bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of physical rehabilitation in the treatment of exudative pleurisy
Authors: Milojevic Momir , Kuruc Vesna
Published: July 2006

INTRODUCTION Exudates are due to a variety of diseases, the major and most common ones being tuberculosis, nonspecific inflammation and malignancy. They are usually treated conservatively, sometimes combined with surgery and physical treatment. Physical the-rapy includes positional exercises, breathing exercises and biostimulation. Aim of the study The study was aimed to find out the following: 1) Is lung function improved by physical therapy; 2) Can adhesions be diminished and mobility of the affected hemidiaphragm improved by physical treatment; 3) Is there a direct positive correlation between physical treatment and obtained improvement, or the same can be achieved in patients receiving medicamentous treatment only; 4) What are the effects of some factors we cannot influence (sex, age, effusion level, position of adhesions) on lung function and diaphragm mobility improvement, that is on the efficiency of physical treatment; 5) How do the factors we can influence (the time interval before initiating the treatment and its duration) affect improvement of the same lung function parameters, that is treatment efficacy? Material and methods Physical treatment of patients with exudative pleurisy was accomplished at the Department of Rehabilitation in our Institute and it consisted of directed breathing exercises and laser biostimulation. Its effects were examined in a group of 175 patients, who received both conservative and physical treatment, and results were compared with the control group patients, treated only conservatively (with antibiotics, antituberculotics, corticosteroids). RESULTS Comparative analysis confirmed a significant improvement of lung function parameters (VC, FEV1, PEF) as well as of hemidiaphragm mobility on the affected side of the thorax in favour of the examined group. The severity of the lung function and diaphragm mobility impairments have been found to be in correlation with the localization of adhesions, whereas the degree of improvement correlated with the time interval before the treatment initiation, as well as with its duration. DISCUSSION and conclusion The applied physical therapy resulted in: 1) significant improvement of all examined lung function parameters in the examined group, which was not registered in the control group; 2) significant improvement of the diaphragm mobility in general; 3) factors such as sex, age and effusion level have no effects on the physical treatment results; 4) treatment results are affected by the time interval passed before the treatment initiation and its duration, as well as the localization of adhesions; anterior adhesions affected lung function and diaphragm mobility least, posterior ones more, while the influence of lateral adhesions was most significant. It is finally concluded that physical treatment should necessarily be included in the treatment of exudative pleurisy.
What are cancer registries
Authors: Miladinov-Mikov Marica
Published: July 2006

Introduction Population-based cancer registries attempt to collect, process, analyze, store and interpret data on persons with cancer in a certain population (most frequently a geographical area). Hospital-based cancer registries register all cases in a given hospital, usually without knowledge of the background population; the emphasis is to serve the needs of the hospital administration, the hospital cancer program, and, above all, the individual patient. History of Cancer Registries Registration of persons suffering from cancer is a slow process. Around the year 1900, England and Germany demanded improvement of statistical investigation on spread of cancer in population in order to undertake etiological researches. The oldest example of a modern cancer registry is that in Hamburg. Today there are more than 200 population-based cancer registries, but they cover only 5% of the world population, mainly in developed countries of the world. Cancer registry of Vojvodina Cancer registry of Vojvodina was established in 1966; it is a member of International Agency for Research on Cancer (IARC) and it is still the only cancer registry from our country whose data are cited in scientific monographs of IARC. The main purpose of cancer registries is to produce statistics on the occurrence of cancer in a defined populatin and to provide a framework for assessing and controlling the impact of cancer on the community. Cancer registries are essential parts of any rational program of cancer control. Their data can be used in a wide variety of areas of cancer control, ranging from etiological research in epidemiology, through primary and secondary prevention to health-care planning and patient care, so benefiting both the individual and society.
Neuropathic pain due to malignancy: Mechanisms, clinical manifestations and therapy
Authors: Pjevic Miroslava , Patarica-Huber Erzebet , Radovanovic Dragana , Vickovic Sanja
Published: July 2006

