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Resection of thrombosed femoral artery over-dimensional stent-graft placed due to multiple arteriovenous fistulas following gunshot wounds
Radak ?or?e,Tanaskovi? Slobodan,Nenezi? Dragoslav,VuureviGoran
Srpski Arhiv za Celokupno Lekarstvo , 2010, DOI: 10.2298/sarh1004233r
Abstract: Introduction. Though surgical approach is common in arteriovenous (AV) fistula treatment, endovascular procedures such as stent-graft placement has become more popular in recent years. We aim to present a case of thrombosed femoral artery stent-graft which was placed one year earlier due to multiple AV fistulas following gunshot wounds. Case Outline. A 43-year-old patient was admitted to the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, Serbia, for arteriography. Five years before, he had suffered from six gunshot wounds in his right leg and one year before, in the health centre in Vienna, stent-graft had been placed in the right superficial femoral artery due to multiple AV fistulas. Because of artery dilation proximal to AV fistula location, a large dimensional stent-graft had to be placed (24 mm). After admission, arteriography and Multislice CT (MSCT) angiography revealed thrombotic masses in the stent-graft with intraluminal stenosis of 50%. Extirpation of thrombosed stent-graft was performed followed by Dacron tubular graft 10 mm interposition. On the fifth postoperative day, the patient was discharged from the clinic, and after 3 months, the right leg vascularisation was well preserved. Conclusion. Large dimensional stent-graft placement in patients with mutiple AV fistulas and blood vessel dilation proximal to AV site of communication carries an increased risk of thrombotic events due to turbulent blood flow and parietal thrombosis occurrence. Though stent-graft placement can be a very useful solution in acute AV fistula treatment, the very same thrombosis should be thought of when surgical management is the only treatment choice.
Congenital interruption of the inferior vena cava: A case report
Mati? Predrag,VuureviGoran,?uleji? Vuk,Ilijevski Nenad
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1206359m
Abstract: Introduction. Congenital interruption of the inferior vena cava is a rare entity. It can be associated with other organ and system malformations, especially the cardiovascular system. Usually, patients are asymptomatic and the anomaly is therefore diagnosed incidentally. In some cases it can be of clinical importance. Case Outline. A 22-year-old female was diagnosed during evaluation of cardiac symptoms. Clinical examination showed normal findings. CT angiography and cavography were used to establish the diagnosis of inferior vena cava interruption. Since there was no need for surgical intervention the patient was discharged in good condition. During a five year follow-up no significant health problems were noted with patient leading normal life. Conclusion. Diagnostic tools used to establish the diagnosis of inferior vena cava interruption are ultrasonography, as well as CT and MR angiography and phlebography. Mediastinal masses found on chest roentgenogram must raise suspicion of inferior vena cava interruption. Although the anomaly is rare, physicians should be aware of the infrahepatic interruption of the IVC, especially because it can present at any age.
Persistent descending mesocolon: Case report
Trebje?anin Zoran,Babi? Sr?an,VuureviGoran,Popov Petar
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1210637t
Abstract: Introduction. Positional anomalies of the right half of the colon are quite common whereas positional anomalies of the left half of the colon are much less common because of embryological disorders during the period of the embryological development of that part of the bowel. The process of the fixation of the descending colon to the posterior abdominal wall can be absent. In that case, when the descending colon has a free descending mesocolon, it shows some degree of mobility. Case Outline. We are presenting an example of one of the anomalies, which is characterized by the persistent descending mesocolon, which extends from the splenic flexure or just below it to the sigmoid colon. The persistent descending mesocolon in our case contains or surrounds almost complete small bowel in a recess which is located laterally to the left of the midline. The content of this hernial sac simulates the symptoms of an internal hernia followed by clinical symptoms and roendgenographical signs. Conclusion. We are of the opinion that this anomaly is more common than some surveys of literature would suggest.
Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report
VuureviGoran,Tanaskovi? Slobodan,Ilijevski Nenad,Kova?evi? Vladimir
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1110666v
Abstract: Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT) supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients’ Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.
Significance of Determining Levels of Apolipoproteins A-I and B in the Diagnostics and Assessment of Lipid-Related Atherogenic Risk in Hyperalpha-Lipoproteinemia, Hypocholesterolemia and Hypo-Hdl-Cholesterolemia
Sun ica Koji -Damjanov, Mirjana eri , Velibor abarkapa, Ljiljana Vu urevi -Risti
Journal of Medical Biochemistry , 2007, DOI: 10.2478/v10011-007-0024-6
Abstract: The significance of determining apolipoproteins apoB and apoA-I and their correlation with lipid status parameters were tested in hyperalpha-lipoproteinemia (30 women), hypocholesterolemia (10 men) and hypo-HDL-cholesterolemia (15 women and 21 men). Control groups were 20 normolipidemic men and women, each. ApoA-I showed positive correlation with HDL-cholesterol in hyperalpha-lipoproteinemia, with total and HDL-cholesterol in hypocholesterolemia, and with total and LDL-cholesterol in females with hypo-HDL-cholesterolemia, and negative correlation with cholesterol ratios only in hypocholesterolemia. ApoB showed a positive correlation with total and LDL-cholesterol in all groups, and with cholesterol ratios in hyperalpha-lipoproteinemia and hypo-HDL-cholesterolemia. The apoB/apoA-I ratio, correlating with the majority of lipid parameters, and with the highest percentage of pathological values in all tested groups, was singled out as the most sensitive parameter for the evaluation of lipid-related atherogenic risks.
The Importance of Free Light Chains of Immunoglobulins Determination in Serum
Velibor abarkapa, Zoran Sto i , Mirjana eri , Ljiljana Vu urevi -Risti , Mirjana Drlja a
Journal of Medical Biochemistry , 2007, DOI: 10.2478/v10011-007-0032-6
Abstract: For many years, Bence Jones proteinuria has been an important diagnostic marker for multiple myeloma. Relatively new serum tests for free kappa and free lambda light chains of immunoglobulins reflect the production of free light chains more accurately than urine tests. In this study, we examined the value of serum free light chains measurement in the diagnosis of some neoplastic diseases and the discrepance between the findings of serum protein electrophoresis and serum free light chains. Thirty one patients (f=19, m=12) were included in the study, most of them with blood malignant diseases. The results show that in six patients with normal gamma and beta electrophoresis fractions there are abnormal levels of free light chains and/or an abnormal κ/LD ratio. In 20 patients we found an abnormal κ/LD ratio, and in 21 patients we found an abnormal κ or LD level, or both. The obtained results show the important role of serum free light chains determination in identifying patients with monoclonal gammopathies.
Serum Cystatin C in Estimating Glomerular Filtration Rate
Velibor abarkapa, Zoran Sto i , Mirjana eri , Ljiljana Vu urevi -Risti , Radmila eravica, Branislava Ilin i
Journal of Medical Biochemistry , 2008, DOI: 10.2478/v10011-007-0042-4
Abstract: Using serum cystatin C in estimating glomerular filtration rate (GFR) has in recent times been recommended. A number of simple formulas for calculating GFR have been derived specifically from serum cystatin C concentrations. The purpose of this study was to assess the significance of cystatin C and of the two most frequently applied of these formulas in estimating glomerular filtration rate compared to serum creatinine and its derived formulas for estimating glomerular filtration rate from creatinine concentrations. The study included 74 patients: 59 were in various stages of chronic renal insufficiency (divided into two subgroups: I with GFR ≥ 60 mL/min/1.73m2 and II with GFR<60 mL/min/1.73m2) and 15 on hemodialysis. A control group of 30 healthy participants was also included in the study. Serum values of cystatin C ranged from: 0.86 ± 0.16 mg/L in subgroup I, and 1.77 ± 0.79 mg/L in subgroup II, to 6.9 ± 1.83 mg/L in patients on hemodialysis. The correlation between the two formulas derived from cystatin C and the clearance of creatinine, as well as the Cockcroft and Gault's formula, was significant, while one of the formulas derived from cystatin C did not show a significant correlation with MDRD. It was concluded that serum cystatin C is a significant marker in estimating glomerular filtration rate, especially in the advanced stages of chronic renal insufficiency.
