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This paper aims to analyze the organic search engine visibility applied on the case of Serbian banks, employing an exploratory approach to the use of search engines as one of the major information, sales and interaction channels in the banking sector. In the methodology, Web crawling and SEO software tools have been used as a source for collecting the website performance data. The generated data was intersected with some of the finance industry ranking factors, aiming to determine how the Serbian banks are performing on Google and what are their common ailments and lost opportunities in organic search visibility. The research findings showed that the country's largest banks are using search engine optimization as an online marketing strategy, but it still lacks strategic orientation in the areas of content relevance, mobile site speed, Web traffic from referrals, social and email marketing, backlinking quality and social signals.

Introduction. Gluten-free diet (GFD) presents the basis of coeliac disease (CD) treatment. If strictly applied, the disorders of the small bowel mucosa and other disease signs rapidly resolve. Objective. The goal of the study was to evaluate the effect of GFD on the growth and nutritional status of children with the classical form of CD. In addition, we analyzed the differences between these parameters with the duration and the patients' compliance with GFD. Methods. The study goals were achieved on a sample of 90 children, 56 female and 34 male, aged 0.5-7.5 (1.53±1.05) years, with the classic CD diagnosed on the basis of typical pathohistological findings of the small bowel mucosa and clinical recovery of patients on GFD. The duration of the patients' follow-up was 1.08-8.75 (3.03±1.14) years, i.e. until the age of 2.5-15 (4.59±1.78) years. The initial and control values of body height (BH) in relation to matched values for age and gender were expressed in percentiles, while the deviation in body weight (BW) for the matched values of height and gender was expressed in percentages. The referent haemoglobin (Hb) rate in blood, as a laboratory indicator of nutritional status in children aged up to 5 years was ≥110 g/L, and for those aged above 5 years it was ≥115 g/L. Compliance with GFD was based on the pathohistological findings of the small bowel mucosa or determination of tissue transglutaminase. Results. Over the studied period, the effect of GFD was highly significant, both on the increase of BH percentiles (37.62±26.26 vs. 57.22±25.29; p

Introduction. Secondary lactose intolerance (SLI) belongs to the rarer manifestations of gluten-sensitive enteropathy (GSE). It occurs in more severe forms of the disease and its presence contributes significantly to the degree of its expression. Objective. The goal of the study was to determine the frequency of SLI in infants with clinically classic form of GSE, as well as its relationship with the duration, severity and age at the diagnosis of the basic disease and the degree of small bowel mucosa damage. Methods. The study was based on a sample of 42 infants, 30 female and 12 male, aged 7-12 months (x=9.98±1.69), with a clinically classic form of GSE. The diagnosis of GSE was established based on the characteristic pathohistological appearance of small bowel mucosa and clinical improvement of patients on gluten-free diet, while SLI on pathological lactose or milk tolerance test. The assessment of basic disease severity was based on body mass divergence in relation to the standard value, as well as on Hb and serum iron levels, while the degree of small bowel mucosa damage was determined according to the modified Marsh criteria. Results. SLI was verified in 8/42 or 19.05% of patients. In addition to the symptoms and clinical signs of GSE, all the patients with SLI also featured the problems characteristic of lactose tolerance disorders, i.e. watery diarrhoea, borborygmus and meteorism occurring after milk meals. In addition, all had perianal erythema (6 with erosive changes), as well as destructive enteropathy (5 subtotal and 3 total). The difference in the duration of the basic disease, age at diagnosis, as well as in the degree of body mass deviation from the standard value between the lactose-tolerant and lactose-intolerant infants was not found. In addition, no difference in Hb and serum iron levels or in the degree of small bowel mucosa damage was found between the two groups. Conclusion. Our findings indicate that SLI presents a relatively frequent occurrence in infants with clinically classic GSE, as well as that it occurs independently to the duration, severity and age at diagnosis of the basic disease and the degree of small bowel mucosa damage.