Introduction Neuropathic pain in cancer patients requires a focused clinical evaluation based on knowledge of common neuropathic pain syndromes. Definition Neuropathic pain is a non-nociceptive pain or "differentiation" pain, which suggests abnormal production of impulses by neural tissue that is separated from afferent input. Impulses arise from the peripheral nervous system or central nervous system. Causes of neuropathic pain due to malignancy Neuropathic pain is caused directly by cancer-related pathology (compression/infiltration of nerve tissue, combination of compression/infiltration) or by diagnostic and therapeutic procedures (surgical procedures, chemotherapy, radiotherapy). Mechanisms Pathophysiological mechanisms are very complex and still not clear enough. Neuropathic pain is generated by electrical hyperactivity of neurons along the pain pathways. Peripheral mechanisms (primary sensitization of nerve endings, ectopically generated action potentials within damaged nerves, abnormal electrogenesis within sensory ganglia) and central mechanisms (loss of input from peripheral nociceptors into dorsal horn, aberrant sprouting within dorsal horn, central sensitization, loss of inhibitory interneurons, mechanisms at higher centers) are involved. Diagnosis The quality of pain presents as spontaneous pain (continuous and paroxysmal), abnormal pain (allodynia, hyperalgesia, hyperpathia), paroxysmal pain. Clinical manifestations Clinically, neuropathic pain is described as the pain in the peripheral nerve (cranial nerves, other mononeuropathies, radiculopathy, plexopathy, paraneoplastic peripheral neuropathy) and relatively infrequent, central pain syndrome. Therapy Treatment of neuropathic pain remains a challenge for clinicians, because there is no accepted algorithm for analgesic treatment of neuropathic pain. Pharmacotherapy is considered to be the first line therapy. Opioids combined with non-steroidal antiinflammatory drugs are warrented. If patient is relatively unresponsive to an opioid, a trial with adjuvant analgesics might be considered. Tricyclic antidepressants might be selected for patients with continuous dysesthesia, and anticonvulsants might be used if the pain is predominanty lancinating or paroxysmal. The complexity of neuropathic syndromes and underlying etiologic mechanisms warrant clinical trials to determine appropriate treatment.
Effects of a one-year weight reduction program and physical activity on obesity and comorbid conditions
Authors: Mijailovic Vesna , Micic Dragan , Mijailovic Milan
Published: July 2006

Introduction Obesity prevalence is increasing all over the world. Obese patients are at increased risk for developing many medical problems, including insulin resistance and type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases and stroke. Excess body weight is associated with substantial increase in mortality from all causes, cardiovascular diseases in particular. Weight control is part of the major health priorities identified for the future. The aim of the study was to evaluate effects of a one-year weight reduction program on obesity and its comorbid conditions and to make a model for long term weight reducing program. Material and methods Two hundred obese (ITM> 30kg/m2) subjects, who attended a 15-day weight reduction ("Cigota") program, three times during a year, were followed up. Participants from group A strictly adhered to the prescribed regimen, while participants from group B followed their own routine of diet and physical activity. Two groups were comparable in terms of gender, age, duration of obesity, previous and concomitant diseases. Results A year later, a statistically significant mean weight loss was established in both groups, but it was greater in group A (p<0.05). In both groups, all serum lipid parameters, parameters of glycemic control, as well as values of systolic and diastolic blood pressures improved. There was a further decrease in serum levels of total cholesterol, LDL-cholesterol, and LDL/HDL ratio in group A. As compared to group B, group A experienced better glycemic control in diabetic and non-diabetic obese patients, and enhanced reversion from diabetes to impaired glucose tolerance or normal glucose tolerance. This study has demonstrated a well-known fact that body mass reduction is associated with a decrease in blood pressure. Conclusion Treatment of obesity can make a substantial contribution to reducing hyperlipidemia, improving glycemic control, and treating hypertension. Prevention and treatment of obesity may reduce overall morbidity and mortality in the years to come. We suggest starting with weight reducing program "Cigota" and combining it with balanced program of diet and physical activity until normalizing body weight.
Otologic surgical procedures in an ear, nose and throat department in Subotica from 1987 to 2001
Authors: Sente Marko , Topolac Radivoj , Aleksov-Hatvan Gabriela
Published: July 2006

Introduction This paper deals with otologic surgical procedures performed in a an Ear, Nose and Throat Depertment during a 15-year period. The authors compared the number of otologic surgical procedures with the number of laryngomicroscopies and procedures performed in Waldeyer's ring. RESULTS From January 1, 1987 to December 31, 2001, 1184 patients underwent the following surgical procedures in total endotracheal anesthesia: 285 paracenteses, 473 ventilation tubes insertions, 175 antrotomies or mastoidectomies, 194 tympanoplasties, 34 radical mastoidectomies, 4 facial nerve decompressions, 5 exostoses or osteoma of the external auditory canal operations and 14 stapedectomies. DISCUsSION Otologic surgical procedures are presented in table 1. In Yugoslav literature Topolac reports approximately 700 tympanoplasties in a 10-year period (1968-1978). Radonjic and associates report 2272 ear operations in the period 1975-1985. Distribution of operations is presented in table 2, whereas in table 3 we can see that the number of operated ears is much greater than the number of operated patients. CONCLUSION We think that the number of operations is not bigger, because we operate only in critical cases. Our human and technical resources should provide advanced ear microsurgery, but only with financial and organizational support.
Early diagnosis of cytomegalovirus infections in organ recipients
Authors: Draskovic Nada , Jovanovic Dragutin , Kuljic-Kapulica Nada
Published: July 2006

