Medicinska istrazivanja最新文献

{"title":"Ventricular tachycardia and hypertensive crisis induced by routine neuromuscular blockade reversal: A case report and literature review","authors":"Ksenija Jovanovic, Ranko Trailović, P. Mutavdzic, I. Tomic, M. Sladojevic, A. Dimić, M. Dragaš, I. Končar, L. Davidović","doi":"10.5937/medi55-38037","DOIUrl":"https://doi.org/10.5937/medi55-38037","url":null,"abstract":"Introduction: Neuromuscular blockade reversal may provoke cardiovascular events. We present the case of a middle-aged, vascular patient in whom ventricular tachycardia and hypertensive crisis occurred immediately after the initiation of neuromuscular blockade reversal. Patient Review: A 56-year-old man was admitted to our institution for emergency surgical treatment of left extremity ischemia. Besides hypertension, the patient's medical history was negative for any other significant acute or chronic diseases. Routine preoperative analyzes, ECG, and echocardiography showed normal findings. The patient underwent urgent trans popliteal thrombectomy under general endotracheal anesthesia. Immediately following the initiation of neuromuscular blockade reversal, with a diluted mixture of atropine and neostigmine (1 mg/2.5 mg, respectively), ventricular tachycardia and hypertensive crisis developed. Arterial blood gas analyses and electrolyte values were within the reference limits at the moment. Adequate therapeutic measures were undertaken immediately, and sinus rhythm was restored shortly. Later, serial ECG records showed negative T waves in the precordial leads, with an increasing trend of troponin I values (ranging from 0.59 to 5.45 mg/L). Coronary angiography was later performed and revealed a normal coronary angiogram. During the next three days, ischemic ECG alterations showed resolution and the patient was hemodynamically stable. On the fifth postoperative day, the patient was discharged, in good general medical condition. Conclusion: A careful administration of the atropine/neostigmine mixture is advised. Malignant arrhythmias must be recognized and treated promptly by an anesthesiologist, in order to achieve positive treatment outcomes.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122994965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rivaroxaban versus Dabigatran: A new era in venous thromboembolism treatment","authors":"Đ. Radak, Nenad Đukić, Mihailo Nešković, S. Babić, S. Tanasković, P. Popov, P. Gajin","doi":"10.5937/medist1601014r","DOIUrl":"https://doi.org/10.5937/medist1601014r","url":null,"abstract":"Considering the frequency of deep vein thrombosis and pulmonary embolism, the therapy of these two conditions takes an important place in vascular surgery. Among numerous therapeutic options, new oral anticoagulants, such as rivaroxaban or dabigatran, represent a great improvement in the treatment of venous thromboembolism. Searching MEDLINE base until December 1, 2015 using MESH term \"Rivaroxaban versus Dabigatran in VTE\", we found 7 studies investigating the usage of new oral anticoagulants in venous thromboembolism treatment. The total of 18,841 patients was enrolled. No head-to-head studies were found. Benefits such as lower therapy price, oral use and greater comfort for patients and health providers place new oral anticoagulants to the frontline of venous thromboembolism treatment. However, we need head-to-head studies to have a clear picture of these two drugs","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123256756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the epidermal growth factor receptor in thrombin regulated vascular smooth muscle cells proliferation","authors":"K. Smiljanic, I. Resanović, K. Savić, A. Jovanović, S. Zafirovic, M. Obradović, E. Isenovic","doi":"10.5937/medist1301010s","DOIUrl":"https://doi.org/10.5937/medist1301010s","url":null,"abstract":"The common factor in the development of vascular diseases, such as atherosclerosis, hypertension and restenosis, is excessive accumulation and proliferation of vascular smooth muscle cells (VSMC) within inner (intima) layer of vessel wall. Thrombin, a key player in athero-coagulation maze, mediates the regulation of vascular permeability and contraction, migration and proliferation of VSMC, attracting monocytes and a variety of proinflammatory markers in atherosclerotic lesions. Thrombin exerts its effects either directly as serine proteinases and/or via activation of its G proteins coupled receptors (GPCR). It has been shown that thrombin mediates transactivation of epidermal growth factor receptor (EGFR) within the process of VSMC proliferation. EGFR transactivation process through the activation of thrombin protease activated receptor (PAR), includes a matrix metalloproteinase cleavage of membrane ligands precursors such as epidermal growth factor like growth factor that binds heparin (HB-EGF) that binds to the EGFR and activates it, leading to VSMC proliferation via downstream signaling pathways of mitogen activated protein kinase (MAPK). This review article presents review of the new literature data concerning: the role of EGFR activation in mediating the proliferative effect of thrombin in VSMC and understanding of the concept of the triple cascade of EGFR transactivation stimulated by thrombin in the mechanism of VSMC proliferation.