bluuebunny/crossref_metadata_2025 huggingface dataset:
Two pp-omas of the head of the pancreas one of which with central necrosis fistulated into the duodenum
Authors: Colovic Radoje , Grubor Nikica , Micev Marjan , Colovic Natasa , Todorovic Vera , Cosic-Micev Milena
Published: July 2008

PP omas are rare, usually malignant tumors of the PP cells of the Langerhan?s islets which secrete pancreatic polipeptide. The authors present two women operated for PP-omas of the pancreas. The first was 55 year-old woman in whom we did a cephalic duodenopan-createctomy (Whipple's procedure) for the tumor of the head of the pancreas with central cavity containing gas due to comunication with the duodenum. Imunohistochemistry showed a PP oma with strong generalised immunoreactivity with antibodies against Chromogra-min A, neuron specific enolasa and PP with more the 95% of tumor cells and coexpression of somatostatine in 35% and VIP in less then 5% of tumor cells. Following uneventful recovery the patient stayed symptom free so far and put 20 kilograms in weight. The second patient was 19 year-old girl with a multinodal tumor of almost the entire pancreas in whom a local excision of the nodal mass of the head of the pancreas had been carried out in the other hospital, three years ago and relaparotomy and tumor biopsy a month before admission to our institution. In her we did a total duodenopancreatectomy and standard limphadenectomy for a multinodal mass ocupying almost the entire pancreas. Immunohistochemistry showed a strong generalised immunoreactivity with antibodies agains Chromographin A, Neuron speciphic enolasa and PP for more then 95% of tumor's cells. Glucagon was expressed in few focuses (in less then 1% of cells), somatostatin was expressed very rarely in single cells while the rest of tumor markers did not show a visible immunologic reactions in the majority of tumor's cells. Three years after surgery she died due to multiple liver secondaries.
Long-term results of treatment of injuries to the sectoral and segmental bile ducts
Authors: Colovic Radoje , Barisic Goran , Markovic Velimir
Published: July 2008

INTRODUCTION Surgically important variations of the sectoral and segmental bile ducts of the right lobe of the liver appear in a significant proportion of patients. Frequency of the injuries to these ducts is not known as the ligature of small ducts may pass without major consequences. MATERIAL AND METHODS Over a 27 year period (1. Jan 1974-31. Dec 2001) along with 168 patients with benign biliary strictures of type I, II, III and IV according to Bismuth's classification, we treated 13 patients with operative sectoral or segmental bile duct injuries, four patients from our institution and nine patients transferred from elsewhere. The injury was recognized at original surgery in all four patients operated in our institution. Primary repair was performed in three patients, in two patients direct end-to-end repair overT-tube and in one patient with anastomosis between the injured duct and Roux-en-Y jejunal limb, while in one patient the injured duct was ligated. In no one of nine patients transferred from elsewhere the injury was recognized during original surgery. Four patients were sent with biliary peritonitis, another four patients with external biliary fistula and one patient for pain and fever due to liver abscess. RESULTS All three patients in whom the primary repair was performed had a quick and uneventful recovery and they stayed symptom-free so far. The patient in whom the injured duct was ligated died after series of complications. Four patients sent to us with biliary peritonitis were treated with relaparotomy, lavage and drainage and all developed external biliary fistula. Three of these patients had their fistula ceased spontaneously within few weeks, while in one patient the fistula didn't show signs of ceasing so that injured duct had to be anastomosed with Roux-en-Y jejunal limb. Two out of four patients sent for external biliary fistula had it ceased spontaneously, while in two patients anastomosis between duct and Roux-en-Y jejunal limb was necessary. The last 13th patient, who had sectoral duct severed and ligated was reoperated liver abscess drained and duct anastomosed with Roux-en-Y jejunal limb. That patient developed an anastomotic stricture a year later and he was successfully reoperated and stayed symptom-free so far. All 12 patients have been followed up from nine months to 27 years (average 9.2 years) and neither developed biliary symptoms. CONCLUSION We conclude that the management of these injuries depends upon the time of recognition of the lesion, size of the injured duct and of the type and stage of complications.
Anatomic segment oriented hepatic resection in the management of colorectal metastases of the liver
Authors: Karamarkovic Aleksandar , Stefanovic Branislav , Djukic Vladimir , Mihailovic Vojin , Popovic Nada
Published: July 2008

The prime role of hepatic resection in the management of colorectal cancer metastatic to the liver is firmly established. At least a third of patients who undergo liver resection for colorectal metastases can expect to survive five years. Since 1999, 106 hepatic metastases were resected in 42 patients (synchr. 8, metachr. 34, pts). We performed 12 monosegmentectomies (S2-S8), 4 bisegmentectomies (S4b, S5 and S5, S6), 6 sectorectomies (right posterior, left paramedian, left lateral), 3 polysegmentectomies (S4b, S5 S6), 8 billateral sectionectomies (S2, S3 and S6,S7) and in 9 cases multiple segmentectomies. In 4 cases initially unresectable colorectal metastases were downstaged by transcatheter HAI regional chemotherapy (Implantofix) and after that successfully resected. We favour vascular inflow occlusion through selective division of appropriate portal pedicle at the porta hepatis or by transparenchymal approach. Median blood loss was330?160 ml. The complication rate ammounted to 9.52% (bile fistula, abscess collection). No method related lethality occurred. During the follow-up period we registered tumor recurrence rate of 19.1% (8 pts), of which two patients were subjected to liver re-resection. Overall 3-year survival rate (Kaplan-Meier) is 38.9%. Multivariate analysis shows a significant correlation between 3-year survival and solitary (p-0.031) and unilobar metastases (p-0.014).
Desensitization with DTP (diphtheria, tetanus and pertussis) vaccine
Authors: Atanaskovic-Markovic Marina , Nestorovic Branimir
Published: July 2008

