bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropsychological tests in stroke patients during medical rehabilitation
Authors: Tomasevic Snezana , Filipovic Danka , Naumovic Nada
Published: July 2006

Introduction There is a necessity for neuropsychological research in everyday clinical practice in stroke patients. Considering the fact that cognitive functions are very frequently impaired in stroke patients, there is a need to examine the level of impairment during recovery and rehabilitation therapy. Material and methods This study included 80 right-handed examinees of certain age and sex distribution. The clinical part of the study evaluated the cognitive recovery of patients by using Mini-Mental State examination and the complex reaction time test during the rehabilitation treatment, four weeks on average. The aim of this study was to establish the characteristics and dynamics of complex reaction time Mini-Mental State examination in patients during medical rehabilitation following brain stroke. Results The average values of Mini-Mental State at the beginning of treatment were 25.90 and at the end of treatment they were 28.93 (variation coefficient less than 30). Growth of average values of Mini-Mental State examination, during the rehabilitation treatment was 10.47%. In the group of patients after stroke, values of complex reaction time at the end of treatment were significantly shortened (p<0.05), but not to the levels established in the control group. Discussion and conclusion The overall results indicate that after rehabilitation treatment there is a statistically significant improvement in cognitive recovery in all patients. Improvement of complex reaction time at the end of treatment is conditioned with complex changes in the neural system. The results of studies point to the significance of early application of facilitatory techniques, as well as neuropsychological rehabilitation of patients after brain stroke.
Prostacyclin and hormone levels in patients with symptoms of miscarriage and infection
Authors: Mitreski Anita , Radeka Gordana
Published: July 2006

During pregnancy, ascending infection into the uterus, is followed by local increase of cyclooxygenase-2 (COX-2) activity, and consequently elevated prostaglandin production. Subclinical infections of fetal amniotic membranes are well known to cause preterm delivery. Spreading of infection from vagina and cervix into uterine cavity, can be tragic for the fetus. The aim of this study was to reveal whether lower genital tract infections are associated with symptoms of threatened miscarriage. Our investigation included 140 patients with symptoms of threatened miscarriage and 70 patients with uncomplicated pregnancies. Infections were detected by vaginal or cervical smears as well as tests for Chlamydial infection. Levels of prostacyclin, main prostaglandin product during pregnancy, were evaluated via its stable metabolite, 6-keto-PGF1-alpha. Both prostaglandin levels and hormones were determined by ELISA method. We found that serum values of prostacyclin were elevated, while levels of estradiol, progesterone and prolactin were significantly lower in patients with lower genital tract infections. Increased prostacyclin levels in pregnancies complicated by lower genital tract infections are caused by stimulation of COX/2 enzyme, due to elevated production of various cytokines which are possibly a compensatory mechanism resolving problems caused by bacterial endotoxins.
Treatment of acute upper respiratory tract infections in children
Authors: Roncevic-Babin Nevenka , Popadic Jelena , Stojadinovic Aleksandra
Published: July 2006

Introduction Acute respiratory tract infections are the most common diseases of childhood. A preschool child suffers up to 5-7 infections of upper airways during a year. Upper airway infections make 80 - 90% of all respiratory infections. Etiology and treatment In 75% of all cases respiratory infections are of viral etiology, 15% of bacterial and 10% are caused by mycoplasma, rickettsiae, fungi, parasites. The treatment of respiratory infections includes antimicrobial therapy (causal), relief of symptoms (symptomatic) and application of general principles of child treatment. The choice of antimicrobial drug is based on the evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where adequate specimen cannot be obtained for microbiologic tests, when these tests do not reveal the agent, or therapy must start before evidence of the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can be modified later, according to the isolated agent and its sensitivity to the drug. Considering the incidence and importance of respiratory infections in morbidity and mortality of children, the aim of this article was to present guidelines in treatment of respiratory infections. The main point remains that the treatment should take into consideration the individual patient before all.
Risk factors for chronic non-communicable diseases: A follow-up model
Authors: Hovan-Somborac Jaroslava
Published: July 2006

Chronic non-communicable diseases are caused by interaction between numerous environmental and socio-economic factors and biological response of the human body. They are gaining importance due to the fact that they largely depend on common risk factors, of which more than 70% can be prevented. In 1996, an integrated health prevention program for chronic non-communicable disease based on the Aims of the World Health Organization ?Health for all in the 21st century? was designed in the Republic of Serbia. This program concerns the whole population and measures for its implementation. For its successful realization it is necessary to define standard procedures: uniform terminology, diagnostics, therapy and rehabilitation, its risk factors. The aim of this study was to establish data from basic medical documentation of the primary health care and propose a more efficient and effective evidence, as well as to establish a program for surveillance, prevention and control of mass non-communicable diseases within the existing medical documentation. The data were gathered from medical records of the general practice and occupational health services. A special questionnaire was designed to register data from medical records. Medical records of general practice and occupational health service in Kikinda have been analyzed. The existing medical documentation is insufficient regarding data necessary for evidence, surveillance and analysis of risk factors for chronic non-communicable diseases. A follow-up model for surveillance and evidence of risk factors in basic medical documentation, which should be incorporated in routine statistical reports, would actively include medical professionals - doctors and medical staff in prevention and detection of risk factors.
Possibilities of balneotherapy in treatment of subjective symptoms of chronic low back pain (lumbar syndrome)
Authors: Batsialou Ioanna
Published: July 2006

