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Uvod: Kardiovaskularne bolesti su vodeći uzrok smrti bolesnika koji se leče redovnom hemodijalizom. Oksidacioni stres je netradicionalni faktor rizika za razvoj kardiovaskularnih bolesti u ovoj populaciji bolesnika. Glavni uzroci razvoja oksidacionog stresa kod bolesnika koji se leče redovnom hemodijalizom su: biokompatibilnost dijalizne membrane, prisustvo endotoksina u rastvoru za hemodijalizu i smanjena aktivnost antioksidacionih enzima. U glavne kliničke posledice oksidacionog stresa spadaju razvoj i ubrzanje procesa ateroskleroze, razvoj anemije i rezistencija na dejstvo eritropoetina, malnutricija i amiloidoza povezana sa hemodijalizom. Cilj rada: procena uticaja dijalizne membrane i modaliteta dijalize na razvoj oksidacionog stresa, procena uticaja mikroinflamacije i malnutricije na razvoj oksidacionog stresa, kao i procena uticaja oksidacionog stresa na razvoj ateroskleroze i rezistencije na dejstvo eritropoetina. Metode: U radu je ispitano 125 bolesnika koji se leče redovnom hemodijalizom uz poštovanje Helsinške deklaracije o medicinskim istraživanjima i Dobre kliničke prakse. Grupisanje bolesnika je učinjeno na osnovu kliničkih parametara u skladu sa ciljevima istraživanja. Rezultati: Bolesnici koji se leče redovnom on-line hemodijafiltracijom sa „highflux“ membranom koja je obložena vitaminom E imaju statistički značajno manju koncentraciju reaktivnih supstancija vezanih za tiobarbiturnu kiselinu (TBARS). Između debljine intima-medija karotidnih arterija i koncentracije TBARS-a u serumu postoji statistički značajna pozitivna povezanost, dok između koncentracije SOD u eritrocitima i debljine intima-medija karotidnih arterija visoko statistički značajna negativna povezanost. Bolesnici sa rezistencijom na dejstvo dugodelujućeg eritropoetina imaju visoko statistički značajno manju koncentraciju prealbumina i vitamina D u serumu, kao i statistički značajno veću koncentraciju CRP-a, superoksidnog anjona i vodonik peroksida u serumu. Mikroinflamacija je nezavisan faktor rizika za razvoj rezistencije na dejstvo eritropoetina. Zaključak: Membrane za hemodijalizu obložene vitaminom E smanjuju koncentraciju parametara lipidne peroksidacije u serumu, kao što su: malondialdehid (MDA), reaktivne supstancije vezane za tiobarbiturnu kiselinu (TBARS) i oksidovani LDL holesterol (oxLDL). Ispitivanja pokazuju da ove membrane smanjuju i koncentraciju 5 parametara oksidacionog oštećenja nukleinskih kiselina, kao što je 8-OHdG, kao i koncentraciju parametara mikroinflamacije (CRP, interleukin-6). Ove membrane obezbeđuju dobru kontrolu funkcije leukocita, ispoljavaju antioksidaciono i antiinflamatorno dejstvo.„High-flux“ hemodijaliza i hemodijafiltracija sa polisulfonskom membranom i membranom oboloženom vitaminom E smanjuje aterosklerozu, amiloidozu povezanu sa hemodijalizom, indeks rezistencije na dejstvo eritropoetina i popravlja lečenje anemije u populaciji bolesnika koji se leče redovnom hemodijalizom. Ključne reči: Hemodijalfiltracija, oksidacioni stres, dijalizna membrana Introduction: Cardiovascular diseases are the leading cause of death for patients treated with regular hemodialysis. Oxidative stress is a non-traditional risk factor for the development of cardiovascular disease in this population of patients. Main causes of the development of oxidative stress in patients treated with regular hemodialysis are dialysis membrane biocompatibility, the presence of endotoxin in hemodialysis solution and decreased activity of antioxidant enzymes. The main clinical consequences of oxidative stress include the development and acceleration of the process of arteosclerosis , the development of anemia and resistance to erythropoietin malnutrition and amyloidosis connected with hemodialysis. Objective: The main objectives of the examination are: dialysis, membrane, impact, assessment and dialysis modality on the development of oxidative stress, microinflammation and malnutrition impact assessment on