The psychological impact of developing gestational diabetes mellitus (GDM) has been investigated widely in both children and adults. Although these studies suggest that person who develop GDM is at risk for emotional/ psychological distress, this finding is not universal. The aim of our study was to look at the state of anxiety in the group of pregnant women with well controlled GDM class A1 patients at 36 weeks of gestation and to compare it with the healthy controls at the same gestational age in population of pregnant women in Belgrade, Serbia. The study was carried on in 48 pregnant women with GDM and 80 healthy controls. The anxiety state of the two groups was evaluated with Hamilton Anxiety Scale (HAMA). The incidence rate of anxiety in the pregnant women with GDM were 27.03% (13/48), and in the healthy pregnant women 13.75% (11/80). The incidence rate of anxiety in pregnant women with GDM was higher significantly than control group, and there were significant difference in total score and its factorial score of HAMA in the two groups. The incidence rate of anxiety in the pregnant women with GDM is higher, and anxiety is the dangerous factor of GDM. Psychological state in pregnant woman, especially in pregnant women with GDM must be noticed, and psychological counseling and psychological therapy may be carried on as early as possible.

Cilj rada: utvrđivanje učestalosti uzročnika nekomplikovanih i komplikovanih infekcija urinarnog trakta novorođenčadi rođene u terminu kao i utvrđivanje eventualnih prediktornih faktora povezanih sa prisustvom najčešćih uzročnika u uzorcima urina. Metod: Retrospektivna studija obuhvatila je terminsku novorođenčad hospitalizovanu na Univerzitetskoj dečijoj klinici zbog urinarnih infekcija u periodu od deset godina. Podaci su prikupljeni iz raspoložive medicinske dokumentacije. Rezultati: Od 4261 hospitalizovanih novorođenčadi u periodu od deset godina, 286 (6.7%) primljeno je na odeljenje zbog infekcije urinarnog trakta. Komplikovane urinarne infekcije dijagnostikovane su kod 61 (21.3%) ispitanika a nekomplikovane kod 225 (78.7%). Kao vodeći uzročnici nekomplikovanih infekcija urinarnog trakta među neonatusima izdvojili su se coli (60.8%), Klebsiella (13.3%) i Enterococcus (4.9%). Pomenuta tri uzročnika najčešće su izolovani i u uzorcima urina kod komplikovanih infekcija (Escherishia coli 52.5%, Klebsiella 23.0% i Enterococcus 11.5%). Rezultati su ukazali da je veća starost neonatusa na prijemu povezana sa većom šansom da je uzročnik Escherichia coli (OR=1.06, 95% IP:1.02-1.11), dok su ženski pol i znaci komplikovane urinarne infekcije protektivni faktori (OR=0.27, 95% IP:0.14-0.49, odnosno OR=0.38, 95% IP:0.19 – 0.74). Sa druge strane ženski pol je faktor rizika za razvoj urinarne infekcije izazvane bakterijama Klebsiella (OR=2.75, 95% IP:1.44- 5.26) i Enterococcus (OR=3.05, 955 IP:1.33 – 6.97). Dodatni faktor rizika za infekciju urinarnih puteva novorođenčadi izazvanu Enterococcus je i komplikovanost infekcije (OR=2.61, 95% IP:1.10 – 6.20). Zaključak: Podaci dobijeni u istraživanju mogu biti od koristi pri odluci o izboru antibiotika u ranoj fazi lečenja urinarnih infekcija terminske novorođenčadi. Poželjna su dalja istraživanja o profilu rezistencije vodećih uzročnika urinarnih infekcija novorođenčadi na antibiotike.

