bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory blood pressure monitoring and left ventricular mass index in children with renal disease
Authors: Pejcic Iris , Peco-Antic Amira , Jovanovic Ida , Kostic Mirjana
Published: July 2008

INTRODUCTION Numerous epidemiological studies have shown that blood pressure (BP) is positively related to cardiovascular morbidity and mortality. Although the relationship between BP and the incidence of morbid events is consistent and highly significant, it is difficult to predict the absolute risk. Several studies have shown that the organ damage associated with hypertension correlate to a greater degree with 24h average BP than with clinic BP and the most of them evaluated left ventricular hypertrophy in these patients. OBJECTIVE To evaluate the correlation between left ventricular mass index (LVMi) and BP, BP variability, pulse pressure (PP) BP load and hyperbaric index (HBI). DESIGN AND METHODS Ambulatory blood pressure monitoring (ABPM) was performed in 30 children with renal disease aged 12.7 ? 5.5 years. Ten of them had normal renal function, 3 had renal transplant and 17 of them had end-stage renal disease and were on chronic haemodialysis. All of the patients were submitted to an echocardiographic evaluation and LVMi was calculated according to Penn convention. Ambulatory blood pressure monitoring was performed during the 24h period and average values of systolic and diastolic BP were evaluated. As an index of variability of BP values we used standard deviation (SD) of mean. Evaluation of average BP values has some disadvantages - it does not take into account the peaks of blood pressure and the values are lower if the circadian rhythm of BP is preserved - for this reason BP load and HBI were evaluated as well. BP load represented the percentage of BPs exceeding the upper limits of normal and HBI the integrated area under the ambulatory BP curve. For the upper limits of normal we used 95th percentile from the multicenter study of German authors. RESULTS There was no correlation between LVMi and evaluated parameters. CONCLUSIONS The response of myocardium to chronic increase of the afterload is highly individual, and probably the role of genetics in this is very important. Echocardiogarphy (LVMi) could not be used with certainty for the evaluation of ventricular mass.
Correlative analyze of predictable factors of successful implantation in assisted reproduction programme
Authors: Papic-Obradovic Milena , Dragojevic-Dikic Svetlana , Mitrovic Ana , Papic Dusan
Published: July 2008

INTRODUCTION Endometrial receptivity as isolated predictive factor of successful implantation, with its specifity is determined with numbered factors. PURPOSE Purpose of this study was to evaluate significance and correlation between relevant factors using appropriate statistical analyses on term of embryo implantation. MATERIAL AND METHODS Evaluated group contained 85 women whom according different causes of infertility have been determined for assisted reproduction program. Analysed measurements were endometrial thickness, assessed hyperechogenity in relation with absolute endometrial thickness (HEA relation) and uterine blood flow (pulsatile index - Pi). Simultaneously were analyzed serum estradiol (E2; pg/ml) and progesteron (P; nmol/l) levels. After these evaluations achieved results were processed with standard statistical pack. Beside that were applied parameter and nonparameter tests with aim to test significancy of difference and multiple regressive analyse (Stepwise). RESULTS Resulted measured parameters have been presented in basic analyse as middle value (Xrs) from all measurements +SD (standard deviation) and significance of difference is tested by mentioned statistical tests (Table 1). Application of Stepwise analyse, "step by step", has used parameter by parameter based on value which has decreased variability and based on achieved correlative coefficient between dependent uneven and complex of independent uneven values. This procedure confirmes best correlation between HEA relation and serum progesteron levels and HEA relation in correlation with associated values: P, E2 and endometrial thickness (Table 1). DISCUSSION Investigation provided till now shows that embryo quality and endometrial receptivity with highest probability determine success of applied assisted reproduction, successful embryonal implantation There is assessed influence of endometrial receptivity represented trough HEA relation using manyfolded regressive analyse where qualitative endometryal value has been looked with dependency with other parameters gives picture for high determinancy with hormonal activity and with stimulative ovarian activity. This determinacy could be viewed mostly through serum progesteron levels on day of HCG administration. Correlative relation between qualitative endometrial characteristics on day of HCG administration has highes value related to progesteron levels. CONCLUSION Results presented with this research confirm once again complexity characteristic for factors that play final role in embryo implantation in IVF program. There is presented only one aspect related with this problem with aim to contribute quantification importance and assessment rate of mutual influence these factors known till now as relevant.
Intravascular lymphomatosis of central nervious system - case report
Authors: Jovic Jasmina , Ercegovac Marko , Dozic Branko , Cvetkovic Dubravka , Zivkovic Miroslava , Beslac-Bumbasirevic Ljiljana
Published: July 2008

Intravascular lymphomatosis is an uncommon lymphoproliferative disorder characterised by intravascular distribution of neoplastic lymphoid cells (B- or T- lymphocites), what leads to occlusion of small vessels and causes signs and simptoms of disorder. Its initial predilection sites are the brain or the skin, and hematopoetic organs are usually spared. The signs and symptoms of the disorder are attributed to vascular occlusion. Clinical course is fatal, besides therapy. In our case disorder has started with partial epileptic seizures with secondary generalisation, and after that with motor aphasia, right hemi paresis, urinary incontinence and cognitive changes. She was hospitalized for several times, completely investigated, but with no conclusion. Seven months after appearance of symptoms, she died. And diagnosis was determined at autopsy. A myriad of neurological and systemic manifestations are putting us in an unequal position with this fatal disease. Early diagnosis can increase survival and decrease intensity of symptoms. So every new case is important as warning that we must not forget about this disease.
Hydatid cyst of the liver which demaged the confluence of the hepatic ducts causing deep obstructive jaundice
Authors: Colovic Radoje , Grubor Nikica , Jovanovic Miodrag
Published: July 2008

