bluuebunny/crossref_metadata_2025 huggingface dataset:
Chondrofibrosis of adolescent hip
Authors: Slavkovic S. , Vukasinovic Z. , Slavkovic N. , Apostolovic M. , Tomic S.
Published: November 2008

Authors present 420 hips with slipped capital epiphysis treated in the IOHB "Banjica", during the period between 1970 and 2005. Research includes the analysis of incidence, diagnostics and causes which contribute to the genesis of hip chondrofibrosis. Risk factors are shown, as well as the approach to eliminate them. 39 hips in which this complication occurred were individually analyzed. Every hip was separately studied with intent to determine the cause of the condition?s genesis, it?s evolution, treatment and it?s final functionality result. Synovia biopsy was performed in 7 cases, as well as the biopsy of the capsule, articular hyaline cartilage and subchondral bone of the femoral head, which enabled detailed description of both microscopic and macroscopic changes that follow this condition. Regardless of still hypothetical comprehension of the inception of chondrofibrosis, authors clearly state all the risky procedures during treatment that can contribute to the development of chondrofibrosis. The importance of early diagnostics and well-timed treatment are highlighted in this article, for they are crucial. Results of treated hip chondrofibrosis presented here give hope for the destiny of the ill joint, which was considered highly uncertain for a long time.
The treatment of infected diaphyseal femoral defects by lengthening one of the bone fragments by Ilizarov
Authors: Tomic S. , Krajcinovic O. , Blagojevic Z. , Apostolovic M. , Lalosevic V.
Published: November 2008

We analyzed 30 patients with infected diaphyseal defect of femur, which have been treated by lengthening one of the bone fragments with Ilizarov apparatus. The mean length of the bone defect was 6 cm. Substitution of the defect, bone healing and elimination of the infection was achieved in 27 patients. The mean time of apparatus fixation was 10 months. According to Palley scoring system, 10 patients had excellent functional results.
Minimalno-inciziona totalna artroplastika kuka
Authors: Bascarevic Z.Lj. , Radojevic B.B. , Timotijevic S.S. , Bascarevic V.D. , Trajkovic G.Z. , Blagojevic Z.
Published: November 2008

"Minimally-invasive" total joint arthroplasty have been widely introduced to the orthopedic community several years ago. The concept has received a great attention and has been greeted variably with enthusiasm, concern, and skepticism. Numerous meetings, scientific exhibits, symposia and congresses has been taking place all around the world. Whether this represents the future of orthopedic surgery or just a fad, the term "minimally-invasive" or "minimally- incision" are yet to be clear and establish. Our intention is to present 72 of first 100 cases of total hip arthroplasty performed by "minimally-incision" surgery. In our opinion first results are positive and we intend to continue with this kind of surgery.
Antebrahijalni reverzni ostrvski rezanj na peteljci AIP za rekonstrukciju defekta na palcu
Authors: Bascarevic V.D. , Bascarevic Z.Lj. , Vukasinovic Z.S. , Raspopovic V.M. , Timotijevic S.S. , Nedeljkovic P.R.
Published: November 2008

Fasciocutaneous lobe on AIP ( a. interossea posterior) is characterized by thin skin, good texture and satisfactory pedicle length, which enables the repair of numerous hand defects. It can be either loose or reversed on the pedicle. We present here 2 neglected cases of thumb injury in which there was a need to compensate the full thickness of the skin. We believe that thumb defects can be repaired with both functionally and esthetically good effects using AIP lobe.
Lecenje nereponiranih zadnjih dislokacija ramena
Authors: Diklic I. , Ganic Z. , Stevanovic V. , Crnobaric A. , Blagojevic Z.
Published: November 2008

Unreduced posterior dislocations of the shoulder are rare and difficult to treat. Treatment depends of defect of the humeral head. Since 1997. to 2002. eleven patients were referred to us for treatment unreduced posterior dislocations of shoulder with impressed fracture of the humeral head. Dislocations have lasted between two to eight months. All patients were treated with open reduction. Allograft reconstruction of the defect was used in six and hemiarthroplasty in two cases. As assessed with the scoring system of Constant, patients were rated excellent (9), satisfactory (1), unsatisfactory (1). Allograft reconstruction is the optimal choice for defects involving 20% to 45% of the humeral head. Prosthetic replacement is preferred for larger defects. Reconstruction of the defects involving less than 20% of the humeral head is not necessary. The observation is only meant to serve as a guide during decision making. The surgeon must make his own surgical choice based on the individual patient factors and on the intraoperative findings.
Posteror cortex violation unrecognized during LCA reconstructive surgery
Authors: Kadija M. , Bumbasirevic M. , Blagojevic Z. , Dubljanin-Raspopovic E.
Published: November 2008

