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Whistleblowing is an important activity not only for combating corruption, but also other irregularities and illegal actions. Protection of the environment is certainly a matter of public interest, and the prevention of crimes that violate its integrity is useful above all from the aspect of protecting peoples' lives and health. In a large number of cases, environmental crime is very difficult to detect and prove. The role of the whistle-blower is of particular importance for the timely detection of environmental offenses and the reduction of occurrence or mitigation of harmful consequences. In this paper, we start from the assumption that whistle-blowers in the field of environmental protection are faced with a large number of challenges and are not adequately protected. They are mostly either fired by their employer or forced due to various pressures to quit without the possibility of new employment. Considering the importance of their role in the field of environmental protection, the possibility of improving their position should be reconsidered. In order to make recommendations for the improvement of both national regulations and practices related to the protection of whistle-blowers, in this work we primarily use the method of content analysis, as well as the dogmatic-legal method.

Background/Aim. Quality of life (QoL) is one of the out-come measures for patients with chronic diseases. Mental health issues often impact the QoL of cancer patients. Cancer patients with a good QoL have a longer life expectancy and are able to lead a more productive and social life. The aim of the study was to determine the association of mental health with the QoL, as well as to determine significant predictors of QoL in patients with breast cancer (BC). Methods. The study included 118 patients treated at the Specialized Breast Cancer Department of the Oncology Clinic of the University Clinical Center Niš, Serbia. The study’s inclusion criteria were the presence of early-stage nonmetastatic BC and completed surgical treatment. The following questionnaires were used: the general sociodemographic questionnaire, Hospital Anxiety and Depression Scale (HADS), Buss-Perry Aggression Questionnaire, Early Maladaptive Schema questionnaire - short form (SQ-SF), Flanagan’s Quality of Life Scale (QoLS), Holmes and Rahe Stress Scale, Berlin Social Support Scales (BSSS), Health Locus of Control. Results. A statistically significant negative correlation was found with emotional state, i.e., anxiety score, depressiveness score, total stress score, and physical aggression score, while QoL correlated positively with all subscales of the perceived social support (PSS) questionnaire. QoL was significantly different for patients with the following early maladaptive schemas: emotional deprivation, emotional inhibition, and a sense of entitlement/narcissism. Moreover, QoL differed significantly depending on partnership status, the presence of clinically significant anxiety, the presence of hormone-sensitive cancer, the presence of human epidermal growth factor receptor 2 (HER2)-positive cancer, and time since diagnosis. Multiple linear regression was per-formed, and depression and PSS had the highest share. Conclusion. In our study, the presence of depressiveness and PSS were the best predictors of QoL of BC survivors.

In the value-added tax system of the European Union, the open market value provision is considered as a special anti-abuse measure. Serbian Law on Value-Added Tax allows the taxpayers to make supplies for the consideration lower than the open market value. In addition, the Law does not stipulate any anti-abuse measure similar to the open market value provision in EU VAT legislation. Between the connected parties, this could become an incentive to taypayers to abuse VAT in certain situations. Within the current domestic legislation, the principle of facticity is the only alternative measure to combat VAT abuse, but it should not be used for the correction of the taxable amount following the open market value. The stipulation of the open market value provision in domestic VAT legislation would be highly beneficial from the point of harmonizing the Serbian regulations with those of the European Union, as well as from the point of the protection of national fiscal system. Following the hypothesis that national legislation needs to be further harmonised with the EU VAT legislation, the authors in this paper used the normative dogmatic and content analysis methods with particular reference to the case law of the Court of Justice of the European Union.

In recent decades, the spread of incriminations in the economic field has been very present. One of the reasons for this is the harmonization of national legislation with acquis communautaire. Bearing in mind the views of other authors, in this paper we started from the assumptions that a large number of economic crimes are unnecessary, because their legal description could be subsumed under the already existing crimes, that excessive criminalization can contribute to problems in practice and that procedural legislation often does not follow the changes in substantive criminal legislation when they are carried out by non-criminal laws, as well as when changing and reforming criminal legislation, crimes prescribed by secondary criminal legislation are generally ignored. Starting from the mentioned assumptions, we try to make recommendations for the further direction of the development of substantive criminal legislation, which, in our opinion, should follow the narrowing of criminal law interventionism in the economic area. In this paper we have analyzed the provisions of secondary criminal legislation, which precisely contain the shortcomings pointed out by the authors when analyzing the need to reform substantive criminal legislation. Therefore, in this paper the dogmatic-legal method is dominant, and special attention is paid to the analysis of the provisions of the Law on Tax Procedure and Tax Administration and the Law on the Capital Market.

