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Introduction. Hydroxycarbamide, used in therapy of hemoglobinopathies, enhances nitric oxide (NO) production both in primary human umbilical vein endothelial cells (HUVECs) and human bone marrow endothelial cell line (TrHBMEC). Moreover, NO increases γ-globin and fetal hemoglobin levels in human erythroid progenitors. Objective. In order to find out whether simple physiologic stimulation of NO production by components of hematopoietic microenvironment can increase γ-globin gene expression, the effects of NO-inducer bradykinin were examined in endothelial cells. Methods. The study was performed in co-cultures of human erythroid progenitors, TrHBMEC and HUVECs by ozone-based chemiluminescent determination of NO and real-time quantitative RT-PCR. Results. In accordance with previous reports, the endogenous factor bradykinin increased endothelial cell production of NO in a dose- and time-dependent manner (0.1-0.6 μM up to 30 minutes). This induction of NO in HUVECs and TrHBMEC by bradykinin was blocked by competitive inhibitors of NO synthase (NOS), demonstrating NOS-dependence. It has been shown that bradykinin significantly reduced endothelial NOS (eNOS) mRNA level and eNOS/Я-actin ratio in HUVEC (by twofold). In addition, bradykinin failed to increase γ-globin mRNA expression in erythroid progenitors only, as well as in co-culture studies of erythroid progenitors with TrHBMEC and HUVEC after 24 hours of treatment. Furthermore, bradykinin did not induce γ/β globin ratio in erythroid progenitors in co-cultures with HUVEC. Conclusion. Bradykinin mediated eNOS activation leads to short time and low NO production in endothelial cells, insufficient to induce γ-globin gene expression. These results emphasized the significance of elevated and extended NO production in augmentation of γ-globin gene expression. [Projekat Ministarstva nauke Republike Srbije, br. 175053]

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Introduction. Colorectal cancer is the third most common cancer worldwide. Signet-ring carcinoma is an extremely rare subtype of colorectal cancer, with frequency ranges 0.3–4.6%. The diagnosis of this type of cancer is based on pathohistological analysis. Case outline. A 58-year-old patient was admitted due to abdominal pain and abdominal swelling. The physical findings indicated abdomen above the level of the chest, soft, painfully sensitive in the left hemiabdomen, with positive clinical signs of ascites. Laboratory analyzes indicated positive inflammatory syndrome, elevation of D-dimer and CA-19-9. Ascites analysis showed the presence of malignant cells. Computed tomography revealed hepatomegaly, liver steatosis, as well as multiple secondary deposits in the liver, ascites, and peritoneal implants. Colonoscopy showed ulceration of the right colon, which was covered with fibrin. The pathohistological findings indicated poorly differentiated, invasive adenocarcinoma of the signet ring carcinoma type. The patient was treated with analgesics, diuretics, proton pump inhibitors, beta 2 blockers, angiotensin-converting enzyme inhibitors, low-molecular-weight heparin, antibiotics, and supportive therapy. The patient was discharged after 10 days of hospitalization. He was presented to the multidisciplinary team, which decided on further symptomatic therapy. Conclusion. Signet-ring colon cancer is a rare, aggressive tumor with a poor prognosis. Although it is most often localized in the stomach, it is necessary to think about the colorectal localization of this tumor in the differential diagnosis of patients with colonic complaints, especially if they have “alarm symptoms” and if they are younger.

Introduction. Peri-implant femoral fractures (PIFF) are defined as fractures of the femur with the presence of previously implanted non-prosthetic osteosynthetic material. A review of available literature revealed that there are several proposed classifications and sets of guidelines for surgical treatment of PIFF. Case outline. A 49-year-old patient was injured from a fall on the same level, the day before admission to the hospital. The anamnesis at admission showed that six months earlier, he had sustained a pertrochanteric fracture of the left femur, which had been treated surgically with a short cephalomedullary nail. Two years prior to hospital admission, the patient had sustained a tibial plateau fracture of the same leg, which was treated non-surgically with above the knee cast immobilization. After the fracture had healed, paresis of the peroneal nerve was diagnosed, while subsequent follow-up revealed secondary post-traumatic arthrosis of the knee joint. Reduction and fixation of the fracture was performed on a surgical extension table, with the use of fluoroscopy. Previously implanted osteosynthetic material was removed, a short cephalomedullary nail, and fixation of the fracture was carried out with a long cephalomedullary nail. Six months after the operation, the patient can ambulate independently, without assistance. He reports no pain in the left groin and upper leg but reports pain and limitation of movement in the left knee joint. Conclusion. By reviewing the available literature, we found that the patient was cared for in our hospital in keeping with all current recommendations for surgical treatment of this type of fracture.

Introduction. Full-thickness burns pose a significant challenge in terms of surgical management, particularly when concurrent trauma of other organs is involved. Traditional treatment of deep burns includes early excision or debridement of necrotic tissue, followed by skin grafting or flap reconstruction. There are numerous challenges such as poor overall general condition, polytrauma, questionable wound bed viability, limited donor sites. Thus, we have to consider skin substitutes. INTEGRAR is an acellular dermal substitute which creates a native dermis. The aim of this case was to share our experience of the treatment by skin substitutes in a polytraumatized burn patient. Case outline. We present a case report of a 46-year-old man with severe work-related contact burn wounds associated with multiple rib and vertebral fractures, as well as lungs contusion with localized bilateral hemothorax. Patient suffered from third-degree burns to the lower extremities, extending to scrotal and gluteal area, which included 15% of the total body surface area. The patient underwent early excision of necrotic tissues with subsequent skin autografting on the right leg; however, due to partial failure of autografts, we had to perform allografting followed by autografting because of limited local donor sites and poor general condition. Successive debridement and partial osteotomy resulted in the left knee defect with exposed patella. Therefore, in order to reconstruct the consequent defect and prevent joint contracture, the defect was finally covered by INTEGRAR. Conclusion. Our experience has highlighted that INTEGRAR prevents functional disability and furthermore, it leads to optimal aesthetic results.

Introduction. Intracavitary aspergilloma is the consequence of a saprophytic infection of the lung with cavitary disease. Pulmonary tumorlet are nodular proliferations of the neuroendocrine cells less than 5 mm in diameter. Both aspergilloma in the bronchiectatic cavity of the lung and pulmonary tumorlet has rare been seen. Case outline. We present a 71-year-old woman with a medical history of recurrent pneumonia complicated with cough and hemoptysis. Computed tomography (CT) scan of the chest showed pulmonary soft tissue mass in the right lower lobe of the lung 42 × 50 mm in diameter. Direct microscopy of the specimens of bronchioalveolar lavage showed spores of Aspergillus. Galactoman Ag test was also positive. Right lower lobectomy and mediastinal lymph node sampling was performed via thoracotomy. Pathohistological findings showed aspergilloma with the presence of pulmonary tumourlet and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) in the lymphovascular spaces. Five years follow up showed no abnormalities on the CT scan, and the patient remained alive without medical problems. Conclusion. The concomitant occurrence of bronchiectasis, aspergilloma, and precancerous lesions such as pulmonary tumourlet and DIPNECH is rare and further increases the risk of developing malignant tumors as well as recurrent infections. Therefore, surgical treatment can prevent the development of premalignant lesions and the occurrence of recurrent infections accompanied by dyspnea and hemoptysis as the main symptoms. The question of the connection between pulmonary tumourlet and chronic inflammatory lung diseases is raised. We hope that future researches will provide answers to this question.