Background/Aim. Preterm delivery together with insufficient body weight and death cases in newborns is the main issue in obstetrics. About 40% of preterm delivery is caused by infections. The aim of this study was to investigate whether and which bacterial infections of genital tract can be associated with preterm delivery, and depending on when diagnosis was made. Method. The study involved 216 pregnant women. According to pregnancy outcome, two groups were formed. The study group involved 29 pregnant women who had preterm delivery out of which nine were examined in I trimester, eight in II trimester and 12 in III trimester. The control group involved 187 pregnant women out of which 47 were examined in I trimester, 73 in II trimester and 67 in III trimester. Bacteriological examination of vaginal and cervical swabs was done in all pregnant women. Infection was diagnosed by finding bacterial antigen in cervical swabs or positive cultures of vaginal and/or cervical swabs followed by the presence of the increased number of polymorphonuclears in direct microscopic preparation. Results. The results showed that in III trimester of pregnancy vaginal bacterial infection was statistically more common (p = 0.021) in women who had preterm delivery (66.7%) in relation to women who delivered in term (29.9%). In this period of gestation the increased number of polymorphonuclears in DMP of vaginal swabs is more common in the women of the study group (75%) than in the women of the control group (43.3%). Preterm delivery was registered in 16.1% women whose microbiological analyses were done in I trimester, 9.9% women in whom microbiological analyses were done in II trimester and in 15.2% pregnant women microbiologically tested in III trimester. Conclusion. Based on the obtained results it could be concluded that bacterial infections of genital tract and period of gestation when infection is diagnosed have influence on reducing perinatal morbidity and mortality caused by preterm delivery.

Introduction: Gilbert’s syndrome represents the most frequent hereditary disorder of bilirubin metabolism. It occurs in 2-7% of subjects in general population, and is manifested by mild unconjugated hyperbilirubinaemia of benign nature. Objective. The study was conducted in order to analyse our experience related to the circumstances of disclosure, age at onset and sex distribution of Gilbert’s syndrome in children. Method. The diagnosis of Gilbert’s syndrome was based on the findings of mild unconjugated hyperbilirubinaemia in the absence of haemolysis and organic liver disease, as well as significant increase of bilirubin unconjugated fraction in serum after a 3-day hypocaloric diet (400 kcal/daily). Results. Of 58 subjects with Gilbert’s syndrome, there were 40 (68.97%) boys and 18 (31.03%) girls, indicating a 2.22 fold higher incidence of boys than girls. The age at diagnosis of the disorder was similar in boys and girls, and was 12.2-18 (X=14.71±1.55) years for boys and 10.5-16.4 (X=14.38±2.10) years for girls (p>0.05). Except for 3 girls aged below 12 years, in all other patients the diagnosis was made after that age; in 20, between age 12 and 14 years and in 14, between age 14 and 16 years, while in 10 patents, it was made at age between 16 and 18 years. In 20 (34.48%) subjects, hyperbilirubinaemia was disclosed on routine paediatric examination, in 19 (32.76%) when differentiating the cause of recurrent or acute abdominal pain, in 17 (29.3%) during febrile condition and in 2 during insufficient caloric intake. The values of unconjugated bilirubinaemia, both before a hypocaloric test and after a 3-day energy deprivation, were higher in boys than girls, but this difference was statistically significant only after the 3-day hypocaloric diet in age group between 16 and 18 years (p=0.038). Also, no significant difference was found in bilirubinaemia level between the different age groups either in boys or girls. Conclusion. According to our findings, in children, Gilbert’s syndrome is manifested only in puberty, and 2.22 times more often in boys than girls. It is most frequently revealed during a routine pediatric examination, as well as when investigating the cause of abdominal pain and fever. A significantly higher level of serum bilirubin in boys as related to girls is registered only after a hypocaloric diet in age group between 16 and 18 years. .

Introduction: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. Objective. The aim of the study was to analyze the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. Method. The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analyzed depending on preoperative radiographic and bronchoscopic aspect. Statistics: chisquare test, t-test. Results. In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1) between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC) in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairment, operative mortality was 3.1%. In the analyzed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analyzed and control groups occurred in 14.7% and 6.1% of patients respectively (p>0.05). Conclusion. Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and additional lung function assessment. .

Introduction Breast milk jaundice occurs in 1-2% of healthy breast-fed newborns and young infants. It develops as the result of liver immaturity and the inhibitory effect of mother’s milk to the clearance of unconjugated bilirubin. Objective The paper analyzes variations in the level and length of unconjugated hyperbilirubinemia in breast-fed infants. Method The study was conducted on a sample of 29 young infants (19 male) with breast milk jaundice. All infants were born on time, by natural delivery and without complications. All were on breast-feeding only and developed optimally. None of the infants had either haemolysis or any other disease associated with unconjugated hyperbilirubinemia. Results All infants had physiological jaundice in the first week after birth, with unconjugated bilirubin level of 166-260 μmol (201.50±36.37 μmol). In the postneonatal period the highest bilirubin level was recorded in the fifth week of life and was 87-273 μmol (166.82±45.06 μmol), which then spontaneously, without interruption of breast-feeding, gradually declined. The decrease of the unconjugated fraction of serum bilirubin between the fourth and fifth week was significant, and after that highly significant. The normalization of serum bilirubin occurred in the seventh and thirteenth week (10.41±1.68 μmol). Negative consequences of hyperbilirubinemia were not noted in any of the infants. Conclusion Breast milk jaundice presents a harmless and transitory disorder of bilirubin metabolism. It occurs in healthy breast-fed neonates and young infants. Jaundice is most marked in early neonatal period, and then it gradually declines and disappears between the seventh and thirteenth week.