The right to a healthy environment is not explicitly mentioned in the European Convention for the Protection of Human Rights and Fundamental Freedoms from 1950. The mentioned right is more recent and belongs to human rights of the third generation In the final Declaration of the United Nations conference on the human environment held in Stockholm in 1972, the basic human right to freedom, equality and adequate living conditions in an environment that allows an individual to live in dignity and wellbeing is mentioned for the first time. Although the right to a healthy environment is not mentioned in the European Convention for the Protection of Human Rights and Fundamental Freedoms, it is still given importance through the judgments of the European Court of Human Rights, which is responsible for considering violations of the said Convention. The protection of that right is linked to other rights guaranteed by the Convention, such as, for example, the right to life, right to private and family life, etc. The aim of the research in this paper is to indicate the importance of establishing a guarantee of the right to a healthy environment, as well as the increasing importance of its protection as a prerequisite for the enjoyment of some other basic human rights. The paper uses the method of content analysis. In addition to the analysis of the Draft Protocol to the European Convention for the Protection of Human Rights and Fundamental Freedoms, we also analyze the content of the verdicts of the European Court of Human Rights.

In 2021, the European Court of Human Rights issued a judgment in the case of Halet v. Luxembourg, which sets a precedent in terms of protecting whistleblowers. Given the position of the Grand Chamber, it seems that the interpretation of the European Court of Human Rights in this case may have a deterrent effect on potential whistleblowers, especially those employed in multinational companies and corporations. At the level of the European Union in 2019, the Directive on the Protection of Persons Reporting Violations of European Union Rights was adopted, which was to be implemented in national legislation by the end of 2021. However, the question arises as to whether existing European standards contain sufficiently effective mechanisms for the protection of whistleblowers in all sectors or whether a higher level of protection can be provided at the national level. In an attempt to answer this question, we will first analyze the judgment of the European Court of Human Rights in the case of Halet v. Luxembourg, then we will point out the provisions of Guja v. Moldova taken into account in passing the above judgment, and then we will look back to the judgment of Heinisch v. Germany, which also had an influence in the decision of the European Court of Human Rights in the case of Halet v. Luxembourg. In order to point out the unjustified expectations of whistleblowers to balance between the protection of public and private interests of any person, we point out the complexity of the content of the concept of public interest, and then analyze European standards in the field of whistleblower protection. The aim of the application of the mentioned methodology is to try to give recommendations for the improvement of the existing system of protection of whistleblowers, which seems to be very necessary in the private sector.

Background/Aim. A type of personality and negative emotional reactions could be important for clustering biological risk factors for a cardiovascular disease in patients with arterial hypertension (AH). This study investigated if the patients with AH and psychological characteristics of the Distressed Type of personality with elevated anxiety/depression/aggression, have a higher risk of metabolic syndrome (MS) and explored value of the assessed parameters for MS occurrence. Methods. A total of 85 patients with AH were included in the cross-sectional observational study. Type D Scale-14 (DS-14) was used to detect Type D (Distressed) personality. The Hospital Anxiety and Depression Scale (HADS) assessed the levels of anxiety and depression and the Buss Perry Aggression Questionnaire (BPAQ) was used for the assessment of aggression. The explored biological parameters included: blood pressure, lipid status, body mass index (BMI), the occurrence of diabetes mellitus (DM) and MS. Results. Type D patients were frequently more anxious, aggressive and had more frequent MS compared to non-type D. Type D females were younger, more anxious and had a greater prevalence of DM than those with non-type D personality. A multivariate analysis revealed that in type D personality patients with AH, depression had predictive value for MS. Conclusion. The occurrence of both MS and AH was in correlation with the type D personality, anxiety and depression. Early detection/treatment of depression in patients with AH and Type D personality could decrease a risk of metabolic syndrome.

