275 - KCUS

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275 - KCUS

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EDITORIAL OFFICE
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Clinical Center University of Sarajevo,
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Contents
ORIGINAL ARTICLE
ANATOMIC CHARACTERISTICS OF ARTERIAL SUPPLY OF THE CONDUCTING SYSTEM OF THE HEART
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EVALUATION OF TREATMENT RESULTS IN CHILDHOOD LYMPHOMA............................................................................... 276
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COMORBIDITY OF DEPRESSION IN NEUROLOGIC PATIENTS............................................................................................. 286
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PREVALENCE AND ANTIMICROBIAL RESISTANCE OF PSEUDOMONAS AERUGINOSA
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PREDICTORS OF PROGRESSION OF BONE METASTASES IN BREAST CANCER DIAGNOSED WITH SKELETAL
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PROFESSIONAL ARTICLE
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REVIEW ARTICLE
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CASE REPORT
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UPUTSTVO AUTORIMA INSTRUCTIONS TO AUTHORS
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Original article
ANATOMIC CHARACTERISTICS OF ARTERIAL SUPPLY OF THE CONDUCTING
SYSTEM OF THE HEART IN PATIENTS WITH CORONARY DISEASE AND DIABETES MELLITUS
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* Corresponding author
ABSTRACT
The aim of the study was to establish angiographi
cally anatomic characteristics of the sinoatrial
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correlation with the dominance of the coronary
arteries in patients with coronary disease and
diabetes mellitus. Coronary artery disease is the
major cardiovascular abnormality in diabetes mel
litus patients and the major cause of mortality in
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coronary angiography in Heart Centre of the Clini
cal Center University of Sarajevo in period from
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ings in all patients included in the study showed
the presence of diabetes mellitus. Coronary an
giography of coronary arteries were performed
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origin of r. nodi sinuatrialis and r. nodi atrioven
tricularis was observed and correlated with the ar
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were detected coronary codominance. R. nodi
atrioventricularis was a branch of the dominant
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nodi sinuatrialis which was a branch of the domi
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the origin of the nodal arteries in relationship to
the type of dominance of coronary arteries, in fa
vor r. nodi atrioventricularis The variations in origin
of the nodal arteries may result with serious post
operative complications due to their intraoperative
damages. Increased prevalence of cardiac con
duction abnormalities in diabetes mellitus patients
is evident. The results of the present study may
provide safe approach to interventional cardiolo
gist and cardiac surgeon during percutaneous and
surgical interventions.
Key words: sinoatrial nodal artery, atrioventricu
lar nodal artery, coronary angiography, coronary
disease, diabetes mellitus
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bolest, dijabetes melitus
INTRODUCTION
Anatomic descriptions of the blood supply of
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node, have been reported in several published
articles in the literature. These descriptions have
been based solely on detailed cadaveric dissec
tions of the human heart and angiographic stud
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branch of the right coronary artery in approximate
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hearts from the RCA in the posterior atrioven
tricular sulcus at a point just beyond the origin of
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The distributing artery of the conducting system
of the heart is occasionally injured in cardiac sur
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relationships to adjacent anatomical structures of
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diovascular disease and mortality with increasing
prevalence in the ageing population. Coronary
artery disease is the major cardiovascular abnor
mality in diabetes mellitus patients. Cardiomyopa
thy and left ventricular hypertrophy are two other
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The aim of the present study was to establish
angiographically anatomic characteristics of the
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coronary arteries in patients with coronary disease
and diabetes mellitus
Coronary angiography was the preferred method
of study as it is most commonly used in today’s
clinical setting and such a study would be of more
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hearts.
MATERIALS AND METHODS
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Retrospectively, the authors studied coronary an
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coronary angiography in Heart Centre of the Clini
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ings in all patients included in the study showed
the existence of diabetes mellitus.
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Coronary angiography was performed by the per
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left coronary arteries were obtained in the right
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angiograms we established anatomical variations
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balance type. On the angiograms the origin of r.
nodi sinuatrialis and r. nodi atrioventricularis from
the coronary arteries was observed and correlated
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gin of the posterior interventricular artery to deter
mine the coronary dominance.
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The statistical analysis of the results was per
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272
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differences in the origin of arteries of conductive
system in correlation with the dominance of the
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nodal artery originating from the proximal part of right coronary
artery it was termed as a right SA nodal artery.
RESULTS
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differences in the type of coronary dominance in
favor of the right coronary dominance.
7DEOHCoronary dominance.
A
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none of the cases was this node supplied by both
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Table 2. Origin of the sinoatrial and atrioventricular
nodal arteries.
B
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the r. nodi sinuatrialis which was a branch of the
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the origin of the nodal arteries in relationship to
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tion showing the SA nodal artery originated from the proximal
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from the posterolateral branch of the right coronary artery.
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supply to the atrioventricular and sinoatrial node
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course and relationships to adjacent anatomical
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clinical practice. The incidence of cardiac rhythm
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ablation procedures in treating arrhythmias can
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On classic anatomical dissection of human hearts
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the SA nodal artery was a branch of the left coro
nary artery or one of its branches. The atrioven
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that the origin of the SA nodal artery was not re
lated to coronary arterial dominance, but the origin
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arterial dominance.
The present study evaluated angiographically an
atomic characteristics of the origins of sinoatrial
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correlation with the dominance of the coronary
arteries in patients with coronary disease and dia
betes mellitus.
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diovascular disease and mortality with increasing
prevalence in the ageing population. Coronary
artery disease is the major cardiovascular abnor
mality in diabetes mellitus patients. Cardiomyopa
thy and left ventricular hypertrophy are two other
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ing increased prevalence of cardiac conduction
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not aware of this association, and it is rarely men
tioned in the published reviews about cardiovas
cular abnormalities in this population. The cause
of cardiac conduction abnormalities in diabetes
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origin of the SA node artery was mainly from the
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es was the SA nodal artery supplied by both coro
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to the sinus node area in 309 consecutive patients
undergoing coronary arteriography. The sinus
node artery arose from the right coronary artery in
SDWLHQWV7KHPDMRULW\DURVHSUR[LPDOO\
1 to 3 cm from the aortic ostium. In 87 of the 119
patients in whom the SA node artery arose from
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study established that the SA nodal artery arose
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In our study, the origin of the SA nodal artery was
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the cases was this node supplied by both coronary
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characteristics of the arterial supply to the sinuatri
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that a single sinuatrial nodal artery originated from
the proximal 40 mm of the right coronary artery
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blood supply to the SA node was seen in six pa
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arteries in two patients.
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determined that the atrioventricular node was sup
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es this node was supplied by both coronary arter
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node arteries”—one from the right coronary artery
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artery lesions in patients with severe conduction
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lesion distribution that involves either proximal
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the topographic relation between the sinus node
artery and the superior posterior border of the in
teratrial septum with regard to the sinus node dys
function that follows the superior transseptal ap
proach to the mitral valve. They established that
the SA nodal artery crosses the superior poste
ULRUERUGHURIWKHLQWHUDWULDOVHSWXPLQRIWKH
FDVHVDQGFRQFOXGHGWKDWWKHULVNIRULQWUDRSHUD
tive damage to the sinus node artery during the
superior transseptal approach to the mitral valve
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originating from posterolateral branch of RCA.
The origin of SA nodal artery was proximal RCA
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,Q WKH SUHVHQW VWXG\ RI RXU SDWLHQWV
KDG WKH ULJKW FRURQDU\ GRPLQDQFH KDG WKH
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ed coronary codominance. Our results regarding
the correlation the origins of sinoatrial and atrio
ventricular nodal artery with the dominance of the
FRURQDU\DUWHULHVVKRZHGWKDWWKH$9QRGDODUWHU\
ZDV D EUDQFK RI WKH GRPLQDQW DUWHU\ LQ LQ
comparison to the SA nodal artery which was a
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test determinated that the relationship between
the blood supply to the conducting system and
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the right coronary dominance. Increased preva
lence of cardiac conduction abnormalities, in dia
betes mellitus patients are evident. The origin of
the supply of blood to the conduction system is
highly relevant to clinical and surgical procedures.
Therefore, we encourage a thorough review of
cardiac mapping, with an eye to revision.
CONCLUSIONS
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ZDV D EUDQFK RI WKH GRPLQDQW DUWHU\ LQ in comparison to the sinoatrial nodal artery which
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gin of the nodal arteries in relationship to the type
of dominance of coronary arteries, in favor r. nodi
atrioventricularis.
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RI WKH /&$ DQG LQ QRQH RI WKH FDVHV WKLV QRGH
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The SA nodal artery originated from the RCA in
RI FDVHV LQ IURP WKH &; EUDQFK RI
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WHULHV5&$&;
,QFUHDVHGSUHYDOHQFHRIFDUGLDFFRQGXFWLRQDE
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diabetes mellitus patients are evident. The cause
of cardiac conduction abnormalities in diabetes
PHOOLWXVSDWLHQWVLVQRWNQRZQ
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result with serious postoperative complications
due to their intraoperative damages. The results
of the present study may provide safe approach
to interventional cardiologist and cardiac surgeon
during percutaneous and surgical interventions.
&RQÀLFWRILQWHUHVW none declared.
REFERENCES
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Anatomical aspects of the arterial blood supply to the
sinoatrial and atrioventricular nodes of the human heart.
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and atrioventricular nodal arteries in South Indians: an
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sinoatrial node and atrioventricular node arteries in
right, mixed, and left inferior emphasis systems. Cathet
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blood supply of the conducting system in normal human
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cations of coronary artery lesions in patients with severe
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ing from posterolateral branch of right coronary artery:
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tomical reasons for the discrepancies in atrioventricular
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Original article
EVALUATION OF TREATMENT RESULTS IN CHILDHOOD LYMPHOMA
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ABSTRACT
The aim of this paper is to present the results of
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study was conducted as a retrospective investiga
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INTRODUCTION
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various diseases according epidemiology, biology,
diagnostic approach, treatment so that they are
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common malignant lymphoma, characterized by
hyperplasia of lymphoid tissue areas which in
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as a painless lymphadenopathy, usually on the
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ger and harder than in benign lymphadenopathy,
which is usually seen in children. Common symp
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vironmental factors, among which socioeconomic
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Barr virus can be proved. Based on the diagnos
tic biopsy and anatomic distribution the stage of
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abdominal disease is commonly diagnosed radio
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guished: lymphocytic predominance, nodular scle
rosis, mixed cellularity and lymphocyte depletion.
The most favorable prognosis is in the patients
with lymphocytic predominance, and the most
disadvantaged in lymphocyte depletion patients.
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including chemotherapy and radiotherapy, perma
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ous group of lymphoproliferative malignancies
characterized with appearance of changed malig
nant cells in the lymph node, and rarely primary
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growth, early dissemination and a high degree of
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increases gradually during childhood reaches its
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more common in boys than in girls. There is the
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pending on the cell line to which they belong, on
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into four main types:
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of chemotherapy and radiotherapy in the treat
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Centre in Sarajevo.
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Study would represent a retrospective analysis of
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tained from patient histories.
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RESULTS
7DEOH Gender structure of children suffering from lymphoma
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277
278
Table 1 shows all patients from ten years study by
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suffering from lymphoma.
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disease progression.
Table 2. The age structure of children suffering from lympho
ma.
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7DEOH Treatment of malignant lymphoma.
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cidence of malignant lymphomas between ages
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Chemotherapy and radiotherapy treatment re
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Table 6. The outcome of treatment of malignant lymphoma at
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DISCUSSION
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ence between the groups of boys and girls suf
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consistent with the literature, which states that
malignant lymphoma has up to 3 times greater
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and the difference between the age groups of the
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ing to the literature. Data from the literature and
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SDWLHQWVZLWK1+/S +/FODVVL¿FDWLRQDFFRUGLQJWRWKHFOLQLFDOVWDJHRI
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nosed patients were in stage III. It is important to
emphasize that there was no detected cases in
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therapy is applied at lower doses and smaller ra
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with purpose to reduce the cumulative toxicity of
certain cytostatics and avoiding the appearance of
resistant tumors. Chemotherapy is the treatment
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stage of the disease. Radiation therapy is rarely
used because it acts locally and the disease is
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course of treatment experienced a relapse of the
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and 7 patients in the course of treatment experi
enced a relapse of the disease. Out of 19 patients
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RFFXUUHQFHRIUHODSVHLQ+/DQG1+/S The percentage of cure in this study is consistent
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CONCLUSION
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Clinic in Sarajevo are similar to results of treat
ment in the other European centers.
REFERENCES
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Cancer in Children: Clinical management. Fourth Edi
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RJ\ WK HG 3KLODGHOSKLD /LSSLQFRWW :LOOLDPV:LONLQV
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Hudson et al. Comparison of Treatment Outcomes of
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Original article
LARYNGOPHARYNGEAL REFLUX DISEASE – OUR THREE YEAR EXPERIENCE
LARINGEALNA REFLUKSNA BOLEST – NAŠE TROGODIŠNJE ISKUSTVO
0LUMDQD*QMDWLü, Slobodan Spremo3UHGUDJâSLULü, Dmitar Travar6DQMDâSLULü'DQLMHOD.HVLü0LMLü2,
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Bosnia and Herzegovina; 3 *DVWURHQWHURORJ\&OLQLF8QLYHUVLW\&OLQLFDO&HQWUH%DQMDOXND%HEDEE%DQMD
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ABSTRACT
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Several millions of people suffer from conse
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complaints to serious diseases, such as asthma,
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sults from repeated extraesophageal exposure to
gastric contents. The recent studies have shown
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toms, pathophysiology and responses to therapy.
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ity patients with laryngeal and gastric symptoms
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sophageal symptoms again showed better results
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symptoms reduction.
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had no effect on Barret’s metaplasia and precan
cerous conditions.
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u simptomatologiji bolesti se odnosi uglavnom na
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INTRODUCTION
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rhinosinusitis, secretory otitis and laryngomalatia
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change present prevention and therapeutic proce
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changes, cough, repetitive throat clearing, and
pharyngeal sensations of fullness. The most com
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symptom is chronic throat clearing which is pre
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laryngeal mucosa by inhibiting gastric acid and re
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is divided into three groups: mild, severe and life
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patients who have serious obstruction of airways,
because of glottic and subglottic stenosis, laryn
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laryngopharyngeal, and those with GERD mostly
gastrointestinal.
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The aim of the article is to estimate improvement
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The second aim was to assess the effectiveness
of an empirical treatment with proton pump inhibi
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MATERIALS AND METODS
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and follow up were used.
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were heartburn, epigastric pain, esophagitis, Ba
rett metaplasia and precancerosis.
RESULTS
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Our results are in accordance with the recommen
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Table 2. Gastroesophageal symptoms.
Figure 2. Age distribution.
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gastroesophageal symptoms where the total num
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baseline.
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extraesophageal symptoms.
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)LJXUH. The most common symptoms.
Extraesophageal symptoms; the best progress
KDV EHHQ PDGH LQ KRDUVHQHVV ZKHUH symptoms were removed and worst results in
bronchial asthma was found in patients who main
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tained:
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while extraesophageal symptoms had been re
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DISCUSSION
GERD is considered as an important cause of la
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cians, include hoarseness, throat pain, sensation
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clearing. However, these symptoms are nonspe
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The study evaluated 17 males and 14 females.
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the current study. This result is in accordance with
the indexed literature where females outnumbered
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Symptomatic improvement was obvious after
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derlying suspected etiology. In clinical practice, it
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treatments to achieve an improvement of larynge
al symptoms than those with typical GERD symp
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Some studies have shown that the proportion of
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tients than in those without GERD. On the other
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40 mg bid for 4 months vs. placebo. In particu
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breath condensate using the pepsin immunoas
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but as reported in literature treatment failures are
not uncommon.
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in ENT settings, the symptoms and signs may be
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ings for diagnosing this condition. Our analysis
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in both extraesophageal as well as gastroesopha
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the best progress was made with heartburn and
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ret’s metaplasia and precancerous conditions. Af
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pachyderm.
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understanding of etiopathogenesis of many dis
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could modify therapeutic approaches and their ef
fectiveness in treating the disease such as chronic
laryngitis and pharyngitis, chronic rhinosinusitis,
asthma, sleep apnea, secretory otitis media in
children, laryngomalatia, and even change the
prevention and treatment for cancers of the larynx
and pharynx.
CONCLUSIONS
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agement need to be expanded with new diag
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standing and the underlying pathophysiological
mechanisms. In this respect, the present study
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to assess the presence of an established associa
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REFERENCES
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speech, voice, and swallowing disorders of the Ameri
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8. Ford CN. Evaluation and management of laryn
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RS, Bosnia and Herzegovina
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Original article
COMORBIDITY OF DEPRESSION IN NEUROLOGIC PATIENTS
KOMORBIDITET DEPRESIJE KOD NEUROLOŠKIH PACIJENATA
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and Herzegovina
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ABSTRACT
Depression is the most common comorbid disease
LQ FKURQLF QHXURORJLFDO GLVRUGHUV 6XLFLGH ULVN LQ
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with depression, feelings of hopelessness and
social isolation. The aim of this study was to in
vestigate the presence of depression, assess se
verity of depressive disorder and to determine the
correlation between the degree of depression and
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and outpatients of both genders, aged 18 years
and older, treated at the Department of Neurology,
Clinical Center University of Sarajevo in the peri
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selected randomly. Applied research instruments
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cant differences between groups. The severity of
depression in most neurological patients positively
correlated with elevated BSS score. Because of
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is a need for routine assessment of depression in
the population of neurological patients.
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multiple sclerosis
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socijalnom izolacijom. Cilj ovog rada bio je da se
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ispita prisustvo depresije, utvrdi nivo depresivnosti
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iznad 18 godina, hospitaliziranih ili ambulantno
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INTRODUCTION
Depressive disorder is a major public health prob
lem worldwide due to a high increase in the fre
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sion will be the second leading cause of world
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to be the largest contributor to disease burden
:+2
Depression occurs in comorbidity with many so
matic diseases and it is the most common comor
bid psychiatric disorder in neurological patients.
