug dependent was examined by calendar week over a 29-month period. RESULTS: Time series analyses showed that attendance was lower during week 1 than week 4. Drug use was the most frequently reported reason for treatment absence during week 1 (25%) but was not reported as a reason during week 3. CONCLUSIONS: Drug-dependent outpatients had increased absences associated with illicit drug use during the first week of the month when welfare payments were received. The generalizability of the findings is unknown.
Building momentum: an ethnographic study of inner-city redevelopment.
Authors: Fullilove M T , Green L , Fullilove R E
Published: November 2008

OBJECTIVES: One factor contributing to the decay of inner-city areas, and to consequent excess mortality, is the massive loss of housing. This report studied the effects of a redevelopment project on social functioning in an inner-city community. METHODS: This ethnographic study included the following elements: a longitudinal study of 10 families living in renovated housing, repeated observations and photographing of the street scene, focus groups, and informal interviews with area residents. The project was located in the Bradhurst section of Harlem in New York City and was focused on a redevelopment effort sponsored by local congregations. RESULTS: Those who were able to move into newly renovated housing found that their living conditions were greatly improved. Neighborhood revitalization lagged behind the rehabilitation of individual apartment houses. This uneven redevelopment was a visual and sensory reminder of "what had been." Residents missed the warmth and social support that existed in Harlem before its decline. CONCLUSIONS: Rebuilding damaged housing contributes greatly to the well-being of inner-city residents. The current pace and scope of rebuilding are insufficient to restore lost vitality.
Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey.
Authors: Walkup J , Crystal S , Sambamoorthi U
Published: November 2008

OBJECTIVES: This study sought to identify and characterize seriously mentally ill patients with HIV infection. METHODS: Medicaid beneficiaries with HIV/AIDS were identified through the merging of New Jersey HIV/AIDS Registry and Medicaid eligibility files. Claims histories were used to classify individuals as having schizophrenia, major affective disorder, or no serious mental illness. RESULTS: Of 8294 individuals, 476 (5.7%) were classified as having schizophrenia, and 564 (6.8%) were classified as having major affective disorder. Those with serious mental illness were more likely than other groups to be injection drug users and to have claims indicative of substance abuse. CONCLUSIONS: Individuals with serious mental illness are a significant but little-recognized subgroup of those with HIV infection.
Diesel exhaust exposure among adolescents in Harlem: a community-driven study.
Authors: Northridge M E , Yankura J , Kinney P L , Santella R M , Shepard P , Riojas Y , Aggarwal M , Strickland P
Published: November 2008

OBJECTIVES: This study sought individual-level data on diesel exhaust exposure and lung function among adolescents in Harlem as part of a community-driven research agenda. METHODS: High school students administered in-person surveys to seventh grade students to ascertain information on demographics, asthma history, and self-reported and maternal smoking. Urine samples were assayed for 1-hydroxypyrene (1-HP), a marker of diesel exhaust exposure, and cotinine, a marker of tobacco smoke exposure. Computer-assisted spirometry was used to measure lung function. RESULTS: Three quarters (76%) of the participating students had detectable levels of 1-HP. Three students (13%) had an FEF25-75 of less than or equal to 80% of their predicted measurements, and 4 students (17%) had results between 80% and 90% of the predicted value, all of which are suggestive of possible lung impairment. CONCLUSIONS: These data suggest that most adolescents in Harlem are exposed to detectable levels of diesel exhaust, a known exacerbator and possible cause of chronic lung disorders such as asthma. Community-driven research initiatives are important for empowering communities to make needed changes to improve their environments and health.
Treatment Outcomes and Costs of Dental Sealants Among Children Enrolled in Medicaid
Authors: Weintraub Jane A. , Stearns Sally C. , Rozier R. Gary , Huang Cheng-Chung
Published: November 2008

Objectives. This retrospective cohort analysis of children enrolled in the North Carolina Medicaid program compared the likelihood of restorative treatments and associated cumulative Medicaid expenditures for teeth with or without dental sealants.

Methods. We assessed the dental experience of the cohort of 15 438 children from 1985 to 1992 on the basis of enrollment and claims files. We conducted regression analyses for outcomes (caries-related services involving the occlusal surface [CRSOs] of permanent first molars) and cumulative expenditures, controlling for characteristics of the child, the treating dentist, and the child's county of residence.

Results. Overall, 23% of children received at least 1 sealant and 33% at least 1 CRSO. Sealants were effective in preventing CRSOs, although the degree of effectiveness was highest for children with the greater levels of CRSOs before sealant placement. Estimated cumulative Medicaid expenditures indicated expenditure savings from sealants within 2 years of application for children with 2 or more prior CRSOs.