Introduction. Lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis are the most common pulmonary cystic diseases. Although they differ in pathogenesis, they share several features. The aim of this paper is to present the similarities and differences between these diseases, as well as to describe two cases from our practice. Outlines of cases. The patient with lymphangioleiomyomatosis (43 years old) had pulmonary changes detected during a regular examination within the underlying disease – tuberous sclerosis. Four years after starting therapy with everolimus, she was still respiratory asymptomatic, a slight radiological deterioration of cystic changes was registered, the diffusion capacity was declining (by 12%). The second patient (23 years old) was admitted due to bilateral radiological lung changes and symptoms in the form of dry cough, quick fatigue, and chest pain. Pathohistological examination of the transbronchial biopsy showed numerous large-core histiocytes, immunohistochemically positive for CD1a and S100, so it was concluded that it was Langerhans cell histiocytosis. Cessation of smoking was advised. The follow-up examinations showed withdrawal of symptoms and an orderly finding of lung function, chest high-resolution computed tomography indicated slight regression of changes. In the meantime, the patient gave birth to a healthy child, the pregnancy and prenatal period were uneventful. Conclusion. These diseases are extremely rare and in cooperation with other specialties should be distinguished from diseases that mimic lung cysts.

Vitamin B1 (aneurin, thiamine) is a water-soluble vitamin necessary for the normal function of the nervous system, visual system and heart and is part of important enzymes in the body. Thiamine enables the normal use of glucose, other carbohydrates and proteins, and enables the supply of energy to the organism. The main sources of thiamine are exogenous and small amounts are synthesized by microorganisms of the human intestinal microbiome. Vitamin B1 cannot accumulate in the body, so signs of deficiency are quickly manifested. Hypovitaminosis B1 is seen in chronic ethyl abuse, persistent vomiting (as in some pregnant women) or after bariatric surgical procedures, but in a mild form it is present in the general population. Normal daily needs for vitamin B1 depend on calorie intake, and 0.4 mg should be ingested for every 1000 kcal.

Introduction/Objective. Angular stability and dynamic fixation are key factors to successful healing of femoral neck fractures. The objective was to evaluate the efficacy of internal fixation of femoral neck fractures with two parallel self-tapping antirotation screws (SAF) compared to standard, three cannulated cancellous screws (CCS) fixation. Methods. In total 100 fractures were retrospectively analyzed, divided in two groups in which two SAF screws were used in parallel (n = 50) or three standard screws in an inverted triangle configuration (n = 50). The groups were compared with operation time, time of consolidation, femoral neck shortening, Harris hip score and reoperation rates. Results. SAF parallel fixation group of patients achieved consolidation rate of 86% compared to 74% in CCS fixation group, without statistically significant difference between the examined groups (p > 0,05). Dynamization of implants was significantly positively correlated with the fracture healing time in both examined groups (SAF: r = 0.324, p = 0.025; CCS: r = 0.572, p = 0.001), with significantly shorter healing time in SAF patients – on average 15 weeks (15.02 ± 1.44) in relation to the CCS group of patients – 19 weeks (19.81 ± 2.94) (χ2/z = 7.048, p < 0.001). There was no statistically significant difference in the Harris hip score and reoperation rate among the study groups (χ2 = 2.44, p = 0.487; χ2 = 0.500, p = 0.696). Conclusion. Our results suggested that dual parallel fixation is simpler, less invasive and it demands less performance time. It is not inferior to fixation with three screws, from the point of biomechanics, possible complications, healing and functional recovery.

Introduction/Objective. Research has demonstrated the toxicant potential of aluminum, but no therapeutic options have been suggested. The aim of the study was to investigate the extent of the aluminuminduced toxicity, evaluated by hematological/biochemical disarrangements, hepcidin concentration and tissue accumulation after chronic aluminum exposure and to determine possible protection with Ca2+-channel blockage, verapamil. Methods. Experimental animals (36 rats) were treated with different doses of AlCl3 during eight weeks and after that their blood and tissues were analyzed. Results. The significant differences, regardless of the aluminum dose administered, were documented in all evaluated hematological (p < 0.001) and biochemical parameters (p < 0.001), as well as in aluminum tissue deposition in liver, kidneys and testicles (p < 0.001), respectively. After verapamil administration, a significant improvement in some hematological and biochemical parameters was demonstrated, p < 0.001, as well as the attenuation of aluminum deposits in liver and testes, p < 0.001. Evaluated parameters of inflammation and kidney deposition did not show significant change after verapamil application. Conclusion. The findings indicate that chronic AlCl3 intoxication, regardless of the dose, results in the microcytic anemia associated with high hepcidin levels, numerous biochemical abnormalities and significant aluminum deposition in liver, kidney and testes and that these effects may be attenuated by verapamil administration. Overall, the results emphasize the significance of calcium homeostasis preservation in chronic aluminum exposure and propose possible therapeutic option.

Introduction/Objective. There are extramedullary and intramedullary methods of trochanteric fractures’ internal fixation with implants having a lag screw. The objective of this study was to examine the difference in impact of these fixation types on final hip function and health-related quality of life. Method. There were 75 patients treated for a trochanteric fracture, using self-dynamisable internal fixator (SIF group), as an extramedullary method, or gamma nail (GN group), as an intramedullary method. These patients were called for the evaluation of Harris Hip Score (HHS) and SF-12 questionnaire at least two years after surgery. The SF-12 questionnaire has dual expression – physical component score (PCS) and mental component score (MCS). Results. There were no significant differences between the SIF group and the GN group regarding HHS, PCS, and MCS. Positive correlation was confirmed between HHS, PCS, and MCS, with the strongest relation between HHS and PCS. Negative correlation was confirmed between age and HHS. Conclusion. There was no difference in final hip function and health-related quality of life between SIF and GN methods in trochanteric fractures treatment (p > 0.05). These parameters of outcome were confirmed to have positive interrelation (p < 0.05). Both submuscular presence of extramedullary implant with dimensions of SIF and the need for bone reaming in cephalomedullary fixation were considered not to have significant impact in HHS and SF-12 scores after trochanteric fractures treatment by internal fixation. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41017: Virtual human osteoarticular system and its application in preclinical and clinical practice]

