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With an estimated rise in poultry production and consumption of chicken meat in Russia by 9% up to 2022, as well as development of self-sustainable poultry production, the need has arisen for environmental assessment of this production, and within it especially greenhouse gases (GHGs) emission assessment. The goal of this work is to show a calculation procedure for obtaining estimations for the carbon footprint of the 1 kg of live chicken at the farm gate, taking into account regional typological features of agricultural production in agro-ecosystems. The methodology of carbon footprint (CF) calculation is based on the life cycle assessment (LCA) methodology, and on IAGRICO2 calculator, developed for agriculture products. Results have shown that in modern technology of poultry farming, 5.79 kg CO2 e was emitted on average per kg of body mass, and that about 47% of emission was from manure, around 27.5% from crop production (fuel and fertiliser) and 25.5% from fuel and energy needed for heating, sanitation and feeding of chickens. The main distinction of Central Russia is low efficiency of the fertiliser application on crop fields and manure management, storage and utilisation, which has as a result high emissions of the nitrous oxide. This is the field where the implementation of the intensive technologies of precise farming, manure handling, utilisation and management will significantly decrease GHG emission, with preserving yield of crops and quantity and quality of chicken meat.

We report on a method of synthesis of single-walled carbon nanotubes percolated networks on silicon dioxide substrates using monodisperse Co and Ni catalyst. The catalytic nanoparticles were obtained by modified method of reverse micelles of bis-(2-ethylhexyl) sulfosuccinate sodium in isooctane solution that provides the nanoparticle size control in range of 1 to 5 nm. The metallic nanoparticles of Ni and Co were characterized using transmission electron microscopy (TEM) and atomic-force microscopy (AFM). Carbon nanotubes were synthesized by chemical vapor deposition of CH4/H2 composition at temperature 1000 °С on catalysts pre-deposited on silicon dioxide substrate. Before temperature treatment during the carbon nanotube synthesis most of the catalyst material agglomerates due to magnetic forces while during the nanotube growth disintegrates into the separate nanoparticles with narrow diameter distribution. The formed nanotube networks were characterized using AFM, scanning electron microscopy (SEM) and Raman spectroscopy. We find that the nanotubes are mainly single-walled carbon nanotubes with high structural perfection up to 200 μm long with diameters from 1.3 to 1.7 nm consistent with catalyst nanoparticles diameter distribution and independent of its material.

Introduction: One of the characteristics of modern era is the explosion of diabetes in the world. Today more than 400,000,000 people suffer from diabetes in the entire world. During the last decade the number of women with the disorder of glucose homeostasis is six to seven times greater than in the previous period. Therefore, the re-evaluation of the impact of glucose intolerance on the course and outcome of pregnancy is very current., Objective: The aim of the study was to evaluate the data on the influence of mothers' glucose homeostasis disturbances on the occurrence of cardiorespiratory disorders in newborns, as well as their influence on the perinatal outcome., Methods: Prospective examination included 102 newborns in total - 31 infants of mothers with glucose homeostasis disorder (Group 1) and 71 infants of healthy mothers (Group II). Average age, body height, body weight, body mass index, parity and illness duration of the pregnant women had been determined, as well as the delivery method. Every newborn was provided with physical examination, Apgar score was calculated, body weight and body length were measured. Also, electrocardiography and brain ultrasound, as well as the basic hematology biochemical and microbiological analysis, were performed within the examinations of the infants., Results: The average weight and obesity incidence with diabetic women was higher than in the control group and their infants were heavier and with lower gestational age. Heart failures were diagnosed in five (16.1%) infants of diabetic mothers and in one (1.4%) infant of a healthy woman (p<0.01). Respiratory disorders were diagnosed in 48.4% infants of diabetic mothers and in 12.6% of healthy mothers (p<0.01). Forty-two percent of infants of diabetic mothers and 19.7% infants of healthy mothers needed additional oxygen., Conclusion: Congenital anomalies of the cardiovascular system and respiratory disorders in the infants of diabetic mothers were six to eight times more frequent than in the infants of healthy mothers.

Introduction: Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease and in some variants represents the only true surgical emergency in congenital heart surgery. Basic anatomical characteristic of this anomaly is an abnormal connection of pulmonary veins with systemic venous circulation. Although the results of TAPVC repair in infancy have been markedly improved in recent years, the recurrent pulmonary venous obstruction (RPVO) remains relatively frequent complication of surgical treatment., Objective: The aim of this study was a retrospective evaluation of TAPVC repair at a single institution, identifying the risk factors associated with the increased mortality and morbidity., Methods: Between January 2001 and January 2010, 43 consecutive patients underwent repair of TAPVC at the University Children's Hospital, with median weight of 3.8 kg (1.8-13 kg). Median age at surgery varied from 5 days to 5 years. Distribution of TAPVC types was as follows: supracardiac 19 (44%), cardiac 12(28%), infracardiac 9 (21%), and mixed 3 (7%). Eleven patients (26%) were emergencies due to obstructed drainage., Results: Early mortality was 9.30% (4/43). An average time of followup/survival for 95% interval of confidence was 101.6 +/- 6.7 months. Kaplan-Meier cumulative survival was 83.7 +/- 5.7%. Freedom from reintervention after 10 years was 87.2 +/- 0.5%. The principal reason for reintervention was RPVO., Conclusion: Preoperative obstruction is not a risk factor of early mortality and RPVO. Low body mass (below 2.5 kg) is the only identified risk factor of early mortality. Complex morphology of the confluens, particularly in a mixed type of TAPVR, is the main risk factor of RPVO development.

Introduction: Atherosclerosis is a progressive, multifactorial, diffuse, multisystemic, chronic, inflammatory disease, which is manifested by disorders of vascular, immune and metabolic system. Pathogenesis of this disease is not fully understood. Accordingly, angiogenesis represents a special field of research due to its role in atherogenesis. STEPS OF ANGIOGENESIS: Angiogenesis is a complex biological process, which requires the precise coordination of its four steps (vasodilatation and permeability, vessel destabilization and matrix degradation, endothelial cell proliferation and migration, and lumen formation and vessel stabilization). MEDIATORS OF ANGIOGENIC PROCESS: The process of forming new blood vessels is regulated by a delicate balance between proangiogenic and antiangiogenic molecules. Numerous soluble growth factors and inhibitors, cytokines, proteases, extracellular matrix proteins and adhesion molecules, as well as hypoxia, inflammatory process, shear stress, hypertension and interaction between cells and extracellular matrix strictly control the angiogenic process. Neovascularization is halted due to the downregulation of angiogenic factors or the increase of inhibitors of this process. TUMOR VASCULARIZATION: In the asymptomatic phase of cancerogenesis, cancer rarely exceeds the diameter of 1-2 millimeters. However, when the metabolic demand increases, it leads to tumor vascularization. In this way, tumor switches to an angiogenic phenotype. The molecular basis of angiogenic switch refers to increased production of angiogenic factors and/or loss of angiogenic inhibitors., Conclusion: The contribution of angiogenic process has become increasingly meaningful in understanding the pathogenesis ofatherosclerosis.

Introduction: Penetrated injuries are most difficult injuries of the eye. Intraocular foreign body (IOFB) may lodge in any of the structures it encounters, from anterior chamber to the retina and choroid. Notable effects caused by foreign body injury include traumatic cataract, vitreous liquefaction, retinal and subretinal hemorrhages, retinal detachment and development of endophtalmitis., Case Outline: A 49-year-old man sustained injury of the right eye with a piece of metal wire. On admission visual acuity was VOD: 1.0 and lower intraocular tension TOD = 6 mmHg (10-22 mmHg). Corneal entry wound was noticed near limb on 11 h with a prominating foreign body of 18 mm in length that passed through the iris, lens and vitreous. X-ray findings confirmed existence of a large foreign body extending along the entire length of the globe. IOFB removal was done with anatomic forceps. On postoperative detailed clinical examination we observed retinal rupture in the upper temporal quadrant fitting in the area of the IOFB damaged retina. Laser photocoagulation of retinal tear (laser retinal barrage) was done. Visual acuity on discharge was the same (1.0) and intraocular tension was within normal limits (10 mmHg)., Conclusion: Penetrated injury of eye requires detailed examination of all eye structures, beginning from the anterior to posterior segment. Timely diagnosed ruptures of the posterior segment of eye before the development of traumatic cataract, and adequate therapeutic procedures prevent serious complications of IOFB penetrated eye injury such as retinal detachment and permanent reduction of visual acuity.

