Extralevator abdominoperineal excision for low rectal cancer: oncological outcome after five-year follow-up.

BACKGROUND: Extralevator abdominoperineal excision (ELAPE) is a surgical technique that is indicated for low rectal cancer where sphincter preservation is not possible. Compared to conventional abdominoperineal excision major advantages of ELAPE are the risk reduction of intraoperative bowel perforation and positive circumferential margin which lead to a better oncological outcome. The aim of this study was to present our results in ELAPE surgery. METHODS: From February 2011 to February 2015, 40 patients underwent surgery for low rectal cancer at the Oncology Institute of Vojvodina. The collected data included sex, age, preoperative staging, neoadjuvant treatment, operative time, rate of intraoperative bowel perforation, rate of positive circumferential resection margins, histopathological analysis, postoperative mortality, tumour, node and metastasis (TNM) classification, local recurrence (LR) rate and presence of distant metastases. RESULTS: Positive circumferential margin was found in three (7.5%) patients while eight (20%) patients had intraoperative bowel perforation. LR during follow-up was seen in seven (17.5%) patients, three of them had intraoperative bowel perforation and two patients had positive circumferential margin. The estimated five-year cumulative incidence of LR is 7%. Distant metastases occurred in 18 (45%) patients. The estimated five-year survival rate is 62%.. CONCLUSION: The study shows satisfactory five-year survival rates of 62% in a highly complex patient group treated by ELAPE procedure.

The impact of the chromium supplementation on insulin signalling pathway in different tissues and milk yield in dairy cows.

Thirty days before expected time of parturition, 20 Holstein cows were divided into -Cr and +Cr groups. From day 25 before parturition (BP) up to day 30 after parturition (AP), +Cr cows received 10 mg of Cr (chromium-enriched yeast) daily. Muscle and adipose tissue samples were taken at days -30, -10, +7 and +10 related to parturition, when body condition score (BCS) was also determined. Hepatic tissue samples were taken at days -10 and +7. Tissue samples were used for determination of the insulin signalling pathway protein expressions. Intravenous glucose tolerance test (IVGTT) was performed at days -28, -7, +10 and +30. Milk yield was recorded during first 14 weeks AP. Milk composition was obtained at days 7 and 28 AP. At day 10 BP, protein content of ß-subunit of insulin receptor (IRß) was significantly higher (p Ë‚ 0.05) in muscle, and phosphorylation of insulin receptor substrate 1 at serine 307 (pIRS-1 Ser307 ) was significantly lower (p Ë‚ 0.05) in hepatic tissue of +Cr group. After parturition, pIRS-1 Ser307 was significantly lower in muscle tissue at days 7 and 28 (p Ë‚ 0.05 and p Ë‚ 0.001, respectively), while phosphorylation of Akt at serine 473 (pAkt Ser473 ) was significantly higher (p Ë‚ 0.01) in hepatic tissue at day 7 AP in +Cr group. Chromium had opposite effect on insulin kinetics during IVGTTs obtained BP and AP. Insulin secretion was significantly reduced at day 7 BP and significantly enhanced at day 10 AP, when NEFA concentration was also significantly increased. Milk yield and ECM value were depressed in +Cr group. DMI and BCS were significantly enhanced in +Cr group at day 7 BP. In conclusion, chromium modulates insulin signalling pathway in dairy cows, but targeted signalling molecules are different in antepartal then post-partal period, probably due to duration of exposure to chromium and different energy status between those periods.

Treatment of Periodontal Disease with an Octenidine-based Antiseptic in HIV-positive Patients.

