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1.  Relationship of hemoxygenase-1 and prolidase enzyme activity with oxidative stress in papillary thyroid cancer 
Hippokratia  2016;20(1):55-59.
Aim: Recent studies associate thyroid cancer with oxidative stress. We aim to clarify the relation between papillary thyroid cancer, oxidative stress, hemoxygenase-1, prolidase enzymes and investigate the availability of these enzymes as markers for diagnosis, success of treatment, and follow-up.
Methods: Thirty-one patients with papillary thyroid carcinoma and 25 healthy control subjects were included in this study. Hemoxygenase-1, prolidase (oxidant stress indicator), malondialdehyde, protein carbonyl, and superoxide dismutase (an indicator of antioxidant defense system) were measured pre-operatively and 30 days after thyroidectomy.
Results: There was a significant decrease in serum levels of malondialdehyde and superoxide dismutase (p <0.001 for both) after thyroidectomy in papillary thyroid carcinoma group. In addition, there was a significant difference in the postoperative serum levels of prolidase, malondialdehyde, protein carbonyl, and superoxide dismutase between papillary thyroid carcinoma and control groups (p =0.024, p <0.001, p =0.002, and p =0.016, respectively) beside significant difference of malondialdehyde, protein carbonyl, hemoxygenase-1, and superoxide dismutase pre-operative serum levels (p <0.001, p =0.003, p =0.006, and p =0.025, respectively).
Conclusion: When the unquestionable role of oxidative stress in the pathogenesis of cancer is considered, in the future it is expected to associate parametric changes in the serum of patients caused by oxidative stress to papillary thyroid cancer. Hippokratia 2016, 20(1): 55-59
PMCID: PMC5074399  PMID: 27895444
Thyroid cancer; antioxidants; superoxide dismutase; malondialdehyde; protein carbonyl
2.  Isotretinoin increased carotid intima-media thickness in acne patients 
Hippokratia  2016;20(1):14-18.
Background: Isotretinoin (Iso) in acne treatment may cause dyslipidemia and increase in liver enzymes. Moreover, its effect on lipid and glucose metabolism may induce atherosclerotic complications. The aim of this study was to evaluate carotid intima-media thickness (CIMT), osteopontin (OPN), lipid, high sensitive C-reaktive protein (hs-CRP) levels, and insulin resistance (HOMA-IR) in acne patients before and after Iso treatment.
Materials: Twenty-one acne patients were treated with Iso (0.5-0.8 mg/kg) for four months. Blood tests for lipid profile, fasting glucose, liver enzymes, OPN, HOMA-IR, hs-CRP and CIMT measurements were performed before and after Iso treatment. Serum levels of OPN and, hs-CRP were measured by ELISA and particle-enhanced turbidimetric immunoassay respectively.
Results: Iso treatment significantly increased lipid levels, CIMT (0.60-0.74 mm; p ˂0.001); whereas it non-significantly increased HOMA-IR (0.91-1.87; p =0.70), OPN (4.32-5.44 ng/ml; p =0.27), and hs-CRP (0.08-0.09 mg/dl; p =0.88) levels. There was no correlation between OPN and CIMT (p =0.77).
Conclusion: Isotretinoin treatment for four months significantly increased CIMT in acne patients. Hippokratia 2016, 20(1): 14-18
PMCID: PMC5074391  PMID: 27895437
Isotretinoin; osteopontin; carotid intima-media thickness; homeostasis model assessment of insulin resistance
3.  The quality of death certification practice in Greece 
Hippokratia  2016;20(1):19-25.
Background: Death certification represents an excellent source for mortality statistics and appropriate public health surveillance. Errors in reporting the cause of death impede the development of national health policies and, accordingly, allocation of resources. The aim of this study was to determine the frequency of errors in the cause of death and to identify factors that may be associated with inaccuracies in death certificates.
Methods: A cross-sectional study of all natural death certifications in a defined Greek region was conducted over the period 2006-2010. Specific criteria for major and minor errors were adopted for the evaluation of death certificates.