Introduction. Human milk proteins are maximally adapted to physiological needs of a neonate. Thus, depending on the speed of the neonatal growth and development, the content of milk proteins changes, both in quantity and quality. Objective. The study was conducted in order to determine variations of total protein concentrations in milk in the first and third lactation week in lactating mothers of term and preterm neonates. Also, we analyzed the influence of the mode of delivery, neonatal Apgar score and parity on the concentration of human milk proteins in both lactation phases. Method. The study aims were evaluated on the sample of 48 women, of whom 33 were mothers of term neonates and 15 of neonates born between the 34th to 37th gestational weeks. Total protein level of the lactation milk from the middle phase was determined using the standard laboratory method (Lowry et al., 1951), and the obtained differences were analyzed by t-test. Results. Total protein concentration in term colostrum was 17.60-45.17 g/l (X=24.71±5.19), while in preterm colostrum it was 28.39-73.30 g/l (X=39.17±11.08). The total protein level of mature milk in women who had term delivery was 11.90-22.11 g/l (X=16.39±2.96), while in women who had preterm delivery it was 14.50-44.19 g/l (X=23.25±8.96). The obtained results indicated that total protein concentration in women who had preterm delivery was significantly higher than that of women who had term delivery, both in the colostral and mature phase of lactation. (p

Introduction. Obesity is well known risk factor of metabolic complications and CVD. On the other hand, CRP as a marker of inflammation has lately aroused huge interest as predictor of cardiovascular risk. Objective. The objective of the study was to determine whether the nutritional status parameters were related to some inflammatory markers and what was the extent of such relation. Method. The study involved 220 patients, 40.5 ± 14.5 years old, who referred to Nutrition Clinic of the Institute of Hygiene in order to get a dietetic advice or nutritional medical therapy. Nutritional status was assessed by BMI (kg/mІ), calculated from measured values of body weight and height, the waist measurement and body fat percentage according to WHO recommendations. Biochemical parameters and inflammatory markers were measured from blood samples collected after a twelve-hour fast. Results. The subjects were categorized into quartiles of BMI (kg/mІ) and % body fat. The inflammatory markers followed the increase of BMI and % body fat, as odds ratio (95% CI) of elevated level of CRP was observed to be highest in the fourth quartiles of BMI [1.55 [(OR = 0.731 - 3.296] as well as in the fourth quartile of % body fat - 1.34 [(OR = 0.598 - 3.009)]. This was confirmed by analysis of linear correlation which resulted in r = 0.148 for BMI (p < 0.05) and r = 0.164 (p < 0.05) for fat percentage. In addition, there was highly significant positive correlation between fibrinogen level, C3 and BMI (p < 0.01), and body fat (p < 0.01). Conclusion. The results showed that determination of inflammatory markers should become a routine screening procedure in all patients with elevated anthropometric parameters in order to prevent the consequences of atherosclerosis as quickly as possible.

Background/Aim. Thanatophobia is an exaggerated, specific, structured fear of death. It appears in childhood and continues to grow over the years, and in the old age it is accompanied with nosophobia and other mental disorders. The aim of this study was to analyze thanatophobia in dialysed patients which was in the direct connection with a basic disorder, and the influence of this disorder on functioning and the quality of life of the patients on dialysis. Methods. In the study we examined 753 patients from the chronic program of haemodialysis in a period from 1999 to 2004. The patients were classified in two groups: 348 randomized patients with Balkan Endemic Nephropathy (BEN), and the control group (N18) of patients with terminal renal insufficiency, and other diagnoses (n = 405). Since the study was a comparative, cross-sectional one, the patients were tested by the appropriate questionnaires for anxiety, depression and general mental functioning. Statistical analysis was done by the standard descriptive and analytic statistic methods. Results. Based on socio-demographics data we revealed a highly significant difference regarding the place of living between the groups BEN and N18 (χ2 = 23.970; p < 0.01), the frequency of occurrence of renal comorbidity (χ2 = 23.970; p < 0.01), the frequency of family renal comorbidity in siblings (χ2 = 23.970; p < 0.01), and the frequency of migrationes (χ2 = 4.874; p < 0.01). According to psychiatry scales, the patients from the BEN group were significantly more anxious and depressive than those from the control group. Conclusion. The signs of thanatophobia were revealed in both examined groups, but significantly more in the patients with BEN than in those with other nephrologic diseases. Thanatophobia starts before dialysis, and dialysis structures it into fear of death which is in a direct connection with the basic disorder. This intensive fear may be connected with dementia and depression, but also with other mental disorders.