Fractures in the level of the ankle are among the most common fractures. A separate entity is associated fractures at the level of the ankle joint with fractures of the lower leg. The aim is to determine what the impact of certain preoperative factors [length preoperative period, the complications of surgical treatment and antibiotics] the length of postoperative hospital stays. This retrospective study included patients were treated surgically with associated fracture of the lower leg and ankle in the Department of Orthopedics and grammatology KBC Zemun between 2003rd by 2011. and were divided into three groups according to the duration of preoperative hospital stay. The length of postoperative hospital stay significantly affect the time to completion of the operation (ρ = 0.405, p <0.01) for the occurrence of complications (ρ = 0.465, p <0.01) and duration of antibiotic use (ρ = 0.580, p <0, 01). The average length of hospital stay in patients with complications was 19 registered (Med 18) days, whereas in patients without complications 10 registered (Med 9) days. There was a statistically significant difference in the length of hospital recovery compared to various complications (log rank = 35.74, DF = 5, p <0, 01). It is these fractures that previously disposed of as such a treatment leads to less frequent complications, a shorter stay in hospital patients and therefore lower costs of the treatment.

There are many authors advocating this surgical procedure in cases where septoplasty alone isn`t efficient enough. We made short prospective study in which we approved joined surgical procedures for improving nasal function. Study was done with 2 groups of patients. In first group of patients (A) septoplasty alone was done, in second (group B) we done partial turbinectomy too. Preoperative there were significant difference in rhinomanometic readings between these two groups, but postoperatively there were not, which lead us to the conclusion that use of this method is justified in cases where turbinate enlargement is significant. In both groups there were significant (p<0, 01) improving in postoperative rhinomanometric results.

Increased number of patients with malignant disease as the cause of death requires a specific concept in the treatment and care those patients. The concept was launched in the UK today is important for patients in the terminal stage by a comprehensive approach to palliative care. Care for these patients is specific with regard of therapy, care and psychological support to patients and their family. Palliative care, effective and quality is reflected in the best possible provided techniques to improve the quality of life in patients in the terminal stage. Marked weakness, difficult movement or immobility, pains, nausea and vomiting, constipation, and decreased food intake of fluids, are just some problems which struggle patients, so that palliative care can be influenced to a greater conforms more dignified person. Patients in the terminal stage with the liver insufficiency and associated complications are the most complex with regard of palliative care. In this paper will demonstrate the principles of palliative care patients suffering from malignant disease in Gastroenterohepatology.

Immunoglobulin A deficiency (IgAD) is the most common form of primary immunodeficiency.

IgAD is characterized by apscence or very low level of serum IgA (<0.7 mg/dL) and normal serum ranges of IgG and IgM. Pathogenesis of IgAD and its molecular and genetic basis is important, knowing that this immunodeficiency is related with epithelial malignancies such as respiratory and gastrointestinal tumors. Aim of this study was to investigate IgAD in patients with gastrointestinal malignancies, as well as to determine potential relation between IgAD and certan type of tumor. The research included 60 patients with confirmed gastrointestinal tumors of various types. For every patient qualitatively were tested levels of serum IgA and anti IgA atibodies, using ID microgel cards (Particle Gel Immuno Assay methods). Levels of serum IgA were also quantitavely tested in reference laboratory. Using Particle Gel Immunoassay method, there was no evidence for decrease of serum IgA or presence of anti-IgA antibodies in our group of patinets. This result was confirmed with quantitative laboratory investigation. This study shows no significant relation between IgAD and gastrointestinal tumors, which is in accordance with actual litarture.

There have only been registered sporadic cases of carcinoma in these patients, which implies that the research should include a larger number of patients.

Also, more detail cognition of molecular and genetic mechanism of IgAD would help in understanding oncogenic effect of this immunodeficiency.

Aneurysm is defined as localized arterial dilatation by at least 50% of normal diameter. Abdominal aortic aneurysm (AAA) affects most often male patients, smokers, older than 65 years, and is considered 13th most common cause of death in the USA. Statistics is not very well developed in Serbia due to poor connection of the medical facilities that deal with this problem. Abdominal aortic aneurysm can be asymptomatic for a long period of time, and often her existence can be diagnosed only when it ruptures, which has a mortality rate of more than 90%. This paper shows a male patient, 83 years old, who is admittedto KBC Zemun with symptoms of weakness, exhaustion and anamnestic information that he had a loss of consciousness carlier that day. By means of physical examination and modern diagnostic tools a ruptured abdominal aortic aneurysm has been diagnosed. The patient has been immediately transferred to an OR where he has been urgently prepared for the operation by two anesthesiologists and then surgery has been performed in general anesthesia by all up-to-date protocols. Postoperative recovery period was satisfactory, and the patient was released from hospital in good general condition.

