bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonfunctioning tumor of the Langerhans' islets
Authors: Grubor Nikica , Micev Marjan , Colovic Radoje
Published: November 2008

About 15% of tumors of Langerhans, islets do not cause any hormon induced syndrom although they sintetise and secrete one or more regulatory peptides. These tumors are most frequently localised in the head and tail of the pancreas. They are usually greater then 5 cm. In diameter and present with pain, jaundice, palpable mass and malaise, rarely with variceal bleeding due to compression of the splenic vein. About 50% of the tumors present with symptoms caused by metastases. We present a 51 year old women in whom during the investigation for paraumbilical pain, predominantely on the left side a tumor of the tail of the pancreas was discovered and subsequently surgically removed. Standard histology showed a neuroendocrine tumor. Irnmunohistochemistry showed generalised immunoreactivity with antibodies against chromographin A, neuron specific enolasa and glucagon in more then 95% of cells. Somatostatin was co -expressed in more then 5% of cells, PP in rare scattered cells. No reactivity was found for the other hormon markers. Ten years after surgery the patient has no signs of tumor recurrency.
Case report: Multidisciplinary treatment of a patient with gas-producing phlegmone
Authors: Vasic G. , Plazincic M. , Zivanovic V. , Ignjatovic D.
Published: November 2008

The authors present a 51-year-old patient with a severe case of gas-producing phlegmone following incision of a perianal abscess. Early diagnosis and extensive surgical excision during the first 12 hours from the onset of symptoms are crucial. Treatment of sepsis complicated by multiple organ failure: lung insufficiency (respiratory distress requiring mechanical ventilation), kidney insufficiency (requiring rehydration, furosemid, manitol), circulation (blood derivatives, saline, colloid solutions, cardio tonics, anti-arrhythmic drugs) and liver must be aggressive. Hyperbaric oxygen therapy is essential with repeated identification of aerobic and anaerobic bacteria (hemoculture, tissue sample, wound swab), their sensitivity to antibiotics and repeated surgical debridment of the wound. Following this treatment the patient was transferred to plastic surgery where Thiersh transplants covered skin defects. He survived with an abdominal wall hernia due to a team effort and aggressive multidisciplinary treatment by the general surgeon, anesthesiologist, hyperbaric medicine specialist, microbiologist and plastic surgeon. He refused hernia repair.
Double mucinous cystadenoma of the pancreas associated with thecoma of the ovary
Authors: Colovic Radoje , Barisic Goran , Colovic Natasa , Markovic V. , Nadj G.
Published: November 2008

Cystadenomas of the pancreas are rare single and isolated tumors, usually appearing in young and middle aged women. Thecomas are rare usually unilateral, benign, estradiol, much rarer androgens producing ovarian tumors. We present a 19 year old girl in whom we removed two mucinous cystadenomas of the tail of the pancreas, 7 and 2 cm in diameter as well as a thecoma of the right ovary. As far as we know this combination of tumors have not been reported before.
The role of surgery for bowel incontinence
Authors: Kieghley M.R.B.
Published: November 2008

It is now recognised that the results of surgical treatment for bowel incontinence are frequently rather disappointing. It is wrong to raise patients expectations and push patients into surgical treatment for bowel incontinence unless they are aware of the likely outcome measures. Frequently there is deterioration in continence with age, often surgical treatments last only a short period.
Adjuvant treatment of colorectal cancer
Authors: Wils J.A.
Published: November 2008

Colorectal cancer is a leading cause of morbidity and mortality, with approximately 300,000 new cases and 200,000 related deaths in Europe and the USA each year. Adjuvant treatment of colorectal cancer is now widely accepted and can reduce mortality with approximately 10%. This can be considered as one of the major achievements in oncology from the past decade. Current results will be discussed and strategies for the future will be outlined, including on-going or planned large-scale trials with new drugs and approaches.
Do we still need a permanent colostomy in XXI-st century?
Authors: Szezepkowski M.
Published: November 2008

The aim of this paper is to answer the question: do we still need a permanent colostomy and present the quality of life of patients operated on for rectal cancer. A comparative analysis of patients after abdomino-perineal resection of the rectum vs. patients after low anterior resection of the rectum with preservation of sphincters is presented. When assessing the quality of life of patients, the following issues were considered: a) function of the whole organism and general condition (physical function); b) psychological well-being (psychological function); c) professional activity, relations with relatives and friends, leisure activities (social function) and d) intimate relations (sexual function). In both groups of patients, both after abdomino-perineal resection of the rectum and after low-anterior resection, a significant deterioration in the quality of life was noted. In spite of a good general health condition in the majority of cases (over 60% in both groups), frequent are irregular stools and diarrhea. Stomy patients complain about uncontrolled passing of gas and urologic problems, while patients with preserved sphincter complain about constipation. Stomy patients significantly more often suffer depression, loneliness and even despair due to low self-esteem and feeling of unfavorable change in body appearance. This feeling is present more often in younger patients and in women. Rectal cancer may cause social dysfunction, like reluctance to resume professional activity after surgery, limitation of social contacts, change of model of rest and leisure activities towards more passive forms and forms which do not require the attendance of many people. These phenomena apply to both groups but are more prominent among stomy patients. As stomy patients are usually older, some of these alterations may be due to age. Sexual dysfunction is significantly more frequent in stomy patients. Age may be one of the causes thereof. These problems are significantly more frequent in males. In some cases of colorectal cancer, the best way of management is colostomy. Further studies are needed to elaborate more clear criteria for optimal management of patients with colorectal cancer.
Laparoscopic versus conventional colorectal surgery
Authors: Vasilev K. , Ivanov P. , Gurbev G.
Published: November 2008

