bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes and variations of body weight as risk factors for coronary heart disease
Authors: Jovanovic Dragana , Jakovljevic Branko , Paunovic Katarina , Grubor Dusan , Milovanovic Aleksandar
Published: December 2008

Introduction Weight variations are a common phenomenon. Therefore, concern has been raised about the association between weight changes and weight variations and coronary heart disease (CHD). The aim of this study was to estimate the influence of weight change and weight variations as risk factors for coronary heart disease. Materials and methods The investigation was conducted as an observational cross-sectional study, including 102 participants of both genders: 61 patients with CHD and 41 healthy controls. All participants underwent anthropometric measurements and completed a questionnaire that included 1) weight changes in adulthood (maximum and minimum weight), 2) presence and number of weight variations in the 10 years prior to the onset of disease and 3) the size of weight change (weight gain or weight loss in kg). One weight variation was defined as weight loss followed by weight gain for more than 10% of body weight, or about 7 kg. Multivariant logistic regression was used for the estimation of significant predictors for the occurrence of coronary heart disease. Results Participants with CHD had higher values of body weight in adulthood compared to healthy controls, larger number of weight variations in the last 10 years, and more frequently reported weight gain and weight loss for more than 10 kg. The highest risk for the occurrence of coronary heart disease was observed for participants who had more than 3 weight variations for 10% (OR=2.13; 95%CI=0.98-5.48), those with weight loss over 10 kg (OR=2.16; 95%CI=1.71-2.72) and those with weight gain over 10 kg (OR=2.71; 95%CI=1.08-6.83), regardless of gender, age, smoking, body mass index and blood pressure. Discussion Several mechanisms are suggested to explain the relationship between weight changes and variations and coronary heart disease, including changes in plasma lipid levels, insulin levels, decrease of HDL cholesterol, increase of C-reactive protein and increase of blood pressure. Conclusion This study suggests that frequent and very intense weight changes can be considered important predictors for the occurrence of coronary heart disease.
Correlation between neurological finding and gestational maturity of newborns determined by neurosonography
Authors: Ilic Nevenka , Obradovic Slobodan , Djindjic Jasmina , Kostic Gordana , Laban Olivera , Vuletic Biljana
Published: December 2008

Introduction Maturity is a complex functional condition influenced especially by the development of the vital functions of a fetus, primarily by the degree of the development of its central nervous system. The aim of this investigation was to establish the gestational maturity of the nervous system by neurosonography and neurological status. Material and methods The parameter of the neurological maturity, compared in this research are a neurological status and the degree of girification established by the ultrasound. Results All the coefficients of correlation between the gestation age determined by the ultrasound and the establishing of the gestation based on the neurological findings show a statistically significant correlation for p<0.01. Of particular parametres of the neurological evaluation , the most appropriate ones appeared to be reflexes (the reflex of crossed extension, Moro reflex and the reflex of the main points), then volar flexion of a hand and the poplietal corner as the indicator of the passive tonus, whereas within the area of the evaluation of the active tonus, the motility was the most valid for establishing the maturity of a neonatal. The lowest coefficients of the correlations were in the automatic walk and the active tonus of the neck flexor, which are the ones of the most common neurological indicators of hypoxic ischemic encephalopathy of a neonatal. Conclusions Bearing in mind that the premature babies are a risky group for existence of perinatal brain damages, we believe the neurosonographic establishing of the gestation age to be a precise and comfortable indicator of the maturity of the nervous system.
Cholestatic syndrome in patients with systemic erythematous lupus: Differential diagnostic aspects
Authors: Tomasevic Ratko , Golubovic Gradimir , Kiurski Miroslav , Pavlovic Aleksandar
Published: December 2008

Systemic lupus erythematosus is a multisystemic inflammatory disease with diverse clinical manifestations. Hepatic lesion is a rarely seen complication of systemic lupus erythematosus. We report a case of complication of lupus presented as cholestatic syndrome in a 41-year old woman with lupus in her medical history for the past seven years. A general examination showed jaundice and hepatomegaly, with elevated bilirubin and aminotransferase levels in the liver function tests. The liver biopsy was performed and the microscopic examination revealed cholestasis with bile plugs without any signs of inflammation and liver tissue necrosis. After the three months steroid therapy the clinical symptoms resolved and the laboratory values normalized. The various factors are considered to be involved in the ethiopathogenesis of liver damage. Previous treatment with potentially hepatotoxic drugs (imuran in this case) or viral hepatitis have usually been implicated as the main cause of liver disease in lupus patients. On the other hand, even after careful exclusion of these ethiologies, the problem remains whether to classify the patient as having a primary liver disease with associated autoimmune and laboratory features resembling lupus, or as having a liver disease as a manifaestaion of lupus.
Recurrent respiratory infections with severely damaged lung functions: Kartagener's syndrome: Case report
Authors: Cekerevac Ivan , Jakovljevic Vladimir , Novkovic Ljiljana , Radovanovic Dragan , Lazic Zorica
Published: December 2008