Background/Aim. Functional mitral regurgitation (FMR) is a common entity in patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR). The aim of this study was to examine evolution of moderate and moderate to severe FMR after an isolated AVR, to identify prognostic indicators for persistent MR postoperatively, and to offer the recommendation regarding surgical intervention for moderate and moderate to severe FMR at the time of AVR for AS. Methods. We retrospectively reviewed 39 consecutive patients with moderate and moderate to severe FMR at the time of isolated AVR from January 2007 to December 2013. We collected preoperative and postoperative echocardiographic data to determine the evolution of FMR after AVR. Patients were divided into the persistent (n = 14) and improved FMR group (n = 25). Secondary division was into the prosthesis-patient mismatch (PPM, n = 7) and non prosthesis-patient mismatch group (non PPM, n = 32 patients). Late follow-up echocardiography was completed in 100% (39/39) of patients. Results. FMR improved postoperatively (MR ˂ 2+) in 64% (25/39) of patients, while 36% (14/39) of patients had persistent MR ≥ 2). In comparison to the persistent group, the patient with improved FMR had significant decrease in the left ventricular enddiastolic diameter, left ventricular end-systolic diameter, posterior wall and septum thickness postoperatively. The same indicators of reverse remodeling were found in the non PPM group in comparison to the PPM group. The incidence of postoperative FMR improvement was higher in the non PPM group (65.6%, p = 0.001) in comparison to the PPM group (42.9%, p = 0.125). The mean follow-up duration was 39.5 ± 23.5 months. Conclusion. In accordance with previous studies, this study also showed improvement in FMR following AVR surgery. Improvement in MR degree was associated with echocardiographic parameters of reverse left ventricular remodeling. Conservative approach is advisable in patients with moderate and moderate to severe FMR, believing that repair or replacement is unnecessary at the time of AVR for severe AS. PPM could prevent downgrading of FMR, stressing out the importance of choosing the prosthesis of adequate size.

In the emerging business environment and with the rapidly growing contemporary business trends, the concepts of entrepreneurship and entrepreneurs tend to adapt to the new circumstances of business practice. According to the entrepreneurship theory, entrepreneurs possess universal characteristics, but some characteristics of entrepreneurs are conditioned by the specificities of their own national culture. Also, entrepreneurship concepts vary from one country to another. The link between entrepreneurship and entrepreneurial behavior and cultural values has been defined by a framework of dimensions of national cultures first introduced by a scientist - Geert Hofstede. Numerous studies on the subject point to a strong link between entrepreneurship and national culture. The aim of this paper is to provide a theoretical overview of the most important facts regarding the connection between entrepreneurship and national culture in general, with an emphasis on the national culture of the Republic of Serbia and its entrepreneurial environment.

In the article, the authors analyze the fundamental challenges in the application of the ne bis in idem principle in the practice of the European Court for Human Rights and Court of Justice of the EU and their interpretation of the principle in relation to the application on the criminal offences and misdemeanour offences, including administrative penal offences, against the same person for the same acts. Article followed the development in interpretation of the principle by the European Court of Human Rights in Zolotukhin case to the interpretation of the Court of Justice of the EU in Menci case. European Courts jurisprudence could be used for dialogue on challenges that the Serbian judiciary and tax authories are facing in the interpretation of legislation and application of ne bis in idem principle on criminal and misdemeanour proceedings against the same person for the same acts. The articile provides the basis for discussion on the unification of court practice.

Establishing appropriate measures to protect the fiscal system at the level of EU Member States also includes the protection of the EU financial interests. That protection also means the prescription of tax offenses. These offenses are prescribed by national legislation of all States. Sometimes it is necessary to adjust their legal description with EU legal standards and to the practical requests. Tax misdemeanours are prescribed in all countries by tax law, but tax crimes in some countries are prescribed by primary and in some others by secondary criminal legislaton. In former Member States of the Socialist Federal Republic of Yugoslavia (excluding the Republic of Serbia) tax crimes are prescribed by primary criminal legislation, while Italian and German legislation contain specific solutions. In Italy tax crimes are prescribed by the Law on tax offenses, and in the Federal Republic of Germany by Fiscal Code. Bearing in mind that the German legislation had a major impact on the development of the criminal law of the Republic of Serbia, in this paper we analyse the provisions that prescribe tax offences in the Federal Republic of Germany. The objective of such analysis is to provide recommendations for possible improvement of the national legislation of the Republic of Serbia.

