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Background/Aim. Achieving good metabolic control, which plays a key role in reducing or preventing macrovascular and microvascular complications of diabetes mellitus (DM), requires continuous patient involvement in the self-management of DM. This continued engagement, which makes type 2 DM (T2DM) one of the most physically and emotionally demanding diseases, can become, at certain periods of life, extremely severe and lead to emotional distress (symptoms of depression and DM-related distress) and d-terioration of metabolic control. The aim of this study was to examine the association and influence of behavioral and psychological factors on the metabolic control of patients with T2DM. Methods. The research was conducted as a descriptive-analytic cross-sectional study. The method of random sampling included 324 subjects with T2DM in the research. The values of biochemical parameters of metabolic control were measured by standard laboratory methods. Blood pressure was measured two times, and the arithmetic mean was calculated. Anthropometric measurement was performed, and body mass index (BMI) was calculated. Attitudes toward medication adherence, adherence to dietary recommendations, level of physical activity, presence of depressive symptoms, and level of DM-related distress were examined using standardized questionnaires. Results. The target values of metabolic control parameters were reached by 21.6% of respondents. Multivariate analysis as predictors of poor metabolic control identified obesity, non-adherence toward dietary recommendations, insulin therapy, low level of physical activity, and clinically significant DM-related distress. Conclusion. Routine application of the questionnaire used in this study in the initial stages or critical moments of the disease can assess patients’ attitudes and knowledge about behavioral determinants of DM self-management and timely detect psychological conditions that affect them. It would be realistic to expect that such a comprehensive holistic approach would contribute to a lower incidence of complications and better metabolic control of T2DM.

Introduction: The use of left ventricular assist device (LVAD) for the treatment of end-stage heart failure and the fast technological development of these devices have led to an increasing number of patients with implanted LVADs with possibilities to be scheduled for different surgical interventions. Urgent abdominal operations in this group of patients are very complex and pose a particular challenge. Case report: A 61-year-old male patient with an implanted LVAD underwent urgent small bowel resection with ileostomy. Given the severity of cardiac and surgical conditions and the limited availability of LVAD specialists, the anesthetic plan had to be tailored to provide hemodynamic stability, adequate organ perfusion, thromboprophylaxis, reduce risk of infection, pump failure and device damage during surgery. Broad-spectrum antibiotics, thromboembolic and anti-ulcer prophylaxis were given before surgery. Midazolam, fentanyl, and succinylcholine were used to administer anesthesia, and sevoflurane, rocuronium, and fentanyl were used for maintenance. The greatest challenge was balancing the pump thrombosis prevention and minimal perioperative bleeding. During the perioperative period INR values were kept in reference range for LVAD. X-ray verification of the cable position was used to prevent device damage through surgical procedure. LVAD pump parameters were monitored, no alarm was sounded. On the ninth postoperative day, the patient was referred to a reference institution for further treatment. Conclusion: Perioperative management of patients with LVAD device, includes hemodynamic stability, careful handling of the device and prevention of complications like thrombosis and bleeding.

Introduction. Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce. Objective. We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center. Methods. A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients’ status was assessed by an office visit or telephone interview. Results. Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n=217). Groups had similar total ischemic time (319 ± 276 vs. 333±372 min; p=0.665), but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p15, as a marker of severe diastolic dysfunction (TA+ 23.1% vs. TA- 15.2%; p=0.050). During average follow-up of 14Ѓ}5 months, major adverse cardiac/ cerebral events occurred at the similar rate (log rank p=0.867). Conclusion. Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn’t influence the incidence of major adverse cardiovascular events. [Projekat Ministarstva nauke Republike Srbije, br. 175099]