Complications of the hydatid cyst of the liver on bile ducts appear in 5-25% representing almost two third of all complications of the hydatid liver cysts. Fortunately a damage to the bile ducts causes only an infection of the cyst usually without major consequences. More serious complications such as cholangitis and deep obstructive jaundice are much rarer. The defect of the bile duct usually is a periferal one. Damage to the major ducts are rarer and those on the confluence of hepatic ducts itself are the rarity. In that case biliary reconstruction may be a serious chalenge. The authors present a 23 year-old man in whom a centrally localised hydatid cyst made a major damage of the confluence of all three hepatic ducts causing deep obstructive jaundice. After standard procedure for hydatid cyst an intracavital mucosa to mucosa hepaticoje-junostomy was carried out with excellent success. More then six years after surgery the patient stayed symptom-free with bilirubin and alkaline phosphatase within normal limits.
Accident after accident - unusual death of a patient in hospital
Authors: Nikolic Slobodan , Micic Jelena , Savic Slobodan
Published: July 2008

The authors present a case of accidental fatal laryngopharyngeal obstruction with bolus of food, in hospital, in a patient who has been treated for twenty days because of injuries sustained in a traffic accident. The injuries were multiple fractures and brain contusions that were not clinically diagnosed, while their simptomatology (somnolence) was attributed to morbous lesions - multifocal brain infarction. Mechanical asphyxiation and death occurred when the patient was fed in hospital by his brother. Unofficially we got an information that whole event was very dramatical, and that medical staff tried to attempt re-suscitative measures but without any written note about that in medical documentation. The terminal phase of his chronic desompensated cardiomyopathia was clinically announced as a cause of death. For forensic pathologists it was relatively easy task to prove mechanical asphyxiation due to laringopharyngeal blockage as a real cause of death on medicolegal autopsy.
Changes of acoustic reflex parameters due to effect of noise
Authors: Zivic Ljubica , Zivic Djordje
Published: July 2008

Acoustic, stapedial reflex represents a response of the m. stapedius to a sonic excitation of supra speech intensity. It is the constitutive part of impendancmetric investigations, it is performed on the same apparatus after tympanometry, and it is the inseparable part in representation of impendancmetric findings. Until now, the most frequently monitored parameters of acoustic reflex of clinical importance are: threshold amplitude, output and input angle of the reflex curve. The aim of this work was to performed detailed analysis of mentioned parameters in workers exposed to extensive action of industrial noise of known physical characteristics (of different durations) and to establish which changes occurred in these workers, to what extent and under which conditions. Investigations included 173 industrial workers (346 ears), which work in working unit "Forge", where during the working process noise is produced which is above permissible limits and of the unfavorable frequency content. Workers were divided into two groups. The first group consisted of workers who were spending the whole working time in the workroom with noise above permissible limits, the second group consisted of workers who were spending 3 hours of the working time in that workroom, while the control group consisted of workers who were spending the whole working time in that workroom but they did not have any hearing impairment. Workers of the first and the second group had the hearing impairment, which occurred exclusively as a consequence of chronic acoustic trauma. For all the workers the anamnesis was taken, as well as ORL status and audiometric and impendancmetric investigations were performed, namely the tympanometry and acoustic reflex. Results have shown that the acoustic reflex threshold at 500 Hz and at 1000 Hz for the first group (95.10 dB) was increased with respect to the reflex threshold of the second and the control group (84 dB). At higher frequencies of 2000 Hz and 4000 Hz an increase of the reflex threshold was found for the first and the second group (96 dB) with respect to the control group (87 dB).The amplitude of acoustic reflex was increased at frequencies 500 Hz and 1000 Hz (3.38), with respect to the second group (2.78) and the control group (2.36), and at higher frequencies, this increase is more prominent. The input angle of the reflex curve was, for the first and the second group, within limits 41? to 50?, and for the control group was from 31? to 50?. The output angle was, at majority of ears of the first and the second group, from 26? to 35?, and for the control group it was from 16? to 35?. Acoustic reflex, as the noninvasive method, short term one, objective and simple for application, does not require collaboration of workers, what provides for objectivity of obtained results and what caused that wrongful estimations, impressions and subjective reactions of workers were avoided.
Surgical tretment of postcontusion orbital hem atom a in its late phase
Authors: Jovanovic Milos
Published: July 2008