Conclusions. Sealant placement was associated with expenditure savings to Medicaid for certain high-risk children, so Medicaid and, more broadly, society will benefit by providing for sealant placement in these children.
Increasing Voluntary HIV Testing by Offering Oral Tests in Incarcerated Populations
Authors: Bauserman Robert L. , Ward Michael A. , Eldred Lois , Swetz Anthony
Published: November 2008

Objectives. This study reports responses of incarcerated persons to voluntary blood and oral HIV testing.

Methods. Males and females in local detention and juvenile justice facilities in Maryland (n = 1314) chose oral or blood testing and reported reactions to the oral HIV test. The relationship of demographics and HIV risk factors to test choice was examined.

Results. Reactions to oral testing were very favorable; some participants reported that they would not otherwise have been tested. Participants who chose oral testing were more likely to be male and African American, but they did not differ from those who chose blood testing in most risk factors or in seroprevalence.

Conclusions. Oral HIV testing in correctional settings may promote voluntary testing among persons who otherwise would refuse or avoid testing, especially among groups (males and African Americans) disproportionately affected by HIV.
Calculating pH in pig manure taking into account ionic strength
Authors: Nielsen A. M. , Spanjers H. , Volcke E. I. P.
Published: November 2008

We regret that as a result of an error in production equation (6) in Table 3 on p1786 was incorrectly reproduced. The correct version of the equation is shown below:
Full-scale application of focused-pulsed pre-treatment for improving biosolids digestion and conversion to methane
Authors: Rittmann Bruce E. , Lee Hyung-sool , Zhang Husen , Alder Jared , Banaszak James E. , Lopez Ronald
Published: November 2008

We tested at full-scale the innovative Focused Pulsed (FP) technology for pre-treating waste sludge in order to improve methane gas production and biosolids reduction in sludge digestion, but without incurring problems of odors, toxicity, and high costs for chemical or energy consumption. FP pre-treatment of a mixture of primary and secondary sludge increased the soluble COD by 160% and DOC 120% over the control. FP pre-treatment of 63% of the input waste sludge increased biogas production by over 40% and reduced biosolids requiring disposal by 30% when compared to the plant baseline. FP pre-treatment also correlated with a shift of the bacterial and archaeal communities. The most significant change was that the acetate-cleaving Methanosaeta became the dominant methanogen. Full FP pre-treatment should increase biogas production and biosolids removal by 60% and 40%, respectively. Full FP pre-treatment should generate energy benefits of at least 2.7 times and as high as 18 times the FP energy input, depending on heat recovery from FP treatment. For a plant treating 76,000 m3/d of wastewater (380 m3-sludge/d), FP treatment should generate an annual economic benefit of approximately $540,000 net of electricity and other operating and maintenance costs. This represents a payback period of three years or less.
Application of ozonation to reduce biological sludge production in an industrial wastewater treatment plant
Authors: Albuquerque J. S. , Domingos J. C. , Sant'Anna G. L. , Dezotti M.
Published: November 2008

Biosolids production in the activated sludge process generates an additional cost to wastewater treatment plants due to the growing requirements for sludge treatment and disposal. This work focuses on the application of ozonation to reduce sludge production in an industrial wastewater treatment plant. The results show that ozonation was able to promote cell wall rupture, releasing intracellular matter into the liquid medium. This effect was observed by the increase in concentrations of DNA (1.14 to 7.83 mg/L) and proteins (0.5 to 45.602 mg/L) in the liquid phase, when ozonation was applied during 10 min, using 30 mg/L of ozone. Reduction of sludge production was assessed by calculating the observed sludge yield coefficient (Y) in bench-scale continuous experiments conducted with varying proportions of ozonated sludge in the recycle stream and recycle ratios. Reduction of sludge production ranged from 14 to 39%, depending on the experimental conditions. The best result in terms of sludge excess reduction was achieved when 20% of the recycle sludge was ozonated and the recycle ratio was 0.67.
Characterisation of biofilm constituents and their effect on membrane filterability in MBRs
Authors: Ng T. C. A. , Ng H. Y.
Published: November 2008

Fouling is still one of the main issues in the operation of membrane bioreactors (MBRs). While most attention has been paid to extracellular polymeric substances (EPS) and soluble microbial products (SMP) in the bulk solution, changes in membrane filterability may be more adequately described by the structural characteristic of the fouling layer or biofilm. This study shows that membrane filterability and the rise in TMP is associated to the changes in the biofiom structure, and polysaccharides may be the most significant fraction that affects fouling.
A contribution to solve the arsenic problem in groundwater of Ganges Delta by in-situ treatment
Authors: Rott U. , Kauffmann H.
Published: November 2008

