bluuebunny/crossref_metadata_2025 huggingface dataset:
Urothelial cancers of the bladder in young people
Authors: Zivkovic Sladjana , Velickovic Ljubinka , Tasic-Dimov Desanka , Kostov Milos , Stojanovic Nebojsa
Published: December 2010

Tumors of the bladder, particularly urothelial carcinoma (UC) are very rare malignant diseases in young people. They mostly occur in elder persons of male gender. We present 8 patients below 35 years of age, (average age 24.7) in whom the presence of UC was verified. The main symptom was total or terminal hematuria. The results showed that 5 patients had low-risc group of tumors (G1, pTa), while 3 tumors were of medium-risk group (G2, pT1). We concluded that UC in young people was low-grade and non-invasive. However for better evaluation it was neccessary to observe patients for longer period of time.
Participation of some campylobacter species in the etiology of enterocolitis
Authors: Otasevic Marica , Lazarevic-Jovanovic Branislava , Tasic-Dimov Desanka , Djordjevic Nebojsa , Miljkovic-Selimovic Biljana
Published: December 2010

Background. In recent decades, medical community has increasingly been calling attention to the importance of Campylobacter as an disease-causing agent in humans. Nowdays, Campylobacter jejuni (C. jejuni) is known as the most frequent bacterial cause of diarrhea worldwide. Epidemiological differences of the infections caused by Campylobacter, present in the developed and the developing countries, are attributed to the differences of the types of virulence. Due to the specificity, and the demanding features of Campylobacter, as well as poorly equipped microbiological laboratories, campylobacteriosis is insufficiently studied in our country. This investigation aimed to determine the participation of some Campylobacter species in the etiology of diarrheal diseases in our population. Methods. The four-years continuous monitoring of Campylobacter presence was performed in the faeces of 12 605 patients with enterocolitis. The control group included 5 774 examinees of healthy children and youth. Faeces samples were cultivated on Skirrow's selective medium, and further incubated according to effective methodology for Campylobacter. Identification of strains was based on morphological, cultural and physiologic features of strains (oxidase test, catalase test, susceptibility to nalidixic acid, and hypurate hydrolysis). As a statistical method, for data processing, c2 test and Fisher?s exact test were used. Results. Campylobacter was proven in 3.86% of enterocolitis patients, and in 0.71% of healthy population. Out of 518 Campylobacter isolates, 86.48% belonged to enterocolitis outpatients, and 13,51% to inpatients. Predominant symptoms of the disease were diarrhea (81.83%), increased temperature (34.71%), vomiting (19.77%), and stomach pain (15.17%). The diseased were predominantly infants in the first year of life. Out of 300 Campylobacter isolates, 75% were identified as Campylobacer jejuni, 23% as Campylobacter coli (C. coli), and 2% as Campylobacter lari (C. lari). Conclusion. Species of Campylobacter genus participate in the etiology of enterocolitis at 3.86%. According to numerous parameters the infection in our population coincides with the infection in the population of European countries. Frequent findings of C. coli in our region are in discrepancy with the results of numerous studies conducted in the developed countries.
Fasciocutaneous flaps in the management of soft-tissue defects of the lower leg caused by explosive weapons
Authors: Petkovic Aleksandar , Trenkic Srbobran , Stevanovic Goran , Rancic Zoran , Golubovic Zoran , Dinic Miodrag , Krasic Dragan
Published: December 2010

The use of fasciocutaneous flaps for the reconstruction of lower leg soft-tissue defects inflicted during the bombing of our country is presented in this case report. The experience with 9 patients with soft-tissue defects of the lower leg is presented with the aim of examining the possibilities of war-wound reconstruction. The results of the earlier use of fasciocutaneous flaps in the lower leg reconstruction as well as the those obtained during the reconstruction of the lower leg soft-tissue defects in war wounds was proven to be safe and reliable method of the reconstructions of severe lower leg injuries, particularly of its distal segment and the malleolus region.
N-Methyl-3,4-methylenedioxyamphetamine-induced hepatotoxicity in rats: Oxidative stress after acute and chronic administration
Authors: Ninkovic Milica , Malicevic Zivorad , Selakovic Vesna , Simic Ivan , Vasiljevic Ivana
Published: December 2010

