bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthotopic ileal W-shaped neobladder: Functional results and oncological outcome
Authors: Hinev Alexander
Published: November 2008

Introduction: There still exists an ongoing debate regarding the optimal method of ureterointestinal reimplantation in continent urinary diversion. The main objectives of the present study was to analyze the long-term functional results and the oncological outcome after the construction of orthotopic ileal neobladders, based on the antireflux serous-lined extramural tunnel technique. Materials and methods: A total of 32 bladder cancer patients (30 males and 2 females, mean age 588 years), who underwent between 1/9/1996 and 1/9/2006 extended pelvic lymphadenectomy and radical cystectomy, followed by the construction of orthotopic Wshaped ileal neobladder, entered the study. All ureters were reimplanted via serous-lined extramural tunnels for reflux prevention. Adjuvant systemic chemotherapy with gemcitabine plus cisplatin was applied in 17 cases. All patients were evaluable for follow up (mean follow up - 53.938 months). Evaluation included clinical, radiographic and urodynamical studies to determine functional and oncological outcomes. Results: None of the patients died in the hospital. Various early and late complications occurred in 18.8% and 21.9% of the patients, respectively. The overall incidence of day- and nighttime continence was 93.8% and 78.1%. Stenosis at the anastomotic site occurred in 2 ureteroileal anastomoses (3.2%), while none of the patients showed evidence of pouchoureteral reflux. Renal function was stabilized or improved in 96.8% of the reimplanted renal units. Eight oncological failures were observed during follow-up: 1 local tumor recurrence and 7 metastatic tumor spreads. The overall and diseasespecific patient survival was 72% and 81%, resp. Conclusion: The serous-lined extramural tunnel technique provides an effective and safe ureteroileal anastomosis, achieving nonobstructed unidirectional flow of urine. The results are durable and sustained with time. Therefore, this technique should be recommended whenever a construction of a continent intestinal urinary reservoir is considered.
Urinary diversion: 30 years experience of a single center in Republic of Macedonia
Authors: Popov Z. , Stavridis A. , Lekovski Lj. , Penev M. , Dohcev S. , Stankov O. , Petrovski D. , Saidi S. , Kuzmanoski M. , Stavridis S. , Mickovski A. , Banev S. , Zografski G. , Janculev J. , Ivanovski O. , Georgiev V.
Published: November 2008

Objectives: The aim of this report is to present our 30 years experience with various types of urinary diversions, in particular the Bricker and Studer techniques for the management of muscle invasive bladder cancer at our institution. Perioperative, early and late complications are also evaluated. Material and methods: Between 1977 and 2007, 186 male and 15 female patients underwent combined radical cystectomy, pelvic lymphadenectomy and urinary diversion. In two subgroups of patients we evaluated the complications, divided as early and late, and subdivided as those related or unrelated to the neobladder. Mean follow up time was 28 months (range 12-60 months). Results: Two main types of urinary diversion were performed: the ileal conduit diversion using a technique previously described by Bricker and the ileal neobladder diversion using a technique previously described by a Studer. The ages at surgery ranged from 40 to 82 years with a mean age of 60 years. Histopathologically, transitional cell carcinoma was the most common tumor cell type (93,7%), followed by difuse papilomatosis (5.5%) and adenocarcinoma (0.7%). The pathological tumor stage was pT1 (4.7%), pT2 (31.4%), pT3 (50.3 %) and pT4a (13,3%). Histological evidence of regional lymph node involvement was seen in 25% of the cases. From 52 patients from the Studer subgroup perioperative complications were found in 16 patients (30.7%). Specific early complications directly related to the neobladder occurred in 14 (26.9%) patients. Prolonged ileus in 2 patient (3.8%), ureteral leakage in 9 patients (17.3%), mucous buildup within the diversion in 3 patients (5.7%). Late complications occurred in 10 patients (19.2%): retention of the urine in 4 patients (7.6%) (stricture of the urethra-pouch anastomosis in one 1 patient) and to big reservoir in 3 patients. One patient (1.9%) developed prolonged metabolic acidosis. Stone formation was observed in one patient, two years postoperatively. Unilateral hydroureteronephrosis was observed in 2 patients whereas bilateral hydroureteronephrosis was observed in one patients at one year postoperatively. Perioperative and late complications were similar in the 32 patients from the Bricker subgroup. Conclusion: We show that our results with urinary diversion are promising in patients requiring radical cystoprostatectomy. The two methods preferred in our institution offer a sufficient protection of the upper urinary tract with a low complication rate, good voiding function and continence.
Modified Mainz pouch II urinary diversion and quality of life
Authors: Dzamic Z. , Hadzi-Djokic J. , Acimovic M. , Jovanovic M. , Filimonovic J. , Tulic C. , Ladjevic N. , Milkovic B. , Pejcic T. , Radosavljevic R.
Published: November 2008

