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Although appendiceal tumours are rare, they may be encountered unexpectedly in any emergency abdominal operation. Many of these tumours are not recognized intraoperatively and are diagnosed only during formal histopathological analysis of an appendectomy specimen. We present a rare case of appendiceal adenocarcinoma which caused acute bowel ob struction. The patient presented with abdominal pain, distension and constipation. Abdominal radiography showed large bowel obstruction. On laparotomy the appendix was abnormal, with a tumor growing in to the ileal loop and creating a bowel obstruction. An appendectomy was performed with enbloc bowel segment resection and end ileostomy. Pathology specimens showed that the primary neoplasm was the appendiceal mucinous adenocarcinoma infiltrating the ileal loop. Patient underwent a right hemicolectomy, and recovered afterwards with no evidence of local recurrence or metastatic disease as confirmed by the standard follow-up. Physicians should keep in their minds that appendiceal neoplasm may have various and nonspecific presentations, but only an accurate diagnosis will lead to correct patients treatment, healing and long-term survival.

Recognising shock due to haemorrhage in trauma patients is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The treatment of bleeding patients who have exsanguinating injuries is aimed at two major goals: stopping the bleeding and restoration of the blood volume with correct coagulation. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of multi-sliding computer tomography, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery with 'blind' transfusion or 'damage control resuscitation' in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. Pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. The role of thromboelastography as point-of-care test for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly after the blood sample is taken.

Although astrocytes presumably participate in maintaining the immune privilege of the central nervous system (CNS), the mechanisms behind their immunoregulatory properties are still largely undefined. In this study, we describe the development of regulatory T cells upon contact with astrocytes. Rat T cells pre-incubated with astrocytes completely lost the ability to proliferate in response to mitogenic stimuli. The cells were blocked in G0/G1 phase of the cell cycle, expressed less IL-2R, and produced significantly lower amounts of interferon-gamma (IFN-gamma), but not interleukin-2 (IL-2), IL-10, or tumor necrosis factor (TNF). These anergic cells completely prevented mitogen-induced growth of normal T lymphocytes, as well as CNS antigen-driven proliferation of autoreactive T cells. The suppressive activity resided in both CD4(+) and CD8(+) T-cell compartments. Heat-sensitive soluble T-cell factors, not including transforming growth factor-beta (TGF-beta) or IL-10, were solely responsible for the observed suppression, as well as for the transfer of suppressive activity to normal T cells. The administration of astrocyte-induced regulatory T cells markedly alleviated CNS inflammation and clinical symptoms of CNS autoimmunity in rats with experimental allergic encephalomyelitis. Finally, the cells with suppressive properties were readily generated from human lymphocytes after contact with astrocytes. Taken together, these data indicate that astrocyte-induced regulatory T cells might represent an important mechanism for self-limitation of excessive inflammation in the brain. (C) 2004 Wiley-Liss, Inc. null

The immunomodulatory potential of tiazofurin (TR) on experimental autoimmune encephalomyelitis (EAE) was investigated. Given continuously, TR dose-dependently suppressed the development of EAE in Dark Agouti (DA) rats immunized with either rat spinal cord homogenate (SCH) or myelin oligodendrocyte glycoprotein (MOG). Amelioration of clinical signs was also obtained when the drug was administered during the inductive phase only (day 0 to 8), or during the effector phase (day 10 to 20) of the disease. Efficacy of TR was further evaluated by adoptive transfer of the disease with myelin basic protein (MBP)-sensitized draining lymph node cells (DLNC). Cells from TR-protected rats failed to transfer the disease into naive syngeneic recipients; in addition, TR treatment of recipient rats that had received MBP-sensitized lymphoid cells diminished the adoptively transferred EAE. A reduction of clinical EAE in TR-treated rats was accompanied with the absence of mononuclear infiltration in the spinal cord and defective adhesive cell-cell interactions. The anti-MOG autoAb production was also decreased. Importantly, no evidence for a generalized impairment of the T cell activity, nor decreased in vitro proliferative antigen specific response of LNC from TR-treated animals was found. These results suggest that TR exerts its EAE protective and suppressive effects by limiting adhesive interactions involved in the autoimmune pathogenic process, and due to the lack of general immunosuppressive activity, it should be considered as a candidate drug for the treatment of neuroinflammatory diseases like multiple sclerosis (MS). (C) 2002 Elsevier Science B.V. All rights reserved. null