Introduction: Penetrating injury is characterized by the existence of entry wound only, and it can be with or without an intraocular foreign body (IOFB). IOFB can lead to a mechanical injury of the eye and to cause infection or to manifest other toxic effects on intraocular structures. Iron and copper can dissolve and cause siderosis, i.e. chalcosis of the eye. Ocular siderosis is diagnosed by clinical and electroretinogram (ERG) findings., Outline of Cases: The first patient was a 37-year-old male who was injured by a metal foreign body. He presented at the Clinic two years after the injury. Visual acuity of the right eye (VOD) on admission was VOD=L+P+ (light projection). Pars plana phaco-vitrectomy with IOFB extraction was done. Visual acuity on discharge was VOD=3/60 cc + 7.50 Dsph=0.2. The second patient was a 55-year-old male who presented at the clinic 18 months after injury. On admission visual acuity in his left eye was VOS 1/60. Pars plana phacovitrectomy with IOFB extraction was done.Visual acuity on discharge was VOS=0.7 through the stenopeic slit., Conclusion: In penetrating injuries caused by a metal IOFB pars plana vitrectomy with IOFB extraction is indicated. In cases with IOFB, when visual acuity is preserved, the lens is transparent, while the eye is without signs of infection, urgent pars plana vitrectomy is not necessary. Such patients need regular followup with obligatory ERG findings.

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 13-year-old girl was initially observed for several months due to elevated sedimentation rate (ESR 75-90 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 SS-A/Ro, anti SS-B/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 12-years follow-up 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: Chlamydia trachomatis is the most common cause of sexually transmitted disease. The possibility of serious complications may be prevented by early detection of the bacteria on the uterine cervix by the application of sensitive and reliable tests such as up-to-date molecular tests., Objective: The aim of the study was the comparison of sensitivity and specificity of three different methods in the diagnosis of Chlamydia trachomatis infection., Methods: The study included 69 female students referred to the gynecological outpatient unit at the Students' Polyclinic for colposcopic examination of the uterine cervix. Cervical Chlamydia trachomatis was diagnosed by using three different methods: direct immunofluorescence (DIF), nucleic acid hybridization assay (hc2), and polymerase chain reaction (PCR)., Results: By using DIF Chlamydia trachomatis was identified in four students (5.80%), by using hc2 also in four (5.80%), while by using PCR test in six students (8.70%). Comparative analysis of the obtained results evidenced sensitivity and specificity rates of DIF in comparison to PCR method of 46% and 95%, respectively. Sensitivity and specificity of DIF method in comparison to hc2 was 62% and 97%. Sensitivity and specificity of hc2 method in comparison to PCR was 76% and 100%., Conclusion: Contemporary molecular methods, such as PCR, are methods of choice for the identification of endocervical Chlamydia trachomatis in the population of university students without symptoms of the disease.

The main goal of this paper is to present clinical results of surgical correction of angular (varus and valgus) deformities of knee area. Goal is also to present new external fixation device for surgical treatment of varus deformity of proximal tibia. As material it has been used series of 70 patients treated during the period of 6.5 years in University Orthopaedic and traumatology clinic. Biomechanical investigation of 80% cut bone model fixed by new external fixation device was performed in the measurement laboratory of Mechanical Faculty University of Nis. Clinical results of treatment of 58 high tibial surgeries (49 varus and 9 valgus) and 12 distal femur surgeries (2 varus and 10 valgus) showed that unicorticotomy and callus distraction by the use of Mitkovic external fixation device leaded to correction and bone union. Superficial pin tract infection happened in 9 patients and has been successfully treated without pins removal. Biomechanical investigation of new device showed that during axial loading of bone model by 690 N (70 kg) movement of medial distal end of bone model was 0.30 mm while posterior distal end of bone model was 0.26 mm. From results obtained in can be concluded that unicorticotomy and gradual callus distraction by the use of external fixation is one reliable method. Biomechanical testing of new external fixation device showed that it is more stable in control of varus and posterior position of proximal tibial fragment.

Introduction: An intraocular foreign body may traumatize the eye mechanically, introduce infection or exert other toxic effects on the intraocular structures. Removal of a metallic intraocular foreign bodies (IOFB) use an internal (vitrectomy followed by forceps or internal magnet use) or external approach (large electromagnet)., Outline of Cases: A 51-year-old man sustained injury of the left eye by a metal foreign body. On admission visual acuity was normal (VOS = 1.0) and intraocular tension was within normal limits (TOS = 10 mmHg). Nasal scleral entry wound was noticed. Ultrasound of the left eye was done, which confirmed existence of IOFB laying nasally, next to the ciliary body. Extraction of IOFB with a big electric magnet was done. Visual acuity on discharge was the same (VOS = 1.0). Another man, aged 30 years, came to the clinic after injury of the left eye by a foreign body. On admission visual acuity was VOS = L + P+ (light and projection), TOS = 44 mmHg (higher), traumatic cataract, scleral entry wound, corneal edema, existence of IOFB and initial endophtalmitis. Lensectomia and vitrectomia via pars plana with IOFB extraction were done.Visual acuity on discharge was VOS = 5/60 with +6.50 Dsph = 0.3-0.4; TOS= 7 mmHg., Conclusion: Magnet removal is indicated in patients when IOFB is laying free in the vitreous body or stopped near the entry wound during injury without other complications. Internal approach--pars plana vitrectomy with forceps removal is used when IOFB is stuck either on the peripheral or posterior part of the retina or if there are some of aforementioned complications.

Introduction: Acetabular fractures are severe injuries, mostly occured in young patients after traffic accident or fall from heights. Of the all acetabular fractures, posterior wall acetabular fractures are the most often observed. Regarding to mechanism of the injury, about 30% of these fractures are associated with posterior hip dislocation., Material and Methods: The incidence of AVN in 18 patients with posterior wall acetabular fractures associated with dislocations of the hip is presented. Thompson-Epstein Scale (type I-V) was used as the classification of the injury. Kocher-Langenbeck surgical approach was achieved in all patients., Results: Average following time after surgery was 22, 66 months (8-36 months). After that period the incidence of femoral head AVN was observed in 33.3%. Femoral head AVN was observed in 5.55% of patient who was treated by the reduction of hip dislocation in first 24 hours after injury, while in patients with later reduction, femoral head AVN were observed in 27.77%., Conclusion: Posterior wall acetabular fractures associated with hip dislocation are severe injuries. Urgent, closed reduction of the hip, early definitive stable osteosynthesis of acetabulum and the experience of surgical team are factors that greatly decrease the possibility for AVN occurence. Later reduction, comminution of posterior wall of the acetabulum (Thompson- Epstein III et IV), impaction, chondral lesion of the femoral head and associated fractures of femoral head, increase the possibility for AVN occurence.