Immunization with DTP vaccine (diphtheria, tetanus and pertussis) is a part of the vaccination calendar offered in childhood. Adverse allergic reactions vary from minimal urticarial reactions to life-threatening anaphylaxis. In infancy these reactions usually interrupt the vaccination calendar, but immunization in these children should be done. At the University Children's Hospital of Belgrade, a group of 137 children with suspected allergic anaphylactic reaction to DTP, DT, TT and monopertussis vaccine was studied for the last six years. Skin (prick and intradermal) tests were performed with corresponding vaccine. If both tests were negative, the vaccine could be given as a single dose of 0.5 ml. If one of these tests were positive desensitization with vaccine could be done (according to the protocol described by Carey and Meltzer). In one group of 52 children three days before desensitization, premedication with antihistamines, was done, whereas in the other group of 52 children premedication was not done. Two (3.8%) children in a group of 52 children with premedication had a minor (local) reaction after vaccination and 50 children (96.2%) had no reaction after vaccination, whereas no children (0%) had systemic reaction after desensitization.
Zdruzeni sadrzaj receptora za estrogen i progesteron u predvidjanju odgovora na hemioterapiju i hormonsku terapiju u karcinomu dojke
Authors: Susnjar Snezana , Neskovic-Konstantinovic Zora , Stamatovic Ljiljana , Vasovic Suzana , Strbac Miroslav , Nikolic-Vukosavljevic Dragica , Jovanovic Dana
Published: July 2008

The predictive value of Human Epidermal growth factor Receptor 2 (HER-2) on the response to chemotherapy and endocrine therapy in breast cancer patients has not yet been determined. The expression of other biomarkers in breast cancer can further influence the response to therapy. The aim of our study was to investigate if status of steroid receptors (SR) influenced the response to anthracycline-containing chemotherapy and tamoxifen in a group of HER-2 positive advanced breast cancer patients. Forty breast cancer patients, who were entered into the various prospective clinical trials conducted at the Institute of Oncology and Radiology of Serbia during their metastatic phase of disease, were involved into this analysis. Steroid receptors content were determined both by biochemical method and immunohistochemical (ICH) method, while HER-2 content were determined only by ICH method. Twelve out of 40 women were sequentially treated by anthracycline-containing chemotherapy and, always upon disease progression with antiestrogen tamoxifen. The objective response to anthracycline therapy was obtained in 4 out of 12 patients (RR=0.33, CI 95%=0.05-0.61). In three of them the response to tamoxifen was noticed, as well. Of 8 anthracycline resistant patients in this group, 7 patients also had disease progression as best response to tamoxifen despite the fact that most of them (5 out of 7 tamoxifen resistant women) had positive SR status. Our results showed a trend (Fisher test, p=0.06) that clinical response to anthracycline-containing chemotherapy might be of some predictive value for the response to subsequent tamoxifen therapy in HER-2 positive advanced breast cancer patients. However, these results were obtained on a small number of patients, so further investigation is warranted.
Infuence of donor specific transfusion on renal allograft outcome
Authors: Jovicic-Pavlovic Svetlana , Lezaic Visnja , Simic Sanja , Blagojevic-Lazic Radmila , Stolic Ivanka , Simonovic Ruzica , Radivojevic-Djokic Dragana , Djukanovic Ljubica
Published: July 2008

Donor specific transfusion (DST) is proclaimed to improve graft survival in living related kidney transplantation (LRTx). The aim of the present study was to estimate the influence of DST on LRTx graft function, acute rejection rate (AR) and survival in the early and late post transplant period. Fifty-five LRTx patients (grafted in the same year, and matched for recipients' and donor's age, sex) were included into the study. Ninety pts received DST: 4 patients were excluded from further evaluation (3 developed positive cross match reaction and one patients received cadaver graft) and 15 patients subsequently underwent LRTx from their respective blood donors (group 1). Their outcome was compared with 15 patients who had never been transfused before (group 2) and 25 random transfused patients (group 3). Besides similar patients' and donors' sex and age, kidney transplantations were performed in the same period. Graft functions were followed-up 6-60 months after LRTx. DST protocol consists of 3x150 ml potentially related donor's fresh whole blood at 2-week intervals (DST1, DST2, DST3) with 3 days azathioprine administration (2 mg/kg bw, one day before to one day after DST administration). Donor specific citotoxic antibodies were determined before DST1, at the day of DST2, DST3 and 14 and 28 days after DST3. All patients were grafted at least one month after the DST3. Immunosuppressive protocol consisted of three drugs. There is no difference in HLA mismatches, MLC answer, and pretransplant panel reactive antibodies level between groups. One patient from group 2 lost their graft in the first postTx month (acute tubular necrosis). A better graft function was preserved in patients from groups 1 and 3 than group 2 in the observed periods. Number of patients with acute rejection was unsignificantly different: 5/15 from group 1,12/25 from group 3 but 8/10 patients from group 2. However, the acute rejection rate was lower in patients from group 1. One and five-year graft survival was 100% for grafts from groups 1 and 3, while it is gradually decreased for group 2 grafts: 84.5% and 57%. Our results confirmed the beneficial effect of blood transfusion on LRTx renal graft function and survival and DST on the incidence of acute rejection.
Burkit-like lymphoma: subileus and ascites as dominant clinical manifestation
Authors: Markovic Olivera , Marisavljevic Dragomir , Cemerikic-Martinovic Vesna
Published: July 2008