Introduction Cytomegalovirus (CMV) infections and acute rejection of organs are the commonest complications in the early posttransplantation period. Clinical picture of CMV reactivation in organ recipients may have a dramatic course, occasionally even with a fatal outcome. Diagnosis of CMV In order to prevent acute rejection of organs in the posttransplantation period, patients are subjected to immunosuppressive therapy, which sustains reactivation of CMV. Thus, early diagnosis of CMV infections before clinical assay of CMV, is of crucial importance. Early diagnosis allows preventive antiviral therapy. Conventional and contemporary diagnostic tests are presented, with particular review on their interpretation and significance in prevention of CMV infections. Present serologic tests are positive a few weeks after infection, which is late for organ recipients. Cytopathogenic effects characteristic for CMV occur several weeks later. Antigenemia assay is a fast, quantitative test for detection of early CMV antigen pp65. Methods of molecular biology represent the latest innovation in the laboratory diagnosis of posttransplantation CMV infections. However, they have been in use only lately, and therefore their use and significance are still not sufficiently experienced. Standardization is thus required, in order to provide comparison between various diagnostic centres.
Effects of systematic lymphadenectomy on length of survival in patients with gastric carcinoma
Authors: Stevanovic Dejan , Radovanovic Dragan , Pavlovic Ivan , Kostic Petar
Published: July 2006

Introduction In the last few years there have been arguments between the Japanese and West European surgeons about benefits of systematic lymphadenectomies in surgery of gastric cancer. In this paper we would like to point out effects of systematic lymphadenectomies on survival of patients with gastric carcinoma. Material and methods This investigestion included two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy Dl. The second group of 114 patients with gastric carcinoma underwent more radical types of lympadenectomy (D2, D2%, D3). Survival analysis included investigation of the following:1 depth of tumor invasion, 2. metastatic involvement of the lymph nodes 3. tumor stage, 4. tumor recurrence. Results Most of examined patients presented with invasion and serosal and subserosal penetration (about 75% in both groups). More than 42% of lymph nodes had metastases and patients with systematic lymphadenctomy had better survival. Patients without subserosal invasion did not have metastatic lymph nodes in H, III, IV drianaged groups. There was no difference in regard to length of survival between the two analyzed group. 5-year survival rate "was highest in stage I of gastric carcinoma (86%), but in stage IV 5-year survival rate was only 3.8%. Local recurrence (26%) and lymph node metastases (53%) were common causes of tumor recurrence in group with peritumor lymphadenectomy. In all groups of patients with advanced gastric cancer patients undergoing systematic lymphadenectomy presented with higher survival rate. Discussion Patients with advanced gastric cancer presented with higher number of metastatic lymph nodes in III and IV drainaged groups. In this stage systematic lympadenectomy played the main role. In the group of early gastric cancer there were no patients with metastatic lymph nodes in drainaged groups. Conclusion D2 lympahedenectomy is a standard procedure for a great number of patients with gastric carcinoma, with high survival rate. Only in the group of advanced gastric cancer, patients un?dergoing more radical types of lymphadenectomies (D2%, D3) presented with better survival rates.
Collaboration in the field of public health in south Eastern Europe
Authors: Kristoforovic-Ilic Miroslava
Published: July 2006

INTRODUCTION Southeastern Europe faces shortage of interest in modern program of public health education and research, and in mutual cooperation and cooperation with countries of European Union. In 2000, Stability Pact for Southeastern Europe has initiated a project: "Academic Programmes for Training and Research in Public Health in South Eastern Europe". The project named "Agreement on Collaboration of the Public Health Consortium for South Eastern Europe (PH-SEE) provides many opportunities to advance the cooperation and student exchange during post graduate studies. Academic Programmes for Training and Research in Public Health in South Eastern Europe Academic programs include education of how to use internet material in regard to public health from relevant areas and select skilled coordinators. 10 appropriate curricula have been developed with many models and most can be expanded. Agreement on Collaboration of the Public Health Consortium for South Eastern Europe This document has the objective of establishing a formal agreement between the members of the Network enabling cooperation and student exchange programs during postgraduate studies. It supports the mobility of postgraduate students in their scientific or practical work, awards student scholarships or acquiring diploma at foreign universities. Each member of this network will support progress in the frame of mutual research and identify program priorities based on unilateral and multilateral cooperation in public health. Conclusion Work on the project "Academic Programmes for Training and Research in Public Health in South Eastern Europe" has to be considered continual, including some colleagues who have interest in preventive medicine and in other areas. Agreement on Collaboration offers younger generations an opportunity for scientific training. According to recently signed Bologna Declaration, we are free to create a school of public health, and it becomes also our obligation.
The role of splenic implants in spleen injuries and postoperative immunity
Authors: Jovanovic Milan , Jovanovic Jovica
Published: July 2006

Introduction Spleen preservation by autotransplantation is indicated in cases of injuries which result with conquassation or total devascularization of this organ. Material and methods Thirty dogs, experimental group, had multiple, devascularized spleen injuries and underwent splenectomy and splenic autotransplantation. The same number of animals were treated by primary splenectomy (control group). Seventy five days later, animals from both groups were exposed to pneumococcal sepsis - by intravenous inoculation of sublethal pneumococcal doses, in order to estimate the immunity of lienal implants and compare the mortality rate between these two groups. Results Positive hemoculture, as well as logarithmic increase of diplococci in blood samples was established in all 60 animals. Higher mortality rate and significantly higher pneumococcal growth was established in control, compared to experimental group. Conclusion These results point to the important role of lienal implants in total immunity and advantage of autotransplantation compared to conventional splenectomy, in cases of most severe and nonreconstructibile spleen injuries.
Specific vestibular exercises in the treatment of vestibular neuritis
Authors: Komazec Zoran , Lemajic Slobodanka
Published: July 2006