OBJECTIVE: To evaluate the effects of a periodontal therapy with subsequent application of an octenidine (OCT)-based antiseptic in HIV-positive patients receiving highly active antiretroviral therapy. METHODS: HIV-positive patients with a clinically diagnosed periodontal disease were randomly divided into two groups (n = 30/group). Both groups initially received a periodontal therapy. Patients in the OCT group additionally used an OCT-based mouthwash. Subgingival plaque samples and periodontal indices were analysed prior to treatment onset as well as one and 3 months post-treatment. RESULTS: Periodontal therapy has resulted in a significant decrease in the values of all periodontal indices one and 3 months following the therapy completion (P = 0.000). The effects of the two applied therapeutic protocols differed significantly in terms of the variation in the PBI (F = 4.617; P = 0.017) and the PD (F = 3.203; P = 0.044) value. In the patients in the OCT group, a more pronounced decrease in the PBI and PD was noted at 1-month follow-up as well as a greater increase in the PD value 3 months upon treatment completion. In the OCT group, no more atypical microorganisms were detectable 1 month post-treatment, while in the control group they were found in 34.5% of patients. CONCLUSIONS: The periodontal therapy bears good results in HIV-positive patients. Additional administration of OCT contributes to the significant decline in the PBI and DS values and eliminates atypical microorganisms within 1 month post-treatment. However, more favourable results were not noted in the OCT group at the 3-month assessment.

Patient-physician relationship in the aftermath of war.

During the period of conflict that led to the dissolution of the former Yugoslavia, the Serbian healthcare system suffered greatly; as a result, relationships between physicians and their patients reached an all-time low. After cessation of the various wars, a group of medical students attempted to assess the state of the patient-physician relationship in Serbia. Their study showed a relationship characterised by very meek patients and rather arrogant physicians. Empowered by their engagement, the medical students constructed a set of standards for achieving a proper patient-physician relationship; physicians should be capable of hearing and understanding patients, with the result that the ensuing empowerment can enable patients and physicians to create a tool for changing the relationship between both parties.

[Guided tissue regeneration--the beginning of a new era in periodontal surgery]. / Vodena tkivna regeneracija--pocetak nove ere u parodontalnoj hirurgiji.

UNLABELLED: The therapy of deep infrabony defects in periodontal diseases has been a great problem for decades both for dentists and their patients, as well. After application of classic therapy in patients with serious stages of periodontal diseases (subgingival curettage, Modified Widmann flap surgery with and without implantation of implants) a significant strengthening of teeth in alveolus was observed, as well as alleviation of patient's discomfort, and decrease of the depth of periodontal pockets, bleeding, inflammation, etc. However, in spite of the application of this therapy a postoperative defect was sometimes filled with different low tissues of periodontium, in other words periodont reparation took place. For this reason, recidives could happen, as well as gingival recession, inflammation, root resorption. At the beginning of the nineties a new principal was introduced in the therapy of periodontal diseases: Guided Tissue Regeneration. This principal includes a controlled action between four different species of periodontal tissue: gingival epithelium, gingival connective tissue, alveolar bone, and periodontal ligament. This is achieved by surgical placement of non resorbale or bioresorbable periodontal membranes, which are placed during flap surgery above the previously treated infrabony defect. With membranes placed in that way the periodontal defect is for some time phisically separated from epithelium and gingival connective tissue and in that way alveolar bone is regenerated, as well as periodontal ligament in other words restitutio ad integram takes place. Nowadays, two concepts of guided tissue regeneration can be considered: a concept of isolation and a concept of integration. The first concept includes application of non resorbable, most frequently synthetic, membranes (so-called E-PTFE polyterafluorethylene) which replace the mucoperiosteal flap into its original position. After six weeks a patient is subjected to one more surgical intervention when flap is raised again and the non resorbable membrane is removed. The second operation diminishes the value and partially discredits the application of non resorbable membranes. For this reason, the concept of integration is today more frequently applied, that is to say the application of bioresorbable membranes is nowadays very frequent. They are by their chemical composition poly D,L lactides and they provide membranes with ideal resorption properties. Of great importance is their property to stay unchanged for six weeks, and then to be resorbed by geometrical progression. As the membrane is resorbed, it is not necessary to remove it, so there is no need for another surgery, and that enables the process of healing to proceed undisturbedly. For this reason, the concept of integration is also called a Single Step Method. CONCLUSION: On the basis of papers of the leading scientists from the field of guided tissue regeneration it can be concluded that by application of Single Step Method or in other words by application of bioresorbable membranes a tremendous progress was made in the therapy of infrabony periodontal defects. The application of these membranes is especially indicated in treating degree II furcation defects, then infrabony defects particularly with 2 and 3 walls and good results were also achieved in the therapy of a big problem in esthetic periodontology--gingival recession. A relatively low price, as well as simple application, biological compatibility and undisturbed process of healing of the wound are great advantages of the application of bioresorbable membranes, so in the near future their application on a large scale can be expected in the therapy of periodontal diseases, as well as further research work on their development, especially on their impregnation by growth factors, antibiotics, etc.