Nodal presentation of Burkitt-like lymphoma is common, particularly in gastrointestinal tract. However, only few cases with massive ascites and signs of subileus due to lymphoma proliferation are described. We report a 31-year-old male patient who presented with fever, night sweats, vomiting and abdominal fullness. Physical examination suggested much ascites. Abdominal X-rays showed hidroaeric levels. Diagnosis of Burkitt-like lymphoma was established on the basis of cytological and imunohistochemical examination of ascites (immune phenotype of malignant cells was EMA -, NSE -, LCA +, CD10 -/+, CD20 +, IgM +, Ki-67 +100%). After treatment with BMF protocol complete remission was achieved and retained for 2.5 years. Authors stressed that imunohistochemical examination of ascites has been proved as simple and efficient method for establishing precise diagnosis. In this way laparotomy was avoided, which otherwise would be necessary due to exclusive abdominal localization of the disease.
Iga nephropathy
Authors: Basta-Jovanovic Gordana
Published: July 2008

IgA nephropathy is glomerular disease first described in 1968 by Berger, named after him Morbus Berger. The disease is characterized by the presence of IgA dominant or codominant imunoglobuline deposits in glomerular mesangium which can be demostrated by immunofluorescence. Clinical manifestations of IgA nephropathy in the majority of cases is hematuria which can be macro or microskopic, isolated or combined with proteinuria which can be of nephrotic range. In some cases nephrotic syndrome can be the first clinical presentatio. In 10% renal insuficiency can be present at the onset of the disease. By light microscopy IgA can manifest any of the histologie phenotypes of immune complex mediated prolifferative glomerulonephritis. According to light microscopy findings a classification systeme have been used to categorize the histologie patterns of IgA nephropathy. Glomerular changes in IgA nephropathy are prolifferative and can be focal or diffuse accompanied by crescentic formation in many cases. Immune deposits seen by electron microscopy appear as electron dense deposites most numerous in mesangium.
The content of copper and zinc in human ulcered atherosclerotic plaque
Authors: Radak Djordje , Cvetkovic Zoran , Tasic Nebojsa , Petrovic Branko , Lackovic Vesna , Djordjevic-Denic Gordana
Published: July 2008

INTRODUCTION Copper and zinc have significant antiatherogenic effect influencing activity of antioxidant enzyms (giutathion-peroxidase i superoxid-dismutase), mechanism of apoptosis and other mechanisms. Few studies showed increased copper and zinc concentration in atherosclerotic plaque in comparison to normal vascular tissue. AIM The aim of the study was to compare copper and zinc concentrations in carotid artery tissue without significant atherosclerotic changes and human ulcered atherosclerotic plaque. MATERIAL AND METHODS Study was conducted on 66 patients. Carotid endarterectomy due to the significant carotid atherosclerotic changes with cerebrovascular disorders was performed in 54 patients (81.8%). Control group consisted of 12 patients (18.2%) without carotid atherosclerotic changes operated due to the symptomatic kinking and coiling of carotid artery. Operated group consisted of 38 man (62.96%) and 16 woman (37.04%). Control group had the same number of patients: six men (50%) and six women (50%). Preoperatively, all patients were examined by vascular surgeon, neurologist and cardiologist. Duplex sonografy of carotid and vertebral arteries was performed by Aloca DSD 630 ultrasound with mechanical and linear transducer 7.7 MHz. Indication for surgical treatment was obtained according to non-invasive diagnostic protocol and neurological symptoms. Copper and zinc concentration in human ulcered atherosclerotic plaque and carotid artery segment were estimated by spectophotometry (Varian AA-5). RESULTS Average age of our patients was 59.8?8.1 years. For males average age was 76.1 ?9.8 years. And for females 42.4?5.8 years. In group with carotid endarterectomy female patients were significantly younger than male patients (p<0.01). In group with carotid endarterectomy clinically determined neurological disorders were found in 47 patients (87.03%)-35 male (74.47%) and 12 female patients (25.53%). Regarding risk factors for cardiovascular diseases, no significant difference among groups was found for blood pressure and smoking. However, patients with carotid endarterectomy had significantly more diabetes mellitus (p<0.05), obesity (p<0.01) and hypercholesterolemia (p<0.01). DISCUSSION Our study showed significantly lower total copper value in the group with human ulcered atherosclerotic plaque in comparison with the control group (p<0.05). We also found significantly lower total zinc value in the group with human ulcered atherosclerotic plaque in comparison with the control group (p<0.05). CONCLUSION Our study revealed significant difference in copper and zinc content between human ulcered atherosclerotic plaque and normal carotid tissue. Closer correlation of these oligoelements and endothelial dysfunction will be established in future investigations.
Moguci znacaj primene ketogene dijete u lecenju rezistentne epilepsije
Authors: Suzic Biljana , Vasiljevic Nadja , Savic-Abramovic Ljiljana , Paunovic Katarina
Published: July 2008

