bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination therapy-permanent interstitial brachytherapy and external beam radiotherapy for patients with localized prostate cancer
Authors: Matzkin H. , Keren-Paz G. , Mabjeesh N.J. , Chen J.
Published: November 2008

Background: Combination of permanent interstitial brachytherapy based on radioactive iodine with external beam radiotherapy is an alternative to other treatment modalities, such as radical prostatectomy or external beam radiotherapy alone in patients with intermediate-risk localized prostate cancer. In this article we report our experience with this combination modality. Methods: Among patients who were treated in our institute with brachytherapy, there were 64 patients who received combination therapy for the above indication. Combination therapy enables administration of 110 Gy as brachytherapy and thereafter 45 Gy as external beam radiation. All patients received adjuvant androgen deprivation therapy for 6 months. The prospective follow-up was done with the aid of validated evaluation instruments (questionnaires). Results: Combination therapy was administered without additional urinary (IPSS-based) or sexual (IIEFbased) side effects above those with brachytherapy alone. No severe perianal and lower intestinal tract side effects were observed. Short-to-moderate-term results based on serum PSA levels are encouraging, and are not inferior to what is accepted by the literature for other radical therapies. Conclusion: Combination of permanent interstitial brachytherapy and external beam radiotherapy in the appropriate patients does not cause any additional morbidity, and its biochemical results justify its application. This modality should be offered as an accepted and good alternative to other radical treatment options, to men with prostate cancer with moderate risk factors.
Radical retropubic prostatectomy for prostate carcinoma: First results of the Clinic of urology in Skopje
Authors: Stavridis S. , Georgiev V. , Popov Z. , Penev M. , Lekovski Lj. , Stankov O. , Dohcev S. , Petrovski D. , Saidi S. , Kuzmanovski M. , Banev S. , Stavridis A.
Published: November 2008

Objectives: The aim of this retrospective study is to present our experience and results in the management of prostate carcinoma, with radical retropubic prostatectomy, for a period of seven years. Material and methods: From December 1997 to April 2005, 61 radical retropubic prostatectomies for prostate carcinoma were performed at the Clinic of Urology in Skopje. Mean age of the treated patients was 66.4 years. Mean serum PSA level was 32.75 ng/ml. None of the patients had distant or bone metastases. Mean operative time was 160 minutes and from 2 to 4 units of blood were transfused intra and postoperatively. Mean follow up time was 39 months. Results: In all of 61 patients, the RRP was performed for adenocarcinoma of the prostate. The pathological findings postoperatively showed the following pTNM grade: pT2a in 8, pT2b in 10, pT3a in 10, pT3b in 27and pT4 in 6 patients. Positive lymph nodes were found in 14 cases. Intraoperative complications occurred in 6 patients. Early postoperative complications were seen in 12 patients. Urine leakage was seen in 2 patients, incontinence (day and night) in 8 and pulmonary embolia in 2 patients. Late postoperative complications occurred in 11 patients. Stenosis of the vesico-urethral anasthomosis was seen in 3 patients and incontinence (during the night only) in 8 patients. The rate of potency was not evaluated but in the last 30 cases we insisted on preservation of the neurovascular bundles in the cases that it was possible. Conclusion: Radical retropubic prostatectomy is the method of choice and the golden standard for treatment of organ confined prostate carcinoma in patients with long life expectancy, no neither local nor distant metastases and good overall status. With this technique complication rates are minimal, the cure rate is very big and the patients have high quality of life. The experience of the surgeon is very important since the learning curve is crucial for diminishing operative time, postoperative complications and blood transfusions.
Correlation of high-molecular cytokeratin in tissue of prostatic cancer with gleason score and PSA
Authors: Acimovic Miodrag , Govedarevic V. , Mitrovic D. , Radosavljevic R. , Hadzi-Djokic Jova , Tulic Cane , Dzamic Zoran , Jovanovic M. , Zivkovic K. , Babic M. , Markovic-Lipkovski J.
Published: November 2008

The absence of basal cell layer of prostatic acini containing high-molecular cytokeratin, which is immunohistochemically detected by monoclonal antibody 34?E12, is an essential diagnostic characteristic of prostatic cancer. The absence of im munohistochemical reaction in 3 or more pseudo glandular structures of prostatic tissue indicates malignant process. The percentage of immunohistochemically completely negative glandular structures was determined by semiquantitative measurement in tissue specimens obtained by TRUS biopsy of the prostate, and it was correlated with serum PSA concentration and Gleason score. The increase of percentage of glandular prostatic formations completely negative to high-molecular cytokeratin detected by 34?E12 led to simultaneous rise of mean value of Gleason prostatic cancer score (p<0.001) as well as the average serum PSA concentration in subjects (p<0.05).
Radical retropubic prostatectomy: Results in 127 surgically treated patients
Authors: Hadzi-Djokic Jovan , Acimovic M. , Dzamic Z. , Pejcic T. , Radosavljevic T. , Basic D. , Colovic V. , Petrovic M. , Obradovic G.
Published: November 2008