Background/aim: Early childhood caries (ECC) is a special form of caries in primary dentition that affect teeth after eruption, with rapid progression, later symptomatology and numerous complications. The aim of this study was to investigate the frequency of ECC among different ethnic groups of preschool children in the South Backa District., Methods: The survey was performed as a cross-sectional analytical study on the sample of preschool children of both sexes and different ethnic groups in the South Backa District. The diagnosis and the clinical form of ECC was defined by dental check-ups according to the modified Wyne's criteria: the initial form (type 1) shows carious lesions without disturbing the surface structure of the tooth enamel, the moderate form (type 2) shows carious lesions affecting one or two teeth or their surfaces, the middle form (type 3) shows carious lesions affecting more than two teeth or their surfaces, the severe form (type 4) shows the presence of two and more gangrenous roots in the maxilla intercanini sector, and the severe form with complications (type 5) shows the presence of two and more gangrenous roots in the maxilla intercanini sector with the presence of fistula and/or abscess of tooth root apex. Epidemiological data on the different ethnic groups were obtained by interviewing the parents of the examined children. The tests on significant statistical differences was performed by the variance analysis and chi2 test., Results: The prevalence of ECC in children oped 41.32 +/- 8.57 months, of the South Backa District was 30.5%. The highest disease frequency was found in Roma children (50.0%) as well as in children of Ruthenian nationality (43.8%), than in children of Slovakia nationality (37.8%), Serbian (26.1%), Hungerian (25.4%) and other nationalities (27.4%). The frequency of types 1, 3, 4, and 5 ECC was twice as high as in children who do not speak Serbian language., Conclusion: The frequency of ECC occurence is different among ethnic groups. The highest frequency of ECC is present among the members of ethnic groups whose native language is not Serbian.

Background/aim: Cytokeratins (CK) 5/6 and 17, myoepithelial markers, are also expressed in a proportion of breast carcinomas. Breast carcinomas expressing basal epithelium cytokeratins constitute a tumor subgroup that shows common but heterogeneous morphological, genetical, and immunophenotypical features and is associated with poor clinical outcome. The aim of this study was to determine the incidence of basal expression of cytokines CK5/6 and CK17 in the tested samples of ductal invasive breast cancers, as well as to test the presence of a correlation of tumor expression of basal cytokines and clinicopathological prognostic factors: age, the level of histological differentiation, hormone receptor status, HER2 (human epidermal growth factor receptor 2) protein expresion and HER2 gene amplification in tumorous tissue., Methods: Immunohistochemistry (IHC) was used to evaluate the CK5/6 and CK17 status of 121 ductal invasive breast cancers. The results thus obtained were compared with clinicopathological characteristics., Results: From the 117 analyzed tumor specimens, 22% and 30% were immunohistochemically positive for CK5/6 and CK17, respectively. Basal cytokeratins showed significant inverse relationship with estrogen and progesterone receptor status and HER2 protein expression. CK5/6 and CK17 immunoreactivities were directly associated with triple-negative phenotype and higher histological grade., Conclusion: Our findings are similar to reports that tumours expression of basal cytokeratins are correlated with adverse pathological parameters. Given the limited number of emerging therapeutic targets in these tumors, routine IHC identification of basal-like subtype as a poor prognostic group of breast cancer could be based on the expression of basal CKs.

Introduction: According to the level of intraocular pressure (IOP), open angle glaucoma is divided into high tension glaucoma (HTG) and normal tension glaucoma (NTG)., Objective: To determine if there are differences in the distribution of patients by age and sex between NTG and HTG., Methods: Our prospective study included 30 patients with NTG and 30 with HTG. A complete eye examination was performed. The examination included measuring of intraocular pressure by Goldmann applanation tonometry, examination of optic disc head by indirect ophthalmoscopy with Volk 90 D lens and visual field examination using the Octopus program., Results: The average damage of visual field in the group of patients with NTG was 8.14 +/- 4.43 dB, while in the group with HTG it was 7.40 +/- 2.84 dB (p > 0.05). The average age of the group of patients with NTG was 66 +/- 11.58 years, while among those with HTG the average age was 59.7 +/- 11.63 years (p < 0.01). Among the patients with NTG there were three times more women than men (chi2 = 9.124; p < 0.01), while in the group of patients with HTG there were more men than women, but without statistically significant difference between the tested groups (chi2 = 1.851; p > 0.05)., Conclusion: Open angle glaucoma is a disease of elderly population. According to our results, risk factors for this disease can be age and sex. NTG is more frequently present than HTG among elderly population and females.

Introduction: Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture., Objective: The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation., Methods: We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Nis from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3%) type 1, 6 (28.6%) type 11, 8 (38.1%) type IIIA, and 4 (19.0%) type IIIB. All the patients were treated by a unilateral type Mitković external fixator by Traffix Company., Results: Union was attained in 16 (76.2%) fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees). Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery., Conclusion: External fixation by the use of Mitković external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections.

Unlabelled: INTRODUCTION. Atherosclerosis is a progressive, multifactorial, diffuse, multisystemic, chronic, inflammatory disease, which is manifested by disorders of vascular, immune and metabolic system. Pathogenesis of this disease is not fully understood. Endothelial Dysfunction and Inflammatory Process. Endothelial dysfunction is recognized as the crucial step in atherogenesis. A lot of studies have confirmed the involvement of various mediators of inflammation in initial proatherogenic processes, such as the upregulation of adhesion molecules on endothelial cells, binding of low density lipoproteins to endothelium, activation of macrophages and proliferation of vascular smooth muscle cells. Fatty stain and Inflammatory Process. Fatty stain consists of foam cell accumulation. After foam cell formation, mediators of inflammation initiate a series ofintracellular events that include the induction of inflammatory cytokines. Thus, a vicious circle of inflammation, modification of lipoproteins and further inflammation can be maintained in the artery. Transitory Lesion and Inflammatory Process. In transitory lesion intensive phagocytosis of oxidized low density lipoproteins additionally activates monocytes and macrophages and consequently facilitates and exacerbates the inflammatory response. Fibrotic Plaque and Inflammatory Process. Inflammatory process, matrix-degrading metalloproteinases activity, platelets aggregation and smooth muscle cells proliferation play a central role in development of fibrotic plaque. Complex Lesion and Inflammatory Process. It has been shown that inflammation is closely related to the development of atherosclerotic plaque rupture., Conclusion: The contribution of inflammatory process has become increasingly meaningful in understanding the initiation, progression and clinical manifestations ofatherosclerosis.

Introduction: Thoracic epidural analgesia, combined with general anesthesia, is an established anesthetic choice for abdominal aortic surgery. However, there are controversies about the level of anesthesia as well as the dose and concentration of the local anesthetic used. The aim of the study was to compare the effects of two different concentrations of epidural bupivacaine on sevoflurane requirements and hemodynamic parameters during aortic surgery under combined epidural/general anesthesia., Methods and Material: Sixty patients scheduled for abdominal aortic surgery were randomly divided into two groups according to the concentration of local anesthetic used for epidural anesthesia: group 1--low concentration--where 0.125% bupivacaine was used, and group 2--high concentration--where 0.5% bupivacaine was used at the beginning and then the concentration was reduced to 0.25%. Anesthesia was maintained with sevoflurane, the dose was adjusted to achieve the target entropy of 40-60. The measurements included the inspired sevoflurane concentrations, blood pressure, and heart rate at the beginning and every 5 min during the surgery., Results: Both groups had similar heart rate and blood pressure, but the inspired sevoflurane concentration was significantly higher and more variable in patients where bupivacaine 0.125% was used. Vasopressors were used more often and in higher doses in the 0.5% bupivacaine group, and in the same group the blood loss and fluid requirements were reduced., Conclusion: When 0.5% bupivacaine is used in combined thoracic epidural/ general anesthesia for aortic surgery, the sevoflurane concentrations are lower and less variable. In addition, the blood loss and fluid requirements are reduced.

Introduction: Perforation of the tympanic membrane in children may be the cause of recurrent middle ear infection and loss of hearing., Objective: The aim of this study was to analyze the application of different reconstructive materials in surgical technique myringoplasty., Methods: We performed 88 myringoplasties due to auricular tragus perforation in 76 children (aged 4 to 16 years, mean 11.9 years) from July 2001 to July 2009. Age, gender, size and the site of perforation, status of the contra lateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels and postoperative complications were recorded and analyzed. In performing myringoplasty we used fascia of the temporal muscle and cartilage of the auricular tragus., Results: In 43 (48%) patients we used fascia of the temporal muscle and in 45 (52%) cartilage of the auricular tragus. Graft success was defined as an intact eardrum at 12 months postoperatively and improvement in the perception of air-bone gap of 10 dB, which we recorded in 73 (83%) cases. Re-perforations were recorded in 12 (13%) patients, of whom in 8 (18.6%) cases we used the temporal fascia and in 4 (9.3%) cases a tragal cartilage. Retraction of the tympanic membrane was recorded in 3 (4%) cases with the temporal fascia., Conclusion: Myringoplasty is a reasonably successful method with good functional results in pediatric patients. Risk factors of surgical failure are young age, the size of auricular tragus perforation and pathological conditions of the contra lateral ear. The tragal cartilage gives better results in cases with bilateral perforations because the possibility of retractions and re-perforations is lower. Relatively small number of patients is probably the reason that, exept for young age, differences between the two groups did not reach the level of statistical significance.

