bluuebunny/crossref_metadata_2025 huggingface dataset:
Efekti sekcije lateralnih retinakula kolena u operativnom lecenju simptomatske patelofemoralne inkongruencije
Authors: Apostolovic M. , Cobeljic G. , Blagojevic Z. , Tomic S. , Slavkovic N.
Published: November 2008

Biomechanical malfunction of the knee extensor mechanism in the patello femoral joint is regarded as patella malalignment but major patients complaints are anterior knee pain and patellar slipping. Lateral retinacular release is one of the basic surgical procedures in the treatment of patellar malalignment. The aim of the study was to estimate the achievements of the lateral retinacular release in solving particular biomechanical disorders of the patello femoral joint, as well as individual patients complaints. Evaluation of objective parameters x-ray and clinical findings before and after the operation, shows statistically highly significant difference, thus confirming implementation of the fore mentioned surgical procedure. Despite the fact that anterior knee pain subsided postoperatively in the number of patients, statistically significant values, comparing to the preoperative findings, could not be obtained. Incidence of the patellar slipping has shown statistically significant reduction two years following the surgery. Achieving proper biomechanical alignment of the patello femoral joint is obviously not sufficient to provide relief of subjective complaints, especially concerning anterior knee pain, although considerable improvements were registered in the number of patients.
Low back pain: Differential diagnosis, prognosis and treatment
Authors: Lalosevic V. , Poleksic Z. , Blagojevic Z. , Tomic S. , Milickovic S.
Published: November 2008

From January 2002 to February 2003, 137 patients complaining of low back pain were treated at the Institute for Orthopedic Surgery "Banjica", Belgrade, Serbia. There were 89 male and 48 female patients aged 13 to 77, mean age 42.2. Their condition was diagnosed through use of radiography, CT, MRI, EMNG, standard battery of neurological tests, and laboratory analyses (urine and blood analysis). Surgical treatment was performed on 39 patients; all other patients received some form of non-surgical care (physical therapy, medication or corset). Treatment efficacy was evaluated by use of the visual analog scales (VAS) and the Oswestry index, before and after treatment. The use Wilcoxon?s pair test revealed statistically significant difference between before and after treatment data on VAS and Oswestry index for all patients.
Treatment of resistant frozen shoulder by manipulation under anethesia, intermittent interscalene blocks and protocol of kinesitherapy (Banjica)
Authors: Diklic I.D. , Ganic Z.D. , Blagojevic Z.B.
Published: November 2008

Treatment of frozen shoulder resistant to conservative therapy is complex problem. Manipulation under anesthesia is undertaken if at least 3 months of physical therapy fails to improve mobility of the shoulder. Maintaining the increased range of motion after manipulation is not easy to achieve. The main reason is the pain, which prohibits optimal physical therapy were treated between 2001 and 2003. The treatment consisted of manipulation in conjunction with intermittent interscalene blocks followed by protocol of kinesitherapy named Banjica. At final follow up, 95% of the elevation and 81% of the external rotation achieved intraoperatively were maintained.
Influence of morphometric intercondylar notch parameters in ACL ruptures
Authors: Stijak L. , Nikolic V. , Blagojevic Z. , Radonjic V. , Santrac-Stijak G. , Stankovic G. , Popovic N.
Published: November 2008

The most important anatomic risk factors in ACL lesions are the morphometric parameters of intercondylar notch. In the morphometric studies index of notch width and index of notch shape (NWI and NSI) are commonly used. The certain morphologic parameters of distal femoral part are used in calculation. Beside standard parameters we measured the maximal width of intercondylar notch and distal part of femur, which we used for calculation of maximal index of notch width and maximal index of notch shape (NWI max and NSI max). We compared two different methods of calculation of intercondylar notch indexes to find out which one represent anatomic risk factor and influence the ACL lesions. The indexes were measured in the two groups of patients (33) who have the history of knee injuries, the first group has document of ACL injuries and the second without ACL injuries (control one). The important difference between two groups was founded in NWI (p<0.01) and NSI (p<0.05). NWImax and NSImax do not show the difference (p>0.05). The NWI and NSI importance is higher in males, and smaller in females. There is no difference in NWImax and NSImax (p>0.05) comparing to the gender.
Ucestalost ortopedskih povreda kod politraume
Authors: Popovic N. , Blagojevic Z. , Nikolic V. , Stefanovic B. , Bajec Dj. , Karamarkovic A. , Vujadinovic D. , Pavlovic A.
Published: November 2008

Trauma is one of the leading causes of mortality in the world. Traumatic injury has a significant impact on the patient, socially, functionally and financially. Orthopedic injuries are generally not life-threatening unless they result in significant hemodynamic instability. The outcome of the orthopedic injuries might lead to mild or severe disability and lost quality of life. Therefore, the orthopedic surgeon has significant role in treatment of trauma patient. In order to control and prevent traumatic injuries, to improve quality of trauma treatment and outcome, including the costs the National trauma registry is essential. The aim of the study was to collect the dates about the frequency of orthopedic injuries in polytraumatised patients who were treated in intensive care unit of Emergency Center of Serbia in last two years. There were significant number of orthopedic injuries (53,2%) in polytraumatised patients. The major cause of the injuries is traffic (78,6%) and most patients were between 30-50 years (30%).
Valjanost klinickog i ultrazvucnog nalaza u odnosu na artroskopski nalaz svezih povreda prednjeg ukrstenog ligamenta kolena
Authors: Timotijevic S.S. , Vukasinovic Z.S. , Basarevic Z.Lj. , Basarevic V.D. , Trajkovic G.Z.
Published: November 2008

