bluuebunny/crossref_metadata_2025 huggingface dataset:
Left atrial size in patients with arterial hypertension
Authors: Milutinovic Suzana , Apostolovic Svetlana , Tasic Ivan
Published: July 2008

INTRODUCTION Left atrial size is increased in patients with arterial hypertension. Left atrial enlargement represents a risk factor of atrial fibrillation and stroke. Left atrial size depends on the effect of many other etiological factors, predominantly by body mass and the left ventricular mass. OBJECTIVE The objective of the study was to investigate the frequency of the left atrial enlargement in patients with arterial hypertension, in obese patients with arterial hypertension and in patients with arterial hypertension and left ventricular hypertrophy. In addition, the aim was to investigate the influence of diastolic function parameters on the left atrial dimension. METHOD The study included 93 patients with arterial hypertension (mean age of 46.9 ? 9.7 years, 50.5% of males) and 33 healthy subjects (mean age 45.6 ?10.6 yrs., 40% of males) who consisted the control group. There was no statistical difference of the age and sex between patients and healthy persons. All patients were examined by the echocardiographic ultrasound device HP Sonos 2500 by three echosonographers. RESULTS The patients with arterial hypertension compared to the control group had significantly higher: body mass index (27.8 ? 4.1 versus 24.3 ? 3.0) (p<0.001), the left ventricular mass (249.7 ? 79.1 versus 174.6 ? 47.7) (p<0,001), the left ventricular mass index (122.2 ? 34.3 versus 96.7 + 20.9)(p<0.001) and the left atrium (3.8 ? 0.7 versus 3.3 ? 0.5) (p<0.001). The frequency of the left atrial enlargement in patients with arterial hypertension was 44.1%. The frequency of the left atrial enlargement In patients with arterial hypertension and the left ventricular hypertrophy was 53.3%, and in obese patients with arterial hypertension was 58.3%. Left ventricular diastolic function parameters in patients with arterial hypertension in relation to control exhibited statistically significant differences: isovolumetric relaxation time (IVRT) was longer (193.2 ? 37.8 versus 175,8 ? 23,6) (p<0.001), deceleration time (DT) was longer (193.2 ?37,8 versus 175.8 ?23.6) (p<0.01) and peak early diastolic filling wave velocity /peak atrial diastolic filling wave velocity ratio (E/A ratio) was lower (1.0 ? 0.3 versus 1.2 ? 0.3) (p<0.01). The quotient of linear correlation of the left ventricular diastolic function parameters in patients with arterial hypertension with left atrial volume did not show any significant correlation. CONCLUSION The left atrial size was statistically bigger in patients with arterial hypertension in relation to healthy subjects. The biggest left atrial enlargement was in hypertensive patients with the left ventricular hypertrophy and obese hypertensive patients. Left ventricular diastolic function parameters in patients with arterial hypertension had no statistically significant influence on the left atrial size.
Effect of fosinopril on progression of the asymptomatic carotid atherosclerosis and left ventricular hypertrophy in hypertensive patients
Authors: Tasic Ivan , Mijalkovic Dragan , Djordjevic Dragan , Lovic Branko , Jankovic Dimitrije , Miladinovic-Tasic Natasa , Lovic Milan
Published: July 2008

INTRODUCTION The cardiovascular changes (vascular structure changes, hypertrophy of the left ventricle) contribute to both the increased cardiovascular morbidity and the mortality of essential hypertension. Therefore, modern treatment strategies should not only target blood pressure (BP) reduction but also normalize cardiovascular structure and function. OBJECTIVE Aim of the study was to determine the effect of the ACE inhibitor Fosinopril on the Intima-media thickness of the common carotid artery and on the left ventricle mass after 9-month treatment of hypertensive patients. METHOD The study included 40 patients with the arterial hypertension and the left ventricle hypertrophy verified by echocardiography. The patients were randomized on A) ACE-inhibitor - Fosinopril and 6) without ACE inhibitor - atenolol, and they were followed up 9 months. The groups were not different by age, sex, and metabolic status. Color Duplex ultrasonography of the carotid arteries was performed by Acuson Sequia C236 with high-frequency linear probe of 8 MHz. The Intima-media thickness of the common carotids on the left and the right was measured in diastole at 1.5. cm from the highest point of bifurcation under maximal magnification. Using the same device, the left ventricle mass and other parameters of the left ventricle were determined in M-mode and by means of 2D image. RESULTS After 9 months, BP In both groups Was reduced In similar range (group A: systolic BP from 158 to 137 mmHg, and diastolic BP from 94 to 85 mmHg, and group B; systolic BP from 164 to 137 mmHg, and diastolic BP from 87 to 84 mmHg). The thickness of the intimomedial complex in patients using Fosinopril was decreased by 0.0278 ? 0.03 mm, while in the group of patients that did not use the ACE-inhibitor, it was increased by 0.078 ?0.13 mm. The left ventricle mass in patients using Fosinopril was decreased by 5 grams (312 ? 72 g vs. 307 ? 77 g), while in group B patients, it was increased by 15 grams (323 ? 79 g vs. 328 ? 58 g. Diastolic function expressed through relation E/A was improved minimally in the group A, while it worsened by 0.1 in the group B. After 9 months, serious cardiovascular events were recorded (one infarction of myocardium and one hospitalization due to the unstable angina pectoris) in two patients of the group A, while four patients of the group B. had serious CV events (1 cerebrovascular stroke and 3 hospitalizations due to unstable angina pectoris). CONCLUSION The results of our study showed that the application of Fosinopril in patients with the arterial hypertension and the left ventricle hypertrophy could efficiently block further progression of the intima-medial thickness of the common carotid artery, reduce the left ventricle mass, and improve. diastolic function of the left ventricle.
Anemia in peritoneal dialysis patients
Authors: Lausevic Mirjana , Nesic Vidosava , Jovanovic Natasa , Stojimirovic Biljana
Published: July 2008

