Srpski Arhiv Za Celokupno Lekarstvo[JOURNAL]
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200 papers
Granulomatous interstitial nephritis associated with influenza A: H1N1 infection--A case report.
Milosevski-Lomić G, Marković-Lipkovski J, Kostić M … +3 more , Dusan Paripović, Spasojević-Dimitrijeva B, Peco-Antić A
Srp Arh Celok Lek · 2016 · PMID 27483570
INTRODUCTION: The causes of acute tubulointerstitial nephritis can be grouped into four broad categories: medications, infections, immunologic diseases, or idiopathic processes. Here we report a 17-year-old female who de...
INTRODUCTION: The causes of acute tubulointerstitial nephritis can be grouped into four broad categories: medications, infections, immunologic diseases, or idiopathic processes. Here we report a 17-year-old female who developed acute kidney injury (AKI) due to granulomatous interstitial nephritis (GIN) associated with influenza A: H1N1 infection. CASE OUTLINE: The illness presented after two weeks of respiratory tract infection, skin rash and hypermenorrhea. On admission the patient was febrile, with bilateral pedal edema, macular skin rash, and auscultatory finding that suggested pneumonia. Laboratory investigations showed normocytic anemia, azotemia, hematuria and proteinuria. Renal ultrasound was normal. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, lupus anticoagulant, antiphospholipid antibodies were negative with normal complement. Urine cultures including analysis for Mycobacterium tuberculosis were negative. The diagnosis of influenza A: H1N1 infection was made by positive serology. A kidney biopsy showed interstitial nephritis with peritubular granulomas. Glomeruli were normal. Staining for immunoglobulins A, M, G, and F was negative. The girl was treated with oseltamivir phosphate (Tamiflu; Genentech, Inc., South San Francisco, CA, USA) for five days, as well as with tapered prednisone after a starting dose of 2 mg/kg. The treatment resulted in a complete remission during two years of follow-up. CONCLUSION: We present a severe but reversible case of GIN and AKI associated with influenza A: H1N1 infection. Although a causal effect cannot be confirmed, this case suggests that influenza A: H1N1 should be considered in the differential diagnosis of GIN manifested with AKI in children.
Laparoscopic gastric wedge resection as the method of choice in the treatment of gastrointestinal stromal tumors--A case report.
Stevanović D, Stojanović D, Jasarović D … +2 more , Mitrović N, Bokun-Vukasinović Z
Srp Arh Celok Lek · 2016 · PMID 27483569
INTRODUCTION: The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The surgery of resectable gastric GIST is the primary therapy for these tumors, but the dec...
INTRODUCTION: The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The surgery of resectable gastric GIST is the primary therapy for these tumors, but the decision regarding the surgical radicality of the procedures is still a point of discussion among surgeons and oncologists. CASE OUTLINE: A 74-year-old patient was admitted to hospital with signs of bleeding from the upper parts of the gastrointestinal tract. Urgent gastroscopy was performed and a subepithelial gastric lesion with bleeding ulceration was noted in the region of the fornix. A computed tomography scan of the abdomen showed a tumor in the fornix region with the dimensions of 48 x 32 mm, which was growing mostly intraluminally. After an adequate preoperative preparation the patient underwent a laparoscopic wedge resection of gastric fornix with intramural tumor lesion. The histopathological analysis of the specimen showed a well differentiated GIST (histological grade Gi), of the spindle cell type. Based on the immunohistochemical analysis of thespecimen it was concluded that the patient was in the IA stage of the disease with a low risk of malignant progression. In the population of patients with GIST, this is the most common group (43%), with low malignant potential, and relapses present in only 3.6% of cases.The patient started with oral food intake on the first postoperative day, the first bowel movement occurred 36 hours after surgery, and the patient was released from hospital on the fourth postoperative day. CONCLUSION: Based on the aforementioned, we consider that the laparoscopic gastric wedge resection is a safe and efficient surgical procedure. This is primary therapy for most common group of patients with resectable gastric GIST.
Hypercalcemia with multiple osteolytic lesions and increased circulating tumor necrosis factor in an adult patient with B-cell acute lymphoblastic leukemia.