Laparoscopic colorectal surgery had a somewhat difficult evolution. It is technically difficult, with a broad field of mobilization requiring multiple careful prot placement, need to deal with major vascular pedicles and the handing of larger surgical specimens. Aim of the present study is to make a comparison between laparoscopic and conventional colorectal surgery of cancer.
Carcinoma of the anal canal: Results of the radical radiotherapy
Authors: Radosevic-Jelic Ljiljana , Stojanovic Suzana , Durbaba M. , Josifovski Jeremija , Krivokapic Zoran
Published: November 2008

From February 1995 to August 2001, 34 pts with squamous cell carcinoma of the anal canal (stage T2-35,3%, stage T3-44,1%, stage T4-20,6%, stage N1-29,4%) were treated prospectively by definitive radiotherapy only, delivered with megavoltage linear accelerator, combined with intracavitary brachytherapy in some patients, at the Institute for Oncology and Radiology of Serbia. Total tumor dose was range 55-75Gy. Median follow-up time was 24,7 months (range 6-66 months). Overall survival and disease free survival at 5 years were 65,44% and 68,44%. Local control was 82,3% (28/34 pts). Eight pts had local or distant failure. Early and late complication rates were acceptable. In majority of patients the anal sphincter function was preserved.
Recurrency of idiopathic thrombocytopenic purpura due to hypertrophied accessory spleens
Authors: Colovic Radoje , Popovic M. , Grubor Nikica , Colovic Milica , Boskovic D.
Published: November 2008

Idiopalhic thrombocytopenic purpura is an autoimmune disease in which macrophages of reticuloendothelial system, mainly in the spleen, remove platelets covered by autoantibodies from circulation. By removing the spleen 60-80% of patients are cured. Partial remission is achieved in 10-20% cases. Very few patients do not react on splenectomy. Recurrency of idiopathic thrombocytopenic purpura in a splenectomized patient after already achieved complete remission, may be caused by hypertrophy of one or more of the retained accessory spleens. We present 3 patients, 41, 23 and 44 year old, in whom splenectomy for HP had been performed 10, 3 and 11 years earlier. After full remission which lasted 10, 2.5 and 10.5 years a full recurrency of ITP took place with signs of severe thrombocytopenia and haemorrhagic syndrom. Using ultrasonography, computed tomography and scintigraphy accessory spleen/s, were discovered. By their removal, a full remission was achieved in all 3 patients, but full favorable effect appeared approximately three months after surgery during which period additional steroid therapy was necessary.
Tehnika splenektomije
Authors: Colovic Radoje
Published: November 2008

Splenectomy has been performed in trauma in a number of benign lesions of the spleen and in a certain haematological diseases. When performed for trauma a luxation technique of splenectomy is applied since it allows quick haemostasis. When performed in other indications, the spleen is usually enlarged. In those patients "splenectomy in situ" is recommended. That means, first, division of the short gastric vessels and gastrosplenic ligament, second, ligation of the splenic artery and finally division of the hilar vessels after which the spleen may be simply removed. Details of operative technique, management of accessory spleens and prevention of operative complications are described.
Povrede slezine i mortalitet u politraumi
Authors: Sijacki Ana , Gregoric Pavle , Bajec Djordje , Atanasijevic Tatjana , Radibratovic Srdjan
Published: November 2008

Severe trauma is the leading cause of death in the working population. Traffic accidents are the most frequent etiological factor, with substantially more male than female victims. In this paper we have analyzed 53 cases of dead patients, among 240 severe traumatized treated in Center of emergency surgery, Emergency Center, CCS from January, 2000 - June 2002. Spleen is the most frequent injured abdominal organ. In 34% surviving period was less than 72 hours. One-third of patients required at least two surgeries, including laparotomy. The most preciously diagnosis were performed in the cases of spleen injuries. The most common cause of death was cariopulmonal insufficiency, according both clinical diagnosis and forensic findings.
Eksperimentalne i klinicke mogucnosti transplantacije konkvasirane ili totalno devaskularizovane slezine
Authors: Jovanovic M. , Stojanovic Miroslav , Stanojevic Goran , Stojiljkovic Miroslav , Jovanovic Jovica , Kostov Milos , Djordjevic Nebojsa , Milic Dragan , Djordjevic Predrag
Published: November 2008

The most severe spleen lesions with conquasation and devascularisation of entire organ, when it is practically impossible to do any preservating surgical procedure, are the true indications for the transplantation of this extremely important immunological organ. We have performed the evaluation of the surgical procedure of heterotopic auto transplantation in the 30 dogs with severe spleen lesions. Simulation of totally devascularized spleen with the lesions of V degree was performed by disrupting all segmental blood vessels with deep and long longitudinal transhilar incision. During the 3 months follow-up period, animals were subjected to numerous explorations in order to macroscopically and histologically valuate the implant. In most cases (80-85%) implants had complete vitality with the preservation of normal tissue architecture, while 15-20% of implants had partial or total fibrosis. There were no mortality and no complications after this preservation procedure. The presence of fibrosis in some implants suggests that the implant preparation should be better performed and that transplantation of larger tissue volume is needed. Enriched with this experimental experience we have performed heterotopic auto transplantation in 2 patients with spleen lesion of V degree (car accident and injury at work) with very satisfactory results.
Laparoskopska splenektomija - indikacije, specificnosti, operativne procedure i operativna tehnika
Authors: Matic Slavko , Milovanovic Aleksandar , Dugalic V. , Petrovic M. , Milicevic Miroslav , Basic Marica
Published: November 2008