OBJECTIVE The object of the study was to present successfully performed decompression of the orbit in orbital hematoma. MATERIAL AND METHODS Male 51 years of age sustained the contusion injury of the right eye during his fall on the bath tap. It caused the development of a large orbital hematoma with protrusion, restricted movement of the eyeball, pain, diplopia folding of the retina due to hemtoma compression to bulbus oculi and retinal hemorrhages, higher intraocular pressure and impaired visual acuity to 2/60. He was treated by medicaments for a month, but the results were not favorable. After one month from the injury, anterior-inferior transcutaneous orbitotomy was performed. During the surgical intervention hematoma and a part of orbital fat tissue were removed. RESULTS The globe of the eye was retracted and the exophthalmos disappeared immediately after the surgery, while the mobility of the eyeball, disappearance of retinal folds with gradual receding of hemorrhage, normal intraocular pressure abatement of pain and diplopia as well as the restoration of visual acuity to normal ensued in a few subsequent days. CONCLUSION This study illustrated that decompression of the orbit in orbital hematoma might be successful even in the late phase, e.g., one month following the injury. It is assumed that surgical intervention would be performed by experienced orbital surgeon.
Atypical hodgkin and reed-sternberg cells in peripheral blood of a patient with advanced stage of Hodgkin's disease - a case report
Authors: Milosevic Rajko , Colovic Milica , Cemerikic-Martinovic Vesna , Colovic Natasa , Bogunovic Marina
Published: July 2008

The occurrence of abnormal Hodgkin's and Reed-Sternberg cells in the peripheral blood in a patient suffering from Hodgkin's disease has been noticed exceptionally rare in a previous period, and especially rare in last ten years primarily due to successfull treatment of this disease. The presence of atypical mononuclear cells in peripheral blood which cytomorphologically resembled Reed-Sternberg cells was registered in 8 patients till 1966. During the last decade, the presence of atypical mononuclear cells in the peripheral blood was used for their isolation cultivation, and detailed immunophenotypic and genetic analysis. The analysis of mononuclear cells in rare patients with Hodgkin's disease was established that they belong to the B-lymphoid cells with expression of CD30 and CD15 antigens. The examination of presence of Hodgkin's cells in the peripheral blood of patients with Hodgkin's disease is important for patients with advanced stage of the disease in which autologous stem cell transplantation and high dose chmeotherapy is planned. The authors present a 33-year-old patient, who noticed enlarged neck lymph nodes in September 2000, high temperature and loss in weight. On physical examination enlarged neck lymph nodes 5x8 cm and hepatosplenomegaly were found. There was anemia and thrombo-cytopenia, and normal WBC count with 24% of lymphoid elements in differential formula. On histologic examination of lymph nodes Hodgkin?s disease, type nodular sclerosis with mixed cellularity was found. Histology of bone marrow showed nodal lymphomatous infiltration. Immunohistochemistry with monoclonal antibodies of concentrate of peripheral blood cells showed expression of CD30+ and CD15+, immunophenotypically and morphologically matching Reed-Sternberg cells. Cytogentic analysis of mononuclear cells of the bone marrow showed normal karyotype. The patient was in clinical stage IV/V of the disease and chemotherapy with 9 cycles of ABVD+Mp protocol was applied. He is still in remission.
Cardiac changes in mediastinal seminoma - a case report
Authors: Ivanovic Branislava , Vujisic-Tesic Bosiljka , Jovanovic Dragana , Kalimanovska-Ostric Dimitra
Published: July 2008

Primary pure cell seminoma of the mediastinum is a rare and potentially fatal lesion. Encroachment or invasion of adjacent structures is common, as are distant metastases. We present an unusual case of mediastinal seminoma with directly intracavitary invasion into the right atrium and extension to the left atrium. A 22-year-old male with right side chest pain, progressive cough, dispnea, fever and right arm swelling lasting about a month is presented. Chest radiography on admission revealed a large mass in the anterior mediastinum. A cardiac ultrasonographic examination showed right atrial compression by the mass, with invasion of the right atrium wall. We also found polyp-like (about 2.5 cm in diameter) masses in left atrium near the area of the right pulmonary veins and a circumferential pericardial effusion. Percutaneous needle biopsy revealed mediastinal seminoma. To our knowledge, no similar case has been previously reported.
Influence of preoperative parametres on survival of patients with ruptured abdominal aortic aneurysm
Authors: Markovic Miroslav , Davidovic Lazar , Maksimovic Zivan , Kostic Dusan , Cinara Ilijas , Cvetkovic Slobodan , Sindjelic Radomir , Vasic Dragan , Lotina Slobodan
Published: July 2008

