Clinical Hospital Center Zemun

Zemun, Serbia

Clinical Hospital Center Zemun

Zemun, Serbia

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Jemcov T.K.,Clinical Hospital Center Zemun | Jemcov T.K.,University of Belgrade | Van Biesen W.,Ghent University
Journal of Vascular Access | Year: 2017

Many guidelines recommend that end-stage renal disease (ESRD) patients should have a permanent vascular access, preferably an autologous arteriovenous fistula (AVF), at the start of renal replacement therapy. Nevertheless, a large proportion of patients still start hemodialysis with a central venous catheter (CVC). On the other hand, there are increasing numbers of patients in whom an AVF has been created, but who never actually end up on dialysis, as well as a substantial number of patients in whom creation of a vascular access has been attempted unsuccessfully. To improve this situation, timely exploration to assess suitability for and creation of preemptive AVF should be promoted. Decision to construct an AVF should depend on the likelihood and rate of progression to ESRD. For this goal, some reliable prediction models are available. Also, the likelihood that such an attempt will result in a successful outcome should be taken into account, but suitable validated models to accurately make such estimates are lacking. Next to patient-specific factors, some local conditions such as easy access to a vascular surgeon should also be incorporated in the decision-making process between the nephrology team and the patient. © 2017 Wichtig Publishing.


Markovic M.,Clinical Hospital Center Zemun | Milenkovic S.,Clinical Hospital Center Zemun | Zivkovic N.,Clinical Hospital Center Zemun
Journal of B.U.ON. | Year: 2013

Purpose: In a series of 78 consecutive patients we analyzed the influence of peritumoral edema (PTE) and angiogenesis (vascular endothelial growth factor/VEGF expression) on the prognosis of morbidity and postoperative complications after intracranial meningioma surgery. Methods: A retrospective analysis was performed of clinical, neuroradiological and histological data of 78 microsurgically treated patients with intracranial supratentorial meningioma, with follow-up period of at least one year. Results: The severity of PTE showed significant correlation with VEGF expression, and all patients with large PTE (>40 mm) had strong VEGF expression (>50%). Treatment outcome was significantly better in patients with low VEGF expression (p<0.05). All of the monitored postoperative complications were more frequent in the group with PTE.The duration of intensive care treatment in the group with PTE (mean 6.85 days) was significantly longer than in the group without PTE (mean 3.68 days) (p=0.003). In the group without PTE, the outcome was significantly better than in patients with PTE (p<0.01). Conclusion: PTE in intracranial meningiomas has significant influence on the prognosis in surgically treated patients in terms of increased risk of morbidity and postoperative complications. VEGF expression is strongly correlated with PTE formation, which also affects the outcome in the management of patients with intracranial meningioma.


Zivkovic M.M.,Clinical Hospital Center Zemun | Stantic T.J.,Ministry of Health | Ciraj-Bjelac O.F.,Vinča Institute of Nuclear Sciences
Nuclear Technology and Radiation Protection | Year: 2010

Mammography is the method of choice for early detection of breast cancer. In Serbia, mammography is performed only clinically, although there is a plan to introduce mammography as a screening method. Currently, there are 60 mammographic units in practice, resulting in 70 000 mammographies annually. The survey was conducted in order to investigate mammographic practice in Serbia, identify weak points and suggest appropriate corrective measures. Basic technical parameters of the X-ray tube and generator, processing, image quality, and patient doses in 20 mammographic units were studied. The survey demonstrated considerable variations in technical parameters that affect image quality, and patients doses. Patient dose levels, in terms of the mean glandular dose, were fairly consistent with current European reference levels: 1.8 (0.40-4.3) mGy. However, due to inappropriate image receptors, image processing and viewing conditions and automatic exposure control adjustment, suboptimal image quality was a common finding. Simple improvements of the radiographic technique and maintenance procedure, along with the rigid implementation of the quality control procedure and training of the operating staff, would improve the performance levels of mammographic practice in Serbia, i. e. result in the production of high quality images with a reasonably low radiation risk to patients.


