Mortality trend of cutaneous melanoma in Montenegro from 1990-2018.

OBJECTIVE: Every year, melanoma claims over 20,000 lives in Europe. In Montenegro, as in Europe, numerous campaigns have been initiated to raise public awareness about the importance of melanoma prevention and its early detection. Thus, accompanying current diagnostic and therapeutic protocols, new methods of melanoma diagnosis and treatment have been implemented. Studying the trend enables the identification of the groups most burdened by mortality and assesses whether there has been a change in trends based on interventions aiming to reduce mortality. The objective of this study is to evaluate the mortality trend from cutaneous melanoma in Montenegro for the period 1990-2018. MATERIALS AND METHODS: We have utilized national data on the causes of death from melanoma, code 179 from the ninth and C43 from the tenth revision of the International Classification of Diseases, categorized by gender and age groups. The study utilized various regression techniques, including Joinpoint regression in the Joinpoint Program, Poisson regression, and linear regression in the SPSS 26th Program, to describe the trend. RESULTS: In Montenegro, during the period from 1990 to 2018, a total of 281 individuals died (51.6% male and 48.4% female). This ranks as the 13th leading cancer in terms of mortality among all cancers. The average age-standardized rate was 1.1 deaths per 100,000 (1.2 for males and 1.0 for females).  The number of death cases has been increasing on average by 3.3% annually [average annual percentage change (AAPC) (95% CI) = 3.3 (1.7-4.9); p<0.001] on an overall level and by 5.4% annually among males [AAPC (95% CI) = 5.4 (3.6-7.3); p<0.001] due to the rises in the age groups 55-64 years and 65-74 years with an average annual percent change of respectively 3.2% [AAPC (95% CI) = 3.2 (0.8-5.8); p=0.012] and 5.4% [AAPC (95% CI) = 5.4 (2.7-8.1); p<0.001] overall level, and 4.8% [AAPC (95% CI) = 4.8 (2.4-7.3); p<0.001] and 7.5% [AAPC (95% CI) = 7.5 (4.9-10.2); p<0.001] among males. For females, an increase of 1.1% was recorded, which was not statistically significant [AAPC (95% CI) = 1.1 (-0.8-3.0); p=0.255]. Furthermore, there was a noted increase in the rates at an overall level [ß (95% CI) = 0.027 (0.008-0.046); p=0.007] and in the age group 65-74 years [ß (95% CI) = 0.249 (0.090-0.407); p=0.003], as well as among males at an overall level [ß (95% CI) = 0.052 (0.025-0.079); p<0.001] and for age groups 45-54 years [ß (95% CI) = 0.102 (0.011-0.193); p=0.030] and 65-74 [ß (95% CI) = 0.410 (0.144-0.676); p=0.004]. In contrast, the rates for females remained constant. The three age groups most burdened by melanoma skin cancer mortality are 65-74 years (23.5%), 55-64 years (21.7%) and 75-84 years  (19.2%). CONCLUSIONS: The results of regression analyses indicate a significant rise in both the number of death cases and mortality rates overall, specifically among males in Montenegro. In females, however, the increase in the number of death cases and rates is not statistically significant. Preventive campaign activities should be redirected towards the most vulnerable groups in terms of mortality, namely males and the elderly population.

Comparison of formulation characteristics of drugs and dietary supplements containing alpha-lipoic acid relevant to therapeutic efficacy.

OBJECTIVE: Healthcare professionals lack the knowledge about the impact of formulations on treatment effectiveness. This is further complicated by the existence of dietary supplements containing the same active pharmaceutical ingredients (API) as drug formulations [e.g., alpha-lipoic acid (ALA)], to which the strict formulation testing requirements do not apply. This research aimed to compare ALA-containing drugs and dietary supplements through the determination of uniformity of content, disintegration time and dissolution rates. MATERIALS AND METHODS: A total of seven different ALA formulations (5 dietary supplements, 2 drugs) were tested for uniformity of content, disintegration time and dissolution rates. All tests were performed in accordance with the 10th European Pharmacopoeia. ALA was determined spectrophotometrically. RESULTS: Uniformity of content testing revealed larger variations of ALA content in three formulations of dietary supplements. Dissolution curves generated at 50 and 100 rpm differed significantly. Testing requirements were met only by one dietary supplement at 50 rpm, and one drug and two dietary supplements at 100 rpm. Disintegration testing showed limited impact on the release kinetic of ALA, as opposed to formulation type. CONCLUSIONS: Considering the lack of regulation on dietary supplement formulations and the variable success of them conforming to pharmacopoeial requirements, it is an imperative for stricter regulations on the dietary supplements' formulations to be imposed globally.