Between 1991-2001 total number of 1058 patients was operated at the Institute of Cardiovascular Diseases of Serbian Clinical Centre due to abdominal aortic aneurysm. Of this number, 288 patients underwent urgent surgical treatment because of ruptured abdominal aortic aneurysm. The aim of this retrospective study was to show results of the early outcome of the surgical treatment of patients with ruptured abdominal aortic aneurysm, and to define relevant preopera-tive factors that influenced their survival. There were 83% male and 17% female patients in the study, mean aged 67 years. Intrahospital mortality that included intraoperative and postoperative deaths was 53.7%. Therefore, 46.3% patients survived surgical treatment and were released from hospital. Intraoperative mortality was 13.5%. Statistics showed that the gender and the age did not have any influence on mortality of our patients, as well as their co morbid conditions (p>0.05). Clinical parameters at admission in hospital such as state of consciousness systolic blood pressure, cardiac arrest and diuresis significantly influenced the outcome of treatment, as well as laboratory findings such as levels of hematocrit, hemoglobin, white blood cells, urea and creatinin (p<0.05; p<0.01). Ruptured abdominal aortic aneurysm still remains one of the most dramatic surgical states with very high mortality reported. We assume that importrant preoperative factors that influence the outcome of surgical treatment can be defined, but there is no single parameter which can certainly predict the lethal outcome after surgery. Also, the presence of co morbid conditions does not significantly influence the outcome of treatment in these patients. Therefore, urgent operation should not be withheld in most of the patients with ruptured abdominal aortic aneurysm.
The first case of isolation of malassezia globosa in our country
Authors: Arsic-Arsenijevic Valentina , Milobratovic Danica , Dzamic Aleksandar , Mitrovic Sanja , Radonjic Ivana , Petkovic Ljubica , Kranjcic-Zec Ivana
Published: July 2008

Today is known that genus Malassezia includes seven species: M. furfur, M. sympodialis, M. obtusa, M. globosa, M. restricta, M. slooffiae and M. pachydermatis, but role of each of the species in the pathogenesis of desease has not been eluciated yet, so futher laboratory isolation and identification are necessary. We report the first case of isolation of Malassezia globosa in Serbia (Belgrade), in a patient suffering from Pityriasis versicolor. Identification of M. globosa was based on macroscopic, microscopic and biochemical characteristics. Isolation was done on Leeming and Notman medium and on mDixona agar, at 350C, during 7 days in aerobic conditions. Also the yeast's biochemical phenotype was determined as catalase (+), lipase (+), esculin degradation (-), Tween (20,40, 60 and 80) asimilation (-). M. globosa is a lipophilic yeast of the genus Malassezia and the common member of the skin flora. In concordance with some predis-poning factors M. globosa is implicated in the pathogenesis of several skin diseases (pityriasis versicolor, malassezia foliculitis sebor-rheic dermatitis and some forms of atopic dermatitis). In immuno-compromised patients and neonates this yeast can even cause fatal systemic infections. Because the role of Malassezia spp. in pathogenesis of skin desease is not still determined, we suggest laboratory diagnosis and identification of these species as a routine diagnostic procedure.
Abnormalities of chromosome 17 in myelodysplastic syndromes: Incidence and biological significance
Authors: Marisavljevic Dragomir , Rolovic Zoran , Pantic Milena , Novak Angelina , Djordjevic Vesna , Lazarevic Vladimir , Boskovic Darinka , Colovic Milica
Published: July 2008

Cytogenetic analysis has proven to be a mandatory part of the diagnosis of myelodysplastic syndromes (MDS) as well as a major indicator for predicting clinical course and outcome. Aside from the 5q-syndrome, no specific clinico-cytogenetic entity has been reported. To determine the incidence and clinical significance of acquired abnormalities of chromosome 17 in adult primary MDS, we reviewed the cytogenetic features of 271 patients detected at our institution during a 10-year period. Clonal cytogenetic abnormalities were identified in 109 cases. Among them, abnormalities of chromosome 17 were identified in 13 patients (11.9%). Five patients had ?single" defects, while in eight patients abnormalities of chromosome 17 were associated with other chromosomal rearrangements (?complex" defects). After chromosomes 5,7,8 and 1, abnormalities of chromosome 17 were the most frequent chromosomal rearrangements in our patients with MDS. Following ?single" defects of chromosome 17 were identified: del(17)(pl2) in two cases, and i(17)(q10), del(17)(q21;q23) and del(17)(ql2;q22) in one case each. Two patients with del(17p), one with RAEB-t and the other one with CMML, had an aggressive course of the disease with accelerated leukemic transformation and short survival. Patient with i(17q) had RARS subtype and died soon after diagnosis, while other two cases with interstitial deletions of the long arm of chromosome 17 had RAEB subtype and stable, no progressive course of the disease. Among ?complex" karyotypes with abnormalities of chromosome 17 we identified der(l 7) in four, monosomy 17 in two, and del(17p) and i(17q) in one case each. Most of these patients transformed to acute leukemia and had very short survival. The results of this study suggest that abnormalities of chromosome 17 are frequent finding in MDS. Loss of genetic material in 17p, both in ?single" and ?complex" defects, seems to be closely related to poor prognosis of MDS patients.
Pathological conditions associated with rhinitis medicamentosa
Authors: Milosevic Dusanka , Janosevic Ljiljana , Dergenc Ranko , Vasic Milan
Published: July 2008