One of the most important technical demands in ACL surgery is good fixation of the graft. Integrity of the posterior femoral cortex is necessary for Interference screws fixation. The femoral tunnel, placed as posterior as possible, is also mandatory for good graft position and potentially leads to violation of the cortex. The divergence between screw and tunnel could result in perforation of the posterior wall. Without intraoperative x-ray it is difficult to be sure that position of the screw is correct, even with good graft tension. Still, the problem exists with absorbable screws. The aim of the study is to show results of 6 patients with this complication treated without revision of the femoral fixation with mean follow up of 1,5 year. Potential pitfall in ACL reconstruction is posterior cortex breakout and loss of fixation. If it is recognized during surgery changing the type of fixation can solve the problem, but if not, in the early phase of rehabilitation and weight bear, graft failure is feasible. The tibia tunnel angle and length, the footprint of femoral tunnel reamer and hyper flexion of the knee during screw insertion are methods for preventing the breakout of the posterior wall and screw-tunnel divergence. Modification of the early postoperative treatment and less aggressive rehabilitation protocol reduced the need for revision surgery. Even with best surgical technique, skill and experience this complication is possible to occur.
Funkcionalni i radiografski rezultati parcijalne unipolarne artroplastike kuka posle 6-15 godina
Authors: Todorovic A. , Tulic G. , Vucetic C. , Bumbasirevic M. , Dulic B. , Blagojevic Z. , Kadija M.
Published: November 2008

Due to extreme conditions during civil war in early l990?s we were forced to deviate from accepted guidelines in treatment of intracapsular fractures of the femoral neck. Therefore, majority of patients were treated non-operatively. In those that were subjected to surgery, unipolar hemiarthroplasty was treatment of choice, since conditions permitted us to attempt osteofixation in very few, youngest of our patients. As a result of this practice born of necessity, we can now look back and learn from this unique experience.
Primary total hip arthroplasty in patients with rheumatoid arthritis
Authors: Gluscevic B.M. , Kraljevic B.D. , Jovanovic V.A. , Stosic P.B. , Milosavljevic D.M. , Radivojevic R.M.
Published: November 2008

Total hip arthroplasty has become a successful way of treating the painful and destroyed hip joint in the patient with rheumatoid arthritis( RA). Two hundred twenty(135 cemented and 85 noncemented) total hip arthroplasties we were performed in 180 patients with rheumatoid arthritis. The average age was 48,61 years and the average follow-up was 8,4 years. Clinical evaluation was based on a Harris hip score that showed significant improvement in pain and function preoperatively compared with pain and function at follow-up. There were two deep infections requiring removal of the prosthesis. Four cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. Three acetabular rings were revised due to aseptic loosening. The relatively inferior results of total hip arthroplasty among RA patients is due not only to fixation method, but also to the poorer bone quality and weakening musculature. The results in these patients suggest that cement less total hip arthroplasty might become a successful way of treating the destroyed hip joint in the patient with rheumatoid arthritis.
Acute upper gastrointestinal bleeding
Authors: Jovanovic I.R. , Popovic D. , Djuranovic S. , Pavlovic A.R. , Mijalkovic N.S. , Culafic Dj. , Krstic M.N.
Published: November 2008

Aims: Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologist. Our aim was to assess the frequency of erosive gastropathy as a cause of upper GI bleeding as well as its relation to age, gender and known risk factors. Material and methods: We conducted retrospective observational analysis of emergency endoscopy reports from the files of Emergency Department of Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, during the period from 2000-2005. Data consisted of patients? demographics, endoscopic findings and potential risk factors. Results: During the period 2000-2005. Three thousandnine hundred and fifty four emergency upper endoscopies were performed for acute bleeding. In one quarter of cases acute gastric erosions were the actual cause of bleeding. One half of them were associated with excessive consumption of salicilates and NSAIDs. In most of the examined cases bleeding stopped spontaneously, while in 7.6% of the cases required endoscopic intervention. Conclusion: Erosive gastropathy represents significant cause of upper gastrointestinal bleeding count up to one quarter of all cases required emergency endoscopy during the 5- year period. Consumption of NSAIDs and salicilates was associated with erosive gastropathy in almost one half of cases (46%) leading us with a conclusion that we must explore other causes of erosive gastropathy more thoroughly.
The influence of risk factors in recurrent peptic ulcer hemorrhage
Authors: Lausevic Z.D. , Resanovic V.R. , Pesko P.P. , Krstic S.N. , Gvozdenovic M.S.
Published: November 2008

Gastrointestinal hemorrhage is one of the most frequent complications that occurs in 15 20% patients with peptic ulcer disease. Recurrent ulcer hemorrhage presents in the first 72 hours after initial bleeding; they are the most important cause of death. The aim of our study was to show the possibility of ulcer recurrent hemorrhage combined with risk factors: age 60, high risk lesion (active arterial bleeding, visible blood vessel, adherent coagulum), the size, ulcer base and localization (posterior duodenal wall, lesser curvature or high gastric ulcer), commorbidities (cardiovascular and liver diseases) and haemodynamic instabilities. The combination of these risk-factors unproportionally increases the risk: presence of two risk factors gives the possibility of recurrent bleeding of 16.67%, three risk factors 58.82%, four 93.33%, while the presence of five risk factors shows 100 % possibility. Probability of death is 8.27 times greater if ulcer hemorrhage occurs.
Hemobilija
Authors: Galun D. , Basaric D. , Lekic N. , Raznatovic Z. , Barovic S. , Bulajic P. , Zuvela M. , Milicevic M.
Published: November 2008