Injuries of anterior cruciate ligament are constantly present in sports, but also in common life activities. Diagnostic procedures which are available today in diagnosis and estimation of severity of intraarticular knee structures, are numerous, but they are not available, plausible and valid in the same manner. Aim of this study was to compare diagnostic validity of clinic and ultrasound examination related to arthroscopy in "fresh trauma: of anterior cruciate ligament This prospective study contains analysis 205 hospitalized patients treated from 2004 to 2006 at IOS "Banjica" Beograd and SOSH "Decedra" Beograd in matter of arthroscopy. Before the arthroscopy, clinical and ultrasound examination was performed. Values of sensitivity(87,1%), specificity(97,7%), positive (98,2%) and negative predictive value (84, 3%) of ultrasound examination are affirmative in high reliability of this diagnostic procedure in a diagnosis of fresh lesions of anterior cruciat ligament.
Our experience of postoperative saving of drainage blood in orthopedic surgery
Authors: Sikimic L.B. , Blagojevic Z.B. , Radojevic B.B. , Mancic N.Z. , Djuric M. , Jovanovic Z.D.
Published: November 2008

Postoperative saving of drainage blood presents postoperative autologous transfusion and that means group of action of collection patients blood and its late reinfision. The conditions of orthopedic surgery join with arthroplasty of coxae and knee are connected with significant loss of blood (800-1200 ml). With the aim of reducing the need for use of heterologous blood and elimination of potentional risks because of her application, we investigate the possibility of application the system of posteoperative saving of drainage blood in the study group of 48 patients in relation of control group of 25 patients. Postoperative blood saving has been derived after the first 4-8 hours, after the and of surgical operation. In the study group only 4 patients (8%) need additional heterologous transfusions. Postoperative blood saving and its reinfusion have not significant effect at hemostasis and system of coagulation. During six months postoperative, no patients in the study group have not any complication after orthopedic surgery.
Artroskopija kuka - operativno lecenje sinovijalne osteohondromatoze
Authors: Crnobaric A. , Blagojevic Z. , Stevanovic V.
Published: November 2008

The hip arthroscopy is an efficient procedure in treatment of synovial chondromatosis in selected patrients. The advantages compared to open procedures are lesser operative morbidity and faster postoperative recovery.
Indikaciona podrucja neoperativnog i operativnog lecenja intraartikularnih preloma kalkaneusa
Authors: Butkovic I.J.
Published: November 2008

Historically, intra-articular calcaneal fractures have been managed, as a rule, nonsurgically, although surgical treatment has more advocates in the past 20 years. Even today many high specialized orthopedic surgeons have a lot of controversies relating the indications fields of nonsurgical and operative treatment of these fractures. For getting correct decision adequate preoperative evaluation of fracture type, overall patients health and his functional needs is necessary. Generally, elderly patients with sedentary habits, without or with minimal fracture displacement, might be treated successfully with nonsurgical management. Good result after surgical treatment might be predicted in patients younger than 40 years, with a simple fracture pattern and high probability of achieving anatomic reduction. Highly precise and good surgical technique is necessary for getting a good final result with a long learning curve of the surgeon. Smoking, diabetes, chronic medical illness, peripheral vascular disease as well workers compensation claim (!) markedly increase the risk of surgical complications.
Gastrointestinalno krvarenje - krvarenje iz gornjih delova digestivnog sistema
Authors: Pesko P. , Jovanovic I.
Published: November 2008

Upper gastrointestinal (GI) bleeding represents the commonest emergency managed by gastroenterologists utilizing substantial clinical and economic resources. Manifestations of GI bleeding depend upon its localization, magnitude and co-morbidity. Although endoscopic haemostasis has significantly improved the outcome of patients with upper GI bleeding, in some cases patients continue to bleed or rebleed after initial control requiring early elective surgery in order to decrease mortality. Despite recent advances in, both, endoscopic and surgical therapy, mortality rates have remained essentially unchanged at 6-15%.
The role of wireless capsule endoscopy in the evaluation of patients with suspected small bowel bleeding: A single center experience
Authors: Krstic M.N. , Martinov J. , Krstic S.N. , Saranovic Dj. , Lausevic Z.D. , Milosavljevic T. , Jovanovic I. , Alempijevic T. , Marisavljevic D. , Pesko P.
Published: November 2008