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result of interplay between variety of endogenous
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It is noteworthy that depressive disorder is associ
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feelings of hopelessness or helplessness, as well
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The goal of this study was to analyze the pres
ence of depression, assess severity of depressive
disorder and to determine the correlation between
the degree of depression and total score on BSS
scale in different groups of neurological disorders
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The study of depression in neurological patients
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cal, descriptive and controlled. The sample was
consisted of three groups of neurological patients
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VSRQGHQWV 7KH ¿UVW JURXS RI UHVSRQGHQWV includes patients with epilepsy;the second group
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Examined inpatients and outpatients have to meet
the following criteria: have clinically established
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sonism, were treated at the Department of Neurol
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2FWREHUVWROGHUWKDQ\HDUVRIDJHRI
both genders, with the signed voluntary consent to
participate in the research.
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tionnaire, constructed for the purposes of this
study, Hamilton Rating Scale for Depression,
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demographic and clinical characteristics of pa
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and clinical characteristics of patients including
type of disease, age of onsetand used medica
tions were collected. Depression was evaluated
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HQWV ZHUH WHVWHG XVLQJ WKH VHOIHYDOXDWLRQ %66
scale.
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computer software for statistical analysis, version
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age, absolute value, odds ratio with corresponding
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cant.
The protocol of this study was approved by the
Ethics Committee of Clinical Center University of
Sarajevo and was carried out in accordance with
the ethical standards laid down in the Declaration
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and gave an informed consent.
RESULTS
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Spearman correlation revealed a statistically
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depression and BSS total score in patients with
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correlation between the BSS total score and
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DISCUSSION
In this study we analyzed the presence of
depression, estimated severity of depressive
disorder and examined the correlation between
the severity of depression and total BSS scores
in different groups of neurological disorders
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The highest rate of depression was observed in
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appearance of depression was found in patients
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groups.
According to the recent studies, the prevalence
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of depression in these patients is biphasic, with
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preparations can lead to the development of
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generation dopaminergic agentsseparately or
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on the presence of depression in sample.
Similar to our results, in a study conducted in
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In our research in case of epilepsy the depression
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similar to other studies. According to the earlier
epidemiological studies, the prevalence of
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found that depressive disorder was diagnosed
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which tested the incidence of depression in
chronic physical illnesses conducted by Filipcic
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There are controversial data whether some of the
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cause or exacerbate existing symptoms of
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the potential adverse effects.
In patients with multiple sclerosis, depression
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times more common than in the general population,
with the prevalence of major depressive disorder
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are similar with epidemiological data from other
studies, according to which the appearance of
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conducted at the Department of Neurology CCUS.
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RI SDWLHQWV KDG GHSUHVVLRQ RI ZKLFK of patients had moderate or severe depression.
Depression was associated with shorter duration of
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symptoms that Gottberg and associates
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The emergence of suicidal thoughts in our study
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effect of certain medications use. Steroids and
spasmolytics may be associated with low mood.
Also, an association may exist between the use
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The presence of depressive symptoms in nearly
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half of surveyed patients with epilepsy and multiple
sclerosis are noteworthy data.
In this paper the presence of depression compared
with different populations with neurological
diseases was determined. Future research should
determine the clinical impact of this phenomenon,
the further course of the disease and fully
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every second patient with epilepsy and multiple
sclerosis had depressive symptoms, so it has
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among neurological patients.
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health is the importance of depression screening
in neurological patients. Because of the high
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need for routine assessment of depression in this
population.
CONCLUSIONS
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SDWLHQWV ZLWK 3DUNLQVRQLVP LQ RI SDWLHQWV
ZLWK HSLOHSV\ DQG WKH VDPH QXPEHU of patients with multiple sclerosis. The study
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and severity of depressive symptoms correlates
with BSS total score in the group of patients with
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patients.
Depressive disorder is a very common psychiatric
comorbidity of neurological disorders. Hence, this
study underlines the importance of recognizing
comorbid depressive disorder at the earliest
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treatment and the need for routine assessment
of depression in the population of neurological
patients with screening instruments.
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Hecimovic H. Depression in epilepsy: ignoring clinical
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prevalence, impact, aetiology, biological correlates
and effect of treatment with antiepileptic drugs. Drugs
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Department of Neurology
Clinical Centre University of Sarajevo
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Original article
PREVALENCE AND ANTIMICROBIAL RESISTANCE OF PSEUDOMONAS AERUGINOSA
IN THE WOUND SWABS
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ABSTRACT
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nosa has emerged as one of the leading nosoco
mial pathogens throughout the world. This is partly
due to its intrinsic aptitude to persist in the hospi
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nisms. The aim of this study was to analyze the
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domonas aeruginosa isolated from wound swabs.
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ized in the different departments in the University
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crobial susceptibility testing was performed by
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guidelines.
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ZDVLVRODWHGLQVZDEVDQGLWZDVWKH
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organisms. Overall yearly resistance rates to anti
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Conclusion: Our study reveals increasing trend of
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crobials. Rapid and accurate reporting of antibi
otic resistance is essential in guiding therapeutic
decisions. Establishing antimicrobial resistance
surveillance systems and implementing measures
to support the prudent use of antibiotics by set
ting evidence based guidelines has been recom
mended.
Key words: wound infections, resistance, antibi
otics
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INTRODUCTION
Nosocomial infections are serious problem in
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infections in developed countries. The rates were
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wound infections, which have been validated and
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invasive capability of the organisms have been
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physiological state of the tissue in the wound and
immunological integrity of the host seem to be of
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Infection of surgical wound is considered as noso
comial infection if it occurred within 30 days after
surgery, or within one year in case of implant. In
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wound, or a clinical suspicion of wound infection,
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perature, redness and tenderness of the wound.
Surgical wound infections are prolonging the du
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cicatrisation and increase morbidity and mortality.
The most critical factors in the prevention of post
operative wound infections are sound judgment
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team, as well as the general health and disease
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postoperative wound infections, it is important to
create a safe environment by controlling four main
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nosis and treatment of these infections are very
expensive and present an additional load to health
insurance funds. It is very useful to explore the
causes of these infections in order to timely detect
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infection is universal and that the bacteria types
present vary with geographical location, bacteria
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es of serious infections. The growing incidence of
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for a long time as one of the leading cause of hos
pital infections all over the world. It is a common
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cause of infection in hospitalized patients and so
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colonize individuals, without symptoms, for either
short or extended period of time, causing disease
when the immune system becomes compromised.
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factors. It has been demonstrated that expression
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exopolysaccharide are important in pathogenic
ity because they enable the bacteria to form bio
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since they are shielded from host defenses such
as phagocytes or antibodies, as well as antibiotics
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and its host is mediated by molecular structures
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ciated molecular patterns; these are recognized
by pattern recognition receptors, associated with
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a lipopolysaccharide receptor complex is asso
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expression of various effector molecules, includ
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lates exhibit varying degrees of intrinsic resist
ance against many antimicrobial agents due to
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aeruginosa has the genetic capacity to express
a wide repertoire of resistance mechanisms. It
can become resistant through mutation in chro
mosomal genes which regulate resistance genes.
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from other organisms via plasmids, transposons
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antimicrobiales of different classes can result in
the emergence of mutant strains that are highly
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present a major therapeutic problem especially
in immunocompromised patients. Resistance to
antimicrobial agents and numerous virulence fac
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Irrational use of antimicrobial drugs leads to the
increase of resistance, causing certain treatment
problems. The spread of microorganisms resistant
to antibiotics represents a global problem in the
world today, because it increases treatment costs
and increases the mortality of patients. The dis
tribution of resistant microorganisms, especially
those causing intrahospital infections, differs de
pending on the type of hospital institution and type
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Numerous studies cite that bacterial resistance
to antimicrobials varies in the different parts of
the world, even in the different parts of the same
country, even in the different wards of one hos
pital. There is a need for constant monitoring of
bacterial resistance for improvement guidelines
for empirical antibiotic treatment.
The aim of this study was to investigate the
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domonas aeruginosa isolated from postoperative
wounds in our hospital.
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were applied in this study.
RESULTS
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talized in the different departments in the Clinical
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WXUH RI SDWLHQWV ZDV IHPDOHV DQG males. The average age of patients was 48 years
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)LJXUH Review of examination wound swabs.
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University of Sarajevo.
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isolation of Enterobacteriacae. These media are
specially designed to distinguish lactose ferment
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oculate was prepared by suspending the freshly
grown bacteria in the sterile normal saline and
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bial susceptibility was determined for cefotaxime,
ceftazidime, ceftriaxone, cefepime, gentamicin,
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isms that are resistant to one or more classes of
antimicrobial agents.
For the evaluation of the results, standard statisti
cal methods were used. Statistical analysis was
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or in tabular form. Ethical principles outlined in the
positive
sterile
The most common isolated microorganisms from
wound swabs were: Staphylococcus aureus in
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7DEOH. The most common causes of wound infections.
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Escherichia coli
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samples in the different surgical departments.
Prevalence of Pseudomonas aeruginosa in the different
departments
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Orthopaedic surgery
Neurosurgery
Other clinics
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antibiotics increased noticeably: ceftriaxone from
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Resistance to antibiotics Pseudomonas aeruginosa
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DISCUSSION
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be a major source of morbidity and mortality for
patients undergoing operative procedures, despite
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better understanding of the pathogenesis of the
wound infections. Diagnosis and treatment of
these infection are very expensive and present
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infections due to timely detection and removal
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of causative agents. Surveillance of surgical site
infection is useful to demonstrate magnitude
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postoperative wound infection is directly related to
increased education and awareness of its causes
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for a long time as one of the leading causes of
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therapeutic problem.
In our study we wanted to explore the most common
causes of wound infections by examination of
wound swabs. Especially, we wanted to analyze
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swabs.
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The results obtained showed a high incidence of
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negative microorganisms.
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prevalence of this microorganism in many
hospitals. Bertrand et al. recorded prevalent rate
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differences in geographical location and hygienic
PHDVXUHV 7KH LQFLGHQFH RI 3VHXGRPRQDV
aeruginosa in postoperative wound infection is
becoming more serious in developing countries
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Evaluation
of
antimicrobial
resistance
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resistant phenotype dominated as the agent of
nosocomial wound infections. The resistance to
all antibiotics demonstrated impressive increase
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Carbapenems have been the agents of choice
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but unfortunately resistance to those agents
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aeruginosa resistance proportions to carbapenems
appear to be rather high all over Europe. The
highest proportions of resistance were reported
E\ WKH &]HFK 5HSXEOLF DQG *UHHFH All northern European countries still reported
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Carbapenems susceptibility data in our study
indicate that of the two carbapenems, meropenem
exhibits robust activity against the resistant
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that the interplay of resistance mechanisms in
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carbapenems. The resistance to meropenem is
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This study provide information on the prevalence
of emerging resistance in clinically important
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to identify candidate antimicrobials for empiric
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crucial step in infectious disease management.
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important tool for the development of rational
therapy protocols.
CONCLUSION
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dominated as the cause of nosocomial wound
infections. Rapid and accurate reporting of
antibiotic resistance is essential in guiding
therapeutic decisions. Restriction of the usage
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resort is a necessary complement to any infection
control strategy. Establishing antimicrobial
resistance surveillance systems and implementing
measures to support the prudent use of antibiotics
by setting evidence based guidelines has been
recommended.
REFERENCES
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infections, including the role of the
microbiology
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European perspective of incidence and economic
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surveillance and management of surgical site infection:
introduction to the problem and symposium overview.
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Original article
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ABSTRACT
Automation is necessary in laboratory system;
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analysis, as well as standardization of methods.
Aim of this study is to compare the diagnostic per
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determine the convenience of use in the labora
tory.
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were analyzed by microscopy and automated
analyzers. Certain elements of urine sediment
separated by manual microscopy were compared
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tested using two commercial control urine mate
rials. All elements of chemical examination were
compared, such as: glucose, proteins, bilirubin,
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gravity.
Conclusion: Automated urinalysis Aution Hybrid
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would remove the need for manual microscopy for
most specimens. The chemical urinalysis system
showed excellent agreement.
Keywords: automated urine analysis, urine sedi
ment, chemical urine analysis
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INTRODUCTION
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lized analyses in the routine laboratory practice
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cal, and microscopic means has become an es
sential part of many diagnostic evaluations, par
ticularly when renal or urinary tract involvement
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Automation is necessary in laboratory systems.
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analysis, as well as standardization of methods.
Not long ago, the necessary automated system
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Urine analysis should be based on standardized
procedures of sample gathering, transporting and
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these procedures, there is a necessity of results
interpretation correlation and referent ranges cor
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The objective of this paper is to perform the ana
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in relation to the standardized microscopes urine
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tive results are reported directly for red blood cells
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centration ranges. Statistical analysis, descriptive
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RESULTS
Inaccuracy of the microscope module in series
was determined in ten measurements in Aution
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7DEOH Inaccuracy of individual analyses according to de
clared values control solution in normal and pathological range.
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ed. Fresh urine samples submitted to the labora
tory were selected for the study and stored at 4
0C for a maximum of 4h until analyzed to avoid
interference of preservative added to the samples.
Analytical procedures
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urine analyzing system. Chemical module for
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is simple to use because, after positioning the
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the Start button. The pipette aspirates the sample,
agitates it and automatically distributes the drops
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cytometry and impedance to identify and count
formed elements in urine sediment. Stained urine
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ance measured simultaneously. Signal rations are
then processed by mathematical cluser analysis to
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standard procedures of manual microscopy and
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paratively. The samples were analyzed not later
than two hours after receipt.
For an analytical evaluation of the Aution Hybrid
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ing test was performed: inaccuracy test in series,
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control material a total of 10 times during the same
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carried out in the period of 10 days, also by using
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Except for urobilinogen, by the automated system
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Results obtained by comparative testing of urine
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Table 7.
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A comparison of pH value results, higher
correlation rate was obtained than in the case of
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DISCUSSION
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The results obtained by comparative testing of
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results.
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in native urine. Our study was intended to evaluate
automated urinalysis systems for comparability of
results with discrepancies resolved by selected
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of chemical urinalysis to minimize the need
for sediment analysis, and relative ease and
convenience of operability. The operation of
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only a few minutes a day and no malfunctions
were observed during the evaluation period which
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from certain clinics. Therefore, the recommended
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should be carried out, is exceeded in numerous
cases. The samples in this study were analyzed
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cannot be calculated for test strip Analyzers
operating in discrete mode, so in the tables the
percentage of times the instrument repeats a
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discrepancies between sediment counts, with
11 for red blood cells, 8 for white blood cells.
Arbitration of these discrepancies with manual
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Except for urobilinogen, by the automated system
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The results obtained by a comparative analysis
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satisfactory compatibility. Testing pH value
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Although automation has already been widely
used in laboratory diagnostics, in urine analysis
it still does not have such an important role.
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for chemical analysis are still common in almost
all laboratories. Utilization of urine samples
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sample analysis provide great advantage for
the automated system in comparison to manual
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CONCLUSION
Utilization of automated urine analyzing systems
is recommendable, especially in institutions with
a large number of daily analyses. Total average
time needed for single urinalysis decreased from
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the transition from manual to automated urinalysis
for both the clinicians and patients.
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sediment Analyzers with manual urine analysis.
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urinanalysis guidelines: introduction of a project under
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assessing agreement between two methods of clinical
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automatic urine sediment Analyzers with manual urine
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Automation in urinalysis: evaluation of three urine test
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Automated urine screening systems. Bristol Urological
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REFERENCES
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ýDUEDNDSD 9 ĈHULü 0 6WRãLü = 7HVWLQJ RI ,4 automated urine analyzer analytical performances
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Address:
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Department of Clinical Chemistry
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Original article
COMPARISON OF EFFICIENCY OF PLEURODESIS WITH DIFFERENT SCLEROSANS THROUGH PLEURAL CATHETER
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ABSTRACT
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cient palliation of dyspnea should be the main ob
jective of the therapy. The aim of the study is the
comparative analyses for chemical pleurodesis by
doxycycline and talc installed through the pleural
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the period of thoracic drainage and appearance
of the complications and assessment of the sub
jective parameters of patient prior and after the
pleurodesis with the impact of the pleurodesis to
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been conducted by talc or doxycycline through the
pleural catheters at the Clinic for Thoracic Surgery
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ders, established pleural effusion with prior estab
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objective better general conditions after the thora
cocentesis. The thoracostomy was performed to
all patients with pleural catheter and patients were
divided into two groups depending on type of scle
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trols were conducted once a month until the third
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software with application of appropriate statistical
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symptoms prior to pleurodesis were: dyspnea in
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same symptoms after the pleurodesis was as fol
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the additional loss of body weight has been es
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tients. Conclusions: Applying pleural catheter with
chemical pleurodesis can achieve identical results
as when using standard thoracic drainage. In rela
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using talc.