Introduction: The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection., Case Outline: We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome., Conclusion: Contamination and devitalization of the soft-tissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.

Introduction: Whipple's disease is a chronic, multisystem, infectious disease caused by Tropheryma whipplei. It most commonly affects Caucasian males, middle-aged. Morbus Whipple is primarily gastrointestinal disease, manifested as malabsorption syndrome, and diagnosed by endoscopy and intestinal biopsy. Extraintestinal manifestations are not rare., Case Report: A 48-year-old male was admitted due to diarrhea, weight loss and weakness in the extremities. Physical examination findings pointed out diffuse hyperpigmentation, pleural effusion and leg edema. Anemia, inflammatory syndrome and malabsorption signs were discovered through laboratory tests. The diagnosis was confirmed by intestinal biopsy. The patient was treated with antibiotic and symptomatic therapy. After 9 months, the patient had no symptoms, and clinical and laboratory findings were regular., Conclusion: Whipple's disease is a rare disease. A high degree of clinical suspicion for the disease (malabsorption, arthritis, fever, neurological symptoms) is the most important for diagnosis. Timely diagnosis and appropriate therapy prevent the disease progression and fatal outcome.

Introduction: One of the most common complications of endovascular repair of abdominal aortic aneurysm is type II endoleak - retrograde branch flow., Case Report: A 76-year-old man with abdominal aortic aneurysm, 7.1 cm in diameter and aneurysm of the right common iliac artery, 3.2 cm in diameter was admitted to our Department with abdominal pain. The patient had no chance of having open repair of abdominal aortic aneurysm because of high perioperative risk (cardiac ejection fraction of 23%, chronic pulmonary obstructive disease). Multislice computed angiography also revealed a large inferior mesenteric artery, 6mm in diameter with the origin in thrombus of aneurysm. We decided to repair abdominal aortic aneurysm with GORE EXCLUDER stent-graft with crossed right hypogastric, but first we decided to embolize the inferior mesenteric artery. Angiography was performed through the right femoral approach and the good Riolan arcade was found. After that the inferior mesenteric artery was embolized with two coils, 5 mm in diameter, at the origin of artery in aneurysm thrombus. At the end of procedure, abdominal aortic aneurysm was repaired with GORE stent-graft, and the control angiography was performed. There was no endoleak, and the Riolan arcade was very good. The patient was discharged after 5 days. There were no signs of ischemia of the left colon, and peristaltic was excellent. Control multislice computed angiography was done after 1 and 3 months. There were no signs of endoleak. On the control colonoscopy there were no signs of ischemia of the colon., Conclusion: Endovascular repair of symptomatic abdominal aortic aneurysm in high risk patients with preoperative embolization of large branch is the best choice to prevent rupture of abdominal aortic aneurysm and to prevent type II endoleak.

Introduction: Submandibular salivary gland is a part of the neuro-immune-endocrine system. It contains biological factors which regulate a number of functions in the body including the modulation of thymus function., Objective: The aim of the study was to investigate immunophenotypic characteristics of submandibular salivary glands of rats during ontogenesis, using the panels of monoclonal antibodies and to compare with the phenotypic characteristics of epithelial components of the thymus., Methods: Submandibular salivary glands and thymus were obtained from 1, 30 and 60 days old male AO (Albino, Oxford) rats. Streptavidin-biotin peroxidase method was used for staining., Results: Immunohistochemical analysis of rat submandibular salivary glands showed phenotypic heterogeneity of particular components of this gland during the postnatal development. We demonstrated that rat submandibular salivary glands share common antigens with rat thymic epithelial cells, but the observed phenotypic similarity between the individual regions was considered much more significant. Our data showed that the phenotypic similarity between duct epithelial cells and subcapsular epithelial cells and most medullary cells, whereas cortical epithelial cells are phenotypically similar to acinar cells., Conclusion: This immunohistological study showed phenotypic complexity of the submandibular salivary gland and similarity to the thymus that opens new perspectives in studying phenotypic similarities between this gland and lymphatic organs.

Introduction: Therapy of impacted teeth is undoubtedly one of the most intriguing issues for the experts in the field of dentistry. General dental practitioners, as well as specialists in the field of pediatric dentistry, periodontology, orthodontics and particularly oral and maxillofacial surgery have been facing this challenge throughout past several years. Each of these experts can contribute to solving this problem; however, each of them alone can solve only a limited number of cases., Discussion and Conclusion: Since recently, the fate of impacted tooth has been determined mainly by the competence, experience and skill of the orthodontist to apply light traction in an appropriate direction once the tooth has been made surgically exposed. Oral surgeon and orthodontist should share the responsibility for a patient with impaction as they together have the necessary skill and competence required for an effective therapy. In addition, dental age of the child is to be taken into consideration, as well as his/her overall health status and potential interference with other anomalies of dental arch.

Introduction: West Syndrome (WS) is age-related epileptic encephalopathy characterised by a triad of symptoms: specific seizure type, pathognomonic electroencephalographic (EEG) pattern--hypsarrhythmia and delay and/or regression in psychomotor development (PMD). Aetiologically, it occurs in three forms: symptomatic, cryptogenic and idiopathic., Objective: Estimation of PMD in children with WS according to aetiology., Methods: The observed group consisted of 65 children. Age range was between 6 and 30 months. The patients were divided into three groups according to aetiology. All patients underwent psychological examination with Brunet-Lesine test, as well as PMD evaluation based on achieved developmental milestones for the corresponding age., Results: Statistically significant better values in the Human Developmental Index (HDI) had patients with idiopathic compared to otherforms of WS, at testing after 12 months (93.0 +/- 8.1 vs. 46.8 +/- 6.1 vs. 45.6 +/- 3.8), as well as after 24 months (93.9 +/- 7.7 vs. 51.9 +/- 5.5 vs. 50.9 +/- 4.4). The best values of HDI after 24 months had patients with improvement in PMD with the average of 66.2 +/- 4.4, which was statistically significant compared to those with unchanged PMD (41.5 +/- 5.3) and with further regression in PMD (28.3 +/- 4.4). Significant correlation was obtained between PMD after 12 and 24 months (r = 0.477), as well as a considerable improvement in HDI from the 12th to 24th month (49.4 +/- 4.0 vs. 53.7 +/- 3.9)., Conclusion: The patients with idiopathic WS accomplished the best PMD. Improvement in PMD after 12 and 24 months of treatment was associated with improved HDI. Improvement in PMD was observed in all patients after 2 years of follow-up.

Introduction: The occurrence of infection after the placement of an extraventricular drainage (EVD) catheter can be a very serious problem in neurosurgery., Objective: The aim of this study was to confirm that the use of special catheters with impregnated antibiotics decreased the percentage of infection., Methods: The prospective study conducted at the Clinic of Neurosurgery in Nis in the period 2006-2009 is presented. Group 1 comprised of 43 patients in whom a commonly used system for EVD was applied. Group 2 comprised of 39 patients in whom the Rifampycin and Clindamycin impregnated EVD catheters were applied (Bactiseal catheters)., Results: In Group 1 infection occurred in nine patients, mainly caused by bacteria of Staphylococcus genus. In Group 2 only two patients developed infections caused by Acinetobacter., Conclusion: The use of Bactiseal EVD catheters considerably decreased the percentage of infection occurrence with prolonged EVD catheter drainage period.