Introduction Vestibular neuritis rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. Rehabilitation The program of vestibular rehabilitation presents a major achievement in the field of treatment of balance disorders. Vestibular compensation is associated with central sensory reintegration and bilaterally equalizes the vestibular tonus over a period of time. Material and methods In this retrospective study of a series of cases authors present their results in 58 patients undergoing a program of vestibular rehabilitation. Patients were divided into two groups. Thirty patients were in group I, and 28 in group II. Specific vestibular exercises were conducted in group I, and non-specific exercises in group II. Analysis of effects of vestibular compensation was made due electronystagmography. Results Results were satisfactory in both groups of patients. Absence of spontaneous nystagmus was detected in 83.3% of patients in group I (specific vestibular exercises) and in 53.5% of patients in group II (non-specific exercises), with an average treatment time of up to 2 months. Harmonization of pendular stimulation was detected in 83.3% and 60.7% of patients in groups I and II, respectively. Conclusion Early physiotherapeutic vestibular rehabilitation supports the vestibular compensation mechanism. At the same time vestibular rehabilitation may prevent panic disorder caused by hyperventilation syndrome.
False aneurysm following arthroscopic meniscectomy of the knee
Authors: Milankov Miroslav , Ninkovic Srdjan , Stankovic Milan
Published: July 2006

Introduction Blood vessel injuries during arthroscopic knee surgeries are unusual and rare and comprise less than 1% of all arthroscopic complications. Between 1990 and 2004, at the Department of Orthopedic Surgery and Traumatology, Institute of Surgery, Novi Sad, 2100 arthroscopic knee surgeries were carried out. Only one case of false aneurysm of the geniculate lateral inferior artery was reported. Case Report A 35-year-old professional waiter injured his left knee while getting up from a kneeling position. He had a typical clinical rupture with an interior meniscus lesion. Knee arthroscopy with resection of the torn part of interior meniscus was performed. Seven days later, we observed a subcutaneous tumefaction, 2 cm in diameter, which was warm, pulsating and painful on palpation. It was located in the region of anterolateral portal. Angiography confirmed the existence of a false aneurysm of lateral geniculate inferior artery. Revision of the wound was performed on the exterior side of the knee. The hematoma was removed and the artery tied. A month later, the patient fully recovered and returned to his professional activities. Discussion Only four injuries, that is false aneurysms of the exterior knee artery after knee arthroscopy, have been described so far. The possibility for this injury to occur lies in the fact the artery lies over and is parallel with the lateral knee joint line, at the very entrance of the anterolateral arthroscopic port. Since the latter is the most often used arthroscopic port to access the knee, the above injury is possible, but it does not minifest clinically. This complication is easily diagnosed by a pulsating tumefaction in the area of arthroscopic port and is confirmed by angiography. These rare blood vessel injuries do not affect the usage of anterolateral arthroscopic procedure. If the injury does exist, revision of the wound and artery ligature should be carried out, which does not affect the final treatment results.
Block dissection of inguinofemoral lymph nodes using separate "S" incision in surgical treatment of vulvar carcinoma
Authors: Djurdjevic Srdjan , Segedi Dimitrije
Published: July 2006

Vulvar carcinomas account for almost 3-5% of all malignant tumors of the female genital organs. The primary therapeutic approach is surgical in all cases. Since 1994, we have used a separate "S" incision for inguinofemoral lymphadenectomy in the treatment of invasive vulvar carcinoma. In the period from 1985 to 2003, 46 patients with invasive forms of vulvar carcinoma were operated at the Department of Obstetrics and Gynecology in Novi Sad. Inguinofemoral lymphadenectomy was performed in 37 (84.4%) patients. During 1994, a wide "block" dissection of the vulva, mons pubis and inguinal area of a "butterfly" shape was performed, whereas during the following period, the operative area was reduced by application of separate inguinal "S" incisions leaving a tissue bridge in between. There were 5 patients with stage I, 1 with stage II and 4 with stage III carcinoma. By applying the technique of two separate inguinal "S" incisions we achieved shortening the intrahospital postoperative period to 14 days and reduction of the risk of wound dehiscence and postoperative complications in the period following 1994.
Some considerations on evaluation of the acutely limping child
Authors: Maric Dusan , Petkovic Lazar , Tomasevic Vladimir , Maric Dusica , Jovanovic Mladen , Bajic Ljubomir
Published: July 2006

