Transcatheter stenting of arterial duct in duct-dependent congenital heart disease

Introduction. Critical congenital heart diseases (CHD) are mostly duct-dependent and require stable systemic-pulmonary communication. In order to maintain patency of the ductus arteriosus (DA), the first line treatment is Prostaglandin E1 and the second step is the surgical creation of aortic-pulmonary shunt. To reduce surgical risk in neonates with the critical CHD, transcatheter stenting of DA can be performed in selected cases. Case Outline. A four-month old infant was diagnosed with the pulmonary artery atresia with ventricular septal defect (PAA/VSD). The left pulmonary artery was perfused from DA, and the right lung through three major aortopulmonary collaterals (MAPCAs). A coronary stent was placed in the long and critically stenotic DA, with final arterial duct diameter of 3.5 mm, and significantly increased blood supply to the left lung. After the procedure, the infant’s status was improved with regard to arterial oxygen saturation, feeding and weight gain. During the follow-up, one year later, aortography revealed in-stent stenosis. The left pulmonary artery, as well as the branches, was well-developed and the decision was made to proceed with further surgical correction. Conclusion. Stenting of DA can be an effective alternative to primary surgical correction in selected patients with duct-dependent CHD

Značaj veličine vegetacionog prostora za zakorovljenost i prinos kukuruza

The arrangement pattern, i.e. shape and size of vegetative space available to growing plants influences crop-weed competitive interaction and weed abundance. Most researches show that growing row crops such as maize, soybean, sunflower etc., with narrow row space, has as a result lower weed infestation and better yield parameters. In this study the effects of the maize vegetative space, which are achieved with combination of different row spaces and spaces between plants in the row, on the weed distribution and fresh matter and some morphological and productive parameters of maize were investigated. The crop density was the same for all arrangement patterns and herbicide application was included with three levels: full and half of the recommended dose and control without herbicide application. In all three years of investigation, the weed fresh matter declined with decreasing row spaces and was, on average, the lowest for the narrower row space and herbicide application at recommended doses (38,6; 12,8 and 351,1 g m-2). In such arrangement pattern of maize plants, significant influence on the fresh matter of D. stramonium, S. nigrum and A. retroflexus, was achieved. Herbicide application at half of the recommended dose also significantly influenced level of weediness compared to untreated control. The size of maize vegetation space significantly influenced grain yield in 2005 and 2006, otherwise, the herbicide application had a significant influence on maize yield in all years. Grain yield did not differ significantly according to LSD-test between treatments with full and half rate of herbicides.Prostorni raspored odnosno oblik i veličina vegetacionog prostora kojim raspolažu gajene biljke značajno utiče na kompeticijske interakcije između useva i korova a time i na zastupljenost korova. Rezultati većine istraživanja su pokazali da gajenje širokoredih useva kao što su kukuruz, soja, suncokret i dr. sa smanjenim međurednim rastojanjem, utiče na smanjenje zakorovljenosti ali i na parametre rodnosti. U radu je ispitivan uticaj veličine vegetacionog prostora koji je ostvaren kombinovanjem međurednog razmaka i razmaka između biljaka u redu u okviru iste gustine, u uslovima primene herbicida u preporučenim i smanjenim količinama, na zastupljenost pojedinih vrsta korova i njihovu biomasu kao i na neke morfološke i produktivne osobine kukuruza. Najmanja ukupna sveža masa korova je u sve tri godine, utvrđena na varijanti sa najmanjim međurednim rastojanjem i primenjenom kombinacijom herbicida izoksaflutol+acetohlor u preporučenoj količini (38,6; 12,8 i 351,1 g m-2). U takvom obliku vegetacionog prostora, značajno je smanjenja sveža masa vrsta D. stramonium, S. nigrum i A. retroflexus. Primena herbicida u polovini preporučene količine takođe je značajno smanjila nivo zakorovljenosti u poređenju sa netretiranom kontrolom. Veličina vegetacionog prostora značajno je uticala na prinos zrna kukuruza u 2005. i 2006. godini, dok je količina primenjenih herbicida vrlo značajno uticala na visinu prinosa u svim godinama. Međusobna poređenja visine prinosa između varijanti sa primenom herbicida u preporučenoj i polovini preporučene količine, na osnovu LSD-testa, nisu pokazale značajne razlike

Anatomski i funkcionalni faktori koji utiču na rezultate klasične hirurške procedure kod bolesnika sa regmatogenom ablacijom retine