Background: Capsule endoscopy (CE) is a new diagnostic tool for the study of patients with suspected small bowel pathology. The aim of the study was to clarify the usefulness of CE in the group of patients with obscure (overt / occult) gastrointestinal (GI) bleeding. Patients and methods: Thirty patients (14 men, 16 women, mean age 50 years, range 9 -79 years) were enrolled in the study. All of them undergone non-diagnostic esophagogastroduodenoscopy, colonoscopy and barium follow-through of the small bowel. All patients underwent capsule endoscopy. Fourteen patients had overt and sixteen occult bleeding. The single senior endoscopist interpreted CE findings in an unblended manner. Results: CE identified a source of bleeding in 14/30 patients (46,6 %). Lesions identified were: tumors in five pts, vascular lesions, Crohn's disease and Meckel's diverticulum in two pts and fresh bleeding, segmental celiac disease and colonic diverticulosis in one patient each. CE identified a source of bleeding in 9/14 (64,3%) of patients with ongoing overt bleeding and in only 5/16 (31,3%) of patients with occult bleeding. The positive suspicious findings were seen in 6/30 (20%) of patients (2/14 with overt bleeding and 4/16 with occult bleeding. In 3/14 (21,4%) with overt and 7/16 (43,7%) with occult bleeding findings on CE were negative. All patients with negative findings on follow-up remained asymptomatic for one year. Capsule retention because of unsuspected stenosis occurred in a single patient and required surgery, which resolved the problem. Conclusion: CE is an effective diagnostic tool for patients with obscure GI bleeding. It is safe and painless technique which can diagnose the bleeding site beyond the reach of conventional endoscopy. The best candidates for the procedure are those with ongoing and overt bleeding.
Coagulopaty in associated with massive transfusion
Authors: Jovanovic B. , Bumbasirevic V.M. , Terziski Z. , Pandurovic M. , Palibrk I. , Djukic V.R. , Karamarkovic A.R. , Radenkovic D. , Stevanovic R. , Simic D.
Published: November 2008

Massive hemorrhage is a formidable challenge for anesthesia care providers in the elective setting and poses even greater potential challenges in the trauma setting. In all this cases, the anesthesia care providers are faced with large-volume resuscitations that typically start with crystalloid and colloid and rapidly progress to blood and blood products. These large-volume replacement may cause coagulopathy, which can be difficult to manage in the setting of ongoing blood loss. Coagulopathy associated with massive transfusion is multifactorial event that results from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of anemia, and the use of hemostatic blood products.
Myeloproliferative diseases as causative agents of portal and hepatic veins thrombosis
Authors: Culafic Dj. , Miljic P. , Perisic M. , Djuranovic S. , Popovic D. , Krstic M.N. , Jovanovic I. , Pavlovic A.R. , Mijalkovic N.S. , Sokic-Milutinovic A. , Pesko P.
Published: November 2008

Thrombosis of portal and hepatic veins is one of the most severe complications and most important causes of death of patients with chronic myeloproliferative diseases. Based on results of the past studies, myeloproliferative diseases were the causes of hepatic veins thrombosis in 30% and portal vein thrombosis in 20% of patients. The study presented 4 patients with myeloproliferative diseases complicated by thrombosis of splanchnic veins, aiming at the illustration of issue complexity in diagnostics and therapy. Two patients with portal vein thrombosis and recurring hemorrhage from esophageal varicosity were described. The first case was planned for shunting, while another case sustained bleeding on what account his anticoagulant therapy was discontinued, but it caused mesenterial thrombosis resulting in lethal outcome. Another two patients had hepatic veins thrombosis. Due to frequent, life-threatening bleeding from the esophageal and gastric varices, a patient with chronic Budd-Chiari syndrome and lineal vein thrombosis underwent mesocaval shunting. An immediate postoperative period was manifested by multiple thrombosis and hemorrhages that ended in his death. A patient with the acute Budd-Chiari syndrome was administered myelosuppressants and anticoagulants on time so reperfusion was restored. In myeloproliferative diseases, thrombosis of portal and hepatic veins gives rise to excessive portal hypertension with profuse hemorrhage from the esophageal and gastric varicosity which is difficult to manage because of complex coagulation disorders.
Acute upper gastrointestinal nonvariceal bleeding: How to determine low risk patients for rebleeding and mortality after endoscopic sclerotherapy?
Authors: Djuranovic S. , Spuran M. , Mijalkovic N.S. , Stanisavljevic D. , Ugljesic M. , Popovic D. , Krstic M.N. , Milosavljevic T. , Pesko P. , Matejic O. , Pavlovic A.R. , Culafic Dj. , Jovanovic I.I. , Alempijevic T. , Sokic-Milutinovic A. , Bulajic M.
Published: November 2008

Introduction: Successful endoscopic sclero-therapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question. AIM: To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB. Patients and methods: Prospective study included 315 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity. Results: Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts? mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values <4 had low risk of rebleeding. We identified 59 pts (18,7% of all) with score for rebleeding <4. Score values for mortality risk ranged from 3 to 8 and the values <5 revealed negligible risk of death. In our group we found 290 pts (92,1% of all) with low mortality score values. Conclusion: Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.
Bleeding oesophageal varices: Therapeutic options
Authors: Pavlovic A.R. , Krstic M.N. , Djuranovic S. , Popovic D. , Jovanovic I. , Culafic Dj. , Mijalkovic N.S. , Krstic S.N. , Milosavljevic T. , Pesko P.
Published: November 2008