A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO) has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13%) patients were treated with rHuEPO, 14 (28%) underwent continuous ambulatory peritoneal dialysis (CAPD), 2 (100%) - automated peritoneal dialysis (APD) and 2 (33.3%) - intermittent peritoneal dialysis (IPD). Mean hemoglobin level was 98.6?17.82 g/l in patients treated with rHuEPO versus 98.81?15.14 g/I in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85?1211.77 IU/week. AII patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 ?360 ?g/l. Transferrin saturation (TSAT) was 0.35?0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and iron-gluconate is absorbed better than iron-sulphate. If required, intra-venous iron bolus is safe and efficient. Continuous peritoneal dialysis treatment improves blood count more effectively compared to intermittent procedures, as hemoglobin levels are significantly higher in patients with comparable iron stores. Peritoneal dialysis is particularly efficient in improving the blood count in diabetics, since no significant difference of anemia between patients affected by diabetes mellitus and the others could be found in our study.
Late thrombosis of coronary bare-metal stent: Case report
Authors: Apostolovic Svetlana , Perisic Zoran , Tomasevic Miloje , Stankovic Goran , Pavlovic Milan , Salinger-Martinovic Sonja
Published: July 2008

Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI). Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS). Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months) thrombosis of coronary bare-metal stent (BMS) is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU) was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.
The outpatient use of beta lactam antibiotics in Montenegro before the introduction of new reform strategy on drug market
Authors: Duborija-Kovacevic Natasa
Published: July 2008

Introduction: The study represents the first investigation of outpatient use of beta lactam antibiotics in Montenegro carried out in accordance with internationally approved methodology (DDD/ATC). Objective: The objective of our study was to establish both the scope and overall use of beta lactam antibiotics, and to assess their compatibility with current pharmacotherapeutic guidelines and their use in developed countries. Methods: The retrospective pharmaco-epidemiological study comprised a 100%-sample of beta lactams that were used in the period prior to introduction of new reform strategy on drug market. Results: Beta lactam antibiotics (J01C, J01D) were the most frequently applied anti-infectives for systemic use (ATC group J) in 2000 (11.3 DDD/1000 inh./day, 61%). Penicillins (J01C) were the most utilized (8.0 DDD/1000 inh./day, 71%). Cephalosporin derivatives (cephalexin and cefaclor) accounted for the remaining 29% (3.3 DDD/1000 inh./day). Aminopenicillins were prevailing among penicillins (85%). Beta lactamase sensitive penicillins were in the second place and approximately accounted for 14%. Conclusion: The results of our study showed that the use of beta lactam antibacterials could be estimated as partially satisfactory. There is a need to make additional efforts with a view of further rationalization.
The prevalence study of hospital-acquired infections at different surgical departments in Banjaluka
Authors: Markovic-Denic Ljiljana , Jankovic Slavenka , Bojanic Janja , Maksimovic Natasa
Published: July 2008

Introduction: Prevalence study is simple, cheap and fast method that provides information about hospital-acquired infections (HAI). Objective: To assess the HAI prevalence at different surgical departments in the Clinical Center of Banjaluka. Method: A point prevalence study design was used. All patients (N = 174) hospitalized on July, 1st, 1999 were included in the study. The study was performed by following the CDC guidelines. All patients with clinically manifested infections on the day of study in all surgical departments were recorded. Infections of more than one site in the same patient were considered separate infections. Results: The overall prevalence of patients with HAI was 16.1% (28/174; 95%CI = 10.4-21.6) and the overall HAI prevalence was 18.4% (32/174). Surgical-site infections were the most prevalent (6.3%) followed by skin/soft tissue infections (4.6%) and urinary tract infections (4.0%). More than two thirds (87.5%) of HAI were microbiologically documented. The most commonly isolated microorganisms were Pseudomonas aeruginosa (29.7%), Enterobacter spp. (24.3%) and Staphylococcus aureus (16.2%). Conclusion: This point prevalence study clearly showed the magnitude of HAI problem at different surgical departments in the Clinical Center of Banjaluka, the most prevalent anatomic localizations of HAI, and the most common causes.
Skin necrosis of penis after chemotherapy regimen in patients with resistant nonseminomatous testicular tumor
Authors: Stijelja Borislav , Milosevic Radovan , Marjanovic Slobodan
Published: July 2008

