Haemodynamic assessment in simulated operative positions before knee arthroplasty can be useful in deep vein thrombosis prediction.

PURPOSE: During knee arthroplasty, the leg is placed in several forced positions, which are mainly uncomfortable for all tissue structures in the region, including the vascular structures. Veins have a weaker quality of the wall structure than arteries, so during the forced position morphological and haemodynamic consequences are expected mainly in the venous system. Conditions of safe aseptic environment for the arthroplasty are in collision with routine intra-operative analysis of local haemodynamics in real time. This is the reason why we have no insight into the haemodynamic and morphological changes at the time in which the initiation of deep vein thrombosis (DVT) occurs. For this reason we created the hypothesis that the monitoring of the occurrence and detection of potential DVT risks can be achieved pre-operatively using echosonograms in simulated operative positions, and then compare them with the cases of postoperative DVT. METHODS: This research was conducted as a prospective, analytical, minimally manipulative and observational clinical study in the period January 2011 to October 2013. In the preoperative period we made ultrasound and colour-Doppler examinations of deep veins in simulated operative position (full extension 0°, semiflexion 30-60°, flexion 90° and maximal flexion 90°+). The target vein was the posterior tibial vein in the distal third of calf. During the operation we took a note of anaesthesia duration and forced positions duration. After the operation we were looking for ultrasound signs of DVT in a follow-up period of six weeks. The sample was made from 91 patients selected for knee arthroplasty: 56 women and 35 men patients of average age 67.46 years. The oldest patient was 81, and the youngest 48. Average body mass index was 26.98 (±2.20) kg/m(2). After initial ultrasound, the sample was divided into two groups according to vein flow velocity. Patients who had a flow velocity lower than 10 cm/s in any of the forced positions were in the investigated group (N-b, n = 38), and patients who had more favourable haemodynamics in forced positions were in the control group (N-a, n = 53). Patients underwent arthroplasty without tourniquet, and the operative, postoperative and anaesthesiological protocol was the same for all the patients. RESULTS: Friedman's test results point out significant differences of posterior tibial vein flow velocity in four simulated positions (0°, 30-60°, 90°, 90°+). Overview of the median value of the posterior tibial vein flow velocity points out reduction of the posterior tibial vein flow velocity in the third and fourth simulated positions. Average range values were lowest in simulated position 90°+. Relative risk for the DVT occurrence was 21.6% higher in the group of patients with flow velocity lower than 10 cm/s with statistical significance. The incidence of DVT was higher in women (22.85%) than in men (14.28%). There was one (1.09%) case of pulmonary embolism (PE) presented as segmental PE. CONCLUSIONS: We believe that preoperative ultrasound analysis performed during the simulation of operative positions is a useful pre-operative test that can identify patients at risk of developing postoperative DVT. We would recommend that during surgery procedure to minimise forced position of knee flexion.

Correlation of autoantibodies presence detected by IFA-anti-dsDNA, IFA-AMA and immunoblotting with corresponding data in clinical management of autoimmune diseases.

Diagnosis and management of patients with SLE (Systemic Lupus Eritematosus), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), involves specific diagnostic tests, such as IFA-AMA, IFA anti-dsDNA and immunoblotting for the detection of autoantibodies for specific autoantigens (mitochondria, dsDNA, M2, LKM-1, LC-1, SLA/LP). We established specific correlation between the detected autoantibodies and corresponding clinical findings. The total of 813 serum specimens were probed with IFA-anti-dsDNA, 98 of which tested positive. We also performed dilution analysis to the end point for all the positive specimens. Numerous specimens were tested by IFA, AMA and immunoblotting.

Immunosuppressive therapy protocols in kidney transplantation in adults.