The phenomenon now known as haemobilia was first recorded in XVII century by well known anatomist from Cambridge, Francis Glisson and his description was published in Anatomia Hepatis in 1654. Until today etiology, clinical presentation and management are clearly defined. Haemobilia is a rare clinical condition that has to be considered in differential diagnosis of upper gastrointestinal bleeding. In Western countries, the leading cause of haemobilia is hepatic trauma with bleeding from an intrahepatic branch of the hepatic artery into a biliary duct (mostly iatrogenic in origin, e.g. needle biopsy of the liver or percutaneous cholangiography). Less common causes include hepatic neoplasm; rupture of a hepatic artery aneurysm, hepatic abscess, choledocholithiasis and in the Orient, additional causes include ductal parasitism by Ascaris lumbricoides and Oriental cholangiohepatitis. Clinical presentation of heamobilia includes one symptom and two signs (Quinke triad): a. upper abdominal pain, b. upper gastrointestinal bleeding and c. jaundice. The complications of haemobilia are uncommon and include pancreatitis, cholecystitis and cholangitis. Investigation of haemobilia depends on clinical presentation. For patients with upper gastrointestinal bleeding oesophagogastroduodenoscopy is the first investigation choice. The presence of blood clot at the papilla of Vater clearly indicates the bleeding from biliary tree. Other investigations include CT and angiography. The management of haemobilia isdirected at stopping bleeding and relieving biliary obstruction. Today, transarterial embolization is the golden standard in the management of heamobilia and if it fails further management is surgical.
Risk factors for bleeding from stress ulcer in severely injured and critically ill persons
Authors: Sijacki A.D. , Popovic N.M. , Karamarkovic A.R. , Stefanovic B.D. , Djukic V.R. , Lausevic Z.D. , Krstic S.N. , Bumbasirevic V.M. , Gregoric P.D. , Stefanovic B.D. , Bajec Dj.D. , Jeremic V.M.
Published: November 2008

Bleeding stress ulcus is a mucosal stress induced lesion which appears as a result of mucosal damage in severely injured and critically ill persons. Prophylaxis treatment has dramatically reduced the incidence of bleeding in Intensive care units. We conducted a prospective study for the five years period. Of 954 patients (196 with acute necrotizing pancreatitis and 758 with severe injuries), 84 (8.5%) has clinically important bleeding. About 80% of these patients had more than one independent risk for acute bleeding from gastrointestinal tract. Prophylaxis treatment reduced bleeding in 90% risk patients (according Zinner score). Despite of prophylaxis, 13 patients required surgery. Overall mortality was 29 (34%) of 84 patients, including seven of 13 who required surgery. Sepsis and respiratory failure were identified as strong risk factors for bleeding in our group. The choice of the best prophylactic agens still remains the question.
Upper gastrointestinal bleeding as a surgical complication of primary gastric lymphoma
Authors: Velickovic D. , Sabljak P. , Ebrahimi K. , Bjelovic M. , Stojakov D. , Nenadic B. , Spica B. , Sljukic V. , Pesko P.
Published: November 2008

Primary gastric lymphomas are of the extranodal non- Hodgkin type. The gastrointestinal tract is the most common site of extranodal non-Hodgkin lymphomas and accounts 30-45% of all extranodal lymphomas. Gastrointestinal lymphomas occurs in the stomach in 55-70% of cases. Primary gastric lymphoma is relatively rare tumor accounting 1-7% of all gastric malignancies. An increased incidence has been documented recently. The median age of diagnosis is approximately 60 years old, and disease affects an equal number of men and women. The initial symptoms may be vague and nonspecific leading to delayed establishment of diagnosis up to several years. Many patients came down late with advanced disease and complications such as upper gastrointestinal bleeding. Twenty to thirty percent may present with occult bleeding or hematemesis et melena while gastric obstruction and perforation are less common. Gastric bleeding can also occur as a complication of chemotherapy. The incidence of gastric bleeding in patients receiving chemotherapy is up to 11%. In most cases surgical resection is necessary to achieve hemostasis. Given the rate of surgical complications, especially gastric bleeding, there is still an important role for surgeon in the multimodal treatment of patients with primary gastric lymphoma.
Hernije hijatusa jednjaka i GERB kao uzrok krvarenja
Authors: Simic A. , Radovanovic N. , Kotarac M. , Gligorijevic M. , Skrobic O. , Konstantinovic V. , Pesko P.
Published: November 2008

Bleeding complications arise in 1/4 of patients with hiatal hernia and GERD, and are the cause in 10% of all acute and 1/3 of chronic foregut bleedings. Most common bleeding disorders directly related to hiatal hernia and GERD are: hiatal hernia ulcers, erosive esophagitis, esophageal ulcers, peptic strictures and Barrett esophagus. The aim of this review article is to point out a significance of proper diagnosis and treatment for conditions bonded with hiatal hernia and GERD which can lead to severe esophageal bleedings. Detailed etiology, incidence, diagnostic algorithm and treatment of Cameron lesions, prolapse gastropathy, erosive esophagitis, peptic esophageal ulcers and postoperative complications related to hiatal hernia and GERD are presented in this article.
Endoscopic haemostasis of bleeding duodenal ulcer
Authors: Popovic D. , Stankovic-Popovic V. , Jovanovic I. , Krstic M.N. , Djuranovic S. , Mijalkovic N.S. , Milosavljevic T. , Pavlovic A.R. , Culafic Dj. , Sokic-Milutinovic A. , Milisic M.
Published: November 2008