Trend of breast cancer mortality in Montenegro, 1990-2018 - Joinpoint regression.

OBJECTIVE: In this study, we analyzed breast cancer mortality data overall and by age groups in women in Montenegro, to determine if there were any changes in trend for period 1990-2018. MATERIALS AND METHODS: The study gathered data on breast cancer mortality in Montenegro obtained from Vital Registration System. Annual data on breast cancer mortality were extracted for period 1990-2018 and analyzed using World Standard Population age-standardized and age-specific rates and Joinpoint regression. RESULTS: In 2018 in Montenegro, breast cancer accounted for 4.64% of all deaths in women and for 19.78% of all cancer deaths in women. In terms of total cancer mortality, it ranked first among women. Age-standardized rates ranged from 11.41/100,000 in 1990 to 20.46/100,000 in 2016. Joinpoint regression showed no one joinpoint for the entire population of all women and age groups. In the observed period, breast cancer mortality rates significantly increased in the women in Montenegro [average annual percentage change (AAPC) = 1.44%; 95% confidence interval (CI): 0.9-2.0]. The most affected age group was 55-64 years. CONCLUSIONS: There is a growing breast cancer mortality trend in Montenegro. It is necessary to create specific programs for urgent action, in order to reduce this undesirable trend. At the same time, support from the competent institutions is needed for increasing screening coverage and better prevention of breast cancer in the target population.

Inflammatory bowel disease and depressive symptoms: the prevalence and factors associated with depression in patients with inflammatory bowel disease on intravenous biological therapy - single center experience.

OBJECTIVE: Depression is one of the most commonly occurring psychiatric comorbidities in patients suffering from inflammatory bowel disease (IBD). This study aims to determine prevalence and risk factors for the more severe symptoms of depression (DP) in IBD patients on intravenous biological therapy (IBT). PATIENTS AND METHODS: The study consisted of 90 IBD patients who completed a Patient Health Questionnaire-9 (PHQ9) to detect symptoms of depression. Demographic information and disease characteristics were collected as well as medication information for these patients. Univariate and multivariate ordinal logistic regression was done to identify risk factors for the DP. RESULTS: Anti-TNF therapy comprised 58.9% of patients and anti-integrin 41.1%. The prevalence of DP (PHQ9score ≥10) among these patients is 20%. For the univariate logistic regression DP was statistically significantly associated with disease activity (OR 6.656; 95% Cl 2.576-17.19, p<0.001), use of corticosteroids (OR 4.224; 95% Cl 1.658-10.76, p = 0.003) and thiopurine (OR 2.502 95% Cl 1.031-6.069, p = 0.042), as well as relationship status (single, in relationship or married) (OR 0.391; 95% Cl 0.173-0.885, p = 0.024). The multivariate analysis indicated that the risk of developing DP was associated with disease activity (OR 5.708; 95% Cl 2.138-15.23, p = 0.001). CONCLUSIONS: Our study shows that most of severe symptoms of depression were present in 20% of the IBD patients examined who were receiving intravenous biological therapy. Particular attention and efforts should, therefore, be focused on patients who have an active form of the disease.

Hyperostosis frontalis interna and frontal bone thickness among various age groups - differences between males and females.

