Stefan Mandić-Rajčević

Outcome after brachial plexus injury surgery and impact on quality of life

BackgroundThe aim of this study was to investigate outcomes after surgery for brachial plexus injury (BPI), not only motor outcomes but also the quality of life of the patients.MethodsWe operated on 128 consecutive patients with BPI from 1992 to 2012. We documented the information on the injured nerve, level of injury, type of treatment used, timing of surgery, patient age, and preoperative and postoperative motor deficits. In 69 patients who agreed to participate in a quality of life study, additional assessments included functionality, pain, quality of life, patient satisfaction, and psychosocial health.ResultsOf patients who underwent only exploration and neurolysis, 35.3% showed a good quality of recovery. Patients who underwent nerve reconstruction using nerve grafting showed a better rate of good quality recovery (56.7%), and the results following nerve transfer depended on the type of transfer used. After surgery, 82.6% of patients showed significant improvement, 82.6% were satisfied, and 81.2% responded positively when asked if they would undergo surgery again if they knew the current result beforehand. Overall, 69.6% patients continued working after surgery. The mean DASH disability score was high (58.7) in the study group. Patients who had early surgery showed a consistently higher DASH score. About 76% of patients reported having pain regularly, and 18.8% reported depression or anxiety.ConclusionsWe consider that it is important to report not only muscle recovery, but also other aspects of recovery.

Symptomatic migration of a Kirschner wire into the spinal canal without spinal cord injury: case report

The migration of Kirschner wires (K-wires) is a rare but significant complication of osteosynthesis interventions, and numerous cases of wire migrations have been reported in the literature. Nevertheless, migration into the spinal canal is very rare, with only 10 cases reported thus far. The authors present a case of K-wire migration into the spinal canal, together with a review of the relevant literature. A 30-year-old male who had suffered a right clavicle fracture in a motorcycle accident was treated with 2 K-wires. Four months after the initial fixation, while he was lifting his child, he experienced short-term pain in his back, numbness in all 4 extremities, followed by a spontaneous decrease in numbness affecting only the ulnar nerve dermatomes bilaterally, and a persistent headache. No urinary incontinence was present. Simple radiography studies of the cervical spine revealed a wire in the spinal canal, penetrating the T-2 foramen and reaching the contralateral foramen of the same vertebra. Computerized tomography showed the wire positioned in front of the spinal cord. Surgery for wire extraction was performed with the patient under general anesthesia, and he experienced relief of the symptoms immediately after surgery. This case is unique because the wire caused no damage to the spinal cord but did cause compression-related symptomatology and headache, which have not been reported in osteosynthesis wire migration to the thoracic region.

Iatrogenic Peripheral Nerve Injuries - Surgical Treatment and Outcome: 10-Years´ Experience

BACKGROUND Iatrogenic nerve injuries are nerve injuries caused by medical interventions or inflicted accidentally by a treating physician. METHODS We describe and analyze iatrogenic nerve injuries in a total of 122 consecutive patients who received surgical treatment at our Institution during a period of 10 years, from January 1, 2003, to December 31, 2013. The final outcome evaluation was performed 2 years after surgical treatment. RESULTS The most common causes of iatrogenic nerve injuries among patients in the study were the operations of bone fractures (23.9%), lymph node biopsy (19.7%), and carpal tunnel release (18%). The most affected nerves were median nerve (21.3%), accessory nerve (18%), radial nerve (15.6%), and peroneal nerve (11.5%). In 74 (60.7%) patients, surgery was performed 6 months after the injury, and in 48 (39.3%) surgery was performed within 6 months after the injury. In 80 (65.6%) patients, we found lesion in discontinuity, and in 42 (34.4%) patients lesion in continuity. The distribution of surgical procedures performed was as follows: autotransplantation (51.6%), neurolysis (23.8%), nerve transfer (13.9%), direct suture (8.2%), and resection of neuroma (2.5%). In total, we achieved satisfactory recovery in 91 (74.6%), whereas the result was dissatisfactory in 31 (25.4%) patients. CONCLUSIONS Patients with iatrogenic nerve injuries should be examined as soon as possible by experts with experience in traumatic nerve injuries, so that the correct diagnosis can be reached and the appropriate therapy planned. The timing of reconstructive surgery and the technique used are the crucial factors for functional recovery.

Upotreba biološkog monitoringa u cilju zaštite životne sredine

Various natural phenomena, such as earthquakes, volcanic activity, or floods, but also changes due to human activity, can influence the health of human beings. The inability of humankind to, using basic principles of ecology, reduce their negative influence on the living environment can be considered one of the biggest failures of the 21st century. Having in mind that the human factor is one of the biggest causes of changes in biological systems, managing this influence requires thorough assessment and control, which is most easily done using biological monitoring. The aim of this paper is to present the basic principles of biological monitoring, as well as demonstrate the most useful methods and examples of their use in health impact assessment.

Defining the Needs and Developing an Informational System for the Monitoring and Assessment of Landfil Gas for Municipal Landfils

Serbia is the largest country in the region, and with a little over 7.5 million people has more than 3600 waste dupmsites. When low level of recycling (less than 10%) and existance of only 7 larger landfils is taken into account, it becomes clear that there is a need for upgrading the waste management in our country in order to prevent the negative influences on the environment and human health, but also to satisfy the requirements necessary to join the European Union. There are many models alowing to estimate the quantities of landfil gas, and several solutions exist in the form of Excel sheets, but there is no integrated software solution which would facilitate monitoring of municipal waste landfilling, estimating emissions, and reporting. The aim of this paper is to analyze the needs for a software solution of this kind and present the basic steps in the development of this software solution.

