Introduction:

Presence mesiodens is not uncommon in clinic practice. It is cause of impacted permanent maxillary central incisors. Diagnosis of the delayed tooth is usually made on the basis of clinical and radiographic findings. The treatment include surgical exposure of the impacted maxillary central incisors and extraction of supernumerary tooth, because it is a direct obstruction for the eruption of maxillary central incisors. Impacted maxillary central incisors is moved into it's proper position with orthodontic traction. The aim is presented surgical-orthodontic treatment of impacted teeth, which is necessary to achieve stability esthetic and functional results.

Case report:

This case report describes a surgical-orthodontic treatment of 9.5-old boy with both impacted permanent maxillary central incisors with supernumerary tooth which disturbs their normal eruption.

Conclusion:

The gnathometric evaluation of spaces in dental arch, the assessment of dental age and radiographic analysis are preconditions of successful therapy. The impacted maxillary central incisors were successfully positioned in the maxillary arch, with an adequate width of attached gingiva. The careful and persuasive treatment planning of an orthodontist, oral surgeon and periodontist are the key to success in resolving such cases.

Introduction/Objective

The objective of this study was to examine the relationship between use of psychoactive substances among University students and diagnosed somatic or mental disorders.

Methods

The cross-sectional study was conducted in a population of 2,000 students of the Belgrade University. Four faculties (Medicine, Geography, Economics, Electrical Engineering) from which the students participating in this research were chosen by the method of random choice (by computer listing), conducted in the period April - June 2010.

Results

We observed that are more numerous students who used psychoactive substances among students with diagnosed somatic illnesses compared to those without them. Statistical significance was found among students who used tobacco (p=0.027), alcohol (p=0.002), sedatives (p<0.001) and cannabis (p=0.021). Mental disorders are also connected to use of psychoactive substances. The statistical significance was achieved for all psychoactive substances except for alcohol.

Conclusion

Use of psychoactive substances is an important issue among University students with diagnosed somatic or mental disorder. Therefore, it is essential to recognize the symptoms and consequences of such behavior, and above all and connection thereof, the importance of prevention which may enhance better solution-seeking via proper education.

The metabolic syndrome (MS) is a clinical entity of substantial heterogeneity, represented by the combination of obesity (especially central obesity),insulin resistance, impaired glucose tolerance, atherogenic dyslipidemia (high triglyceride levels and low levels of HDL-cholesterol (HDL-C)), and hypertension. Childhood obesity has become more common as a result of urbanization, bad diets, and more sedentary lifestyles.

The incidence of metabolic syndrome is ten times higher in children with obesity, and a special risk factor is the presence of obesity in the pediatric population, the classification of metabolic syndrome is based on standards set by the International Diabetes Federation (IDF).

Our goal is to summarize the diagnostic procedure of metabolic syndrome as well as comorbidity based on conventional methods and modern imaging procedures by analyzing the published papers.

Objective:

To investigate correlation between ultrasonically calculated urinary bladder weight and lower urinary tract symptoms (LUTS).

Methods:

3D and 2D measurement of parameters necessary to determine bladder weight: Inner and outer radius of the bladder, in 10 male and 10 female patients with LUTS, with urinary bladder filled to at least 200 ml of urine volume.

Results:

Average urinary bladder weight in males was 53,8 g and in female patient was 45,2 g. We found no statistically significant difference between male and female patients, all with LUTS. We also found that patients in LUTS have hypertrophied bladder, which means that urinary bladder mass should be larger and results in an increase of blader weight and both inner and outer radius of the urinary bladder, that should be detected ultrasonographically, but not too much over of pre- determined variations of normal bladder weight.

Conclusion:

Estimation of urinary bladder weight should be considered as non-invasive approach to patients with LUTS. However, it is more plausible to measure only urinary bladder wall thickness ultrasonically than to calculate urinary bladder weight without built-in software.

Introduction:

Diabetes insipidus (DI) is a disease that occurs due to inappropriate secretion of anti-diuretic hormone from the pituitary, or as a result of disorder in which the level of the kidneys cannot adequately respond to the secretion of this hormone. Also, it is known as central diabetes insipidus. The most common causes are head traumas, tumors of the hypothalamus and pituitary glands, inflammatory processes, histiocytosis, anomalies in the development of brain. It can appear in the form of familial diabetes insipidus or in certain syndromes (Wolfram syndrome). It is characterized by hypotonic polyuria higher than 3l/24h (which persists if even taking liquids stops), then by nocturia and compensatory polydipsia. Enuresis often occurs among children.

