Apstrakt Uvod / Cilj. Procena stanja volemije pacijenata na hroničnom programu hemodijalize (HD) je teška uprkos postojećim razvijenim tehnikama. Cilj ove studije je bio da pokaže adekvatnost i efikastnost ultrazvuka pluća (UZP) i B linijskog skora (BLS) u proceni stanja volemije kod pacijenata na HD u poređenju sa drugim tehnikama: dijametrom donje šuplje vene (DŠVD) i B tipom natriuretskog peptida (BNP). Metode.UZP, ehokardiografija sa ultrasonografijom donje šuplje vene u inspirijumu (DŠVDi) i ekspirijumu (DŠVDe) i kolekcija krvi za određivanje BNP-a su izvršeni pre i posle HD kod 83 pacijenta. Rezultati. Registrovana je signifikantna redukcija BLS, DŠVDii DŠVDe, BNP i nekoliko ehokardiografskih (EHO) parametara (dimenzije leve pretkomore, komore u sistoli i dijastoli i zapremina leve pretkomore) (p < 0.001). Postojala je signifikantna korelacija između BLS i BNP pre i posle HD (p=0.01), između BLS i EHO parametara(p=0.01), i slabija, signifikantna korelacija između BLS i DŠVDi i DŠVDe pre HD (p=0.01). Zaključak. Sve tehnike su uspešno procenile hipervolemiju pre i posle HD. BNP je korelirao sa UZ pre i posle HD, a DŠVDi i DŠVDe korelirari su sa UZP većinom pre HD. UZP je jeftin, jednostavan, može se izvoditi pored postelje i pouzdano koristi za procenu stanja volemije na HD.

OPŠTA BOLNICA KIKINDA Sažetak:Uvod: Transplantacija lica je hirurški postupak presađivanja dela ili celog lica. Postupak je kompleksan i indikovan je kod pacijenata kod kojih standardne rekonstruktivne operacije ne daju efekte. Profesor Peter Butler je prvi predložio ovu proceduru 2002. godine. Cilj: Pokazati da transplantacija lica predstavlja humano primenjenu umetnost. Pacijenti i metode: U periodu od novembra 2005. do januara 2014. godine izvedeno je ukupno 30 transplantacija lica u 7 različitih zemalja. Operacije su trajale 8-36 sati i u svakoj je učestvovalo do 30 hirurga različitih specijalnosti. Pacijentima je postoperativno uvedena doživotna imunosupresivna terapija. Trajanje hospitalizacije je u proseku iznosilo 10-14 dana. Rezultati: Kompletna transplantacija lice je uspešno izvedena kod 40% (12/30), parcijalna kod 50% (15/30) pacijenata, a 10% (3/30) je preminulo usled komplikacija. Najviše transplantacija je urađeno u Francuskoj (10), potom u SAD-u i Turskoj, po 7, u Španiji 3, Belgiji, Kini i Poljskoj po 1. Prva uspešna parcijalna transplantacija lica je obavljena u Francuskoj 2005. godine ženi čije je lice unakazio njen pas, dok je prva uspešna kompletna transplantacija lica urađena u Španiji 2010. godine muškarcu koji je s desna upucao sebe u lice. Najobimnija kompletna transplantacija lica do sada urađena je 2012. godine u SAD-u, pacijentu nakon povrede vatrenim oružjem. Pored lica, pacijent je dobio novu vilicu, zube i jezik. Zaključak: Pacijent nikada neće u potpunosti izgledati kao nekada, ali neće izgledati ni kao donor, već će biti kombinacija donora i primaoca. Identitet pacijenata ostaje isti. On će i dalje imati istu gestikulaciju, isti glas i pogled... Umetnost hirurgije i jeste u tome! Ključne reči: Hirurgija, umetnost, transplantacija, lice. Summary:Introduction: Face transplantation is a surgical procedure to transplant all or part of the face. The procedure is complex and is indicated in patients when standard reconstructive surgery cannot give the desired effect. Professor Peter Butler first propounded this procedure in 2002. Objective: To show that face transplantation represents humanly applied art. Patients and methods: Between November 2005 and January 2014, 30 face transplantations were performed in 7 different countries. All operations lasted from 8 to 36 hours and were performed by 30 surgeons of different specialties. Patients were postoperatively prescribed a lifelong immunosuppressive therapy. Hospitalisation took on average 10 to 14 days. Results: Complete face transplantation was successfully performed in 40% (12/30), partial in 50% (15/30) and 10% (3/30) died because of complications. the largest number of transplantations were done in France (10), followed by 7 in USA and Turkey, 3 in Spain, 1 in Belgium, China and Poland. The first successful partial face transplantation was performed in France in 2005 on a woman whose face was disfigured by her dog. The first successful full face transplantation was done in Spain in 2010 on a man who accidentally shot himself in the...