Introduction: Emergency endoscopy plays the most important role in diagnosis and treatment of patients with esophageal variceal bleeding. Endoscopic sclerotherapy (EST), placement of esophageal band ligatures (EVL), medicamentous treatment using somatostatin and its derivatives and balloon tamponade are the methods most frequently applied in treatment of the bleeding esophageal varices. Patients and methods: Endoscopic reports on the patients with bleeding esophageal and gastric varices were retrospectively analyzed in the emergency unit of the Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia over the five-year period - since January 2001 till December 2005. Results: The total of approximately 3, 954 emergency upper endoscopies were performed due to the upper gastrointestinal tract bleeding. Out of the total number of patients, bleeding was diagnosed in 324 (8.2%) patients due to the esophageal varices. In the group of patients with bleeding esophageal varices, the total of 252 (77.8%) males and 72 (22.2%) females averagely aged 56.8+7.5 years (range 24 - 80 years) were examined. The primary sclerosant therapy with absolute alcohol was applied in 118 (36.4%) patients, while Blakemore probe tamponade was performed in 145 (44.8%) patients with bleeding esophageal varices. The total of 240 (74.1%) patientswere treated with vasoactive substances (somatostatin and its analogues), as additional therapy and control of the primary hemostasis. It was evidenced that out of 118 patients intra and paravariceally treated with the sclerosant agent (absolute alcohol) hemostasis was achieved in 47 (39.8%). Out of 145 patients subjected to Blakemore probe placement, bleeding was successfully arrested in 117 (80.7%) patients. Somatostatin and its analogues as primary and only treatment of the bleeding esophageal varices were applied in 71 (29.6%) patients, while in the remaining 169 (70.4%) patients, they were applied as additional therapy to the endoscopic sclerotherapy and mechanical treatment of bleeding. Out of 71 patients treated with somatostatin preparations as the only therapeutic option, 45 (63.4%) responded positively by arrest of bleeding for 72 hours. Conclusion: Treatment of the acute bleeding esophageal varices is focused on the arrest of bleeding, prevention of early recurrent bleeding and reduction of mortality. Based on the most recent studies, efficacy of the modern endoscopic therapy in the form of sclerotherapy and band ligature placement, as well as application of vasoactive substances reaches up to 90%. Our results evidence minimal efficacy of the sclerotherapy (approximately 40%), which indicates the need of better preparation of patients for the intervention itself and additional education of the personnel.
Gastrointestinalni tumor zeluca (GIST) kao uzrok masivnog krvarenja iz gornjih partija digestivnog trakta
Authors: Djukic V.R. , Karamarkovic A.R. , Mijatovic S. , Micev M. , Bumbasirevic V.M. , Djurovic M. , Stepic D. , Jeremic V.M. , Popovic N.M. , Sijacki A. , Krstic S.N. , Gregoric P.
Published: November 2008

Gastrointestinal stromal tumors GIST are rare mesenchymal tumors of the gastrointestinal tract characterized by expression of a receptor that activates tyrosine kinase called C- kit. Since malignant GIST has an extremely poor prognosis even after surgical resection. The development of a tyrosine kinase inhibitor, STI571/imatinib mesylate/Gleevec, Glivec which inhibits the BCR-ABL, PDGF-R alpha, and C-Kit receptors, has changed the management of unrespectable malignant GIST and has improved the survival of patients with metastaic disease. We report a 32 year old male patient with subcardiale gastric GIST and massive gastrointestinale bleeding. The patient underwent total gastrectomy, D2 lymphadenestomy, distal pancreatectomy and splenectomy on 02.02. 2004. Histopathology examination of the primary tumor revealed a strong C-Kit expression and CD 34 +++, Ki67 20 and so called "Pure GIST" was approved Liver metastasis was detected on ultrasound and CT 12 months later and segmentectomy S7 was performed on 23.03.2005. Postoperative course was uneventful. HP examination - malignant 35 x 30 mm sarcoma like tumor of mesenchymal origin. The patient received adjuvant imatinib -mesylate Gleevec Novartis Pharma Basel 400 mg a day. The initial complete response to treatment continued to 24 months postoperatively Imatinib is a recent and very promising treatment extirpation remains the only curative treatment of malignant GIST as evidenced by our patient.
Total gastrectomy in the surgical treatment of massive upper
Authors: Karamarkovic A.R. , Gregoric P.B. , Popovic N.M. , Ivancevic N.N. , Bumbasirevic V.M. , Sijacki A.M. , Lausevic Z.D. , Bajec Dj.D. , Djukic V.R. , Jeremic V.M.
Published: November 2008

GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a rare cause of massive gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. We report a case of an 42-year-old man presented with upper GI hemorrhage. Repeated upper GI endoscopies revealed a missed diagnosis of subcardial gastric ulcer and Mallory-Weis lesion. Following conservative treatment, the frequency and amount of haemorrhage decreased and totally stop. 48 hours after admission patient developed sudden massive upper GI bleeding and underwent emergency total gastrectomy. The diagnosis of Dieulafoy lesion was made histologically. The patient recovered uneventfully and discharged on the postoperative day 11th. Therefore, Dieulafoy disease represent a diagnostic and therapeutic challenge. Advances in endoscopic technique have greatly assisted in earlier diagnosis and added options to the treatment regimen for this lesion. The relationship of this anomaly to possible exsanguinations makes it essential that both endosopical and surgical approach play an important role in the management of this pathology.
Systemic hemostatic drugs
Authors: Vucelic D. , Pesko P. , Stojakov D. , Sabljak P. , Bjelovic M. , Dunjic M. , Ebrahimi K. , Nenadic B. , Velickovic D. , Spica B.
Published: November 2008

Understanding the haemostatic changes is crucial in developing strategies for the management of haemorrhage syndroma. In recent years, the revised model of coagulation ("cell based" model) provided a much more authentic description of the coagulation process. Pharmacological intervention, especially desmopresin, antifibrinolytics (synthetics and nature) and increasingly recombinant activated factor VII are being used in prevention and therapeutically to control bleeding of variety etiologies. Skilful surgery combined with blood saving methods and careful management of blood coagulation will all help in successful hemorrhage prevention and treatment, and reduce unnecessary blood loss and transfusion requirements and its attendant risks. Among the all avalaible tests, the use of thromboelastography has allowed for more detailed dynamic assessment of the various steps of hemostasis.
Tacka vodilja kao los prognosticki faktor u terapiji invaginacija kod dece
Authors: Djordjevic I.M. , Milicevic R. , Djordjevic N. , Karanikolic A.D. , Ignjatovic N.
Published: November 2008

Invagination is specific form of bowel obstruction that is seen in 1-4 children per 1000 births, usually in the period from 3 to 12 months of age. In 90-95 % reason for invagination in unknown so we called this forms idiopathic. In 5-10% invagination is caused by specific leading point. The aim of this retrospective study was to determinate prognostic valye of used biochemical tests (hemograms, glucosa, electrolites ( levels of Na+, K+ , Ca+ and Cl-) and to prove bad influence of existing "leading point" in therapy of invagination (weather it will be surgical or hydrostatic desinvagination). Methods: We analyzed 65 patients with invagination. We divided all our patients into 2 groups: first group consisted patients with idiopathic forms of invagination, and the other one were patients with invagination caused by specific leading point. Results proved that leading point in invagination has great implications on clinical presentation, laboratory results, diagnostic and therapeutic procedure, and finally in prognosis. .
Reconstruction of the alae nasi by folded nasolabial flap
Authors: Jovanovic M. , Colic M. , Rasulic L. , Stojicic M. , Malis M.
Published: November 2008

Reconstruction of the nose is very old surgical procedure and, in fact, represents the beginnings of plastic surgery. In reconstruction, an effort has to be made in order to achieve a normal look. A surgeon must choose carefully the method of reconstruction, taking into consideration the skin color, texture and nasal topography. Full-thickness nasal defects in alar region are very difficult for reconstruction due to anatomic characteristics and structures, which are very important for normal breathing and cosmetic result. Our study analyzed 16 patients with full-thickness defect of alae nasi. Folded nasolabial flaps were used for reconstruction of these defects. Good results were achieved in all cases. The flap was vital. No flap necrosis was reported in any of these patients. The lining of the nose was good. Postoperatively, the alar edge was thickened, but it became thinned after six months. The incision in donor?s region was well placed in the natural line of nasolabial fold. It was concluded that folded nasolabial flap was extremely good one-step procedure for reconstruction of full-thickness defects of alar region. .
Treatment of femoral shaft fractures in polytrauma patients using Mitkovic type internal fixator
Authors: Stojiljkovic P.M. , Golubovic Z.S. , Mitkovic M.B. , Mladenovic D.S. , Micic I.D. , Stojiljkovic D.M. , Karaleic S.S. , Najman S.
Published: November 2008

Polytrauma remains a major social, economic and medicine affliction. Successful surgical treatment of polytrauma patient?s requires an approach predicated on prioritizing injuries. An isolated fractures rarely poses any threat but in association with multiple injuries, a fractures assumes greater significance. Proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. In this work the results of the operative treatments of the femoral shaft fractures in polytrauma patients using Mitkovic type internal fixator (14 patients) and Kuntscher nail (9 patients) are compared. The average patients age was 28.43 years (range 16 to 61). Internal fixation using Mitkovic type internal fixator can be method of choose in treatment of femur fractures in polytrauma patient?s. Its application is relatively simple. It doesn?t damage the periosteal and meduullary bone vascularization, which favors osteosynthesis and provides considerable contribution in osteogensis. .
Retroperitoneal endoscopic adrenalectomy vs. Conventional adrenalectomy in treatment of benign adrenal lesions: Comparative analysis
Authors: Todorov G. , Lukanova Tc.
Published: November 2008