Background. The underlying mechanisms of N-Methyl-3,4-methylenedioxyamphetamine-MDMA-induced hepatotoxicity are still unknown. The aim of this study was to evaluate hepatic oxido-reductive status in the rats liver after the single and repeated administration of MDMA. Methods. MDMA was dissolved in distilled water and administered in the doses of 5 mg, 10 mg, 20 mg, and 40 mg/kg. The animals from the acute experiment were treated per os with the single dose of the appropriate solution, through the orogastric tube. The animals from the chronic experiment were treated per os, with the doses of 5, 10, or 20 mg/kg of MDMA every day during 14 days. The control groups were treated with water only. Eight hours after the last dose, the animals were sacrificed, dissected their livers were rapidly removed, frozen and stored at -70?C until the moment of analysis. The parameters of oxidative stress in the crude mitochondrial fractions of the livers were analyzed. Results. Superoxide dismutase (SOD) activity increased in the livers of the animals that were treated with single doses of MDMA. Chronically treated animals showed the increased SOD activity only after the highest dose (20 mg/kg). The content of reduced glutathione decreased in both groups, but the depletion was much more expressed after the single administration. Lipid peroxidation index increased in dose-dependent manner in both groups, being much higher after the single administration. Conclusion. The increased index of lipid peroxidation and the decreased reduced glutathione levels suggested that MDMA application induced the state of oxidative stress in the liver. These changes were much more expressed after the single administration of MDMA.
Epidural hematomas of posterior fossa
Authors: Radulovic Danilo , Tasic Goran , Jokovic Milos
Published: December 2010

Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT) and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.
Clinical significance of intramammary arterial calcifications in diabetic women
Authors: Milosevic Zorica , Bjekic Jelica , Radulovic Stanko , Goldner Branislav
Published: December 2010

Background. It is well known that intramammary arterial calcifications diagnosed by mammography as a part of generalized diabetic macroangiopathy may be an indirect sign of diabetes mellitus. Hence, the aim of this study was to determine the incidence of intramammary arterial calcifications, the patient?s age when the calcifications occur, as well as to observe the influence of diabetic polineuropathy, type, and the duration of diabetes on the onset of calcifications, in comparison with nondiabetic women. Methods. Mammographic findings of 113 diabetic female patients (21 with type 1 diabetes and 92 with type 2), as well as of 208 nondiabetic women (the control group) were analyzed in the prospective study. The data about the type of diabetes, its duration, and polineuropathy were obtained using the questionnaire. Statistical differences were determined by Mann-Whitney test. Results. Intramammary arterial calcifications were identified in 33.3% of the women with type 1 diabetes, in 40.2% with type 2, and in 8.2% of the women from the control group, respectively. The differences comparing the women with type 1, as well as type 2 diabetes and the controls were statistically significant (p=0.0001). Women with intramammary arterial calcifications and type 1 diabetes were younger comparing to the control group (median age 52 years, comparing to 67 years of age, p=0.001), while there was no statistically significant difference in age between the women with calcifications and type 2 diabetes (61 years of age) in relation to the control group (p=0.176). The incidence of polineuropathy in diabetic women was higher in the group with intramammary arterial calcifications (52.3%) in comparison to the group without calcifications (26.1%), (p=0.005). The association between intramammary arterial calcifications and the duration of diabetes was not found. Conclusion. The obtained results supported the theory that intramammary arterial calcifications, detected by mammography could serve as markers of co-existing diabetes mellitus and therefore should be specified in radiologic report in case of their early development.
Ocular rosacea
Authors: Djakovic Zorana , Vukicevic-Sretenovic Jelica , Dobrosavljevic Danijela , Milenkovic Svetislav
Published: December 2010

Five cases of ocular rosacea (one male and four females) are reported in this paper. Two of the patients were with keratoconjunctivitis sicca, one with conjunctivitis chronica and blepharitis, one with conjunctivitis chronica and meibomitis, and one with reccurent corneal erosions with meibomitis and chordeloum. In four patients ocular symptoms preceded the occurence of skin lesions. The treatment with oral tetracyclines significantly improved the state of ocular rosacea in four patients, while in one case the changes of the anterior eye segment progressed in more severe state of ulcerative keratitis. It is considered that in almost 20% of the patients with rosacea ocular lesions may precede the skin changes, representing a diagnostic problem. Thus, in those cases multidisciplinary approach is suggested. Such approach is particularly important because of the decrease of morbidity and the prevention of the onset of the eye complications such as drastic worsening of visual acuity, i.e., the blindness.
Clinical and echocardiographic characteristics of patients with diabetic cardiomyopathy
Authors: Perisic Zoran , Burazor Mirko , Radjen Goran , Todorovic Lazar , Burazor Zorka , Dimic Dragan
Published: December 2010