Introduction. Angioedema is characterized by subcutaneous and/or submucosal swelling usually localized to the lips, eyelids, tongue, oral cavity, larynx and pharynx. Various types of angioedema, caused by different pathophysiologic mechanisms, can have the same or very similar clinical picture and require different diagnostic and therapeutic procedures. The immediate threat to life as a result of rapidly developed edema of the pharynx and larynx with airway obstruction requires endotracheal intubation or emergency tracheotomy. Standard therapy, which includes epinephrine, second-generation antihistamines and steroids, is not effective in the treatment of all types of angioedema. Objective. On the basis of the clinical presentation and course of angioedema, this retrospective study was aimed at contributing to a better understanding of the etiopathogenesis of the disease and at helping determine the most effective available treatment modalities. Methods. This retrospective study included patients treated under the diagnosis of angioedema of the upper aerodigestive tract between 2000 and 2012 in the Department of Otorhinolaryngology, Clinical Center of Banja Luka. Results. A total of 76 subjects were included in the study. The average age was 62.8 years. There were 40 (52.6%) male and 36 (47.4%) female patients. The largest number of patients (44.7%) had type II angioedema. Almost half of the patients or 36 patients (47.4%) were on treatment with an angiotensinconverting enzyme inhibitor (ACEi), but there was no statistically significant difference under the total number of patients (p=0.678). Conclusion. Better understanding of pathophysiologic mechanisms and the adoption of diagnostic protocols contributes to more effective treatment of angioedema.

Introduction. Primary mucosal melanoma of the sinonasal tract is a rare neoplasm, accounting for less than 1% of all melanomas. It has an aggressive and unpredictable biologic behavior characterized by frequent incidence of local recurrence, local and distant metastasis of the disease. Case report. This report summarizes the results of the previous research concerning sinonasal mucosal melanoma, and by the example of the two patients suffering from mucosal melanoma, we described clinical and histopathological features of this rare neoplasm and our experience in its diagnosis and treatment. Conclusion. Only histopathological analysis complemented by immunohistochemical analysis contributes to early and accurate diagnosis of the disease.

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

By different moving activities, learning about their body and its mothoric, a child develops its mothoric, acquires different motoric skills and habits and develops motoric activities. In this work, the subject of the research is just one segment of the anthropological area which refers to the appearance of appropriate motor abilities-speed. The research involved a total sample of 212 girls from the 3th and 4th grade of elementary school. The subjects were classified in three experimental and one control groups. The experimental groups were practicing according to planning instruction where the artistic, rhythmic and developmental gymnastics had the primary part. The control group of 48 students was practicing according to official instructional plan and program for P.E. of the Republic of Serbia. At the beginning of the academic year, initial (first) measurement was performed, followed by experimental final (second) measurement at the end of experiment. Research data was processed using SPSS standard statistics procedure. The multi-variant procedures were used in this research ant those were: the multi-variant analysis of the variable MANCOVA i MANOVA. Also, the mono-variant procedures were used and those were: the variable analysis ANCOVA, ANOVA and the interval of entrust. Considering the difference of the influence of treatments, it can be pointed out that the experimental programs, with all its characteristics, widely contributed to all its segments to the improvement of speed.

Introduction: Sudden sensorineural hearing loss (SSNHL) is defined as an acute, unilateral or bilateral hearing loss for sounds in three adjacent frequencies and greater than 30 dB occurring over a period from 24 hours to three days. The unknown etiology of this condition has resulted in diverse treatment modalities in the past. The aim of our retrospective study was to compare the results of three different therapeutic protocols for the treatment of patients with varying degrees of SSNHL. Methods: The study group consisted of 30 patients who were treated for SSNHL. Three therapeutic modalities were compared: vasodilators (6 patients), corticosteroids (16 patients) and a combination of corticosteroids and hyperbaric oxygen therapy (HBOT), 8 patients. Results: Patients treated with corticosteroid therapy, either alone or in combination with HBOT, experienced clinically and statistically significant (p

Hyoid bone, is located in anteriorsuperior site of the neck. Represents the odd bone which is the only bone in the human body that is not articulated or otherwise normally, associated with any other bone. Bearing in mind its embryonic origin, the bone is part of the skeleton viscerocranium. It has a horseshoe shape and consists of a body, two large and two small horns. In our study, we investigated sexual dimorphism hyoid bone. Testing we did at 42 hyoid human cadaver bones with known sex and age. We made 5 oseometric mesaurements. Metric analysis of the hyoid bone is a useful technique in the determination of sexual dimorphism hyoid bone that can give good results, but is not entirely satisfactory, and can serve as a complementary method.