Hyperostosis frontalis interna (HFI) represents an abnormality of the frontal cranial bone that is characterized by bilateral, nodular thickening of its inner lamina and may sometimes be associated with neuropsychiatric symptoms such as headaches and depression. The aim was to assess prevalence, sex and age differences of HFI and frontal bone thickness by means of MRI. This retrospective study included 908 subjects who were divided into male and female groups and further subdivided into three groups, youngest (≤45 years), middle-aged (46- 65 years) and the oldest group (65 years). The thickness of the frontal bone was measured on the T2-weighted axial images at the top level of the lateral ventricles as a mean from both sides. We considered 10mm or thicker frontal bone as HFI. The total prevalence of HFI was 8.1%, with a more frequent occurrence in women (p0.05). In males, there was no difference in the frontal bone thickness between different age groups (p0.05), while in females we found differences between the youngest and the oldest group, and also between the middle-aged and the oldest group (p0.05). The female respondents had a thicker frontal bone, which was statistically significant only in the oldest group (p0.001). Frontal bone thickness was age-dependent only in women (Spearman's Rho 0.11; p≤0.01). In women, unlike in men, there is an age-related progression of HFI with increasing prevalence, with 16.4% occurrence in the oldest group.

Perineural invasion on biopsy specimen as predictor of tumor progression in aging male treated with radical prostatectomy. Could we use it for pre-surgical screening?

We aimed to analyze the correlation of perineural invasion on transrectal ultrasound guided prostate biopsy with predictors of biochemical cancer recurrence, as well as its impact on clinical outcomes, for non-metastatic prostate cancer. For the study, patients with perineural invasion (N = 86) were recruited into group I and underwent open retropubic prostatectomy, regardless of clinical stage; cases with prostate cancer but without perineural invasion on biopsy, who received radical prostatectomy as the treatment modality, were placed into group II (n = 90). Perineural invasion was detected preoperatively in 43% of cases that revealed surgical margin positivity postoperatively, while 85% of the remaining cases (group II) had negative surgical margins. There was no correlation on prostate biopsy between perineural invasion and Gleason score or PSA, based on Sperman's rank-order correlation analysis. However, there was strong positive correlation of perineural invasion with clinical stage and patients age. Additionaly, we demonstrated that perineural invasion on biopsy is a non-independent risk factor for metastatic occurrence, although the correlation was significant in univariate analysis. Nevertheless, we found strong correlation between invasion on initial biopsy specimen with biochemical cancer recurrence, suggesting that perineural invasion on prostate biopsy is a significant predictor of worse prognostic outcome.

UGT1A1 (TA)n Promoter Genotype: Diagnostic and Population Pharmacogenetic Marker in Serbia.

The UGT1A1 enzyme is involved in the metabolism of bilirubin and numerous medications. Unconjugated hyperbilirubinemia, commonly presented as Gilbert syndrome (GS), is a result of decreased activity of the UGT1A1 enzyme, variable number of TA repeats in the promoter of the UGT1A1 gene affects enzyme activity. Seven and eight TA repeats cause a decrease of UGT1A1 activity and risk GS alleles, while six TA repeats contribute to normal UGT1A1 activity and non-risk GS allele. Also, the UGT1A1 (TA)n promoter genotype is recognized as a clinically relevant pharmacogenetic marker. The aim of this study was to assess diagnostic value of UGT1A1 (TA)n promoter genotyping in pediatric GS patients. Correlation of the UGT1A1 (TA)n genotypes and level of unconjugated bilirubin at diagnosis and after hypocaloric and phenobarbitone tests in these patients was analyzed. Another aim of the study was to assess pharmacogenetic potential of UGT1A1 (TA)n variants in Serbia. Fifty-one pediatric GS patients and 100 healthy individuals were genotyped using different methodologies, polymerase chain reaction (PCR) followed by acrylamide electrophoresis, fragment length analysis and/or DNA sequencing. Concordance of the UGT1A1 (TA)n promoter risk GS genotypes with GS was found in 80.0% of patients. Therefore, UGT1A1 (TA)n promoter genotyping is not a reliable genetic test for GS, but it is useful for differential diagnosis of diseases associated with hyperbilirubinemia. Level of bilirubin in pediatric GS patients at diagnosis was UGT1A1 (TA)n promoter genotype-dependent. We found that the frequency of pharmacogenetic relevant UGT1A1 (TA)n promoter genotypes was 63.0%, pointing out that UGT1A1 (TA)n promoter genotyping could be recommended for preemptive pharmacogenetic testing in Serbia.

