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Introduction. Minimally invasive approach for the treatment of acute pancreatitis (AP) and its complications has proven to reduce morbidity and mortality rate, length of hospitalization and costs of treatment, and improve quality of life of the patients. This approach for the AP has been implemented in developed countries, but in our region lags behind. In this case report we presented the successful endoscopic transgastric drainage of the large pancreatic pseudocyst (PPC) developed as a complication of AP. Case report. A 63-years old male patient was presented with nausea and vomiting as a consequence of the compressive effects of the PPC in the body and tail of the pancreas after episode of AP. On computed tomography (CT) scan, it was shown a cystic formation in the region of the pancreatic body and tail compressing stomach which was verified on upper endoscopy. Under fluoroscopy, using lateral duodenoscope, the biliary plastic prosthesis of 12 French and 8 cm of length was placed throughout posterior stomach wall into the PPC. The intervention was finished uneventfully, without complications. On CT scan performed 7 days after procedure, the reduction of the PPC size was significant and control CT scan one month after the procedure and removal of the prosthesis showed almost complete resolution of the PPC. Conclusion. Endoscopic transgastric drainage is safe and effective procedure for PPCs especially when the PPC has propulsion effects on stomach wall. [ABSTRACT FROM AUTHOR]

Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of metabolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and metabolic variables - glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides l evels in the blood; 2) endocrinological variables - DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable - SYNTAX score, and 5) clinical variables in modified age, creatinine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in oneyear follow-up. A high predictive risk index was evaluated that a ssessed p articular or associated risks for one-year MACE (cstatistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c = 8%, triglyceridemia = 2.3 mmol/L in patients with insulin therapy, and ACS modality - unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYNTAX score (c statistic = 0.798), as well as ACF score (c statistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner. [ABSTRACT FROM AUTHOR]

Introduction. Primary appendiceal adenocarcinoma is a very rare malignancy which accounts for 0.1% of all appendectomy specimens. In both patients presented in this paper, appendectomy was performed due to suspected acute complicated appendicitis. Case Reports. The first patient, a 77-year-old man, presented with a low grade colonic-type pT3 adenocarcinoma of the appendix, diagnosed by histopathological examination of the resected appendix delivered in a fixative. A month after appendectomy, the patient underwent right hemicolectomy of a tumor at the edge of the resection. Due to a cardiovascular disease, adjuvant chemotherapy was not indicated. The second patient, a 74-year-old female, presented with a low grade mucinous adenocarcinoma of the appendix with subserous infiltration, diagnosed by histopathological analysis of the resected appendix. Eight months after appendectomy, the patient developed a recurrent tumor in the cecal area. After radical surgical excision of the recurrent tumor, the patient received adjuvant chemotherapy. Both patients had a 5-year survival without relapse. Conclusion. Preoperative diagnosis of appendiceal adenocarcinoma is a challenge due to overlapping symptoms of complicated acute appendicitis. Our results suggest that in elderly patients with symptoms of complicated acute appendicitis, appendectomy should be done with intraoperative histopathological frozen section consultation. In advanced stages of adenocarcinoma, right hemicolectomy is a better choice than appendectomy. [ABSTRACT FROM AUTHOR]