Results: A total of 5,828 death certificates due to natural causes were identified. Major errors were found in 64.6 % of them with almost every death certificate having a minor error. Major error rate did not differ per year (p =0.65). Most commonly encountered major errors were a non-acceptable cause of death (31.2 %) and an incorrect sequencing (16.8 %). Factors affecting their frequency were the age of the deceased (older than 80 years, p =0.025), the area of certificate completion (rural and semi-urban, p <0.001) and doctor’s grade (consultant, p <0.026).
Conclusions: High rate of recording errors at death certification influences the accuracy of the cause of death in a defined region in Southern Greece. Due to their impact on mortality statistics and health policies, standard practices of death certification should be established. Coordinated educational interventions are expected to play a significant role on this. Hippokratia 2016, 20(1): 19-25
PMCID: PMC5074392  PMID: 27895438
Death certificate; errors; mortality; public health; health policy
4.  Comparison of two different molecular weight intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis 
Hippokratia  2016;20(1):26-31.
Background: Knee osteoarthritis (OA) is an incurable joint disorder, representing a major public health issue. Among options for symptom control, viscosupplementation with hyaluronic acid (HA) had established usefulness in pain and function improvement of the knee. However, it is not clear which form of HA yields better results.
Material and Methods:We compared two HA preparations with high (HMW) or low molecular weight (LMW) in terms of pain control and function improvement using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analog scale (VAS) score in patients with knee OA. During 2013, 80 patients were enrolled in this prospective, double-blind, randomized study. Each patient received a weekly injection of either preparation with a total of five injections for the LMW group and three for the HMW group. They were evaluated at baseline, five weeks, three months and one year after treatment.
Results: In both groups, HA treatment resulted in significant improvement in pain and function that begun immediately after treatment and lasted for one year. However when compared with each other, HMW and LMW groups were comparable in mean WOMAC, and VAS score at each time point. Neither preparation can interrupt disease progression as radiological findings remained constant during follow-up.
Conclusions: Intra-articular injections using HMW or LMW HA can improve stiffness, joint function and pain in patients suffering from knee OA. However, no clear benefit seems to exist between the two preparations and neither can slow disease progression. Hippokratia 2016, 20(1): 26-31
PMCID: PMC5074393  PMID: 27895439
Knee osteoarthritis; high molecular weight hyaluronic acid; low molecular weight hyaluronic acid; viscosupplementation
5.  Is there a direct correlation between the duration and the treatment of type 2 diabetes mellitus and hearing loss? 
Hippokratia  2016;20(1):32-37.
Aim: The aim of the study was to determine the impact of the duration of diabetes and the control of glycemia on the auditory function of patients with type 2 diabetes mellitus (T2DM).
Materials and Methods: This prospective study included 80 patients with T2DM (divided depending on when T2DM was diagnosed, and also according to the control of glycemia), and 50 healthy subjects.
Results: The hearing threshold in T2DM patients was statistically significantly higher for 1,000 Hz, 2,000 Hz, 4,000 Hz and 8,000 Hz. Absolute latencies of brainstem auditory evoked potentials (BAEP) revealed significant differences between average absolute latencies for waves I, III and V, as well as inter-wave latencies I‒V and I‒III (p <0.001). A statistically significant difference was noted in the presence of transitory otoacoustic emissions (TEOAE) (p <0.001). In T2DM patients with poor glycemic control, where the glycated hemoglobin (HbA1c) is above 7%, the hearing threshold levels were statistically significantly higher in both ears at 8,000 Hz and at 2,000 Hz in the right ear, and the absolute latency of wave V was prolonged in the right ear. There was no evidence that the duration of diabetes significantly affected the auditory threshold, absolute and inter-wave BAEP latencies.
Conclusion: The patients with T2DM displayed an increased hearing threshold, qualitative changes in BAEP and the absence of TEOAE. The duration of poorly-controlled glycemia had a greater effect on the patients’ auditory function than the duration of T2DM. Hippokratia 2016, 20(1): 32-37
PMCID: PMC5074394  PMID: 27895440
Type 2 diabetes mellitus; pure tone audiometry; transitory otoacoustic emissions; brainstem auditory evoked potentials
6.  A retrospective analysis of postoperative patients admitted to the intensive care unit 
Hippokratia  2016;20(1):38-43.