Introduction/Objective. Biofilm and pyocyanin production are essential components of Pseudomonas aeruginosa virulence and antibiotic resistance. Our objective was to examine inhibitory effect of synthetized propafenone derivatives 3-(2-Fluorophenyl)- 1-(2- (2-hydroxy-3-propylamino-propoxy)-phenyl)-propan-1-one hydrochloride (5OF) and3-(2- Trifluoromethyl-phenyl)-1-(2-(2-hydroxy-3-propylamino-propoxy)-phenyl)-propan-1-one hydrochloride (5CF3) on biofilm and pyocyanin in Pseudomonas aeruginosa clinical strains. Methods. Effects were tested on nine clinical isolates and one control laboratory strain of P. aeruginosa. In vitro analysis of biofilm growing was performed by incubating bacteria (0.5 McFarland) with 5OF and 5CF3 (500–31.2 μg/ml) and measuring optical density (OD) at 570 nm. Bacteria in medium without compounds were positive control. Blank medium (an uninoculated medium without test compounds) was used as negative control. Pyocyanin production was estimated by OD at 520 nm, after bacteria incubated with 5CF3 and 5OF (250 and 500 μg/ml), treated with chloroform, and chloroform layer mixed with HCl. Results. A total of 500 μg/ml of 5OF and 5CF3 completely inhibited biofilm formation in 10/10 and 4/10 strains, respectively. A total of 250 μg/ml of 5OF and 5CF3 strongly inhibited biofilm formation in 7/10 strains, while inhibition with 125 μg/ml of 5OF and 5CF3 was moderate. Lower concentrations had almost no effect on biofilm production. Pyocyanin production was reduced to less than 40% of the control value in 6/9, and less than 50% of the control in 7/9 strains with 500 μg/ml of 5OF and 5CF3, respectively. At 250 μg/ml 5OF and 5CF3, most strains had pyocyanin production above 50% of the control value. Conclusion. Synthetized propafenone derivatives, 5OF and 5CF3, inhibited biofilms and pyocyanin production of Pseudomonas aeruginosa clinical strains. Presented results suggest that propafenone derivatives are potential lead-compounds for synthesis of novel antipseudomonal drugs. [Projects of the Serbian Ministry of Education, Science and Technological Development, Grant no. OI 172041 and Grant no. III 41030]

Introduction/Objective. Fracture malunion is still a major problem in orthopaedic practice. The external fixation of tibial fracture malunion has become popular in recent years. The objective of this work was to evaluate clinical results in tibial shaft malunion treatment based on unilateral external fixation method. Methods. The patients with tibial shaft malunion have surgically been treated by unilateral Mitkovic external fixation system. Malunion deformities were corrected by “one stage” technique, using Mitkovic-CD type external fixator, or gradually, using Mitković-V type external fixator. This retrospective study included 15 patients with tibial shaft angular malunion. The main type of malunion was valgus deformity, in 10 patients, and varus deformity, in five patients. Results. The mean healing time was 89.66 days (range 50–125). There were no complications in the present study. The follow-up time after surgery was three years. Final functional results were excellent in 13 cases and good in two cases. Conclusion. This unilateral external fixator system was successfully used in the treatment of tibial shaft malunion, with good results and low complications rate. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41017: Virtual human osteoarticular system and its application in preclinical and clinical practice]

Sepsis is a medical emergency and therefore requires early identification and immediate management, which is not a matter of hours, but minutes. Since the first definition in 1991, sepsis remains a major challenge for clinicians and scientists. Despite significant advances in technology and therapy, mortality and cost of treatment are unacceptably high. Septic shock is the leading cause of mortality in critically ill patients. Cognitive impairment and functional disability were observed after survivors’ long-term follow-up. Since its foundation in 2002, Surviving Sepsis Campaign aims to implement global strategies and to raise awareness of the challenges associated with sepsis. The implementation of guidelines and sepsis care bundles resulted in significant decrease in mortality. Hospital mortality is lower in hospitals with high versus low bundle compliance. Still, epidemiological data for sepsis are missing for low- and middleincome countries.

Acetabular fractures represent severe injuries that mostly occur in car accidents, or after falling from greater heights, most often in the working male population. Acetabular fractures are present in our clinical practice and their treatment requires good education and surgical training. Surgical experience is one of the prerequisites for achieving good treatment results, since these fractures are accompanied by numerous complications. In order to acquire knowledge and skills in this field of surgery, it is necessary to have a national center for education at one of the medical faculties in Serbia. All dislocated acetabular fractures (≥ 2 mm) require early surgery, anatomical reduction, and stable internal fixation of acetabular fracture. Acetabular fracture-dislocation requires urgent reduction of the dislocated femoral head. The anatomic reduction of the fracture is related to the time of definitive bone fixation of the fracture. Fourteen days after the fracture, anatomic reduction is more difficult to achieve. In addition to the factors that positively affect the results of treatment, there are negative factors as well, which result in poor outcomes. They are directly correlated to the initial trauma that occurs at the time of injury. Fracture comminution, large dislocation (> 20 mm), injury of the femoral head, posterior dislocation of the hip, impaction, traumatic or iatrogenic sciatic nerve palsy – these are all factors that negatively affect the outcome and are responsible for complications, as opposed to positive factors.

Introduction/Objective. The purpose of this study was to determine if patient-related factors, such as hospitalization length and preoperative use of walking aids, and geometrical factors, measured with antero-posterior radiographs of hip, affect the risk of hip dislocation after total hip arthroplasty. Methods. A total of 36 of 433 (8.31%) patients with hip dislocation were identified in the institutional registry during a two-year period. The data for patients with and without hip dislocation were matched and compared. Results. Hip dislocation more often occurred in patients who had used walking aids before the operation compared to the ones who had not (p < 0.001). Also, a difference in the number of hip dislocations was noticed between the patients who stayed longer in the hospital after THA (p < 0.001). The patients with higher acetabular inclination angle (p < 0.005) and height of greater trochanter (p < 0.001) on radiographs had been more prone to hip dislocation. In addition to this, the “safe-zone” was not identified in our study (p > 0.005). Conclusion. Several factors which influence hip dislocation were identified in this study: patient characteristics and radiograph characteristics. Both groups of factors require attention and monitoring in future studies.

Accession to the European Union (EU) is a comprehensive process of reforms and harmonization of legislation with EU regulations, which must be accompanied by the implementation of EU standards. Although the EU competencies in the field of health care are limited, and health law does not represent a large part of the EU legislation, harmonization and further reforms are needed in a number of areas. The main focus of this paper is the negotiation Chapter 28 within the EU accession process, which covers a number of thematic areas in the field of public health encompassing various legislative and strategic acts of the EU. At the moment, the EU has still not opened the negotiations in this field with Serbia. In order to introduce health professionals in Serbia to current developments, the paper analyzes the most important aspects of alignment with EU legislation and the need for further regulatory reforms. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 179023: Ljudska prava i vrednosti u biomedicini - demokratizacija odlučivanja u zdravstvu i implementacija]

Lateralization is one of the central questions in neurology, neuropsychology, and other related scientific disciplines. There has been very little change in the proportion of left-handers since the Upper Paleolithic Age about 10,000 years ago and it is estimated to be around 10%. As the history of human thinking has developed from superstition to science, the explanation of left-handedness transformed from “devil’s work” to neurological specificity. This paper presents this very interesting historical change by analyzing the data on left-handedness and the attitudes towards it in human societies from prehistory to today. Even in a relatively open-minded society, parents and teachers may encourage a left-handed child to switch to right-handedness to make their lives easier in a largely right-handed world. On the other hand, left-handedness is increasingly seen as a special gift, and left-handed people have started to favor themselves as more competent in relation to the right-handed people. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 41020, Grant no. 175078 and Grant no. 175067]

