Спонтан хематом во обвивката на правиот абдоминален мускул – сè почеста причина за акутен абдомен кај пациенти на антикоагуланта терапија: приказ на два случаи

(Spontaneus)  Rectus sheath hematoma ((S)RSH) is an accumulation of blood in the sheath of the rectus abdominis muscle, secondary to rupture of an epigastric vessel or muscle tear. It is defined as spontaneous in patients without history of abdominal trauma. It can be located supra- or infraumbilically. Although the exact incidence is unknown, Klingler et al. observed 23 cases (1.8%) of rectus sheath hematoma among 1257 patients evaluated by ultrasound for acute abdominal disorders.  Ultrasonography can help in the diagnosis, but CT scan is most accurate in its ability to define the lesion. When diagnosed clinically, a conservative therapeutic program can usually be instituted. Only in cases of supportive management failure, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated. Case presentation: We present two cases of SRSH in patients using oral anticoagulant agent (acenocoumarol). Their chief complaint was sudden onset of acute abdominal pain. On admission they were haemodynamically stable. After thorough clinical evaluation a suspicion for SRSH diagnosis was made and then confirmed by ultrasonography and CT. Both of them were successfully treated conservatively and discharged home in a good general condition. Conclusion: These two cases illustrate the accurate diagnosis of SRSH treated conservatively leading to optimal patient outcomes.Спонтаниот хематом во обвивката на правиот абдоминален мускул е акумулација на крв во обвивката на правиот абдоминален мускул како резултат на руптура на епигастричните крвни садови или руптура на самиот мускул. Се дефинира како спонтан кај пациенти каде отсуствува анамнеза за абдоминална траума. Може да е лоциран супра или инфра умбиликално. Иако точната инциденција е непозната, Kingler и соработниците опсервирале 23 случаи  (1,8%) на хематом во обвивката на правиот абдоминален мускул кај 1257 пациенти евалуирани со ехосонографија за акутни абдоминални нарушувања. Eхосонографијата може да придонесе во дијагнозата, но КТ е најточна во можноста да се дефинира лезијата. Кога се дијагностицира клинички, најчесто се започнува со конзервативен третман. Само во случај на неуспешен супортивен третман, прогресивен и голем хематом и хемодинамски нестабилен пациент, интервентниот третман вклучувајќи хируршка интервенција или некој од поновите помалку инвазивни методи е индициран. Приказ на случаи: Презентираме два случаи со спонтан хематом во обвиката на правиот абдоминален мускул кај пациенти на орална антикоагулантна терапијa (acenocoumarol). Главен симптом беше нагло настаната акутна абдоминална болка. При прием беа хемодинамски стабилни. По сеопфатно земена анамнеза и детален клинички преглед беше поставена суспекција за спонтан хематом во обвивката на правиот абдоминален мускул која подоцна беше и потврдена со помош на ултрасонографија и КТ. Обата пациента беа успешно конзерватино третирани и испуштени од болница во добра општа состојба. Заклучок: Презентираните два случаи илустрираат точна дијагностика и конзервативен третман на спонтан хематом во обвивката на правиот абдоминален мускул со оптимален исход

