bluuebunny/crossref_metadata_2025 huggingface dataset:
Nerve transfer in brachial plexus injuries: Comparative analysis of surgical procedures
Authors: Rasulic Lukas , Samardzic Miroslav , Grujicic Danica , Bascarevic Vladimir
Published: November 2008

Nerve transfer is the only possibility for nerve repair in cases of the brachial plexus traction injuries with spinal roots avulsion. From 1980. until 2000. in Institute of Neurosurgery, Clinical Center of Serbia, nerve transfer has been performed in 127(79%) of 159 patients with traction injuries of brachial plexus, i.e., 204 reinnervation procedures has been performed using different donor nerves. We achieved good or satisfactory arm abduction and full range or satisfactory elbow flexion through reinnervation of the axillary and musculocutaneous nerve using different donor nerves in 143 of 204 reinnervations, which presents general rate of useful functional recovery in 70,1% of cases. Mean values of the rate of useful functional recovery in individual modalities of nerve transfer in our series are 50,1% for intercostal and/or spinal accessory nerve transfer, 64,5% for plexo-plexal nerve transfer, 81,7% for regional nerve transfer, and 87,1% for combine nerve transfer.
Functional reconstruction of extremities in cases with definitive peripheral nerve lesions
Authors: Vuckovic Cedo , Andjelkovic Sladjana , Jovanovic Nebojsa , Samardzic Miroslav , Rasulic Lukas
Published: November 2008

Deficit if the functional integrity of the limbs as a consequence of the definitive lesions of the peripheral nerves necessitates surgical treatment aimed at regaining of the optimal mobility and strength of the parts of the limbs or whole limbs. Our study was aimed at presenting our experience in functional reconstruction of the extremities, evaluation of significance of primary and delayed microsurgical reconstruction of the injured nerves with respect to further course of treatment and presenting innovative modifications of certain surgical techniques. The total of 101 surgical procedures were performed in 91 patients, out of which 76 were at the level of the shoulder, elbow and hand and 29 were on the feet. Depending on the local findings, the following techniques were applied: transposition of the muscles and tendons, transfer of the free microneurovascular muscle flaps and surgical fusion of the joints. Functional improvement was achieved in 98,7% of the cases . Increased range of movements and strength depended on the applied technique and preoperative findings. Primary and delayed microsurgical reconstruction of nerves increases the probability for choice of adequate surgical techniques. Muscle and tendon transfers are the methods of choice in most of the patients. Free microneurovascular muscle flaps are applied in the most complicated cases.
Rekonstruktivna hirurgija povreda facijalisa
Authors: Bascarevic Vladimir , Samardzic Miroslav , Rasulic Lukas , Simic Vesna
Published: November 2008

The facial nerve is main motor nerve of the face and its injury leads to total ipsilateral paralysis. There are several surgical procedures in reconstruction of the facial nerve, and the most frequent one is hypoglosso-facial anastomosis. In this study were analysed a series of 69 patients operated on Institute of neurosurgery from 1981 to 2000 year. The most frequent cause of injury was the operation of cerebellopontine angle tumors, as well as the skull base fractures. Hypoglosso-facial anastomosis was done in 57 patients, in 5 cases we performed nerve grafting in the cerebellopontine angle, and in 7 patients the facial nerve was operated peripherally. Results were analyzed in 27 of 57 patients with hipoglosso-facial nerve anastomosis. Functional recovery was achived in 22 (81,4%) patients.
The treatment of facial nerve palsy by static suspension methods
Authors: Jovanovic Milan , Roncevic Radmilo , Colic Miodrag , Stojicic Milan , Rasulic Lukas
Published: November 2008

After the injury of facial nerve, facial muscles are subjected to complex series of biochemical and histological changes, which lead to muscular atrophy if reinnervation is not restored. Facial palsy is very difficult to manage completely. Regardless this fact, the plan of correction has to be directed towards the following: restoration of normal function, normal facial appearance at rest, symmetry in voluntary movements as well as symmetry in involuntary and emotional movements. Static suspension methods were used in our study. All patients had unilateral complete facial nerve palsy but one female patient who experienced the palsy of frontal branch of n.facialis. This method was successfully used to lift the eyebrow, the lid and to improve lagophthalmus on the paralytic side, then the angle and paralytic part of the lip, to reinforce buccal wall of oral cavity as well as to reconstruct new nasolabial fold. The results were satisfactory and permanent.
Postoperative rehabilitation in patients with peripherial nerves injury
Authors: Petronic Ivana , Marsavelski Ana , Nikolic Gordana , Cirovic Dragana
Published: November 2008

Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. Material and methods: Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3 - 6 months after injury. In early postoperative treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual physiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and physiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.
Investigation of interleukin-8 serum concentration in patients undergoing different types of open heart surgical procedures with the extracorporeal circulation
Authors: Tadic Svetlana , Ristic Miljko , Balint Bela , Milic Natasa
Published: November 2008