Key words: malignant pleural effusion, pleural
catheter, chemical pleurodesis
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INTRODUCTION
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TXHQW LQ WKH ODWH SKDVH RI HYROXWLRQ RI WKH PD
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symptomatically since such an effusion indicates
to the extended disease. Dyspnea is the most
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HIIXVLRQ LWVHOI$V D UXOH WKH XVHIXO DQG HI¿FLHQW
palliation of dyspnea should be the main objec
tive of the therapy, especially in patients with tu
mors with poor reaction to the given systematic
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by the thoracocentesis. Thoracocentesis provides
fast and satisfactory relief of symptoms caused by
WKHSOHXUDOHIIXVLRQEXWLWLVLQHI¿FLHQWLQSUHYHQWLQJ
RIUHDFFXPXODWLRQRISOHXUDOOLTXLGHI¿FLHQF\
,IWKHG\VSQHDHQGDQJHUVWKHTXDOLW\RIWKH
patient’s life and if it is the intention to alleviate it
for a longer term by the therapeutic intervention, it
is necessary to conduct one of the following pro
FHGXUHV 6WDQGDUG WKRUDFRVWRP\ ODUJH ERUH
GUDLQ )) ZLWK LQVWLOODWLRQ RI VFOHURVDQVH
7KRUDFRVFRS\ ZLWK SOHXUDO DEUDVLRQ DQGRU E\
application of sclerosanse, 3. Thoracostomy with
SOHXUDO FDWKHWHU )) DQG SOHXURGHVLV RU (PEHGGLQJ RI WKH SOHXURSHULWRQHDO VKXQW &KHPLFDOSOHXURGHVLVLVRIWHQVXI¿FLHQWRSWLRQIRU
FRQWURORIUHDFFXPXODWLRQRISOHXUDOOLTXLGDOOHYLD
tion of pain and dyspnea and improvement of the
TXDOLW\RIOLIH7KHPDLQREMHFWLYHRIFKHPL
cal pleurodesis is to cause the creation of adhe
sion between the visceral and parietal pleura thus
creating obliteration which eliminates the pres
HQFHRISOHXUDOVSDFHSUHYHQWLQJUHDFFXPXODWLRQ
RI ÀXLG 7KH PDLQ LQGLFDWLRQ IRU FKHPLFDO
pleurodesis is the presence of dyspnea and chest
pain, which is proved to be related with pleural ef
IXVLRQ7KHUDGLRORJLFDOFRQ¿UPDWLRQLVQHFHVVDU\
VRWKDWWKHOXQJVPD\EHIXOO\UHH[SDQGHG&KHP
ical pleurodesis is contraindicated in the patients
ZLWK VKRUW OLIH H[SHFWDQF\ GD\V DQG LQ WKH
SDWLHQWVZLWKLQFRPSOHWHOXQJUHH[SDQVLRQ$EVR
lute contraindications for pleurodesis include the
absence of relief of dyspnea after the therapeu
WLFWKRUDFRFHQWHVLV³WUDSSHG´OXQJRURFFOXVLRQRI
the main bronchus. Relative contraindications for
pleurodesis include the terminal condition of pa
tient, widespread of metastasis, poor performance
VWDWXVDFWLYHDLU¿VWXODVORZS+SOHXUDOOLTXLGVH
vere existing lung disease, and the condition after
the extensive pleural abrasion or several biopsies.
7RGD\ WKH PRVW IUHTXHQWO\ XVHG DJHQWV ZLWK WKH
aim to achieve pleurodesis are talc, doxycycline
and bleomycin. Chemical pleurodesis should be
FRQGXFWHGLQWKHPRVWHI¿FLHQWWKHPRVWFRPIRUW
able and the most humane manner for the patient.
Since the placing of the large bores thoracic drains
is invasive procedure with potential morbidity and
complications, there is a need for the use of small
er diameter drains, so called pleural catheters that
are well tolerated and with minimal complications.
8VHRISOHXUDOFDWKHWHUVLVUHÀHFWLRQRIWKHGHVLUH
of the part of the health service providers, patients
DQGWKRVH¿QDQFLQJWKHKHDOWKLQVXUDQFHWKDWWKH
03(WUHDWPHQWLIDQGZKHQSRVVLEOHLVFRQGXFWHG
on an outpatient basis. Twelve studies with total of
SDWLHQWV SXEOLVKHG WKH DSSOLFDWLRQ RI SOHXUDO
FDWKHWHUV &K ZLWK WKH JRDO WR DFKLHYH WKH
chemical pleurodesis where the average rate of
HI¿FLHQF\ZDV
Goals
The comparative analyses of chemical pleu
rodesis with doxycycline or talc instilled through
WKH SOHXUDO FDWKHWHU 3OHXUDFDQ DQDO\VHV RI WKH
length of the period of thoracic drainage and ap
pearance of complications, assessment of the
VXEMHFWLYHSDUDPHWHUVG\VSQHDFRXJKSDLQORVV
RIERG\ZHLJKWIDWLJXHRISDWLHQWSULRUDQGDIWHU
the pleurodesis with the impact of the pleurodesis
WRWKHTXDOLW\RIOLIH
5HWURVSHFWLYH DQDO\VHV LQFOXGHG SDWLHQWV WR
whom the chemical pleurodesis has been con
ducted by talc or doxycycline through the pleural
catheters at the Clinic for Thoracic Surgery Clini
-DQXDU\XQWLO-DQXDU\7KHFULWHULD
for inclusion into study: both genders, pleural effu
sion has been established with prior established
PDOLJQDQW FRQGLWLRQ .DUQRIVN\ LQGH[ OLIH
expectancy over 30 days, subjective and objective
better general conditions after the thoracocente
VLV7KHFULWHULDIRUH[FOXVLRQIURPVWXG\.DUQRI
VN\ LQGH[ SRRU JHQHUDO FRQGLWLRQ ZLWK OLIH
expectancy of < 30 days, atelectasis due to endo
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pleural empyema, inability to achieve the full lung
UHH[SDQVLRQ DQG FRQWDFW EHWZHHQ WKH YLVFHUDO
DQGSDULHWDOSOHXUDH[LVWLQJOXQJVGLVHDVHODUJH
DLU ¿VWXOD DQG VLPLODU SOHXUDO HIIXVLRQ RI RWKHU
etiology. The thoracostomy was performed to all
SDWLHQWV ZLWK SOHXUDO FDWKHWHU 3OHXUDFDQ %UDXQ
and patients were divided into two groups depend
LQJ RQ W\SH RI VFOHURVDQV *URXS 3OHXURGHVLV
E\WDOFDQG*URXS3OHXURGHVLVE\GR[\F\FOLQH
2EWDLQHG SOHXUDO ÀXLG KDV EHHQ DQDO\]HG PLFUR
biologically, biochemically and cytopathologically.
3RVWSOHXURGHVLVFRQWUROVZHUHFRQGXFWHGRQFHD
PRQWKXQWLOWKHWKLUGPRQWKZKHQWKHHI¿FLHQF\RI
conducted pleurodesis was assessed.
7KH WHFKQLTXH RI LQVHUWLQJ WKH SOHXUDO FDWKHWHU
In the local anaesthesia the pleural catheter is in
VHUWHGSHUFXWDQHRXVO\3OHXUDFDQ%UDXQDQGWKH
SOHXUDOÀXLGLVHYDFXDWHG$IWHUWKHHYDFXDWLRQWKH
UHH[SDQVLRQRIOXQJVLVFKHFNHGUDGLRJUDSKLFDOO\
:KHQWKHFRQGLWLRQVDUHPHWVHFUHWLRQLVUHGXFHG
EHORZ PO K RU PONJ RI ERG\ ZHLJKW
the pleurodesis by talc or by doxycycline was per
formed. After the instillation of agent, the drain is
FORVLQJWKHSDWLHQWIRUQH[WKRXUVFKDQJHVWKH
SRVLWLRQ LQ WKH EHG HYHU\ PLQXWHV LQ RUGHU WR
KDYH WKH DJHQW HTXDOO\ GLVWULEXWHG DOO RYHU WKH
pleural surfaces, and then the drainage system is
FRQQHFWHGWRWKHDFWLYHVXFWLRQIRUQH[WKRXUV
After the reduction or elimination of secretion the
drain should be removed. The success of pleu
rodesis is controlled radiologically.
The success of chemical pleurodesis was catego
rized as:
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SDUWLDO OHVV UHDFFXPXODWLRQ LQ FRPSDULVRQ WR
WKHSUHGUDLQDJHOHYHODQG
XQVXFFHVVIXOVDPHRUODUJHUUHDFFXPXODWLRQ
Statistical analysis of data has been performed
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application of appropriate statistical methods. De
WHUPLQHGOHYHORIVLJQL¿FDQFHLVS7KHUH
sults were determined and comparison has been
made between the results with the data of relevant
research in modern referential literature with the
presentation of discussion and comments of indi
vidual results.
RESULTS
At the Clinic for Thoracic Surgery, in the period
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WLHQWV ZLWK FRQ¿UPHG 03( ZHUH WUHDWHG ,Q UHOD
WLRQWRJHQGHUZHUHZRPHQDQG
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causes are presented in the Figure 1.
)LJXUHType of primary malignancy.
lung cancer
brest cancer
lymphoma
others
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FDQFHU > @ DQG EUHDVW FDQFHU
>@2EWDLQHGSOHXUDOÀXLGZDVDQD
O\]HG F\WRSDWKRORJLFDOO\ PLFURELRORJLFDOO\ DQG
ELRFKHPLFDOO\ 7KH F\WRORJLFDO DQDO\VHV )LJXUH
0HGLFLQVNLåXUQDO
FRQ¿UPHG WKH SUHVHQFH RI PDOLJQDQW FHOOV LQ
SDWLHQWV%LRFKHPLFDODQDO\VHVRI
SOHXUDOÀXLGWKHSRVLWLYHK\DOXURQLFDFLGDONDOLQH
S+ORZOHYHOVRIJOXFRVHKLJKOHYHOVRI/'+ZHUH
IRXQG LQ SDWLHQWV 0LFURELRORJL
cal analyses showed the presence of bacteria in
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remained sterile.
Figure 2. 3UHVHQFHRIPDOLJQDQWFHOOVLQSOHXUDOHIIXVLRQ
Complete success of pleurodesis by talc was in
ZKLOH E\ GR[\F\FOLQH LW ZDV LQ
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7KHPDLQGLI¿FXOWLHVWKDWWKHSDWLHQWVFRPSODLQHG
were dyspnea, cough, pain, fatigue and loss of
ERG\ZHLJKW)LJXUH
)LJXUH)UHTXHQF\RIV\PSWRPDWRORJ\SULRUWRDQGDIWHUWKH
pleurodesis.
90,00%
80,00%
70,00%
60,00%
50,00%
pre-pleurodesis
post-pleurodesis
40,00%
positive
30,00%
negative
20,00%
10,00%
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Figure 3.
)LJXUH0DFURVFRSLFDSSHDUDQFHRISOHXUDOHIIXVLRQ
50,00%
45,00%
40,00%
35,00%
30,00%
25,00%
20,00%
15,00%
10,00%
5,00%
0,00%
hemorragic
sero-hemorragic
serous
0DOLJQDQWSOHXUDOHIIXVLRQLQWKHPDMRULW\RIFDVHV
ZDVVHURKHPRUUKDJLF>@DQGVH
URXV>@
7KH VXFFHVV RI SOHXURGHVLV 7DEOH LV FDWHJR
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ZLWKLQ PRQWKV DIWHU WKH LQWHUYHQWLRQ SDUWLDO
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UHDFFXPXODWLRQ
0,00%
cough
dyspnea
pain
fatigue
loss of body weight
7KHPRVWIUHTXHQWV\PSWRPVSULRUWRSOHXURGHVLV
ZHUH G\VSQHD HVWDEOLVKHG LQ FRXJKLQIDWLJXHLQDQG
SDLQ LQ RI FDVHV /RVV RI ERG\
ZHLJKWKDVEHHQHVWDEOLVKHGLQRI
SDWLHQWV7KHIUHTXHQF\RIVDPHV\PSWRPVDIWHU
the pleurodesis was as follows: dyspnea, cough
DQG SDLQ HDFK LQ DQG IDWLJXH LQ
SDWLHQWV ZKLOH WKH DGGLWLRQDO ORVV RI
ERG\ZHLJKWKDVEHHQHVWDEOLVKHGLQ
of cases.
The average length of drainage for all patients
ZDVGD\V7KHDYHUDJHOHQJWKRI
drainage for group of patients with talc pleurode
VLVZDVDQGWKHJURXSZLWKGR[\F\FOLQH
GD\V7KHUHLVQRVWDWLVWLFDOO\VLJQL¿FDQW
GLIIHUHQFH S! LQ WKH OHQJWK RI GUDLQDJH EH
tween the two groups.
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fever, pain and separation of effusion.
Table 2. Complications of pleurodesis.
7DEOH. Success of pleurodesis after three months in relation
to type of sclerosans.
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DQGSDLQLQSDWLHQWV
During the period of three months, pleurodesis
PXVW KDYH EHHQ UHSHDWHG *URXS LQ FDVHVDQG*URXSLQRIFDVHV
,QSDWLHQWVIURP*URXSWKHSOHX
0HGLFLQVNLåXUQDO
ral catheter had to be changed as it was clogged
DQG REVWUXFWHG ,Q RI SDWLHQWV WKH
catheter was dislocated outside of pleural space
and new one had to be placed in.
DISCUSION
At the Clinic for Thoracic Surgery CCUS pleurode
sis was performed through the pleural catheter
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NQRZQLQDOOSDWLHQWVSULRUWRWKHXQGHUJRLQJSURFH
GXUHRIFKHPLFDOSOHXURGHVLV,QWKHPRVWIUHTXHQW
QXPEHU RI FDVHV LW ZDV WKH OXQJ FDQFHU >
@ DQG EUHDVW FDQFHU > @
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PDMRULW\RIFDVHVZDVVHURKHPRUUKDJLFLQ
DQGVHURXVLQSDWLHQWV
&\WRSDWKRORJLFDODQDO\VHVRISOHXUDOFRQWHQWFRQ
¿UPHGWKHSUHVHQFHRIPDOLJQDQWFHOOVLQ
SDWLHQWV %LRFKHPLFDO DQDO\VHV RI SOHXUDO
OLTXLG VKRZHG SRVLWLYH K\DOXURQLF DFLG DONDOLQH
S+ ORZ YDOXHV RI JOXFRVH KLJK OHYHOV RI /'+ LQ
SDWLHQWV0LFURELRORJLFDODQDO\VHV
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6XFFHVVRISOHXURGHVLV7DEOHZDVFDWHJRUL]HG
as follows:
&RPSOHWH WKHUH LV QR UHDFFXPXODWLRQ ZLWKLQ PRQWKVDIWHUWKHLQWHUYHQWLRQ
ƕ7DOFLQSDWLHQWV
ƕ'R[\F\FOLQHLQSDWLHQWV
3DUWLDOOHVVUHDFFXPXODWLRQLQFRPSDULVRQWRWKH
SUHGUDLQDJHOHYHO
ƕ7DOFLQSDWLHQWV
8QVXFFHVVIXOVDPHRUODUJHUUHDFFXPXODWLRQ
ƕ7DOFLQSDWLHQWV
7KH PRVW IUHTXHQW VXEMHFWLYH V\PSWRPV SULRU WR
SOHXURGHVLV ZHUH G\VSQHD LQ FRXJKLQDQGIDWLJXHLQ
DQG WKH SDLQ LQ FDVHV
/RVV RI ERG\ ZHLJKW SULRU WR SHUIRUPDQFH RI WKH
SOHXURGHVLV ZDV HVWDEOLVKHG LQ SDWLHQWV7KHIUHTXHQF\RIWKHVDPHV\PSWRPVDI
ter the pleurodesis was as follows: dyspnea, cough
DQGSDLQLQDQGIDWLJXHLQ
SDWLHQWV ZKLOH DGGLWLRQDO ORVV RI ERG\
ZHLJKW KDV EHHQ HVWDEOLVKHG LQ cases. The average length of the pleural drainage
IRU DOO SDWLHQWV ZDV GD\V ,Q WKH
JURXS ZLWK WDOF SOHXURGHVLV LW ZDV DQG
WKHGR[\F\FOLQHJURXSGD\V7KHUHLVQR
VWDWLVWLFDOO\ VLJQL¿FDQW GLIIHUHQFH S! LQ WKH
length of drainage between the two groups. The
PRVWIUHTXHQWFRPSOLFDWLRQZDVIHYHUUHJLVWHUHGLQ
DQG SDLQ LQ SD
WLHQWV ,Q SDWLHQWV IURP *URXS the pleural catheter had to be changed as it was
FORJJHGDQGREVWUXFWHG,QSDWLHQWV
the catheter was dislocated outside of the pleural
space and new one had to be placed in. During the
period of three months, the pleurodesis must have
EHHQUHSHDWHG*URXSLQFDVHV
DQG*URXSLQRIFDVHV,Q3DW]
published a series of 19 patients who underwent
successful outpatient pleurodesis by pleural cath
HWHUDQG3DUXOHNDUHWDOZKRDUJXHWKDWWKHUHLVQR
GLIIHUHQFH LQ HI¿FDF\ FRPSDUHG WR VWDQGDUG SOHX
UDOGUDLQDJH)XUKDP/DZOHVVHWDOXVHG
GUDLQVFDWKHWHUVRIVPDOOGLDPHWHUDQGIRXQGWKDW
they are less traumatic and more comfortable for
SDWLHQWVZLWKDQHI¿FLHQF\WKDWLVVLPLODUWRWKDWLQ
the application of pleural drains of larger diameter
WKH VXFFHVV UDWH WR *UR]GLQ
DQG%DFNDUHDOVRXVHGVPDOOGLDPHWHUGUDLQVLQ
cases and found that they are safe, effective and
FRVWHI¿FLHQW&OHPHQWVHQHWDODUJXHWKDWWKH
success of pleurodesis with drains of small diame
WHUVLQDPEXODWRU\FRQGLWLRQVUDQJLQJIURP
WR6XPPDU\RI(QJOLVKOLWHU
ature described the treatment of malignant pleural
HIIXVLRQZLWKFKHPLFDOVXEVWDQFHVLQSDWLHQWV
,QWKHDIRUHPHQWLRQHGUHSRUWVXFFHVV
IXOSOHXURGHVLVKDVEHHQGH¿QHGDVFRPSOHWHUH
sponse to the applied sclerosans, which means the
DEVHQFHRIWKHUHDFFXPXODWLRQRIWKHSOHXUDOÀXLG
DV GH¿QHG E\ WKH FOLQLFDO FRQGLWLRQ RI WKH SDWLHQW
DQGFKHVWV;5D\%\XVLQJWKHPHQWLRQHGFULWHULD
WKH FRPSOHWH VXFFHVV ZDV DFKLHYHG LQ SDWLHQWV 1HDUO\ RI
patients treated with talc had a complete response.