Virijevic M, Vidović A, Colović N … +4 more , Djunić I, Mitrović M, Nada Suvajdzić-Vuković, Tomin D
Srp Arh Celok Lek · 2016 · PMID 27483568
INTRODUCTION: Acute lymphoblastic leukemia (ALL) is very rarely presented with diffuse osteolytic lesions and hypercalcemia. CASE OUTLINE: We report a 28-year-old male with the B-cell ALL who presented with extensive ost...
INTRODUCTION: Acute lymphoblastic leukemia (ALL) is very rarely presented with diffuse osteolytic lesions and hypercalcemia. CASE OUTLINE: We report a 28-year-old male with the B-cell ALL who presented with extensive osteolytic lesions, bone pain, hepatosplenomegaly, and pancytopenia without circulating blasts in peripheral blood. An increased serum level of tumor necrosis factor (TNF-α) was registered while the levels of IL-1α and IL-1β were normal. The patient failed to achieve remission on two induction regimens but achieved one after the successful allogeneic stem cell transplantation, which lasted for six months, after which he developed a relapse and died. CONCLUSION: The presented case may serve as a clinical demonstration of possible involvement of TNF-α as a pathogenic factor in the evolution of osteolytic lesions that are occasionally observed in patients with ALL. This might have relevance in the management of such patients as chemotherapy alone may not represent the beneficial option in this clinical context.
Severe neonatal subgaleal hemorrhage as the first presentation of hemophilia A.
Radovanović T, Spasojević S, Stojanović V … +1 more , Doronjski A
Srp Arh Celok Lek · 2016 · PMID 27483567
INTRODUCTION: Subgaleal hemorrhage is a rare but potentially fatal birth trauma. It is caused by rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by the accumulation of bloo...
INTRODUCTION: Subgaleal hemorrhage is a rare but potentially fatal birth trauma. It is caused by rupture of the emissary veins (connections between the dural sinuses and scalp veins), followed by the accumulation of blood between the epicranial aponeurosis and the periosteum. Usually, it is associated with instrumental delivery (vacuum extraction, forceps delivery), but it may also occur spontaneously, suggesting the possibility of congenital bleeding disorder. CASE OUTLINE: A full term male neonate was born at 40 weeks gestation by spontaneous vaginal delivery, with birth weight of 3,700 g. The Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. At the age of 23 hours, the baby became pale and lethargic. Large fluctuant swelling on his head was noted. He developed severe anemia and hypovolemia as a result of massive subgaleal hemorrhage. After successful treatment, the baby fully recovered. Follow-up and further evaluation revealed hemophilia A as a result of a de novo mutation. CONCLUSION: This case illustrates that subgaleal hemorrhage may be the first presentation of hemophilia A. Infants without obvious risk factors for developing subgaleal hemorrhage should be evaluated for congenital bleeding disorder. Successful outcome in affected infants requires early diagnosis, careful monitoring and prompt treatment.
Challenges in interpretation of thyroid hormone test results.
Lalić T, Beleslin B, Savić S … +3 more , Stojković M, Cirić J, Zarković M
Srp Arh Celok Lek · 2016 · PMID 27483566
INTRODUCTION: In interpreting thyroid hormones results it is preferable to think of interference and changes in concentration of their carrier proteins. OUTLINE OF CASES: We present two patients with discrepancy between...
INTRODUCTION: In interpreting thyroid hormones results it is preferable to think of interference and changes in concentration of their carrier proteins. OUTLINE OF CASES: We present two patients with discrepancy between the results of thyroid function tests and clinical status. The first case presents a 62-year-old patient with a nodular goiter and Hashimoto thyroiditis. Thyroid function test showed low thyroid-stimulating hormone (TSH) and normal to low fT4. By determining thyroid status (TSH, T4, fT4,T3, fT3) in two laboratories, basal and after dilution, as well as thyroxine-binding globulin (TBG), it was concluded that the thyroid hormone levels were normal. The results were influenced by heterophile antibodies leading to a false lower TSH level and suspected secondary hypothyroidism.The second case, a 40-year-old patient, was examined and followed because of the variable size thyroid nodule and initially borderline elevated TSH, after which thyroid status showed low level of total thyroid hormones and normal TSH. Based on additional analysis it was concluded that low T4 and T3 were a result of low TBG. It is a hereditary genetic disorder with no clinical significance. CONCLUSION: Erroneous diagnosis of thyroid disorders and potentially harmful treatment could be avoided by proving the interference or TBG deficiency whenever there is a discrepancy between the thyroid function results and the clinical picture.
