Clinical Hospital

Zemun, Serbia

Clinical Hospital

Zemun, Serbia

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Neymark M.I.,Altai State Medical University | Kiselev R.V.,Clinical Hospital
Obshchaya Reanimatologiya | Year: 2017

The purpose of the study is to examine the effect of anesthesia and respiratory support parameters on central and peripheral hemodynamics in patients with morbid obesity undergoing an endoscopic gastric resection. Materials and methods. A randomized study of 43 patients with a body weight index of >40 kg/m2 who underwent an endoscopic longitudinal gastric resection (sleeve gastrectomy) was performed. Patients were divid- ed into two groups. In Group 1 (n=22), combined anesthesia based on the low-flow desflurane inhalation was applied along with the mechanical ventilation in the VC-CMV mode with a constant PEEP level. In Group 2 (n=21), combined anesthesia based on the low-flow desflurane inhalation was applied along with the prolonged epidural analgesia (PEA) with 0.2% ropivacaine solution and VC-CMV respiratory pattern, with PEEP dose esca-lation using titration, inverted respiratory cycle, and a gradual increase in the respiratory rate. The intraoperative monitoring included central and peripheral hemodynamics, blood gases, and ABB. The purpose of the study is to examine the effect of anesthesia and respiratory support parameters on central and peripheral hemodynamics in patients with morbid obesity undergoing an endoscopic gastric resection. Materials and methods. A randomized study of 43 patients with a body weight index of >40 kg/m2 who underwent an endoscopic longitudinal gastric resection (sleeve gastrectomy) was performed. Patients were divid- ed into two groups. In Group 1 (n=22), combined anesthesia based on the low-flow desflurane inhalation was applied along with the mechanical ventilation in the VC-CMV mode with a constant PEEP level. In Group 2 (n=21), combined anesthesia based on the low-flow desflurane inhalation was applied along with the prolonged epidural analgesia (PEA) with 0.2% ropivacaine solution and VC-CMV respiratory pattern, with PEEP dose esca-lation using titration, inverted respiratory cycle, and a gradual increase in the respiratory rate. The intraoperative monitoring included central and peripheral hemodynamics, blood gases, and ABB. Results. The study demonstrated that there was more stable central and peripheral hemodynamics in Group 2 during the intraoperative period as compared to Group 1, where increased systolic BP, median NMBP, diastolic BP, HR, CI, SVI, and SVRI levels were registered. In addition, in Group 2, ??O2 levels were significantly higher and ?CO2 levels were lower during pneumoperitoneum; no significant changes in ABB were recorded. Conclusion. Thoracic epidural analgesia with pneumoperitoneum, increased intraabdominal pressure, and PEEP escalation mode provide stable intraoperative central and peripheral hemodynamics during endoscopic gastric resection in patients with morbid obesity. © 2017, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.


Objectives: The study was designed to determine the accuracy of using systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), and increase of blood pressure (BP) to predict Preeclampsia (PE). Materials and Methods: We examined 300 normotensive and 100 PE pregnancies divided in two subgroups: mild (n=67) and severe (n=33) PE. The patients had a BP check in first and second trimester (SBP, DBP, and MAP). Results: We found out significant difference between the groups, but what is more important is that the difference in BP values (especially diastolic and MAP) existed before the pathological increase of the BP above the normal values. This was happening most often after 31 wg (at 92.5%) and less often after 26 wg (at 7.5%) at the pregnancies with mild PE while at the pregnancies with severe PE, 18,2% had increased tension after 21 wg; 24% in the period of 26-30 wg and 57.58% after 31 wg. Conclusion: Based on the results we could conclude that when BP is measured in the first or second trimester of pregnancy, the MAP is a better predictor for PE than SBP and DBP. © Polskie Towarzystwo Ginekologiczne.