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126164885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel facts in pharmacology of endothelial dysfunction","authors":"M. Radenković, M. Stojanović, M. Prostran","doi":"10.5937/medist1502018r","DOIUrl":"https://doi.org/10.5937/medist1502018r","url":null,"abstract":"Homeostasis of different blood vessels is directly linked with physiological and pathological features of morphological and functional integrity of vascular endothelial cells. Vascular endothelium has a central role in the modulation of vascular tone, together with established local antioxidant, anti-inflammatory, profibrinolytic, anti-adhesive and anticoagulant activity. These effects are results of timely production and release of vaso-active autacoids, where nitric oxide, prostacyclin and endothelially-derived hyperpolarizing factor are considered to be crucial for physiological cellular signaling mechanisms. In contrast, endothelial dysfunction is a pathological process, which is known to be correlated with different vascular pathological conditions. It is basically characterized by marked disturbance of the regulation of vascular tone, as a consequence of reduced bio-availability of endothelial relaxing factors and concomitant enhanced production of endothelial contractile factors. Moreover, endothelial cells are affected by oxidative stress and increased inflammatory processes that are all associated with migration of circulating leukocytes in subendothelial space and enhanced pathological proliferation of adjacent smooth muscle cells. Pharmacological approach in improving endothelial dysfunction currently represents a crucial part in different cardiovascular clinical trials. Conventional drugs, including statins, ACE-inhibitors, angiotensin receptor blockers, oral antidiabetic agents or some beta adrenoceptor antgonists, all have clearly established efficacy in improving endothelial function, either via direct or indirect mechanisms of action. Besides, it has been concluded that, under specific conditions, some dietary ingredients, natural products or specific dietary supplements can improve endothelial dysfunction and overall vascular homeostasis. Owing to the fact that endothelial dysfunction was confirmed to be associated with etiology and/or further progression of different vascular disturbances, clinical investigations of novel pharmacological possibilities for improving endothelial dysfunction still represents an up-to-date trend in scientifically-based attempts of discovering a viable therapeutic solutions in treating cardiovascular diseases.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"150 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125769231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of L-Arginine in cardiovascular system","authors":"E. Sudar-Milovanovic, M. Obradović, V. Bajic, Nikola Bogdanović, Đ. Radak, E. Isenovic","doi":"10.5937/medist1501036s","DOIUrl":"https://doi.org/10.5937/medist1501036s","url":null,"abstract":"The essential amino acid, L-Arginine (L-Arg) has an important role in the cardiovascular system. Literature data show that L-Arg is the only substrate for the production of nitric oxide (NO), from which L-Arg develops its effects on the cardiovascular system. As a free radical, NO is synthesized in all mammal cells by L-Arg with the activity of NO synthase (NOS). In the states of hypertension, diabetes, hypercholesterolemia and vascular inflammation, a disorder occurs in the metabolic pathway of the synthesis of NO from L-Arg which all together bring alterations to blood vessels. Clinical studies show that L-Arg has an effect on thrombocytes, the process of coagulation and the fibrolytic system. All the new data summarized in this review suggest that L-Arg could be one of important therapeutic molecules for improving cardiovascular disorders.