Environmental and take-home lead exposure in children living in the vicinity of a lead battery smelter in Serbia

ABSTRACT Blood lead levels (BLLs) have been falling steadily worldwide due to restricted use of lead (Pb) and its compounds. although they remain above preindustrial Pb levels. Elevated BLL can still be found in children living near secondary Pb smelters that represent around 50% of Pb production. There have been no studies on Pb exposure in children living in Serbia ever since the 1980s. The aim of this study was to evaluate the BLLs in children living in two villages in Serbia (Zajača, the location of a secondary lead smelter, and Paskovac, 5 km away), identify the primary determinants of children’s BLLs, and investigate the impact of BLLs on children’s health symptoms and school achievement. The study was conducted in 2011 on 127 children, aged 1–18 years, whose BLLs were measured using inductively coupled argon plasma mass spectrometry (ICP‐MS). The median BLL in children was 12 &mgr;g/dl, with a significantly higher value of 17.5 &mgr;g/dl in Zajača, compared to 7.6 &mgr;g/dl in Paskovac. Only 1 out of 75 and 12 out of 52 children from Zajača and Paskovac, respectively, had BLLs below the CDC recommended 5 &mgr;g/dl level. Living near the smelter resulted in 19 times, and having a father who works in the plant 4 times higher odds of elevated BLLs. No significant effects of elevated BLLs health symptoms were seen in this study. BLLs of children living near a battery recycling plant in Serbia, an upper‐middle income European country, were in the range and even higher than those of children living in developing countries. For the first time, the contribution of environmental and take‐home lead exposure was quantified using mixed‐effect modeling, and our results indicate a contribution of 25–40% of the take‐home lead exposure to the BLLs of children living in the vicinity of a secondary lead smelter. HighlightsChildren living near a battery recycling plant had elevated blood lead levels (BLLs).Children 0–6 years old living closest to the plant had the highest BLLs.Higher lead exposure was found in children whose fathers worked in the plant.The contribution of take‐home lead exposure was between 25% and 40%.

Occupational exposure to blood and bodily fluids among healthcare workers in Serbian general hospitals

Abstract The risk of occupational bloodborne infections (HBV, HCV, and HIV) among healthcare workers remains a serious issue in developing countries. The aim of this study was to estimate occupational exposure to bloodborne infections among general hospital workers in Serbia. This cross-sectional study was conducted in the spring of 2013 and included 5,247 healthcare workers from 17 general hospitals. The questionnaire was anonymous, self-completed, and included sociodemographic information with details of blood and bodily fluid exposure over the career and in the previous year (2012). Significant predictors of sharps injuries were determined with multiple logistic regressions. The distribution of accidents in 2012 was equal between the genders (39 %), but in entire career it was more prevalent in women (67 %). The most vulnerable group were nurses. Most medical doctors, nurses, and laboratory technicians reported stabs or skin contact with patients’ blood/other bodily fluid/tissue as their last accident. Healthcare workers from the north/west part of the country reported a significantly lower number of accidents over the entire career than the rest of the country (p<0.001). The south of Serbia stood out as the most accident-prone in 2012 (p=0.042).

Mogućnost odgovara zdravstvenih ustanova na industrijske akcidente-primer zdravstvene ustanove u opštini Obrenovac

Based on the Hyogo and Sendai Framework for Disaster Risk Management caused by natural or human factors, a study was conducted on the territory of Obrenovac municipality regarding the readiness of health care facilities to respond to potential industrial accidents. Local health care facilities are public service provider which often represent the primary level in the hierarchy of providing health care services to the local population in case of smaller or larger industrial accidents. Through our paper we will present the methodology used for calculating the hospital safety index defined by the World Health Organization, the possibility to apply this method of evaluation on health care facilities in Serbia, the preliminary results of our studies and suggested procedures for overcoming organiza-tional, architectural, and construction problems in the primary health care facility of Obrenovac.

Cranial Reconstruction Using Autologous Bone and Methylmethacrilate

Background: Having in mind the importance of reconstruction of the calvaria, our goal was to compare the complication rates following the use of autologous bone and methylmethacrilate grafts, and explain the factors influencing them. Methods: The authors collected information of all the patients undergoing cranial reconstructive surgery (N = 149) at the Military Medical Academy in Belgrade. Procedures were performed either using a craniotomy bone flap, removed and replaced in the same act, or using methylmethacrilate. These 2 groups were compared using the Chi-squared test, controlling for the confounding influence of the size of the defect. Results: Intracranial neoplasms were the cause for the reconstruction in 71.1% of patients. The total complication rate was 7.4%, while the infection rate was 5.4%. The infection rate was significantly higher in those procedures done using methylmethacrilate (11.3% compared with 2.1%, P = 0.017), but when controlling for the confounding effect of the size of the defect treated, the difference in infection rate was significant only in large defects (13.9% compared with 2%, P = 0.031), while for small defects the difference was not statistically significant. Conclusions: Our study suggests that the material used for reconstruction of calvaria influences the infection rate only in large and complicated defects. Considering the importance of the reconstruction, further studies should explore and confirm the role of material type on the rate of complications.