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Background/Aim. The main complication of the atherosclerotic abdominal aortic aneurism (AAA) is her rupture that begins with lesion in intima and rupture. The purpose of this work was to determine immunocytochemical and morphofunctional characteristics of the cells in aortic wall in ruptured atherosclerotic abdominal aortic aneurysm. Method. During the course of this study, 20 samples of atherosclerotic AAA were analyzed, all of them obtained during authopsy. The samples were fixed in 4% formalin and embedded in paraffin. Sections of 5 μm thickness were stained histochemically (of Heidenhain azan stain and Periodic acid Schiff - PAS stain) and immunocytochemically using a DAKO LSAB+/HRP technique to identify α-smooth muscle actin (α-SMA), vimentin, myosin heavy chains (MHC), desmin, S-100 protein, CD45 and CD68 (DAKO specification). Results. The results of our study showed that ruptured atherosclerotic AAA is characterized by a complete absence of endothelial cells, the disruption of basal membrane and internal elastic lamina, as well as a presence of the remains of hypocellular complicated atherosclerotic lesion in intima. On the plaque margins, as well as in the media, smooth muscle cells (SMCs) are present, which express a α-SMA and vimentin (but without MHC or desmin expression), as well as leukocyte infiltration, and a large number of foam cells. Some of the foam cells show a CD68-immunoreactivity, while the others show vimentin- and S-100 protein-immunoreactivity. Media is thinned out with a disorganized elastic lamellas, while adventitia is characterized by inflammatory inflitrate (infection). Conclusion. Rupture of aneurysm occurs from the primary intimal disruption, which spreads into thinned out media and adventitia. Rupture is caused by unstable atherom, hypocellularity, loss of contractile characteristics of smooth muscle cells in intima and media, neovascularization of the media, as well as by the activity of the macrophages in the lesion.

Background/Aim. Graves disease (GD) is defined as hyperthyroidism with diffuse goiter caused by immunogenic disturbances. Antibodies to the thyroid stimulating hormone (TSH) receptors of thyroid gland (TRAb) have crucial pathogenetic importance in the development and maintenance of autoimmune hyperthyroidism. The aim of this study was to identify sensitivity, specificity, positive an negative predictive value of TRAb level in sera of patients with GD as well as to estimate significance of TRAb level for remission and GD relapses occurrence. Methods. We studied prospectively and partly retrospectively 149 patients, 109 female and 40 male patients, 5-78 years old, in the period 1982-2007. There were 96 patients with GD. The control group consisted of 53 patients, 21 with hyperthyroidism of second etiology and 32 patients on amiodarone therapy, with or without thyroid dysfunction TRAb was measured by radioreceptor assay (TRAK Assay and DYNO Test TRAK Human Brahms Diagnostica GMBH). Results. According to the results the sensitivity (Sn) of TRAb test was 80%, specificity (Sp) 100%, positive predictive value (PP) 100% and negative predictive value (NP) 83%. Also, the Sn of hTRAb test was 94%, Sp 100%, PP 100% and NP 94%. Our results show that an increased level of TRAb/hTRAb at the beginning of the disease and the level at the end of medical therapy is associated with an increased number of GD relapses and a shorter remission duration. Conclusion. Detection and measurement of TRAb in serum is a very sensitive method for diagnosing GD and very highly specific in vitro method for differential diagnosis of various forms of hyperthyroidism. Clinical significance of differentiating various forms of hyperthyroidism, using this in vitro assay, lays in adequate therapeutic choice for these entities.

Background/Aim. A cost-effectiveness analyses of immunomodulatory treatments for relapsing-remitting multiple sclerosis (RRMS) in developed countries have shown that any benefit from these drugs is achieved at very high cost. The aim of our study was to compare the cost-effectiveness of five treatment strategies in patients diagnosed with RRMS (symptom management alone and in combination with subcutaneous glatiramer acetate, intramuscular interferon β-1a, subcutaneous interferon β-1a, or intramuscular interferon β- 1b) in a Balkan country in socio-economic transition. Methods. The Markov model was developed based on the literature about effectiveness and on local Serbian cost calculations. The duration of a cycle in the model was set to a month. The baseline time horizon was 480 months (40 years). The societal perspective was used for costs and outcomes, and they were discounted for 3% annually. Monte Carlo micro simulation with 1000 virtual patients was done. Results. Significant gain with immunomodulatory therapy was achieved only in relapse-free years, while the time spent in health states EDSS 0.0-5.5 was longer with symptomatic therapy only, and gains in life years and QALYs were only marginal. One QALY gained costs more than a billion of Serbian dinars (more than 20 million US dollars), making each of the four immunomodulatory therapies costineffective. Conclusion. Our study suggests that immunomodulatory therapy of RRMS in a Balkan country in socioeconomic transition is not cost-effective, regardless of the type of the therapy. Moderate gain in relapse-free years does not translate to gain in QALYs, probably due to adverse effects of immunomodulatory therapy.

