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Background: Pretreatment differentiation between glioblastoma and metastasis is a frequently encountered dilemma in neurosurgical practice. Distinction is required for precise planning of resection or radiotherapy, and also for defining further diagnostic procedures. Morphology and spectroscopy imaging features are not specific and frequently overlap. This limitation of magnetic resonance imaging and magnetic resonance spectroscopy was the reason to initiate this study. The aim of the present study was to determine whether the dataset of diffusion tensor imaging metrics contains information which may be used for the distinction between primary and secondary intra-axial neoplasms. Methods: Two diffusion tensor imaging parameters were measured in 81 patients with an expansive, ring-enhancing, intra-axial lesion on standard magnetic resonance imaging (1.5 T system). All tumors were histologically verified glioblastoma or secondary deposit. For qualitative analysis, two regions of interest were defined: intratumoral and immediate peritumoral region (locations 1 and 2, respectively). Fractional anisotropy and mean difusivity values of both groups were compared. Additional test was performed to determine if there was a significant difference in mean values between two locations. Results: A statistically significant difference was found in fractional anisotropy values among two locations, with decreasing values in the direction of neoplastic infiltration, although such difference was not observed in fractional anisotropy values in the group with secondary tumors. Mean difusivity values did not appear helpful in differentiation between these two entities. In both groups there was no significant difference in mean difusivity values, neither in intratumoral nor in peritumoral location. Conclusion: The results of our study justify associating the diffusion tensor imaging technique to conventional morphologic magnetic resonance imaging as an additional diagnostic tool for the distinction between primary and secondary intra-axial lesions. Quantitative analysis of diffusion tensor imaging metric, in particular measurement of fractional anisotropy in peritumoral edema facilitates accurate diagnosis.

Background/Aim. Although considered rare, gliomas cause morbidity and mortality disproportionate to their incidence. The aim of the study was to determine whether pre and post-therapeutic metric values, derived from the FDG PET/CT maximal standardized uptake value (SU-Vmax) and calculated ratios between tumor and normal brain tissue, may provide a predictive/prognostic biomarker information in estimating overall survival of glioblastoma patients. Methods. In 26 out of 31 patients with glioblastoma treated with standard Stupp protocol after maximal safe reductive surgery, we performed a baseline 18F-FDG PET/CT examination before commencing combined and concomitant chemotherapy/radiotherapy (pre-therapy FDG PET/CT) and a second examination three months after the therapy completion (post-therapy FDG PET/CT). Two-graded SUVmax values and a calculated ratio of uptake in tumor-to-normal-tissue (T/N ratio) value, divided into two grades by the calculated cut-off value, were measured in all patients at both pre- and post-therapy FDG PET/CT studies. Data sets were statistically analyzed by the Kaplan-Meier survival test and Log-rank was calculated, with the level of confidence determined at p < 0.05. Results. Pre-therapy FDG PET/CT two-grade T/N ratio value and both pre-and post-therapy FDG PET/CT derived two-grade SUVmax values had a strong predictive impact on overall survival of glioblastoma patients. Conclusion. Based on two-grade SUVmax and T/N ratio values assessment, FDG PET/CT could provide valuable predictive survival information in glioblastoma patients and serve as a selection tool for identifying patients at higher risk from worse outcomes and shorter survival time.