Introduction: Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. It manifests like: haematemesis, melaena or haemochezia. Diagnostic endoscopy accurately defining the cause of hemorrhage, while therapeutic endoscopy improves prognosis in patients who present with severe bleeding. Endoscopic therapies can be classified as those based on injection, application of heat, or mechanical clips. Patients and methods: This investigation was conducted in Department of endoscopic haemostasis, Clinic for gastroenterology and hepatology, CCS, using retrospective analysis of patients with acute upper gastrointestinal bleeding during the last five years. The aim of this study was to establish the number of upper gastrointestinal bleeding in our hospital during the last five years, and distribution of income according to type, difficulty, cause factors and risk factors of gastrointestinal bleeding and method of haemostasis. Results: In Department of endoscopic haemostasis 3954 patients with upper gastrointestinal bleeding were endoscoped, and 33,4% of them had bleeding duodenal ulcer. Male patients were statistically significant more present than female patients in group with duodenal ulcer ( 71,8%: 28,2%). 79.7% patients with duodenal ulcer had only haematemesis, while 14,4% patients had haematemesis and melaena. 59,1% patients with bleeding duodenal ulcer consumed salicylates and/or non-steroidal anti-inflammatory drugs ( NSAIDS) ( statistical significant differences ?2 test; p=0.007). Only endoscopic injection was used: in 36.8% of patients used injection of adrenaline solutions, while in 5,9% of patients used injection of adrenaline and absolute alcohol solutions. Conclusion: Using of therapeutic endoscopy improves better prognosis in patients who present with severe acute upper gastrointestinal bleeding. Endoscopist?s experience is an important independent prognostic factor for acute upper gastrointestinal bleeding.
Surgical perspectives in treatment of bleeding peptic ulcers
Authors: Lausevic Z.D. , Pesko P.M. , Krstic S.N. , Sijacki A. , Gvozdenovic M.S. , Bumbasirevic V.M. , Karamarkovic A.R. , Resanovic V.R. , Kaljevic G. , Vukovic G.
Published: November 2008

Peptic ulcer bleeding has overall incidence of 50 to 150 on 100.000 grown-ups per year and represents cause for over 1% of all urgent hospitalization today. Despite of the evolution of the endoscopic diagnostics and haemostasis, improved intensive care and surgical treatment, overall mortality is still over 10% (operative treatment over 20%), and it almost hasn?t changed over past 40 years. For more than 100 years surgery had major role in treatment of peptic bleeding ulcers, whereas nowadays it is limited to treatment of its complications. Adequate surgical treatment demands properly timed operation, safest but appropriate operation and trained surgeon. Early surgery is much better compared to the last minute surgery. At high risk rebleeding ulcer, early delayed surgery appears to be adequate, since the complications and lethal outcome are more frequent in this group.
Doppler hemodynamic study in evaluation of liver metastases
Authors: Stojcic-Djenic S. , Sarenac-Kovac R. , Kerkez M. , Jurisic V.
Published: November 2008

The color Doppler spectral analyses can be usefully in description of the liver circulation as one from non-invasive methods. Using color Doppler B mod ultrasound (Toshiba Core Vision) with duplex ultrasound we founded difference in liver circulation between patients with colon cancer and liver metastasis in comparison with those without metastases. We suggested this non invasive method for early detection of occult liver metastasis presence. .
Comparasion of granisetron and metoclopramide for prevention of nausea and vomiting following total cystectomy and ileal conduit
Authors: Ladjevic N. , Likic-Ladjevic I. , Krivic B. , Filimonovic J. , Acimovic M. , Dragicevic D. , Argirovic R.
Published: November 2008

The objective of this study was to examine the use of granisetron in actual clinical practice and to compare effect of dose of 1 mg granisetron after total cystectomy plus ileal conduit with group of patients which received metoclopramide. Granisetron established total control of PONV in 93,33% patients. Granisetron is 40% more effective in PONV control than metoclopramide. Only minimal nausea episodes were observed in early postoperative period in patients who had received low dose of granisetron (1 mg i.v.). .
Relation of surgical results and proposed skull base maningioma grading system: Analysis of clinical series with 42 patients
Authors: Tasic G.M. , Jovanovic V.T. , Slavik E.E. , Radulovic D.V. , Nikolic I.M. , Janicijevic M.A.
Published: November 2008

Anatomical localization of skull base meningioma link, their growth and relations with neurovascular structures reduce possibility for radical operation, and often request additional preoperative or postoperative radiotherapy. We compared personal results of extent surgical resection and skull base meningioma treating outcome with predispose factors scale for surgical radicality and postoperative outcome. We present 42 patients, who were operated in Institute of neurosurgery CCS during the period from 2004 to 2006. RESULTS: Radical resection was possible in 29 cases, and in 13 cases reduction of tumor mass has been performed. Statistical significant predispose factor for radical resection were: absence of preoperative radiotherapy, intact functions of n.III, n.VI, tumor borders inside one skull base fossa and outside of magistral blood vessels. Karnofsky index at the end of following period statistical significant higher in patients with radical resection of skull base meningeioma. Preoperative radiological finding is significant guide in planning of therapeutic protocol for skull base meningioma. Growth of tumor and relation with neurovascular structures restrict extent of resection and often request additional postoperative radiotherapy or reoperation. .
Olfactory groove maningiomas
Authors: Slavik E. , Radulovic D. , Tasic G.
Published: November 2008