Introduction Kartagener's (or Siewert) syndrome represents a clinical presentation of primary ciliary diskinesia (PCD) with 3 dominant symptoms: bronchiectasiae, chronic sinusitis and situs viscerum inversus totalis or dextrocardia, only. Siewet demonstrated the first case of this clinical phenomenon in 1904, which was recognized by Kartagener in 1933, as a congenital disorder. PCD is an autosomal recessive disease with extensive genetic heterogenity. Dyskinetic or completely absent motility of cilia predisposes to reccurent pulmonary and upper respiratory tract infections resulting in bronchiestasis. Also, infections of the middle ear are common due to lack of ciliary movement in the Eustachian tube. Men have reduced fertility due to spermatozoa with absent motility or abnormalities in the ductuli afferents. Case report Our case report represents a middle age woman, treated ambulatory for many years as a chronic obstructive pulmonary disease (COPD). The patient noted recurrent upper respiratory tract infections from her childhood, headaches and recurrent sinusitis. Also, she had extrauterine pregnancy, no children, in spite of several arteficial inseminations. Due to the clinical signs of the right heart failure and the described ECG changes, the echocardiographic examination was done, which showed the dextracardia and the ultrasonographic examination of the abdomen revealed the situs inversus, the finding being within the physiological limits. Conclusion All data regarding situs viscerum invesrus, supported by CT verification of bronchiectasiae and chronic inflammation of maxillar sinus led us to conclude that the patient suffered from Kartagener's syndrome.
Cyclopentolate as a cycloplegic drug in determination of refractive error
Authors: Bolinovska Sofija , Popovic Jovan
Published: December 2008

Cycloplegia is loss of the power of accommodation with inhibition of a ciliary muscle. We obtain in this way the smallest refraction of the lens and make it possible to determine the presence and size of the particular refractive error in cycloplegia by using cyclopentolate. Cyclopentolate is a synthetic anticholinergic drug and antagonist of the muscarine receptors. If applied in the eye, it blocks the effect of cholinergic stimulation on the sphincter pupillae muscle and ciliary muscle. It provokes severe mydriasis (dilation of the pupil) and cycloplegia (paralysis of the accommodation). Cyclopentolate has been used occasionaly in diagnostic purposes: defining ocular refraction and in ophthalmoscopy. This is the prospective study which included 200 children (400 eyes) aged 3-18 years, carried out in one ambulatory ophthalmological examination. The results were analysed using standard statistical methods. The most often refractive error in the examined group of children is hyperopia with hyperopic astigmatism, then myopia with myopic astigmatism and mixtus astigmatism are the most often in the oldest group of children. The mean value of corneal astigmatism on the right eye was 1.24 D, on the left eye 1.23 D. Anisometropy was found in 40% children. The presence of myopia, myopic and astigmatism mixtus tended to increase, and hyperopia and hyperopic astigmatism tended to decrease toward older groups of children. Refractive error could result in a poor development of visual acuity, causing amblyopia and strabismus, and because of that represents an important public health problem. As one of amblyogenic risk factors in children, it can be prevented with screening program and appropriate treatment, thus providing prevention of amblyopia as one form of blindness.
Impact of inaccuracy of peak flowmeters with Wright scale on asthma severity assessment in children
Authors: Stamatovic Dragana , Bokan-Erdeljan Nada , Gajic Milan , Vujnovic-Zivkovic Zorica
Published: December 2008

Introduction Measurement of daily variability of peak expiratory flow (PEF) is widely accepted as an objective method to assess asthma severity. Recent investigations have proved nonlinearity of original Wright scale of peak flowmeter. All country members of European Union have been obliged to implement a new scale according to standard EN 13826 since 2005. This study examined whether the correction of PEF values for the inaccuracy of the scale would affect asthma management based on their daily variability. Material and methods We analyzed PEF values (2352) in 34 children, aged 5-16, during 3-5 weeks of monitoring in order to establish the diagnosis of asthma by using peak flowmeters with Write scale. The correction of measured values for inaccuracy was managed with original Dr M. Miller's predictive equation. The daily variability of PEF (amplitude percent mean) up to 20% was considered as 'normal', 20-29.9% as 'raised', and 30% and above as 'high'. The assessment of daily variability was performed before and after correction. Results There was no significant change in the number of days with airway liability as regarding the assessed whole study group (p=0.475). However, 22 (64.7%) of children had at least one false clinical message about daily variability during the monitoring. It was overestimated in 12 (7%) days in younger (6.6?0.8 years) or of shorter stature (122.6?3.6cm) and underestimated in 13 (4%) days in older (11.1?2.7) or taller ones (150.9?12.5 cm) (p<0.001). Conclusion Usage of peak flowmeters with Wright scale may lead to an error in asthma severity assessment based on daily variability of PEF. It may cause overtreatment or undertreatment of asthmatic children.
Multi-factoriality of dentine hypersensitivity
Authors: Stojsin Ivana , Petrovic Ljubomir , Stojanac Igor , Drobac Milan
Published: December 2008