Surgical treatment of intramural hematoma of the ascending aorta.
Susak S, Redzek A, Torbica V … +2 more , Rajić J, Todić M
Srp Arh Celok Lek · 2016 · PMID 27483565
INTRODUCTION: Intramural hematoma of the aorta presents potentially fatal condition developing as a result of a vasa vasorum rupture. It is a major risk factor for developing a frank aortic dissection. CASE OUTLINE: A 65...
INTRODUCTION: Intramural hematoma of the aorta presents potentially fatal condition developing as a result of a vasa vasorum rupture. It is a major risk factor for developing a frank aortic dissection. CASE OUTLINE: A 65-year-old woman was admitted to our clinic for the second time, after her symptoms of chest pain and vertigo (with no electrocardiographic signs of myocardial infarction) hadn't disappeared after several months of medicament treatment (indicated in the first hospitalization). Computed tomography arteriography of the aorta showed no sign of acute aortic dissection, but revealed a contrast depo in the aortic wall of 8 x 14 mm dimensions, with no extravasation of contrast. Also, massive pericardial effusion was observed (10-30 mm in thickness). Transesophageal echocardiography confirmed these findings completely. The patient underwent surgery, in which plaque exulceration was detected on the convex side of the ascending aorta, 3 cm above the aortic valve, 1 cm in diameter, with no signs of intimal tear. A resection of the ascending aorta was performed, and the aorta was reconstructed with a 30 mm Dacron tube graft. The patient was discharged on the 14th postoperative day with satisfactory results. CONCLUSION: Intramural hematoma is not a common event, but it is potentially a fatal one. Open surgery in patients with an intramural hematoma is an effective treatment strategy, although percutaneous endovascular treatment options are being described.
Analysis of load distribution in tooth-implant supported fixed partial dentures by the use of resilient abutment.
Glisić M, Stamenković D, Grbović A … +3 more , Todorović A, Marković A, Trifković B
Srp Arh Celok Lek · 2016 · PMID 27483564
INTRODUCTION: Differences between the tooth and implant response to load can lead to many biological and technical implications in the conditions of occlusal forces. OBJECTIVE: The objective of this study was to analyze...
INTRODUCTION: Differences between the tooth and implant response to load can lead to many biological and technical implications in the conditions of occlusal forces. OBJECTIVE: The objective of this study was to analyze load distribution in tooth/implant-supported fixed partial dentures with the use of resilient TSA (Titan Shock Absorber, BoneCare GmbH, Augsburg, Germany) abutment and conventional non-resilient abutment using finite element method. METHODS: This study presents two basic 3D models. For one model a standard non-resilient abutment is used, and on the implant of the second model a resilient TSA abutment is applied. The virtual model contains drawn contours of tooth, mucous membranes, implant, cortical bones and spongiosa, abutment and suprastructure. The experiment used 500 N of vertical force, applied in three different cases of axial load. Calculations of von Mises equivalent stresses of the tooth root and periodontium, implants and peri-implant tissue were made. RESULTS: For the model to which a non-resilient abutment is applied, maximum stress values in all three cases are observed in the cortical part of the bone (maximum stress value of 49.7 MPa). Measurements of stress and deformation in the bone tissue in the model with application of the resilientTSA abutment demonstrated similar distribution; however, these values are many times lower than in the model with non-resilient TSA abutment (maximum stress value of 28.9 MPa). CONCLUSION: Application of the resilient TSA abutment results in more equal distribution of stress and deformations in the bone tissue under vertical forces. These values are many times lower than in the model with the non-resilient abutment.
Posture in dentists: Sitting vs. standing positions during dentistry work--An EMG study.
