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Introduction. Bleeding to death is one of the leading causes of death speaking about violent death in general. Bleeding to death mostly happens through hurt organs or blood vessels of thorax, abdomen and neck or because of destruction of extremities or the whole body. Bleeding to death is very often the consequence of blood pouring, rarely of simultaneous pouring and suffusing of blood, and it is extremely rarely the result of blood suffusing solely and especially due to subcutaneous, retoperitoneal and intramediastinal blood suffusing. Fatal bleeding into soft tissues solely is very rare. During a 10- year- period among 3 000 performed autopsies in the Department of Forensic Medicine in Podgorica, the presented case was the unique one. Case report. The paper presents a 5-year-old boy who was beaten to death by his mother and step-father and died because of massive bleeding into soft tissues. Conclusion. In order to establish a cause of death in cases of exsanguination in soft tissues, a series of postmortem diagnostic procedures should be performed, like those presented in this paper. [ABSTRACT FROM AUTHOR]

Background. Mucosa-associated lymphoid tissue (MALT) lymphoma was described for the first time in 1983 by Isaacson and Wright. It was classified into extranodal non-Hodkin's lymphomas of B-cell lymphocytes of the marginal zone of reactive lymphe follicles. It is characterized by both hyperplasia and colonization of plasmocytic, centrocytoid and monocytoid cells, by the infiltration of interfollicular and parafollicular parts of interstitium, as well as by the invasion of clusters of neoplastic lymphoid cells of the glandular epithelium, forming the pathognomic lymphoepithelial MALT limphoma lesions. Case report. In this paper we presented the two female patients, 59 and 75 years of age, with MALT lymphomas, associated with Miculicz's and Sjögren's syndromes. The paper also underlined rather many-month-long, indolent clinical course, evalution of both tumors, massive in size, as well as two-sided localization in the case of the Miculicz's syndrome. After the subtotal parotidectomy, using conservation of nerve facialis, the tissue blocks were fixed in 10% formaldehyde. The paraffine sections were stained by routine histochemical and an immunohistochemical method by using monoclonal antibodies for both B-cell and T-cell lymphomas, due to the verification of lymphoepithelial lesions. The MALT lymphoma diagnosis was based on the histological criteria and confirmed by an immunohistochemical method. After the surgical therapy accompanied by chemotherapy, the patients were controlled at regular intervals, and residual MALT lymphoma did not appear. Conclusion. MALT lymphoma is a rare tumor of the salivary glands, with the most frequent localization in the parotide gland. It had a slow clinical course, without metastases in both patients. The diagnosis was made pathohistologically and confirmed immunohistochemically. The surgical therapy was accompained by adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Background/Aim. Medial open wedge tibial osteotomy is one of the most widely accepted method of treatment for varus knee deformity in younger patient population. Its success depends on the quality of fixation and preservation of the outer cortex of the tibia. The aim of the study was to evaluate stress distribution in five numerically designed plate configurations which can be used in open wedge tibial osteotomy. Methods. The paper describes the 3D numerical model of the tibia with 10° varus deformity correction obtained by an optical scanner ATOS. The simulation anticipated axial compressive loads of 700 N, 1 400 N and 2 100 N. We used a modification of the standard T-plate in all of the five tested models. Modalities were tested with and without a metal block, and with and without a stable angle fixation plates and screws. Software PAK was used in the analysis of stress distribution. Results. With exception for the standard T-plate configuration without the supporting block, the loads up to 1400 N did not result in critical stresses on the outer cortex of the tibia in the remaining four models. There is an objective risk of possible failure of the outer cortex and loss of correction at a load of 2100 N in all configurations. The plate model with the angle stable fixation and the supporting metal block showed the most optimal distribution of stresses on the plate-bone composite compared to other models. Conclusion. The standard T-plate configuration without supporting metal block is not sufficient to stabilize the open wedge osteotomy of the tibia. Numerical models of the angle stable T-plate and the supporting metal block achieved a favorable distribution of stresses on the bone and implant which require further biomechanical testing. [ABSTRACT FROM AUTHOR]

Background/Aim. There is clear evidence on direct realtionship between periodontal disease and diabetes mellitus. Many investigations point out greater prevalence and severity of periodontal disease among diabetic patients. During last decade, low level laser therapy has been used in periodontal therapy. It has biostimulative effect, accelerates wound healing, minimizes pain and swelling, and there is almost no contraindication for its usage. The aim of the paper was to investigate the efficiency of low level laser therapy as adjuvant tool in reduction of gingival inflammation in diabetic patients. Methods. The study incuded 150 participants divided into three groups: group I (50 participants with diabetes mellitus type 1 and periodontal disease), group II (50 participants with diabetes mellitus type 2 and periodontal disease), group III (nondiabetic participants with periodontal disease). Gingival health evaluation was done using gingival index Löe Silness. Soft and hard deposits were removed, periodontal pockets cleaned and GaAlAs low level laser therapy (5 mW) applied five consecutive days. In each patient, low level laser therapy was not applied on the left side of the jaw in order to compare the effects of the applied therapy. After the first, third and fifth therapy and one month after the last visit gingival index was evaluated. Before the first and after the fifth therapy exfoliative cytology of gingiva was done and nuclei areal was analyzed morphometrically. Results. After all investigated periods, gingival index and nuclei areal were significantly decreased comparing to values before the therapy, at both jaw sides (p < 0.001). After the 1st, 3rd and 5th therapy, the t-test showed a significantly decreased gingival index at the lased side of jaw comparing to non-lased side. Conclusion. Low level laser therapy is efficient in gingival inflammation elimination and can be proposed as an adjuvant tool in basic periodontal therapy of diabetic patients. [ABSTRACT FROM AUTHOR]

Background. Maxillary tuberosity during teeth extraction can occur in dental practice. The aim of this paper was to present a case of the maxillary tuberosity fracture occurred during tooth extraction, which was the subject of the forensic expertise. Case report. The maxillary tuberosity fracture created during the extraction of the upper molar was neither timely nor adequately managed by the doctor who started extraction. After the treatment at the specialist institution, the patient sued the doctor for the criminal offense of negligent treatment. The task of the expert was to give a professional answer to the question whether the doctor, who caused a maxillary tuberosity fracture during the tooth extraction, acted negligently and applied inadequate treatment. Conclusion. The maxillary tuberosity fracture during molar extraction may be its complication. If it is diagnosed promptly, immediately and adequately managed, there is no possibility for negligence action. [ABSTRACT FROM AUTHOR]