Pletersek A.,IDS D.o.o. | Sok M.,Clinical Hospital
Journal of Medical Systems | Year: 2012

This work demonstrates the developed application for disinfection control by the sensing of chemical agents. The objective was to develop an Automatic Disinfectant Tracker (ADT) that would verify the disinfection of the hands of nurses, doctors, staff, patients, and visitors in hospitals within a required time frame. We have successfully investigated the development of hand disinfection control mechanisms and demonstrated two approaches, both based on the wireless Ultra-High-Frequency-based Radio-Frequency Identification (UHF-RFID) technology. The 100 % efficacy of detecting propanol and ethanol concentration was achieved by using the static disinfectant control (SDC-ADT) method. The time domain response provides an accurate determination of their performance in practice simply by measuring the applied disinfectant concentration and the duration of application. The present paper resulted from the measurements of a capacitive chemical sensor fabricated in the Laboratory for Microelectronics, (LMFE) and on measurements, based on a commercially available resistive type of sensor. A graphic user interface (IDS-GUI) is designed to successfully set the logger parameters and display the results. © 2012 Springer Science+Business Media, LLC.


Britez M.E.M.,Clinical Hospital | Llano C.C.,Instituto Nacional del Cancer | Chaux A.,Research Laboratory
European Journal of Plastic Surgery | Year: 2012

Background Silicone gel-containing breast implants have been widely used for aesthetic and reconstructive mammoplasty. The development of a periprosthetic capsule is considered a local reparative process against the breast implant in which a variety of inflammatory cells may appear. Nevertheless, only few reports have evaluated the immunophenotypes of those inflammatory cells. Herein, we aim to provide more information in this regard evaluating 40 patients with breast implants. Methods We studied the immunophenotype of the inflammatory cells of capsular implants using antibodies against lymphocytes (CD3, CD4, CD8, CD20, CD45, and CD30) and histiocytes (CD68). Percentages of CD3 and CD20 positive cells were compared using the unpaired Student'st test. Fisher's test was also used to compare Baker grades by implant type, implant profile, and location and the presence of inflammatory cells by implant type. Results The associations between Baker grades and implant type and location were statistically nonsignificant (p00.42 in both cases). However, the use of low profile implants was significantly associated (p00.002) with a higher proportion of Baker grades 3 and 4. We found evidence of inflammation in 92.5 % of all implant capsules, with a statistically significant (p00.036) higher proportion in textured breast implants. T cells predominated over B cells. Textured implants elicited a more marked response to T cells than smooth implants, with a similar proportion of helper and cytotoxic T cells. Textured implants showed statistically significant higher percentages of CD3 positive cells than smooth implants. Percentages of CD20 positive cells were similar in textured and smooth implants. Conclusions These results suggest that textured breast implants might induce a stronger local T cell immune response. Our findings could shed some light to understand the association of silicone breast implants and some cases of anaplastic large cell lymphomas. Level of Evidence: Level III, prognostic study. © The Author(s) 2012.


Drakaki E.,National and Kapodistrian University of Athens | Vergou T.,National and Kapodistrian University of Athens | Dessinioti C.,National and Kapodistrian University of Athens | Stratigos A.J.,National and Kapodistrian University of Athens | And 2 more authors.
Journal of Biomedical Optics | Year: 2013

The importance of dermatological noninvasive imaging techniques has increased over the last decades, aiming at diagnosing nonmelanoma skin cancer (NMSC). Technological progress has led to the development of various analytical tools, enabling the in vivo/in vitro examination of lesional human skin with the aim to increase diagnostic accuracy and decrease morbidity and mortality. The structure of the skin layers, their chemical composition, and the distribution of their compounds permits the noninvasive photodiagnosis of skin diseases, such as skin cancers, especially for early stages of malignant tumors. An important role in the dermatological diagnosis and disease monitoring has been shown for promising spectroscopic and imaging techniques, such as fluorescence, diffuse reflectance, Raman and near-infrared spectroscopy, optical coherence tomography, and confocal laser-scanning microscopy. We review the use of these spectroscopic techniques as noninvasive tools for the photodiagnosis of NMSC. © 2013 SPIE.