The paper discusses features of leaders and leadership in global enterprises. The key hypothesis is that in times of globalization a different approach to leadership is necessary than the one proposed by the traditional leadership theory. The paper also indicates some techniques for the management of global enterprises to promote and incite the development of global leadership.

Background. This paper presents our experience with cytologic examination of urine in diagnosing renal allograft dysfunction. Methods. The study group included 23 patients with renal allograft dysfunction, selected from 56 patients who underwent renal transplantation. Etiologic diagnosis was made according to the clinical picture, histological findings during allograft biopsy, and cytologic examination of urine. Urine sediment was obtained in cytocentrifuge and was air dried and stained with May Grunwald Giemsa. Results. Out of 23 patients with allograft dysfunction in 18 (78.3%) patient it was caused by acute rejection, and in 5 (8.9%) patients by allograft infarction, cyclosporine nephrotoxicity, acute tubular necrosis and chronic nephropathy. In eighteen patients (78.3%) cytologic examination of urine was pathologic, while in 16 (70%) clinical and histology findings coincided with urine cytology findings. Out of 18 patients with acute allograft rejection in 15 patients cytologic examination of urine coincided with acute rejection. Out of 7 patients with expressed cyclosporine nephrotoxicity, in 5 cytologic examination of urine confirmed the cause of allograft dysfunction, as well as in one of 2 patients with acute tubular necrosis. Cytologic examination of urine indicated parenchymal damage in 2 patients with reccurent disease (membranoproliferative and focal sclerosing glomerulonephritis). In 4 of 5 patients suffering from chronic rejection in a year’s monitoring period, urine sediment periodically consisted of lymphocytes, neutrophilic leucocytes, monocyte/macrophages, tubular cells and cilindres, without the predominance of any cell type. In 3 patients allograft dysfunction was caused by infective agents (bacteria, fungus cytomegalovirus). Conclusion. Cytologic examination of urine might be an alternative to histological in diagnosing acute allograft rejection and acute tubular necrosis or nephtotoxicity. Also it might indicate parenchymal disease while the importance of urine cytology in chronic allograft nephropathy needs to be investigated further.

Background. Acute rejection of allograft is one of the most serious complications of renal transplantation that requires fast and precise diagnostic approach. In this paper our experience in cytologic urinalysis as a diagnostic method of the acute renal allograft rejection was reviewed. Methods. The study group included 20 of 56 patients with transplanted kidneys who were assumed for the acute allograft rejection according to allograft dysfunction and/or urine cytology findings. Histological findings confirmed allograft rejection in 4 patients. Urine sediment obtained in cytocentrifuge was air-dried and stained with May-Grunwald-Giemsa. Acute allograft rejection was suspected if in 10 fields under high magnification 15 or more lymphocytes with renal tubular cells were found. Results. Acute transplant rejection occured in 32.1% patients. In 15 patients clinical findings of the acute renal allograft rejection corresponded with cytological and histological findings (in the cases in which it was performed). Three patients with clinical signs of the acute allograft rejection were without cytological confirmation, and in 2 patients cytological findings pointed to the acute rejection, but allograft dysfunction was of different etiology (acute tubular necrosis, cyclosporine nephrotoxicity). In patients with clinical, cytological and histological findings of the acute allograft rejection urine finding consisted of 58% lymphocytes, 34% neutrophilic leucocytes and 8% monocytes/macrophages on the average. The accuracy of cytologic urinalysis related to clinical and histological finding was 75%. Conclusion. Urine cytology as the reliable noninvasive, fast and simple method is appropriate as the a first diagnostic line of renal allograft dysfunction, as well as for monitoring of the graft function.