Introduction. Coronary artery anomalies are infrequent but anticipated findings during percutaneous coronary interventions (PCI). Compared to consistent reporting in angiographic series, they seem to be underreported in interventional studies, and particularly in the setting of primary PCI, where their prompt recognition is of the utmost importance. Case report. We present a 50 years old male with inferior ST-elevation of myocardial infarction (STEMI) and right ventricular involvement with solitary ostium for all three coronary arteries in the right aortic sinus of Valsalva. The patient had an extremely rare variant of coronary artery origination belonging to the type A4b2c2 of Angelini’s classification. Correspondingly, it belongs to the left Anomalous origination of a Coronary Artery from the Opposite Sinus of Valsalva (ACAOS) class with the intraseptal course of left anterior descending artery. We managed successfully to implant a drug eluting stent in the proximal right coronary artery in a lengthy and stormy procedure, with the need for guiding catheter exchange, temporary pacing and dealing with no-reflow phenomenon. Conclusion. We summarize diagnostic hints for angiographic recognition of dominant variants of the left ACAOS and practical aspects of performing PCI in such patients. Also, we debate on the functional significance of coronary anomalies and its further implications from the prognostic and therapeutic aspects. We propose adoption of the novel classification of coronary anomalies of Angelini’s group in the routine clinical practice. Finally, we call for the inclusion of specific training in coronary artery anomalies into the interventional cardiology fellowship curriculum.

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscAof more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR. [Projects of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175005, Grant no. 175061, Grant no. III45005, Grant no. III41002, Grant no. III41022]

In the modern economies, capital markets can greatly contribute to the development of the national economy. Bearing in mind above mentioned, during the time the idea of improving the protection of the capital market participant's interests has been developed. Therefore, at the EU level in 2014 has been adopted Regulation and Directive which provides the obligation for member states to prescribe the criminal sanctions for capital market abuses. Nowadays, almost all national legislation provides protection of the capital market participants interests by criminal law. In some of them criminal sanctions have been provided by secondary criminal legislation. Such an approach exists in the Republic of Serbia and Italy. Before the accession to the European Union, the Republic of Serbia should harmonize its national legislation with Union acquis. Bearing in mind the similarity of access to capital markets protection by criminal law between Italian and Serbian legislation, perhaps some Italian solutions could be an example for further harmonization with EU standards. Therefore, the subject of analysis in this paper is the capital market protection by Italian criminal law and its compliance with the EU legislation in this area.

Background/Aim. According to currently available data, there is no research dealing with evaluating empathy in adolescents with conduct disorders in our region. The aim of the research was to examine the differences in the severity of cognitive and affective empathy in adolescents with and with no conduct disorder, as well as to examine the relationship between cognitive and affective empathy and the level of externalization in adolescents with conduct disorder. Methods. This research was conducted on 171 adolescents, aged 15 to 18, using the Interpersonal Reactivity Index, Youth Self- Report and a Questionnaire constructed for the purpose of this research. Results. The results showed that adolescents with conduct disorder had significantly lower scores for Perspective Taking (t = 3.255, p = 0.001), Fantasy (t = 2.133, p = 0.034) and Empathic Concern (t = 2.479, p = 0.014) compared to the adolescents in the control group, while the values for Personal Distress (t = 1.818, p = 0.071) were higher compared to the control group, but the difference was not statistically significant. The study showed a statistically significant negative correlation between Perspective Taking and aggression (r = - 0.318, p = 0.003) and a negative correlation between Perspective Taking and the overall level of externalizing problems (r = -0.310, p = 0.004) in the group of adolescents with conduct disorder. Conclusion. This research contributes to better understanding of behavioral disorders in terms of individual factors, especially empathic reactivity. Preventive work with young people who have behavioral problems associated with empathy deficit disorder proved to be an important tool in preventing the development, or at least relieving the symptoms, of this ever more common disorder.

[Projekat Ministarstva nauke Republike Srbije, br. 175005, 175061, III41002, III45005 i 41022]

Considering the intensive preparation of the 11th revision of the International Classification of Diseases (ICD-11), we discussed the justification of the existing classification of emotional disorders with onset specific to childhood. This paper presents the citations from the ICD-10 (F93 block) and the authors’ comments as a critical review of the justification of further existence of emotional disorders with onset specific to childhood as a separate block in ICD-11 classification. We concluded that the block F93 is insufficiently defined and should be completely changed or removed from the ICD-11 classification. Additionally, the specificities of the clinical picture of anxiety disorders in children should be adequately described within the future category of anxiety and phobic disorders by giving an explicit set of instructions for identifying clinical manifestations which vary by age.

