Srpski Arhiv Za Celokupno Lekarstvo[JOURNAL]
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200 papers
Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report.
Djerić D, Folić M, Janićijević M … +2 more , Blažić S, Popadić D
Srp Arh Celok Lek · 2016 · PMID 29648753
INTRODUCTION: Necrotizing otitis externa is a rare but conditionally fatal infection of external auditory canal with extension to deep soft tissue and bones, resulting in necrosis and osteomyelitis of the temporal bone a...
INTRODUCTION: Necrotizing otitis externa is a rare but conditionally fatal infection of external auditory canal with extension to deep soft tissue and bones, resulting in necrosis and osteomyelitis of the temporal bone and scull base. This condition is also known as malignant otitis due to an aggressive behavior and poor treatment response. Early diagnosis of malignant otitis is a difficult challenge. We present an illustrative case of necrotizing otitis externa and suggest some strategies to avoid diagnostic and treatment pitfalls. CASE OUTLINE: A 70-year-old patient presented with signs of malignant otitis externa, complicated by peripheral facial palsy. Adequate diagnostic and treatment procedures were performed with clinical signs of resolution. The recurrence of malignant infection had presented three months after previous infection with multiple cranial nerve neuropathies and signs of jugular vein and lateral sinus thrombosis. An aggressive antibiotic treatment and surgery were carried out, followed by substantial recovery of the patient and complete restoration of cranial nerves’ functions. CONCLUSION: Necrotizing otitis externa is a serious condition with uncertain prognosis. The suspicion of malignant external otitis should be raised in cases of resistance to topical treatment, especially in patient with predisposing factors. Evidence-based guideline for necrotizing otitis externa still doesn’t exist and treatment protocol should be adjusted to individual presentation of each patient.
The role of apraclonidine in Horner’s syndrome – A case report.
Karadžić J, Kovačević I, Ljikar J
Srp Arh Celok Lek · 2016 · PMID 29648752
INTRODUCTION: Horner’s syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner’s syndrome is classically presented as an ipsilateral mios...
INTRODUCTION: Horner’s syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner’s syndrome is classically presented as an ipsilateral miosis, subtle ptosis, and facial anhidrosis. Pharmacologic testing is very useful in the diagnosis of Horner’s syndrome as it could help to localize the lesioned neuron in the sympathetic pathway, suggesting an etiology. CASE OUTLINE: We present a case report of a 41-year-old woman who reported right eyelid drooping immediately after operation of sympathetic chain schwannoma. We performed apraclonidine test for the diagnosis of Horner’s syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. Based on the clinical presentation of anisocoria and one-sided ptosis, and previous medical history of surgical removal of the mediastinal tumor, the patient was diagnosed with a right-sided, partial Horner’s syndrome. CONCLUSION: Timely recognition, exact localization of the lesioned neuron, and referral for urgent imaging studies are important for ophthalmologists in order to prevent and treat life-threatening conditions. Besides its diagnostic value in Horner’s syndrome, topical apraclonidine could correct ptosis for the sake of esthetics or when ptosis reduces the superior visual field.
Detection of carbapenemase genes in Klebsiella pneumoniae isolates.
Mihajlović-Ukropina M, Trudić A, Jelesić Z … +3 more , Medić D, Milosavljević B, Zivlak B
Srp Arh Celok Lek · 2016 · PMID 29648751
INTRODUCTION: Klebsiella pneumoniae is one of the leading causes of serious hospital-acquired infections worldwide among Enterobacteriaceae species. It is the most common producer of carbapenemases in many parts of the w...
INTRODUCTION: Klebsiella pneumoniae is one of the leading causes of serious hospital-acquired infections worldwide among Enterobacteriaceae species. It is the most common producer of carbapenemases in many parts of the world. OBJECTIVE: The aim of the study was to determine which enzymes were responsible for resistance to carbapenems in Klebsiella pneumoniae strains isolated at the Centre of Microbiology of Public Health Institute of Vojvodina. METHODS: A total of 29 Klebsiella pneumoniae non-duplicated strains resistant to at least one carbapenem isolated from clinical samples of hospitalized patients between November 1st 2013 and April 30th 2014 were studied. The species identification and susceptibility were done using VITEK 2 (bioMérieux, Marcy-l’Étoile, France) system. Phenotypic conformation of carbapenemase production was done by double-disc synergy test. PCR technique was performed for detection of genes encoding production of carbapenemases (bls(KPC), bla(VIM), bla (NDM), bla(OXA-48)). RESULTS: Isolates of Klebsiella pneumoniae resistant to at least one carbapenem showed positive on double- disc synergy test between meropenem and dipicolinic acid. All strains positive in phenotypic test contained bla(NDM) gene. In isolates resistant only to ertapenem, neither production of carbapenemases nor presence of genes encoding these enzymes were detected. Among these isolates, nine produced extended-spectrum β-lactamase. CONCLUSION: The presence of NDM metallo-β-lactamase was determined in all Klebsiella pneumoniae isolates resistant to at least one carbapenem.
