bluuebunny/crossref_metadata_2025 huggingface dataset:
Soft-contact-lenses-induced complications
Authors: Suvajac Gordana
Published: December 2010

Background/Aim. Soft contact lenses occupy significant place in ophthalmology, both in the correction of refraction anomalies and in the treatment of many eye diseases. The number of patients that wear soft contact lenses for the purpose of correcting ametropia is constantly increasing. Due to the increasing number of wearers, the percentage of complications that can lead to serious eye damage and serious vision loss is also increasing. The aim of this study was to point out the most common complications related to soft contact lens use. Methods. In the period from 1995?2004 this prospective study included 510 patients wearing soft contact lenses for correcting ametropia. None of the patients wore contact lenses before and none suffered from any system or local diseases that could affected the development of eventual complications. The study took seven years with the patients who wore conventional lenses and three years with those who wore replacement contact lenses. All the necessary ophthalmologic examinations were done (visual acuity, refractokeratometry, the quantity of tear film, biomicroscopic examination of anterior eye segment). All the complications were filmed by video camera. Results. Of all the patients, 19 had blepharitis, 73 suffered from ?dry eye?, 57 had conjunctival hyperemia, 12 had conjunctivitis, 34 had gigantopapillary conjunctivitis (GPC), 93 had punctiform epitheliopathy, 20 had corneal infiltration, one patient had keratitis, 91 had corneal vascularisation, and 95 patients had corneal deposits. Conclusion. Both the type and frequency of complications related to soft contact lens use in our group of patients, proved to be significant. Some of this complications (keratitis) can significantly damage vision and lead to loss of vision and sometimes can require operative treatment.
The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children
Authors: Colovic Hristina , Stankovic Ivona , Dimitrijevic Lidija , Zivkovic Vesna , Nikolic Dejan
Published: December 2010

Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire represents a region- specific instrument for functional outcome measurement of hand function. The aim of the study was to analyze the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF) of humerus and to analyze the effects of early rehabilitation. Methods. The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children), and group B in which rehabilitation started after 15 days and more (15 children). The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest) and after the rehabilitation. Pearson's coefficient of liner correlation was applied. Results. Statistically significant negative correlation of DASH score and extension was verified in all three measurements. The values for the first test and for the final test were highly significant (p < 0.001), as well as negative correlation of DASH score and flexion on the first test and retest (p < 0.01), and at the end of rehabilitation (p < 0.001) in the group B. For all three tests in the group A negative correlation without significant differences for DASH score and flexion was found. Conclusion. A modified DASH questionnaire correlates with objective parameters of final status of elbow after SCF in children and it is applicable to small series of patients. A positive effect of early rehabilitation of children with SCF was found.
Alphabet patterns
Authors: Risovic Dusica , Vicic Dragan
Published: December 2010

 Alfabetski sindromi predstavljaju inkomitentne strabizme ciji se horizontalni ugao razrokosti menja pri pogledu nagore, pravo i nadole. Svaki peti bolesnik sa strabizmom ima neki oblik A ili V fenomena. Ispitanici se zale na astenopijske smetnje i na duple slike, narocito pri radu nablizu i imaju prinudni polozaj glave. Kako ne postoji nijedan etioloski faktor odgovoran za pojavu ovih sindroma, veoma je vazno precizno uraditi klinicki pregled da bi se donela odluka o pravilnom lecenju. Hirurgija je neophodna metoda lecenja bolesnik sa inkomitencijom vecom od 15 DP. Neophodno je da ove operacije obavi iskusan hirurg, jer se klasicnim hirurskim indikacijama dobijaju hiperkorigovani uglovi devijacije, sto se veoma tesko podnosi, zbog pojave duple slike.
Safety of simultaneous colon and liver resection for colorectal liver metastases
Authors: Stojanovic Miroslav , Stanojevic Goran , Radojkovic Milan , Zlatic Aleksandar , Jeremic Ljiljana , Brankovic Branko , Jovanovic Milan , Kostov Milos , Zdravkovic Miodrag , Milic Dragan
Published: December 2010

Background/Aim. Surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer (CRC) remains controversial. The aim of this study was to assess safety of simultaneous colon and liver resections and the direct effects of this type of treatment upon morbidity and mortality of the patients with synchronus hepatic metastases of CRC. Methods. Intraoperative and postoperative data of 31 patients with simultaneous liver and colorectal resection were compared with the data of 51 patients who had undergone colon and hepatic resection in the staging setting. Analyzed were demographic data, number of metastases, type of the liver resection, operation time, intraoperative blood loss, percentage of postoperative complications, morbidity and mortality and length of hospitalisation. Results. In the group of the patients operated simultaneously 5 hepatectomies, 3 sectionectomies, 2 trisegmentectomies, 3 bisegmentectomy, 6 segmentectomies, and 12 metastasectomies were combined with colon resection. In this group operation time (280 vs. 330 minutes) and intraoperative blood loss (450 vs. 820 ml) were lower than those in the two staged operation group. Postoperative complication rate was lower in the simultaneous group (19.35%) than in the two-staged operation group (19.60%), without statistical significance. There was no hospital mortality in both groups. The patients having simultaneous resection required fewer days in the hospital (median 10.2 days) than the patients undergone operation in the two stage (18.34 days). Conclusion. By avoiding a second laparotomy, overall operation time, blood loss, hospital stay and complication rate are reduced with no change in hospital mortality, so simultaneous colon and hepatic resection performed by the competent surgeons are safe and efficient for the treatment of synchronous colorectal liver metastases.
On 10-year experience in the use of direct and antireflux techniques of anastomosis of ureter and orthotopic intestinal neobladder after radical cystectomy
Authors: Aleksic Predrag , Bancevic Vladimir , Stijelja Borislav , Milovic Novak , Tosevski Perica , Campara Zoran , Kosevic Branko , Mocovic Dejan
Published: December 2010