The aim of this study was to evaluate clinical and echocardiographic characteristics of patients with diabetic cardiomyopathy. The study included 72 patients, divided into two groups. The experimental group consisted of 32 diabetics, while 40 gender and age-matched healthy subjects were in the control group. In the experimental group there were 17 patients with insulin-dependent diabetes mellitus, and 15 patients with non-insulin-dependent diabetes mellitus. The average duration of diabetes mellitus was 9.53 years. All the patients underwent the following diagnostic procedures: standard laboratory tests, 12-lead ECG, chest X-ray, 24-h Holter ECG, and complete echocardiographic examination. More frequent appearance of ventricular rhythm disturbances (65,6% vs. 47,5%), increased heart rate (78.3 ? 8.2 vs. 72.1 ? 4.6 beats per minute), and alteration of diastolic (56.25% vs. 12.5%) and systolic function (43.8% vs. 0%) was registered in patients with diabetes, compared to the control group. Experimental group was divided, according to their left ventricular dimensions, into two subgroups: the subgroup with normal left ventricular dimensions, and the subgroup with the increased left ventricular dimensions. Patients with the increased left ventricular dimensions not only had significantly lower ejection fraction (37.4 ? 7.0 vs. 61.3 ? 4.2%), but also had significantly longer duration of diabetes (12.6 ? 5.8 vs. 8.01 ? 3.01 years), worse quality of glycoregulation (13.1 ? 2.5 vs. 10.4 ? 2.1%), and higher Shapiro?s microvascular complications index (2.7 ? 1.26 vs. 0.68 ? 0.56). High degree of correlation was also found between the duration of diabetes left ventricular ejection fraction (-0.86), and left ventricular mass (0.86). The similar level of correlation was shown with Shapiro?s index (-0.77 and 0.88), as well as with morning glycaemia (-0.57 and 0.41). According to the obtained results it could be concluded that the changing rate of diabetic cardiomyopathy was in direct correlation with the quality of diabetes control, the duration of diabetes, and the presence of complications in other organs.
Assessment of diet therapy effect on blood pressure of obese persons with and without antihypertensive therapy
Authors: Vasiljevic Nadja , Paunovic Katarina , Backovic Dusan , Jorga Jagoda , Ristic Gordana , Plecas Draga , Stojanovic Svetlana
Published: December 2010

Background. Arterial hypertension is a multicausal chronic disease often accompanied by obesity. The aim of this investigation was to examine the effect of diet therapy in the treatment of obese hypertensives with and without antihypertensive therapy. Methods. The investigation was conducted at the Department of Nutrition on a sample of 110 obese hypertensive patients on diet therapy. Subjects were divided into two groups: the group on diet therapy with antihypertensive drugs E1 (n=78), and the group on diet therapy without pharmacotherapy E2 (n=32). Nourishment state i.e., obesity level was assessed by body mass index (BMI). All the patients belonged to the obese group - BMI > 30 kg/m2. Besides blood pressure values, the following parameters were monitored: serum cholesterol, trygliceride levels and BMI. Results. The obtained results in the group with diet therapy combined with antihypertensive therapy showed highly significant decrease of anthropometrical parameters: body weight (99.14 kg vs. 90.16 kg) (p<0.001) and BMI (37.32 vs. 34.09) (p<0.001); percent body fat (41.97 vs. 38.78) (p<0.001); systolic (154.81 vs. 141.91) (p<0,001), and diastolic pressures (95.42 vs. 87.36) (p<0,001); cholesterol (6.39 vs. 5.99) (p<0,002), and triglycerides concentration (2.69 vs. 2.21) (p<0.019). In the group on single diet therapy, highly significant decrease of body mass (99.33 vs. 90.18) (p<0.001), BMI (34,79 vs. 31.58) (p<0.001), percent body fat (39.27 vs. 36.70) (p<0.001), systolic (148.44 vs. 132.74) (p<0.001), and diastolic pressures (93.97 vs. 82.90) (p<0.001), was achieved, while the differences between initial and final cholesterol and triglyceride concentrations although observed, were not statistically significant. Conclusion. The obtained results implicated that diet therapy significantly helped the normoregulation of both systolic and diastolic blood pressure. Considering this, during physicians? routine practice in the treatment of hypertension attention should be paid on the reduction of the corresponding level of obesity.
Antiepileptic, behavioral, and antidepressant effects of adjuvant lamotrigine therapy in drug-resistant epilepsy
Authors: Martinovic Zarko , Buder Nevenka , Milovanovic Maja , Velickovic Ruzica
Published: December 2010

Aim. To evaluate the behavioral effects of lamotrigine as add-on therapy in treatment-resistant epilepsy. Methods. An open, prospective, long-term study of lamotrigine as adjuvant therapy was performed in 56 patients with drug-resistant epilepsy (female/male ratio 35/21, age range 16-51 years). All the patients kept seizure diaries, and electroencephalograms were recorded at baseline and during 24 months of the treatment. Quality of life questionnaire, Hamilton depression scale (HMD), Beck depression scale (BDI), and Hamilton anxiety scale (HMA) were used before and during lamotrigine therapy. Comparative assessments were made in an age- and sex-matched control group treated with other antiepileptic drugs. Results. Overall, seizure control was improved in 55.3% of the patients, remained unchanged in 39.3%, and deteriorated in 5.4%. Improvement in some quality of life measures occurred in 50% of the patients. The HMD subscales and BDI scale showed significant improvement in lamotrigine treated patients compared to the control group (ANOVA, p < 0.01). Negative behavioral effects occurred in 10.7% of the patients. Conclusion. Lamotrigine demonstrated significant antiepileptic long-term efficacy, and its positive effects on the mood and quality of life, which surpassed the negative behavioral effects, and contributed highly to the favorable treatment outcome.
Endothelial trauma in the surgery of cataract
Authors: Djurovic Branislav
Published: December 2010

