The role of oxidative stress as a risk factor for rupture of posterior inferior cerebellar artery aneurysms.

Cerebral aneurysm affects 2-5% of the population and posterior inferior cerebellar artery (PICA) aneurysms account for 1-3% of all intracranial aneurysms. Oxidative stress is known to contribute to the progression of cerebrovascular disease and it may be increased by inflammation, a key contributor to cerebral aneurysm development and rupture. The aim of this study was to examine the role of overall oxidative stress as a risk factor for rupture of PICA aneurysms. This study included 29 patients with PICA aneurysms: 18 ruptured and 11 unruptured. We determined catalase, malondialdehyde, myeloperoxidase and carbonyl groups in homogenates of excised aneurysm tissue after surgery and plasma levels of C reactive protein and fibrinogen. The patient's age and sex, size of aneurysms, multiplicity, history of previous subarachnoidal hemorrhage (SAH) and risk factors for oxidative stress such as hypertension and smoking were compared between unruptured and ruptured aneurysms. Maximal diameter and SAH history were independent predictors for aneurysm rupture. Activity of catalase was decreased while activity of myeloperoxidase, levels of malondialdehyde, carbonyl groups in aneurismal tissue and plasma levels of C reactive protein and fibrinogen were increased in patients with ruptured aneurysms. Plasma levels of C reactive protein and fibrinogen showed positive correlation with myeloperoxidase, malondialdehyde, carbonyl groups and PHASES score and negative correlation with catalase. These findings suggest that oxidative stress may contribute importantly to rupture of PICA aneurysms and plasma levels of C reactive protein and fibrinogen correlate with oxidative stress markers in tissue.

The effect of resveratrol on contractility of non-pregnant rat uterus: the contribution of K(+) channels.

This study was aimed to evaluate resveratrol (1-100 µM) effect on the spontaneous rhythmic contractions (SRC), oxytocin-induced (0.2 nM, POxC) phasic and tonic (20 nM, TOxC) contractions of isolated rat uterus. The SRC and POxC were more sensitive to resveratrol than TOxC (pD2 values: 4.53 and 4.66 versus 4.06). Different blockers of K(+) channels (glibenclamide, tetraethylamonium, iberiotoxin, 4-aminopyridine) antagonized the response to resveratrol on the SRC and phasic contractions, but did not antagonize the effect of resveratrol on the TOxC. In order to compare the relaxant activities of resveratrol on the TOxC with that of potassium channel openers, a separate experiments with NS 1619, a highly specific big Ca(2+)-sensitive K(+) (BKCa) channels opener and pinacidil, a predominant opener of ATP-sensitive K(+) (KATP) channels were done. NS 1619 (10-100 µM) and pinacidil (10-100 µM) produced more potent inhibition of TOxC than resveratrol (pD2 values were 6.00 and 5.29). Iberiotoxin, a highly selective BKCa channels blocker, antagonized the response to NS 1619 and glibenclamide, a highly selective KATP channels blocker, antagonized the response to pinacidil on the TOxC. To test K(+)- and extracellular Ca(2+)- independent mechanism(s) of resveratrol on TOxC, a K(+)-rich, Ca(2+)-free solution was used. Under this condition, only high concentrations (≥30 µM) of resveratrol inhibited TOxC. Western blots analysis confirmed expression of Kir6.1, Kir6.2, KCa1.1, Kv2.1 and Kv4.2. channel proteins in myometrium. Thus, the effect of resveratrol is dependent on the types of contractions. The inhibitory response of resveratrol on the SRC and phasic contractions involves different myometrial K(+)- channels. When applied in high concentrations, resveratrol has an additional K(+)- channels independent mechanism(s) of action. As the effects of NS 1619, pinacidil and resveratrol on the TOxC are different, we can conclud that resveratrol does not behave as a classical potassium channel opener.

[Malignant disease of the appendix]. / Maligna bolest crvuljka.

The authors shows case report 81 old patient, underwent surgical treatment on Surgical Clinic KBC DR Dragisa Misovic because of malignant appendix. Primary symptoms of illness was acute abdomen. Histology confirm nature of illness. The authors discusses about different types of malignant appendix and ways of their treatment, and propose operative procedures which are need to be done in these cases.

