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Banja Luka, Bosnia and Herzegovina

Kovacevic P.,Medical School Banja Luka | Kovacevic P.,Medical Intensive Care Unit | Dragic S.,Medical Intensive Care Unit | Rajkovaca Z.,Medical School Banja Luka | And 2 more authors.
Renal Failure | Year: 2014

End-stage renal disease (ESRD) and its treatment modules affect almost all organs and organ systems including vascular endothelium. It is well known that disturbance of vasoactive substances (nitric oxide-NO and endothelin-1-ET-1) production appears in these patients. There is a small number of studies which investigated serum levels of NO and ET-1 in ESRD patients treated with continuous ambulatory peritoneal dialysis (CAPD). Therefore our study aimed to measure serum levels of NO and ET-1 in this population. This study included 23 ESRD patients (10 males and 13 females) treated with CAPD, mean age 55.8 ± 15.8 years. Mean duration of CAPD treatment in this group of patients was 3.4 ± 14.7 years. Besides this group of patients (CAPD), we included a second group which consisted of 30 healthy controls [14 males, 16 females, mean age 51.8 (±15.6) years]. Our results show significantly higher serum levels of NO in CAPD patients ( ± SD = 19.09 ± 6.9) in comparison to the control group ( ± SD = 9.5 ± 1.9) (p < 0.05). There was no significant difference in serum levels of ET-1 between CAPD patients ( ± SD = 7.3 ± 5.6) and the control group ( ± SD = 6.6 ± 4.2), (p > 0.05). From our results, we concluded that imbalance in production of vasoactive substances is present in CAPD patients. This imbalance can lead to disturbance in local blood flow control. These pathophysiological mechanisms can cause significant hemodynamic disturbance (hypertension) and atherosclerosis. © 2014 Informa Healthcare USA, Inc. Source

Grubor P.,Clinical Center Banja Luka
Medicinski arhiv | Year: 2012

Developmental hip disorder (DHD) is a disorder in development of the acetabulum which remains abrupt (dysplasia) and probably consequential cranialisation of the femur head (luxation). The aim of this paper is to establish the total number of DHD and its subtypes at the first clinical and ultrasound exam of newborns in a retrospective-prospective study made in the period from 1st Jan 2006 through to 31 Dec 2010 at the Clinic for orthopaedics and traumatology in Banja Luka. In total 6132 patients were examined and 99 cases diagnosed with DHD (dysplasia and luxation). Ultrasonic exam was done by means of electronic probe of 5-12 MHz according to standard method after Graph. Girls were significantly more present (96%). Positive family anamnesis on DHD was present with 7.8% examinee, mainly with primiparas, and/ or with 77.8% children with DHD. Dominant intrauterine risk factors for DHD were: mal position of foetus in uterus (78.6%), oligoamnion (17.9%), malformation of the spinal column of the pregnant woman (3.6%), whereas with 38.4% of children with a certain form of DHD the following were found: breech presentation, caesarean section or twin pregnancy. The clinical exam indicated DHD with 8.87% examinee, out of which hip looseness was found with 5% examinees. Ultrasonic finding was positive with 99 examinee, that is with 1.61% of them (deficient and badly formed acetabulum, sleeked protrusion; 8 luxations and 91 dysplasia). Prophylactic measures were requested by 58.6% children (abductive bending and exercises), whereas 41.4 % needed non-intervention therapeutic measures (traction, Pavlik's straps, Graph's knickers, plastering), after which there were no children needing surgical correction of DHD. These data indicate that clinical exam is unreliable for DHD diagnostics, and that Ultrasonic diagnostics and treatment of DHD should start as early as possible applying atraumatic helping devices and procedures in the period when all structures are elastic, flexible and adaptable. Source