Human papillomavirus infection prevalence in female university students in Novi Sad, Serbia.
Kovačević G, Jovanović-Galović A, Petrović V … +4 more , Vinarž Ž, Marinković G, Brašanac B, Milošević V
Srp Arh Celok Lek · 2016 · PMID 29648749
INTRODUCTION: Cervical cancer, attributed to human papillomavirus (HPV) infection, represents the fourth most common and lethal cancer in Serbian women, and the second most common cancer in women aged 15–44. OBJECTIVE: T...
INTRODUCTION: Cervical cancer, attributed to human papillomavirus (HPV) infection, represents the fourth most common and lethal cancer in Serbian women, and the second most common cancer in women aged 15–44. OBJECTIVE: The aim of the study was to determine the presence of high-risk and low-risk HPV types in population of unvaccinated female university students in Novi Sad, Serbia, and to evaluate possible risk factors for HPV infection. METHODS: Sample consisted of 250 young women (19–26 years of age) attending outpatient clinics for screening gynecological examination. All participants in the study completed a specially designed anonymous questionnaire. For the detection of HPV DNA, two commercial kits – High Risk HPV Real-TM and Low Risk HPV 6/11 Real-TM (Sacace Biotechnologies, Como, Italy) were used. Thirty positive samples were retested by GenoFlow HPV Array Test (DiagCor Bioscience Incorporation Limited, Hong Kong, China). RESULTS: The overall prevalence rate of HPV was 61.6%. The most common HPV types in the present study were as follows: HPV 16, 31, 51, 52, and 18. Female students with only one sexual partner had significantly lower chance of having HPV infection. Other variables describing lifestyle did not show statistical significance. CONCLUSION: The present paper provides data on the prevalence of high- and low-risk HPV genotypes among university students in Novi Sad. Obtained results indicate the need for educational activities on sexually transmitted infections, including HPV, together with promotion of healthy lifestyles. According to our results, bivalent and quadrivalent prophylactic vaccines have the potential to prevent over 50% of infections. Percentage of protection with a second-generation prophylactic nonavalent vaccine would be more than 80%.
Results of open tibial fracture treatment using external fixation.
Golubović I, Ristić B, Stojiljković P … +7 more , Ćirić M, Golubović I, Radovanović Z, Petrović S, Djordjević N, Golubović Z, Najman S
Srp Arh Celok Lek · 2016 · PMID 29648747
INTRODUCTION: Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. OBJECTIVE: The aim of the paper was to present the resul...
INTRODUCTION: Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. OBJECTIVE: The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. METHODS: In the analyzed group, there were 45 (66.18%) men and 23 (33.82%) women. The majority of patients – 33 (48.53%) of them – were injured in motor vehicle accidents, whereas 24 (35.29%) patients sustained injuries due to falls from heights. In two (2.94%) patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47%) type I open fractures, 21 (30.88%) type II open fractures, 19 (27.94%) type IIIA open fractures, seven (10.29%) type IIIB open fractures, and three (4.41%) type IIIC open fractures. RESULTS: The tibial shaft fracture healed without serious complications in 50 (73.53%) patients, whereas in 18 (26.47%) patients we observed some complications. Nonunion was found in 10 (14.71%) patients, osteitis in four (5.88), malunion in two (2.94%) patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12%) patients, infection of the open fracture wound soft tissue was observed in four (5.88%) patients. CONCLUSION: Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies.
Tensor fascia lata flap is a workhorse for defects after inguinal lymph node block dissection.
Veličkov AV, Kovačević P, Veličkov AI
Srp Arh Celok Lek · 2016 · PMID 29648746
INTRODUCTION: Enlarged inguinal lymph nodes very often present a site of metastatic disease. Inguinal lymph node block dissection is a demanding procedure, which usually requires at least one of reconstructive modalities...
