Higher percentage of in vitro apoptotic cells at time of diagnosis in patients with chronic lymphocytic leukemia indicate earlier treatment requirement: Ten years follow up

Introduction. Chronic lymphocytic leukemia (CLL) has an extremely variable clinical course. Biological reasons for that wide variation in clinical course and survival rates in CLL patients are not fully understood. Objective. The aim of the study was to evaluate the value of spontaneous apoptosis of CLL cells in vitro determined at presentation of disease, in prediction of treatment requirements and evolution of the CLL. Methods. Malignant B cells were isolated from the whole blood of 30 newly diagnosed CLL patients and cultured for 24 hours in RPMI-1640 medium supplemented with 10% of serum obtained from the same CLL patient. Cells were later fixed and processed for embedding in Epon, or cell smears were prepared and stained with TUNEL technique. Results. Ten-year follow-up revealed that patients with lower percentage of cells in apoptosis at presentation of disease had significant longer time treatment initiation (log rank test p<0.05). On the contrary, apoptosis of CLL cells was not shown to have significant impact on survival of patients (Kaplan Meier log rank test p>0.05). Conclusion. The results of this study emphasize the importance of apoptosis of CLL cells at the time of the initial diagnosis in pathobiology of this disease. [Projekat Ministarstva nauke Republike Srbije, br. 41025

Apoptosis Induced by Microtubule Disrupting Drugs in Normal Murine Thymocytes In Vitro

Disruption of cytoplasmic and spindle microtubules by colchicine or nocodazole increases mitotic index, but it also enhances apoptosis in isolated mouse thymocytes; the apoptotic index exceeds 20% after 4 hours of incubation with either drug (5% in controls). Apoptosis was confirmed by DNA fragmentation, and was blocked by calcium chelators and inhibitors of protein synthesis. The apoptotic effect of microtubule disrupting drugs (MOD) was directed to interphase thymocytes and was independent on MOD action on mitotic cells. However, cell death of mitotically arrested cells showed ultrastructural changes similar in many aspects to apoptosis