The majority of patients with resistant nonseminomatous testicular tumor can be cured with standard chemotherapy based on cisplatin regimen. However, complete remission cannot be achieved in 10%-30% of patients, or the disease recurs after the first chemotherapy cycle, on what account the salvage chemotherapy is administered. The initial BEP chemotherapy was applied in patients with gonadal nonseminomatous tumors B2 clinical stage after the left side inguinal orchiectomy. Due to manifested resistance, further chemotherapy was given according to VIP and one cycle by VEIP regimen. Upon inserting the urinary catheter because of total urinary retention, the phlegmonous inflammation and subsequently the necrosis of preputial and corpus skin of the penis were observed. The necrectomy with autotransplant was performed after demarcation. The skin necrosis of penis is very rare post chemotherapy complication in the stage of evident peripheral pancytopenia that may be the result of toxic effects of the used cytostatics or development of local infection with resulting necrosis.
Relationship of psychiatric comorbidity and treatment of panic disorder and agoraphobia
Authors: Latas Milan , Starcevic Vladan , Trajkovic Goran
Published: July 2008

Introduction. Besides numerous studies that examined various aspects of comorbidity in patients with panic disorder and agoraphobia and numerous studies that examined efficacy of different treatment modalities in these patients, there was no study that examined relationship of overall psychiatric comorbidity and treatment of patients with panic disorder and agoraphobia. Objective. The objective of the study was to establish the effect of psychiatric comorbidity on treatment efficiency of patients with panic disorder and agoraphobia. Method. The sample of the study consisted of 119 patients with primary diagnosis of panic disorder and agoraphobia. The therapy of patients was based on the use of individual integrative model of treatment, which incorporated psycho-pharmaceuticals (benzodiazepines and antidepressants) and cognitive- behavior therapy. Symptom severity was estimated by Panic and Agoraphobia Scale before and after the completion of treatment. Patients with comorbidity and patients without any comorbidity were compared by MANOVA and ANOVA with repeated measures. Results. The results of the study showed that 91% of patients met diagnostic criteria of comorbid psychiatric disorder and these patients had more severe clinical picture than patients without any comorbid disorder before the treatment. The results also showed that, after the completion of treatment, there was a significant reduction of all analyzed symptoms, that the effects of treatment were significantly better in patients with psychiatric comorbidity and that comorbid psychiatric disorders had no negative effect on the main goals of the treatment. Conclusion. Based on these results, it may be concluded that: in patients with panic disorder and agoraphobia and comorbid psychiatric disorders, the pharmacotherapy must be based on simultaneous use of antidepressants and benzodiazepines, while standard cognitive-behavior therapy of patients with panic disorder and agoraphobia must be modified in case of the existing comorbid psychiatric disorders.
Five-year experience with ileal neobladder according to original and modified Hautmann method
Authors: Stijelja Borislav , Milovic Novak , Milosevic Radovan
Published: July 2008

Introduction. Radical cystectomy is the method of treatment of muscle invasive tumor of the urinary bladder, T2-T4a, N0-Nx, M0, which is also performed in patients at high risk of superficial tumors G3, CIS (carcinoma in situ), which are resistant to BCG and diffuse papillary tumors which can not be controlled by conservative treatment. After radical cystectomy, an adequate derivation of the urine is needed, and in the best interest for patient?s comfort, is to make a new bladder from the parts of gastrointestinal tract and suture it to the rest of the urethra. In 1988, German surgeon Richard Hautmann published his method of creating a new bladder, for what he used 60cm of ileum. This method is in use at Department of Urology, Military Medical Academy, Belgrade, but, we introduced our modification of original operation because of early and late postoperative complications. Objective. The analysis of early and late complications after derivative surgery of orthotopic ileal bladder according to Hautmann. The patients operated According to original and modified method were analyzed. Method. From 2000-2004, 117 radical cystectomies were performed due to malignant urinary bladder tumors as well as the same number of derivative surgeries at the Clinic for Urology, Military Medical Academy, Belgrade. During this five-year period, the orthotopic ileal neobladder surgery according to Hautmann was performed in 41 patients after radical cystectomy. Twenty three patients were operated on using the original method and 18 patients by our modification. Results. Metabolic disorders and problems of high capacity of neobladder were manifested in all patients operated on by original method, while the stenosis of the ureteroileal anastomosis was present in most of these patients. Metabolic disorders were less frequent and of lower degree in patients operated by our modification and there was no stenosis of the ureteroileal anastomosis. The problems with urination were not reported. Conclusion. In our opinion and on the basis of our experience, Hautmann method is the method with fewer complications. However, our modifications are also acceptable because the number of complications is smaller and the value of operation is being kept.
Insulin sensitivity in patients with adrenal incidentaloma
Authors: Ivovic Miomira , Vujovic Svetlana , Penezic Zorana , Zarkovic Milos , Drezgic Milka
Published: July 2008