INTRODUCTION: Enlarged inguinal lymph nodes very often present a site of metastatic disease. Inguinal lymph node block dissection is a demanding procedure, which usually requires at least one of reconstructive modalities. Among different reconstruction options we selected the tensor fascia lata (TFL) musculocutaneous flap. OBJECTIVE: The paper aims at presenting a series of inguinal block dissections, followed by immediate reconstruction, using the TFL flap, and evaluation of tumor type, flap dimension, complication rate and the duration of hospital stay. METHODS: We present a consecutive case series of 25 conducted block dissections. The defects were reconstructed using TFL flap, because of the extent and site of the tissue defects, reliability of the flap, and potentially primarily infected exulcerated tumors. RESULTS: The reconstruction was successful in all cases, the incidence of surgical complications was 16%, no further complications, such as lymphedema or gait disturbances, were noted. Primary skin tumors were predominant (13 cases), followed by genitalia tumors (four cases). The male sex was more frequently affected (14 vs. 11 cases). CONCLUSION: Having in mind that TFL presents as a flap of adjustable size, length, shape, and volume, with negligible donor site morbidity, and after comparing of our results to those of other authors, we advise broader use of TFL flap. As a reliable flap, not too difficult to harvest, with a low complication rate, it must be taken into consideration regarding the benefits for the patient, and, on the other hand, the surgery cost and duration.
Cytotoxicity investigation of a new hydroxyapatite scaffold with improved structural design.
Sjerobabin N, Čolović B, Petrović M … +3 more , Marković D, Živković S, Jokanović V
Srp Arh Celok Lek · 2016 · PMID 29648745
INTRODUCTION: Biodegradable porous scaffolds are found to be very promising bone substitutes, acting as a temporary physical support to guide new tissue regeneration, until the entire scaffold is totally degraded and rep...
INTRODUCTION: Biodegradable porous scaffolds are found to be very promising bone substitutes, acting as a temporary physical support to guide new tissue regeneration, until the entire scaffold is totally degraded and replaced by the new tissue. OBJECTIVE: The aim of this study was to investigate cytotoxicity of a synthesized calcium hydroxyapatitebased scaffold, named ALBO-OS, with high porosity and optimal topology. METHODS: The ALBO-OS scaffold was synthesized by the method of polymer foam template. The analysis of pore geometry and scaffold walls’ topography was made by scanning electron microscope (SEM). The biological investigations assumed the examinations of ALBO-OS cytotoxicity to mouse L929 fibroblasts, using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidefor (MTT) and lactate dehydrogenase (LDH) tests and inverse phase microscopy. RESULTS: The SEM analysis showed high porosity with fair pore distribution and interesting morphology from the biological standpoint. The biological investigations showed that the material is not cytotoxic to L929 cells. Comparison of ALBO-OS with Bio-Oss, as the global gold standard as a bone substitute, showed similar results in MTT test, while LDH test showed significantly higher rate of cell multiplication with ALBO-OS. CONCLUSION: The scaffold design from the aspect of pore size, distribution, and topology seems to be very convenient for cell adhesion and occupation, which makes it a promising material as a bone substitute. The results of biological assays proved that ALBO-OS is not cytotoxic for L929 fibroblasts. In comparison with Bio-Oss, similar or even better results were obtained.
Comparative effects of riboflavin, nicotinamide and folic acid on alveolar bone loss: A morphometric and histopathologic study in rats.
Akpınar A, Karakan NC, Alpan AL … +3 more , Dogan SSA, Goze F, Poyraz O
Srp Arh Celok Lek · 2016 · PMID 29648744 · Publisher ↗
INTRODUCTION: Periodontitis is a chronic inflammatory and osteolytic disease. Vitamin B complex is a class of water-soluble vitamins that play important roles in cell metabolism. OBJECTIVE: The aim of this study was to e...