Background. At the Clinical Center of Serbia (CCS), which includes 21 Institutes and 6 Centers, approximately 10% of the total annual budgetary funds is spent on the drugs. During the studied period, it was estimated that 0.5% of the above amount has been spent at the Institute for Otorhinolaryngology and Maxillofacial surgery (Institute for ORL and MFS), Clinical Center of Serbia. The aim of this study was to find out if these antibiotics had been used rationally by the monitoring of antibiotics in relation to the number of inpatients, and by the 5 most frequent diagnoses. Methods. The authors monitored the tree-year consumption of antibiotics for In hospital treated patients during the period 2001-2003. Data were obtained from the itemized quarterly report on the consumption by the Central Pharmacy of the CCS. Results. The results were statistically analyzed and presented in percentages and Defined Daily Dasages (DDD) for each group of the antibiotics. The results were analyzed in accordance with the World Health Organization Recommendations and the Guidelines. Conclusion. The authors concluded that antibiotics were adequately used at the Institute for ORL and MFS-CCS. The most commonly used antibiotics for grampositive infections were those from the penicillin and cephalosporin groups. According to the international trends and recommendations, the selected therapy was rational and the antibiotics consumption was cut down during the observed three-year period. It was a true confirmation that the recommendations for the rational antibiotics consumption had been fruitful (produced good results).

INTRODUCTION Each fracture of long or pelvic bones as well as large contusions of subcutaneous fat tissue cause releasing of fat globules that rapidly penetrate into circulation through the ruptured veins of the injured tissue, and reach the lung circulation [1,2]. During the first phase, fat emboli block the functional lung circulation by their mechanical effect in capillaries producing so called isolated post-traumatic lung fat embolism [3]. The surface layer of a fat embolus, which is practically in liquid state, behaves as a membrane of very high density, i.e., as it is under high pressure which obstruct the blood stream [4] that is finally stopped at the level of lung blood vessels with diameter of approximately 20 µ [5].This pathophysiological mechanism produces cor pulmonale acutum, with poor pathological findings [8]. Nowadays, the post-mortem diagnosis of lung fat embolism is based on microscopical examination of tissue specimens, usually prepared with special histological staining (Sudan III) [9]. The grading of fat embolism according to Sevitt's criteria is generally accepted [10]. Taking of slices from apicoventral areas of the lungs has been recommended [11]. With longer outliving period, the total number of fat emboli in the lung circulation gradually decreases, due to their disintegration and resorption. It has been stated that fat globules completely disappear about 4-6 weeks after injury, and that they should not be searched for microscopically in this post-traumatic phase [11]. OBJECTIVES The aim of our work was to determine whether the age of injured, their gender, total severity of trauma, outliving period, and hypovole-mic shock that develops after injuring, may induce development of more severe forms of post-traumatic lung fat embolism. MATERIAL AND METHODS A prospective histological study was performed on the autopsy material of the Institute of Forensic Medicine in Belgrade. The analyzed sample consisted of individuals with injuries that might be a source of fat emboli (fractures of long bones, large contusions of subcutaneous fat tissue). The lung slices were systematically taken and stained with special fat staining (Sudan III). In each particular case, the grade of lung fat embolism was counted on the basis of microscopical appearance, according to Sevitt's criteria. The total severity of trauma was estimated by calculation of the Injury Severity Score (ISS) [13,14]. In no cases from the analyzed sample, the fat embolism was mentioned as either singular or plural cause of death. The obtained results were analyzed by means of appropriates statistical methods (ANOVA LSD-test, x2 test, Man-Whitney test, Fischer's test of correct probability). RESULTS AND DISCUSSION The analyzed sample included 58 fatally injured individuals, 39 males and 19 females. The average age was 54.10 years (SD=16.56), the average value of ISS was 34.69 (SD=5.88), and the average outliving period was 3.74 days (SD=5.88). However, all these data look differently when the analyzed sample has been stratified and analyzed according to the estimated grade of lung fat embolism. It was not showed that severity of lung fat embolism depends on sex of the injured (^2=0.842 p>0.05). The groups with the slightest and the most severe grade of lung fat embolism are statistically significantly different in relation to age of individuals (ANOVA, p=0.017). By means of LSD test, it has been showed that the group with the most severe grade of lung fat embolism (grade III) is statistically significantly different comparing to other two groups (with grade I and II) in relation to the age of injured (the values are p=0.16 and p=0.19 respectively, and the both groups are less than p=0.05). In the group with the most severe grade of lung fat embolism, the older individuals are statistically significantly represented comparing to othertwo groups. CONCLUSION The analysis of our sample showed that the most severe grade of post-traumatic lung fat embolism (microscopical grade III according to Sevitt's criteria) was determined in older individuals, more severely injured, and with shorter outliving period. The severity of fat embolism depends neither on sex of the injured, nor on development of post-traumatic hypovolemic shock. The obtained results related to the influence of hypovolemic shock on severity of fat embolism should be accepted with a caution. Namely, sometimes there is an intention to simplify a procedure of creating of autopsy conclusion about the cause of death, so that loss of blood is not mentioned at all, in spite of fact that it could have been a concurrent cause of death, while in other cases exsanguination is designated as a sole cause of death, forgetting the possibility that fat embolism could have really been the immediate cause of death.