Arsenic in groundwater is a huge problem in numerous regions of the world. Many people are exposed to high arsenic concentrations and consequently risk getting ill or even die as a result of arsenic poisoning. There are several efficient technologies for the removal of arsenic but often these methods have disadvantages, e.g. high costs for installation and/or operation, the need for chemicals or the production of arsenic contaminated filter sludge. These disadvantages can make the application difficult, especially in poor regions. Under suitable ancillary conditions the subterranean (in-situ) treatment, which is often used for iron and manganese removal from groundwater, can also be applied for the removal of arsenic and can be a cost-effective treatment technology. A field trial was carried out with a low-cost in-situ treatment plant in West Bengal/India which is described in this paper, in order to investigate whether this treatment technology is also applicable under the boundary conditions there. As for the in-situ treatment technology besides oxygen no additives are required and no arsenic contaminated filter sludge is produced this technology could be a suitable method for arsenic removal especially in poor regions.
Monitoring of transparent exopolymer particles (TEP) in a membrane bioreactor (MBR) and correlation with other fouling indicators
Authors: de la Torre T. , Lesjean B. , Drews A. , Kraume M.
Published: November 2008

The occurrence of Transparent Exopolymer Particles (TEP), an acidic fraction of polysaccharides, was monitored for more than six months in the activated sludge of three MBR units, and the relationship between TEP and other fouling indicators was studied. These compounds consist mainly of exopolysaccharides of a sticky nature, a characteristic which makes them a group of interesting substances in processes like sedimentation, flocculation and membrane fouling. The relationship between capillary suction time (CST) and polysaccharides (PS) was linear for the three tested sludges, although the correlation with TEP concentrations was stronger. A slight linear correlation of both TEP and PS was found with the critical flux (CF) measured with a small filtration test cell, which was submerged in the membrane tank to assess the filterability performance of the sludge in situ. However, the correlation CF-PS was clearer. The relationship between TEP, polysaccharides and sludge filterability highlights the potential of this parameter for the monitoring of membrane systems.
Constructed wetland treatment system in textile industry and sustainable development
Authors: Davies L. C. , Pedro I. S. , Ferreira R. A. , Freire F. G. , Novais J. M. , Martins-Dias S.
Published: November 2008

This study focuses on the evaluation of the adequacy and sustainability of a constructed wetland (CW), with vertical flow (VF) design to treat a strongly coloured textile wastewater.

Secondly an accidental AO7 overloaded discharge (700 mg l−1) was studied. A set of three similar VFCW beds (3 × 1 m2), operating in series, allowed also the efficient treatment of the AO7 heavy loaded wastewaters. The treated effluent quality enables water reuse for irrigation purposes or within the process.
AN EXAMINATION OF CULTURAL DIFFERENCES IN ETHICAL DECISION MAKING USING the MULTIDIMENSIONAL ETHICS SCALE
Authors: Lin Chieh-Yu , Ho Yi-Hui
Published: November 2008

The Multidimensional Ethics Scale (Reidenbach & Robin, 1988, 1990) was applied to accounting-specific scenarios to measure students' ethical decision-making attitudes towards accounting ethics. Accounting students in the US and Taiwan were taken as research subjects. A total
of 201 US students and 396 Taiwanese students were analyzed. US students made ethical decisions significantly based on justice and egoism dimensions, while Taiwanese students focused on justice and deontology dimensions.
COMMUNICATION SKILL LEVELS IN TURKISH PROSPECTIVE TEACHERS
Authors: Yuksel-Sahin Fulya
Published: November 2008

The author of this study tested whether Turkish prospective teachers' levels of communication skill differed significantly according to submissive acts, self-images drawn from social comparisons, and several other personal variables. A total of 274 persons participated in this study. The Communication Skills Assessment Scale (Korkut, 1996), The Submissive Acts Scale (Gilbert & Allan, Turkish version Sahin & Sahin, 1992), The Social Comparison Scale (Gilbert & Allan, Turkish version Sahin & Sahin, 1992) and a personal information form developed by the author were used for data collection. Results showed that individuals with a positive self-image, those who perceived themselves as popular and assertive, those coming from a higher income status, and individuals with perceived democratic parental styles reported higher levels of communication skills. No significant differences were found in prospective teacher's communication skills according to submissive acts.
Mesto strikturoplastike u lecenju Crohn-ove bolesti
Authors: Popovic Milos , Petrovic Milorad , Matic Slavko , Milovanovic Aleksandar
Published: November 2008