The surgical management of splenic disorders has changed considerably over past few years. The increased use of laparoscopic approach for general surgical problems has prompted surgeons to investigate feasibility of laparoscopic splenectomy. However, some unique anatomical features of disordered spleen may limit the application of laparoscopic techniques for this procedure. In this article we analyzed indications for laparoscopic a surgery of the spleen, some surgical particularities of laparoscopic splenectomy, as well as the techniques to accomplish this procedure.
Microsurgery of peripheral nerve injuries: Analysis of twenty-five year experiences
Authors: Samardzic Miroslav
Published: November 2008

Microsurgical procedures on injured peripheral nerves have been performed in Institute of neurosurgery in Belgrade for twenty-five years. During this period 1284 procedures, including 1029 on peripheral nerves, and 255 on brachial plexus were done. In this paper we analyze surgical results of individual procedures and the other factors influencing the outcome. Despite advances caused by introduction of the operating microscope, there are numerous controversies mainly in microsurgical technique that are discussed.
Surgical treatment of nerve entrapment syndromes
Authors: Rasulic Lukas , Bascarevic Vladimir , Cvrkota Irena
Published: November 2008

Nerve entrapment syndromes are, by definition, states of disproportion between the volume of the peripheral nerve and the space through which a nerve in extremities passes. In the Institute of Neurosurgery, Clinical Center of Serbia carpal tunnel syndrome and cubital tunnel syndrome are the most frequent compressive neuropathies, and their frequency in our series is 91%. This study represents comparative analysis of parameters which can influence on surgical treatment of carpal and cubital tunnel syndrome. Analysis was performed on 169 patients operated on because of carpal tunnel syndrome, and 83 patients operated on because of cubital tunnel syndrome by microsurgical procedures such as decompression, transposition, epineurectomy or interfascicular neurolysis, during the period from 1979. up to 2000. Through the comparative and descriptive analysis it was investigated corelation between clinical and electrodiagnostical findings, as well as between results of the surgical treatment with intention of checking of indication for surgical treatment.
Large defect of abdominal wall repair by dermal and sinthetic graft
Authors: Stojiljkovic Danilo , Visnjic Milan , Trenkic Srbobran , Rancic Zoran , Milic Dragan , Stanojevic Goran , Stojiljkovic Marija , Kovacevic Predrag , Stojanovic Miroslav , Stevanovic Goran
Published: November 2008

Large defects of abdominal wall (greater than 8 cm in diameter) related to different cause, are still difficult problem of modern surgery. The best results in order to obtain safe and permanent anatomical and functional abdominal wall integrity are reached by autogenous dermal and synthetic grafts. Controversies concerning quality of these procedures are still presents. Our work is based on two equal experimental groups of 20 Vister rats each, with large artificial abdominal wall defects: one treated with autogenous dermal graft, another with synthetic Mersilene mesh graft. The animals from both groups were sacrificed in previous planned time intervals (3rd, 7th, 14th and 48th days). Afterwards detailed microscopic and gross examination of abdominal wall reparation and quality of reconstructed abdominal wall defects had been performed. According to our results both methods are easy to be performed and safety surgical procedures. Overestimated usage of synthetic grafts should be diminished because of advantages of autologous dermal graft - availability, substitution of firmly fibrosis tissue and endurance against infection.
Otkrivanje infekcija u abdomenu primenom radioobelezenog antibiotika
Authors: Artiko Vera , Davidovic Branka , Nikolic Nadezda , Petrovic Milorad , Petrovic Nebojsa , Vlajkovic Marina , Obradovic Vladimir , Matic Slavko , Bosnjakovic Vladimir , Milovanovic Valentina
Published: November 2008

The aim of the study is detection of the abdominal infective foci using 99mTc-ciprofloxacin, radiopharmaceutical supposed to distuinguish inflammation from infection. Twenty one patient was investigated. There were 11 true positive findings, 7 true negative, two were false negative, while 1 was false positive. Sensitivity of the method was 79% and specificity 91%. According to our results, scintigraphy with infecton is a useful method for detection and assessment of exact localization of deep seated bacterial infections, which might be useful for (differential) diagnosis, surgical treatment in due time as well as monitoring of the treatment of conservative therapy.
Rivesova tehnika (direktan ingvinalni pristup) u resavanju velikih ingvinoskrotalnoh i recidivantnih kila
Authors: Zuvela M. , Milicevic Miroslav , Lekic Nebojsa , Raznatovic Z. , Palibrk I. , Bulajic P. , Petrovic Milorad , Basaric D. , Galun D.
Published: November 2008