Introduction Chronic low back pain is a degenerative rheumatic disease and is characterized by various symptoms and clinical signs. Balneotherapy Balneotherapy represents a therapy by various hot or warm baths in natural mineral waters of specific physical and chemical characteristics. When used externally, they have mechanical, chemical and thermic effects. Balneotherapy of lumbar syndrome includes: individual baths, swimming in the pool, hydrokinesitherapy, underwater massage, underwater extension, mud therapy, mud baths. The therapy should be closely monitored for optimal efficacy and it is necessary to examine: functional status of the lumbosacral region, general functional status (level of activity), lower extremities, pain measurement, use of non-steroid anti-rheumatic and analgesic agents. In order to follow-up the effects of therapy and establish the prognosis it is important to perform: detailed anamnesis, anthropometrics measurements, socio-epidemiological research, clinical examinations. Conclusion Lumbar syndrome is usually caused by a degenerative disease of the spinal column. More than 25% of people under 45 years of age are unable to work due to chronic low back pain. That is why preventive measures, prompt diagnosis and adequate therapy are of utmost importance.
Diagnostic approach to peripheral solitary pulmonary lesions
Authors: Djuric Mirna
Published: July 2006

Introduction Peripheral localization and lack of symptoms are reasons why it is difficult to establish the diagnosis of peripheral pulmonary lesions commonly of malignant nature. Therefore thoracotomy often represents a diagnostic and therapeutic method at the same time. There is a need to define an adequate and optimal diagnostic approach to these lesions in order to establish their etiology, if possible, at low costs. Material and methods This retrospective study included 50 patients with peripheral solitary pulmonary lesions (PSPL) who underwent thoracotomy at the Institute of Lung Diseases in Sremska Kamenica. In all patients both bronchoscopy and transthoracic puncture were performed prior to surgery. Having evaluated the diagnostic procedures, their proper sequence has then been applied in the prospective group of another 50 patients admitted to the Institute for similar lesions. Results In the retrospective group the etiology of PSPL was established by bronchoscopy in 4% and using transthoracic puncture in 58% of patients, with sensitivity, specificity and accuracy of 78.78%, 100% and 85.1%, respectively. In the prospective group, transthoracic puncture (TTP) provided the final diagnosis in 70% of patients, with 86.2% sensitivity, 100% specificity and 90% accuracy. Conclusion Transthoracic puncture is a method of choice in preoperative diagnostics of solitary peripheral pulmonary lesions, quite like thoracotomy in cases where applied diagnostic procedures were inefficient.
Emphysematous cholecystitis
Authors: Stojanovic Dragos , Lalosevic Djordje , Stojanovic Mirjana , Caparevic Zorica , Djosev Marija , Ilic Jasna
Published: July 2006

Introduction Emphysematous cholecystitis is a rare gallbladder pathology characterized by gas accumulation in the gallbladder wall as a result of severe inflammation, mostly caused by bacteria known as Clostridium species. Case report This is a case report of a 59 year-old male diabetic, with typical anamnestic, clinical, ultrasonographic and radiological findings, pointing to acute cholecystitis of emphysematous form. Surgical and bacteriological procedures confirmed the preoperative findings. Conclusion Reliable findings considering clinical status, ultrasonographic and radiological differential diagnosis, adequate and quick preoperative preparation, cholecystectomy and drainage with appropriate antibiotic treatment and hyperbaric oxygenation, represent the basic principles in diagnostics and treatment of this disease.
Celiac disease - case report
Authors: Bojkovic Gradimir , Caparevic Zorica , Ilic Vesna , Stojanovic Dragos , Lalosevic Djordje , Stojanovic Mirjana
Published: July 2006

Introduction Celiac disease (nontropical sprue, gluten-sensitive enteropathy, chronic intestinal malabsorption disorder) is caused by gluten intolerance. This hereditary disorder is caused by sensitivity to gliadin. Because the body's own immune system causes the damage, celiac disease is considered to be an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny finger-like protrusions, called villi, on the lining of the small intestine are lost. The diagnosis is suspected on the basis of symptoms and signs, enhanced by laboratory and x-ray studies, and confirmed by biopsy revealing flat mucosa and subsequent clinical and histologic improvement on a gluten-free diet. Gluten must be excluded from diet. Supplementary vitamins, minerals and hematinics may be given depending on deficiency. Case report This is a case report of a 23-year old female patient with a mineralization defect (osteomalacia) and secondary osteoporosis caused by long-time unrecognized celiac disease. The patient had many symptoms: short stature, steatorrhea, anemia, weight loss and chronic bone pain. Laboratory and x-ray studies and jejunal biopsy revealed a chronic intestinal malabsorption disorder caused by gluten intolerance. Gluten-free diet and supplementary vitamins, minerals and hematinics were included with apparent clinical remission. Discussion and Conclusion Some people with celiac disease may not have symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for complications of celiac disease. Biopsy of the small intestine is the best way to diagnose celiac disease. Decreased bone density (osteoporosis and osteomalacia) is a serious problem for celiacs. If calcium is not absorbed, due to small intestinal damage caused by untreated celiac disease, bones are not as dense. The only treatment for celiac disease is gluten-free diet, that is, avoiding all foods that contain gluten. For most people, this diet stops symptoms, heals the existing intestinal damage, and prevents further damage.
Physiology of fracture healing: New aspects
Authors: Gajdobranski Djordje , Zivkovic Dragana
Published: July 2006