Cataract surgery is most common in human surgery and comprises 80% of eye surgery programs. Owing to sophisticated technologies, it has become a routine surgery with lowered complications rate; hence, the functional outcome is more conditioned by operative trauma. The aim of this study was to demonstrate the significance of specular microscopy in the evaluation of operative trauma during extra-capsular cataract extraction (ECCE) and phacoemulsification (P), in a controlled environment. The study included 100 consecutive patients who met the established criteria, and groups were formed according to the type of surgery by the assignment of successive numbers from a random number table. Examination and photographs of the corneal endothelium, as well as pachymetry were performed on Keeler-Konan Poclington Specular Microscope (KSP). The obtained results revealed significant dissimilarity in endothelial cell reduction (9.17% in group E, and 4.72% in group P), which generated statistically significant correlation of pre-operative and post-operative pachymetry in the group E (p=0.0004). On the basis of the results obtained by specular microscopy, it was concluded that under the same conditions phacoemulsification caused reduced operative trauma of the corneal endothelium.
Evaluation of local and regional spread of malignant tumors of the tongue and floor of the mouth
Authors: Dimitrijevic Milovan , Djukic Vojko , Trivic Aleksandar
Published: December 2010

Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surrounding regional lymph nodes. The aim of this study was to evaluate the correlation between clinically confirmed local and regional spread and intraoperatively and histopathologically verified local spread. A series of 74 patients with carcinoma of the tongue and floor of the mouth were analyzed. All the patients were surgically treated during the period 1991-1995. Clinical evidence of local spread (cT) was in high accord with intraoperatively and histopathologically evidenced spread (pT) amounting to 83.8%. The degree of correlation decreased with the increase of T stage. Clinically observed regional spread (cN) and intraoperatively and histopathologically confirmed regional spread (pN) was lower, amounting to 56.8% in comparison to the corresponding T categories.
Neuroendocrine differentiation in prostate cancer
Authors: Cerovic Snezana , Brajuskovic Goran , Maletic-Vukotic Vinka , Micic Sava
Published: December 2010

Background. In numerous recent studies attention has been focused to neuroendocrine differentiation (NED) in prostate cancer (PC). Focal NED is present in almost all PCs, but it is prominent in only 5-10% of the carcinomas. The prognostic significance of focal NED in PC is controversial, but current evidence suggests its influence on the onset and/or conversion of hormon resistant tumor phenotype. The aim of this study was to evaluate the relationship between NED status, based only on immunohistochemical use of neuroendocrine (NE) markers, with PC grade and stage, and preoperative serum levels of prostate-specific antigen (PSA). Methods. The study included the biopsy material of 73 untreated PC patients (pts.) obtained by transurethral resection (TUR) (37 pts.), and radical retropubic prostatectomy (RRP) (36 pts.). Two representative tissue samples (tipically the block containing the largest amount of neoplasm) were selected for immunohistochemical (IMM) staining. NE cells were identified using a panel of IMM markers: chromogranin A, neuron-specific enolase, and serotonin. The level of PC exocrine differentiation was detected by monoclonal antibodies against PSA. Results. Significant expression of NE cells was demonstrated in 26 (70.2%) pts. with PC after TUR. In this group, serum preoperative PSA values ranged from 0.1 to 9.6 ng/ml. The majority of pts. with NED had low differentiated PC with Gleason grade score (GGS) >7, and normal PSA values below 4 ng/ml (77%), in clinical stage D (54%). Statistically significant correlation (p<0.01) of positive NED with higher stage and grade and low PSA values was established. Among the pts. with localized PC in whom RRP was performed (n=36), significant expression of NE cells was found in 15 pts. (41.7%), 8 (53.3%) in pT2 stage, and 7 (46.7%) in pT3 stage. Significant correlation between NED with preoperative PSA values and stage of PC in pts. with RRP was not found. Conclusion. We demonstrated the significant NED in poorly differentiated PC in patients in the advanced stage of the disease. The expression of NED in organ-confined PC did not correlate with tumor stage, but it correlated with tumor grade (GGS?7).
Autologous bone marrow-derived progenitor cell transplantation for myocardial regeneration after acute infarction
Authors: Obradovic Slobodan , Rusovic Sinisa , Balint Bela , Ristic-Andjelkov Andjelka , Romanovic Radoslav , Baskot Branislav , Vojvodic Danilo , Gligic Branko
Published: December 2010