Background/Aim. Intramyocardial bone marrow mononuclear cells (BMMNC) implantation concomitant to coronary artery bypass grafting (CABG) surgery as an option for regenerative therapy in chronic ischemic heart failure was tested in a very few number of studies, with not consistent conclusions regarding improvement in left ventricular function, and with a follow-up period between 6 months and 1 year. This study was focused on testing of the hypothesis that intramyocardial BMMNC implantation, concomitant to CABG surgery in ischemic cardiomyopathy patients, leads to better postoperative long-term results regarding the primary endpoint of conditional status-functional capacity and the secondary endpoint of mortality than CABG surgery alone in a median follow-up period of 5 years. Methods. A total of 30 patients with ischemic cardiomyopathy and the median left ventricular ejection fraction (LVEF) of 35.9 ± 4.7% were prospectively and randomly enrolled in a single center interventional, open labeled clinical trial as two groups: group I of 15 patients designated as the study group to receive CABG surgery and intramyocardial implantation of BMMNC and group II of 15 patients as the control group to receive only the CABG procedure. All the patients in both groups received the average of 3.4 ± 0.7 implanted coronary grafts, and all of them received the left internal mammary artery (LIMA) to the left anterior descending (LAD) and autovenous to other coronaries. Results. The group with BMMNC and CABG had the average of 17.5 ± 3.8 injections of BMMNC suspension with the average number of injected bone marrow mononuclear cells of 70.7 ± 32.4 × 106 in the total average volume of 5.7 ± 1.5 mL. In this volume the average count of CD34+ and CD133+ cells was 3.96 ± 2.77 × 106 and 2.65 ± 1.71 × 106, respectively. All the patients were followed up in 2.5 to 7.5 years (median, 5 years). At the end of the follow-up period, significantly more patients from the group that received BMMNC were in the functional class I compared to the CABG only group (14/15 vs 5/15; p = 0.002). After 6 months the results on 6-minute walk test (6-MWT) were significantly different between the groups (435 m in the BMMNC and CABG group and 315 m in the CABG only group; p = 0.001), and continued to be preserved and improved on the final follow-up (520 m in the BMMNC and CABG group vs 343 m in the CABG only group; p < 0.001). Cardiovascular mortality was also significantly reduced in the BMMNC and CABG group (p = 0.049). Conclusion. Implanatation of BMMNC concomitant to CABG is a safe and feasible procedure that demonstates not only the improved functional capacity but also a reduced cardiac mortality in a 5-year follow-up in patients with ischemic cardiomyopathy scheduled for CABG surgery.

Introduction. Astasia is the inability to maintain an upright body position without assistance in the absence of motor weakness or sensory loss. Abasia is described as the inability to walk or as uncoordinated walking, while preserving mobility of the lower limbs. Ganser syndrome is described as a dissociative disorder characterized by approximate answers, somatic conversion symptoms, clouding of consciousness, as well as visual and auditory pseudohallucinations. The aim of this study is to present a case that seemed like a combination of neurological and internal disturbances, but actually represented a psychogenic disorder. Case Outline. This paper presents the case of a 13-year-old patient with the first manifestation of the inability to walk and stand. Medical history, diagnostic instruments and differential diagnostic methods have been presented in detail. The clinical manifestation was initially interpreted as a neurological disorder. However, after the application of diagnostic procedures and a change in family circumstances, the patient was diagnosed with a psychogenic movement disorder, astasia-abasia, with progressive clinical presentation that included dissociative psychotic reactions (Ganser syndrome). Differential diagnosis as well as the elements of the therapeutic approach have been discussed. Conclusion. Presenting a case of psychogenic astasia-abasia in children contributes to a better understanding and differentiating between conditions with a clinical presentation of signs and symptoms dealt with by other branches of medicine.

[Projekat Ministarstva nauke Republike Srbije, br. 175005, 175061, III41002, III45005 i 41022]