Minimally invasive adrenalectomy is considered to be the standard of care for the surgical treatment of the adrenal gland? s pathology. Since the initial report of laparoscopic adrenalectomy in 1992 and of retroperitoneal endoscopic adrenalectomy in 1994, it has evolved into a feasible and safe minimally invasive procedure for benign adrenal tumors. Clinical characteristics and outcomes of 63 retroperitoneal endoscopic adrenalectomies (REAs) and 45 conventional adrenalectomies (CAs) from 1996 to 2004 were evaluated. 61 patients underwent 63 REAs. Tumor size varied from 2 to 8 cm. Median age was 48.6 years. Median operative time was 135 min (45-240), median intraoperative blood loss - 85 ml (30- 550). The complication rate was 17.77%. Median postoperative hospital stay was 5 days (2-10). 44 patients underwent 45 conventional adenalectomies. Median age was 44.5 years (16-71). Intraoperative complication rate was 17.77%, postoperative - 22.22 %, Median operative time was 120 min (75 -240). Median postoperative hospital stay was 10 days (6-21). No statistically significant difference was established between median operative times of REA- and CA-groups (p=0.91). Conventional adrenalectomy was associated with a significantly increased complication rate (p= 0.009). Hospitalization was also longer after the open technique (d). Introduced in 1994 and displaying all advantages of minimal access surgery REA has become the standard of care for benign adrenal tumors. .
Treatment of unstable closed tibial shaft fractures by external fixation
Authors: Golubovic Z.S. , Stojiljkovic P.M. , Mitkovic M.B. , Macukanovic-Golubovic L.D. , Bumbasirevic M.Z. , Lesic A.R. , Milenkovic S.S. , Najman S.R. , Visnic A.M. , Karaleic S.S. , Matovic Z.M. , Jovanovic V.R.
Published: November 2008

The fracture of tibia shaft is one of the most common fracture of long bones. The authors bring out the results of the treatment of 90 patients with unstable closed tibial shaft fractures treated by the use of Mitkovic external fixation systems. Within the analyzed group there were 66 (73%) male and 24 (27%) female. The average patients age was 43.9 years (range 15 to 82). Excellent result in treatment of unstable closed tibial shaft fractures with external fixation were achieved in 15 (16,7%) patients, very good in 38 (42,2%) patients, good in 24 (26,7%), poor in 9 (10%) and bad in 4 (4,4%) patients. With 4 (4,4%) patients pseudoarthrosis was formed. Additional treatment of patients with pseudoarthrosis (spongioplastic and placing of CD device) led to pseudoarthrosis healing. Within the analyzed group in all patients treated with external fixation there were no registered cases of postoperative osteitis. External fixation by the use of Mitkovic external fixation is one of the method of choose in the treatment of unstable closed tibial fractures, providing dynamic and balanced biomechanical conditions for fracture healing. .
"I am sorry, I have bad news...": Principles in informing patients on the gravity of a disease and the treatment
Authors: Dimitrijevic I. , Kalezic N. , Ristic J. , Stefanovic D. , Milicevic M. , Bumbasirevic M. , Subotic D. , Pavlovic D. , Vucetic C. , Ivanovski P.
Published: November 2008

The discovery of the appearance of a serious disease, and the necessity for diagnostics, treatment and rehabilitation, particularly when malignity is involved, represents exceptionally stressful news for the patient and his family. Most often this is a task for the physician. In this paper the authors consider the meaning of bad news in unexpected life events which significantly disturb the individual psycho-social balance of the patient, as well as the family dynamics and structure. It presents a review of available literature on the subject of the definition of so-called "bad news", the development of approaches in announcement, and current practical approaches and models which assist physicians in helping suffering patients in professional and humane ways. It points out inadequacies in the education of physicians for this kind of task, and the variety of approaches. With the aim of improving the education of physicians, and especially clinicians in surgical fields, the authors recommend a number of educational programs: education in the area of psychological and psychiatric aspects of learning of a serious disease, including acute reactions such as depressive states, reactive psychotic states, consumption of alcohol, etc.; education in the area of the family life cycle, and the effect of the disease as an unexpected life crisis on the family dynamic; education in the area of fundamental principles of psycho and pharmaco-therapy, as well as the provision of support to the patient and his family; training in the skills of announcing bad news to the patient and his family through the explanatory presentation of the case and supervised simulation of sessions. .
Current opinion in epidural analgesia influence on incidence of complications after major abdominal surgery
Authors: Stamenkovic D.M. , Rankovic V.I. , Slavkovic Z.V. , Ostojic M.
Published: November 2008

Review article summarizes current knowledge of general and epidural anesthesia combination for major abdominal surgery and incidence of postoperative complications. Continuous epidural local anesthetics especially through thoracic placed epidural catheter decrease opioids use and as part of "acute rehabilitation" plays important role in postoperative recovery. Most of the studies showed cognition is not dependent on kind of anesthesia and analgesia. Successfully treated postoperative pain prevents chronic postoperative pain, which is best achieved in abdominal surgery with thoracic epidural use. .
Perspective of mechanical ventilation of lungs
Authors: Sindjelic R. , Vlajkovic G. , Markovic D.
Published: November 2008