Background/Aim. It has been observed that a large number of patients with low urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH)) has been treated with a combination of tamsulosin (TAM) + Serenoa repens (SR) (TAM + SR). The aim of this study was to compare a combination TAM + SR with TAM and SR alone, to see if there was any difference in efficacy and tolerance of each in patients with LUTS/BPH. Methods. In this prospective study patients had to have prostate volume (PV) < 50 mL, International Prostate Symptom Score (IPSS) of 7-18, Quality of Life score (QoLs) > 3, a maximal flow rate (Qmax) of 5-15 mL/s, with post voiding residual volume (PVR) < 150 mL and serum prostatic antigen (PSA) < 4 ng/mL. TAM (0.4 mg) was administered once a day, SR (320 mg) daily or SR (320 mg) + TAM (0.4 mg) daily for a median period of 6 months. Results. A total of 297 patients were recruited, whereas 265 patients were fully available: 87 into the group TAM, 97 into the group SR and 81 into the group TAM + SR. There was no statistically significant difference between the treatment groups in the sense of demographic and other baseline parameters. No difference was found among the 3 treatment groups, neither in the major endpoint of the study in the sense of a change between baseline and final evaluation in total IPSS, obstructive and irritative subscores, improvement of QoLs, increase in Qmax, nor for the second endpoint including diminution of PV, PSA and PVR. During the treatment period 20 (23%) of the patients managed with TAM and 17 (21%) with TAM + SR had drug- treated with related adverse reactions. No adverse effect was detected in the group SR. Conclusion. Treatment of BPH by both SR and TAM seems to be efficacious alone. None of them had superiority over another and, additionally, a combined therapy (TAM + SR) does not provide extra benefits. Furthermore, SR is a well-tolerated agent that can be used alternatively in the treatment of LUTS/BPH.


Stojanovich L.,University of Belgrade | Kontic M.,University of Belgrade | Smiljanic D.,Clinical Hospital Center Zemun | Djokovic A.,University of Belgrade | And 2 more authors.
Clinical and Experimental Rheumatology | Year: 2013

Objectives The aim of this study was to investigate the association between non-thrombotic neurological and cardiac manifestations in patients with antiphospholipd syndrome (APS), as well as their connection with type and level of antiphospholipid antibodies. Methods Our prospective study comprises 333 patients: 218 with primary and 115 with secondary APS. Antiphospholipid antibody (aPL) analysis included detection of aCL(IgG/IgM), β2GPI(IgG/IgM) and LA and served to evaluate associations with distinct neurological manifestations. Results The presence of aCL IgG was more common (p=0.001) in SAPS and LA in PAPS patients (p=0.002). High β2GPI IgM levels (>100PLU/ml) were more common in epilepsy (p=0.00001) in PAPS, and in transient ischaemic attack (p=0.029) in SAPS. High β2GPI IgG levels (>100PLU/ml) were more common in epilepsy (p=0.035) in SAPS. Chorea, migraine and epilepsy occurred more often in SAPS and headache and depression in PAPS. We found statistical significance considering the presence of aCL IgG and acute ischaemic encephalopathy in SAPS, aCL IgM and epilepsy in SAPS, aCL IgM and migraine in PAPS, β2GPI IgG and chorea in SAPS and β2GPI IgM and TIA and epilepsy in PAPS. LA was linked to depression, transient global amnaesia and migraine in PAPS. Patients with non-stable angina pectoris were more likely to develop TIA in both PAPS and SAPS, epilepsy and transient global amnaesia in PAPS and acute ischaemic encephalopathy in SAPS. Patients with valve vegetations were more prone to epilepsy and depression. Conclusion Certain aPL type and levels are associated with distinct neurological non-thrombotic manifestation, suggesting their predictive role. There is strong link between some non-thrombotic neurological and cardiac manifestations in APS patients, suggesting the complexity and evolutionary nature of APS. © Clinical and Experimental Rheumatology 2013.


