THE EFFECTS OF ENDOCRINE DISRUPTORS ON FEMALE GONADAL AXIS: AN UPDATE.

Endocrine disruptors (EDs) are considered to have an impact on the function of reproductive axis at different levels as well on reproductive organs in both sexes. Complexity of female reproductive system influenced with various stressors including EDs lead to morphological and functional alterations. This is resulting in modulation of neuroendocrine regulation with consequent developmental irregularities and derangements, causative infertility, endometriosis as well as premature ovarian insufficiency or polycystic ovary syndrome. A number of experimental clues was obtained on female animal models using various EDs such as synthetic estrogens and phytoestrogens, neurotransmitters, pesticides or various chemicals. These substances lead towards consequent derangement of the neuroendocrine control of reproduction from early phases of reproductive development towards different phases of adult reproductive period. This text will address some novel insights into the effects of EDs on neuroendocrine regulation of gonadal axis, effects on ovaries as well on endometrium during implantation period.

Potential causes of medication errors: perceptions of Serbian nurses.

AIM: The aim of this study was to identify the most common contributing factors to medication errors in everyday practice of Serbian nurses. BACKGROUND: Nurses have the key role in medication, and it is very important that they understand why errors occur. METHODS: This research study was a cross-sectional study in five healthcare institutions. The sample was 965 nurses. A specially designed questionnaire was used as the research instrument. RESULTS: The most dominant contributing factor of medication errors was insufficient number of nurses. Interestingly other dominant factors given in literature were not recognized in this research study. DISCUSSION: The study results confirm that the recommendations we find in literature cannot be simply copied and implemented into the existing system, but can be used as a starting point for further research. LIMITATION: The obtained data were compared with the studies of the countries with different healthcare systems and different educational structures of nurses. CONCLUSION: The results of the study imply that healthcare institutions have to take the initiative and the responsibility for teaching safe medication use during formal education, as well as in clearly planned programmes of continuous education for nurses. IMPLICATIONS FOR NURSING: To reduce errors to the least possible level, it is important that nurses clearly define what an error is and recognize the causes and the importance of reporting and analysing them. IMPLICATIONS FOR HEALTH POLICY: Systemic practices are required in the health system in Serbia and the culture of patients' safety accepted as the common goal and imperative of everyday practice.

Cardiac Nitric Oxide Synthases and Na⁺/K⁺-ATPase in the Rat Model of Polycystic Ovary Syndrome Induced by Dihydrotestosterone.

Nitric oxide synthases (NOSs) and Na(+)/K(+)-ATPase are enzymes essential for regular functioning of the heart. Since both enzymes are under insulin and androgen regulation and since insulin action and androgen level were disturbed in polycystic ovary syndrome (PCOS), we hypothesized that cardiac nitric oxide (NO) production and sodium/potassium transport would be deteriorated in PCOS. To test our hypothesis we introduced animal model of PCOS based on dihydrotestosterone (DHT) treatment of female Wistar rats and analyzed protein expression, phosphorylation or subcellular localization of endothelial NOS (eNOS), inducible NOS (iNOS) and alpha subunits of Na(+)/K(+)-ATPase in the heart. Obtained results indicate that DHT treatment significantly decreased cardiac eNOS protein level and activating phosphorylation at serine 1,177, while inhibitory phosphorylation at threonine 495 was increased. In contrast to expression of eNOS, iNOS protein level in the heart of DHT-treated rats was significantly elevated. Furthermore, cardiac protein level of alpha 1 subunit of the ATPase, as well as its plasma membrane content, were decreased in rats with PCOS. In line with this, alpha 2 subunit protein level in fraction of plasma membranes was also significantly below control level. In conclusion, DHT treatment impaired effectiveness of NOSs and Na(+)/K(+)-ATPase in the female rat heart. Regarding the importance of NO production and sodium/potassium transport in the cardiac contraction and blood flow regulation, it implicates strong consequences of PCOS for heart functioning.

Benefits of physical exercises in developing certain fitness levels in children with hyperactivity.

The objectives of this study were to assess the effects of participating in regular physical activity on the fitness of children with hyperactivity. The study compared a sample of children who were assessed as hyperactive with the same number of children rated as non-hyperactive. The Conners' Rating Scale was used for hyperactivity evaluation, while fitness levels were assessed using a battery of six motor tests prior to and following the completion of the physical exercise programme. The findings indicated that while overall fitness levels of both groups improved, the differences were not statistically significant. However, improvements shown within the group of hyperactive children with regard to coordination of the whole body, trunk strength and agility were statistically significant. Physical activity may be associated with enhanced levels of some aspects of physical fitness.