Background/Aim. Today, radical cystectomy is the method of choice in treatment of muscle invasive bladder carcinoma in stage T2-T4a, No-Nx, Mo, and orthotopic derivation is for patients the most comfortable derivation of urin. From 1888 when Tizzoni and Foggi performed the first orthotopic derivation on animals, and 1913 when Lemoin declared the first orthotopic derivation in humans there has been a constant improvement and modification of orthotopic urinary diversion after radical cystectomy which significantly decrease the number and severity of postoperative complications. The aim of this study was to compare complications regarding the direct and antireflux ureter-neobladder anastomosis. Methods. This retrospective study included 79 selected patients operated over the last ten years having medical records available. Previously, we excluded the patients with prior radiation therapy, systemic illness, diabetes mellitus, previous history of calculosis and metabolic disorders etc. Hautmann orthotopic technique was used in almost 70% of the patients. We analyzed complications regarding direct and antireflux ureter-neobladder anastomosis with a median follow-up period of 4,72 years. We followed-up the appearance of unilateral and bilateral hydronephrosis, forming of renal stones in the patients without previous history of renal calculosis, and renal insuficiency caused by stenosis on the site of anastomosis. We used the Kolmogorov-Smirnov test, Mann-Whitney U test, Student's t test i ?? test for statistic analysis. Results. The median age of the patients was 68,2 years. Totally 88.61% of the patients were male and 11.39% were female. The direct anastomotic technique secundum Wallace was used in 43.03% of the operated patients and antireflux technique secundum Le Duc in 56.97%. Renal deterioration caused by stenosis on the site of the ureter-neobladder anastomosis was statistically significantly higher in the antireflux anastomosis compared to direct anastomosis (??= 4.71, p = 0.0299). No one of the patients with direct anastomosis had poucho-ureteral reflux higher grade than gr III. Conclusion. In our study, complication as renal deterioration as a result of stenosis on the site of the ureter anastomosis was significantly more common in the group of patients exposed to antireflux technique.
Use of Marlex mesh with methylmethacrylate to repair large full-thickness defects after subtotal sternectomy caused by chondroma
Authors: Stanic Vojkan , Vulovic Tatjana , Stamenovic Davor , Djordjevic Gordana
Published: December 2010

Background. Sternal benign neoplasms are extremely rare. Chondroma is a benign tumor of cartilage and can be single or multiple. Case report. We presented a case of 28-year-old woman with chondroma of the sternum treated by "en bloc" resection of the tumor (subtotal sternectomy). The chest wall defect was repaired by the placement of Marlex mesh and metylmethacrylate ("sandwich method") for stabilization of the thoracic wall. This place was covered with pectoralis major muscle and skin. The postoperative course was uneventful and the wounds healed by primary intention. Conclusion. The functional and cosmetic results in the usage of Marlex mesh with metylmethacrylate to repair a large full-thickness defect after subtotal sternectomy caused by chondroma were good and the patient was able to resume her preoperative level of activity.
Chromosomal aberrations as etiological factors of intrauterine growth retardation
Authors: Petrovic Bojana , Ljubic Aleksandar , Nikolic Ljubinka
Published: December 2010

Background/Aim. Intrauterine growth retardation (IUGR) is a pathological condition of pregnancy characterised by birth weight below the 10th centile. A number of fetal, placental and maternal causes can lead to IUGR; although, in most cases no specific causes can be identified. The aim of this study was to determine the part of chromosomal abnormalities in IUGR etiology. Methods. Fetal blood karyotype taken by cordocentesis from 168 fetuses with diagnosed IUGR was analyzed. Results. Chromosomal rearrangements both numerical and structural were detected in 14 cases (12.2%). Two cases were triploid. Patau syndrome, Edwards syndrome and Down syndrome were found in two cases each. There was one case of trisomy 7 (47, XY, +7) and one case of trisomy 16 (47, XX, +16); one translocation, 46, XY, t (2; 14)(q23; q32) and a deletion 46, XYdel (12) (p12) as well as two cases of sex chromosomes abnormalities, 45, X (Turner syndrome) and 47, XYY. Conclusion. These findings suggest that a consistent number of symmetrical IUGR cases (about 12%) can be associated with chromosomal rearrangements. Chromosomal aberrations that cause IUGR are heterogeneous, aberration of autosomes, mostly autosomal trisomies, being the most common.
Assessment of clinical depression comorbid with posttraumatic stress disorder
Authors: Simonovic Maja , Grbesa Grozdanko , Milenkovic Tatjana , Radisavljevic Misa
Published: December 2010