the development of oxidative stress, as well as assessment of the effect of oxidative stress on the development of arteriosclerosis and resistance to erythropoietin. Method: The study examined 125 patients treated with regular hemodialysis respecting the Declaration of Helsinki on Medical Research and Good Clinical Practice. The grouping of patients was done on the basis of clinical parameters in accordance with the objectives of the research. Results: Patients treated with regular on-line hemodiafiltration with “high-flux” coated with vitamin E have statistically significantly lower concentration of reactive supstances related to thiobarbituric acid (TBARS). Between the thickness of the intima-media of the carotid arteries and the concentration of TBARS in the serum, there is a statistically significant positive connection, while between concentration of SOD in erythrocyte and carotid artery thickness of intima-media, there is highly significant negative connection. Patients with resistance to long-acting erthropein have statistically significantly lower concentration of prealbumin and vitamin D in the serum, as well as statistically significantly higher concentration of CRP, superoxide anion and hydrogine peroxide in the serum. Microinflammation is an independent risk factor for the development of erythropoietin resistance. Conclusion: Membranes for hemodialysis coated with vitamin E reduce serum peroxidation lipid concentration parameters, such as malondialdehyde (MDA), reactive substances related to thiobarbituric acid (TBARS) and oxidized LDL cholesterol (oxLDL). Studies show that these membranes reduce both the concentration of oxidative damage parameters of nucleic acids such as 8-OHdG, as well as the concentration of microinflammation parameters (CRP, interleukin-6). These membranes provide good control 122 of leukocyte function, manifest antioxidant and anti-inflammatory effects. High -flux hemodialysis and hemodiafiltration with polysulfone membrane and vitamin E coated membrane reduces atherosclerosis, hemodialysis-related amyloidosis, erythropoietin resistance index, and improves the treatment of anemia in the population of patients treated with regular hemodialysis...

Background. The authors investigated morphologic parameters of the palatal cortex that affect the diffusion of local anesthetic solution in the region of the anterior middle superior alveolar (AMSA) nerve block injection site. Methods. The authors used computed tomographic (CT) and micro-CT imaging to assess 20 human skulls from an anatomic collection. Analysis of the C1 images included frequency, distribution, and width of the nutrient canals in the bony palate, according to to the person's sex and age. Micro-CT analysis involved measuring the thickness and porosity of palatal cortical bone in the area of the AMSA injection site in relation to the thickness and porosity of the opposite buccal cortical bone. Results. There was a statistically significant difference (P = .042) in the location of the nutrient canals between male specimens (> 50% in the border region) and female specimens (> 50% in the palatal process). Furthermore, the female skulls had significantly wider nutrient canal foramina (P = .042) than did the male skulls. Despite greater thickness, the palatal cortex in the area of the AMSA injection site had slightly greater porosity than did the buccal cortex. A significantly greater number of microcanals penetrated the whole cortical thickness in palatal than in buccal cortical bone (P = .001). Conclusions. The distribution and width of nutrient canals differed between male and female skulls. At the microscopic level, structural characteristics of the palatal cortex provide a good anatomic basis for the potential of a satisfactory AMSA injection success rate. Practical Implications. The AMSA technique success rate might be increased if the clinician adjusts the injection site to the distribution of nutrient canals, depending on the sex of the patient.