In practical terms, regardless of HLA compatibility level, whenever tissues are transplanted from one person to another it is essential to suppress the immune response of the recipient. A variety of methods are available however, the most frequently used ones have the disadvantage of being immunologicaly non specific. The consequence is a difficult balance between immunosuppression sufficient to prevent the tissue rejection and maintenance of immune system at the level of ability to adequately deal with an infection. The goal, not yet achieved, is to find a way of generating donor specific immunosuppression that leaves the immune machinery otherwise completely intact. The major approaches to immunosuppression are described below.

Evaluation of ENA-6 Profile by ELISA Immunoassay in Patients with Systemic Lupus Erythematodes.

Autoimmune diseases occur in 3-5% of the population. Study included 30 patients with clinically diagnosed SLE and 30 healthy controls (American college of Rheumatology, 1997). SLE was diagnosed according to criteria issued in 1997 by the American College of Rheumatology (ACR). The aim of this study was to evaluate concentration values of each antigen of ENA-6 profile in SLE, to investigate possible correlation between the concentration of Sm antibodies and CIC, and to test their use as possible immunobiological markers in SLE. Furthermore, the aim of our study was to determine whether there is a correlation between Sm antibodies and CIC and SLE activity. The results revealed that all of these ENA-6 and Sm antibodies as biomarkers complement diagnoses of active SLE but their use as solo markers does not allow classifying patients with SLE. Our study has shown that based on calculations from ROC curves, Sm/RNP was clearly a very important marker for diagnosis of SLE (cut off ≥ 9.56 EU, AUC 0,942). The high incidence of Scl-70 (10%) reactivity suggests that ELISA monitoring of this antibody produces more false positive results than other multiplex assay. An important conclusion that can be drawn from the results of our study is that laboratory tests are no more effective than clinical examination for detecting disease relapse, but are helpful in the confirmation of SLE activity.

ELISA subtypization of anti-ENA autoantibodies in clinical management of autoimmune diseases in Bosnia and Herzegovina.

The basis of autoimmune diseases such as SLE (Systemic Lupus Eritematodes), Sjogren's syndrome, scleroderma, dermatomyositis and polymiositis is the creation of auto-antibodies to the following specific extractable nuclear antigens (ENA):Jo-1, Ssl-70, SS-A, SS-B, Sm and Sm/RNPs. Some of these antigens are in fact enzymes (Jo-1-histidil-tRNA synthetase, Scl-70-topoisomerase) which are inhibited by specific autoantibodies--this leads to disturbance in the metabolism of DNA and protein biosynthesis. During 2009, we analyzed total of 87 serum samples of patients suspected for autoimmune disorder using ANA-IFA and ELISA-ENA-6 methods. After establishing IFA-ANA positivity (83.9%), all serum specimens; ANA positive and negative, were subtypized by ELISA ENA-6 test. Analysis showed the highest incidence of anti-SS-A (56%), and incidence of anti-SS-B (29.8%), anti-Sm/ RNP (11.5%), anti-Jo-1 (2.3%) and anti-Scl-70 (1,1%) auto-antibodies. Also, 78.5% of IFA-ANA negative serum specimens showed high level of positivity (212.50 and 277.0 IU/ml) to SS-A (78.5%) and SS-B (21.4%) antigenes using ELISA-ENA-6 subtypization. Following these results, we conclude that it is necessary to introduce Western blot confirmation testing. After comparing with other clinical findings, we diagnosed the following autoimmune diseases: SLE, Sjogren's syndrome and dermatomiosytis.

Comparative study of interleukin 1ALFA and interleukin 6 concentrations in serum specimens detected by ELISA.

Interleukin 1 (IL-1) contains two proteins, which are the products of distinct genes, but which recognize the same cell surface receptors. In the liver, IL-1 initiates the acute phase response resulting in an increase in hepatic protein synthesis and decreased albumin production IL-1 also plays an important role in immune functions, having effects on macrophages/monocytes, T lymphocytes, B lymphocytes, NK cells, and LAK cells. Interleukin-6 (IL-6) is a cytokine that regulates immune responses. We analyzed total 160 serum specimens of patients from Clinical Center University of Sarajevo with different inflammatory diseases by ELISA method on interleukins: IL-1alfa and IL-6. Tests that we performed with IL-lalfa and IL-6 by ELISA method confirmed that serum specimens with IL-6 ELISA showed increased values of tested specimens, than the lowest standard and blank. We had average levels of IL-1alfa 3.7 pg/ml which was below the level of the lowest standard. All obtained results were in accordance with the results in IBL protocol for blank and lowest standard values, as well as the average levels of serum specimen values.