Background/Aim. Conduct disorder is characterized by repetitive and persistent presence of dissocial, aggressive and defiant behavioral patterns, thus represents important public issue with comprehensive and far-reaching consequences both for the individual and society. The aim of this study was to investigate the differences in sociodemographic family characteristics and the prominence of parental acceptance/rejection dimensions in groups of adolescents with and without conduct disorder, as well as to examine the connection between parental acceptance/rejection dimensions and externalizing symptoms in the group of adolescents with conduct disorder. Methods. This research was conducted on 134 adolescents, aged 15 to 18, using the Parental Acceptance/Rejection Questionnaire (PARQ child), Youth Self-Report (YSR), and a questionnaire constructed for the purpose of this survey. Results. The results showed that the number of adolescents with conduct disorder coming from divorced families was significantly higher than from complete families (44.8% vs 13.4%, respectively; p < 0.001). Also, in this group of adolescents there was a statistically significantly higher number of parents suffering from psychiatric disorders compared to the controls (31.3% vs 8.9%; respectively; p = 0.001). The perceived rejection dimension and the total index of maternal acceptance/ rejection were significantly higher in adolescents with conduct disorder than in those with no such disorder (132.30 ± 38.05 vs 93.91 ± 26.29 respectively; p < 0.001). Similar results were found for paternal acceptance/rejection dimension (129.40 ± 39.58 vs 86.10 ± 15.95 respectively; p < 0.001). Adolescents with conduct disorder and severe perceived maternal and paternal rejection showed a significantly higher average score on the subscale of externalizing symptoms (14.55 ± 4.45 and 13,27 ± 5,05) compared to adolescents with conduct disorder and lower total index of parental acceptance/rejection (8.32 ± 5.05 and 8.28 ± 5.08). Conclusion. The results suggest that adolescents with conduct disorder perceive their parents as more rejecting and less warm and supportive compared to adolescents without conduct disorder. The perception of significant and severe parental rejection was associated with a significantly higher averaged score on the subscale of externalizing symptoms in the group of adolescents with conduct disorder compared to those with no such disorder. It was found that adolescents with conduct disorder most often come from large families, have divorced parents or parents with multiple psychiatric disorders.

Introduction Rhabdomyolysis is a rare, but serious and potentially fatal adverse reaction of the statin application that may be developed in any time of therapy. It is characterized by massive destruction of muscles associated with the large increase of creatine kinase (CK) leading to myoglobinuria and potential acute renal failure. Combined statin-fibrate therapy increases the risk of rhabdomyolysis, especially in elderly and diabetic patients. Case report An 81-year-old male was admitted to Coronary Care Unit of the Emergency Center, Clinical Center of Serbia (CCS) with the clinical picture and electrocardiogram of the acute anterior wall myocardial infarction complicated with pulmonary edema. Laboratory tests on admission showed higher elevated values of serum creatinine 179 μmol/L and BUN 9.2 mmol/L (eGFR 32 mL/min/1.73m2), CK 309 U/L (on day 2: 3476 U/L) and mixed hyperlipidemia (total cholesterol 10.3 mmol/L, HDL 2.26 mmol/L, TG 4.85 mmol/L). The patient was treated with thrombolysis medication therapy (Alteplase), anticoagulant and dual antiplatelet therapy, diuretics, organic nitrates, angiotensin-converting enzyme (ACE) inhibitors, antibiotics, and proton pump inhibitors. During seven days, his therapy included combined pravastatin 20 mg and fenofibrate (160 mg), which was discontinued due to pains and weakness of muscles and significantly elevated CC to 7080 U/L (upper limit 200 U/L), but no significant deterioration of renal function was observed. Discontinuation of therapy resulted in CC level normalization and improvement of clinical condition. Conclusion Combined statin and fibrate therapy requires strict clinical control and monitoring of CK i transaminases. Four-time or higher increase of CK requires discontinuation of therapy. In addition, patients are advised to report immediately any pains in muscles, sensibility, weakness or cramps.

Within modern medicine at the beginning of 21st century, we are witnessing a revolutionary development of the invasive diagnostics and therapy of cardiovascular system diseases. With the discovery of X-rays at the end of 19th century by Wilhelm Roentgen, it is appropriate to reflect on the gifted individuals whose efforts drastically altered radiology and cardiology. The early techniques used in peripheral percutaneous transluminal angioplasty form the basis for subsequent percutaneous intervention both in the peripheral and coronary arteries and are largely the contribution of Charles Dotter. The main goal of his work was the use of catheters for diagnosis and treatment in an attempt to replace the scalpel. He was 20 years ahead of his time, especially with percutaneous transluminal angioplasty. The first percutaneous transluminal angioplasty marked a new era in the treatment of peripheral atherosclerotic lesions. This practical genius dedicated his considerable energy to the belief that there is always a better way to treat disease. His personal contributions to clinical medicine, research, and teaching have saved millions of limbs and lives all over the world. European physicians, who were more open to unproven techniques, almost immediately embraced percutaneous transluminal angioplasty. Without the contribution and help of his colleagues, Forssmann, Sones and Gruntzig, all of them pioneers, nothing would be done. They were all ahead of there time and opened completely new chapter in medicine.