Crohn's disease is pandigestive disease of unknown ae-thiology, with tendency to recurrences. Until now it is impossible to heal this disease either by medical or surgical treatment. All unfavorable consequences of this disease are result of inadequate treatment of complications which are leading to systemic weakening, with further progression of morbid process. Therefore, the principle of timely and minimal invasive surgical procedure has been generally adopted. Introduced in eighties, strictureplasty is a procedure of such characteristics. During the period 1980-2001 this method was used in 1/3 of 126 patients with Crohn's disease. There were 79 strictureplaties performed, 9 long and 70 short. Out of these 42, 12(28,6%) were postoperative recurrences, and there was one case of duodenal strictureplatsty. Postoperative small bowel fistulae were not observed, and there was no mortality in this group. During the follow up period of at least 5 years, in only two cases (4,76%) some functional disturbances of digestive functions were observed, without indications for reoperation. In this article indications and details of operative technique are discussed.
Uloga Swan-Ganz PA katetera u proceni hemodinamskih promena tokom hirurske revaskularizacije miokarda u bolesnika sa oslabljenom funkcijom leve komore
Authors: Jovic M. , Popovic Zoran , Nezic Dusko , Ilic V. , Gradinac Sinisa , Babic M. , Kenkovski A. , Radomir Bosko
Published: November 2008

Coronary artery bypass surgery in patient with bad left ventricular function is a challenge for surgical time. Specially important is monitoring of haemodynamics. We performed this open, prospective, randomized study with the aim to assess haemodynamics and oxygen profile monitoring. 34 pts for coronary surgery (EF < 40%) were divided in two groups. Group A, 17 pts. Received glucose-insulin-potassium (GIK) solution. Group B, 127 pts. Received Ringer solution. Haemodynamic and oxygen metabolism parameters were measured in four time points. I after the induction in anesthesia; II after the operation; III 6 hours post op.; IV 24 hour post op. Data are expressed as mean +/-SD, ANOVA for repeated measures followed by Newman-Keuls testing were used. In both groups were evident deterioration of cardiac function during first 6h as well as VO2 and DO:, more prominent in Group B. Significant recovery and improvement of cardiac function were evident in Group A after 24 h. CI during the time in Group A improves significantly (2.14+/-0.36 v. 3.05+/-0.55; p=0.0002) and difference during the time between groups was p=0,005. LVSWI improved significantly during the time him Group A (AIII vs. AIV) p=0.007. Simultaneously. VO improves significantly in Group A (103+/-21 vs. 164+/-30, p=0.00001) while difference between groups in DO was p=0.037. Importance of oxygen metabolism monitoring for both, left ventricular function and haemodynamics assessment was evident in our study.
Anestezija kod bolesnika sa diabetes mellitusom
Authors: Rankovic Vitomir , Micic D. , Bumbasirevic Vladimir , Palibrk I. , Basic Marica , Bukumirovic V.
Published: November 2008

Pojava diabetes mellitusa se u zadnjih 30 godina stalno povecava, kako kod odraslih, tako i kod dece. Svetska zdravstvena organizacija procenjuje da ce se broj bolesnika sa diabetes mellitusom povecati sa sadasnjih 150 miliona na 213 miliona do kraja 2010. godine. Dijagnoza diabetesa mellitusa ne postavlja se tesko ukoliko su ispoljeni osnovni simptomi, kao sto su pojacan osecaj zedji, poliurija, polifagija i povecana koncentracija glukoze u krvi. Uzorak krvi se uzima ujutru na prazan stomak. Postupak se ponavlja 2 puta. Granicna vrednost glikemije je 7,8 mmol/l. Ukoliko nije utvrdjena povecana vrednost glukoze u krvi, a postoje ostali simptomi diabetes mellitusa, neophodno je uraditi test opterecenja glukozom.
Kombinovana primena unutrasnje mamarne i desne gastroepiploicne arterije u revaskularizaciji miokarda sa i bez primene vantelesnog krvotoka
Authors: Milojevic Predrag , Neskovic Vojislava , Stojanovic Dragan , Jakovljevic M. , Sagic Dragan , Djukanovic Bosko
Published: November 2008

Use of arterial grafts represent the new approach in coronary artery bypass grafting (CABG) surgery these days. This article represents our experience in use of two or more arterial grafts in combination (internal mammary artery - IMA and right gastroepiploic artery - RGEA). Between March 2000 February 2002, 10 patients underwent CABG with exclusive use of left or both IMAs and RGEA, with or without extracorporal circulation (ECC). In the group without ECC fast truck anesthesia was used. Post CABG catheterization was performed in three patients. There were no 30 day mortality or morbidity. Post CABG catheterization in two patients showed excellent graft patency. One patient continued to have chest pain and after the catheterization we found ostial narrowing of the celiac trunck which was successfully dilated. One of participants had abdominal hernia repair. Our opinion is that use of arterial grafts in CABG surgery has much lower risk, excellent patency and good long term prognosis.
Novelties in cardiopulmonary resuscitation of adults
Authors: Jovanovic N.
Published: November 2008