The incidence of antinuclear antibodies (ANA) detected by indirect immunofluorescence assay (IFA) method.

Human anti-nuclear antibodies (ANA) in Systemic Lupus Erythematosus (SLE) react specificaly with DNA, RNA, several proteins and ribonucleoproteins. Systemic Lupus Erythematosus is the classic type of polysystemic autoimmune disease. The high frequency of ANA is determined in these patients. Actually, all SLE patients are ANA positive. ANA testing by IFA (Indirect Immunofluorescence Assay) is an excellent screening tool for SLE cases, but it is not so highly specific test. Patients with connective tissue diseases, such as rheumatoid arthritis, scleroderma and dermatomyositis are also frequently positive. Results of IFA ANA have relative low specific degree, and for this reason the titration of these specimens to the end point is usually recommended. Indirect immunoflourescence is reference method for ANA testing. Common substrates are thin sections of rodent organs or various types of cell lines. The cell line substrates are preferable to organ sections, because these rapidly dividing cells have higher level for detection of certain clinically relevant antigens such as (e.g., centromere, SSA (Ro) and Scl-70). In this paper we present the results evaluation of ANA incidence, detected by IFA in serum specimens of corresponding clinical patients, during 2005 and 2006.

Ultrasound evaluation of vascular complications in pancreas transplant recipients.

Transplantation of the pancreas is progressively becoming one of the preferred options of treating the insulin addicted diabetes mellitus. Pancreas can be transplanted alone, or together with a kidney, the latter option becoming more successful in recent years. In this case, the successfully transplanted pancreas with the regulation of sugar, protects the kidney from further damage. Among the more important complications in the recipient of the graft, we can certainly include vascular complications. One of the most important non-invasive methods of early discovery of vascular complications on the pancreas is in the first place ultrasound. Early diagnosis with ultrasound enables timely appropriate treatment and therefore the survival of the transplant. Especially unavoidable and useful in everyday practice is the role of the modern forms of ultrasound such as the Gray-scale sonography, duplex Doppler imaging and sonographic guidance for percutaneous biopsy. Color and Doppler ultrasound have proved themselves in everyday use as a precious source of information for diagnosis of eventual vascular complications and the status of regional vasculature. Early diagnosis resulting from the ultrasound and the concurrent use of other laboratory and clinical findings enables us to timely recognize and preempt the consequences of vascular complications thereby increasing the chances of pancreatic survival.

A simple method of DNA extraction in solving difficult criminal cases.

AIM: We examined combined use in house method and DNA IQ system (Promega) procedure for the extraction DNA from biological trace in order to help the solving some crime cases. METHOD: Simple and efficient method for extraction of the DNA from biological trace samples included the well washed trousers and the knife without any visual biological trails (from some one hard criminal case). In this method there were used: centrifuge, microwave oven, shaker, chelex, proteinase K, DNA IQ System (Promega). RESULTS: The extraction of DNA could be done within 2.5 hours or over the night. The DNA prepared on this way was good quality and could be used for STR analysis. CONCLUSIONS: This combined, simple, and safe method could be used for extraction DNA from samples containing a minute amount of the biological trace.

Gene analysis of steroid 5 alpha-reductase 1 in hyperandrogenic women.