Radical prostatectomy represents an optimal therapeutic method in treatment of the localized prostatic carcinoma. It may be performed using retropubic, perineal, transcoccygeal or laparoscopic approach. In a multicenter study, the authors have analyzed 127 patients surgically treated in the period 1992 - 2003. All the patients were preoperatively diagnosed with the localized prostatic carcinoma. The patients were operated at the Clinic of Urology in Belgrade (92 patients) and other departments of urology in Serbia (35 patients). The youngest patient was 49 while the oldest one was 75 (mean age 64 years). The surgical procedure duration ranged between 60 and 120 minutes. Over the last five years, the need for blood transfusion was below 50%. All the patients underwent retropubic radical prostatectomy.
Urinary prostate specific antigen: Is the clinical use likely?
Authors: Pejcic T. , Hadzi-Djokic J. , Acimovic M. , Topuzovic C. , Milkovic B. , Janjic A.
Published: November 2008

Prostate specific antigen (PSA) blood test represents the standard procedure in prostate cancer (CaP) diagnosis and follow-up. However, determination of PSA in the urine, where PSA is present in much higher concentrations than in the blood, still remains in the field of research. Objectives: To determine urinary concentrations of PSA (uPSA) in different groups of patients (pts.), and to estimate is it possible to differentiate benign and malignant prostate diseases and to follow-up the results of treatment. Methods: Between January 2001. and November 2003., urinary concentrations of PSA were determined at 142 pts. divided in seven groups: 1. young and healthy volunteers, 2. "BPH-24": pts. with benign prostatic hyperplasia (BPH) who collected the sample of 24- hour voided urine, 3. "BPH-I": pts. with BPH who collected the first portion of first urinary voiding, 4. "TRUS-CaP": pts. with CaP which gave the first portion of urine just prior to transrectal ultrasound guided prostate biopsy (TRUS- biopsy), 5. "TRUSnon- CaP": pts. who gave first portion of urine prior to TRUS-biopsy, but biopsy did not prove the presence of CaP, 6. "RRP": pts. who underwent radical retropubic prostatectomy (RRP), 7. "AAT": pts. who underwent androgen deprivation therapy. Results: Average uPSA value in the group of young and healthy volunteers, was 13.8+19.6 ng/ml, in "BPH-24": 38.0+ 44.4 ng/ml, in "BPH-I": 140.8+140.9 ng/ml, in "TRUSCaP": 234.8+277.7 ng/ml, in TRUS-non-CaP: 113.1 +148.5 ng/ml, and in the group "RRP": 4.4+4.7 ng/ml. There was no statistically significant difference of average uPSA values between "BPH-I" and "TRUSCaP" groups. The significant difference was found between the group of young volunteers and "BPH-I". In "TRUS-CaP" group, there was strong correlation between tumor size and aggressiveness and uPSA concentration. Finally, PSA and uPSA decline during androgen deprivation therapy, strongly correlated (up to r=0.95). Conclusions: Determination of uPSA cannot differentiate BPH and CaP. However, in the group of pts. with proven localized CaP, uPSA can provide additional information concerning T-staging. Moreover, simultaneous monitoring of PSA and uPSA response on hormonal therapy, can provide an early recognition of androgen-in different CaP (AIPCA) and hormone resistant CaP (HRPCA).
Radical retropubic prostatectomy: Report on 41 cases
Authors: Colovic V. , Hadzi-Djokic J. , Filipovic Z. , Popovic D. , Sola N. , Paunkovic P. , Masulovic D.
Published: November 2008

Anatomic radical retropubic prostatectomy is an effective method for long-term control of the prostatic carcinoma. In the current era of the anatomic prostatic surgery, blood loss is reduced, complication rate is low and control of the disease may be excellent. Some authors1,2,3 reported cancer- specific survival rate after the radical retropubic prostatectomy of 85-90% over the 10-year period and 82% over the 15-year period. The survival may be more favorable in the patients with lower Gleason scores. The former indicates that radical retropubic prostatectomy is an excellent therapeutic option for treatment of the localized prostatic carcinoma, while selection of patients is a crucial factor for true success of therapy based on this method.
The possibilities of age reference values of PSA density in prostatic cancer screening
Authors: Acimovic Miodrag , Dzamic Zoran , Tulic Cane , Lalic N. , Janicic A. , Radosavljevic R. , Mitrovic D. , Hadzi-Djokic Jovan
Published: November 2008

INTRODUCTION: The possibilities of PSA (prostate specific antigen) test in screening of prostatic cancer may be evaluated by measuring its sensitivity, specificity and positive predictive value. The majority of reference articles in this field has evaluated the possibility of detection of prostatic cancer by radioimmunoassay (RIA). MATERIAL AND METHODS: Prospective study included 2000 male patients over 50 years of age. The objective of the study was to examine the possibility of enzyme PSA test for differentiation of benign prostatic hyperplasia (BPH) and localized prostatic cancer (PC). The possibility of enzyme PSA assay for detection of prostatic cancer was compared with RIA method, by digital rectal examination and echotomography. The effect of PSA density and age reference values for differentiation of PC from BPH was also examined. DISCUSSION: The results of enzyme immunoassay test (EIA) were compatible with radioimmunoassay results (RIA). Diagnostic algorithm of prostatic cancer detection should be corrected with PSA density values according to aged-specific groups (49 years - 0.09 ng/ml/cm3; 59 years - 0.13 ng/ml/ cm3; 69 years - 0.17 ng/ml/cm3; 79 years - 0.19 ng/ml/cm3) in order to reduce the number of false positive results in PSAD grey zone (0.10 - 0.20).
New generation urethral stents in treatment bladder outlet obstruction caused by prostate cancer
Authors: Markovic B. , Markovic Z. , Filimonovic J. , Hadzi-Djokic J.
Published: November 2008