The current referential literature describes over 40 surgical techniques of continent urinary derivations. A variation of ureterosigmoidostomy, published by Hadzi Djokic et al. (1996) is a combination of the original Mainz pouch II (sigma rectum pouch) technique (Fish & Hohenfellner, 1991) and modified ureterointestinal anastomosis as described by Camey & LeDuc (1979) with a few new details described by the author himself. In the period 1994- 2006. the total of 236 patients were treated by this method. Radical cystectomy in cases of multifocal transitional cell carcinoma of the bladder was the most common indication for this method (91,5%). In the course of follow-up (mean duration 24 months) the quality of life (QL) of these patients was evaluated by physical characteristics, mental status, social aspects and comparative evaluation of quality of life with ileal conduit which is still considered the "gold standard" for urinary derivations. A very good quality of life in all studied dimensions (3/4) patients) suggests the fact that this form of continent urinary derivation provides the patients with the fair quality of life and confirms justifiability of this surgical procedure under certain indications.
Local recurrence of bladder cancer after cystectomy with orthotopic bladder substitution and ileal conduit
Authors: Pejcic T. , Hadzi-Djokic J. , Acimovic M. , Markovic B.B. , Maksimovic H.M. , Milkovic B. , Kajmakovic B.
Published: November 2008

Objective: To present the local recurrence rates after radical cystectomy for advanced bladder cancer and to compare them between patients with orthotopic neobladder and ileal conduit. Patients and methods: 97 patients with radical cystectomy were analyzed: 75 patients with orthotopic ileal neobladder, operated from 1985. to 2006, and 22 patients with ileal conduit, operated from 2000. to 2006. Results: Overall recurrence rate was 41.3% in the neobladder group, and 50% in the ileal conduit group. The rate of pelvic, upper urinary tract and urethral recurrence was 13.3%, 8%, and 10.6% in the neobladder group, and 9.1%, 13.6% and 9.1% in the ileal conduit group. Conclusion: Comparable recurrence rates, operative time, the complexity of the surgical technique and the results between two groups, strongly support the construction of orthotopic neobladder, as superior in functional, esthetic, and psychological point of view.
Clam ileoplasty bladder augmentation and renal transplantation
Authors: Milutinovic D. , Topuzovic C. , Hadzi-Djokic J.
Published: November 2008

In our patient, with a small contacted bladder and end stage renal failure, bladder augmentation (clam ileocystoplasty) was done in conjunction with renal transplantation. Our patient has stable renal and bladder function 46 months after kidney transplantation.
Elevated plasma D-dimer as a predictor of postoperative complications after radical cystectomy
Authors: Djukic-Filimonovic J. , Tulic C. , Dzamic Z. , Krivic B. , Milkovic B. , Markovic B.B. , Hadzi-Djokic J.
Published: November 2008

Detailed preoperative evaluation is essential in prevention of perioperative complications. As thorough anamnesis, physical examination and standard laboratory investigation do not contribute much in prediction of perioperative complications and outcome, and detection of tumor markers is also insufficient in means of prognosis, some molecular marker have emerged lately as prognostic markers in surgery. Recent data on pathophysiological processes stress response, derangements of hemostasis, in sepsis or in thromboembolism as well as in malignancy, indicate that presence or elevation of some molecular markers of fibrinolysis can indicate possibility of perioperative complications and even predict outcome. As it is evident that neoplastic cells enhance thrombin and other procoagulant production, detection of degree of activation of coagulation and fibrinolysis can contribute in prediction of treatment outcome in patients with bladder carcinoma scheduled for radical surgical procedures.
The significance of TPSA, free to total PSA ratio and PSA density in prostate carcinoma diagnostics
Authors: Milkovic B. , Hadzi-Djokic J. , Dzamic Z. , Pejcic T.
Published: November 2008

Prostate-specific antigen (PSA) is the one of the most valuable tumor markers for the early detection and management of prostate carcinoma, but not an ideal one because of poor specificity in the case of prostatic hypertrophy and other benign conditions. In order to overcome this drawback some other parameters as is free to total ratio (F/T) PSA and PSA density (PSAD) are introduced. It has been investigated in 60 patients, 18 of them are proved to be found prostate cancer and other 42 were identified as benign prostatic hyperplasia. Patients with CaP had TPSA median of 11.4 ng/ml and the others with benign prostatic hyperplasia (BPH) had 6.9 ng/ml. In these two groups there was statistical significant difference (p 0.01). By receiver operating characteristics curve (ROC) estimated cutoff for TPSA was 4.0 ng/ml with 95% sensitivity, 30% specificity and area covered by ROC was in amount of 0.76. Median F/T ratio for patients with prostate cancer was 0.10, and for benign prostatic hyperplasia patients it was 0.25.For these values there is also statistical difference (p). Using ROC cutoff for F/T PSA was determined at the value of 0.18 with sensitivity 95%, specificity 80% and area under the curve (AUC) 0.93. Median for PSAD in the group with CaP was 0.38 and in the BPH group was 0.16. There was statistical significance within those two groups. In conclusion F/T PSA, PSAD and TPSA are valuable tumor markers in distinguishing patients with CaP ant those without with modestly raised TPSA. Also F/T PSA showed up as better marker than TPSA and PSAD in investigated group of patients.
Stage T2 prostate cancer presented with high serum prostate specific antigen and nonspecific bone lesions
Authors: Pejcic T. , Hadzi-Djokic J. , Markovic B.B. , Maksimovic H.M. , Acimovic M. , Miljkovic S.
Published: November 2008