Postoperative complications are the major cause of postoperative morbidity and mortality and remain to be a serious burden for a healthcare system. The early identification of patients at risk may play a pivotal role in rational decisions regarding perioperative management. The aim of this study was to explore the characteristics of complications in high-risk patients after major abdominal surgery. We also assessed and compared the accuracy of the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) for evaluation of postoperative morbidity and the predictive performance of the POSSUM scoring system for complications and mortality. Finally, we wanted to explore the significance of early indicators of altered peripheral perfusion after major abdominal surgery for the occurrence of severe complications. A prospective, observational, cohort study included 206 high-risk surgical patients undergoing major abdominal surgery at the Clinic for Digestive Surgery, Clinical Center of Serbia, from November 2016 to October 2017. We found that the complication rate in our cohort was 60.7% and that the occurrence of complications was associated with the longer ICU stay (p

Cilj ove studije bio je određivanje nezavisnih prediktora i najboljeg trauma skoring sistema (REMS, RTS, GSC, SOFA, APPACHE II) intrahospitalnog mortaliteta kod pacijenata sa teškom traumom, lečenih u Urgentnom centru Kliničkog centra Srbije u Beogradu. Materijal i metode: Longitudinalna studija je uključila 208 konsekutivnih pacijenata sa teškom traumom, primljenih u Urgentni centar Kliničkog centra Srbije u Beogradu. U cilju određivanja nezavisnih prediktora preživljavanja, urađene su univarijantna i multivarijantna Koksova regresiona analiza. Takođe, uticaj sistema skorovanja ranije pomenutih skorova na prijemu u Urgentni centar (UC) u predikciji mortaliteta poređen je korišćenjem AUC (Area under curve) testom. Rezultati: Ispitivani uzorak činilo je 208 pacijenata (159 muškaraca, 49 žena), prosečnog uzrasta 47,3±20,7 godina. Većina pacijenata bila je inicijalno intubirana (86,1%), na prijemu u UC, a 59,6% pacijenata bilo je sedirano pre intubacije. Posle završetka dijagnostičkih procedura, 17 pacijenata je dodatno intubirano, tako da je na mehaničkoj ventilaciji bilo 94,2% pacijenata. Pacijenti su najčešći povređivani u saobraćajnim nesrećama (33,2%), prilikom pada sa visine (26,4%) i kao pešaci (22,6%). Prosečna dužina boravka u jedinici intenzivne nege iznosila je 24,7±21,2 dana. Letalitet je bio 17/208 (8,2%). Koksovom regresionom analizom pokazano je da su povišena srčana frekvenca (HR=1,03, p=0,012) i snižena saturacija krvi kiseonikom (HR=0,91, p=0,033) nezavisni prediktori smrtnog ishoda pacijenata sa teškom traumom...

Trauma predstavlja vodeći uzrok smrti u grupi pacijenata do 40 godina. Sepsa je jedna od najčešćih i najznačajnijih infektivnih komplikacija u toku lečenja teško povređenih pacijenata. Definiše se kao životno-ugrožavajuće stanje sa insuficijencijom organa uzrokovano neadekvatnim odgovorom domaćina na infekciju. Imuno-inflamatorni odgovor u traumi i sepsi umnogome je determinisan genetskom predispozicijom za modulisanje i alteraciju proinflamatornih i antiinflamatornih procesa. Polimorfizmi pojedinačnih nukleotida (PPN) su najčešći tip genskih polimorfizama i predstavljaju normalnu varijaciju u naslednoj osnovi. Polimorfizmi gena za proinflamatorni citokin TNFA, TNF-β, kao i receptore slične Toll-u 2 i 4 (TLR2 i TLR4) i njihova povezanost sa sepsom nisu bili predmet dosadašnjih istraživanja u populaciji traumatizovanih pacijenata u našoj zemlji. Cilj studije bila je procena epidemioloških karakteristika infekcija krvi i sepse kod pacijenata sa traumom lečenih u jedinicama intenzivnog lečenja (JIL). Procenjeni su incidencija, ishodi lečenja, uzročnici infekcija krvi (IK) i sepse i njihova antimikrobna rezistencija, izvori infekcije kod sepse i uticaj IK na ishod i preživljavanje kod sepse, kao i faktori rizika za nastanak IK i sepse. Drugi cilj studije bila je procena genetičkih faktora rizika za nastanak sepse, odnosno distibucija PPN gena TNFA, LTA, TLR2 i TLR4 kod pacijenata sa sepsom, pacijenta bez sepse i zdravih pripadnika kontrolne grupe, kao i asocijacija ovih PPN sa nastankom sepse. Pored toga procenjen je doprinos kliničkih i genetskih faktora rizika u predikciji sepse nakon traume. Sprovedena je prospektivna kohortna studija u koju je uključeno 406 odraslih pacijenata sa srednje teškom i teškom traumom hopitalizovanih duže od 48h u JIL Urgentnog centra Kliničkog centra Srbije u periodu od 01.11.2014. do 30.04.2016. godine. Na prijemu su procenjeni brojni klinički paramteri i uzeta je krv za molekularno-genetičku analizu. Primarni ishodi su bili IK i sepsa, a sekundarni ishodi uzročnici IK i sepse i antimikrobna rezistencija uzročnika...