Case report:

A boy, aged 11, lives with his mother and brothers. Mother noticed that the boy was urinating frequently in last few months (diuresis 4.6 l/24h, and 3.25 l/24h). After two months, the boy developed double images and severe headaches, vomiting, inability to see, squinting in the right eye and headache in the back of the head. MNR of the endocranium indicates the presence of a tumor formation. The tumor was surgically removed, and the boy started with chemotherapy and radiotherapy. Due to persistent diabetes insipidus, the boy started using desmopressin-acetate - in tablet form. Active substance desmopressin - acts in the same way as the natural hormone vasopressin and regulates the kidney's ability to concentrate urine. The positive effect of taking the drug appeared after three weeks from the start of taking the therapy.

Conclusion:

Central (neurogenic) DI occurs as a result of a relative or absolute deficiency of antidiuretic hormone, which is responsible for the osmolality of body fluids. Based on this case, we want to show the importance of early diagnosis of the disease in order to improve the prognosis and the necessity of careful monitoring of these patients.

Introduction: This study highlights the importance of transitioning to a modern approach to outpatient surgery, analyzing the safety and feasibility of this treatment model in patients undergoing hemithyroidectomy or total thyroidectomy, with a focus on postoperative complications.

Materials and Methods: Data were collected from the medical records of 626 patients over a five-year period, from 2011 to 2015, at the Surgery Clinic of the "Dr Dragiša Mišović – Dedinje" in Belgrade. This period allowed for a reliable analysis of the safety and feasibility of outpatientthyroid surgery.

Results: A total of 97 hemithyroidectomies and 529 total thyroidectomies were performed. The average age of hemithyroidectomy patients was 51.24 years, and for total thyroidectomy patients, it was 54.88 years. The most common substrates were benign tumors (over 50%) for hemithyroidectomies and multinodular goiters (almost 50%) for total thyroidectomies. The average hospital stay was 1 day for hemithyroidectomies and 1.48 days for total thyroidectomies. Complications included postoperative bleeding (0.57%), subcutaneous hematoma (1.32%), subcutaneous seroma (2.08%), temporary hypocalcemia or hypoparathyroidism (18.9%), permanent hypocalcemia or hypoparathyroidism (0.76%), temporary vocal cord paralysis (2.65%), permanent vocal cord paralysis (1.89%), bilateral vocal cord paralysis (0.19%), and mortality (0%).

Conclusion: The study confirmed the feasibility and safety of outpatient thyroid surgery, with minimal complications and short hospital stays, especially for hemithyroidectomy, but careful postoperative monitoring is required for patients undergoing total thyroidectomy. 

Introduction: Peptic ulcer is a chronic recurrent disease of the gastrointestinal tract, which most often occurs as gastric or duodenal ulcer. Peptic ulcer is characterized by certain geographical and temporal trends.

Objective: The aim of this study is to determine the frequency of gastric and duodenal ulcers among subjects who underwent esophagogastroduodenoscopy (EGDS) endoscopy due to dyspeptic complaints, as well as to analyze the trend of ulcer disease over a period of 10 years.

Material and Methods: The data of a total of 4074 subjects with an average age of 54.53 ± 15.03 years, both sexes, 1841 men and 2233 women, who underwent EGDS in 2005 and 2015 calendar years were retrospectively analyzed. Results: This study showed that the trend of ulcer disease significantly decreased in the observed ten-year period, accompanied by concomitant decrease in the prevalence of duodenal ulcers, while the frequency of gastric ulcers retained approximately at the same level. The results showed that men were at greater relative risk than women for the development of duodenal ulcers, in both calendar years. In the ten-year period, the average age of patients with ulcer disease increased by about 4 years, especially in the group with duodenal ulcer, and particularly within women with duodenal ulcer. Compared to 2005, the average age of subjects undergoing EGDS in 2015 increased by about 2 years, regardless of whether or not they were diagnosed with ulcer disease.