Objective: To present the case of T2 prostate cancer (PCa) mimicking disseminated PCa that was successfully treated with radical retropubic prostatectomy (RRP). Patient and the method: The patient had prostate specific antigen (PSA) level higher than 30ng/ml and multiple atypical lesions on bone scan. TRUS guided biopsy proved small PCa, only in 1/18 biopsy cores, with Gleason grade 6 (3+3). Bone lesions appeared to be posttraumatic. Result: The patient underwent RRP; six months after surgery there is no evidence of the disease. Conclusion: Serum PSA level is the sum of cancer activity, normal and BHP tissue production, as well as the result of other pathological conditions, like prostatitis. In some cases, inflammation can be responsible for high PSA level and over-staging.
Pelvic lymphadenectomy for localized prostate cancer
Authors: Bogdanovic J. , Djozic J.
Published: November 2008

In the era of prostate specific antigen, there is increasing proportion of patients with localized prostate cancer. Accurate preoperative determination of lymph node status is important for adequate selection of treatment option, monitoring of response to treatment and early detection of recurrence. Lymph node invasion (LNI) is crucial prognostic parameter for patients who underwent curative treatment. Despite of continuous improvements of radiological armamentarium, CT, MRI and PET scans are not absolutely reliable in lymph node staging. Many nomograms have been developed for prediction of lymph node status, but accuracy of these statistical models is not better than 78%. Surgery, either open or laparoscopic pelvic lymphadenectmy (PLND), remains a cornerstone in lymph node staging. However, there are several controversies regarding PLND 1) necessity for routine perfoming in each patient, 2) anatomic boundaries for PLND, 3) morbidity of PLND, and 4) diagnostic and therapeutic value.
Border line cases and diagnostic doubts in definition kidney parenchimal and collecting tract neoplasia
Authors: Markovic B.B. , Maksimovic H.M. , Markovic Z. , Pejcic T. , Hadzi-Djokic J. , Filimonovic J.
Published: November 2008

Aim of this work is to present cases of renal neoplasms where all available diagnostic modalities and control exams were applied, still explorative surgery was needed. Asymptomatic tissue mass with diagnostic findings of hypovascular renal cell carcinoma and renal pelvic carcinoma were inconclusive. While percutaneous CT guided biopsy is advisable in such cases, it was not performed due to central, hilar localization of the lesions and its small dimensions. In rare cases, such ours are diagnosis is achieved by surgery-histology examination.
Estimation of the relative liver perfusion using two methods of radionuclide angiography in the patients with hemodynamic disorders in the portal system
Authors: Artiko V.M. , Sobic-Saranovic D.P. , Pavlovic S.V. , Perisic-Savic M.S. , Stojkovic M.V. , Radoman I.B. , Knezevic S.J. , Vlajkovic M.Z. , Obradovic V.B.
Published: November 2008

The aim of this study is the assessment of the relative arterial and venous contribution to the total liver blood flow (hepatic perfusion index-HPI), with two methods (S1 and S2), and estimation of their value. With this correction, HPI nonsignificantly increases (p>0.05) in all the groups of patients, with a very high correlation between the HPI(S1) and HPI(S2) values (p<0.01). In comparison to the portal perfusion in controls, values were significantly (p<0,01) lower in chronic active hepatitis and liver cirrhosis and differed between themselves (p<0.01). In the groups of cirrhotic patients with esophageal varices, sclerosated esophageal varices, recanalized umbilical vein, portal thrombosis and cavernous portal vein, portal perfusion was lower (p<0.01) than in controls, chronic active hepatitis and liver cirrhosis without collaterals. Both angioscintigraphic methods are useful for the estimation of the disturbances in the portal system. Because of the more exact estimation of the liver perfusion, S2 is recommended.
Revaskularizacija miokarda bez primene vantelesnog krvotoka
Authors: Milojevic P.S.
Published: November 2008

Contemporary treatment of coronary disease includes: drug treatment, percutaneous coronary angioplasty (PCI), with or without stent implantation and surgical myocardial revascularization. For more than 30 years, conventional coronary bypass (on-pump CABG), using cardiopulmonary bypass (CPB), represented the standard regarding myocardial revascularization, particularly in patients suffering from three vessel disease or left main coronary artery stenosis. Recent development of invasive cardiology and increased interest in coronary surgery on the beating heart (OPCAB), challenging traditional on- pump CABG procedure, as optimal strategy for the treatment of coronary artery disease. In order to improve clinical outcome, OPCAB seems to be a good choice in patients with co-morbidities critical for use of CPB. Results of OPCAB revascularization in general patient population are considerably different and require further evaluation. This review article shows the development of OPCAB and elaborates potential advantages and weaknesses of this method of revascularization, from both, theoretical and clinical point of view, compared to standard surgical myocardial revascularization.
Prisutnost plakova na karotidnim arterijama kod osoba sa poremecajem glikoregulacije
Authors: Savic Z.N. , Djordjevic P.B. , Ilic M.M. , Popovic S.S. , Dimitrijevic-Sreckovic V. , Canovic F.M. , Brajovic M.D.
Published: November 2008