INTRODUCTION: Periodontitis is a chronic inflammatory and osteolytic disease. Vitamin B complex is a class of water-soluble vitamins that play important roles in cell metabolism. OBJECTIVE: The aim of this study was to evaluate the effects of riboflavin (RBF), nicotinamide (NA), and folic acid (FA) on alveolar bone loss in experimental periodontitis rat model. METHODS: Sixty-four male Wistar rats were randomly divided into the following eight groups: Control, Ligated, RBF50 (RBF, 50 mg/kg daily), NA50 (NA, 50 mg/kg daily), FA50 (FA, 50 mg/kg daily), RBF100 (RBF, 100 mg/kg daily), NA100 (NA, 100 mg/kg daily), and FA100 (FA, 100 mg/kg daily). Periodontitis was induced using silk ligature around the right first mandibular molar. After 11 days the rats were sacrificed. Mandible and serum samples were collected. Changes in alveolar bone levels were measured clinically, and periodontal tissues were examined histopathologically. Serum IL-1β (pg/ml) levels were analyzed by using ELISA. RESULTS: Mean alveolar bone loss in the mandibular first molar tooth revealed to be significantly lower in RBF100 group than in the Control group. In the Ligated group, alveolar bone loss was significantly higher than in all other groups. The ratio of presence of inflammatory cell infiltration in the Ligated group was significantly higher than in the Control group. The differences in the serum IL-1β levels between the groups were not statistically significant. Osteoclasts that were observed in the Ligated group were significantly higher than those of the Control and FA100 groups. The osteoblastic activity in the Ligated group, RBF100, and NA100 groups were shown to be significantly higher than those in the Control group. CONCLUSION: This study has demonstrated that systemic administration of RBF, NA, and FA in different dosages (50–100 mg/kg) reduced alveolar bone loss in periodontal disease in rats.
Relationship between serum tumor necrosis factor receptor-2 concentration and periodontal destruction in patients with type 2 diabetes: Cross-sectional study.
Matić-Petrović S, Pucar A, Jotić A … +4 more , Miličić B, Arambašić-Jovanović J, Vidaković M, Leković V
Srp Arh Celok Lek · 2016 · PMID 29648743
INTRODUCTION: The role of tumor necrosis factor-α (TNFα) is well documented in pathogenesis of chronic periodontitis (CP) and type 2 diabetes (T2D). Considering short half-life of TNFα, tumor necrosis factor receptor-2 (...
INTRODUCTION: The role of tumor necrosis factor-α (TNFα) is well documented in pathogenesis of chronic periodontitis (CP) and type 2 diabetes (T2D). Considering short half-life of TNFα, tumor necrosis factor receptor-2 (TNFR2) is used as prosperous surrogate marker of TNFα activity. OBJECTIVE: The aim was to detect TNFR2 serum concentration and correlate it with periodontal destruction in patients with diagnosed T2D and nondiabetics. METHODS: The study included 85 patients divided into three groups: T2D + CP (group T2D, n = 34); nondiabetics + CP (Group PD, n = 27); and healthy controls (group HC, n = 24). T2D was diagnosed according to WHO criteria (2013) and periodontitis was diagnosed using International Workshop for a Classification of Periodontal Diseases and Conditions criteria (1999). TNFR2 level was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: There was no difference in TNFR2 level among the groups (Kruskal–Wallis, p = 0.482). Significant correlation (Pearson’s correlation coefficient) was observed between clinical attachment loss (CAL) and TNFR2 concentration in PD group (rp = -0.460, p = 0.016). In T2D group, correlations were observed between TNFR2 concentration and CAL (rp = 0.363, p = 0.005) and periodontal inflamed surface area (PISA) (rp = 0.345, p = 0.046) and periodontal epithelial surface area (PESA) (rp = 0.578, p = 0.000). CONCLUSION: Higher concentration of TNFR2 was associated with higher CAL, PESA, and PISA scores in T2D group. Contrary to that, nondiabetics with higher values of CAL exhibited lower concentration of TNFR2, presenting potential protective effect on periodontal destruction. These results imply that diabetes may alter TNFR2 secretion originated from periodontium.
The effect of fatigability on Expanded Disability Status Scale components in multiple sclerosis.
Dujmović I, Demetz S, Millonig A … +1 more , Deisenhammer F
Srp Arh Celok Lek · 2016 · PMID 29648741 · Publisher ↗
INTRODUCTION: The Expanded Disability Status Scale (EDSS) is the most widely used disability measure in multiple sclerosis (MS). The effect of fatigability on EDSS components has been underreported to date. OBJECTIVE: We...