The correlation of SYNTAX score by coronary angiography with breast arterial calcification by digital mammography.

AIM: To evaluate the hypothesis that breast arterial calcification (BAC) may predict coronary artery disease (CAD) severity. MATERIALS AND METHODS: The study comprised 102 women >45 years (mean age 62±8 years) referred for digital mammography after coronary angiography. BAC was assessed using the Likert scale and CAD severity was assessed using the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial) score. RESULTS: In comparison to the low SYNTAX score group (≤22) patients with a intermediate-to-high SYNTAX score (>22) were older (p=0.001), they more often had hypercholesterolaemia (p<0.001), diabetes (p=0.021), and a history of smoking (p=0.048). They also had a statistically higher level of fasting blood glucose (p<0.001), glycated haemoglobin (HbA1C; p<0.001), triglycerides (p=0.002), fibrinogen (p=0.001), whereas high-density lipoprotein (HDLc) was lower than in the group with a SYNTAX score ≤22 (p=0.005). BAC was significantly higher in patients with a SYNTAX score >22 (p<0.001). At multivariate analysis, BAC (odds ratio [OR] 34.24, 95% confidence interval [CI]: 8.05-145.7, p<0.001), hypercholesterolaemia (OR 22.65, 95% CI: 4.18-122.81, p<0.001) and fibrinogen (OR 2.55, 95% CI: 1.28-5.07, p=0.008) were independent predictive factors for patients with intermediate-to-high SYNTAX score. CONCLUSIONS: In women >45 years, there was a significant correlation between the severity of CAD as evaluated by the SYNTAX score and BAC as evaluated by the Likert scale. BAC, hypercholesterolaemia, and fibrinogen may be used as an additional diagnostic tool to predict the presence and severity of CAD.

Kidney injury secondary to endovascular treatment of renal artery stenosis. / Povrezhdenie pochki posle éndovaskuliarnogo vmeshatel'stva pri stenoze pochechnoi arterii.

In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.

Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS).

The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

A correlation between selenium and carnitine levels with hypo-osmotic swelling test for sperm membrane in low-grade varicocele patients.

OBJECTIVE: The hypo-osmotic swelling (HOS) test predicts membrane integrity by determining the ability of the sperm membrane to maintain equilibrium between the sperm cell and its environment. The aim of our study was to determine the correlation between selenium and carnitine levels in the seminal fluid with HOS test for sperm membrane in low-grade varicocele patients. PATIENTS AND METHODS: Study numbered 64 examinees who suffered from low-grade varicocele and were divided into two groups, according to fertility potential and HOS test outcome. The study also included a control group of 64 healthy subjects, with no varicocele. RESULTS: From the Shapiro-Wilk's test, it is clear that carnitine distribution differs significantly from normal (0.938, p = 0.03). In distribution of selenium, Kolmogorov-Smirnov test clearly shows statistically significant deviation from the normal curve (z = 0.225, p < 0.000), likewise Shapiro-Wilk's statistic (0.787, p < 0.000). According to the results, the second group had significantly higher levels of carnitine and selenium than the first group of examinees (p < 0.05); therefore, when we compared epididymal markers with HOS tests outcomes, we found significant differences between the two groups. There were no significant differences between second group and healthy subjects (p > 0.05). CONCLUSIONS: HOS test outcome in varicocele patients is directly proportional to the carnitine and selenium levels, which could play a major role in both determining fertility parameters and in the treatment of its impairment. This result is important for sub-clinical varicocele in infertile patients with normal semen analysis, since there is no evidence of benefit from any treatment so far.

Advantages of microsurgical varicocelectomy over conventional techniques.