Purpose: The aim of this study was measurement of artery intima media thickness (IMT) and plaques as an early indicator of atherosclerosis in diabetics comparing with other risk factors of carotid artery. Methods and Materials: 110 pts: 50 with Diabetes Mellitus, type 1 (25) and type 2 (25), 20 pts with glucose intolerance, 20 pts with type 2 de novo and 20 pts obese without diabetes. Ultrasound examination (using 7.5MHz sound on Toshiba SSA- 270A) end measurement of intima-media ticknes (IMT) were performed on Carotis communis (CCA), bifurcation and distal from bifurcation to a.carotis intern (ACI), expressed in mm. Plaques were correlated with other common factors age, BP, lipid parameters (Chol, HDL, LDL, Triglycerides), smokes, alcoholism and obese (BMI). The authors used 2 test and Spearman?s correlation . Results: The lowest percent of plaques was found in group with type DM 1. The highest percent of plaques was found in type DM 2. Statistically there is highly significant difference between plaques founded on type 2 DM and types 2 DM de novo and on other types. Conclusion: DM is not an independent risk factor for developing of macroangiopathic changes an arterial walls, but their appirience are more presenting in diabetic patients. The highest number of plaques are presenting DM type 2 (29.6%), and after type 2 de novo (26.8%), the next highest position of plaques were in patients with obese but without DM and intolerantio glucosae (IFG+IGT) (17.1%) and type 1 DM (9.8%). Risk factors were presented in following percentage : Obese 80.5% pts; hyperlipidema 53.7% pts; HTA 51.3%; smoking 51.2% pts and alchocholism 2.4% pts. According to these results, all risk factors were included in patophysiology of plack forming except alcoholism. Influences of these risk factors are very importance and their synergic action lids to their rapid appirience and clinical manifestations. DM has specific position in patophisiology of atherosclerosis.
Gastroesophageal reflux in infants and children
Authors: Sretenovic A. , Perisic V. , Simic A. , Zivanovic D. , Vujovic D. , Kostic M. , Pesko P. , Krstic Z.
Published: November 2008

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder and the most frequent reason why infants are referred to the pediatric gastroenterologist, affecting as much as 30% of the pediatric population. Presenting features of GERD in infants and children are quite variable and follow patterns of gastrointestinal and extra-esophageal manifestations that vary between individual patients and may change according to age. Patients may be minimally symptomatic, or may exhibit severe esophagitis, bleeding, nutritional failure, or severe respiratory problems. GERD is also complex for the diagnostic techniques required to assess its repercussions or explain its origin. Although different abnormalities in motility variables, such as lower esophageal sphincter (LES) function, esophageal peristalsis and gastric motor activity can contribute to the development of GERD, the degree of esophageal acid exposure represents the key factor in its pathogenesis. Esophageal pH monitoring, based on both the detection of acid reflux episodes and the measurement of their frequency and duration, has been regarded as the most sensitive and specific diagnostic tool for diagnosing reflux disease. The aim of this paper is to give a concise review for the clinicians encountering this specific disease in infants and children.
Epidermoidne ciste slezine kod dece i adolescenata
Authors: Marjanovic Z.O. , Djordjevic I.M.
Published: November 2008

Epidermoid cysts of the spleen are a rare lesion comprising less than 10% benign non-parasitic splenic cysts. Two boys and three girls, aged 13 to 24 years (mean 18,0 years) were diagnosed over a 4-year period. Presenting symptoms were dull, acute left hypochondrium pain and diffuse abdominal pain. Hemogram and routine analyses, as well as radiography were performed for the diagnosis. Ultrasound and CT confirmed the cystic nature of the lesion. Definitive diagnosis is made by pathological findings. Was performed splenectomy on one patient, and was performed a partial splenectomy on the other patients, in order to eliminate the symptoms produced by the cyst and prevent potential complications (postspleenectomiam sepsis). Patients were examined postoperatively. They were asymptomatic and with a normal spleen remnant detected by ultrasound and CT. Routine hematological data, blood clotting factors, and immunoglobulins were normal.
The incidence rate of thyroid microcarcinoma during surgery benign disease
Authors: Zivaljevic V.R. , Diklic A.D. , Krgovic K.Lj. , Zoric G.V. , Zivic R.V. , Kalezic N.K. , Kazic M.T. , Tatic S.B. , Havelka M.J. , Paunovic I.R.
Published: November 2008

Thyroid microcarcinoma are well-differentiated tumors less than 1 cm in diameter. A retrospective analysis was performed on patients operated of benign thyroid disease at the Center for endocrine surgery, Institute of endocrinology, Clical Center of Serbia in Belgrade, from January 1st to December 31st 2004, in order to establish the incidence of microcarcinoma. Indications for surgery were euthyroid multinodular goiter in 201 patients, thyroiditis in 31, thyroid adenoma in 178, Graves disease in 89 and Plummers disease in 79 patients. The results of this study, demonstrate that in 13,4% of the patients operated for goiter, 6,4% operated for thyroiditis, 5,6% for thyroid adenomas, 9,0% for Graves disease and 7,0% of the patients operated for Plumers disease, the presence of a microcarcinoma was noticed in the definitive histopathologic examination. The results obtained are in line with the current knowledge of high incidence of thyroid microcarcinoma.
Pathophysiological mechanism of the developing maxillofacial radicular cyst
Authors: Colic S. , Jurisic M. , Jurisic V.
Published: November 2008