Background/Aim. Consequences of individual adverse childhood experiences for adult mental health have been precisely studied during past decades. The focus of past research was mainly on childhood maltreatment and neglect. The aim of this paper was to determine association between multiple adverse childhood experiences and psychiatric disorders, as well as their correlation to the degree and type of aggressiveness in adult psychiatric patients. Methods. One hundred and thirteen psychiatric outpatients were divided into three diagnostic groups: psychotics, non-psychotics and alcoholics and compared with forty healthy individuals. Adverse childhood experiences data were gathered retrospectively, using the Adverse childhood experiences questionnaire and explanatory interview. Aggressiveness was assessed using Buss-Perry Aggression Questionnaire. The Student's t test, ANOVA and correlational analysis were used for evaluation of statistical significance of differences among the groups. A value p < 0.05 was considered statistically significant. Results. Our results showed that the mean number of adverse childhood experiences in each group of psychiatric patients, as well as in the whole group of patients, was statistically significantly higher than in the group of healthy individuals (p < 0.001); there was a statistically significant difference in score of physical aggressiveness between the patients exposed to adverse childhood experiences and those who were not exposed to them (p < 0.05); scores of physical aggressiveness were in positive correlation with the number of adverse childhood experiences (p < 0.05). The highest mean score of adverse childhood experiences was evidenced in the group of patients with psychotic disorders. Conclusion. Multiple adverse childhood experiences are significantly associated with psychotic disorders, nonpsychotic disorders and alcohol dependence in adulthood and their presence is important morbidity risk factor for psychiatric disorders. They are in positive correlation with physical aggressiveness of the patients from these diagnostic groups. [ABSTRACT FROM AUTHOR]

Background/Aim. Deep venous thrombosis (DVT) is a lifethreatening condition, which could be manifested with discrete symptoms (silent DVT). High mortality and disability of patients with DVT indicate the importance of early diagnosis, especially of "silent" DVT. The aim of this paper was to evaluate of reliability of early detection model for diagnosing DVT in ambulatory patients by using clinical probability of DVT presence, D-dimmer test (DD) and ultrasound evaluation (US). Methods. Ambulatory patients with suspected DVT were classified as "unlikely" and "likely" DVT by the Wells clinical model. The patients were randomly divided into the control and DD group. In the control group (629 patients) only US examination of lower limbs deep vein was done. All patients in the DD group (643 patients), with "unlikely" TDV, had DD, and in the positive patients US examination was done. In the "likely" patients US examination was done and negative US finding indicated DD test. Positive DD test was an indication for US examination after 7 days. The patients with initially excluded DVT were evaluated during 3 months. Results. A total number of 1 272 patients were examined; 117 (9.19%) patients were with DVT - 62 (9.64%) in the DD and 55 (8.74%) in the control group. During the follow-up periods in the DD group (with 582 initially excluded DVT) we registered DVT in only one patient (0.17%). It was significantly lower (p < 0.05) compared to the control group where we registered 7 (1.1%) DVT (a group with 581 initially excluded DVT). The applied DD diagnostic strategy for 70.7% (p < 0.001) reduced the need for US examination. Conclusion. The applied DD strategy in the diagnostic of DVT reduces the need for US examinations and reduces frequency of false negative results, with direct impact on cost and efficacy of procedures. DD diagnostic model should replace serial US examination in patients with suspect DVT. [ABSTRACT FROM AUTHOR]

Background. The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. Case report. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score - 7.1). We performed total rearthroplasty by a custom- made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score - 87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Conclusion. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specificaly for a patient) and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects. [ABSTRACT FROM AUTHOR]

Background/Aim. Pterygium internum presents a significant epidemiological problem. Its etiopathogenesis is still unclear. After surgical removal it shows great tendency to recidives. The aim of this paper was to investigate connection between histopathological characteristics (inflammation presence, vascularization degree and fibrinoid changes) of pterygium and its clinical characteristics (duration, size, pterygium grade, presence of Fuchs' spots and recidives) and determine indicators for recidives prediction. Metods. We analyzed the material taken from 55 patients operated by Arlthi's method. The samples were colored by using standard histochemical methods: hematoxylin-eosin (HE), trichrome Masson painting, Gomora reticulin and PAS technique. Results. Pterygium was mostly covered by epithelium resembling conjunctival, while in the frontal cap region it showed the morphology of plate-layer cornea epithelium. The structural basis of the epithelium was composed of continuous basal lamina and continuous adhesive fibres underneath. This adhesive basis showed fibrinoid changes in the form of oval islands of various size, parallel to convexity of pterygium, or in the form of unified focus. The number, caliber and type of blood vessels showed a pronounced variability. Duration of pterygium and its size were in negative correlation with intensity of inflammation, without statistical significance. Pterygium with a longer period of develepment had negative correlation with the degree of vascularization (p > 0.05). The presence of Fuchs' spots showed a statitistically significant positive correlation with the degree of vascularization (p < 0.05). The intensity of fibrinoid changes was higher in pterygium with Fuchs' spots and in those which recurred (p > 0.05). Conclusion. Histopathological analysis of pterygium morphological shapes is a good basis for the prediction of recidives, which present the greatest problem in the treatment of this widely spread disease. [ABSTRACT FROM AUTHOR]

Introduction. Anterior tibial muscle hernia is the most frequent lower extremities muscle hernia. The aim of this paper was to present a possibility of a new surgical technique for anterior tibial muscle hernia reparation. Case report. We presented three cases of anterior tibial muscle hernia in adolescents. The cases were diagnosed clinically and ultrasonographycally. In all three cases reconstruction was done with periosteal patch plasty of fascial defect. Conclusions. Easy approachable, cheap, autologous material, periost, in the frame of periosteal patch plasty, could be one of the possible solutions in anterior tibial muscle hernia treatment. [ABSTRACT FROM AUTHOR]

Background/Aim. Statins produce hipolipemic and pleotropic effects on markers of inflammation with stabilization of atheromatous plaque. The aim of this paper was to examine gender difference in hipolipemic and antiinflammatory effects of statins in patients with diabetes mellitus (DM) type 2 with coronary artery disease (CAD). Methods. Sixty dyslipidemic patients with DM type 2 were analyzed. Lifestyle modification and hipolipemic diet were applied in all patients divided into two groups: 30 patients with statins therapy (20 mg of simvastatin or equivalent dose of some other statins, during 3 months) and 30 patients without statins therapy. Estimation of obesity, quality of glicoregulation, and determination of inflammatory parameters: Creactive protein (CRP), fibrinogen, total and differential leukocyte count, intracellular adhesive molecules (ICAM-1), vascular adhesive molecule-(VCAM-1) and lipid profile (total cholesterol -- TC, LDL-C, HDL-C, triglicerides -- TG) were done. Results. Women with DM type 2 were more obese and had significant disturbances in lipid profiles, glicoregulation and inflammatory markers compared to men. Statins therapy significantly improved all lipid parameters and quality of glicoregulation in women, while there were only significant reduction of LDL-C and nonHDL-C in males. There were more significant reductions of inflammatory markers in women as compared to men with statins therapy. In the group without statins there was not such significant reduction. Concentration of ICAM-1 was the lowest in men on statins therapy, while there were no significant variability of VCAM-1 values between groups and genders. Conclusion. Women with DM type 2 and CAD have more prominent lipoprotein disorders and impaired glicoregulation with expression of enhanced proinflamatory state which could not be seen in men. Statins therapy exerts more favorable effects in women leading to stabilization of lipoprotein profiles, improvement of glicoregulation and reduction of inflammatory markers. More superior antiinflammatory effects of statins therapy in men were registered only in significant ICAM-1 reduction. [ABSTRACT FROM AUTHOR]

