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The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side effects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p

Intracranial aneurysm is a focal, abnormal dilation of an artery of the brain. Magnetic resonance angiography (MRA) is a non-invasive technique for vascular imaging and is thus widely used for screening for intracranial vascular lesions. The aim of the study was to show the diagnostic accuracy of 3D Time-of-Flight (3D TOF) MRA in the detection of unruptured cerebral aneurysms with the use of digital subtraction angiography (DSA) as the gold standard. A total of 2.612 consecutive patients underwent 3DTOF MRA. It showed unruptured aneurysms in 94 (3.6%) patients. They included 68 women and 26 men ranging in age from 29 to 76 years (mean, 52.5 years). Twenty-six of them, 20 women and 6 men, underwent DSA. The Mann-Whitney U test was used for the correlation of size. Fisher’s test was used for the correlation of location. The statistical level of significance was set at p0.05) of aneurysms between TOF MRA and DSA. MRA is an accurate and non-invasive method for diagnosis of unruptured intracranial aneurysms. The results of study show the compatibility of MRA findings, the location and the size of an aneurysm in comparison with the “gold standard” – cerebral DSA.

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder of unknown etiology characterized by synovial hyperplasia and resulting joint destruction. Despite reduced needs for total joint arthroplasty in the treatment of end-stage damage of the hip and knee in RA, many patients still require hip and knee arthroplasty to restore the hip function and quality of life. We present the surgical treatment of young RA patient with bilateral total hip and bilateral knee arthroplasty at the Clinic of Orthopaedics and Traumatology Clinical Center Niš. Male patient with seropositive RA was implanted with bilateral total hip and knee over a period of 4 years (2008 to 2011). At the time of the first left hip arthroplasty, the patient was 32 years old. Surgical treatment in all arthroplasty procedures passed without complications. At the control examination 3 years after the last surgery, the patient was walking without mobility aids. His walk was safe and stable. The postoperative scars on hips and knees were stable, with no signs of inflammation. The flexion of the knees was possible till 110 degrees, and the extension to the full capacity.The patient resumed his work and life activities, and now he works as a game warden. He normally performs everyday activities, including climbing to the watchtower. Total hip and knee arthroplasty in rheumathoid arthritis patients with advanced joint destruction is a successful solution.

We present a 71-year old patient admitted to Plastic and Reconstructive Surgery Clinic, Clinical Center Niš for the right leg conquasation. The patient was injured accidentally by a petrol tiller. On admission, both thigh and lower leg conquasation was observed with large wound on anteromedial thigh and one on medial side of the lower leg. Soft tissue and bones were covered with dirt and pieces of clothing. The wounds were thoroughly rinsed and dirt was removed followed by detailed debridement. After primary surgical treatment of the wound, open proximal lower leg fracture was stabilized with external skeletal fixation using two nails in the proximal and two nails in the distal fragment. Soft tissue defect was treated by plastic surgeon. The patient was administered anti-tetanus protection, antibiotic treatment and anticoagulant prophylaxis of deep vein thrombosis and pulmonary thromboembolism. Physical therapy was initiated subsequent to successful healing of the soft tissue wounds. External skeletal fixation was removed after three months for infection around the proximal nails and the treatment was contuinued using functional Sarmiento’s plaster imobilization leading to full recovery of open lower leg fracture.

Non-ionizing radiation has a significant and positive impact on modern society through a number of uses. There is increasing public concern regarding the health risks of radio-frequency (RF) radiation, particularly that produced by mobile phones. Concern regarding the potential risks of exposure to EMFs has led to many epidemiological investigations, but the effects of EMF exposure on human and other mammalian cells are still unclear. One of the most frequently asked questions about the effects of microwave radiation on biological systems is whether they produce genotoxic effects and could be there a possible link with oncogenic processes. It is most difficult to get accurate and reproducible results for the studies that tell us most about the effects of EMF on humans. Based on some “weak” evidence suggesting an association between exposure to radiofrequency fields (RF) emitted from mobile phones and two types of brain cancer, glioma and acoustic neuroma, the International Agency for Research on Cancer has classified RF as ‘possibly carcinogenic to humans’ in group 2B. Literature results suggest that pulsed microwaves from working environment can be the cause of genetic and cell alterations. Taken together, the increased frequency of DNA damages, increased intensity of oxydative stress and production of reactive oxygen species as well as prolonged disruption in DNA repair mechanisms could be possible mechanisms for microwave induced cytogenetic damages even at low-level electromagnetic fields. Although there were contradictory results about harmful effects of electromagnetic fields we recommend that the mobile phone should be kept as far as possible from the body during conversations and also during usual daily activities to reduce the absorption of radiation by cells. In addition, the appropriate intake of antioxidant-rich food or drugs may be helpful for preventing the genotoxic effects that could be caused by mobile phone use.

Posterior reversible encephalopathy syndrome (PRES) is an obstetric emergency frequently occurring in a pregnant or puerperal woman, manifested with an acute headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem and basal ganglia. Since magnetic resonance imaging (MRI) is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image.

