Introduction: The study of importance of left ventricular contractile reserve presence and changes plasma brain natriuretic peptide levels (BNP) during exercise in patinets with idiopathic dilated cardiomyopathy is very popular today, but these two parametres have rarely been interconnected. The study of response BNP during echocardiography stress tests in patients with idiopathic dilated cardiomyopathy with or without preserved left ventricular contractile reserve. We studied 55 consecutive patients with idiopathic dilated cardiomyopathy (mean age 54.98 ± 9.84, 49 (89.1%) male) treated in the outpatient clinic for heart failure at the Institute of Cardiovascular Diseases "Dedinje". All the patients underwent the echocardiography stress test. Contractile reserve was assessed by measuring of the changes of the left ventricle ejection fraction basally and in the first minute after the strongest stress. Level of BPN was measured at rest, in the first minute and after 20 minutes of maximal exercise stress. Following the kinetics of BNP level during stress testing, we find that in patients with preserved left ventricular contractile reserve BNP level is rising at maximum load achieved (Mediana (IQR) - 59 (22-113) vs. 91 (37-135) vs. 78 (30-159) ng/L, p<0.001), whereas in patients without preserved left ventricular contractile reserve BNP level does not change significantly (Mediana (IQR) – 89 (50-322) vs. 119.5 (61.3-321.8) vs. 136 (72- 281), p=0.102). The increase in BNP in the peak load compared to its value at rest was positively correlated with preserved contractile reserve (r=0.38, p=0.009), better WMSI at rest (r=-0.28, p=0.04), greater difference in the double product (r=0.40, p=0.002), as well as the work accomplished on the test (r = 0.47, p <0.001), and longer duration of the test (r = 0.43, p = 0.001). The increase in BNP during physical exercise in patients with idiopathic dilated cardiomyopathy suggests a preserved contractile reserve of the left ventricle.

Očuvana kontraktilna rezerva leve komore podrazumeva sposobnost hipokinetičnih segmenata miokarda da pod dejstvom različitih inotropnih stimulusa poprave svoju kontraktilnost. Utvrditi razlike u kliničkim karakteristikama kod pacijenata sa dilatacionom kardiomiopatijom u zavisnosti od očuvane kontraktilne rezerve leve komore. U studiju je uključeno uzastopnih 55 bolesnika sa idiopatskom dilatativnom kardiomiopatijom. Svim bolesnicima uključenim u studiju urađen je stres ehokardiografski test fizičkim opterećenjem po standardnom protokolu. Postojanje očuvane kontraktilne rezerve je određivano uz pomoć promene ejekcione frakcije leve komore. Prosečna starost ispitivanih bolesnika je bila 54,98 ± 9,84 godina, 49 (89,1%) je bilo muškog pola. Na osnovu promene ejekcione frakcije leve komore kao kriterijuma kontraktilne rezerve leve komore, očuvanu kontraktilnu rezervu je imalo 25 bolesnika (45,5%). Bolesnici bez očuvane kontraktilne rezerve leve komore znatno češće u anamnezi imaju zastupljenu arterijsku hipertenziju (46,7 vs. 20,0%, p=0,038). Nema značajne razlike u zastupljenosti ostalih faktora rizika. Pacijenti sa očuvanom kontraktilnom rezervom leve komore imaju manju dimenziju leve komore na kraju sistole (49,64 ± 7,26 vs. 55,27 ± 8,36 mm, p=0.011), manji indeks volumena leve komore na kraju dijastole (77,35 ± 26,41 vs. 94,59 ± 34,97 ml/m2, p=0,005) i na kraju sistole (59,31 ± 26,05 vs. 78,62 ± 34,42 ml/m2, p=0,002), veću ejekcionu frakciju leve komore (25,48 ± 8,32 vs. 18,33 ± 6,49%, p=0,002) i niži indeks pokreta zidova leve komore (2,23 ± 0,27 vs. 2,48 ± 0,27, p=0,002). Kod bolesnika sa očuvanom kontraktilnom rezervom leve komore nalazimo manju zastupljenost arterijske hipertenzije i morfološki i funkcionalno manje oštećenu levu komoru.

Even 1000 years BC the famous Persian physician Aviccena describet the first time gangrene diabetes mellitus as a complication. Basic pathohistological substrate vascular complication is atherosclerotic plaqueand therefore is an adequate treatment opf patients with vascular disease is conditioned by timely and precise diagnosis.The introduction of ultrasound technology in clinical practice enabled Edler and Hertz when the shou moves infarction 1954th,a then and Yoshida (1956.) and Sotomura (1959.), Frenklin (1961.) who are using ultrasound display of blood flow in the courts of man. The aim of our study was to deterimne the frequency of occurrences of atherosclerotic plaque in the carotid arteries and ultrasound examination of differences in the variability of certain plaques between patients with diabetes mellitus type 2 and healthy subjects. The examination was attended by a total of 82 people divided into two group. In first group they are 51 persons suffering from diabetes mellitus type 2 in to second control, the number of healthy respondents was 31. Among our respondents, a significantly higher incidence and plaque vulnerability was ina group of patients with diabetes mellitus type 2. 