OBJECTIVE: Varicocelectomy is the only effective method of treating varicocele. Nowdays, many techniques for varicocelectomy include retroperitoneal, inguinal, and subinguinal varicocele repairs with or without magnification and laparoscopic repair. The advantages of the microsurgical approach to varicocele repairs are reliable identification and preservation of the vascular structures. Thus, our aim is to compare the efficiency of microsurgery over conventional techniques of varicocele repairs. PATIENTS AND METHODS: We have evaluated 105 man divided into three groups of 35 patients surgically treated with open varicocelectomy in the first group, microsurgical varicocelectomy in the second, and laparoscopic varicocelectomy in the third group. Sperm test improvement and complications were then compared. RESULTS: The testicular volume shows a significant increase after all three types of surgery, the highest one being after the laparascopic varicocelectomy (14.47 ± 6.76 vs. 21.8 ± 7.52), whereas the lowest increase was recorded in open varicocelectomy (14.90 ± 6.26 vs. 17.46 ± 5.89). Regarding motility of spermatozoids, the highest postoperative increase of values is after microsurgical varicocelectomy (4.30 ± 2.19 vs. 15.88 ± 3.13). CONCLUSIONS: Our study shows the lowest degree of postoperative complications among patients treated with microsurgical varicocelectomy, and the most frequent complications in those treated by open varicocelectomy. Sperm test outcomes after microsurgical varicocelectomy was better than those after other conventional techniques: significantly higher improvement of sperm quality, shoter postsurgical clinical treatment, and the lowest rate of postsurgical complications.

Effect of obesity on patient-reported outcomes in sarcoidosis.

OBJECTIVES: To assess the impact of high body mass index (BMI) on patient-reported outcomes in sarcoidosis patients and healthy persons. METHODS: In this case-control study, we investigated symptoms of fatigue and dyspnoea, health status, BMI and spirometric tests in 184 sarcoidosis patients and the same number of sex- and age-matched healthy subjects. Fatigue was assessed using the fatigue scale (FS), dyspnoea was determined by the baseline dyspnoea index (BDI) and health status was measured using the respiratory-specific St George's Respiratory Questionnaire (SGRQ). RESULTS: There were significantly more subjects with increased BMI (≥25 kg/m(2)) among the sarcoidosis patients than among the healthy volunteers ((2) 37.675, P < 0.01). Sarcoidosis patients also had a greater probability of having a higher BMI (P < 0.01, OR 1.18, 95%CI 1.071.3). We found significantly lower BDI scores and forced expiratory volume in 1 s/forced vital capacity, as well as higher total SGRQ and total FS scores in sarcoidosis patients than in healthy individuals (P < 0.01 for all differences). CONCLUSION: Sarcoidosis significantly reduces patients' health status, both independently and also due to increased BMI. Reduction in BMI may contribute to improved spirometry results and health status of patients with sarcoidosis.

Semen analysis before and after antibiotic treatment of asymptomatic Chlamydia- and Ureaplasma-related pyospermia.

Pyospermia is the abnormally high concentration of white blood cells in human ejaculate, as caused by a bacterial infection. This study addresses the evaluation of the use of an antibiotic treatment in infertile patients who show asymptomatic pyospermia through the monitoring of semen analysis parameters. The study was carried out on 60 infertile patients who were diagnosed with asymptomatic genital infections, focused on pyospermia caused by Chlamydia trachomatis and Ureaplasma urealyticum. The volume of the ejaculate, pH, sperm concentration and progressive motility, as well as the viability of the spermatozoa and their morphology, were all observed before therapy, 10 and 30 days after. Patients were treated with antibiotics in accordance with the recommendations given by the European Urology Association. The results showed a clear effect of antibiotic therapy on the volume and pH of the seminal fluid; moreover, only 30 days after completion of the therapy sperm concentration itself significantly increased, and progressive motility greatly improved, albeit slowly. However, it must be noted that the antibiotic therapy had no significant effect on the viability of the spermatozoa within 30 days of beginning the treatment.

Validation of a patient satisfaction questionnaire in primary health care.