Introduction An acute limp implies an underlying pathology that causes disruption of the standard gait pattern. Diagnosis and history of disease The differential diagnosis of a limp includes trauma, infection neoplasia, inflammatory, congenital, neuromuscular or developmental disorders. History of disease and clinical examination present first steps in adequate evaluation. A useful approach is to consider the causes of limping from head to foot to avoid overlooking common underlying conditions. The age of patient can further narrow the differential diagnosis, because certain disease entities are age-specific. Laboratory analysis Laboratory analysis should always include complete blood count, erythrocyte sedimetation rate, C-reactive protein, rheumatic factor, PPD 3. In some cases we have to perform tests of enzyme values such as alkaline phosphatase, lactate dehydrgenase, and other subspecial analyses in order to exclude some systemic and autoimmune diseases. Radiologic diagnosis Radiologic diagnosis should include: ultrasonography (doppler ultrasonography and in some cases, arteriography); Plain films (always anteroposterior (AP) and profile or some special angle); computed tomography, magnetic resonance imaging. Conclusion In this paper we suggested an algorhytm for examination of a limping child: 1. Analysis of foot morphology and the gait without socks and shoes. 2. Strength test including walking on toes and heels and running. 3. Evaluation of arthritis, stiffness, pain, skin changes. 4. Points of a maximum pain with ROM testing. 5. Traces of trauma with echimosis. 6. Evaluation of leg length discrepancy. 7. Muscle tonus. 8. Abdominal examination 9. Examination of the spine and back.
Autoantibodies in children with vitiligo
Authors: Prcic Sonja , Djuran Verica , Poljacki Mirjana , Petrovic Lada , Jakovljevic Anica , Jokic Mira
Published: July 2006

Introduction Vitiligo is an acquired, sometimes familial skin depigmentation disorder. In about half of patients it occurs before the age of twenty. The aim of this study was to investigate the incidence and significance of autoantibodies (AT) and associated autoimmune and endocrine diseases in children with vitiligo, in relation to adults with vitiligo and children without vitiligo. Material and methods The research was conducted in fifty children with clinically diagnosed vitiligo from 2 to 16 years of age. Children were compared with control groups of children with other skin diseases (aged from 2 to 16) and with adults with vitiligo. Each group comprised 30 patients. A detailed history was obtained and physical examination was performed in each patient to determine presence of autoimmune and endocrine diseases in patients with family history of vitiligo. Routine blood examination, routine urinalysis and stool were performed in all patients. We evaluated the incidence of antinuclear (ANA) and antithyroid antibodies (ATA) in each patient, as well as the incidence of antibodies to gastric parietal cell (APCA), smooth muscle (SMA), cord (ACA) and mitochondrial antigens (AMA) in 38 children with vitiligo and in control groups. Results Children with vitiligo had positive family history of vitiligo more often compared to children without vitiligo (p<0.05). Presence of ANA, ATA, APCA, SMA, ACA and AMA was not considerably increased in children with vitiligo compared with their age group. ANA was more common in adults with vitiligo, in comparasion with children with vitiligo (p<0.05). None of the children with vitiligo had an associated autoimmune and endocrine disease in contrast to adults with vitiligo (p<0.05). Discussion and conclusion Several studies have shown a significant incidence of positive autoantibodies in children with vitiligo, compared to children without vitiligo. However, in our series, presence of ANA, ATA, APCA, SMA, ACA and AMA was not significantly increased in children with vitiligo, compared with children without vitiligo. Further studies are necessary in this area in order to draw more conclusions. In the previous studies, it has been established that children with vitiligo were generally healthy, whereas adults with vitiligo had an increased incidence of autoimmune and/or endocrine diseases. No studies have shown this association in children with vitiligo. Our results support findings of previous studies.
Simple methods for nutritional status assessment in patients treated with repeated hemodialysis
Authors: Tirmenstajn-Jankovic Biserka , Dimkovic Nada
Published: July 2006

Introduction Protein-energy malnutrition is common in chronic hemodialysis patients and is strongly associated with increased morbidity and mortality. While determination of the nutritional status is often based on objective measurements such as biochemical parameters and anthropometric measurements, there is no single measurement that can reliably identify risk for malnutrition. Material and methods A subjective global assessment (SGA) was performed to evaluate the nutritional status in 43 chronic dialysis patients (27 men and 16 women). Anthropometric measurements including body weight (BW), body mass index (BMI), skin-fold thickness (triceps-TS, biceps-BS, subscapular-SSS, suprailiac-SIS), mid-arm circumference (MAC); mid-arm muscle circumference (MAMC); body fat percentage (%BF); total body fat (TBF); lean body mass (LBM) and laboratory parameters (total proteins, albumins, transferrin, hemoglobin, lymphocytes. Results According to SGA, patients were divided into three groups: first group of 23 pts with a normal nutritional status, second group of 11 pts with mild malnutrition and third group of 9 pts with moderate or severe malnutrition. In examined groups there was a significant decrease in total protein (p = 0.02), serum albumin (p = 0.000) and hemoglobin (p = 0.04) levels with an increase in SGA scores (oneway ANOVA). In the same way, SGA was correlated with the number of anthropometric parameters (BW, BMI, TS, SSS, SIS, MAC, MAMC, % BF, TBF, LBM). Conclusion Our data confirmed a high prevalence of malnutrition in hemodialysis patients and showed that SGA closely correlated with more objective measures. Being an inexpensive method of well-proven realibility, SGA can be recommended for a more frequent assessment of nutritional status in dialysis patients.
Liver and splenic sarcoidosis: Diagnostic procedures
Authors: Skodric-Trifunovic Vesna , Vucinic Violeta , Colovic Radoje , Videnovic-Ivanov Jelica , Zugic Vladimir , Stojsic Jelena
Published: July 2006