Background: The aim of this retrospective study was to evaluate postoperative patients admitted to the intensive care unit (ICU) and to describe their characteristics and outcomes.
Methods: We performed a retrospective chart review of 1,756 postoperative patients admitted to the ICU of a tertiary referral hospital from January 2008 to December 2012. For each patient we recorded: demographic data, reason for admission to the ICU, duration of mechanical ventilation, elective versus emergency surgery, type of anaesthesia, American Society of Anesthesiologists (ASA) physical status, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score (GCS), and outcome.
Results: During the study period, the rate of postoperative ICU admission increased each year, and the number of ICU beds was increased in order to perform a greater number of elective surgical procedures for patients who required postoperative ICU care. In 2008, 20.80 % of the patients were postoperatively admitted to the ICU; 58.97 % were in 2012. The mean ratio of five years was 46.97 %. Median age was 63 (1-94) years, and 57.4 % of the patients were male. The most common reasons for admission were major surgery (41.90 %) and comorbidities (34.10 %). Mortality rates were higher in patients that underwent emergency surgery, received general anesthesia, were operated on by a general surgeon, or had low GCS scores coupled with high ASA or APACHE II scores.
Conclusions: The postoperative patients who had metabolic or hemodynamic instability, high ASA or APACHE II scores, and low GCS had higher mortality rates despite ICU care. Hippokratia 2016, 20(1): 38-43
PMCID: PMC5074395  PMID: 27895441
Surgical intensive care; postoperative care; critical care; postoperative complications
7.  Optimal MRI interval for detection of asymptomatic recurrence in surgically treated early cervical cancer by use of a mathematical model 
Hippokratia  2016;20(1):4-8.
Introduction: Applications of mathematical modeling may provide an insight into the timing of surveillance modalities. We aimed to determine the optimal magnetic resonance imaging (MRI) interval for the detection of surgically treated early cervical cancer asymptomatic recurrence by using a mathematical model for volumetric tumor growth time.
Methods: We assumed that tumor volume increases by a factor equal to the basis of natural logarithms (e~2.718) at constant time intervals. Using a mathematical formula, the tumor volume (V) was converted to diameter (D), which could be expressed as a function of time (t), given an initial diameter Di (corresponding to initial volume Vi) and a constant DT, where DT is the time required for volumetric tumor growth by a factor (e). Three different DTs were used for demonstration of the model, i.e. 20, 100 and 400 days.
Results: Assuming complete surgical clearance, a worst-case scenario for a 20-day DT indicated that a 20 μm cervical tumor would need at least 12 months to reach 10 mm in diameter, which would be detected with an annual surveillance interval MRI. Over a 5-year (60 months) follow-up, nearly five surveillance MRIs would be required if the threshold of 10 mm was desired. For a 100-day DT over a 5-year (60 months) follow-up, a single only MRI would be required, if the threshold of 10 mm was desired. In the case of an indolent tumor (DT is 400 days), the model would not recommend a surveillance MRI to detect asymptomatic recurrence. A positive linear association between optimal MRI intervals and volumetric tumor DTs was demonstrated.
Conclusion: In the absence of evidence, we postulate annual MRI scanning is probably the shortest interval, which can be clinically useful for optimization of routine surveillance follow-up protocols in surgically treated early cervical cancer. This mathematical model requires proper verification in prospective clinical studies. Hippokratia 2016, 20(1): 4-8
PMCID: PMC5074396  PMID: 27895435
Cervical cancer; mathematical model; optimal MRI interval; tumor growth
8.  Translation of the Medical Fear Survey to Serbian: psychometric properties 
Hippokratia  2016;20(1):44-49.
Background: Medical Fear Survey (MFS) is an instrument designed for measuring fear of medical and related treatments.
Objective: Aim of the present study was MFS translation into Serbian, measurement of its psychometric properties and MFS validation using other Blood-injury-injections and related stimuli instruments that have been translated from English into Serbian.