nema
Plasminogen activator inhibitor-1 in the evolution of stroke
Authors: Jovanovic Zagorka , Ilic Mirka , Zidverc-Trajkovic Jasna , Pavlovic Aleksandra , Mijajlovic Milija , Sternic-Covickovic Nadezda , Stankovic Sanja , Beslac-Bumbasirevic Ljiljana , Kostic Vladimir
Published: July 2008

Fibrinolytic activity in the acute stroke was examined by monitoring the level of plasminogen activator inhibitor-1 (PAI-1), as one of the indicators of fibrinolytic activity. Given the role of PAI-1 in the processes of atherogenesis and thrombogenesis, plasma PAI-1 level was measured in 59 patients (up to 50 years of age) with atherothrombotic stroke (verified by computed tomography scanning or magnetic resonance imaging of brain) in the period from 12 to 24 hours (I analysis) and 30 days after the onset of stroke (II analysis); then, it was correlated with plasma PAI-1 level in the control group (57 healthy subjects), which was 2.86?0.70 U/ml. It was found that PAI-1 level was significantly higher in the acute stroke (I analysis: PAI-1 =4.10?1.40 U/ml, p<0.001; II analysis: PAI-1 =3.64+0.90 U/ml, p<0.001), while fibrinolytic activity was lower, especially on the first day from the stroke that was not completely increased even after 30 days. There was no difference in PAI-1 levels between the subgroups of patients with infarction and lacunar cerebral ischemia (p>0.05), as well as between females and males (p>0.05). Along with significantly increased fibrinogen level (4.65?1 g/l, in the controls - 2.83?0.64 g/l, p<0.001), significantly higher triglycerides (2.04?0.76 mmol/l, in the controls - 1.38+0.54 mmol/l, p<0.001) and lipoproteins(a) (0.405?0.29 g/l, in the controls -0.172?0.14 g/l, p<0.001) were found, correlating with higher plasma PAI-1 level in these patients. The increased plasma level of PAI-1 pointed to possibility of decreased fibrinolytic activity in pathogenesis of ischemie stroke, as well as, risk of reinsult, which had been the greatest after the onset of stroke and declined gradually within several weeks.
Conservative treatment of ectopic pregnancies: Comparison of velocity of decrease of beta-hcg between spontaneous and methotrexate induced resorptions
Authors: Dokic Milan , Perisic Dusan
Published: July 2008

The evolution of the process can take two different directions. If an intact pregnancy continues to grow, there is a tubal abortion or a rupture of the Fallopian tube. In the oppsote case, there is spontaneous resorption of the tubal pregnancy. In certain cases with the application of methotrexate, the ectopic pregnancy growth can be interrupted and spontaneous resorption can be induced. Nowadays, the international standards of treating patients with early ectopic gravidities and no peritoneal effusions, with ?-HCG values below 6000 Ul/I, gestational sac diameter below 3 cm, and without any visible heart action, imply methotrexate treatment. The objective of this study is to prove the efficiency of methotrexate use in patients who meet the above criteria. The first group did not manifest satisfying decrease of ?-HCG after two measurements, so methotrexate was used, while the second group showed satisfying decrease of ?-HCG, measured on the third day. Comparing the velocity of decrease of ?-HCG level among both groups of patients, it was proved that iatrogenically induced decrease, that is to say the achieved resorption, was equal to the spontaneous resorption, which justified the use of methotrexate in ectopic pregnancy treatment.
Aplastic anaemia caused bythiamazole: A case report
Authors: Milosevic Rajko , Bogunovic Marina , Antonijevic Nebojsa
Published: July 2008