Metformin is an anti-hyperglycemic agent used for the treatment of type 2 diabetes mellitus. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbe. The purpose of the study was to establish the effect of metformin on insulin secretion in obese patients with newly diagnosed diabetes mellitus type 2. We included 40 patients with Type-2 Diabetes Mellitus, who were treated on Department for Internal Disease in Hospital King Milutin Laplje Selo. Patients included in the study were newly diagnosed with diabetes mellitus type 2, glycemia < 12 mmol/L, and hed the Body Mass Index >30 kg/m2. They were treated with metformin, 1000 mg/day. Insulin sensitivity was determined by HOMA IR, insulin secretion by HOMA, lipid status by spectrophotometry. After six months of treatment blood biochemistry tested again. BMI was also established. Metformin significantly lowered BMI (BMI before therapy 31.02 kg/m2, after treatment 28.7 kg/m2) (both p<0,001 vs baseline) waist circumference mean value 98±0.55 cm-93,12 cm. (p<0,001) During the therapy the glycaemia decreased from 11.7 mmol - 6,78 mmol/l, insulinemia mean value 20.141 mlU/l -13.691, HOMA IR elevated in all patients. Among the cholesterol fractions, most significant results were obtained in LDL cholesterol. Mean LDL cholesterol levels 4.51± 2.02 mmol/L. Mean cholesterol level 6.98±2.31 mmol/L. HDL levels -1.32 mmol/L. Serum triglycerides was (mean) 2.63±1.32mmol/L. After six months therapy Metformin produces beneficial changes in lipid states. Metformin may be the first therapeutic option in the diabetes mellitus type 2 with overweight or obesity. Metformin produces beneficial changes in glycemia control, and moderated in weight, lipids and insulinemia. 

Formation of vascular access in elderly and diabetic patients is burdened with many difficulties. The aim of this study was to determine the factors that older people and patients with diabetes mellitus defined as the population risk for the formation of arteriovenous fistula for hemodialysis. The study was organized as a retrospective study, a subject of interest in people older than 65 years of age and diabetes, which in four years because of the need for further treatment performed arteriovenous fistula. Analyzed the demographic structure of the patient, type of anastomosis, the use of central-venous catheters for hemodialysis, arterial blood pressure and size of the lumen of blood vessels used for anastomosis, intraoperative measured. From the laboratory analysis determined the routine hematological and biochemical parameters. In relation to the positioning of arteriovenous fistula (p=0.033), the placement of catheters for hemodialysis (p=0.0009), preventive form of vascular access (p=0.04) and values of systolic (p=0.0001) and diastolic (p=0.0001) arterial blood pressure, achieved a statistically significant difference. Patients with diabetic nephropathy, compared to the population of elderly, have a significantly higher number of leukocytes (7.5±2.61 vs. 8.5±3.24, p=0.03), fibrinogen level (5.57±2.39 vs. 6.8±1.71, p=0.036), glycemia (5.35±1.24 vs. 7.1±2.28, p<0.0001), cholesterol (3.77±1 , 03 vs. 4.5±1.71, p=0.001), triglycerides (1.59 ±0.62 vs. 1.86±0.76, p=0.009) and LDL-cholesterol (2.13±0.76 vs. 2.42±2.04, p=0.02). Total proteins (64±9.98 vs. 62 ±7.4, p=0.027) and albumin (36±34 vs. 9.55±5.49, p=0.037) were significantly lower values in diabetics. Characteristics of older diabetics and is characterized as a risk population of patients for the creation of arterio-fistula were timely creation and position of arterio fistula, the need for placement of central-venous catheters for hemodialysis and arterial blood pressure.