Background/Aim. Comorbidity of the posttraumatic stress disorder (PTSD) and depression is often recognized in the clinical practice. The aim of the paper was to determine the severity of depression and the group of symptoms which are the most prominent in clinical depression comorbid with PTSD. Methods. Totally 60 patients were assessed and divided into the experimental and control group using the Structured Clinical Interview for DSM-IV Axis I Disorders, Investigator Version (SCID-I, modified) (SCID for DSM-IV) and ICD-10 diagnostic criteria. The presence and the severity of the disorders were assessed by means of the following instruments: Clinician-Administrated PTSD Scale for DSM-IV (CAPS-DX), Montgomery-Asberg Depression Rating Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HAMD). The differences between groups were evaluated using Student t test and by means of the correlation analysis of the data with p < 0.05. Results. The obtained results showed that depression witch was comorbid with PTSD was of significant clinical severity with 31.20 score on HAMD and 30.43 score on MADRS in PTSD-D group. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression on MADRS. The group of the symptoms: suicide and somatic symptoms, gastrointestinal, guilt, hypochondriasis, work and activity, anxiety psychic, agitation, and weight loss, genital symptoms and anxiety somatic contributed mostly to the global severity of comorbid clinical depression on HAMD. The average score was 16.03 and 16.97 on HAMD and MADRS, respectively in PTSD group. Conclusion. Depression which is comorbid with posttraumatic stress disorder represents significant clinical entity with domination of the different groups of symptoms between the groups PTSD and PTSD-D on HAMD. Identification of aforementioned severity of illness and delineated group of symptoms lead the clinician to establish the diagnosis of depression, reduce the risk of diagnostic ommition of the depression and enable the clinician to chose the optimal treatment method for the delineated disorders.
Hyperbaric medicine: Dilemmas regarding its possibilities
Authors: Rabrenovic Milorad , Matunovic Radomir , Rabrenovic Violeta , Zoranovic Uros
Published: December 2010

 Napredak u oblasti hiperbaricne medicine sve je ocigledniji, ali njena primena ne sme biti svojina male grupe ljudi, bilo zbog monopola, ili zbog neznanja i nezainteresovanosti drugih. Iako je koriscenje hiperbaricne oksigenacije kao i nabavka hiperbaricnih komora (visemesnih ili jednomesnih) uslovljena velikim finansijskim ulaganjima, korist od njene primene daleko je veca, a toga treba da budu svesni svi koji odlucuju o njoj. U poslednje vreme sve je manje dilema o opravdanosti primene HBOT, a sve vise se otvaraju nova polja moguce primene. Razvoj molekularne medicine stvorio je nove prostore u tretmanima odredjenih bolesti gde HBOT moze imati svoje mesto. U korak sa novim medicinskim saznanjima, odredjivanjem pravih indikacija, primenom korektnih doza kiseonika kao i vremena ekspozicije, napredak ce biti evidentan i moze se zakljuciti da doba HBOT tek dolazi.
New universal definition of myocardial infarction: What is the difference?
Authors: Vucinic Zarko
Published: December 2010

 Ucinjene su brojne izmene univerzalne definicije infarkta miokarda u odnosu na verziju iz 2000. godine, ali troponin ostaje zlatni standard za opstu definiciju u miljeu karakteristicnog klinickog scenarija za ishemiju miokarda i tipicnih EKG promena. Svako povecanje troponina ne znaci istovremeno i definitivno infarkt miokarda. Postoje i mnogi drugi uzroci porasta troponina. Nekroza miokarda nije uvek posledica ishemije, vec postoje i druge nokse koje mogu dovesti do smrti celija miokarda. U novim preporukama navodi se da je troponin 'izabrani' marker, ali i drugi biomarkeri, pre svega MB frakcija kreatinin kinaze, mogu biti dovoljni, ako nije dostupan test sa troponinom. Ostale inovacije ukljucuju kriterijume za infarkt miokarda kao uzrocnika naprasne smrti i posebna tezina koja se daje nalazima dobijenim ehokardiografski, perfuzionom scintigrafijom i ostalim neinvazivnim metodama. Jedan od ciljeva ovog konsenzusa je da se utvrde specificni kriterijumi za postavljenje dijagnoze infarkta miokarda koji ce biti moderni, prakticni i relevantni u svakoj prilici sirom sveta. Ideja je bila da se definicija standardizuje tako da sve klinicke studije i svi ljudi u bolnicama sirom sveta budu 'na istoj talasnoj duzini'.
Diarrhoea caused by Clostridium difficile in patients with postoperative subhepatic abscess
Authors: Stojanovic Predrag , Kocic Branislava
Published: December 2010