Bacground/Aim. Researchers suggest that among people with schizophrenia, the prevalence of depressive symptoms ranges from 7% to 80%. The rate of depressive symptoms among people with schizophrenia varies widely because of the phase of the disease, type of study applied, rating scale for depressive symptoms and diagnostic criteria. The aim of this research was to determine the prevalence of depressive symptoms and the clinical correlation of depressive symptoms with other clinical parameters (type and severity of psychotic symptoms, severity of illness, insight and global functioning) among patients with schizophrenia in acute and remission phases. Methods. This prospective clinical study enrolled 100 consecutive patients with schizophrenia both in acute and remission phases. Psychometric assessments were made using the Positive and Negative Syndrome Scale (PANSS) for rating the symptoms of schizophrenia, Scale to Assess the Unawareness of Mental Disorder (SUMD), Calgary Depression Scale for Schizophrenia (CDSS), and Global Assessment of Functioning Scale. Results. The prevalence of depressive symptoms among patients with schizophrenia in the acute phase was 23% at the study group, while in the remission phase it was 13%. In the acute phase, the CDSS scale correlated with a depressive and positive subscale of the PANSS scale as well as SUMD scale. In the remission phase, the CDSS scale correlated only with a depressive subscale of the PANSS scale. The CDSS scale did not correlate with the negative subscale of the PANSS scale. The subjective nature of depressive symptoms is more pronounced in the remission phase. Conclusion. Our findings showed that depressive symptoms were more pronounced in the acute psychotic phase than in the remission phase of schizophrenia. Targeted, patient oriented, and algorithm-based approach for treatment management, with taking into account different phenotypic expressions of the disorder (patients with and without affective symptoms) is warranted in patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Background/Aim. Infection is the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of the study was to establish the most common bacterial agents of AE-COPD in patients hospitalized in a tertiary medical care institution. Methods. This retrospective study included the patients hospitalized due to infective AE-COPD in the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica in a 12-month period. We evaluated clinical data, spirometry, pathogen etiology in the patients with positive sputum findings and disease outcome. Results. The study included a total of 81 patients, 47 (58.02%) males and 34 (41.97%) females of the mean age of 65.7 years. The mean history of the disease was 14.5 years. The median forced expiratory volume in one second (FEV1) was 30.12%. The most common isolated pathogens was Pseudomonas aeruginosa (n = 36; 38.29%), followed by Haemophilus influenzae (n = 25; 26.59%) and Streptococcus pneumoniae (n = 16; 17.02%). Coinfections were present in 9 (9.57%) of the patients. The median FEV1 values of 28.67%, 37.23%, and 42.26% were registered in the patients with Pseudomonas aeruginosa, Haemophilus influenza, and Streptococcus pneumonia induced infection, respectively. The case fatality rate (CFR) was 6.2%. Of the deceased, 100% had Pseudomonas aeruginosa- induced infection. A statistically significant difference in FEV1 values was registered between the patients with and without Pseudomonas aeruginosa in their sputum finding (p = 0.016). Conclusion. The most common pathogens in patients with AE-COPD were Pseudomonas aeruginosa, Haemophilus influenzae, and Streptococcus pneumonia. The CFR was 6.2%. All (100%) deceased patients had the infection induced by Pseudomonas aeruginosa. [ABSTRACT FROM AUTHOR]

Introduction. Double heart rupture is a rare complication of acute myocardial infarction with high mortality. Case report. We presented a 67-year-old female patient with symptoms and signs of myocardial infarction, diagnosed with echocardiography, rupture of the septum, the presence of a thrombus and a small pericardial effusion. Soon after admission the patient died. Autopsy revealed tamponade and double myocardial rupture, free wall rupture and ventricular septal rupture, as a cause of death. Conclusion. This case highlights the need to evaluate patients with myocardial infarction, recurrent chest pain, echocardiographic signs of effusion and the presence of thrombus in the pericardium in terms of double rupture of the heart. [ABSTRACT FROM AUTHOR]

Introduction/Aim. Atherosclerosis presents a serial of highly specific cellular and molecular responses, and could be described as inflammatory diseases. Accordingly, for development of acute myocardial infarction (AMI), structure and vulnerability of atherosclerotic plaque are more important than the extent of stenosis of infarct-related artery. Consequently, inflammation and atherosclerosis and its complications are in good correlation. C-reactive protein (CRP) as nonspecific inflammatory marker, has prognostic significance in coronary artery diseases. The aim of this study was to establish the correlation between inflammatory response expressed as levels of CRP and fibrinogen in serum and extent of coronary artery stenosis. Methods. Study included 35 patients with acute myocardial infarction, as the first manifestation of coronary artery disease, which were treated with thrombolytic therapy according to the guidelines. All the patient had a reperfusion. The patients with acute or chronic inflammatory diseases, an increased value of sedimentation, fibrinogen, CK ≥ 190 U/L, early and late complications of AMI were excluded. CRP was measured on admission, after 24, 48 and 72 hrs, and 21 days latter, while fibriogen only on admission. Results. All the patients underwent coronary angiography, and were divided into two groups: the group 1 (23 patients), with significant stenosis of infarct-related artery (stenosis 75%), and the group 2 (13 patients) without significant stenosis (< 75%). Mean value of CRP serum level on admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p < 0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L, and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the group 2 (p < 0.001). There was no significant difference between the groups 1 and 2 related to gender, age, localization of AMI, CK, EF value, and risk factors for coronary artery disease. Conclusion. The patients with nonsignificant stenosis of infarct-related artery had increased inflammatory responses according to the CRP value, as a result of inflammatory process in atherosclerotic plaque and/or enhanced individual reactivity. [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]