Our clinical trial included until now, 22 patients in whom new generation urethral stent named Allium, were inserted due to bladder outlet obstruction caused in 7 patients (pt) with benign prostae hyperplasia, in 13 pt with bulbar urethral stricture of different ethiology and in 2 pt with prostate cancer. Allium prostatic stents, designed by Daniel Yachia differs in some crucial characteristics from previously used stents: they are covered for the first time in urethra stenting history, without relatively low radiation force and because of that nonirritative. the indications, contraindications and preliminary results in this study are discussed concerning the patients with cancer of the prostate.
Radio therapy in prostate cancer treatment
Authors: Radosevic-Jelic Ljiljana , Stojanovic Suzana , Popov I.
Published: November 2008

Prostate cancer is a complex disease, with many controversial aspects of management in almost all stages of disease. The natural history of this tumor is variable and is influenced by multiple prognostic factors. Radical prostatectomy and radiotherapy are standard treatment options for disease limited to the prostate. The data in literature does not provide clear- cut evidence for the superiority of any treatment. Neo- adjuvant or adjuvant hormonal therapy improves local control and survival in locally advanced disease. The patients treated with radiotherapy would have a relatively long life expectancy, not great risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a significant potential for cure, it is well tolerated in the majority of men especially when the modern techniques of conformal radiotherapy and intensity modulated therapy are used and it is non-invasive therapeutic options with no anesthesia risk. Expected complications like radiation cystitis, impotence and proctitis are registered in about 1% of patients.
Anesthesia for radical prostatectomy
Authors: Filimonovic J. , Gvozdic B. , Krivic B. , Acimovic M. , Tulic C. , Hadzi-Djokic J.
Published: November 2008

Radical prostatectomy is one of most common treatment options currently recommended for clinically localized prostate cancer. Evaluation of intraoperative and postoperative complications is important in evaluation of relative morbidity of this treatment option. Furthermore, investigation of complications of surgical treatment in correlation with not only surgical technique, but comorbidity, ASA stage and anesthetic technique enables improvements in complete perioperative treatment and decrease of incidence of complications resulting from the procedure. Improvement of anesthetic techniques and use of new anesthetic agents contributes to better outcome of surgical treatment. For radical surgery, combined epidural analgesia and general anesthesia reduces postoperative complications and mortality. Benefits can be conferred most likely by altered coagulation activation in surgery, increased blood flow, reduction of operative stress response. Modalities for reduction of intraoperative blood loss during radical prostatectomy are normovolemic haemodilution, preoperative donation of blood for autologus transfusion and use of erythropoietin for increasing red cell mass.
Zometa in the treatment of disseminated prostate cancer
Authors: Djokic M.
Published: November 2008

Zoledronic acid is the first bisphosphonat that confirms the a efficacy in the treatment of bone metastases in prostate carcinoma. That is the most potent bisphosphonat up to date which safe and simple administration. Zometa is strong inhibitor of osteoclast activity.
Plantago ovata
Authors: Ceranic M. , Kecmanovic D. , Pavlov M. , Sepetkovski A. , Kovacevic P. , Stamenkovic A. , Masirevic V. , Rankovic V.
Published: November 2008

Plantago ovata is a high fibre bulk forming laxative. It absorbs water and expands to provide increased bulk and moisture content to the stool. The increased bulk encourages normal peristalsis and bowel motility. Clinical Indications: Constipation, Fecal Incontinence, Hemorrhoids, Ulcerative Colitis, Appetite, Hyperlipidemia, Diabetes mellitus.
Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis
Authors: Djukic P.L. , Obrenovic-Kircanski B.B. , Vranes M.R. , Kocica M.J. , Mikic A.Dj. , Velinovic M.M. , Kacar S.M. , Kovacevic N.S. , Parapid B.J.
Published: November 2008

Mitral valve replacement with posterior leaflet preservation was shown beneficial for postoperative left vetricular (LV) performance in patients with mitral regurgitation. Some authors find it beneficial even for the long term LV function. We investigated a long term effect of this technique in patients with rheumatic mitral stenosis. We studied 20 patents with mitral valve replacement due to rheumatic mitral stenosis, in the period from January 1988. to December 1989. In group A (10 patients) both leaflets and coresponding chordal excision was performed, while in group B (10 patients) the posterior leaflet was preserved. In all patients a Carbomedics valve was inserted. We compared clinical pre and postoperative status, as well as hemodynamic characteristics of the valve and left ventricle in both groups. Control echocardiographyc analysis included: maximal (PG) and mean (MG) gradients; effective valve area (AREA); telediastolic (TDV) and telesystolic (TSV) LV volume; stroke volume (SV); ejection fraction (EF); fractional shortening (FS) and segmental LV motion. The mean size of inserted valve was 26.6 in group A and 27.2 in group B. Hemodynamic data: PG (10.12 vs 11.1); MG (3.57 vs 3.87); AREA (2.35 vs 2.30); TDV 126.0 vs 114.5); TSV (42.2 vs 36.62); SV (83.7 vs 77.75); EF (63.66 vs 67.12); FS (32.66 vs 38.25) Diaphragmal segmental hypokinesis was evident in one patient from group A and in two patients from group B. In patients with rheumatic stenosis, posterior leaflet preservation did not have increased beneficial effect on left ventricular performance during long-term follow-up. An adequate posterior leaflet preservation does not change hemodynamic valvular characteristics even after long-term follow-up.
The role of PCR in detection of cytomegalovirus in blood and urine of transplanted patients
Authors: Lazarevic I. , Stanojevic M. , Cupic M. , Jovanovic T.
Published: November 2008