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Aim: The aim was to investigate somatostatin receptor (sstr) expression in normal prostate by determining the maximum standardized uptake value (SUVmax) of 68Ga-DOTATOC PET/CT in neuroendocrine tumor (NET) patients, without NET involvement of the prostate gland, for establishing the reference standard. Methods: Sixty-four NET patients underwent 68Ga-DOTATOC PET/CT. SUVmax of the prostate gland, normal liver, testes, and gluteus muscles were evaluated. The prostate gland size was measured. Statistical analysis was performed using dedicated software (SPSS13). Results: Mean/median 68Ga-DOTATOC SUVmax values were as follows: normal prostate 2.6±0.0, slightly enlarged prostate 4.2±1.6, prostatic hypertrophy 4.9±1.6, prostatic hyperplasia 5.0±1.5, prostate cancer 9.5±2.1, normal liver 7.3±1.8, testes 1.8±0.5, and gluteus 1.0±0.2. The normal prostate gland had three times less sstr expression than normal liver tissue. Strong correlation was found between patient age and sstr expression in prostate/prostate size. No significant difference existed in sstr expression between prostatic hypertrophy and hyperplasia. Much higher sstr expression was found in prostatic cancer compared with normal prostate. Conclusion: 68Ga-DOTATOC PET/CT defines the baseline sstr uptake in prostate not affected by NET (significantly lower than in the liver). Higher values were established in prostatic hyperplasia and hypertrophy. Only concomitant prostate cancer was associated with higher SUVmax in comparison with non-neoplastic liver. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish whether older patients with skin melanoma (in an analyzed group of 189 patients treated at the Institute for Oncology and Radiology of Serbia from 2004 to 2008), have worse survival compared to younger patients. In 100 men and 89 women with an average age of 58.9 years, the following parameters were observed and statistically analyzed in SPSS: gender, age, localization, tumor thickness, ulceration, lymphonodal status and invasion level. In the four age subgroups - quartiles, the best survival was shown in patients 70 years (76.1%). Patients without ulcerations, with negative lymph nodes, thin melanomas and Clark levels I and II had significantly better survival outcomes. Although the results showed no statistical significance of age as a prognostic factor in the survival of patients with skin melanoma, further research on a larger number of patients is warranted.