Introduction/Objective. The aim of this study was to determine independent predictors and the best trauma scoring system (REMS, RTS, GSC, SOFA, APPACHE II) of in-hospital mortality in patients with severe trauma at the Department of Emergency, Emergency Center, Clinical Center of Serbia, Belgrade. Methods. Longitudinal study included 208 consecutive patients with severe trauma. In order to determine independent survival contributors, univariate and multivariate Cox regression analyses were performed. The power of above-mentioned scoring systems (measured at admission to the Emergency center) to predict mortality was compared using the area under the curve (AUC). Results. There were 208 patients (159 male, 49 female), with the average age of 47.3 ± 20.7 years. Majority of patients were initially intubated (86.1%) on admission to the emergency department, and 59.6% patients were sedated before intubation. After finishing of diagnostic procedures, 17 patients were additionally intubated, and, at that time, 94.2% patients were on mechanic ventilation. The majority of patients was traumatized in a car crash (33.2%), followed by falls from height (26.4%) and as pedestrians (22.6%). Patients had an average of 24.7 ± 21.2 days spent in intensive care unit. The overall case-fatality ratio was 17/208 (8.2%). In Cox regression analysis only elevated heart rate (HR = 1.03, p = 0.012) and decreased arterial oxygen saturation (SpO2) (HR = 0.91, p = 0.033) singled out as independent contributors to in-hospital mortality of patients with severe trauma. REMS (AUC 0.72 ± 0.64) and SOFA (AUC 0.716 ± 0.067) scores were found fair and similar predictor of in-hospital mortality, while APACHE II (AUC 0.614 ± 0.062) and RTS (0.396 ± 0.068) were poor predictors. Conclusion. Results of this study showed an important role of REMS, which appears to provide balance between the predictive ability and the practical application, and components of REMS in prediction of outcome in patients with severe trauma and that HR and SpO2 are independent predictors of in-hospital mortality.

Introduction/Objective. Subtrochanteric fractures are unstable, tending to a varus, antecurvatum, and shortening deformity. The aim of this paper was to compare operation time and fluoroscopy time between different internal fixation methods in the treatment of subtrochanteric fractures. Method. The prospective study of the group of 27 patients with a subtrochanteric fracture treated by the SIF (selfdynamisable internal fixator with a trochanteric unit) method had been done. Operation time and fluoroscopy time values from this group were compared to the same parameters data from the literature for intramedullary (IM) nails, proximal femur locking plates (PF-LCP), dynamic condylar screws (DCS), and the 95°-angled blade plate. Results. In the SIF group, operation time was 62.2 (25–140) minutes and fluoroscopy time was 43 (20–95) s. Average operation time from the literature data was: 102.1 (43–181) minutes for IM nail, 94.2 (75–129) minutes for PF-LCP, 105.3 (70–166) minutes for DCS and 221.5 (171–272) minutes for blade plate. Average fluoroscopy time from the literature data was: 109.6 (34–250) seconds for IM nail, 102.3 (47–180) seconds for PF-LCP, 238 seconds for DCS. Operation time and intraoperative fluoroscopy time were higher in IM nail, PF-LCP, DCS and blade plate comparing to SIF method (p < 0.05). Conclusion. The above mentioned difference could be explained by a degree of required accuracy in the initial operative technique maneuvers, by used number of screws and by the type of the fracture reduction performance in different fixation methods. Operation time during IM nailing of subtrochanteric fractures sometimes can be shorter than average operation time in SIF method, what could be explained by the skill of the surgeon to perform as fast closed reduction for insertion of guide wire. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41017: Virtual human osteoarticular system and its application in preclinical and clinical practice]

Introduction/Objective. Thermophilic campylobacters, especially Campylobacter jejuni (C. jejuni) and Campylobacter coli (C. coli), are the most important causes of bacterial diarrhea in developed and developing countries. The disease can occur as a sporadic infection or as large and small outbreaks. Phenotyping and genotyping methods are in use to determine similarities between strains as well their possible common origin. The goal of the study was to compare discriminatory power of biotyping tests and comparative genomic fingerprinting (CGF) 40 (100%), as well as a combination of the two tests in detection of clonality or epidemiological relatedness between the studied strains. Methods. We investigated 23 Campylobacter strains using biotyping and CGF typing. Results. We found that biotyping was a more discriminatory method for C. coli, and CGF for C. jejuni strains. In the discrimination of C. jejuni strains, CGF had better discriminatory power [Simpson’s index of diversity (ID) was 0.879] over the discrimination of C. coli strains (Simpson’s ID was 0.389). Conclusion. Biotyping and CGF can be complementary methods in detection of similarity, relatedness and possible common origin between strains since the combination of biotyping and CGF methods gives more precise data about diversity within C. coli and C. jejuni strains. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. TR34008]

Introduction. Pulmonary embolism (PE) is a serious complication of deep venous thrombosis, with a significant morbidity and mortality. More often, PE complicates the course of the nephrotic syndrome (NS), in particular when the disease is active, but it may occur as the first sign of illness when the diagnosis of the NS is being delayed as a result. Membranous nephropathy is, generally speaking, the most commonly reported glomerulonephritis associated with the increased risk of thrombosis. Case outline. This report summarizes our experience with three young male patients (a 26-year-old, a 22-year-old, and a 45-year-old), in which PE was the first presenting feature of the NS. All of them were admitted to the hospital experiencing chest pains, dry cough, and shortness of breath. One of them had high temperature and the other two swelling of the lower parts of legs. Computed tomography of the thorax showed pulmonary artery thrombosis in all three patients. Diagnosis of the NS was confirmed by laboratory analysis, while renal biopsy showed membranous nephropathy. The treatment was based on the pulse of methylprednisolone (1.5 g over a period of three days), with alternating therapy of oral corticosteroids and cyclophosphamide on a monthly basis during six months. After six months, two patients reached incomplete remission, while the third one still has the NS and normal renal function. Conclusion. Not so rare occurrence of thromboembolic events in the NS suggests that one should always suspect the NS in all patients with deep venous thrombosis or PE.