Antithyreoid drugs are known causative agents of agranulocytosis and, in rare cases, aplastic anaemia as well. This is a case report of a female patient with secondary aplastic anaemia developed two years after continual use of thiamazole. She suffered from exhaustion and massive epistaxis. Physical examination revealed pale skin and mucous membranes, skin hematomas (body and legs) and high body temperature - 39?C. At admission, her blood film revealed pancytopaenia with 75 g/l hemoglobin concentration, 1.0xl09/l leukocytes and severe thrombocytopaenia - 7.0x109/l. Differential count showed 91% of lymphocytes, 1% of monocytes and only 8% of neuthrophils. Bone marrow cytology and pathohistologic findings revealed severe hypocellularity, replaced with fat cells and only 10% of active hematopoietic tissue. In the acute phase of illness, in vitro growth of bone marrow progenitors was completely absent. Treatment was initiated with prednisone and danazol. During that time, she suffered from epistaxis, gastrointestinal bleeding and herpes infection. Due to therapeutic failure cyclosporine A was added after 21 days. Thereupon, slow recovery ensued. After two months, she was discharged from hospital with stable blood film findings (HB 83 g/l, WBC 4.6x109/l, and PIT 30.0x109/l). She was forbidden thiamazole for her life time. After recovery from the acute phase of illness, in vitro haematopoietic precursor cells examination was repeated. The number of CFU-E colonies stimulated with 1 IU EPO was decreased in comparison with the control values. Upon adding 100 ? /l of thiamazole (5 mg/ml concentration e.g. 500 mg per culture), the growth of CFU-E was completely prevented, followed by marked cytotoxicity signs. The treatment including low doses (5 mg/ kg body weight daily) of cyclosporine A administration was continued on outpatient basis. After one year, blood film showed almost normal results with 120 g/l hemoglobin concentration, 4.3x109/l leukocytes and mild thrombocytopaenia 72.0x109/l. She was transfusion free.
Anomalous choledocho-pancretic ductal junction in a choledochal cyst: A case report
Authors: Jovanovic Miodrag , Bilanovic Dragoljub , Colovic Radoje , Grubor Nikica , Ugljesic Milenko
Published: July 2008

Choledochal cysts are rare congenital anomalies, mostly detected in adults. Pathogenesis of these cysts seems to be in anomalous junction between pancreatic and common bile duct, above the papillary sphincterand outside of the duodenal wall. The absence of the sphincter above the junction is followed by reflux of the pancreatic juice into the bile duct leading to dilatation and fibrous changes of bile duct wall. A 38-year-old female is presented in whom a choledochal cyst was found 11 years earlier, during the operation performed for obstructive jaundice, when cystojejunostomy with Roux-en Y jejunal limb was carried out. In February 1990, she was admitted to our Institution for jaundice and biliary colic. The patient was reoperated. Operative cholangiography showed an anomalous pancreatobiliary junction, choledochal cyst, dilated cystic duct and moderate dilatation of intrahepatic bile ducts. Cholecystectomy, desanastomosis with partial excision of choledochal cyst, and retrocolic choledochojejunostomy with the same Roux-en-Y jejunal limb were performed. Total excision of choledochal cyst was too risky due to chronic inflammatory changes in the hepatoduodenal ligament. Postoperative recovery was uneventful and the patient remained symptom-free so far.
Dental characteristics of children with cerebral palsy
Authors: Stevanovic Radoje , Jovicic Olivera
Published: July 2008

Cerebral palsy is one of the commonest children's physical handicaps with frequency of 1.5-3/1000. Beside many other disturbances, these children may have serious disorders caused by dental diseases. Concerning this fact, the objective of our study was to examine children with cerebral palsy in our country and determine condition of dental health and suggest adequate protective measures. A total of 116 children, 3-18 years old, with cerebral palsy were examined and the results were compared to the control group of healthy children of the same age. Among healthy children, 7-10 years old, 66.3% had healthy parodontium, while none of children with cerebral palsy had healthy parodontium. Children, 11-14 years old with cerebral palsy had higher percentage of untreated caries, but lower percentage of filled teeth (18.7%) compared to healthy children (55.0%). Children, 15-18 years old with cerebral palsy had significantly higher percentage of extracted teeth (10.6%) than healthy children (4.1%) and more often orthodontic anomalies (70.6%), compared to healthy children (46.9%). Results of these study indicate that children with cerebral palsy need special and planned dental care.
Serum amyloid a in clinical practice
Authors: Jovanovic Dijana
Published: July 2008

Serum amyloid A (SAA) is an acute phase first class protein discovered a quarter of the century ago. Its concentration depends on clinical findings of the patient, illness activity and the therapy applied. SAA increases moderately to markedly (100-1000 mg/l) in bacterial and fungal infections, invasive malignant diseases, tissue injuries in the acute myocardial infarction and autoimmune diseases such as rheumatoid arthritis and vasculitis. Mild elevation (10-100 mg/l) is often seen in viral infections, systemic lupus erythematosus and localized inflammation or tissue injuries in cystitis and cerebral infarction. SAA as sensitive, non-invasive parameter is used in organ transplantation where early and correct diagnosis is needed as well as where prompt therapy is required. Besides acute kidney allograft rejection, SAA is used in the diagnosis of rejection after liver transplantation, simultaneous pancreas and kidney transplantation and also in bone marrow transplantation (acute ?graft vs. host disease"). Simultaneous determination of C-reactive protein (CRP) and SAA may point to acute kidney allograft rejection. Standard immunosuppressive therapy with cyclosporine A and prednisolone significantly suppresses the acute phase CRP reaction both in operation itself and acute rejection, but not in infection. On the other hand, SAA rejection in operation, acute allograft rejection and infection is present in spite of cyclosporine A and steroids therapy. Different reaction of SAA and CRP in transplant patients to cyclosporine A therapy helps in differentiation between the infection and rejection. Although CRP and SAA are sensitive and acute phase reactants, their serum concentrations cannot be valued as prognostic and diagnostic criteria without creatinine serum concentration and clinical findings. In addition, they offer important information for clinical diagnosis as well as the kind of therapy.
Smallpox - past or not past?
Authors: Kuljic-Kapulica Nada
Published: July 2008