Rhinitis medicamentosa (nose-drop-nose") is a term used for pathological condition of the nasal mucous membrane that results from long-term abuse with intranasal vasoconstrictors. The aim of this work was to examine what lead the patients with nosedropnose rhinitis to the initial usage of intranasal vasoactive drugs, in this prospective study, 92 patients with rhinitis medicamentosa were included. The evaluation of all study subjects comprised the history, ORL, microbiological and radiological examination, skin prick tests with a battery of routine respiratory and nutritive allergens and nasal cytology. The results of this study showed that the pathological conditions for initial use of intranasal vasoactive drugs were: acute upper respiratory infections in 293%, vasomotor rhinitis in 21.7%, allergic rhinitis in 16.3%, deviated nasal septum in 13.0%, nasal polyposis in 12%, rhinitis induced by mechanical trauma in 4.4%, and hormonal rhinitis in 3.3% of patients with rhinitis medicamentosa. In conclusion, the most common pathological conditions for developing rhinitis medicamentosa were chronic inflammatory and structural diseases manifested by permanent nasal obstruction as well as acute upper respiratory infections are.
Myomectomy by vaginal route
Authors: Milovanovic Zagorka , Stanojevic Dusan
Published: July 2008

In recent years, the development of new surgical techniques in uterus myoma treatment have reduced operative trauma significantly. Our objective was to present operative technique-vaginal myomectomy, making a prospective clinical study where we have evaluated the operative and postoperative period after intentive diagnosis. The result of our study shows the feasibility of myomectomy by entering the peritoneum through the posterior vaginal fornix, using traditional and cheap surgical instruments and thus avoiding the trauma of laparatomy, minimal operative blood loss, reduced operating time and postoperative recovery. In our opinion, vaginal myomectomy could be useful for the treatment of selected cases with fundal or posterior wall uterine myomas.
The importance of microbiological tests of vaginal secretion during reproductive period
Authors: Arsic-Arsenijevic Valentina , Radonjic Ivana , Mijac Vera , Cirkovic Ivana
Published: July 2008

Vaginal infections, during reproductive period are frequent and although not life treating, they can affect their normal functions. They can also affect wommen's fertility as well as the course of pregnancy. The outcome of pregnancy can be endangered due to the possibility of infection of newborn while passing trough birth canal of the infected mother. As statistically shown, bacterial vaginosis is considerably more often found with the patients having precancerous changes on cervix, or diagnosed cancer of cervix, comparing with women with healthy cervix. It can also cause the apperance of postoperative pelvic cellulitis after hysterectomy. On the other side, the presence of S. agalactiae in vaginal secretion may cause very serious and lethal infections of the newborn such as meningitis, pneumonia and sepsis. As for protozoa T. vaginalis it has been shown that it could cause reduced fertility ability and that during pregnancy it could demage fetal membranes and bring to its premature rupture and premature birth. There is also increased risk of cervix cancer. During reproductive period of women especially if risk factors are existing such as hormone therapy, diabetes mellitus type 1 and applications of wide range antibiotics, vaginal fungal infections caused by Candida can frequently appear. These infection apart from the discomfort like itch and affluent secretion they can also mean diagnostic and therapeutical problem. Regular microbiological test of women are highly recommended during reproductive period as standard for bacterial vaginosis, fungal and trichomonas infections. If those results appear negative, further microbiological tests are necessary. Such tests which are more elaborate, more timely and more expensive are referring to tests on chlamidia, micoplasma and some viruses that can also be the cause of vaginal secretion disbalance in women during reproductive period.
Centar za kontinuiranu medicinsku edukaciju, Medicinski fakultet, Beograd
Authors: Radak Djordje , Dedovic Snezana , Nikolic Ruzica
Published: July 2008

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Convenience of vestibular surfaces of lower canines for accepting retention elements of removable partial denture
Authors: Stancic Ivica
Published: July 2008

Lower canines often appear as abutment teeth of partially edentulous dental arch. Crown contours of these teeth are mostly inconvenient for placing clasps. The convex vestibular surfaces with sufficient undercuts for placing retention elements are obligatory on lower canines but it is not common case. Aim of this paper was to confirm a high frequency of inexistence of buccomesial and buccodistal undercuts of the lower canines. Measuring of buccomesial and buccodistal undercuts on abutment lower canines was preformed on 50 diagnostic casts of lower jaw, belonging to Kennedy class I, where the canine was a border of shortened dental arch. For this procedure paralelometar Unit ?Degussa" with a special measuring device was used. The undercut depth could be read directly within a range of 0-1.0 mm. Results show that unprepared lower canines have poor possibilities for retention removable partial denture with clasps. Our positive clinical experiences in recontouring vestibular surfaces of the abutment teeth point to two methods of making an artificial undercut: non-invasive (making an artificial undercut using composite materials) and invasive (using modified fixed restorations). Considering fact that vestibular surfaces of lower canines as abutment teeth are in most cases without undercuts, recontouring of this surfaces in almost all occasions is necessity. If vestibular undercuts don't exist, non-invasive techniques should always have advantiges to invasive techniques. The vestibular surfaces of abutment teeth might be recontoured by using non-invasive techniques with minimal destruction of integrity of teeth. Lately, the composite materials are used for forming artificial undercut.
External fixation for the treatment of open fractures of the proximal humerus caused by firearms
Authors: Miric Dragan , Senohradski Kenan , Starcevic Branislav , Djordjevic Zoran
Published: July 2008