Cvetkovic B.,Clinical Hospital Center Zemun | Vucic V.,University of Belgrade | Cvetkovic Z.,Clinical Hospital Center Zemun | Popovic T.,University of Belgrade | Glibetic M.,University of Belgrade
Medical Oncology | Year: 2012

The relationship between plasma levels of total phospholipids (PL) and/or PL fractions and neoplastic diseases are not fully understood. Therefore, the aim of this study was to analyze concentrations and distribution of plasma phospholipids in patients with prostate cancer (PCa) related to the Gleason score, clinical stage and pathologic grade of prostate cancer. We analyzed plasma phospholipids in 57 newly diagnosed, untreated PCa patients and in 43 age-matched healthy male subjects. Significantly lower (P<0.01) levels of total plasma PL and all PL classes were found in PCa patients when compared with healthy subjects. The relative concentrations of PL fractions were also changed. Further decrease of total PL and PL fractions was found related to an increase of clinical stadium, pathologic grade, and Gleason score, with phosphatidylethanolamine as the most sensitive plasma PL, the level of which significantly decreased even at the first stage of PCa. Our results showed an altered plasma PL profile in PCa patients, which may contribute to monitoring of the disease progression. © Springer Science+Business Media, LLC 2011.


Stankovic I.,Clinical Hospital Center Zemun | Vlahovic-Stipac A.,Clinical Hospital Center Zemun | Putnikovic B.,Clinical Hospital Center Zemun | Cvetkovic Z.,Clinical Hospital Center Zemun | Neskovic A.N.,Clinical Hospital Center Zemun
Clinical Therapeutics | Year: 2010

Background: Simvastatin, a 3-hydroxy-3-methylglutarylcoenzyme A reductase inhibitor, is indicated for the treatment of hypercholesterolemia and plays an important role in both the primary and secondary prevention of cardiovascular disease. Danazol is a steroid analogue approved for the treatment of endometriosis, fibrocystic breast disease, and hereditary angioedema. Despite not being licensed, danazol has been used for other off-label indications, such as idiopathic thrombocytopenic purpura (ITP), paroxysmal nocturnal hemoglobinuria, and aplastic anemia.Objective: We report a case of fatal rhabdomyolysis that occurred after concomitant administration of simvastatin and danazol in a patient with ITP.Case summary: An 80-year-old white male (height, 182 cm; weight, 90 kg) presented to the emergency department of the Clinical Hospital Centre Zemun, Belgrade, Serbia, with head injuries after an accidental fall caused by generalized weakness. He denied other complaints, except fatigue, mild pretibial edema, and progressive bilateral leg pain and cramping that began 7 days before. At the time of presentation, he was receiving aspirin 100 mg/d, clopidogrel 75 mg/d, ramipril 2.5 mg/d, pantoprazole 40 mg/d, danazol 600 mg/d, prednisone 60 mg/d, simvastatin 40 mg/d, and longacting insulin 24 IU/d. After the injuries were treated, he was diagnosed with collapse and nasal contusion, and discharged without any changes in his therapy. Two days after initial presentation, the patient was readmitted to the hospital due to nausea, dark urine, and oliguria. All clinical signs (oliguria, dark urine, muscle pain, and tenderness) and laboratory markers (creatine kinase levels ~100 times the upper limit of normal, along with hyperkalemia, hyperphosphatemia, and hypoalbuminemia) were consistent with severe rhabdomyolysis. Despite intravenous hydration, forced diuresis, and hemodialysis, oliguria persisted and the patient died 6 days after admission. A score of 5 on the Naranjo adverse drug reaction probability scale was consistent with a probable association of rhabdomyolysis and concomitant treatment with simvastatin and danazol in this patient.Conclusions: Statin-induced rhabdomyolysis must be considered whenever muscle or motor symptoms occur, especially when concomitant treatment with known inhibitors of statin metabolism is administered. Patients must be strictly monitored and the statin should be promptly discontinued with the onset of first signs and symptoms of myopathy. Clinicians should be aware of the potentially fatal consequences of both approved and unapproved treatments and be alert for the early detection of toxicity. © 2010 Excerpta Medica Inc.