Introduction Skeletal system has a great regenerative potential, but it isn't the case with other tissues. Bone fracture healing includes a complex cascade of processes at cellular and biochemical levels, ending with a complete structural and functional restoration of the damaged bone. Impaired healing occurs in 5-10% of all fractures, manifesting as delayed union or non-union Such a high incidence of impaired healing certainly presents a problem, and therefore, permanent research regarding physiology of fracture healing is justified. Phases of fracture healing In this paper we described four phases of fracture healing. They are not clearly separated, but overlap. These data are based on contemporary literature and newest achievements in the field of fracture healing. Discussion Many data regarding this phenomenon were obtained from animal studies, but they may also be applied in human medicine since there is a great similarity between fracture healing in animal models and humans. Conclusion Full and complete knowledge of mechanisms of bioregulation of normal fracture healing process certainly presents the basic prerequisite for successful surgical and orthopedic treatment.
Food allergy in children: Part I: Pathogenesis and diagnostic approach
Authors: Tomic Jelena , Jovanovic Mirjana , Tomic Dusan
Published: July 2006

Introduction Food allergy is a form of adverse food reaction to different nutritive agents caused by immunological mechanisms. This condition is frequent in individuals with genetic predisposition. Frequency of food allergies in childhood varies in general population from 0.3 - 7.5 %. Characteristics of neonatal and infant gastrointestinal tracts are described as well as the role of gastrointestinal tract?s immunological immaturity in development of food sensitivity. Pathogenesis Features of physical and immunological barriers of gastrointestinal tract are described as well as their role in physiological conditions, in digestion and absorption of foreign proteins and prevention of foreign agents penetration and potentially dangerous proteins into the systemic circulation. Gastrointestinal-associated lymphoid tissue (GALT) is the basic part of immunological barrier. Its first role is to induce oral tolerance. In normal conditions cytokines induce T cells towards Th2 response and also promote synthesis of IgA antibodies Pathogenic mechanisms in evolution of reaginic hypersensibility in cases of chronic inflammation are also described. Pathological status of gamma/delta T cells plays an important role in this process, resulting in loss of oral tolerance and development of sensibilitivity. Conclusion Diagnostic procedures are multiple and complex. They consist of detailed history taking clinical findings, in vitro and in vivo tests, endoscopy, elimination diets and oral provocation tests. Food allergy in childhood is often transient and resolves spontaneously.
Off-pump myocardial revascularization using the octopus tissue stabilizer system
Authors: Milojevic Predrag , Neskovic Vojislava , Stojanovic Dragos , Jakovljevic Miroslav , Nenic Sava , Peric Miodrag , Nezic Dusko , Djukanovic Bosko
Published: July 2006

Off-pump coronary artery bypass surgery (OPCAB) has changed the approach to contemporary coronary surgery. Development of new surgical devices and techniques has reduced morbidity and mortality during off-pump surgery. From March 2000 - April 2002, a total of 136 patients underwent open heart surgery using off-pump technique and fast-track anesthesia at Dedinje Cardiovascular Institute. Octopus Medtronic coronary stabilizer was used for stabilization of targeted vessel. Arterial grafts were used 169 times and saphenous vein 69 times. Average number of anastomoses was 1,830,73 per patient. One patient (0.74%) died. Three patients (2.21%) underwent surgery revision due to postoperative bleeding and one (0.74%) because of graft dysfunction Perioperative myocardial infarction was registered 2 times (1.47%) pneumothorax 3 times (2.21%), postoperative arrhythmias 11 times (8.09%) transitory ischemic attack once (0.74%) and deep wound infection once (0.74%). Twelve patients (8.82%) required prolonged inotropic support Angiographies early revealed patent grafts in 8 patients (5.88%). OPCAB is a safe and effective alternative approach to coronary artery revascularization Use of coronary stabilizer has improved the safety and quality of OPCAB surgery.
Low level laser therapy and its effects on reparatory processes of the skin
Authors: Matic Milan , Lazetic Bogosav , Poljacki Mirjana , Djuran Verica , Ivkov-Simic Milana
Published: July 2006