Uvod:Apendicitis je oboljenje, koje se najčešće javlja u dečjem uzrastu. Poslednjih godina se laparoskopska apendektomija sprovodi sve češće u ovom uzrastu, međutim ne postoji jasan konsenzus o optimalnom izboru anestetika za održavanje opšte anestezije u toku ove hirurške metode u dečjem uzrastu. Cilj istraživanja: Utvrditi uticaj vrste anestezije i vrste hirurške procedure na odgovor organizma na hirurški stres tokom operacije crvuljka. Metodologija: Klinički prospektivno istraživanje je sprovedeno na Klinici za dečiju hirurgiju, na Institutu za zdravstvenu zaštitu dece i omladine Vojvodine. Istraživanjem je obuhvaćeno 120 dece, uzrasta od 7 do 17 godina, bez postojećih komorbiditeta, koji su operisani zbog zapaljenja crvuljka. U zavisnosti od vrste operativnog zahvata i vrste primenjene anestezije deca su podeljena u četiri grupe bolesnika. Kod sve četiri ispitivane grupe uzimana je venska i kapilarna krv, nekoliko minuta nakon uvoda u anesteziju, u momentu vađenja crvuljka iz trbuha i 12 časova nakon kraja hirurške intervencije. Laboratorijski su određeni markeri oksidativnog stresa (TBARS), metaboličkog odgovora na hirurški stres (laktat, glikemija), inflamatornog odgovora organizma (IL-6, leukociti), gasne analize, parametri oksigenacije i ventilacije, i hemodinamski parametri ispitanika. Rezultati:U istraživanju je dobijen rezultat da je zapaljenje crvuljka oboljenje koje se češće javlja kod dečaka. Tokom apendektomije u dečjem uzrastu, sevofluran je bolje kontrolisao arterijsku tenziju, dok na srčanu frekvencu vrsta anestezije nije imala uticaja. Sevofluran je anestetik tokom čije primene je manji inflamatorni odgovor tokom laparoskospske apendektomije. Propofol deluje suprimirajuće na oksidativni stres, ali nije nađena statistička značajnost u odnosu na vrednosti dobijene analizom uticaja sevoflurana na parametre oksidativnog stresa. Zaključak: Laparoskopska apendektomija u odnosu na laparotomiju nije praćena većim stepenom hirurškog stresa, a sevofluran je anestetik koji tokom anestezije za laparoskopsku apendektomiju u dečijem uzrastu daje bolju kontrolu kliničkog, metaboličkog i inflamatornog odgovora., Introduction: Appendicitis is a disease which appears most commonly in children. In recent years appendectomy in children is performed by laparoscopy, but there is no consensus yet on the optimal choice of anesthetics during general anesthesia for this procedure. Aim: To determine the influence of type of anesthesia and type of surgical procedure for appendectomy, on surgical stress in children. Methodology: A prospective clinical trial in Clinic of pediatric surgery in Novi Sad, Vojvodina. The study included 120 children aged from 7 to 17 years, with no commorbidities, who underwent appendectomy. Children were divided in four groups based on the type of anesthesia and type of surgery they received. In all participants, venous and capillary blood was sampled for analyzis 10 minutes after induction of anesthesia, at the moment of appendix removal and 12 hours after the procedure. The laboratory analysis included markers of oxidative stress (TBARS), metabolic response to surgical stress (lactate, blood glucose), inflammatory response (IL-6, leucocites), bloodgas analyses, parameters of oxygentation and ventilation and haemodynamic parameters of the participants. Results: In the study appendicitis was more common in boys. During laparoscopic appendectomy sevoflurane controlled better the blood pressure, but not the heart rate. Sevoflurane maintained a better control of parameters of the inflammatory response. Propofol decreased the oxidative stress, but there was no statistical difference compared to the effects of sevoflurane on oxidative stress. Conclusion: Laparoscopic appendectomy shoved no difference in the level of surgical stress compared to laparotomy, and sevoflurane appeared as an anaesthetic which had a better control of the metabolic, clinical and inflammatory response.