Nine patients with open fractures of the proximal humerus were treated using an external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Radial nerve injury was present in five and two multiply injuried patients with thoracic wall and abdominal viscera were present. There were no major arterial injuries. Chronic osteitis with fistula and sequestra developed in one. There were no nonunions and no refractures. Minor painless limitation of shoulder and elbow motion presented in all patient. Upper-third humeral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted therefore, stable fixation is difficult or impossible to achieve. On the other hand, the risk of infection is high following plate fixation. External fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early mobilization of the shoulder and elbow.
Injury severity score as possible parametar for evaluation of height of fall in deadly injured
Authors: Atanasijevic Tatjana , Nikolic Slobodan , Djokic Vesna
Published: July 2008

The injuries caused by high falls from over the seventh floor are considered mostly fatal. It is possible to survive the high fall from over 30 meters at landing on the surface of high deformity (snow or water). The Injury Severity Score (ISS) due to a high fall is influenced by the height from which the body has fallen, then, the body and surface features, and finally, the manner of body impact on to the surface. The aim of the study was determining the possibility of the height estimation that caused the fatality of the impact, considering the severity of injury expressed by ISS. A retrospective autopsy study was done on the materials of Institute of Forensic Medicine in Belgrade, during a twenty-year period: 1981-2000. The autopsy records were analyzed together with clinical medical data, of the deadly injured due to high falls on to a solid surface. ISS value was determined in each case. The height of fall was determined on the basis of police reports, i.e. death scene analysis. The results were done statistically (linear correlation). The sample included 660 cases: 469 males (71%) and 191 females (29%). The average age of the examined sample was 44.66 (SD=6.62).The number of 290 cases (44%) were accidental deaths, while 370 were suicidal ones (56%). Only few injured due to high falls up to 7 meters had ISS value below 26. Deaths in these cases were caused by complications of the injuries. The ISS value in the injured rose with the height from which the victim had fallen: ISS was 25 in all falls over 7 meters of height. In all cases were severe, critical injuries of one organic system (mostly severe head injuries). According to the analysis of our sample, we concluded that it was not possible to determine the precise height of fatal falls only on the basis of the injury severity score estimation by ISS. This determination, approximate one, was possible only in falls on to a solid surface up to 30 meters. The same determination was not possible by the analysis of the time of survival. It is obvious that determining the height of fall is more possible by types and combinations of single injuries which are, single or combined with other injuries, characteristic for single mechanisms of primar body contact with the solid surface depending on the height of fall.
Paroxysmal hemicrania: A case report
Authors: Zidverc-Trajkovic Jasna , Pavlovic Aleksandra , Mijajlovic Milija , Jovanovic Zagorka , Sternic-Covickovic Nadezda
Published: July 2008

Paroxysmal hemicrania (PH) is one of the trigeminai autonomie cephalgias (TACs), a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomy features. The TACs are relatively rare, which is likely to be why they are poorly recognized in primary care. TACs will thus be referred to neurologists eventually, offering an excellent opportunity to diagnose and treat these patients. PH responds in a dramatic and absolute fashion to indomethacin. The importance of recognizing these syndromes is underscored by their excellent but highly selective response to treatment. This is the case report of our patient with PH and the review of current knowledge about pathophysiology of TACs, as well as differential diagnosis of other entities from this headache group.
Reiter's syndrome after salmonella infection
Authors: Canovic Predrag , Gajovic Olgica , Mijailovic Zeljko
Published: July 2008

Two patients with Reiter's syndrome, after Salmonella infection were treated on the Infections disease ward at Clinical hospital center in Kragujevac. In the first patient, ten days after the onset of Salmonella infection, signs of edema and pain in the right ankle occurred, accompanied by expressed conjunctivitis. Within next two months consecutive metatarsophalanges changes joint of the right foot have appeared. In the second patient, two weeks after the onset of Salmonella infection, edema of the left hand joints and a week later edema of the right hand and right ankle joints appeared. In both patients inflammatory syndrome was expressed (high erythrocyte sedimentation rates, fibrinogen, C-reactive protein) along with negative rheumatoid factors and positive antigen HLA-B27. Outcome of the disease in both cases was favorable upon receiving nonsteroid antirheumatic therapy. Signs of arthritis disappeared after three months. No signs of recurrent arthritis have been seen during the next four years in the first and next two years in the second patient.
Pseudoaneurysm of gastroduodenal artery due to duodenal ulcer causing jaundice and interstitial pancreatitis but not gastrointestinal bleeding
Authors: Jovanovic Miodrag , Colovic Radoje , Grubor Nikica , Perisic Mirjana , Radak Vladimir
Published: July 2008

Aneurysms and pseudoaneurysms of the gastroduodenal artery are rare with less then 50 cases reported. Most frequently they are one of the consequences of pancreatitis much rarer duodenal ulcer or operative trauma during gastrectomy for duodenal ulcer or choledochotomy. We report on a 47 year-old man, chronic heavy alcohol consumer in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum, eroded gastroduodenal artery causing pseudo-aneurysm but without noticeable gastrointestinal bleeding. The patient had jaundice of obstructive type and elevated amilase. After Billroth II gastrectomy, suture of the gastroduodenal artery, cholecystectomy and T tube drainage of the common bile duct the patient developed intestinal obstruction caused by two interintestinal abscesses so that he had to be reoperated. After that he had a successful recovery, his general health greatly improved, he gained 15 kg in weight but two years after surgery he again started with heavy drinking and soon died due to serious brain damage. The case is rare and unusual at least for few reasons: First, the pseudoaneurysm was caused by duodenal ulcer. Second, a serious gastrointestinal bleeding did not take place. Third, the pseudoaneurysm was diagnosed by Doppler ultrasonography while angiography failed to opacity it due to thrombosis of the artery.
Frequency of the external resorptions of root apex
Authors: Opacic-Galic Vanja , Zivkovic Slavoljub
Published: July 2008