Introduction Application of laser beams for therapeutic purposes is of relatively recent date, but today there is no field of medicine where lasers cannot be used. Physical characteristics of laser radiation Laser radiation is a type of electromagnetic radiation with some specific characteristics such as coherence, monochromaticity and parallelity. Types of laser devices Nowadays, there are many laser devices on the market used in medicine and dentistry. According to the type of their active medium, lasers can be classified as solid, gas, semiconductor and liquid. Effects of low level laser therapy on biological systems The exact mechanism of action of low level laser therapy is still not completely understood. Its basic feature is to modulate cell behaviour, without causing significant temperature increase. During irradiation of a tissue with a laser beam, an interaction between cells and photons takes place - photochemical reaction. After a cell absorbs the photon, the photon stops existing, and its energy is incorporated into the molecule which has absorbed it. Once this energy is transferred to different bio-molecules, it can be transferred to other molecules as well. The energy transferred to the molecule can increase its kinetic energy, and activate or deactivate enzymes or alter physical or chemical properties of main macromolecules. Effects of low level laser therapy on wound healing Effects of low level laser therapy on wound healing process is one of the most fully studied aspects of this type of therapy. It affects all phases of this very complex process. This paper offers a more detailed analysis of these aspects.
Impaired fracture healing
Authors: Gajdobranski Djordje , Zivkovic Dragana
Published: July 2006

Introduction Bone fracture healing is a complex cascade of events at cellular and biochemical levels, that ends by complete structural and functional restoration of a damaged bone. Impaired healing develops in 5-10% of all fractures, and manifests as delayed union or non-union. This paper deals with the problem of impaired healing as well as with methods of fracture healing enhancement. Causes of impaired fracture healing There are many factors causing impaired fracture healing (inadequate vascularization, mechanical causes, infection, etc.), and it is very important to recognize the principle cause of delayed union and non-union, since therapy is based on eliminating the factor that causes it. Fracture healing enhancement Through constant attempts to find adequate solutions and procedures in order to resolve the problem of impaired fracture healing, many alternatives in treatment of impaired healing have been developed. Some of these procedures may also be useful in treatment of fresh fractures, especially when it comes to fractures that are prone to delayed union and non-union more than usual. All currently known methods of healing enhancement may be classified as biological, mechanical and biophysical. Conclusion Certain methods are in clinical use for several decades. The newest methods, such as locally applied growth factors, composite biosynthetic grafts, gene therapy and systemic approaches are studied all around the world, and are on the verge of clinical application. Due to impressive number of therapeutic options, certain therapeutic procedures of choice will be developed for specific impairments.
High thoracic epidural anesthesia for coronary artery bypass graft surgery
Authors: Neskovic Vojislava , Milojevic Predrag
Published: July 2006

Introduction High thoracic epidural anesthesia and analgesia are being increasingly used for coronary artery bypass graft surgery. The reasons for this include excellent perioperative pain control with advantage of early tracheal extubation, improved postoperative pulmonary function, and cardiac protection due to sympathetic blockade. Effects of high thoracic epidural anesthesia Cardiac protection is the consequence of decreased heart rate, myocardial contractility and arterial blood pressure, without changes in coronary perfusion pressure. Therefore, high thoracic epidural analgesia beneficially alters major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. In addition, decrease of functional residual capacity, may reduce postoperative pulmonary morbidity. Results of clinical studies Patients with high thoracic epidural anesthesia revealed a more favourable perioperative hemodynamic profile, lower incidence of ischemia and better response to perioperative stress. High thoracic epidural anesthesia technique The epidural catheter should be placed at the Th2/Th3 interspace at least one hour before administration of heparin. After local anesthetic bolus dose, a continuous epidural infusion is recommended. Conclusion There is strong evidence for beneficial effects of high thoracic epidural anesthesia in patients undergoing surgical myocardial revascularization. However, it is still underutilized in current clinical practice.
Current aspects of pharmacologic application of bile acids
Authors: Mikov Momir , Kuhajda Ksenija , Kandrac Julijan
Published: July 2006

Effects of bile acids and their salts on absorption of other substances Bile acids and their salts increase intestinal absorption of lipids and transmembrane and paracellular transfer of small and endogenous and exogenous polar molecules. It has been established that they are good promotores of insulin absorption through skin and nasal mucose, and of blood-brain barrier transfer of salycilates and quinine. Effects of bile acids and their salts on absorption of other substances and their potential action It has been established that combination of bile acids with amphotericin B has potential Leishmanicideal effect and combination with ciprofloxacine has improved its antibacterial activity against Pseudomonas aeruginosa in vitro. Bile acids pharmacodynamic effects Bile acids have analgesic and hypoglycemic effect They also have anti-HIV effect probably suppressing virus transmission from cell to cell. Conclusion New studies of natural bile acids and new synthetic bile acids have revealed that they are not only adjuvants to existing active principles in pharmaceutical forms, but they can act as new therapeutic agents. However, it is necessary to study their possible mechanisms, but they are not crucial for their therapeutic application. Toxicological and pharmacological studies will determine the role of newly synthetized bile acids and their salts in current therapy.
Heparin-induced thrombocytopenia type II: Innovations in diagnostics and treatment
Authors: Antonijevic Nebojsa , Stanojevic Milica , Milosevic Rajko , Mikovic Danijela , Kovac Mirjana , Terzic Branka , Vasiljevic Zorana
Published: July 2006