Pneumonije povezane sa mehaničkom ventilacijom predstavljaju jednu od najčešćih formi intrahospitalnih infekcija u jedinicama intenzivnog lečenja. Ciljevi ove disertacije su bili da se sagledaju faktori rizika vezani za karakteristike pacijenta kao i za karakteristike i stanje na prijemu koji su od značaja za pojavu pneumonija povezanih sa mehaničkom ventilacijom. Takođe je cilj bio da se sagleda incidencija multirezistentnih sojeva patogena u bolničkim uslovima kao i efikasnost empirijske antibiotske terapije. Praćeno je 363 pacijenata koji su lečeni u Urgentnom centru Kliničkog Centra Srbije, u dve jedinice intenzivnog lečenja i koji su zahtevali mehaničku ventilaciju duže od 48 sati u periodu od 1.1.2013. do 31.12.2014. godine. Ispitivan je uticaj demografskih karakteristika, uzroka hospitalizacije i pratećih bolesti, kao i karakteristika pacijenata na prijemu u jedinice intenzivnog lečenja. Nezavisni prediktori za nastanak pneumonija povezanih sa mehaničkom ventilacijm prema multivarijantnoj regresionoj analizi su: primena masivne transfuzije na prijemu, koma, GKS manjeg od 8 i veći APACHE II skor. Pacijenti koji su razvili pneumoniju duže su boravili na mehaničkoj ventilaciji i imali su duži boravak u jedinicama intenzivnog lečenja. Intrahospitalni mortalitet je bio u ovoj grupi značajno veći kao i mortalitet 28 dana. U multivarijantnoj logističko regresionoj analizi faktor rizika za nastanak prošireno rezistentnih bakterija kao uzročnika VAP-a izdvaja se neadekvatna empirijska antibiotska terapija. Gram negativne bakterije bili su najčešće izolovani patogeni. Na osnovu rezultata ove disertacije predlaže se uvođenje protokola i mera kojima bi se delovalo na preventibilne faktore rizika radi redukcije incidencije pneumonija povezanih sa mehaničkom ventilacijom sa ciljem sprečavanja komplikacija i samanjenje mortaliteta kod traumatizovanih pacijenata u jedinicama intenzivnog lečenja. Ventilator associated pneumonia are most common intrahospital infections in intensive care units. The aims of this dissertation were to examine the patient-related caracteristics, as well as admission caracteristics and their influence on ventilator associated pneumonia incidence. We also studied multidrug resistant pathogens incidence and initial empiric antimicrobal therapy. There were 363 patients treated in Emergency center of Clinical centre of Serbia in two intensive care units requiring mechanical ventilation more than 48 hours in the period between 1.1.2013-31.12.2014. On admission sociodemographic data, cause for hospitalization and concomitant diseases as well as patients caracteristics due to trauma were evaluated. According to multivariate regression analysis independent predictors for ventilator associated pneumonia were: massive transfusion, coma, high value of APACHE II score on admissin. Patients who developed ventilator associated pneumonia spent more days on mechanical ventilation and in intensive care unit and their mortality was higher. Our results show the importance of guidelines and preventive measures reducing incidence of ventilator associated pneumonia, especially in early phase of treatment. We aslo shown that there are no difference in isolated pathogens between early and late form of ventilator associated pneumonia.