Introduction/Objective. Although female street sex workers are contextually vulnerable to numerous health-endangering factors, they also contribute in re-producing them. This synergetic production is approached by syndemic theory developed within medical anthropology. The objective of the study is to present an analysis of the results of a qualitative ethnographic study conducted in Belgrade, Serbia in 2015, and reflect upon social environment factors influencing syndemic development of medical conditions. Methods. The risk environment factors enhancing possibilities of developing particular medical conditions were investigated by applying qualitative anthropological methodology, emphasizing semi-structured in-depth interviews, a standard qualitative sample, and respondents’ self-reporting. Results. Social environment of sex work, generally considered risky due to sexually and blood-transmitted diseases, in this study also proved as receptive for many other illnesses, whose syndemic character has been insufficiently addressed. The study confirmed the syndemic nature of street sex work. Conclusion. The social science perspective should be used in health policy conceptualization and implementation not only during latter stages, i.e. in the interpretation of the social conditions influencing medical related issues, but during early stages of understanding how those conditions and issues circularly constitute each other. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 177017 and Grant no. 177018]

To date, lateralization in living beings is a phenomenon almost mythologically unexplored. Scientists have proved that lateralization is not exclusively a human feature. Investigations in molecular biology, protein structure, mobility of bacteria, and intracellular lateralization in ciliates, shows important and universal nature of lateralization in living systems. Dominant lateralization implies the appearance of a dominant extremity, or a dominant sense during the performance of complex psychomotor activities. Hand dominance is usually defined as a tendency to use one hand rather than another to perform most activities and this is considered to be the most obvious example of cerebral lateralization and exclusive characteristic of humans. However, there are some exceptions in other species. The dominant hand is able to perform more complex and subtle manual tasks than the non-dominant hand, and this behavioral superiority is the absolute result of additional cerebral support. The asymmetry of brain organization was confirmed in rats, chimpanzees, dogs and birds, some fishes and lizards. The relationships between hand dominance with brain structure and function remain far from clear. For a long time, lateralization was considered unique to humans, but recently it has become clear that lateralization is a fundamental characteristic of the organization of brain and behavior in all vertebrates. It has been questioned to what extent lateralization in humans and other vertebrates may be comparable. [Projekat Ministarstva nauke Republike Srbije, br. 41020 i br. 175078]

Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8Ч5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

Introduction. X-linked adrenal hypoplasia congenita (AHC) is a rare cause of adrenocortical insufficiency. Early postnatal diagnosis may prevent severe hypoglycemia, Addisonian crises and death. Low maternal estriol (E3) levels in the second trimester of pregnancy could indicate the possibility that the fetus suffers from a disorder that causes adrenal insufficiency. Suspicion is based on the fact that E3 originates from dehydroepiandrosterone (DHEA) synthesized in the fetal adrenals. In case of adrenal insufficiency, the impaired production of fetal DHEA leads to a subsequent reduction of E3 concentrations in maternal serum. There are only a few reports of AHC suspected prenatally due to low maternal E3 levels. Case Outline. We describe two brothers with adrenal insufficiency due to AHC. The older brother was admitted to the hospital at the age of 33 days due to failure to thrive, vomiting, and dehydration. Genetic analysis revealed a hemizygous mutation in DAX-1 gene, thus confirming the diagnosis of ACH. The same mutation was detected in his mother. In the second pregnancy, E3 concentrations were determined from maternal serum. Estriol levels during the second trimester were extremely low suggesting the diagnosis of AHC. The diagnosis was confirmed during the neonatal period by genetic testing, and replacement therapy was started at the age of 10 days. This boy never experienced an adverse episode such as hypoglycemia or adrenal crises. Conclusion. Since determination of E3 is a simple, sensitive, noninvasive and cheap method, its use as an obligatory prenatal screening test should be accepted as a standard practice in Serbia.

Introduction. Medulloblastoma is a primitive neuro-ectodermal malignant tumor most commonly seen in childhood and rarely and uncommonly in adult age. Treatment consists of surgery followed by radiotherapy. In the case of a relapse there is no overall accepted treatment. Tumor metastasis can be seen along the neural axis, lymph nodes, soft tissues, bones and distant organs. Case Outline. In this paper we present a 45-year-old female patient with a thoraco-spinal extramedullary metastatic medulloblastoma and progressive neurological deterioration seen 11 months after the first operation and description of magnetic resonance and intraoperative finding. Conclusion. Although rare, the presence of metastasis is a poor prognostic factor. The treatment options for patients with metastases are limited and their prognosis continues to remain poor.

Introducion. Intracranial chondroma is a very rare, slow growing, benign cartilaginous tumor that arises usually from the base of the scull. Chondroma located at the falx is extremely rare. According to our best knowledge 15 cases of falx chondromas have been reported in the literature. Case Outline. This is the first case report of falx chondroma located in the parietal area associated with hyperostosis. Magnetic resonance imaging of the brain revealed a 3Ч4Ч4 cm solid, calcified, ring-shaped, well-defined tumor at the posterior falx. The patient underwent surgery and complete resection was performed. Histological examination confirmed chondroma of the falx. Postoperative CT scan showed no residual of tumor and the patient was discharged. Conclusion. The long-term prognosis is good after a total excision of the tumor. Awareness of this rare pathology in the differential diagnosis of falx mass could facilitate the diagnosis.

This year Zemun Hospital - Clinical Hospital Center Zemun celebrates 230th anniversary of continuous work, thus becoming the oldest medical facility in Serbia. The exact date of the hospital founding has been often questioned in history. Various dates appeared in the literature, but the most frequent one was 25th of February 1784. Until now, the document which confirms this has never been published. This article represents the first official publication of the document which confirms that Zemun Hospital was indeed founded on this date. The first hospitals started emerging in Zemun when the town became a part of the Habsburg Monarchy. The first sanitary facility ever formed was the “Kontumac” - a quarantine established in 1730. Soon after, two more confessional hospitals were opened. The Serbian (Orthodox) Hospital was founded before 1769, whereas the German (Catholic) Hospital started working in 1758. Both hospitals were financed, amongst others, by the Town Hall - the Magistrate. In order to improve efficiency of these hospitals, a decision was made to merge them into a single City Hospital. It was founded on 25th February 1784, when the General Command ordered the Magistrate of Zemun to merge the financess of all existing hospitals and initiate the construction of a new building. Although financially united, the hospitals continued working in separate buildings over a certain period of time. The final, physical merging of these hospitals was completed in 1795. [Projekat Ministarstva nauke Republike Srbije, br. 47030]

Introduction. Surgical treatment is the treatment of choice in patients with symptoms and radiological signs of femoroacetabular impingement. Objective. Our experience and early results of surgical treatment of patients with signs of femoroacetabular impingement and early hip osteoarthritis are reported. Methods. The results of treatment of 21 patients aged 23-54 years with different types of femoroacetabular impingement are presented. Safe open surgical dislocation of the hip was performed in all patients. Before and after surgery, the WOMAC score was performed, clinical and radiographic data of the operated hips were evaluated and t-tests were used for statistical analyzes of data. Results. The WOMAC score improved from 70.5 points ( range 56.3 to 89.8 points) to 90.3 points (range 70.3 to 100 points) at one year of follow-up (p

Introduction. Controversial results on the relationship between the left-handedness and neurotic disturbances have been obtained in so far investigations. Objective. The aim of this study was to investigate the link between the left-handedness and neurotic disturbances in an adult urban population. Methods. A cross-sectional study was performed on 1,202 adult residents of the Stari Grad municipality in Belgrade, out of which 401 were males (33,4%) and 801 were females (66,6%). A questionnaire was used as an investigation instrument, with questions concerning age, gender, writing hand and neurotic disturbances: tension, agressiveness, anger, nervousness, weepiness and seclusion. Results. Left-handedness was found in 60 subjects (5%) and it was statistically more frequent in males (7.7%) compared to females (3.6%) (p=0.003). A decreasing trend of proportion of left-handed males was found in relation to aging. In the age group 18 to 39 years, agressiveness, as a specific neurotic disturbance, was significantly more frequent in left-handed males in comparison to right-handers (p=0.035). In the age group 40 to 59 years, neurotic disturbances were more common among left-handed males compared to right-handers (p=0.030). There were no significant diferences in the proportion of neurotic disturbances between the left-handed and the right-handed females. Conclusion. From a public health point of view, left-handed men may be regarded as a relatively vulnerable population category concerning mental health.