Background. Experimental and first clinical studies suggest that the transplantation of bone marrow derived, or circulating blood progenitor cells, may beneficially affect postinfarction remodelling processes after acute myocardial infarction. Aim. This pilot trial reports investigation of safety and feasibility of autologous bone marrow-derived progenitor cell therapy for faster regeneration of the myocardium after infarction. Methods and results. Four male patients (age range 47-68 years) with the first extensive anterior, ST elevation, acute myocardial infarction (AMI), were treated by primary angioplasty. Bone marrow mononuclear cells were administered by intracoronary infusion 3-5 days after the infarction. Bone marrow was harvested by multiple aspirations from posterior cristae iliacae under general anesthesia, and under aseptic conditions. After that, cells were filtered through stainless steel mesh, centrifuged and resuspended in serum-free culture medium, and 3 hours later infused through the catheter into the infarct-related artery in 8 equal boluses of 20 ml. Myocardial viability in the infarcted area was confirmed by dobutamin stress echocardiography testing and single-photon emission computed tomography (SPECT) 10-14 days after infarction. One patient had early stent thrombosis immediately before cell transplantation, and was treated successfully with second angioplasty. Single average ECG revealed one positive finding at discharge, and 24-hour Holter ECG showed only isolated ventricular ectopic beats during the follow-up period. Early findings in two patients showed significant improvement of left ventricular systolic function 3 months after the infarction. There were no major cardiac events after the transplantation during further follow-up period (30-120 days after infarction). Control SPECT for the detection of ischemia showed significant improvement in myocardial perfusion in two patients 4 months after the infarction. Echocardiographic assessment in these two patients also showed significant improvement of systolic function three months after the infarction. Conclusion. Preliminary results of the study showed that the transplantation of bone marrow-derived progenitor cells into the infarcted area was safe, and feasible, and might improve myocardial function. Further follow-up will show if this treatment is effective in preventing negative remodeling of the left ventricle and reveal potential late adverse events (arrhythmogenicity and propensity for restenosis).
Psoriasis in a patient with dermatomyositis
Authors: Pavlovic Milos , Zecevic Rados , Zolotarevski Lidija
Published: December 2010

Psoriasis has been consistently associated with arthritis and inflammatory bowel diseases, though there have been reports on patients with psoriasis and other autoimmune dermatoses. Sometimes, sharply demarcated scaly plaques located over extensor surfaces in patients with dermatomyositis may clinically resemble psoriatic lesions. Histologic findings of interface dermatitis, typical for dermatomyositis, help clinicians to rule out psoriasis. A patient is presented with dermatomyositis in which psoriatic lesions developed over the extremities and lower trunk. Histological examination confirmed the diagnosis of psoriasis. Both diseases have run independent courses. It is prudent to include psoriasis in the differential diagnosis of scaly eruptions occurring in dermatomyositis patients.
Soldier’s social adaptation during the military service
Authors: Dedic Gordana
Published: December 2010

Soldier?s social adaptation includes his interpersonal relationships with his environment integration into the military community and the ability to fulfill his role in the military environment and to function adequately outside of it. The aim of this study was to establish the dynamics of soldier?s social adaptation during the military service. The study involved soldiers of two platoons of the Armed Forces of Serbia and Montenegro, divided into three groups according to the period of the study: after the first month, after the basic training and at the end of the military service. The instruments applied for the study were sociodemografic questionnaire and Social Adaptation Self-evaluation Scale. Statistical analysis of the obtained data was done using Stident?s t-test. The results of the study that soldier's contentment with his professional role and with the quality of his interpersonal relations was highest during the basic training, but the quality of leisure activities was lowest at the end of the military service.
Significance of transvaginal Doppler ultrasonography for detection of malignant gestational trophoblastic disease
Authors: Nikolic Branka , Rakic Snezana , Pavlovic Dejan , Popovac Svetlana , Lukic Relja
Published: December 2010

Transvaginal Doppler ultrasonography has an important role in detecting and confirming the gestational trophoblastic disease (GTD). It can also be helpful in early detection of the malignant cases of GTD such as the invasion and protrusion of trophoblastic tissue into the uterine wall. Ultrasonographic picture of the malignant GTD is also specific for the presence of prominent zones of vasculavization in the peritrophoblastic tissue, as well as in the uterine tissue in which malignant GTD is developed. Resistance Index (RI) values were measured at the level of blood vessels of peritrophoblastic tissue and of suspected zones in the uterine tissue to detect neovascularization, which followed the malignant process. Theca luteal cysts were often detected by Transvaginal Doppler ultrasonography.
Variability in interpretation of static renal scintigraphy findings
Authors: Jaksic Emilija , Beatovic Slobodanka , Zagar Ivana , Ajdinovic Boris , Paunkovic Nebojsa , Stefanovic Aida , Han Ruben
Published: December 2010