In solving inguinal hernias, surgeons today have in front of them many variations of different operative procedures (both tensional and nontensional techniques). They are performed through operative or endoscope approach. Classical tension techniques present the operation of choice for smaller indirect, direct or femoral hernias among younger patients while non/tensional techniques are the best solution for all types of inguinal herniar among older patients with big destruction of transversal fascia and the best solution for most of recurrent hernias. Positioning of mesh with nontensional techniques can be completed on different levels. with big hernias where the biggest part of transversal fascia of miopectineal orifitium is destroyed it is anatomically the most useful to place the mesh in preperitoneal space. Rives technique is the base of that concept and it presents one of good solutions in that kind of situations. In the period January 2001 until December 2002 using different operative techniques the authors treated 99 inquinal hernias of which 78 were primary and 21 recurrent hernias. Rives technique was performed in 46 cases (46.5%) among which 26 cases were primary inguinoscrotal hernias (3 patients IIIA, 22 patients IIIB, 1 patient IIIC, according to Nyhus classification) and 20 cases were recurrent hernias (6 patients IVA, 11 IVB, 3 IVD). Complications after Rives technique were the following: 1 recurrence (2,17%), 1 ischemic orchitis (2,17%) and 1 scrotal hematoma (2,17%). Infections and chronic pain were not present. The follow up was from 30 days to 2 years. Authors have shown that Rives technique is reliable solution for primary indirect, direct and femoral hernias with big hernial defect (especially for big, so called "giant" inquinoscrotal hernias) and for all types of recurrent hernias. The advantage of the technque is an easy performace without some previous special training because of the fact that dissection and preparation is the same as for the tension techniques. With small amount of prosthetic material all weak points of miopectineal orifitium are closed. The real risks of this technique are ischemic orchitis and chronis neuralgia in treatment of recurrent hernias and the presence of polypropylene mesh in Bogras space.
The role of nitric oxide in treatment of acute lung injury after surgery with extracorporeal circulation
Authors: Sindjelic R. , Vlajkovic G. , Ristic Miljko , Divac I. , Markovic D.
Published: November 2008

Postoperative acute lung injury (ALI) compromises oxygen transfer across alveolar-capillary membrane with consecutive hypoxia, one of its indicators being reduction of oxygenation index PaO2/FiO2 below 40 kPa (300 mm Hg). Management of ALI includes different procedures like mechanical lung ventilation (MLV), drugs and others. One of the new possibilities for treatment of ALI is nitric oxide (NO) inhalation. The aim of this prospective study was to examine the role of NO inhalation in treatment of ALI. 14 patients with ALI developed immediately after operation with extracorporeal circulation (ECC) were included in the study. Group A (n = 8) inhaled NO and group B (n = 6) did not inhale NO during treatment of ALI. All other therapeutic measures were the same in both groups. The groups were similar in relation to demographic data, type of surgery and duration of ECC. PaO2/FiO2 was calculated before operation (T1), immediately after surgery (T2) and after lung recovery, when the need for MLV stopped (T3). The duration of MLV was also registered. PaO2/FiO2 (kPa) in referent times was in group A 54,9 ? 1,6, 33,8 ? 1,2 and 46,2 ? 0,8 and in group B 52,2 ? 1,1, 33,5 ? 1,5 and 47,3 ? 0,9, respectively. There was a statistically significant decrease of PaO2/FiO2 in T2 and T3 vs T1 in both groups (p < 0,05), while the difference between the groups was not statistically significant. The duration of MLV (h) in group B (28,5 ? 1,6) was statistically significantly shorter than in group A (63,1 ? 8,7) (p < 0,01). According to the results of this study we conclude that NO inhalation during ALI after surgery with ECC significantly reduces the duration of MVL and improves pulmonary recovery .
Prognosticki faktori resektabilnog primarnog nemikrocelularnog karcinoma bronha
Authors: Subotic Dragan , Mandaric Dragan , Andric Ljiljana , Atanasijadis Nikola , Gajic Milan
Published: November 2008

This study represents the univariate and multivariate analysis of prognostic factors of resectable non small cell lung cancer (NSCLC) that included 360 patients who underwent a surgical treatment because of primary (NSCLC) in the aforementioned institution in a period between 1985 and 1992. Patients with incomplete resection were rejected, perioperative deaths were not included in the analysis. In the analyzed group there were 293(81.38%) males and 67(18.62%) females - M:F ratio 4.37:1. Age of the operated patients was 36-75 years with the mean age of 55.15 years. Right-sided tumours existed in 197(54.72%) patients, left-sided tumors in 163(45.28%) patients. Based on pTNM, 157, 65, 114, 18 and 6 patients were classified into stages I, II, IIIA, IIIB and IV respectively. In the univariate analysis, survival curves were obtained using the life table method, with the statistical analysis of the obtained data using the Gehan-Wilcoxon method. In the multivariate analysis - Cox regression analysis was performed. Multivariate analysis found only T-stage, N-stage and the stage of the disease as significant independent prognostic factors. Mode of influence of factors that were found significant in the univariate analysis (age >60 years, tumor diameter > 60 mm, involvement of the visceral pleura, indirect tumor signs) is discussed and compared with literature data. Survival differences depending on other factors (tumor location, bronchoscopic aspect, extent of the resection), although without statistical significance, can be useful for the clinician, in the same time contributing to the better comprehension of information's obtained by basical investigations, especially of lymphatic spread of the disease and tumor pathology.
Lateral lymphadenectomy in treatment of rectal carcinoma
Authors: Pavlov Maja , Kecmanovic Dragutin , Kovacevic Predrag , Sepetkovski Aleksandar , Ceranic Miljan , Stamenkovic Aleksandar
Published: November 2008