Background. Isolated cleft of secondary palate has a specific clinical picture due to a wide communication between the mouth and nose cavity. As a consequence of that, babies born with this malformation are often subject to infections of the upper bronchial tubes, middle ear, speech disorders, and certainly the most difficult existential problem they face at the very beginning of their lives, the impossibility of suckling (breast feeding). Such babies have to be fed with gastric probe. The difficulties in their nutrition have often been described in literature, yet a singular attitude toward early orthodontic therapy has not been adopted still. The aim of the paper was to describe a design and application of obturator immediately after the birth of a baby with isolated palatal cleft, and the role in feeding. Case report. We presented a female neonate, born on 27th December 2007, with a wide fissure in the shape of the letter U over the entire secondary palate. The baby was referred to the Stomatology Clinic due to nutrition impossibility. To avoid feeding with gastric probe, the formation of RB obturator was performed (artificial palate). Hereby, the procedure of obturator making with an explanation of its function is presented. Conclusion. The application of RB obturator and the necessary education of parents have a major role in shortening the time of breast feeding and increasing the amount of food intake and, thus, for the normal growth and development of newborn infants with isolated palate cleft. [ABSTRACT FROM AUTHOR]

Introduction/Aim. By analysing activity of some of the enzymes normally present in the saliva and the level of malondialdehyde in gingivitis, it is possible to estimate the functional condition of parodontium, and the examined parametres can be considered as biochemical markers of its functional condition. The aim of this paper was to examine activity of alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase and the level of malondialdehyde in the saliva of children affected with gingivitis, as well as the values of the mentioned parametres in relation to the level of the inflammation of gingiva. Methods. The research included 120 children at the age of 12.2 with permanent dentition. Löe and Silness gingival index was used to estimate the condition of gingiva, based on which the childen were classified into four groups: the children with healthy gingiva (the control groups), the children with mild, moderate and severe inflammation of gingiva (the study group). Enzymes of the saliva were determined by the use of original tests and measured by the autoanalyser (Bio Systems A25, Spain). A modified method with tiobarbituric acid was used to determine malondialdehyde in nonstimulated mixed saliva. Results. The results of the examined enzyme activity and the level of malondialdehyde in the saliva of the study groups showed statistically considerably higher values for the level of malondialdehyde (p < 0.001), for the activity of aspartate aminotransferase and gamma glutamyl transferase (p < 0.01), as well as for alanine aminotransferase (p < 0.05) in comparison with the control group, whereas the activity of lactate dehydrogenase did not show a statistically significant increase. In relation to the level of the inflammation of gingiva, the results of the examination of the enzyme activity in the study groups showed statistically significantly higher values in the group with severe inflammation in comparison with those with mild, as well as the moderate inflamatiory, except for the gamma glutamyl transferase, and in the group with moderate inflammation compared to that with the mild one, except for alanine aminotransferase. The results of the examination of the level of malondialdehyde in the saliva of the study groups did not show a statistically significantly increase in relation to the level of the inflammation of gingiva. Conclusion. There is a higher level of alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase and lactate dehydrogenase enzyme activity together with the higher level of malondialdehyde in the saliva of children with gingivitis in comparison with the activity of the same enzymes and the level of malondialdehyde in the saliva of children without gingivitis. The activity of the examined enzymes in the saliva of children with gingivitis increases in relation to the intensity of the pathological process, whereas the level of malondialdehyde shows no significant difference in relation to the level of the inflammation of gingiva. [ABSTRACT FROM AUTHOR]

Background/Aim. Hand injuries in agriculture are characterized by massive destruction of all tissues, frequent amputations of finger, hand and often the whole extremity. These injuries are mutilant and can cause death. The aim of this paper was to show the specificities of hand injuries in agriculture in regard to hand injuries of other etiology. Methods. We analyzed patients that were treated in the Departement for Plastic and Reconstructive Surgery, Clinical Center Vojvodina, during a five-year period (2003-2007) because of hand injuries. Results. In a five-year period there were 366 patients hospitalized because of hand injuries, out of whom 36 injuries were related to agricultural machinery use. In both groups the number of patients trended to increased, with male gender being dominant. Most of the patients were young or middle-aged men. In agricultural injuries most of the patients were in the group of 41-50-year old (30%), while in the other group, the patients were younger (21-30-year old). Hand injuries in agriculture resulted in finger amputation in 92%, while in the other group that number was much smaller (13%). Skin defect reconstruction in agricultural injuries required complex methods of skin grafting or skin flaps in more than 71%, while this was necessary in only 10% of other hand injuries. Conclusion. Hand injuries in agriculture are very mutilant and often result in conquassation and finger amputation. A possibility to preserve tissue damaged in this way is very limited, and skin closer usually requires complex methods. [ABSTRACT FROM AUTHOR]

Background. The most important predictors of longterm survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV) volume, ejection fraction (LVEF) and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC) in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. Case report. We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia). He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO) and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber, BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche) was applied deeply subcutaneously, every second day from 2 000 IU to totally 16 000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity abnormal motion and wall thickening for all segments. Left ventricle end-diastolic volume was 393 ml (normal < 142 ml), and LV end-systolic volume was 334 ml (normal < 65 ml). Four months after the therapy G-SPECT showed improvement in any parameters; LVEF 25%, with improvement in wall motion (normalized wall motion in the anterior, lateral area, and proximal septum) and wall thickening, LV end-diastolic volume was 390 ml, LV end-systolic volume was 289 ml. Conclusion. Using G-SPECT method before and after the therapy with hyperbaric oxygenation and erythopoietine we obtained objective improvement and good therapy effects in the treatment of chronic heart insufficiency. [ABSTRACT FROM AUTHOR]

Background/Aim. Vascular cell adhesion molecules-1 (VCAM-1) and intercellular cell adhesive molecules-1 (ICAM-1) play an important role in developing and progression of coronary atherosclerosis. The aim of the paper was to compare concentrations of soluble forms of VCAM-1 and ICAM-1 in patients with different clinical presenations of coronary artery disease (CAD) and patients without CAD. Methods. Blood samples were taken from 25 patients with acute myocardial infarction (AMI), 25 patients with unstable angina pectoris (UAP), 25 with stable angina pectoris (SAP) and from 15 control patients without CAD, and concentrations of solubile adhesive molecules (VCAM-1, ICAM-1) were determined. Results. Obesity was more prominent in the NAP than in the SAP and the control patients (p < 0.05). There were no significant differences in gender distribution, age, duration of the CAD and body mass index between the groups. Hypertension and diabetes mellitus type 2 were more frequent in the CAD patients than in the controls (p < 0.01). Family history of the CAD was more frequent in the AMI and the UAP group than in the controls (p < 0.05). Serum concentrations of VCAM-1 was similar in the patients with AMI (955.9 ± 117.8 ng/mL), UAP (952.4 ± 139.1 ng/mL) and SAP (931 ± 169.8 ng/mL), and significantly higher in these groups compared with the controls (823.4 ± 97.6; p < 0.05, p < 0.05 and p < 0.1 respectively). Serum concentration of ICAM-1 was similar in the patients with AMI (699.2±125.6 ng/mL), UAP (727.6±171.8 ng/mL) and SAP (697.5±165.6 ng/mL), and significantly higher in these groups compared with the controls (583.4 ± 86.6; p < 0.1, p < 0.05 and p < 0.1 respectively). Conclusion. Increased concentrations of VCAM-1 and ICAM-1, as markers of inflammation, showed the importance of inflammatory processes in development of atherosclerosis and clinical expresion of CAD. Measurement of soluble ICAM-1 and VCAM-1 concentrations is a usefull indicator of atherosclerosis presence but not severity of CAD clinical presentation. [ABSTRACT FROM AUTHOR]

