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Background/Aim. There are numerous studies on the usefulness of computed tomography (CT) in the assessment of the bone volume and morphology and on the relationship between CT and primary implant stability. But there is the scarcity of data about the correlation between bone density and the value of primary implant stability. The aim of this study was to examine the correlation of cone beam CT (CBCT) analysis derived bone density with primary stability value. Methods. Clinical prospective experimental study was conducted on 38 healthy patients missing one tooth in the lateral region. It was planned to install Bredent Blue Sky Narrow self-taping dental implants with dimensions 3.5 × 10 mm. During preoperative preparation, a CBCT scan was performed on Planmeca apparatus, followed by preimplantation measurements and planning in the CBCT apparatus software (Romexis). The mean value of the average bone density was automatically generated and expressed in Hounsfield units (HU). Upon implant placement, we performed measurements of the primary implant stability using Osstell apparatus. Results. Of the 38 patients included in the study, there were 68.4% male patients and 31.6% female patients. The arithmetic mean of the measured bone density of all subjects in the study amounted to 536.2 HU. The arithmetic mean of dental implant primary stability for all subjects in the study was 68.7 ISQ. There was a statistically significant strong positive connection between HU and ISQ (r = 0.744, p < 0.001). Higher HU values were connected to higher ISQ values. In the multivariate linear regression model, statistically significant predictors of higher ISQ values: males (B = 4.669; p = 0.047) and higher HU values (B = 0.032; p < 0.001). Conclusion. In our clinical study, there was a statistically significant strong positive correlation between the bone density expressed in HU units, measured in the software of the CBCT device and the primary stability of dental implants expressed in ISQ units.

Introduction. Infection of synthetic graft in the groin is a rare but devastating complication. When it occurs, several possibilities of treatment are available. Extra-anatomic reconstruction and in-situ implantation of new, infection resistant grafts are associated with high mortality and morbidity. Therefore, more conservative approach is needed in some cases. Negative-pressure wound therapy is one of the options in treating such patients. Objective. The aim of this study was to assess the outcome for deep groin vascular graft infection treated with negative-pressure wound therapy. Methods. Seventeen patients (19 wounds), treated for Szilagyi grade III groin infections between October 2011 and June 2014, were enrolled into this observational study. Results. Majority of the wounds (11/19) were healed by secondary intention, and the rest of the wounds (8/19) were healed by primary intention after initial negative-pressure wound therapy and graft substitution with silver-coated prostheses or autologous artery/vein implantation. No early mortality was observed. Minor bleeding was observed in one patient. Reinfection was noted in three wounds. Only one graft occlusion was noted. Late mortality was observed in three patients. Conclusion. Negative-pressure wound therapy seems to be safe for groin vascular graft infections and comfortable for both patient and surgeon. However, the rate of persistent infection is high. This technique, in our opinion, can be used as a “bridge” from initial wound debridement to definitive wound management, when good local conditions are achieved for graft substitution, either with new synthetic graft with antimicrobial properties or autologous artery/vein. In selected cases of deep groin infections it can be used as the only therapeutic approach in wound treatment.

Introduction. An extracranial carotid artery aneurysm is a rare clinical entity with potentially debilitating consequences. Our aim is to present a case of a large internal carotid artery aneurysm combined with medial internal carotid artery (ICA) kinking successfully treated by resection with an end-to-end anastomosis. Case outline. A 34-year-old female patient was admitted to our hospital due to dizziness and frequent non-specific headaches. On admission, routine echocardiography showed an aneurysm of the atrial septum. Multislice computed tomography of the supraaortic branches showed medial kinking of the right ICA with a 15 mm aneurysm localized on the vertex of the angulation. Kinking was present on the left ICA as well, with a small aneurysm of 5 mm in diameter. The right ICA aneurysm was resected and the artery was reconstructed with an end-to-end anastomosis. The postoperative course was uneventful and the patient was symptom-free after a one-year follow-up. Conclusion. We showed that surgery of an aneurysm and kinking of the carotid artery in the medial segment of the ICA is possible and safe to perform. Detailed preoperative preparation, precise surgical technique, and short clamping time all contributed to a good final outcome.

Introduction. Acute lower limb ischemia results from thrombosis or embolization of diseased native artery or previously implanted bypass graft. When this occurs, several options are available to restore blood flow: catheter-directed thrombolysis, mechanical thrombectomy or open surgery. Fundamental reasons to apply percutaneous interventions are avoiding open procedures in high risk patients, and avoiding difficult dissection through scar tissue. Case Outline. A 67-year-old male was admitted at our Institution for critical limb ischemia. After performed angiography the diagnosis of occluded femoropopliteal graft was established. Occlusion was resolved by catheter-directed thrombolysis with plasmin. Culprit lesions were treated by angioplasty. Conclusion. Our patient underwent a successful thrombolysis of occluded femoropopliteal graft with locally-delivered human plasmin.