Root resorptions present a significant problem in endodontic therapy of the affected teeth and in dentistry in general. The objective of this study was to analyze, based on epidemiological and statistical research, the frequency of clinical incidence of pathological root resorptions in everyday practice related to localization, type of tooth, age and sex of patients. Radiographie documentation of patients treated from 1997 till 2002 at the Department of Conservative Dentistry and Endodontics, Faculty of Stomatology in Belgrade, was used as baseline for this study. Retroalveolar radiographs of teeth with visible signs of resorptions were singled out from 15654 patients' clinical records used for this study. The external resorptions were shown as radiolucent areas localized on various outer root surfaces, followed by significant or less significant resorption of lamina dura and alveolar bone. Out of all teeth analyzed in this study, 594 (3.79%) showed some kind of resorption. The external resorptions were found to be more present in the upper jaw (55.10%) and molars (50.30%) than in the lower jaw (44.90%) and single root teeth (49.70%), but in both cases without significant statistical differences. The most frequent localization of resorptions was root apex (82.44%). In regard to age, the most frequent resorptions were recorded in patients aged between 21 and 30 years (28.40%), and the lowest incidence was found in the youngest population (5.51%). The results also showed that resorptions were more frequent among the female population (59.04%) than among the male population (40.96%). Based on these results, we may conclude that the external root resorptions are not a frequent clinical phenomenon. Proper and early diagnostics of such tissue pathology is one of the basic prerequisites for successful endodontic therapy of the affected root.
Diagnostics of mucopolysaccharidoses presented through the case of sanfilippo syndrome
Authors: Durkovic Jasmina
Published: July 2008

Mucopolysaccharidoses (MPS) are recessive inheritable, progressive diseases of disordered degradation and storage of acid glucos-aminoglycans. A five-year old child with psychomotor development retardation, which started at his age of two, was presented in our study. Clinical examination showed big head with rough facial features, skeleton deformities and hepatosplenomegaly. The diagnosis Dysostosis epifisealis multiplex was also confirmed by the X-ray examination of skeleton. Karyotype: 46, XY. Mental retardation: IQ-48. Clinically suspected mucopolysaccharidosis called for metabolic screening of first morning urine and the positive toluidine blue test result indicated the increased excretion of mucopolysaccharides. Further enzyme analyses of peripheral blood leucocytes confirmed the heparin sulphate sulphatase deficiency on the basis of which A (MPS III) Sanfilippo syndrome was defined. Our patient was born as a twin sibling. The other sibling is clinically healthy and of normal metabolic screening. It was not possible to define precisely the healthy heterozygote by testing the enzyme activities. A large number of mutations at various loci and big genetic heterogeneity of mucopolysaccharidoses made molecular diagnostics difficult. In the subsequent pregnancy, the mother was recommended prenatal diagnostics by enzyme analysis from the cultured chorionic villus. The prognosis of the presented patient is bad, the course of the disease is progressive and the patient can be expected to die in spastic tetraplegia in the second decade of life. The treatment is symptomatic for the time being.
Sudden cardiac death
Authors: Arandjelovic Aleksandra , Pavlovic Sinisa , Mazic Sanja , Aleksandric Branimir
Published: July 2008

Sudden cardiac death in an athlete is rare and tragic event. An athlete's death draws high public attention given that athletes are considered the healthiest category of society. The vast majority of sudden cardiac death in young athletes is due to congenital cardiac malformations such as hypertrophie cardiomyopathy and various coronary artery anomalies. In athletes over age 35, the usual cause of sudden cardiac death is coronary artery disease. With each tragic death of a young athlete, there is a question why this tragedy has not been prevented. The American College of Sports Medicine and the American Heart Association recommend that a pre-participation exam should include a complete cardiovascular history and physical examination.
Physicians founders of orthopedic surgery in Serbia
Authors: Bumbasirevic Marko , Lesic Aleksandar
Published: July 2008

The beginnings of the development of orthopedic surgery in Serbia have been related to the name of Dr Nikola Krstic and his first radiography of the hand in 1908. The foundation of the Orthopedic Ward, led by Dr Nikola Krstic, within the General State Hospital in Belgrade, in 1919, marks the definition of orthopedics as a separate branch of surgery. In addition to Dr Nikola Krstic, Dr Borivoje Lalovic and Temp. Docent Dr Borivoje Gradojevic, who published the first orthopedics textbook in Serbian in 1934, also worked at the orthopedic ward between the two world wars. The work at the orthopedic ward, which grew into a clinic in 1947, was continued by Prof. Dr Milos Simovic, Prof. Dr Svetislav Stojanovic and Prof, dr Ljubisa Boric. Their successors would have high achievements: Prof. Dr Zivojin Bumbasirevic became the only orthopedist who was a regular member of the Serbian Academy of Sciences and Arts, and Chief of Staff Dr Predrag Klisic and Prof. Dr Branko Radulovic provide impetus for further development of orthopedics by founding Specialist Orthopedics Hospital "Banjica".
The outcome and prognosis following the surgical intervention in patients with severe aortic stenosis with respecttothe presence and severity of associated aortic regurgitation
Authors: Catovic Suad , Otasevic Petar , Miric Milutin , Neskovic Aleksandar , Popovic Zoran
Published: July 2008