Rapid and reliable laboratory diagnosis of cytomegalovirus (CMV) infection in transplanted patients becomes more significant considering possible prevention or moderation of CMV disease. The aim of this study was comparison of CMV isolation in cell culture and CMV detection by PCR in blood and urine samples of transplanted patients. The study comprised 21 patients undergoing immunosuppressive therapy after renal or bone marrow transplantation. MRC-5 cell culture was used for viral isolation. Inoculated cultures were maintained for 4 weeks or until appearance of specific cytopathic effect (CPE). Primers used in PCR were specific for the sequence within egzon 4 of immediate-early 1 (IE-1) gene. Presence of anti-CMV IgG and IgM antibodies was determined by ELISA. PCR was more sensitive for blood (4/21) and urine samples (3/19) than cell culture method - blood (0/21) urine (2/19). Statistically significant correlation was not shown between presence of CMV(determined by PCR) in blood and urine of the same patient.
Retrohepaticne vene posteriornog sektora desnog lobusa jetre -terminologija i hirurski znacaj
Authors: Djukanovic B. , Boricic I. , Djordjevic Lj. , Bilanovic D. , Bulajic P. , Milicevic M.
Published: November 2008

Three main hepatic veins: right, middle and left are constant, but there is a variable number of retrohepatic vessels called accessory or minor hepatic veins. The most important of them are veins reffered to as middle right hepatic vein (MRHV) draining segment VII and inferior right hepatic vein (IRHV) draining segment VI. The incidence of large MRHV and IRHV reaching or exceeding a caliber of 5mm, their arrangement in the liver and drainage territories were investigated in our collection of 142 injection-corrosion specimens of the liver. In 1/5 of the cases with large IRHV this vein drains small part of segment VI, sometimes its insignificant marginal part so it couldn?t be used for segment VI preservation when it is necessary. A precise knowledge of the vein anatomy of right posterior sector of the liver and its vein drainage territories is very important during complex dissections of the retrohepatic areas, resections and preservation liver parenchima.
Increse of newly - detected in situ cancers in non-palpable breast lesions
Authors: Miletic N. , Stojiljkovic D. , Inic M. , Prekajski M. , Celebic A. , Kosovac O.
Published: November 2008

Great importance in detecting cancer in the phase of in situ lays in the fact that the epithelial layer is deprived of blood and lymph vessels, so metastases may develop only when basal membrane has been broken. This paper includes 46 operated women in whom it preoperatively had been verified suspect non-palpable lesion. The preoperative diagnostics included use of high- resolution mammography, aimed mammography, palpatory examination, as well as fine-needle aspiration (FNA), biopsy and cytologic analysis of the sample. The methodology of this work implies the use of stereotaxic marking, specimen mammography and ex-tempore pathohistology analysis. Out of 46 investigated patients in clinical stage T0N0M0, in whom there were no signs of malignant disease, and according to suspect lesion of initial screening mammography, malignant lesions of breast tissue were diagnosed in 19 patients (41%) intraoperatively. Three of these lesions (15,8%) were histopathologically verified as in situ. Comparing our results with data of the Institute of oncology and radiology of Serbia hospital registry (IORS) for the year 2001, from 1173 patients registered with malignant lesions, only 16 ones (1,4%) had in situ cancer, operated on the basis of the suspect mammography of clinical stage T0N0M0. Statistically significant difference was found related to the number of detected cancers in this early phase of the breast malignant disease. This limits surgical intervention to tumorectomy, with preservation of the remaining breast tissue, what brings to healing, justifying in that way, screening examinations and routine application of the most contemporary diagnostic procedures.
Endoscopic removal of pedunculated leiomyoma of the sigmoid colon (case report and literature review of dignostic and treatment options)
Authors: Jovanovic I. , Cvejic T. , Popovic D. , Micev M.
Published: November 2008

Colonic leiomyoma are remarkably rare cause of colonic symptoms in clinical practice. They constitute only 3% of gastrointestinal leiomyomas and complete endoscopic removal of the tumor can be a problem because of its submucosal origin. We describe a 62-year female patient with a 8 mm leiomyoma of sigmoid colon that was successfully removed by conventional endoscopic snare electrocauterisation, without complications.
The role of SEMS in malignant and benign colon obstruction
Authors: Al-Kawas Firas
Published: November 2008

SEMS are highly valuable in the management of patients with malignant colon obstruction with high technical and clinical success. Currently, their role is in colon decompression as a bridge before surgery and in the palliative management of inoperative patients. SEMS appear to be more effective and less costly than emergency surgery. SEMS should be avoided in benign strictures. More data is needed in reference to the role of plastic expandable stents in the management of patients with benign colon strictures.
Radiofrequency surgery: Novel techniques in the treatment of ano-rectal disease
Authors: Gupta Pravin
Published: November 2008

