In vitro antifungal activities of amphotericin B, 5-fluorocytosine, fluconazole and itraconazole against Cryptococcus neoformans isolated from cerebrospinal fluid and blood from patients in Serbia.

Recently, geographic variations in resistance to agents commonly used in the treatment of cryptococcosis have been reported. Therefore, the antifungal susceptibilities of 31 clinical isolates of Cryptococcus neoformans, collected in Serbia during 10-year period, were investigated. Strains were isolated from cerebrospinal fluid (n=28) and blood (n=3), from patients with AIDS (n=26), lymphoma (n=4) and kidney transplant recipient (n=1). The minimal inhibitory concentrations (MICs) of amphotericin B, 5-fluorocytosine, fluconazole and itraconazole were determined by the E-test(®) method. The isolates were highly susceptible to amphotericin B (100% susceptibility at MIC<0.5 µg/mL) and 5-fluorocytosine (87.1% susceptibility at MIC ≤ 4 µg/mL). Geometric mean MIC of amphotericin B and 5-fluorocytosine were 0.102 µg/mL and 0.396 µg/mL, respectively. Fluconazole exhibited the lowest activity in vitro (48.4% susceptibility at MIC ≤ 8 µg/mL) with a significant resistance rate. The activity of itraconazole was also decreased (48.4% susceptibility at MIC ≤ 0.25 µg/mL). The geometric mean MIC of fluconazole stood at 15.14 µg/mL and of itraconazole was 0.144 µg/mL. Cross-resistance among azoles was not common (3.2%), but the parallel increase in fluconazole and itraconazole MIC has been observed (P<0.01). The low rate of susceptibility to fluconazole stresses the need for active antifungal surveillance of C. neoformans and of the corresponding data from different geographic regions.

[Surgical treatment of pancreatic injuries in severe abdominal trauma].

In spite of its low incidence, pancreatic injuries hold important place in abdominal trauma because of diagnostic difficulties, severe potential complications, therapeutic challenges, and high mortality rates. These injuries are related with specific morbidity and are very often accompanied with injuries of other organs. This retrospective study included 31 patients treated at The Clinic for Emergency Surgery of Clinical Center of Serbia during the period of 2004-2009 with intraoperativelly confirmed diagnosis of pancreatic trauma. The most common mechanism of injury was blunt trauma (83.9%). Among available diagnostic methods, abdominal ultrasound was characterized with high incidence of false-negative findings (33.3%) while for CT it was at 16.6%. The type of surgical procedure was related to degree and severity of injury. Specific complications occurred in 22.6% of patients, while mortality rate was 25.8%. The creation of unambiguous algorithms for optimal treatment of patients with pancreatic trauma require multi-centric prospective studies.

[Surgical treatment of gastroduodenal ulcer bleeding-our experience].

INTRODUCTION: Acute bleeding from the upper gastrointestinal tract remains the commonest emergency in gastroen-terology, and is most often caused by gastroduodenal ulcer disease. Despite introduction of novel endoscopic techniques and pharmacological treatment, 6-15% patients have to be operated. The aim of our investigation is analyze data of patients treated for gastrointestinal ulcer bleeding in our institution, their treatment options and outcome. PATIENTS AND METHODS: We included 2237 patients admitted in the Department for Emergency medicine of Clinical center of Serbia during the period from January 1999 until December 2003. because of gastroduodenal ulcer bleeding. We analyzed age, gender treatment option, hospital stay and mortality. RESULTS: The mean age of our patients was 61.58 years, 1346 male and 891 female. The majority of patients were conservatively treated (84.5%). Operated patients mostly undergo Billroth II resection (57.8%). The mean hospital stay was 7.3 days. Average mortality was 14.4%. CONCLUSIONS: Despite adequate endoscopic management of bleeding gastroduodenal ulcer, surgeons will continue to treat this patients for emergency surgery.