Introduction: According to the classification given by Crawford et al. type III thoracoabdominal aortic aneurysm (TAAA) is dilatation of the aorta from the level of the rib 6 to the separation of the aorta below the renal arteries, capturing all the visceral branch of aorta. Visceral hybrid reconstruction of TAAA is a procedure developed in recent years in the world, which involves a combination of conventional, open and endovascular aortic reconstruction surgery at the level of separation of the left subclavian artery to the level of visceral branches of aorta., Case Report: We presented a 75-years-old man, with elective visceral hybrid reconstruc tion of type III TAAA. Computerized scanning (CT) angiography of the patient showed type III TAAA with the maximum transverse diameter of aneurysm of 92 mm. Aneurysm started at the level of the sixth rib, and the end of the aneurysm was 1 cm distal to the level of renal arteries. Aneurysm compressed the esophagus, causing the patient difficulty in swallowing act, especially solid food, and frequent back pain. From the other comorbidity, the patient had been treated for a long time, due to chronic obstructive pulmonary disease and hypertension. In general endotracheal anesthesia with epidural analgesia, the patient underwent visceral hybrid reconstruction of TAAA, which combines classic, open vascular surgery and endovascular procedures. Classic vascular surgery is visceral reconstruction using by-pass procedure from the distal, normal aorta to all visceral branches: celiac trunk, superior mesenteric artery and both renal arteries, with ligature of all arteries very close to the aorta. After that, by synchronous endovascular technique a complete aneurysmal exclusion of thoracoabdominal aneurysm with thoracic stent-graft was performed. The postoperative course was conducted properly and the patient left the Clinic for Vascular Surgery on postoperative day 21. Control CT, performed 3 months after the surgery showed that the patient's vascular status was uneventful with functional visceral by-pass and with good position of a stent-graft without a significant endoleak., Conclusion: Visceral hybrid reconstruction represents a complementary surgical technique to that with open reconstruction of TAAA. This approach is far less traumatic to a patient, and is especially important in patients with lot of comorbidities, because there is no need for thoracotomy, and ischemic-reperfusion injury of the body is reduced to a minimum.

Introduction: It is important to know the risk factors for visual field defect progression in order to predict the future development of glaucoma., Objective: To investigate the influence of visual field initial sensitivity on the rate of visual field progression., Methods: A minimum of five visual fields were performed using computerized perimetry (Octopus) over a mean followup 4-year period (48.85 +/- 17.84 months) in 64 persons (114 eyes) with primary open angle glaucoma. The rate of change of the whole central visual field and each of the seven regions of the field were measured by linear regression analysis of the mean sensitivity value versus time. Based on the slope of the regression line of visual field mean sensitivity over time the eyes were divided into two groups: the group with stable and the group with progressive visual field.The comparison of the mean sensitivity of the whole central visual field between the groups was performed using the Mann-Whitney U-test. The Spearman rang correlation coefficient and the Spearman probability p values were calculated to assess the mean sensitivity of the whole central visual field and of each visual field regions determined at the beginning of the study., Results: The initial mean sensitivity of the whole central visual field was lower in the group with progressive visual field (16.62 +/- 6.35 dB). Correlation between the initial mean sensitivity and the slope of the regression line was negative. The lowest mean sensitivity was in the group with progressive visual field in the upper temporal (13.73 +/- 7.35 dB), nasal (14.74 +/- 7.23 dB) and upper nasal (15.03 +/- 7.75 dB) regions., Conclusion: The lower mean sensitivity value of the visual field, especially in the nasal and upper nasal visual field regions, carries a greater risk for delayed progressive loss of the visual field in persons with glaucoma.

Introduction: Thoracoabdominal aortic aneurysm (TAAA) type IV represents an aortic dilatation from the level of the diaphragmatic hiatus to the iliac arteries branches, including visceral branches of the aorta. In the traditional procedure of TAAA type IV repair, the body is opened using thoractomy and laparotomy in order to provide adequate exposure of the descending thoracic and abdominal aorta for safe aortic reconstruction., Case Report: We reported a 71-year-old man with elective reconstruction of the TAAA type IV performed by transabdominal approach. Computed tomography scans angiography revealed a TAAA type IV with diameter of 62 mm in the region of celiac trunk andsuperior mesenteric artery branching, and the largest diameter of 75 mm in the infrarenal aortic level. The patient comorbidity included a chronic obstructive pulmonary disease and hypertension, therefore he was treated for a prolonged period. In preparation for the planned aortic reconstruction asymptomatic carotid disease (occlusion of the left internal carotid artery and subtotal stenosis of the right internal carotid artery) was diagnosed. Within the same intervention percutaneous transluminal angioplasty with stent placement in right internal carotid artery was made. In general, under endotracheal anesthesia and epidural analgesia, with transabdominal approach performed aortic reconstruction with tubular dakron graft 24 mm were, and reimplantation of visceral aortic branches into the graft performed. Postoperative course was uneventful, and the patient was discharged on the postoperative day 17. Control computed tomography scan angiography performed three months after the operation showed vascular state of the patient to be in order., Conclusion: Complete transabdominal approach to TAAA type IV represents an appropriate substitute for thoracoabdominal approach, without compromising safety of the patient. This approach is less traumatic, especially in patients with impaired pulmonary function, because there is no thoracotomy and any complications that could follow this approach.

Introduction: Any factor causing constriction of the neck may lead to an increase in intraocular pressure. A tight necktie may result in increasing intraocular pressure, which could lead to an erroneous diagnosis and treatment of ocular hypertension or even glaucoma. This study was aimed at evaluating the effect of a tight necktie on intraocular pressure measurement using Goldmann applanation tonometry., Material and Methods: This study included forty eyes of 20 patients with primary open angle glaucoma and 20 healthy controls (all male). Intraocular pressure was measured without a necktie, 3 minutes after placing a tight necktie and 3 minutes after loosening it. Student's t-test was used to analyze the data between two groups. The intraocular pressure measurements were subjected to paired t-test. The va lue p < 0.05 was considered statistically significant. A possible correlation between the age of subjects and intraocular pressure values was analyzed using linear regression (Pearson)., Results: A statistically significant difference was found in intraocular pressure readings in all three measurements between two tested groups (p < 0.05). When analyzed within groups, statistical significance in intraocular pressure readings was found after loosening the necktie (< 0.05). No correlation between the age of subjects and increased intraocular pressure was found in either tested group of subjects after the necktie had been tightened (r2 = 0.006, p = 0.70 for primary open angle patients, r2 = 0.07, p = 0. 22 for healthy controls)., Conclusion: Wearing a tight necktie for a limited period of time during the day could be considered as a possible risk factor for glaucoma development.

Introduction: A stroke is the most common neurological disorder, and the most common cause of severe disability. The aim of this study was to establish the incidence and recurrence of the stroke among the population of the Doljevac district, as well as the differences in the outcome of disease between the patients diagnosed with the first and recurrent stroke., Material and Methods: A prospective examination was carried out, and the study included all patients with the first and recurrent stroke in the territory of the Doljevac district (population, 19529) in the period from 2004 to 2008, after two years of monitoring., Results: During the observed period, the total number of the affected people was 380, of whom 182 (47.89%) were males, and 198 (52.10%) were females. The overall standardized incidence rate of the stroke was 270.20, and with recurrences--42.03. Among the patients with the first stroke, we recorded a higher number of survivals (Chi2 = 3.99; p = 0.04) and patients with recurrences in a one-year period (Chi2 = 5.29; p = 0.02), as well as in a two-year period (Chi2 = 7.72; p = 0.00) since the beginning of the disease. Among the patients with recurrences, we recorded a higher demand for medical help in home healthcare environment (Chi2 = 4.97; p = 0.02), and the higher one-month (Chi2 = 12.09; p = 0.00), and one-year lethality (Chi2 = 9.03; p = 0.00). Among the patients with recurrences, there were no differences in the diagnosis of the first and recurrent stroke (p > 0.05)., Conclusion: This study showed that there were no statistical differences in the incidence between the first and recurrent stroke between the sexes (p > 0.05). Among the patients with the first stroke, we recorded a higher tendency for survival, and frequent cases of recurrence, and among those with recurrences, the rate of mortality was higher.