Background: In septuagenarians, lobectomy is the preferable operation, with lower morbidity than for pneumonectomy. However, the 1-year impact of lobectomy on lung function has not been well studied in elderly patients. Materials and Methods: Retrospective study including 30 patients 70 years or older (study group), 25 patients with chronic obstructive pulmonary disease (COPD) under 70 years (control group 1), and 22 patients under 70 years with normal lung function (control group 2) operated for lung cancer in a 2-year period. The study and control groups were compared related to lung function changes after lobectomy, operative morbidity, and mortality. Results: Postoperative lung function changes in the elderly followed the similar trend as in patients with COPD. There were no significant differences between these two groups related to changes in forced expiratory volume in the first second (FEV 1 ) and vital capacity (VC). Unlike that, the pattern of the lung function changes in the elderly was significantly different compared with patients with normal lung function. The mean postoperative decrease in FEV 1 was 14.16% in the elderly, compared with a 29.23% decrease in patients with normal lung function ( P < 0.05). In the study and control groups, no patients died within the first 30 postoperative days. The operative morbidity in the elderly group was significantly lower than in patients with COPD (23.3% vs. 60%). Conclusions: The lung function changes after lobectomy in the elderly are similar to those in patients with COPD. The explanation for such a finding needs further investigation. Despite a high proportion of concomitant diseases, the age itself does not carry a prohibitively high risk of operative mortality and morbidity.

Abstract Background beside the well known predominance of distant vs. loco-regional relapse, several aspects of the relapse pattern still have not been fully elucidated. Methods prospective, controlled study on 88 patients operated for non-small cell lung cancer (NSCLC) in a 15 months period. Stage IIIA existed in 35(39.8%) patients, whilst stages IB, IIA and IIB existed in 10.2%, 4.5% and 45.5% patients respectively. Inclusion criteria: stage I-IIIA, complete resection, systematic lymphadenectomy with at least 6 lymph node groups examined, no neoadjuvant therapy, exact data of all aspects of relapse, exact data about the outcome of the treatment. Results postoperative lung cancer relapse occurred in 50(56.8%) patients. Locoregional, distant and both types of relapse occurred in 26%, 70% and 4% patients respectively. Postoperative cancer relapse occurred in 27/35(77.1%) pts. in the stage IIIA and in 21/40(52.55) pts in the stage IIB. In none of four pts. in the stage IIA cancer relapse occurred, unlike 22.22% pts. with relapse in the stage IB. The mean disease free interval in the analysed group was 34.38 ± 3.26 months. The mean local relapse free and distant relapse free intervals were 55 ± 3.32 and 41.62 ± 3.47 months respectively Among 30 pts. with the relapse onset inside the first 12 month after the lung resection, in 20(66.6%) pts. either T3 tumours or N2 lesions existed. In patients with N0, N1 and N2 lesions, cancer relapse occurred in 30%, 55.6% and 70.8% patients respectively Radiographic aspect T stage, N stage and extent of resection were found as significant in terms of survival. Related to the relapse occurrence, although radiographic aspect and extent of resection followed the same trend as in the survival analysis, only T stage and N stage were found as significant in the same sense as for survival. On multivariate, only T and N stage were found as significant in terms of survival. Specific oncological treatment of relapse was possible in 27/50(54%) patients. Conclusion the intensified follow up did not increase either the proportion of patients detected with asymptomatic relapse or the number of patients with specific oncological treatment of relapse.

Aim: To determine the impact of two apparent diffusion coefficient (ADC) measurement techniques on diffusionweighted magnetic resonance images (DW MRI) on the assessment of rectal cancer response to neoadjuvant chemoradiotherapy (CRT). Methods: ADC values were measured prospectively with two different techniques - the first, which measures ADCs in the most cellular tumor parts, and the second, which measures the entire tumor area, in 58 patients with locally advanced rectal cancer on pre-CRT and post-CRT image sets. Areas under the receiver operating characteristic curves (AUCs) and parameters of diagnostic accuracy were calculated for pre- and post-CRT ADC values and numeric and percent ADC change for each technique to determine their performance in tumor response evaluation using histopathological tumor-regression grade as the reference standard. Results: The second technique yielded higher AUCs (0.935 vs 0.704, P < 0.001), percent-change (0.828 vs 0.636, P < 0.001), and numeric-change (0.866 vs 0.653, P < 0.001) than the first technique for post-CRT ADC. Accuracies for post-CRT ADC assessment were 62% for the first and 88% for the second technique (cut-off values: 0.98 and 1.29 × 10-3 mm²/s, respectively) and for ADC change assessment, both numeric and percent, 59% and 74%, respectively (cut-off values: increase of 0.18 and 0.28 × 10-3 mm²/s; increase of 24% and 37%, respectively). Conclusions: The type of measurement technique significantly affected ADC results. ADC measurements covering a larger area better predicted tumor response to therapy. Post-CRT ADCs, regardless of the measurement technique, and numeric ADC change measured in the whole tumor volume accurately identified non-complete responders. Post-CRT ADCs measured in the entire tumor area yielded the highest accuracy level in tumor response evaluation. [ABSTRACT FROM AUTHOR]