Introduction. Dentine hypersensitivity has been defined as a sharp, short pain arising from exposed dentin in response to stimuli typically thermal, evaporative tactile, osmoticor, chemical and which cannot be ascribed to any other form of dental defect or pathology. Prevalence. The most affected patients range in age from 20 to 40. The following teeth tend to be most sensitive: cuspids, premolars and incisors, location-concentrated on the facial surface. Morphological bases of dentine hypersensitivity Sensitive teeth have much greater numbers of open tubules per unit area and the average diameter of tubules is almost 2 times greater than tubules in nonsensitive teeth. Mechanisms of dentine hypersensitivity. The most widely accepted theory of how the pain occurs is Brannstroms theory. Etiology Dentine hypersensitivity represents a condition of presumable multifactorial pathology. Two processes are essential for its development: (1) dentin must be exposed through either genetic disturbance, enamel defect (lamellae, tufts and spindles), loss of enamel (erosion, abrasion, attrition, abfraction), gingival recession with rapid loss of cementum and (2) the dentin tubules must be open to both the oral cavity and the pulp. Diagnosis. Diagnostic protocol for this condition consisted of Medical, Dental Dietary, Oral Hygiene History and Intra-oral examinations with air indexing method. Differential Diagnosis: We must take into consideration a number of variables such as: dental caries, cracked tooth, restorative sensitivity, medication sensitivity, bleaching sensitivity and abscessed or non-vital tooth. Conclusion. Dentin hypersensitivity is a problem that bothes many patients. Many conditions share the symptoms of tooth sensitivity so differential diagnosis is essential for suitable treatment or preventive measures.
Etiology and pathogenesis of precancerous lesions and invasive cervical carcinoma
Authors: Panjkovic Milana , Ivkovic-Kapicl Tatjana
Published: December 2008

Cervical cancer is the second most common gynecological malignancy in the world. Human papilloma virus (HPV) infection is the leading ethiologic agent in the development of premalignant and malignant cervical diseases. HPV is a member of the Papovaviridae family and until now over 100 types have been recognized. There are two types of viral infection: latent and productive. Virus induced oncogenesis is the result of interaction between virus oncoproteins E6 and E7 and tumor supresor host genes p53 and Rb. Many cofactors such as immunosuppression, early sexual relationship, multiple sexual partners, other sexualy transsmited infections and smooking are contributing factors of the precancerous and invasive cervical lesions. According to the oncogenic potential HPV are divided into three groups: low, intermediate and high oncogenic risk viruses. Molecular technics which are used for the virus detection are: In situ hibridisation,, Hybrid capture test and polymerasa chain reaction. Human papilloma virus testing has an important role in the follow up and treatment of women with 'atypical squamous cells of unknown significant' changes in cervical smears and low-grade squamous intraepithelial lesions, changes in punch biopsy.
Left ventricular hypertrophy in patients treated with regular hemodialyses
Authors: Petrovic Dejan , Stojimirovic Biljana
Published: December 2008

Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Left ventricular hypertrophy is found in 75% of the patients treated with hemodialysis. Risk factors for left ventricular hypertrophy in patients on hemodialysis include: blood flow through arterial-venous fistula, anemia, hypertension, increased extracellular fluid volume, oxidative stress, microinflammation, hyperhomocysteinemia, secondary hyperpara- thyroidism, and disturbed calcium and phosphate homeostasis. Left ventricular pressure overload leads to parallel placement of new sarcomeres and development of concentric hypertrophy of left ventricle. Left ventricular hypertrophy advances in two stages. In the stage of adaptation, left ventricular hypertrophy occurs as a response to increased tension stress of the left ventricular wall and its action is protective. When volume and pressure overload the left ventricle chronically and without control, adaptive hypertrophy becomes maladaptive hypertrophy of the left ventricle, where myocytes are lost, systolic function is deranged and heart insufficiency is developed. Left ventricular mass index-LVMi greater than 131 g/m2 in men and greater than 100 g/m2 in women, and relative wall thickness of the left ventricle above 0.45 indicate concentric hypertrophy of the left ventricle. Eccentric hypertrophy of the left ventricle is defined echocardiographically as LVMi above 131 g/m2 in men and greater than 100 g/m2 in women, with RWT ?0.45. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors lead to regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.
Cardiac perioperative complications in noncardiac surgery
Authors: Radovanovic Dragana , Kolak Radmila , Stokic Aleksandar , Radovanovic Zoran , Jovanovic Gordana
Published: December 2008

Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative) cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical procedure, age, presence of concurrent diseases. A total of 100 patients with cardiac diseases undergoing noncardiac surgery were included in the prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery). The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of cardiac events. Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction) occurred in 64% of the patients. One of the 100 patients (1%) had postoperative myocardial infarction which was fatal. Systemic arterial hypertension occurred in 57% of patients intraoperatively and 33% postoperatively, abnormalities of cardiac rhythm in 31% of patients intraoperatively and 17% postoperatively, perioperative myocardial ischemia in 23% of patients intraoperatively and 11% of postoperatively. The most often cardiac complications were systemic arterial hypertension, abnormalities of cardiac rhythm and perioperative myocardial ischemia. Factors independently associated with the incidence of cardiac complications included the type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes.
Serum calcium and phosphorus concentration and alkaline phosphatase activity in healthy children during growth and development
Authors: Savic Ljiljana , Savic Dejan
Published: December 2008

Introduction. Many changes happen during growth and development in an organism as a result of important hormone changes, especially biohumoral ones. These changes make a problem when interpreting biochemical results in pediatric population. The most important changes are intensive calcium and phosphorus metabolic turnover in bone tissue with changes in alkaline phosphatase activity as a result of osteoblast activity. The aim of this study was to follow the serum calcium and phosphorus concentration and alkaline phosphatase activity in children 1-15 years old in different growth and development period and of different sexes and to fortify the influence of growth and development dynamics on biohumoral status in healthy male and female children. Material and methods. We evaluated 117 healthy children of both sexes from 1-15 years of age and divided them into three age groups: 1-5, 6-10 and 11-15 years. We followed the serum calcium and phosphorus concentration and alkaline phosphatase activity in different groups and in different sexes. Results and conclusion. Our investigation found significantly higher values of serum calcium in boys than in girls with no important changes between the age groups and significantly higher values of serum phosphorus in the youngest age group in all children and in different sexes with no important sex differences. Alkaline phosphatase activity followed the growth spurt and was the biggest in 6-10 years group in girls and in 11-15 years group in boys.
Results of kidney function measurement and blood pressure in population from endemic region of Vitina
Authors: Stasevic Zvonimir , Subaric-Gorgieva Gordana , Krcmarevic Jelica , Stolic Radojica , Trajkovic Goran
Published: December 2008

Introduction. The analysis of frequency of kidney diseases, causes of terminal renal failure in patients subjected to repeated dialysis in major dialysis centers in the region of Kosovo and Metohija as well as mortality rate in these patients showed a stable number of patients with kidney diseases, evidencing that the populations of Vitina and Gnjilane were the most commonly affected. These towns are designated as regions with the highest incidence of Balkan endemic nephropathy. The present analysis was aimed at: 1. establishing the incidence rate of hypertension and renal function impairment by using clinical and laboratory analyses in individuals from Vitina and neighboring villages, and 2. investigating the correlation between creatinine clearance, age and arterial blood pressure in the studied group. Material and methods. The analysis included 510 individuals (excluding diabetics) over the one-month period during 2004 (201 males with their age ranging from 18 to 90 years). Blood pressure measurements were performed in all the individuals, while renal function was determined by glomerular filtration rate (GFR), as calculated according to Cockcroft-Gault formula. Results. Creatinine clearance was lower than 100 ml/min in 237 (46.5%) individuals, out of whom 62 (12%) had GFR below 60 ml/min. Among the remaining 273 (53.5%) individuals with GFR above 100 ml/min, 68 individuals had GFR above 140 ml/min. The distribution of patients depending on their systolic blood pressure values revealed that systolic blood pressure was lower in 44 subjects and higher in 302 subjects (59%). The correlation test revealed significant association between the studied parameters. The positive correlation between patients' age and kidney function means the higher the age of subjects the lower creatinine clearance value (r=-0.622, p<0.001). The negative correlation of the systolic blood pressure value and kidney function was found, meaning that higher the systolic blood pressure is accompanied by lower creatinine clearance (r= -0.204, p<0.001). Moreover, patients' age was significantly correlated with the systolic blood pressure level (r=0.511, p<0.001), as well as with the diastolic blood pressure level (r= 0.299, p<0.001). The former means that higher values of both systolic and the diastolic pressures were found in older subjects. No correlation was found between the diastolic blood pressure level and kidney function (the results are not presented). Conclusion. The results obtained in the study confirm significant incidence of renal function impairment measured according to creatinine clearance values in patients from the endemic nephropathy region. Reduced kidney function is found in both elderly individuals and those with high systolic blood pressure. In order to establish the correlation with the incidence and presence of BEN or other kidney diseases additional population screening is necessary.
Viral form of hemophagocytic syndrome with erythrodermal clinical picture: Case report
Authors: Gajinov Zorica , Vuckovic Nada , Djuran Verica , Matic Milan , Ivkov-Simic Milana , Rajic Nebojsa
Published: December 2008