Lazovic B.,Clinical Hospital Center Zemun
Medicinski arhiv | Year: 2012

Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. Aspergillus species causes a variety of pulmonary diseases such as saphrophyticus (aspergilloma/mycetoma), hypersensitivity reaction (allergic bronhopulmonary), semi- invasive (chronic necrotizing) and angioinvasive aspergillosis. We report a case of pulmonary aspergilloma (PA) in 38 years old patient who was previously healthy with complaints of fever and hemoptysis. PA was diagnosed radiologically and confirmed by serology. Oral itraconazole was administered. The patient responded well to the treatment with improvement in his systemic symptoms and regression of the pulmonary lesions.


Rakonjac N.,Clinical Hospital Center Zemun | Markovic S.,Clinical Hospital Center Zemun
Vojnosanitetski Pregled | Year: 2012

Introduction. Collections of neuroendocrine cells dispersed throughout the body are known as paraganglia and the tumor arising from these paraganglia are known as paragangliomas. Paragangliomas located along side the aorta are associated with the pheochromocytoma and they secrete and store catecholamines. Case report. We reported a 29-year-old woman with episodes of headache, palpitations, dizziness and sweats, associated with hypertension. Elevated urine catecholamines were consistent with pheochromocytoma. Nuclear magnetic resonance (NMR) was performed and the symptoms were caused by associated mediastinal and retroperitoneal paragangliomas. The tumors were surgically removed. In a 3-year follow-up period the patient had two recidivate lesions, one of them was surgically removed, and for the last one a 6- month follow-up was recommended, because urine cathecholamine level was not significantly elevated and blood pressure was normal. Conclusion. Clinical and imaging data of patients with extra adrenal paragangliomas are not specific. Many of them may be asymptomatic even when the lesion is large, but if tumor is functional, diagnosis may be easier. Patients should be initially evaluated by determining catecholamine level, followed by computerized tomography (CT) or NMR to locate the primary lesion. Since there are no definite microscopic criteria for the distinction between benign and malignant tumors, radical excision and prolonged follow-up is necessary.


Lazovic B.,Clinical Hospital Center Zemun
Medicinski pregled | Year: 2013

Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a persistent airflow limitation usually progressive and not fully reversible to treatment. The diagnosis of chronic obstructive pulmonary disease and severity of disease is confirmed by spirometry. Chronic obstructive pulmonary disease produces electrical changes in the heart which shows characteristic electrocardiogram pattern. The aim of this study was to observe and evaluate diagnostic values of electrocardiogram changes in chronic obstructive pulmonary disease patients with no other comorbidity. We analyzed 110 electrocardiogram findings in clinically stable chronic obstructive pulmonary disease patients and evaluated the forced expiratory volume in the first second, ratio of forces expiratory volume in the first second to the fixed vital capacity, chest radiographs and electrocardiogram changes such as p wave height, QRS axis and voltage, right bundle branch block, left bundle branch block, right ventricular hypertrophy, T wave inversion in leads V1-V3, S1S2S3 syndrome, transition zone in praecordial lead and QT interval. We found electrocardiogram changes in 64% patients, while 36% had normal electrocardiogram. The most frequent electrocardiogram changes observed were transition zone (76.36%) low QRS (50%) and p pulmonale (14.54%). Left axis deviation was observed in 27.27% patients. Diagnostic values of electrocardiogram in patients with chronic obstructive pulmonary disease suggest that chronic obstructive pulmonary disease patients should be screened electrocardiographically in addition to other clinical investigations.

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