Background. Static renal scintigraphy with 99mTc-DMSA is a sensitive method for evaluation of any reduction of cortical mass function. There is not enough reliable references in the literature on scintigraphic reports in terms of objectivity and standardization. The aim of this paper was to assess the differences in interpretation of routine renal scintigraphic findings by nuclear medicine specialists from various institutions (interobserver variability). Methods. Both interobserver variability and agreement in the interpretation were evaluated in two groups. Six observers from four different institutions (group A), and three observers from the same institution (group B) interpreted independently 60 static renal scintigraphy findings obtained by analogous imaging using x-ray films in four standard projections. Using at least two options, seven parameters of renal scintigraphy protocols were analyzed: size (1), uptake (2), outlines (3), scars (4), focal changes (5), relative function (6), and conclusions (7). Results. The interpretations of scintigraphic findings were in accordance in items 1 to 7 within the group A: 62, 42.5, 45, 9, 47, 52, and 34 percent respectively, and within the group B: 72, 55, 59, 22, 62, 60, and 41 percent, respectively. The conformity was more significant in the findings observed in group B as opposed to group A, which was statistically highly significant, especially for the category of scars (p<0.01). Significant variability was also observed by six observers in all the parameters of scintigraphic protocol, especially, again, in the scars analysis (p<0.01). Conclusion. Insignificant degree of accordance, especially in the assessment of scars necessitates the standardization of criteria and terminology in order to interpret the renal scintigraphy with more accuracy and objectivity.
Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure
Authors: Ilic Radoje , Trifunovic Zoran , Tisma Svetislav , Ristic-Andjelkov Andjelka , Veljovic Milic
Published: December 2010

Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.
Very early increase in nitric oxide formation and oxidative cell damage associated with the reduction of tissue oxygenation is a trait of blast casualties
Authors: Zunic Gordana , Romic Predrag , Vuceljic Marina , Jovanikic Olivera
Published: December 2010

Background. In our previous experimental studies, we found evidence for the increase of nitric oxide (NO) formation immediately after blast injury. In the present study we investigated whether NO overproduction was a trait for the period immediately after blast injury in humans. Concomitant metabolic disturbances were also studied, and compared to the alterations in other traumatized patients. Methods. Blast casualties (group B, n = 13), surgical patients with the hip replacement or fractures, not exposed to blast effects (group S, n = 7) and healthy volunteers as controls (group C, n = 10), were examined. Both arterial and venous blood samples were taken within 6 hours, and 24 hours after blast injuries or surgical procedures, respectively. Plasma levels of nitrite/nitrate (NOx), superoxyde anion (O2.-), sulfhydrils (SH), malondialdehyde (MDA) as well as acid-base status and other biochemical parameters (glucose, urea, creatinine, total proteins, albumin) were measured. Results. Significant, but transient increase in plasma NOx levels occurred only in group B. It was associated with the significant increase of hemoglobin oxygen (sO2) saturation of the venous blood and the concomitant decrease of its arterial - venous difference. In group S the venous sO2 decreased, its arterial - venous difference increased, while NOx levels were within the control limits. In both groups, other parameters of arterial acid-base status were kept within the control limits throughout the examined period. The decrease of SH levels were similar in the examined groups, while the increase of O2 .- was greater in group B. Conclusion. Early NO overproduction was a trait of blast injuries in humans, contributing to the reduction of tissue the oxygenation and intensifying the oxidative cell damage that had to be considered in the therapy of casualties with blast injuries. These alterations were different from those observed in other surgical patients without blast injuries.
Constructional apraxia in patients with closed head injury
Authors: Pavlovic Dragan , Pavlovic Aleksandra
Published: December 2010

Introduction. Constructional apraxia is a disorder characterized by an inability to join the elements into a unity. It has not been studied much in patients with closed head injury (CHI). Methods. Forty-one patients with CHI were examined, of which 11 (26.83%) were with the right-sided, 12 (29.27%) with the left-sided, and 18 (43.90%) with bilateral lesion using the Wechsler Individual Intelligence Test (VITI) - Serbian version, Rey Complex Figure (RCF) test, Trail Making Test - TMT A and B, and the Wisconsin Card Sorting Test (WCST). Results. Intelligence quotient (IQ) was significantly higher in the patients with the right-sided (95.27) and bilateral cerebral lesions (87.56) than in the left-sided (84.42). RCF scores did not show any significant difference regarding the side of the lesion, but was numerically the lowest scores were in patients with bilateral brain damage. Patients with left-sided lesions had the score of 30.63, right-sided of 28.68, and bilateral of 27.39. TMT B showed a significantly lower result in patients with the left-sided (196.50 seconds) and bilateral lesions (192.07 seconds) compared to the right-sided (140.14 seconds). WCST scores were not significantly different regarding the side of the lesion, but the absolute value of the categories was less than expected. Conclusion. Constructional apraxia was more frequently present in the patients with CHI than it was previously considered. The use of sensitive tests can show the presence of the disorder mainly in bilateral, but also in unilateral lesions.
Influence of base on the release of antibiotics from officinal ointments
Authors: Toskic-Radojicic Marija , Nonkovic Zorka
Published: December 2010