The radicular cysts are result of inflammatory process in the periapical tissues associated with necrotic and infected pulps. Humoral and cellular immune responses play a central role in the pathogenesis of these lesions. The most important role in the growth of these lesion have proinflammatore cytokine TNF-?, IL-1 and IL-6. Cytokine can be secreted by macrophages, monocytes and other cells of the immune system and can participate in skeletal homeostasis including osteoclastic formation, and bone resorption in maxillofacial region. The aim of this study is to give a concise review for mechanism of growth of maxilofacial radicular cysts, indicated of clinical aspect, as well as explained role of cytokine in this pathophysiology process.
Management of cadaveric organ donors
Authors: Jovanovic B. , Bumbasirevic V. , Pavlovic A. , Palibrk I. , Pandurovic M.
Published: November 2008

Because the supply of cadaveric organ donors is limited and their ICU management is complex, a multidisciplinary, well-coordinated, and institutionally supported approach to management is essential to ensure the maintenance of the current supply and to increase the future supply of organs and tissues that are suitable for transplantation. The potential organ donor is at high risk for instability as a direct consequence of the loss of physiologic homeostatic mechanisms that are dependent on functioning of the central nervous system. The keys to successful ICU management of the potential organ donor include a team approach that is focused on the anticipation of complications, appropriate physiologic monitoring, aggressive life support, with frequent reassessment and titration of therapy.
The first transendoscopic plastic to self-expandable metal stent replacement in Serbia and Montenegro using a diagnostic duodenoscope
Authors: Bulajic M. , Milojkovic B. , Jakovljevic M. , Milosevic P. , Gazivoda I. , Sankovic Z. , Bulajic M.
Published: November 2008

Studies have shown that SEMS remain patient longer with fewer associated complications compared with conventional plastic strents. Zilver stent ?, a nitinol zig-zag mash SEMS has a special advantage, having a thin introducer diameter of 7 Fr with a fully deployed span of 10mm. For a 48- year-old woman presented with obstructive jaundice and a diagnosis of unresectable pancreatic carcinoma with consequent stenosis of common bile duct (CBD), infiltration of local blood vessels and life expectancy longer than six months, it was decided that an endoscopic palliative drainage procedure should be performed. The technique of transendoscopic plastic to metal stent exchange is described, using a diagnostic duodenoscope. The patient lived 7 months after implementation of Zilver stent? and died anicteric due to progression of a primary disease. The transendoscopic plastic to metal stent exchange is feasible palliative method which requires a basic endoscopic equipment and experienced staff and therefore is applicable in developing countries as well.
Laboratorijski multipozicioni drzac baze lobanje
Authors: Nagulic M. , Ivanovic Z. , Nikolic I. , Alempijevic Dj. , Dunjic D.
Published: November 2008

Authors present an original multipositional holder for skull base cadaveric specimens, either formalin or fresh. It is constructed to be fixated for standard neurosurgical operating table, devoted for laboratory micro neurosurgical dissection and suitable for simulation operation on patient. The holder is made of solid stainless steel, practical and easy for cleaning. The device permits good tree point?s fixation, extensive angular mobility of the primary and secondary joints, that the skull base specimen can be placed and supported in any desired position. It fulfills demands for fixation from external skull base surface with thin needles ensuring full surgical dissection field without obstacles or invisible angles.
Surgery of the arteriovenous cerebral malformations
Authors: Janicijevic Milos
Published: November 2008

According to the present technical possibilities modalities of the treatment of the arteriovenous cerebral malformations (surgery, embolization, radiosurgery) for direct neurosurgical excision of malformations remains of cases. Decision to operate is made separately for each malformation and is based on anticipation of the natural course of the illness, precise estimate of the risk from operation and on the estimate of the condition of the patient. Surgical technique is also chosen for each malformation separately, depending on its size, angioarchitecture, hemodynamic characteristics and localization. The following techniques are used: resection of the malformation "en blocque", coagulation of the lesion in situ, gradual marginal coagulation in the lesion cleavage, "backword technique", perivenous approach and excision of the complex malformations in several acts. The safety of the surgical excision is increased by preoperative and perioperative actions already described. Intraoperative problems and postoperative complications (brain edema, uncontrolled hemorrhage, intracerebral hematoma and others) were discussed.
Early surgery of hemorrhaging aneurysms of brain blood vessels
Authors: Lakicevic N.P.
Published: November 2008

Comprehension of the natural course of the aneurisms on the blood vessels of the brain has imposed the need for timely surgical treatment. The comfort of delayed surgery, due to the high risk of the rupture had to be overlooked. Early surgery, within the first three days from the rupture of the aneurysm, has a double role - it prevents rupture, but considerably decreases the risk of complications caused by subarachnoid hemorrhage, vasospasm and hydrocephalus. We present the results of the surgical treatment of 710 patients operated during the period from year 1994 until 1996. We point out that the treatment of patients was conducted in conditions that were not standard, due to sanctions. During operations at our disposal most of the time was only one clip and a limited quantity of drugs for the perioperative treatment. Our results show that compulsory candidates for early surgery are small patients in good clinical grading, without associated illnesses. Patients without clinical and angiographic signs of vasospasm may also be operated in the intermediary term. Patients with massive intracerebral hematoma caused by the rupture of the aneurysm who are in a coma should be urgently operated.
Morphologic analysis of the coexisting anomalies of the arteries of the cerebral base and aneurysms: Clinical study
Authors: Jovanovic I.B. , Rakic M.Lj. , Nestorovic B.D. , Milojevic T.M. , Rasulic L.G. , Micovic M.V. , Bulatovic M.B. , Milicevic M.V.
Published: November 2008