Pejcić N, Jovicić MĐ, Miljković N … +2 more , Popović DB, Petrović V
Srp Arh Celok Lek · 2016 · PMID 27483563
INTRODUCTION: Adequate working posture is important for overall health. Inappropriate posture may increase fatigue, decrease efficiency, and eventually lead to injuries. OBJECTIVE: The purpose was to examine posture posi...
INTRODUCTION: Adequate working posture is important for overall health. Inappropriate posture may increase fatigue, decrease efficiency, and eventually lead to injuries. OBJECTIVE: The purpose was to examine posture positions used during dentistry work. METHODS: In order to quantify different posture positions, we recorded muscle activity and positions of body segments. The position (inclination) data of the back was used to assess two postures: sitting and standing during standard dental interventions. RESULTS: During standard interventions, whether sitting or standing, a tilt of less than 20 degrees was most prevalent in the forward and lateral flexion directions. Amplitude of electromyography signals corresponding to the level of muscle activity were higher in sitting compared with the electromyography in standing position for all muscle groups on the left and right side of the body. Significant difference between muscle activity in two working postures was evident in splenius capitis muscle on the left (p = 0.032), on the right side of the body (p = 0.049) and in muscle activity of mastoid muscle on the left side (p = 0.029). CONCLUSION: These findings show that risk for increased fatigue and possible injures can be reduced by combining the sitting and standing occupational postures.
Outcome of orthograde endodontic retreatment--A two-year follow-up.
Nesković J, Zivković S, Medojević M … +1 more , Maksimović M
Srp Arh Celok Lek · 2016 · PMID 27483562
INTRODUCTION: Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. OBJECTIVE: The aim of the study was to as...
INTRODUCTION: Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. OBJECTIVE: The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. METHODS: Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2) while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5). Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. RESULTS: Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. CONCLUSION: Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions.
Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia--Cross-sectional analysis.
Kuburović NB, Dedić V, Djuricić S … +1 more , Kuburović V
Srp Arh Celok Lek · 2016 · PMID 27483561
INTRODUCTION: The quality of health care significantly depends on the satisfaction of the employees. OBJECTIVE: The objective of this study was to establish the level of professional satisfaction of healthcare profession...
INTRODUCTION: The quality of health care significantly depends on the satisfaction of the employees. OBJECTIVE: The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. METHOD: Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. RESULTS: This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. CONCLUSION: There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.
Ability to solve riddles in patients with speech and language impairments after stroke.
Savić G
Srp Arh Celok Lek · 2016 · PMID 27483560
INTRODUCTION: Successful riddle solving requires recognition of the meaning of words, attention, concentration, memory, connectivity and analysis of riddle content, and sufficiently developed associative thinking. OBJECT...
INTRODUCTION: Successful riddle solving requires recognition of the meaning of words, attention, concentration, memory, connectivity and analysis of riddle content, and sufficiently developed associative thinking. OBJECTIVE: The aim of the study was to determine the ability to solve riddles in stroke patients who do or do not have speech and language disorders (SLDs), to determine the presence of SLDs in relation to the lesion localization, as well as to define the relationship between riddle-solving and functional impairment of a body side. METHODS: The sample consisted of 88 patients. The data used included age, sex, educational level, time of stroke onset, presence of an SLD, lesion localization, and functional damage of the body side. The patients were presented with a task of solving 10 riddles. RESULTS: A significant SLD was present in 38.60% of the patients. Brain lesions were found distributed at 46 different brain sites. Patients with different lesion localization had different success in solving riddles. Patients with perisylvian cortex brain lesions, or patients with Wernicke and global aphasia, had the poorest results. The group with SLDs had an average success of solved riddles of 26.76% (p = 0.000). The group with right-sided functional impairments had average success of 37.14%, and the group with functional impairments of the left side of the body 56.88% (p = 0.002). CONCLUSION: Most patients with SLDs had a low ability of solving riddles. Most of the patients with left brain lesions and perisylvian cortex damage demonstrated lower ability in solving riddles in relation to patients with right hemisphere lesions.
The effect of anterior cruciate ligament reconstruction on hamstring and quadriceps muscle function outcome ratios in male athletes.