Background/Aim. In December 2001, an outbreak of trichinellosis spreaded in a military unit. The aim of this paper was to show possibilities and consequences of trichinellosis infestations in military units during peace time, as well as to improve knowledge and awareness of medical corps personnel, commanders and soldiers about this disease. Methods. A descriptive and analytical epidemiological models were used to find out a source of outbreak and to identify the ways of its transmission. Results. This outbreak was caused by the contaminated raw smoked sausage which had not undergone health inspection and brought from civilians to a military unit. Thirty-eight persons were exposed, twenty-one affected and hospitalized. The most frequent symptoms reported were fever (76.2%), myalgia (76.2%), palpebral edema (42.8%), face edema (19.0%) and diarrhea (14.3%). Test for indirect immunofluorescence was positive in 14.3% and ELISA test was positive in 28.6% of the patients. Eosinophilia was present in 85.7% of the affected. IgE values were increased in 28.6% and CPK values were increased in 61.9% of the diseased. All of the 17 exposed undiseased had negative laboratory analyses for trichinellosis. Conclusion. We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs. A well-tuned, fast-reacting epidemiological monitoring system has to be obligatory. [ABSTRACT FROM AUTHOR]

Background. Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. Case report. This paper presents a 44-year old male patient with carotidcavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. Conclusion. Embolization of complex carotidcavernous fistula type A was successfully performed with platinum coils by endovascular approach. [ABSTRACT FROM AUTHOR]

Bacground/Aim. Major aims of mechanical ventilation (MV) in pediatrics mean the contribution to complete recovery of acute disorder or to establishing stability of previously longterm changed health condition. MV is used today in 16-46% of patients treated in pediatric intensive care units. The aim of this paper was to get insight into the presence of the disease and pathologic conditions and outcome of MV regarding previous health condition of pediatric patients. Methods. This retrospective study included 476 pediatric patients (beyond neonatal age) who underwent mechanical ventilation (MV). On the basis of previous health status the patients were classified in two groups: the group A consisted of 157 children with no previous chronic disease leading to MV and the group H comprised of 319 children who received MV due to worsening of previous chronic disease. Results. In both groups of pediatric patients there was significant predominance of younger age patients. Acute and chronic neurological disorders were the most frequent conditions requiring use of MV. Out of a total number (476) of the patients, 178 patients (37.4%) died. In the group A 17 patients (10.9%) died, while in the group H mortality rate was significantly higher (161 or 50.5% patients died; p < 0.01; RR 4.85; CI 3.1-7.6). Total duration time of MV in all the patients was 7 525 days, with 1 345 days (15%) accounted for the group A and 4 567 days (85%) for the group H. Mean MV duration was 7.48 (± 9.23) days for the patients in the group A which is significantly shorter in comparison to mean 21.8 (± 57.96) days for the group H patients (p < 0.001). Conclusion. These results point out significant contribution of MV to better outcome in pediatric patients with different acute disorders. Clear dominance of chronically ill children requiring mechanical ventilation due to acute worsening of their condition implies new complexity of problems regarding organization of pediatric intensive care and treatment. [ABSTRACT FROM AUTHOR]

Background/Aim. Renal carcinoma represents histologically heterogeneous group of malignant tumors, with various clinical aggressiveness. The frequency of p53 mutation in primal renal carcinoma is rare, although there are information about its heterogeneous accumulation. The loss of protein p16 expression in primal renal carcinoma is detected in 20-30% of the cases. The aim of this paper was to determine frequency of mutated protein p53 and expression of protein p16INK4a in renal carcinoma, to analyze their correlative relation and relation with the examined clinicopathological parameters. Methods. The examination included 12 patients (66.7% men, 33.3% women), with patohistologically verified renal carcinoma. Expression of mutated form of protein p53 and protein p16 was determined in tissue samples, by immunohistochemical analysis using of mice monoclonical antibodies produced by DAKO, Denmark. Results. In 9 (75%) of the cases was detected mutated protein p53, of whom 66.6% had higher histological gradus of tumor (G3-4) and higher pathological stadium of the disease (pT3a-b) at the same time. In 7 (58.3%) and 5 (41.7%) of the cases expression of protein p16, the loss of expression of protein p16 were detected respectively. A statistically significant positive correlation was determined between pathological stadium of disease (TNM) and the degree of tumor differentiation (G) (ρ = 0.834; p < 0.001), as well as between TNM and mitotic index (ρ = 0.622; p = 0.031). Conclusion. A mutated form of protein p53 exists in 75% of the cases with the renal carcinoma and 66.6% of then have higher histological gradus of tumor and higher stadium of tumor disease at the same time. Coexpression of mutated protein p53 and protein p16INK4a in renal carcinoma is not statistically significant and it is not in correlation with clinicopathological parameters. Immunohistochemical analysis of mutated protein p53 in renal carcinoma can have predictive significance. [ABSTRACT FROM AUTHOR]

Background/Aim. Comorbidity of the posttraumatic stress disorder (PTSD) and depression is often recognized in the clinical practice. The aim of the paper was to determine the severity of depression and the group of symptoms which are the most prominent in clinical depression comorbid with PTSD. Methods. Totally 60 patients were assessed and divided into the experimental and control group using the Structured Clinical Interview for DSM-IV Axis I Disorders, Investigator Version (SCID-I, modified) (SCID for DSM-IV) and ICD-10 diagnostic criteria. The presence and the severity of the disorders were assessed by means of the following intruments: Clinician-Administrated PTSD Scale for DSM-IV (CAPS-DX), Montgomery-Asberg Depression Rating Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HAMD). The differences between groups were evaluated using Student t test and by means of the correlational analysis of the data with p < 0.05. Results. The obtained results showed that depression wich was comorbid with PTSD was of significant clinical severity with 31.20 score on HAMD and 30.43 score on MADRS in PTSD-D group. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression on MADRS. The group of the symptoms: suicide and somatic symptoms, gastrointestinal, guilt, hypochondriasis, work and activity, anxiety psychic, agitation, and weight loss, genital symptoms and anxiety somatic contributed mostly to the global severity of comorbid clinical depression on HAMD. The average score was 16.03 and 16.97 on HAMD and MADRS, respectively in PTSD group. Conclusion. Depression which is comorbid with posttraumatic stress disorder represents significant clinical entity with domination of the different groups of simptoms between the groups PTSD and PTSD-D on HAMD. Identification of aforementioned severity of illness and delineated group of symptoms lead the clinician to establish the diagnosis of depression, reduce the risk of diagnostic ommition of the depression and enable the clinician to chose the optimal treatment method for the delineated disorders. [ABSTRACT FROM AUTHOR]