Aune D.,Imperial College London | Deneo-Pellegrini H.,Clinical Hospital | Ronco A.L.,Latin American Center for Human Economy | Boffetta P.,International Prevention Research Institute | And 4 more authors.
Annals of Oncology | Year: 2011

Background: There is limited, but inconclusive, epidemiological evidence that high folate intake decreases the risk of colorectal and esophageal cancers. For other cancer sites, the evidence is even less consistent or extensive. Materials and methods: We conducted a case-control study of dietary folate intake and risk of 11 cancer sites in Uruguay between 1996 and 2004, including 3539 cancer cases and 2032 hospital controls. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cancer associated with folate intake. Results: In the multivariable model, there was a significant decrease in the risk of cancers of the oral cavity and pharynx (OR = 0.49, 95% CI 0.24-0.98), esophagus (OR = 0.29, 95% CI 0.14-0.60), upper aerodigestive tract (OR = 0.41, 95% CI 0.26-0.65), colorectum (OR = 0.42, 95% CI 0.23-0.76) and kidney (OR = 0.35, 95% CI 0.13-0.93) for the highest versus the lowest quartile of dietary folate intake. Conclusions: Our results not only confirm earlier findings of decreased risk of colorectal and esophageal cancers with a high dietary folate intake but also suggest decreased risk of several other cancers. However, we cannot exclude the possibility that residual confounding, multiple comparisons or other forms of bias could explain these results. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Serman A.,Clinical Hospital | Serman L.,University of Zagreb
Frontiers in Bioscience - Elite | Year: 2011

Rodents provide an excellent experimental model to study human placental development. In this review, our aim was to explain major events that underlie the placental development in mammals in general, and specifically in rodent. Those events include trophoblast cell proliferation, decidual reaction and contact between the mesenchyme of the allantois with ectoplacental cone, all orchestrated by activation of a series of genes. We also aimed to compare molecular and genetic events of rodent and human placentation. Employing the rodent placenta development model will yield better understanding of these processes in other mammals, especially in humans.


Corotchi M.C.,Romanian Academy of Sciences | Popa M.A.,Romanian Academy of Sciences | Remes A.,Romanian Academy of Sciences | Sima L.E.,Romanian Academy of Sciences | And 2 more authors.
Stem Cell Research and Therapy | Year: 2013

Introduction. Human Wharton's jelly (WJ) has become a preferred source of mesenchymal stem cells (MSCs) whose clinical applications are limited by the use of adequate xeno-free (XF), in vitro manipulation conditions. Therefore, the objective of our study was to characterize WJ-derived MSCs (WJ-MSCs), isolated by different methods and cultured in a commercially available, MSC XF medium, not least of all by investigating their endothelial differentiation capacity. Methods. WJ explants and enzymatically dissociated WJ cells were cultured in a defined, XF medium for MSCs. Adherent cells at passages 2 and 5 were characterized as MSCs by flow cytometry, MTT, real-time quantitative reverse transcription PCR, and functional multipotent differentiation assays. The endothelial differentiation capacity of MSCs isolated and expanded until passage 2 in the MSC XF medium, and then subcultured for five passages in a commercially available endothelial growth medium (group A), was assessed over serial passages, as compared to adherent WJ-derived cells isolated and expanded for five consecutive passages in the endothelial medium (group B). Results: The MSC phenotype of WJ explant- and pellet-derived cells, isolated and expanded in the MSC XF medium, was proven based on the expression of CD44/CD73/CD90/CD105 surface markers and osteo-/adipo-/chondrogenic multipotent differentiation potential, which differed according to the isolation method and/or passage number. Upon exposure to endothelial differentiation cues, cells belonging to group A did not exhibit endothelial cell characteristics over serial passages; by contrast, WJ pellet-derived cells belonging to group B expressed endothelial characteristics at gene, protein and functional levels, potentially due to culture conditions favoring the isolation of other stem/progenitor cell types than MSCs, able to give rise to an endothelial progeny. Conclusions: The use of defined, MSC XF media for isolation and expansion of human WJ-MSCs is a prerequisite for the establishment of their real endothelial differentiation capacity, as candidates for clinical therapy applications. Thus, the standardization of WJ-MSCs isolation and culture expansion techniques in defined, MSC XF media, for their accurate characterization, would be a priority in the stem cell research field. © 2013 Corotchi et al.; licensee BioMed Central Ltd.