Samoprijavljene alergije na lijekove kod kirurških bolesnika u Srbiji

History of drug allergy is of major concern during perioperative period. Medical records usually lack documents confirming the stated allergy. This study aimed to investigate the prevalence of self-reported drug allergies and their characteristics in adult Serbian surgical population, and to analyze their influence on drug prescription during perioperative period. The study enrolled patients scheduled for general surgery during a one-year period at a tertiary care hospital. They were questioned using a structured questionnaire about the existence of drug allergy and its nature. Medical records were examined after discharge to assess medical prescription during hospitalization. Of 1126 patients evaluated during the study period, 434 (38.5%) reported a total of 635 drug reactions. The most common allergy claim was to antibiotics (68%), nonsteroidal antiinflammatory drugs (16.4%) and iodine (3.9%). Women, urban residents and herbal drug consumers were more likely to state an allergy. The majority of reported reactions were cutaneous (72%) and respiratory (34%), while anaphylaxis was reported by 3.2% of patients. Only 38 (8.7%) patients had previously undergone any allergology testing. Retrospective chart review revealed that 26 (6%) patients were administered the drug to which they had reported allergic reaction in the past, with no adverse effects. Drug allergies are frequently self-reported in surgical population in Serbia, which is in contrast to a very low rate of explored and documented allergies. In order not to deny an effective treatment or postpone a surgery, health care practitioners should pay more attention to an accurate classification of adverse drug reactions.Podatak o alergiji na lijekove je od velikog značenja u perioperacijskom razdoblju, a medicinska dokumentacija obično ne sadrži dokumente koji potvrđuju prijavljenu alergiju. Cilj ovoga istraživanja bio je ispitati učestalost i značajke samoprijavljenih alergija na lijekove od strane odraslih kirurških bolesnika u Srbiji i analizirati utjecaj takvog anamnestičkog podatka na propisivanje lijekova u perioperacijskom razdoblju. Studija je obuhvatila bolesnike podvrgnute elektivnim kirurškim intervencijama iz područja opće kirurgije tijekom jednogodišnjeg razdoblja u tercijarnoj zdravstvenoj ustanovi. Oni su ispitivani primjenom strukturiranog upitnika o postojanju alergija i njihovoj naravi. Medicinska dokumentacija je pregledana nakon otpusta iz bolnice kako bi se ispitalo propisivanje lijekova tijekom hospitalizacije. Od 1126 bolesnika evaluiranih tijekom studije, 434 (38,5%) ih je prijavilo ukupno 635 reakcija na lijekove. Najčešće samoprijavljene alergijske reakcije su bile na antibiotike (68%), nesteroidne protuupalne lijekove (16,4%) i jodni kontrast (3,9%). Samoprijavljivanje alergija je bilo češće kod žena, stanovnika urbanih područja i korisnika biljnih lijekova. Većinu prijavljenih reakcija su činile kožne (72%) i respiracijske (34%), dok je anafilaksu prijavilo 3,2% bolesnika. Samo 38 (8,7%) bolesnika je nakon reakcije podvrgnuto nekom alergološkom testiranju. Pregled povijesti bolesti je pokazao da je 26 (6%) bolesnika tijekom hospitalizacije primilo lijek na koji su prijavili alergijsku reakciju u prošlosti, što nije bilo praćeno neželjenim učincima. Samoprijavljivanje alergija na lijekove je veoma često kod kirurških bolesnika u Srbiji, što je u suprotnosti s niskom stopom ispitanih i dokumentiranih alergija. Kako se bolesnicima ne bi uskratila učinkovita terapija ili odlagala operacija, zdravstveni radnici bi trebali više pozornosti posvetiti preciznoj klasifikaciji neželjenih reakcija na lijekove

In vitro assays for cell death determination

In this paper, we focused on commonly used in vitro assays for estimation of cell death: morphological analyses of cell death, cytotoxic assays based on enzymes activity determination, flow cytometry, and western blot techniques. We discussed advantages and disadvantages of several assays used in the modern research for estimation of cell death

Arteficijalni otvoreni prelomi tibije lečeni kloksacilinom

Three methods of treatment by Cloxacillin were applied for the prevention of deep infection of bones after artificial contamination of fractured rat tibia, with Staphylococcus aureus. Thus, combined intramedullary and parenteral therapy was compared with intramedullary administration only and parenteral therapy only. Intramedullary injection of 15 mg Cloxacillin (dissolved in water) during surgical management of the fracture and postoperative parenteral treatment with the same antibiotic in a dose of 50 mg/kg/day over 14 days prevented the development of staphylococcal infection in all animals (n=21). Cloxacillin parenteral treatment only achieved a therapeutical effect after 42 days of application in a dose of 50 mg/kg. A single, intramedullary injection of 15 mg aqueous solution of Cloxacillin failed to prevent completely the staphylococcal infection. This therapy was relatively successful till postoperative day 28, namely, there were only 16.6% of positive results for S.aureus in relation to 40% on day 42 after the surgery. Gross, radiological and histological changes of the operated tibia of rats were correlated to the effects of the therapy applied. The results of our studies suggest that, in open tibial fractures, parenteral therapy together with intramedullary administration of antibiotics may prevent the development of infection and shorten the parenteral therapy by a direct effect on the contaminated injury during the first few postoperative days.Na modelu arterficijalnog preloma potkolenice pacova i posle arteficijalne kontaminacije sa Staphylococcus aureus-om, u cilju sprečavanja duboke infekcije kostiju primenjene su tri metode lečenja antibiotikom Kloksacilinom: 1 kombinovana intramedularna I parenteralna terapija koja je poređena sa: 2. samo intramedularnom i 3. samo parenteralnom terapijom Kloksacilinom. Intramedularna inokulacija 15 mg Kloksacilina (rastvorenog u vodi) u toku hirurškog zbrinjavanja preloma i postoperativnog parenteralnog lečenja istim antibiotikom u dozi od 50 mg/kg dnevno u toku 14 dana, sprečila je nastajanje stafilokokne infekcije kod svih životinja (n=21). Samo parenteralnim lečenjem Kloksacilinom postignut je terapijski efekat posle 42 dana davanja u dozi od 50 mg/kg. Jednokratnom, intramedularnom aplikacijom 15 mg vodenog rastvora Kloksacilina nije u potpunosti sprečena stafilokokna infekcija. Ova terapija bila je uspešnija do 28-og postoperativnog dana (16,6% pozitivnih nalaza S.aureusa, u odnosu na 40%, 42-og dana posle operacije). Makroksopski, radiološki i histološki promene na operisanoj potkolenici pacova bile su u skladu sa efektima primenjene terapije. Rezultati naših istraživanja ukazuju da kod otvorenih preloma potkolenice uz parenteralnu terapiju, intramedularna aplikacija antibiotika, zbog direktnog delovanja u kontaminiranoj povredi, u prvim postoperativnim danima sprečava razvijanje infekcije i skraćuje period parenteralne terapije