Introduction. Persistent left superior vena cava represents a congenital vascular defect of the venous system, which often makes standard 58 cm endocardial lead placement impossible. Case Outline. A right chamber approach by the left cephalic vein was tried. This was impossible because standard endocardial lead (SJM Isoflex S 1646T, bipolar lead, 58 cm in length, body diameter 7 French) was too short for this patient. A unipolar lead for coronary sinus (Medtronic ATTEIN 4193-88), 88 cm in length, body diameter 4 French, was placed in the posterior branch of the coronary sinus. With such positioning of the lead, a VVI pacemaker pacing was enabled. The operation lasted for 48 minutes, and the time of total X-ray exposure was 9.6 minutes. The values that were achieved were: threshold 0.3 V, pulse width 0.37 ms, maximum R 22.55 mV. Ten months after the implantation, the values were: thresh- old 0.3 V, maximum R 28.8 mV. Conclusion. Persistent left superior vena cava in some cases makes standard 58 cm endocardial lead placement impossible due to its joining to the right atrium over the dilated coronary sinus. Coronary sinus lead placement in the posterior or lateral coronary sinus branch represents an acceptable alternative approach for pacemaker lead placement in these patients.

Enhancing production and sale has a very significant effect on the competitive advantage of any production enterprise. In practice, especially in companies with highly diversified production, products have a different impact on generating revenue. Therefore, operational management pay attention to the products of the utmost importance. The Pareto analysis is the most broadly used product classification method. It can be said that the results obtained by this analysis are still very burdened by decision-makers’ subjective attitudes. This paper proposes a model for selecting products with the biggest impact on generating revenue in an exact way. In the model’s first stage, whether there is a linear relationship between volume demand and a discounted amount is analyzed applying mathematical statistics methods. In the second stage, the Genetic Algorithm (GA) method is proposed so as to obtain a near-optimal set of the most important products. The proposed model is shown to be a useful and effective assessment tool for sales and operational management in a production enterprise.

Education has always been a driving force behind economic prosperity. However, this has become especially important in a globalized knowledge- and new-technology-based economy. The research presented in this paper focuses on the relationship between ICT, population education, and economic growth and development. The analysis of this relationship is based on the latest data collected from relevant national and international institutions. The results obtained from a survey conducted at the Faculty of Economics, University of Belgrade, are also analyzed. The paper highlights the challenges faced by the education systems in general, and the education system of the Republic of Serbia in particular, confronted with the new wave of technological innovation which is fundamentally changing the nature of work and imposing new requirements with regard to the necessary knowledge and skills. Our research results indicate that ICT and education have been recognized by the Government of the Republic of Serbia as the important determinants of economic and the overall social development.

Despite the fact that most of the theories and models of leadership are solely focused on the leader as the central figure of the leadership process, there is a need to draw attention to the importance of the followers’ role in the organizational leadership process, which is the main subject of this paper. Newer approaches to leadership provide a framework for the study of a reciprocal influence in the leadership process, in which the behavior of the leader appears as both an independent and a dependent variable at the same time. The aim is to draw attention to the necessity of adjusting leadership styles to the characteristics of the followers and encourage the followers’ active role in leadership, as the basic precondition for the effectiveness of the entire leadership process. The paper reviews the evolution of the role of the followers in organizational leadership through various approaches and models of leadership, from the attribution of potential leadership qualities through the process of attribution, through the followers’ influence in the selection of the dominant leadership style, to the equal participation in the leadership process, reflected in the concepts of servant leadership and shared leadership.

The subject of the research in this paper is the emergence of big data phenomenon and application of big data technologies for business' needs with the specific emphasis on marketing and trade. The purpose of the research is to make a comprehensive overview of different discussions about the characteristics, application possibilities, achievements, constraints and the future of big data development. Based on the relevant literature, the concept of big data is presented and the potential of large impact of big data on business activities is discussed. One of the key findings indicates that the most prominent change that big data brings to the business arena is the appearance of new business models, as well as revisions of the existing ones. Substantial part of the paper is devoted to the marketing and marketing research which are under the strong impact of big data. The most exciting outcomes of the research in this domain concerns the new abilities in profiling the customers. In addition to the vast amount of structured data which are used in marketing for a long period, big data initiatives suggest the inclusion of semi-structured and unstructured data, opening up the room for substantial improvements in customer profile analysis. Considering the usage of information communication technologies (ICT) as a prerequisite for big data project success, the concept of Networked Readiness Index (NRI) is presented and the position of Serbia and regional countries in NRI framework is analyzed. The main outcome of the analysis points out that Serbia, with its NRI score took the lowest position in the region, excluding Albania. Also, Serbia is lagging behind the appropriate EU mean values regarding all observed composite indicators - pillars. Further on, this analysis reveals the domains of ICT usage in Serbia, which could be focused for an improvement and where incentives can be made. These domains are: political and regulatory environment, business and innovation environment, business usage, government usage and social impacts of ICT.