Meningiomas, usually histologically benign tumors, are originating from the arachnoidal cap cells normally present intracranially in varying sites. Olfactory groove meningeomas arise from the medline of the anterior fossa between the crista galli and the tuberculum sellae. The most common presenting symptoms are the visual field defects, epilepsy, and psychological change. They are often large before they are detected because of slowly asymptomatic growing in the interhemispheric space of the frontal lobes. This series is consisted of 29 patients suffering from olfactory groove meningiomas treated surgically between May 1992 and November 2003. The surgical results and complications are presented and analyzed, comparing them by the other reported series. .
Congenital anomalies of the mesonephronic duct and fertility
Authors: Tzvetkova P.
Published: November 2008

Agenesia of deferential duct and the others congenital malformations of mesonephronical duct are often encountering condition in andrological practice. This study presents the possibilities of reproductive medicine to restore the male fertility and concentrates on biological and clinical aspects of malformations of mesonephronic duct like factors for excretory male infertility. The investigations including 104 patients (mean age 30.25+1.91 years old) with congenital anomalies of mesonephronical duct with: Agenesia of mesonephronical derivates - case with unilateral agenesia of the deferent duct, kidney and left urether (n=1); Dysgenesia of the epididymis (n=5); Cysts of the epididymis (n=47); Agenesia of the deferential duct (n=48); Aplasia of the eja-culatorial duct (n=3). The following methods were used: open testicular biopsy by Vilar; objective findings in situ operation; bilateral epididymo - and deferentovesiculography; morphological specimens of the testicular and epididymal tissues; enzymohistochemical analysis of testicular specimens; the ejaculates and morphological analysis of spermatozoa were assessed for quality parameters by the standard protocol; enzymocytological research of spermatozoa in seminal fluid; biochemical analysis of seminal fluid fructose and citric acid concentrations; radioimmunoassay for measurements of blood FSH and testosterone concentration. Results: Most often observed localization of the malformations of mesonephronic canal is bilateral at 54.81%. The testicular specimens proved preserved testicular architecture and spermatogenesis, and the epididymal slides showed dilatation of the epididymal tubules, which were overfilled with a lot of spermatozoa. The strongest expression of the enzymichistochemical NADH-TR reactions is in the Sertoli cells. We observed spermatozoa with disrup-ted configuration among which the abnormalities in sperm head and acrosome were predominated. The biochemical analysis of seminal fluid proves normal citric acid and low or lack of fructose concentration in seminal fluid. There were no breaches in endocrine regulation of the reproductive process. Patients with congenital anomalies of mesonephronic canal have preserving fertility in 31.73%. There are morpho-functional disorders of the testes, epididymis and seminal ducts in 68.27%. Conclusion: There are normal spermatogenesis but definite sterility. These results necessitate an application of plastic reconstructive operation for recovery of fertilizing ability of the patients, or their involvement in ICSI programme. .
The role of functional sinus surgery for treatment of antrochoanal polyp
Authors: Pendjer I. , Dudvarski Z. , Janosevic Lj. , Mikic A. , Vujicic Z.
Published: November 2008

Antrochoanal polyp (ACP) is a benign lesion which arises from the mucosa of maxillary sinus, fills it and expands through natural ostium towards choana protruding in the epipharynx. Objective: to present our experience in endoscopic surgery of ACP. Material and methods: prospective study included 24 patients operated at the Institute of Otorinolaryngology and Maxillofacial surgery, Clinical Center of Serbia, Belgrade, in the period 2002- 2004. Subjective symptoms, endoscopic and CT findings were evaluated postoperatively, following up the patients in the period 12-20 months. Subjective difficulties of patients were tested by 100mm-analogue scale, while endoscopic and CT findings were demonstrated by three-stage scale from 0 to 2. Applying the technique of ACP extraction in Trendelenburg?s position and approaching the part which protrudes in the epipharynx, we successfully removed the endonasal part by means of curved forceps for epipharyngeal biopsy. By endoscopic middle meatotomy, the natural ostium of maxillary sinus was expanded and pathological process from the very sinus was successfully removed. Results: only one female patient had the majority of symptoms after the operation, while all others had no complaints. Endoscopic and CT findings were normal in all patients at the latest control, without any signs of ACP recurrence. There were no intraoperative or postoperative complications. Conclusion: minimal damage to sinus mucosa due to forceps is lesser problem than complications developed upon creating even the miniature opening in the canine fossa. Using this technique, a dexterous surgeon may successfully extract pathological process with minimal incidence of recurrence, and, more important, with no complications and maximally fast recovery of patients. .
Amputacija donjeg kapka u terapiji tumora kapaka
Authors: Bobic-Radovanovic Anica , Latkovic Zoran
Published: November 2008

In carefully selected cases of tumors of the lower eyelid (tumors which destroy more than 40% of the eyelid margin and are not higher then 3mm, in old patients in bad general condition and in the cases of multiple microrecurrences of a tumor) authors suggest simple excision of a tumor without reconstruction of a eyelid. It is an effective method of treatment of the tumor with good functional effects and acceptable cosmetic results. .
Medicolegal aspects in gastroenterology
Authors: Alempijevic Dj. , Alempijevic T. , Savic S. , Kovacevic N. , Krstic M.
Published: November 2008