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124580874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The analysis of influence of tumor localization on late diagnosis and treatment in patients with skin melanoma","authors":"D. Lukic, P. Lazić, Jadran Milos Bandic, Đ. Radak, N. Babić, D. Ivić","doi":"10.5937/medist1301045l","DOIUrl":"https://doi.org/10.5937/medist1301045l","url":null,"abstract":"With the prospective study, from June 2004 to June 2012, were compared the results of the influence of tumor position on late diagnosis and treatment of skin melanoma. Respondents were classified according to clinical appearance in 2 equal groups. The first group, group A (32 respondents) consisted of respondents that underwent radical wide excision of the primary tumor at an early stage of the disease. In the second group, group B (32 respondents) were classified respondents with melanoma that underwent radical excision of melanoma at a later stage of the disease. The aim of this study was to analyze the influence of tumor localization on late diagnosis and treatment of skin melanoma. In 25 respondents (78.1%) who were operated at an early stage, melanoma was located on the face, chest, abdomen and extremities, while in 7 (21.9%) respondents, melanoma was localized on the back. In the group of late operated respondents, melanoma was positioned on the face, chest, abdomen and extremities in 9 (28.1%) respondents, while in 23 (71.9%) respondents, tumor was localized on the back. It has been shown that tumor localization essentially determines the time of visits of respondents for examination. Melanoma on the back remains unnoticed for a long time, i.e. unrecognized changes in lesions compared to lesions of other anatomical regions, which is probably the reason for the bigger waste of time and late diagnosis. Respondents in group B consulted the doctor 4-5 months later, because of melanoma position than the group A, which is proved to be statistically significant. There was found a statistically significant difference in terms of recurrence of the disease. Relapse was observed in group B 3 times higher than in group A. Localization of melanoma significantly affects the outcome of the treatment of the disease. There was a statistically significant difference in survival of respondents in groups, because the mortality rate in group B was almost three times higher.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124625501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual case of combined laryngocele presenting as cervical swelling","authors":"Anđelina Jovanović, S. Valjarević, M. Jovanovic","doi":"10.5937/medi55-40512","DOIUrl":"https://doi.org/10.5937/medi55-40512","url":null,"abstract":"Laryngocele is a sac-like, pathological enlargement of the Morgagni's ventricle, which occurs between the true and false vocal cords. This change is filled with air and is continuous with the lumen of the larynx. It is usually asymptomatic and is accidentally detected during radiological diagnostics. We present the case of a 54-year-old patient who came for examination due to a painless swelling in her neck on the left side, which lasted for 8 months and increased upon Valsalva's maneuver. Occasionally the patient was hoarse. By clinical otorhinolaryngological examination and computed tomography of the neck and larynx, we found a cystic formation, filled with air, which extended above the larynx and spread to the side of the neck.The laryngocele was surgically removed using an external cervical approach. The neck of the laryngocele is sent through the thyroid membrane, while preserving the upper laryngeal nerve and the accompanying vascular stalk. Pathohistological examination revealed that the laryngocele consisted of respiratory layered cylindrical epithelium. Laryngocele should be taken into account in differential diagnosis of neck swelling.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124875096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of radicality surgical excision on results in the treatment of Basocellular Skin Carcinoma (BCC)","authors":"D. Lukic, P. Lazić, Jadran Milos Bandic, Z. Tačević, N. Babić, D. Ivić","doi":"10.5937/medist1301039l","DOIUrl":"https://doi.org/10.5937/medist1301039l","url":null,"abstract":"With the prospective study, from June 2003 to January 2013, were compared the results of treatment of basocellular carcinomas (BCC) of the skin in 210 respondents. The respondents were divided into 3 groups. The first group, group A (61 respondents) consisted of respondents treated for BCC with surgical excision, with distance incision of 1 cm from the tumor. In the second group, group B (79 respondents) were classified respondents treated for BCC with surgical excision, at distance incision 2 cm from the tumor, while the third group, group C (70 respondents) was classified by respondents treated with surgical excision of BCC, at distance incision approximately 3cm from the tumor. The parameters for comparison of treatment results were: the method (radicality) of treatment, number of the relapse, elapsed time from surgery to relapse and subsequent