Background: Radiofrequency surgery is a method of utilizing high frequency (3.8 to 4MHz) radio wave energy to incise, excise, or coagulate tissues. Radiofrequency (RF) is a relatively new modality that is being used for ano-rectal surgeries with increasing frequency. As the RF energy is applied, frictional heating of tissues results, with cell death occurring at temperatures between 60 and 1000 C. Objective- This paper discusses author?s clinical experience with radiofrequency for various ano-rectal pathologies namely hemorrhoids, anal fistula, anal polyps, sinuses and anal papillae. A Ellman dual frequency radiofrequency generator was used to carry out the procedures. This study is intended to be somewhat of a "how we do it" manual, explaining the principles of radiofrequency. Conclusion: Radiofrequency proctological procedures are simple to perform with many advantages over the more traditional techniques. The procedures take less operative time, the postoperative recovery is accelerated and the incidences of complications are negligible.
Better surgery and better selection for adjuvants: Still the key to improving outcomes in rectal cancer
Authors: Heald B.
Published: November 2008

In reviewing the current issues in rectal cancer management the word specialist recurs again and again. The modern hospital requires consultants with special interest in each of the key stages of decision making: Clinical assessment - usually the surgeon MRI. Fine slice individually orientated phased array coil studies with a specially trained radiologist. CT - now routine for metastases Neo-adjuvant therapy. Special interest in the disease in both clinical and medical oncology is essential. Surgery: The challenges of the distal pelvis make it increasingly unacceptable for surgeons without a "special interest" to operate on mid and low cancer. Histopathology: The lessons of Professor Quirke have brought the specialized histopathologist out of his laboratory into the cruel role of "surgical auditor" - providing circumferential margin examination plus naked eye, TME quality assessment. This gives us two invaluable measurable short term goals improving the quality for surgical practice. When a hospital can provide special interest doctors in all these fields and when they co-operate in a constructive manner the modern colorectal MDT can lead the way for the whole field of cancer management. It remains a probability that the use of high definition improved quality video based teaching of surgical technique is the single most effective weapon that we have in our battle against this most challenging of malignanvies.
The role of cytology in the diagnosis of benign and malignant anal lesions
Authors: Karaitianos Ioanis , Archondakis Stavros , Korkolis Dimitris , Koundouris Christos , Xenitidis Michael , Daskalopoulou Dimitra , Tsigris Christos
Published: November 2008

Squamous cell carcinoma is a rather infrequent neoplasm of the gastrointestinal tract. Nevertheless its frequency is increasing lately especially in high risk groups of the population infected from HIV or HPV viruses. Squamous cell carcinoma is a slowly and locally growing neoplasm which metastasizes in advanced stages. Its diagnosis must be accomplished by the least traumatic examinations possible. In our study we reviewed our five years experience that included 116 cases. In 89 of them cytological material from ulcerated positions of the anal region was examined. In the rest 27 cytological material was obtained by fine needle aspiration of subcutaneous or submucosal anal lesions. All 116 case reports were retrospectively evaluated. Cytological evaluation revealed 29 cases of normal anal epithelium, 13 granulomas, 12 cases of HPV infection, 28 anal squamous intraepithelial lesions (ASIL), 17 post radiation injuries of the anal mucosa and 17 carcinomas. The neoplasms were further sub classified in 12 well differentiated squamous cell carcinomas, 4 cloacogenic carcinomas and 1 leiomyosarcoma. Histological examination followed the initial cytological diagnosis in 75 cases. The correlation between cytological and histological reports did not reveal any false negative or any false positive result. The agreement between histological and cytological evaluation was absolute. Cytological examination is proved to be an easily accessible and totally reliable, low cost diagnostic method, not requiring any kind of anesthesia. It is well accepted by the patients and of paramount clinical utility for the initial diagnostic assessment, the long term follow up after treatment of anal cancer patients. It is also valuable for the differential diagnosis among benign, premalignant and malignant anal lesions.
Experiences with PPH gun stapled ileo or coloanal anastomoses after ultralow rectal resections and proctocolectomies with J pouch reconstructions
Authors: Nagy Attila , Kovacs Tamas , Lóderer Zoltan
Published: November 2008

A new method of stapled ileo and coloanal anastomosis with PPH gun (Johnson and Johnson USA) is presented. On 47 totalcolectomised FAP and UC patients and 9 low rectal benign or clinically T1 or T2N0 rectal tumor resection there was only 5 radiologically proven anastomotic leakage without serious septic complications. The anal sphincter function after 6 month of the ileoanal anastomosis remained good in 33/39 and acceptable in 6 cases, if the sphincter function was intact praeoperatively. There was no worsening of the moderate praeoperatively observed insufficiency. After the ultra low rectal resections all patients kept the normal anal shpincter function. The procedure seems to be as good as the double stapler method, but there remained no remnant mucosal ring between the anastomsois and the dentate line. An additional advantage of the method, that only one stapler was consumed per patient compared to the two one at the double stapler technique.
Management of T1 carcinoma of the lower third rectum
Authors: Nivatvongs Santhat
Published: November 2008

The earliest invasive carcinoma of colon and rectum is an invasion into the submucosa. For the TNM classification, these lesions are T1 Nx Mx. They present as an adenoma with invasive carcinoma, or a frank carcinoma. Local excision for T1 carcinoma of the rectum can be curative if the lesion is accessible for an adequate excision and if the lesion has not spread to the lymph nodes or distant metastasis. The key to success in local excision is selecting the lesions that have low risk of metastasis.
Surgery for constipation
Authors: Pfeifer Johann
Published: November 2008