Heparin-induced thrombocytopenia (HIT) Management of heparin-induced thrombocytopenia (HIT) and treatment options have significantly changed recently. Heparin may induce two types of thrombocytopenia. Type I, occurring earlier with a much higher rate of incidence (5-30%), is characterized by mild thrombocytopenia without significant clinical manifestations. Type II is less frequent (0.5-2%), life threatening immune type, develops following a period of minimum 5-7 days upon introduction of heparin therapy (patients earlier treated with heparin are excluded). Type II heparin-induced thrombocytopenia with severely reduced platelet count may be clinically manifested by thrombosis in 20-50% cases within the period of 30 days. HIT is suspected in persons resistant to heparin with relatively reduced platelet count, though HIT is described in person with normal platelet counts, as well. None of available assays used for HIT detection is completely reliable Sensitivity of a highly specific platelet aggregation assay is only 36% sensitivity and specificity of 14C-serotonin release assays amounts to 95% while ELISA using a heparin/platelet factor-4 target has a sensitivity of 85%. Thus, it is sometimes necessary to combine functional and antigen assays. Furthermore, new classes of antigen assays, like antibody detection tests of complexes between heparin and neutrophil-activating peptide-2 as well as those between heparin and interleukin-8, have been used. Current therapy options Current therapy options exclude formerly applied low-molecular-weight heparins due to the existing cross-reactivity of 80?100%. Danaparoid sodium exhibits in vitro cross-reactivity of 10?61%, clinically manifested in less than 5% of patients. Two drugs are drugs of choice in HIT type II treatment: lepirudin, especially in patients without renal failure and argatroban, particularly in patients with renal failure. The following procedures and agents are also efficient: asmapheresis in the first four days, high-dose intravenous gammaglobulin, antiagregans, especially ADP antagonists, aspirin, dipirydamole, dextran, prostacyclin analogues thrombolytic therapy as well as thromboembolectomy. Oral anticoagulants are not administered in active HIT type II, in deep vein thrombosis with high international normalized ratio (INR) and thrombin-antithrombin complexes, and low protein C levels to avoid the possibility of venous limb gangrene development. They can be administered in a stable phase, when the thrombin generation is controlled by previous administration of one of the above-mentioned alternative anticoagulants.
Specificities of psychoses in children and adolescents with mental retardation
Authors: Kolar Dusan , Bojanin Svetomir , Kolar Mila
Published: July 2006

Mental retardation is a heterogeneous neurodevelopmental disorder characterized by arrested or incomplete psychological development. The first part of the study deals with psychological and biological factors: etiology and pathogenesis of mental retardation and comorbid psychiatric disorders Their etiopathogenesis is similar as in other neurodevelopmental disorders and it was analyzed in the part dealing with biological specificities of persons with mental retardation. Numerous bio-psycho-social factors cause increased vulnerability of the mentally retarded to development of mental disorders. Thus, prevalence of these disorders is higher in mentally retarded persons than in general population. This study also deals with specificities regarding diagnosis of psychotic disorders in mentally retarded persons as well as neurobiologic, epidemiologic, clinical and therapeutic characteristics of schizophrenic psychoses, autism and affective disorders in persons with mental retardation. Special emphasis was given to diagnostics of these disorders in mentally retarded children and adolescents, as well as to problems of differential diagnostics. Apart from other things, we have concluded that specific clinical pictures demand subspeciality approach in the frame of developmental psychiatry.
Septic arthritis in the newborn and infants
Authors: Gajdobranski Djordje , Petkovic Lazar , Komarcevic Aleksandar , Tatic Milanka , Maric Dusan , Pajic Milos
Published: July 2006

Introduction Septic arthritis represents an intra-articular infection caused by pyogenic bacteria. During the earliest childhood it is considered to be a systemic septic condition and demands early diagnosis and prompt surgical treatment. Material and methods This is a retrospective analysis of patients with septic arthritis treated at the Department of Orthopedics of the Pediatric Surgery Clinic in Novi Sad, over a 10-year period. We are also presenting a case of a 12-day-old newborn baby, with clear radiological signs of osteoarthritis of the right knee. Results A retrospective study included the period 1991-2000, and showed that 15 patients, aged 10 days - 12 months were treated for osteoarthritis. The most common localization was the hip, in 60% of cases. In 11 patients the causative agent was Staphylococcus aureus while in the 4 remaining patients the bacteriologic finding was negative. One patient died of generalized sepsis. Discussion In neonates and infants septic arthritis is characterized by atypical clinical picture, often causing delayed diagnosis. In the initial phases of the disease ultrasonographic findings were of greater use compared to radiological imaging, due to relatively late appearance of radiological signs of disease. Conclusions Due to possible development of serious and irreversible damage, even lethal outcome, septic arthritis requires early diagnosis, prompt administration of antibiotics and early surgical treatment. It is a quite unique area in Pediatric Orthopedics where missed or delayed diagnosis may have serious consequences.
Production and therapeutic application of rhenium isotopes, rhenium-186 and rhenium-188: Radioactive pharmaceuticals of the future
Authors: Vucina Jurij , Han Ruben
Published: July 2006