BACKGROUND: Improvement in patient satisfaction with healthcare services can be evaluated by satisfaction questionnaires of high construct validity. OBJECTIVES: To establish the dimensions and construct validity of a 20-item patient satisfaction questionnaire to assess satisfaction with general practice services. SUBJECTS: In total, 1314 adult patients of both genders, who were users of healthcare services at the General Medicine Department of Health Centre Valjevo in Serbia for two consecutive years, were included in the study. METHODS: Multidimensional scaling (MDS) was employed to identify similarities and dissimilarities among items comprising the satisfaction questionnaire. Patient satisfaction dimensions were estimated by principal component analysis for categorical data (CATAPCA). RESULTS: The MDS model configuration derived two dimensions: (1) patient satisfaction with the timeliness of healthcare service provision; and (2) patient centredness related to doctors' and nurses' commitment towards their health. In the CATAPCA model, two dimensions of patient satisfaction were found: the first dimension patient satisfaction with medical staff and the second dimension was indicative of contextual patient dissatisfaction. CONCLUSIONS: This study shows that the applied patient satisfaction questionnaire has high validity and reliability. It also has high sensitivity for longitudinal measurements, as well as good discriminatory power in measuring the different levels of patient satisfaction.

Malignant peritoneal mesothelioma: a case report.

In this paper we report a case of malignant peritoneal mesothelioma, a rare abdominal tumour. A 72-year-old male with a medical history of heart disease presented to our Clinic because of pain in the right half of the abdomen. Diagnostic procedures, including clinical and laboratory examination, X-ray, ultrasonography and computed tomography, revealed a tumour in the right lower quadrant of the abdomen. The approximate size of the tumour size at initial detection was 7 cm. During the pre-operative procedure an evident growth of the tumour was noticed, indicating exploratory laparotomy. Intra-operative findings revealed a large tumour of the anterolateral abdominal wall, involving the greater omentum. Tumour resection was performed, as well as resection of the portion of the anterolateral abdominal wall and omentectomy. Postoperative immunohistochemical analysis revealed malignant peritoneal mesothelioma.

Buccal mucosa grafts for repair of stenotic catheterizable continent stoma.

PURPOSE: Different tubular structures have been used to create cutaneous catheterizable continent urinary stomas. The most common complication is stomal stenosis on the cutaneous end of the tubes. We present a variant of stomal stenosis repair that uses a buccal mucosa graft. MATERIALS AND METHODS: Between January 2000 and March 2006 stenotic stomal repair was performed in 10 patients between 3 and 17 years old (mean age 6). A Mitrofanoff channel was created from a bladder tube in 4 patients, from appendix in 3, from ileum in 2 and from the ureter in 1. The procedure involved the removal of scar tissue and the creation of well vascularized dermal beds by skin de-epithelialization (epidermis removal). After that we formed 2 elliptical dermal flaps. Two elliptical buccal mucosa grafts were quilted to the recipient bed (the dermal flap) and anastomosed with the mucosa of the normal part of the channel. The flaps were joined, tubularized and sutured to the skin. An indwelling catheter was left in the channel for 2 weeks. Postoperatively the buccal mucosa was wetted with saline solution for 4 consecutive days. RESULTS: Followup was between 12 and 39 months (mean 22). There was no partial or total graft necrosis. None of the patients experienced repeat stenosis. The stoma was visible (uncovered) and the esthetic appearance was satisfactory in all patients. CONCLUSIONS: Repair of Mitrofanoff stomal stenosis using a buccal mucosa graft is a minor procedure. It is a good salvage procedure that excludes the need to create a new channel.

[Alternative arterial cannulation site in acute aortic dissections].