Introduction: Reactivation of chronic hepatitis B virus (HBV) infection often occurs in hepatitis B surface antigen (HBsAg) positive patients undergoing immunosuppressive or chemotherapy, but can also occur in HBsAg negative, anti-HB core positive patients. Treatment of HBV reactivation with lamivudin results in favourable outcome in the majority of patients. The aim of the authors was to show the effect of lamivudin therapy to HBV reactivation caused by immunosuppressive therapy., Outline of Cases: The first patient was a 35-year-old woman with chronic hepatitis B virus infection who underwent prednisolone therapy for pulmonal sarcoidosis. Four months after the beginning of the therapy she presented with jaundice and a significant increase in serum aminotransferase level. Liver biopsy showed chronic viral B hepatitis of strong activity in the stage of rapidly developed cirrhosis. The patient was treated with lamivudine with slow reduction of prednisolone doses, which resulted in full clinical and biochemical recovery. The second patient was a 40-year-old HBsAg negative female with a previous history of resolved acute B hepatitis who received chemotherapy for non-Hodgkin lymphoma. After the third cycle of chemotherapy a significant increase in aminotransferase level occurred, chemotherapy was discontinued, but aminotransferase level still increased. At that moment she was found to be HBsAg positive, and PCR analysis detected a high viral load. Lamivudine treatment resulted in the patient's recovery and allowed further chemotherapy., Conclusion: In case of the reactivation of chronic HBV infection during immunosuppressive therapy, it should be stopped and antiviral therapy should be immediately initiated. The use of lamivudine results in rapid suppression of serum HBV DNA, improves the outcome and enables the continuation of immunosuppressive and chemotherapy.

Introduction: The aim of the paper is to examine the incidence and the rate of cardio respiratory disorders in mothers of newborns with diabetes mellitus in pregnancy as well as their influence on the perinatal outcome., Material and Methods: A prospective and random study included 102 newborns, 31 newborns of mothers with glucose homeostasis disorder (group I) and 71 newborns of healthy mothers (group II). The average age, body height, body weight, body mass index, parity and illness duration of the pregnant women were recorded as well as the delivery method Every newborn underwent physical examination in order to determine the Apgar score, body weight and length. Electrocardiogram, brain ultrasound and the basic hematology biochemical and microbiological analysis were done as well., Results: The average weight and obesity incidence were higher in diabetic women than in the control group and their newborns were heavier and of lower gestational age. Heart failures were diagnosed in 5 (1612%) newborns of diabetic mothers and in 1 (1.4%) of a healthy pregnant woman (p<0.01). Respiratory disorders were diagnosed in 48.4% of newborns of diabetic mothers and 12.64% of healthy mothers (p<0.01). Additional oxygen was needed by 42% of newborns of diabetic mothers and 19.7% of newborns of healthy mothers., Conclusion: Congenital anomalies of cardiovascular system and respiratory disorders were 6-8 times more frequent in newborns of diabetic mothers than in newborns of healthy mothers.

Background/aim: Abdominal aorta aneurysm (AAA) represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR) of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR) AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA be tween endovascular and open, conventional surgical technique., Methods: A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54%) of the patients, 58-87 years old (mean 74.3 years), who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46%) of the patients, 49-82 (mean 66.8) years, operated on using OR technique. All of the treated patients in both groups had AAA larger than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine--interleukine (IL)-2, IL-4, IL-6 and IL-10). Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy., Results: The study showed a statistically significantly shorter time of treatment in the EVAR group (average 90 min) compared to the OR group (average 136 min). Also, there was a statistically significantly less blood loss in the patients operated on by the use of EVAR surgery (average 60 mL) as compared to the patients treated with OR techinique (average 495 mL), as well as a shorter postoperative hospitalization of patients in the EVAR group (average 4 days) compared to the OR group (average 8 days). The OR group was detected with a statistically significant increase of leucocytes and statistically significant fall of the number of thrombocytes in comparison with the EVAR group in all the investigated terms. A significant concentration rise of IL-2 in the OR group and concentration rise of IL-6 in the EVAR group was shown 24 hours after the procedure, whereas on the second postoperative day there was detected a significant fall of IL-6 in the EVAR group. IL-4 concentration in the OR group was significantly higher as of the third postoperative day in comparison to the EVAR group. There was no significant difference in IL-10 concentration between the groups., Conclusion: The EVAR techinique is a safer and less invasive and less traumatic procedure for patients than the OR of AAA. Following the EVAR, there are less inflammatory reactions in the early postoperative period as compared to the OR and therefore less possibility of the development of systemic inflammatory respons syndrome in patients treated.

Background/aim: Using vacuum in medicine has been known from long ago, however, it has not been used for the treatment of wounds. The first experiments in this field were performed by Wagner Fleischmann, University of Ulm, Ulm, West Germany, in 1993. The aim of this study was to present our clinical experience with the treatment of surgical wounds complications in vascular patients by the use of controled vacuum., Method: In a period October 2006 - December 2009 a total of 18 patients with infection and surgical wound dehiscence were treated by the use of vacuum. Vacuum was applied to wounds by placing a polyurethane sponge on them and by fixing a polyurethane foil and a sponge to the surrounding healthy skin so to completely airtight wounds. Over a foil vacuum of--150 mmHg was applied for a 5-day period, and on the day 6 a foil and a sponge were removed., Results: In all the 18 wounds treated by the use of vacuum secondary wound closing was achieved with no complications and with a significantly shortened time period treatment. Wound infections were healed using this method and only in 2 patients antibiotics were used at the same time., Conclusion: The use of vacuum in the treatment of operative wounds complications is an easy and reliable method contributing significantly to wounds better healing.

Introduction: In the recent years, herbal preparations have been more used to treat diabetes. Dietetic supplement based on barley and beer yeast enriched with chromium (BBCr) is registered in Serbia as a supplement in the treatment of type 2 diabetes., Objective: To investigate the effect of the preparation based on barley and brewer's yeast with chromium (BBCr), rosiglitazone (R) and their combination (BBCr+R) on fasting glycaemia and glycaemia in mice after glucose, adrenalin and alloxan application., Methods: The animals were divided into three groups: glucose 500 mg/kg (I); adrenalin 0.2 mg/kg (II); and alloxan 100 mg/kg (III) and into subgroups according to the substance they received (BBCr: 750 mg/kg, R: 0.75 mg/kg and BBCr+R). Each animal was its own control in respect of glycaemia before and after the treatment with test substances, except for group III which contained a placebo subgroup., Results: BBCr caused a significant decrease of fasting glycaemia and significant reduction of glycaemia after glucose load compared to the values before treatment (7.4 +/- 0.6 mmol/l vs 9.2 +/- 0.6 mmol/l; p=0.01). R and BBCr+R significantly decreased glycaemia after adrenalin load (R: 8.6 +/- 1.8 mmol/l vs 15.4 +/- 3.2 mmol/l; p=0.004; BBCr+R: 9.6 +/- 2.4 mmol/l vs 15.0 +/- 4.4 mmol/l; p=0.04). After alloxan application the glycaemia was significantly lower in the subgroups treated with BBCr, R and BBCr+R compared to placebo subgroup (10.1 +/- 8.0 mmol/l vs 6.8 +/- 2.7 mmol/l vs 13.5 +/- 9.7 mmol/l vs 24.5 +/- 4.7 mmol/l; p=0.001)., Conclusion: Pretreatment with BBCr caused a significant reduction of fasting glycaemia and glycaemia after glucose load. Rosiglitazone and BBCr+R caused a significant reduction of glycaemia after adrenalin load. Pretreatment with BBCr, R and BBCr+R prevented the onset of experimental diabetes caused by alloxan, which was confirmed by histological analysis of pancreas tissue.