Hypothalamic-pituitary-adrenocortical axis hypersensitivity and glucocorticoid receptor expression and function in women with polycystic ovary syndrome.

INTRODUCTION: Molecular mechanisms underlying pathophysiology of polycystic ovary syndrome (PCOS), especially those related to cortisol signaling, are poorly understood. We hypothesized that modulation of glucocorticoid receptor (GR) expression and function, may underlie possible PCOS-related impairment of feedback inhibition of hypothalamic-pituitary-adrenocortical (HPA) axis activity and thus contribute to increased adrenal androgen production in women with PCOS. MATERIALS AND METHODS: 24 normal-weight and 31 obese women with PCOS were compared to 25 normal-weight controls. Fasting blood samples were collected for measurements of serum concentrations of dehydroepiandrosterone sulfate, testosterone, sex hormone-binding globulin, insulin, basal cortisol and cortisol after oral administration of 0.5 mg dexamethasone. Concentrations of GR mRNA, GR protein, mineralocorticoid receptor (MR) protein and heat shock proteins (Hsps), as well as the number of GR per cell (B(max)) and its equilibrium dissociation constant (K(D)) were measured in isolated peripheral blood mononuclear cells. RESULTS: An increase in HPA axis sensitivity to dexamethasone, an elevation of the GR protein concentration, and unaltered receptor functional status were found in both normal-weight and obese women with PCOS vs. healthy controls. Lymphocyte MR, Hsp90 and Hsp70 concentrations, and MR/GR ratio were similar in all groups. Correlation between B(max) and K(D) was weaker in the group of obese women with PCOS than in the other 2 groups. CONCLUSIONS: The results did not confirm the initial hypothesis, but imply that PCOS is associated with increased GR protein concentration and HPA axis sensitivity to dexamethasone.

Treatment of emergency surgical complications of kidney transplantations.

Surgical complications subsequent to the kidney transplantation are not infrequent and they are characterized by the high percentage of graft loss (596-18% in standard surgical procedures and up to 37% in atypically performed transplantations). The study included 311 transplanted patients (206 (66.2%) living donors and 105 (33.8%) cadaver donors). Surgical complications developing during the immediate posttransplantation period as well as during the late period (after a year and a half) were classified as: I urinary complications; II vascular complications; III other complications. In majority of the cases urinary complications (urinary fistulas, ureteral obstructions, vesico-ureteral reflux) as well as other complications (cholecystopancreatitis and lymphocele) did not necessitate urgent treatment, unlike most of the vascular complications. All the vascular complications (29/311) developed during the immediate postoperative period, except for occurrence of arterial stenoses which ensued later on, while the development of symptoms was rapid. Severity of both symptoms and clinical picture necessitated urgent surgical re-intervention in order to preserve the graft and patient's life. Vascular complications were classified as: true vascular complications, hemorrhages and kidney ruptures in order to distinguish technical and other factors contributing to development of the complications. Onset of the true vascular complications related to the graft and recipient blood vessel changes was evidenced in 20 patients (69%/29 patients) while the incidence of hemorrhages and ruptures was considerably lower (14%/29 patients and 17%/29 patients). As for the true vascular complications, vascular stem thrombosis subsequent to cadaveric transplantations was the most frequent, and transplantectomy was performed in all the cases in absence of any lethal outcomes. Two cases with iliac artery rupture resulted in graft loss subsequent to urgen exploration. In all cases with hemorrhages the applied therapy resulted in positive responses, except in one case in which massive gastrointestinal hemorrhage led to lethal outcome. The response to the urgent surgical treatment of spontaneous kidney graft ruptures was positive in 60% of the cases, while in the remaining 40% transplantectomy was necessitated due to the extensiveness of the lesion in order to preserve patient's life.

Evaluation and management of traumatic rupture of the corpus cavrnosum.

Fracture of the penis, or rupture of the corpus c avernosum is an uncommon injury, but probably under-reported entity. Only approximately 180 cases have been reported in the literature. Penile fracture with urethral injury is even more uncommon, accounting for approximately 10 to 20% of the cases reported. Early reports on this injury suggest conservative therapy as the choice of treatment. Recent reports emphasize immediate surgical repair to prevent late sequelae of injury, especially those associated with urethral rupture. We review 5 cases with evaluation, treatment and followup. Delays in treatment lead to long-term complications.

Process noise: an explanation for the fluctuations in the immune response during acute viral infection.