The proper approach and surgical plan in solving impressive comminuted frontal bone trauma is reflected in adequate fixation of numerous fragments, which have to go through proper repositioning and osteosynthesis to achieve adequate stability of the fragments and to return the original contour of the frontal bone and/or frontal sinus walls. We carried out the restoration of the normal bone contour through a quick and easy way of treating frontal fractures using titanium 3D mesh - a technique that involves 'pulling the bone to the network' and fixing it with the mono cortical screws. We present our experience with this technique in solving the case of frontal impressive and comminuted fractures, on the material of 43 patients at the Centre for Medical Emergencies and Neurotrauma Emergency Centre of the Clinical Centre of Serbia through a retrospective cohort study accompanied with technical aspects and clinical results of this simple method application. The study was previously approved by the Ethics Committee of the Clinical Centre of Serbia. In the period of three years 43 patients had fractures in the area of the frontal bone and frontal sinus. The surveyed period was 1st January 2013 to 31st December 2016. The youngest patient was 17 and the oldest 78 years, the average age being 29 years. The main cause was traffic accidents in 29/43 (67.44%) patients, sport in 4/43 (9.30%), falling down from one's own height in 5/43 (11.63%), a fall from a height higher than 2m in 4/43 (9.30%) and machinery operation in 1/43 (2.33%). The ratio towards sex distribution was men/women 3:1. All patients were operated within the period of six days after the injury. The diagnostic evaluation of patients was made with multi slice computed tomography with 3D reconstruction (3D MDCT) pre- and postoperatively, all patients were controlled on the examinations within the follow-up period of the first 12 postoperative months. The stability of the fragments during the surgical procedure was achieved fully, the position of fragments in the reconstructive act was in satisfactory anatomic contours. The aesthetic results were satisfactory and there were no complications related to the procedure applied, such as uncontrolled bleeding from sinus infection, damage to the rear wall of the sinuses and brain. The effectiveness of the applied procedure indicated to us that we had no deformities of the forehead contour and that the full cosmetic result was achieved. The usage of the titanium 3D mesh in solving such complex impressive comminuted fractures showed as the procedure of choice because in a simple manner with good surgical approach it gives excellent results and the procedure is performed with minimal morbidity in addressing primarily comminuted fracture of the anterior wall of frontal sinus and the frontal bone., Pravilan pristup i hirurški plan u rešavanju impresivne kominutivne traume čeone kosti ogleda se u adekvatnoj fiksaciji brojnih ulomaka koji moraju proći kroz adekvatnu repociziju i osteosintezu da bi se postigla adekvatna stabilnost ulomaka i vratila prvobitna kontura čeone kosti i/ili zidova čeonog sinusa. Obnovu normalne konture kosti sproveli smo kroz brz i jednostavan način lečenja frontalnog preloma korišćenjem titanijum 3D mesh-a. Tehnika podrazumeva 'izvući kost na mrežu' i fiksirati je monokortikalnim šrafovima. Iznosimo naša iskustva sa ovom tehnikom u slučaju rešavanja frontalne impresivne i kominutivne frakture, na bolesničkom materijalu od 43 pacijenta u Centru za zbrinjavanje urgentnih stanja i neurotraume Urgentnog centra Kliničkog Centra Srbije, kroz retrospektivnu kohortnu studiju, propraćeno kroz tehnički aspekt i kliničke rezultate primene ove jednostavne metode. Studija je prethodno odobrena od Etičkog odbora KCS. U periodu od tri godine njih 43 su imali prelome u predelu čeone kosti i čeonog sinusa. Period praćenja je od 01. januara 2013. godine do 31. decembra 2016. godine. Najmlađi bolesnik imao je 17, a najstariji 78 godina, sa prosekom 29 godina. Glavni uzrok su bile saobraćajne nesreće, kod 29/43 (67,44%) pacijenata, sport, kod 4/43 (9,30%), pad sa svoje visine, 5/43 (11,63%), pad sa visine veće od 2m, 4/43 (9,30%) i rukovanje mašinama, 1/43 (2,33%). Odnos prema polnoj distribuciji muškarci/žene je 3:1. Svi pacijenti su operisani u periodu od 6 dana posle povrede. Dijagnostička evaluacija pacijenata načinjena je multislajsnom kompjuterizovanom tomografijom sa 3D rekonstrukcijom (MDCT 3D) pre i postoperativno. Svi pacijenti su kontrolisani na pregledima kroz period praćenja od prvog do 12. postoperativnog meseca. Stabilnost fragmenata tokom operativnog zahvata postignuta je u potpunosti, pozicija fragmenata u rekonstruktivnom aktu je u zadovoljavajućim anatomskim konturama. Estetski rezultati bili su zadovoljavajući i bez komplikacija vezanih za primenjeni postupak, kao što je nekontrolisano krvarenje iz sinusa, infekcije, oštećenja zadnjeg zida sinusa i mozga. Efektivnost primenjenog postupka ukazala nam je da nismo imali deformitete konture čela i da je postignut potpun kozmetički rezultat. Primena metoda sa titanijum 3D mesh-om u rešavanju ovako složenih kominutivnih impresivnih preloma pokazala se kao postupak izbora jer na jednostavan način uz dobar hirurški pristup daje odlične rezultate, a sam postupak se izvodi uz minimalan morbiditet u rešavanju prevashodno kominutivnih preloma prednjeg zida čeonog sinusa i čeone kosti.