Conclusions: In the period 2005 - 2015, the age of patients with peptic ulcer tended to increase, whilst the prevalence of ulcer disease, especially duodenal ulcer, has decreased. The relative risk for duodenal ulcer in men was higher than in women. 

Introduction: Syncope is a sudden, short-lived, transient loss of consciousness associated with the inability to maintain postural tone. The aim of this paper is: to determine the frequency of syncope in children and adolescents in our conditions, to analyze the characteristics of syncopal episodes and clinical presentation in order to identify the etiology of seizures, and to provide diagnostic protocols, i.e. guidelines for streamlining clinical trials.

Methodology: The diagnosis of the disease was made clinically on the basis of well-taken anamnestic data and a detailed description of the quality of the attack, physical examination and routine laboratory analyzes: (CBC, glycemia, standard ECG). Additional tests were selectively performed: Holter ECG, ergometry, Tilt table test, Echocardiogram, NMR, EEG.

Results: Out of the total number of examined children in the outpatient Children’s Hospital, Department of Pediatric Cardiology, 139 patients (0.6%) reported due to short-term loss of consciousness. The largest number of children was between 15 and 18 years old. Ninety-two ( 66%) of those 139 were girls, and 47 (34%) were boys (p <0.05). Regarding the cause of syncope, it was found in 117 (84%) patients, and in 22 (16%) children the cause of syncope was unknown (p <0.05). Etiologically spreaking, syncope was divided into 3 groups: autonomic (vasovagal, situational, orthostatic, increased vagus tone in athletes) was the most common, in 88 patients (75%), cardiogenic in 5 (4%) and non-cardiogenic in 24 patients.(21%). There was also a recurrence of the attack. In two children, the syncopal attack was repeated 4 times.

CONCLUSION: Syncope most often occurs in teenagers and is mostly benign. To assess syncope, it is necessary to gather a detailed history of the attack, to conduct a detailed physical examination and routine laboratory analyzes: CBC, glycemia and standard ECG. Supplementary diagnostics should be performed exclusively in patients where there is a reasonable suspicion of heart disease or neurological diseases. 

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in children under the age of 5 years. In addition to the progress of modern medicine, the cause of KD is currently unknown and specific diagnostic tests for definitive diagnosis does not exist. The differential-diagnostic enigma is the exclusion of other diseases with similar clinical features. The primary treatment in the acute phase of KD is intravenous immunoglobulin (IVIG) and acetylsalicylic acid (ASA/aspirin). There is not a recommendation to a uniform therapeutic approach in refractory KD. The role of corticosteroids is still controversial, but there are studies that support its use as adjuvant treatment. Most patients have a good prognosis. The focus of future research should be the formulation of new algorithms for detection, differential diagnostic triage and treatment of KD. 

Introduction: Paraneoplastic pemphigus is an autoimmune bullous and erosive mucocutaneous syndrome associated with malignancy. First of all, it is associated with lymphoproliferative disorders, but also with solid tumors.

Case report: We present a 73-year-old female patient who developed polymorphic lesions on the skin and mucous membranes after treatment of nonHodgkin's lymphoma. Disseminated pale erythematous macules, exudative papules and plaques, papulovesicles, pustules, targetoid lesions and bullae are present on the skin, mostly with a flaccid roof, some with a hypopyon. Oral mucosal changes included erosions and ulcerations covered by fibrin deposits. Histopathological examination of several biopsies revealed the presence of interface dermatitis, eosinophils, necrotic keratinocytes, as well as intraepidermal cracks with acantholytic cells, dominated by eosinophils. Direct immunofluorescence microscopy of the perilesional skin showed fluorescent intraepidermal reticular IgG deposits, as well as segmental linear IgG deposits along the basement membrane zone. Indirect immunofluorescence microscopy revealed circulating IgG autoantibodies binding to monkey esophagus and rat bladder at a titer of 1:320. Initially, he was treated with systemic corticosteroid therapy, then, in consultation with a hematologist, rituximab therapy was indicated (375 mg/m2, 4 doses once a week). The patient died after the 2nd dose of rituximab.

Conclusion: Considering the different clinical, histopathological and immunological features, paraneoplastic pemphigus presents a challenge for the clinician. Knowledge of different clinical presentations, as well as individualization of therapy with a multidisciplinary approach, are of crucial importance.