Backgraund. Officinal basis for the antibiotic ointments according to the 4th Yugoslav Pharmacopoeia is a hydrophobic base containing only aliphatic hydrocarbons. The fact that antibiotics are predominantly not lipophylic raises the question about the suitability of that particular type of the base for the manufacturing of antibiotic ointments. Recent studies of the lipid analysis of the skin corneal layer indicated that lipids had shown the bilamellar organization in the skin intercorneal space. Such structural organization could be seen in the ambiphylic bases whose structure was based on carefully selected emulsifier couple, consisting of the lyotropic and thermotropic liquid crystals. The aim of this study was to test the velocity of antibiotics (klindamycin hydrochloride, erythromycin base and chloramphenicol) release from the hydrophobic ointment-type bases, and from ambiphylic bases of anionic and non-ionic types. Methods. Membrane-free agar diffusion test as the basic method for testing the release velocity in vitro and Staphylococcus aureus as the strain highly susceptible to the chosen antibiotics were used. All the analyzed samples were manufactured as the suspension-type ointments. Results. The highest growth inhibition zone of the Staphylococcus aureus strain for all three analyzed antibiotics was achieved from the non-ionogenic ambiphylic base; the clear growth inhibition zone area for Staphylococcus aureus strain in the preparations containing anionic ambiphylic base was smaller by 10-31.28%, and in the preparations containing aliphatic hydrocarbon-type base, the decrease was 11.46-31.28%, compared to the results achieved with the non-ionogenic ambiphylic base. Conclusion. The optimal release velocity for the analyzed antibiotics was achieved from the non-ionic ambiphylic base.
External transluminal drainage of the pancreatic duct due to fistula caused by postbioptic pancreatic necrosis
Authors: Ignjatovic Dragan , Kronja Goran , Misovic Sidor , Mirkovic Dragan
Published: December 2010

Background. Pancreatic fistulas are not frequent after the needle biopsy of the pancreatic head. The aim was to present a patient with this type of fistula who was managed using the surgical method never previously applied in our surgical practice. Case report. In our patient, pancreatic fistula appeared at the site of the needle biopsies due to the development of the necrosis. Since the conservative treatment with octreotide and the total parenteral nutrition were without result, we turned to the surgical treatment by placing a silicone prosthesis along the pancreatic duct into the duodenum, next through the Roux-en-Y flexure to provide the external drainage of a pancreatic juice. Postoperatively, applying the conservative treatment, pancreatic fistula disappeared, and a silicone prosthesis was removed three weeks later. Conclusion. The described surgical procedure can be successful in managing fistulas which occur after the pancreatic necrosis.
Aneurysmal bone cyst of the frontal bone
Authors: Peric Predrag , Antic Branislav , Radic-Tasic Olga
Published: December 2010

Background. Aneurysmal bone cyst (ABC) is a benign, expansive, osteolytic lesion that mainly occurs in young people, and involves the skull bones only exceptionally. The origin of ABC is controversial: secondary reactive bone lesion, or primary disease that represents an independent nosological entity. Blunt head trauma was suggested as a possible etiological factor. Case report. A case of a 19-year old man with primary ABC of the right frontal bone was reported. The lesion was totally excised through frontal craniotomy, and the skull bone defect primarily reconstructed with an acrilate cranioplasty. Five years after the surgery, the patient was without signs of local recurrence. Conclusion. Clinical and neuroradiological presentation of the skull ABC was not specific. Pathohistology confirmed the diagnosis. Total excision was the treatment of choice.
Neuropsychological profile of patients with bipolar depression in remission
Authors: Totic-Poznanovic Sanja , Marinkovic Dragan , Pavlovic Dragan , Paunovic Vladimir
Published: December 2010

Aim. To determine if the patients with bipolar affective disorder, after the depressive phase, would exhibit cognitive impairment in remission. Methods. Twenty three euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty-one healthy subjects in the control group, for the presence of the symptoms of depression. The patients and the control group were tested with a battery of neuropsychological tests. Results. Impairments were found in the patients compared with the control group in tests of verbal learning and memory and in tests of executive function. Verbal learning and memory, as well as executive functions, did not correlate either with the clinical indices of patients, or with the demographic and baseline clinical measures of depression. Conclusion. Impaired verbal learning and memory and executive functions may represent a trait rather than the state variables in bipolar disorder.
Age assessment at the time of death based on panoramic radiography
Authors: Djuric Marija , Rakocevic Zoran , Rankovic Nenad
Published: December 2010

Background. The determination of age at the time of death is an important method in forensic anthropology and paleodemography. The possible postmortem investigation of the teeth and jaws enables the determination of age at the time of death, as the bones and teeth are both resistant to degradation in soil and characterized by age-related morphological changes. The aim of this study was to determine whether the age-related changes visible on panoramic radiography correlated with age, and enabled the assessment of individual age. Methods. Seven radiographic parameters were used in the study: tooth loss, occlusal tooth wear, pulp stones, carious teeth, periapical disease, tooth restoration, and alveolar bone loss associated with periodontal disease. Results. The material comprised 314 dental panoramic tomograms of living patients of both sexes with documented age (18 to 77 years). Multiple regression equations were constructed for the age estimation, including four parameters (the number of missing teeth, the number of intact teeth, the distance of cement-enamel junction from the alveolar ridge, the number of abraded teeth). The nature of data treated by regression analysis required the careful choice of parameters, appropriate functional model for each parameter, and the experience of the investigator. With the four parameters included in equations, the error was ? 2.55 years. Conclusion. This preliminary analysis showed that the conventional regression technique could be appropriate for the age estimation based on panoramic radiography, and that an additional study with a larger sample and on wider population was required.
Acquired factor V inhibitors in a polytraumatized patient
Authors: Tukic Ljiljana , Stamatovic Dragana , Tarabar Olivera , Elez Marija , Zoric Miodrag , Mandic-Radic Slavka
Published: December 2010