The development and emergence of mucocele in the salivary glands is very rare. They often appear in small salivary glands and oral mucosa, while extremely rarely in major salivary glands. Current knowledge through literature review has indicated 14 detected cases in submandibular salivary gland with a mucocele entity. The occurrence and development of mucocele is related to various etiological partial obstructions or disruptions of single secretory channels of salivary glands. The mechanism of origin and development of mucocele is explained by the accumulation of mucus or extravasation within it, which is confirmed by the histopathological image. The treatment of mucocele salivary gland requires surgical treatment and such a radical approach minimises the rate of recidivism. As this is an extremely rare entity in its incidence and persistence and has been scarcely reported in literature reviews, we thought we should indicate the existence of this rare disease that has occurred in our practice. We present a 47-year-old male patient with mucocele in the left submandibulary salivary gland, with the disease duration of three years, with occasional remissions and final progressive growth, who underwent surgical treatment after MSCT examination and aspiration puncture., Razvoj i pojava mukokela u pljuvačnim žlezdama je izuzetno retka. One se češće pojavljuju u malim pljuvačnim žlezdama i oralnoj sluznici, dok izuzetno retko u velikim pljuvačnim žlezdama. Dosadašnja saznanja kroz literaturni pregled ukazuju na otkrivena 14 slučaja u submandibularnoj pljuvačnoj žlezdi sa entitetom mukokele. Sam nastanak i razvoj mukokela vezan je etiološki za razne parcijalne opstrukcije ili poremećaje u samim izvodnim kanalima žlezde. Mehanizam nastanka i razvoja mukokela objašnjava se nagomilavanjem ili ekstravazacijom mukusa unutar nje, što histopatološka slika i potvrđuje. Sam tretman mukokela pljuvačnih žlezda zahteva hirurško zbrinjavanje i takav radikalni pristup svodi na minimum stopu recidiva. Kako je ovo izuzetno redak entitet u svojoj pojavnosti i perzistenciji, a i kroz literaturni pregled u malom obimu javljanja, smatrali smo da treba da ukažemo na postojanje ovog retkog oboljenja koje nam se kroz praksu pojavilo. Prikazujemo pacijenta starosti 47. godina sa trajanjem bolesti unazad tri godine, sa povremenim remisijama i konačnim progresivnim rastom mukokele leve submandibularne pljuvačne žlezde, kod koga se, nakon MSCT pregleda i punkcije. pristupilo operativnom tretmanu.