Introduction. Joubert syndrome (JS) and related disorders (JSRD) are a group of rare multiple congenital anomalies syndromes, defined by complex midbrain-hindbrain malformation that creates the “molar tooth sign” (MTS) on brain imaging and may be associated with multisystem organ pathology, mainly of the retina, kidney, liver and skeleton. Prenatal diagnosis of JSRD has proved difficult because of the rarity of the condition and low sensitivity of ultrasound in evaluation of the fetal posterior fossa (PF) in most affected fetuses. Case report. We presented an unusual case of JSRD, pure Joubert syndrome with unilateral frontal polymicrogyria and supratentorial white matter microcysts, diagnosed by magnetic resonance imaging (MRI), in fetus aged 30 gestational weeks. The distinctive MRI features of this rare ciliopathy were confirmed by 6-months postnatal MRI study. The postnatal outcome was poor; clinical follow- up in the first 6 months of life confirmed hypotonia, developmental delay, oculomotor apraxia and seizures. Conclusion. To the best of our knowledge, fetal MRI features of the coexistence of pure JS and supratentorial abnormalities leading to postnatal cerebellar dysfunction and epilepsy, have never been reported before. Presented case may contribute to the broadening of the spectrum of sparse prenatal features of JRSD, and support the stand that presence of neuronal migration abnormalities can affect the clinical outcome and prognosis of fetuses with JSRD.

In the modern ages of rapid technological and computational advances, development of numerous novel diagnostic imaging techniques have enabled not only visual detection of disease processes, but also provided the tools to achieve quantified functional, structural, dynamic, metabolic, and molecular information. A pathway toward the quantitative imaging by use of quantitative imaging biomarkers analysis has been widely opened, enabling further development of radiomics, radiogenomics, and radioproteinomics analysis in addition, and initiating the dawn of theranostics, eventually bringing the wishful personalised medicine concept closer to reality.

Introduction: Although they represent an important mediator between patients and National Pharmacovigilance Centre, pharmacists still don't participate enough in system of reporting adverse drug reactions (ADR). By reporting ADR both quality of therapy and quality of patient's life are improving, and pharmaceutical industry is also encouraged to invent and produce new formulations which will be better beared and whose use will significantly improve risk-benefi t ratio. Aim: The aim of this work is that by collecting information about ADRs, based on direct contact of a pharmacist and patients, explain and improve the role of a pharmacist in pharmacovigilance system. Subjects and Methods: Information about adverse reactions were being collected in three private pharmacies in Inđija and in one private pharmacy in Sombor. In period from 20.12.2017.-10.01.2018. pharmacists collected data about adverse reactions of medicines. In period from 11.01.-01.02.2018. patients were additionally informed about unexpected and adverse drug reactions. The standard form for reporting an adverse reaction, which was taken from the site of Medicines and Medical Devices Agency of Serbia (ALIMS), was fi lled for each reported case and sent to National Pharmacovigilance Center (NPC). Suspect drugs were classified in categories according to Anatomical-Therapeutic-Chemical classification (ATC). Results: In first period, there were 19 reported reactions. After additional information given to patients, there were 33 reported adverse reactions. The most numerous adverse drug reactions were reported for the group of cardiovascular drugs (32.7%), the group of anti-infective drugs with systemic effects (15.4%) and for group of drugs which affect nervous system (13.5%). After analyzing reported reactions, according to NPC all of reactions were expected (52), but 3 of them fulfilled criteria of seriousness. Conclusions: Thanks to additional information and direct communication between a pharmacist and patients, reporting unexpected and adverse drug reactions is significantly improving.

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Globalization, competition, development of the Internet, strengthening of the role of consumers in the global market, technology development and consumer homogenization contributed to a situation in which national markets have become tight. This is why many companies expand their business activities by finding new markets, which are becoming an important factor in their future growth and development. The rapid globalization processes, economic and political integration, the development of modern technologies and new ways of communication have opened the possibility of the development of small and medium-sized enterprises (SMEs) which constitute an integral sector of all economies and present a major contribution to economic development, in terms of both flexible entrepreneurial ideas and employment. Small and medium-sized enterprises promote private ownership and entrepreneurial skills, and in developed countries they represent the 'engine of economic development', whereas their propelling impact in countries in transition is still insufficient. The comparative advantage of these companies is that they can relatively quickly adapt to changes and meet the requirements of the market. This paper emphasizes the fact that the experiences of developed as well as developing countries indicate that proportional development of companies of all sizes and their integration into the main stream of international economy through the process of internationalization, should all lead to a stable and steady development of economy as the ultimate goal.