The parameters of the immune response dynamics are usually estimated by the use of deterministic ordinary differential equations that relate data trends to parameter values. Since the physical basis of the response is stochastic, we are investigating the intensity of the data fluctuations resulting from the intrinsic response stochasticity, the so-called process noise. Dealing with the CD8+ T-cell responses of virus-infected mice, we find that the process noise influence cannot be neglected and we propose a parameter estimation approach that includes the process noise stochastic fluctuations. We show that the variations in data can be explained completely by the process noise. This explanation is an alternative to the one resulting from standard modeling approaches which say that the difference among individual immune responses is the consequence of the difference in parameter values.

Clam ileoplasty bladder augmentation and renal transplantation.

In our patient, with a small contacted bladder and end stage renal failure, bladder augmentation (clam ileocystoplasty) was done in conjunction with renal transplantation. Our patient has stable renal and bladder function 46 months after kidney transplantation.

Ex vivo repair of renal artery aneurysm associated with repairing of abdominal aortic aneurysm. Case report.

A case of right renal artery distal aneurysm associated with juxtarenal abdominal aortic aneurysm in a 75-year-old male, who presented with abdominal and back pain and chronic renal failure, is reported. The abdominal aortic aneurysm was repaired with a bifurcated Dacron graft. The right kidney was simultaneously explanted, ex vivo reconstruction of the renal artery with PTFE graft was performed, followed by autotransplantation of the kidney into the right iliac fossa. In the postoperative course the renal function returned to normal.

Mercury inhibits rat liver and kidney glucocorticoid receptor hormone binding activity.

The present study was focused on the influence of mercury on the rat liver and kidney glucocorticoid receptor (GR) binding properties. The time-course and dose-dependence of mercury effects, as well as possible involvement of thiol groups were examined after in vivo and in vitro administration of the metal in the form of HgCl2. Mercury led to reduction of the liver and kidney GR hormone binding capacity. In both examined tissues maximal reduction was noticed 4 h after administration of the metal at 2 and 3 mg Hg/kg bw, but the effect was more prominent in kidney as compared to liver. On the other hand, binding affinity in the two tissues was similar. The complete reversal of mercury effects on GR binding capacity by 10 mmol/L DTT was achieved in liver and partially in kidney. The reversal by DTT suggested that mercury caused the decrease of GR binding activity by interacting with thiol groups. The difference in the response of the two tissues reflected the fact that kidney contained a higher mercury concentration and a lower thiol content in comparison to liver. The implicated thiols probably belong to GR, since when applied in vitro at 0 degrees C, mercury produced reduction of the receptor binding activity similar to that observed in vivo. GR protein level examined by quantitative Western blot was either unchanged, when determined by polyclonal antibody, or reduced, when determined by BuGR2 antibody, suggesting that Hg might affect BuGR epitope availability.

Renal allograft implantation in respect of atypical vascular procedures.

In minority of renal transplants it is unevitable to perform atypical vascular procedures of renal allograft implantation, which increases the risk of vascular complications, graft loss and lethality. In the presenting study, we retrospectively evaluated kinds of atypical vascular procedures in renal allograft implantation by donor type and the transplants outcome related to these procedures. From 1980 to 1998, a total of 463 patients (mean age 36.2+/-10.3), underwent renal transplantation (319 from living donor and 144 from cadaveric donor) at the Institute of Urology & Nephrology in Belgrade. Atypical vascular procedures of renal allograft implantation were representative for the some of the following cohorts: bypass grafting, endarterectomy, end to side both arterial and venous anastomotic site. A total of 45 patients (9.72%) underwent some of atypical vascular procedures (41 from living donor and 4 from cadaveric donor) (p<0.01). Among analyzed procedures, bypass grafting was performed in majority of cases (n=38). A total of 101 patients underwent endarterectomy. End to side both arterial and venous anastomotic site was done in two patients. Severe direct postoperative vascular complications following by lethal outcome appeared in 2 patients. Related to standardized, atypical vascular procedures had been of increased risk for appearance of severe vascular complication.