Doxycycline, Corynebacterium parvum and Bleo
P\FLQDFKLHYHGWKHFRPSOHWHUHVSRQVHLQ
DQG SDWLHQWV UHVSHFWLYHO\ 7KH
most common side effects of chemical pleurodesis
were chest pain and fever. Based on the reports,
which are mostly retrospective, the incidence of
SDLQYDULHVIURPWRDQGIHYHUIURP
WRRIWKHFDVHV)HYHUXVXDOO\DS
SHDUHGZLWKLQWKH¿UVWKRXUVDIWHUWKHLQVWLOODWLRQ
of sclerosans and it generally stoped, without spe
FLDOWUHDWPHQWHYHQWXDOO\DQWLS\UHWLFVGXULQJWKH
QH[WKRXUV7ZHOYHDGGLWLRQDOVWXG
LHVZLWKWRWDORISDWLHQWVSXEOLVKHGWKHDSSOL
FDWLRQRISOHXUDOFDWKHWHUV&KZLWKREMHFWLYH
WR DFKLHYH WKH FKHPLFDO SOHXURGHVLV ,Q SDWLHQWV WKH SOHXURGHVLV ZDV SHUIRUPHG E\
WDOFLQE\GR[\F\FOLQHLQE\EOHRP\FLQDQG
0HGLFLQVNLåXUQDO
LQSDWLHQWVE\WHWUDF\FOLQH2YHUDOOVXF
FHVVUDWHLQSDWLHQWVLQZKRPSOHXUDOFDWKHWHUV
XVHGZDV
CONCLUSION
Applying pleural catheter with chemical pleurode
sis can achieve identical results as when using
standard thoracic drainage. In relation to the ap
SOLHG VFOHURVLQJ DJHQW WDOF YV GR[\F\FOLQH VXF
cess of pleurodesis was better when using talc.
&RQÀLFWRILQWHUHVW none declared
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UDOQLP L]OLYRP 8 *XVND 6 2SãWL SULQFLSL VDYUHPHQH
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6DUDMHYRVWU
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5REHUWV0(1HYLOOH(%HUULVIRUG5*$QWXQHV*$OL
1-0DQDJHPHQWRIDPDOLJQDQWSOHXUDOHIIXVLRQ%ULWLVK
7KRUDFLF6RFLHW\3OHXUDO'LVHDVH*XLGHOLQH7KR
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'UHVVOHU &' 2ODN - +HUQGRQ -( 5LFKDUGV :*
6FDO]HWWL ()OHLVKPDQ 6% HW DO 3KDVH ,,,LQWHUJURXS
study of talc poudrage vs talc slurry sclerosis for malig
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6KDZ 3 $JDUZDO 5 3OHXURGHVLV IRU PDOLJQDQW
pleural effusions. Cochrane Database Syst Rev.
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pleurodesis outcome in patients with malignant pleural
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TA, Sutherland S, et al. Optimal management of malig
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trasound in the diagnosis of malignant pleural effusion.
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+XQW%0)DULYDU$69DOOLqUHV(/RXLH%($\H5:
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neled pleural catheters for palliation of malignant pleural
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talc pleurodesis in malignant recurrent pleural effusions.
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Original article
THE PREVALENCE OF BACTERIAL VAGINOSIS IN PREGNANT WOMEN WITH
THREATENED PRETERM BIRTH
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ABSTRACT
In Europe and many developed countries the pre
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play a major role in the genesis of preterm birth
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Aims were to determine demographic and clinical
characteristics of pregnant women with threat
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necology and Obstetrics, Clinical Center Univer
sity of Sarajevo in one year period. In the control
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were analyzed. Statistical analysis was performed
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Conclusion: the present study showed that preva
lence of bacterial vaginosis in women with threat
ened preterm birth was higher than in women
without threatened preterm birth.
Key words: bacterial vaginosis, threatened pre
term birth
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INTRODUCTION
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of gestation, is a major determinant of neonatal
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and many developed countries the preterm birth
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in the genesis of preterm birth and may account
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characterized by a reduction in concentration of
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ing lactobacilli and an increase in concentration of
other organisms, especially anaerobic gram nega
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Fusobacterium species and Atopobium vaginae
are also common. Gardnerela vaginalis is a part of
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the anaerobes produce enzymes that dissolve the
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trimetilamin. The amines increase the vaginal se
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ally representative sample of pregnant women
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ed no symptoms; pregnant women who have not
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on lifetime number of sexual partners. In clinical
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At least three of four criteria should be present for
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pitalized at the Clinic of Gynecology and Obstet
rics and Clinical Center University of Sarajevo
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Inclusion criteria were: pregnant women from
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or local maternal infection, except for an infection
of the lower genital tract, systemic autoimmune
diseases, malignity, endocrinopathies, previously
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plying following Amsel’s criteria: the presence of
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test was determined by exposing the vaginal se
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ous normal distributed variables. In case of cat
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RESULTS
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groups. The high school educational level was
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7DEOH Demographic and clinical characteristics of pregnant
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CONCLUSION
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DISCUSSION
Amsel’s clinical criterion is the most widely recog
nized test and its disadvantage is the subjective
visual and olfactory criteria. In the present study,
bacterial vaginosis was more common among
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were included. Bacterial vaginosis increased the
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et al.bacterial vaginosis in early pregnancy was
associated with hospitalization for preterm labor
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pregnant women with bacterial vaginosis was 0.9
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ever, bacterial vaginosis was associated with late
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tween prevalence of bacterial vaginosis in threat
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threatened preterm, preterm, and term labor was
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The present study showed that prevalence of bac
terial vaginosis in women with threatened preterm
birth was higher than in women without threatened
preterm birth. The testing for bacterial vaginosis of
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preterm birth.
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Original article
PREDICTORS OF PROGRESSION OF BONE METASTASES IN BREAST CANCER
DIAGNOSED WITH SKELETAL SCINTIGRAPHY BASED ON THE HORMONE RECEPTOR STATUS AND HER2 PROTEINS
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KARCINOMOM DOJKE PREMA STATUSU HORMONALNIH RECEPTORA I HER2
PROTEINA
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zegovina; &OLQLFIRU2QFRORJ\&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR%ROQLþND6DUDMHYR%RVQLDDQG
Herzegovina
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ABSTRACT
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Bone is one of the most common locations for the
breast cancer metastasis. Numerous reports have
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patient’s age, represent positive predictors to the
bone metastasis development in breast cancer
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seen as consistent within both, the primary tumor
tissue and the metastatic tissue. Certain reports of
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of metastasis spreading to the lungs, liver and
brain is higher than the one to the bones.
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included patients with the positive status of ER
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status and the second group consisted of patients
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the third group had patients with triple negative
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breast cancer patients had their diagnosis patho
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ative, hormone positive and triple positive breast
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statusom, u drugoj grupi su pacijentice sa nega
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Key words: bone metastases, bone scintigraphy,
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INTRODUCTION
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disease. In developed countries, breast cancer
is responsible for one fourth of new cases of car
FLQRPD ZLWK ZRPHQ ,Q (XURSH DURXQG women fell to this illness every year, and 131,900
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nant Neoplasm Clinical Centre University of Sa
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underwent breast cancer treatments at CCUS in
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RI WKH RYHUDOO QXPEHU RI WKH PRVW IUHTXHQW
tumor types treated at CCUS during this time
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PRVW IUHTXHQW W\SH RI WXPRU ULJKW DIWHU WKH OXQJ
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of all malignoma detected with women in the said
time period. According to data from the Croatian
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cancer every year. Unfortunately, B&H has not still
established a cancer registry at the national level,
so we have considered herein information from
the Croatian National Cancer Registry for reasons
of similar geomorphologic and hereditary charac
teristics of the population and similar population
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There is whole range of prognostic factors regard
ing the breast cancer. Some of these factors are
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pecially in patients with negative values for armpit
lymph nodes. There is a linear relationship be
tween tumor size and affected regions of lymph
nodes, on one side, and tumor size and survival
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and analysis of lymph nodes rests primarily with
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trolling of the illness. This is the most important
prognostic factor for patients with breast cancer.
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rate also depend on the number of affected lymph
nodes.
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nected to the primary tumor. Their occurrence is
one of the most important characteristics of ma
lignity, although not all malignant tumors produce
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lishing the primary diagnosis of the breast cancer,
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system, determined as a sign of the primary illness
progression, varies among different authors deal
ing with this issue and is found to be somewhere
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age represent positive predictive factors to de
velopment of bone metastasis for breast cancer
patients . Another possible predictive factor is the
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protein over expression is generally considered
consistent within the primary tumor tissue, as well
as within the metastasis tissue. Also, metastasis
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pression. Certain reports suggest that the HER”
over expression also entails higher incidence of
metastasis of lungs, liver and brain, rather than
the bone metastasis. So far, no comparative stud
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cal results, this manner of monitoring bone me
tastases would also help further determine models
for screening of breast cancer patients.
There are several diagnostic methods to detect
ing bone metastasis, among which are radiology
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raphy is a highly sensitive method in detection of
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response even in cases when a lesion is osteo
lytic. This is a precondition for metastases to at
tract more radiopharmaceuticals during the scin
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In most cases, this relates to multiple metastases
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cer, prostate cancer, bronchial cancer, gastric
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used to monitor the bone metastases’ response
to treatment by means of examining deposits of
radiopharmaceuticals in lesions before and after
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bone metastasis, the scintigraphy will provide a
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high accumulation of radiopharmaceuticals in the
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and very low circulatory activity and activity with
regards to soft tissues.
This study includes scintigraphy images of a total
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These are patients referred by oncologists from
the Oncology Clinic, by surgeons from the Glan
dular and Oncology Surgery Clinic of CCUS and
by physicians of other relevant medical institutions
within the Federation of Bosnia and Herzegovina.
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diagnosis of the breast cancer.
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thology Clinic of CCU.
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range gamma camera and a high resolution col
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three hours after an intravenous application of
osteotropic radiopharmaceutical. The most ap
propriate time for the scintigraphy is three hours
after administrating the radiopharmaceutical since
this is the best time span for bone activity in their
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or diphosphate compound. Gamma camera can
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that we compare an activity within the bone with
pathological changes and an activity of a healthy
bone in the same region. In this way, we arrive to
the activity ratio between bones with pathological
changes and healthy bones.
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spective study and was conducted within the pe
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with positive status of hormonal receptors ER and
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tween the occurrence of bone metastasis and
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group to possibly conduct a routine screening of
bone metastasis. Secondary objective was to run
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cation of the breast cancer.
Statistical processing and analysis of data was
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groups. The selected methods are standard meth
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the primary hypothesis at the reliability level of
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tables and charts based on an absolute number
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arithmetical mean, standard deviation, standard
error and value range depending on data type.
RESULTS
According to immunohistochemical characteris
tics of a tumor, patients were divided into 4 tested
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of patients was within the group of triple negative
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cates that the largest number of carcinoma in the
tested sample is in the N1 stage, while the least
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tal sample showed that there were 119 patients
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sults. The largest number of positive scintigraphy
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between tested groups of breast cancer patients
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group, as well as between the triple negative group
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the analysis of these parameters, this means
that patients with triple positive carcinoma have
greater chances of developing bone metastasis,
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developing such metastasis. This may represent
an important element in a clinical evaluation of
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groups of patients.
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is accompanied with an increase in statistical
probability of the bone metastasis occurrence
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patients.
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within the triple positive group and within the over
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brings along an increase of statistical probability of
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sense that larger tumor with affected lymph nodes
can be an independent predictive factor to devel
opment of bone metastasis with breast cancer pa
tients.
DISCUSSION
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group of patients with positive scintigraphy results
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Development of a breast cancer is a gradual pro
cess based on genetic alterations leading to a pro
gressive transformation of normal human cells to
highly malignant products. In case of the breast
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vance, the main cell and molecular mechanisms
involved in the bone metastasis process are still
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essary to gain more comprehensive and clear
understanding of these cell and molecular pro
cesses.
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occurrences with breast cancer patients. Accord
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of all patients who died of the breast cancer had
the metastatic bone dispersion. This was a chron
ic condition with most of these patients.
Since the occurrence of distant metastasis is
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consistently related to the mortality rate of breast
cancer patients, measurement of this distant met
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potential of ensuring early results related to testing
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shown that bone metastases were the most fre
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rence of the metastatic illness.
Out of this number, 170 patients had no evidence
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tion.
Also out of this total number, 91 patients had the
bone metastasis as the only location of the met
astatic illness. It is generally accepted fact that
the hormonal receptors’ status correlates with the
overall survival rate. However, actual effect of hor
monal receptors to the dispersion manner of this
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receptors. These were patients with a potential for
metastatic breast cancer, where all of them under
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brain.
Results obtained in this research indicated that
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with a metastatic illness within the thorax and ab
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group included patients with the metastatic illness
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According to this study, there are two forms of me
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cancer and with a potential for brain metastases.
Upon considering these distributions, a clinician
can estimate a metastasis probability for different
organ systems. This study corroborates our re
search in sense that patients with triple negative
cancer have fewer incidence of the bone metas
tasis as opposed to those with positive hormonal
status.
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with types of relapses and metastatic dispersion
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metastatic breast cancer. The research resulted
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out any relapses was longer with patients within
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within the patients of these groups. Our research
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available materials substantiating this thesis.
CONCLUSIONS
In our study we presented data that patients with
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ple positive breast cancer have statistically great
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their case is indicated only in special cases.
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guideline regarding a diagnostic protocol in sense
that, in certain selected cases patients, it should
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during the cancer staging process for these pa
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&RQÀLFWRILQWHUHVWnone declared.
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REFERENCES
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characteristic of bone metastases in breast cancer.
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pert consensus on the primary therapy of early breast
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11. Coleman RE. Clinical features of metastatic bone
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ing to estrogen receptor status. Cancer Chemother
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Original article
IMPACT OF EARLY DETECTION OF ELBOW OVERUSE SYNDROME ON TREATMENT
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ABSTRACT
Overuse elbow syndrome is a set of chronic dam
age incurred in sport and recreation, or in some
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The main symptom is pain in the lateral or medial
epicondyle. Often enough attention is not given to
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sis and thus the approach to treatment. However,
based on a thorough history and physical exami
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disease is important for treatment that is basically
conservative. Surgical treatment is rarely used.
The aim of this study was to demonstrate the im
pact of early detection of overuse elbow injuries
to treatment, duration of treatment and complete
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ries related to professional or sports activity and
were treated in the primary health care center af
ter more than 48 hours after symptoms occurred,
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of sports medicine or club doctors within 48 hours
of symptom onset, and covered the period of two
years . The results showed that the analysis of
the duration of physical treatment, complete treat
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and perform sports activities shows that all three
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indicating shorter treatment and a better outcome
in patients who earlier reported to the treatment
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tion of overuse elbow injuries shortens the dura
tion of treatment, and enables faster and more
complete return of patients to their professional,
sports and everyday activities.
Key words: overuse syndrome, detection, pain,
elbow
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INTRODUCTION
Overuse syndrome is a set of chronic elbow dam
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creating discomfort or pain in the muscles, joints,
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side and the inside of the elbow, from which depart
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overuse injuries in the elbow joint can complicate
these movements and occur not only by sports,
but also by everyday life and professional activi
ties.
Cause of golfer’s and tennis elbow is repeated me
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muscle origin. This result in more or less damage
to tendons of affected muscle, their bone origin,
and in untreated patients and patients with chronic
illnesses also damage to the surrounding tissue.
The most common symptoms are reduced hand
function, sensitivity and tenderness over the bony
origin of muscle tendons which increases with the
use of arms. Symptoms develop gradually and
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in both sexes, more in the dominant hand, and
most affected are those in the middle age, which
in the course of using the maximum way forearm
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barbers , builders, drivers, mechanics, ceramists,
waiters, persons engaged in gardening, carpen
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players, hence the name tennis elbow, table ten
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Tennis elbow occurs 10 times more often than
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and golfer’s elbow is pain in the lateral or medial
epicondyle of the elbow, which can be of varying
intensity, from mild after the activity, to the constant
pain that prevents any activity. The characteristic
symptom is decreased strength of the hand, that
patients complain about the appearance of strong
pain when lifting even very light loads which are
held in the hand, such as when lifting a cup of tea
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tention which leads to delay in diagnosis and thus
the approach to treatment.
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determine the exact painful parts of the elbow joint
and functional changes in their active and passive
motion, sometimes the presence of effusion in the
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Although the diagnosis of lateral epicondylitis is
essentially set on the basis of clinical examination,
however, also may be helpful radiological and ul
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elbow in most cases are normal and are made to
identify any other damage or deformation of the
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trasound examination can detect focal hypoecho
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around which can be found traces of effusion, as
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for the treatment which needs to start as early as
possible. Treatment is essentially conservative.
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and refrain from activities that lead to unhealthy
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tion of cold compresses and ice, as well as elastic
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(OHYDWLRQ DQG SK\VLFDO WKHUDS\ VWUHWFKLQJ H[
ercises, isotonic and isometric exercises, cryo
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ment is rarely used and is reserved for resistant
and recurrent cases where are diagnosed degen
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structures with the aim of removing the damaged
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Aim
The aim of this study was to show the effects of
early detection of overuse elbow injuries on treat
ment, achievement of better treatment results and
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activities.
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sexes, whose painful symptoms were related to
RFFXSDWLRQDODQGVSRUWVDFWLYLWLHVDWDJHIURP
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athletes and were treated by a doctor of sports
medicine and club doctor at sports clubs. To col
lect relevant data on each patient, manner of in
jury, type of professional or sports activities, time
to consult a doctor, diagnostic procedures, type
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length of disability since sports activities and the
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The study covered a period from November 1,
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All patients were divided into two groups of 30 pa
tients:
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subjects with injuries related to professional activ
ity and a smaller number of athletes who reported
to an examination by a surgeon in a medical cent
er because of pain in the elbow for a period of time
longer than 48 h.