Introduction. Frequent use of modern imaging methods (such as ultrasound, CT and MRI) results in high incidence of accidentally discovered adrenal mass. Adrenal incidentalomas are accidentally discovered adrenal tumors by imaging methods without any prior suspicion of adrenal disease. Some studies have shown decreased insulin sensitivity in patients with adrenal incidentaloma. Objective. The objective of our study was to assess the insulin sensitivity in patients with adrenal incidentalom a. Method. A total of 22 patients with accidentally discovered adrenal mass confirmed by CT/MRI were evaluated in our study. Average age was 53.31?26.5 years and average BMI 25.84?3.65 kg/m2. Control group consisted of 33 healthy subjects. Insulin sensitivity was assessed by short ITT (insulin tolerance test). Blood samples were taken before, 3, 6, 9, 12, 15, 20 and 30 minutes after i.v. bolus of regular insulin (0.05 IU/kg BW). Glycemia was determined by glucose oxidase method. Statistical analysis was done by ANCOVA, using BMI as covariate. Results. Our results showed significantly lower insulin sensitivity in patients with adrenal incidentalomas comparing to the control group (4.95?0.58 vs. 6.62?0.47, p=0.015). Conclusion. Our patients with adrenal incidentalomas manifested lower insulin sensitivity what suggested further follow up and assessment of insulin sensitivity during endocrine evaluation of these patients.
Hemangioma of the spleen
Authors: Colovic Natasa , Cemerikic-Martinovic Vesna , Micev Marijan , Radak Vladimir , Colovic Radoje
Published: July 2008

Although the most frequent benign tumors of the spleen, hemangiomas are very rare, much rarer than hemangiomas of the liver. They manifest as localized (either single or multiple) or diffuse lesions, vary from solid to cystic, histologically from capillary to cavernous. Usually, they are small in size (1-3 cm), rarely larger and very rarely of large size. A 67-year old woman admitted to Institute of Hematology, CCS, for investigation of the left upper abdominal pain, loss of appetite, loss in weight and malaise. As the investigation showed a number of hypoechogenic lesions within the enlarged, diffusely non-homogenic spleen, splenectomy was indicated. The spleen weighing 2600 grams was removed, in which the number of lesions histologically corresponded to hemangioma of the spleen. Postoperative recovery was uneventful. The patient has remained symptom free more than two years after surgery.
Infected giant liver cyst
Authors: Colovic Radoje , Grubor Nikica , Radak Vladimir , Micev Marijan , Colovic Natasa
Published: July 2008

Congenital liver cysts are not as rare as it was thought in the past. Thanks to new imaging diagnostic techniques, these cysts have been discovered with increasing frequency. Uncomplicated congenital liver cysts are usually asymptomatic or followed by mild symptoms. Various complications of these cysts were reported. Infection of the congenital liver cyst is, however, very rare complication. A 65-year old man with huge infected congenital central liver cyst containing 3400 ml of pus from which Escherichia coli was cultivated was presented. The patient had a number of other histologically confirmed congenital cysts of the liver and the cyst of the left kidney. The patient was cured by pus evacuation, partial excision of the cyst wall and drainage of the cavity and subphrenic space. The uninfected cysts were operated using deroofing technique. A year after surgery the patient remained symptom free.
Postoperative cognitive deficits
Authors: Kalezic Nevena , Dimitrijevic Ivan , Leposavic Ljubica , Kocica Mladen , Bumbasirevic Vesna , Vucetic Cedomir , Paunovic Ivan , Slavkovic Nemanja , Filimonovic Jelena
Published: July 2008

Cognitive dysfunctions are relatively common in postoperative and critically ill patients. This complication not only compromises recovery after surgery, but, if persistent, it minimizes and compromises surgery itself. Risk factors of postoperative cognitive disorders can be divided into age and comorbidity dependent, and those related to anesthesia and surgery. Cardiovascular, orthopedic and urologic surgery carries high risk of postoperative cognitive dysfunction. It can also occur in other types of surgical treatment, especially in elderly. Among risk factors of cognitive disorders, associated with comorbidity, underlying psychiatric and neurological disorders, substance abuse and conditions with elevation of intracranial pressure are in the first place in postoperative patients. Preoperative and perioperative predisposing conditions for cognitive dysfunction and their incidence were described in our paper. These are: geriatric patients, patients with substance abuse, preexisting psychiatric or cognitive disorders, neurologic disease with high intracranial pressure, cerebrovascular insufficiency, epilepsia, preeclampsia, acute intermittent porphyria, operation type, brain hypoxia, changes in blood glucose level, electrolyte imbalance, anesthetic agents, adjuvant medication and intraoperative awareness. For each of these factors, evaluation, prevention and treatment strategies were suggested, with special regard on anesthetic technique.
Perception of quality of life and social adjustment of patients with recurrent depression
Authors: Stankovic Zana , Nikolic-Balkoski Gordana , Leposavic Ljubica , Popovic Ljiljana
Published: July 2008