Mesothelial paracrystalline inclusions in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: Uremia is known to be followed by changes in the serous membranes of pleura, pericardium, and peritoneum. During continuous ambulatory peritoneal dialysis (CAPD), the peritoneum is exposed to altered body conditions as well as to the influence of dialysate. The aim of the present study was to examine the ultrastructure of the mesothelial cells in CAPD patients, and to compare the findings with those from studies of the peritoneum in uremic controls. Paracrystalline intracytoplasmic inclusions in mesothelial cells were objects of special interest. METHODS: Biopsies of human parietal peritoneum were studied. These were taken from 12 uremic patients during catheter implantation before the start of CAPD, and from 7 CAPD patients during catheter removal for infection or malfunction. The samples were prepared in the standard way to be studied by transmission electron microscopy (TEM). RESULTS: Paracrystalline intracytoplasmic inclusions were seen in mesothelial cells only by TEM. They appear as filamentous structures at the outer part of the inclusions, and as pearl-like structures at the core of the inclusions. Sacculate dilatations of rough endoplasmic reticulum cisternae with partly destroyed membranes and only few ribosomes were also seen, with and without densely osmiophilic filaments within the cisternae. We have found paracrystalline intracytoplasmic inclusions in mesothelial cells from uremic and CAPD patients both. According to the literature, these changes are present in one third of biopsies from uremic patients. Until now, however, they have not been mentioned in CAPD patients.

[Ultrastructure of peritoneal mesothelial cells]. / Ultrastruktura mezotelnih celija peritoneuma.

The introduction of peritoneal dialysis (PD) as a respectable modality of renal replacement therapy some three decades ago, suddenly drew attention of many authors to peritoneal membrane as insufficiently investigated structure. In order to explain the pathological changes in peritoneum due to renal diseases, it became necessary to explore the normal peritoneal structure. The aim of this study was to examine the morphology of peritoneal lining cells in healthy persons. Biopsies of the peritoneum were performed on 20 volunteer kidney donors. Tissue samples were taken during renal transplantation. Special care was taken in getting appropriate samples without artificial damage because of the extreme fragility of the peritoneal tissue. The preparing procedure was standard for routine HE staining and for plastic embedded semifine and fine sections studies. Semifine sections were made on ultramicrotome, stained with Toluidin blue and studied by light microscope, while fine sections were made by ultramicrotome and studied by transmission electron microscope. One layer of cuboidal or flattened lining cells present over the lamina propria connective tissue presented mesothelium. The cells were overlapped like tiles on the roof. Lateral parts of their interdigitated membranes were interconnected with different types of cell junctions: unpermeable, adhesion and communication junctions; inhibiting intercellular transport. Cell surface was often covered with great number of microvilli and lamellar bodies. A single kinocilia was also often present on apical cell surface. Nuclei were euchromatic with well developed nucleoli. Cytoplasm was filled with a great number of ribosomes, mitochondria, cisterns of rough endoplasmatic reticulum and Golgi apparatus, lamellar bodies and lipid inclusions. Numerous pinocytic vesicles on all parts of the membrane as well as in the cytoplasm indicating active endocytosis, egsocytosis and transcytosys in the process of secretion and reabsorption of serous liquid in peritoneal cavity, were visible. Euchromatic nuclei with prominent nucleoli and numerous mitochondria indicate cells of great metabolic activity.

[Changes in peritoneal mesothelial cells in patients on peritoneal dialysis]. / Promene celija mezotela peritoneuma kod bolesnika na peritonealnoj dijalizi.

INTRODUCTION: Some thirty years ago peritoneal dialysis (PD) became a respectable modality of renal replacement therapy. That is why peritoneal membrane attracted interest of investigators. Certain changes, known as uremic serositis, appear in morphology of serous membranes in end stage kidney disease (ESKD). The aim of our investigation was to examine the morphology of peritoneal lining cells in control group of healthy persons and morphology of peritoneal lining cells in patients on PD. MATERIAL AND METHODS: Peritoneal biopsies were taken in 10 healthy volunteers during the kidney donation and in 15 patients on PD during clinically indicated extirpation. Biopsy samples were prepared for standard routine HE staining and for plastic embedded fine sections studying. Sections were mounted in an ultramicrotome, stained with Toluidine blue (TB) and studied by light microscope (SM), while fine sections were mounted in an ultramicrotome and studied by transmission electron microscope (TEM). RESULTS: One layer mesothelium of the cuboidal or flattened lining cells were present over the lamina propria connective tissue. Mesothelial cells were overlapped like tiles on the roof. These cells were interconnected with different types of cell junctions (unpermeable, adhesion and communication junctions) positioned on lateral parts of the interdigitated cell membranes. A great number of microvilli were often present on the appical surface, as well as a kinocilia and lamellar bodies. Nuclei were euchromatic with well developed nucleoli. Many ribosomes, mitochondria, cisternae of rough endoplasmic reticulum (RER) and Golgi apparatus, lamellar bodies and lipid inclusions were present in the cytoplasm. Using TEM in analyzing fine sections of biopsies of patients on PD, characteristic ultrastructural changes including epithelial defects with only remaining parts of destroyed cells were established, as well as significantly greater number of rough endoplasmic reticulum (RER) cisternae and immature mesothelial cells in lamina propria indicating intensive regeneration of this epithelium. The cytoplasm of new mesothelial cells were of less electron density on TEM photomicrographs, whereas the nuclei of mesothelial cells in these patients were euchromatic with prominent nucleoli and numerous perichromatic granules and fibrogranular nuclear bodies, indicating cells of great activity. Cytoplasmic protrusions of different shape and content were often recognized on the apical surface of cells. Lamellar bodies were also present in this group of patients within the mesothelial cells, as well as between two mesothelial cells or on their apical surface. Mitochondria were picnotic in many of the mesothelial cells of peritoneum in this patient group. In these mesothelial cells intracytoplasmic paracrystaline inclusions were established. TEM photomicrographs showed basal lamina multiplication in this epithelium. CONCLUSION: Our findings comply with reports of other authors. It should be stressed that TEM examination detects characteristic ultrastructural changes in mesothelial lining cells of peritoneum in patients on PD, which could compromise the function of peritoneum as a membrane for dialysis.