Физикален третман на пострауматски контрактури на лакот кај деца – наше искуство

The most common complications of elbow trauma are contractures and neurovascular injuries. The complications can be a result of the initial injury, but they can also be a result of a surgical treatment. In addition to orthopedic treatment of elbow fractures, physical therapy and rehabilitation play a significant role in treatment of posttraumatic contractures. To determine the effects of physical therapy and rehabilitation of posttraumatic elbow contractures in children. This was a retrospective cross-sectional study conducted in the University Clinic for Physical Medicine and Rehabilitation, Skopje in the period 01.01.2021 – 01.07.2022. A total of 52 children were included, at the age between 2 and 13 years who had a posttraumatic elbow contracture, limited range of motion, pain and/or limitations in accomplishing daily activities. Depending on the clinical finding, children underwent a relevant physical therapy (kinesitherapy, functional therapy, electrotherapy, thermotherapy, hydrotherapy and magnetotherapy) in duration of three weeks. For assessing the effects of the rehabilitation therapy, the range of motion of the elbow and forearm was examined along with the Flynn’s scale in all children, prior to and after completion of the physical treatment. Applied physical treatment resulted in a significant improvement in all analyzed movements such as: elbow flexion (p=0.00001), elbow extension (p=0.00001), forearm pronation (p=0.00001), forearm supination (p=0.0000) and Flynn’s scale (p=0.0000). After completion of the rehabilitation treatment, excellent results were registered in 41 (85%) children, moderate in 10 (19.23%) and favorable in 1 (1.92%). Timely and adequate application of physical therapy and rehabilitation can significantly improve the final outcome in treatment of posttraumatic elbow contractures in children. A combination of different physical procedures adequately applied and personalized can significantly improve the range of motion of the elbow.  Најчестите компликации на траумата на лактот се контрактури и невроваскуларни повреди. Компликациите може да бидат резултат на иницијална повреда, но може да бидат и резултат на хируршки третман. Покрај ортопедскиот третман на фрактури на лактот, физикална терапија и рехабилитација играат значајна улога во третманот на посттрауматски контрактури. Целта на оваа студија беше да се утврдат ефектите од физикална терапија и рехабилитација на посттрауматски контрактури на лактот кај децата. Материјали и методи: Ова беше ретроспективна студија на пресек спроведена на Универзитетската клиника за физикална медицина и рехабилитација, Скопје во периодот 01.01.2021 – 01.07.2022 година. Вклучени се вкупно 52 деца, на возраст меѓу 2 и 13 години кои имале посттрауматска контрактура на лактот, ограничен опсег на движења, болка и/или ограничувања во извршувањето на секојдневните активности. Во зависност од клиничкиот наод, на децата им беше извршена соодветна физикална терапија (кинезитерапија, функционална терапија, електротерапија, термотерапија, хидротерапија и магнетотерапија) во времетраење од три недели. За проценка на ефектите од терапијата за рехабилитација, опсегот на движење на лактот и подлактицата беше испитувана и Флиновата скала кај сите деца, пред и по завршувањето на физичкиот третман. Резултати: Применетиот физикален третман резултираше со значително подобрување на сите анализирани движења како што се: флексија на лактот (p=0,00001), екстензија на лактот (p=0,00001), пронација на подлактицата (p=0,00001), супинацција на подлактицата (p=0,0000's) и Флинова скала (p=0,0000). По завршувањето на рехабилитациониот третман, одлични резултати се забележани кај 41 (85%) дете, умерени кај 10 (19,23%) и поволни кај 1 (1,92%). Заклучок: Навремената и адекватна примена на физикална терапија и рехабилитација може значително да го подобри крајниот исход во третманот на посттрауматски контрактури на лактот кај децата. Комбинацијата на различни физички процедури соодветно применети и персонализирани може значително да го подобри опсегот на движење на лактот

Dislocated Extension – Type Supracondylar Humerus Fractures in Children: Single Centre Experience

Aim: The aim of this study is to show our experience in cases of dislocated extension type – supracondylar humeral fractures and evaluate the results of their treatment in the period from 2000 to 2010 with a follow up of a maximum six months.Material and Methods: A retrospective analysis of the clinical cases for the period 2000 – 2010 was done. Children from 4 to 14 years of age with supracondylar fractures of the humerus – extension type are included. The total number of patients treated at the Clinic for Pediatric Surgery was 230.Results: The results of the treatment were evaluated after the last control examination six months later. We noticed postoperative neurological damage in 10 cases (4.85%). In 14 patients (6.8%) we noticed long term deformities such as cubitus varus or cubitus valgus. Infection at the entering place of the needles occurred in 4 patients (1.94%), which did not indicate premature extraction of the needles and conversion of the treatment.Conclusion: As a conclusion, we can stress that our outcomes in treatment of dislocated suparacondylar fractures of the humerus in children meet the world standards