Method: After obtaining permission from the author of the original MFS, double forward translation from English to Serbian and backward translation to English were conducted in ten steps, according to International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Reliability, factorial analysis and concurrent validation of Serbian version of MFS were conducted on a sample of 485 medical or pharmacy students at University of Kragujevac, Serbia.
Results: Serbian version of MFS showed high internal consistency with a Cronbach’s alpha 0.968 and good temporal stability after testing-and-retesting (Spearman’s correlation coefficient 0.838, and intraclass correlation coefficient 0.877). Factorial analysis confirmed the same five factors demonstrated in the original English version: fear of mutilated bodies (10 items), fear of blood (11 items), fear of injections and blood draws (9 items), fear of sharp objects (10 items), and fear of medical examinations and physical symptoms (10 items). The total score of MFS correlated significantly with the total scores of Injection Phobia Scale-Anxiety (Spearman’s correlation coefficient 0.391, p <0.001), Blood/Injection Fear Scale (Spearman’s correlation coefficient 0.502, p <0.001) and Medical Avoidance Survey (Spearman’s correlation coefficient 0.396, p <0.001).
Conclusions: Serbian version of the 50-item MFS showed similar psychometric properties as the original English version of this scale, with the same factorial structure. It could be used for measurement of fear of medical and related treatments in Serbian socio-cultural milieu, preferably self-administered. Hippokratia 2016, 20(1): 44-49
PMCID: PMC5074397  PMID: 27895442
Medical Fear Survey; translation; transcultural validation; Serbian
9.  The validation and inter-rater reliability of the Serbian translation of the Richmond agitation and sedation scale in post anesthesia care unit patients 
Hippokratia  2016;20(1):50-54.
Background: Targeted light sedation is recommended because it shortens the time of mechanical ventilation and the length of stay in an intensive care unit (ICU). However, there is no validated scale for sedation and agitation in ICU in the Serbian speaking area. The aim of the current study was to validate, verify the reliability and enable the application of the Richmond Agitation and Sedation Scale (RASS) in the Serbian speaking area.
Methods: In this prospective cohort study, RASS was applied to 301 adult patients hospitalized in surgical ICUs by two different research team members. We tested RASS for inter-rater reliability by the correlation between them. The scale was validated by comparison to Glasgow Coma Scale (GCS) scores which was applied by the third investigator. Interrater agreement was measured using weighted kappa (k) and for correlation Spearman’s test was used.
Results: The inter-rater reliability of the scale was high (k ˃0.7). The degree of correlation between the RASS and the GCS during all five days of observation was high (˃0.7 for both investigators, the fifth day). In all the cases, Spearman’s correlation coefficient was highly significant (p ˂0.01).
Conclusions: The Serbian translation of the RASS is a reliable and valid instrument for the assessment of the levels of sedation and agitation with patients in ICU. Hippokratia 2016, 20(1): 50-54
PMCID: PMC5074398  PMID: 27895443
Richmond Agitation and Sedation Scale; intensive care unit; inter-rater reliability; validity
10.  Amblyopic-related frontal changes in an orientation discrimination task: a research of P3a event-related potentials in anisometropic amblyopia 
Hippokratia  2016;20(1):60-66.
Background: Amblyopic deficits in the primary and secondary visual cortex have been demonstrated broadly. However, the cognitive process at late stage originating in higher brain area in amblyopes hasn’t been studied yet. The aim of this study was to investigate the late cognitive process at the frontal lobe in anisometropic amblyopes of a distinct degree, using visual event-related potential (ERP) techniques.
Methods: Thirteen severe anisometropic amblyopes, 14 mild-to-moderate anisometropic amblyopes, and 13 control subjects participated in this study. Oddball paradigm (three stimuli: target, novel, and non-target stimuli) of low spatial frequency (1 cycle per degree, CPD) was used to elicit brain ERP waves. Reaction time, accuracy, latency, and amplitude of P3a waves evoked by novel stimuli at Fz electrode (the central electrode at frontal lobe), were analyzed statistically.