The aim of this work is to present existence of the lateral lymphatic spread of metastases in patients with Dukes C low rectal carcinoma (60 % of all patients), located at or bellow peritoneal reflexion. Prospective clinical investigation analyzed the group of 64 patients (32 underwent lateral lymphadenectomy and 32 didn?t), all treated at 1st Surgical Clinic, Clinical Center of Serbia. Lateral lymphatic spread of metastases was proven by frozen section in 8 cases, so extensive lateral lymphadenectomy was performed. In the group of patients who underwent lateral lymphadenectomy, positive lymph nodes were registered in 18 patients (56,2%); in group of patients operated without lateral lymphadenectomy, metastatic lymph nodes were registered in 12 patients (37,5%). According to results of this investigation, method of lateral lymphadenectomy, as well as extensive lateral lymphadenectomy, is significant for exact determination of postoperative stage of the disease. Also, there is a significant increase in number of patients with Dukes C stage of the disease. In those patients, mesorectectomy alone is not sufficient.
Hirurska revaskularizacija miokarda
Authors: Nezic Dusko , Milojevic Predrag , Knezevic Aleksandar , Cirkovic Milan , Lausevic-Vuk Ljiljana , Jovic Miomir , Djukanovic Bosko
Published: November 2008

It has been 45 years ago when Longmire (1958.) used internal thoracic artery (ITA) for the first time in coronary artery bypass surgery (CABG). In this review, we are presenting novel surgical approaches in CABG surgery. We have also been summarized the best of knowledge, up to date, regarding histology, pharmacology and pathophysiology of conduits (VSM, ITA and alternative venous and arterial grafts) which have been used in CABG surgery, as well as factors influence on its short and long-term patency.
Aktuelni principi i neki od novih metoda fleksibilne fiksacije preloma dugih kostiju
Authors: Tulic Goran , Bumbasirevic Marko , Dulic Borislav , Vucetic Cedomir
Published: November 2008

The modern developments in orthopedic traumatology brought various modifications of modes and principles in operative fixation of fractures. Contrastingly to previous concept of rigid fixation as a priori necessary element for complete fracture union, a principle of flexible or elastic fixation took an equal place in contemporary professional doctrine. The results of these changes were technological innovations of fixation implants, with their mechanical characteristics as a base for their biological application that promoted essential advancements in fracture treatment and full functional recovery of injured patients. We review in this paper the modern principles and some new implant generations in flexible fracture fixation.
Prevention and treatment of progressive multiple organ disfunction in acute pancreatitis
Authors: Bumbasirevic Vladimir , Milicevic Miroslav , Bukumirovic V. , Rankovic Vitomir , Pavlovic A. , Djukic Vladimir , Radenkovic Dejan , Lausevic Z. , Sijacki Ana
Published: November 2008

Acute pancreatitis is illness with unpredictable outcome. In some patients course of illness is progressive and leading to multiple organ dysfunction syndrome often resulting with lethal outcome. During last decade the treatment protocols have changed. Basic patophysiologic mechanisms leading to progression of the illness, as well as, contemporary diagnostic and treatment possibilities that can prevent occurrence of severe consequences and improve outcome are presented.
Ucestalost javljanja karcinoma u solitarnim nodusima stitaste zlezde
Authors: Stojanovic Dragos , Radovanovic Dragan , Caparevic Zorica , Jakovljevic-Stojanovic Mirjana , Lalosevic Djordje , Stevanovic Predrag
Published: November 2008

Find of malignances in solitary thyroid gland nodes represent an entity in itself in thyroid surgery and endocrinology because of frequency in occurrence and differential diagnosis of thyroid diseases. Similarities in clinical characteristics and differences in the histological structure and development of the disease, request quick and adequate application of all available diagnostic procedures in evaluation of disease. After all clinic methods of examination, surgery includes necessary range of extraction of tissue at benign changes while at malignant changes radical intervention on the gland is suggested and if it is necessery on the surrounding structures of the neck. "Biopsio ex tempore" still represents vital method in histological diagnosis and help in making decision aboute radicaly of operative procedure. Because of that, surgery represents et last diagnostic and therapy procedure. Data analysis shows the presence of carcinoma in solitary thyroid gland nodes in 15% of all cases.
Etiology of differentiated carcinoma of the thyroid current apprehension
Authors: Han Ruben
Published: November 2008

It is apparent that in the last decade carcinoma of the thyroid is becoming increasingly prevalent. The multistage complex theory of thyroid carcinogenesis is based on observations made on cohort patients studies and during animal experiments over a period of last fifty years. The process of thyroid oncogenesis is conceived to be a series of events induced by genetic and environmental factors which alter follicular cells division and growth control. These factors can be considered as initiators (chemical agents and ionising radiation) and promoters (some goitrogenes and drugs). The first class of factors induce incipient tumorigenesis while the second augments TSH secretion and radically increases tumour growth. Normally silent, intracellular proto-oncogenes (of which Ret/PTC series are the most conceived ones) can become activated by chromosomal translocations, deletions or mutations and can transform normal follicular cell into a condition of uncontrolled division and growth. The most significant known cause of thyroid carcinomas in men is exposure to external or internal ionising radiation. Beside that, long-term iodine deficiency, effects of certain chemical carcinogens, drugs and goitrogenes must be considered as significant risk factors. Possible role of sodium/iodide symporter is becoming an objective of the most recent investigations.
Classification, gradation, prognostic factors and risk factors for thyroid carcinoma
Authors: Zivaljevic Vladan , Paunovic Ivan , Diklic Aleksandar , Krgovic Ksenija , Zivic Rastko , Kazic Milena , Kalezic Nevena , Bozic Vesna , Tatic Svetislav , Havelka Marija
Published: November 2008