Background. Toxigenic strains of Clostridium difficile in the majority of cases cause disease of the intestinal tract of hospitalized patients. For a long time, Clostridium difficile was considered to produce both types of toxins (A+/B+ strain), however, the investigations conducted in the last ten years point to the existence of clinically significant isolates which produce only toxin B, i.e. toxin A negative / toxin B positive (A-/B+ strain) Clostridium difficile. Case report. We presented the case of a patient admitted to the Surgery Clinic, Clinical Center Nis due to the presence of calculus in the ductus choledochus. Twenty-four hours after the surgical intervention for calculus removal, the first signs of the operative wound infection began to appear. In the course of infection treatment, different antibiotics were administered (cefuroxine, ciprofloxacin, vancomycin, imipenem). After making etiological microbiological diagnosis and application of antibiotics according to antibiogram results, the signs of the operative wound infection began to withdraw, but the patient reported the abdominal pain and liquid stools with traces of blood (up to 17 stools per day). By microbiological examination, Clostridium difficile was cultivated and the presence of toxin B was detected in the stool samples. The patient was sent to the Clinic for Infectious Diseases, where the causal therapy of mitronidazol was administered. Liquid and electrolytes were made up by substitution therapy. After the eight-day-treatment, the patient felt much better, and diarrheas stopped on the 10th day of the therapy application. Conclusion. Our results have shown that toxingen strains Clostridium difficile are present in our country so this bacterium sort have to be considered in differential causal diagnosis of diarrhoea syndrom. Considering that it can cause difficult form of the disease, it is an obligation to establish the presence of some toxins of Clostridium difficile in stool samples of patients and/or production of some toxins in liquid culturate of isolates to provide data for the presence of strains which produce only toxin B.
Stability investigation of total parenteral nutrition admixture prepared in a hospital pharmacy
Authors: Mirkovic Dusica , Antunovic Mirjana , Putic Vesna , Aleksic Dragana
Published: December 2010

Background/Aim. In the cases when nutrition of patients can not be orally nor enterally performed, parenteral nutrition is a method of the therapy that provides more successful and rapid recovery. In that way, hospitalization can be significantly shorter, healing costs reduced and mortality minimized. Total parenteral nutrition (TPN) admixtures are the most complex systems which contain amino acids, carbohydrates, lipid emulsion, macroelectrolytes (Na+, K+, Ca2+, Mg2+, Cl-, SO42-, PO43-), oligoelements, hydro- and liposoluble vitamines, heparin, insulin and water. Concerning the mentioned complexity, special attention should be payed to physicochemical and microbiological stability of a mixture, because of interactions among components, that can be very hard to analyze. The aim of this study was to investigate the problem of stability of TPN admixtures prepared in a hospital pharmacy. Methods. Admixture TPN was aseptically prepared in laminar air - flow environment on the basis of the specified order in supplementing components and additives to basic solutions. Solutions were kept in sterile multicompartment ethylene-vinyl-acetate bags. After preparation and slow homogenization, TPN admixtures were submitted to physicochemical and microbiological stability analyses in various period of time. The assessment of physical stability of TPN admixture was done on the basis of visual inspection, determination of pH value and measuring of particle size. The investigation of sterility and pyrogenic test were performed according to Ph. Yug. V regulations. Results. Physico-chemical and microbiological analyses were applied and no significant changes in visual sense, pH value and droplet size stability of the TPN admixture were observed during the period of 60 hours. The lipid droplets were smaller in size than 5 ?m, that is the most common pharmacopoeia requirement. Conclusion. The results of our study confirmed that a TPN admixture prepared in a hospital pharmacy can be stored without stability loss for at least 60 hours.
Long QT syndrome: Genetic implications and drug influence
Authors: Savic Natasa , Gojkovic-Bukarica Ljiljana
Published: December 2010

 Produzeni QT interval predstavlja problem u klinickoj praksi kome se posvecuje sve veca paznja i koji je oblast intenzivnog istrazivanja. Genetske studije kod pojedinaca koji imaju klinicki izrazene simptome produzenog QT intervala i/ili pozitivnu porodicnu anamnezu za iznenadnu srcanu smrt, mogu za pocetak da budu ogranicene na KCNQ1, HERG i SCN5A gene sa verovatnocom otkrivanja mutacije od 65%. Predstojece studije tek treba da objasne znacaj polimorfizma odredjenih gena za pojavu produzenja QT intervala.
99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis
Authors: Jaukovic Ljiljana , Ajdinovic Boris , Gardasevic Ksenija , Dopudja Marija
Published: December 2010

Background. Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. Case report. We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. Conclusion. Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activites.
Correlation between 24-hour profile of blood pressure and ventricular arrhythmias and their prognostic significance in patients with arterial hypertension
Authors: Djordjevic Dragan , Deljanin-Ilic Marina , Tasic Ivan
Published: December 2010

Background/Aim. Left ventricular hypertrophy (LVH), apart from arterial hypertension, is a risk factor for electrophysiologic heart condition disorder and sudden cardiac death. The aim of this study was to examine a relationship between complex ventricular arrhythmias and parameters of 24-hour ambulatory blood pressure monitoring in the patients with arterial hypertension and left ventricular hypertrophy (LVH), as well as their prognostic significance during a five-year follow-up. Methods. Ninety patients with arterial hypertension and LVH were included in this study (mean age 55.2?8.3 years). There were 35 healthy people in the control group (mean age 54.5?7.1 years). Left ventricular mass index was 171.9?32.4 g/m2 in the LVH group and 102.4?13.3 g/m2 in the control group. Clinical examination, echocardiogram, 24-hour ambulatory blood pressure monitoring and 24-hour holter monitoring were done in all of the examined persons. Ventricular arrhythmias were classified by the Lown classification. Results. In the LVH group there were 54 (60.0%) of the patients with ? III Lown class. The best predictor of a Lown class were left ventricular mass index by using multivariate stepwise regression analyses (? = 0.212; p < 0.05) and small decrease of diastolic blood pressure during the night (? = -0.293; p < 0.01). The main predictor of bad prognosis was left ventricular mass index during a five year follow-up (? = 0.302; p < 0.01, for stepwise regression model: F = 8.828; p < 0.01, adjusted R2 = 0.091). Conclusion. Left ventricular arrhythmias are frequent in patients with lower decrease of blood pressure during the night. There was no correlation between the degree of ventricular arrhythmias and parameters from 24-hour blood pressure monitoring and a five-year prognosis in the patients with arterial hypertension and LVH. A bad five-year follow-up outcome of hypertensive disease depends on left ventricular mass index.
Staphylococcus aureus methicillin-resistance mechanisms
Authors: Petrovic-Jeremic Ljiljana , Kuljic-Kapulica Nada , Mirovic Veljko , Kocic Branislava
Published: December 2010

