Variability of Silver Fir Needle (Abies alba Mill.) Anatomical Features in the Southeast Europe Natural Populations.

The survival of marginal/peripheral silver fir (Abies alba Mill.) populations in the broader region of Southeast Europe is endangered due to climate change and population decline. This study aimed to determine the level and pattern of variability for the anatomical traits of needles and the possibility of linking the pattern of phenotypic variability with environmental factors. In most of the analyzed needle traits, the statistically significant variability between populations was determined. According to the results of the multivariate principal component analysis, it is evident that the populations are distinct from each other, in three groups. The climatic factors Hargreaves reference evaporation, mean annual temperature, and growing degree-days, were statistically significantly correlated. The altitude and heating degree-days are statistically significantly correlated with the following three environmental factors: Hargreaves reference evaporation, mean annual temperature and growing degree-days, but negatively with others. The paper's findings indicate significant moderate and high correlations between the anatomical traits of the needles' central bundle diameter with the resin duct diameter, the distance between the vascular bundle and the resin duct and the epidermis thickness with cuticle, the resin duct diameter with the distance between the vascular bundle and the resin duct and the epidermis thickness with cuticle, as well as the distance between the vascular bundle and the resin duct with the hypodermis height and the epidermis thickness with cuticle. The results of agglomerative hierarchical clustering analysis, performed for anatomical and climatic traits, confirmed the existence of three groups of tested populations according to the altitude gradient. Research results provide knowledge on the diversity and structure of Abies alba populations of Southeast Europe, important for further research and guidelines for the species' conservation and genetic variability preservation in the southern marginal distribution area and keeping in line with climate change projections.

The evaluation of hazardous element content in the needles of the Norway spruce (Picea abies L.) that originated from anthropogenic activities in the vicinity of the native habitats.

The aim of this research was to quantify the content of hazardous elements in the needles of Norway spruce (Picea abies L.) in the natural habitats that were accumulated from thermal power plants, mines, and metal processing industry. Fifteen natural populations of the Norway spruce were sampled from the mountain ranges in Southeastern Europe (Dinaric Alps and Balkan Mountains). Two-year-old spruce needles were evaluated the content of the following hazardous elements: heavy metals cadmium, mercury, nickel, lead and zinc, and metalloid arsenic. The effect of the distance between air pollution emitters and the Norway spruce natural habitats on the hazardous elements content in needles was also evaluated. The results of the analysis of variance confirmed interpopulation differences in the content of all analyzed hazardous elements. The effect of the air pollution source (thermal power plants, mines, and industry) on the content of hazardous elements in the spruce needles was also assessed. Significant correlation was found between the distance of air pollution emitters and the amount of zinc. This study could serve as the startup point of future monitoring programs and provide new prospect of using Norway spruce needles as the bioindicator of air pollution with hazardous elements on Balkan Peninsula since the fact that the Norway spruce natural populations inhabit wide geographic range of the continental Europe, from the Balkan Peninsula, over European Alps to Scandinavia and a large-scale of altitude from 980 to 1860 m above sea level.

Analysis of postoperative radiotherapy effects within risk groups in patients with FIGO I, II, and III endometrial cancer.

INTRODUCTION: To define indications for adjuvant radiotherapy in patients with endometrial cancer, the risk groups have been established according to clinical and pathological prognostic factors. The purpose was to determine precise criteria for adjuvant radiotherapy and identify patients with increased risk for disease relapse who may benefit from postoperative radiotherapy, with an acceptable level of toxicity. MATERIALS AND METHODS: A retrospective study was conducted at the Department of Oncology and Radiology, Kragujevac, during a 5-year period. A group of 80 patients with endometrial cancer treated with adjuvant radiotherapy were included in the study. Patients were divided into four risk groups according to ESMO-ESGO-ESTRO Consensus Conference classification. The Kaplan-Meier method was used for overall and progression-free survival. A statistical analysis was performed using SPSS 20.0 statistical software. RESULTS: The 5-year survival rate was 80%, and 66.3% patients were progression-free during this period. Fatal outcome occurred in 20% of patients. The results showed survival was shortest in patients from the high-risk group. Factors that had impact on the 5-year survival were comorbidities, FIGO stage, postoperative radiotherapy, organ site of late toxicity, and localization of metastases. The analysis of postoperative radiotherapy effects showed that 72.5% of patients had no complications. The most common symptoms of late irradiation toxicity arose from the gastrointestinal tract. Toxicity was usually moderate. CONCLUSIONS: Adjuvant radiotherapy can potentially prolong survival and prevent recurrence, with acceptable level of toxicity, to preserve patient's quality of life. Patient classification into appropriate risk groups allows for adjuvant treatment individualization.

Transplantation of infant kidneys--The surgical technique en bloc and transplant position variation: A case report.