Spa tourism in Serbia has a considerable tourist potential. Today there is a strong competition on the tourist market, particularly among destinations in spa tourism. Competitiveness of any tourist destination, in particular a spa tourism desti¬nation, greatly depends on key attributes of tourism supply. This paper includes the result of a study which was carried out in order to improve tourists' perception of the importance of the attributes of tourism supply in Vrnjacka Banja. By reviewing the literature, attributes were extracted and grouped into factors in order to decide which groups had the greatest importance in the minds of spa tourists. There were six factors in total. After that and based on t-test, a statistically significant difference between the tourists who plan to visit Vrnjacka Banja again and to recommend this tourist destina¬tion and those who do not was determined according to their attitudes towards these factors. Finally, using ANOVA test, the study proves a statistically significant differ¬ence related to the attributes depending on how long the tourists stayed in Vrnjacka Banja. By recognizing the key attributes of a spa tourist destination in the spa tourists' perception, organizations and individuals who are responsible for the development of tourism will be able to form a supply which suits tourists' needs best, while achieving a high-level competitiveness on the tourist market at the same time.

Introduction. Extraction of impacted mandibular third molars is often accompanied by intraoperative and postoperative complications such as damage of the inferior alveolar nerve, prolonged difficulty in mouth opening, alveolitis, pain and swelling in the region of surgery. The aim of this study was to compare two surgical techniques (standard and piezo) in the extraction of mandibular third molars and to assess their postoperative complications. Material and Methods. Study included 16 patients (8 male and 8 female) age 17 to 32 years treated in the period from 2012 to 2014. All patients had both mandibular molars impacted. One third molar was extracted using classical technique while the other one using a piezo device. Preoperative preparation was the same for all patients and included radiological analysis and verification of teeth by ortopan tomography (OPG) and CT. Patients were assessed one, seven and 14 days after the procedure. Results. After the extraction, all patients were followed for postoperative symptoms: pain, swelling and paresthesia of the inferior alveolar nerve. The results confirmed advantages of piezosurgery in the removal of impacted mandibular third molars. Average duration of the intervention was 18 minutes with standard technique while the duration with piezo technique was 23 minutes. According to the visual-analog scale (VAS) the average pain in the standard group was 9 whereas in the piezo group it was 6. Postoperative swelling was 10 mm (pronounced) the first day after the procedure in the standard group while in the piezo group it was 6 mm (moderate). Conclusion. The use of piezo technology for the extraction of impacted wisdom teeth is reliable method which reduces the risk of the most common postoperative complications following mandibular wisdom teeth removal.

Beckground/Aim. Cerebrovascular diseases are the third leading cause of mortality in the world, following malignant and cardiovascular diseases. Therefore, their timely and precise diagnostics is of great importance. The aim of this study was to compare duplex scan Color Doppler ultrasonography (CDU) with multislice computed tomography angiography (MSCTA) in detection of morphological and functional disorders at extracranial level of carotid arteries. Methods. The study included 75 patients with 150 carotid arteries examined in the period from January 2008 to April 2009. The patients were firstly examined by CDU, then MSCTA, followed by the surgery of extracranial segment of carotid arteries. In 10 patients, the obtained material was referred for histopathological (HP) examination. We used both CDU and MSCT in the analysis of: plaque surface, plaque structure, degree of stenosis, and the presence of intraplaque hemorrhage. Results. The results obtained by CDU and MSCTA were first compared between themselves, and then to intraoperative findings. Retrospective analysis showed that MSCTA is more sensitive than CDU in assessment of plaque surface (for smooth plaques CDU 89% : MSCTA 97%; for plaques with irregular surface CDU 75% : MSCTA 87%; for ulcerations CDU 54% : MSCTA 87%). Regarding determination of plaque structure (mixed plaque CDU 66% : MSCTA 70%; correlation with HP findings CDU 94% : MSCTA 96%) and localization (CDU 63% : MSCTA 65%), and in terms of sensitivity and specificity, both methods showed almost the same results. Also, there is no statistical difference between these two methods for the degree of stenosis (CDU 96% : MSCTA 98%). Conclusion. Atherosclerotic disease of extracranial part of carotid arteries primarily affects population of middle-aged and elderly, showing more associated risk factors. Sensitivity and specificity of CDU and MSCTA regarding plaque composition, the degree of stenosis and plaque localization are almost the same. These results and the fact that there are no adverse effects (high radiation dose) compared to MSCTA indicate that CDU should be the initial method in diagnostic algorythm for carotid arteries.