Background/Aim. In many hospitals in the world and in our country, the spread of methicillin-resistant Staphylococcus aureus (MRSA) is so wide that nowdays vancomycin is recommended for empiric treatment of staphylococcal life threatening infections (sepsis, pneumonia) instead of beta-lactam antibiotics. The aim of this study was to determine the production of beta-lactamases in hospital and community isolates of staphyloococus aureus, i. e. hospital associated MRSA (HA-MRSA) and community associated MRSA (CA-MRSA), the presence of homogeneous and heterogeneous type of methicillin resistance, and border-line resistance in Staphylococcus aureus (BORSA). The aim of this study was also to determine if there was a statistically significant difference between mechanisms of resistance in HA-MRSA and CA-MRSA. Methods. A total 216 clinical Staphylococcus aureus isolates from the General Hospital in the town of Cuprija and 186 ambulance Staphylococcus aureus isolates from the community were examined for the presence of methicillin-resistance using disk-diffusion test with penicillin disk (10 ij), oxacillin disk (1 ?g) and cefoxitin disk (30 ?g). Betalactamases production was detected by nitrocefin disk and betalactamase tablets. Determination of oxacillin minimum inhibitory concentracion (MIC) was done by agar-dilution method. Results. The prevalence of HA-MRSA was 57.4%, and CA-MRSA was 17.7% (p < 0.05). There was a higher rate of heterogeneous type of resistance among clinical MRSA isolates (11.1%) compared with ambulance ones (3.8%) (p < 0.05). The rates of beta-lactamases production were similar among hospital associated isolates (97.5%), as well as in the community associated isolates (95.5%) (p > 0.05). There were 4.6 % of BORSA hospital isolates and 3.3 % of BORSA ambulance isolates (p > 0.05). Conclusion. The frequency of MRSA isolates in hospital was significantly higher than in community, as well as the heterogeneous type of resistance. The frequency of BORSA isolates and production of betalactamases were higher among hospital Staphylococcus aureus isolates, but the difference is not significant.
Evaluation of schizophrenic patients quality of life
Authors: Opalic Petar , Nikolic Sanja
Published: December 2010

 I pored metodoloskih i epistemioloskih nedostataka istrazivanja kvaliteta zivota shizofrenih bolesnika (manjkavost jedinstvenog metodoloskog pristupa, sto povlaci za sobom neodredjenosti u definisanju problema istrazivanja i teskoce u operacionalizaciji) ova ispitivanja su se pokazala kao pouzdan indikator ishoda (outcome indicator) razlicitih oblika tretmana shizofrenih bolesnika, primene lekova, posebno. I ako rezultati ovih, u sustini multidimenzionih, istrazivanja zavise od depresivnog raspolozenja, crta licnosti i mehanizama prilagodjavanja koje shizofreni ispitanik koristi, istrazivanja kvaliteta zivota shizofrenih bolesnika ce ostati pouzdan, naucno verifikovan pokazatelj humanog statusa najbrojnijih medju teskim psihijatrijskim bolesnicima. Sto se instrumenata istrazivanja kvaliteta zivota tice, izdvojili bismo tri. Prvi od njih, Upitnik o kvalitetu zivota (QLS), najstariji je i dugo se, zbog dobrih metrickih svojstava, koristio u istrazivanjima ove vrste u svetu, ukljucujuci i domace autore 84. Sledeci, Mancesterski upitik o kvalitetu zivota (MANSA) relativno je kratak i primenjivan je u novijim istrazivanjima kvaliteta zivota psihijatrijskih bolesnika u svetu i kod nas. Najzad, izdvojili bismo onaj koji se najvise koristi. To je WHO-QOL-Brief, kraca verzija Upitnika o kvalitetu zivota shizofrenih bolesnika SZO. On se vrlo cesto pojavljuje u najnovijim istrazivanjima ove vrste (poslednjih pet godina) u svetu, a posebno u studijama sa transkulturnim obelezjima. Izbor ovog poslednjeg instrumenta omogucio bi nasim istrazivacima, ne samo brzo prikupljanje podataka, nego i validnije poredjenje sopstvenih rezultata istrazivanja sa slicnima u svetu. Istrazivanja kvaliteta zivota psihijatrijskih bolesnika, a shizofrenih bolesnika posebno, smatramo nezaobilaznim, ne samo u naucnim studijama vezanim za probleme najrasirenijeg psihoticnog poremecaja, nego i vaznim za planiranje i evaluaciju programa pomoci hronicnim psihoticnim bolesnicima uopste, posebno ako se imaju u vidu ambiciozne reforme institucijske psihijatrijske zastite zapocete kod nas.
An autopsy case of asthmatic death: Usefulness of biochemical examination
Authors: Kinoshita Hiroshi , Kubota Akira , Kasuda Shogo , Nishiguchi Minori , Ouchi Harumi , Minami Takako , Matsui Kiyoshi , Yamamura Takehiko , Motomura Hiroyuki , Ohtsu Nao , Yoshida Shie , Adachi Nobuyuki , Aoki Shigeru , Komeda Motoo , Hishida Shigeru
Published: December 2010