Introduction Measurement of daily variability of peak expiratory flow (PEF) is widely accepted as an objective method to assess asthma severity. Recent investigations have proved nonlinearity of original Wright scale of peak flowmeter. All country members of European Union have been obliged to implement a new scale according to standard EN 13826 since 2005. This study examined whether the correction of PEF values for the inaccuracy of the scale would affect asthma management based on their daily variability. Material and methods We analyzed PEF values (2352) in 34 children, aged 5-16. during 3-5 weeks of monitoring in order to establish the diagnosis of asthma by using peak flowmeters with Write scale. The correction of measured values for inaccuracy was managed with original Dr M. Miller's predictive equation. The daily variability of PEF (amplitude percent mean) up to 20% was considered as "normal", 20-29.9% as "raised", and 30% and above as "high". The assessment of daily variability was performed before and after correction. Results There was no significant change in the number of days with airway lability as regarding the assessed whole study group (p=0.475). However. 22 (64.7%) of children had at least one false clinical message about daily variability during the monitoring. It was overestimated in 12 (7%) days in younger (6.6±0.8 years) or of shorter stature (122.6±3.6cm) and underestimated in 13 (4%) days in older (11.1±2.7) or taller ones (150.9±12.5 cm) (p<0.001). Conclusion Usage of peak flow meters with Wright scale may lead to an error in asthma severity assessment based on daily variability of PEP. It may cause overtreatment or undertreatment of asthmatic children. [ABSTRACT FROM AUTHOR]

Background/Aim. Thanatophobia is an exaggerated, specific, structured fear of death. It appears in childhood and continues to grow over the years, and in the old age it is accompanied with nosophobia and other mental disorders. The aim of this study was to analyze thanatophobia in dialysed patients which was in the direct connection with a basic disorder, and the influence of this disorder on functioning and the quality of life of the patients on dialysis. Methods. In the study we examined 753 patients from the chronic program of haemodialysis in a period from 1999 to 2004. The patiens were classified in two groups: 348 randomized patients with Balkan Endemic Nephropathy (BEN), and the control group (N18) of patients with terminal renal insufficiency, and other diagnoses (n = 405). Since the study was a comparative, cross-sectional one, the patients were tested by the appropriate questionnaires for anxiety, depression and general mental functioning. Statistical analysis was done by the standard descriptive and analytic statistic methods. Results. Based on socio-demographics data we revealed a highly significant difference regarding the place of living between the groups BEN and N18 (χ² = 23.970; p < 0.01), the frequency of occurrence of renal comorbidity (χ² = 23.970; p < 0.01), the frequency of familly renal comorbidity in siblings (χ² = 23.970; p < 0.01), and the frequency of migrationes (χ² = 4.874; p < 0.01). According to psychiatry scales, the patiens from the BEN group were significantly more anxious and depressive than those from the control group. Conclusion. The signs of thanatophobia were revealed in both examined groups, but significantly more in the patients with BEN than in those with other nephrologic diseases. Thanatophobia starts before dialysis, and dialysis structures it into fear of death which is in a direct connection with the basic disorder. This intensive fear may be connected with dementia and depression, but also with other mental disorders. [ABSTRACT FROM AUTHOR]