Introduction Hemophagocytic syndrome is patophysiological entity with proliferation and over-activation of macrophages, with hemophagocytosis and production of proinflammatory cytokines. It arises as hereditary forms, or acquired, during viral, autoimmune or malignant diseases, and is usually a disorder with fulminant course and high incidence of lethal outcome. The precise mechanism is not resolved; it is a consequence of cytokine storm generated by over-activated T cells and macrophages, due to defects in T cellular cytototoxic function and inadequate down-regulation of immune response. Case report A male patient, 26 years old, previously healthy, is presented. Generalized exfoliative dermatitis and lymphadenomegalia had lasted for half a year before admission to the hospital. Hemophagocytosis in lymph gland histology was diagnostic, with T cellular immunohistochemical profile CD3+, CD5-, CD8/-, CD43+/-, CD45RO+, bcl-2+, and numerous CD68+ histiocytes. Apart from elevated titer of Adenovirus serology, other laboratory findings and bone marrow histology were within normal limits. Two weeks of oral antibiotic and topical skin corticosteroid therapy were followed by a rapid improvement of clinical features. Residual skin lesions, linear petechia and flares of pale pink erythema used to recur for the next half a year. During the follow up, two years later there was no lymph gland enlargement, skin rash, or other signs. Discussion The diagnosis of virus-associated hemophagocytic syndrome with mild clinical course and seemingly spontaneous improvement was established, although it did not fulfill all proposed diagnostic criteria. It is possible that it increased the clinical awareness for these mild forms in immune-competent patients could account for the improved recognition of atypical cases with favorable outcome.
Gastrointerstinal stromal tumors of gaster: Case reports
Authors: Radovanovic Dragan , Stevanovic Dejan , Pavlovic Ivan , Jasarovic Damir , Mitrovic Nebojsa , Ilic Ivana
Published: December 2008

Introduction Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality. Material and methods In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 years old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST. Discussion In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment. Conclusion The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.
Percutaneous transluminal angioplasty and stenting of carotid arteries: Early results
Authors: Colic Momcilo , Jadranin Dragica , Markovic Dejan , Davidovic Lazar
Published: December 2008

INTRODUCTION Treatment of carotid stenosis could be surgical: eversion endarterectomy, conventional endarterectomy and patch-plasty, resection with graft interposition and bypass procedure or, in the past few years, carotid artery angioplasty (PTA) with stent implantation. OBJECTIVE The aim of this study is to present early results of carotid artery angioplasty and stenting, as well as to identify indications for this procedure. METHOD Twenty-three patients with stenosis of internal carotid artery were included in the prospective study which was performed in the period from July 2006 to July 2007. For PTA and stenting of the carotid artery we used Balloon dilatation catheter Ultra-softTM SV and Carotid WallstentTM MonorailTM. During the procedure, brain protection by embolic protection system Filter Wire EZ was essentially performed. Descriptive statistical methods were performed to present and describe the patient characteristics, risk factors and results. RESULTS 23 patients were examined. In four (17.39%) cases there was asymptomatic, while in 19 (82.61%) there was symptomatic homodynamic significant stenosis of the internal carotid artery. Four of these 19 patients (17.39%) had late restenosis following carotid endarterectomy, four (17.39%) important respiratory failure, and 11 (47.83%) important heart disease. Patients were followed up for the first 30 postopertive days. In that period, there were no mortality and no needs for surgical conversions. In one case (4.35%), residual stenosis of 30% remained. Two patients (8.70%) had TIA and one (4.35%) had CVI. CONCLUSION Main indications for PTA and stenting of carotid arteries are: surgically inaccessible lesions (at or above C2; or subclavial); radiation-induced carotid stenosis; prior ispilateral radical neck dissection; prior carotid endarterectomy (restenosis), severe cardiac and pulmonary conditions. Limitations and contraindications to carotid angioplasty and stentning include: significant peripheral occlusive diseases; unfavorable aortic arch anatomy; severe tortuosity of the common and internal carotid artery; severely calcified stenosis, lesions containing fresh thrombus; stenosis longer than 2 cm; critical (>99%) stenosis; associated carotid artery aneurysm; contrast-related issues and severe aortic valve stenosis.
Treatment of traumatic rupture of the thoracic aorta
Authors: Davidovic Lazar , Markovic Miroslav , Colic Momcilo , Ilic Nikola , Koncar Igor , Cvetkovic Slobodan , Sindjelic Radomir , Markovic Dejan
Published: December 2008