Introduction/Aim. Anthropometric methods of measuring the whole body and body parts are the most commonly applied methods of analysing the growth and development of children. Anthropometric measures are interconnected, so that with growth and development the change of one of the parameters causes the change of the other. The aim of the paper was to analyse whether dental development follows the overall growth and development and what the ratio of this interdependence is. Methods. The research involved a sample of 134 participants, aged between 6 and 8 years. Dental age was determined as the average of the sum of existing permanent teeth from the participants aged 6, 7 and 8. With the aim of analysing physical growth and development, commonly accepted anthropometric indexes were applied: height, weight, circumference of the head, the chest cavity at its widest point, the upper arm, the abdomen, the thigh and thickness of the epidermis. The dimensions were measured according to the methodology of the International Biological Programme. The influence of the pertinent variables' related size on the analysed variable was determined by the statistical method of multivariable regression. Results. The middle values of all the anthropometric parametres, except for the thickness of the epidermis, were slightly bigger with male participants, and the circumference of the chest cavity was statistically considerably bigger (p < 0.05). The results of anthropometric measurement showed in general a distinct homogeneity not only of the sample group but also within gender, in relation to all the dimensions, excyt for the thickness of the epidermis. The average of the dental age of the participants was 10.36, (10.42 and 10.31 for females and males respectively). Considerable correlation (R = 0.59) with high statistical significance (p < 0.001) was determined between dental age and the set of anthropometric parameters of general growth and development. Conclusion. There is a considerable positive correlation (R = 0.59) between dental age and anthropometric parameters of general growth and development, which confirms that dental development follows the overall growth and development of children, aged between 6 and 8 years. [ABSTRACT FROM AUTHOR]

Background/Aim. Pulmonary sequestration is a congenital malformation which consists of afunctional part of the lung, separated of the normal airway, and vascularisated with anomal systemic artery instead of pulmonary artery. There are two kinds of sequestration. Intralobar is surrounded with normal lung and its pleura, and extralobar which has extrapulmonary position and pleura of its own. This anomaly is very rare and appears in 1.1-1.8% of all congenital lung malformations. The illness is revealed either in early childhood whith other life-threatening anomalies or in adulthood and middle age when secondary infection arises. The aim of this paper was to show our own experience in surgical treatment of pulmonary sequestration and to emphasize sequestration as a real differential-diagnostic possibility with patients with recidive bronchopneumonias. Methods. We retrospectively analyzed medical records for the period from 1967-2007 and found 15 patients with pulmonary sequestration at the average age of 30 years. We pointed out the well known problems with identification of this anomaly, preoperative diagnostic procedures and surgical possibilities of treatment. Results. There were 13 patients with intralobar and two patients with extralobar sequestration. By the use of preoperative angiography, seven patients were found to have intralobar pulmonary sequestration. All intralobar sequestrations were clinically manifested, the most often with recidive bronchopneumonia. Six patients had no preoperative diagnosis of lung sequestration. The most common locality of intralobar sequestration was the left lower lobe (eight patients). We performed nine lobectomies, three sequestrectomies, two segmentectomies and one pneumonectomy. Both extralobar sequestrations were diagnosed intraoperatively. Conclusion. Pulmonary sequestration is a rare malformation. Diagnosis is established by angiography. Treatment is exclusively surgical. In the last three years we have had one patient per year. This experience obliges to consider pulmonary sequestration as a real differntial-diagnostic possibility in patients with localised repeated bronchopneumonias. [ABSTRACT FROM AUTHOR]

Background. Somatostatinomas of the gastrointestinal tract secret hormon somatostatin which can cause "inhibitory syndrom" comprising diabetes mellitus, cholelithiasis and steatorrheic diarrhea. It is also secreted by the D cells of Langerhans's islands of the pancreas as well as endocrine cells of the stomack, small bowel, salivary glands and parafollicular cells of the thiroid gland. Somatostatinomas of the digestive tract appear within the pancreas and duodenum. Patients suffering from von Recklinghausens's disease are paticularly prone to the somatostatinomas of the duodenum. Case report. In this paper we presented a 51-year old female patient with von Recklinghausen's disease in whom, during the investigation for obstructive jaundice, tumor of the Vater's papilla was found. The patient was submitted to Whipple's duodenopancreatectomy. Histology and immunohistochemistry discovered type B glandular carcinoid tumor with strong antisomatostatin and mild antigastrin immunoreactivity. The patient stayed symptom-free more than four years now. Conclusion. Patients with von Recklinghausen's disease should be examined for other tumors, particularly carcinoids of the duodenum and papilla, especially if the signs of cholestasis are present. [ABSTRACT FROM AUTHOR]

Background. Villous duodenal adenomas are rare, tend to malignant alteration and recurrency if surgical procedures are not sufficiently radical. They are mostly localized in the second portion of the duodenum and close to a papilla and are prone to malignant alteration. Case report. In this paper we presented a 79-year-old female patient already operated on twice elsewhere due to obstructive jaundice caused by villous duodenal adenoma, using, firstly, cholecystectomy and T-tube drainage of the choledoclus, and, then, an unsuccessful attempt of radical surgery -- duodenopancreatectomy. The patient was some time wearing a T-tube drainage, and, then, submitted to endoscopic papillotomy, endoscopic stenting, and, finally to the insertion of a self-expandable metallic stent which got clogged three months later causing chalangitis. Three years following the first surgery, the patient presented to our institution and submitted to cephalic duodenopancreatectomy. Histology confirmed villous duodenal adenomas with II and III grade dysplasia and carcinoma in situ. The limph nodes were tumour-free. The postoperative recovery was somewhat prolonged due to cardiologic difficulties and a mild infection of the wound. Conclusion. Villous duodenal adenoma is curable if treated correctly and in a proper time. Radical treatment delay increases the risk for malignant alteration which was the case with our patient who was submitted to it three years after the histologic confirmation of the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction. Bartonella henselae is included into the group of gramnegative bacteria that can cause not so rare disease known as catscratch disease (CSD). This disease is characterized by the specific general symptoms, and the complications in the eyes can be manifested in the form of neuroretinitis, follicular conjunctivitis and focal chorioretinitis. In this paper clinical and epidemiological characteristics of a patient with ophthalmologic complications caused by Bartonella henselae are described. We indicate diagnostic possibilities and the criteria for making the diagnosis. Case report. We presented a 42-year-old female patient with CSD symptoms, and with a registered neuritis as an ophthalmologic complication. Two weeks after the occurrence of a scratch on the hand after the contact with a cat, there was a slight lymphadenopathy of the axial area of the left side, accompanied by light febrility and weakness. A week after these symptoms occuring, the patient complained of a reduction of the visual acuity in her left eye. The established visual acuity in the left eye was 0.1 with ophthalmological findings of a light edema of the optical disk and a partial star-like edema in the nasal half of the macula. Central scotoma was present, with the extension of the blind spot and the constriction of central isopter of the left eye visual field. Fluorescein biomicroscopy revealed an intensive leaking of fluoresceins at the level of optical disk and macular region in an early arterial phase, without the appearance of pathological phenomena at the level of retinal blood vessels. With the application of doxycyline 100 mg two times a day, and systemic application of prednisolone (at the initial doses of 120 mg), after a two-week period, there was a full recovery of the visual acuity, out the optical disk edema, and the presence of light edema in the left eye macula receded. The complete disappearance of the edema in the macula was registered four weeks following the application of the therapy. Conclusion. Cat-scratch disease can be recognized by means of characteristic general symptoms, and it must be considered in persons with ophthalmologic picture of neuroretinitis. In spite of the good prognosis for the general condition of a patient, it is advised to apply antibiotic therapy in the cases where ophthalmologic complications appear. We recommend the application of doxycyline 100 mg two times a day, for a month. When pronounced edema of the optical disk and edema in the macula are present, a systematic application of corticosteroids is necessary. [ABSTRACT FROM AUTHOR]