Background/Aim. Rhegmatogenous retinal detachment is a potentially blinding condition of the posterior segment of the eye. Currently, the only treatment modality is surgery and surgical options include scleral buckling, pars plana vitrectomy and pneumoretinopexy. Many factors may influence the outcome of the surgery. Well defined indications are essential for achieving the best postoperative results. The aim of this study was to assess anatomical and functional outcome of treatment with scleral buckling for macula-off rhegmatogenous retinal detachments. Methods. This prospective, nonrandomized, interventional study included consecutive patients underwent scleral buckling for macula-off retinal detachment in the tertiary centre for vitreoretinal surgery. Results. A total of 168 consecutive patients (mean age 58.2 ± 13.9 years) were included in the study. Postoperatively, anatomical success was achieved in 152 (90.5%) of the patients. Parameters that influenced the anatomical success included the number of retinal breaks (p = 0.040), lens status (p = 0.041), preoperative proliferative vitreoretinopathy (p lt 0.001), patients' age (p = 0.049), and marginally, the presence of typical symptoms (p = 0.057). Duration of macular detachment, previous ocular trauma and refraction of the eye did not affect the anatomical result. Functional success was evaluated using the postoperative visual acuity and depended mainly on the duration of macular detachment prior the surgery. Visual acuity 0.4 or better was significantly more often achieved if duration of macular detachment was up to seven days (p lt 0.001). Refraction and patients' age did not influence the functional result. Conclusion. Scleral buckling is an efficient surgical procedure for treatment of patients with retinal detachment. Optimal results are achieved if operation is performed within the first seven days of duration of macular detachment.Uvod/Cilj. Regmatogena ablacija retine je oboljenje zadnjeg segmenta oka koje, ako se ne leči, može dovesti do slepila. Trenutno, jedini način lečenja je hirurški i opcije su klasična metoda (scleral buckling), pars plana vitrektomija i pneumoretinopeksija. Mnogi faktori mogu uticati na ishod operacije. Jasno definisane hirurške indikacije su ključne za postizanje dobrih postoperativnih rezultata. Cilj ove studije bio je da se procene faktori koji utiču na anatomski i funkcionalni ishod lečenja klasičnom metodom lečenja bolesnika sa regmatogenom ablacijom retine sa zahvaćenom makulom. Metode. U prospektivnu, nerandomizovanu, interventnu studiju bili su uključeni svi bolesnici operisani klasičnom metodom zbog ablacije retine sa zahvaćenom makulom, u tercijarnom centru za vitreoretinalnu hirurgiju. Rezultati. Ukupno 168 bolesnika (starosti 58,2 ± 13,9 godina) bilo je uključeno u studiju. Postoperativno, anatomski uspeh postignut je kod 152 (90,5%) bolesnika. Parametri koji su uticali na anatomski uspeh operacije bili: su broj ruptura retine (p = 0,040), status sočiva (p = 0,041), preoperativno prisustvo proliferativne vitreoretmopatije (p lt 0,001), starost (p = 0,049) i, granično, prisustvo tipičnih simptoma (p = 0,057). Dužina odvojenosti makule, ranije povrede oka i refrakcija oka nisu uticali na anatomski rezultat. Funkcionalni uspeh procenjivan je na osnovu postoperativne vidne oštrine i zavisio je uglavnom od preoperativne dužine trajanja odvojenosti makule. Vidnaoštrina 0,4 ili bolja bila je značajno češće postignuta ako je dužina trajanja odvojenosti makule bila do sedam dana (p lt 0,001). Refrakcija oka i životno doba bolesnika nisu uticali na funkcionalni ishod operacije. Zaključak. Klasična metoda scleral buckling je efikasna hirurška procedura za nekomplikovane slučajeve ablacije retine. Kada je makula zahvaćena, najbolji rezultati postižu se operacijom u toku prvih sedam dana od početka simptoma