Uvod: Sepsa je jedan od vodećih uzroka smrtnosti u jedinicama intenzivnog lečenja i van njih uprkos implementaciji novih dijagnostičkih i terapijskih protokola širom sveta. Multiorganska disfunkcija (MODS), koja predstavlja najtežu formu nepovoljnog toka sepse, je u osnovi svojih patofizioloških dešavanja obeležena promenama, koje se dešavaju na nivou kapilara, pre svega u endotelu. Poremećaji koagulacije koji se javljaju kao posledica ovih promena u endotelu su prepoznati kao jedan od dijagnostičkih kriterijuma prema najnovijim smernicama za dijagnostiku i lečenje sepse, međutim njihov značaj u predviđanju toka i ishoda ovog oboljenja još uvek nije precizno definisan. Cilj istraživanja: Odrediti koncentraciju markera endotelne aktivacije, aktivacije koagulacije, aktivnost prirodnih inhibitora koagulacije i funkcionalnost fibrinolize kod obolelih od sepse u odnosu na njihove vrednosti u zdravoj populaciji. Ispitati mogućnost upotrebe markera endotelne disfunkcije i pokazatelja poremećaja mehanizma hemostaze za postavljanje dijagnoze sepse i predikciju pojave komplikacija. Ispitati mogućnost upotrebe markera endotelne disfunkcije i pokazatelja poremećaja mehanizma hemostaze za procenu ishoda kod obolelih od sepse. Materijal i metode: Istraživanje je sprovedeno analitičkom metodom u formi studije preseka, a obuhvatilo je pacijente lečene na Odeljenju anestezije i reanimacije Urgentnog centra Kliničkog centra Vojvodine i na Klinici za infektivne bolesti Kliničkog centra Vojvodine, u Novom Sadu. Istraživanje je sprovođeno tokom 2012. i 2013. godine u trajanju od dve godine. U studiju je bilo uključeno 180 ispitanika od kojih je 150 imalo postavljenu dijagnozu sepse,a 30 ispitanika su činili kontrolnu grupu su klinički i biohemijski zdravih ispitanika, dobrovoljni davaoci krvi. Ispitanici su kategorisani u četiri grupe u odnosu na kliničko stanje i laboratorijske nalaze unutar prvih 24 časa od prijema: bolesnici sa sepsom, teškom sepsom, septičkim šokom i multiorganskom disfunkcijom na prijemu. Nakon kategorizacije ispitanika, izračunati su APACHE II i SOFA numerički pokazatelji procene težine bolesti ispitanika. U roku 24 časa od trenutka postavljanja dijagnoze sepse, iz uzoraka krvi ispitanika, izvršene su predviđene laboratorijske analize u cilju praćenja endotelne aktivacije, aktivacije koagulacije i inhibicije antikoagulantnih mehanizama. U toku 48 časova od prijema, bolesnici koji nisu imali MODS na prijemu su intenzivno praćeni u cilju evidentiranja razvoja multiorganske disfunkcije, dok su bolesnici koji su imali MODS praćeni radi evidentiranja perzistiranja ili eventualne rezolucije MODS-a. Zdravstveno stanje bolesnika je praćeno tokom 28 dana od trenutka uključivanja u studiju i nakon tog perioda je evidentiran ishod lečenja u smislu preživljavanja ili smrtnog ishoda. Statistička analiza je izvršena pomoću statističkog paketa IBM SPSS 20 Statistics. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p< 0,05. Rezultati: Vrednosti bioloških markera endotelne aktivacije i aktivacije koagulacije su statistički značajno povišene kod obolelih od sepse u odnosu na njihove vrednosti u zdravoj populaciji, dok su vrednosti prirodnih inhibitora koagulacije statistički značajno snižene kod obolelih od sepse u odnosu na njihove vrednosti u zdravoj populaciji. Vrednosti APTT-a, PT-a, D-dimera, fibrinogena, prirodnih inhibitora koagulacije i markera endotelne aktivacije (endokan i vWF antigena i aktivnosti) imaju značajan i veoma visok dijagnostički potencijal. Vrednosti biomarkera endotelne disfunkcije i pokazatelja poremećaja hemostaznog mehanizma su značajni prediktori komplikacija kod bolesnika sa sepsom. APTT, PT, D-dimer, broj trombocita, vrednosti priorodnih inhibitora koagulacije, trombomodulina, endokana i ETP-a su jednako validni u inicijalnoj proceni toka kliničke slike sepse kao i prediktivni APACHE II i SOFA skorovi. Koncentracija trombomodulina, D-dimera, ETP-a i PC su dobri prediktori nastanka MODS-a u prvih 48 časova u toku sepse. Endokan, PT, APTT, koncentracija fibrinogena, prirodnih inhibitora koagulacije i vrednosti ETP-a su značajni u predikciji mortaliteta kod bolesnika sa sepsom. Zaključci: Ukoliko bi pokazatelji aktivacije endotela i mehanizma hemostaze bili inkorporirani u određeni sistem skorovanja