Introduction: Medical practice is under continual public scrutiny. There are increasing concerns on medical malpractice and its consequences - further deterioration of health and death. Public criticism of medical practice very often outrageous, but sometimes medical negligence is obvious. Aim of the study: We are presenting basic medicolegal analysis of causation in cases of medical malpractice with subsequent fatal outcome. Case study: We are reporting on two cases from archives of Institute of Forensic Medicine. The selected cases (biliary ileus and pseudomembranous colitis subsequent to elective cholecistectomy) may reflect common gastroenterological pathology. The analysis of medical practice and its consequences, i.e. analyze of causation has been presented and commented in regard to the pertinent legislation. Conclusion: Doctors ought to be familiar with medicolegal aspects of their practice. This might affect them to improve the quality of health care, and to increase protection, both of health care personal and patients. .
Allantoic remnants presenting as a giant retroperitoneal cyst
Authors: Antic S. , Petrovic J. , Barisic G. , Dimitrijevic I. , Micev M. , Krivokapic Z.
Published: November 2008

Urachal anomalies are usually found in early childhood or just after birth. These usually involve patent ductus urachus, urachal cyst, umbilicalurachal sinus or vesicourachal diverticulum. Very rarely are urachal anomalies found in adults, usually as an infected urachal cyst. We are presenting a case of surgically removed giant urachal retroperitoneal cyst that was found by chance during the abdominal ultrasound examination of a 22 year old man who was initially treated for idiopathic hypertension. .
The history of urinary diversion
Authors: Basic Dragoslav , Hadzi-Djokic Jovan , Ignjatovic I.
Published: November 2008

The earliest attempt to divert urine flow from the ureters to the intestine, was performed in 1851 by John Simon. In the absence of antibiotics, ureterosigmoidostomy and its modifications during the 19th and early 20th century have been associated with high rate of surgical and metabolic complications. In 1910, Robert Coffey demonstrated a new method for ureterointestinal anastomosis, which renovated primary enthusiasm in ureterosigmoidostomy and it gained broad popularity during the next forty years. In 1950, Ferris and Odel reported 80% incidence of hyperchloremic metabolic acidosis following ureterosigmoidostomy. Based on further investigations by Lapides in 1951, Parsons, Powel and Pyrah in 1952, and Stamey in 1956, which clearly demonstrated that hyperchloremic metabolic acidosis is inevitable complication of ureterosigmoidostomy, this urinary diversion lost its popularity. In 1950?s ileal conduit, popularized by Bricker, became the gold standard for the subsequent 35 years. Early attempts for continent urinary diversion occurred form 1888, by Guido Tizzoni and Alfonso Poggi, while the first reservoir-type ileal loop urinary diversion was performed by Cuneo in 1911. By better understanding of principles of detubularization, based on works of Kock and principles of clean intermittent catheterization, established by Lapides, interest in continent urinary diversion has increased. Up to date, various continent cutaneous stomal reservoirs, sigmoidorectal pouches and orthotopic bladder substitutes have been described. Regarding encouraging improvements in biocompatible materials, alloplastic bladder replacement could be the next step for the future in bladder replacement surgery.
Modified Mainz Pouch II (sigma rectum pouch) urinary diversion: 12 years experience
Authors: Ignjatovic I. , Basic D.
Published: November 2008

Objective: To analyze the outcome of Mainz Pouch II urinary diversion related to complications and life quality. Patients and Methods: From 1995 to 2006, a total of 67 patients (60 male and 7 female, mean age 58.4 years, range 48 to 70) who underwent modified ureterosigmoidostomy (Mainz Pouch II) procedure have been retrospectively analyzed. The mean follow-up was 18 (1 - 72) months and it was available for 56 patients (84%). Early and late postoperative complications as well as quality of life after surgery were analyzed. An clinical questionairre has been used for examination specific urinary diversion items. Results: Early postoperative complications (<30 days) we-re detected in 9 patients (13%) and late complications (>30 days) in 19 patients (28%). Early complications consisted of urine leakage of moderate degree in 5 (7%) and ileus requiring surgical revision in 4 (6%) patients. The late complications included acute pyelonephritis in 12 patients (18%) and uretero-sigmoidal anastomotic site stenosis in 7 (11%). Ureterosigmoidal anastomotic site stenosis was detected in 7 patients with 7 renoureteric units (RU). In 4 RU, metal Strecker stent was successfully applied. In 3 RU, permanent nephrostomy catheter was applied. Oral alkalizing agents were applied in 22 patients (33%) due to metabolic acidosis. Two patients died due to severe acidosis. Continent rate was 96%. The mean voiding frequency during the day and night was 5.2+1.8 and 2.7+ 0.5, respectively. Global life quality was bad for 3 (8%), acceptable for 15 (38%) and good for 22 (54%) patients. Conclusion: The Mainz Pouch II urinary diversion is simple and safe procedure regarding complications rate, continence and quality of life. It is good alternative to other forms of continent urinary diversion. Patient selection and compliance following by meticulous follow-up are of utmost importance for successful operative outcome.
Interventional radiology methods of treating ureteral strictures developed on anastomoses after the radical cystectomy in Mainz Pouch II and ileal conduit derivation
Authors: Maksimovic H.M. , Markovic B.B. , Pejcic T. , Hadzi-Djokic J. , Markovic Z. , Yachia D.
Published: November 2008

