A revised taxonomy of crested newts in the Triturus karelinii group (Amphibia: Caudata: Salamandridae), with the description of a new species.

We present a taxonomic revision of the crested newt Triturus karelinii sensu lato. Based on the presence of discrete nuclear DNA gene pools, deep genetic divergence of mitochondrial and nuclear DNA, and no indication of gene flow, we interpret this taxon as comprising two species: one covering the southern Caspian Sea shore, the Caucasus and the Crimea, i.e. the eastern part of the total range and another covering northern Asiatic Turkey and western Asiatic Turkey plus the southeastern Balkan Peninsula, i.e. the central and western part of the total range. We acknowledge that the central/western species should likely be further subdivided into a central and a western taxon, but we prefer to await a more detailed genetic analysis of the putative contact zone, positioned in northwestern Asiatic Turkey. The name T. karelinii (Strauch, 1870) applies to the eastern species as the type locality is positioned along the coast of the Gulf of Gorgan, Iran. The name T. arntzeni has been applied to the central/western species with Vrtovac, Serbia as the type locality. We show that not T. karelinii sensu lato but T. macedonicus occurs at Vrtovac. Hence, the name T. arntzeni Litvinchuk, Borkin, Dzukic and Kalezic, 1999 (in Litvinchuk et al., 1999) is a junior synonym of T. macedonicus (Karaman, 1922) and should not be used for the central/western species. We propose the name T. ivanbureschi sp. nov. for the central/western species and provide a formal species description.

[Surgical treatment of patients with perforated peptic ulcers].

Results of surgical treatment of 782 patients with perforated gastric and duodenal ulcers are analyzed. Gastric ulcers of I type were diagnosed at 86 (10.9%) patients, prepyloric and pyloric ulcers - at 441 (56.4%), duodenal ulcers - at 255 (32.6%) patients. Perforation was combined with bleeding and stenosis at 24 (3.1%). Palliative operations have been performed at 172 (22.0%) patients, stem vagotomy with ulcer excision and pyloroplasty - at 58 (7.4%), various types of stomach resection - at 54 (6.9%), proximal gastric vagotomy with excision of gastric, pyloric or duodenal ulcer - at 77 (9.8%), proximal gastric vagotomy with excision or suturing of ulcer and pyloro- or duodenoplasty - at 421 (53.8%) patients. The rate of postoperative complications after proximal gastric vagotomy was 3.6%, after stomach resection - 18.2% (p<0.01). Early postoperative complications after vagotomy with ulcer excision and pyloroplasty were diagnosed at 8.3%, after stomach resection - at 18.2% patients (p<0.01). The quality of patients life was higher after organ-saving operations. Proximal gastric vagotomy with excision of ulcer and pyloro- or duodenoplasty should be regarded as operation of choice at perforated duodenal ulcers.

[Helicobacter heilmanni (Gastrospirillum hominis) as a new cause of gastritis--case report]. / Helicobacter heilmanni (Gastrospirillum hominis) novi uzrocnik gastritisa--prikaz slucaja.

INTRODUCTION: During the course of research into Helicobacter pylori, further microorganisms colonizing the gastric mucosa have been detected. The large spiral-shaped bacteria deviating from Helicobacter pylori was originally described by Dent. The bacteria was initially named Gastrospirillum hominis, but after sequencing of 16S rRNA it was classified as Helicobacter and named Helicobacter Heilmannii in honour of the pathologist Prof. Dr. Konrad Heilmann. We report two additional cases. CASE REPORTS: In 1997 at the Department of Pathology of General Hospital in Senta 268 gastric biopsies (151 male, 117 female), average age of 50.4 were analyzed. Helicobacter pylori was identified in 176 biopsies (65.7%). Helicobacter Heilmannii was found in two cases (0.74%). The clinical details were as follows: Case 1. A 32-year-old male complained of dyspepsia. Esophagogastroduodenoscopy disclosed hyperemia and scattered erosions in the lower third of stomach. Case 2. a 55-year-old female was admitted at the hospital with lumbar pain, loss of appetite and body weight. Esophagogastroduodenoscopy findings were normal. The patient lived in rural household in contact with various domestic animals. In the biopsy specimens of both cases in the antral gastric mucosa large bacteria resembling a corkscrew were found, 6-10 microns length, consisting of 5-9 regular tight spiral. The bacteria were midly eosinophilic and Gram negative. The bacteria stained strongly with the Warthin-Starry silver stain, and with Giemsa stain. The distribution of Helicobacter Heilmannii was patchy in the central zones of the gastric pits, deep or more superficial including the foveolar opening on the mucosal surface. A mild degree of chronic gastritis characterized both cases, with, focally active inflammation and lymphoid aggregates. None of biopsies had atrophy, intestinal metaplasia or epithelial damage. There was a symptomatic improvement after a 4-week course with triple therapy (H2 antagonist & metronidazole & amoxycillin). After treatment rebiopsy specimens displayed mild chronic gastritis and no spiral organisms. CONCLUSION: Our reported cases are the first described cases of gastritis caused by Helicobacter Heilmannii in our region with successful eradication after therapy. Morphologically similar bacteria have been found in the stomachs of domestic animals. It is a general opinion that Helicobacter Heilmannii is characteristic for animals but it is occasionally transmitted to humans.