Disturbing media pictures of the deterioration and disappearance of villages in almost all parts of the Republic of Serbia (RS), as a consequence of insufficient progress in the implementation of the paradigm of the rural way of life, desirable and necessary for any community and any economy, are an alarming call to every subject of the society to do whatever they are entitled to and capable of to stop these unfavorable processes. The potentials of a small rural community in RS to survive and develop for its own benefit and for the benefit of the society as a whole have studied in this article. Bearing in mind the fact that relevant social documents have their significance and role in all social processes, but are not a sufficient precondition for their improvement, the authors surveyed and interviewed the local population in the Velebit village about their attitudes, potentials, needs and limitations regarding the establishment of and their permanent involvement in organic agricultural production necessary for the village to survive and improve its economic and social position. The research results show that the inhabitants of the village of Velebit are interested in remaining in the countryside and setting up organic agricultural production, but they need assistance, both advisory and financial, as they lack sufficient capacities for it.

Actinomycosis is caused by microorganisms of the Actinomyces species, found in the oral cavity, gastrointestinal and genital tract. Infection by Actimomyces species mainly causes chronic supurative disease of the oral, cervico-facial, thoracic, and abdominal regions. Clinical manifestations have been described at every level, but the disease is relatively rarely diagnosed. The causative agent is considered to be an opportunistic pathogen associated with infection, trauma, surgical procedures, or associated with a neoplasm or foreign body. Symptoms include intermittent fever, weight loss, abdominal or thoracic pain, pseudotumor and tumor masses, and local symptoms from the infected area. Pseudotumor and tumor masses are diagnosed by ultrasonography and computerized tomography. The diagnosis is confirmed by the presence of a causative agent in biopsy or surgically acquired samples. The treatment includes the administration of high doses of antibiotics (penicillin, amoxicillin, ceftriaxone) for at least 6-12 months, as well as surgical tretment. Penicillin is a drug of choice. This infection is often polymicrobial, so that antibiotic therapy should include agents that act against the associated pathogens. Treatment outcome and prognosis in these three cases were excellent, despite the prolonged course of the extensive disease. [ABSTRACT FROM AUTHOR]

Background. Acute rejection of allograft is one of the most serious complications of renal transplantation that requires fast and precise diagnostic approach. In this paper our experience in cytologic urinalysis as a diagnostic method of the acute renal allograft rejection was reviewed. Methods. The study group included 20 of 56 patients with transplanted kidneys who were assumed for the acute allograft rejection according to allograft dysfunction and/or urine cytology findings. Histological findings confirmed allograft rejection in 4 patients. Urine sediment obtained in cytocentrifuge was air-dried and stained with May-Grunwald-Giemsa. Acute allograft rejection was suspected if in 10 fields under high magnification 15 or more lymphocytes with renal tubular cells were found. Results. Acute transplant rejection occured in 32.1% patients. In 15 patients clinical findings of the acute renal allograft rejection corresponded with cytological and histological findings (in the cases in which it was performed). Three patients with clinical signs of the acute allograft rejection were without cytological confirmation, and in 2 patients cytological findings pointed to the acute rejection, but allograft dysfunction was of different etiology (acute tubular necrosis, cyclosporine nephrotoxicity). In patients with clinical, cytological and histological findings of the acute allograft rejection urine finding consisted of 58% lymphocytes, 34% neutrophilic leucocytes and 8% monocytes/macrophages on the average. The accuracy of cytologic urinalysis related to clinical and histological finding was 75%. Conclusion, Urine cytology as the reliable, noninvasive, fast and simple method is appropriate as the a first diagnostic line of renal allograft dysfunction, as well as for monitoring of the graft function. [ABSTRACT FROM AUTHOR]