Results: Neither accuracy nor reaction time showed significant difference among the three groups. The latency of N200 wave showed no significant difference. The latency of P3a wave was delayed in the amblyopes compared with healthy controls, but there was no significant difference between severe and mild-to-moderate amblyopes. P3a amplitude in mild-to-moderate amblyopes was significantly higher than in controls and severe amblyopes.
Conclusions: Our findings indicated that the cognitive process in anisometropic amblyopes was impaired, and the compensative effect of P3a amplitude was shown in mild-to-moderate amblyopes. P3a visual ERP could become a useful tool to investigate cognitive processing in amblyopes. Hippokratia 2016, 20(1): 60-66
PMCID: PMC5074400  PMID: 27895445
Anisometropic amblyopia; event-related potentials; P3a; Gabor patches; latency; amplitude
11.  A case of fatal sepsis due to multidrug-resistant Corynebacterium striatum 
Hippokratia  2016;20(1):67-69.
Background: Although non-diphtheria corynebacteria have traditionally been regarded as avirulent members of human bacterial flora, their pathogenic potential is increasingly recognized in our time. Reasons for this include the prolonged survival of severely ill and immunocompromised patients, the development of more invasive diagnostic and therapeutic procedures and the sub-optimal use of antibiotics that disrupts normal microbial balance and favors superinfections.
Case Report: We present a rare case of sepsis due to multidrug-resistant Corynebacterium striatum in a 76-year-old host. The patient suffered from myelodysplastic syndrome and was on corticosteroid treatment due to atopic dermatitis. He had, also, a recent hospital admission and received a course of broad-spectrum antibiotics due to lower respiratory infection. The patient responded neither to empiric nor to targeted treatment and finally succumbed.
Conclusion: Diphtheroids are emerging pathogens capable of causing severe opportunistic infections. Their multidrugresistant nature renders treatment problematic and poses a threat to the currently established antimicrobial stewardship programs. Hippokratia 2016, 20(1): 67-69
PMCID: PMC5074401  PMID: 27895446
Corynebacterium striatum; sepsis; opportunistic infection; multidrug-resistant
12.  Intrauterine device migration to the urinary bladder causing sexual dysfunction: a case report 
Hippokratia  2016;20(1):70-72.
Background: Intravesical migration represents an uncommon complication of intrauterine device (IUD) insertion. We present the case of an IUD that migrated to the urinary bladder, causing significant sexual complaints.
Case report: A 38-year-old woman presented with complaints of gradually evolving dyspareunia and recurrent urinary tract infections during the past 12 months. She reported an IUD insertion 18 months before. Further detailed evaluation revealed disorders in all sexual domains. Imaging and cystoscopy detected the presence of IUD in the urinary bladder. Under anesthesia, the IUD was removed out of the bladder without any complications. In her follow-up evaluation after six months, her sexual function was significantly improved and she had no urinary symptoms.
Conclusion: Sexual difficulties in a woman with an IUD should raise the suspicion of device dislodgement or dislocation. Hippokratia 2016, 20(1): 70-72
PMCID: PMC5074402  PMID: 27895447
Intrauterine device; IUD; migration; dislodgement; dislocation; female; sexual dysfunction; dyspareunia
13.  Neonatal acute kidney injury following Valsartan exposure in utero: report of two cases 
Hippokratia  2016;20(1):73-75.
Background: Maternal sartan intake during pregnancy has been associated with several fetal/neonatal complications related to disturbed renal development.
Description of cases: We present two cases of neonatal acute kidney injury (AKI) following valsartan administration during pregnancy and provide evidence for the use of novel AKI biomarkers in these neonates. The first case was a female neonate, delivered at 32+4 weeks of gestation after maternal valsartan intake from 24 to 32 gestational weeks. In the second case, ultrasound examination revealed a growth-restricted fetus with severe oligohydramnios following maternal valsartan intake during the first 29 gestational weeks. In the absence of any improvement in amniotic fluid, the neonate was born at 31+5 weeks. In both cases, AKI was documented after birth, but renal function progressively recovered. Urine cystatin-C and neutrophil gelatinase-associated lipocalin were found abnormally increased during the first week of life.