Introduction In contemporary nuclear medicine, alpha, pure beta or beta-gamma emitters are used for targeted therapy. Use of pure and combined alpha/beta emitters in oncology, endocrinology, rheumatology and, a short while ago, interventional cardiology, has refined as an important alternative to more common therapeutic regimens. Two radioisotopes of rhenium, rhenium-186 and rhenium-188, are of particular interest. Production of Rhenium-186 and Rhenium-188 Rhenium-186 is routinely produced in nuclear reactors by direct neutron activation of metallic rhenium enriched with 185Re via 185Re(n,)186Re nuclear reaction. For production of 188Re the target is 186W. 188W is produced by double neutron capture which gives 188Re due to beta decay. Separation of 188Re is performed in generators by column chromatography, extraction or by gel technology. The best results are obtained using chromatographic 188W/188Re generator in which 188W is adsorbed on aluminum. Rhenium-188 is eluted in saline solution. Radiopharmaceuticals labeled with rhenium radioisotopes and their clinical applications There are several fields of applications of radiopharmaceuticals labeled with 186,188Re. For bone pain palliation the most often used are 186Re-HEDP and 188Re-DMSA. For synovectomy, 186Re-sulphide in kit form is already commercially available. Endovascular radiation therapy is performed by using 188Re-perrhenate or 188Re-MAG3. Labeling of peptides and antibodies with 188Re is also reported. Application of rhenium radioisotopes depends on their specific activity. Rhenium-186,188 of low specific activity can be used only for labeling of particles or diphosphonates. However, labeling of peptides or antibodies can be performed only by using 188Re of high specific activity. Conclusion 188Re is expected to have wide applications after development of a chromatographic 188W/188Re generator. One of the advantages of rhenium is its chemical similarity with technetium. So technetium analogues labeled with 186,188Re can be developed for several specific applications.
Frequency of congenital abnormalities in mortality of fetuses and newborns autopsied in 1991 and 2001 at the Department of pathology and histology in Novi Sad
Authors: Eric Mirela , Vuckovic Nada , Pilija Vladimir , Misolic Mirjana
Published: July 2006

Introduction Congenital malformations are morphological developmental anomalies visible during clinical examination or autopsy (in case of death, stillborn or abortion). Their incidence in human population is estimated to be between 5-10%, and perinatal mortality rate varies from 20-25%. Material and methods The research was conducted at the Department of Pathology and Histology and at the Department of Obstetrics and Gynecology in Novi Sad. We analyzed autopsy reports of newborns (under 28 days old), stillborns and miscarried fetuses in 1991 and 2001. Data on type and incidence of malformations in 1991 and 2001 were compared in order to determine statistically significant differences. Results Autopsy reports for 1991 revealed malformations in 21 cases, whereas autopsies were performed in 103 fetuses and newborns. The total number of deliveries at the Department of Obstetrics and Gynecology in Novi Sad was 6.160. Autopsy reports for 2001 revealed malformations in 33 cases, and autopsies were performed in 126 fetuses and newborns. The total number of deliveries at the Department of Obstetrics and Gynecology in Novi Sad was 6.101. Comparison regarding incidence of malformations in 1991 and 2001, showed no statistically significant difference. Discussion Congenital malformations are the most important cause of prenatal and perinatal mortality and morbidity. One reason for that is better treatment of other diseases, but on the other side, there are more toxic materials in human environment. Conclusion It is concluded that the incidence of congenital malformations in mortality of fetuses and newborns is high (20.39% in 1991, and 26.19% in 2001). We can also point to increase of central nervous system malformations in comparison with malformations of other organ systems.
Parathyroid gland adenoma: Case report
Authors: Bojkovic Gradimir , Caparevic Zorica , Stojanovic Dragos , Lalosevic Djordje , Stojanovic Mirjana
Published: July 2006

Introduction Primary hyperparathyroidism is a generalized disorder resulting from excessive secretion of parathyroid hormone involving one or more parathyroid glands. Both familial and sporadic forms exist. Histologic examination reveals parathyroid adenoma in about 90% of patients, although it is sometimes difficult to distinguish an adenoma from a normal gland. Primary hyperparathyroidism is commonly characterized by hypercalcaemia, hypophosphatemia and excessive bone resorption. Case report This is a case report of a 52-year old female patient with toxic thyroid adenoma and a parathyroid gland adenoma. The patient underwent partial thyroidectomy as a method of choice in treatment of toxic thyroid adenoma. Two years later, clinical hyperparathyroidism caused by an adenoma of parathyroid gland has manifested and was surgically removed. Discussion and conclusion In mild hypercalcaemia, many patients are asymptomatic and this condition is frequently discovered accidentally during routine laboratory screening. In order to provide operative treatment efficiency in thyroid nodule cases, besides thyroid gland morphological diagnostics, it is necessary to perform a preoperative verification of parathyroid glands as well. This diagnostic approach is essential in identifying possible simultaneous occurrence of multiple diseases, such as: thyroid and adenoma of parathyroid gland, in order to diminish incorrect diagnostic estimates.
Ketamine: In the past thirty years and in the future
Authors: Radovanovic Dragana , Pjevic Miroslava
Published: July 2006