The aim of the study was to test the influence of noise on the occurrence of thyroid disease. A group of examinees included the noise-exposed workers (300) who work in the production halls and the control group (50) doing administrative jobs in the office. The testing was performed by the service of occupational medicine, within regular control and periodic check-ups of the noise-exposed group and health systematic examinations of the control group. Some laboratory analyses of the thyroid hormone were used for the purpose of this study. The percentage of those with an increased thyroid activity in the control group is 2%, while in the group of workers exposed to noise it equals 6,8%. In the control group, the total number of those with a decreased thyroid function is 0,85% and 4,85% in the noise-exposed group. In the control group, the total number of workers with the changed thyroid function is 2,85%, while in the group exposed to noise, the total number of workers with the changed thyroid function is 11,65%. By comparing the number of workers having disturbances in the thyroid function from the control group to those from the noise-exposed group who have hearing nerve damage, it can be noticed that there is no statistically significant difference. There were 21 examinees that had subjective health complaints with the levels of hormones increased; 15 examinees had subjective health complaints while the levels of hormones were decreased, and 77 examinees had subjective health complaints with the levels of hormones within the normal range. The largest number of workers with a changed thyroid function had between 10 and 20 years of service. After analyzing the results, obtained in both control and noise-exposed groups, the conclusion was that the number of workers having problems with the thyroid activity is larger in the group exposed to noise in relation to the workers from the control group. These values are in correlation with the level of noise at the working place.

Ocular type 1 neurofibromatosis is an autosomal dominant phacomatosis with variable expression and the occurrence of characteristic changes in the eye. The most frequent ophthalmologic finding in the eye is the presence of characteristic iris nodules. The shared result also describes the neurofibromatosis of the upper eyelid, an optic nerve glioma, choroidal hamartomas as well as congenital glaucoma. In addition, the paper gives a detailed presentation of a patient with type 1 neurofibromatosis, with the characteristic changes on the skin, which spread on the central nervous system and characteristic changes in the eye and its adnexa.It is also points out how much a detailed ophthalmologic examination is essential for detecting and recognizing possible manifestations, as well as criteria for making correct diagnoses of ophthalmologic diseases. Furthermore, the paper presents criteria for making diagnoses of type 1 neurofibromatosis in detail, taking into account a large number of manifestations on different organs.

The paper presents a roentgen image of the pathological states and disordes of the sinus and diagnostical possibilities of roentgenogram: anomalies of paranasal sinuses, tumors of sinuses, bones’ fractures of paranasal sinuses, foreign bodies of paranasal sinuses.The conclusion is that radiological presentation of pathological states and diseases of paranasal sinuses is pathognomonic.

Introduction: Etopic pancreas is a rare developmental anomaly. It is presence of pancreatic tissue without anatomic or vascular continuity with the normally developed pancreas. The most common heterotopic site is the stomach commonly involving antrum and prepyloric region on the greater curvature or posterior wall. Ectopic pancreas is diagnosed by endoscopic ultrasound, gastroscopy and biopsy, CT scan and MRI of the abdomen, a definitive diagnosis is verified by histopathological examination. Treatment is surgical. Case report: A 56-year-old woman presented with epigastric pain, nausea and fatigue. Esophagogastroduodenoscopy showed submucosal mass in the prepyloric region, biopsy was performed. Histopatological findings described normal gastric mucosa. Endoscopic ultrasonogpraphy and CT of the abdomen showed submucosal tumor, 18 mm in diameter, located in the prepyloric region. Surgical treatment was indicated. Gastrotomy with total extraction of tumor was performed. Histopathology findings showed ectopic pancreatic tissue in the submucosal and muscular layer of the stomach. Postoperatively patient fully recovered, and in the 2 year folow-up did not develop any symptoms related to gastrointestinal tract. Conclusion: Although presentation of ectopic pancreatic tissue in stomach is very rare condition, it should be considered during gastroitestinal diagnostic in patients with nonspecific gastrointestinal symptomatology. In most of cases, for this patients, surgery is curative and definitive solution.

Hydatidosis is a parasite disease (of the liver, lungs, kidneys, bones and other organs) caused by larva of cystic form (cysta hydatigena) of thedogechinococcus (T. echinococcus). Its knowledge is of special diagnostic and clinic importance. The paper gives a x-ray image of the liver hydatidosis (calcified hydatid cyst, hydatid cyst with cysts-sprouts of the first order) as well as that of the lungs (hydatid cyst with the Zhebe's sign, empty pericyst) and of the kidneys (calcified hydatid cyst). In the hydatidosis diagnostics, the x-ray diagnostics is a method of choice.

The diagnostic possibility of the native x-ray of the urotract and the x-raypicture of the pathological states and the urotract diseases on the native urotract x-raygram is presented, namely, anomalies of the urosystem (agenesis, aplasia, kidneyectopia, a horse-shoe-like or "humpbacked" kidney, inborn kidney cyst, M.Lenarduzzi), of parasite diseases (kidney hydatidose, urosystem schistosomiasis),nephrocalcinosis, piclonephritis calculi, kidney tuberculosis, urolithiasis andurogenital system tumors (Wilms tumor, neuroblastoma, uterus mioma).

A rudimentary form of the Morbus Sturge - Weber - Krabbe is shown in threepatients. For a proper diagnosis of this rare disease the most important examination isx-raying (standard craniograms and computed brain tomogipahy). The reason for thisis the fact that is can be diagnosed in patienls withouL cutaneous and ophtalmologicalsymptoms only by x-ray examination methods; on the other hand, in patientswith cutaneous and ophtalmological symptoms it can be diagnosed by the ophtalmologicaland dermatological examination (inspection). The decisive things in diagnosticare: the theoretical knowledge of the disease, the proper ophtalmological anddemnatological examination (inspection) as well as the x-ray (standard craniograms,computed brain tomography) examination.

The paper presents therapeutic procedures and actions in relieving anaphylacticreactions to the iodic contrast medium (ICM). On the basis of the author'spersonal experience and the literal data, the therapy (general reanimation and medicamentapplication) for the anaphylactic reactions to the ICM (easy, medium-serious and serious reactions) is described. In the conclusion it is stressed that only a timely,professional and adequate intervention can be successful in relieving anaphylacticreactions to the TCM while the serious reactions that could have ended in a lethal way,can end in a favorable way by a proper and efficient treatment (that is why they areregistered as serious ones).