Background. Asthma is the one of the major causes of sudden death in Japan. Postmortem diagnosis of asthma has been based on morphological findings in lungs, but it histological evidence, was also reported that the biochemical markers such as total and specific immunoglobulin E (IgE) are useful. Case report. We present here a case of fatal asthmatic death. A Japanese male in his thirties, complaining of dyspnea, collapsed suddenly. He was taken by ambulance to hospital, but cardiopulmonary resuscitation was ineffective. From autopsy findings, we concluded that the cause of death was asphyxia due to asthma attack. Biochemical findings indicated that the deceased had a severe asthmatic condition. Conclusion. In the presented case, the biochemical examination of the serum obtained at autopsy gave helpful information for the diagnosis that asthmatic attack was a cause of death.
Interrelationship of interleukin 6, C-reactive protein and Chlamydia pneumoniae IgG antibodies in patients with acute coronary syndromes
Authors: Burazor Ivana , Vojdani Aristo , Burazor Mirko
Published: December 2010

Background/Aim. Inflammation due to infection could be associated with the development of acute coronary syndromes, clinical manifestations of ongoing atherosclerosis in vessel walls. Our aim was determine whether interleukin 6, C-reactive protein and Chlamydia pneumoniae IgG antibodies are connected with the development of acute coronary syndromes, to evaluate their interrelationship and to examine whether they are predictive of new events and mortality. Methods. This prospective study included 211 subjects, of whom 111 were patients with acute coronary syndromes (60% male, mean age 59.42 years) and 100 were healthy controls (58% male, mean age 59.03 yuears). Blood samples were taken for analysis on admission, before the application of the therapy. Interleukin 6, high sensitivity C-reactive protein and Chlamydia pneumoniae IgG antibodies were measured, in a follow-up period of 30 days. Results. Levels of interleukin 6 (p < 0.001) and C-reactive protein (p < 0.001) were significantly higher among the patients with acute coronary syndromes than among controls. Chronic infection caused by Chlamydia pneumoniae was present in 72% of patients and in 22% of healthy controls (p < 0.001). There was a correlation between interleukin 6 and C-reactive protein, C-reactive protein and Chlamydia pneumoniae but not between Chlamydia pneumoniae and interleukin 6. Higher levels of interleukin 6 and C-reactive protein were seen with increasing body mass index, smoking exposure, presence of hypertension and diabetes, and decreasing ejection fraction. The patients with ST-segment elevation had higher examined markers than the patients without ST-segment elevation. Interleukin 6 and C-reactive protein were independently related to the clinical outcome. Conclusion. Interleukin 6, C-reactive protein and Chlamydia pneumoniae infection are connected with the development of acute coronary syndromes and may reflect a clinical outcome of the disease.
Comparative immunohistochemical and quantitative analysis of inflammatory cells in symptomatic and asymptomatic chronic periapical lesions
Authors: Lukic Aleksandra , Danilovic Vesna , Petrovic Renata
Published: December 2010

Background/Aim. It has been demonstrated that lymphocytes, plasma cells, macrophages and neutrophil granulocytes represent the predominant cells of the inflammatory lesion of the dental granulomas. Other cells, such as mast cells, eosinophils, dendritic cells comprise minor, but functionally important cell populations. Most of the data considering cells that take part in these processes have been derived from immunohistological studies. This study was undertaken with the aim to determine the phenotype profile of inflammatory cells of dental granulomas using immunohistochemical method in order to study the differences of their quantitative properties and distribution between symptomatic and asymptomatic lesions. Methods. The material for the analysis originated from 42 individuals with clinic and radiographic diagnosis of chronic periapical lesions. The tissue was take either during the periradicular surgery, or tooth extraction. Cryostat tissue sections were stained using the alkaline phosphatase-antialkaline phosphatase assay (APAAP). This method is highly valid and sensitive using a panel of specific monoclonal antibodies: CD3, CD4, CD8, CD19, CD38, CD14, CD1a, CD83, CD80, CD86, CD45 and CD123. Results. The composition of the cell population revealed that there was no homogenous and site-specific pattern of the distribution of inflammatory cells. The results of our investigation revealed that the majority of inflammatory cells comprised lymphocytes and plasma cells, followed by subpopulations CD4+, CD8+ and CD14+ cells. Much lower in number were CD80+, CD86+ and CD83+ and CD1a+ cells. There were no statistically significant differences in mean values of inflammatory cells number between symptomatic and asymptomatic lesions, with the exception of CD86+ cells, the number of which was statistically higher in symptomatic lesions. Conclusion. Inflammatory infiltrate cells in dental granulomas are dominated by T- and Blymphocytes. It points out the complexity of immunopathogenic events in imitiating and progressing of dental granulomas that involve mechanisms of both cellular and humoral immunity. Regarding the quantitative presence of immunocompetent cells in symptomatic and asymptomatic lesions no statistically significant difference was determined unless in mature dendritic cells present in symptomatic lesions.
Effect of local administration of platelet-rich plasma and guided tissue regeneration on the level of bone resorption in early dental implant insertion
Authors: Duka Milos , Lazic Zoran , Bubalo Marija
Published: December 2010