[Results of kidney transplantation at the Institute of Urology and Nephrology of the Serbian Clinical Center in Belgrade]. / Rezultati transplantacije bubrega u Institutu za urologiju i nefrologiju klinickog centra Srbije u Beogradu. Rezultati Rezultati Rezultati transplantacije bubrega u Institutu za urologiju i nefrologiju Klinickog centra Srbije u Beogradu.

UNLABELLED: Over the period 1980-1992 256 kidney transplantations were carried out in the Institute of Urology and Nephrology, Clinical Centre, Belgrade: 105 (41%) from cadaveric and 151 (59%) from alive related donors. The first kidney transplantation was performed in our Institution in 1974; however, in the first decade only 27 kidney transplantations were performed. Since 1987, thanks to an increasing number of living kidney donors, the number of transplantations continually increased, and after that period an average of 30 kidney transplantations are performed annually (Figure 1). The aim of the study was to establish the survival of patients and grafts, and factors influencing this survival, as well as to determine the causes of patients' death and graft loss. All the patients were followed-up in our outpatient department within at least 5 years to maximum 17 years. Drug combination therapies were changed in the observation period. From 1983 cyclosporin A (CyA) was added to azathioprine (Aza) and prednisolone (Pr). An increasing number of patients with high immunological risks necessitated the strongest initial immunosuppressive treatment with ALG in addition to Aza and Pr. CyA in a dose of 8 mg/kg b.w. was introduced when serum creatinine concentration fell below 300 mumol/L. The triple treatment including CyA, Aza and Pr was the most common maintenance immunosuppressive therapy in our patients. RESULTS: One and five years survived 95% and 75% of patients, and 84% and 52% of grafts. In assessing the impact of donor source, the year of transplantation, and age of donors we obtained the following results: Living related grafts survived better than cadaver grafts, especially during the first posttransplantation year (Figure 2). Furthermore, graft survival rates from 1987 to 1992 were significantly better than those from early period i.e. 1980 to 1986 (Figure 3). The significantly worse survival rate for grafts from donors older than 60 was noted than for grafts from younger donors. Searching for factors influencing the survival, non immunological and immunological differences between donors and recipients were analyzed. Our analysis showed that 50 living related donors were older than 60. In addition, the majority of them were 20 years older than their graft recipients. Two and more HLA mismatches were observed in 46% of our transplant patients, and 20 patients were highly sensitized. However, the immunological risks were higher in living related transplantations: different ABO blood groups, historical positive cross match reaction between donors and recipients (Table 1). A multivariate analysis using Cox proportional hazards model was performed to determine the important independent predictors of graft survival, and it revealed the following factors (Table 2): number of acute rejections, graft function at the end of the first month and until the end of the first posttransplant year, donors' age, and age and sex differences between donors and recipients. The occurrence of acute rejection at any time had a significant negative effect on graft survival. Since better HLA matching is likely to mean less early rejection it could be concluded that HLA matching influenced graft function and survival in our patients. Absence of acute rejection and delayed graft function or acute tubular necrosis were associated with an improvement of the graft function based on serum creatinine concentration, indicating that delayed graft function also influenced graft survival. The relative risk of graft loss was 2 times higher for patients receiving graft from donors older than 60. Until December 1997, when our analysis was done, of 256 kidney transplant patients 156 lost their grafts. The major causes of graft loss (Table 3) in the early period from 1980 to 1986 were non immunological such as acute tubular necrosis, vascular thrombosis and patients death with functioning graft. (ABSTRACT TRUNCATED)

Ultrastructural changes of peritoneal lining cells in uremia.