Serum concentrations of proinflammatory cytokine interleukin-8 (IL-8) in 15 patients with surgically revascularized myocardium by triple venous cardiopulmonary bypass (CPB x 3) and in 10 patients with implanted artificial aortic valves (AV) were measured. Average IL-8 concentrations in ?CPB x 3? patients and in those with artficial aortic valve were 7,3 +/- 11,6 pg/mL 24 hours before surgery, i.e. 3,3 +/- 3,4 pg/mL; six hours after surgical procedure 32,7 +/- 71,4 pg/mL, i.e. 8,9 +/- 9,9 pg/mL; and 24 hours after surgery 10,9+/-9,7pg/mL, i.e. 8,3 +/- 4,6 pg/mL. Extracorporeal circulation (ECC) caused significant increase of IL-8 serum concentration in both investigated groups six hours after surgery. Comparing preoperative values of the both groups, as well as those of 6 and 24 hours after surgery, no significant values of IL-8 were found. Various types of open heart surgical procedures had no influence on the extent of the production and secretion of proinflammatory IL-8 cytokine measured in patients during 24 hours after surgery.
Surgery of the vertical tropias: Dissociated vertical deviation and primary overaction of the inferior oblique muscles
Authors: Risovic Dusica
Published: November 2008

We have treated 27 children with DVD and primary overaction of the inferior oblique muscles in the same time. In all of them we have done recession of the inferior oblique muscles (for 4, 6, 8 or 10 mm). In only seven of them we did recession of the superior recti (for 7, 8 or 9 mm) simultaneously. DVD doesn?t need to be operated in every child. Large recession of the superior rectus muscles very significantly and adequately ameliorate the DVD in 79% of children. Hypocorrection of the DVD we have in another 21% of the operated eyes. We get valid results one month after the surgery. They were constant after six months too.
Historical review of the thyroid gland surgery
Authors: Ignjatovic Mile
Published: November 2008

Thyroid gland surgery passed through history from the suggestions for prohibition, during middle of XIX century due to unacceptable mortality even for mediaeval conditions, to highest level of surgical art later, as W. Halsted sad. First thyreoidectomy was done by Albucasis (El Zahrawi) in 925 A.D, and after him by Roger from Salerno. While Pierre-Joseph Desault in 1791 has done first operation on thyroid gland that can fulfill today?s criteria, Theodor Billroth gave scientific grounds of thyroid surgery. Genius attitude and surgical talent of Theodor Kocher raised thyroid surgery on scientific level, brought surgical skills on the top of surgical art pyramid, and brought him personally to the Nobel Prize in 1909. Very important contribution to development of thyroid surgery gave its giants: Johann von Mikulicz, William Halsted, Charles Mayo, George W. Crile and Frank Lahey. Thomas P. Dunhill, F. A. Coller, A. M. Boyden, and many others did important contribution, too. Development of thyroid surgery was constant to nowadays, with tendention for multidisciplinary approach in specialized centers. Thyroid surgery in Serbia followed this world trends, in spite of great problems in this area during history.
Cytological evaluation of thyroid solitary nodules
Authors: Tatic Svetislav , Havelka Marija , Sopta Jelena , Bozic Vesna , Paunovic Ivan , Diklic Aleksandar , Krgovic Ksenija , Zivaljevic Vladan , Todorovic Milena , Kalezic Nevena
Published: November 2008

Fine-needle aspiration is a low-cost diagnostic tool with principal value in determining which patients with thyroid nodules should undergo surgery. Team work and close cooperation among endocrinologists, surgeons, and pathologists are essential for success. Cytologic criteria for diagnosis of the most frequent conditions (benign cystic lesions), Hashimoto thyroiditis and malignancies found in thyroid aspirates have been provided. The unsolved problem of the so-called "follicular" or oxyphilic lesion or neoplasia will be investigated by immunocytochemistry.
Specifics of preoperative management, intraoperative monitoring and postoperative evaluation of patients with thyroid gland carcinoma
Authors: Kalezic Nevena , Kazic Milena , Paunovic Ivan , Diklic Aleksandar , Tatic Svetislav , Krgovic Ksenija , Zivaljevic Vladan , Zivic Rastko
Published: November 2008

The aim of the study was to show the standards of preoperative management, intraoperative monitoring and postoperative evaluation of patients with thyroid gland carcinoma. It was point out the importance of the preoperative diagnosis of the tumor, and the concurrent diseases. The special attention was paid to difficult airway recognition and resolving this situation. Both, anesthetist?s and surgeon?s point of view of perioperative and postoperative complications were discussed with special interest on early surgical complications and the need for urgent anesthetic treatment. Criteria for minimal and desirable monitoring of vital functions were suggested in order to prevent, recognize and cure complications. Our conclusions were based on recent references from the world literature and on our own experience in Center for endocrine surgery KCS, Belgrade.
Principi hirurgije limfnih nodusa kod diferentovanog tiroidnog karcinoma
Authors: Dzodic Radan , Markovic Ivan , Inic Momcilo , Milovanovic Zorka , Pupic Gordana , Jovanovic Nikola
Published: November 2008