Background/Aim. Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL) contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. Methods. The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type). In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG) or a graft of the patellar ligament (B-Pt-B). Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. Results. The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft) in 139 of the knees. Chronic injuries were revealed in 132 (94.9%) of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9%) of the knees, pain in 72 (51.7%), effluents in 24 (17.2%), and blockages in 13 (9.3%). Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. Conclusion. On the basis of these findings, we can conclude that this method is the method of choice in preventing further "worsening" of the chronically instable knee. The surgical technique of choice is arthroscopically assisted reconstruction using a B-Pt-B or STG graft. [ABSTRACT FROM AUTHOR]

Background. Renal injuries are most often caused by traumatic injuries, but they can also be induced iatrogenically, during renal biopsy, percutaneous nephrostomy or lithotripsy. Vascular renal injuries may be treated by embolization, nonsurgical or surgical methods. Case report. In this paper we presented a high-risk patient with poor outcome of an open surgery threatment and a prior attempt of embolization, with gross haematuria caused by traumatic renal arterio-venous (AV) fistula and pyelocalical injury who was managed by supraselective embolization of the irrigating arterial vessel. Conclusion. Supraselective embolization is a first choice method for the treatment of low grade renal vessel injuries. Even patients with the most severe renovascular lesions and major renal destruction (a grade IV injury) can be treated nonsurgically with supraselective embolization, with an excellent chance to preserve the maximal amount of functional renal parenchyma. This method is rapid, effective, tissue preserving, and likely to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background. Autoimmune hepatitis is a chronic inflamatory disease of the liver of unknown etiology, characterized by the loss of tolerance against hepatic tissue, leading to the destruction of hepatic parenchyma. It predominantly affects females, and rarely occurs in the same family. Case report. In this paper we presented brother and sister with autoimmune hepatitis according to the criteria of the International Autoimmune Hepatitis Group. Conclusion. Because of a possible genetic predisposition to autoimmune hepatitis, the occurrence of the disease in a family member suggested the need to examine other family members. [ABSTRACT FROM AUTHOR]

This paper analyzes the reliability of the Işcan's sternal rib-ends phase method for the assessment of individual age at the time of death in the Balkan population. The method is based on the morphological age changes of the sternal rib ends. The tested samples consisted of 65 ribs from autopsy cases in the Institute for Forensic Medicine, University of Belgrade, during 1999-2002 (23 females, and 42 males of various ages, ranged from 17-91 years), according to the forensic documents. Significant differences between the real chronological age of the individuals and the values established by the Işcan's method was found, especially in the older categories (phases 6 and 7), in both males and females. The results of the discriminative analysis showed the values of the highest diagnostic relevance for the assessment of age in our population: the change of the depth of the articular fossa, the thickness of its walls, and the quality of the bones. [ABSTRACT FROM AUTHOR]

Background. High-dose chemotherapy followed by hematopoietic stem cell support can be used as a first-line treatment in patients with germ-cell tumor (GCT) with poor prognosis. Long-term survival rate is attained in 50% of these patients. The aim of this paper was to present the experience at the Department of Hematology, Military Medical Academy, with high-dose cytostatic therapy as first-line chemotherapy in GCT patients with poor prognosis. Methods. Between 1997 and 2003, five patients with high-risk germ-cell tumors were treated with high-dosage chemotherapy followed by an autologous stem cell transplantation. All the patients were with non-seminomatous germ-cell tumors with mixed histology, and one was with extragonadal retroperitoneal germ-cell tumor. Results. The follow-up period ranged from 8 to 33 months. Three patients achieved complete remission, two patients only partial remission, and one was not followed-up. One patient was with residual tumor resection, using retroperitoneal lymphadenectomy, after autologous stem cell transplantation. All the patients were treated according to standard protocols. Conclusion. Early high-dose chemotherapy associated with hematopoietic stem cell support as a first-line treatment in the patients with germ-cell tumor with a poor prognosis, represented an efficient treatment modality. [ABSTRACT FROM AUTHOR]

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 analysed: 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 interprete the renal scintigraphy with more accuracy and objectivity. [ABSTRACT FROM AUTHOR]

Although a common disease, conversion disorder still calls attention in the clinical practice. A case of conversion disorder, diagnosed as a psychogenic aphonia that persisted for a week, was reported in this paper. A 21-year-old woman developed symptoms after breaking off a long-lasting relationship with her boy-friend. History revealed that she was introvert with high neuroticism and communication problems. Cognitive-behavioral therapy was used. After the positive reinforcement in the therapy of her aphonia, assertion training for the development of communication skills was performed. In the end, cognitive restructuring was used to prevent relapse in regard to her actual life situation of being a refugee preparing for immigration to Australia. [ABSTRACT FROM AUTHOR]

Background. This paper presents our first experience in the treatment of primary anal fissure by injection of botulinum A toxin into the internal sphincter. Methods. The study group of the retrospective study included 12 outpatients (8 females and 4 males), mean age 42 (range 18-60). During the period 2000-2003, after unsuccessful conservative treatment, patients were treated with the injections of botulinum A toxin, 100 units on both sides of the anal fissure laterally into the internal anal sphincter (50 units on either side). The patients were clinically evaluated 3, 7, and 30 days, and 3 and 6 months after the treatment. Results. Three fissures had healed after a month, and seven after 3 months. Two remained unhealed, but asymptomatic. There was no incontinence of flatus or faeces after 3 months of the treatment. After temporary healing, two fissures relapsed after 6 months, and these patients had the adequate tonus of the anal sphincter muscles. Except for the temporary incontinence, there were neither other side-efects, nor serious complications. Conclusion, injection of botulinum A toxin achieved good results in the treatment of anal fissure. The appropriate use makes this method safe as an alternative to surgical treatment of anal fissure. [ABSTRACT FROM AUTHOR]

Background. Castleman's disease is an atypical lymphoproliferative disorder characterized by angiofollicular hyperplasia of lymph nodes. Histologically, it can be classified into a hyaline-vascular type, plasma-cell type, and transitional (mixed-cell) type, while clinically localized type has been classified as unicentric, or generalized (multicentric) form of the disease. Case report. This paper presents a 21 years old male patient with multicentric Castleman's disease, a transitional (mixed-cell) type. The disease was manifested by fever, generalized enlargement of peripherial lymph nodes, breast glands enlargement, hyperemia of the face, and weakness of the lower extremities. We found mediastinal lymphadenopathy, pleural and pericardia! effusions, sensorimotor peripherial neuropathy and polycional hypergammaglobulinemia. The simultaneous presence of these manifestations of the disease (sensomotor peripheral neuropathy, lymphadenopathy, effusions, endocrinopathy, polydonal gammaglobulinemia and skin changes) is indentified as POEMS syndrome. The diagnosis of Castleman's disease was based on the results of histopathologic analysis of mediastinal lymph node biopsies after thoracotomy. The patient was treated with corticosteroids (prednisone 80 mg daily for 2 weeks followed by 60 mg daily). A partial response was achieved after 4 months of treatment. Conclusion. A transitional type of multicentric Castleman's disease may be present itself as POEMS syndrome. The effect of corticosteroid therapy in this form of the disease is unpredictable. [ABSTRACT FROM AUTHOR]