Introduction Clinical studies indicate involvement of the liver and spleen in approximately 20-30% of patients affected with sarcoidosis and their detection should be based on a standardized diagnostic procedure. Diagnostic procedures Ultrasonography is a reliable and safe method to assess changes related to size and structure of the affected organs that are pathognomonic for sarcoidosis. Further evaluation may include computerized tomography or magnetic resonance, while percutaneous needle aspiration biopsy or laparoscopy may also be applied when indicated. The most important criterion used for final diagnosis is pathohistological evidence of epithelioid noncaseating granuloma in bioptic material along with already established sarcoidosis of the lungs or some other organ. Material and methods The study on the incidence of liver and spleen sarcoidosis included a group of 130 patients affected with sarcoidosis hospitalized at the Institute of Pulmonary Diseases and Tuberculosis, Clinical Center of Serbia, over the period 2002-2003. Results The analysis evidenced that 31.5% of sarcoidosis patients had pathognomonic echographic findings of abdominal organs: splenomegaly (13%), hepatomegaly (10.8%) and hepatosplenomegaly (7.7%). Three patients underwent surgical treatment of liver and spleen sarcoidosis. Conclusion Pathognomonic findings of liver and spleen sarcoidosis were evidenced in approximately one third of sarcoidosis cases and they represented a significant parameter for further therapy, particularly in chronic patients.
Fatal outcome after postexposure rabies vaccination in a patient with Parkinson’s disease
Authors: Lalosevic Dusan , Lalosevic Vesna , Saric Milorad , Mazibrada Jasenka , Babovic Sinisa , Sekulic Slobodan , Mitic Zorica
Published: July 2006

Introduction In Serbia and Montenegro postexposure rabies vaccination is performed using five doses of rabies vaccine with a potency of 2.5 I.U. It is given on 0, 3rd, 7th, 14th and 28th day, combined with human rabies immunoglobulin with the first dose. Modern rabies vaccines produced in cell cultures rarely cause neurological complications, among which Guillain-Barre syndrome and parkinsonism. Case report The authors report a case of a 78-year-old woman with a documented five-year history of Parkinson's disease, who was bitten by a rabid cat. Twelve hours later, when the rabies infection of the cat was confirmed by an immunofluorescence test, the patient received the first dose of rabies vaccine Verorab (Aventis), a cell culture vaccine, together with the human rabies immunoglobulin produced in Belgrade. After the third dose of rabies vaccine, the symptoms of Parkinson's disease progressed and vaccination was interrupted. However, one month later, the patient died with predominantly neurological symptoms. As the patient died at the time when incubation of rabies might have been expected, autopsy and rabies diagnostics were performed. Autopsy and pathohistologic findings The autopsy and pathohistologic findings from the specimens treated with routine hematoxylin and eosin staining, together with immunofluorescence test, excluded rabies as a cause of death and revealed neurodegenerative changes typical for Parkinson's disease. Using two different fluorescent rabies antibodies, we performed a direct immunofluorescence antibody tests, but no rabies antigens were detected. However, in histologic slides of the brain stem, large intracytoplasmic inclusions were found in some neurons, identified as Lewy bodies characteristic for Parkinson's disease Conclusion Parkinson's disease, with its complications, was the cause of death of the patient bitten by a rabid cat. Furthermore, the coincidence of the progression of Parkinson's disease symptoms, at the time of post exposure rabies vaccination, points to the vaccine as a possible contributing factor to aggravation of the disease and lethal outcome.
Multiple brain abscesses: A case report
Authors: Banic-Horvat Sofija , Cvijanovic Milan , Ilin Miroslav , Kopitovic Aleksandar , Simic Svetlana , Jovin Zita
Published: July 2006

Case Report 10 days before admission a 45-year old female experienced general weakness, and T 38oC. During that period she had no cardio-respiratory nor neurological complaints, and the temperature varied between 37.5oC and 38oC. Her medical history was unremarkable, without immunodeficiency. The day before admission she presented with left arm paresis and during the next day it progressed to paralysis. She had no headache. On admission the following diagnostic procedures were performed: the cranial CT scan showed two lesions (possibly meta lesions). Chest X-ray was normal. WBC=15x109/L, ESR= 90/120. On the second day following admission brain MRI showed multiple abscesses in both hemispheres, mostly in the gray/white junction. High doses of IV metronidasol, cephtriaxon and cipfloxacin were administered without obtaining specimens for micro- biological diagnosis. In next two days she developed coma, respiratory insufficiency and septic temperature. Brain surgery was not performed due to severe involvement of the brain with multiple abscesses. Repeated chest X-ray revealed bilateral pneumonia. A lethal outcome occurred on the third day, regardless of all efforts. Autopsy showed multiple brain abscesses as well as on the lungs and liver. A beta-hemolytic streptococcal infection was established. Conclusions Prevention includes treatment of the infection source. The classic triad of headache, fever and focal deficit occur in less than 50% of patients. Even in such cases brain abscess must be reconsidered. CT appearance of brain abscess is similar to that of neoplastic and other infectious and non infectious deseases - especially in the stage of early cerebritis. If the CT findings are not clear, MRI should be performed.
Light induced polymerization of resin composite restorative materials
Authors: Blazic Larisa , Markovic Dubravka , Djuric Milanko
Published: July 2006