Background. Factor V (FV) inhibitors are a rare disorder reported for the first time about fifty years ago, mostly with the unknown cause. The appearance of FV inhibitors is usually preceded by surgery, infections, administration of antibiotics or transfusions. Clinical manifestations of the presence of FV inhibitors vary from mild to severe and in some instances fatal hemorrhage. Case report. A healthy 51-year-old man with severe multiple injuries (traffic accident), and hemorrhage, which occurred during the orthopedic treatment, was admitted with hemoptysis, epistaxis and hematoma of the right upper leg, and with prolonged prothrombin time (PT), and activated partial thromboplastin time (aPTT). Treatment with vitamin K, fresh-frozen plasma and cryoprecipitate stopped the hemorrhage, but the results of coagulation tests were not normalized. The correction of aPTT and PT with normal plasma showed the decreased activity of FV (1%) due to the presence of inhibitors (titer 17.5 IU). The abnormal results of coagulation tests remained for three weeks, but without clinically manifested hemorrhagic syndrome. At the fourth week after the appearance of FV inhibitors PT, aPTT and the activity of FV became normal and antibodies disappeared spontaneously. Conclusion. Our patient with polytrauma developed a mild hemorrhagic syndrome due to the presence of FV inhibitors five weeks after the accident. Hemorrhage was treated with substitution therapy. The cause of the development of FV inhibitors was unclear (?fibrin glue? was not used during the orthopedic treatment). Factor V inhibitors disappeared spontaneously within four weeks. The fast spontaneous disappearance of FV inhibitors in our patient, confirmed the observations of some authors that they disappeared faster in those patients who were surgically treated prior to their appearance.
Psoriatic arthritis: A retrospective study of 162 patients
Authors: Pavlica Ljiljana , Peric-Hajzler Zorica , Jovelic Aleksandra , Sekler Boris , Damjanovic Milorad
Published: December 2010

Aim. The aim of our study was to determine the prevalence of psoriatic arthritis in the patients with psoriasis and to analyze retrospectively the results of a 34-year multidisciplinary management of the patients with psoriatic arthritis. Methods. The study included 162 out of 183 treated patients with psoriatic arthritis, aged 48 ? 15 years. All the patients satisfied the current diagnostic criteria for psoriasis and psoriatic arthritis according to the American College of Rheumatology. Results. Psoriatic arthritis developed in 183 (9.3%) out of 1976 patients with psoriasis. Time interval for establishing the diagnosis was 4 years. A positive family history of the disease had 15.0% of the studied patients. Its onset was most often at 42 years of age in 70.4% of the cases, and 2 months to 59 years after the appearance of psoriasis. Psoriatic arthritis without psoriasis appeared in 1.8% of the patients. A severe form of arthritis had 64.2% of the patients, mainly the patients with scalp psoriasis (?2=3.2; p<0.05). Nail changes had 35% of the patients. Distal interphalangeal joints were involved in 63.6%, axial skeleton in 36.4%, oligoarthritis in 45.0%, polyarthritis in 55.0%, and mutilating form in 6.8% of the patients. Elevated Erythrocyte Sedimentation Rate was reveald in 61.7% of the patients. Immunoglobulin M (IgM) rheumatoid factor was altered in 4.3% of the patients. The human leukocyte antigen (HLA) typing in the 28 patients were: A2 32.0%, A3 18.0%, Al and A9 14.0%, A28 and A29 3.5%, B8 and B16 14.0%, B5 and B12 11.0%, B13,B15, B18, B27 and B35 7.0%. Radiologic changes were most often in hand and foot joints, less frequently in the knees and quite infrequently in hips and shoulders joints. Sacroiliitis was found in 46.4% of the patients. Psoriasis was treated with topical corticosteroids and salicylic ointments in all the patients, ultraviolet (PUVA therapy) in 5.6% and retinoids in 4.3% of them. Artrithis was treated with nonsteroidal anti-inflammatory drugs, with systemic corticosteroids 41.3% and with disease modified antirheumatic drugs, most frequently methotrexate, 59.9% of the patients. Radionuclide synovectomy was performed in 6.8%, surgery in 6.2% and physical therapy in all the patients. Conclusion. Psoriatic arthritis developed in 9.3% of the psoriatic patients. Time interval for establishing the diagnosis was long, and there were no specific laboratory findings. All the synovial joints could be involved in the psoriatic process. Scintigraphy should be used only in case of early suspected sacroiliitis. The treatment of psoriatic arthritis was the teamwork between the dermatologist, rheumatologist, physiatrist and orthopedic surgeon.