Although primary toxic action of organophosphorous insecticides is associated with acetylcholinesterase inhibition, later studies suggest that oxidative stress may be responsible for induced organophosphates toxicity. These studies mostly include thio forms, while the effects of their metabolites/degradation products have been less investigated. Therefore, this paper studies the toxic effects of diazinon degradation products, diazoxon and 2-isopropyl-6-methyl-4-pyrimidinol, and compares them with the toxic potential of the parent compound. The toxicity induced by various concentrations of the investigated compounds was in vitro evaluated by the activities of acetylcholinesterase, ATPases, antioxidant defense enzymes and lactate dehydrogenase, and malondialdehyde level in rat brain synaptosomes. Diazinon inhibited acetylcholinesterase and Na + /K + -ATPase in dose-dependent manner, while the inhibition of ecto-ATPase activity was less than 15% at all investigated concentrations. It did not demonstrate noteworthy prooxidative properties causing increase (up to 10%) in antioxidant enzymes activity and malondialdehyde level, as a marker of lipid peroxidation. Diazinon oxidation product, diazoxon was found as the most toxic investigated compound. Beside the expected strong inhibitory effect on acetylcholinesterase, it induced dose-dependent and almost complete inhibition of Na + /K + -ATPase and ecto-ATPase at the highest investigated concentration (0.1 mM). Increasing diazoxon concentrations activated catalase (up to 30%), superoxide dismutase (up to 50%), glutathione peroxidase (up to 30%), and significantly increased malondialdehyde level (up to 50%). The investigated hydrolysis product of diazinon, 2-isopropyl-6-methyl-4-pyrimidinol did not remarkably alter the activities of acetylcholinesterase, Na + /K + -ATPase, catalase, glutathione peroxidase and lipid peroxidation level (up to about 10%). Although this diazinon metabolite has been known as non toxic, it induced superoxide dismutase stimulation up to 30%. Finally, even high concentrations of both diazinon and its metabolites did noticeably affect lactate dehydrogenase activity as a marker of synaptosomal integrity. The changes in investigated biochemical parameters in rat brain synaptosomes could serve as indicators of toxicity due to the exposure to thio organophosphates and/or their break-down products. [ABSTRACT FROM AUTHOR]

Background/Aim. Preterm delivery together with insufficient body weight and death cases in newborns is the main issue in obstetrics. About 40% of preterm delivery is caused by infections. The aim of this study was to investigate whether and which bacterial infections of genital tract can be associated with preterm delivery, and depending on when diagnosis was made. Method. The study involved 216 pregnant women. According to pregnancy outcome, two groups were formed. The study group involved 29 pregnant women who had preterm delivery out of which nine were examined in I trimester, eight in II trimester and 12 in III trimester. The control group involved 187 pregnant women out of which 47 were examined in I trimester, 73 in II trimester and 67 in III trimester. Bacteriological examination of vaginal and cervical swabs was done in all pregnant women. Infection was diagnosed by finding bacterial antigen in cervical swabs or positive cultures of vaginal and/or cervical swabs followed by the presence of the increased number of polymorphonuclears in direct microscopic preparation. Results. The results showed that in III trimester of pregnancy vaginal bacterial infection was statistically more common (p = 0.021) in women who had preterm delivery (66.7%) in relation to women who delivered in term (29.9%). In this period of gestation the increased number of polymorphonuclears in DMP of vaginal swabs is more common in the women of the study group (75%) than in the women of the control group (43.3%). Preterm delivery was registered in 16.1% women whose microbiological analyses were done in I trimester, 9.9% women in whom microbiological analyses were done in II trimester and in 15.2% pregnant women microbiologically tested in III trimester. Conclusion. Based on the obtained results it could be concluded that bacterial infections of genital tract and period of gestation when infection is diagnosed have influence on reducing perinatal morbidity and mortality caused by preterm delivery. [ABSTRACT FROM AUTHOR]

Introduction. Recent literature data suggest that permanent or reversible hearing loss may occur after general anesthesia. The etiology varies, while hearing loss following middle ear surgery is attributed to exposure to nitrous oxide (N2O). The objective of our study was to measure, using tympanometry, the middle air pressure change caused by nitrous oxide during general anesthesia and to establish its emetogenic effects during the postoperative period. Material and Methods. This academic (non-commercial) prospective study included two groups of patients (a total of 58), with ASA status I, II and III. The study group (n 30) consisted of patients undergoing unilateral ear surgery. In this group, the intratympanic pressure was measured in the unoperated (healthy) ear before and during the surgery. The control group (n 28) patients underwent nose, throat or neck surgical interventions. This group underwent measurement of bilateral intratympanic pressure in healthy ears, before and during the surgery. Both groups were operated under general balanced anesthesia. Pain, nausea and antiemetics were monitored during the first 24 postoperative hours. Statistical analysis was performed using the Mann-Whitney-Wilcoxon test. Results. This perioperative study confirmed the following: highly significant (p<0.001) increase in intratympanic pressure in non-operated ears in the study group and significant (p<0.05) in controls. However, there was no statistical significance (p>0.05) between groups. Pain was more frequent in controls, and nausea in the study group, but without significant difference (p>0.05). Conclusions. Postoperative audiometry findings showed no conductive or sensorineural hearing loss after interventions. Nitrous oxide can be used in general balanced anesthesia with discontinuation 15 to 45 minutes before insertion of the tympanic membrane and completion of middle ear surgery. [ABSTRACT FROM AUTHOR]