INTRODUCTION: The Expanded Disability Status Scale (EDSS) is the most widely used disability measure in multiple sclerosis (MS). The effect of fatigability on EDSS components has been underreported to date. OBJECTIVE: We investigated daytime variability in EDSS score and EDSS components – functional scores (FS) and walking distance (WD) up to 500 m, in MS patients who underwent a standardized fatiguing exercise. METHODS: Twenty-four patients with relapsing-remitting MS (n = 7), secondary-progressive MS (n = 8) and primary-progressive MS (n = 9) were included. Exclusion criteria were as follows: current MS relapse, infection/fever/flu-like symptoms, conditions prohibiting safe exercise testing, current medication affecting fatigue. One trained examiner performed baseline (BL) and follow-up (FU) assessments (FU1 after a standardized fatiguing exercise, FU2 after rest) over a single day. EDSS score change of ≥1 point if BL EDSS score was <5.5 or of ≥0.5 point if BL EDSS score was ≥5.5 were considered clinically meaningful. RESULTS: In progressive MS subtypes, WD decreased at FU1, but recovered at FU2, more so in secondary progressive MS subgroup with the highest BL EDSS score. Although BL EDSS scores (median, 5.0; range 4.0–6.5) and FS remained relatively stable over repeated assessments in the total group, a clinically meaningful transitory post-exercise EDSS score increase was observed in three patients with progressive MS. CONCLUSION: WD seems to be more influenced by fatigability than the total EDSS score, more so in patients with progressive MS and higher disability. WD should be assessed after rest and this strategy should be implemented into protocols of clinical trials recruiting patients with progressive MS phenotypes.
[Collaboration between Physician Emerich Lindenmayer and Architect Jan Nevole in Restoring the Sokobanja Turkish Bath].
Mitrović G, Nešković M
Srp Arh Celok Lek · 2015 · PMID 26946778 · Publisher ↗
The Sokobanja Turkish bath is an exceptional example of two-section baths and quite particular in its style, structure type and technology used. It is one of the two of the same type that remained in Serbia and the only...
The Sokobanja Turkish bath is an exceptional example of two-section baths and quite particular in its style, structure type and technology used. It is one of the two of the same type that remained in Serbia and the only one that has retained its original function. About its construction we learn from the Vidin sanjak defter from the second half of the 16th century. In the lavish built heritage inventory, Turkish baths are quite unique secular public structures, playing a prominent role in the development of health culture. Based upon their specific function, these baths possess a special architectural expression, are often monumental, decorative and imaginative in their forms and ornamentation. Prince Miloš initiated repair works of the Soko Banja baths and spa springs immediately after the settlement became a part of the Serbian Principality in 1834. When work on restoring the men's baths started, a separate room with a tub was built for Prince Miloš, while the women's bath remained in ruins. In 1847, the Ministry of Interior sent Dr Emerich Lindenmayer and architect Jan Nevole, as an expert team, to assess the state of the hammam so that it could be included in the undertakings funded from the state budget. After the assessment and review of the existing issues and upon a detailed report submitted to the Ministry of Interior, complex repairs were conducted in 1850, according to Nevole's architectural design and his constant supervision. The approach implemented in the architectural renovation process was based on highly regarded principles of the time, thus preserving both the hammam's original function and its valuable architecture.
Accurate Completion of Medical Report on Diagnosing Death.
Savić S, Alempijević D, Andjelić S
Srp Arh Celok Lek · 2015 · PMID 26946777 · Publisher ↗
Diagnosing death and issuing a Death Diagnosing Form (DDF) represents an activity that carries a great deal of public responsibility for medical professionals of the Emergency Medical Services (EMS) and is perpetually ex...
Diagnosing death and issuing a Death Diagnosing Form (DDF) represents an activity that carries a great deal of public responsibility for medical professionals of the Emergency Medical Services (EMS) and is perpetually exposed to the control of the general public. Diagnosing death is necessary so as to confirm true, to exclude apparent death and consequentially to avoid burying a person alive, i.e. apparently dead. These expert-methodological guidelines based on the most up-to-date and medically based evidence have the goal of helping the physicians of the EMS in accurately filling out a medical report on diagnosing death. If the outcome of applied cardiopulmonary resuscitation measures is negative or when the person is found dead, the physician is under obligation to diagnose death and correctly fill out the DDF. It is also recommended to perform electrocardiography (EKG) and record asystole in at least two leads. In the process of diagnostics and treatment, it is a moral obligation of each Belgrade EMS physician to apply all available achievements and knowledge of modern medicine acquired from extensive international studies, which have been indeed the major theoretical basis for the creation of these expert-methodological guidelines. Those acting differently do so in accordance with their conscience and risk professional, and even criminal sanctions.
Acute Diarrhea in Children.
Radlović N, Leković Z, Vuletić B … +2 more , Radlović V, Simić D
Srp Arh Celok Lek · 2015 · PMID 26946776 · Publisher ↗
Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood. It is manifested by a sudden occurrence of three or more watery or loose stools per day lasting for s...
Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood. It is manifested by a sudden occurrence of three or more watery or loose stools per day lasting for seven to 10 days, 14 days at most. It mainly occurs in children until five years of age and particularly in neonates in the second half-year and children until the age of three years. Its primary causes are gastrointestinal infections, viral and bacterial, and more rarely alimentary intoxications and other factors. As dehydration and negative nutritive balance are the main complications of AD, it is clear that the compensation of lost body fluids and adequate diet form the basis of the child's treatment. Other therapeutic measures, except antipyretics in high febrility, antiparasitic drugs for intestinal lambliasis, anti-amebiasis and probiotics are rarely necessary. This primarily regards uncritical use of antibiotics and intestinal antiseptics in the therapy of bacterial diarrhea.The use of antiemetics, antidiarrhetics and spasmolytics is unnecessary and potentially risky, so that it is not recommended for children with AD.
A Novel Frameshift Mutation of the IKBKG Gene Causing Typical Incontinentia Pigmenti.
Minić S, Trpinac D, Obradović M
Srp Arh Celok Lek · 2015 · PMID 26946775 · Publisher ↗
INTRODUCTION: Incontinentia pigmenti (IP) is a rare X-linked dominant genodermatosis. Mutations of the IKBKG gene are responsible for IP. A deletion of exons 4-10 can be found in 80% of patients with IP. There are 69 dif...
INTRODUCTION: Incontinentia pigmenti (IP) is a rare X-linked dominant genodermatosis. Mutations of the IKBKG gene are responsible for IP. A deletion of exons 4-10 can be found in 80% of patients with IP. There are 69 different mutations of the IKBKG gene that have been reported. CASE OUTLINE: A proband, female patient from a family without previously diagnosed IP is reported. She had skin and dental changes typical of IP. The diagnosis was made according to updated IP criteria. Pathohistological and ultrastructural analysis of skin biopsy confirmed the diagnosis. However, the common deletion of exons 4-10 in the IKBKG gene could not be detected. Sequencing revealed the indel (deletion/insertion) mutation c.641_647delGCATGGAinsAT (p.Arg214HisfsX38) in exon 5 of the IKBKG gene. Because this mutation could not be detected in the unaffected mother of the proband, it seems to be a de novo mutation. CONCLUSION: The registered novel frameshift/KBKG mutation c.641_647delGCATGGAinsAT (p.Arg214HisfsX38) can be considered to be the cause of IP in this case.
Pseudo-Bartter's Syndrome in Patients with Cystic Fibrosis: A Case Series and Review of the Literature.
Vilotijević-Dautović G, Stojanović V
Srp Arh Celok Lek · 2015 · PMID 26946774 · Publisher ↗
INTRODUCTION: Pseudo-Bartter syndrome (PBS) is characterized by hyponatremic, hypochloremic metabolic alkalosis that mimics Bartter syndrome but with no pathology in the renal tubules. We present five patients with cysti...
INTRODUCTION: Pseudo-Bartter syndrome (PBS) is characterized by hyponatremic, hypochloremic metabolic alkalosis that mimics Bartter syndrome but with no pathology in the renal tubules. We present five patients with cystic fibrosis (CF) and PBS. CASES OUTLINE: Four children aged between three and five-and-one-half months with previously diagnosed CF and one aged 17 months with previously undiagnosed disease, were hospitalized during the summer season, with severe dehydration, oliguria, apathy and adynamia. Additionally, one of them had an ileostomy due to meconium ileus after birth. All children were on a diet without additional salt intake. Laboratory analysis on admission showed hyponatremia (115-133 mmol/L, mean 122.4 mmol/L), high plasma renin activity (229-500 pg/ml, mean 324 pg/ml) and metabolic alkalosis (pH 7.5-7.6, mean 7.56) in all the patients, and in four of them high blood level of aldosterone (74-560 pg/ml, mean 295.9 pg/ml), hypokalemia (2.3-2.8 mmol/L, mean 2.6 mmol/L), hypochloremia (59-71 mmol/L, mean 66 mmol/L) and low urinary sodium (5-12 mmol/L, mean 9 mmol/L). After intravenous rehydration followed by additional use of sodium and chloride in mean dosis of 1.78 mmol/kg per day, all the patients made a complete recovery. With advice for additional use of salt in the mentioned amount, the patients were discharged from the hospital. CONCLUSION: PBS is one of CF complications, especially in infants and young children in situations accompanied by increased sweating and/or other causes of additional loss of sodium and chlorine. Sometimes, as was the case with one of our patients, PBS may be the initial presentation form of the disease.