The patient presented in this paper was admitted to the hospital for the evaluation of radiologlcally revealed shadow in both lungs. In the course of diagnostic procedures, fine needle aspiration biopsy of the intrathoracic mass was performed. Cytologic analysis of the smear was performed because of clinical suspicion of plasma cell proliferative disease that was confirmed by bone marrow aspiration. Thus, the cytologic finding of intrathoracic lesion preceded the diagnosis of multiple myeloma. [ABSTRACT FROM AUTHOR]

In patients with chronic respiratory diseases that last since the early childhood, primary ciliary dyskinesia (PCD) needs to be considered. Four patients reviewed in this paper were with typical disease history and clinical picture, as well as clear ciliary axonema damage. Complete examination was performed in all the patients, including bronchoscopy with bronchography, and the examination of the biopsy samples of respiratory airways' mucous membrane, obtained by transmission electron microscope (TEM). In two of the patients spermatozoa were also examined by TEM. Large anatomic deflects of airways were found in all the patients, but pulmonary function was normal (except in one case), representing one of PCD's significant characteristics. First two cases fulfilled the criteria for Kartagener's syndrome, which was initially sufficient for the diagnosis of PCD. [ABSTRACT FROM AUTHOR]

In this paper a 21 year old patient was presented with Ménétrier's disease, associated with ulcerative colitis. The first symptoms of ulcerative colitis occured at the age of eleven, since when the patient has been conservatively treated several times because of the exacerbations of the desease, During control examinations presence of polipoid changes in stomach was discovered by upper endoscopy. Gastrectomy was suggested because the patient had excessive anemic syndrome which required weekly substitutional therapy with deplasmatic eritrocytes, as well as hypoproteinemia, while multiple polipoid changes suspect for malignancy were gastroscopically identifided. Patient accepted surgical treatment, and was transfered to the Clinic of Surgery. Total gastrectomy was performed, and patohystological finding confirmed Ménétrier's desease. After two weeks, the patient was released from the hospital in good general condition, with regular clinical and laboratory findings. [ABSTRACT FROM AUTHOR]

Pertrochanteric fractures usually occur in patients over 65 years of age, with greater loss of skeletal mass (osteoporosis). Nonsurgical methods of treatment are accompanied by relatively high lethality rate. Moreover, they do not produce satisfactory anatomical and functional results. Surgical treatment by using dynamic implants represents a method of choice in the fixation of pertrochanteric fractures. This paper presents the treatment results of 110 patients, 61 with pertrochanteric fractures, who were surgically treated by the dynamic method of internal fixation, and 49 patients who were treated by the method of external fixation. Dynamical implants enabled both dynamization and compression of the fracture in the axis of the neck, as well as the diaphysis of the femur, which lowered the risk of mechanical complications, and, at the same time, provided effective healing of the fracture, early activation, and mobilization of the patients on whom the surgery was performed. In patients infected by various diseases, for whom surgical trauma represents a life threat, the external fixation is recommended as a method of choice. [ABSTRACT FROM AUTHOR]

Background. The aim of the study was to evaluate the quality and persistance of esthetics of dedicated inlay by clinical methods. Methods. The paper reviews the clinical significance and technique of preparing particular composite inlays before and after the construction of the metallic framework partial denture. On the basis of Indications the total of 30 inlays were placed into cavities under relatively dry working conditions. Six, twelve, eighteen and twenty-four months after the placement of filling, control check-up was carried out by Ryge criteria. Results. After two years marginal discoloration as well as the change of the colour occured in 3.3% of inlays. There was neither detectable secondary caries, nor the symtoms of pulpal damage. The requirements to be fulfilled concerning the composite materials, in order that they can be implemented for this purpose, were also discussed. Conclusion. From the clinical point of view, purpose inlays from Herculite XRV lab C8B in combination with Opti Bond System and composite cement Porcelite Dual Cure showed high functional and esthetic values in the observational period of two years. [ABSTRACT FROM AUTHOR]

This paper presents 4 patients with chylothorax, and one patient with bilateral chylothorax and chyloperitoneum. The chylous effusions were of benign etiology, developed as a complication of miliary tuberculosis (1 patient), after L-2 vertebral body fracture (1 patient), and Idiopathic (2 patients). The diagnosis was confirmed by the presence of chylomicrons and high content of triglycerides in the effusion, ranged 11,9-29,1 mmol/l. Lymphangiography showed multiple abnormalites of lymphatic system, the obstruction of ductus thoracicus, dilatation and convulsion of lymphatic channels, but the site of lymphatic leak was not detected. The treatment included an extended period of pleural and peritoneal drainage with total parenteral nutrition (1 patient), pleurodesis using Corynebacterium parvum (2 patients), and surgical partial parietal pleurectomy with continous drainage (1 patient). The treatment was successful in all patients. [ABSTRACT FROM AUTHOR]

A 'new' group of pathogenic agents, enterohemorrhagic Escherichia coli (EHEC) (particularly the strains of O157 serogroup), emerged in the last 20 years, causing an increased number of sporadic and epidemic diarrhoeal diseases with hemorrhagic enterocolitis as a most common clinical manifestation of the infection. As a consequence of the absorption and cytotoxic effect of the main virulence factor of these bacteria -- verotoxin (shiga-toxin), in about 10% of the affected persons extraintestinal complications, most frequently hemolytic-uremic syndrome (HUS), occurred 7-14 days after an episode of diarrhoeal disease. The first case of hemorrhagic enterocoiitis with the documented EHEC O157 infection in Yugoslavia is presented in this paper. Considering the existing expansion trend of these carriers, practitioners should be aware of them in case of the occurrence of diarrhoeal disease, (particularly hemorrhagic enterocolitis), and keep these patients under control during the reconvalescence period because of potential development of extraintestinal complications, such as HUS. [ABSTRACT FROM AUTHOR]

Background. This paper presents our experience with cytologic examination of urine in diagnosing renal allograft dysfunction. Methods. The study group included 23 patients with renal allograft dysfunction, selected from 56 patients who underwent renal transplantation. Etiologic diagnosis was made according to the clinical picture, histological findings during allograft biopsy, and cytologic examination of urine. Urine sediment was obtained in cytocentrifuge and was air dried and stained with May Grunwald Giemsa. Results. Out of 23 patients with allograft dysfunction in 18 (78.3%) patient it was caused by acute rejection, and in 5 (8.9%) patients by allograft infarction, cyclosporine nephrotoxicity, acute tubular necrosis and chronic nephropathy. In eighteen patients (78.3%) cytologic examination of urine was pathologic, while in 16 (70%) clinical and histology findings coincided with urine cytology findings. Out of 18 patients with acute allograft rejection in 15 patients cytologic examination of urine coincided with acute rejection. Out of 7 patients with expressed cyclosporine nephrotoxicity, in 5 cytologic examination of urine confirmed the cause of allograft dysfunction, as well as in one of 2 patients with acute tubular necrosis. Cytologic examination of urine indicated parenchymal damage in 2 patients with reccurent disease (membranoproliferative and focal sclerosing glomerulonephritis). In 4 of 5 patients suffering from chronic rejection in a year's monitoring period, urine sediment periodically consisted of lymphocytes, neutrophilic leucocytes, monocyte/macrophages, tubular cells and cilindres, without the predominance of any cell type. In 3 patients allograft dysfunction was caused by infective agents (bacteria, fungus, cytomegalovirus). Conclusion. Cytologic examination of urine might be an alternative to histological in diagnosing acute allograft rejection and acute tubular necrosis or nephtotoxicity. Also it might indicate parenchymal disease while the importance of urine cytology in chronic allograft nephropathy needs to be investigated further. [ABSTRACT FROM AUTHOR]