Uvod: Pleurocenteza (torakocenteza) je dijagnostičko-terapijska metoda koja se koristi za dobijanje uzorka ili evakuaciju pleuralne tečnosti. Palijativna pleurocenteza se izvodi u cilju evakuacije malignog izliva koji je znak uznapredovalog stadijuma maligne bolesti. Cilj: Prikazati primenu metode palijativne pleurocenteze i odnos broja pacijenata sa malignim pleuralnim izlivom u zavisnosti od porekla primarnog tumora u jednogodišnjem periodu. Pacijenti i metode: U periodu od 01. 08. 2014. do 01. 08. 2015. godine na hirurškom odeljenju Opšte bolnice u Kikindi primenjena je palijativna pleurocenteza kod 23 pacijenta, prosečne starosti 68,6 godina. Dijagnoza je prethodno postavljena na osnovu kliničkog pregleda i rendgenskog snimka pluća. Za punkciju je korišćen set za jednokratnu upotrebu Pleurofix® Nr.1, kompanije B. Braun. Kod svih pacijenata pleurocenteza je izvedena u sedećem položaju, u lokalnoj anesteziji (2% lidokain), u VII ili VIII međurebarnom prostoru, u zadnjoj aksilarnoj liniji, tik uz gornju ivicu donjeg rebra. Za statističku analizu korišćen je χ 2-test. Rezultati: Palijativna pleurocenteza je primenjena kod 14 (60,87%) žena i 9 (39,13%) muškaraca (χ 2 =1,08; p>0,05). Ukupno je urađeno 38 pleurocenteza, prosečno po pacijentu 1,65. Jedna pleurocenteza je urađena kod 18 (78,25%) pacijenata, a dve ili više kod 5 (21,75%) pacijenata (χ 2 =30,21; p<0,01). Dve pleurocenteze su urađene kod 1 (4,35%), tri kod 2 (8,7%) i šest kod 2 (8,7%) pacijenta. Sa desne strane je urađena kod 14 (60,87%), a sa leve kod 6 (26,09%) pacijenata (χ 2 =8,43; p<0,05). Obostrano je urađena kod 3 (13,04%) pacijenta. Etiološki, karcinom pluća je bio uzrok kod 9 (39,13%), dojke kod 4 (17,39%), GIT-a kod 3 (13,04%), UGT-a kod 3 (13,04%), dok je kod 4 (17,39%) pacijenta ostalo nepoznato mesto primarnog tumora. Zaključak: Maligni pleuralni izliv se najčešće javlja kod pacijenata obolelih od karcinoma pluća i dojke. Češće je lokalizovan na desnoj strani. Kod značajnog broja pacijenata ostaje nepoznato mesto primarnog tumora. Palijativna pleurocenteza ima ulogu u trenutnom ublažavanju simptoma. U cilju adekvatnog tretmana potrebno je konsultovati grudnog hirurga. Ključne reči: Maligni pleuralni izliv; pleurocenteza; torakocenteza.