Forearm reconstruction after loss of radius: Case report
Manojlovi? Radovan,Tuli? Goran,Kadija Marko,Vu?eti? ?edomir
Srpski Arhiv za Celokupno Lekarstvo , 2013, DOI: 10.2298/sarh1302100m
Abstract: Introduction. Osteomyelitis of the radius resulting in the radial clubhand is a very rare condition and few studies have been published about its prognosis and treatment. Case Outline. This is a case report of hematogenous osteomyelitis of the radius with a complete loss of the radius leaving only the distal radial metaphysis to carry the carpus. In order to achieve best functional results, four-step operative protocol was performed for reconstruction; lengthening of the forearm by external fixator, radioulnar transposition to create a one-bone forearm, plate removal and transposition of brachioradialis to the extensor pollicis longus as well as proximal row carpectomy. After nine years of the last operation, the function of the elbow and hands is good with acceptable cosmetic result. The forearm is 5 cm shorter and there has been a persistent mild limitation of palmar flexion. Conclusion. Creation of the one-bone forearm normalizes the elbow and wrist function, corrects forearm malalignment, and improves forearm growth potential.
Avoidable and unavoidable exergy destruction and exergoeconomic evaluation of the thermal processes in a real industrial plant
Vu?kovi? Goran D.,Vuki? Mi?a V.,Stojiljkovi? Mirko M.,Vu?kovi? Dragan D.
Thermal Science , 2012, DOI: 10.2298/tsci120503181v
Abstract: Exergy analysis is a universal method for evaluating the rational use of energy. It can be applied to any kind of energy conversion system or chemical process. An exergy analysis identifies the location, the magnitude and the causes of thermodynamic inefficiencies and enhances understanding of the energy conversion processes in complex systems. Conventional exergy analyses pinpoint components and processes with high irreversibility. To overcome the limitations of the conventional analyses and to increase our knowledge about a plant, advanced exergy-based analyses are developed. These analyses provide additional information about component interactions and reveal the real potential for improvement of each component constituting a system, as well as of the overall system. In this paper, a real industrial plant is analyzed using both conventional and advanced exergy analyses, and exergoeconomic evaluation. Some of the exergy destruction in the plant components is unavoidable and constrained by technological, physical and economic limitations. Calculations related to the total avoidable exergy destruction caused by each component of the plant supplement the outcome of the conventional exergy analysis. Based on the all-reaching analysis, by improving the boiler operation (elimination of approximately 1 MW of avoidable exergy destruction in the steam boiler) the greatest improvement in the efficiency of the overall system can be achieved.
The treatment of subtrochanteric fractures
Vu?eti? ?edomir S.,Duli? Borislav V.,Vuka?inovi? Zoran S.,Tuli? Goran D?.
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1108540v
Abstract: Subtrochanteric fractures of the femur have a special place because of a significant number of complications following treatment. Powerful loading forces asymmetrically acting to this bone segment, as well as poor vascularization interfere with bone union. There are basically two current approaches in the fixation of subtrochanteric fractures; the first involves a plate with a compression screw and another one is intramedullary (IM) nail, with two options: centromedullary (standard interlocking femoral nail) and cephalomedullary femoral nail with two modifications, reconstructive and trochanteric. All IM nails may be used by open technique or closed minimal invasive method. IM nailing is favoured in view of a shorter operative time, shorter hospitalisation and complications. Indirect fracture reduction and knowledge of biology of bone fracture may result in full success without any bone graft.
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