Background/Aim. Osseointegration is a result of cellular migration, differentiation, bone formation, and bone remodeling on the surface of an implant. Each of these processes depends on platelets and blood coagulum. Platelet-rich plasma (PRP) is used to improve osseointegration and stability of implants. The aim of the research was to test the influence that PRP and guided tissue regeneration in bone defects have on bone defect filling and the level of bone resorption in early implant insertion. Methods. This experimental study included 10 dogs. A total of 40 BCT implants were inserted, 4 in each dog (two on the left side and two on the right side), with guided tissue regeneration. Radiologic analyses were done immediately after the insertion and 10 weeks after the insertion. Bone defect filling was measured by a graduated probe 10 weeks after the implant insertion. The following protocols were tested: I - PRP in combination with bovine deproteinized bone (BDB) and resorptive membrane of bovine origin (RBDM), II - BDB + RBDM, III - PRP + RBDM and IV - RBDM. Results. The applied protocols affected differently the bone defect filling and the level of bone resorption. Significantly better results (the lowest bone resorption) were achieved with protocol I (PRP + BDB + RBDM) in comparison with protocols III (PRP + RBDM) and IV (RBDM), but not with protocol II (BDB + RBDM). On the other hand, no significant difference was found among protocols II (BDB + RBDM), III (PRP + RBDM) and IV (RBDM) in the level of bone tissue resorption. Conslusion. The bone defect filling was largest and the level of bone resorption was lowest in the protocol with PRP applied in combination with BDB and RBDM.
Injuries of the retrohepatic inferior vena cava and the liver
Authors: Koprivica Radenko , Cvijovic Radisa , Koprivica Ranka , Smiljanic Radmila
Published: December 2010

Beckground. Injuries of the retrohepatic inferior vena cava, and the liver have mortality rate up to 71-78%. We presented a patient with combined injury of the retrohepatic inferior vena cava, liver, craniocerebral and thoracic traumas, inflicted in a traffic accident. Case report. Man, 20 years old has been injured in a traffic accident. At admission, 20 minutes after the injury, the patient was comatose and hypotensive. Bloody content was obtained by abdominal tracer. The patient underwent emergent laparotomy, utilizing trifurcated incision and cell saver device. Abdominal exploration revealed two liters of free blood and massive retroperitoneal hematoma. Manual compression of the liver was done, as well as perihepatic packing, complete hepatic vascular exclusion and mobilization of the right liver lobe. Due to impressive chemodynamic instability supraceliac aortic clamping was performed. Upon exposure of the retrohepatic inferior vena cava and right liver lobe, multiple lacerations of retrohepatic inferior vena cava and right hepatic vein, and right hepatic vein avulsion were found. We also identified an injury of VII and VIII segments of the liver (grade V according to the Moore's classification). Nonexpansive hepatoduodenal ligament hematoma and the injury of II and III segments of the liver group II/III according to Moore were found. Venorrhaphy of the inferior vena cava was done in the area of circumference of the right hepatic vein, a portion of which served as autologous vein patch. Continuous prolene 3/0 venorrhaphy of the distal caval laceration was done. Total caval and aorta clamping time of the inferior vena cava was 41 minutes. Atypical resection, debridment, of hepatic segments was done by using a harmonic scalpel. Hepatoduodenal ligament was declamped after 65 minutes. Fibrin glue was applied on the resectioned area of liver. The patient received 3.2 l of autologuos blood transfusion with 5 units of packed red blood cells, 6 units of fresh frozen plasma, 13 units of concentrated thrombocytes and 15 units of cryoprecipitates. Due to coagulopathy, factor rVIIa was administered. Bilateral toracal drainage was done. Small bilateral contusions of the frontal part of the brain were noticed but the patient successfully recovered and was dismissed after three weeks. Conclusion. Combined injuries of the inferior vena cava and the liver befall into the most complex vascular traumas, thus representing a challenge for any complete medical team to manage them. The patient presented in our study was urgently transported to the hospital, immediately operated on applying modern doctrines of anesthesiology, transfusiology and vascular surgery that, all together, resulted into favorable treatment outcome with no distant complications.
Neurolytic blockade of the obturator nerve in the treatment of idiopatic obturator neuralgia
Authors: Culafic Slobodan , Spaic Milan , Zoranovic Uros , Misovic Sidor
Published: December 2010