Background and Aims Expended hemodialysis (HDx) with medium cut-off (MCO) membrane enables efficient depuration of middleweight uremic toxins, which play significant roles in inflammation and cardiovascular morbidity. Hemodiafiltration (HDF) is known for good removal of middle molecules but it requires more technical resources and well-functioning dialysis access. The aim of this study is to evaluate the efficacy of depuration of uremic toxins with a high-flux dialyzer during HDF session and with a MCO membrane (Theranova®) in HDx session and its impact on quality of life (QoL) in hemodialysis patients. Method In an open, single-centre, prospective observational clinical study, 28 adult stable HD patients without residual renal function were assigned to be treated by on-line HDF (HDF group) with the APS-21H dialyzer (polysulfone membrane, 2.1 m2, Asahi Kasei Medical Co., Japan) or by HDx (HDx group) with the Theranova® 400 (1.7 m2) and Theranova® 500 (2.0 m2) dialyzers (Baxter International Inc, USA). The study was conducted during 2019-2020 and completed after 12 months period. All patients were receiving maintenance high-flux membrane HDF treatment at least six months before they were enrolled in the study. Groups of patients were matched in age, sex, BMI, dialysis length and underlying disease. Complete blood count (CBC), renal function and inflammation, electrolytes, liver function tests, iron and nutritional status were evaluated at the beginning of the study and after 3, 6, 9 and 12 months. Pre and postdialysis levels for urea, creatinine, albumin, calcium, phosphorus, C-Reactive Protein, kappa and lambda free light chains (FLC), vitamin B12, β2 microglobulin levels were determined in each patient quarterly and reduction rate (RR) for uremic toxins were calculated. Furthermore single-pool Kt/V, dose of erythropoietin therapy (EPO) and vascular access were evaluated during the study, while bioimpedance analysis using Body composition monitor (Fresenius Medical Care, Germany) and QoL using SF-36 questionnaire (Kidney Disease Quality of Life Short Form-KDQOLTM-36) were evaluated at the end of observation period. The values have been reported as mean ±SD. Results There were 28 patients (14 in each group) mean age of 54.24 years (57.71±9.65 in HDx group vs 59.81±7.99 in HDF group). Median dialysis vintage was 4.77 years (5.33 in HDx group vs 6.46 in HDF group, p=0.55). Vascular access was native arteriovenous fistula in 23 patients, arteriovenous graft in 2 patients and tunnelled dialysis catheter in 3 patients (p=0.98). Kt/V was similar in both groups (1.57±0.31 vs 1.45±0.24, p=0.9), as well as weekly dose of EPO (4533.3±1922.3 vs 4233.3±1971.8, p=0.67). Patients in HDF group had a significantly higher interdialysis fluid overload (2,48±1,37 in HDx group vs 3,64±1,33 in HDF group, p=0.04), without difference in relation to the systolic and diastolic blood pressure values, as well as others BCM parameters. There were not significant differences in examined parameters of CBC, renal function and inflammation, electrolytes, liver function tests, iron and nutritional status at the beginning and at the end of the study. RR of small and middle molecules are presented in Table 1. Serum albumin level has decreased from 37.8 g/dL to 36.4 g/dL in 12 months during HDx treatment with maximal change of serum albumin level of -3.7% during that period (Figure 1). Evaluation of Kidney Disease Quality of Life Short Form at the end of study period in both groups is shown in Figure 2. Conclusion Compared to HDF, HDx with MCO membranes show greater RR for large middle molecules such as lambda FLC (45kD), while RRs for middle molecules- kappa FLC (23kD), β2 microglobulin (12kD) and small uremic toxins are similar. During one year of treatment with MCO membranes serum albumin levels remain stable. HDx treatment may improve quality of life, making an impact primarily in energy status and emotional satisfaction.

Introduction. Hemodialysis patients often have chronic volume overload, hypervolemia, which may cause severe complications. In some patients hypervolemia is masked, without any signs and symptoms, such as hypertension, edema and bibasilar crackles on lung auscultation. Lung ultrasound can be used to detect these patients. Pre-and post-dialysis lung ultrasound can be used to quantify lung congestion using the B line score. High post-dialysis B line score can identify patients with residual hypervolemia and adequate measures can be taken (increasing ultrafiltration, extended duration of hemodialysis, additional dialysis sessions). Case Reports. The first patient was a 57-year-old male. The hemodialysis vintage was 4 years. His interdialytic weight gain was 2.8 kg. The lung ultrasound was performed before and after dialysis and B line score was calculated. The pre-dialysis score was 15 and post-dialysis score was 2. The second patient was a 72-year-old male. The hemodialysis started 5 years before. This patient was noncompliant with the medical advice of his physician regarding diet and medications. His interdialytic weight gain was 5.6 kg. His pre-dialysis score was 26 and post-dialysis score was 15. Both patients were without signs and symptoms of hypervolemia after dialysis. Nevertheless, the second patient was 1.6 kg over his dry weight after dialysis. An additional dialysis session was scheduled, after which his post-dialysis B line score fell to 5. Conclusion. Lung ultrasound can be used to assess volume status in dialysis patients. It can identify hypervolemia in asymptomatic patients and allow necessary corrections.