During operations of the aneurysms showing anatomical details is the means that leads to the aim, and it is not only a purpose in itself. Data on details that the surgeons come across during their work and which sometimes represent difficulties during interpretations of angiographic findings and planning operations, as well as the intraoperative orientations and identifications of the elements . Frequency of occurrence of such anatomical details and anomalies may be completely different from the one that autopsy series show. Knowledge of this makes the work of surgeons easier and gives a necessary feeling of confidence during operations. Thus, we decided to conduct a clinical, morphological study based on angiographic and surgical analyses of the explored segments of the Wilson circle. The study included 344 patients from the Institute for Neurosurgery, during the period of 2 years; the patients had complete angiographic diagnosing and operative exploration. Our findings confirm differences in localization of aneurysms according to sex. Aneurysms on the front communicant complex are to a great extent associated with anomalies of the front part of the Wilson circle.
Development of new intracranial saccular aneurysms
Authors: Radulovic D.V. , Tasic G.M. , Nikolic I.M. , Jokovic M.B. , Repac N.R. , Cvrkota I.S. , Kojic Z.
Published: November 2008

Newly formed aneurysms developing from a cerebral vessel which had appeared to be normal in a previous angiographic study are very rare. Four cases of angiographically documented newly developed saccular aneurysms are described in this report. In all four patients, the new aneurysms were symptomatic, causing subarachnoid hemorrhage (SAH). Repeat angiography, performed after the second SAH, revealed new aneurysms that were not demonstrated on initial angiograms after the first SAH. They were clipped with good postoperative course. Our observations and literature data suggest that some patients with SAH need further neuroradiological followup. The presence of the risk factors and age of the patient should be taken into consideration.
Cerebral vasospasm after subarachnoid hemorrhage
Authors: Milojevic T.M. , Baljozovic B.V. , Rakic M.Lj. , Nestorovic B.D. , Dostanic M.M. , Milakovic B.D. , Kojic Z. , Repac N.R. , Cvrkota I.S.
Published: November 2008

Cerebral vasospasm causes permanent neurolological deficit or death occurrence in 13% of clinical cases. Peak frequency is from 8-10th day after SAH. The purpose of this study is factor analysis that may have influence on vasospasm development , as well as predictor determination. The study is prospective and analysis 192 patients treated in Institute of Neurosurgery, Clinical Centre of Serbia, Belgrade. The majority of patients were admitted in hospital in first four days after SAH, and 184 had GCS over 7. Univariate methods of factor analysis were used, and for significance of predictors influence testing multivariante regression analysis was used . Vasospasm occurred in 22,40% of all cases. No relationships have been found between sex, age, previous hypertension, timing of surgery, appearance of hydrocephalus and intracerebral hematoma, hypertermia or mean arterial blood pressure, with occurrence of cerebral vasospasm. Factors with significantly associated with the occurrence of vasospasm were: hearth disease, hypernatriemia, Hct, clinical grade on admission as well as preoperative clinical grade and Fisher CT scan grade. In the first four days after SAH, Fisher scan grade, preoperative clinical grade and Hct, appeared as predictors. After four days, clinical grade on admission and hypernatiemia, showed as predictors.
Analysis of the therapeutic modalities when cerebral vasospasm occurs and the outcome of the treatment of patients with SAH
Authors: Milojevic T.M. , Baljozovic B.V. , Dostanic M.M. , Milakovic B.D. , Djurovic B.M. , Tasic G.M. , Jovanovic V.T. , Nikolic I.M.
Published: November 2008

Vasospasm is the principal cause of a poor outcome in patients with SAH. The aim of the study is to establish the effect of the therapeutic modalities on vasospasm, to establish morbidity and mortality of patients with SAH, as well as the causes of the poor outcome. The study is prospective and analyzes 192 patients treated at C ward of the INH KCS. Vasospasm incidence was 22.40%. Therapeutic modalities depended on prescribed quantities of colloid solutions and MgSO4 solution. Differences in the vasospasm incidence between the groups were not significant, the reason probably being that the maximal doses of colloid solutions were prescribed mostly to the higher graded patients. In patients who received MgSO4 vasospasm was less frequent, but not statistically significant (11.11% vs. 23.56%) Of 192 patients, 78.1% completely recovered, 9.9% had a certain degree of invalidity, and 12.0% did not survive. The most frequent cause of death was vasospasm (41.67%) and then general medical complications (20.93%).
Space reconstruction of the aneurysms of the vertebrobasilary confluence based on conventional angiography: Our experience
Authors: Nikolic I.M. , Rakic M.Lj. , Slavik E.E. , Tasic G.M. , Djurovic B.M. , Jovanovic V.T. , Radulovic D.V. , Jokovic M.B. , Rasulic L.G. , Stankovic S.
Published: November 2008