Introduction. Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful compressive neuropathy in more than 85% of the cases. Case report. A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and anterointernal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month follow-up period. Conclusion. Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia.
The influence of oxygenotherapy on the hypercapnia in patients with chronic obstructive pulmonary disease
Authors: Lazic Zorica , Cekerevac Ivan , Novkovic Ljiljana , Cupurdija Vojislav
Published: December 2010

Background/Aim. Oxygen therapy is a necessary therapeutic method in treatment of severe chronic respiratory failure (CRF), especially in phases of acute worsening. Risks which are to be taken into consideration during this therapy are: unpredictable increase of carbon dioxide in blood, carbonarcosis, respiratory acidosis and coma. The aim of this study was to show the influence of oxygen therapy on changes of arterial blood carbon dioxide partial pressure. Methods. The study included 93 patients in 104 admittances to the hospital due to acute exacerbation of CFR. The majority of the patients (89.4%) had chronic obstructive pulmonary disease (COPD), while other causes of respiratory failure were less common. The effect of oxygenation was controlled through measurement of PaO2 and PaCO2 in arterial blood samples. To analyze the influence of oxygen therapy on levels of carbon dioxide, greatest values of change of PaO2 and PaCO2 values from these measurements, including corresponding PaO2 values from the same blood analysis were taken. Results. The obtained results show that oxygen therapy led to the increase of PaO2 but also to the increase of PaCO2. The average increase of PaO2 for the whole group of patients was 2.42 kPa, and the average increase of PaCO2 was 1.69 kPa. There was no correlation between the initial values of PaO2 and PaCO2 and changes of PaCO2 during the oxygen therapy. Also, no correlation between the produced increase in PaO2 and change in PaCO2 during this therapy was found. Conclusion. Controlled oxygen therapy in patients with severe respiratory failure greatly reduces the risk of unwanted increase of PaCO2, but does not exclude it completely. The initial values of PaO2 and PaCO2 are not reliable parameters which could predict the response to oxygen therapy.
Impact of hyaluronidase on anesthetic distribution in retrobulbar region following sub-Tenon anesthesia
Authors: Surbatovic Maja , Kendrisic Mirjana , Jevtic Miodrag , Filipovic Nikola , Popovic Nada , Slavkovic Zoran
Published: December 2010

Background/Aim. Sub-Tenon's block is nowadays commonly used in ophthalmic surgery because of its safety and efficacy. The aim of this study was to investigate the distribution of the anesthetic solution with different amounts of hyaluronidase in the retrobulbar space, following an injection into the Sub-Tenon's space. Methods. In this experimental study, 40 pig cadaver heads were used (80 eyeballs). The material was divided into four groups (of 20 eyeballs each). Each group was administered 4.5 ml of a mixture of 2% lignocaine, 0.5% bupivacaine, and 0.5 ml of Indian ink, with different amounts of hyaluronidase - 15 IU/ml, 75 IU/ml, 150 IU/ml, except the control one. Samples of retrobulbar tissue were analyzed using the standard histopathological procedure. After that, they were also analyzed using the Adobe Photoshop program? (Windows, USA). The retrobulbar space was divided into eight zones by four perpendicular lines, which crossed in the centre of the optic nerve. The presence of ink in fat and muscle tissues and in the sheath of the optic nerve was observed. Results. The presence of the local anesthetic solution was significantly higher in inferonasal and superonasal quadrants of the fat and muscle tissues (p < 0.01). The distribution in optic nerve sheath is similar in each quadrant. Distribution of local anesthetic in each zone of the muscle tissue (I-VIII) was strongly influenced by the amount of hyaluronidase added. In the fat tissue, the distribution of local anesthetic under the influence of hyaluronidase was significantly higher (p < 0.05) in the areas which were distant from the place of injection (I-IV). The distribution in the optic nerve sheath is significantly higher (p < 0.01) in the group with 150 IU/ml of hyaluronidase. Conclusions. Following a sub-Tenon block local anesthetic was present in the retrobulbar space in a high percentage of the cases. The presence of local anesthetic solution in retrobulbar space depends on the amount of hyaluronidase previously added to the local anesthetic.
Extremely rapid development of transurethral resection of the prostate syndrome
Authors: Ladjevic Nebojsa , Likic-Ladjevic Ivana , Durutovic Otas , Nale Djordje , Dzamic Zoran
Published: December 2010

Background. The transurethral resection of the prostate (TURP) syndrome is reported after ureteroscopic procedures with irrigating solutions. TURP syndrome may occur quickly or up to 24 hours postoperatively. TURP syndrome affects many systems and manifests itself mainly through acute changes in intravascular volume and plasma solute concentrations. Case report. We reported a 72- year-old patient with benign prostatic hyperplasia, diabetes mellitus and angina pectoris who underwent TURP under spinal anesthesia. Unusual marked somnolence, bradycardia (38 beats/min), disorientation and face edema indicated a diagnosis of TURP syndrome only 15 minutes after the operation had started. The diagnosis confirmed by arterial gas analyses (metabolic acidosis, pH was 7.29) and hyponatremia (96 mmol/l). Aggressive and adequate therapy with diuretic and bicarbonates decreased symptoms and saved patient's life. Conclusion. Very fast development of TURP syndrome is possible. Continuous patient monitoring is necessary to provide fast recognition of TURP syndrome. Adequate therapy can prevent considerable complications.