Grubor P.,Clinical Center Banja Luka
Medicinski arhiv | Year: 2011

The pelvis is the central part of the body that receives the weight from the vertebral column and transfers it to the lower extremities. It protects the internal organs with its specific structure and shape. The study aims to compare the clinical outcomes of emergency non-surgical and surgical treatment of such patients, to analyze the types and severity of complications and final functional outcome. We present a series of 47 patients treated in the period between 1999 and 2009 at the Traumatology Clinic, CHC Banja Luka. According to Marvin Tile's classification, fractures were distributed as follows: Type A fractures occurred in 19 patients (40.6%), Type B in 18 (38.1%) and Type C in 10 (21.3%). 30 patients (63.8%) were polytraumatised, with craniocerebral injuries in 12 patients (25.5%), chest cavity injuries in 5 (10.6%) and abdominal organ injuries in 13 patients (27.6%). 27 patients (57.4%) had clinical and laboratory signs of hemorrhagic shock on admission, while 26 patients (56.2%) received conservative treatment and 21 patients (43.8%) were treated using surgical methods of stabilization of the pelvic ring. The analysis of the outcomes of treating pelvic ring fractures in our series of patients by using radiography (x-rays according to Slatis) showed that out of 47 treated patients, the outcomes were excellent in 28 (60%), good in 7 (15%), fair in 5 (12%) and poor in 7 (14%). The functional outcomes in all patients were evaluated according to the D'Aubigne-Postel scale, on average 18 months after the trauma. The outcomes were excellent in 22 patients (45%), good in 15 (31%), fair in 4 (9%) and poor in 6 (14%). The chi-square test showed that there was no significant statistical difference between the outcomes monitored using x-rays and functional outcomes monitored using the D'Aubigne-Postel scale (p = 0.097). The surgical treatment efficiency coefficient was introduced for the purpose of comparative evaluation of treatment outcomes. The surgical treatment efficiency coefficient, compared with conservative treatment, showed that all evaluated parameters were between 1.56 and 16.33 times lower in surgical treatment, which represents the more favorable outcome. We can conclude that conservative treatment is the treatment of choice for Tile's Type A fractures, external fixator for treating Type B fractures (including all subtypes), and internal fixation, as mono therapy or in combination with external fixator, for treating Type C2 and Type C3 fractures. Surgical treatment, compared with conservative treatment, allows faster mobilisation of the patient and it shortens the recovery period, which in turn lowers the total treatment costs. Source

Spiric S.,Clinical Center Banja Luka
Medicinski pregled | Year: 2011

Transient-evoked otoacoustic emissions are transmitted through the middle ear. The purpose of this study was to investigate the effects of dynamic properties of the transmission system on the measurability of transient otoacoustic emissions. The authors analyzed the presence of transient otoacoustic emissions in 48 children with serous otitis media regarding the tympanogram, presence and type of effusion and pure tone average findings. The results obtained in this research show the predominant absence of transient otoacoustic emissions in patients with type B tympanogram (69.1%) especially if the effusion is mucoid (77.5%) with the hearing loss of 15 decibel hearing level. This research shows that disorders in dynamic characteristics of the middle ear in patients with serous otitis obstruct the transmission of acoustic energy and affect the measurability of transient otoacoustic emissions, especially if the effusion is mucoid and hearing loss of 15 decibel hearing level. Source

Algaithy Z.K.,Italian National Cancer Institute | Algaithy Z.K.,King Abdulaziz University | Petit J.Y.,Italian National Cancer Institute | Lohsiriwat V.,Italian National Cancer Institute | And 10 more authors.
European Journal of Surgical Oncology | Year: 2012

Background: Nipple sparing mastectomy (NSM) is an accepted surgical approach in selected breast cancer and prophylactic mastectomy, nevertheless post-mastectomy skin necrosis is one of the frequent complications. This study aimed to analyze the factors that may lead to skin necrosis after NSM. Patients and methods: From May 2010 to July 2010, we prospectively registered 50 consecutive NSM from 45 patients. There were 40 mastectomies for cancer, and 10 prophylactic mastectomies. The various patient's and surgical factors were registered during pre-, intra- and postoperative period. Results: No total necrosis of the nipple areola complex (NAC) was observed. There were thirteen cases with partial necrosis (26.0%) of the areola or the adjacent skin. All these necrosis were partial both for the surface and the thickness. Surgical debridement was performed in 9 (18.0%) cases. The significant risk factors are smoking, young age, type of incision and NAC involvement with areola flap thickness less than 5 mm. Conclusion: NSM should be done with high caution in smokers. Young patients, periareolar incision and superior circumareolar incision have also a higher risk of necrosis. We recommend keeping areolar flap thickness more than 5 mm in areola region. © 2011 Elsevier Ltd. All rights reserved. Source

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