Thyroid carcinomas arise from follicular cells (papillary, follicular, Hurthle, anaplastic), parafollicular cells (medullary) and stroma (lymphoma, sarcoma?). Gradation and prognostic factors are different for every one of histological type. Most patients with papillary and follicular thyroid cancer have an excellent prognosis. At the other extreme is anaplastic thyroid cancer whose usual mean survival can be measured in months. Exposure to external radiation and living in endemic goiter area increase the frequency of thyroid cancer. Medullary thyroid carcinoma is often familial and may occur in associations with the multiple endocrine neoplasia syndromes.
Papillary thyroid carcinoma in intrathoracic goiter
Authors: Ignjatovic Mile , Cerovic Snezana , Stanic Vojkan , Cuk Vladimir , Kostic Zoran , Bokun Radojka
Published: November 2008

Intrathoracic goiter (more than 80% of tissue in the thoracic cavity) represents very rare clinical entity (less than 1% of total number of thyroid gland surgical procedures). Cancer incidence in these goiter is 0-5%. The aim of this article is to present a case report of intrathoracic thyroid papillary carcinoma with multiple compressive syndrome and review of compressive intrathoracic syndrome of thyroid etiology. In our patient we have found: tracheal and oesophageal deviation and compression, superior vena cava syndrome, downhill varices, chylothorax, pericardial effusion, compress of the left a. subclavia, unilateral lesion of recurrent and phrenic nerve, and brachial plexopathy. This was a unique case with multiple compressive syndrome between 3000 patients surgically treated for all kinds of thyroid deceases. Intrathoracic goiter can cause all the known symptoms and syndromes of intrathoracic compression with possibility of rapid deterioration and fatal end.
Papillary microcarcinoma of the thyroid gland and secundary hiperparathyroidism in patient on dialysis
Authors: Cerovic Snezana , Ignjatovic Mile , Brajuskovic Goran , Knezevic-Usaj Slavica , Cuk Vladimir , Hrvacevic Rajko , Ajdinovic Boris
Published: November 2008

Association between non-medullar thyroid carcinoma and secondary hyperparthyroidism have been rarely reported in patients with renal failure. A few cases of micropapillary thyroid carcinoma have been reported in patients before and after renal transplantation. We present a case of incidental detection of thyroid carcinoma at the time of parathyroidectomy in patient on dialysis after cadaver renal transplantation.
Provera strazarskih limfnih nodusa kod tiroidnog karcinoma
Authors: Dzodic Radan , Markovic Ivan , Inic Momcilo , Jokic Neven , Zegarac Milan , Djurisic Igor , Milovanovic Zorka , Pupic Gordana , Jovanovic Nikola
Published: November 2008

Introduction: Sentinel lymph node (SLN) was defined as the first lymph node that the tumor would drain to, within that tumor?s regional lyphatic basin. In 1998, Kelemen and co-workers have published the first results on SLN lymphonodectomy in thyroid carcinomas. Methodology: Different methods have been used in a goal of lymphatic mapping (application of vital blue dye and/or radio colloid). Results: In a period from 2001 to 2003 we have performed SLN biopsy in 64 patients with thyroid tumors. There were 12 cases of thyroid carcinoma. SLN identification rate was 73,44%. We found no false positive or negative results on definitive histopathology. Discussion: The impact of lymph node metastases in differentiated thyroid carcinoma is still controversial. The management of cervical lymph nodes varies from ?berry peacking? to modified radical neck dissection. There is a significant disproportion in percentage of pre and intraoperatively enlarged lymph nodes (27-45%) and histological confirmed lymph node metastases (80-90%) in papillary thyroid carcinoma. In the current literature the average rate of SLN identification is 91% (66-100%) and when identified, the SLN accurately predicts the disease status of the neck in most patients (80-100%).Conclusion: The SLN biopsy for thyroid carcinoma is good and feasible technique for estimating the cervical lymph node status.
Medullary thyroid carcinoma: Sporadic, hereditary
Authors: Paunovic Ivan , Diklic Aleksandar , Krgovic Ksenija , Zivaljevic Vladan , Tatic Svetislav , Havelka Marija , Kalezic Nevena , Todorovic-Kazic Milena , Bozic Vesna
Published: November 2008

Medullary thyroid cancer (MTC) is uncommon thyroid tumor with specific characteristics which undoubtedly divide this tumor from other thyroid malignances. Patients with sporadic or hereditary form of MTC differ in clinical presentation, recurrence of the disease and outcome. The aim of study was to establish surgical characteristics of MTC as well as clinical factors that influence surgical treatment. The study group consisted of 68 patients with MTC managed at the Center for Endocrine Surgery between 1987. and 1999. Retrospective analysis included clinical form of the disease, general data, histological and other tumor characteristics. Mean age of the patients were 47.3 years (female/male ratio: 1.5:1). Mean size of tumor was 80.5 cm3, 72.1% patients had tumor greater than 4 cm. in diameter or extrathyroid spread. The majority of patients were in II and III stadium of the disease. Primary operation (at least total thyroidectomy) was performed in 57 (84%) patients. 2(3%) had postoperatively temporally nerve palsy and 7(10.29%) temporally hypoparathyroidism. The overall survival was 46.8 + 9.9% after 9 years and 63.6 + 7.2% at 5 years. Postoperative calcitonin value is significant predictor of survival /Spearman's coefficient (R=0.7048)/, worse prognosis is in correlation with high postoperative calcitonin values. The treatment of choice is at least total thyroidectomy and central lymph nodes resection if enlarged lymph nodes are found. Precise operative technique lowers the risk of postoperative complications. Complex approach to the patient with MTC includes all available methods in pre and postoperative evaluation as well as surgeon's knowledge and skill.
Anaplastic thyroid carcinoma
Authors: Zivaljevic Vladan , Diklic Aleksandar , Paunovic Ivan , Krgovic Ksenija , Zivic Rastko , Kazic Milena , Kalezic Nevena , Bozic Vesna , Tatic Svetislav , Havelka Marija
Published: November 2008