Previous clinically-epidemiological studies suggested that the presence of a lower third molar (wisdom tooth), especially unerupted, increases the risk of mandibular angle fracture. However, in the case of absent third molar, a greater frequency of condylar fractures is noted, the treatment of which is more complicated. Since previous studies have not considered other risk factors besides the the wisdoom tooth, the interest was to analyse the impact of the lower third molar parallel with the impacts of other risk factors (patient gender and age, trauma etiology, site od action of the traumatic force) on mandibular angle and condylar fractures, and to show possible predictors of these fractures. Given that the impact of the wisdom tooth on the distribution of the stress (important for fracture development) in the mandibular angle and condylar regions is not familiar, it was meaningful to analyze the stress distribution in the terms of the presence, position, eruption status of the wisdom tooth, and of the site of action of the impact force. The aim of the study was to investigate the influence of the lower third molar presence, position and number of the roots, on the risk of mandibular angle and condylar fractures. The aim was also to estimate the influence of trauma factors (trauma etiology and site of action of the impact force) on these fractures. The study consisted of two separate units: clinical-epidemiological study and Finite Element Analysis (FEA) of the computational models of the lower jaw. In the clinical-epidemiological study, collected data were based on the patient history, anamnesis, clinical examination and radiographs: the ortopantomorgraph and frontal radiograph of the lower jaw. Primary independent variables were: properties of the wisdom tooth (presence, eruption status, vertical and horizontal position classified by Pell and Gregory, angulation, relation to the inferior border of the mandible, number of roots), patient gender and age, trauma etiology and site of action of the impact force. The main outcome variables were the mandibular angle and condylar fractures. In the second part of the study computer models of the lower jaw were analysed by means of Finite element Analysis- FEA. The models were created on the basis of the CT scans of the mandible belonging to an adult male person with full dental arch and erupted third molars..., Dosadašnje kliničko-epidemiološke studije su pokazale da prisustvo donjeg trećeg molara (umnjaka), naročito neizniklog, povećava rizik za nastanak preloma donjeviličnog ugla. Međutim, u slučaju odsustva umnjaka, zapažena je veća učestalost preloma zglobnog nastavka donje vilice, koji u odnosu na prelom vličnog ugla iziskuje komplikovaniji hirurški tretman. Kako dosadašnje studije, pored umnjaka, nisu razmatrale i druge faktore rizika za nastanak preloma donjeviličnog ugla i zglobnog nastavka, od značaja je bilo analizirati uticaj umnjaka uporedno sa uticajem drugih faktora rizika (pol i starost pacijenata, etiologija povrede, mesto dejstva traumatske sile) i izdvojiti moguće prediktore ovih preloma. Obzirom na to da nije poznat uticaj umnjaka na distribuciju napona značajnog za nastanak preloma u regionu donjeviličnog ugla i zlobnog nastavka, od značaja je takođe bilo analizirati i distribuciju napona u zavisnosti od prisustva, položaja i stepena izniklosti umnjaka, kao i od mesta dejstva traumatske sile. Cilj rada je bio da se ispita uticaj prisustva, položaja i broja korenova donjeg umnjaka na rizik za nastanak preloma u regionu donjeviličnog ugla i zglobnog nastavka. Takođe, cilj je bio i da se proceni uticaj faktora traume (etiologije povrede i mesta dejstva traumatske sile) na ove prelome. Studija se sastojala iz dva zasebna dela: kliničko-epidemiološke studije i analize kompjuterskih modela donje vilice primenom metode konačnih elemenata. U kliničko-epidemiološkom delu studije, prikupljeni podaci su bili bazirani na istorijama bolesti, anamnezi, kliničkom pregledu i načinjenim radiogramima: ortopantomogramu i postero-anteriornom radiogramu donje vilice. Primarne nezavisne varijable su bile: svojstva donjeg umnjaka (prisustvo, stepen izniklosti, vertikalni i horizontalni položaj klasifikovan po Pell-u i Gregory-ju, nagib, odnos prema donjoj ivici donje viice, broj korenova), pol, starost, etiologija povrede i mesto dejstva traumatske sile. Glavne ishodne varijable su bili prelomi donjeviličnih uglova i zglobnih nastavaka. U drugom delu studije analizirani su kompjuterski modeli donje vilice primenom “metode konačnih elemenata” (Finite element Analysis-FEA). Modeli su kreirani na osnovu kompjuterizovano-tomografskih (Computerised Tomography- CT) snimaka donje vilice odrasle muške osobe, sa punim zubnim nizom i izniklim umnjacima...