Introduction Dimensional stability of polymer-based dental materials is compromised by polymerization reaction of the monomer. The conversion into a polymer is accompanied by a closer packing of molecules, which leads to volume reduction called curing contraction or polymerization shrinkage. Curing contraction may break the adhesion between the adhesive system and hard tooth tissues forming micrographs which may result in marginal deterioration, recurrent caries and pulp injury. Polymerization shrinkage of resin-based restorative dental materials Polymerization of the organic phase (monomer molecules) of resin-based dental materials causes shrinkage. The space occupied by filler particles is not associated with polymerization shrinkage. However, high filler loading within certain limits, can contribute to a lesser curing contraction. Polymerization shrinkage stress and stress reduction possibilities Polymerization shrinkage stress of polymer-based dental resins can be controlled in various ways. The adhesive bond in tooth-restoration interface guides the contraction forces to cavity walls. If leakage occurs, complications like secondary caries and pulpal irritation may jeopardize the longevity of a restoration. Stress relieve can be obtained by modifications of the monomer and photoinitiator, or by specially designed tooth preparation and application of bases and liners of low modulus of elasticity. The polymerization contraction can be compensated by water absorption due to oral cavity surrounding. The newest approach to stress relief is based on modulation of polymerization initiation. Conclusion This work deals with polymerization contraction and how to achieve leak-proof restoration. Restorative techniques that may reduce the negative effect of polymerization shrinkage stress need further research in order to confirm up-to-date findings.
New insights into transmission of tuberculosis
Authors: Skodric-Trifunovic Vesna
Published: July 2006

Introduction Considering the fact that tuberculosis is a global problem, that one third of the world population is infected with tuberculosis and that 8-10 million of newly recognized cases are detected per year, the need for acquiring new knowledge on pathogenesis and transmission of tuberculosis becomes obvious. Application of molecular biology methods in clinico-epidemiology practice has identified transmission chain of tuberculous bacilli in numerous intrahospital outbreaks of tuberculosis. Conditions favoring transsmition of tuberculous The possibility of transmission primarily depends on the following conditions: contagiousness of the patient who is a source of infection, conditions in which the exposure takes place, length of exposure, as well as the immune status of the exposed individual. Risk factors for transsmition of tuberculosis Unrecognized, i.e., untreated tuberculosis represents a major risk factor for environmental spread of the bacillus. Therefore, early diagnosis and initiation of adequate therapy are priority tasks. High risk of tuberculous bacilli transmission is associated with all diagnostic and therapeutic procedures inducing cough, such as bronchoscopy, endotracheal intubation, induction of sputum, inhalation therapy as well as work in microbiological laboratories dealing with identification of M. tuberculosis. Discussion Results of numerous studies indicate that there is significant risk for transmission and infection of individuals exposed to the source of infection in family settings, work environment or other close contacts. The problem of exposure of health workers at their workplaces represents a problem in institutions dealing with diagnosis and treatment of tuberculosis. Conclusion A more comprehensive insight into significance of the problem and application of measures aimed at preventing transmission of tuberculosis sholud lead to practical application of preventive measures proposed by the International Union Against Tuberculosis and Lung Disease, in both hospital and non-hospital environments.
Dilemmas in the surgical treatment of cervical cancer
Authors: Djurdjevic Srdjan
Published: July 2006

Introduction Cervical cancer is the second most common cancer of the female genital tract. There are 2.200 newly registered cases of cervical cancer each year in Serbia, out of which 650 women die. The incidence of invasive, advanced cervical cancer has been on decrease, whereas the incidence of "in situ" stage carcinoma increases by 2% per year with tendency of increase in the younger age groups. Historical data The first radical abdominal hysterectomy was performed by Ernst Wertheim from Wienna in 1898, whereas Schauta performed the first vaginal hysterectomy in 1902. It was in 1995 when Daniel Dargent introduced radical vaginal trachelectomy combined with laparoscopic lymphadenectomy in order to preserve fertility in cases of initial-invasive stages of cervical cancer (FIGO I A2, I B1). Choice of surgical procedure Before choosing the surgical procedure, it is necessary to make a correct preoperative estimation of the stage of disease according to FIGO classification. Apart from gynecologic and rectovaginal examinations, in some cases it is necessary to perform additional examinations such as: cystoscopy, rectoscopy, CT or MRI examination of the pelvis, IVU, chest X-ray etc. The decision can be made only by an expirienced gynecologist-surgeon who is able to solve all complications of treatment by himself. Conclusion There are different surgical procedures for cervical cancer: abdominal, vaginal and combined. Introduction of laparoscopic lymphadenectomy combined with vaginal radical operations, to decrease surgical trauma and preserve fertility, has been of great significance.
Amnioreduction in treatment of increased amniotic fluid volume
Authors: Stojic Sinisa , Novakov-Mikic Aleksandra , Bogavac Mirjana , Mandic Aljosa
Published: July 2006