Introduction. New methods for studying brain functions have provided the new insights into human brain. It is really possible to study a cortical adaptation in adults who have sustained injury. We reported cortical changes in a left frontal low-grade glioma patient during disease progression and after reoperation by functional magnetic resonance imaging (fMRI). Case report. The use of fMRI exams for localisation of eloquent motor and language areas were performed three times in a period of 15 months: seven years after initial tumor resection, eleven months later and three months after the reoperation. The first fMRI demonstrated cortical activation for motor tasks in the expected location of primary motor area while later examinations showed activations of both primary motor areas for right hand movement. The first exam language evaluation showed the left hemisphere dominance for both language tasks, while the second fMRI demonstrated the right hemisphere dominance for complex word generation task, but the left hemisphere remained dominant in simple language task. After the reoperation, language mapping revealed the left hemisphere dominance for both language tasks. Conclusion. fMRI evaluation of cortical changes in low-grade glioma patients may additionally optimize and individualize neurosurgical treatment.

Background/Aim. Bone scintigraphy is well-known method for the detection of neoplastic lesions with a high sensitivity and, at the same time, a lower specificity. On the other hand magnetic resonance imaging (MRI) is previously established noninvasive imaging method regarding its diagnostic specificity. The aim of this study was to determine the possibilities and to correlate two different diagnostic methods - bone scintigraphy and MRI in the detection of bone metastasis in the spine and pelvic bones. Methods. A total of 123 patients who underwent both bone scintigraphy and spine and pelvic MRI on 1.5 T MR imager were enrolled in this study. Scans were subsequently analyzed in total and divided in regions of interest (cervical, upper, middle and lower thoracic, upper and lower lumbar and pelvic region, which includes sacral spinal segment); afterwards the total number of 585 matching regions were compared and statistically analyzed. Results. The statistical analysis demonstrated significant correlation between the findings of both methods in total. Divided by regions of interest, significant degrees of correlation were demonstrated in all of them, except in the cervical spine region where the r-value was in the range of low correlation. Conclusion. Having a high mutual correlation, bone scintigraphy and MRI are to be considered as the complementary diagnostic methods in the detection of bone metastases. Still, increased diagnostic potential of MRI may highlights negative bone scintigraphy findings in the patients with solitary metastatic lesions or diffuse vertebral infiltration. Advances in the bone scintigraphy (single photon emission tomography - SPECT, SPECTcomputed tomography - SPECT-CT) and MRI (whole body MRI, diffusion MRI), make it possible the diagnostic potential of both methods will result in a further improvement in bone metastasis detection.