Mechanisms of Prostate Cancer Cells Survival and Their Therapeutic Targeting

Prostate cancer (PCa) is today the second most common cancer in the world, with almost 400,000 deaths annually. Multiple factors are involved in the etiology of PCa, such as older age, genetic mutations, ethnicity, diet, or inflammation. Modern treatment of PCa involves radical surgical treatment or radiation therapy in the stages when the tumor is limited to the prostate. When metastases develop, the standard procedure is androgen deprivation therapy, which aims to reduce the level of circulating testosterone, which is achieved by surgical or medical castration. However, when the level of testosterone decreases to the castration level, the tumor cells adapt to the new conditions through different mechanisms, which enable their unhindered growth and survival, despite the therapy. New knowledge about the biology of the so-called of castration-resistant PCa and the way it adapts to therapy will enable the development of new drugs, whose goal is to prolong the survival of patients with this stage of the disease, which will be discussed in this review

Klima vinogradarskih podrucja SR Jugoslavije i lista podudarnih sorti vinove loze

According to general characteristics of the climate of vineyard zones in Yugoslavia in 1976, ten (10) vineyard zones were established. For better presentation of the climate conditions of the vineyard zones of Yugoslavia in this work the data of 12 representative meteorological stations for the period 1951-1995 were used. Meteorological parameters are presented in tab.l and 2. Taking into account the presented climate conditions in vineyard zones of Yugoslavia (Serbia and Montenegro), one can conclude that suitable temperature and another climate conditions exist for vine varieties growing from earliest to the late period of maturing.U cilju uporednih ispitivanja opstih karakteristika klime najznacajnijih vinogradarskih podrucja u svetu, Medjunarodni ured za vinovu lozu i vino (O.I:V. - Paris) je preporucio da se za karakterizaciju vinogradarske klime (parcele jednog vinograda, lokaliteta iIi vinogradarskog regiona) koriste pored osnovnih rneteoroloskih podataka i sledeci klimatski indeksi koji obuhvataju 2 ili vise meteoroloskih cinilaca: - IW, indeks Vinklera (Wink Ier, 1962) - IH, heliotermicki indeks Iglena (Hug len, 1978) - IS, indeks suse (Riou et al. 1994) - IF, indeks svezine noci u periodu sazrevanja grozda (To n n ie t to , 1999) U ovom radu su prikazani podaci 12 reprezentativnih meteoroloskih stanica u Jugoslaviji (1951-1995. god.) na osnovu kojih se moze izvrsiti karakterizacija klime u najznacajnijim vinogradarskim podrucjima nase zemlje (tab. 1 i 2). U radu je data i lista podudarnih - adaptivnih vinskih sorti za cije gajenje postoje povoljni uslovi u vinogradarskim podrucjima Srbije i Crne Gore. U vinogradarskim podrucjima Srbije (tab. 1) srednja godisnja temperatura vazduha varira od 10.8 do 11.9 DC, a srednja vegetaciona 16.5 do 17.7 DC. Godisnja suma padavina iznosi 553-750 mm, a u periodu vegetacije padne 351-451mm. U vinogradarskoj zoni Crne Gore srednja godisnja temperatura iznosi 15.6 DC, a srednja vegetaciona 21.1 DC. Godisnja suma padavina iznosi 1592 mm, a za period vegetacije 662 mm. Prema vrednostima indeksa po Vinkleru sva vinogradarska podrucja Srbije pripadaju klimatskoj zoni II, odnosno zoni B po EU. Suma efektivnih temperatura varira od 1390 DC U Vranju, do 1577 DC U Negotinu. U Crnoj Gori, suma efektivnih temperatura iznosi 2382 DC, sto ovo vinogradarsko podrucje svrstava u zonu V po Vinkleru, odnosno, C-3 po EU. Na osnovu heliotermickog indeksa (IH po Huglenu) klima vinogradarskih podrucja nase zemlje se moze okarakterisati na sledeci nacin: - U vinogradarskim podrucjima Srbije oko Subotice, Vrsca, Beograda, Cuprije, Krusevca i Vranja vlada umerena klima (IH3 = 1994 do 2090), a u podrucjima oko Sapca, Negotina, Nisa. Leskovca i Prizrena vlada umereno - topla klima (IH4 - 2100 - 2196). - U podrucju Podgorice vlada topla klima (IHs = 2568). Na osnovu vrednosti Indeksa suse (IS po Riou) proizilazi da u nasim vinogradarskim podrucjima vladaju sledece klase klima: - U podrucju oko Vrsca, Sapca, Beograda, Cuprije, Krusevca i Leskovca vlada subhumidna klima (ISo ukazuje da u zemljistu ima od 50 do 150 mm pristupacne vlage vise nego sto je neophodno za vinovu lozu), pa nema izrazene suse. Navodnjavanje vinograda nije potrebno. - U podrucjima oko Subotice, Negotina, Nisa, Leskovca i Prizrena vlada klasa klime lSI, umereno suva klima, sa viskom vode u zemljistu 50 mm. odnosno sa manjkom pristupacne vlage u zemljistu do 100 mm. Navodnjavanje vinograda je korisno. - U podrucju Podgorice vlada klasa klime IS2, u kojoj se javlja susa sa manjkom pristupacne vode u zemljistu izmedu 100 i 200 mm, pa je neophodno redovno navodnjavanje vinograda. Na osnovu indeksa svezine noci (IF), koji reprezentuje srednje minimaIne temperature vazduha u septembru, proizilazi da vrednosti IF variraju od 9.8-12.1°C. To znaci, da u svim vinogradarskim podrucjima Srbije vlada klasa klime IF4, u kojoj su noci veoma sveze, sto pogoduje dobrorn sazrevanju grozda, nagornilavanju dovoljnih kolicina bojenih i arornaticnih materija u grozdu, Sarno u podrucju Prizrena, IF3 =12.1, sto znaci da su noci izmedu klase .veoma svezih" i "svezih", koje pogoduju veorna dobrorn sazrevanju grozda, U vinogradarskom podrucju oko Podgorice, IFI = 19.2, sto znaci da su u periodu sazrevanja grozda noci tople, iznad neophodnih temperatura za sazrevanje grozda vecine gajenih sorti vinove loze. Na osnovu klimatskih uslova u vinogradarskirn podrucjima Srbije i Crne Gore, daje se sortna lista internacionalnih i autohtonih vinskih sorti, koje su rejonirane i zauzimaju najznacajnije rnesto u vinogradarstvu nase zemlje