Conclusion: Sartan use during pregnancy is associated with the development of neonatal AKI. Novel urine biomarkers may be used to document renal injury. Hippokratia 2016, 20(1): 73-75
PMCID: PMC5074403  PMID: 27895448
Valsartan; pregnancy; neonate; cystatin-C; neutrophil gelatinase-associated lipocalin
14.  CADASIL presenting with spontaneous intracerebral hemorrhage: report of a case and description of the first family in Northern Greece 
Hippokratia  2016;20(1):76-79.
Introduction: CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), the most common inherited cause of stroke and dementia in adults, has been described in six Greek families. Common presenting manifestations include migraine with aura, brain ischemia, mood disorders and cognitive decline. Spontaneous intracerebral hemorrhage (SICH) rarely occurs in CADASIL and only exceptionally as the first clinical manifestation.
Case description: We have previously reported the sixth Greek family with CADASIL and in particular, two brothers in whom the genetic testing documented a classic mutation of the NOTCH3 gene (Arg169Cys). In this report, we describe the 30-year-old son of the second brother, who suffered a thalamic SICH as the presenting manifestation of CADASIL, in the absence of arterial hypertension or antiplatelet drug use.
Conclusion: Patients with acute subcortical infarcts, leukoencephalopathy, a history of migraine, mood disorders, and dementia, should always raise the suspicion of CADASIL. However, a SICH, even in the absence of classical risk factors for hemorrhage, is possible and should not exclude the diagnosis of CADACIL. Hippokratia 2016, 20(1): 76-79
PMCID: PMC5074404  PMID: 27895449
CADASIL; NOTCH3 gene; intracerebral hemorrhage
15.  Dermatofibrosarcoma protuberans: a case report and review of the literature 
Hippokratia  2016;20(1):80-83.
Background: Dermatofibrosarcoma protuberans (DFSP) represents less than 0.1% of all tumors, but it is considered the most common skin sarcoma. Wide local excision (=5 cm) has been largely replaced by Mohs micrographic surgery; however, recurrence is not rare.
Description of the case: A 35-year-old man presented with a large tumor on the upper side of his back and underwent local excision with the possible preoperative diagnosis of lipoma. Upon histological examination, the diagnosis of DFSP was made, and the patient underwent wide local excision with skin flap reconstruction and was referred for adjuvant radiotherapy.On twenty months follow-up, no recurrence has been observed.
Conclusion: DFSP is the most common cutaneous sarcoma. It originates in the dermis and tends to infiltrate underlying structures, including muscles, tendons, fascia and bone. In our case, the tumor was confined to the skin and subcutaneous tissue, however, our patient underwent adjuvant radiotherapy to avoid a possible relapse that would infiltrate deeper structures. Long-term follow-up is strongly recommended. Hippokratia 2016, 20(1): 80-83
PMCID: PMC5074405  PMID: 27895450
Dermatofibrosarcoma; local excision; flap reconstruction; adjuvant radiotherapy; recurrence
16.  Non-cardiogenic pulmonary edema, rhabdomyolysis and myocardial injury following heroin inhalation: a case report 
Hippokratia  2016;20(1):84-87.
Background: Heroin use by non-injecting routes of administration (snorting, swallowing, “chasing the dragon”) is considered to be safer but is not risk-free for fatal overdose or serious side effects. We report the case of an adolescent who was transferred unconscious to the emergency department after heroin inhalation.
Description of the case: A 17-year-old male was transferred to the emergency department unconscious (Glasgow coma scale: 6/15) after heroin inhalation. He was treated with non-rebreather mask and intravenous infusion of naloxone with gradual improvement of consciousness and arterial blood gasses. The chest computed tomography showed signs of acute respiratory distress syndrome. Laboratory exams on the second day of hospitalization showed elevated creatine kinase (CK) and troponin-I levels while his electrocardiography (ECG) showed J-point elevation in V1, V2, and V3 precordial leads. On the second day of hospitalization the pulmonary infiltrates were not present in his chest X-ray while on the eighth day, troponin-I and CK levels were normalized without dynamic ECG changes and the patient was discharged uneventfully.