Some thirty years ago, peritoneal dialysis (PD) became a respectable modality of renal replacement therapy. That is why peritoneal membrane attracted the interest of investigators. Uremia is followed by changes in the morphology of serous membranes (uremic serositis). Uremic effects on pleura and pericardia have been studied for a long time, but the peritoneum is affected as well. The aim of our study was to examine the morphology of the peritoneum in uremic patients before the start of PD and to compare the findings with those from examinations of peritoneum in healthy controls. We examined 12 uremic patients and 10 healthy controls (kidney donors). Biopsies were taken from parietal peritoneum. The samples were prepared in the standard way for study by transmission electron microscopy (TEM). Certain pathological changes--deformation of mesothelial cells, their detachment from the basement membrane, and unusual bulging of apical surface--were identified at the light microscopy level on semi-fine sections. Paracrystalline intracytoplasmic inclusions were seen in mesothelial cells only by TEM. We hypothesize that the inclusions were causing deformation of the mesothelial cells and detachment of those cells from the basement membrane. Sacculate dilatations of rough endoplasmic reticulum (RER) cisternae with partly destroyed membranes and few ribosomes were also seen, with and without densely osmiophilic filaments within cisternae. Although these changes are mentioned in the literature, the exact reason for their appearance remains unknown.

[Quality of life after kidney transplantation]. / Kvalitet zivota nakon transplantacije bubrega.

316 kidney graft recipients responded to the questionnaire. The questionnaire concerned general, physical and mental life quality as well as sexual capacity, the attitude towards graft and donor and immunosuppressive side effects. The questionnaire had a rating scale from 0 to 4. The ratings were correlated with clinical data (creatinine, hemoglobins levels, duration after transplantation) by simple bivariate correlation coefficient (r) was estimated. Statistical significance (P < 0.05) was defined as r > 0.11 for n = 316. A general improvement of life quality after renal transplantation was noted by 87.5% of patients. This statement did not correlated to time after transplantation, serum creatinine levels or hemoglobin levels. 40.8% of patients evaluated their physical conditions as good, these data again did not correlate to hemoglobin levels or kidney function (expressed as serum creatinine). 73.1% regarded their mental condition as excellent and only 4% as poor. Again, mental condition did not correlate to hemoglobin levels or renal function. Sexual function was assessed to be good or excellent by 48% of patients. In contrast to these positive results, a minority of 14.5% of patients participated in sporting activities on a regular full basis and only 37.5% of all patients believed them selves to be capable of performing a full time job. Only 12.9% suffered from drug-related side effects. Transplantation itself posed no emotional problem for the recipients. Only 2.2% felt unpleasant about carrying a foreign organ and only 17.4% reflected on their donor.

[Treatment of impotence with implantation of penile prosthesis]. / Lecenje impotencije implantacijom penilnih proteza.

The authors have presented results and importance of the treatment of impotence by implantation of different types of penile prostheses in 46 patients. The aim of the study was to evaluate success in recovery of potency with modern types of prostheses. Problems related to characteristics of prostheses and risk groups of patients for this kind of treatment have been recognized. It has been concluded that penile prostheses are very good means for solving the problem of impotence which is exclusively or mainly of the organic origin when other methods are not suitable for a patient or have not given favourable results.

[Viscerosynthesis--use of mechanical sutures in digestive tract surgery]. / Viscerosinteza--primjena mehanickog sava u digestivnoj kirurgiji.

Mechanical suture (stapler) was applied 164 times in digestive surgery in the period from October 1985 to December 1988. There have been performed 82 anastomoses (30 low collateral, 20 esophagointestinal, 20 ileocolic, 10 enteroenteral and 2 colocolic) and 76 closure of intestines. Anastomoses were performed with EEA stapler in 50, GIA stapler in 30 and TA stapler in 2 cases. Intraoperative complications related to the use of stapler were observed in 4.8% cases. Clinically manifested dehiscence of the stapler anastomoses was evident in 4.8% (82) and immediate cause of death in 1.2% (1) case. The incidence of secondary wound infection after four years was 2.4%. No clinically manifested stenosis of anastomoses were observed within the follow up period from one to four years.