Introduction There are two isomers of ketamine: S(+)ketamine and R(-) ketamine. Effects of this drug are mediated by N-methyl-D-aspartate (NMDA), opioid and muscarinic receptors. Pharmacokinetics Due to its high lipid solubility and low protein binding, ketamine is extensively distributed in the body. Ketamine metabolism is mediated by hepatic microsomal enzymes. Effects on body systems Ketamine causes increased intracranial pressure, bronchodilation and stimulation of cardiovascular system. Clinical use Anesthesia It is used for premedication, sedation, induction and maintenance of general anesthesia. Ketamine is an ideal anesthetic agent for trauma victims, patients with hypovolemic and septic shock, patients with pulmonary diseases. Analgesia Even subanesthetic doses of ketamine have analgesic effects, so ketamine is also recommended for postoperative analgesia. Recent results show that ketamine is not always effective as an analgesic in treatment of chronic pain and that some side effects limit its use in patients with chronic pain. Intensive care Combination of ketamine and midazolam can be very useful and safe for sedation and pain relief in intensive care patients, especially during ventilator management. Ketamine may be the anesthetic of choice for painful procedures in intensive care units. Emergency medicine Ketamine is recommended for critically ill patients with sedative, inotropic and bronchodilatatory effects. New clinical use Future studies will reveal if ketamine can be used for outpatient anesthesia, intravenous regional anesthesia and in treatment of depression. S(+)ketamine is a more effective anesthetic with significantly less psychomotor effects which provides rapid recovery from anesthesia in regard to racemate or R(-)ketamine. Conclusion Increasing interest in use of ketamine has resulted from current knowledge. In the future we expect new clinical uses in treatment of acute and chronic pain, intensive care and emergency medicine.
Catheter-associated urinary tract infections in Clinical Center of Banja Luka
Authors: Verhaz Antonija , Skrbic Ranko , Rakic-Music Mirjana , Sabo Ana
Published: July 2006

Introduction Catheter-associated urinary tract infections are the most common nosocomial infections of the urinary tract, and among the most common nosocomial infections in general. The major problems of these infections include antibiotic resistance and enormous direct and indirect cost of treatment. Material and methods A retrospective study on major causes of infections and antibiotic resistance was conducted at four clinics of the Clinical Center of Banja Luka. An anonymous questionnaire was distributed to nursing staff dealing with urinary catheters in order to get an overview of their clinical performance. Results The results showed that in 89% of cases (out of 198 patients with developed catheter-associated urinary tract infection) infections were caused by gram-negative bacteria, in 7% by gram-positive bacteria and in 4% by Candida. The most common bacteria were: Escherichia coli (33.6%), Pseudomonas aeruginosa (14.1%), Proteus mirabilis (13.3%), and Enterobacter (10.5%). Majority of bacteria presented with extremely high resistance (72-100%) to ampicillin, gentamycin and cotrimoxazole, and in some cases a significant resistance to ciprofloxacine, nalidixic acid, ceftriaxone and ceftazidime. The questionnaire showed that nursing staff did not follow guidelines for medical care of patients with urinary catheters. Conclusion It can be concluded that poor hygienic and epidemiological conditions, as well as irrational use of antibiotics contribute to uncontrolled development of urinary tract infections in catheterized patients.
Total thyroidectomy for thyroid C-cell hyperplasia
Authors: Stojanovic Dragos , Paunovic Ivan , Caparevic Zorica , Lalosevic Djordje , Stojanovic Mirjana
Published: July 2006

Introduction Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor of the thyroid parafollicular or C-cells. MTC accounts for approximately 3 to 5% of thyroid carcinomas. A characteristic feature of this tumor is production of calcitonin. Sporadic MTC accounts for 60-80% of all cases of the disease. The most common presentation of sporadic MTC is a solitary thyroid nodule, which occurs in 75 to 95% of patients. It typically occurs in the fifth or sixth decades, with slight female predominance. Case report A case of a 58-year old woman with elevated basal calcitonin levels (221 pg/ml) has been presented. Preoperative ultrasound of the thyroid gland and body (99m)Tc DMSA scintigraphy showed a diffuse goiter. Hyperparathyroidism and pheochromocytoma - were not present. Total thyroidectomy was performed. Only C-cell hyperplasia was found. Discussion and conclusion Many patients with elevated basal serum calcitonin level ranging between 150 and 1000 pg/ml, have only C-cell hyperplasia, but a few have small MTCs. For persons in known kindreds with familial MTC, prospective screening, using serum calcitonin measurement, can identify those at risk for the disease before MTC is clinically evident. Due to the possibility that any patient with MTC may have multiple endocrine neoplasia type 2 (MEN-2), preoperative testing must also include measurement of serum calcium (to rule out hyperparathyroidism) and a test for pheochromocytoma. Total thyroidectomy is indicated in patients with high levels of calcitonin.
Morphology of renal pelvis and clearance of lower pole stones following ESWL
Authors: Bogdanovic Jovo , Stojkov Jovan , Djozic Jasenko , Marusic Goran , Sekulic Vuk
Published: July 2006