INTRODUCTION Interest for traumatic thoracic aorta rupture stems from the fact that its number continually increases, and it can be rapidly lethal. OBJECTIVE The aim of this study is to present early and long term results as well as experiences of our team in surgical treatment of traumatic thoracic aorta rupture. METHOD Our retrospective study includes 12 patients with traumatic thoracic aorta rupture treated between 1985 and 2007. There were 10 male and two female patients of average age 30.75 years (18-74). RESULTS In six cases, primary diagnosis was established during the first seven days days after trauma, while in 6 more than one month later. In 11 cases, classical open surgical procedure was performed, while endovascular treatment was used in one patient. Three (25%) patients died, while two (16.6%) had paraplegia. Nine patients (75%) were treated without complications, and are in good condition after a mean follow-up period of 9.7 years (from one month to 22 years). CONCLUSION Surgical treatment requires spinal cord protection to prevent paraplegia, using cardiopulmonary by-pass (three of our cases) or external heparin-bonded shunts (five of our cases). Cardiopulmonary by-pass is followed with lower incidence of paraplegia, however it is not such a good solution for patients with polytrauma because of hemorrhage. The endovascular repair is a safe and feasible procedure in the acute phase, especially because of traumatic shock and polytrauma which contributes to higher mortality rate after open surgery. On the other hand, in chronic postrauamatic aortic rupture, open surgical treatment is connected with a lower mortality rate and good long-term results. There have been no published data about long-term results of endovascular treatment in the chronic phase.
Clinical characteristics and survival of children with Langerhans cell hystiocytosis
Authors: Krstovski Nada , Janic Dragana , Dokmanovic Lidija , Brdar Radivoj
Published: December 2008

INTRODUCTION Langerhans cell histiocytosis is a rare disease in children, initial presentation is variable, clinical course, prognosis and survival are mostly unpredictable. OBJECTIVE To summarise clinical characteristics and treatment results in children with Langerhans cell histiocytosis. METHOD Retrospectively there were analyzed patients with LCH diagnosed and treated at Hematology Department of University Children's Hospital in Belgrade from 1990 to 2006. Clinical presentation, therapy and survival according to Kaplan-Meier's statistical test was analysed. RESULTS 30 patients were treated, aged from 4 months to 14 years, mean 3.9 years, median 2.3 years, 18 (60%) males, 12 (40%) females. A single system disease was diagnosed in 16 (53%) patients, of whom 6 patients with multifocal bone disease. All patients were in complete remission averagely following162 and 82 months respectively. Multisystem disease was found in 14 (47%) patients. The lymph nodes and skin were more frequently involved organs than the central nervous system (diabetes insipidus), lung, liver and spleen. The number of involved organs ranged from 2 to 8, mean 4.2. Four patients died due to disease progression 3, 16, 36 and 66 months after diagnosis. Nine patents with multisystem disease were in remission with 117 months of follow-up. One patient was lost on follow-up. CONCLUSION The clinical course of patients with a single system disease is usually benign while a multisystem disease has to be aggressively treated with precise initial evaluation and staging before therapy.
Degree of genetic homozygosity among patients with spinal dysraphia
Authors: Cvjeticanin Suzana , Nikolic Dejan , Petronic Ivana , Jekic Biljana , Damnjanovic Tatjana , Cirovic Dragana , Radlovic Vladimir , Knezevic Tatjana
Published: December 2008

INTRODUCTION Our study of genetic homozygosity degree includes an analysis of the presence, distribution and individual combination of 15 selected genetically controlled morphophysiological traits in the sample of patients with spinal dysraphia (N=35) and in the control-healthy group (N=50). OBJECTIVE Assuming that spinal dysraphia is a genetically controlled disease, we made a hypothesis that an increased homozygosity level, as well as the changed variability among patients, could be a population-genetic parameter for the prediction of the illness. METHOD Taking into consideration our experience, as well as the experience of numerous scientists who studied the nature of the inheritance of monoand oligo-genically controlled qualitative traits, we applied a methodology to estimate the proportion of such homozygously recessive characters (HRC-test,). RESULTS This population-genetic study did not only show a statistically significant difference of the mean values of genetic homozygosity (SD 4.8?0.3; control 3.5?0.3), but of the differences in the type of distribution too, as well as the differences in the presence of certain individual combinations of such traits. CONCLUSION Due to the fact that those genes which control such qualitative recessive traits are distributed in different human chromosomes, being their visible markers, this could indicate that degrees of genetic homozygosity are ostensibly greater in a sample of patients with spinal dysraphia compared to the control group of individuals.
Seasonal alterations in serum iron levels in elite football players
Authors: Malicevic Sead , Nesic Dejan , Rosic Ilija
Published: December 2008