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tacted and were treated at a sport medicine spe
cialist or club doctor because of pain in the elbow
at a time up to 48 hours since the onset of pain.
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Data were collected and used from medical re
cords of patients and the protocol of registry of
medical records from the surgical clinic of the
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of medical records from sports clubs, physiatrist
protocols and surgical protocols of Hospital Nova
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formed the same diagnostic procedures. In each
SDWLHQWZDVWDNHQDGHWDLOHGPHGLFDOKLVWRU\FRQ
ducted clinical examination to determine the exact
location of pain, and in case of suspicion to ten
nis and golfer’s elbow were applied some of the
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as observations of other injury or deformity of the
elbow.
Ultrasound examination revealed focal hypoecho
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and around which can be found traces of the ef
fusion. If necessary, magnetic resonance imaging
was done, especially in another suspected joint
disease of the elbow.
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patient from the II group, which includes athletes,
was performed by a doctor of sports medicine and
club doctor with the availability of standard radi
ography, ultrasound of the painful elbow area and
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After diagnostic procedure was indicated individu
al therapy by choice of sports medicine doctor or a
FOXEGRFWRUZLWK¿OOLQJRXWD¿OLQJPHGLFDOUHFRUGV
of the treatment procedures performed, which are
used for evaluation.
All patients examined in this study, to which was
indicated physical therapy, the treatment was con
ducted at the Department of physical medicine at
Hospital Nova Bila.
For statistical analysis was used statistical soft
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ods of descriptive statistics in order to calculate
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RESULTS
The study involved two groups of 30 patients each.
In both study group analysis by gender showed a
higher prevalence of male patients, while accord
ing to the side, the localization of the disease in
most cases was on the right side.
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side.
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ed in both groups as well as in the total sample,
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S!
According to the localization of the disease in most
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tion is retained within the group and between the
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Table 2. 3UHVHQWDWLRQRIDFWLYLWLHVDQGW\SHVRIV\QGURPHVE\
localization.
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Analyzing the occurrence of the syndrome by ac
tivities it can be noticed that in the total sample,
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corded only in group I.
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cant differences in the activities in which the injury
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Also type of overuse injuries localization shows
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groups as well as the activities which leaded to
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If we compare the average age of patients in both
groups we can notice that patients in group II, with
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are slightly older than the patients in group I with
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7DEOH Type of treatment in groups I and II.
7DEOH Comparison of age groups.
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type.
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It is notable that all patients from group II 30
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tients from Group I were treated conservatively
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Review by age groups indicates that in the total
sample as well as in the individual groups of larg
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7DEOHComparison of the average duration since the symp
tom onset until start of the treatment.
7DEOHD Comparison of mean age between the groups.
Analysis of time from symptom onset to the start
of treatment indicates that the patients in group
I had the average time since onset of symptoms
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while the patients from group II had an average
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Table 6. Comparison of the average time of treatment and dis
ability.
)LJXUH Comparison of the average time of treatment and
disability.
Analysis of the physical treatment duration, com
plete treatment duration and the length of inability
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longer for patients in group I compared to group
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and better outcome in patients who have started
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DISCUSSION
Overuse elbow syndrome is a set of chronic dam
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Analyzing the results obtained in both groups, we
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groups as well as in the total sample but without
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syndrome is usually localized at the dominant
hand. In our study the localization of the disease
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distribution is retained within the groups and be
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noted that in the total sample as well as individual
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paring the average age of patients in both groups
is observed that patients in group II, with a mean
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slightly older than the patients in group I with a
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S 2YHUXVH HOERZ V\QGURPH GHYHORSV LQ
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more in the dominant hand, while most affected
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LQWKHPD[LPDOPDQQHUIRUHDUPPXVFOHV.UDSDF
HWDO
Comparing the data obtained in this study with
data found in other studies, it can be said that the
incidence of overuse elbow syndrome according
to gender, age and according to the side are con
sistent.
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with delay in the diagnosis and therefore the start
of the treatment. However, based on detailed case
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ZLWKGLDJQRVWLFSURFHGXUHV;UD\DQGXOWUDVRXQG
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Basically there is a great similarity in damages re
lated to the sports and professional activities with
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Analyzing the development of the activities of the
syndrome in our study, we see that the majority of
syndromes in the baseline sample was related to
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differences in the activities in which the infringe
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Similarly type of overuse syndrome localization
in our study indicates that most of are of tennis
HOERZ W\SH RU FRPSDUHG WR JROIHU¶V
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differences between the groups as well as the ac
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According to data from other studies, tennis elbow
occurs 10 times more often than golfer’s elbow
&DYHHWDO
Analysis of time period from symptom onset to
start of treatment indicates that patients in group
I had a long period since symptom onset until
VWDUWRIWUHDWPHQWZKLFKZDVRQDYHUDJH
GD\VUDQJHGD\VDQGLWZDVDFDVHIRUODUJH
number of subjects related to an occupation injury,
while in group II subjects had a shorter period with
DYHUDJHRIGD\VUDQJHGD\VLQGLFDW
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JURXSVS
Damage is usually chronic, resulting in a series
of consecutive micro trauma, which are initially ig
nored, patient continues its activities and it is dif
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had the time up to two days since onset of symp
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in group II and all patients were treated conserva
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conservative treatment it was also applied surgi
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case of car mechanic and one person who was
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Treatment is essentially conservative, nonsur
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access is at the individual level, because we can
not treat in the same manner active sportsmen,
those injuries related to a professional activity and
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served for resistant and recurrent cases when are
diagnosed degenerative and calcifying changes in
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ing the damaged tissue and section of affected
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From our study it can be seen that the patients
IURPJURXS,,DQGSDWLHQWV
from group I were treated conservatively and only
RU RI SDWLHQWV IURP JURXS , ZHUH WUHDWHG
ZLWKDFRPELQDWLRQFRQVHUYDWLYH±VXUJLFDOWUHDW
PHQW ZLWKRXW VWDWLVWLFDOO\ VLJQL¿FDQW GLIIHUHQFHV
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In our study, analysis of the duration of physical
treatment, duration of complete treatment and
WKH GXUDWLRQ RI WKH LQDELOLW\ WR ZRUN DQG HQJDJH
in sports activities shows that all three param
HWHUV ZHUH VWDWLVWLFDOO\ VLJQL¿FDQWO\ ORQJHU LQ SD
tients from group I than in case of group II pa
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treatment outcome in patients who have started
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analysis are in favor of group II, which included
patients with painful syndrome in the elbow, and
the problems were related to sports activity.
By such early detection, we have shown the im
pact on the treatment, achievement of better re
sults of treatment and full return of patients to daily
0HGLFLQVNLåXUQDO
ZRUNDQGVSRUWVDFWLYLWLHVDQGFRQ¿UPWKHJRDOV
of our study.
CONCLUSION
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ERZ LV D VHW RI FKURQLF PLFUR WUDXPD GDPDJHV
incurred in sport and recreation, or in some occu
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In this paper we have shown that early detection
of overuse injuries in the elbow, and the length of
time from symptom onset to start of treatment af
fects the course and results of treatment of this
disease. Clinical diagnostics, along with a detailed
KLVWRU\ DQG H[DPLQDWLRQ RI VSHFL¿F FOLQLFDO WHVW
WHVWZLWKFKDLU0LOOHVWHVWDOORZVHDUO\GLDJQRVLV
and hence early treatment. Treatment is usually
conservative with a recommendation to start as
early as possible, and access is always individual,
because we cannot treat the same the persons
with injuries related to a sporting, recreational or
professional activity.
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VSRUWV ELRPHFKDQLFDO FRQVLGHUDWLRQV 0HG 6FL 6SRUWV
([HUF
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epicondylitis in occupational settings: prevalence, in
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Original article
IMPACT OF ACCOMPANYING DISEASES ON RESULTS OF TREATING PATIENTS
WITH PLEURAL EMPYEMA
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PLEURALNIM EMPIJEMOM
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zegovina
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ABSTRACT
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patients who are hospitalized with pneumonia,
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pyema. Treatment of acute empyema is focused
on rapid and complete evacuation of empyema
content and supporting measures enabling to
achieve general resistance of the organism. One
of the important factors that affect the outcome of
treatment is presence of accompanying diseases.
The study included 100 patients with test results
corresponding to parapneumonic and metapneu
monic pleural empyema, who were treated at the
&OLQLF IRU 7KRUDFLF 6XUJHU\ 7KH ¿UVW JURXS FRQVLVWHGRISDWLHQWVZLWKRXWFOLQLFDOO\YHUL¿HGV\V
WHPGLVHDVHV7KHVHFRQGJURXSFRQVLVWHGRI
patients with accompanying diseases.
Diabetes mellitus was leading disease among ac
companying diseases in patients covered by this
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and average length of treatment of patients with
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GD\V 7RWDO PRUWDOLW\ SHUFHQWDJH ZDV 0RU
tality in group I was not recorded. All cases with
fatal outcome were recorded in patients with ac
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tic problem in patients with severe accompanying
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years. There was an increased mortality rate com
pared to patients without accompanying diseases,
and treatment is prolonged.
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Key words: parapneumonic pleural empyema,
accompanying diseases.
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INTRODUCTION
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patients who are hospitalized with pneumonia,
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S\HPD3OHXUDOHPS\HPDLVDUHODWLYHO\IUH
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pleural empyema early correct diagnosis is of sub
stantial importance. Treatment of acute empyema
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empyema content and supporting measures that
achieve general resistance of organism affected
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evaluation in connection with probable cause of
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viously isolated bacteria, presence of concurrent
infection of other sites in organism, status of ex
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other factors accompanied with patient. One of im
portant factor affecting the outcome of treatment is
presence of other accompanying diseases in pa
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FRPSDQ\LQJGLVHDVHVZHUHWUHDWHG±JURXS
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covered by this study is shown in Tables 1 and 3
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7DEOH3UHVHQFHRIDFFRPSDQ\LQJGLVHDVH
)LJXUH Review of accompanying diseases.
34%
The study included 100 patients with clinical,
laboratory and radiological tests corresponding to
parapneumonic and metapneumonic pleural em
pyema treated at the Clinic for Thoracic Surgery
Clinical Center University of Sarajevo in period
-DQXDU\-DQXDU\&ULWHULDIRULQ
clusion in the study were clinical, radiological and
biochemical tests corresponding to pleural empy
ema, with test showing presence of pus in pleura
during thoracentesis. The study included both
presence of accompanying diseases in patients
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course and outcome of treatment.
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companying disease: diabetes mellitus, chronic
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etc.
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difference in regard of accompanying diseases
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S Table 2. Accompanying diseases.
RESULTS
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Clinic for Thoracic Surgery, Clinical Centre Univer
sity of Sarajevo 100 patients with parapneumonic
pleural empyema were treated. Average age of
0HGLFLQVNLåXUQDO
)LJXUHRecorded mortality per groups.
Figure 2. Accompanying diseases.
16%
12
40%
10
8
6
26%
4
2
8%
10%
0
Cor decompensatum
Diabetes mellitus
ICV
Epilepsy
Other diseases
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*URXS,
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Average length of treating patients with
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days, and average length of treating patients
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cured, and percentage of patients who died was
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cases with fatal outcome were found in patients
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gical treatment was carried out at level of thoracic
drainage.
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DISCUSSION
Diabetes mellitus was leading disease among
accompanying diseases covered by this
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25
20
15
10
5
0
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treated longer.
Outcome of treatment of patients in this study is
shown in Table 3 and Figure 3.
7DEOH Outcome of treatment.
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100 patients with pleural empyema, average age
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men suffered from pleural empyema more often
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the course and outcome of treatment of patients
suffered from pleural empyema was analysed. In
RISDWLHQWVSUHVHQFHRIDFFRPSDQ\
ing diseases was recorded. Statistically, there is a
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GLVHDVHVSUHVHQFH; S In our series of 100 cases, the ratio between pa
tients with severe accompanying diseases and
patients without these diseases is highly unfavour
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of patients is similar. These patients have an ex
tremely bad prognosis of pleural empyema and
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Diabetes mellitus was leading disease among
patients with accompanying diseases covered by
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Despite using modern therapy, mortality caused
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high and according to most literature data ex
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higher than mortality determined within this study
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mainly patients with severe accompanying diseas
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were recorded in the group of patients with ac
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recorded in this study is one of more favourable
outcomes in comparison with results published in
reference literature.
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RI SDWKRJHQV *UDPQHJDWLYH HQWHUREDFWHULD
and also from the fact that these were patients
with severe accompanying diseases. Although the
results in terms of mortality in this study is lower
than the results provided in reference literature,
there is a possibility for improving these results if
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doctor to visit to thoracic surgeon is shorter.
CONCLUSIONS
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tic problem in patients with severe accompanying
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An increased mortality rate was found in regard
of patients without accompanying diseases, and
treatment was prolonged and faced with major
challenges both in surgical and medicament seg
ment.
Regular radiological test made in all patients suf
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groups and early diagnostic thoracentesis are ba
sic measures to reduce morbidity and mortality in
case of pleural empyema.
REFERENCES
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3URF$P7KRUDF6RF±
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HPS\HPD6HPLQ5HVSLU,QIHFW±
&RRWH 1 6XUJLFDO YHUVXV QRQVXUJLFDO PDQDJHPHQW
of pleural empyema. Cochrane Database Syst Rev
&'
7KRPVRQ$++XOO-.XPDU05:DOOLV&%DOIRXU/\QQ
,05DQGRPLVHGWULDORILQWUDSOHXUDOXURNLQDVHLQWKHWUHDW
PHQWRIFKLOGKRRGHPS\HPD7KRUD[±
5LV +% 3H]]HWWD ( .UXHJHU7 /DUGLQRLV ' 6XUJLFDO
treatment of pleural infections: the surgeon’s point of view.
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WHUV-:7KHUDS\RISDUDSQHXPRQLFHIIXVLRQVLQFKLOGUHQ
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/DUGLQRLV'*RFN03H]]HWWD(%XFKOL&5RXVVRQ9
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isms increase the conversion thoracotomy rate in patients
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agement of parapneumonic effusion and empyema. Arch
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thoracoscopic surgery in the treatment of chronic empy
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outcome of empyema in children in the north east of Eng
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Address:
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Clinic for Thoracic Surgery
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Original article
ANALYSIS OF CORONARY RISK FACTORS IN OBESE PATIENTS WITH HYPOTHYROIDISM
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71000 Sarajevo, Bosnia and Herzegovina; (PHUJHQF\0HGLFDO6HUYLFH6DUDMHYR&DQWRQ6DUDMHYR%RVQLD
and Herzegovina, 3&OLQLFIRUJDVWURHQWHURORJ\DQGKHSDWRORJ\&OLQLFDO&HQWUH8QLYHUVLW\RI6DUDMHYR%ROQLþND
71000 Sarajevo, Bosnia and Herzegovina.
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ABSTRACT
Cardiovascular disease remains the leading
cause of global mortality and morbidity. Strong ef
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drop in mortality from coronary heart disease by
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patients with hypothyroidism is more common
than in patients with normal body weight.
The aim: to compare the prevalence of coronary
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thyroidism; in overweight patients and in ones with
normal weight.
The study was conducted as an observational,
open, retrospective clinical study, with data col
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Clinical Centre University of Sarajevo, Clinic of
Endocrinology as well as from Sarajevo Canton
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hypothyroidism, were divided into groups, accord
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The analysis included blood pressure monitoring
and laboratory tests: blood glucose, cholesterol,
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tus.
Results: The average serum cholesterol level
was higher in patients with hypothyroidism, with
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cal analysis with Student’s t test showed that the
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Conclusion: These results suggest that obese pa
tients with hypothyroidism have increased serum
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pared with patients having normal body weight.
Evaluation of the hormonal status of the thyroid
gland should be an integral part of the treatment
of patients with coronary heart disease
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INTRODUCTION
Cardiovascular disease remains the leading cause
of global mortality and cause of the nearly 17 mil
lion deaths per year and almost half of deaths in
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Causes that lead to the development of coronary
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emergence and development of coronary artery
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tors present, and their early detection and action
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further course of the disease.
In patients suffering from hypothyroidism, altera
tion of metabolic processes is expected; in addi
tion, increased body weight has an additional ef
fect on the cardiovascular system and coronary
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Development of atherosclerosis may be due to
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lesterolemia, after which the platelet adhesion
comes in place, platelet aggregation, then pen
etration of monocytes in the sub endothelial layer
occurs together with the release of growth factors
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It has been shown that the occurrence of athero
sclerotic changes has a higher incidence in pa
tients who had repeated viral or bacterial infec
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has poorer hospital prognosis in coronary artery
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stimulate platelet aggregation, promote adhesion
of molecules on the endothelium and to increase
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+'/FKROHVWHURO
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terol plays an important role in the development of
atherosclerosis. After endothelial damage, adher
ence and platelet aggregation, adhesion of mono
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fats accumulate and lead to the formation of foam
cells. Endothelial cells are damaged and endothe
lial windows that have electronegative charge are
thus created. Therefore, there is suction and the
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molecules exhibit hemotactic effect on circulating
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in their adhesiveness and increased aggregation.
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terol, which in recent literature, is referred to as a
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The aim of the study is to analyze the prevalence
RIFRURQDU\ULVNIDFWRUVLQREHVHSDWLHQWVZLWKK\
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The study was a retrospective, observational,
comparative study.
Evaluation for inclusion in the study included:
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available medical records as proof of primary di
DJQRVHV K\SRWK\URLGLVP DYDLODEOH PHGLFDO UH
cords of previous treatment, and available labora
tory records with the values of needed laboratory
parameters. Special forms have been designed
for the study in order to collect the relevant data
ZRUNVKHHWLQZKLFKIROORZLQJGDWDRQWKHEDVLV
of medical interviews was collected and entered:
name, gender, age, body weight and height, the
FULWHULDIRULQFOXVLRQH[FOXVLRQGDWDRQGLDJQRVLV
DQGWUHDWPHQWRIK\SHUWKLUHRVLVH[LVWHQFHRIULVN
factors for developing coronary artery disease.