INTRODUCTION: Acute aortic dissection is an urgent surgical disease. Often, due to hemodynamic instability, that is an indication for emergent surgical intervention. Majority of surgeons uses Femoral or Axillary artery as arterial inflow site forextracorporal circulation. Both approaches have disadvantages that potentially may cause devastating complications. Some of them have been described in literature such as inadequate flow on heart-lung machine, retrograde dissection and malperfusion syndrome. AIM OF STUDY: Aim of study is to show, that by using transventricular cannulation we are eliminating all technical problems and lowering peroperative morbidity and mortality. METHOD: Between 1996-2006 at Institute for Cardiovascular Disease "Dedinje" 107 patients were operated for acute ascending aortic dissection Femoral artery was used for arterial cannulation in 91 patients. Last 16 patients were operated by using transventricular approach to establish extracorporeal circulation. We used retrograde cerebral perfusion in 21 cases at the beginning of our experience. RESULTS: In group of patients where transapical cannulation was used, no neurological incidents were noticed. We didn't have any other problems related to extracorporeal circulation or placement of arterial cannula. Is this series we had only one death case. Patient passed away on eight postoperative day due to multiorgan insufficiency. CONCLUSION: Transapical cannulation is very simple and safe method for quick establishment of extracorporeal circulation. It always gives patient sufficient antegrade, physiological flow on heart-lung machine. This is the way to minimize possibility of malperfusion syndrome and to significantly diminish risk of neurological complication. By using this method all negative effects of other cannulation sites will be avoided.

Success of acupuncture and acupressure of the Pc 6 acupoint in the treatment of hyperemesis gravidarum.

OBJECTIVE: The aim of this study was to evaluate the antiemetic effect of acupuncture (AP) and acupressure (APr) of the Pc 6 acupoint in pregnant women with hyperemesis gravidarum (HG). METHODS: A prospective, placebo-controlled trial included 36 pregnant women with HG. Two methods of acupuncture were used: bilateral manual AP of the Pc 6 (Neiguan) acupoint (group 1, n = 10) and bilateral APr of the Pc 6 acupoint (group 2, n = 11); furthermore, superficial intracutaneous placebo AP (group 3, n = 8) and placebo APr (group 4, n = 7) was carried out. RESULTS: Anxiodepressive symptoms occurred in 9 pregnant women with HG from group 1, 8 women from group 2, 7 women from group 3, and 5 women from group 4 (p < 0.001). The average gestation age at the occurrence of HG symptoms and the beginning of treatment was 7 weeks in group 1 and 8 weeks in groups 2, 3, and 4. Four women from group 1 and 7 women from groups 2, 3, an 4 needed intravenous compensation of liquid and electrolytes. The antiemetic metoclopramide was given intravenously to 1 woman from group 1, 2 women from group 2, 6 women from group 3, and 4 women from group 4. Promethazine was given to 1 woman from group 2, 1 woman from group 3, and to 3 women from group 4. The efficiency of the HG treatment with AP of the point Pc 6 was 90%, with APr of the Pc 6 63.6%, with placebo AP 12.5%, and with placebo APr 0%. CONCLUSION: Acupuncture (p < 0.0001) and acupressure (p < 0.1) are effective, nonpharmacologic methods for the treatment of HG.

Five years of nitrate removal, denitrification and carbon dynamics in a denitrification wall.

Denitrification walls are a useful approach for removing nitrate from shallow groundwater, but little is known about the sustainability of nitrate removal, which is dependent on the continued supply of organic carbon to denitrifying bacteria. To address this question, we monitored nitrate removal, denitrification and carbon dynamics in a pilot-scale denitrification wall for 5 yr. The wall continuously removed more than 95% of the incoming nitrate in groundwater, which ranged from 5 to 15 mg N L(-1). We did not detect decreases in total carbon during the 5-yr study. Available carbon declined for the first 200 days after the wall was constructed but has since remained relatively constant. While microbial biomass has varied between 350 and 550 microg C g(-1) there was no downward trend, suggesting that carbon availability was not limiting the size of the microbial population. However, there was a large decrease in denitrifying population, as indicated by declines in denitrifying enzyme activity. Despite this decrease, denitrification rates have remained high enough to remove nitrate from groundwater and denitrification was limited by nitrate rather than by carbon. Our data demonstrates that there was sufficient available carbon in this denitrification wall to support denitrification and nitrate removal for at least 5 yr.