The aim of the present paper was to study some characteristics and posibility of surgery of anaplastic thyroid cancer. During five years period in Center for endocrine surgery, we found anaplastic thyroid cancer in 65 patienst (44 female and 21 male), median age 63 years (from 37 to 88 years). Surgical treatment was peerformed in one half (32) anaplastic thyroid cancer patients, at majority of them operative biopsy or tumor reduction only. Radical syrgery was performed in about 10% patients. Posibility of surgery in anaplastic thyroid cancer are very limited. In one third patients there were longstanding goter or thyroid nodul or histological verified dediferentiation of papillary thyroid cancer. This patienst should be operated formerly, before anaplastic transformation.
Surgical management of recurrent thyroid cancer
Authors: Diklic Aleksandar , Zivaljevic Vladan , Paunovic Ivan , Krgovic Ksenija , Zivic Rastko , Kazic Milena , Kalezic Nevena , Tatic Svetislav , Havelka Marija , Bozic Vesna
Published: November 2008

Recurrent thyroid tumors are much less frequent but more aggressive than primary tumors. The aim is to find out their characteristics, aggressiveness and the possibility of radical surgical excision as well as the frequency of complications. Method and material: retrospective study on 69 patients operated for recurrent thyroid tumors. Results: Recurrent tumors were found in 42 patients with papillary, 11 with follicular (8 with Hurthle), 9 with medullary and 7 with anaplastic thyroid tumors. Relapse in thyroid bed on dominant side had 41 patients (59.4%), relapse on the opposite side we found in 19 patients (27.5%) and relapse in lymph nodes outside of thyroid bed in 37 patients (53.6%). In 33/69 patients, the first procedure was incomplete (reduction in 5, partial resection in 19, hemithyroidectomy in 9). The second procedure was incomplete in 14, near total thyroidectomy in 2, total thyroidectomy in 33 and dissection of lymph nodes in 33, among them in 20 with the operation in thyroid bed. Preoperative recurent nerve palsy had 2 patients and transitional recurent nerve palsy occured after second procedure in 2 patients. Among 33 patients after thyroidectomy for recurent tumor, postoperative hypoparathyroidism occured in 8 (24.2%), of whome in 2 permanent (6%). In the group of 54 patients with recurent differentiated thyroid cancer, radioiodine therapy after first operation had received only 7 patients (13%). Conclusion: the main causes of thyroid cancer relapse are incomplete first procedure and agressiveness of cancer. It is not always possible to excise the complete recurrent tumor. After surgery for papillary cancer, radioiodine therapy is seldom used.
Radioterapija malignih tumora stitaste zlezde
Authors: Stankovic Vesna , Borojevic Nenad , Golubicic Ivana
Published: November 2008

The primary treatment of thyroid gland malignoma is surgery. Success of radiotherapy depends of extent of the previous surgery treatment. The types of radiotherapy are: curative (profilactic and postoperative) and paliative. Tumor dose and radiotherapy technique depend on histological type, extent of the privioud surgery treatment, curative or paliative intent and general condition of patient, and they are from 40 Gy to 65 Gy by conventional fractionation. The basis of radiotherapy treatment planning and choice of radiotherapy treatment technique in survey of the region of interest by imaging procedure. On the basis of those data we determine therapeutic volume and structure of risk (spinal cord, lung) and protection of the risky structures is planned.
Modifikovana rivesova tehnika u tretmanu recidivantnih ingvinalnih kila
Authors: Zuvela M. , Milicevic Miroslav , Gulim D. , Bulajic P. , Raznatovic Z. , Lekic Nebojsa , Basaric D. , Palibrk I. , Petrovic Milorad
Published: November 2008

After the introduction of prosthetic material in hernia surgery the fundamental changes in operative strategy occurred. This is because the coverage of miopectineal orifitium with non-absorbable prosthesis decreases the incidence of recurrences. Because of the appearance of lateral re-recurrences after the classical Rives procedure, we modified the operative technique. The modified Rives technique consists of the following: always polypropilen mesh 15x10cm; creation of the new internal inguinal ring between Poupart's ligament and mesh; no lateral notching the mesh and anchoring mesh 2-3cm from the medial, inferior, lateral and superior edge. During the period January 2001 - December 2003, 34 cases of recurrent hernias were operated on 7th dept. of I Surgical Clinic of CCS. The recurrences were managed by classical (10/34) or modified Rives technique through direct inguinal approach (22/34), less frequently Lichtenstein procedure (1/34) and McVay (1/34) technique. Among 10 patients with recurrent inguinal hernias managed by classical Rives technique 2 re-recurrences appeared (indirect and interstitial) and 2 cases of infection (immediately after the operation or 7 months after the operation), and in the group of 22 cases with recurrent inguinal hernias managed by modified Rives technique the aim complications didn't appear. Using the modified Rives technique we managed the primary hernias in 56 cases without recurrences and infections. The modified Rives technique, because of the way of mesh fixation (all around), no lateral notching of mesh and remaining hem in all directions secures abdominal wall protection 2-3cm from the line of fixation and prevents any movement of the mesh. This procedure enables management of all inguinal hernias regardless to their size and full protection of the medial, femoral and lateral inguinal triangle. The modified Rives technique is the technique of choice for big multiple defects (giant inguino-scrotal and re-recurrences), especially among patients with increased infra-abdominal pressure when other techniques may be insufficient because of mesh protrusion.
Postcardiotomy assisted circulation with roller pump-early and late results
Authors: Nezic A. , Knezevic Aleksandar , Cirkovic Milan , Milojevic Predrag , Jakovljevic Miroslav , Jagodic S.
Published: November 2008