Introduction: Depression is the most commonly present psychiatric entity in clinical practice, accompanied by significant impairment of both social and professional functioning. In addition, depression frequently develops as complication of other psychiatric disorders and various somatic diseases. Objective: To investigate subjective perception of quality of life and social adjustment, severity of depressive symptoms as well as level of correlation of severity of depressive symptoms and quality of life and social adjustment of patients with recurrent depression in comparison to the group of patients with diabetes and healthy subjects. Method: The study included 45 subjects of both sexes, ranging from 18 to 60 years of age, divided in three groups of 15 subjects each. The experimental group comprised the patients diagnosed with recurrent depression in remission (DSM-IV), one control group was consisted of patients diagnosed with Type 2 Diabetes mellitus and another one comprised healthy subjects. The instruments of assessment were: The Beck Depression Inventory- BDI, The Social Adaptation Self -evaluation scale - SASS, The Psychological General Well-Being Scale - WBQ. Results: Significant difference of both BDI and WBQ scales was found between the experimental and the control group of healthy subjects (ANOVA, Mann Whitney; p?0.01), as well as between two control groups (p?0.02). The level of inverse correlation of mean score values of BDI and SASS scales was significant in the control group of patients with diabetes while such levels of BDI and WBQ scales (Spearman correlation coefficient, p<0.01) were found in all groups of our study. Conclusion: In the group of patients with recurrent depression, significant decline of quality of life and significantly higher severity of depressive symptoms were present in comparison to the group of healthy subjects as well as significant level of inverse correlation of severity of depressive symptoms and quality of life.
The relationship of occlusal disharmonies and symptoms of temporomandibular disorders
Authors: Dodic Slobodan , Stanisic-Sinobad Darinka , Vukadinovic Miroslav
Published: July 2008

Introduction: The influence of occlusal condition on the onset of temporomandibular disorder (TMD) has been strongly debated for many years and is still the source of controversy. Until 1980s, the occlusal factors such as the presence of uncured malocclusions, discrepancies between intercuspal position (ICP) and retruded contact position (RCP) greater than two millimeters, occlusal abnormality, particularly mediotrusion and retrusion, and loss of posterior teeth were considered the primary causes of TMD. Objective: The objective of our study was to find correlation of occlusion disharmonies (difference between ICP and RCP) and present sings and symptoms of TMD. Method: The study involved 60 subjects between 18 and 26 years of age who were divided in two groups. The study group consisted of 30 subjects between 18 and 26 years of age with sings and symptoms of temporomandibular disorders (TMD). TMD was confirmed according to Helkimo index. An average value of Helkimo index in this group was 1. The control group included 30 subjects between 20 and 25 years of age without TMD sings and symptoms. An average value of Helkimo index in this group was 0. The function analysis of cinematic centers position in RCP and ICP was performed in each subject using the computer pantograph Arcus-Digma (KaVo EWL GmbH, Leutkirch, Germany). Results: The results of our study showed that the translation tracing of cinematic points from RCP to ICP was significantly different in TMD subjects and asymptomatic group (p>0.16). In addition, the study revealed that 53.4 % of subjects with sings and symptoms of temporomandibular disorders had marked translation in the lower temporomandibular joint (0.61-1.2 mm) what directed to intracapsular disorders. Conclusion: The results of our study suggested significant difference of RCP and ICP between subjects with sings and symptoms of the temporomandibular disorders and subjects without sings and symptoms.
Physical examination of sexual assault victims in Belgrade area
Authors: Alempijevic Djordje , Savic Slobodan , Kesic Vesna , Baralic Ivanka , Ilic Goran
Published: July 2008

Introduction: Sexual crimes represent various forms of contact of perpetrator?s genitals, lips, tongue, and fingers with genitals, lips and/or anus of the victim, in order to achieve sexual satisfaction, without victim?s consent. Objective: The aim of this work was to analyze the type of medical institution in which victims of sexual assaults are being examined in Belgrade area, to assess the quality of these examinations and medical records, as well as to control whether standardized protocols are followed. Method: Data were obtained through analysis of 113 cases of sexual assaults prosecuted in the District Court of Belgrade. Results: All victims were females with mean age of 24.1 years. The majority of victims (85%) were examined in one medical institution, most often in the Institute of Gynecology and Obstetrics, Clinical Center of Serbia, and only by one medical doctor (81.4%). Gynecologists were most frequently included in examination, while specialists of forensic medicine were engaged in only 9 cases (7.9%). In 84% of victims, the examination was performed during the first three days after the assault, and in 52% of cases on the first day. Standard techniques of clinical and gynecological examinations were applied only, without following any protocols, so the reports were made exclusively on individual basis. In no case an informed consent by victim was obtained before examination. Anamnestic data were collected in only 15.9% of cases, and they were generally incomplete. Conclusion: The results of investigation show that the quality of examination of sexual assault victims in Belgrade area is not adequate. Therefore, such negative practice should be changed in future through introduction of standardized protocols for examination of victims, as well as development of clinical forensic medicine.
The effects of pulsed low frequency magnetic field in early rehabilitation of patients with cementless total hip arthroplasty
Authors: Djurovic Aleksandar , Zivotic-Vanovic Mirjana , Popovic Dejan
Published: July 2008