Introduction and objective A prerequisite for successful outcome of extracorporeal shock wave lithotripsy (ESWL) is effective stone fragmentation. Despite successful stone fragmentation, complete clearance of stone fragments cannot be achieved patient, due to various factors. The aim of this prospective study was to determine morphological factors that affect clearance following successful stone fragmentation by ESWL. Material and methods In the period October 1999 and January 2001, 60 patients (45 male and 15 female) with single lower pole kidney stones have been treated using lithotripter Lithostar 2000TM. Parameters of radiographic anatomy, measured on intravenous pyelography, included infundibular width and length, infundibuloureteral infundibulopelvic angles. After the follow-up period of 3 months, patients were divided into two groups regarding clearance status: Group I consisted of stone free patients, and group II of those with residual fragments. Results Average values of measured parameters in group I vs group II were as follows: infundibular length 27.70?5.48 mm vs 30.25?3.95mm (p=0.045, Mann-Whitney test); infundibular width 5.98?3.28 mm vs 4.70?1.30 mm (p=0.018, Mann-Whitney test); infundibulopelvic angle 52.92?20.76o vs 34.10?8.19o (p=0.00001, Mann-Whitney test); infundibuloureteral angle 48.00?21.13o vs 30.70?7.49o (p=0.00001, Mann-Whitney test). Conclusion This study revealed that parameters of infundibulopelvic anatomy were significantly different in the examined groups. The success of clearance of fragments following ESWL procedure can be predicted using these morphologic parameters.
The role and importance of fungal infections in intensive care units, ICU
Authors: Tatic Milanka , Stanic-Canji Danica , Draskovic Biljana , Komarcevic Aleksandar , Gajdobranski Djordje
Published: July 2006

Introduction The incidence of fungal infections is constantly increasing, especially in Intensive Care Units (ICU). On the one hand ICU are places for treatment of most difficult, often immunodeficient patients, and on the other hand their treatment often requires invasive procedures, support of vital organs and adequate monitoring. Epidemiology In approximately 78% of patients the cause of infection are Candida species with mortality rate of 57%. Less common causative agents are Aspergillus species, but with very high mortality rate of up to 100%. Pathogenesis Candida albicans is a normal inhabitant of the oropharingeal and digestive systems. Hospitalization, trauma, loss of immunity and use of strong antibiotics facilitate fungal colonization. Inadequate nutrition, poor perfusion, ischemia and corticosteroids therapy lead to damage of intestinal mucosa. Combined with improper production of IG A, it predisposes to translocation of fungi through mucosa and invasion of the blood stream. Clinical manifestations Most common forms are urinary tract infections, intraabdominal candidiasis, disseminated candidiasis and candidemia. Diagnosis Diagnosis of fungal infections is very difficult. It is based on clinical picture, microbiological, histological, radiological, serologic and molecular examinations. Treatment Treatment is usually based on systemic antimycotic agents (Amphotericin B, Azoles: Fluconazole, Flucytosine). Prophylactic treatment is still a matter of debate. It is not routinely recommended in ICU, but is commonly used in transplant patients.
Characteristics of immune response to protozoan infections
Authors: Arsic-Arsenijevic Valentina , Dzamic Aleksandar , Mitrovic Sanja , Radonjic Ivana , Kranjcic-Zec Ivana
Published: July 2006

Introduction When protozoa enter the blood stream or tissues they can often survive and replicate because they adapt to the resisting natural host defenses. The interaction of immune system with infectious organisms is a dynamic interplay of host mechanisms aimed at eliminating infections and microbial strategies designed to permit survival in the face of powerful effectors mechanisms. Protozoa cause chronic and persistent infections, because natural immunity against them is weak and because protozoa have evolved multiple mechanisms for evading and resisting specific immunity. Natural and specific immune response to protozoa Different protozoa vary greatly in their structural and biochemical properties and stimulate distinct patterns of immune responses and have evolved unique mechanisms for evading specific immunity. Protozoa activate quite distinct specific immune responses, which are different from the responses to fungi, bacteria and viruses. Protozoa may be phagocytozed by macrophages, but many are resistant to phagocytic killing and may even replicate within macrophages. T. brucei gambiense is the best example of protozoa which can induce humoral immune response because of its extra-cellular location. In Leishmania sp. infections, cellular defense mechanisms depend upon CD4+ T-lymphocytes and activate macrophages as effectors cells that are regulated by cytokines of Th1 subset. Plasmodium sp. is a protozoa which show the diversity of defence mechanisms which can be cellular or humoral, depending on Ag and protozoa's location. Immune evasion mechanisms of protozoa Different protozoa have developed remarkably effective ways of resisting specific immunity: a) anatomic sequestration is commonly observed with protozoa Plasmodium and T. gondii; b) some protozoa can become resistant to immune effectors mechanisms: Trypanosoma, Leishmania and T. gondii; c) some protozoa have developed effective mechanisms for varying their surface antigens: Plasmodium and Trypanosoma; d) some protozoa shed their antigen coats, either spontaneously or after binding with specific antibodies: E. histolytica; e) some protozoa alter host immune response by nonspecific and generalized immunosuppression (abnormalities in cytokine production, deficient T cell activation): Trypanosoma, Leishmania, Toxoplasma, Entamoeba. Conclusion Protozoa activate numerous, different immune mechanisms in human body. Evolution, progression and outcome of diseases depend upon these mechanisms. Resent progresses in research have defined and selected Ag as candidates for new vaccines. Better definitions regarding the role of cytokines in protozoaninfections will facilitate rational development of cytokines and cytokine antagonists and their use as immunotherapeutic agents.