Introduction. Association studies have shown that gene polymorphisms in various classes of genes can modulate cancer risk. The -31G/C polymorphism in the promoter of survivin gene, affects the expression of the anti-apoptotic protein survivin which in turn may predispose an individual to some types of cancer. Objective. The aim of the study was to determine whether the survivin promoter -31G/C polymorphism could be a susceptibility factor for squamous cell carcinoma (SCC) of the oral cavity and basal cell carcinoma (BCC) of the skin. Methods. The DNA obtained from 88 patients with SCC, 60 patients with BCC and 111 healthy individuals was subjected to polymerase chain reaction-restriction fragment length polymorphism analysis (PCR- RFLP) in order to determine genotype and allele frequencies in patients and control groups. Logistic regression was used for cancer risk assessment. Results. The following distribution of genotypes was obtained: CC genotype 15% in the SCC group, 13% in the BCC group and 12% in controls; CG genotype 41% in SCCs, 35% in BCCs, 48% in controls; GG genotype 44% in SCCs, 52% in BCCs and 40% in controls. Allelic frequencies were as follows: G allele 0.65 in SCCs, 0.69 in BCCs and 0.64 in the control group; C allele 0.35 in SCCs, 0.31 in BCCs and 0.36 in the control group. There was no statistically significant difference in allele or genotype frequencies between the patients and controls (p>0.05). Conclusion. In Serbian population, -31G/C polymorphism in the promoter of the survivin gene cannot be considered as a risk factor for oral squamous cell carcinoma and skin basal cell carcinoma. [Projekat Ministarstva nauke Republike Srbije, br. 175075]

Introduction. Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis represents a complex congenital anomaly, also known in the literature as Herlyn-Werner-Wunderlich (HWW) syndrome. Case Outline. A 16­year­old patient presented with secondary amenorrhoea and abdominal pain. Her history revealed anorexia nervosa; she had menarche at the age of 14; her menstrual cycles were regular, with progressive dysmenorrhoea. Nine months after the explorative laparotomy performed at the regional healthcare center there was no a definitive diagnosis. Pelvic examination showed a paravaginal pelvic mass located on the right side. Magnetic resonance imaging of the abdomen and pelvis confirmed the diagnosis of HWW syndrome. Transvaginal excision and marsupialisation of the vaginal septum were performed. Regular menstrual cycles were resumed after four years following the treatment of anorexia nervosa. Twelve years after the operation, the patient conceived spontaneously; pregnancy developed in the left non­obstructed uterus. She underwent Cesarean section at the 37th gestational week and gave birth to a healthy female infant. Conclusion. HWW syndrome is an uncommon cause of abdominal pain and progressive menstrual discomfort shortly after menarche. It is therefore essential to maintain a high index of suspicion of the existence of this syndrome in such cases, since prompt and adequate treatment prevents the development of complications and allows for preservation of the reproductive potential of both hemiuteri. [Projekat Ministarstva nauke Republike Srbije: Celularni i molekularni patogenetski mehanizmi poremećaja reprodukcije i genitalnih organa u prevenciji, dijagnostici i terapiji podprojekat, br. 41021: Tretmani antenatalnih hidronefroza]

Introduction. Growth hormone deficiency (GHD) can be isolated or associated with deficiency of other pituitary gland hormones. According to age at diagnosis, causes of GHD are divided into congenital or acquired, and according to etiology into recognized and unknown. Objective. We analyzed etiology and prevalence of GHD, demographic data at birth, age, body height (BH) and bone age at diagnosis as well as the frequency of other pituitary hormone deficiencies. Methods. The study involved 164 patients (109 male). The main criterion for the diagnosis of GHD was inadequate response of GH after two stimulation tests. The patients were classified into three groups: idiopathic, congenital and acquired GHD. Results. Idiopathic GHD was confirmed in 57.9% of patients, congenital in 11.6% and acquired in 30.5%. The mean age at diagnosis of GHD was 10.1±4.5 years. The patients with congenital GHD had most severe growth retardation (-3.4±1.4 SDS), while the patients with idiopathic GHD showed most prominent bone delay (-3.6±2.3 SDS). The prevalence of multiple pituitary hormone deficiency was 56.1%, in the group with congenital GHD 73.7%, acquired GHD 54.0% and idiopathic GHD 53.7%. The frequency of thyrotropin deficiency ranged from 88.2-100%, of adrenocorticotrophin 57.1-68.8% and of gonadotrophins deficiency 57.1- 63.0%, while deficiency of antidiuretic hormone was 2.0-25.0%. Conclusion. Although regular BH measurements enable early recognition of growth retardation, patients’ mean age and degree of growth retardation indicate that GHD is still diagnosed relatively late. A high incidence of other pituitary hormone deficiencies requires a detailed investigation of the etiology of disorders and evaluation of all pituitary functions in each child with confirmed GHD.

Introduction. Lateralization of brain functions such as language and manual dominance (hand preferences and fine motor control) are most likely under genetic control. However, this does not preclude the effect of various environmental factors on functional brain lateralization. A strong association of non-right-handedness (left- and mixed-handedness) with various neurodevelopmental conditions (e.g. schizophrenia, autism, Rett syndrome) implies that in some cases, non-right-handedness may be acquired rather than inherited (i.e., pathologically determined). Objective. The aim of the study was: (a) re-investigation of several known risk factors for left-handedness (age of mother and/or father, twin pregnancies, and birth order), and (b) examination of hitherto uninvestigated factors (type of birth, Apgar score, maternal smoking during pregnancy). Methods. Putative, causative environmental agents for this shift in manual distributions are explored in a sample of 1031 high school students (404 males and 627 females) from Belgrade. Both pre-existing (age of parents, twin pregnancy, and birth order) and new (Apgar score, maternal smoking, type of birth) putative agents are examined. Results. We found that maternal smoking and low Apgar score (2-6) can significantly increase risk for left-handedness (p=0.046 and p=0.042, respectively). The remaining factors showed no significant association with left-handedness in adolescents. Conclusion. Our study clearly demonstrates that left-handedness may be related to maternal smoking during pregnancy and a low Apgar score on birth.