Introduction: Acute myocardial infarction has negative influence on patient's quality of life. The objective of the paper was to assess the health-related quality of life in the patients one month and twelve months after acute myocardial infarction and to compare it with the healthy controls., Material and Methods: A prospective cohort study involved 160 patients aged from 30 to 79 and 240 healthy controls. The health-related quality of life was assessed with the Serbian version of these questionnaires: EuroQuol-5-Dimension and EuroQuolVAS. Angina pectoris was ranked according to the classification of Canadian Cardiovascular Society. Multivariate logistic regression analysis was used., Results: The healthy controls had significantly higher average scores in EuroQuolVAS compared with the patients one month after acute myocardial infarction (74.35 +/- 9.42 vs 60.50 +/- 12.03, p<0.001), as well as twelve months afte acute myocardial infarction (74.35 +/- 9.42 vs 69.83 +/- 12.06, p<0.001). Significantly lower average ranges in EuroQuol-5-Dimension questionnaire and higher quality of life were found twelve months after acute myocardial infarction than one month after acute myocardial infarction (1.41 +/- 0.26 vs 1.53 +/- 0.26, p<0.001). The average ranges of angina pectoris were significantly lower in all the patients twelve months after acute myocardial infarction compared with the first month (0.78 +/- 0.51 vs 0.91 +/- 0.44, p<0.01). The multivariate regression analysis confirmed thrombolytic therapy, percutaneous transluminal angioplasty and age to be important factors influencing health-related quality of life., Conclusion: The patients assessed their health condition to be significantly higher twelve months after acute myocardial infarction than one month after it. The health-related quality of life was significantly higher in patients who had undergone the percutaneous intervention than in those who had been treated with the thrombolytic therapy.

Introduction: Uretero-intestinal anastomisis has a large influence on derivation quality., Objective: The aim of the study was to present the modified serous lined extramural Abol-Enein method of implantation of low quality ureter into the sigma-rectum pouch and comparison of the results with Le Duc implantation., Methods: From 1995 to 2009, 62 dilated ureter units were implanted in the detubularized rectosigmoid urinary reservoir. In 28 units Le Duc, and in 34 Abol-Enein method was done. Urinary fistula and ileus were considered as early complications, while late complications included stenosis and reflux pyelonephritis. Frequency of urination was considered as a parameter of functionality., Results: Transitory urine fistulae occurred only in the ureters implanted according to Le Duc technique in 4/28 (14.2%); the difference between the examined groups was close but still below the level of statistical significance (p = 0.07). Iieus occurred with nearly equal frequency in both groups. Stenosis on the ureteral implantation place was significantly more frequent (p = 0.04) in the Le Duc group 5/28 (21.7%) than in the Abol-Enein group 0/34 (0%). Refluxive pyelonephritis occurred in 3/34 (8.8%) of the Abol-Enein group, and in 5/28 (21.7%) of patients in the Le Duc group. Concerning the daily frequency, there was no difference between the examined groups., Conclusion: Uretero-intestinal anastomisis of dilated ureters through a serous-lined extramural tunnel decreases the risk of reflux in a considerable number of patients, with an acceptable level of complications. There are several advantages in comparison with Le Duc method.

Background/aim: Chronic venous ulcer (CVU), a disease of high incidence, is one of the most serious chronic venous insufficiency complications. It has been estimated that there are 1%-2% of adults with CVU deriving a high social significance. The aim of this study was to, using the clinical experience, determine the influence of subcutaneous paratibial fasciotomy (SPF) on the course and the treatment outcome of CVU., Methods: From February 2006 to September 2009 SPF was applied in a group of 43 patients treated for CVU along with other standard methods of treatment, and its influence on the course of ulcus cruris was followed up regarding the control group of another 43 patients treated with standard methods with no paratibial fasciotomy., Results: In the group of patients treated with SPF there was a significantly better clinical course of ulcus cruris closing as compared with the group of patients in which this method was not applied. In the group with paratibial fasaciotomy there was no Thiersch skin transplant rejection recorded nor ulcus recurrence within a 6-month after-surgery period, while in the control group there was Thiersch skeen transplant rejection in 11 patients, and ulcus recurrence in 9 patients within the same period., Conclusion: SPF is a useful method with a favorable influence on better clinical course of ulcus cruris closing, reducing recurrence rate and improving local microcirculation in the affected region. Operation act itself is safe, requires no specific equipment nor special training of the team of surgeons, thus being applicable to the majority of patients with ulcus cruris indicated for surgery.

Introduction: Shooting injuries of shoulder with destruction of proximal humerus are rare and severe orthopaedic injuries., Case Outline: A 74-year-old patient was wounded at close range by a shotgun. He was wounded in the left shoulder and suffered a massive defect of the proximal humerus and soft tissue. The neurocirculatory finding of the injury extremity was normal. After a short resuscitation, x-ray of the thorax and the left shoulder registered a complete destruction of humeral head. After the primary treatment of the wound under general endotracheal anesthesia, the shoulder was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins, where two pins were placed in the neck of scapula and two in the humeral shaft, because the left scapular acromion was fractured by shotgun projectiles., Conclusion: After radical wound debridement, external fixation is the method of choice for shoulder stabilisation in shooting injury of shoulder with bone defect. If this is not possible, pins of the left external skeletal fixator should be placed into the coracoid process and acromion. The pins can be also placed into the humeral shaft, as done in the presented case, and by which a good stability of the injured proximal humerus, easy approach to the wound for bandaging and reconstructive surgery can be achieved.

Introduction: Nutritional abnormalities have one of the most important systematic effects on chronic obstructive pulmonary disease (COPD). A relationship between COPD and obesity has been observed and recognised. In COPD patients, beside changes in the total body weight, changes in body composition are also possible with the loss of fat-free mass (FFM)., Objective: This study was undertaken to evaluate the impact of obesity and the change of body composition on the pulmonary function, dyspnoea level and the quality of life in COPD patients., Methods: Seventy-nine patients in the stable state of COPD were evaluated. Pulmonary function and arterial blood gas analysis were assessed. Nutritional status was analyzed according to Body Mass Index (BMI). Body composition was evaluated by using anthropometric measurement by fat free mass index (FFMI). Quality of life was assessed using the St. George Respiratory Questionnaire (SGRQ). The Visual Analogue Scale (VAS) was used to evaluate dyspnoea., Results: The highest prevalence of obesity (50.0%) was found in patients with mild COPD, while the lowest prevalence was detected in very severe COPD patients (10.0%). The loss of FFM occurred in 22.2% patients with normal body weight and in 9.0% of overweight COPD patients.The quality of life was lower in obese patients compared to other COPD patients. A higher dyspnoea level was also present in obese patients. The lowest airflow obstruction was in obese patients (p = 0.023). We found a significant positive correlation between forced expiratory volume in the first second (FEV1%) and BMI (r = 0.326, p = 0.003), FEV1% and FFMI (r = 0.321, p = 0.004)., Conclusion: The highest prevalence of obesity was in patients with mild COPD. Obese patients with COPD had the lowest level of airflow obstruction, higher dyspnoea level and lower quality of life in comparison to other COPD patients.

Introduction: Cerebrovascular diseases have drawn great public attention recently due to a high death rate and an even higher disability rate. The aim of the research was to determine the basic descriptive-epidemic characteristics of patients with cerebrovascular diseases, to assess the incidence rate according to the gender and age, as well as mortality and the disease prognosis after one-year follow up period., Material and Methods: A prospective survey was conducted, and the study included all registered patients with cerebrovascular diseases from the municipality of Doljevac in the period from 2005-2007, who were monitored for 1 year since the onset of the disease., Results: During the period monitored, there were a total of 230 patients suffering from this disease. The average standardised incidence rate in both genders was 274.67. Ischemic brain stroke occurred in 146 (63.4%) subjects, the intracerebral haemorrhage in 39 (17%) and the subarachnoid haemorrhage occurred in 9 (3.9%). The 90-day lethality was 14.8%; 1-year lethality was 21.7%. Out of 123 patients (53.4%), who were recorded to have various degree of disability, 44 (35.8%) were independent in everyday activities, 41 (33.3%) needed assistance while walking and maintaining personal hygiene, whereas 38 (30.9) were bedridden. After a year of monitoring, 30 (13.1%) patients suffered a recurrent brain stroke., Conclusion: Cerebrovascular disease morbidity rate was found to be increasing. However, there were no statistically significant differences in morbidity by diagnosis and the disease outcome between genders.