Background/Aim. A vast majority of current radiogical techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI) have great potential of visualization and delineation of cerebrospinal fluid spaces morphology within cerebral aqueduct. The aim of this study was to determine the possibilities of two differently acquired FISP (Fast Imaging with Steady State Precession) 2D MR sequences in the estimation of the pulsatile cerebrospinal fluid (CSF) flow intensity through the normal cerebral aqueduct. Methods. Sixty eight volunteers underwent brain MRI on 1.5T MR imager with additionally performed ECG retrospectively gated FISP 2D sequences (first one, as the part of the standard software package, with following technical parameters: TR 40, TE 12, FA 17, Matrix: 192 × 256, Acq 1, and the second one, experimentally developed by our investigation team: TR 30, TE 12, FA 70, Matrix: 192 × 256, Acq 1) respectively at two fixed slice positions - midsagittal and perpendicular to cerebral aqueduct, displayed and evaluated by multiplegated images in a closed-loop cinematographic (CINE) format. Results. Normal brain morphology with preserved patency of the cerebral aqueduct in all of 68 healthy volunteers was demonstrated on MRI examination. Cerebrospinal fluid flow within the cerebral aqueduct was distinguishable on both CINE MRI studies in midsagittal plane, but the estimation of intraaqueductal CSF flow in perpendicular plane was possible on CINE MRI studies acquired with experimentally improved FISP 2D (TR 30, FA 70) sequence only. Conclusion. Due to the changes of technical parameters CINE MRI study acquired with FISP 2D (TR 30, FA 70) in perpendicular plane demonstrated significantly higher capability in the estimation of the CSF pulsation intensity within the cerebral aqueduct. .

Large bone defects in the jaws can occur as a result of previous trauma, tumor or bone destruction caused by infection. Significant loss of bone volume also may be caused by premature loss of teeth, application of inadequate extraction technique, periodontitis or trauma caused by incorrect prosthetic reconstruction. Very few of these defects are treated using materials for bone augmentation or regeneration in order to preserve the total volume of bone. Depending on the size of a defect, spontaneous bone regeneration of untreated defects is limited by proliferation of surrounding soft tissue. Bone replacement by connective tissue leads to loss of stability, reduces function and disturbs anatomical form of the jaws. The aim of the study was to present a case from clinical praxis which demonstrates bone regeneration provided by bone substitute or its combination with bone grafts.

Introduction. An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from traumatic injury or may occur as congenital abnormality. Stent graft repair through arteriovenous fistula could lead to complications. Case report. Endovascular stent graft repair in a 23-year-old patient with posttraumatic superficial femoral arteriovenous fistula was performed to cover a fistula. During the procedure the device migrated through the fistula into the femoral vein. Due to eventual risk of migration to the heart, a prompt decision was made to fix the stent graft with three puncture needles in the common femoral vein region under fluoroscopy guidance. The vascular surgeon was called to perform open surgery. Conclusions. The presented way of treating this rare complication in an extreme and uncommon situation is very efficient, safe and inexpensive.

Introduction. Foetal tumours are relatively rare; prenatal diagnosis enables additional diagnostics, and thus the decision on the continuation of pregnancy and planning of delivery. The paper presents prenatal ultrasound diagnostics of foetal head tumour with additionally analyzed magnetic resonance imaging (MRI). Case Outline. On ultrasound imaging, in a 27-year old nullipara, a tumour of the foetal head was suspected at the 22nd gestational week. By consultative ultrasound, a 45x41x50 mm echogenic soft tissue tumour with hypoechogenic areas was confirmed, which originated from the left side of the skull spreading towards the neck on the left behind the ear. On colour Doppler no vascularisation was seen within the tumour but several vessels were seen along the border-line and on the surface. The scan showed no associated abnormalities. Karyotype was 46, XY. MRI scan using triplanar SSFSE and HASTE sequences was done at 26 weeks and confirmed a 84Č45Č71 mm tumour originating from the scalp, spreading along the endocranium over the entire surface of the fronto-temporal sqama and left parietal bone. The tumour did not disturb the integrity of the internal tabula, and did not spread intracranially. Based on these findings, the diagnosis of haemangioma was made. At 38 weeks gestation, a 3810 g male infant was delivered by Caesarean section. A bluish, well-defined, non-pulsatile tumour arising from the left frontoparietal region was seen, thus confirming the diagnosis of haemangioma. Conclusion. MRI improved delineation of the tumour facilitating better planning of postnatal management and mode of delivery, with the information on the postnatal course and prognosis. In the prenatal period, MRI following an ultrasound diagnosed foetal tumour, is an additional part of diagnostic examinations, and is not contraindicated during pregnancy.