Objective of this work is to evaluate interventional radiology modalities such as balloon catheter dilation (BCD) and stent insertion, as minimally invasive methods in treatment uretero-enteral anastomotic strictures. Material and method: Retrospective study enrolled 26 patients (pts) in whom percutaneous BCD (17 pts) and metal stent implantation (9 pts) were done. Study was conducted from June 2005 till August 2007 and included total amount of 470 pts operated during 4 year period from 2003 till 2007. In 26 pts 35 ureteral units were treated, all of them in ambulatory conditions under oral analgosedation, monitored by fluoroscopy. Percutaneous BCD or stent implantation was performed in 24 pts and in 2 pts combined antegrade- retrograde approach for stent delivery, was applied. In all cases percutaneous nephrostomy (PCN) was left for 7 days period after procedure but in 6 units (5 pts) it remained permanent solution. First check up was done 7 days after by contrast media injection through nephrostomy tube prior to its extraction. Second control was done 30 days after by ultrasound exam and the last control (3 months after) by intravenous urography (IVU). Results: In our specimen 17pts had strictures unilaterally (65.4%) and in 9 pts (34.6%) it occurred bilaterally. First check up revealed 82.7% success of BCD, in 17.3% BCD was repeated with the final success rate of 73.5% (19/26). In four pts (26.5%) after BCD reobliteration happened and PCN was left. Patent ureteral lumen was observed in 6 pts (85.7%) with stent inserted while one pt underwent surgical reintervention. No significant difference between BCD and stent insertion success rate was noticed, based upon morphological parameters (ureteral lumen diameter, pelvicaliceal system dilatation) and serum creatinin level. Conclusion: BCD and stent insertion showed satisfactory results (following 3 months) in ureteroenteral anastomotic stricture recanalization. They include ambulatory conditions, ability to repeat procedure, without complications -excluding restenosis which finally can be surgically treated.
Combined general end epidural anesthesia versus general anesthesia for radical cystectomy
Authors: Ladjevic N. , Likic-Ladjevic I. , Dzamic Z. , Acimovic M. , Dragicevic D. , Durutovic O.
Published: November 2008

The basic objective of the study is to present the effects of two types of anesthesia, general and combined general and epidural, on intraoperative bleeding and to present the effect of epidural analgesia during the postoperative period in radical cystecomy. Subjects who received general and epidural anesthesia had on the average 28.5% less bleeding than those who only had general anesthesia. Patients who received postoperative epidural analgesia had statistically significantly better analgesia during the postoperative period than those who were administered Tramadol intramuscularly.
Occurrence and risk factor for development of pancreatitis and asymptomatic hyperamilasemia following endoscopic retrograde cholangiopancreatography: Our experiences
Authors: Lukic S. , Alempijevic T. , Jovanovic I. , Popovic D. , Krstic M. , Ugljesic M.
Published: November 2008

Introduction: Chronic pancreatitis is defined as chronic inflammatory lesion of pancreatic parenchyma leading to destruction and fibrosis of exocrine pancreas. Endoscopic retrograde cholangiopancreatography (ERCP) is the most sensitive and specific method for detection of morphological alterations in chronic pancreatitis. ERCP is inevitably associated to post-ERCP acute pancreatitis, as well as hyperamilasemia. Study aim: This study aims to determine frequency of post - ERPC pancreatitis and asymptomatic hyperamilasemia. Study methods: We have studied l60 patients who underwent ERCP in Institute of Digestive Diseases, Clinical Centre of Serbia in Belgrade. Data regarding cholecystectomy, papillotomy, peripapillary diverticulosis, Oddi?s sphincter hypertension, choledoch canulation and diameter, Wirsung duct canulation, minor duodenal papilla patency, anomalies of BP junction, as well as chronic pancreatitis has been analysed and correlated with eventual development of post-ERCP pancreatitis and asymptomatic hyperamilasemia. Results: Asymptomatic hyperamilasemia was determined in 51 subjects (31.9%), while pancreatitis has been developed in 5 patients (3.1%) subsequent to ERCP. It has been proofed that Wirsung duct canulation plays significant role in development of post-ERCP complications. Conclusion: Although numerous factors may potentially contribute to development of post-ERCP pancreatitis, none of them, with the exception of Wirsung duct canulation, has been determined to play significant role in development of these complications.
Diagnostic and therapeutic approaches to bleeding from lower parts of the digestive system
Authors: Antic S. , Dimitrijevic I. , Markovic V. , Petrovic J.
Published: November 2008

Bleeding from the gastrointestinal tract represents a relatively common diagnostic and therapeutic challenge in clinical work of gastroenterologists and surgeons. Bleeding from the lower GI (LGIB) is mostly caused by pathologic conditions of the colon, although the source of bleeding cannot always be exactly localized, thus rendering optimal and prompt therapy difficult. During two year period, at III department of the First Surgical Clinic in Belgrade, we performed 424 colonoscopies for LGIB. According to our results the exact diagnosis was established in about 76% (324 patients) showing a great similarity with the results of other published studies (varying between 74% and 89%). The most common causes of bleeding were diverticulosis (37.11%), polyposis (10.3%) and colorectal cancer (46.14%). Besides that we have mentioned some specific facts involving the diagnosis and treatment of LGIB with an accent on some rare conditions, like angiodysplasia. Review of the diagnostic procedures and treatment modalities of the LGIB is useful for everyone who meets with this type of pathology in clinical practice. The diagnostic approach and the surgical treatment of these patients may represent a great problem, since the planning of the operative procedure can be very difficult and with uncertain result. Based on the literary data and our experience we have tried to set the algorithm of the diagnostics and treatment of the LGIB.
Evaluation of the Alvarado score in the diagnosis of acute appendicitis
Authors: Subotic A.M. , Sijacki A.D. , Dugalic V.D. , Antic A.A. , Vukovic G.M. , Vukojevic V.S. , Glisic T.M. , Galun D. , Petrovic M.N.
Published: November 2008