CHANGE OF ECG PARAMETERS DEPENDING ON THE LOAD LEVEL IN ATHLETES

The influence of physical training on bodies of athletes leads to changes that can be characterized as morphological, functional, electrophysiological and psychological. Dynamic exercise, such as running, swimming and riding a bicycle, leads to volume load of heart. Static exercise (gymnastics, weightlifting, wrestling) leads to the development of relatively large muscle force, with or without changes in muscle length and movement of the joint. Given the frequent number of sudden cardiac death cases in sport, it is important to distinguish between changes of the heart that occur as a result of adaptation to physical activity and changes due to some pathological conditions. The aim of this paper is to present the latest information on changes in ECG parameters depending on the load of athletes while performing aerobic trainings in order to better identify markers of adverse cardiovascular events, particularly sudden death in athletes. It is common to see on the ECG of athletes at rest hypertrophy of the left and right ventricle, interventricular conduction disorder, positive ST changes, and short-term tachycardia. Changes that occur in athletes are due to increased vagal tone and suppression of sympathetic nerve regulation. Many changes can be attributed to intrinsic cardiac component that is responsible for the lower frequency of athlete's heart deinnervation (with atropine or propranolol), which means that intense training influences how the autonomic regulation and the intrisic cardiac pacemaker function. It is common for athletes to have sinus bradycardia, sinus arrhythmia, first degree AV block and Mobitz I, as well as junctional rhythm, ST segment elevation, high and sharp, or biphasic T-waves, while ST depression or isolated T-wave inversion are less common. They can also have increased amplitude of P-wave and QRS complex, QRS axis rotation to the right and incomplete right branch block. Some but insufficient data tell about the presence of the third-degree AV block and atrial and ventricular ectopic beats and their predictive role for malignant rhythm disorders

Successful surgical closure of an aortopulmonary window associated with Holt-Oram syndrome in adulthood

Introduction. Aortopulmonary window (APW) is a rare congenital anomaly caused by incomplete division of the embryonic common arterial trunk which allows direct and usually unobstructed communication between the ascending aorta and pulmonary artery trunk. Holt-Oram syndrome (HOS) is an autosomal dominant disorder caused by the mutation in the TBX5 gene and it is characterized by bones abnormalities in at least one limb while the association with APW is extremely rare. Case report. We report a case of a female patient in her thirties with an extremely rare combination of the HOS and APW window that reached the adulthood without surgical correction. The adult patient came to our clinic with signs of severe heart failure and pulmonary hypertension. Although previously diagnosed as inoperable, after the decongestive medical treatment and detailed diagnostic procedures we proved reactive pulmonary vascular resistance and the patient was successfully surgically treated. Conclusion. This case confirms the absolute necessity of cautious and comprehensive examinations of each patient with congenital heart disease and pulmonary hypertension irrespective of age

The thickness of the retrobulbar portion of the optic nerve in Graves ophthalmopathy measured by ultrasound

Introduction. The clinical diagnostic of Graves ophthalmopathy is based on the association of ocular signs and the disease of the thyroid gland. The evolution of the disease involves the development of eye globe protrusion, extraocular muscle thickening pressuring the optic nerve, which can result in its thickness. Objective. The aim of the paper is to find whether the retrobulbar optic nerve thickened and if there was a correlation between its possible thickening and the thickness of the muscles in Graves ophthalmopathy. We also wished to test the theory of compressive aetiology of such thickening using a 30-degree test. Methods. We examined 28 patients with Graves ophthalmopathy. The thickness of the retrobulbar optic nerve was measured by ultrasound on a B-scan using the Schraeder's method and by the largest thickness of the internal muscle. Results. The thickness of the retrobulbar portion of the optic nerve in the 52 analyzed eyes with signs of the disease ranged between 3.24 mm to 6.30 mm, with median of 5.13 mm, indicating that the majority of the patients had optic nerve thickening rating at this value. Forty-eight eyes had a marked retrobulbar optic nerve thickening, with the thickening over 4 mm, while in 4 eyes with signs of Graves ophthalmopathy the thickness of the optic nerve was within normal limits. We detected that 92.3% of the patients with muscular thickening also had a directly proportional thickening of the retrobulbar optic nerve. By using the 30-degree test we confirmed the diagnosis of compressive neuropathy. Conclusion. Patients with Graves ophthalmopathy and thickened muscles, also have a thickening of the retrobulbar optic nerve; the rate of the thickness directly depends on the degree of the muscular thickness. The word is of compressive neuropathy, i.e. the thickness of the optic nerve is the result of subarachnoid fluid stasis caused by the compression on the optic nerve