[Diagnosis of solitary thyroid gland nodules]. / Dijagnostika solitarnih nodusa stitaste zlezde.

Solitary thyroid gland nodes have presented an entity in thyroid surgery and endocrinology for a long period of years mostly due to frequent occurrence of malignomas and other changes of thyroid gland as well as to insufficient and uncertain clinical diagnostics. The only certain diagnostics is still the intraoperative exploration and ex tempore biopsy of the change, which means that surgery presents both a diagnostic and therapeutic procedure. At the Clinical-Hospital Center "Dr Dragisa Milosevic" in Belgrade, Department of Surgery, 100 patients with preoperatively diagnosed solitary thyroid gland nodes underwent surgery during a 4 year period. In all patients a uniform clinical diagnostics was performed, and then, on the basis of intraoperative findings and ex tempore biopsy, gathered results were compared and reliability of certain preoperative diagnostic procedures was considered in regard to intraoperative findings. The aim of this study was to point to necessity of application of all relevant indexes in diagnostics with a special review on the intraoperative finding as the most relevant in making the decision about the range of surgery and further postoperative treatment.

[Surgical procedures in acute pancreatitis]. / Operativni postupci pri akutnom pankreatitsu.

The author points out the increased hepatobiliar intracanalicular pressure represents one of the factors responsible for the development of acute pancreatitis. Decompression of ductus choledochus by T-drainage or by reestablishment of the flow of pancreatico-biliary secretion through the Vater's papilla leads to the fall of the pressure in ductus choledochus, and probably to the decrease of intracanalicular pressure in the pancreas. They think that gastro-jejunostomy plays a significant role in the decrease of reflectory mediatory gastro-antral-duodenal influence upon a pancreatic secretion as well as on gastric decompression. Further, they think that one should not wait for a progressive pancreatic tissue necrosis to happen before operation, since this increases the risks involved; but the patient with acute pancreatitis should be operated on, when conservative treatment has not give the expected results. The number of the operations performed in cases of acute pancreatitis, their postoperative course, as well as the absence of the common complications give hope, that by the mentioned surgical procedures the present high mortality rate of this severe disease will be decreased.

[An ultrasonic scalpel for laparoscopic gynecologic surgery]. / Ultrazvucni skalpel u ginekoloskoj laparoskopskoj hirurgiji.

In order to obtain good results in laparoscopic surgery the surgeon should be well trained and experienced and the equipment perfect. The recent innovation in laparoscopic surgery is the ultrasonically activated scalpel. Scissors make the working part of scalpel with one hand vibrating 55,000 Hz in a second. The effect reflects in braking hydrogen links and denaturation of proteins in instant haemostasis and coagulation in blood vessels, and there is no need of tying them up. Practically, there is no damaging of the surrounding tissues. The technique is easy to use. When performing laparoscopic vaginal hysterectomy and adnexectomy the ligamentum infundibulopelvicum and ligamentum rotundum are cut, and there the blood vessels are not thicker than 3 millimeters. As these ligaments are easy to reach with ultrasonically activated scalpel, we can say that this instrument is the ideal option for laparoscopic vaginal hysterectomy.

[Advantages of laparoscopically-assisted vaginal hysterectomy in comparison with the traditional approach]. / Prednosti laparoskopski asistirane nad tradicionalnim postupkom histerektomije kroz vaginu.

The authors are discussing the advantages of the laparoscopically assisted vaginal hysterectomy over the traditional vaginal method, comparing two groups of patients operated in both techniques. In 30 patients from the first group the traditional vaginal hysterectomy have been performed as part of the operation needed in order to change their sex. 20 patients from the second group have been operated, due to different indications, by laparoscopically assisted vaginal hysterectomy. Comparing the indications, the operation itself and the results in postoperative treatment the authors concluded that, for the laparoscopically assisted vaginal hysterectomy the indications are more numerous, practically there are no contraindications, the operation itself is easier, because all abdominal organs are visible on the screen. As for the results after the operation, they are almost identical in both groups. The only advantage of the traditional method is that, sometimes, the operation itself does not last long. The greatest benefit of laparoscopic assisted vaginal hysterectomy is the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy. The authors unanimously concluded that only experienced surgeons can perform both operations.