Patients with intractable chronic constipation should be evaluated with physiologic tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried excessively. If surgery is indicated subtotal colectomy with IRA is the treatment method of choice. However, segmental resection may be a good option for isolated megasigmoid, sigmoidocele or recurrent sigmoid volvulus. In general patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection as they tend to have poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist even if surgery normalizes bowel frequency. Patients with associated problems may be better served by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is no option to treat pain and/or abdominal bloating.
Does epidural anesthesia and analgesia really improves surgical outcome after colorectal cancer surgery
Authors: Rimaitis K. , Pavalkis D.
Published: November 2008

Lithuanian Cancer Register has registered 1443 new cases of colorectal cancer in 2004 and this value constantly increases about 200 cases per year 1. Colorectal cancer is on the third place among all cancer patients in our country. Colorectal cancer surgery is associated with a major surgical trauma. Majority of recent randomized clinical trials (RCT) has shown that combined general - epidural anesthesia and postoperative epidural analgesia has demonstrated some beneficial effects and improved surgical outcome in various fields of surgery 2-4. However controversies still exist about epidural anesthesia and analgesia effects on colorectal anastomosis and it?s influence on patients? outcome.
Straight and colonic J-pouch reconstruction after low anterior resection
Authors: Teleky B. , Jech Barbara , Karner-Hanusch Judith , Kuehrer Irene , Götzinger P. , Herbst F. , Jakesz R.
Published: November 2008

Purpose: A complication after restorative rectal surgery with a straight anastomosis is low-anterior resection syndrome with a postoperatively deteriorated anorectal function. The colonic J-reservoir is sometimes used with the purpose of reducing these symptoms. An alternative method is to use a simple side-to-end anastomosis or a coloplasty. Material and Methods: Three-hundred fifty seven patients with rectal cancer undergoing total mesorectal excision (TME). Three-hundred (84.0%) received a low anterior resection with primary anastomosis and colo-rectal n=194 (64.6%) or colo-anal anastomosis n=106 (35.3%). A colonic pouch using the descending colon was created in 24 patients and in 75 patients respectively. Surgical results and complications were recorded. Patients were followed with a functional evaluation at 6 and 12 months postoperatively. Results: Patient characteristics in both groups were very similar regarding gender, age, tumor level, and Dukes? stages. A large proportion of the patients received short-term preoperative radiotherapy (72%). There was no significant difference in surgical outcome between the 2 techniques with respect to anastomotic height, perioperative blood loss, , postoperative complications, reoperations, hospital stay or pelvic sepsis rates except the anastomotic stricture rate in the colonic J-Pouch group after coloanal anastomosis (p<0.02). Conclusions: These data show that either a colonic Jpouch or a straight anastomosis performed on the descending colon in low-anterior resection with TME are methods that can be used with similar expected surgical and functional results.
Salvage rectal surgery: Overview
Authors: Krivokapic Z. , Dimtrijevic I. , Markovic V. , Barisic G. , Antic S. , Jovanovic D. , Petrovic J.
Published: November 2008

Recurrence of the disease represents the major problem in patients who undergo "curative" resection for rectal cancer, with published rate ranging from 3 to 50 %. Most relapses occur within first two years of follow-up. Depending on the site of the recurrence, it can be local or distant. It also can be solitary or diffuse. In terms of potential surgical cure the best results are achieved with solitary, localized metastases. The most common sites of the solitary metastases are pelvis, liver and lung, with a fairly even distribution among these three sites. Other sites of the localized metastases can be peritoneum, lymph nodes, brain, bone, abdominal wall, ureter and kidney. These sites are less common, but not so amenable to resection. Local recurrence varies depending on the original type of surgery. It can be stated that surgical technique directly influences local recurrence rate in patients with rectal cancer. According to the results from a number of different authors 5-year survival rate after reresection is 2-13 % of all patients with locally recurrent cancer, both alone and associated with distant metastases. The most important moment in this problem is to decide when not to operate. The absolute contraindications for salvage surgery are: "frozen pelvis", aneuploid tumors and those with mucinous component, clinical or CT evidence of invasion of the pelvic nerves, lymphatics or veins, or ureter bilaterally. Also, evidence of involvement of the lateral pelvic sidewalls and/or upper sacral marrow, and/or S2 is an absolute contraindication for surgery. Thus, main goals of this type of surgery are respectively: palliation of symptoms, a good quality of life and, if possible, cure with low treatment-related complication rates.
Surgery for colorectal liver metastases: Expanding the boundaries but where have all the patients gone
Authors: Milicevic Miroslav , Bulajic Predrag , Zuvela Marinko , Raznjatovic Zoran , Lekic Nebojca , Basaric Dragan , Galun Danijel , Barovic Svetlana
Published: November 2008