Self-reported drug allergies in surgical population in Serbia

History of drug allergy is of major concern during perioperative period. Medical records usually lack documents confirming the stated allergy. This study aimed to investigate the prevalence of self-reported drug allergies and their characteristics in adult Serbian surgical population, and to analyze their influence on drug prescription during perioperative period. The study enrolled patients scheduled for general surgery during a one-year period at a tertiary care hospital. They were questioned using a structured questionnaire about the existence of drug allergy and its nature. Medical records were examined after discharge to assess medical prescription during hospitalization. Of 1126 patients evaluated during the study period, 434 (38.5%) reported a total of 635 drug reactions. The most common allergy claim was to antibiotics (68%), nonsteroidal antiinflammatory drugs (16.4%) and iodine (3.9%). Women, urban residents and herbal drug consumers were more likely to state an allergy. The majority of reported reactions were cutaneous (72%) and respiratory (34%), while anaphylaxis was reported by 3.2% of patients. Only 38 (8.7%) patients had previously undergone any allergology testing. Retrospective chart review revealed that 26 (6%) patients were administered the drug to which they had reported allergic reaction in the past, with no adverse effects. Drug allergies are frequently self-reported in surgical population in Serbia, which is in contrast to a very low rate of explored and documented allergies. In order not to deny an effective treatment or postpone a surgery, health care practitioners should pay more attention to an accurate classification of adverse drug reactions

Clamp-Crushing vs. Radiofrequency-Assisted Liver Resection: Changes in Liver Function Tests

Background/Aims: Liver resection is the gold standard in managing patients with metastatic or primary liver cancer. The aim of our study was to compare the traditional clamp-crushing technique to the radiofrequency-assisted liver resection technique in terms of postoperative liver function. Methodology: Liver function was evaluated preoperatively and on postoperative days 3 and 7. Liver synthetic function parameters (serum albumin level, prothrombin time and international normalized ratio), markers of hepatic injury and necrosis (serum alanine aminotransferase, aspartate aminotransferase and total bilirubin level) and microsomal activity (quantitative lidocaine test) were compared. Results: Forty three patients completed the study (14 had clamp-crushing and 29 had radiofrequency assisted liver resection). The groups did not differ in demographic characteristics, pre-operative liver function, operative time and perioperative transfusion rate. In postoperative period, there were similar changes in monitored parameters in both groups except albumin levels, that were higher in radiofrequency-assisted liver resection group (p=0.047). Conclusions: Both, traditional clamp-crushing technique and radiofrequency assisted liver resection technique, result in similar postoperative changes of most monitored liver function parameters

Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn’s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications. [Projekat Ministarstva nauke Republike Srbije, br. 175095