Doppler ultrasound check-up significantly increases a possibility of initial functioning of arteriovenous fistula. The aim of the study was the preoperative evaluation of vascular system of the extremity for creation of arteriovenous fistula for haemodialysis. The examination was organized at Urology and Nephrology Clinic, Clinical Centre "Kragujevac". The examined subjects were 87 patients, 52 (59,8%) male and 35 (40,2%) female, mean age of 61±11,1 years. There were performed the routine biochemical analyses, demographical structure and clinical characteristics (type of anastomosis, fistula placement, arterial blood pressure, lumen size of the artery and vein, measured intraoperatively by Doppler technique). In 72,1% of patients with functioning fistula there was made a terminal-lateral anastomosis, compared to 57,7% of patients with initial non-functioning fistula, there was found a statistically significant difference between the groups p=0,008. Radiocephalic fistula was created in 62,3% of the examined patients with initial functioning , in patients with non-functioning, the distal fistula was created in 38,5% of the examined patients. Regarding the type of the fistula location there was obtained statistically significant difference; p=0,04. There was found a statistically significant difference between the group of patients with initial functioning of arteriovenous and the group without, concerning the intraoperatively measured lumen of the cephalic vein (2±0,29 vs. 2±0,38 mm); p=0,03 (2,1±0,5 vs. 1,8±0,4); p=0,0009. Statistical significance between the groups was also found in the lumen of the cephalic vein verified by the ultrasound (2,1±0,53 vs. 1,8±0,25 mm); p=0,038. Peak of the systolic speed of the radial, corelated to the group of patients with and the group without initial functioning fistula (50 ± 12,42 vs. 40 ± 6,9 cm/sec); (p=0,0026), has statistically significant value. By the correlation of the group of patients with initial functioning and the group of patients without initial functioning, regarding hemoglobin (97 ± 16,1 vs. 88 ± 18,3 g/l); p=0,006 and the level of urea (22,6 ± 12,7 vs. 23,9 ± 9,8); p=0,02, there was found a statistically significant difference. Color Doppler ultrasound has an important role in preoperative evaluation of blood vessels and it represents a meaningful predictive parameter of functioning of arteriovenous fistula. 

Because of it’s anabolic and lipolytic effects and with the beginnings of the production of recombinant growth hormone for the treatment of many congenital diseases began and growth hormone abuse in sport. His contributions to enhancing the physical performances of athletes are debatable, and there are many side effects. Detection of growth hormone use as doping agents is impossible by standard means of doping because of the identity of its recombinant and natural forms. There are various tests measuring its isoforms and collagen peptide, while the use of carbon isotope is still under investigation. Efficient detection tests, the use of "athlete passport" and education of athletes, are good way to prevent misuse of growth hormone.

Quick, proper and efficient transport is an integral part of all measures taken in treatment and effective care of polytraumatized patients. Before or during the transport, without regard to the transportation means, such patients often need their airways to be protected, connection to mechanical ventilation, applying of oxygen, infusion solution, painkillers or some other drugs. Continual monitoring of vital functions is required part of treatment during transport of critically ill or injured patients. Their transport, beside adequate equipment, demands theoretically and practically well trained stuff. In most European countries anesthesiologists have primary role especially in interhospital transport (for example in transport of neurosurgical patient from local to university hospital). Unfotunatelly, in our conditions transport is often carried out by unsufficiently skilled medical stuff without adequate equipment and experience what may have an effect on treatment success and surviva.

The existence of left ventricular hypertrophy is an independent prognostic factor for cardiovascular morbidity and mortality. Heterogenous factors lead to left myocardial hypertrophy. The most frequently factors are: arterial hypertension, valvular heart disease (aortic stenosis and insufficiency, mitral insufficiency), hypertrophic myocardiopathy, left myocardial hypertrophy after myocardial infarction... For making the diagnosis of left ventricular myocardial hypertrophy used electrocardiography („voltage“ and „repolarization“ criteria) and echocardiography. Echocardiography is the gold standard for diagnosis of left ventricular myocardial hypertrophy. Left ventricular mass was estimated by the modified formula 3 3 using measurements obtained in accordance with the Penn convention: MLK = 1,04 (LDDd+PWDd+IVSDd) - (LVDd) - 13,6 Where LDDd is diastolic left ventricular internal dimension, IVSDd is diastolic ventricular septal thickness and PWDd 2 is diastolic posterior left ventricular wall thickness in diastole. LV mass indexed by body surface area (g/m ). By Penn con2 2 vention left ventricular hypertrophy criteria were ≥134 g/m for men and ≥110 g/m for women.

The middle of last century it was established that the increased value registered fibrinogen in patients with coronary disease, hypertension, peripheral artery disease, patients with diabetes mellitus. Fibrinogen also participate in the earliest stages of atherosclerosis.Task of our research was to compare the level of fibrinogen in patients of type 2 diabetes mellitus without complications, and manifested in patients with apparent chronic complications as well as the correlation of fibrinogen with the parameters of metabolic control. Included 64 respondents, a close age divided into 4 groups: control group, people of type 2 diabetes mellitus without complications, people with microvascular complications, and people with macrovascular complications.The highest average value of fibrinogen in the blood we had in the group with diabetes mellitus without complications (3.47±0.26 g/l) and the lowest mean value in the control group (2.87±0.15 g/l). It is a test of correlation showed a strong correlation with the value of fibrinogen level of development of chronic complications.