disfiguration. The aim of this study was to determine the optimal radicality in the treatment of BCC, i.e., the number of relapses in relation to the radicalism of the BCC excisions. In most of the respondents, intraoperative skin defect was closed by direct suture. Spare distance, from the edge of the BCC, which amounts to 1 cm in group A, results in significantly lower percentage of disfigurement. At the same time, in group A was recorded the highest number of recurrences of BCC. Radical surgeries of BCC, which were performed with the resection margin of 3 cm from the BCC, resulted in the lowest number of relapses, but statistically significant percentage of postoperative disfigurement. The most optimal excisional distance from the edge of the BCC is about 2 cm. Due to the significantly smaller number of disfigurement, resections distance of 2 cm from the BCC and direct suture of postoperative defect take precedence, regardless of the localization of the tumor.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131115786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic management of patients with adrenal incidentaloma","authors":"Danica Bajčetić, S. Tanasković, V. Sotirović, Marija Jovanovic, P. Jovanovic, P. Popov, D. Nenezić, Biljana Despotović, Đ. Radak","doi":"10.5937/medist1501047b","DOIUrl":"https://doi.org/10.5937/medist1501047b","url":null,"abstract":"Routine and frequent use of computerized tomography (CT) angiography in vascular disease detection has led to frequent suprarenal gland abnormal findings that could, if undiagnosed, significantly complicate the course of the future treatment. The term adrenal incidentaloma refers to adrenal lesion discovered serendipitously during an imaging investigation. Adrenal incidentalomas do not constitute a single pathological entity. Major concerns are risks of malignancy and autonomous hormone secretion. The majority of all adrenal incidentalomas (approximately 79%) are nonfunctioning benign lesions. Among functioning lesions subclinical cortisol excess is most frequently found. All patients with adrenal incidentaloma should undergo clinical, biochemical, and imaging evaluation for malignancy and hormone production. In this review, we discuss the current issues in diagnostic and therapeutic management of patients with adrenal incidentaloma. Follow-up of patients with adrenal incidentalomas involves the assessment of growth and development of hormonal function. After this review analysis several useful protocols could be designed to help vascular surgeons to adequately treat patients with concomitant vascular disease and adrenal incidentaloma.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121333865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mutaf one-stage technique for congenital constriction rings: Safe and effective","authors":"A. Vlahović, Mila Živković, N. Begović, I. Dizdarević, Nataša Vlahović","doi":"10.5937/medi56-41165","DOIUrl":"https://doi.org/10.5937/medi56-41165","url":null,"abstract":"Introduction: Congenital constriction ring is a rare congenital malformation that especially affects the limbs. It is associated with fibrous bands that could encircle, strangle, or amputate some parts of the fetus. However, there are only a few techniques described for the correction of this anomaly. We aim to present a successful treatment of congenital constriction ring by means of the one-stage Mutaf technique. Patient Review: In our report, we presented two infants with congenital constriction rings. In the first case, we presented an infant with a constriction band on the right arm accompanied by deformity of the distal part and lymphoedema. In the second case, we presented an infant with multiple constriction bands on the distal part of the right leg with clubfeet and severe lymphoedema. They were both treated by the one-stage Mutaf technique using rectangular dermofat grafts to fill the groove. Using this technique we obtained a normal limb contour, with no oedema or neurovascular compromise. Filling the groove with the rectangular dermofat flaps parallel to the relaxed skin tension lines provides a better scar in comparison with multiple Zor W-plastics techniques. Additionally, advantages of the one-stage procedure are reduction of surgical and psychological trauma in patients and their parents, less time spent under general anesthesia and lower amount of anesthetic the patient receives, and lower treatment costs. Conclusion: We find the Mutaf technique to be an effective and safe technique for the treatment of congenital constriction rings.","PeriodicalId":167411,"journal":{"name":"Medicinska istrazivanja","volume":"398 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116501862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}