In the paper it is presented novelties in cardiopulmonary resuscitation of adults. It was indicated to importance of maintenance of cardiac output as main factor of successful resuscitation. In was pointed out defibrillation by automatic external defibrillators (AED), especially of biphasic type. Recapitulation of the novelties was also stated.
Where to incise and/or divide the cystic duct
Authors: Ignjatovic D. , Djuric B. , Zivanovic V.
Published: November 2008

The study concern was to establish the position of cystic duct incision/division in circumstances of laparoscopic cholecystectomy. Seventy consecutive human cadavers were dissected. Corrosion casting (50) and post-mortem cholangiography (20) were employed. Cystic duct length was 34.6 mm, and in 88.6 % cases its length was 1-5 cm. Mean cystic duct diameters next to the gallbladder neck, within the valve and 5 mm proximal to the junction with the common hepatic duct were 1.95, 0.42 and 1.85 mm, respectively. Lateral cystohepatic junction was identified in 78.6%, spiral in 10% and parallel in 10%. In 90% cases the cystohepatic junction is within 4 cm of the hepatic duct junction. One case (1.43%) of cystic duct entering the right hepatic duct was identified. The valve of Heisteri consisted of three spiral turns in 73% of the cases with a range from 0 to 5. In 3/70 specimens the spiral valve did not exist.
Sphincter and nerve preserving total mesorectal excision
Authors: Heald Richard
Published: November 2008

The summer of 2002 has seen the introduction of two new key words in the literature on rectal carcinoma. The words are TME Workshop. Papers attesting to a major impact on rectal cancer outcomes in Norway , Sweden, and Holland, are the background to two major papers in the August British Journal of Surgery, one from Ireland and one from Sweden plus a leading article from a professor in Singapore entitled "Adjuvant therapy for rectal cancer cannot be based on the results of other surgeons".
What role, if any, for laparoscopis surgery in Chron's disease of the hindgut?
Authors: Ignjatovic D. , Bergamaschi R.
Published: November 2008

An outsider to the Held of surgery would probably take it for granted that surgeons have a highly developed rationale for choosing a laparoscopic approach to Crohns disease. After all, an increasing number of surgeons are performing laparoscopic surgery for Crohn's disease as witnessed by several articles published in the 1990s (Table)1-19. In fact this is not quite true. Most papers are case reports or series without controls, capable only of suggesting feasibility. Furthermore, comparison studies often feature selection flaws, and therefore beg the question of whether laparoscopic surgery should or not be considered as standard care. An attempt is made herein to give readers a concise insight of the evidence available in the English language literature. It does not pretend to offer a comprehensive review of the topic rather, it highlights some relevant issues, and then outlines what role, if any, laparoscopic surgery should play in Crohn's disease. There are at least 6 categories for discussion.
Local recurrence and five year survival after abdominoprineal resection of the rectum due to the rectal carcinoma
Authors: Krivokapic Zoran , Barisic Goran , Markovic V. , Popovic Milos , Antic Sladjan , Jovanovic Dejan , Protic S. , Micev Marjan , Adanja G. , Saranovic Djordjije , Stevovic Dragoslav
Published: November 2008

In the period 01.01.1991 - 12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65,2%. In the middle third, there were 28,9% and in the upper, intraperitoneal third 5,9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4,9% cased with Dukes D stage). There were 74,3% males and 23,7% females median age 59,2 years. According to Dukes classification there were 4,9% in stage A, 47,2% in stage B, 43,1% stage C, and 4,9% stage D. There were 4 (2,7%) postoperative deaths. Recurrence of the disease was registered in 44 (30,5%) patients. Local recurrence alone was found in 14 (9,7%) patients, while distant spread was registered in 30 (20,8%) patients. At present, the median follow-up is at 72,9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63,4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; sur-M\al after 60 months of follow up shows cumulative Survival of 0,35 while Dukes B has far better prognosis (0,86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0,36 after 60 months), while stage B has much better prognosis (0,84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84,9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1,00% disease free survival for cases in stage A, 0,94 for Dukes B and 0,66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p=0,005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.
Radio (chemo) therapy in locally advanced rectal cancer
Authors: Radosevic-Jelic Ljiljana
Published: November 2008