[Mammographic structure of breast parenchyma and the manifestations of breast cancer]. / Mamografska struktura parenhima dojke i pojava raka dojke.

The occurrence of breast carcinoma in regard to mammographic parenchyma samples applying the technique of Wolfe was analyzed. In the examined group of patients (n = 105) after clinical and mammographic examination mastectomy was performed with evacuation of axillary tissue. The malignancy was confirmed pathohistologically as well as the degree of spreading. The control group consisted of (n = 105) patients of the same age in whom at the time of examination and 6 months later malignancy was not confirmed. P-2 was more frequent in the group of the sick, while N-1 sample (X2 = 17.15, p < 0.01) was rarer. In patients older than 50 years of age Dy sample (x2 = 11.95, p < 0.01) was also more frequent. The difference can be explained by the fact that P-2 and Dy mammographic samples represent the picture of dysplastically changed breast tissue and depending on the presence of histologic elements of proliferation and cell atypias point to an increased risk of cancer. Consequently the samples are divided into "highly risky" (P-2 and Dy) and "of low risk" (N-1 and P-1). Women with mammographic parenchymal samples of a higher risk together with other risk factors should be frequently controlled.

[Perforated pyloric and prepyloric ulcers]. / Perforativnye piloricheskie i prepiloricheskie iazvy.

Various surgical interventions were conducted in the clinic on 63 patients for perforation of pyloric and prepyloric ulcers. Closure of the perforated ulcer was performed in 8 patients, excision of the ulcer and transverse pyloroplasty in 14, truncal and selective vagotomy in combination with antrumectomy in 6, and truncal vagotomy and pyloroplasty in 3 patients. According to the authors, the operation of choice is anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy and obligatory excision of the ulcer for histological study, and transverse pyloroplasty of the Aust-Holle type which was performed in 22 patients. The indications for radical operations were expanded bearing in mind the peculiarities of the course of peritonitis in patients with perforated gastric ulcers. In addition to the traditional prophylactic treatment of the abdominal cavity, the complex treatment of peritonitis included the use of low-frequency ultrasound during the operation and prolonged laparoscopic prophylactic treatment with low-intensity laser beam in the postoperative period.

[Clinical and endoscopic characteristics of duodenal ulcer in patients from the Tis River region from the aspect of functional status of the gastric mucosa and therapeutic effects]. / Klinicke i endoskopske karakteristike duodenalnog ulkusa potiskog regiona sa aspekta funkcionalnog stanja zeludacne sluzokoze i terapijskog efekta.

A group of 300 patients with peptic ulcers was formed by the method of accidental choice and consists of 252 males (84.00%) and 48 females (16.00%) with a ratio between sexes of 5.25:1 in favor of the male sex. Out of risk factors of the disease, the most frequent ones were the caffeine beverage (in 69.66% of patients) and smoking (in 67.0% of all examined subjects). Laboratory findings were of no greater significance in the diagnostics of peptic ulcer, while radiological examination verified ulcers of this location in 43.33% of patients. By means of endoscopic examination a defect of duodenal mucosa was visualized in 100% of patients and this was most frequently seen on the anterior wall of the bulb (60.33%), small ulcerations up to 0.5 mm in diameter (in 55.0% of cases). Different forms of chronic atrophic gastritis were determined in 48.00% of patients by means of pathohistological expert opinion, and chronic enteritis was the fact in 71.66% of patients. In duodenal ulcer therapy, the best results were achieved with preparations of the third generation of H2 antagonists (complete reepithelialization in 94.00% of cases H2 = 38.72, p less than 0.001), and with omeprazol (healing of ulcer in 98.00% of patients, H2 = 68.50, p less than 0.001).

[Clinico-anatomical basis for using the variants of proximal gastric vagotomy in the treatment of gastroduodenal ulcers]. / Kliniko-anatomicheskoe obosnovanie variantov proksimal'noi selektivnoi vagotomii v lechenii iazvennoi bolezni dvenadtsati- perstnoi kishki i zheludka.

Anatomical examinations (33 cadavers) for studying parasympathetic innervation of the upper abdominal organs formed the basis for developing a new variant of proximal gastric vagotomy--anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy. This variant excludes mobilization of the esophagus and makes it possible to preserve the ligament apparatus of the esophago-gastric junction as well as the parasympathetic innervation of the pancreas, small and large intestine, kidneys, and adrenals, which may be a measure for the prevention of some ++post-vagotomy complications.

[Anterior seromyotomy of the body and the functional part of the stomach combined with posterior truncal vagotomy and ulcer excision in the surgical treatment of complicated stomach ulcer]. / Peredniaia seromiotomiia tela i funktsional'nogo otdela zheludka v sochetanii s zadnei stvolovoi vagotomiei i issecheniem iazvy v khirurgicheskom lechenii oslozhnennoi iazvennoi bolezni zheludka.

Anterior seromyotomy of the body and fundus of the stomach was combined with posterior truncal vagotomy and excision of the ulcer in 23 patients with gastric ulcer complicated by bleeding or perforation. Seventeen patients had chronic ulcers of the body of the stomach (type I), 3 patients had concurrent ulcers (type II), and 3 more patients had acute ulcers of the body of the stomach. Operation was undertaken for active bleeding from the ulcer in 20 patients and for perforating ulcer in 3 patients. One patient died. Mild disorders of evacuation of an aqueous barium sulfate suspension from the stomach were noted in 4 patients.