The use of intragastric nutrition to study saliva secretion and the relationship between rumen osmotic pressure and water transport.

Four sheep sustained by intragastric nutrition were used to study saliva secretion and the relationship between osmotic pressure in the rumen and net water transport across the rumen wall. Different concentrations of buffer were infused into the rumen to change the rumen osmotic pressure. Salivary secretion was estimated from entrance of P into the rumen. Net water transport across the rumen wall was calculated as the difference between water inflow and water outflow from the rumen. A negative linear relationship between the rumen osmotic pressure (X, mOsm/kg) and the water absorption across the rumen wall (Y, ml/h) was found: Y = (394 SE 8.3)-(1.22 SE 0.03) X, r2 0.83, (P < 0.001), and a positive linear relationship was found between the rumen osmotic pressure (X, mOsm/kg) and the outflow rate of rumen fluid (Y, ml/h): Y = (34.0 SE 8.0) + (0.97 SE 0.03) X, r2 0.56, (P < 0.001). The implication is that rumen osmotic pressure can be a key factor in the control of the net water transport across the rumen wall, the outflow of rumen fluid to omasum and the rumen liquid dilution rate. A method is suggested by which salivary secretion in sheep may be calculated from the water balance in the rumen.

Indirect measurement of saliva secretion in sheep fed diets of different structures and the effect of such diets on ruminal fluid kinetics and fermentation pattern.

Four Suffolk x Dorset sheep were allocated in a 4 x 4 Latin square design and received a hay-barley-molasses diet in one of four different physical structures: (1) pelleted; (2) pelleted:chopped (60:40); (3) chopped:pelleted (60:40); or (4) chopped. The animals were penned individually and the diet was restricted to provide 20 g of dry matter (DM) per kilogram live weight daily. The effects of the diets on rumen fluid kinetics, fermentation pattern and microbial nitrogen (MN) supply were examined. Saliva secretion was estimated using an indirect method based on water balance in the rumen. When the animals were fed the chopped diet, the salivation rate, rumen fluid volume and rumen liquid outflow were all increased significantly (P < 0.05 to P < 0.01). No consistent effect of dietary structure on rumen fluid dilution rate, purine derivative (PD) excretion or MN supply was observed. Dietary structure had no effect on the rumen fermentation pattern, digestibility of DM or nitrogen.

[Pulmonary adiaspiromycosis]. / Adiaspiromikoza pluca.

A 54-yr old male patient with a history of dyspnea and cough is presented. Due to the clinical course of disease and the radiological changes in the chest a diagnosis of sarcoidosis was established. However, the open lung biopsy revealed the true nature of the pulmonary disease: pulmonary adiaspiromycosis, only secondary to asbestosis, siderosis and silicosis as due to the well known occupational exposure to asbestos and other dusts.

[Rare complications in primary echinococcosis]. / Rijetke komplikacije primarnog ehinokoka.

We presented two cases of complication of the echinococe cyste various localizations which are very rare. We had not managed to get the real alignosis before the operation. Only on the operating table we found cut that, at the first case, echinococe cyste ruptured on the lateral upper right part of the peritoneum, in the projection of the right livu lobus. In the second case we found out the rupture of echinococ cyste on the lower right part of liver lobus because of the pressure of distended hepatal ways and vesicae fellae. This work is of great importance because of rearness of the first localization of echinococ cyste, and specially of the rupture of the cyste, while in the second case the importance is in the rare rupture of echinococ cyste in hepatal ways which could conduct to sanation, but it caused, the opstruction of papillae. Vateri and progrediant icterus.

[A new cerclage procedure]. / Jedan nov nacin serklaze cerviksa.

The author describes a modified cerclage procedure using the right Deschamps and Mersilene band without any incisions of the mucous membrane in the uterine portion. The advantages of the operation lie in that it could be applied even in the third trimester because it takes a very short time and produces no bleeding. All 50 women operated on in this way gave birth to normal babies, except for two stillborns.