Introduction. Severe extremity ischemia and the presence of the “blue-toe” syndrome are rarely the first complications of the present abdominal aortic aneurysm. We report two interesting cases of this rare entity. Outline of Cases. A 61-year-old man presented with the rest pain of his toes accompanied with digital ischemia of both feet. Physical examination confirmed regular arterial pulses at lower extremities accompanied with palpable pulsate mass in the abdomen. Vascular ultrasound and multidetector tomography (MDCT) of blood vessels revealed small abdominal aortic aneurysm (37 mm in diameter), filled with the irregular, ulcerated, heterogeneous thrombotic masses. Aneurysm sac resection was performed with an aorto-bi-iliac bypass reconstruction. A week later, it was mandatory to amputate the fifth toe on the left foot because of the advanced gangrenous process. The second case was a 77-year-old woman with 7-day history of severe feet pain. Abdominal examination revealed pulsatile mass paraumbilical to the left. Performed abdominal ultrasonography and MDCT angiography confirmed coexistence of the infrarenal aortic aneurysm, 40.5 mm in diameter, covered by significant mobile mural thrombus and ulcerations. Surgical reconstruction was mandatory and patient underwent aneurysm sac resection and aortobifemoral reconstruction. Conclusion. Embolic phenomenon and peripheral embolic occlusion from the mural thrombus within the abdominal aortic aneurysm are relatively rare events, but associated with tissue loss. Thorough diagnostic examinations and prompt management are required regardless of the aneurysm size once these signs occurred.

Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). Results. In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT) arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

Introduction. Carotid endarterectomy is a safe and reliable surgical procedure to treat the narrowing of the internal carotid artery greater than 70%. One of the most serious complications of surgical wound after endarterectomy is an infection caused by methicillin-resistant Staphylococcus aureus (MRSA) which is accompanied with high morbidity and mortality. Case Outline. A 62-year-old woman developed a graft infection caused by MRSA after a carotid endarterectomy with synthetic graft placement. Two years after unsuccessful antibiotic and local wound treatment, we replaced the infected graft by an autologous saphenous vein conduit. Conclusion. The case suggests that only by aggressive surgical approach with replacement of infected graft a successful outcome can be achieved in such a rare but potentially fatal post-operative complication.

Introduction. Multislice CT angiography (CTA) is a noninvasive and quick technique to image carotid artery stenosis, as well as intracerebral vasculature. Modern multidetector CTA produces images with a high resolution of, not only the contrast-filled lumen, but also of the vessel wall and the surrounding soft tissues. Multiple studies have verified the ability of CTA to provide an accurate representation of the degree of carotid stenosis in comparison to digital subtraction angiography, both for moderate and high-grade stenosis. Because of its fast and accurate vessel imaging, CT angiography is increasingly used in the assessment of carotid artery stenosis. Case Outline. A 37-year-old female patient was admitted at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, for angiography and endovascular procedure of a high-grade stenosis of the left common carotid artery based on Multislice CT findings brought by the patient. She complained of problems which we considered to be the result of cerebral circulation ischemia. After detailed diagnostic procedures, we concluded that no pathological lesions could be verified either on the left common carotid artery or other supraaortic branches. Therefore, the patient was discharged for further neurological examinations. Conclusion. Although Multislice CTA has many advantages over classical angiography, its validity should be taken with reserve, especially in younger patients.

Introduction. Congenital coarctation of the thoracic aorta at the ligamentum arteriosum or the aortic arch is well recognized. But a much less common variety (0.5-2.0%) of aortic coarctation is located in the distal thoracic aorta or abdominal aorta or both and is often called 'middle aortic syndrome' or 'midaortic dysplastic syndrome'. This represents serious pathological condition and indicates multidisciplinary therapy approach. Outline of Cases. From 1996 to 2007, at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, three patients were treated due to abdominal aorta coarctation, two females aged 55 and 50 and a 4-year-old child. The patients were treated surgically (by-pass with a prosthetic graft and patch angioplasty) and endovascular-percutaneous transluminal angioplasty (PTA) with and without a stent. The follow-up period was 3-70 months. In the 50-year-old patient, angiography showed severe narrowing of the suprarenal segment of the abdominal aorta. Thoraco-abdominal bypass with a 16 mm dacronic tubular graft was performed. In the 4-year-old patient angiography also showed a suprarenal aorta narrowing. In the first act patch angioplasty was performed and after PTA of the visceral arteries was done on several occasions. In the 55-year-old patient, after diagnostic angiography, infrarenal aorta coarctation was registered. PTA was performed with stent placement. All patients were asymptomatic on control check-ups. Conclusion. Abdominal coarctation is a pathological disease which is seldom found in vascular surgery. Angiography is of major importance for setting the diagnosis and for the control of the results of surgical and nonsurgical treatment. The combination of surgical and endovascular treatment in our patients showed very good results in the studied period.