Mechanical ventilation of lungs during the long history has gone through different phases, which have been associated with technological and scientific development of its time. This is the most complex process and in spite of many progress it does not solve all problems, maintained of respiratory homeostasis, especially in patients with difficult lungs damage. Therefore, there is an existing need for further development of mechanical ventilation of lungs. Over the past time, a number of innovative approaches or adjuncts to mechanical ventilation have been actively researched. Many of these have shown some promise in improving our ability to provide ventilatory support. Which of these innovations will outlast the future? Based on actual development at innovations of mechanical ventilation, it can be assumed that it will be: protective lung ventilation, special form of gas exchange, weaning from mechanical ventilation, noninvasive and home use ventilators, development in fallowing patient?s condition and pharmacotherapy development.
A case of transitional cell bladder carcinoma prolapsed from the external urethral orifice: A 6-year follow-up after percutaneous suprapubic bladder
Authors: Uzunov N.A. , Ovcharov I.P. , Uzunov A.N. , Hinev A.I.
Published: November 2008

A 30-year-old female was admitted in emergency with acute urinary retention due to bladder tumour prolapsed from the external urethral orifice. The patient underwent immediate endoscopic surgery via suprapubic percutaneous approach. The histological examination confirmed a superficial highly differentiated transitional cell bladder carcinoma. During the 6-year follow-up no evidence of local recurrence or metastatic tumor spread was revealed. The comprehensive Medline search confirmed that this is the fourth case of bladder tumor prolapsed from the external urethral orifice, reported so far. The case deserves the interest of practicing urologists because of the exceptional rarity of the entity and the unconventional treatment approach which involves using a percutaneous suprapubic endoscopic technique. Based on the results achieved, we can recommend this unconventional endoscopic approach as specifically indicated in certain situations. .
Massive GIST of the stomach: Case report
Authors: Jovovic M. , Bajic P. , Golubovic M. , Dobricanin V. , Maric I.
Published: November 2008

Gastrointestinal stromal tumors (GIST) are rare mesenchimal neoplasmas of the gastrointestinal tract. The diagnosis of this tumors are often very difficult. Patients with this tumor are usually admitted to the hospital cause of the gastrointestinal bleeding, abdominal pain, abdominal distension, dysphagia, obstructive jaundice and bowel obstruction. In this case report, we present a 86 year old patient with massive GIST of the stomach which was not preoperatively diagnosed. .
Evaluation of the bard BTA-test in the diagnosis of upper urinary tract tumors
Authors: Jovanovic M. , Hadzi-Djokic J. , Dzamic Z. , Acimovic M.
Published: November 2008

The BTA-test is an agglutination assay that qualitatively detects the presence of complexes of basement membrane within the urine of patients with bladder cancer. However, the significance of BTA test in other urotelial tumors has not been extensively studied. Therefore, in the present research, we examined the validity of BTA-test in patients suffering from ureteral or renal pelvis cancer, and compare results with urincitology. 35 patients were included in this study (13 with ureteral and 22 with renal pelvis cancer). BTA-test and urincitology in each patient was performed on two urine specimens: morning voiding urine and separate urine. Separate urine was obtained by means of ureteral catheter. The results of BTA test were compared with urine cytology. All patients udervent routine clinical examination (biochemical analysis, ultrasonography, i.v. urography and retrograde urography). The presence of urothelial carcinoma was histopatologically proved in all cases. 35 patients with renal calculosis without malignancy were control group. Separate and voided urine was taken for examination with BTA test and urincitology from all these patients. BTA test in urine specimen obtained by ureteral catheter were positive in 22 (62.9 %) patients and in complete urine in 18 (51,4%) patients. Urine cytology was positive in 20 (57,1%) separate urine specimen and in complete urine in 17 (48.6%) patients. Characteristics of each patient, clinical findings and patohystology findings take places in statistic evaluation of the results. The sensitivity of BTA test depends directly on histopatology characteristics of tumors. Tumors with high grade and high stage more often have positive results of test and urincitology. The test had the highest sensitivity among the group of high risk patients, with T2, T3, T4 stadium, 77,8% in separate urine and 61.11% in voided urine with specificity of 80% for separate urine and 85.71% for voided urine. Sensitivity for cytology in the same group was 72,22% for separate and 55,56% for voided urine, with specificity of 97,14% in both specimens. Based on the obtained results, we can conclude that simple and rapid BTA test can have significant position in the diagnostics of upper urinary tract tumors, but we still have to search for an ideal tumor marker for transitional cell carcinoma of upper urinary tract.
The role of partial cystectomy in treatment of muscle invasive bladder cancer
Authors: Vukotic V. , Lazic M. , Savic S. , Cerovic S. , Kojic D.
Published: November 2008