Introduction. Sjögren’s syndrome (SS) is an autoimmune disease of unknown etiology, clinically manifested by dry eyes (xerophthalmia) and dry mouth (xerostomia). In childhood SS is a rare disease, clinically atypically or asymptomatic and is often unrecognized. We report a girl with asymptomatic, juvenile form of primary Sjögren’s syndrome (JSS). Case Outline. A 13­year­old girl was initially observed for several months due to elevated sedimentation rate (ESR 75­90 mm/h) without signs of inflammation or other symptoms and disease signs. Subjective symptoms of dryness of the eyes and mouth were absent at the beginning. Ophthalmologic examination demonstrated hypolacrimia although the patients had no subjective signs of xerophthalmia. Ultrasonography (US) revealed mild enlargement and heterogeneity of large salivary glands parenchyma. Increased rheumatoid factor (RF), anti SS­A/Ro, anti SS­B/La antibodies were found in serum. Ophthalmologic examination demonstrated decreased lacrimation. JSS was confirmed on the basis of ophthalmologic examination, immunological tests, histological findings of biopsy of small and US of major salivary glands. During a 12­years follow­up period systemic or extraglandular manifestations of JSS and other autoimmune diseases were not observed. Conclusion. Our experience suggests that in the differential diagnosis of unexplained elevated ESR the primary form of JSS should be also taken into consideration. Ultrasonographic changes of major salivary glands in the absence of symptoms of xerostomia point out that this noninvasive method has an important role in the diagnosis and management of patients with JSS.

Introduction. Traumatic hand amputation is a very severe and rare injury. Replantation and revascularization surgery requires the existence of specialized centres and well-educated teams of microsurgeons. In places where there are no such specialized centres for this kind of surgery, traumatic hand amputation is a major concern and quite a challenge, and a successfully performed replantation is a great accomplishment. Case Outline. We report a case of a successfully survived replanted hand in a 35-year-old male patient with unfortunately bad end result of the treatment. The patient with the amputated left hand (disarticulation) had a surgery 4 hours after injury. The urgent surgical procedure required a debridement, the excision of the first row of the carpal bones, external fixation of the wrist, vascular anastomoses, nerve repair, tenorrhaphy, skin sutures and decompression skin incisions. The successful operation did not have a successful post-operative course due to the patient’s psychiatric problems and lack of rehabilitation at the psychiatric institution where the treatment was continued. Conclusion. Successful surgical performance can unfortunately be ruined due to inadequate further treatment course or the wrong selection for such a demanding surgery. The survival of the amputated hand can be achieved surgically, but achieving refunctioning does not always depend on surgery. It also depends on the very patient, his motivation, rehabilitation, as well as on the proper selection for such a demanding and complex surgical procedure.

Fatigue is a prominent symptom in a large number of medical conditions, malignant and infectious diseases. Fatigue is also a prominent symptom of sarcoidosis. The occurrence of fatigue in sarcoidosis is well known but exact incidence has not been established and varies from 30-70% of patients depending on age, sex and organ involvement by the granulomatous process. The exact definition of fatigue varies broadly. It can be both physical and mental. The patients describe their sensation of fatigue qualitatively different from that fatigue they experienced before they became sick. Fatigue has a major impact on the quality of life in sarcoidosis. Establishing the extent of fatigue in sarcoidosis provides relevant insight regarding the patient’s quality of life. Unfortunately there is no objective parameter for assessing fatigue in sarcoidosis. Generally, fatigue is detected by means of questionnaires. Regarding the therapy, there is no effective treatment for fatigue in sarcoidosis.

Introduction. Lung cancer is the leading cause of death from malignancy in Serbia. Objective. This is a retrospective analysis of lung cancer epidemiological changes regarding to its histological type and patients’ age of both genders. Data were based on surgically treated lung cancer patients from 1985 to 2005. Methods. Data were collected from 972 pathohistological reports of operated patients of both genders divided into age groups. Histological types of lung cancer were distributed in four major groups: squamous cell cancer (SCC), adenocarcinoma (AC), small cell cancer (SCLC) and other rare histological types. Both genders together and separately were analysed. Chi-square with the level of significance p

Introduction. Over the last three decades the prevalence of respiratory diseases has been increasing worldwide thus increasing economic burden on the healthcare system. Recent studies have shown that the prevalence of asthma in West European countries ranges from 6-9%, while of chronic obstructive pulmonary diseases (COPD) is 8.0% worlwide. Objective. The aim of the study was to estimate the prevalence of respiratory symptoms and smoking habits, and to assess the prevalence of asthma and chronic bronchitis among adults in Belgrade, Serbia. Methods. To collect data we used a questionnaire based on the European Community Respiratory Health Survey (ECRHS) protocol, which was mailed to 10,208 randomly selected subjects. Results. There were 58.3% of responders to our questionnaire. We noted a higher prevalence of respiratory symptoms in subjects who responded promptly. The majority of the respondents were current or former smokers (37.5% and 17.5% respectively) and 79.9% of them reported respiratory symptoms. The most frequent symptoms were longstanding cough (32.2%), sputum production (30.4%) and wheezing (30.3%). Asthma attacks were reported in 4.4% of cases and 5.6% of subjects were using asthma medications. The prevalence of respiratory symptoms increased with age. Women reported coughing, attacks of breathlessness and coughing, chest tightness by night, allergic rhinitis and chronic coughing, more frequently than men. Productive cough was more frequent in men. The prevalence of almost all symptoms was higher in smokers compared to nonsmokers. Conclusion. In Serbia there is a high prevalence of respiratory symptoms, asthma and chronic bronchitis smoking addiction.

Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Niš from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average). According to the classification by Judet and Letournel, 15 (68.18%) patients had an elementary acetabular fracture, whereas 7 (31.82%) patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36%) patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18%) patients, good in 4 (18.18%) patients and moderate in 3 (13.63%) patients. According to Merle d’Aubigné Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54%) patients, good in 7 (31.81%) patients and moderate in 3 (13.63%) patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

Introdution. Tumour necrosis factor alpha (TNFα) has a central role in the host immune response to mycobacterial infection. TNFα blockade may therefore result in reactivation of recent or remotely acquired infection. In reported mycobacterium tuberculosis infections, extra-pulmonary and disseminated tuberculosis (TB) was common, appeared rapidly, and if unrecognized, with fatal outcome. We present a female patient with miliary TB following treatment with infliximab for fistulizing Crohn’s disease. Case Outline. Five years before admission, the patient was diagnosed with Crohn’s disease, with inflammation limited to the terminal ileum and sigmoid colon and has been on azathioprine 100 mg/day for the last 10 months. Three months before admission to the hospital she developed an enterocutaneous fistula for which therapy with infliximab was started in addition to azathioprine therapy. A tuberculin skin test and a chest x-ray were performed prior to the first infusion with normal findings. She presented with a 6-week history of fever, weakness, weight-loss and a 2-week dry cough. Chest x-ray and computed tomography displayed remarkable bilateral hilar and mediastinal lymphadenopathy and uniformly distributed fine nodules throughout both lung fields varying in size from 2 to 3 mm, without any signs of cavitation. Since there were clinical and morphological signs that indicated miliary TB, the treatment with antituberculous therapy was started and six weeks later all of the symptoms completely resolved and the lesions visible on x-ray diminished. Conclusion. The clinical use of TNF-inhibitors is associated with increased risk of developing tuberculosis. Physicians should be aware of the increased risk of reactivation of TB among patients treated with anti-TNF agents and regularly look for usual and unusual symptoms of TB.

Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome), developmental disorders (autism, dislexia and sttutering) and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about 'anomalous' cerebral domination, as a consequence of hormonal disbalance. .