AIM: To examine the gene encoding for 5alpha-reductase type 1 in hyperandrogenic women, and assess the association of its eventual mutations or polymorphisms with the development of the hyperandrogenic female pattern. METHODS: Sixteen hyperandrogenic women were included in the study. Single-stranded conformation polymorphism analysis (SSCP) and DNA sequencing were performed after polymerase chain reaction amplification of each of the 5 exons of the SRD5A1 gene in both hyperandrogenic and control group (16 participants). RESULTS: Sequence analysis identified the existence of many polymorphisms; in codon 24 of exon 1, GGC (Gly) into GAC (Asp); in codon 30 of exon 1, CGG (Arg) into CGC (Arg); in exon 3 codon 169, ACA to ACG (both encoding for threonine); in exon 5, AGA to AGG (both encoding for arginine, codon 260); and T/C polymorphism in intron 2. Polymorphisms were found in both groups. CONCLUSION: Polymorphisms of SRD5A1 gene were the same in both hyperandrogenic and healthy women, indicating no significant associations of genetic polymorphisms/variations of SRD5A1 gene with clinical manifestations of hyperandrogenic disorders in women.

[Lesions of the peripheral nerves after surgical treatment of fractures of the distal humerus]. / Lezije perifernih nerava nakon operativno saniranih prijeloma distalnog humerusa.

In the work we have examined 44 patients (16 women and 28 men), which the break of distal humerus is saned with operation, using adequate OSM. The average years of women patients was 29 (from 3 to 79), and of male patients 24 (from 1 to 75). After thr operative sanitary breaks distal part of humerus, using adequate OSM (fillo Kurschneri, platho metalico, clavo spiralis), it can come on lesion of perifer nerves of the arm, and mostly of n. radialis. Lesions of n. radialis we have notice on 5 patients. The rehabilitation our patients was made with prevention contraction of shoulder, elbow, hand and fingers using kinesitherapy, hydrotherapy and electrotherapy paralysis musculature with intentional exercises to the reinervation of perifer motor neuron and raising the force of musculus.

[Incidence of malignancies of the colon treated at the Clinic for Abdominal Surgery at the University Clinical Center in Sarajevo in the prewar (1987-1991) and postwar (1996-2000) period]. / Incidenca malignoma kolona, lijecenih na Klinici za abdominalnu hirurgiju Klinickog centra Univerziteta u Sarajevu u predratnom (1987.-1991.) i poslijeratnom (1996.-2000.) periodu.

Malignant tumours are important health problems today. In most countries they are second cause of death in general population. In this work it was presented epidemiology of rectal cancer which are treated in Abdominal Surgery Department at University Clinical Center in Sarajevo of Bosnia and Herzegovina. This is only part of complete investigation of incidence malignants in Bosnia and Herzegovina. Our study is a retrospective and observation two five years periods. First is between 1987.g. and 1991.g., and second is between 1996 and 2001.g. During first period in Abdominal Surgery Department, we had 668 cases of abdominal malignant and 225 of these cases were carcinoma colorecti. In the second period we had 831 cases of abdominal malignant and 311 of these cases were carcinoma colorecti. When we compared our data with other referents from East Europe, we can say that the results mostly the same, and when we compared first five years period (1987-1991), with second five years period (1996-2001), there are also no statistically significant increase.

[Detection of antibodies against cytomegalovirus in donors and recipients of kidney transplants]. / Ispitivanje antitijela protiv citomegalovirusa kod donatora i primaoca bubreznog transplantata.

UNLABELLED: The paper analyzed the values and titer of IgM and IgG antibodies on CMV in donors and recipients of kidney transplntats. The objective was to investigate the presence of CMV in donors and recipients. SUBJECT AND METHODS: Test enzignost anti CMV/IgM was used. Detection of antibodies in 15 donors before transplantation and in 22 patients-recipients before and after the transplantation was done. RESULTS: From total of 15 donors, the values of IgM ranged from 0,002 I.U. do 0,080 I.U. One case was positive. Four patients were seropositive and treated by Gancyclovirom 10 mg/kg/b.w (body weight) in period of 3 month. IgM values ranged from 0.88399 to 25978. The control finding 3 patients was negative, in 1 patient positive (IgM 0.569). In 18 patients the finding was negative. Refererent value for IgM is < 0.10 the result is negative. For IgG four times greater value comparing to the basic value was found. CONCLUSION: The most significant factor for reactivation of CMV infection is iatrogenic Immunosuppressive therapy. Exclusion of CMV infection in donors and negative finding in recipient decrease.