Radiotherapy has an role in combined treatment to lower local recurrence in resectable rectal cancer. Radiotherapy also has an established role in nonresectable rectal cancers to increase the operability, but radiochemotherapy is more efficient. Radiotherapy can be administered as a transcutaneous therapy on the megavoltage machines as well as brachytherapy and combined - transcutaneous and brachtherapy.
Risk factors in the recurrence of the colorectal cancer
Authors: Ulanska J. , Dziki A. , Langner W.
Published: November 2008

Traditionally, the clinical outcome of colorectal cancer patients may be predicted by pathological staging by either Dukes staging or the UICC-TNM system. However, some of Dukes stage A (approximately 10% of patients) and Dukes B patients (30-40%) will develop local recurrence or distant metastasis years after receiving standard surgical treatments. Therefore it is important to find some other indicators that can predict for recurrence so that we can screen for high-risk early-stage patients who may need preventive chemotherapy or other adjuvant therapy. The aim of this study is determination of risk factor for local recurrence in rectal cancer. In this study there has been used and summarized also research records and publications from different clinical hospitals according to actual international literature. Part of elements connected with patient, tumor and genetic and immunological factors remains independent on curative procedures. However better investigation these factors might affect on therapy, frequency of follow-up examinations, and help to detect recurrence at very early phase. Concomitant treatment factors are able to be moderate by surgeons and therapeutics. Therefore precise definition of risk factors might be helpful in decrease recurrence rate in patients with rectal cancer.
Micrometastatis in colorectal cancer
Authors: di Giacomo , Altomare D. , Guanti G.
Published: November 2008

Colorectal cancer is one of the most common malignancies in the word and can be usually cured if diagnosed at an early stage. In the European area the estimated number of new cases of cancer in 1995 were approximately 334.000 and 189.000 died of cancer in that year. Despite recent progress in early detection and surgical therapy, the mortality remained unchanged over the past decades. The major reason for this disturbing discrepancy is that occult dissemination of viable cancer cells can occur at any stage of tumorigenesis. Occult dissemination of the tumor cells in patients with operable cancer may be considered a determinant of subsequent metastasis formation. Several groups have therefore designed immunocytochemical and molecular assays to identify such minimal amounts of residual tumor cells that have successfully invaded secondary organs. The question whether circulating tumor cells represent metastatic dissemination or are merely cancer cells without metastatic potential that have detached from the primary tumor, has been debated for over half a century.
Septic complication after low anterior rectal resection: Is diverting stoma still justified?
Authors: Lecster B. , Asztalos I. , Polnyib C.
Published: November 2008

A retrospective study was designed to determine the effects of faecal diversion on the rate and severity of clinical anastomotic leaks after low anterior resection. The study explored the complications of stoma closure as well. During the period between 1 January 1995 and 30 July 2000, anterior rectal resection was performed on 249 patients with anastomoses created at a 6-cm or smaller distance to the dentate line. In 74 cases, the anastomosis was protected by loop ileostomy. The indications for creating a stoma were evaluated subjectively, by the operating surgeon. In 64 patients, the ileostoma was closed 3 months later. A "clinical leak" after anterior resection was defined as an anastomotic insufficiency with clinically relevant consequences. The overall rate of anastomotic leak was 6.4 per cent; it was 5.1% (9/175) without and 9.4% (7/74) with a protective stoma. In 8 out of 9 patients, the anastomotic leak that had occurred without a protective stoma warranted laparatomy and defunctioning colostomy. Lavage and drainage of the peritoneal cavity and the pre-sacral space were necessary in 6 out of these 8 cases - and furthermore, the deranged anastomosis had to be removed in 2 patients. Local management was successful in a single case only. Although relaparotomy entails long-term intensive care, all reoperated patients survived anastomotic leakage. Seven patients with a leak despite a protective did not require laparatomy; transanal drainage was appropriate in all cases. There were no fatalities in this group either. Only one fatal complication from suture leakage occurred after stoma-closure. Abdominal exploration was inevitable in almost all patients with a clinical anastomotic leak and without defunctioning stoma. By contrast, patients with anastomotic insufficiency despite a protective stoma were successfully managed without further intra-abdominal intervention. As shown by these results, faecal diversion undoubtedly mitigates the clinical consequences of anastomotic leaks, but cannot prevent its occurrence. When considering the cumulative risk of surgical complications associated with anterior resection, the complications of stoma-closure must also be taken into account. Our data confirm that a defunctioning stoma is beneficial for high-risk patients, who are unfit for a second abdominal procedure required to control suture leakage.
Surgical anatomy of the spleen with particular review on its segmentation
Authors: Ignjatovic D. , Stimec Bojan , Kostic Nada , Milicevic Miroslav
Published: November 2008