Introduction. Measurement of vessel stenosis using ultrasonography or magnetic resonance is still the principal method for determining the severity of carotid atherosclerosis and need for endarterectomy. Case Outline. A 56-year-old male was admitted to the Cardiovascular Institute 'Dedinje' due to a clinically asymptomatic restenosis of the operated left internal carotid artery (ICA). Angiography and magnetic resonance angiography (MRA) in previous hospitalization had revealed occluded right ICA. However, routine duplex ultrasonography revealed a highgrade restenosis (85%) of the left ICA and subocclusion of the right ICA by an ulcerated plaque (confirmed on repeated MRA). Conclusion. Selective arteriography examination could misrepresent the degree of stenosis especially in patents with the ICA that seems to be occluded. MRA is considered the method of choice for identifying pseudo-occlusions of ICA.

INTRODUCTION Inflammatory abdominal aortic aneurysm accounts for 5% to 10% of all cases of abdominal aortic aneurysm and differs from typical atherosclerotic abdominal aortic aneurysm in many important ways. Although both inflammatory and atherosclerotic abdominal aortic aneurysms most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic abdominal aortic aneurysm, most with the inflammatory variant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm can be primarily infected by degenaration of an infected artery (in less than 1% of cases), or can become secondary infected in the already existing aneurysm. Secondary infection of the pre-existing aneurysm has big influence on treatment choice, but is also rare. Clinically non-symptomatic infection, also known as bacterial collonisation, can be very frequent, regarding a greatly increased number of positive intraoperative findings (10-15%). Prolonged intravascular catheterization, vascular grafting, repeated punctures with large bore needles, and decreased immune defense mechanism make uraemic patients undergoing hemodialysis more likely to develop Staphylococcus aureus bacteraemia and its complications. CASE OUTLINE The case shows a gigantic inflammatory aneurysm of the abdominal aorta, localized infrarenally, which was solved successfully by resection of the aneurysm of the abdominal aorta, and interposition of Dacron tubular graft 22 mm. Bacterial examination of the aneurysmal sac was positive: methicillin-resistent Staphylococcus aureus was detected. CONCLUSION There were no postoperative complications, and the final outcome was fully satisfactory. Control CT scans after 3, 6 and 12 months were regular, with signs of regression fibrosis of the retroperitoneum.

INTRODUCTION Although the incidence is low, infection of prosthetic vascular graft bears a high incidence of serious complications including 25-75% mortality rate and 40-75% limb loss. The standard treatment of vascular graft infection consists of excision of the prosthesis, wound debridement and extraanatomic revascularization. Conservative treatment might be an option in a limited number of patients. We present three cases of surgical and conservative treatment of vascular graft infection. CASE OUTLINE Case 1: A patient developed silver-coated graft infection after femorodistal arterial reconstruction performed because of critical limb ischemia. In the early postoperative period, massive skin and subcutaneous tissue necrosis developed, with the graft being exposed. After two months of persistent debridement and wound toilette, the defect was covered with a Thiersch skin graft. Case 2: PTFE graft infection in the right groin followed reconstruction of the isolated common femoral artery aneurysm. This graft was replaced with a silver-coated graft in situ. Reinfection of the proximal end of the implanted silver-coated graft occurred and the graft was exposed. After repeated debridement and wound toilette, the exposed prosthesis was covered with granulomatous tissue, and the wound healed. Case 3: A year after anastomotic pseudoaneurysm resection in the left groin, prosthesis was exposed following wound infection. This graft was substituted with a silver-coated graft in situ. The wound healed primarily. CONCLUSION These three cases demonstrate that under some circumstances vascular prosthesis infection can be successfully treated conservatively without graft removal, and also by in situ replacement using silver-coated graft.

Since antiquity, there has been a mystery about the cerebral circulation function. Scientific methods were introduced in research at the end of the nineteenth century. During the first half of the last century, the problem of occlusive carotid disease was defined and the basis for the surgical treatment of carotid disease was established. The first contemporary reconstructive surgical procedures were performed in the middle of the last century, the time when successful surgical treatment of carotid disease began. Today, carotid endarterectomy is one the most frequently performed vascular surgical procedures of all, followed by very low morbidity and mortality rates.

Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. Results Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. Conclusion The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation.

Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren) with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren) with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years) who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years) that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%), while in the second group there were 13 patients with splenomegaly (68%). Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p

Introduction: The goal of modern carotid surgery is relief of symptoms, stroke prevention, improvement in quality of life, prevention of vascular dementia, and prolongation of lifetime. OBJECTIVE: The objective of this paper was to compare the outcome of carotid endarterectomy in cervical block vs. general anesthesia in patients with occluded contralateral internal carotid artery (ICA). METHOD: One hundred patients (76 male, 24 female, mean age 60.81 years) with occluded contralateral ICA were operated from 1997-2000. Neurological symptomatology, deficiency and stroke incidence were preoperatively analyzed in two groups. Duplex-scanning, angiograms and CT-scan confirmed the diagnosis. Risk factors analysis included hypertension, diabetes, lipid metabolism disorders, smoking and history of CAD, CABG and PAOD. Morbidity and mortality were used to compare the outcome of surgery in two groups. RESULTS There was no difference of age, gender and symptomatology between the groups. Paresis, TIA and dysphasia were most frequent. 70%-90% of ICA stenosis was seen in the majority of patients. Hypertension and smoking were dominant risk factors in these two groups. Eversion carotid end arterectomy was the most frequent technique used. In three cases out of nine that were operated under cervical block, the neurological symptoms developed just after clamping, so the intra-luminal shunt was placed. Postoperative morbidity was 12% and mortality was 8%. Conclusion: There was no difference of preoperative parameters, surgical technique and outcome in these two groups. Without other intraoperative monitoring, cervical block anesthesia might be an option in patients with the occlusion of the contralateral ICA. However, prospective studies involving more patients are needed.

Introduction. Though surgical approach is common in arteriovenous (AV) fistula treatment, endovascular procedures such as stent-graft placement has become more popular in recent years. We aim to present a case of thrombosed femoral artery stent-graft which was placed one year earlier due to multiple AV fistulas following gunshot wounds. Case Outline. A 43-year-old patient was admitted to the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, Serbia, for arteriography. Five years before, he had suffered from six gunshot wounds in his right leg and one year before, in the health centre in Vienna, stent-graft had been placed in the right superficial femoral artery due to multiple AV fistulas. Because of artery dilation proximal to AV fistula location, a large dimensional stent-graft had to be placed (24 mm). After admission, arteriography and Multislice CT (MSCT) angiography revealed thrombotic masses in the stent-graft with intraluminal stenosis of 50%. Extirpation of thrombosed stent-graft was performed followed by Dacron tubular graft 10 mm interposition. On the fifth postoperative day, the patient was discharged from the clinic, and after 3 months, the right leg vascularisation was well preserved. Conclusion. Large dimensional stent-graft placement in patients with mutiple AV fistulas and blood vessel dilation proximal to AV site of communication carries an increased risk of thrombotic events due to turbulent blood flow and parietal thrombosis occurrence. Though stent-graft placement can be a very useful solution in acute AV fistula treatment, the very same thrombosis should be thought of when surgical management is the only treatment choice.

INTRODUCTION Aneurysms of digital arteries are considered to be rarity. They could be true or false. False aneurysms are usually the result of penetrating trauma, while the causes of development of true aneurysms are various, such as blunt trauma, and rarely atherosclerosis, vasculitis and infection. Also, they can be idiopathic. Reviewing the literature we found 13 cases of previously described true aneurysms of digital arteries. None of them referred to the common digital artery aneurysm. CASE OUTLINE We report a case of an idiopathic true aneurysm of the common digital artery, with its clinical presentation and a corresponding multislice CT arteriogram. Surgical treatment by ligation and excision of the aneurysm was performed. CONCLUSION As mentioned above, true aneurysms of digital arteries are very rare, so they are of little clinical importance. The most common symptom of digital artery aneurysms is pain, with a tender pulsatile mass on examination. Since natural healing cannot be expected, surgical treatment of true digital artery aneurysms is recommended for pain relief and avoidance of complications which may occur and are related to the aneurysm presence. Aneurysm resection and ligation of a blood vessel can be performed. Also, artery reconstruction can be performed by primary end-to-end anastomosis or the placement of a reversed interposition vein graft.

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft.