Conclusion: Heroin inhalation may cause severe complications, such as non-cardiogenic pulmonary edema, rhabdomyolysis or myocardial injury. Hippokratia 2016, 20(1): 84-87
PMCID: PMC5074406  PMID: 27895451
Heroin inhalation; illegal drugs; heroin; non-cardiogenic pulmonary edema; rhabdomyolysis
17.  Laparoscopically assisted treatment of transverse testicular ectopia with persistent Müllerian duct syndrome: a case report and review of the literature 
Hippokratia  2016;20(1):88-89.
Background: Transverse testicular ectopia coexisting with persistent Müllerian duct syndrome is a rare malformation and evidence regarding the optimal treatment of these patients is still unclear.
Description of the case: We present the case of a 4-month-old boy in whom laparoscopy was utilized for the surgical correction of transverse testicular ectopia and excision of Müllerian remnants.
Conclusion: Based on current literature and the presented case, we support that laparoscopy is a feasible and safe procedure in patients with transverse testicular ectopia and persistent Müllerian duct syndrome. Hippokratia 2016, 20(1): 88-89
PMCID: PMC5074407  PMID: 27895452
Transverse testicular ectopia; crossed testicular ectopia; laparoscopy; persistent Müllerian duct syndrome
18.  Rising incidence of thyroid cancer in Serbia 
Hippokratia  2016;20(1):9-23.
Background: In the past decade, the incidence of thyroid cancer (TC) has shown a stable increase, for both sexes, in many parts of the world at a rate faster than for any other type of malignancy. The aim of our study was to analyze and report changes in TC incidence in Serbia, as well as to evaluate potential reasons for these changes. So far, the incidence of TC in Serbia has not been reported. Material and Methods: This is a retrospective descriptive epidemiological study of TC data from the Cancer Register for Serbia for a ten year period, from 1999 to 2008. Crude rates (CR), age-specific rates (ASR), age-adjusted rates (AAR), linear trends and average annual percentage changes (AAPC) were calculated and analyzed.
Results: TC incidence increased substantially for both genders with the highest increase in 2007 for the age group 50-59 (females 14.2, males 10.3). TC was three times more common in females (CR 4.7:1.5). The AAR for females ranged 1.9-4.8 (3.3, 95% CI 2.6-4.0), for males 1.0-2.6 (1.0, 95% CI 0.8-1.2) and for both sexes combined 1.4-3.2 (2.2, 95% CI 1.7-2.6). The incidence trend for males showed an increase (y =0.05x + 0.70, p =0.058). It was highly statistically significant for females (y =0.31x + 1.61, p <0.001) and both genders combined (y =0.18x + 1.18, p <0.001). AAPC was highest for ages 20-29 and 30-39, for females (+25.2%) and males (+17.3%), respectively.
Conclusions: We found a substantial increase in TC incidence in Serbia for both genders. The highest increase in TC incidence was found in females aged 20 to 29 years while the highest incidence was found in the age group 50 to 59.
PMCID: PMC5074408  PMID: 27895436
Thyroid cancer; Serbia; incidence; crude rates; age-specific rates; age-adjusted rates; average annual percentage changes
19.  A case of a living-related kidney transplantation after ex-vivo repair of the donor renal artery aneurysm 
Hippokratia  2016;20(1):90-92.
Background: Kidney transplantation is the definite surgical treatment for end-stage renal disease. Shortage of organs and the increasing number of patients with end-stage renal disease has led to an expansion of the selection criteria promoting the use of organs from marginal donors. Use of kidneys with renal artery aneurysm (RAA) is one such example.
Description of the case: We report a case of living-related kidney transplantation from a 46-year-old female donor with unilateral RAA to her 68-year-old father. The pre-operative donor’s assessment with a computed tomography angiogram revealed a saccular aneurysm of the left renal artery. The transplant team proceeded to the left nephrectomy, surgical ex vivo repair of the aneurysm and transplantation of this kidney to the recipient, with the total ischemic time of 130 minutes. At revascularization, there was no anastomotic leak with good perfusion of the organ and normal postoperative kidney function.
