Biomedical subjects

Dragana Zivković

Publications and source records attributed to Dragana Zivković.

7 recordsLinked to original sources

PubMedDate not supplied

[New physiologic aspects of fracture healing].

INTRODUCTION: Skeletal system has a great regenerative potential, but it isn't the case with other tissues. Bone fracture healing includes a complex cascade of processes at cellular and biochemical levels, ending with a complete structural and functional restoration of the damaged bone. Impaired healing occurs in 5-10% of all fractures, manifesting as delayed union or non-union. Such a high incidence of impaired healing certainly presents a problem, and therefore, permanent research regarding physiology of fracture healing is justified. PHASES OF FRACTURE HEALING: In this paper we described four phases of fracture healing. They are not clearly separated, but overlap. These data are based on contemporary literature and newest achievements in the field of fracture healing. DISCUSSION: Many data regarding this phenomenon were obtained from animal studies, but they may also be applied in human medicine, since there is a great similarity between fracture healing in animal models and humans. CONCLUSION: Full and complete knowledge of mechanisms of bioregulation of normal fracture healing process certainly presents the basic prerequisite for successful surgical and orthopedic treatment.

Animals↗

PubMedDate not supplied

[Disorders in fracture healing].

INTRODUCTION: Bone fracture healing is a complex cascade of events at cellular and biochemical levels, that ends by complete structural and functional restoration of a damaged bone. Impaired healing develops in 5-10% of all fractures, and manifests as delayed union or non-union. This paper deals with the problem of impaired healing as well as with methods of fracture healing enhancement. CAUSES OF IMPAIRED FRACTURE HEALING: There are many factors causing impaired fracture healing (inadequate vascularization, mechanical causes, infection, etc.), and it is very important to recognize the principle cause of delayed union and non-union, since therapy is based on eliminating the factor that causes it. FRACTURE HEALING ENHANCEMENT: Through constant attempts to find adequate solutions and procedures in order to resolve the problem of impaired fracture healing, many alternatives in treatment of impaired healing have been developed. Some of these procedures may also be useful in treatment of fresh fractures, especially when it comes to fractures that are prone to delayed union and non-union more than usual. All currently known methods of healing enhancement may be classified as biological, mechanical and biophysical. CONCLUSION: Certain methods are in clinical use for several decades. The newest methods, such as locally applied growth factors, composite biosynthetic grafts, gene therapy and systemic approaches are studied all around the world, and are on the verge of clinical application. Due to impressive number of therapeutic options, certain therapeutic procedures of choice will be developed for specific impairments.

Bone Regeneration↗

PubMedDate not supplied

[Osteosynthesis with Kirschner pin fixation in treatment of fractures with dislocation of the lateral condyle of the humerus in a pediatric population].

INTRODUCTION: Fractures of lateral condyle represent 17% of all pediatric fractures of the distal humerus, and in current pediatric orthopedics there is still no agreement regarding optimal treatment modalities. We presented a treatment protocol for pediatric dislocated fractures of the lateral condyle of the humerus used at the Pediatric Surgery Clinic in Novi Sad. MATERIAL AND METHODS: Over the study period (1991-2000) a total of 48 patients with dislocated fractures of the lateral condyle of the humerus were hospitalized at the Pediatric Surgery Clinic. Orthopedic reduction and percutaneous pin fixation under radiological supervision was done in 15 patients, while 33 patients needed surgical reduction and pin fixation. RESULTS: Satisfactory results were obtained in 42 patients (91.3%), out of which 29 patients (63.1%) presented with excellent results. Good results were obtained in 8 patients (17.4%), and fair results in 5 patients (10.8%). Unsatisfactory results were present in 4 patients (8.7%). Two patients were lost to follow-up. DISCUSSION: Dislocation fractures of the lateral condyle represent high risk for development of complications. Adequate diagnosis and treatment represent basic conditions for successful postinterventional result. Orthopedic reduction with percutaneous pin fixation is recommended for fractures that may be anatomically reduced. In cases of unsatisfactory results of reduction, as well as in cases with completely dislocated and rotated fragments, surgical reduction and pin fixation is necessary. CONCLUSIONS: Satisfactory results in 91.3% of cases, and long-term experience suggest that the recommended therapeutic option is adequate in treatment of dislocated fractures of the lateral condyle of the humerus in pediatric population.

Adolescent↗

PubMedDate not supplied

[Possibilities of endoscopic treatment of primary vesicoureteral reflux].

INTRODUCTION: Vesicoureteral reflux, urinary infection and pyelonephritic scarring represent a well known triad in pediatric practice that may lead to severe scarring of kidneys, and development of so called reflux nephropathy. Apart from standard therapeutic options (conservative treatment and surgical therapy), endoscopic correction of refluxing vesicoureteral junction has been introduced into clinical practice. MATERIAL AND METHODS: This study included endoscopically treated patients with primary vesicoureteral reflux over a 9-year period, as well as certain clinical parameters. RESULTS: Endoscopic correction of primary vesicoureteral reflux with teflon paste has been successful in up to 93.5% of patients. After one application vesicoureteral reflux disappeared in 58.8% of cases. After two applications 86.0% of ureters were cured, whereas the third application had no further effect on existing reflux. Improvement with spontaneous regression of reflux was established in 7.5% of treated ureters. DISCUSSION: Endoscopic correction should be performed in all patients with third grade vesicoureteral reflux, and in selected patients with second and fourth grade reflux. First grade reflux should be treated conservatively, and fifth grade reflux should be treated surgically. CONCLUSION: Endoscopic treatment of primary vesicoureteral reflux is an easy, simple, fast and safe procedure that prevents regurgitation of urine from bladder to upper parts of the urinary system in most of cases.