Introduction Increased amniotic fluid volume may significantly increase the risk for preterm delivery. Amniodrainage is a symptomatic treatment by which excess amniotic fluid is reduced to provide fetal lung maturation. The aim of this study is to estimate the efficacy and safety of this procedure, our results and give a literature review. Material and methods Sonografic criteria were used (AFI> 400 ml, or the biggest amniotic fluid pocket > 150 mm) to choose patients in whom 18G needle was used to allow leaking of excessive amniotic fluid. Results 10 patients underwent 26 procedures. The procedures were performed at 28.6th week gestation, on average and 6.25 weeks average gain or 1000 g. We had two sets of monochorionic twins with twin-to-twin transfusion syndrome (TTTS), where one child survived. One procedure was followed by premature placental abruption, and premature delivery in 28th week. The rest of procedures were uneventful. Conclusion In our series of 10 women, 26 procedures were performed to prolong pregnancies, enable fetal maturation and weight gain. In majority of cases amnioreduction was done without complications, so we could repeat the intervention and prolong the pregnancy. Survival of one child in two TTTS pregnancies should not be regarded unsuccessful in our conditions.
Characteristics of sexual behavior among teenagers in Belgrade
Authors: Bjekic Milan , Vlajinac Hristina , Sipetic Sandra , Marinkovic Jelena
Published: July 2006

Introduction The risks associated with teenage sex include pregnancy and a high rate of sexually transmitted diseases (STDs). Material and methods The study compared female teenagers: 32 with STDs and 90 with fungal skin infections who were treated in the City Center for Skin and Venereal Diseases in Belgrade from January 2000 to June 2001. An anonymous questionnaire was used to collect data and an univariate logistic regression analysis was performed. Results The mean age of participants was 18.2 years. About 40% of respondents reported to have their first sexual intercourse at the age of 14-16 years. The majority of cases and controls had one or two partners, but a greater percentage of cases had six or more partners compared to controls (12.5% vs. 3.3%). Adolescents with STDs frequently had sexual intercourse on the first date (p<0.05), and more frequently reported previous STDs in their personal history (p<0.05). Consistent use of condoms was less frequent among cases than among controls, both with steady (9.4% vs. 27.8%) and irregular partners (30.0% vs. 70.6%). The majority of teenagers (95%) thinks that sexual education at schools should be better. Discussion According to the results obtained, which are in agreement with literature data, teenagers should change their behavior, especially with respect to condom use both during vaginal and anal sex. Health education at schools could probably influence future sexual behavior, and counseling for STDs should be offered to all teenagers attending STD clinics. Conclusion The best way to avoid unwanted pregnancy and STDs is to delay the first sexual experience, reduce the number of sexual partners and increase the protection by condom use.
Developmental parameters and vitality of newborn infants in the period 1991-2002 in the Health centre in Subotica
Authors: Durkovic Jasmina , Pavlovic Mirjana
Published: July 2006

Introduction Infants having a birth weight of 2500g or less are known as low birth weight infants. There are multiple factors which affect the nutritional status of newborn children: genetic potential, maternal age, parity, maternal health and maternal nutrition, drugs, alcohol, smoking, geographical situation and socioeconomic living conditions. Material and methods Developmental parameters were analyzed in 15.455 live newborn infants in Subotica, from 1991 to 2002. The following parameters were registered: body mass in the first hour of life, body length, head and thorax circumference. These parameters were examined and correlated with other indicators of maturity and vitality, such as gestational age and Apgar score values. Results and discussion Parameter mean values are presented for each year from 1991 to 2002. Mean body mass values ranged from 3335.74 g in 1991 to 3418.01 gin 1998. Compared with the estimates provided by World Health Organization, the percentage of newborn infants with birht weight under 2500 g has increased (5.64%) in 1991, which was the first year of war and sanctions in our country. From 1994 to 1997, there was a war in neighbouring republics and a huge number of refugees from war regions arrived. The percentage of newborn infants with low birth weight has increased (the gratest percentage 5.08% has been found in 1996). During 1999, our country was bombed and since then, we have an increased number of newborn infants with low birht weight (4.46% were registered in 1999 to 5.22% in 2002). The number of children born before 37th week of gestation is greatest in 2000 (3.17%). Average Apgar score in 1992 was (9.20), showing graduate decrease since 1999, with lowest value during 2001 (8.85). Conclusion Harmful environmental factors can strongly affect fetal growth. Continual follow-up of developmental parameters and vitality of infants on population level is an index of interactions between genetic potential and environmental factors, pointing to quality of health care and preventive services. .