u cilju procene težine bolesti u smislu ishoda kod bolesnika sa sepsom, to bi moglo doneti doprinos boljoj klasifikaciji bolesnika, te primeni pravovremene i adekvatne terapije u cilju postizanja pozitivnog ishoda kod bolesnika sa sepsom. Prilikom interpretacije pokazatelja inflamacije i koagulacije neophodno je steći uvid u celokupnu sliku pro-i antikoagulantnih dešavanja koja se odvijaju tokom sepse, odnosno adekvatno proceniti pravac toka disbalansa mehanizma hemostaze da bi se eventualnim terapijskim merama mogao postići pozitivan učinak., Introduction: Sepsis is one of the main causes of death in intensive care units and other hospital wards in spite of implementation of new sepsis treatment guidelines in everyday hospital practice worldwide. Changes that occur in the microvasculature, affecting primarily endothelial cell, are the basis of the pathophysiology of multiorgan dysfunction (MODS) in sepsis. Coagulation abnormalities which occur as a consequence of endothelial changes are recognized as diagnostic criteria for sepsis, but significance of these changes in the outcome prognosis and prediction of the course of sepsis is still not accurately defined. Aims: Evaluation of hemostasis related parameters and endothelial activation biomarkers values in patients with sepsis and healthy volunteers. Determination whether the levels of hemostasis-related parameters and biomarkers of endothelial activation have diagnostic significance and are they associated with MODS development and persistence in the first 48 hours of hospitalization and 28-day mortality in patients with sepsis. Material and methods: This is cross-sectional study conducted in 2012 and 2013 in the Department of Anesthesia and Reanimation at the Emergency Center of the Clinical Center of Vojvodina and in the Clinic of Infectious Disease at the Clinical Center of Vojvodina. 150 patients who fulfilled criteria for diagnosis of sepsis were included in the study. Patients were divided into 4 groups: sepsis, severe sepsis, septic shock and MODS. 30 healthy volunteers, blood donors were the control group. After the categorization of patients, during the first 24 hours of hospitalization, predictive APACHE II and SOFA scores were calculated. Hemostasis related parameters and endothelial activation biomarkers concentrations were determined within the first 24 hours of the onset of the disease. To assess the development of complication of the disease, patients were monitored for 48 hours for MODS development and persistence or resolution and for 28 days from the onset of sepsis for outcome assessment. Data were analyzed using SPSS 20.0 software and are presented in tables and graphs, statistical significance was set at p< 0,05. Results: Biomarkers of endothelial and coagulation activation are significantly higher in patients with sepsis in comparison to their values in healthy volunteers, while concentrations of natural anticoagulants are significantly lower in patients with sepsis than in healthy volunteers. APTT, PT, D-dimer, fibrinogen, natural anticoagulants and biomarkers od endothelial activation (endocan and vWF antigen and activity) have diagnostic significance in patients with sepsis. Hemostasis related parameters and endothelial activation biomarkers are good prognostic factors for complication development in patients with sepsis. APTT, PT, D-dimer, platelet count, natural anticoagulants, thrombomodulin, endocan and ETP are equally valuable in early prediction of sepsis development as APACHE II and SOFA scores. Thrombomodulin, D-dimer, ETP and PC are good predictors of MODS development during the first 48 hours from sepsis onset. Endocan, PT, APTT, fibrinogen concentration, values of natural anticoagulants and ETP values are significant in 28-day mortality prediction in patients with sepsis. Conclusion: A combination of markers of endothelial dysfunction with widely used ICU scores and organ failure assessment could contribute to an early recognition of complication development and consequent death in patients with sepsis. It is necessary to obtain the full insight in pro-and anticoagulant dynamic evaluation while interpreting coagulation and inflammation processes in sepsis development, in order to accurately lead early resuscitation therapy.