:RUNLQJVKHHWLQFOXGHGODERUDWRU\GDWDDQG%0,
The study used materials and medical histories of
the Clinical Center University of Sarajevo, Clinic
of Endocrinology as well as data from Sarajevo
Canton Health Center.
6XEMHFWV
7KHVWXG\LQFOXGHGPDOHDQGIHPDOHVXEMHFWV
0HGLFLQVNLåXUQDO
ZLWK D PHDQ DJH RI \HDUV ROG ZLWK K\SRWK\
roidism, divided into two groups according to
%0,%RG\0DVV,QGH[6FUHHQLQJ LVGRQHRQD
sample of 133 patients; 38 of them did not have
complete information needed for carrying out the
study. Data was collected from medical records
of patients with hypothyroidism during the period
-DQXDU\6HSWHPEHU
Before inclusion in the study subjects had to meet
WKH FULWHULD IRU LQFOXVLRQ 3DWLHQWV ZKR KDG WKH
FULWHULD IRU QRQ LQFOXVLRQ DQG H[FOXVLRQ IURP WKH
VWXG\ ZHUH QRW HYDOXDWHG 3DWLHQWV ZHUH GLYLGHG
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ing out the form. The survey was conducted for a
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Subjects were divided into the following groups:
*URXSSDWLHQWVZLWKK\SRWK\URLGLVP%0,
group included 43 patients;
*URXSSDWLHQWVZLWKK\SRWK\URLGLVP%0,!
JURXSLQFOXGHGVXEMHFWVLQZKLFKZHLQFOXGHG
SDWLHQWVZLWKD%0,!JURXSD
5HVHDUFKPHWKRGV
3DWLHQWVZHUHDQDO\]HGFOLQLFDOO\DQGLQODERUDWRU\
with special emphasis on the thyroid gland func
tional status.
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tus presence:
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The history of disease; data on the existence of
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istence of a positive family history on cardiovascu
lar disease, data on the use of medications.
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WK\URLGJODQGVHUXPOHYHOVRI7776+ELR
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ease was done according to the criteria of the
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where the table was determined on the basis of a
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Statistical analysis of data was performed upon
completion of the tests as well as preparation of
comprehensive statistics thesis on the tests. The
statistical evaluation and analysis included all sub
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search results is given in tables and graphs.
Statistical analysis was performed using descrip
tive statistics, Student’s t test, test of multiple cor
relation and linear regression analysis.
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Basic demographic data are presented in tables.
1RQSDUDPHWULF PHGLDQ FKL VTXDUH WHVW ;WHVW
for two independent samples was applied. This
test examined whether two samples belong to the
same median population. The Yates correction
was applied.
Testing was done by calculating the multiple cor
relations and using the Student t test. The level of
VLJQL¿FDQFHZDVS
RESULTS
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According to the demographic characteristics cri
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and the differences observed in the examined pa
rameters might have been due to the prevailing
diseases that we have studied.
The following tables show the results of a statisti
cal analysis of descriptive statistics parameters by
groups.
The table 1 shows the basic demographic and an
thropological parameters of subjects per group.
)LJXUHDQGVKRZWKHGLVWULEXWLRQRI%0,YDOXHV
LQJURXSVDQG
Gender structure of subjects per group is shown
in Figure 3 i 4.
7DEOH Demographic and anthropological parameters by
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*URXS$JH\HDUV6' %0,6'
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Figure 2.RI%0,GLVWULEXWLRQLQWKHJURXS
Table 2.%LRFKHPLFDOSDUDPHWHUVRIVXEMHFWVSHUJURXS$E
EUHYLDWLRQVDUHGH¿QHGLQWKH0DWHULDOVDQG0HWKRGVVHFWLRQ
6'VWDQGDUGGHYLDWLRQ
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ing in groups; it is evident that there is a greater
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WLHQWVZLWKD%0,!
)LJXUH*HQGHUVWUXFWXUHRIJURXSPDOHV
)LJXUH3UHYDOHQFHRIVPRNLQJDVDULVNIDFWRULQWKHJURXS
Figure 6.3UHYDOHQFHRIVPRNLQJDVDULVNIDFWRULQWKHJURXS
)LJXUH*HQGHUVWUXFWXUHRIJURXS
Figures 7, 8 and 9 show the positive family history
DVDULVNIDFWRUIRUFDUGLRYDVFXODUGLVHDVHDFFRUG
ing to the groups.
Figure 7. 3UHVHQFHRISRVLWLYHIDPLO\KLVWRU\DVDULVNIDFWRU
in the group 1.
7DEOHVKRZVWKHUHVXOWVRIWKHDYHUDJHYDOXHDF
WLYLWLHVRIJO\FHPLDFKROHVWHUROWULJO\FHULGHV+'/
/'/DQGWK\URLGKRUPRQHVWDWXVLQJURXSV1RWH
the elevated serum blood glucose, the cholesterol
DQG/'/LQWKHJURXSZLWK%0,!FRPSDUHGWR
WKHJURXSZLWK%0,HVSHFLDOO\LQSDWLHQWVZLWK
D %0,! 7ULJO\FHULGH OHYHOV ZHUH VLJQL¿FDQWO\
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of the thyroid gland was balanced in both groups.
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Figure 8. 3UHVHQFHRISRVLWLYHIDPLO\KLVWRU\DVDULVNIDFWRU
LQWKHJURXS
)LJXUH3UHYDOHQFHRIK\SHUWHQVLRQDVDULVNIDFWRULQWKH
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)LJXUHV DQG VKRZ WKH EORRG SUHVVXUH
score in patients. Distribution of systolic and dias
tolic pressure is shown, measured in mmHg.
)LJXUHThe blood pressure score in patients with hypothy
URLGLVP%0,
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pertension in groups, greater number of hyperten
sive patients was observed in group 1.
)LJXUHThe blood pressure score in patients with hypothy
URLGLVP%0,!
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group 1.
)LJXUH The blood pressure score in patients with
K\SRWK\URLGLVP%0,!
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JURXS
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)LJXUH3UHYDOHQFHRIGLDEHWHVE\JURXSV
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Figure 17 displays the values of cholesterol, tri
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DQG/'/WKDQSDWLHQWVZLWKQRUPDOZHLJKW)LJXUH
18 shows the average value of the measured T3
and TSH in groups.
)LJXUH$QDO\VLVRIG\VOLSLGHPLDLQJURXSVDQG
)LJXUH Analysis of hormonal status of thyroid glands in
JURXSVDQG
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with Student t test, comparing the average valu
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ZDVS $YHUDJH YDOXHV RI V\VWROLF EORRG SUHVVXUH PP
+JE\JURXSVVKRZHGDGLIIHUHQFHZLWKDVLJQL¿
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¿FDQFHRIS ,QWHUGHSHQGHQFHEHWZHHQ%0,DQGVHUXP/'/OH
vels on the entire sample is shown in Figure 19. It
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,W LV SURYHQ WKDW /'/ UDQJH PRYH GHSHQGLQJ RQ
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ssion of the studied sample.
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DISCUSSION
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trol of hypothyroidism, in all subjects.
:H VWDWLVWLFDOO\ DQDO\]HG SDUDPHWHUV RI LQWHUHVW
WRWKHVWXG\EORRGJOXFRVHFKROHVWHUROWULJO\FH
ULGHV+'//'/V\VWROLFSUHVVXUHDQGFRPSDUHG
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test.
Statistical analysis of glucose by groups differed
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The average serum cholesterol level was higher
in the group of patients with hypothyroidism, with
D %0,! DQG DPRXQWHG WR PPRO O DQG
GLIIHUHGFRPSDUHGZLWKWKHJURXSZLWK%0,RQ
WKHOHYHORIS 6HUXPWULJO\FHULGHVOHYHOVGLIIHUHGZLWKS LQ
FRPSDULVRQWR%0,JURXSDQG
7KH DYHUDJH +'/ OHYHO ZDV KLJKHU LQ WKH JURXS
ZLWK %0,! DQG DPRXQWHG WR PPRO O D
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ease was performed according to the criteria of
WKH (XURSHDQ $VVRFLDWLRQ IRU $WKHURVFOHURVLV ($6ZKHUHE\WKHWHQ\HDUULVNLVHYDOXDWHGEDVHG
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blood pressure, diabetes, genetic predisposition,
age and sex of patient, obesity and physical inac
tivity, lipoprotein a, psychological and social fac
tors.
In cases of altered metabolic processes, as in
imbalance in the hormonal status of the thyroid
JODQGLWLVJHQHUDOO\NQRZQWKDWWKHFRQVHTXHQFHV
occur in almost every process in the body, at the
OHYHORIHDFKFHOODQGWKHPLWRFKRQGULD0HWDEROLF
SURFHVVHVDUHGLUHFWHGWRSODFHV³GLFWDWHGE\WK\
roid hormones.”
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Due to the great abundance of changeable and
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ease existence in the general population, it re
mains important and interesting to compare how
GR WKH LQGLFDWRUV IRU WKH H[LVWHQFH RI ULVN IRU GH
veloping coronary heart disease in patients with
hypothyroidism, with or without obesity, actually
PRYH
The patient sample was made on the popula
tion with established hypothyroidism, which was
treated by medications. The sample was divided
LQWRWZRJURXSVGHSHQGLQJRQWKHYDOXHRI%0,!
RUDQGLQWKHJURXSZLWK%0,!WKHUHZDVD
SURFHVVHGVXEJURXSZLWK%0,!2EVHUYHGSD
rameters were contrasted comparatively.
Biochemical parameters analyzed were: blood
JOXFRVH FKROHVWHURO WULJO\FHULGHV +'/ DQG /'/
and hormonal status of the thyroid gland. The
study included clinical monitoring of the hyperten
VLRQ SUHVHQFH V\VWROLF DQG GLDVWROLF SUHVVXUH
5LVNIDFWRUVIRUVPRNLQJGLDEHWHVSRVLWLYHIDPLO\
history were also observed.
Emphasis was made on the metabolic role of thy
URLGKRUPRQHVLQWHUPVRILPSDFWRQWKH.UHEVCV
cycle and metabolism of fat, so it was of great in
terest to observe the relationship between the de
JUHHRIREHVLW\PHDVXUHGE\%0,DQG/'/WKH
PDLQELRFKHPLFDODWKHURJHQLFIDFWRUV
This paper presents the results of comparing the
parameters in two groups of patients with hypo
WK\URLGLVP IRUPHG E\ WKH SUHVHQFH RI RWKHU ULVN
IDFWRUVREHVLW\
The aim of this study was to investigate whether
patients with hypothyroidism, in the presence or
DEVHQFHRIREHVLW\FDQEHFODVVL¿HGLQWRGLIIHUHQW
JURXSVDFFRUGLQJWRWKHSUHVHQFHRIULVNIDFWRUVRI
heart disease.
7KHVWXG\ZDVUHWURVSHFWLYHSHUIRUPHGIURP-DQ
XDU\6HSWHPEHU
Database search returned no results with similar
studies, but it was found that in recent times there
was an increasing interest in role of hormonal sta
tus of the thyroid gland in the occurrence of coro
QDU\DUWHU\GLVHDVH
$ WRWDO RI SDWLHQWV ZLWK K\SRWK\URLGLVP ZHUH
observed, and divided into two groups: normal
ZHLJKW%0,ZKLFKLQFOXGHGSDWLHQWVDQG
DJURXSRI%0,!ZLWKSDWLHQWVLQZKLFKWKH
JURXS ZLWK D %0,! ZDV WUHDWHG LQFOXGLQJ patients.
7KHJURXSVGLGQRWGLIIHUVLJQL¿FDQWO\DFFRUGLQJWR
characteristics by age, and in this regard, we de
termined the homogenization of the respondents,
which ensured the objectivity of comparing the re
sults obtained, according to the criteria of weight.
$QWKURSRORJLFDO SDUDPHWHUV ZHLJKW KHLJKW DQG
%0, ZHUH WKH FULWHULD IRU GLIIHUHQWLDWLRQ LQ WKH
0HGLFLQVNLåXUQDO
JURXSVRWKHJURXS%0,KDGDQDYHUDJHRI
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%0,DPRXQWHGWR
It was observed that most of the respondents were
IHPDOH LQ WKH JURXS ZLWK QRUPDO ZHLJKW FRPSDUHGWRWKHJURXSZLWK%0,!,QWKH
VXEJURXS ZLWK D %0,! DOO UHVSRQGHQWV ZHUH
female. These results were considered to be as
a result of involvement of hypothyroidism demo
graphically in predominantly female population,
and according to the latest research in our region
WKLVUDWLRLVLQIDYRURIZRPHQ,QFUHDVHG
QXPEHURIZRPHQLQWKHJURXSZLWK%0,!ZDV
probably caused by changes in the metabolism
and hormones in most subjects, considering that
the average age was slightly higher in this group
DQGZDV
The average value of glucose was higher in the
JURXSRISDWLHQWVZLWK%0,!PPROOWKDQ
that of the group of patients having proper body
ZHLJKW PPRO O VWDWLVWLFDOO\ FDOFXODWHG E\
WKH 6WXGHQW W WHVW ZKLFK VKRZHG D VLJQL¿FDQFH
OHYHORIS 6HYHUDOVWXGLHVKDYHGHDOWZLWK
SDWKRSK\VLRORJLFDO PXWXDO LQÀXHQFH RI K\SRWK\
roidism and diabetes, as well as undisputed in
terconnection of these metabolic disorders. Given
that disturbed hormonal status of the thyroid gland
is found in a large number of diabetics, some au
thors recommend screening for thyroid hormones
GXULQJK\SHUJO\FHPLDWUHDWPHQW
Analysis of biochemical parameters of dyslipid
emia included analysis of serum cholesterol, tri
JO\FHULGHV+'/DQG/'/
Average serum cholesterol levels were higher in
WKH JURXS RI SDWLHQWV ZLWK %0,! FRPSDUHG WR
those in patients with normal weight, with statisti
FDOGLIIHUHQFHDWS 7ULJO\FHULGHOHYHOVZHUH
KLJKHVWLQWKHJURXSZLWK%0,!PPROO
Statistical difference measured by Student t test
IRU WZR LQGHSHQGHQW VDPSOHV ZDV ZLWK D VLJQL¿
FDQFHRIS 7KHGLIIHUHQFHLQWKHPHDVXUHG
+'/ZDVDWWKHOHYHORIS 7KHPRVWVLJQL¿FDQWUHVXOWVZHUHIRXQGZKHQFRP
SDULQJVHUXP/'/LQERWKJURXSVRISDWLHQWV7KH
DYHUDJHYDOXHRIVHUXP/'/FKROHVWHUROSDUWLFOHV
ZDVKLJKHULQSDWLHQWVZLWK%0,!FRPSDUHGWR
WKRVHSDWLHQWVZLWK%0,PPROO
6WDWLVWLFDO DQDO\VLV VKRZHG VLJQL¿FDQFH RI S $ SRVLWLYH FRUUHODWLRQ ZDV REVHUYHG EH
WZHHQ %0, DQG VHUXP /'/ WKH 3HDUVRQ FRHI¿
FLHQWU 8VLQJOLQHDUUHJUHVVLRQDQDO\VLVZH
SHUIRUPHGSUHGLFWLYHPRGHOWKDWSUHGLFWV/'/YDO
XHVGHSHQGLQJRQ%0,LQFUHPHQW)LJXUH
After searching the medical database, we found
LQWHUHVWLQJVWXGLHVRQWKHLQÀXHQFHRI%0,RQWKH
degree of dyslipidemia and increased cardiovas
FXODU ULVN +RZHYHU ZH KDYHQ¶W IRXQG
any studies that follow these parameters in pa
tients with established hypothyroidism, so these
results can be considered as preliminary in consid
eration of the pathophysiology of hypothyroidism,
DWKHURVFOHURVLVDQGFRURQDU\ULVNDVVHVVPHQW
0RQLWRULQJRIVHUXPOHYHOVRI7776+LQSD
WLHQWVPRQLWRUHGE\JURXSVVKRZHGQRVLJQL¿FDQW
differences, indicating good medical therapy in
WKHVHSDWLHQWV0RQLWRULQJRIEORRGSUHVVXUHLQSD
tients, showed that the values of systolic pressure
ZHUHKLJKHULQWKHJURXSRISDWLHQWVZLWKD%0,!
WKDQLQWKRVHRIQRUPDOZHLJKWDQGWKHVWDWLVWL
FDOVLJQL¿FDQFHRIS 'LDVWROLFEORRGSUHV
sure values were also higher in the group of pa
WLHQWVZLWKD%0,!DQGWKHGLIIHUHQFHEHWZHHQ
WKH WZR JURXSV ZDV S +\SHUWHQVLRQ ZDV
DOVRLQGLFDWHGDVDULVNIDFWRULQWKLVVWXG\ZKLFK
RFFXUVRULQWHQVL¿HVLQSDWLHQWVZLWKK\SRWK\URLG
ism and obesity.
6WXG\E\-HUDQWRDQGDQDVVRFLDWHLQVKRZHG
that being overweight is associated with diabetes
and hypertension, causing an increase in mortal
LW\
*UHDW(QJODQGVWXG\SXEOLVKHGLQRQDVDP
ple of 1.4 million patients showed that overweight,
REHVLW\ DQG SRVVLEOH PDOQXWULWLRQ LV DVVRFLDWHG
ZLWKLQFUHDVHGWRWDOPRUWDOLW\0RUWDOLW\ZDVORZHVW
DPRQJUHVSRQGHQWVZLWK%0,WR
7KH VWXG\ LQFOXGHG DQDO\VLV RI VPRNLQJ KDELWV
positive history for family cardiovascular disease,
and the presence of diabetes and hypertension.