The incidence of postcardiotomy myocardial failure (PMF) requiring mechanical circulatory support beyond IABP is reported to be 0.2% to 1.2%. From Dec. 1989 through Dec. 1995, 18 patients (0.3% of the total pump cases) were supported with roller pump type of LVAD. Assisted flow ranged from 3.5 up to 5 L/min with average support time of 35.5 hours. Six (33.3%) patients (pts) died while on LVAD. The causes of additional seven deaths (pts weaned of LVAD) were: myocardial failure (4), stroke (2) and intractable bleeding during removal of the LVAD (1). Overall, five patients (27.8 %) were successfully discharged from the hospital. Two out of five long-term survivors died later, 6 months and 4 years postoperatively, both of cardiac causes. The actuarial survival rate of long-term survivors was 60% at 7 years, all of them being in NYHA functional class II. These results have proved efficiency of roller pump driven LVAD for short-term circulatory support in pts with PMF. Results are comparable to so far published data on postcardiotomy support with the same, as well as other types of more versatile and costly devices.
Renal allograft implantation in respect of atypical vascular procedures
Authors: Basic Dragoslav , Hadzi-Djokic Jovan , Milutinovic Drago , Basic Marica , Djokic Milan
Published: November 2008

In minority of renal transplants it is unevitable to perform atypical vascular procedures of renal allograft implantation, which increases the risk of vascular complications, graft loss and lethality. In the presenting study, we retrospectively evaluated kinds of atypical vascular procedures in renal allograft implantation by donor type and the transplants outcome related to these procedures. From 1980 to 1998, a total of 463 patients (mean age 36.2?10.3), underwent renal transplantation (319 from living donor and 144 from cadaveric donor) at the Institute of Urology&Nephrology in Belgrade. Atypical vascular procedures of renal allograft implantation were representative for the some of the following cohorts: bypass grafting, endarterectomy, end to side both arterial and venous anastomotic site. A total of 45 patients (9.72%) underwent some of atypical vascular procedures (41 from living donor and 4 from cadaveric donor) (p<0.01). Among analyzed procedures, bypass grafting was patients (319 from living related donor and 144 from cadaveric donor) undergoing renal transplantation were analyzed retrospectively in respect of vascular surgical complications (standard procedures vs. atypical). Atypical vascular procedures following renal allograft implantation are associated with high complication rates.
Surgical management of long-term complications after derma tojejunoplasty of postcorrosive esophageal strictures
Authors: Knezevic J. , Radovanovic N. , Simic Aleksandar , Kotarac M. , Pesko Predrag
Published: November 2008

Authors present their experience in treatment of the long term complications afther Lexer-Judin and Lexer-Judin- Papo operations. They discuss the advantages and disadvantages of this procedures. In the period from 1977 to 2003 in the Institute for digestive diseases 16 patients had to be operated because of the stenosis in the region of dermato-jejunal anastomosis or because of the bed estetic results of this operations. They suggest that the extirpation of dermal tube, mobilisation of the jejunum and new pharingo-jejunal anastomosis is the operation of choice.
C-reaktivni protein kao pokazatelj tezine ratne povrede
Authors: Radakovic Sonja , Surbatovic Maja , Pavlica Milan , Stankovic Nebojsa
Published: November 2008

During the general reaction to trauma, acute phase proteins are synthesized. The aim of the prospective study was to determine CRP concentrations in sera of war casualties during the first 14 posttraumatic days, and to establish the correlation between these changes and severity of trauma. Subjects were 79 war casualties. Controls: 33 blood donors. Methods: Injury severity was determined according to ISS and CRP concentrations with immunonephelometric analysis. Blood samples were collected 12 hours after trauma, then on the 1st, 2nd, 5th and 14th posttraumatic day. In war casualties CRP values were significantly increased (56.257.53 mg/dl after 12 hrs, 107.0976.08 on 1st, 144.3570.23 on 2nd, 71.42558.66 on 5th and 37.656.14 on 14th posttraumatic day; p). Significant differences were observed between groups with TSS and ISS 12 (p) in first two days and later between group with ISS24 (144.1766.94 mg/dl on 5th and 111.588.5 on 14th posttraumatic day) and others (p). Conclusions: During the acute-phase response to trauma, significant changes in concentration of CRP occur in sera of war casualties. These changes are the most promrninent during the first 48 hours, with tendency for normalization after the 5th day. Intensity of these changes depend of the severity of trauma. CRP is valid marker of war wound severity.