Conclusion: RAA is a rare renal anatomical abnormality with unproven clinical significance. Advanced microvascular surgical techniques can be used to repair the aneurysm with subsequent successful use for transplantation. Hippokratia 2016, 20(1): 90-92
PMCID: PMC5074409  PMID: 27895453
Renal artery aneurysm; ex vivo repair; living-related kidney transplantation
20.  Diagnosis of type IV-A congenital choledochal cyst in a 73-year-old man 
Hippokratia  2016;20(1):93.
PMCID: PMC5074410  PMID: 27895454
Choledochal cyst; polycystic kidney disease; magnetic resonance cholangiopancreatography; endoscopic retrograde cholangiopancreatography
21.  Soluble triggering receptor expressed on myelocytes-1 compared to procalcitonin in patients with infectious and autoimmune systemic inflammatory response syndrome 
Hippokratia  2016;20(1):94.
PMCID: PMC5074411  PMID: 27895455
Procalcitonin; sTREM-1; sepsis; autoimmune systemic inflammatory response syndrome
22.  Acute necrotizing pancreatitis after chemoembolization for hepatocellular 
Hippokratia  2016;20(1):95.
PMCID: PMC5074412  PMID: 27895456
Necrotic pancreatitis; chemoembolization; hepatocellular carcinoma
23.  Tracheo-innominate artery fistula: surgical primary closure of the artery defect, a successful treatment of a potential catastrophe 
Hippokratia  2016;20(1):96.
PMCID: PMC5074413  PMID: 27895457
Tracheo-innominate artery fistula; tracheostomy; emergency surgery
25.  Effects of acute cigarette smoking on total blood count and markers of oxidative stress in active and passive smokers 
Hippokratia  2015;19(4):293-297.
Background: Free radicals, as a product of cigarette smoke, are considered to have deleterious effects causing oxidative stress. Acute active smoking seems to be followed by transient leukocytosis and delayed increase in neutrophil activation. The aim of the present study was to investigate the oxidative status of smokers and passive non-smokers, as well as the impact that acute cigarette smoking has on hematological parameters.
Methods: Thirty-two healthy volunteers, 16 active smokers (Group A) aged 20-23 years and 16 age-matched, non-smokers (Group B), 18 women and 14 men in total, participated voluntarily in the study. All subjects did not have any food, drink, or cigarette smoking for eight hours before the study. Each time, two active smokers and two non-smokers were exposed simultaneously for half an hour to the smoke of two cigarettes smoked consecutively by the smokers. Blood was drawn before and after the exposure to cigarette smoke. Whole blood was analyzed immediately for total blood count parameters and serum was stored in -70◦C until serum levels of malondialdehyde (MDA) and vitamin E (VitE), and total antioxidant capacity (TAC) were determined.
Results: No statistical significant difference was observed in the values of white blood cells and their subpopulations between the two groups and within the same group before and after exposure to cigarette smoke. In the group of smokers, granulocyte/lymphocyte ratio increased significantly, MDA levels showed significant elevation and protective VitE serum levels decreased significantly, whereas TAC was reduced, but not significantly, after the exposure. In the group of passive, non-smokers the results of the blood count parameters, MDA and VitE were similar to Group A, and there was a significant decrease in TAC, as well. Between the two groups, only hematocrit values and MDA levels differed significantly before the exposure to smoke, and no other significant difference was detected before or after the exposure, between active and passive smokers.
Conclusions: Acute exposure to cigarette smoking affects hematological indexes and oxidative stress biomarkers negatively, in both active and passive smokers, with similar results. The outcome seems to be even worse in passive smokers regarding oxidative stress and antioxidant protection markers. Elimination of cigarette smoking could prevent the adverse effects for smokers, as well as for healthy non-smokers in their vicinity. Hippokratia 2015; 19 (4): 293-297.
PMCID: PMC5033137  PMID: 27688691
acute smoking; passive smoking; malondialdehyde; WBC; vitamin E; total antioxidant capacity

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