7KHVHULVNIDFWRUVZHUHTXLWHHYHQO\UHSUHVHQWHG
in groups, showing that it could be expected that
the differences in the studied parameters of dys
lipidemia have been dependent to a greater extent
on obesity.
CONCLUSION
It has been proven that in obese patients suffering
from hypothyroidism there is an increasing preva
OHQFHRIFRURQDU\ULVNIDFWRUVKLJKHUOHYHOVRI/'/
cholesterol, triglycerides, and higher prevalence
of hypertension compared with patients having
proper body weight.
Assessment of the thyroid gland hormonal status
should be an integral part in the treatment of pa
tients with coronary artery disease.
&RQÀLFWRILQWHUHVWnone declared
REFERENCES
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gional guidelines on cardiovascular disease prevention.
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Professional article
EVALUATION OF DIASTOLIC DYSFUNCTION IN ACUTE MYOCARDIAL
INFARCTION
PROCJENA DIJASTOLNE DISFUNKCIJE U AKUTNOM INFARKTU MIOKARDA
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ABSTRACT
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systolic function within patients that suffer acute
myocardial infarction can be observed. This study
GHPRQVWUDWHVIUHTXHQF\RIGLDVWROLFG\VIXQFWLRQRI
patients with previous acute myocardial infarction.
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FOXGHG LQ WKH VWXG\ WKHUH ZHUH PHQ DQG women. These patients were treated at Internal
Department of General Hospital in Sarajevo due
to myocardial infarction on the basis of clinical pic
ture, ECG changes and biohumoral status. From
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astolic dysfunction of pseudonormalization, while
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tolic function of restrictive type.
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of the patients included in the study and localiza
tion of myocardial infarction. On the other hand,
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older age patients with acute myocardial infarction
was observed.
Conclusions: It can be concluded that coronary
heart disease, especially acute coronary incidents
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diastolic function.
Key words: diastolic dysfunction, echocardiogra
phy, myocardial infarction.
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INTRODUCTION
Diastolic ventricular dysfunction is an important
factor in numerous heart diseases. According to
the available literature, almost half of patients with
symptoms of heart disease have preserved sys
tolic function, or ejection fraction of left ventricle,
therefore they have primary diastolic heart failure
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Diastole can be divided in 4 phases:
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Among patients with signs of heart failure, Doppler
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FDUGLRJUDSK\ZLOODQVZHUWKHTXHVWLRQZKHWKHUWKH
FDXVH RI KHDUW GLVHDVH V\PSWRPV LV OLNHO\ WR EH
diastolic dysfunction of left ventricle.
7KHPRVWIUHTXHQWFDXVHVRIGLDVWROLFG\VIXQFWLRQ
of left ventricle are those conditions that may also
cause systolic dysfunction of left ventricle, more
precisely, coronary artery disease, arterial hyper
tension and valvular heart disease.
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develop some level of diastolic dysfunction dur
LQJWKH¿UVWGD\VDIWHULQIDUFWLRQ)XUWKHUPRUHDQ
LQFUHDVHRIKHDUWELRPDUNHUVLVVLJQL¿FDQWO\ODUJHU
in case of restrictive disorder of diastolic function.
,QÀDPPDWRU\ UHVSRQVH &53 DOVR SOD\V DQ LP
portant role in development of diastolic dysfunc
tion. Diastolic function is in close relationship with
systolic as it is believed that ejection fraction at
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cantly lower than in case of impaired relaxation.
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In the studies of some authors a correlation is
found between impaired diastolic function deter
mined by Doppler ultrasound regarding acute my
ocardial infarction with not so rare lethal outcome
especially at severe forms of disorder of diastolic
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tolic dysfunction is called pseudonormal because
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maneuver E speed decreases so it becomes
less than 1. Other features are short deceleration
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tolic component. Severe diastolic dysfunction of
UHVWULFWLYHW\SHLVIHDWXUHGE\LQFUHDVHG($UDWLR
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Recent studies lead to the conclusions that the
presence of diastolic dysfunction is much more
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cardial infarction that were hospitalized in General
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DU\XQWLO'HFHPEHURWKHUSDWLHQWVZLWK
acute pain were transferred from the above hospi
tal to Clinical Center Sarajevo due to possibility of
percutaneous coronary intervention.
The inclusion criteria were: patients of both sexes,
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ternal Diseases, General Hospital Sarajevo due
to diagnosed myocardial infarction on the basis
of clinical signs, changes on electrocardiography
and positive biohumoral status.
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angina pectoris, chronic ischemic cardiomyopa
thy.
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FRPH DWULDO ¿EULOODWLRQ SDWLHQWV UHIHUUHG WR RWKHU
hospitals and patients who were discharged from
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study.
Echocardiography was performed within seven
days from acute myocardial infarction on the ma
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SUREH'DQG0PRGHSXOVHFRQWLQXRXVFRORU
and tissue Doppler.
All patients were treated with conservative ther
apy.
RESULTS
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the oldest patient at age of 89 and youngest at 19.
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ZRPHQ
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DVWROLF IXQFWLRQ KDG PLOG GLDVWROLF
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dial infarction.
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tween separate degrees of diastolic dysfunction
in patients with acute myocardial infarction with
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statistical difference among patients considering
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Table 2. Structure of sample considering sex and age.
7DEOH Degree of diastolic dysfunction in regards to localiza
tion of myocardial infarction.
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and age.
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DISCUSSION
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male and female patients with diastolic dysfuncti
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ZLWKYDOXH; DQGS
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age.
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younger patient, more precisely, younger patient
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days after an ultrasound is done. The major num
ber of patients suffering from diastolic dysfunction
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1st degree or impaired relaxation. On the other
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tolic dysfunction in relation to the patient’s gender
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not found in the presence of diastolic dysfunction
between male and female patients. However, there
is a difference regarding level of diastolic dysfunc
tion between male and female patients. There are
more male patients with diastolic dysfunction of
1st degree, in fact; there is a major percentage
of female patients with acute myocardial infarction
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of 3rd degree of diastolic dysfunction there is no
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,Q WRWDO SDWLHQWV ZKR ZHUH DOPRVW DOO ROGHU
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tion. On the other hand, younger patients with
myocardial infarction have preserved diastolic
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protracted observations of general disorder of di
astolic function in relation to infarction localization
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diastolic function in relation to mentioned localiza
tions.
Doppler echocardiographic evaluation of hemody
namics of patients with acute myocardial infarc
tion is very important, in particular, as a noninva
sive prognostic tool. It is also very important for
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comparing with 3rd degree of diastolic dysfunction
2XUSDWLHQWVWKDWKDGOHWKDORXWFRPHZHUH
found to have predominantly diastolic dysfunction
of 3rd degree. Additionally, a damage to diastolic
function as well as systolic of left ventricle appears
very early at as a heart disease, but often with
subclinical forms and mild symptomatology being
REVHUYDEOH7KLVSRVWXODWHPLJKWLQGLUHFWO\
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perienced by our patients.
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myocardial infarction, poor prognosis had from
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the patients with mild disorder of diastolic function.
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that before acute myocardial infarction younger
persons have usually normal diastolic function of
the left ventricle, while older patients with coexist
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HDUOLHUP\RFDUGLDOLQIDUFWLRQXVXDOO\H[SHULHQFHD
certain level of diastolic dysfunction.
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farction and elevation of ST segment had diastolic
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dilatation of left ventricle and possible death of pa
tients with pseudo normal and restrictive diastolic
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age of our patients having pseudonormal and re
strictive diastolic dysfunction, it is still necessary to
proceed with further echocardiographic follow ups
of patients after acute myocardial infarction.
If patient suffers from acute myocardial infarction
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and appropriate therapy might cause the diastolic
function of left ventricle to return to normal.
If a patient experienced myocardial infarction but
preserved systolic function, mild diastolic dysfunc
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tion of impaired relaxation type would be the most
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systolic function of left ventricle, moderate dias
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patients would experience high level of diastolic
function impairment of the left ventricle which is of
irreversible restrictive type.
CONCLUSIONS
Coronary heart disease, in particular acute coro
nary incidents represent very important factor
contributing to the impairment of diastolic heart
function, therefore heart function in whole, even
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a damage to diastolic function of left ventricle and
after that systolic function.
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dial infarction has an important impact on disease
prognosis.
REFERENCES
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$KPHG$ 1DQGD 1& :HDYHU 07$OOPDQ 50 'H
/RQJ -) &OLQLFDO FRUUHODWHV RI LVRODWHG OHIW YHQWULFXODU
diastolic dysfunction among hospitalized older heart
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ing pattern of the left ventricle and outcome in acute
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diastolic function after acute myocardial infarction. Am
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systolic and diastolic left ventricular function. A tis
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Review article
RUNNING INJURIES
3295('(35,75ý$1-8
Emir Benca3HMPDQ=LDL2, Gobert von Skrbensky$PLU$KPHWRYLü, Reinhard Windhager, Selma Krpo
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tria; 6SRUWKRPHG9LHQQD .UHX]JDVVH 9LHQQD $XVWULD 3 Orthopaedic and Traumatology Clinic, Clinical
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ABSTRACT
This study was conducted with a purpose to pre
sent common running injuries, their etiology and
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was performed and additional literature was used
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the patellofemoral pain syndrome as the predomi
nant diagnose in runners. A yearly incidence rate
UDQJHGIURPWR7ZRWKLUGVRIWKHVHUXQ
ners are forced to interrupt their normal training
program due to injury. There is a strong evidence
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men, other intrinsic factors, which increase injuries
in running, are age, higher body mass index, low
SK\VLFDO¿WQHVVLQÀH[LELOLW\DQGWKHSDVWKLVWRU\RI
injury, while training errors, shoes, running terrain
present most common extrinsic factors leading to
injury.
Key words: running injuries, marathon
6$ä(7$.
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svoj normalan program treninga zbog ozljede.
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INTRODUCTION
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lished in Nature the genus Homo evolved to travel
ORQJ GLVWDQFHV E\ ERWK ZDONLQJ DQG UXQQLQJ Running was advantageous for early Homo in
hunting or scavenging, but also to compete with
other scavengers, including other hominids and
DELOLW\HVVHQWLDOIRUVXUYLYDO
Running represents not only a terrestrial locomo
tion allowing rapid movement on foot, but a sport
practiced by millions of athletes and amateurs
worldwide with rising popularity. It is the most
FRPPRQSHUIRUPHGVSRUWVDFWLYLW\ZRUOGZLGHGXH
WRLWVHFRQRPLFFRQYHQLHQFHDQGKHDOWKEHQH¿WV
such as reduction of obesity, cardiovascular dis
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United States.
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held in Bosnia and Herzegovina’s capital Sarajevo
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be expected that the city of Sarajevo will intro
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future. The number of the participants is presently
UHODWLYHO\ ORZ SDUWLFLSDQWV LQ 7DEOH compared to similar modern competitions in the
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of amateur and professional runners in every age
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7DEOH1XPEHURISDUWLFLSDQWVLQ6DUDMHYRKDOIPDUDWKRQIRU
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and Bosnian nationals as well as the annual growth of the total
number in percent.
Running can be performed on different surfaces
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VDQGWUDFNVRUWUHDGPLOOV7KHPDMRULW\RIUXQQHUV
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options.
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might cause injury ranging from sore muscles and
blisters to complex fractures.
The aim of this paper is to present common run
ning injuries from recent literature with attention
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cal treatment methods and educate medical pro
fessionals in order to reestablish the anatomical
structures and biomechanics and allow injured
professional athletes and amateurs to continue
their running career, but also to prevent or mini
mize the injury rate.
METHODS
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Abstract.
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running in general, long distance running or bio
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injuries of lower extremities or the entire body,
were considered.
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cluded.
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lished papers and conference abstracts were not
included.
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a full text through the study group, were included.
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3DSHUUHYLHZLQFOXGHGVFUHHQLQJRIWKHWLWOHVDE
stract, and full texts by a single reviewer.
A total of 113 articles were now found and where
DVVL[W\RIWKHPZHUHLGHQWL¿HGDVSRWHQWLDOO\UHO
HYDQW EDVHG RQ WKH 0HGOLQH VHDUFK$OO RI WKHVH
were obtained in abstract form and most of them,
depending on their availability in full length and
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sonal reviews of the study group members were
also added.
)LJXUH Number of studies published for each year since
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RUDEVWUDFW$OLQHDUWUHQGOLQHVKRZVWKHJURZWKRISXEOLVKHG
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Table 2. Sarajevo half marathon age statistic for the years
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commonly presented race results.
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Review of injuries
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A Swiss Study showed that running injuries are
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distance. Two thirds of these runners are forced
to interrupt their normal training program due to
injury, however most injuries are not serious and
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according to the exposure of running is as high as
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It can be distinguished between acute or traumatic
and overuse injuries. Running is one of the most
common sports activities in which overuse injuries
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anatomical structures that are repeatedly applied
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time between force application can cause overuse
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Overuse injuries in runners are typically runner’s
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itis, runner’s heel bumps, heel spurs, arch fatigue,
pain and cramps, neuromas, and boney deformity
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develop over a long period of time and are exclu
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training is a common cause for overuse injuries,
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e.g. length discrepancies, or an abnormally sized
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footwear. The pain resulting from these injuries
is mostly not severe; however in cases of persist
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assistance should be sought. Traumatic injuries
are caused by a violent and sudden incident and
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tearing or popping sound and the pain persists.
Typical traumatic injuries include sprains, lac
erations, torn ligaments, pulled muscles, or bone
fractures. Traumatic injuries are hard to prevent
as they happen sudden, whereas proper training,
proper conditioning and proper biomechanical
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most prevalent site of running injury, account
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ing running, but not restricting distance or speed
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in joggers and professional runners and is often
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.
Patellofemoral Pain Syndrome
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ed to be the most commonly occurring injury in
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from either abnormal forces or prolonged repeti
tive compressive or shearing forces on the patel
lofemoral joint during running. It leads primarily
to chondromalacia of the cartilage in the patella
and femoral condyles, synovial irritation and in
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secondarily to fractures, joint derangement and
osteoarthritis.
Hill running, especially downhill, causes excessive
patella load and should be avoided by athletes
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Generally there is a wide range of treatment meth
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Iliotibial Band Syndrome
An overuse syndrome of tractus ilitibialis can be
observed proximal as well as distal, whereas the
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factors as a cause can be varus deformities with a
higher internal rotation of the lower limb, a higher
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between the distal tractus with the lateral condylus
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tus and the trochanter mayor of the femur, which
causes tendinitis. In this context diverse patholo
gies of the pelvic girdle might constitute predispos
ing factor. The recognition of a malalignment as an
initiating factor and its elimination is essential for a
permanent and successful therapy.
Plantar Fasciitis
Heel spurs are considered to be a condition of a
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where the arch meets the heel, easily noticeable
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contact point and is exposed to ground reaction
forces as high as three times the body weight
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where conservative treatment with orthotics and
cortisone injections failed.
Meniscal Injury
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can cause a higher degenerative reduction of
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generates an increased load on the medial me
niscus, a valgus malalignment results in a higher
degeneration of the lateral meniscus. Instability
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instability, lateral or medial ligamentous instability
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generates a higher degeneration in menisci, as
well as in cartilage.
Medial Tibial Stress Syndrome
The medial tibial stress syndrome or commonly
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generated by repetitive contraction of the poste
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periosteal tissue, and a high persistent stress on
the tibia caused by muscular contracting forces
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monly involved with running on hard surfaces or
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strengthen of the extensor group, stretching of the
Achilles tendon and utilization of ice following a
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depending on its availability.
Achilles Tendinitis
Excessive and repetitive loading might lead to
tendon degeneration. The loads generated in the
gastrocnemius and soleus muscles while running
might cause Achilles tendinitis in runners. A seg
mental malalignment of the leg, the hind foot or
the arch is seen as a predisposing factor. A 3° or
more malalignment of the calcaneus in connec
tion with hind foot varus or valgus can result in a
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of gastrocnemicus as the end result. Some au
thors suggest changing the running pattern from
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Ankle Sprain Trauma
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sports involving running experience one or more
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as trivial, not only by athletes, but also by medical
professionals.
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from sports, which include jumping, where the
dominant leg is more exposed to higher impact
forces.
In case of recurrent sprains stabilizing foot orthot
ics are suggested, however most orthotics are not
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should be chosen carefully by orthopedic profes
sionals.
Stress Fractures
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or the metatarsal bone of the foot. They might not
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Blisters
Blisters result from mechanical friction between
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sions and pain in the affected area. Runners often
face this problem, which also might be caused by
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however it is probably the most common problem
a runner will face in his athletic career.
To avoid blister formation, it is advisable to wear
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Treatment of blisters includes piercing the blister
itself, sterilization and mechanical decompression.
Increasing running injuries correlate with extrin
sic factors such as training intensity, training er
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of the day, warm up and stretching, but also with
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number of studies exist demonstrating an associa
tion between running injuries and factors such as
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performance, shoes and stabilizing orthoses. Fur
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epidemiological literature that age, gender, body
mass index, running hills, running on hard surfac
es, participation in other sports, time of the year
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factorial and can also often be ascribed to training
errors. The three most common factors described
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anatomical and physiological abnormalities such
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muscle stabilization11, the latter one especially in
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Other factors such as stretching were found insuf
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Running Distance
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Any changes in training programs should be done
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grams are highly recommendable since body re
sponse to physical stress differs.
Footwear
Running footwear is used to protect the foot from
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and provide grip. Additionally proper shoes should
also allow biomechanical support of the foot. The
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that the foot is in the neutral position in two leg
stand prior the moment when the heel leaves the
ground. An abnormal pronation of the foot results
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leg with upcoming unstable patella and runner’s
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ble a neutral position and excessive pronation and
avoid additional load and overtime muscle activity
to prevent overload.
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a certain construction, designed to support the
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vidual conditions. However there is often no suf
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topics in running sports nowadays and further re
search is needed.