Smallpox is a potentially deadly illness caused by the variola virus, an orthopoxvirus. Severe illness followed by blister-like body rash is the sign of smallpox. Smallpox symptoms develop about 12 days after exposure. V. variole can spread very readily by aerosol, which may lead to explosive epidemics. For centuries, smallpox has been a worldwide cause of death, killing about 30% of the infected people. In 1972, the epidemic of smallpox in ex-Yugoslavia was the largest postwar smallpox epidemic in Europe. The total number of the affected was 175, out of whom 35 with fatal outcome, accounting for 20% of mortality. However, after a decade-long vaccination effort, the last natural case of smallpox occurred in 1977 The only way to prevent smallpox epidemic is by vaccination and patients' isolation. The possibility of future bioterrorism attacks, which may cause a new outbreak of smallpox and return variola, is very serious. World population is not immune, because of lack of vaccination. In 1980, the World Health Organization (WHO) declared the disease fully eradicated.
Complications of cochlear implant surgery
Authors: Kosanovic Rade , Ivankovic Zoran , Stojanovic Sandra
Published: July 2008

During the last several decades, cochlear implant has been fully recognized in treatment of severe hearing loss. Development of modern technology enabled inconceivable possibilities of technical qualities of the device as well as development of usable coding strategies, which led to extraordinary results in patient rehabilitation. Although cochlear implantation has become one of the routine operative procedures throughout the world nowadays, it gives rise to certain complications. These complications, though rare, can sometimes be very serious, even with fatal outcome. If cochlear implantation is performed by experienced and well-educated team of experts, the possibility of complications is minimal and is certainly not the argument against cochlear implantation as a method of treatment of severe hearing impairments.
Voiding dysfunction in children aged five to 15 years
Authors: Karaklajic Dragana , Peco-Antic Amira
Published: July 2008

Voiding dysfunction in children was analyzed in 91 patients in a period from January 1st to October 1st 1998. Most of the patients had functional voiding disorder (92.31%), and only 7.69% manifested monosymptomatic night enuresis. The number of girls was bigger in the group of patients with voiding dysfunction while the boys were predominant in the group with mono-symptomatic nocturnal enuresis. More than a half of children with functional voiding disorder had repeated urinal infections (58.23%), incontinence (93.49%), need for urgent voiding (68.13%), and vesicoureteral reflux (47.61%). The most common type of voiding dysfunction was urge syndrome/urge incontinence. The incidence of dysfunctional voiding disorder was more often in children with scaring changes of kidney which were diagnosed by static scintigraphy.
Successful revascularization of the kidney: Case reports
Authors: Davidovic Lazar , Sindjelic Radomir , Stanojevic Mirjana , Kuzmanovic Ilija , Colic Momcilo , Perisic Mirjana , Pejkic Sinisa
Published: July 2008

Three cases of successful kidney revascularization and recovery of renal function are presented in this study. In all three cases, renal failure and renovascular hypertension were caused by renal artery occlusion associated with aortic aneurysm (two abdominal and one thoracoabdominal). Prior to operation, one patient required dialysis 4 months, one 25 days and one 2 days. After kidney revascularization, renal function recovered immediately in the first case, in the second case after three months, and in the third case after 10 days. In one case, blood pressure restored to normal without medical therapy, while in two other cases blood pressure decreased nearly to normal with minimal medical therapy. In appropriately selected cases, revascularization of the occluded renal artery is recommended for treatment of both renal failure and renovascular hypertension. In such cases, collateral circulation is crucial to enable the preservation of dysfunctional kidney.
Determination of ventilatory threshold based on rating of perceived exertion scale
Authors: Stojiljkovic Stanimir , Nesic Dejan , Mazic Sanja , Popovic Dejana , Mitrovic Dusan , Mitic Dusan
Published: July 2008

The objective of the study was to test the possibility of using the fixed value (12-13) of the Rating of Perceived scale (RPE scale), as a valid method for determination of ventilatory threshold (VT). The sample of the subjects included 32 physically active males (age: 22.3; TV: 180.5; TM: 75.5 kg; V02max: 57.1 mL/kg/min). During the continuous test of progressively increasing load on a treadmill, cardiorespiratory and other parameters were monitored using ECG and gas analyzer. Following the test, VT and V02max were determined. During the test, at each level, at the scale from 6 to 20, the subjects pointed the number that suited best their currently feeling of strain. The RPE threshold was defined as constant value of 12-13. Average values of ventilatory and RPE threshold were expressed by parameters that were monitored and then compared by using t-test for dependent samples. No significant difference was found between mean values of VT and RPE threshold, when they were expressed by relevant parameters: speed, load, heart rate, absolute and relative oxygen consumption. Fixed value (12-13) of RPE scale may be used to detect the exercise intensity that corresponds to ventilatory threshold.
Management of refractory angina pectoris
Authors: Ristic Andjelka , Angelkov Lazar , Damnjanovic Milorad , Baskot Branislav
Published: July 2008