Impacts of climate change on olive crop evapotranspiration and irrigation requirements in the Mediterranean region

none5siThe Mediterranean basin is the largest world area having specific climatic conditions suitable for olive cultivation, which has a great socio-economic importance in the region. However, the Mediterranean might be particularly affected by climate change, which could have extensive impacts on ecosystems and agricultural production. This work focussed on the climate change impact on olive growing in the Mediterranean region considering the possible alterations of cultivable areas, phenological dates, crop evapotranspiration and irrigation requirements. Monthly climate data, with a spatial resolution of 0.25°×0.25° (latitude by longitude), have been derived from Regional Climate Models driven by ECHAM5 for the A1B scenario of the Special Report on Emissions Scenarios (SRES). The data used in the analysis represented two time periods: (i) present, called year 2000 (average values for the period 1991-2010), and (ii) future, called year 2050 (average values for the period 2036-2065). The areas suitable for olive cultivation were determined using the temperature requirements approach known as the Agro Ecological Zoning method. Crop evapotranspiration and irrigation requirements were estimated following the standard procedure described in the FAO Irrigation and Drainage Paper 56. Results showed that the potentially cultivable areas for olive growing are expected to extend northward and at higher altitudes and to increase by 25% in 50 years. The olive flowering is likely to be anticipated by 11±3 days and crop evapotranspiration is expected to increase on average by 8% (51±17mmseason-1). Net irrigation requirements are predicted to increase by 18.5% (70±28mmseason-1), up to 140mm in Southern Spain and some areas of Algeria and Morocco. Differently, effective evapotranspiration of rainfed olives could decrease in most areas due to expected reduction of precipitation and increase of evapotranspirative demand, thus making it not possible to keep rainfed olives' production as it is at presentLazar Tanasijevic;Mladen Todorovic;Luis S. Pereira;Claudia Pizzigalli;Piero LionelloLazar, Tanasijevic; Mladen, Todorovic; Luis S., Pereira; Claudia, Pizzigalli; Lionello, Pier