Ideally running shoes should be purchased in spe
cialized shops with treadmills and video analysis
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Taunton et al. showed that runners with shoes one
to three months old had an injury rate above the
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ing new shoe models, as well as in the fact that
injured runners try to solve their problems by fre
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expose the body to the new footwear allowing the
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biomechanics. However more research is neces
sary to provide the effect of shoes, shoe inserts
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Barefoot running or running with minimal footwear
as prevention for future injuries has been a contro
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and only a small percentage, mostly elite run
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land more softly landing on the ball of the foot,
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stride length, where the foot lands closer to the
body’s center of mass resulting in a smaller mo
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and hip joint and the generated moments in these
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calf musculature is increased in barefoot runners
and presents a potential cause for calf strains and
Achilles tendinitis, but also to cuts, bruises and
abrasions. Altman et al. suggest a slow adaption
from normal footwear to barefoot or running with
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biomechanics and injury patterns in barefoot run
ners in order to give a clear recommendation for
the ideal footwear.
Age
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factor for running injuries in the literature. Howev
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assumption. Taunton et al. found that among rec
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group nor among male runners in the same study.
Body Mass Index and Bodyweight
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a higher percentage of body fat have excessive
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lean body mass to support their bodies during
physical activities and are also more predisposed
to osteoporosis and reduced collagen elasticity
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Gender
As mentioned above, many authors associate
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Taunton et al assume that this might be caused by
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might seem a plausible explanation, while on the
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pelvis, smaller heart volume, lower vital capac
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women are more affected by e.g. osteoporosis,
which might result in a higher rate of stress frac
ture, which are however rarely reported in the lit
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Past History of Injury
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found that recreational runners with a past history
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limb injury then runners without any previous injury
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so that the ligamentous structures are exposed to
excessive loads prior to complete healing of the
original injury. It is recommendable to commence
with exercising only after full recovery of musculo
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regular training intensity.
Physical Fitness
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cessive load in running as well as a proper tech
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effected group, experienced sportsmen are more
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Terrain
Biomechanically, the majority of overuse injuries
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the magnitude of impact forces and the magnitude
joint forces and moments. Even though there is
no prove of running terrain to be associated with
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running on different surfaces, it seems plausible,
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Hard terrain or hills stress the anterior leg mus
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as stabilizing foot orthotic could provide additional
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pending on the terrain, athletes should also use
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new terrains should be introduced gradually to al
low the joints to adapt to different biomechanics.
CONCLUSIONS
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our society is steadily reducing the physical labor
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reational outlets, such as running, are steadily
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cal professionals in order to recognize and also
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juries in recreational but also competitive runners.
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ing injured. It is impossible to relate the statistical
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single individual with exact factors on when and
how will an injury occur. However it is advisable for
every athlete to listen to the language of their body
and respect the limitations set by factors such as
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injury and pay close attention to overall training
load and moderate increase in training intensity
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strain’. Excessive training intensity doesn’t allow
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injury. In order to reduce the injury probability a
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mileage and eliminate some impact loads that con
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ening of the anterior muscles and stretching of the
Achilles tendon in order to prevent medial tibial
stress syndrome. Injury prevention should include
health education, which includes early recognition
of symptoms, especially in overuse injuries and
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professionals should give greater attention to the
past medical history due to higher incidence rate
in runners with injury history in the past, especially
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to prevent reoccurring injuries primary diagnosis
has to include all simultaneous injuries followed
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don overload or dislocation, could be necessary.
Treatment: treatment of running injuries consists
of multioriented measures. Conservative therapy
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and physiotherapy, stretching and strengthening
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therapy. In case of overload, symptomatic treat
ment is often successful. Recognition of muscu
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physiotherapy in a middle term would be neces
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plicated soft tissue damages could need surgery.
In most cases conservative treatment with immo
bilization in especially designed apparatus with
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REFERENCES
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of lower extremity injuries in male marathon runners.
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terminants of lower extremity running injuries in long
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9. Hreljac, A. Impact and overuse injuries in runners.
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nisms in the Cause of Overuse Running Injuries: A Clini
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ence in Sports & Exercise 1981;3:83 .
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38. Altman AR, Davis IS. Barefoot running: biomechan
ics and implications for running injuries. Curr Sports
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Attenuation of foot pressure during running on four dif
ferent surfaces: asphalt, concrete, rubber, and natural
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Experimental Orthopaedic Surgery
Department of Orthopaedic Surgery
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Case report
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THE PATIENT WITH ACUTE PROMYELOCYTIC LEUKEMIA: Case Report
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ABSTRACT
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is characterized by increased intracranial pres
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main symptoms are headache, nausea and vomit
ing, as well as pulsatile tinnitus, double vison and
other visual symptoms. Intracranial hypertension
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with benign intracranial hypertension caused by
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INTRODUCTION
%HQLJQLQWUDFUDQLDOK\SHUWHQVLRQ%,+RUSVHXGR
WXPRUFHUHEUL37&LVDQHXURORJLFDOGLVRUGHUWKDW
is characterized by increased intracranial pres
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UDQLDO DEQRUPDOLWLHV E\ &7 RU 05, RI KHDG 7KH
main symptoms are headache, nausea and vomit
ing, as well as pulsatile tinnitus, double vision and
other visual symptoms. In some cases etiology is
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GXH WR PHGLFDWLRQV VXFK DV KLJKGRVH YLWDPLQ$
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hormonal contraceptives. Common causes of sec
ondary intracranial hypertension include obstruc
tive sleep apnea, systemic lupus erythematosis
6/(FKURQLFNLGQH\GLVHDVHDQG%HKFHW¶VGLV
ease.
Intracranial hypertension secondary to ATRA was
LQLWLDOO\ GHRFLPHQWHG LQ RI SHGLDWULF SDWLHQWV
ZLWK DFXWH SURP\HORF\WLF OHXNHPLD $3/ WUHDWHG
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the subject of many case reports, predominantly in
SHGLDWULFSDWLHQWVUHFHLYLQJ$75$GRVHRIPJ
PSHUGD\RUPRUHEXWDOVRRFFDVLRQDOO\LQ\RXQJ
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a relatively rare form of acute myelogenous leu
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Retinoids are drugs that are relatives of vitamin A.
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nausea and vomiting, rash, mouth sores, itching,
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intracranial hypertension due to vitamin A toxicity.
ATRA may cause overstimulation of RAR alfa re
ceptors in the central nervous system, resulting in
increased intracranial pressure by impairing CSF
absorption. If untreated, it may lead to swelling of
the optic disc in the eye, which can progress to vi
VLRQORVV,QWUDFUDQLDOK\SHUWHQVLRQDVVRFLDWHG
with ATRA usually presents between 3 to 17 days
after onset of ATRA therapy, but there have been
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Differential diagnosis include: intracranial hemor
rhage, ATRA induced headache, optic nerve in
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hypertension, cessation of ATRA treatment or
halving dosage usually leads to the resolution of
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cluding resolution of headache and disc edema
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sometimes permanent relief from the symptoms.
Some respond to Acetazolamide, but others re
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CASE REPORT
0.D\HDUROGPDOHZDVDGPLWWHGDW&OLQLFRI
Hematology Clinical Center University of Saraje
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amination showed remission and we continued
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After 39 days of ATRA therapy the patient started
WR FRPSODLQ RQ KHDGDFKH 3K\VLFDO H[DPLQDWLRQ
of the nervous system was normal. Ophthalmo
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RI &16 LQYROYHPHQW E\ OHXNHPLF FHOOV ZDV SHU
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head showed cystis arachnoidalis located in right
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EEG was normal. In the further course of his treat
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cles of consolidation chemotherapy which include
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$75$WRPJPSHUGD\ZKDWLQGXFHGWHPSR
rary relief from headache. One day after he com
pleted his third cycle of consolidation chemothera
py, 3 months of onset of ATRA therapy the patient
started to complain on severe headache, diplopia
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FRQ¿UPHG DFKLHYHPHQW RI FRPSOHWH UHPLVVLRQ
Ophthalmological examination documented bilat
eral papilledema with ophtalmoplegia of the right
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WKH VDPH DV SUHYLRXVO\ :H FRQVXOWHG QHXURVXU
geon who done lumbar punction and documented
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punction was followed by prompt clinical improve
ment of the patient status. The patient started to
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what induced further improvement of the patient’s
status. Ophthalmologic follow up documented no
papilledema and ophthalmoplegia of right abdu
cens nerve 10 days after.
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nance therapy with administration of ATRA again
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concurrently. After one year the patient is still do
ing great.
DISCUSSION
Benign intracranial hypertension is a diagnosis of
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tion:
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1. signs and symptoms of intracranial hyperten
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3. increased intracranial pressure of more than
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pertension.
CONCLUSIONS
The case described in this article is a typical ex
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ZKRKDVEHHQWUHDWHGZLWK$75$7KLVLVWKH¿UVW
reported case of BIH induced ATRA at region as
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possibility of BIH during ATRA therapy even in
adults.
3. Ribeiro R. Update on the management of pediatric
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FRO
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Idiopathic intracranial hypertension. Neurosurgery
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REFERENCES
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FKLOGUHQ ZLWK DFXWH SURP\HORF\WLF OHXNDHPLD /DQFHW
&ROXFFLHOOR 0 3VHXGRWXPRU FHUHEUL LQGXFHG E\ DOO
trans retinoic acid treatment of acute promyelocytic leu
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Address:
/HMOD%XUD]HURYLü0'06F
Clinic of Hematology
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Case report
INVERSE POSITION OF SPLEEN, STOMACH AND PANCREAS
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ABSTRACT
The authors present a case of a rare congenital
condition with inversed position of spleen, stom
ach and pancreas. Situs inversus totalis is a rare
congenital anomaly with mirror image of viscera
combined with dextrocardia. The concept of situs
or laterality of the viscerovascular anatomy is im
portant for understanding, imaging, and interpre
tation of congenital visceral and vascular malfor
mations.
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&7 DQG 05, RI WKH DEGRPHQ IROORZHG WKH 86
exam. Both of these methods revealed right sided
spleen, prevertebral position of the pancreas and
VWRPDFKERWKRQWKHULJKWVLGH3DWLHQWZDVZLWK
out any clinical symptoms and laboratory abnor
PDOLWLHVDQGWKLVZDVDQDFFLGHQWDO¿QGLQJ
Conclusion: variation in spleen position can be
congenital as a part of Situs viscerum inversus,
RU FDQ EH DFTXLUHG &7 DQG 05, DUH PRGDOLWLHV
of choice for correct diagnosis. Our patient was
FRPSOHWHO\ DV\PSWRPDWLF DQG WKH ¿QGLQJV ZHUH
accidental.
Key words: inverse position, spleen, stomach,
pancreas.
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INTRODUCTION
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SRVLWXVLVDFRQJHQLWDOFRQGLWLRQLQZKLFKWKHPD
jor visceral organs are reversed or mirrored from
their normal position. The normal arrangement is
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FRQGLWLRQNQRZQDVVLWXVDPELJXXVRUKHWHURWD[\
situs cannot be determined. The term situs inver
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VXV YLVFHUXP³ PHDQLQJ ÄLQYHUWHG SRVLWLRQ RI WKH
LQWHUQDORUJDQV³'H[WURFDUGLDWKHKHDUWEHLQJOR
FDWHGRQWKHULJKWVLGHRIWKHWKRUD[ZDV¿UVWVHHQ
DQG GUDZQ E\ /HRQDUGR GD 9LQFL LQ DQGWKHQUHFRJQL]HGE\0DUFR$XUHOLR6HYHULQRLQ
+RZHYHUVLWXVLQYHUVXVZDV¿UVWGHVFULEHG
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prevalence of situs inversus varies among differ
ent populations, but less than 1 in 10.000 people
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with accumulation of mesenchymal cells in dor
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sal mesogastrium. Then a dorsal mesogastrium
divides in two parts, one which connects spleen
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PHVRJDVWULLGRUVDOLVDQGVHFRQGSDUWZKLFKFRQ
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HG E\ VWRPDFK OHIW NLGQH\ FRORQLF OLHQDO ÀH[XUH
and pancreatic tail. Usually spleen is completely
FRYHUHG ZLWK SHULWRQHXP /LHQRUHQDO OLJDPHQW
PDNHVVSOHHQ¶VKLOXVZKLFKFRQWDLQVOLHQDODUWHU\
and vein and its position is in front of pancreatic
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spleen”, or ectopic spleen, is seen when spleen
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rant, accessory spleen is more common condition.
It is usually located in spleen’s hilum, but it can be
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Accessory spleen length can be up to 4 cm. Ac
cessory spleen has also been described near
SDQFUHDWLF DUHD DQG DURXQG RI DFFHVVRU\
VSOHHQV FDQ EH VHHQ LQ SDQFUHDWLF WDLO DUHD and can be misinterpreted as an endocrine pan
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These variations of spleen position can be asymp
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SWRVLV ZKHQ S\ORULF FDQDO LV ORFDWHG LQ WKH OHYHO
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and than it is located in lower hemiabdomen more
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FDQ EH ORFDWHG LQ WKH ULJKW KHPLDEGRPHQ WDLO
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frame, i.e. prevertebraly.
The aim of this report was to present rare case of
anomalous position of spleen, stomach and pan
creas.
Study case
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examination. She was not complaining to any ab
dominal pain and her lab test were in the normal
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performed and revealed soft tissue, oval tumor
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on the right and lateral side, right adrenal gland
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UDSK\06&7ZDVSHUIRUPHGLQWKHQDWLYHVHULHV
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)LJXUHDQG Coronal CT scan normal position of gallblad
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was performed in the native and post contrast
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liver that occupies almost the whole subdiaphrag
mal space of the upper abdomen was found. Gall
bladder was located in right hypochondrium at its
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Stomach was located on the right ventral side;
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gus was in front of the aorta and vena cava. In the
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well as pancreas and stomach. Subdiaphragmal
space was occupied with enlarged left liver lobe
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DISCUSSION
In projection above and lateral of upper pole of
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formation notch that is typical for spleen hilus has
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Below the spleen hilus four accessory spleens
were seen. In front and caudally, glandular pa
renchyma structure was observed, which was
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vertebraly. In its parenchyma pancreatic duct was
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The concept of situs or laterality of the viscera
vascular anatomy is important to understanding,
imaging and interpretation of congenital visceral
and vascular malformations. Assignment of lat
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gist may focus on the presence or absence of the
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act diagnosis of spleen position is very important.
Change in spleen position can be of importance in
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condition where spleen has increased movements
compared to normal movements of spleen and di
aphragm during respiration. One of the congenital
causes of mobile spleen is anomaly in develop
ment of posterior mesogastrium, when the con
nection between lateral part of mesogastrium and
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dominal wall. Another cause of mobile spleen can
be decreased tension of the abdominal wall, which
is followed by general enteroptosis. This condition
is usually a result of sudden decreased in body
weight. Trauma with stretch of the suspension
mechanisms can cause change in spleen position.
Also in same infective diseases, position of spleen
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of spleen position are usually asymptomatic, but
in cases of spenomegalia, spleen can cause pres
sure to surrounding organs. In the case of mobile
spleen there is always possibility of torsion that
can appear suddenly or gradually with repeated
colic pain.
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ally associated with incomplete development of
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structures predominate. Generalization may be
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can be composed of multiple fragments which can
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around a spleen, but can be founded in other loca
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In our case, patient has variation in spleen posi
WLRQ ULJKWVLGHG VWRPDFK DQG SDQFUHDV DQG WKLV
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literature, Situs inversus viscerum, dextrocardia
and complete inversion of abdominal organs and
digestive system is commonly described. In our
case only partial inversion of the spleen, stomach
and pancreas was detected.
Situs ambiguus associated with other conditions
of major clinical relevance, such as intestinal mal
rotation, biliary atresia, splenic abnormalities and
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gastric suspension mechanisms, displacement of
abdominal viscera and aberrant vascular struc
tures and vascular connections. Each of these
abnormalities is derived from embryologic inability
to determine laterality and establish the complex
solitus asymmetry, where as symmetrical struc
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CONCLUSION
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tion of the spleen, pancreas and stomach was
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FDOH[DPLQDWLRQZKHQXOWUDVRXQG¿QGLQJUHYHDOHG
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ney. Than as a second imaging method, abdomi
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the stomach were revealed. Funding: there is no
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spleen: Impact for percutaneous left renal procedures.
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G. Intrapancreatic accessory spleen. Diagnosis with
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R. Isolated levocardia: prenatal diagnosis, clinical im
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splenia syndrome accompanied with situs inversus to
talis and annular pancreas in an elderly patient. Clinical
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REFERENCES
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asymmetry in brains, bodies, atoms and cultures. Cam
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Saunders Company;1998.
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Corresponding member of the Academy of Sci
ence and Art of B&H
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ARTICLE CONTAINS:
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TITLE OF THE ARTICLE IN ENGLISH LANGUAGE
First name and last name of author and co-authors
Name and address of institutionLQZKLFKDXWKRUFRDXWKRUVDUHHPSOR\HGVDPHIRUDOODXWKRUVLQ
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Summary LQ %6& ODQJXDJH ZLWK WKH SUHFLVH WUDQVODWLRQ LQ (QJOLVK $EVWUDFW RI DSSUR[LPDWHO\ words should concisely describe the contents of the article.
Key wordsLQ%6&DQGLQ(QJOLVKODQJXDJHXSWR¿YHZRUGVVKRXOGEHOLVWHGEHORZ6XPPDU\RU
Abstract.
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ARTICLE BODY
The main body of the article should be systematically ordered under the following headings:
- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- DISCUSSION
- CONCLUSION
- REFERENCES
INTRODUCTION
Introduction is a concise, short part of the article, and it contains purpose of the article relating to other
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and epidemiological studies the following should be described: sample, protocol and type of clinical
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from the study.
RESULTS
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and contrasted, graphs clear, with visible text and explanation.
DISCUSSION
Discussion is concise and refers to own results, in comparison with the other authors’ results. Citation
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stated aim or hypothesis, or by its negation.
CONCLUSION
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