An increasing number of patients with coronary artery disease have ischemie symptoms that are unresponsive to both conventional medical therapy and revascularization techniques. The objective of this study was to define the population of patients with refractory angina pectoris and to present the therapeutic options currently available for this condition. Among many techniques, the enhanced external counterpulsation, transmyocardial laser revascularization and neurostimulation have been shown to reduce angina and to improve objective measures of myocardial ischemia in patients with refractory angina.
Clinical significance of infection with cag A and vac A positive helicobacter pylori strains
Authors: Sokic-Milutinovic Aleksandra , Todorovic Vera , Milosavljevic Tomica
Published: July 2008

Clinical relevance of infection with different Helicobacter pylori strains was reviewed in this paper. Helicobacter pylori (H. pylori) infection plays a role in pathogenesis of chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and MALT lymphoma. Extragastric manifestations of H. pylori infection most probably include acne rosacea and chronic urticaria, while the importance of H. pylori infection for pathogenesis of growth retardation in children, iron deficiency anemia, coronary heart disease, stroke and idiopathic thrombocytopenic purpura remains vague. The expression of two H. pylori proteins, cytotoxin associated protein (cag A) and vacuolization cytotoxin (vac A) is considered to be related with pathogenicity of the bacterium. It is clear that presence of cag A+ strains is important for development of peptic ulcer; nevertheless, it is also protective against esophageal reflux disease. On the other hand, cag A+ strains are common in gastric adenocarcinoma and MALT lymphoma patients, but it seems that certain subtypes of vac A cytotoxin are more important risk factors. Infection with cag A+ strains is more common in patients with acne rosacea, stroke and coronary heart disease.
Generalized epilepsy with febrile seizures plus: Clinical and genetic analysis of three Serbian families
Authors: Ristic Aleksandar , Jankovic Slavko , Annesi Grazzia , Carrideo Sara , Annesi Ferdinanda , Gambardella Antonio , Maksimovic Goran , Gnjatovic Brankica , Petrovic Igor , Vojvodic Nikola , Sokic Dragoslav
Published: July 2008

The results of clinical and genetic analysis of three Serbian families (pedigrees) with autosomal dominant inheritance, incomplete penetrance and phenotypic features of GEFS+ are presented in this study. Mutation analysis of the SCN1A, SCN1B and GABRG2 genes was performed in all affected and some unaffected members of these three families. Twentysix exons of SCN1A, five exons of SCN1B and nine exons of GABRG2 were individually amplified using primers based on intronic sequence. PCR products were sequenced in both forward and reverse directions. Subsequently, the samples were run and analyzed using 377 DNA automated sequencer. No consanguinity was noticed. The MM and OM family members live in Republic of Srpska while KS family originates from the central Serbia. No mutations of the exons of SCN1A, SCN1B and GABRG2 genes were found in tested subjects. Obligate carriers in MM family (III-1, III-2, and III-4) exhibit variable expressivity or incomplete penetrance rather than proof of polygenetic inheritance. OM pedigree follows autosomal dominant pattern despite reduced penetrance. Bilinear transmission may assume the possibility of multigenetic mode of inheritance in KS family. The fact that all affected members in three Serbian families were negative for mutations in SCN1A, SCN1B and GABRG2 genes strongly supports the hypothesis of significant genetic heterogeneity of GEFS+. Recognizing GEFS+ on clinical grounds contributes to more precise integration of this syndrome into already existing classification of epileptic syndromes.
Human Figure Test in the research of psychopathological state of refugees and somatically traumatized
Authors: Opalic Petar
Published: July 2008

Machover Human Figure Test was used to investigate eight clinical features in five diagnostic categories (neurosis, depression, schizophrenia, paranoid feature and aggressiveness) and one symptom (motor deficiency) through graphical features of human figure drawing. The test involved 201 subjects, out of whom 109 were refugees from refugee camp in Krnjaca, 31 somatically traumatized patients from the Orthopedic Clinic, Clinical Center of Serbia, Belgrade, and 61 subjects from Belgrade denying any traumatic experience whatsoever. The following was determined in three tested subgroups: - Out of general psychopathological features, "thickened line of the drawing", "unclear medium line of the drawing" and "absence of an arm or a leg" were significantly most frequent in the group of somatically traumatized subjects, thus supporting the hypothesis that Machover Test examined projective aspects of disorder of the body scheme experience. - Out of eight diagnostic categories, only "motor deficiency" was significantly different - of course, in the group of somatically traumatized subjects, while "aggressiveness" was different in the group of refugees.
Social phobia in developmental period: From theory to therapy
Authors: Kolar Dusan , Bojanin Svetomir
Published: July 2008