Introduction: Early rehabilitation of patients with cementless total hip arthroplasty (cTHA) includes different physical modalities and pulsed low frequency magnetic field (PLFMF), which effects have not been explored yet. Objective: To investigate the effects of PLFMF which was applied in different doses in early rehabilitation of patients with cTHA. Method: Prospective, controlled, clinical study included 90 patients, divided in three groups with 30 patients each. First two groups were treated with high (group A) or low (group B) doses of PLFMF, in addition to kinesitherapy. Control group C was treated only with kinesitherapy. Study was completed in three weeks. Results: Subjects of group A had significantly lower pain than group B (p<0.01) and group C (p<0.001) subjects in the first postoperative week. Pain in group B subjects was significantly lower than in group C in all three postoperative weeks (p<0.01). In relation to other two groups, subjects of group A had higher hip Harris score values at the end of the third postoperative week (p<0.05), and they were faster on 10-meter distance at the end of the first postoperative week (p<0.01). Conclusion: PLFMF used in low and high doses for patients with cTHA had significant effects on pain abatement, especially at higher doses. Improvement of function was earlier and more manifested in the group treated with high doses of PLFMF.
Analysis of traffic accidents in children
Authors: Pavlekic Snezana , Puzovic Dragana
Published: July 2008

Introduction: Violent health damages of different origin (accidents, murders, suicides) in children and youth are one of the main causes of death and disabilities in this group of population in most countries. Objective: Objective of our paper was to analyze all related factors of traffic accidents involving children and to propose adequate measures of their prevention. Method: The analysis of fatal traffic accidents of children and youth aged to 18 years on the territory of Belgrade, within the period from 1998 to 2002. Results: In relation to other forms of violent death, the traffic mortality rate in children and youth holds the leading position, accounting for 56.9% with pedestrians as the most frequent category (57.4%). The most frequent age was between 7 and 9 years (46.8%) and the boys were more frequently injured than the girls. It was established that the majority of children (51.9%) was either running across the street outside the pedestrian/ zebra crossings or they were carelessly running out in the street, especially in April, July, August and September. More than a half of them (55.5%), predominantly school children, were injured by the end of working week, on Thursday and Friday. Conclusion: Results of our research have shown that the traffic education of children in our region is inadequate. Due to the abovementioned, it is primarily necessary to establish long-term and permanent education of this category of population. In addition, some public investments in the City infrastructure will be required in order to reduce the risk of traffic injuries in children.
Rating on life valuation scale
Authors: Lapcevic Mirjana , Dimitrijevic Ivan , Ristic Jelena , Vukovic Mira
Published: July 2008

Introduction: World Health Organization (WHO) Articles of Association defines health as the state of complete physical, mental and social well-being and not merely the absence of disease. According to this definition, the concept of health is enlarged and consists of public and personal needs, motives and psychological nature of a person, education, culture, tradition, religion, etc. All these needs do not have the same rank on life valuation scale. Objective: The objective of our study was ranking 6 most important values of life out of 12 suggested. Method: Questionnaire about Life Valuation Scale was used as method in our study. This questionnaire was created by the Serbian Medical Association and Department of General Medicine, School of Medicine, University of Belgrade. It analyzed 10% of all citizens in 18 places in Serbia, aged from 25 to 64 years, including Belgrade commune Vozdovac. Survey was performed in health institutions and in citizens? residencies in 1995/96 by doctors, nurses and field nurses. Results: A total of 14,801 citizens was questioned in Serbia (42.57% of men, 57.25% of women), and 852 citizens in Vozdovac commune (34.62% of men, 65.38% of women). People differently value things in their lives. On the basis of life values scoring, the most important thing in people?s life was health. In Serbia, public rank of health was 4.79%, and 4.4% in Vozdovac commune. Relations in family were on the second place, and engagement in politics was on the last place. Conclusion: The results of our study in the whole Serbia and in Vozdovac commune do not differ significantly from each other, and all of them demonstrated that people attached the greatest importance to health on the scale of proposed values. Relationships in family were on the second place, and political activity was on the last place. High ranking of health and relationships in family generally shows that general practitioners in Serbia take important part in primary health care and promotion of health care management. They have responsibility to preserve and enhance health of a person, family and society as a whole.
Desmoid tumor within lesser sac
Authors: Colovic Radoje , Grubor Nikica , Radak Vladimir , Micev Marijan , Colovic Natasa
Published: July 2008