Extreme Hypertriglyceridemia in an Infant with Hemophagocytic Lymphohistiocytosis and Hydroxycobalamin Deficiency.
Dokmanović L, Krstovski N, Lazić J … +4 more , Rodić P, Milosević G, Janković S, Janić D
Srp Arh Celok Lek · 2015 · PMID 26946773 · Publisher ↗
INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition characterized by fever, cytopenias, hepatosplenomegaly and hemophagocytosis. HLH may be primary or secondary to infection, au...
INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition characterized by fever, cytopenias, hepatosplenomegaly and hemophagocytosis. HLH may be primary or secondary to infection, autoimmune disease or malignancy. Hypertriglyceridemia is a common abnormality in HLH and one of the HLH-2004 diagnostic criteria. CASE OUTLINE: We present an infant with severe hypotonia and hypoproteinemic edema who also had extreme hypertriglyceridemia (21 mmol/l) and was diagnosed with HLH based on six of eight HLH-2004 criteria (fever, hepatosplenomegaly, bicytopenia, hypertriglyceridemia with hypofibrinogenemia, slL-2R > 2400 IU/ml, hemophagocytosis). The presence of IgM antibodies to Epstein-Barr virus and cytomegalovirus indicated a probable infectious trigger. The child was cured by the HLH-2004 protocol for secondary HLH (consisting of dexamethasone and cyclosporine). He was also found to have low serum hydroxycobalamin levels, promptly corrected upon hydroxycobalamin administration. CONCLUSION: The presented case history underlines the need to ascertain the presence or absence of each of the eight HLH-2004 criteria in any patient suspected to suffer from HLH.
JAK2V617F Mutation in a Patient with B-cell Chronic Lymphocytic Leukemia and Prefibrotic Primary Myelofibrosis.
Ristić S, Radojković M, Kostić T … +3 more , Spasovski V, Pavlović S, Cemerikić-Martinović V
Srp Arh Celok Lek · 2015 · PMID 26946772 · Publisher ↗
INTRODUCTION: Secondary malignancies, particularly solid tumors, are common in patients with chronic lymphocytic leukemia (CLL), but association of myeloproliferative neoplasms and chronic lymphocytic leukemia in the sam...
INTRODUCTION: Secondary malignancies, particularly solid tumors, are common in patients with chronic lymphocytic leukemia (CLL), but association of myeloproliferative neoplasms and chronic lymphocytic leukemia in the same patient is very rare. CASE OUTLINE: We report of a 67-year-old man with B-cell chronic lymphoid leukemia (B-CLL) who developed primary myelofibrosis (PMF) nine years after initial diagnosis. Patient received alkylation agents and purine analogue, which can be a predisposing factor for the development of myeloproliferative neoplasms. JAK2V617F mutation was not present initially at the time of CLL diagnosis, but was found after nine years when PMF occurred, which indicates that B-CLL and PMF represent two separate clonal origin neoplasms. CONCLUSION: Pathogenic mechanisms for the development of myeloproliferative and lymphoproliferative neoplasms in the same patient are unknown. Further research is needed to determine whether these malignancies originate from two different cell clones or arise from the same pluripotent hematopoietic stem cell.
Acute Myocardial Infarction during Induction Chemotherapy for Acute MLL t(4;11) Leukemia with Lineage Switch and Extreme Leukocytosis.
Colović N, Bogdanović A, Virijević M … +2 more , Vidović A, Tomin D
Srp Arh Celok Lek · 2015 · PMID 26946771 · Publisher ↗
INTRODUCTION: In patients with acute leukemias hemorrhage is the most frequent problem. Vein thrombotic events may appear rarely but arterial thromboses are exceptionally rare. We present a patient with acute leukemia an...