Aim: To review and discuss the current strategies and controversies in the surgical management of colorectal cancer liver metastases. Methods: An analysis of indications, contraindications and scoring systems and concepts for expanding the indications for resection are discussed. The findings and discussion are related to our own experience, especially with radiofrequency assisted liver resection for colorectal cancer liver metastases. Results: Resection is the only management strategy that can potentially cure the patient. Certain controversies still exist, such as contraindications for surgery, timing of treatment of synchronous metastases, significance of extra-hepatic disease etc. Strategies that can improve respectability are discussed. Parenchyma oriented, tissue sparing surgery facilitates reresection should it become necessary. Conclusion: The management of colorectal cancer liver metastases is still a confusing issue for general oncologists and general surgeons. A multidisciplinary approach that tailors the management strategy to the individual patient is the only option that provides optimal results for patients with advanced disease.
Prognostic value of Thymidylate Synthase, Epidermal Growth Factor Receptors and Vascular Endothelial Growth Factor in patients with stage III colon cancer
Authors: Tarabar Dino , Knezevic-Usaj Slavica , Petrovic Zoran , Jovanovic Dusan , Doder Radoje
Published: November 2008

Purpose: We studied the prognostic value of thymidylate synthase (TS), Epidermal Growth Factor Receptors (EGFR) and Vascular Endothelial Growth Factor (VEGF) expression in primary colon cancer (CC). Patients and Methods : Those three markers were immunohistochemically assessed on tumor sections from 100 patients with CC Dukes C. All patients received the same adjuvant chemotherapy with FU/Leukovocin according to Mayo protocol. Considering the clinical course they were classified in two groups: bad in which all patients progressed and good in which neither progressed during the five year follow up period. Results: TS, EGFR and VEGF were an independent prognostic factor for time to progression (TTP) and overall survival (OS). Findings of at least two maximum expressed investigated markers, significantly increases the risk of progression which influences shorter five year survival, and the single maximum expression does not necessarily have to be a bad prognostic sign. Conclusion: Highest expression of TS, EGFR and VEGF carries prognostic significance with respect to TTP and OS for patients with Dukes C colon cancer.
Primary esophageal motility disorders: Concise review for clinicians
Authors: Simic A. , Raznatovic Z. , Skrobic O. , Pesko P.
Published: November 2008

Primary esophageal motility disorders comprise various abnormal manometric patterns which usually present with dysphagia or chest pain. Some, such as achalasia, are diseases with a well defined pathology, characteristic manometric features, and good response to treatments directed towards the palliation of symptoms. Other disorders, such as diffuse esophageal spasm and nutcracker esophagus, have no well defined pathology and could represent a range of motility abnormalities associated with subtle neuropathic changes, gastresophageal reflux and anxiety states. On the other hand, hypocontracting esophagus is generally caused by weak musculature commonly associated with gastresophageal reflux disease. Although manometric patterns have been defined for these disorders, the relation with symptoms is poorly defined and in some cases the response to medical or surgical therapy unpredictable. The aim of this paper is to present a wide spectrum of the primary esophageal motility disorders, as well as to give a concise review for the clinicians encountering these specific diseases. .
Elevated serum uric acid reduce heart damage in patients undergoing open-heart surgery
Authors: Nikolic A. , Mijalkovic D. , Nikolic A. , Kastratovic D. , Blagojevic D. , Davidovic B. , Spasic M.
Published: November 2008

Objectives: Peroxynitrite is species claimed to propagate ischemia/reperfusion damage. In this report levels of serum uric acid (UA), a peroxynitrite scavenger, are compared with creatine phosphokinase (CPK) in male patients before and after open-heart surgery in order to asses if increased levels of UA may protect heart from biochemical damage induced by peroxynitrite during the coronary by-pass grafting (CABG) intervention. Methods: 45 male patients (16 carvedilol pretreated (6.25 mg/ daily, during 6 weeks before surgery, mean age 55.3+1.7 years, range 50-71) and 29 patients without carvedilol pretreatment (mean age 58.3+1.4 years, range 47-73) underwent elective CABG were examined. Study inclusion criteria were CABG performed on two and more coronary-vessels with aortic crossclamp during 30-40 minutes. For assessment of patients objective health status before operations Euro- SCORE were used. Serum uric acid (UA) levels and creatine phosphokinase (CPK) were measured spectrophotometricaly by using a quantitative enzymatic assay. Results: Carvedilol pretreated patients had higher amount of serum UA (p<0.05) comparing to non-treated patients. During the surgical procedure patients are subjected to temporary ischemia due to transfer from corporeal to extracorporeal circulation. In this period of time the amount of UA decreased in carvedilol pretreated group (406+46 (t1) vs. 300+22 mmol/L (t2)) to the level of non-treated patients (328+14 (t1) vs. 322+18 mmol/L. Carvedilol pretreated patients and non-treated patients had the same level of CPK at the beginning of the surgical procedure (t1) (78+6 vs. 83+13 U/L) but lower increase (p<0.05) in CPK activity in carvedilol pretreated patients in respect to nontreated patients (338+46 vs. 644+103 U/L) at the end of procedure (t2). Such results suggest that open heart surgery led to elevated CPK levels, but this effect was less pronounced in patients with higher level of UA. Conclusions: Our results suggest possible role of UA in the protection from reperfusion injury. Increase of UA before surgery may be beneficial factor during CABG procedure in patients treated with carvedilol by decreasing level of peroxynitrite as one of molecular causes of reperfusion injury. Our results showed influence of UA on CPK levels at the end of surgical procedure, indicating that increased levels of UA may protect heart from biochemical damage induced by peroxynitrite during the CABG intervention. .
The influence of Helicobacter pylori eradication on appearance of gastro-oesophageal reflux disease
Authors: Popovic D. , Stankovic-Popovic V. , Milosavljevic T. , Jovanovic I. , Pesko P. , Simic A. , Micev M. , Milicic B. , Krstic M.
Published: November 2008

Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric acid regurgitation through the incompetent lower oesophageal sphincter in oesophagus. Etiopathogenesis of GERD is multifactorial. Aim of this study: to establish the relationship between Helicobacter pylori eradication and appearance or aggravating of present GERD. If this relationship exist, the aim is to estimate its level and clinical consequences. Material and methods: 50 Helicobacter pylori positive patients with different endoscopic findings (ulcer disease, gastritis and non-ulcer dyspepsia) to whom eradication of Helicobacter pylori was done, were following next 6 months. Questionnaire, uppear GI endoscopy with verification changes of oesophagus in accordance to LA classification, histopathological examination of gastric and oesophageal mucosal biopsy specimens, and oesophageal manometry have been done to all patients. These examinations have been done before Helicobacter pylori eradication and one, three. six and none months after that. Results: non statistical significant difference was found among the appearance or aggravating of present GERD in all patients during the following period (Cochran Q test; p=0,408). Non statistical significant difference was found among the endoscopic types of oesophagitis (LA classification) in all patients during the following 6 months (Friedman test; p=0,058). Non statistical significant difference was found among the changes of histopathological findings on distal oesophagus, too (Friedman test; p=0,217). Conclusion: Eradication of Helicobacter pylori infection does not cause the appearance or aggravating of present GERD. The presence of mildly form of GERD, or aggravating of present GERD is transitory, and haven?t the statistical signification. .
Anal canal melanoma: Case report
Authors: Stanojevic G. , Rancic Z. , Jovanovic M. , Stojanovic M. , Mihailovic D. , Brankovic B.
Published: November 2008

Anal canal melanoma is a rare disease comprising 1% of all colorectal ie. anal malignant tumours with very poor long term prognosis. Its significant biologic aggressivity is the consequence of the tendency towards lymphatic, local and hematogenous spread. At the moment of diagnosis even 30% of the patients have distant metastases. Surgical intervention represents the only possibility for cure. Modern approach to the anal canal melanoma treatment implies two types of intervention: wide local excision preserving the sphincter mechanism and abdominoperineal resection of the rectum. There are numerous dilemmas about the choice of surgery in particular disease stages. The authors report on a 61 years old women in which anal canal melanoma with left inguinal lymphatic metastases was detected during the inspection of "haemorrhoids". After the diagnosis was established, abdominoperineal resection of the rectum was performed with dissection of both inguinal regions. .
Prikaz slucaja hirurskog zbrinjavanja trudnoce u rudimentarnom rogu uterusa stare pet meseci
Authors: Boskovic V. , Vrzic-Petronijevic S. , Petronijevic M. , Berisavac M. , Likic-Ladjevic I.
Published: November 2008

Cornual ectopic pregnancy is rare clinical entity with high maternal mortality. In all cases surgical treatment is indicated, and taking care of most important complication - haemorrhagic shock. Therapeutic approach is individual and depending of simptomatplogy, gestational age of pregnancy and condition of the patient in time of diagnosis. Authors are presenting the case of cornual ectopic pregnancy of five months. .
Choice of operative procedures to correct equinus deformity in patients with cerebral palsy
Authors: Cobeljic G. , Vukasinovic Z. , Apostolovic M. , Bajin Z.
Published: November 2008

Equinus deformity of the foot presents a great number of difficulties to ambulant patients with cerebral palsy. Non-operative treatment of the incorrectible - fixed equinus is not successful. Many procedures are applied to treat it operatively, so its not clear which procedure at what age is the most successful. The purpose of this manuscript is to clarify the issue. The results of four procedures are analyzed: aponeurectomy of m. gastrocnemius, Achilles tendon lengthening by z-plasty, a combination of these two procedures and sliding elongation of m. triceps surae. The analysis was based on 417 operations in 291 patients of the average age of 9 years (1-64). The average follow-up was 7 years. The assessment of the results was based on the visual evaluation of the gait, on pedoscope prints and on comparison of ankle movements before and after operation. The analysis shows that the best results were achieved by sliding elongation of m. triceps surae after the age of 7.
Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: Semitendinosus / gracilis tendon vs. Ligamentum patellae
Authors: Blagojevic Z. , Stevanovic V. , Apostolovic M. , Lalosevic V. , Popovic N.
Published: November 2008

In this study we have analyzed outcome during the early rehabilitation period phase following two different methods of anterior cruciate ligament (ACL) reconstruction: ligamentum patellae (LP) and semitendonosus/gracilis tendon (SG) based reconstruction. This study included 40 patients treated by each method, examined 6 weeks and 3, 6 and 12 months after surgery. Patients in the SG group showed significantly better Lysholm scores at 6 and 12 months, Tegner Activity Scale scores at 3 months, and pain profile assessments at 6 weeks and 3 months than those in the LP group. Significant differences were observed in LP group in range-of-motion at 6 weeks and 3 and 6 months post-surgery. Stability tests revealed no significant differences between patients in the two groups. SG-based reconstruction of the ACL thus demonstrated advantages over LP-based reconstruction regarding pain and function, while LP-based reconstruction was associated with an earlier return of motion.