Desmoid tumors or fibromatoses comprise a number of benign fibrous proliferative lesions that have local infiltrative growth and tendency to recur after incomplete excision. They never metastasize. The authors present a 31-year old woman who, due to epigastric pain and palpable mass detected on presentation, underwent the excision of firm tumorous mass, 210x140x115mm in diameter, from the lesser sac. Compressing the splenic vein, the tumor caused left-sided portal hypertension which subsided after the mass was removed. The recovery was uneventful. The histological examination verified typical desmoid tumor. Twelve years after surgery, the patient remained symptom-free with no signs of recurrence.
A suicide by insulin injection: Case report
Authors: Nikolic Slobodan , Atanasijevic Tatjana , Popovic Vesna
Published: July 2008

Suicide by injection of insulin overdose is uncommon. Insulin has been used as an agent for suicide both in diabetics and healthy subjects. The methods of postmortem forensic diagnosis of insulin overdose were reviewed. Police investigation could be crucial to document the amount and type of insulin used. In addition, the complete forensic autopsy, microscopic analysis of tissue samples, consecutive chemical-toxicological investigation and appropriate laboratory tests are required to make proper diagnosis in these cases. To assess pre-mortem hypoglycemic state at the time of dying, it is necessary to establish postmortal concentrations of glucose, lactate and potassium in vitreous humor. Since the use of insulin for medical treatment, only two cases with diagnosis of suicidal insulin overdose were confirmed at the Institute of Forensic Medicine in Belgrade. In this paper, the authors present one such case. An 84-year-old male was found dead in his flat. He had diabetes mellitus during the last fifty years, and he used insulin twenty years. A few empty insulin ampullae's and plastic syringes were found nearby deceased, on the room-table during the crime scene investigation, as well as his suicidal note. The forensic autopsy, microscopic, chemical-toxicological and biochemical analyses of tissue and body-liquid samples as well as police investigation indicated suicide due to insulin-overdose.
Early risk predictors of sudden cardiac death after myocardial infarction: Results of follow up of 881 patients
Authors: Milovanovic Branislav , Krotin Mirjana , Vukovic Dejana , Bisenic Vesna , Mirjanic Tijana , Nikolic Slavica
Published: July 2008

Introduction: It has been shown that depolarization disorders, autonomic dysfunction, and systolic dysfunction of the left ventricle are associated with sudden cardiac death after myocardial infarction. Objective: The Objective of study was to examine the prognostic value of the most important predictors in the first week after myocardial infarction. Method: Study included 881 patients who were followed up from 1 to 60 months. During the first week after myocardial infarction, following examination were performed: ECG with standard leads and X, Y, Z orthogonal leads, vectorcardiogram, QT interval, late potentials, short-time spectral analysis of RR variability, nonlinear (Poincare plot) analysis and echocardiogram. Results: In univariate analysis, the following parameters measured on the first day were important predictors of sudden cardiac death: lower LF/HF ratio(<1.5) (p=0.000), T wave inversion in X lead (p=0.000), high P wave in D2 lead (p=0.030), and diminished systolic function (p=0.000). In multivariate analysis, the following parameters were significant risk predictors: T wave inversion in X lead, lower LF/HF ratio, positive late potentials and the left ventricle systolic dysfunction. Conclusion: The parameters of the left ventricle systolic dysfunction with sympathicovagal imbalance and electric instability are the key risk predictors in the first few days after myocardial infarction.
Leptin and inhibin B as predictors of reproductive recovery in patients with anorexia nervosa during weight gain
Authors: Cetkovic Aleksandar , Djurovic Marina , Milic Natasa
Published: July 2008

Introduction: Anorexia nervosa represents an eating disorder that is associated with substantial psychological, social and physiological abnormalities, involving 0.5-2% of female population. Objective: The secretion patterns of inhibin B, as marker of gonadal activity, and leptin, as an indicator of energy balance and body composition, were analyzed in our cross-sectional study in order to asses the restoration of reproductive function in patients with anorexia nervosa (AN) during gaining of normal weight. Method: The study included 20 patients with low weight AN (BMI 14.3?0.3 kg/mI), 22 partially recovered AN (BMI 17.4?0.1 kg/mI), and 29 gained regular weight, out of whom 16 had no restoration of menstrual cycle (BMI 19.5?0.1 kg/mI), and 13 had at least six consecutive menstrual cycles (BMI 19.3?1.0 kg/mI). Nineteen eumenorrheic females with BMI 19.8?0.4 kg/mI were the controls. Results: Significant correlation between leptin and inhibin B (?=0.446; p=0.000), leptin and delta LH (?=0.611; p<0.001), and inhibin B and delta LH (?=0.574; p<0.001) was found in patients with anorexia nervosa during weight gain. Leptin (p=0.0039), inhibin B (p=0.0173), LH (p=0.0323) and delta LH (p=0.0087) were important predictors of reproductive recovery in patients with anorexia nervosa during gaining of normal weight. Among aforementioned parameters, leptin (p=0.0057) appeared to be the most important. Conclusion: Leptin is the most important predictor of reproductive recovery in patients with anorexia nervosa during weight normalization. These findings suggest that decreased leptin levels may be responsible for several neuroendocrine abnormalities seen in anorexia nervosa. Thus, interventional studies involving administration of recombinant leptin are required to fully clarify the physiologic and potentially therapeutic role of leptin in anorexia nervosa.
Relationship between respiratory symptoms and satisfaction with inhaled asthma medication
Authors: Gvozdenovic Branislav , Zugic Vladimir , Lapcevic Mirjana , Vukovic Mira , Milosevic Svetlana , Plavsic Slavica , Orlovic Smiljana
Published: July 2008