CORRELATION OF SEVERITY OF ELECTROCARDIOGRAPHIC CHANGES AND TROPONIN LEVEL IN ACUTE CORONARY SYNDROME

The patients with a wide variation of clinical course and subsequent cardiac events risks are classified within acute coronary syndrome (ACS). In order to select an appropriate therapeutic approach, there is a need for precise diagnostics and risk evaluation of future cardiac events, so evaluation should be done early, based on available clinical electrocardiographic and sensitive and specific biomarkers. The aim of the paper was to evaluate cardiac markers values in diagnostics of ACS, especially in the group UAP/NSTEMI, interconnections of ECG markers and cardiac troponin levels as well as their prognostic value.In the examined population there were 333 patients involved. The total follow-up period was three months. Health control check-ups were performed in the 1st and 3rd month since discharge and they involved clinical examination, ECG, establisment of the course of the illness regarding recurrent angina, reinfarction revascularisation or percute interventions, as well as the results. Laboratory analysis involved troponin T and I (TnT, TnI), myoglobin, CK-MB and CK-MB mass. Most of the examined patients belonged to the group NSTEMI, that is 50%. Total number of male patients was 251 or 2/3, female patients 106 or 1/3. Mean age in male patients was 61,86±11,02 years, and in female patients 64,19±10,14 years. Although women were older about 2,33 years, that difference was not statistically significant (p>0,05).Frequency and severity analysis of ST depression showed that most of the patients had ST depression (1mm and 2mm, each 21%), while in the subgroups depression was 3 and 4mm, which was present in 10%, and 5mm in 2,63%. There is a significant correlation between ST depression and positive TnT findings. In all the subgroups of patients with ST depression there was high, statistically significant, troponin level. About 40% of patients with T wave is TnT positive, and in Tnl that relation is more expressed and is up to 50% positive. Out of 220 patients with UAP/NSTEMI without Q-wave on admission, 18 or 8,18% patients developed Q-wave during hospitalisation. In 10 (13,51%) patients presented on admission as NSTEMI, new Q-wave was developed in TnI positive, while in the troponin negative group there were no Q-waves, what is statistically significant.High sensitivity and specificity of troponin for diagnosing acute coronary syndrome, as well as their correlation with the rate of ST depression, changes in T wave and occurrence of new Q-wave was proved. In our research troponin values were especially valuable in making the diagnosis of NSTEMI and in risk stratification

NEW RECOMMENDATIONS FOR APPLYING THE HEPARIN IN ACUTE CORONARY SYNDROMES: A CRITICAL VIEW

The heparin therapy in acute myocardial infarct as well as in unstable anginapectoris is useful though risk-taking. New recommendations presented by competentassociations also included the results of the recent studies; thus, it is expected thatthey would improve the quality of daily work in the coronary unit. The cardiologistare obliged to get to know and to apply adequately the given exact advice as well asthe principles that the recommendations are based upon.Some possible shortcomings of these suggestions are also perceived; theiranalysis can help create an attitude implying that the advice is not to be taken as alaw. We consider it ethically proper to include, as an indispensable part, an explanationof one's own achievements and shortcomings in the recommendations. Thismeans that the doctors dealing with the respective urgent problems will have to takea critical view of the recommendations on the basis of their own knowledge,experience and logic