The number of malignant neoplasm in Sarajevo region during the period 1998-2002.

UNLABELLED: Due to the specific war and post-war situation in Bosnia and Herzegovina it is possible to notice some differences in the number, type, advancement, biological course, treatment and its outcome. The actual situation which appeared in connection to depleted uranium has additionally raised questions about its influence on human health and about eventual increase in the number of malignant diseases in Bosnia and Herzegovina. In public, we often see that there are claims about enormous increase in the incidence of cancer. In order to achieve a realistic picture of actual condition and to avoid panic and ignorant attitude, correct and constant data of malignant tumors are necessary. THE AIM OF THE STUDY: To collect and analyze data on population with malignant tumors in the region of Sarajevo city, which represents a symbol of difficult times in our country in the recent past. MATERIAL AND METHODS: We have collected and analysed data on, population with malignant tumors which included persons with permanent residence in Sarajevo Canton during 5-year period, from 01.01.1998, until 31.12.2002. Results were compared to regional and world indicators, and were observed in the light of specific local situation. RESULTS: During period of 5 years (1998-2002) 7733 new cases of malignant tumors were registered in Sarajevo Canton; 3940 among men and 3809 among women. Mostly registered tumors were: lung cancer, amelanotic skin tumors, breast cancer, colorectal cancer, cervical and uterine cancer, urinary bladder cancer, prostate cancer and cancer of larynx. CONCLUSIONS: Number of all malignant tumors in the region of Sarajevo Canton correlates to those in South European countries and the one estimated by GLOBCAN 2000. High number was registered in 1998, possibly due to normalization of the health services (diagnostics and treatment of malignant tumors), which didn't exist during the war and early post-war period. After 2000, there is a gradual increase in the number of people with malignant tumors. The most common tumors are lung and breast cancer. Significant differences to estimation and data registrated in other South European counties is high number of laryngeal cancer, urinary bladder cancer, bone and cartilage sarcoma, brain tumors and malignant lymphomas among both genders. Cervical cancer is extremely high up on the list, which correlates with data in developing countries. The incidence of smoking in Bosnia and Herzegovina is extremely high, almost complete, which can influence not only the appearance of lung cancer but also laryngeal and urinary bladder cancer. It is hard to say whether the war and post-war stress, irregular and insufficient nutrition during and after the siege of the city or some other factor have influenced their appearance among exposed population and differences in the observed incidence.

[Interinnominate abdominal amputation (hemipelvectomy) in treatment of pelvic malignancy]. / Interinominoabdominalna amputacija (hemipelvektomija) u lijecenju malignoma karlice.

Cancers of rectum and anus are among most frequent cancers with a tendency of increasing frequency. According to available data, the percentage of surgeries performed during period 1973-1977 was 61%, and during period 1991-1993 78%. From those data it can be seen that the frequency of performed surgical treatments is evidently increasing lately. High percentage of patients suffer from the process that is involving neighbouring organs and tissues, therefore declared as inoperable. In this study we present five cases with malignant tumors of pelvis who were treated during period 1990-2002 with mutilating surgical technique--chemipelvectomy. In all surgical procedures we have used King's and Steelquist's methods. At the same time, these surgical procedures are moving the limits of tumors' inoperability. The survival period for 4 patients was over one year, and 1 patient died due to postoperative embolism. In 1 patient, the wound has healed per secundam. We registered no cases of local recurrence. The new possibilities in the treatment of pelvic tumors which are often declared as inoperable are opened due to the fact that chemipelvectomy is moving the limits of so-called inoperable types of tumors. We believe that it is necessary to open new discussions on this issue because the coming time will offer new possibilities in the surgical treatment of pelvic tumors.