The authors have analyzed several aspects of the surgical anatomy of spleen, commencing with historical data, topography, peritoneal ligaments, variations in shape, embryology and accessory spleens and venous system of the spleen. The mode of splenic artery branching, variations of polar arteries, and intra- and extraparenchymatous arterial anastomoses were thoroughly analyzed. It was shown that the spleen in most cases consists of five vascular territories (segments) clearly demarcated from each other, stressing the practical significance of splenic anatomy in segmental dearterialization of the spleen.
Elektivna resekcija slezine - pregled tehnika resekcije i prikaz nove tehnike zasnovane na radiofrekventnoj koagulaciji i desikaciji
Authors: Milicevic Miroslav , Bulajic P. , Zuvela M. , Raznatovic Z. , Obradovic V. , Lekic Nebojsa , Palibrk I. , Basaric D.
Published: November 2008

The authors present a short overview of the development of elective splenic resections. Past and present indications are presented. Contemporary hemostatic technique for elective splenic resection are discussed. An original new technique for transsegmental partial splenic resection using RF generator (Radionic Cool Tip) without any additional hemostatic procedures is presented. This technique is inovative and when use properly it is a practically zero blood loss technique. A patient with transsegmental splenic resection using RF generator is presented. Further clinical application of the technique is necessary.
Preparation of haematological patients for splenectomy
Authors: Colovic Milica
Published: November 2008

enectomy in haematological patients is usually performed as an elective surgery. These patients may have thrombocytopenia or coagulation abnormalities which have to be corrected as much as possible before surgery. The increase of number of platelets may be achieved by increase of dose of steroids, with immunoglobulins, with danazol or by transfusion of platelets. The coagulation abnormalities are to be corrected by appropriate treatment. The risk of postsplenectomy sepsis may be reduced by proper preoperative vaccination and/or by antibiotics.
Long term follow up of splenectomised patients with idiopathic thrombocytopenic purpura
Authors: Elezovic Ivo , Boskovic Darinka , Colovic Milica , Tomin Dragica , Suvajdzic-Vukovic Nada , Gotic Mirjana , Colovic Radoje , Popovic M.
Published: November 2008

Splenectomy is definitive treatment for idiopathic thrombocytopenic purpura (ITP) because it removes both the sites of autoantibody producing cells and also the major site of platelet destruction. The purpose of this study was to evaluate long term results of splenectomised patients with ITP and to determine predictor factors for good response. A 167 patients with chronic ITP (136 females, 31 males), median aged 35 years (17-74) was splenectomised after 2 to 160 months (Median 12) from diagnosis of ITP. Indications for splenectomy were: 6 weeks of steroid therapy with platelet count below 10x10^9/l or 3 months with platelet count under 30xl0^9/l, or treatment with prednisone above 30 mg more of 6 months to increase platelet count over 30x10^9/l, or repeated relapses. Postoperative complications developed in 16 patients (9.5%), 3 of them died (1.8%) due to thromboembolism and 17 patients discontinued later controls. During follow up to 172 months (Median 62) 111/147 splenectomised patients were in remission (75.5%), 99 in complete (above 100x10^9/l), 12 in partial (50-100x109/l) and 36 patients (24.5%) were relapsed (below 50x10^9/l). Remission was achieved in 79/88 patients (89.8%) with good response to prednisone before splenectomy toward 32/62 patients (51.6%) with poor response to prednisone (p<0.01). Remission was obtained in 9/11 patients (81.8%) who responded well to intravenous immune globulin (0.4 g/kg x 5d) and only in 1/8 who did not (p<0.05). Higher response rate was achieved in patients under 40 years of age (81.6%) than in older ones (63.4%) (p<0.05). No difference was shown between sex and time intervals (3, 6, 12, 24, 36 or over 36 months) from diagnosis to splenectomy. Splenectomy is an effective treatment of refractory ITP with response rate of 75.5% after median follow up of 62 months. In our patients better results on splenectomy were associated with age less than 40 years, good responses to steroid, and intravenous immune globulin.
Cesarean section combined with splenectomy in severe resistant immune thrombocytopenia
Authors: Elezovic Ivo , Boskovic Darinka , Tomin Dragica , Pilic Z. , Mikovic Zeljko , Popovic M. , Knezevic S. , Sukalo M.
Published: November 2008