Introduction. Necrotizing fasciitis is a rare, progressive bacterial infection of superficial fascia followed by secondary subcutaneous tissue necrosis. We pressented a patient with massive fulminant lifethreatening necrotising fasciitis after bellow-knee femoro-popliteal vein bypass grafting successfully treated by antibiotics, surgical debridement and final skin reconstruction using the Tierch method. Case report. A 61-year-old patient was ad-mitted to the Vascular Surgery Clinic for below-knee femoro-popliteal bypass grafting. He complained of intermittent claudication in the left leg after 50 m, ankle brachial indexes were 0.45 on the left and 1.0 on the right side. Femoropopliteal below-knee bypass grafting was done using the autologous great saphenous vein. In the very next day, initial signs of skin infection appeared including local inflammation, erythema, swelling and cellulitis restricted to saphenectomy site. These changes had rapidly spread in the following days on the deep tissue of the whole upper and lower leg, including the groin and with clinical signs of life-threatening systemic infection. Immediate surgical debridement was done followed by extensive wound packing and wide spectrum antibiotics administration for the next 33 days when final skin reconstruction by the Tierch method was performed. Interesting point is that this entire time wound swab was sterile. Conclusion. In the presented case immediate surgical debridement, wide spectrum antibiotics administration and consistent wound packing gave satisfactory results in this life-threatening systemic infection. Wound swab is not always a reliable indicator of the infection while clinical findings and surgeons’ experience are of great significance in rapid reaction to this rare surgical complication. [Projekat Ministarstva nauke Republike Srbije, br. 41002]

Introduction. Ameloblastomas are odontogenic epithelial, locally invasive tumors of slow growth and mostly of benign behavior. Their frequency is low (they account for 1% of all head and neck tumors and about 11% of tumors of dental origin). Malignant variations of ameloblastoma are malignant ameloblastoma and ameloblastic carcinoma. They constitute less than 1% of all ameloblastomas. We presented a case of malignant ameloblastoma of the mandible with neck metastasis. Case report. A patient, aged 72, presented with the following symptoms: pain in the lower jaw, swelling in the left submandibular area and difficult mouth opening. The patient was admitted to the Department of Oral and Maxillofacial Surgery, Clinical Center of Montenegro, two months after he had noticed the symptoms. Panoramic radiography (OPG) showed that both jaws were partially toothless with terminal stage of periodontitis of the remaining teeth. Also, OPG showed sharply limited semicircular defect in the retromolar region and along the front edge of the mandible rami. Conventional histopathologic examination of the neck masses showed malignant ameloblastoma which contained central fields of squamous differentiation. Immunoreactivity of several markers was determined using immunohistochemical analyses. After these diagnostic methods a definite histopathology diagnosis was made: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Conclusion. It is not possible to distinguish conventional, ie intraosseous, ameloblastoma from malignant ameloblastoma according to histopathologic features. It is necessary to pay special attention, especially in elderly patients, and to carry out further clinical, radiological and pathohistological diagnostic procedures, such as immunohistochemical analysis. A timely and correct diagnosis and treatment of malignant ameloblastoma require a multidisciplinary approach.

Background/Aim. Doppler ultrasonography is now a reliable diagnostic tool for noninvasive examination of the morphology and hemodynamic parameters of extracranial segments of blood vessels that participate in the brain vascularisation. This diagnostic modality in recent years become the only diagnostic tool prior to surgery. The aim of the study was to determine hemodynamic status in symptomatic and asymtomatic patients with severe carotid stenosis prior to and after carotid endarterectomy (CEA). Methods. A total of 124 symptomatic and 94 asymptomatic patients who had underwent CEA at the Clinic for Cardiovasculare Disease “Dedinje” in Belgrade were included in this study. Doppler ultrasonography examinations were performed one day before CEA and seven days after it. The peak systolic velocity (PSV), end-dyastolic velocity (EDV), time-averaged maximum blood flow velocity (MV), resistance index (RI) and the blood flow volume (BFV) of the ipsilateral and the contralateral internal carotid artery (ICA) were measured. Results. Diabetes was the only risk factor found significantly more frequent in symptomatic patients. There were significantly more occluded contralateral ICAs in the group of symptomatic patients. There was a significant increase in PSV, EDV, MV and BFV of the ipsilateral ICA after CEA and a significant decrease in PSV, EDV, MV and BFV of the contralateral ICA after CEA. RI is the only hemodynamic parameter without significant changes after CEA in both groups of patients. Comparing the values of hemodynamic parameters after CEA between the group of symptomatic and the group of asymptomatic patients no significant differences were found. Conclusion. The occlusion of the contralateral ICA is an important factor differentiating between symptomatic and asymptomatic patients with severe carotid stenosis. Successful surgery provides good recovery of cerebral hemodynamics in both symtomatic and asymptomatic patients.