Prelom kuka predstavlja veoma estu traumu kod osoba starijeg uzrasta. Jedna od naješih komplikacija kod ovih pacijenata nakon operacije preloma kuka je delirijum. Ciljevi ove disertacije su bili da se sagledaju faktori rizika vezani za pacijenta kao i za hospitalizaciju i hiruršku intervenciju koji su od znaaja za pojavu postoperativnog delirijuma kod pacijenata sa prelomom kuka. Praeno je 277 pacijenata starosti 50 godina sa akutnim prelomom kuka operativno leenih na Institutu za ortopedsku hirurgiju i traumatologiju Klinikog centra Srbije u periodu od 1.4.2010. do 1.4.2011. godine. Ispitivan je uticaj demografskih i socioekonomskih karakteristika, mesta preloma, same hirurške intervencije i vrste anestezije, fizikog zdravlja, broj lekova u linoj terapiji, kognitivnog statusa, poremeaja raspoloženja, funkcionalnog statusa, dužine bolnikog leenja, pojave komplikacija i postoperativnog bola na pojavu postoperativnog delirijuma. Nezavisni prediktori za nastanak postoperativnog delirijuma kod pacijenata sa prelomom kuka prema multivarijantnoj regresionoj analizi su; stariji uzrast ( 85 god.), ošteenje vida, depresija na prijemu, teško kognitivno ošteenje, dehidratacija (urea/kreatinin odnos 14), lošiji fiziki status pacijenata, kao i prisustvo jakog akutnog postoperativnog bola. Od ovih faktora rizika, teško kognitivno ošteenje i jak akutni bol prvog postoperativnog dana su bili najjae povezani sa pojavom postoperativnog delirijuma. Na osnovu rezultata ove disertacije predlaže se uvoenje interventnih mera kojima bi se delovalo na preventibilne faktore rizika radi redukcije incidencije postoperativnog delirijuma sa ciljem spreavanja komplikacija i samanjenje mortalitata kod starijih pacijenata nakon preloma kuka. Hip fracture in the geriatric population is a common injury. One of the most frequent complication in these patients is postoperative delirium. The aims of this dissertation were to examine the patient-related, hospitalization-related, and surgery-related risk factors for occurrence of postoperative delirium in hip-fracture patients. A total of 277 community-dwelling elderly patients ( 50 years) who underwent surgery for hip fracture were observed at the Clinics for Orthopedic Surgery and Traumatology, Clinical Canter of Serbia in the period 1.4.2010.- 1.4.2011. On admission sociodemographic data, data related to the fracture, cognitive function, presence of depression, functional status, length of hospital stay, postoperative complications and postoperative pain were evaluated. According to multivariate regression analysis independent predictors for postoperative delirium after hip fracture surgery were age, vision impairment, depression on admission, severe cognitive impairment, dehydration (urea/creatinin ratio 14), poor physical status, and severe postoperative pain. The severe cognitive impairment and severe postoperative pain were strongly related to postoperative delirium. Intervention programs for reducing the incidence of delirium should be introduced into routine clinical practice in order to prevent complications and reduced mortality...

Introduction: birth, although a physiological act, it is followed by the stress response from mothers and newborns. The mode of delivery and the type of obstetrical anesthesia may affect the level of oxidative stress. Uncomplicated vaginal delivery exposes mothers and newborns to a state of increased oxidative stress. Ending the pregnancy by cesarean section has become more common, and the modem spinal anesthesia is preferred to obstetric anesthesia. Direct effects of anesthesia on neonatal outcome, complications related to the birth and the newborn, as well as the oxidative stress that occurs during childbirth, have not been not studied in our community. The activity of the GPx enzyme in infants at birth has been insufficiently addressed in the professional written material it the world in general, and in pregnant women it is unknown. Aim: To determine the effect of mode of delivery and the type of obstetric anesthesia at the level of oxidative stress and complications in newborns and mothers. Methods: A prospective clinical study was conducted at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. The study included 150 healthy, term infants, delivered by a planned cesarean section with general or spinal anesthesia, as well as in a natural way, and their 150 mothers. Depending on the mode of delivery and the type of obstetric anesthesia, the newborns and mothers were divided into six groups of 50. In all six tested groups, venous blood samples were taken a few minutes after the birth, together with certain laboratory markers of oxidative stress (TBARS and GPx), lactate and gas analysis. The general condition and potential complications of the newborns and mothers during childbirth and hospitalization were monitored and evaluated. Results: The values of Apgar score after 1 and 5 minutes were significantly higher (p < 0.01) in infants who were born by cesarean section under spinal anesthesia . The highest concentration of TBARS and the lowest concentration of GPx were present in infants who were born naturally. The lowest TBARS values had newborns and their mothers from the group of spinal anesthesia, while the concentration of GSH was highest in the group of general anesthesia. The newborns had higher values of markers of oxidative stress than their mothers. The most common complications were maternal hypotension in spinal and general anesthesia in PDPH. Statistically, a significantly (p < 0.001) higher postpartum pain was experienced by the mothers who delivered their babies naturally and the lowest by those who gave birth by caesarean section under spinal anesthesia. Conclusions: The markers of oxidative stress, clinical and laboratory parameters in newborns and mothers, indicate the advantages of the electoral caesarean section over a natural birth, and those of spinal anesthesia over general anesthesia.