INTRODUCTION It is very important to monitor levels of serum iron and other factors of iron metabolism and oxygen transport system as they play a very important role in functional ability of football players. A decrease in serum iron level can be the very first sign of development of iron deficiency anemia, which seriously influences health and functional ability of an athlete and is a common problem in competitive sports. OBJECTIVE The aim of this study was to observe and evaluate changes in serum iron values during the competition season in relation to the training process. METHOD During four years, serum iron level was measured in 28-34 players of one of the top football clubs in Serbia, four times a year: at the beginning and at peak-point of both half seasons. Differences between basic and control findings, relative and absolute changes in serum iron levels and statistical significance of the findings were than calculated. RESULTS There was a significant decrease in mean serum iron levels on each control test, compared to basic values. Mean value of control serum iron levels is significantly lower than mean of preseason values (20.64? 6.58 vs. 16.38?5.51 ?mol/l). CONCLUSION A significant decrease in serum iron level among footballers during both half-seasons is most probably due to an increased loss and/or diminished absorption resulting from a high intensity training process. Because the decline in serum iron may be an early sign of iron store depletion and iron deficiency anemia, it is very important to evaluate it regularly, along with other factors of iron metabolism and oxygen transport system.
Surgery of infrarenal inflammatory aneurysm of abdominal aorta infected with methicillin resistant Staphylococcus aureus in a patient undergoing haemodialysis
Authors: Babic Srdjan , Popov Petar , Milicic Miroslav , Ilijevski Nenad , Nenezic Dragoslav , Tanaskovic Slobodan , Gajin Predrag , Jovanovic Predrag , Vucurevic Goran , Milin Aleksandar , Radak Djordje
Published: December 2008

INTRODUCTION Inflammatory abdominal aortic aneurysm accounts for 5% to 10% of all cases of abdominal aortic aneurysm and differs from typical atherosclerotic abdominal aortic aneurysm in many important ways. Although both inflammatory and atherosclerotic abdominal aortic aneurysms most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic abdominal aortic aneurysm, most with the inflammatory variant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm can be primarily infected by degenaration of an infected artery (in less than 1% of cases), or can become secondary infected in the already existing aneurysm. Secondary infection of the pre-existing aneurysm has big influence on treatment choice, but is also rare. Clinically non-symptomatic infection, also known as bacterial collonisation, can be very frequent, regarding a greatly increased number of positive intraoperative findings (10-15%). Prolonged intravascular catheterization, vascular grafting, repeated punctures with large bore needles, and decreased immune defense mechanism make uraemic patients undergoing hemodialysis more likely to develop Staphylococcus aureus bacteraemia and its complications. CASE OUTLINE The case shows a gigantic inflammatory aneurysm of the abdominal aorta, localized infrarenally, which was solved successfully by resection of the aneurysm of the abdominal aorta, and interposition of Dacron tubular graft 22 mm. Bacterial examination of the aneurysmal sac was positive: methicillin-resistent Staphylococcus aureus was detected. CONCLUSION There were no postoperative complications, and the final outcome was fully satisfactory. Control CT scans after 3, 6 and 12 months were regular, with signs of regression fibrosis of the retroperitoneum.
Malignant hyperthermia in children
Authors: Igrutinovic Zoran , Vuletic Biljana , Vujic Ana , Markovic Slavica , Kostic Gordana
Published: December 2008