Muscle invasive bladder cancer is usually treated by radical cystectomy, but in some selected cases with solitary tumor with appropriate localization partial cystectomy can be the treatment of choice achieving long term results with bladder preservation. We reviewed records of 11 patients which were treated in 5 year period from June 2002 to June 2007. by partial cystectomy according to the size of the tumor, localization, histology, multifocality, pathological and clinical stage, sex, and age. Male: female ratio was 6:5, mean age of the patients being 64.9 years. All patients bur one had solitary lesions located in the bladder dome in 4, on lateral sides in 5,2 patients had a tumor in diverticulum. TCC gr II was diagnosed 6 pts, TCC gr III in 5. One patient died in a year from disease progression, one from other reason, while all other patients are alive and disease free, the longest disease free interval being 3 years. Bladder capacity is adequate in all patients resulting in good quality of life .Our results suggest that in selected patients cancer control can be achieved with partial cystectomy.
Results of application of orthotopic urine diversion according to Studer
Authors: Acimovic M. , Tulic C. , Dzamic Z. , Pejcic T. , Ladjevic N. , Jovanovic M. , Radosavljevic R. , Hadzi-Djokic J.
Published: November 2008

Introduction: Prolonged survival of patients undergoing radical cystectomy due to the infiltrative carcinoma of the urinary bladder has increased the need for development of the orthotopic bladder enabling preservation of the upper urinary ways for the extended period of time. Orthotopic bladder with tubular afferent segments in which ureters are implanted without antireflux mechanism has been introduced into the practice in 1984 by Studer and collaborates. Material and methods: In the period 1998-2007 12 patients averagely aged 62 years were subjected to orthotopic derivation from ileum, when low-pressure reservoir was constructed and the ureters were implanted into the afferent non detubularized segment of ileum without antireflux mechanism. The follow-ups included determination of serum creatinine level, ultrasound monitoring of the upper urinary ways condition in three-month intervals and pyeloureterography with intravenously applied contrast medium one year after the surgery. Immediately before the follow-up examinations, the patients were asked to complete voiding and incontinence onset diary. Results: Complete exclusion of the kidney that was in the stasis before surgery was evidenced only in one case, in a patient with tumor infiltration of the ureteral orifice. Significant obstruction of the ureteroileal anastomosis was found in 4 renal units and it was resolved by antegrade balloon catheter dilatation. Diurnal continence was established in all patients within the initial 6 months after the surgery. Mild form of nocturnal incontinence persisted in 33% of the patients. Stenosis of the urethrovesical anastomosis was a cause of urine retention in 1.8% of patients and it was endoscopically resolved. Conclusion: The advantage of implantation into the afferent non detubularized segment of ileum over the antireflux mechanism has been verified in our study based on the low percent of stenoses.
Orthotopic neobladder: A 22-year experience
Authors: Hadzi-Djokic J. , Pejcic T. , Vuksanovic A. , Acimovic M. , Dzamic Z.
Published: November 2008

Objective: To analyze the outcome of orthotopic ileal neobladder related to complications and quality of life. Patients and methods: From 1985 to 2006, 75 patients with mean age of 57 years, (41-75) underwent radical cystectomy and orthotopic ileal neobladder substitution. The mean follow up was 72 months (6-144). Mean operative time was 240 minutes. Results: Intraoperative blood loss ranged from 250 to 2810 ml. Ureteral stents were removed on 14th postoperative day, and patients were discharged at 21st day, average. Complications appeared in 23 patients. There were two recurrent TCC in the neobladder. Three patients died from pulmonary embolism. Vesicoureteral reflux appeared in three patients, and it was bilateral in two patients. Total of 98% patients have daytime continence. Conclusion: Continent urinary reservoirs represent the state of the art in urinary diversion. Surgeons who perform these operations are urgent to institute requirements for careful long-term follow-up of these patients.
Ureteral substitution by an isolated ileal segment via novel antireflux technique: Initial experience with 5 cases
Authors: Hinev Alexander
Published: November 2008

INTRODUCTION: With an aim to provide an optimal solution for the management of large defects of the distal ureter we developed a novel antireflux technique of ileal ureteral substitution. METHODS: The new method was applied in 5 female patients (mean age 39.4 years, range 29 - 53 years) with iatrogenic injury to the distal ureter that occurred as a complication after total hysterectomy and pelvic irradiation for gynaecological malignancies. Reconstructive surgery was done, and the damaged ureter was replaced by an isolated ileal segment. The ureteroileal anastomosis was created in an antireflux manner by the implementation of the serous-lined extramural tunnel technique, originally described in orthotopic bladder substitutes. To avoid mucus retention, the distal end of the isolated ileal segment was widely anastomosed with the bladder. RESULTS: Surgery was performed without any major perioperative complications. The follow up ultrasound and radiological studies confirmed that the procedure efficiently provided a nonobstructed unidirectional flow of urine. Optimization of the renal function and restoration of the previous patient quality of life were recorded in all cases treated by the new technique. CONCLUSION: Ureteral substitution by an isolated ileal segment via antireflux ureteroileal and reflux ileovesical anastomosis could be a viable option when large defects of the distal ureter are encountered.