Uvod: Naprasna srčana smrt (NSS) je prirodna smrt koja nastaje iz srčanih razloga, unutar jednog sata od početka akutnih kardiovaskularnih događaja, a prethodi joj nagli gubitak svesti. Najčešći uzrok je koronarna bolest (80%). Naprasna srčana smrt može nastupiti u bilo koje vreme od srčanog infarkta, a usled pojave komorske fibrilacije (VF) ili brze prolongirane komorske tahikardije (VT) koja alterira u VF. Perioperativni srčani zastoj kod operacija na otvorenom srcu se javlja u 0,7-2,9% bolesnika. Preživljavanje ovih bolesnika je 17-79%. Terapije beta blokatorima i amiodaronom nije dala zadovoljavajuće rezultate u prevenciji NSS uzrokovane malignim poremećajima ritma za razliku od profilaktičke implantacije implantabilnog kardioverter defibrilatora (ICD). Ovo je potvrdilo nekoliko studija: Multicenter Automatic Defibrillator Implantation Trial (MADIT), The Multi-center Unsustained Tachycardia Trial (MUSTT), MADIT II i Sudden Cardiac Death-Heart Failure Trial (SCD-HeFT). U The Coronary-Artery Bypass Graft-Patch (CABG-Patch) studiji primarne prevencije NSS, u koju su, kao i kod nas, uključeni bolesnici kojima je urađena hirurška revaskularizacija miokarda i sa ejekcionom frakcijom EF≤36%, nije dokazana povezanost preživljavanja sa implantacijom ICD-a na osnovu kumulativnih krivi preživljavanja. Razlika između naše i CABG-Patch studije bila je u tome što su oni intraoperativno implantirali ICD bolesnicima koristeći epikardnu „patch― elektrodu, a mi između prvog i trećeg meseca po revaskularizaciji miokarda, plasirajući elektrodu transvenoznim putem, endokardno. Primarni cilj ove studije bio je da ispita da li je opšte preživljavanje duže kod bolesnika sa ishemijskom bolesti srca, EFLV≤35%, bez predhodno registrovanih NSVT, VT i VF, a posle učinjenog aortokoronarnog bajpasa i kojima je preventivno implantiran ICD, nego kod bolesnika sa antiaritmijskom terapijom β-blokatorima i Amiodaronom... Introduction: Sudden cardiac death (SCD) is a natural death from cardiac causes happening within one hour of the onset of acute cardiovascular symptoms, and is preceded by a sudden loss of consciousness. The most common cause of SCD is a coronary artery disease (80%). Sudden cardiac death can develop at any time after the acute myocardial infarction, due to the ventricular fibrillation (VF), or fast prolonged ventricular tachycardia (VT) progressing to VF. Cardiac revascularization, either by percutaneous coronary intervention (balloon angioplasty or stenting) or by surgical revascularization improves cardiac function, and with that survival of patients with low left ventricular ejection fraction (EF). Incidence of perioperative cardiac arrest after the open heart surgery is 0,7-2,9%. Survival of these patients is 17-79%. Beta blocker therapy, and amiodarone therapy haven’t yielded satisfying results in prevention of SCD caused by ventricular tachyarrhythmias as has prophylactic implantation of ICDs. This has been confirmed by several studies: Multicenter Automatic Defibrillator Implantation Trial (MADIT), The Multi-center Unsustained Tachycardia Trial (MUSTT), MADIT II and Sudden Cardiac Death-Heart Failure Trial (SCD-HeFT). Primary prevention of SCD trial - The CABG-Patch Trial included, as our trial did, patients with EF≤36%, that were scheduled for surgical revascularization. This trial didn’t show correlation of survival with ICD implantation. Difference between our trial and CABG-Patch was that in CABG-Patch trial they implanted ICD patch electrode epicardially during CABG surgery, while we implanted ICD patch electrode transvenously endocardially between the first and the third month after CABG surgery. The primary aim of the study was evaluation of overall survival of patients with IHD, EF≤35%, without prior NSVT,VT, VF and after CABG surgery with prophylactic ICD implantation compared to overall survival of patients on conservative medical therapy amiodarone and beta blockers...