INTRODUCTION: Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called "marginal donors" group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. CASE REPORT: We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. CONCLUSION: The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

An analysis of the influence of intra-operative blood salvage and autologous transfusion on reducing the need for allogeneic transfusion in elective infrarenal abdominal aortic aneurysm repair.

BACKGROUND: An intra-operative cell salvage machine, commonly known as a "cell saver", aspirates, washes, and filters patient's blood during an operation so that the blood can be returned to the patient's circulation instead of being discarded. This procedure could significantly reduce the risks related to the use of allogeneic blood and blood products in surgery. The aim of this study was to analyse the influence of intra-operative cell salvage on reducing the need for allogeneic blood in patients with asymptomatic infrarenal abdominal aortic aneurysm undergoing elective repair of the aneurysm. MATERIAL AND METHODS: We retrospectively collected data from the clinical records of patients who underwent elective infrarenal abdominal aortic aneurysm repair. Two groups were formed: the "cell saver" group, in which intra-operative cell salvage was used, and the control group, in which a cell saver was not used. RESULTS: Thirty patients underwent abdominal aortic aneurysm repair with the use of a cell saver, while 32 underwent the same operation without cell salvage. We found a significant association between use of the cell saver and a reduced need for allogeneic blood in these patients. Operations performed with the use of a cell saver lasted, on average, less time than those performed without it. The difference between pre-operative and post-operative haemoglobin levels was significantly greater in the group of patients who underwent repair with the use of a cell saver than in the control group. CONCLUSION: The use of a cell saver in elective abdominal aortic aneurysm repair significantly reduces the need for intra-operative use of allogeneic blood.

Stent graft infixation after venous dislodgement in a patient with femoral posttraumatic arteriovenous fistula.

INTRODUCTION: An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from traumatic injury or may occur as congenital abnormality. Stent graft repair through arteriovenous fistula could lead to complications. CASE REPORT: Endovascular stent graft repair in a 23-year-old patient with posttraumatic superficial femoral arteriovenous fistula was performed to cover a fistula. During the procedure the device migrated through the fistula into the femoral vein. Due to eventual risk of migration to the heart, a prompt decision was made to fix the stent graft with three puncture needles in the common femoral vein region under fluoroscopy guidance. The vascular surgeon was called to perform open surgery. CONCLUSIONS: The presented way of treating this rare complication in an extreme and uncommon situation is very efficient, safe and inexpensive.

Analysis of associated diseases in patients with acute critical lower limb ischemia.

INTRODUCTION: Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases. MATERIAL AND METHODS: This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment. RESULTS AND DISCUSSION: Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number ofarterial thrombosis demanded more complex "inflow" and "outflow" ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation. CONCLUSION: Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.

The analysis of the connection between plaque morphology of asymptomatic carotid stenosis and ischemic brain lesions.

BACKGROUND/AIM: A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke by modern imaging methods. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. METHODS: This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 tears. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. RESULTS: Out of 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). CONCLUSIONS: Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

[Out-of-hospital treatment in case of drowning].

INTRODUCTION: Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. FIRST AID: The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. BASIC LIFE SUPPORT: The first and most important treatment option of a drowning victim is the provision of ventilation which increases the chances of survival. As soon as the unresponsive victim is removed from the water, the lay rescuer should immediately begin chest compressions and provide cycles of ventilations and compressions. Some recent investigations have revealed that exterior compression of the chest is a necessary measure even in a situation when bystanders cannot provide airway. It is recommended to train bystanders to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early as possible. ADVANCED LIFE SUPPORT: In drowning, the victim with cardiac arrest requires advanced life support, including an early intubation. Extended medical measures, which are primarily provided by medical professionals, include cervical spine immobilization in case a spinal injury is suspected, or, establishment of the ventilation with oxygen, emergency transport, application of reanimation and advanced vital support measures.

Surgical treatment of big splenic artery aneurysm--case report.

An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at least 50% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time, with the incidence of its rupturing being 2-10% and then the mortality rate ranges from 20 to 36%. A 51-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure--computerized tomography of the abdomen with i.v. contrast subtraction angiography--confirmed the splenic artery aneurysm to have the diameter of 5 cm and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistological finding confirmed the atherosclerotic etiology of the aneurysm. Since the postoperative course was normal, the patient was discharged on the eighth postoperative day.

[Surgical treatment of a giant extracranial internal carotid artery aneurysm--a case report].