Throughout human history left-handedness has been considered as sinful. It has been associated with the devil, weakness, female gender, unhealthiness, evil, something that has to be turned to a “good” - right side by force. Left-handedness is being more and more acceptable at rational level, but in everyday life it is still considered to be unusual if someone writes with the left hand. Lessening of the number of lefthanders is associated with ageing. There are about 13% lefthanders among people in twenties and less than 1% lefthanders among those in eighties. This finding may be explaned with more pronounced socio-cultural pressure on left-handed people in the past, compared to nowadays. On the other hand, this may also support the hypothesis about a reduced life span of lefthanded people. With cross-exercising of left-handedness, certain typical characteristics and behavioral patterns appear in these people. This was a sort of provoked behavior and an attack on the integrity of an emotional attitude toward oneself. Stuttering may also appear as a consequence of unsuccessful cross-exercising of left-handedness. The hypothesis about left-handedness as an advantage is supported with the reports about relatively more lefthanders in some specific groups such as: mathematicians, sculptors, architects, painters, musicians, actors, tennis players, as well as famous army commanders and rulers.

Introduction. Tuberculous otitis is a diagnostic problem due to the difficulty to obtain microbiological, histomorphological and cytological confirmation of the disease. Objective. Our objective was to compare clinical and radiological characteristic and development of otogenic complications in patients with tuberculous otitis and otitis with cholesteatoma as the most destructive form of chronic nonspecific otitis in the purpose of establishing the diagnostic criteria for tuberculous otitis. Methods. Medical records of 12 patients with tuberculous otitis and 163 patients with cholesteatoma treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery in Belgrade during the eight-year period were analyzed. All of the patients underwent otomicroscopic, audiological and radiological examination of the thorax and temporal bone, microbiological examination of the secretion and histomorphological examination of the tissue taken during middle ear surgery. Statistical analysis was done using χ2 test with Yates correction. Results. Otogenic complication as facial palsy and sensorineural hearing loss were more frequent in tuberculous otitis patients, than in cholesteatoma. Also, fistulas of the labyrinth and facial canal bone destruction were also more frequent in tuberculous otitis than in cholesteatoma. A larger extent of temporal bone destruction was noticed on CT scans of the temporal bone in half of the patents with tuberculous otitis. Coexistence with miliary pulmonary tuberculosis was detected in one third of the patients. There were no microbiological or histomorphological confirmations of the disease, except in one case with positive Ziehl-Neelsen staining. Conclusion. Tuberculous otitis media should be considered in patients with serious otogenic complications and with shorter duration of ear discharge, and in association with diagnosed miliary pulmonary tuberculosis and extensive temporal bone destruction. Polymerase chain reaction still is not reliable for diagnosis.

Introduction. Localization of ureteric stones and difference in disintegration success are the most important factors in determining the first treatment approach for ureteric stones. Objective. The aim of our study was to evaluate the difference in complication rate between different ureteric stone lithotripsy modalities. Methods. Two hundred sixty patients with ureteric stones were analyzed in a prospective bicentric study that lasted 1 year. The patients were divided into two groups: I - 120 patients who underwent ESWL (extracorporeal shockwave lithotripsy) treatment and II - 140 patients who were treated endoscopically with ballistic lithotripsy. Results. Ureteroscopic lithotripsy of all pelvic and iliac stones was significantly more successful comparing to ESWL, while lumbar ureteric stone treatment with ureteroscopic lithotripsy was not significantly more successful than ESWL, except for lumbar stones larger than 100mm2 that were significantly better treated endoscopically. In the I group complications after lithotripsy were recorded in 64 (59.3%) and in the II group in 58 (42.0%) patients, meaning that complications were statistically significantly more frequent in the I than in the II group. In the II group complications were significantly more often recorded after treatment of proximal comparing to ureteric stones of other localizations, while in the I group complications were significantly more often detected after treatment of impacted stones than in the II group. Conclusion. Being significantly successful comparing to ESWL, ureteric stone treatment with ureteroscopic lithotripsy should be considered as the first therapeutic option for all, especially impacted stones located in the iliac and pelvic ureteric portion. In spite of absent statistical difference in the success rate, ESWL should be chosen as the first treatment option in all cases of lumbar ureteric stones due to lower complication rate except for stones larger than 100mm2 that should be primarily treated endoscopically.

Introduction: Solitary fibrous tumors of the pleura are uncommon and discovered fortuitously or in patients with non-specific respiratory symptoms. When associated with hypoglycaemia, they are commonly referred to as Doege-Potter syndrome. Case outline. A 68-year old woman presented with a large pleural mass. She had a long history of headache and decreased consciousness with one-year worsening dyspnoea and right-sided chest pain. The chest X-ray revealed an enormous opacity occupying almost the entire right hemithorax. Endocrine tests showed an extremely reduced glucose level and blood concentration of insulin, C-peptide, glucagon, growth hormone and catecholamines within normal range. After fine-needle aspiration, by histological and immunohistochemical analysis, a benign solitary fibrous pleural tumor was diagnosed. Although surgical resection of such a huge tumor with hypoglycaemia is usually curative, our patient declined surgery and opted for conservative treatment with intravenous glucose. Conclusion. Clinicians should be aware of this rare, but important cause of hypoglycaemia and exclude a fibrous pleural tumor in the assessment of their patients. .

Introduction The role of rehabilitation programmes in chronic obstructive pulmonary disease (COPD) patients is to lower dyspnoea, improve exercise tolerance and quality of life. Objective We have developed a short-course, home-based, rehabilitation programme of physical exercise for lower limb muscles, based on walking at patients’ fastest pace. The aim of the study was to investigate the effectiveness of such a programme regarding the exercise tolerance, pulmonary functions and quality of life. Method Twenty-nine individuals with stable COPD (22 males, 7 females), with a mean age of 59.6±8.9 years participated in the study. Subjects were assessed before and after the 8-week rehabilitation programme using the six-minute walking test (6MWT), Borg breathlessness score, oxygen saturation, St. George’s Hospital Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Scale (HADS) and spirometry. Results The 6MWT distance improved significantly from 337 to 362 m, representing 8.3% (25 m) improvement over baseline. SGRQ activity, impact and total scores improved significantly after the rehabilitation programme (p

Introduction Alveolar adenoma belongs to the group of benign epithelial tumors. Histogenesis of alveolar adenoma is a combination of proliferation of alveolar pneumocytes and fibrous tissue originating from septal mesenchyma. Case outline A sixty-nine-year old female patient was hospitalized for clinical examination and surgery of well defined and homogenous timorous lesion in the right middle lobe causing pleural pain. Bronchoscopic examination with biopsy did not resolve etiology of the disease. Tumorectomy was performed. Timorous nodule had a multicystic appearance and histologically, histochemically and immunohistochemically, an alveolar adenoma was estimated. Five years after surgery, the patient feels well, without respiratory symptoms and signs of recurrence or malignant alteration, respectively. Conclusion Alveolar adenoma is a rare benign lung tumor, most frequently presented as a solitary pulmonary nodule. After complete surgery, the tumor neither relapses nor malignantly alters. Surgical excision is curative. It is necessary to take into consideration alveolar adenoma, too, when a solitary pulmonary nodule is diagnosed.

Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30) or to conventional treatment (Group B, n=30), with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist), courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p