The importance of this paper is in the fact that there is a need for in-hospital protocols for hospitals that do not routinely work with emergency vascular pathology, in order to improve communication among admission ward and other departments (before others with anesthesia dept.) and quicken the path from diagnostic to operation room, where at this moment a lot of valuable time is lost.

The granuloma is defined as a focal, chronic, mostly mononuclear inflammatory response to present irritants. The Material of the investigation included bronchobiopsy samples taken from 31 TB patients. The histological features of 53 tuberculous granulomas localized in the bronchial structures were determined in the study. The quantity, structure and distribution of the cellular and connective elements in the bronchial structures, as well as in the gra-nuloma, were determined by the quantitative stereome-tric method, using the numerical density as the stereolo-gical variable. The tuberculous granuloma, in the average size of 622x343 microns, was most frequently localized in the internal third of the lamina propria (34% of the ca-ses), at the average distance of 185 microns from the basal membrane. The central part of the granuloma was invaded by epithelioid and giant cells, macrophages, lymp-hocytes, plasma cells and fibroblasts, with the mean numerical density of 84151 mm-3. Lymphocytes were greatest in number, followed by epithelial cells, which were 2.5 times as few as lymphocytes. Giant cells, mostly Langhans in type, were registered in 66% of the granulomas. The mean numerical density of all cells in the peripheral part of the granuloma was 243964 mm-3. The peripheral part of the granuloma was predominantly infiltrated by lymp-hocytes, making 93% of all cellular elements. Caseous necrosis was registered in 13% of the granulomas, and acid resistant bacilli in 11% of the biopsy samples. The mean numerical density of all cells in the central part of the tuberculous granuloma was 84151 mm-3, with predominating lymphocytes and epithelioid cells. The mean numerical density of all cells in the peripheral part of the granulo-ma was 243964 mm-3, with predominating lymphocytes, making 93%. Caseous necrosis and acid-resistant bacilli were registered in every eighth granuloma.

The aim of this paper is to show our results in the treatment of femur neck fractures in patients on hemodialysis. The femur neck fractures are more common in patients on hemodialysis than in patients without chronic renal failure. From the year 2000. to 2012, in the Traumatologic center of the CHC Zemun, 12 patients in terminal renal failure with femur neck fractures, were treated. The postoperative rehabilitation, occurence of complications and survival rates were followed. The operative treatment of femur neck fractures by implantation of endoprosthesis in patients with chronic renal failure, although followed by frequent complications, gives the patient a chance to return to normal activity.

The major goals of this presentation are to give the updated knowledge of primary heart muscle disease, cardiomyopathies (CMP), their classification, the diagnostic possibilities using endomyocardial biopsy (EMB) and to estimate the value of EMB in the choice of the right therapeutic approach. Despite many controversies, EMB is today a widely accepted method, with low percentage of complications for analysing CMPs, and is considered to be a routine procedure in many cardiological centers. Inspite the fact that we started with the use of EMB in 80’s, it is not performed often today in Belgrade, like many yeras ago (2). It’s difficult to say why ? The CMPs may be subdivided, according to the functional and structural features, into two groups: idiopathic and specific, or primary and secundary. Idipathic group is consisted of 5 subgroups: hypertrophic, dilated, restrictive, arrithmogenic right ventricular CMP and unclassified. Specific CMPs may be subdivided into 8 groups mainly based on etiopathogenetic characteristics: infective, with viral myocarditis as the most common entity, metabolic, including endocrine disorders and infiltration and storage diseases. Deficiency disorders and heart involvement in connective tissue disorders are also included. Granulomas, neoplasms and neuromuscular disorders are also wery often presented with cardiac disfunction and structural abnormalities. Sensitivity and toxic reactions with long list of substances wich may affect the heart are probably the most present today. Finally, the last group represent miscellaneous systemic syndromes with heart affection. EMB has been increasingly used in the diagnosis of CMPs, with special influnce on diagnosis of heart transplant rejection, myocarditis, treatment modalities of different types of myocarditis, with low complication rate, considered effective, usefull and safe procedure.