Besides current development of the new diagnostic procedures conventional angiography still represents the golden standard in the diagnosing of intracranial aneurysms. Since it gives a two-dimensional image if the presentation of the third dimension is wanted it is necessary to apply appropriate algorithm structures and computers. In this study we show our experience in the application of space reconstruction of blood vessels and aneurysms of the vertebrobasilary confluence in 6 patients operated at the Institute for Neurosurgery, Clinical Center of Serbia. Intraoperative finding in all patients matched the finding that we got by space reconstruction of the blood vessels, which was possible to observe from different angles. Postoperative course in all patients was satisfying. Upon discharge the patients were without rough lateralization of the pyramidal system. Our initial results and their practical agreement with the interoperative finding give us right to recommend this method as the standard for the preoperative diagnostic protocol.
Results of the operative treatment of the ruptured aneurysm: Prospective clinical study
Authors: Jovanovic I.B. , Milojevic T.M. , Djurovic B.M. , Jovanovic V.T. , Tasic G.M. , Nikolic I.M. , Bulatovic M.B. , Milic I.S.
Published: November 2008

Aneurysmal subarachnoid hemorrhage (SAH) is a dramatic, frequently fatal event. With the incidence of 10 to 15 in 100 000 and a total mortality which even today is 40-50%, it represents a significant problem. Early surgical care for the hemorrhaging aneurysms has, without doubt, an importance in prevention of the rupture, however different series show different results as regards surgical timing and they are very different as regards giving advantage to the early or delayed time of the operation. Our aim was to perceive the results of the treatment in our group of 197 consequently operated patients for ruptured aneurysms with a special attention to the time of operation. This was a prospective clinical study and it was carried out at the Institute for Neurosurgery in Belgrade. Mortality of the operative treatment was a total of 15.74% in the entire group. According to operative intervals from the early to the delayed mortality the range is 35.71%, 22.22%, 11.63% and 8.88% respectively. The results of the treatment are in direct connection with the seriousness of the clinical picture. Being in the group graded from 1-3 decreases the probability of a fatal outcome, and graded from 1-2 decreases probability of morbidity. Early operated patients who in our group included also the most serious cases, life endangered ones, although with higher mortality do not have higher morbidity.
Distal posterior cerebellar artery aneurysm: Case report
Authors: Jovanovic V.T. , Rakic M.Lj. , Djurovic B.M. , Tasic G.M. , Nikolic I.M. , Piscevic I.A. , Repac N.R.
Published: November 2008

Vertebrobazilar aneurysms make about 15% of all intracranial aneurysms, from which one fifth belongs to aneurysms a. posterior inferior cerebelli (PICA). Majority of PICA aneurysms is located in the place of separation from a. vertebralis. Aneurysms of distal part of PICA are very rare, according to literature they make 0.5 to 3% of all aneurysms. 70 years old man came to neurologist because sudden headache, pain in the neck and a feeling of stiffness followed by throwing up in stream. On the occasion of medical check up attack of spontaneous subarachnoid hemorhage was suspected. Clinical gradus according to H&H III, initial CT of endocranium showed existence of smaller intracerebellar hematoma next to lateral wall of IV ventricle and trace of blood in the very ventricle without signs of acute hydrocephalus. The seventh day after the hemorrhage angio CT was done and it showed existence of aneurysm on distal part of PICA, more specially in the televelotonzilar segment on the right. After the diagnostics supplemented with standard digital substractional angiography which confirmed nature and localization of the lesion. In the postponed procedure, and in conformity with strategy of surgical timing of aneurysms in the back circulation, patient was operated three weeks after the attack of hemorrhage. Disregarding low incidence of existence of aneurysms of distal circulation (under 1% of all in the back circulation) high level of suspicion should be present and angio CT should be done as screening method, if CT shows hemorrhage which according to localization responses to possible aneurysm.
Endovascular occlusion of the intracranial aneurysms: An alternative for surgical treatment
Authors: Tasic G.M. , Rakic M.Lj. , Jovanovic V.T. , Djurovic B.M. , Nikolic I.M. , Jokic M.B. , Radulovic D.V. , Bogosavljevic V.M.
Published: November 2008

Aneurysms on cerebral blood vessels due to their localization, size, relationship with neurovascular structures, even today, represent besides the constant progress of the diagnostic techniques and instruments in the operating theaters, a great therapeutic challenge. Gigantic aneurysms, aneurysms localized within the cavernous sinus and aneurysms of the vertebrobasilary confluence carry a great perioperative risk of mortality and morbidity. In fact, development of the endovascular procedures for the occlusion of their lumen made possible great progress in the treatment of aneurysms of this localization. In a not so small number of cases endovascular procedure means remodeling of the lumen of the main blood vessel. Endovascular obliteration of aneurysms has a certain advantage as regards the surgical treatment of aneurysms in which, on the basis of the expected natural course and presumed operative risk, may be judged that there exists unacceptably great operative risk. We present a personal series and results in 6 patients with aneurysms of various localizations.
Natural course of the arteriovenous malformations of the brain
Authors: Tasic G.M. , Kostic A. , Djurovic B.M. , Jovanovic V.T. , Nikolic I.M. , Eric A.M. , Jokovic M.B. , Micovic M.V.
Published: November 2008

Arteriovenous cerebral malformations represent congenital malformations. Considering the anatomical characteristics of the cerebral angiomas and their localization, in a great number of cases they demand a combined therapeutic approach - surgery,. embolization and radiotherapy. Besides the constant progress of technology, 5% of all cerebral angiomas can not be completely excluded from the circulation. Therefore, the need to understand their natural course became a necessity. Our results point to the fact that they are vascular malformations of a considerably more benign clinical course than the aneurysms. Our clinical model points to an annual risk of hemorrhage which is 3.3% with total mortality of 5.3%, especially if the size of the angioma is 2.5-5 cm, localized in the motor zone of the brain, with combined type of vein drainage and arterial supply from the vertebrobasilary confluence. Epilepsy caused by the cerebral angioma is in 26.7% refractory to medicamentous therapy and in 25% (every 4th patient) will have hemorrhage with an annual risk of 0.14%.
Treatment of patients with spontaneous intracranial hematomas
Authors: Jokovic M.B. , Radulovic D.V. , Tasic G.M. , Djurovic B.M. , Jovanovic V.T. , Nikolic I.M. , Slavik E.E. , Rakic M.Lj.
Published: November 2008