Kadija M, Knezević OM, Milovanović D … +2 more , Nedeljković A, Mirkov DM
Srp Arh Celok Lek · 2016 · PMID 27483559
INTRODUCTION: Maximal strength ratios such as the limb symmetry index (LSI) and hamstring-to-quadriceps ratio (HQ) may be considered the main outcome measures in the monitoring of recovery after anterior cruciate ligamen...
INTRODUCTION: Maximal strength ratios such as the limb symmetry index (LSI) and hamstring-to-quadriceps ratio (HQ) may be considered the main outcome measures in the monitoring of recovery after anterior cruciate ligament (ACL) reconstruction. Although explosive strength is much more important than maximal strength, it is generally disregarded in the follow-up of muscle function recovery. OBJECTIVE: The purpose of this study was to compare ratios between maximal (Fmax) and explosive strength (rate of force development--RFD) in individuals with ACL reconstruction. METHODS: Fifteen male athletes were enrolled and had maximum voluntary isometric quadriceps and hamstring contractions tested (4.0 ± 0.1 months post reconstruction). In addition to Fmax RFD was estimated (RFDmax, as well as RFD at 50, 100, and 200 ms from onset of contraction) and LSI and HQ ratios were calculated. RESULTS: The involved leg demonstrated significant hamstring and quadriceps deficits compared to uninvolved leg (p < 0.01). Deficits were particularly significant in the involved quadriceps, causing higher HQ ratios (average 0.63), compared to the uninvolved leg (0.44). LSI was significantly lower for RFD variables (average 55%) than for Fmax (66%). CONCLUSION: The assessment of RFD may be considered an objective recovery parameter for one's readiness to return to sports and should be an integral part of standard follow-up protocol for athletes after ACL reconstruction. Moreover, the combination of indices derived from maximal and explosive strength may provide better insight in muscle strength balance, as well as a clear picture of functional implications.
Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate-resistant polycystic ovarian syndrome patients.
Bjelica A, Trninić-Pjević A, Mladenović-Segedi L … +2 more , Cetković N, Petrović D
Srp Arh Celok Lek · 2016 · PMID 27483558
INTRODUCTION: Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive-age. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozo...
INTRODUCTION: Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive-age. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozole and gonadotropins. OBJECTIVE: The aim of the study was to compare the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients who are resistant to clomiphene citrate alone. METHODS: The investigation was conducted as a retrospective study involving 60 moderately obese patients with polycystic ovary syndrome. Thirty-one of them received the clomiphene citrate-metformin, and 29 letrozole-metformin therapy. Stimulation was carried out for the procedures of intrauterine insemination (IUI). RESULTS: The age of patients, duration of infertility, and body mass index in both groups were similar. There was statistically significant difference in the thickness of the endometrium in favor of the group having the letrozole-metformin therapy (8.9 ± 1.7 mm) compared with the group receiving the clomiphene citrate-metformin treatment (6.3 ± 1.3 mm). The number of follicles was not statistically significantly different. Pregnancy rate in the first cycle of IUI in the clomiphene citrate group was 6.4%, and 17.2% in the letrozole group, which also was not statistically different. After the third IUI cycle, the pregnancy rate was significantly higher in the letrozole group (20.6%), while in the clomiphene citrate group it was (9.6%). CONCLUSION: This retrospective study demonstrated the advantages of the use of letrozole over clomiphene citrate in combination with metformin in moderately obese patients with polycystic ovary syndrome who are resistant to stimulation with clomiphene citrate alone.
General ward and pneumonia size as predictors of noninvasive ventilation failure.
Joves-Sević B, Obradović D, Srdjan Stefanović … +3 more , Batranović U, Repić J, Vukoja M
Srp Arh Celok Lek · 2016 · PMID 27483557
INTRODUCTION: Shortage of intensive care beds has led to more frequent use of noninvasive ventilation (NIV) outside respiratory units, and data on NIV efficacy and safety on general wards is lacking. OBJECTIVE: The aim w...