The contemporary integrative theoretical and therapeutic concepts of social phobia in developmental period have been presented in the study. Besides current neurobiological theories, a very important hypothesis about behavioral inhibition has been represented as a predisposition of social phobia. The cognitive-behavioral theories of social phobia are dominant among psychological theories. The integrative concept of social phobia is the most realistic approach to this disorder and the bridge between biological and psychological theories. The interaction between biological and psychological etiological factors is represented through different therapeutical approaches to social phobia. Therapy of social phobia is integrative and involves different therapeutical modalities in different phases of therapy. In integrative psychotherapy, we use cognitive-behavioral therapy, dynamic oriented supportive psychotherapy, psychodynamic psychotherapy and phenomenological-existential psychotherapy. The cognitive-behavioral therapy yields the best results. The medicaments in use are the following: selective serotonin reuptake inhibitors, mono-amine oxidase inhibitors, high-potency benzodiazepines, new antiepileptic drugs and rarely (3-blockers. The combination of integrative psychotherapy and pharmacotherapy is the most optimal therapeutic approach to social phobia. This integrative and to patient adapted treatment will produce the best results in management of children's and adolescent's social phobia.
Etika savremenog sveta na pocetku XXI veka
Authors: Milovanovic Dimitrije , Milovanovic Srdjan
Published: July 2008

nema
Panic disorder: Psychobiological aspects of personality dimensions
Authors: Draganic-Gajic Saveta , Lecic-Tosevski Dusica , Paunovic Vladimir , Cvejic Vesna , Svrakic Dragan
Published: July 2008

Attempts to understand the underlying mechanisms of association between psychological factors and panic disorder have been mostly based on psychodynamic description. Evidence of the importance of serotonergic (5-HT) system in panic disorder (PD), however, has substanti ally increased in recent years. OBJECTIVE The objective of our study was to determine whether there was a specific personality profile of panic disorder patients and how it was related to possible neurobiological mechanisms underlying personality dimensions. PATIENTS AND METHODS Sample consisted of 14 inpatients with ICD-X diagnosis of panic disorder and 34 healthy control subjects. Personality dimensions were assessed by Minnesota Multiphasic Personality Inventory (MMPI-201) and Tridimensional Personality Questionnaire (TPQ). To assess central 5-HT function, platelet monoamine-oxidase (MAO) activity was measured. RESULTS In panic disorder group, higher scores of histrionic, depressive and hypochondriac subscales and significant increase of harm avoidance (HA) scale as well as low MAO activity were found. Negative correlation was established between MAO activity and psychopathic deviance MMPI scale. CONCLUSION The obtained results might indicate a specific personality profile of patients with panic disorder, which is characterized by high neuroticism, fearfulness, inhibition, shyness and apprehensive worry. Low MAO activity and high HA scores possibly indicate underlying hyperserotonergic state. The observed correlation between personality traits and MAO activity provide additional support for the hypothesized functional relationship between underlying central monoaminergic activity and temperament traits associated with anxiety, depression and impulsivity.
Slip of the T tube within the common bile duct: A little known complication of the T tube drainage
Authors: Colovic Radoje , Radak Vladimir , Grubor Nikica , Matic Slavko
Published: July 2008

Complications related to the T tube drainage of the common bile duct are not uncommon. Some, like dislocations of the T tube out of the common bile duct, could be very serious, particularly if developed during the first few days after surgery, when the abdominal drain in the subhepatic space had been already removed. Then, an emergency reoperation might be necessary. The slip of the T tube upwards or downwards inside the common bile duct is not so rare. Fortunately, it is less dangerous and can usually be resolved without reoperation. It takes place several days after surgery, followed by the right subcostal pain, occasionally with temperature, rise of the bilirubin and with decrease or complete cessation of the bile drainage through the T tube. The diagnosis can be made only on the basis of T tube cholangiography. The re-establishment of the proper T tube position must be done under X-ray visualization. Seven cases of the T tube slip within the common bile duct, its clinical presentation, diagnosis and method of repositioning were presented. Possible mechanism of complication was described. As far as we know, the complications have not been described by other authors.
Health-related quality of life assessment in patients with allergic rhinitis
Authors: Maksimovic Natasa , Jankovic Slavenka , Tomic-Spiric Vesna , Marinkovic Jelena
Published: July 2008

Allergic rhinitis is a chronic inflammatory disease of the airways, which can interfere with many aspects of an individual's life and severely diminish the quality of life of the person affected. The objective of this study was to assess the quality of life of patients suffering from allergic rhinitis during and out of pollen season. The study involved 100 patients diagnosed with allergic rhinitis, 48 of who had seasonal, 25 perennial, and 27 who manifested both forms of allergic rhinitis. All study participants were treated at the Institute of Allergology and Immunology, Clinical Centre of Serbia, Belgrade, in the period March-November 2002. A specific quality of life questionnaire for patients with rhinoconjunctivitis was used in the study. During pollen season, itchy eyes (x2=6.34; p=0.042), red eyes (x2=7.44; p=0.024), and swollen eyes (x2=6.65; p=0.036) caused significantly more difficulties for subjects with seasonal and those with both seasonal and perennial rhinitis than for subjects with perennial allergic rhinitis. A highly significant difference in the mean scores of the indoors activity variable during and out of pollen season (F=347.28; p=0.000) was noted, that is to say, significant irritation was noted during pollen season among subjects with seasonal and those with both seasonal and perennial allergic rhinitis, however the dynamics of irritation remained the same in both study groups (F=0.145; p=0.704).The patients with seasonal and those with both seasonal and perennial allergic rhinitis experienced a significantly poorer quality of life during pollen season than out of it, as well as an inferior quality of life in comparison to patients with perennial allergic rhinitis during pollen season.