Spontaneous intracerebral haemorrhage is a common cause of stroke especially in the young. The term "spontaneous intracerebral haemorrhage" refers to bleeding without coincident trauma. About 80% of this haemorrhage occur supratentorial in the basal nuclei and they are associated with hypertension. Etiological factors range from congenital vascular malformations (aneurysmas, AVM, cavernomas) to acquired and degenerative vascular and brain conditions. In primary intracerebral hemorrhage arterial hypertension and consequent vascular changes are the major etiological factors. In secondary- nonhypertensive hemorrhage cause may be associated with aneurysms, AVM, tumors, coagulation disorders. Contemporary diagnosis imaging (CT, MRI) and neurological evaluation, allow early diagnosis and effective medical and/or surgical therapy in a majority patients. Without treatment, the risk of mortality and morbidity is high. Medical management involves normalization of blood pressure, reduction of intracranial pressure, control of brain edema and prevention of seizures. In design for operative treatment must be include age of the patient, hematoma size and location, clinical condition, the level of consciousness and patient outcome. The role of surgery remains controversial.
Neurosurgical treatment of patients with supratentorial cavernoma
Authors: Djurovic B.M. , Jovanovic V.T. , Tasic G.M. , Nikolic I.M. , Jovanovic I.B. , Jokovic M.B. , Krunic-Protic R.V. , Ilic R.V.
Published: November 2008

The aim of this study is to present the principal clinical manifestations and neurosurgical results of the treatment of patients with supratentorial cavernoma and epilepsy. The retrospective study included 14 patients with supratentorial lesion on MRI and CT scan of the brain that manifested with epileptic seizures. All patients were surgically treated and pathophysiologic evaluation in all patients confirmed that cavernoma was in question. Results were analyzed and compared with data from the literature. Epileptic seizures are the most frequent clinical manifestation found in supratentorial cavernoma and neurosurgical treatment gives excellent result as regards the control of epilepsy, with a very low incidence of morbidity and mortality. A complete resection of all cavernomas in this study was confirmed by postoperative neurosurgical diagnosing. 12 patients did not have any more epi seizures in the postoperative period, and in 2 patients we found decrease in the occurrence of epi seizures.
Long-term results of laparoscopic treatment for advanced rectal cancer
Authors: Pignata G. , Barone M. , Stefanoni M. , Bracale U.
Published: November 2008

Backgraound. The management of advanced rectal cancer has changed into a multidisciplinary treatment model. Only limited randomized data are available for patients with rectal cancer treated laparoscopically. Aim. We report a multimodal treatment of advanced rectal cancer: preoperative oncological treatment, use of endoscopic stent (for malignant obstruction), minimal invasive treatment. Methods. The Authors reported a series of 45 laparoscopic rectal resections for adenocarcinoma, some of them with malignant obstruction. Long term oncological results were reviewed. Results. The 30-day mortality was 2.2%. Of 45 adenocarcinoma, 4 cases were obstructed. Successful stent positioning was obtained in all patients and treated with radiochemiotherapy before laparoscopic resection. The 5-year global survival rate (including stage IV) was 62.2%; for stage II was 77.9% and 53.8% for stage III. Conclusion. This study indicates that laparoscopy for advanced rectal cancer have good long-term results. In high and middle rectal malignant obstructions, we considered the use of stents to be useful.
Prognostic value of clinical, pathological and immunohistochemical markers in stage II colon cancer patients
Authors: Stor Z. , Frkovic G.S. , Bracko M. , Repse S.
Published: November 2008

Background/Aims: The purpose of our analysis was to determine the prognostic value of molecular markers for identifying high-risk TNM stage II colon cancer patients, the association with various clinical and pathological features, and possible relation to survival. Methods: In 191 colon cancer patients who underwent a potentially curative resection, clinical and pathological factors (age, tumour site, histological grade of malignancy, pT stage, presence of venous, lymphatic and perineural invasion) and tumour molecular markers were analyzed. Molecular markers were assessed immunohistochemically in sections of paraffin- embedded tissues. Patients were followed for a median of 8.7 years. The 5-year survival rate was estimated using the Kaplan-Meier statistical method. Results: From 1. Jan.1994 to 31.Dec.2000, 191 patients underwent radical resection for T3-4 N0M0 colorectal cancer without adjuvant chemotherapy. A significant decrease in survival was identified in older patients, patients with tumours pT4 and with perineural invasion. We found no significant differences in survival of patients with expression of MLH1, Cyclin D1 and reduced overexpression of E-cadherin. Conclusions: The results of our study indicate that the presence of perineural invasion, pT4 stage and the patient?s age are significantly correlated with the expected survival in radically resected TNM stage II colon cancer patients, while immunohistochemical markers are not related to survival.