INTRODUCTION: True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment is considered to be the best therapeutic option. However, the use of the intraluminal shunt remains controversial. CASE REPORT: We reported a case of a giant extracranial internal carotid artery aneurysm treated by reconstructive surgery. A 76-year-old woman was referred with a pulsatile mass inside her mouth, associated with dizziness and dysarthria. There was no history of cerebrovascular symptoms, neck pain, or cervical trauma. A magnetic resonance scan showed a 45 mm aneurysm of the internal carotid artery (ICA), and kinking of ICA. Angiography demonstrated a saccular ICA aneurysm, with a lengthening and tortuosity of the ICA. The aneurysm and the carotid artery branches were easily exposed through a standard anterior cervical incision. After resection of the aneurysm, a Javid shunt was inserted between the common and internal carotid arteries, and end-to-end repair of ICA was easily performed due to ICA redundancy. The aneurysm was of atherosclerotic origin. Four months after the operation, the patient showed a complete recovery from peripheral neurological deficit. DISCUSSION: Our results show that surgical reconstruction is a satisfactory therapeutic choice in the management of extracranial carotid artery aneurysms in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. To date, there has been little experience with endoluminal exclusion techniques and the long-term effectiveness is still uncertain.

[Femoro-popliteal reconstructions: "in situ" versus "reversed" technique: comparative results].

INTRODUCTION: Infrainguinal arterial reconstruction is a procedure with two main types of autologous venous grafts: reversed-vein bypass grafting, and the in situ bypass grafting. Both techniques have advantages and disadvantages, and the aim of this study was to compare the results of each technique. MATERIAL AND METHODS: In the period from 1999 to 2003, 118 patients with infrainguinal arterial occlusive disease (IAOD) underwent reconstruction surgery at the Vascular and Transplantation Surgery Clinic in Novi Sad. 141 reconstruction procedures were performed using the autologous great saphenous vein. The patients were divided into two groups: group I included 72 patients with "in situ" bypass grafts and group II included 46 with 55 "reversed" bypass grafts. The postoperative function was evaluated by using a pocket-sized Doppler sonography, and by assessment of the postoperative increase in API in regard to preoperative values. RESULTS: Statistical analysis of the investigated groups of patients and X2 showed that there were no statistically significant differences in postoperative patency, complication rate and number of salvaged limbs. CONCLUSION: We can conclude that both investigated reconstruction techniques have advantages and minor disadvantages: they are applicable, safe and reliable and each has a specific range of indications.

[Results of autovenous femoro-distal bypass procedures in the type III peripheral obliterative arterial disease of the extremities in diabetic and nondiabetic patients].

INTRODUCTION: It has been established that infrainguinal occlusive disease, type III peripheral obliterative arterial disease (POAD), is more common in diabetics than in non-diabetics. It is presumeable that after surgical treatment of this arterial segment diabetics develop more complications and higher mortality rate than non-diabetics. The aim of this study was to analyze the results of reconstructive surgical treatment of diabetic and non-diabetic patients with type III PAOD. MATERIAL AND METHODS: In the period 1999-2003, 118 patients with Type III PAOD underwent surgery at the Vascular Surgery Clinic in Novi Sad. They were divided into two groups: group I included 51 nondiabetic patients, and group II 67 diabetic patients. Subgroups were formed based on the clinical status. Differencies were established in IVa, (46 diabetics and 4 non-diabetics) and IVb stage (11 diabetic and 30 non-diabetic patients). RESULTS: Statistical data analysis using X2 test showed a stastical difference in complications rates, number of salvaged limbs and finally, in the mortality rates between diabetic and non-diabetic patients. CONCLUSION: Diabetic patients presented with significantly more trophic lesions (IVa stage). The overall complication rate was significantly higher in diabetics, as well as the amputation rate. Finally, the mortality rate was also significantly higher in diabetics than in nondiabetic patients.

[Effects of intermittent negative pressure ventilation on impaired microcirculation in diabetes--a case report].

INTRODUCTION: Generally impaired microcirculation, with microvascular and neuropathic complications, is one of the most severe consequences of diabetes mellitus. Considering the fact that drug therapy ad physical training may have adverse effects, we decided to utilize the beneficial effects of hypobaric sac treatment on skin microcirculation (using Greensac-Iskra Medical, Slovenia). CASE REPORT: A female patient, 64 years of age, with a past medical history of diabetes mellitus type IIb (last 18 years) complained of intermittent claudication (the pain score after a 150 m walk was 7, on a scale from 1 to 10). The temperature at her left popliteal pit was 34.8 degrees C, and at the right pit 34.9 degrees C. The temperature at the left dorsal pedis artery was 34.4 degrees C and at the right 34.1 degrees C. We applied intermittent negative pressure ventilation on the lower limbs in order to improve the microcirculation (using Greensack by Iskra-Medical, Slovenia). A total of ten 20-minute treatments were delivered in a month time, three treatments a week. After treatment, the temperature at the left popliteal pit was 35.2 degrees C, and at the right pit 35.4 degrees C. The temperature at the left dorsal pedis artery was 34.7 degrees C and at the right 34.6 degrees C. The pain score after a 150 m walk lovered to 4. CONCLUSIONS: We concluded that the one-month treatment with Greensack (10 treatments in total) had beneficial effects on patient's microcirculation. These initial results are considered encouraging, but the number of examined parameters and the length of treatment should also be increased.