Terson’s syndrome: A report of two cases

Introduction. Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage is known as Terson’s syndrome. In Terson’s syndrome, intracranial hemorrhages are followed by intraocular hemorrhage, classically in the subhyaloid space, but may also include subretinal, retinal, preretinal, and vitreal collections. Vitreous hemorrhage recovery is usually spontaneous in six to 12 months, otherwise vitrectomy is considered. Outline of Cases. We report of two cases of Terson’s syndrome. The first was in a hypertensive middleaged female, following anterior communicating artery aneurismal subarachnoid hemorrhage, after postneurosurgical interventions. The second case report was of a young male who suffered from the bilateral vitreous hemorrhage after a severe traumatic brain injury. Conclusion. Terson’s syndrome should be considered in patients who had previous cerebral hemorrhage and are referred to eye specialist because of loss of vision. However, this phenomenon has only rarely been described in association with subdural and epidural hematomas or traumatic subarachnoid hemorrhage

Toxic elements in eggs and egg-based products: occurrence, exposure assessment and risk characterisation for the Serbian population

This study aimed to assess the exposure of the Serbian adult population to As, Cd, Pb and Hg through the consumption of eggs and egg-based products and to assess health risks. Coccidiostat residues were also examined, and their contribution to acceptable daily intake was calculated. Egg samples were collected from 2018 to 2020. The consumption survey was conducted during 2020. A Monte Carlo simulation was performed to estimate the intake of toxic elements based on one-day and seven-day recalls of egg consumption. The results obtained showed that the adult population in Serbia is not exposed to health risks from the studied toxic elements when consuming eggs and egg-based products. The presence of anticoccidial agents was detected in 22% of egg samples at concentrations above the limits prescribed by current regulations in Serbia (which do not allow detectable levels of coccidiostats in eggs), with the main risk of exposure being to coccidiostat residues associated with maduramycin

Pars plana vitrectomy with extraction of intraocular foreign body in patients with siderosis of the eye: Report of two cases

Introduction. Penetrating injury is characterized by the existence of entry wound only, and it can be with or without an intraocular foreign body (IOFB). IOFB can lead to a mechanical injury of the eye and to cause infection or to manifest other toxic effects on intraocular structures. Iron and copper can dissolve and cause siderosis, i.e. chalcosis of the eye. Ocular siderosis is diagnosed by clinical and electroretinogram (ERG) findings. Outline of Cases. The first patient was a 37­year­old male who was injured by a metal foreign body. He presented at the Clinic two years after the injury. Visual acuity of the right eye (VOD) on admission was VOD=L+P+ (light projection). Pars plana phacovitrectomy with IOFB extraction was done. Visual acuity on discharge was VOD=3/60 cc + 7.50 Dsph=0.2. The second patient was a 55­year­old male who presented at the clinic 18 months after injury. On admission visual acuity in his left eye was VOS 1/60. Pars plana phacovitrectomy with IOFB extraction was done. Visual acuity on discharge was VOS=0.7 through the stenopeic slit. Conclusion. In penetrating injuries caused by a metal IOFB pars plana vitrectomy with IOFB extraction is indicated. In cases with IOFB, when visual acuity is preserved, the lens is transparent, while the eye is without signs of infection, urgent pars plana vitrectomy is not necessary. Such patients need regular follow­up with obligatory ERG findings

Treatment of infantile tibia vara - 18-year follow-up: A case report

Introduction. Blount disease is developmental disorder of the lower leg, manifested by multiplanar deformity. Surgical treatment includes corrective osteotomy, lateral hemiepiphisyodesis, distraction of the proximal tibial physis, physeal bar resection and elevation of the medial tibial plateau. Case Outline. A case of a 4-year-old girl with bow legs is presented. Condition was recognized as Blount disease, type five. Both lower legs were operated by medial methaphyseal semi-osteotomy of the proximal tibia with the elevation of the medial tibial plateau. Prospectively, bilateral proximal hemiepiphysiodesis was done. Total follow-up period was eighteen years. The patient has no disturbances, clinical and radiographic findings are excellent. Improvement of the femoro-tibial angle is 22° on the right side, and 21° on the left side. Improvement of the varus angle is 7° on the right side, and 27° on the left side. Medial plateau depression is completely bilaterally reduced; improvement on the right side is 46°, and 51° on the left side. Conclusion. It is known today that multiplanar deformity is a part of the disease; varus, antecurvatum and internal rotation of the lower leg. By elevation of the medial plateau varus of the lower and antecurvatum component of deformity can be solved, while internal torsion cannot be solved. This deformity has to be either skillfully neglected, or corrected by an additional osteotomy by the elevation of the medial tibial plateau. Lateral hemiepiphysiodesis serves as extra stabilisator of the achieved result, and it is recommended to be done in combination with surgical elevation of the medial tibial plateau and derotative corrective osteotomy of the tibia. [Projekat Ministarstva nauke Republike Srbije, br. 41004