Introduction: Asthma is the chronic inflammatory disease of the airways, and the inhalation treatment is the most convenient way to deliver the medication directly to the airways. Objective: The aim of our study was to evaluate the relationship between respiratory symptom scores in asthmatic outpatients and their satisfaction with inhaled asthma medication. Method: In 124 patients, (39 males; mean age 45?18 years; mean forced expiratory volume in one second (FEV1) 71.8?23.4% predicted), respiratory symptoms were determined by 4-item questionnaire for most frequent asthma symptoms - cough, wheezing, dyspnea and chest tightness (all of them graded from 1 - without symptoms, 2 - mild, 3 - moderate, and 4 - severe symptoms), with overall score (from 4 to 16), as well as by scale for assessment of sinonasal symptoms ? the 20-item sinonasal outcome test (SNOT-20) (in 65 out of 124 patients). SNOT-20 scores ranged from 0 to 5, where higher score indicated more manifested symptom. Patients? satisfaction was measured by standardized "Satisfaction with Inhaled Asthma Treatment Questionnaire" (SATQ), which scores were calculated for the overall satisfaction as well as for individual domains (effectiveness of treatment, easy application, medication burden, and side-effects and related worries). The bigger the score the better the satisfaction, and vice versa. Results: The highest degree of correlation with overall satisfaction scores was found (using the Pearson?s coefficient of linear correlation) for the scores of wheezing (r=-0.271; p=0.002). SNOT-20 scores best correlated with side-effects and worries domain scores. Conclusion: The severity of respiratory symptoms in the asthmatics is strongly correlated with satisfaction with inhaled medication. Improving the asthmatic symptoms Results in enhancement of their satisfaction with inhaled medication and compliance.
Natural history of supratentorial low-grade astrocytoma: Case report
Authors: Radulovic Danilo
Published: July 2008

Low-grade astrocytomas comprise a group of primary brain neoplasms with relatively low anaplastic potential, although through time they tend to behave more aggressively. They have a very heterogeneous natural course and clinical behavior. This report presents a natural history of a patient with low grade astrocytoma. A 32-year-old male sustained head injury after grand mal seizure. On admission, he was conscious and without neurological deficit. Initial computerized tomography and magnetic resonance of brain revealed oval, 4 cm in diameter, lesion in the left parietal region that was considered as low-grade glioma. The patient refused surgery. Eight years and four months later, he was readmitted. This time, he was subcomatose with right hemiplegia. Repeated computerized tomography showed huge tumor in the left frontoparietal region at the site of previous lesion. Urgent left frontoparietal craniotomy and reduction of tumor were performed. The patient recovered after surgery. Right hemiparesis remained. The described patient with low-grade astrocytoma lived without any oncological treatment eight years and four months from the time when diagnosis was made until intracranial herniation. The natural history of disease in presented patient indicated that rational therapeutic strategy, for low-grade astrocytoma with epilepsy only, would be deferral of surgery until the time of manifestation of neurological or radiological deterioration.
Isolated metastasis of the granulosa cell tumor of the ovary in the small intestine mesentery 19 years after salpingo-oophorectomy
Authors: Colovic Radoje , Grubor Nikica , Micev Marjan , Colovic Natasa , Radak Vladimir
Published: July 2008

Introduction: Granulosa cell tumor is uncommon malignant tumor which belongs to the sexual cord-stromal tumors of the ovary. It arises from the specialized stromal cells of the ovary. These tumors are unilateral in 95%. Over 90% of patients survive more than 10 years after surgery, but the recurrence may appear even 25 years after surgery. CASE REPORT The authors present a 54-year old woman who was admitted for abdominal pain and ultrasonography revealed tumor in the abdomen. During the surgery, a spheric, well circumscribed tumor of the mesentery, close to the forth portion of duodenum, was excised. Histological and immunohistochemical examinations verified that it was the metastasis of the granulosa cell tumor of the ovary that had been removed 19 years ago when salpingo-oophorectomy had been performed. Postoperative recovery was uneventful. Twenty six months later, the tumor 4 cm in diameter recurred, and was localized to the left of duodenum, close to the inferior mesenteric artery, which was perfectly ideally, together with fat tissue and surrounding lymph nodes. She has remained symptom free so far. Conclusion: To the best of our knowledge, this is the first case of the isolated metastasis of the granulosa cell tumor in the mesentery, that appeared 19 years after original surgery.