This paper presents a combined surgical-prosthetic procedure of reconstructing mandibular bone defect in a 53 year old patient, following enucleation of a mandibular cyst (Cystectomy Partsch II). After a thorough diagnostic evaluation, a surgical procedure was planned with the particular attention to the nature of the disease, patient's condition, size and extension of the cyst, tissue loss, and the possibilities of prosthetic management of a mandibular bone defect with partial postresection dental prosthesis. It is of great importance to point to the significance of teamwork of a maxillofacial surgeon and a specialist in prosthodontics. This kind of cooperation provided very effective and less risky soft tissue, as well as bone tissue regeneration (osteogenesis). The patient's recovery was fast, and he could return to his daily activities and work without significant changes regarding quality of life after surgery and prosthetic treatment. [ABSTRACT FROM AUTHOR]

Fulminant hepatitis, or fulminant hepatic failure, is defined as a clinical syndrome of severe liver function impairment, which causes hepatic coma and the decrease in synthesizing capacity of liver, and develops within eight weeks of the onset of hepatitis. Several independent factors influence the survival of patients: age, the cause of liver disease, the degree and the duration of encephalopathy in relation to the onset of the disease, and the prevention of complications. Over the years many intensive treatments have been practiced. Liver transplantation is expensive, and patients who survive transplantation require life-long immunosupression, clinical care and complications management. Without transplantation fulminant hepatitis and hepatic failure might be completely recovered spontaneously, and the patient could expect a normal life, Two cases of fulminant B hepatitis with intensive care treatment, and their survival despite unfavorable prognosis are presented in this paper. The menagement of patients with fulminant hepatitis required intensive monitoring and therapeutic measures, including corticosteroids. The prognosis for survival without transplantation in fulminant hepatitis is limited by the measures of medical treatment and new specific therapeutic modalities which must be developed through basic research. [ABSTRACT FROM AUTHOR]

Background. The aim of this paper was to determine whether the surgery on vertical muscles of the eye influenced the change in refraction and visual acuity. Methods. This prospective study included testing of 79 children with infantile esotropia who suffered from the vertical strabismus after the surgery on horizontal muscles. Patients were divided into two groups: the first group of 52 children (the test group) had only vertical component (overaction of m. obliqui inferior) and the second group (the control group) had two vertical components (dissociated vertical deviation -- DVD and overaction of m. obliqui inferior). Refraction and visual acuity were tested before the surgery on the vertical muscles and one month and six months after the surgery. There was no significant difference between the results of the objective refraction in those three different periods of time. Results. In both groups mild hypermetria (according to Costenbander) occurred in 40-48% of the examinees of both groups, while moderately-expressed hypermetropia occurred in 40-50% of the examinees. There was neither statistically significant difference between the results of the three observed measurings among every group, nor between the observed groups of patients (p>0,05). By the analysis of the results of visual acuity it could be concluded that it was significantly improved 6 months after the surgery on cyclovertical muscles. This change was more significant in the sample group of patients (p<0,01) than in the children from the control group (p<0,05), who were much older. Conclusion. Objective refraction in patients was in the range of low values of hypermetropia (+2.00 Dsph - t 3.00 Dsph). Significant improvement of visual acuity occurred 6 months after the surgery performed on vertical muscles of the eye. These results were achieved by the repeated measuring of objective refraction and the precise correction of every new accommodative element. [ABSTRACT FROM AUTHOR]

This paper presents a case of a sixteen-year-old female patient with a genesis of corpus callosum which was accidentally discovered during etiological investigation of the consciousness disorder. Agenesis of corpus callosum, a rare congenital defect, might be associated with macrocephalia and various degrees of mental impairment, optic defects, and seizures. Apart from patients with these pathologic states, there are individuals with agenesis of corpus callosum, but without any clinical disturbances. [ABSTRACT FROM AUTHOR]

Background. Acute rejection of allograft is one of the most serious complications of renal transplantation that requires fast and precise diagnostic approach. In this paper our experience in cytologic urinalysis as a diagnostic method of the acute renal allograft rejection was reviewed. Methods. The study group included 20 of 56 patients with transplanted kidneys who were assumed for the acute allograft rejection according to allograft dysfunction and/or urine cytology findings. Histological findings confirmed allograft rejection in 4 patients. Urine sediment obtained in cytocentrifuge was air-dried and stained with May-Grunwald-Giemsa. Acute allograft rejection was suspected if in 10 fields under high magnification 15 or more lymphocytes with renal tubular cells were found. Results. Acute transplant rejection occured in 32.1% patients. In 15 patients clinical findings of the acute renal allograft rejection corresponded with cytological and histological findings (in the cases in which it was performed). Three patients with clinical signs of the acute allograft rejection were without cytological confirmation, and in 2 patients cytological findings pointed to the acute rejection, but allograft dysfunction was of different etiology (acute tubular necrosis, cyclosporine nephrotoxicity). In patients with clinical, cytological and histological findings of the acute allograft rejection urine finding consisted of 58% lymphocytes, 34% neutrophilic leucocytes and 8% monocytes/macrophages on the average. The accuracy of cytologic urinalysis related to clinical and histological finding was 75%. Conclusion, Urine cytology as the reliable, noninvasive, fast and simple method is appropriate as the a first diagnostic line of renal allograft dysfunction, as well as for monitoring of the graft function. [ABSTRACT FROM AUTHOR]

This paper presents the experiences of the thumb reconstruction with osteofasciocutaneous reverse flap (OFCR flap). In the period between 1987 and 2000 the OFCR flap was used in 15 patients. The youngest of them was 18 and the oldest was 38 years of age. The average age was 25.4. All the patients had posttraumatic amputations. Defects on proximal phalangae and a part of metacarpal bone occurred in two cases. In one case there was an amputation on the base level of proximal phalanx and the metacarpophalangeal (MPH) joint was preserved. In all cases of reconstruction the OFCR flap was used, which included antebrachial skin nervs that were anastomosed with digital nerv. The flap nutrition was carried out through the reverse circulation of a. radialis, and the venous drainage through the comitant vein of a. radialis. Superficial veins were not anastomosed. Secondary defects were covered with a free skin graft. All the flaps survived. The bone graft was healed in the period of eight weeks. The sensibility of this flap was regained in the period of three to six months after the surgery. The distance of two-point discrimination (TPD) was increased for 30% compared to the same region on the other hand after six months. The opposition of the reconstructed thumb to the other fingers was possible, as well as abduction, adduction and normal grasp. The method of reconstruction of the amputated thumb with the OFCR flap was better than other classical methods because it allowed the reconstruction of all the structures in one surgical operation. The sensibility that was regained represented good protection from injuries. There were no funcional damages on the secondary defect. The esthetic result was not good due to the lack of a fingernail. [ABSTRACT FROM AUTHOR]