Moreno D.H.,Clinical Hospital | Andrade L.H.,Institute of Psychiatry
Journal of Affective Disorders | Year: 2010

Background: Current diagnostic criteria cannot capture the full range of bipolar spectrum. This study aims to clarify the natural co-segregation of manic-depressive symptoms occurring in the general population. Methods: Using data from the Sao Paulo Catchment Area Study, latent class analysis (LCA) was applied to eleven manic and fourteen depressive symptoms assessed through CIDI 1.1 in 1464 subjects from a community-based study in Sao Paulo, Brazil. All manic symptoms were assessed, regardless of presence of euphoria or irritability, and demographics, services used, suicidality and CIDI/DSM-IIIR mood disorders used to external validate the classes. Results: The four obtained classes were labeled Euthymics (EU; 49.1%), Mild Affectives (MA; 31.1%), Bipolars (BIP; 10.7%), and Depressives (DEP; 9%). BIP and DEP classes represented bipolar and depressive spectra, respectively. Compared to DEP class, BIP exhibited more atypical depressive characteristics (hypersomnia and increase in appetite and/or weight gain), risk of suicide, and use of services. Depressives had rates of atypical symptoms and suicidality comparable to oligosymptomatic MA class subjects. Limitations: The use of lay interviewers and DSM-IIIR diagnostic criteria, which are more restrictive than the currently used DSM-IV TR. Conclusions: Findings of high prevalence of bipolar spectrum and of atypical symptoms and suicidality as indicators of bipolarity are of great clinical importance, due to different treatment needs, and higher severity. Lifetime sub-affective and syndromic manic symptoms are clinically significant, arguing for the need of revising DSM bipolar spectrum categories. © 2009 Elsevier B.V. All rights reserved.


Grubnik V.V.,Clinical Hospital | Tkachenko A.I.,Clinical Hospital | Ilyashenko V.V.,Clinical Hospital | Vorotyntseva K.O.,Clinical Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

The aim of the study was to analyse safety and benefits of laparoscopic common bile duct (CBD) exploration compared to open. Prospective randomized trial included a total of 256 patients with CBD stones operated from 2005 to 2009 years in a single center. There were two groups of patients: group I-laparoscopic CBD exploration (138 patients), group II-open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiology (ASA) score; i.e. ASA II-109 patients, ASA III-59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, by magnetic resonance cholangiopancreatography in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. There was no statistical significant difference between 2 groups of patients. No mortality occurred. The mean duration of laparoscopic operations was 82 min (range, 40-160 min). The mean duration of open operations were 90 min (range, 60-150 min). Mean blood loss was much less in laparoscopic group than in open group (20±2 vs. 285±27 ml; p<0.01). Postoperative complications were observed is nine patients of laparoscopic group and in 15 patients in open group (p<0.01). There were 102 attempts to perform transcystic exploration of CBD. External drainage was used in 25 (32.8%) patients with transcystic approach. Conversion to laparotomy was performed in two patients. Open operations were performed in 118 patients with choledocholithiasis. External drainage was used in 85% of patients. Morbidity in open group was higher (12.7%) than in laparoscopic group (6.5%). Laparoscopic CBD exploration can be performed with high efficiency, minimal morbidity and mortality. Laparoscopic procedures have advances over open operations in terms of postoperative morbidity and length of hospital stay. © Springer Science+Business Media, LLC 2012.

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