INTRODUCTION: Shortage of intensive care beds has led to more frequent use of noninvasive ventilation (NIV) outside respiratory units, and data on NIV efficacy and safety on general wards is lacking. OBJECTIVE: The aim was to identify potential predictors for NIV failure. METHODS: This was a retrospective analysis of patients treated with NIV at the Institute for Pulmonary Diseases of Vojvodina from 2009 to 2013. Demographics, blood gases, chest radiographs, setting, and outcomes were analyzed to identify predictors of NIV failure. RESULTS: A total of 138 patients (65% men, mean age 66 ± 11 years) were treated with NIV. Indications for NIV were acute exacerbation of chronic obstructive pulmonary disease (85%) and cardiogenic pulmonary edema (7%), as well as respiratory insufficiency related to obesity and central hypoventilation (5%) and neuromuscular disease (3%). Rate of NIV failure was 34.8%. In 86 patients NIV was applied in the High Dependency Unit (HDU), while 52 received NIV on the general ward. Baseline characteristics in terms of gender, arterial blood gases, and the extent of consolidation on chest radiographs were similar. Patients treated in HDU were younger (64.4 ± 1.2 vs. 69.4 ± 1.5 years, p < 0.001). NIV on the general ward compared to HDU had higher rates of NIV failure (28/52 vs. 20/86, p < 0.001). Presence of consolidation involving two or more quadrants on chest radiograph (55% vs. 29%, p < 0.001) was associated with NIV failure. When adjusted for age and the extent of consolidation on chest radiograph, NIV failure was still less likely in patients treated in HDU (OR 0.23, 95% Cl 0.10-0.50). CONCLUSION: Patients with consolidation on chest X-ray and patients treated with NIV outside of dedicated respiratory units are at a higher risk for NIV failure.
Can we always take analysis of complete blood count by automated blood cell analyzer as absolutely correct?
Čolović N, Leković D, Jaković L
Srp Arh Celok Lek · 2016 · PMID 29652459
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Capture the fracture – Use of bone turnover markers in clinical practice.
Vuksanović M, Beljić-Živković T
Srp Arh Celok Lek · 2016 · PMID 29652458
Bone is a living tissue, metabolically very active, with the level of turnover of about 10% per year. Bone remodeling is a well-balanced process of bone resorption, induced by osteoclasts and bone formationmaintained ost...
Bone is a living tissue, metabolically very active, with the level of turnover of about 10% per year. Bone remodeling is a well-balanced process of bone resorption, induced by osteoclasts and bone formationmaintained osteoblasts. Loss of bone remodeling balance, with increased bone resorption, leads to osteoporosis. Bone turnover markers are classified as markers of bone formation and of bone resorption. During the growth and development of skeleton, bone turnover markers show higher levels of activity than in the adult period. The increase in biochemical markers peaks again in the postmenopausal period, indicating accelerated bone remodeling. Bone mineral density is an important predictor of an osteoporotic fracture. Timely assessment of risk factors of osteoporosis and bone markers can detect subjects with accelerated bone remodeling and osteoporosis. This may introduce adequate therapy and prevent fracture.
Allogeneic fetal stem cell transplantation to child with psychomotor retardation – A case report.
Dajić K, Veličković V, Djurdjević P … +2 more , Simović AM, Stojković AK
Srp Arh Celok Lek · 2016 · PMID 29652457
INTRODUCTION: The consequences of autologous and allogeneic stem cell transplantation (stem cells of hematopoiesis), applied in adults and children suffering from leukemia or some other malignant disease, are well-known...
INTRODUCTION: The consequences of autologous and allogeneic stem cell transplantation (stem cells of hematopoiesis), applied in adults and children suffering from leukemia or some other malignant disease, are well-known and sufficiently recognizable in pediatric clinical practice regardless of the indication for the treatment. However, the efficacy of fetal stem cell transplantation is unrecognizable when the indications are psychomotor retardation and epilepsy. CASE OUTLINE: With the exception of neurological psychiatric problems, a boy aged 9.5 years was in good general health before transplantation with allogeneic fetal stem cells. The main aim of allogeneic fetal stem cell transplantation was treatment of psychomotor retardation and epilepsy. After 13 months of treatment, he was admitted to hospital in a very serious, life-threatening condition due to sepsis and severe pleuropneumonia. The humoral immunity in the boy was adequate, unlike cellular immunity. The immune imbalance in terms of predominance of T-suppressor lymphocytes contributes to delayed and late development of sepsis and severe pleuropneumonia. The boy still shows the same severity of psychomotor retardation, dyslalia, epilepsy, strabismus and amblyopia. CONCLUSION: Implementation of fetal stem cell therapy for unconfirmed indications abuses the therapeutic approach, harms patients, misleads parents, and brings financial harm to the healthcare system of any country, including Serbia.