Background/aim: Hormone suppression therapy is used in men with advanced prostate cancer improving chances of longer survival. The aim of this study was to investigate the influence of androgen blockades on testosterone and luteinizing hormone (LH) values in patients with locally advanced and metastatic prostatic cancer., Methods: The study included a total of 60 patients out of which 45 with prostatic cancer divided into 3 subgroups based on the type of the applied treatment protocol: 15 patients on monotherapy with luteinizing-releasing hormone (LH-RH) agonists (group I), 15 patients on total androgen blockade (group II) and 15 patients on monotherapy with antiandrogen (group III)). The control group consisted of 15 patients with benign prostatic hyperplasia. In all the patients, values of testosteron, LH and prostate-specific antigen (PSA) were monitored initially, as well as 3 and 6 months after the treatment protocol introduction., Results: In the patients of the groups I, II and III, values of testosterone decreased after three months by 95.58%, 95.72%, and 67%, respectively. The difference was significant (p < 0.01). Between the values after three and six months there was no significant difference in these groups of participants. Testosterone values were significantly higher in the patients of the group III in both analyses. Comparing the values between the groups III and I, as well as those of the groups III and II, a significant difference was found after three and six months of the therapy (p < 0.01). There was a difference in testosterone values between the groups I and II after 3 and 6 months, but not significant. All types of the applied treatment protocols in the therapy of prostatic cancer significantly decreased the values of LH compared to the basal ones., Conclusion: Total androgen blockade and LH-RH agonists are more effective in lowering testosterone values (to castration values) compared to the antiandrogen monotherapy, where testosterone values stay above the castration level. This therapy approach has advantages, since it decreases testosterone values providing better therapy response. There is a difference in testosterone values, but not significant, when total androgen blockade and monotherapy with LH-RH agonists are administered. Registered lower basal values of LH in all patients with prostatic cancer open the possibility to introduce LH as a new additional, significant marker in diagnosis of this neoplasm.

Introduction: We present a patient with perforative eye injury, a metal foreign body in the lens and traumatic cataract. The paper emphasises the importance of phacoemulsification in case of patients with a traumatic cataract and the presence of a metal foreign body., Case Outline: A 41-year-old patient had a perforative wound of the cornea caused by a metal foreign body that also perforated the anterior lens capsule and remained in the paracentral anterior part of the lens. The injury, which happened upon hitting of a hammer against a metal object, showed the presence of a tangential wound of the cornea adapted edges, and a formed anterior eye chamber. The presence of a metal spear-shaped foreign body was partly inside the anterior eye chamber and partly in the central area of the lens. The visual acuity of the injured eye was 0.2. The technique of removing the foreign body out of the lens and the phacoemulsification of the lens with the implantation of intraocular lens is presented. The paracentral wound on the cornea was not sutured because of well-adapted edges. On the first postoperative day there were no inflammatory signs, and best uncorrected visual acuity of 0.8., Conclusion: Posttraumatic cataracts with a metal foreign body in the lens require operative treatment in order to remove the foreign body, phacoemulsification and implantation of artificial lens. Because of anterior capsule lesion, special care should be taken in regard to anterior capsulorhexis and appropriate hydrodisection. Ocular hypotonia and possible damage of the posterior capsule in some cases can make phacoemulsification more difficult to perform.

Introduction: In many developing countries and in countries in transition, an increased incidence of cerebrovascular disease has been observed. The aim of this study was to determine the influence of acute and chronic stress on the development of acute brain stroke and its relapse., Material and Methods: The study included all recorded cases of cerebrovascular disease in the municipality of Doljevac in the period 2005-2007 (the stroke victims), and 230 healthy controls. By using the method of interview, the frequency of chronic stress situations was examined, as well as the occurrence of acute stress situations 24 hours prior to the acute brain stroke and its relapse., Results: In the group which consisted of stroke victims, a large number of subjects was found to have had an acute stress 24 hours prior to the onset of the disease, and the type of stress which proved to be statistically significant was the one which had been provoked by problems between family members (Chi2 = 4,03: p = 0,04). All of the chronic stressors were more frequent in the group consisting of stroke victims than in the control group and among the statistically significant stressors were stressful situations in the family and at work. In recidivists, a greater presence of acute and chronic stressors was observed, but the statistical significance was not proved when this disease occurred again., Conclusion: The presence of acute stressors was found to have been more frequent in the group of stroke victims 24 hours prior to the onset of the disease. The effect of acute and chronic stressors upon the brain stroke recidivism has not been statistically proved yet.

Introduction: Multifocal choroidopathy syndromes are a group of rare disorders, which involve a primary pathologic process occurring at or near the level of the retinal pigment epithelium, with or without choriocapillaris involvement. The aetiology of multifocal choroidopathy syndrome is still unknown., A Case Report: We present a case of multifocal choroidopathy syndrome. A 54-year-old woman was referred to our department with blurred vision on both eyes, mild ocular pain, accompanied by metamorphopsia, floaters, scotomas and photopsia. The anterior segment examination showed small to medium size keratic precipitates, posterior synechiae, and iris atrophy. Mild to moderate aqueous inflammation with cells and flair was present in the anterior chamber. The fundus examination showed multiple small yellow--white spots, round-shaped changes located at the level of the retinal pigment epithelium and choriocapillaris. According to the fluorescein angiography the active lesions exhibited blockage of the early choroidal fluorescence followed by late staining The old inactive lesions corresponded to the retinal pigment epithelium windows defects. The laboratory examination showed high level of blood glucose, C reactive protein, cholesterol HDL, LDL, triglycerides. According to the immunological examination the C3 component of complement was lower (0.630), as well as the C4 component of complement (0.158), and the immunological complex in blood was elevated (171). ELIZA test on viral infection showed Citomegalo viruses IgG positive, Herpes Simpler Virus lgG positive, Varichela Zoster Virus lgG positive. The results of human leucocyte antigen typization were humuan leucocyte antigen A1:A2, human leucocyte antigen A2:A24(9), human leucocyte antigen B1:B44(12), human leucocyte antigen B2:B60(40), human leucocte antigen C1:Cw3, human leucocyte antigen C2:Cw5. The radiological examination of lungs, the Mantoux test, Treponemnal serology, Toxocara and Toxoplasma serology, magnetic resonance of endocranium and orbit were also performed. The multiple viral infection, which was detected in our patient with immunological abnormalities pointed to an underlying autoimmune mechanisnm, possibly triggered by an infectious agent, a virus.

Background/aim: Tumescent local anesthesia (TLA) is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventional treatment for varicose vein., Methods: Seventy-two patients with varicose vein were enrolled in the study. All of them were operated on applying TLA, from April 2008 to November 2009. TLA solution consisted of local anesthetics was used. TLA solutions used were: 1% prilocaine-chloride with adrenaline supplement, and 2% lidocaine-chloride and adrenaline in concentration of 0.1%-0.4%., Results: Out of 72 patients, we stripped great saphenous vein from 60 patient and did varicectomy as well as ligation of insufficiently perforating veins. In 12 patients we did partial varicectomy and ligation of perforating veins. There were not any patients with the need for continued surgery, as well as bringing patient to the general anesthesia due to pain during the surgery. One patient came for postoperative opening wound in the groin, one for infection of the wound and one for the formation of seroma in the groin. There were not any allergic reactions or systemic complications in the operations as well as postoperative period. Postoperatively, all the patients were treated with compressive elastic bandage during the period of 6 weeks as well as anticoagulation prophylaxis in the duration of 5 days., Conclusion: Surgery of varicose veins with implementation of TLA is easy and safe method with very low percentage of complications and unwanted effects. It is a good alternative method to classic surgery of varicose veins. The economic aspect is a very important component because the cost of this method is significantly lower than that of a classical surgical treatment of varicose veins.