Introduction. Congenital anomalies of the aortic arch, although numerous and heterogeneous, occur in less than 1% of individuals at autopsies. Left aortic arch with an aberrant right subclavian artery, also called arteria lusoria dextra, is the most common anomaly of the aortic arch, occurring in 0.5-2.5% of individuals. Case Outline. We report the case of a 48-year-old man suffering from acute inferoposterior-wall ST elevation myocardial infarction successfully treated by primary percutaneous coronary intervention. Ten years ago, the patient had undergone coronary artery bypass graft surgery with the implantation of two arterial grafts - left and right internal mammary arteries on both left anterior descending and right coronary artery. After several attempts to canulate truncus brachiocephalicus, angiogram revealed the left aortic arch with the aberrant right subclavian artery. To our knowledge, this is the first described case of primary percutaneous coronary intervention via the aberrant right subclavian artery and right internal mammary artery graft with stent implantation in the infarct related lesion of the distal segment of right coronary artery. Subsequent 64-multidetector computed tomography confirmed the angiographic findings. Conclusion. Early recognition of congenital anomalies of the aortic arch and its great vessels, even before coronary artery bypass graft surgery, could be crucial for the urgent and successful treatment of patients with life-threatening conditions, such as ST segment elevation myocardial infarction.

Background/Aim. Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. Methods. The sample of this clinical observational study included 7-sixth grade pupiles - 5 boys and 2 girls, aged 13. All of the pupils were involved in car accident with one death. Two groups were formed - one group included three children who were involved in 8 SFT sessions together with their families. The second group included 4 children who received an antidepressant sertraline in the period of three months. Results. Two months after the car accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. Conclusion. Systemic family therapy was efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk factor of retraumatization.

Background/Aim. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) characterized by myelin destruction and axon loss. Among various clinical manifestations of MS cognitive disorders are frequent. Olfactory disorders are also noticed but they are rarely considered in clinical practice. The aim of the present study was to examine frequency of olfactory dysfunction in patients with MS and its relationship to clinical parameters. Methods. Our study comprised 61 consecutive patients with definite MS who were hospitalized at the Department for Multiple Sclerosis and Other Immune- Mediated Disorders of CNS, Institute of Neurology, Clinical Center of Serbia, Belgrade, and 45 gender-, age- and education-matched healthy voluntaries. The Pocket Smell Test (PST) was used for examination of olfactory function. Cognitive functions were analyzed using the tests from the Brief Battery of Neuropsychological Tests: Paced Auditory Serial Addition Test 3-minute Version (PASAT 3'), Word List Generation (WLG) and Symbol Digit Modalities Test (SDMT). Results. Olfactory dysfunction was found in 26 (43%) MS patients and 5 (11%) controls (p = 0.001). Statistically significant positive correlation was found only between PST score and WLG scores (r = 0.297, p = 0.030). In comparison with the previously published normative values, our subjects with MS had decrease in the mean indices of the PASAT 3' in 28%, SDMT in 51% and WLG in 90% of the subjects. Conclusion. Olfactory dysfunction is frequent in our population of patients with MS. This disturbance correlates with the impairment of cognitive functions in these patients.

Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV) is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA) was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab), according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

During the last 10 years a new group of drugs was developed--platelet glycoprotein IIb/IIIa blockers that is nowadays largely and efficiently used as for the prevention of percutaneous coronary intervention complications as well as in the treatment of acute coronary syndromes. In the period February-June 2000--19 patients (18 males, 1 female, of average age 53.3 years) were administered Abciximab in the bolus dose of 10 mg immediately before the intervention and afterwards 10 mg by 12-hour infusion. All patients received aspirin and ticlopidine hydrochloride if the stent was introduced and heparin by the standard protocol. Elective intervention was done in 17 patients (non-Q infarction in 3 patients, unstable angina pectoris in 5 patients, postinfarction angina pectoris in 2 patients, acute myocardial infarction at least 1 month before the intervention in 6 patients and 1 patient with myocardiopathy) and in 2 patients the intervention was performed during the myocardial infarction. In 15 patients (79%) intracoronary stent was introduced and in 5 patients (21%) the intervention was performed on 2 arteries. Maximal immediate effect of the dilatation was achieved in 18 patients (94.7%). In the first 60 days of the follow-up 1 patient (5%) died of some other disease, and in no patients symptomatic myocardial ischemia was found. No adverse effects were observed.