INTRODUCTION Malignant hyperthermia is a rare disease which is mainly an inherited autosomal dominant trait. It is characteristic for muscle rigidity, metabolism or respiratory acidosis, high values of serum creatine kinase. Then appears myoglobinuria which can lead to tubular necrosis and acute renal failure. CASE OUTLINE The male child, ten years old, hospitalized because of the high temperature, exhaustion and cough. On the second day of hospitalization, he has hyperthermia (39.8?C), dyspnoea, tachypnoea, was somnolent, occasionally raving, exhausted with the pains in the muscles which were rigid and painfully sensitive. During the night, the urine was dark red, but the diuresis was well. The next day, laboratory analyses showed high values of aspartate aminotransferase (4263 IU/l), alanine aminotransferase (1311 IU/l), lactate dehydrogenase (11787 IU/l), while the values of serum creatine kinase were so high that they could not be registered. The urine analysis showed the negative result on gall colours and haematuria and positive on myoglobin. During the following days, the patient had normal skin temperature, the pains in the muscles were gradually weakened and the urine cleared up. On the third day, the value of creatine kinase was measured and it was 178700 IU/l. During the next two weeks, the clinical finding was gradually normalized while the laboratory values of serum enzyme were gradually normalized only in twenty days. CONCLUSION Malignant hyperthermia is a serious clinical syndrome which can be found with, until then, a clinically healthy child (without chronic myopathy) and it appears with the high temperature or during the surgical interventions with anesthetics, which is especially dangerous.
Recent treatment of postischaemic anoxic brain damage after cardiac arrest by using therapeutic hypothermia
Authors: Andjelic Sladjana
Published: December 2008

Organ injury caused by ischemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35?C) is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC). Two randomized clinical trials show improved survival and neurological outcome in adults who remained comatose after initial resuscitation from prehospital VF cardiac arrest, and who were cooled after ROSC. Different strategies can be used to induce hypothermia. Optimal timing of therapeutic hypothermia for cardiac ischemia is unknown. In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v.) fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia, will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal 'therapeutic window' for gene therapy.
Hypochondriasis between health and psychosis
Authors: Starcevic Vladan
Published: December 2008

Considering the lack of clarity in the conceptualisation of hypochondriasis, it is not surprising that the concept is quite heterogeneous and that there are dilemmas in terms of what is encompassed by hypochondriasis and where its boundaries are. Therefore, the aim of this review paper was to contribute towards a more coherent view on hypochondriasis, which would also allow its more adequate classification. The essential features of hypochondriasis were identified as an overvalued idea about the presence of disease, fear that the person has already become seriously ill, reassurance-seeking and other forms of health checking, and disturbances in the perception of bodily sensations and symptoms. These four aspects of hypochondriasis can be assessed dimensionally to ascertain to what extent they characterise each patient. Suggestions have been made to delineate more precisely hypochondriasis from health anxiety, anxiety disorders, obsessive-compulsive disorder, other somatoform disorders, personality disorders, depression, and delusional disorder with disease-related delusions. In the absence of better alternatives, hypochondriasis should continue to be classified among the somatoform disorders. In order to improve communication between clinicians and reduce conceptual heterogeneity, the term 'hypochondriasis' should be used to refer only to primary hypochondriasis. The pressure to abandon this term should be resisted until an adequate substitution for it has been found.
Approaching the social control of drugs, II: Deconstruction of the problem: Use of drugs in scientific discourse
Authors: Radulovic Dragan
Published: December 2008

Deconstruction of the problem of drug use through public discourse has been analyzed in the paper by means of logical-epistemological framework of sociological approach, which refers to studying this phenomenon in its totality. Elements of deconstruction of the problem as a general theoretical-methodological approach are, as follows: conceptual definitions and distinctions, analytical decomposition of the phenomenon and detailed consideration of its relevant dimensions, such as ethno-cultural background, social-historical embeddedness, economic and political framework, legislative and normative system, health, importance of social protection and upbringing and education. Deconstruction of the problem, as general framework of the approach, enables overall consideration of the specificity of the discourse and, by that, characteristics of ideological directions, as well as particular interests embodied in them.
Application of dyadic adjustment scale in the systemic family therapy for alcoholism
Authors: Dragisic-Labas Sladjana
Published: December 2008

Conceptions about marriage with alcoholic relations (based on empirical and clinical research by domestic and foreign authors) are presented in the introductory part of the paper, followed by evaluations of marital (family) therapies and conclusions about its importance in treating alcoholism. The study has included 200 marital couples (husband-alcoholic) on therapy in three psychiatric institutions from Belgrade. Dyadic Adjustment Scale test has been applied, measuring (in three time points - on the beginning, in six months, and after one year of therapy) marital couple cohesion, satisfaction (with marital relations), emotional expression and consensus. The results show the existence of firm alcoholic marital system at the beginning of the treatment, with low consensus and high satisfaction, which has been deconstructing and changing over time and forming more functional (healthier) marital relationship. Couples (17) that self-excluded from the therapy in first two months have been compared with the sample of couples, which successfully completed the treatment. Differences (lower score on DAS) have been noted from the beginning - weaker marital dyad, in comparison to couples that completed the treatment. The results showed that system family (marital) therapy had influenced significant changes in marital relations - higher consensus, stronger emotional expression and cohesion, as well as satisfaction with non-alcoholic marital relations during one-year treatment.