INTRODUCTION It is not clear whether associated aortic regurgitation (AR) should be regarded as a risk factor in patients undergoing surgery for severe aortic stenosis (AS). Some authors have suggested that morbidity and mortality are increased in these patients as compared to patients operated for pure AS, whereas others have found no difference of the outcome and prognosis between these groups. OBJECTIVE This study made an attempt to compare the outcome and prognosis following the surgical intervention in patients with severe AS and associated AR and those operated for pure AS, as well as to determine predictive value of clinical, functional and echocardiographic data for the outcome of surgery. METHODS Study population consisted of 122 consecutive patients operated at Dedinje Cardiovascular Institute during 1999 due to severe AS, defined as mean gradient over aortic valve >30 mmHg. The patients were divided into AS group (63 patients with AS without AR or with mild AR) and AS+AR group (59 patients with AS and moderate, severe or very severe AR). The patients were subjected to control clinical, functional and echocardiographic examinations 12 and 18 months following the surgery. RESULTS AND DISCUSSION Preoperatively, the patients in AS group were older and had coronary artery disease more frequently, whereas patients in AS+AR group had higher left ventricular volumes and mass. Preoperative NYHA class, ejection fraction, mean gradient over aortic valve, type and size of the implanted mechanical prosthesis, and the incidence of associated coronary artery bypass surgery were similar between the groups. Similarly, the operative mortality was similar in AS and AS+AR groups (1.6% vs 8.5%, respectively, p=0.11). Twelve months postoperatively, there were no difference of average NYHA class and NYHA class III/ IV between the groups. The patients in AS+AR group were unable to walk >300 meters on 6 minute walk test more frequently than those in AS group (64% vs. 36%, respectively; p=0.043). Eighteen months postoperatively, NYHA class III/IV was found more frequently in AS+AR than in AS group (26% vs. 8%, respectively; p=0.0343). In patients with associated AR, there was no difference of NYHA class with respect to the severity of AR (p=0.815). Multivariate analysis found the association of more than mild AR as an independent predictor of poor functional capacity, irrespective of its severity. CONCLUSION Patients with severe AS and associated AR have poorer postoperative functional capacity as compared to patients operated for pure AS.
Sick building syndrome: A disease of modern age
Authors: Nikic Dragana , Stojanovic Dusica
Published: July 2008

Sick building syndrome (SBS) is a term used to describe situation in building when more than 30% of occupants suffer from various symptoms which tend to increase by severity during the time people spend in "sick" building and disappear when they leave the building. Typical cases of SBS report vague symptoms, which cannot be objectively measured, and sufferers usually show no clinical signs of illness. Symptom heterogeneity suggests that they do not represent a single disorder. The objective of our study was to establish if SBS is present in our town because new buildings have been built lately producing the artificial environment - exclusively artificial lightning and mechanical ventilation. A total of 812 subjects were included in our study. The investigation of SBS was performed by standardized questionnaires to determine the prevalence of symptoms and complaints. Questionnaires were used to collect data on perception of environment conditions and health during the period they work in this building. The subjects were divided in three groups according to sex, level of education and ownership. Our data suggested that the incidence of symptoms was higher in employers than in owners of the offices. Moreover, the prevalence of SBS was very high - up to 74.76%. It is obvious that certain physical, psychological and organizational factors are involved in the incidence of symptoms, but our investigation suggests that physical factor has a dominant role in development of symptoms, particularly low humidity and low air flow. In addition, our judgment is that SBS exists in our city, probably in the whole country and, therefore, it must be investigated properly.
Musculoskeletal diseases in forestry workers
Authors: Vukovic Sladjana , Krstev Srmena , Maksimovic Milos
Published: July 2008

The most common hazards in the forestry that may induce disorders of the musculoskeletal system are vibrations, unfavorable microclimatic conditions, noise, over-time working hours, work load and long-term repeated movements. The objective of this study was to analyze the prevalence of musculoskeletal diseases and its difference among workers engaged in various jobs in the forestry. Two groups of workers were selected: woodcutters operating with chain-saw (N=33) and other loggers (N=32). Selected workers were of the similar age and had similar total length of employment as well as the length of service in the forestry. Both groups of workers employed in the forestry had the high prevalence of musculoskeletal diseases (woodcutters 69.7% and other loggers 62.5%, respectively). Degenerative diseases of spinal column were very frequent, in dependently of the type of activity in the forestry. Non-significantly higher risk of carpal tunnel syndrome was found in woodcutters with chain-saw compared to workers having other jobs in the forestry (OR=3.09; 95%CI=0.64-19.72). The lateral epicondylitis was found only in woodcutters operating with chain-saw with the prevalence of 18.2%.