Glomus tumor – A case report.
Stošić M, Stojanović I, Lalić M
Srp Arh Celok Lek · 2016 · PMID 29652456
INTRODUCTION: Glomus tumor is a neuromyoarterial tumor. It is a rare tumor which accounts for about 2% of all hand tumors. The diagnosis is based on the triad of symptoms, clinical examination which includes three tests,...
INTRODUCTION: Glomus tumor is a neuromyoarterial tumor. It is a rare tumor which accounts for about 2% of all hand tumors. The diagnosis is based on the triad of symptoms, clinical examination which includes three tests, magnetic resonance imaging, and ultrasound imaging. The most common treatment is surgical excision, using transungual or lateral subperiosteal approach. Sclerotherapy and radiotherapy may be the treatments of choice, but they are less effective. The recurrence rate is high – from 5% to 50%. CASE OUTLINE: We diagnosed a glomus tumor of 1 cm in diameter in the distal phalanx of the fourth finger of the right hand in a 30-year-old woman. She had been visiting different physicians for more than two years and had been variously diagnosed. We performed a biopsy of the tumor, which was bleeding profusely during the procedure. Upon biopsy results, the tumor was excised with transungual approach. Two and a half months after the procedure the patient was feeling well. CONCLUSION: There should be higher awareness of this tumor in order to diagnose it more easily and treat it accordingly, and thus alleviate the severe pain which the tumor causes. When it is considered as the possible cause of the lesion, the diagnosing is easier and treatment is immediate.
Subendocardial hemorrhages in a case of extrapercardial cardiac tamponade – A possible mechanism of appearance.
Nikolić S, Živković V
Srp Arh Celok Lek · 2016 · PMID 29652455
INTRODUCTION: Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free...
INTRODUCTION: Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from “shock” in the widest sense and, even more often, in combination with brain injuries. CASE OUTLINE: We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma. CONCLUSION: We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage.
Primary reconstruction of neck defect after excision of metastatic melanoma of unknown primary site with regional pectoral myocutaneous flap.
Veličkov A, Kovačević P, Veličkov A … +1 more , Ghanaati S
Srp Arh Celok Lek · 2016 · PMID 29652454
INTRODUCTION: Metastatic melanoma of unknown primary (MMUP) is already a well described oncologic phenomenon in the literature, whereas tissue defects’ reconstructions on the neck region always present a challenge for th...
INTRODUCTION: Metastatic melanoma of unknown primary (MMUP) is already a well described oncologic phenomenon in the literature, whereas tissue defects’ reconstructions on the neck region always present a challenge for the reconstructive surgeon. Two cases of giant metastatic, skin infiltrative neck tumor masses are presented. In both cases MMUP was diagnosed. Both intraoperative tissue defects were reconstructed using pectoralis major (PM) regional flap. OUTLINE OF CASES: The first patient was admitted with giant tumor mass on the right side of the neck. The fast growing mass appeared two months prior to the admission. Thorough examination showed no signs of primary tumor. Removal surgery was performed and the defect was reconstructed using the PM musculocutaneous flap. The second patient was admitted with large tumor mass on the left side of the neck. Thorough examination displayed no signs of any primary tumor. After the excision, the tumor mass and subsequent neck dissection, reconstruction followed, using the pedicled PM muscle flap and partial thickness skin transplants. There were no major complications in either case. The histopathological examinations presented metastatic melanoma diagnoses. CONCLUSION: Clinical outcome of MMUP described in literature is rather variable. Different studies have shown that prognosis in patients with MMUP is better than that in patients with diagnosed primary melanoma with metastatic disease. Therefore, the best initial course of action in those cases would be surgery, according to oncological principles, if possible. Neck defects’ reconstructions should fulfill both functional and esthetic demands. Due to the reliability and low cost of the procedure, PM regional flap presents a very good and trustworthy reconstruction modality.
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