INTRODUCTION: In patients with acute leukemias hemorrhage is the most frequent problem. Vein thrombotic events may appear rarely but arterial thromboses are exceptionally rare. We present a patient with acute leukemia and bilateral deep leg vein thrombosis who developed an acute myocardial infarction (AMI) during induction chemotherapy. The etiology and treatment of AMI in patients with acute leukemia, which is a rare occurrence, is discussed. CASE OUTLINE: In April of 2012 a 37-year-old male presented with bilateral deep leg vein thrombosis and malaise. Laboratory data were as follows: Hb 118 g/L, WBC 354 x 10(9)/L (with 91% blasts in differential leukocyte count), platelets 60x109/L. Bone marrow aspirate and immunophenotype revealed the presence of acute lymphoblastic leukemia. Cytogenetic analysis was as follows: 46,XY,t(4;11)(q21:q23) [2]/62-82,XYt(4;11)[18]. Molecular analysis showed MLL-AF4 rearrangement. The patient was on low molecular weight heparin and combined chemotherapy according to protocol HyperCVAD. On day 10 after chemotherapy he got chest pain. Three days later AMI was diagnosed (creatine kinase 66 U/L, CK-MB 13U/L, troponin 1.19 µg/L). Electrocardiogram showed the ST elevation in leads D1, D2, aVL, V5 and V6 and "micro q" in D1. On echocardiography, hypokinesia of the left ventricle and ejection fraction of 39% was found. After recovering from AMI and restoring left ventricle ejection fraction to 59%, second course of HyperCVAD was given. The control bone marrow aspirate showed 88% of blasts but with monoblastic appearance. Flow cytometry confirmed a lineage switch from lymphoblasts to monoblasts. In further course of the disease he was treated with a variety of chemotherapeutic combinations without achieving remission. Eventually, palliative chemotherapy was administered to reduce the bulk of blasts. He died five months after the initial diagnosis. CONCLUSION: AMI in young adults with acute leukemia is a very rare complication which may occur in patients with very high white blood cell count in addition with presence of a CD56 adhesion molecule and other concomitant thrombophilic factors. The treatment of AMI in patients with acute leukemias should include antiplatelet and anticoagulant therapy, even with more aggressive methods depending on patient's age and clinical risk assessment.
Giant Vertebrobasilar Fusiform Aneurysm as a Cerebellopontine Angle Mass.
Živković NZ, Marković M, Aleksić V … +1 more , Jovanović MB
Srp Arh Celok Lek · 2015 · PMID 26946770 · Publisher ↗
INTRODUCTION: According to the literature, a fusiform aneurysm located in the cerebellopontine angle (CPA) is an extremely rare condition. CASE OUTLINE: We report a case of a 59-year-old patient with initial dizziness an...
INTRODUCTION: According to the literature, a fusiform aneurysm located in the cerebellopontine angle (CPA) is an extremely rare condition. CASE OUTLINE: We report a case of a 59-year-old patient with initial dizziness and left-sided sensorineural hearing loss that had gradually developed over six months. Vertebrobasilar fusiform aneurysm, with intraluminal thrombus, which was displaced to the right cerebellopontine angle, creating mass effect, was diagnosed using brain magnetic resonance imaging and magnetic resonance angiography. CONCLUSION: Atherosclerosis may be the essential factor in the pathogenesis of a fusiform aneurysm of the basilar artery, especially in elderly patients. The best treatment option is yet to be determined, but in soite of numerous previous large studies, personalized approach is probably the best.
The First Telephone Line for the Psychological Support to Oncological Patients and Their Family Members in Serbia.
Klikovac T
Srp Arh Celok Lek · 2015 · PMID 26946769 · Publisher ↗
INTRODUCTION: In October of 2010, Serbian Association for Psycho-Oncology, in collaboration with the Ministry of Health of Serbia and the National Health Insurance has launched the first national telephone line for free...
INTRODUCTION: In October of 2010, Serbian Association for Psycho-Oncology, in collaboration with the Ministry of Health of Serbia and the National Health Insurance has launched the first national telephone line for free psychological counseling and support for oncology patients and their families. OBJECTIVE: The aim of this study was to present results of the first national telephone helpline for psychological support for oncological patients and their families. METHODS The telephone line for the psychological help and support was available from 10 a.m. to 10 p.m., seven days a week and on holidays. A total of 12 previously educated psychologists were involved, with two on duty in the mornings and two in the afternoons.The basic work principles of the Line were anonymity for users (if they wished), free of charge service available to patients from all of Serbia, careful listening, emphatic reflection on anything communicated by users and adequate counselling. RESULTS: Since the beginning of the project (October 2010 up to April 2011) we received a total of 2,748 calls from across Serbia. Almost half of these calls were repeated calls, as patients asked for continuous psychological counselling. Larger percent (63.9%) of women called, when compared to men (35.4%) who used the Line. Most (52.4%) conversations were categorized as "psychological support and counseling," and as continual psychological counseling work (21.1%). CONCLUSION: The large number of calls suggests that this kind of public, free service for psychosocial and psychological support to cancer patients is necessary in Serbia.
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