Immune thrombocytopenic purpura (ITP) associated with pregnancy often involves considerable risk both for mother and child, and usually worsens in the third trimester of gestation. Pregnancy and delivery are especially difficult in patients with severe ITP (platelet count below 20x10^9/l), who are resistant to prednisone and high dose intravenous immunoglobulin (IVIgG). In those cases we applied cesarean section (CS), to prevent intracranial haemorrhage due to fetal/neonatal ITP, and splenectomy at the same time as an effective therapeutic strategy for ITP. We present 5 patients (4 with chronic ITP and 1 with ITP associated with HIV infection), aged 21-35 years, with severe ITP (platelet count 2-10xl0^9/l), resistant to prednisone (1-2 mg/kg), and 2/3 were resistant to IVIgG (0.4 g/kg x 5d). Four patients with severe resistant ITP were supported with 1-2 doses of platelets from cell separator before CS and 1-3 dose during splenectomy. One patient increased platelet count to 55x10^9/l after treatment with IVIgG and splenectomy following CS were done without platelet transfusion. Splenectomy was performed immediately after CS in all patients, and two of them were hysterectomised (one with HIV infection). After splenectomy, platelet count was normalised in all patients, and they had no haemorrhage, wound haematoma formation or any adverse events. But ITP relapsed in 2/5 patients after 1-2 months. Two newborns had severe thrombocytopenia, which solved spontaneously after 3 days in one or after treatment with IVIgG in other. We propose that splenectomy following cesarean section should be considered as approach for delivery and treatment option for mothers with severe resistant ITP.
Dvovremensko krvarenje kod bolesnika sa povredom slezine
Authors: Stefanovic B. , Karamarkovic Aleksandar , Loncar Z. , Mijatovic Sladjana , Stefanovic B. , Jeremic Vasilije , Savic P.
Published: November 2008

Although the diagnosis of spleen injuries is not a considerable clinical problem today, subsequent ruptures of this organ may occur in a smaller number of patients (2-5% of total proportion of spleen injuries) following the so-called "free interval". Such injuries are most commonly explained by present hematoma localized in the central spleen, which becomes larger in time, and eventually causes its rupture. This form of lesion may be found both in isolated blunt abdominal injuries and in associated injuries. When it is the question of delayed hemorrhage, our results as well as data obtained from foreign literature, suggest three basic rise factors of the etiology of this type of injury. These are as follows: a) spleen injuries in severe trauma or polytrauma, b) older patients (over 65 years of age), and c) in cases when more than a single blood unit had to be administered for the initial hemodynamic stabilization of a patient. Delayed hemorrhage, which is occult in polytraumatized patients since it is frequently "disguised" by severity of clinical picture and traumatic shock, may subsequently cause sudden fall of hemogram and hemodynamic parameter values, and if immediate surgery is not performed, it may lead to heavy bleeding and lethal outcome of the patient.
Autotransplantacija slezine
Authors: Knezevic S. , Stefanovic D. , Petrovic M. , Djordjevic Z. , Matic Slavko , Artiko Vera , Milovanovic Aleksandar , Popovic Milos
Published: November 2008

Auto transplantation of the spleen can be performed in the patients with traumatic rupture of the spleen, in whom spleen could not be conserved in the other way. The right indication for this method is isolated rupture of the spleen (concvasation or complete devascularisation). This method is not recommended in the endangered patients, patients with previous disease of the spleen as well as in the patients with the perforation of the other abdominal organs at the same time. Auto transplantation was performed in 12 patients with isolated splenic rupture and hematoperitoneum, 11 men and one woman. The majority of patients are younger. In 8 patients, autotransplantat was placed into big omentum, in three into lipomatous tissue surrounding left kidney, and in one into anterior abdominal wall. In all the patients from this group, following analysis were taken: MCV (middle volume of erythrocytes), HTC, Hb, Le, Glucose, urea, creatinin, sodium, potassium, alkali phosphatasis, target cells, Howell Jolly's bodies, Heinz's bodies, IgG, IgA, igM, C3, C4, T3, T4, T8, B, segmentated, eosinophiles, lymphocytes, reticulocytes, thrombocytes, fibrinogen, PT, APTT, aggregation of thrombocytes and aggregation of thrombocytes on collagen. The same parameters were taken in 12 patients with surgery similar to splenectomy and in 12 after splenectomy. After splenectomy, there was decrease of the immunologic defending abilities of the organism because of the loss of the clirens function of the spleen, decreased level of the opsonines and tutsin, which leads to the impaired phagocytosis, decreased concentration of IgM and T and B lymphocytes, while in patients after auto transplantation the results were physiological. The most important thing in the assessment of the function of the autotransplantated spleen is scintigraphic investigation using 99mTc-denaturated red blood cells. In our study, auto transplant function was assessed in 10/12 patients by scintigraphy. Five years after surgery no one patient was proved to have postsplenectomic sepsis.
Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia
Authors: Stevanovic Valentina , Milakovic Branko , Stanimirovic Zorica , Stosic Mila
Published: November 2008

Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transpher; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.); for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgens and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.