Adolescent↗

PubMedDate not supplied

[External genital abnormalities in male schoolchildren: an epidemiological study].

INTRODUCTION: External genital abnormalities represent the most common congenital anomalies. Proper, not delayed diagnosis and treatment of certain abnormalities (undescended testis, hypospadia, varicocele) is of great importance for future fertility potential of children. MATERIAL AND METHODS: An epidemiological study, that consisted of an urological checkup, was performed among school-aged boys in two elementary schools. Prevalence of external genital, and inguinal region was examined. RESULTS: A total of 1229 elementary school boys were examined. The incidence of external genital abnomalities was 27.8%. Certain anomalies were already surgically treated in 7.8% of boys. Phimosis wasfound in 66 patients (5,5%), which represents 26.6% of all abnomalities. DISCUSSION: In this study the incidence of undescended testis was 2.0%. Although it is similar to literature data, the fact that undescended testis was found in 25 boys older than 7 years (two of them 15 years old!) suggests that the primary health care is not satisfactory. The incidence of inguinal hernia and hydrocele varies according to different authors from 0.8-4.4% to 13.44%. In this study the incidence was 2.4%. Varicocele represents a developmental anomaly and the incidence is increasing with age. It is rare in boys up to 10 years of age, but the incidence of varicocele in boys aged 15 years (15.8%) reaches the level of incidence in adults (19.82%). The incidence of phimosis in this study was 5.5%. CONCLUSION: High incidence of external genital abnormalities in school aged boys suggests a need for further education of physicians in primary health care services as well as of parents.

Adolescent↗

PubMedDate not supplied

[Urogenital abnormalities and atresia of the gastrointestinal tract].

INTRODUCTION: The goal of the study was to ivestigate the frequency of urogenital congenital abnormalities among atresias of the digestive system and analyze fetal maldevelopment. The study also deals with gastrointestinal and urogenital embryology. MATERIAL AND METHODS: This retrospektive study analyzed the clinical status of 55 newborns admitted to the Pediatric Surgery Clinic in Novi Sad due to atresia of the gastrointestinal tract during 1995-2003. All atresias were classified at primordial gut levels (foregut, midgut and hindgut). The incidence of associated abnormalities, especially urogenital, was analyzed. Diagnostic procedures included standard methods: clinical investigation, ultrasound, native and contrast medium radiography, etc. RESULTS: Results showed that urogenital anomalies were present in 21 (38.18%) newborns with gastrointestinal atresia. Foregut atresia was diagnosed in 14 newborns and it was associated with urogenital congenital anomalies in 9 (64.28%) newborns. Midgut atresias were found in 15 patients and in 4 (22.22/%) they were associated with urogenital anomalies. Hindgut atresias were established in 23 and in 8 (34. 78%) cases they were associated with urogenital anomalies. DISCUSSION AND CONCLUSIONS: It was confirmed that foregut atresias ara commonly accompanied by associated abnormalities. That is why the fourth gestational week is important when both gastrointestinal and urogenital systems are developed. When midgut differentiates into its own derivates, the frequency of congenital anomalies decreases for a short period, and then increases again during foregut development (seventh and eighth gestational weeks). There were no information on environmental teratogenic factors in maternal history. These abnormalities may be explained by complex urorectal development and separation of two systems.

Abnormalities, Multiple↗

PubMedDate not supplied

[Ureteral triplication--a case report].

INTRODUCTION: Of all children born with congenital anomalies, 30-40% have urogenital abnormalities. Most of them are asymptomatic, but if any symptoms occur, they are usually symptoms of urinary infections. CASE REPORT: A four-year old girl was admitted because of recurrent urinary infections and in order to perform a thorough clinical examination. Clinical examination showed an asymmetrical gluteus and presence of a fibroma in the same region. Detailed radiologic examinations (ultrasonography, plain X-ray, excretory urography, voiding urethrocystography) revealed a triplicate ureter on the right side with a vesicoureteral reflux of the fifth grade on the same side. Intraoperatively, type III ureteric triplication according to Smith's classification was established. Ureteral remodeling and reimplantation was done. The postoperative course was good, and follow-up voiding urethrocystography showed absence of reflux. DISCUSSION: Ureteral triplication is a consequence of either development of three buds on the mesonephric duct, or development of two buds, one of which further divided into two parts. Most common anomalies associated with ureteral triplication are: ureteral duplication on the other side (37%), ectopy of the ureteric orifice (28%) and kidney dysplasia (8%). Vesicoureteral reflux is very common on affected or on both sides. Symptomatology is the same as in ureteral duplication--dominated by signs of urinary infections. CONCLUSION: Diagnosis of ureteral duplication requires detailed imaging. Treatment of symptomatic abnormalities should be individual, regardless of the applied treatment (conservative or operative).

Child, Preschool↗