This study has been performed in the Emergency center, Clinical centre of Serbia, during the period 01.03.2007-01.09.2007. We performed this study on 57 patients with diagnosis suspected for acute appendicitis (ages 16-70). Parameters that make the Alvarado score are the following: migration of pain, anorexia, nausea or vomiting, right lower abdominal quadrant tenderness, rebound tenderness in right iliac fossa, elevated temperature, leukocytosis, shift to the left of neutrophils. The aim of the work is to evaluate the Alvarado scoring system in diagnosis of the acute appendicitis. With all the patients Alvarado score has been determinate preoperatively, and diagnosis was confirmed by intraoperative finding and histopatological examination of the removed appendix. All the patients with score 7 or more were surgically managed. Specificity (positive predictive value) was 92,59 % in males and 76,67 % in females. The negative appendectomy rate was 7,41 % with the males and 23,33 % with the females. The values of the Alvarado score are significantly higher in the patients with acute appendicitis, compared with the patients of the other diseases. With the application of the Alvarado scoring system we can decrease postoperative morbidity and mortality.
Hemodynamic effect of local infiltrative 2% lidocaine adrenaline anesthesia in general balanced anesthesia during middle ear surgery
Authors: Majstorovic B.M. , Radulovic R.B. , Kastratovic D.A. , Djukic V.B. , Popovic N.P. , Stosic-Divljak S. , Gajic M.M.
Published: November 2008

Hemodynamic effect of different techniques and type of anesthesia are defined. The volume of reduced hemorrhage in surgical field is debatable, without any definite conclusion. The objective of the study is to investigate the effects of local infiltrative anesthesia with adrenaline during general balanced anesthesia and nitroglicerol on blood pressure and hemorrhage reduction in middle ear operations. Prospective, randomized study included 58 adult patients planned for the otorhinolaryngological surgery. Studied group of patient (n 30) planned for middle ear operations. Before incision surgeon was administered local infiltrative anesthesia using 2% lidocaine with adrenaline (1:200000) The controls group (n 28), planned for other surgery had no local infiltrative anesthesia with adrenaline. Hemodinamic parameters were monitored before surgical incision and 30 minutes after that. Surgeon?s verbal reply on hemorrhage reduction during surgery was recorded. Statistical analysis of parametric data was carried out by Mann-Whitney sum test. Blood pressure and heart rate was not different between the two groups. But, intraoperatively, the study showed lowering of systolic and diastolic blood pressure. This mode of treatment and surgeons verbal reply confirmed that local infiltrative anesthesia with adrenaline under balanced anesthesia had no effect on hemorrhage reductionin surgical field.
Surgical or conservative treatment of penile fracture
Authors: Nale Dj. , Nikic P. , Vukovic I. , Djordjevic D.
Published: November 2008

Introduction: Penile fracture presents with rupture of corpora cavernosa. It is not rare but is remarkable. Treatment options are controversial. Aim: To establish the incidence, what are early and late complications in patients treated surgically or with conservative treatment options (prospective/retrospective and randomized analysis). To find out what therapy verified as superior. Material and method: The total of 32 patients with typical acute penile fracture were analyzed. The patients were between 20 and 56 years of age (Mean age 40+7.25 SD). A total of 11 patients that presented up to 48h after the rupture of tunica albuginea (34.37%) were operated, while 9 patients (28.13%) were conservatively treated. 12 patients (37.5%) reported to andrology consulting room due to penile fibrous alterations and/or erectile dysfunction 6 to 14 months after the anamnesticaly established, typical penile fracture ("primary latent penile fracture"). Both groups of patients were strictly clinically followed 3, 6, 9 and 12 months after the penile fracture. Eventual development of late complications (erectile dysfunction ED, penile curvature, induratio, caverno-urethral fistula and urethral stenosis) was also recorded. Etiology of ED was investigated: anamnesticaly, by hormone and laboratory analysis, using penodynamic test (PGE1), Duplex Doppler echosonography, and dynamic cavernosography. Results: In the operated group of patients, (11 pts, 34.37%) preserved erectile capacity was recorded and no penile deformity or plaque lesions on the site of suture, after the patients were recommended to have 4 weeks of sexual abstinence. The rupture of tunica albuginea was always transversal in relation to penile axis i.e. in relation to axial force against which the penis acts during the intercourse. The rupture is always on the basis or mid penile portion . Out of 21 (65.63%) conservatively treated patients in 13 (61.9%) plaque lesions (longitudinal diameter 2 cm) was recorded, while sexual dysfunction was established in 13 patients (12 with ED and 1 patient with incapability for vaginal penetration). Evaluation of post therapeutical complications in relation to type of treatment, significantly higher frequency was recorded in the group of conservatively treated patients (p<0.01). Penile veno-oclusive dysfunction was registrated as significantly most frequent cause of ED (in 10 - 76.92% out of 13 patients). All patients with ED had palpable fibrous lesion similar to Peyrone?s plaque, while the degree of penile deviation correlated to the size of plaque lesion. Conclusion: The late complications of penile fracture were significantly more frequently recorded in the group of conservative treated patients (p< 0.01) which proves that this lesion presents as urgent urological entity. The penile rupture is always transversal, and most probable place of rupture is physiological penile curve since this is the site of weakened structural integrity.