Surgery is the initial therapy in differentiated thyroid carcinoma (DTC). The surgery is performed on organ of tumor origin and regional lymphatic basins. The aim of surgery in DTC is to eradicate all tumor foci, cure the most number of patients, reduce recurrence and mortality rate, and provide good quality of life. There is no doubt between oncologists that the surgery for thyroid carcinoma has no alternative. The extent of surgery is matter of actual controversies. It should be performed by well trained surgeons. Dissection of central and biopsy of supraclavicular and lower third of jugulo-carotid chain of neck lymph nodes is the integral part of surgery in DTC, together with total thyroidectomy. If lymph node metastases are found in jugulo-carotid chain, modified radical neck dissection, unilateral or bilateral is indicated. Dissection of mediastinal lymph nodes should be performed too in cases of involvement. The extent of primary surgery should be dictated by stage of disease and prognostic factors. The quality of surgery and incidence of complications depends prognostic factors, as well as on surgeon?s skill and experience. That is why the surgeon is factor of prognosis in treatment of patients with DTC.
Follicular thyroid carcinoma
Authors: Krgovic Ksenija , Paunovic Ivan , Diklic Aleksandar , Zivaljevic Vladan , Tatic Svetislav , Havelka Marija , Todorovic-Kazic Milena , Kalezic Nevena , Bozic Vesna
Published: November 2008

Follicular thyroid cancer is the second most common thyroid malignancy. This tumor has a predisposition for hematogenous dissemination an extrathyroid spread. Accurate cytological diagnosis of follicular thyroid cancer is not possible and this fact highlights the necessity for surgical treatment of any suspicious thyroid nodule. Aggressiveness of this tumor is greater than in the case of papillary thyroid cancer and it is the reason for radical surgical treatment of follicular thyroid cancer. Total thyroidectomy facilitates later adjuvant therapy with thyroid hormones and radioiodine. This procedure improves the outcome and the risk of relapse. Results of our study clearly demonstrate that diagnosis of follicular thyroid cancer in us is established in the early phase of the disease (78.57%), but the significant number of the patients (21.43%) is still in the advanced phase of the disease.
Medularni karcinom stitaste zlezde-uticaj postoperativne transkutane zracne terapije u lokalnoj kontroli i rezultatima lecenja
Authors: Stankovic Vesna , Borojevic Nenad , Dzodic Radan , Golubicic Ivana
Published: November 2008

In the period of Octo. 01, 1987. up to Dec. 31, 1998. retrospective-prospective, non-randomized study was conducted at IORS, which included 36 patients diagnosed with thyroid gland medullar cancer. Our study had the following aims: evaluation of treatment results following probability of total survival, survival without signs of disease and disease-free interval until local reccurrence of the disease and influence of parameters of transcutaneous radiotherapy (intensity of total tumor dose and length of disease-free interval from date of performed operation to beginning of radiotherapy). After finished treatment, median of the patient follow-up was 37,75 months (3,5 up to 141 monts); probability of total five-year survival was 62,61% and of 10 year survival was 23,48%. Probability of 5-year survival, without signs of disease was 37,13%, and of 10-year survival 18,56%. As to radiotherapy parameters, intensity of total therapy dose was statisticaly insignificant, while time interval to beginning of transcutaneuos radiotherapy, shorter than 2 months, was statistically significant in relation to prognosis of disease outcome.
Characteristics of thyroid carcinoma in Graves' disease, chronic lymphocitic thyroiditis and nodular goiter
Authors: Filipovic Aleksandar , Paunovic Ivan
Published: November 2008

The biology of thyroid cancer represents a spectrum of behavior ranging from well - differentiated lesions with an excellent prognosis to anaplastic carcinoma, wich is almost fatal. For this reason, it is important that clinicians have methods at their disposal to asses the characteristics of patient's thyroid malignancy. In this work we discuss the behavior of differentiated thyroid cancer in associated diseases of thyroid as : Graves? disease, chronic lymphocitic thyroiditis - Hashimoto and nodular goiter. This is retrospectively reviewing of 50 patients treated for differentiated thyroid carcinoma at Department of surgery, Clinical Centre of Montenegro in Podgorica from 1998 until 2003. We evaluated occurrence, as well as the role of this diseases in patients with thyroid cancer.We found a more favorable course of thyroid cancer in the presence of chronic lymphocitic thyroiditis and nodular goiter, a contrary Graves? disease. In associated diseases of thyroid, a significantly greater proportion of patients with thyroid cancer, have modular goiter.
Early diagnosis, therapy, follow-up and survival rate of the patients with thyroid malignancy
Authors: Malesevic Milica , Mihailovic Jasna , Vojicic Jelena , Popadic Silvija
Published: November 2008

The Aim of the paper was to give a reviw of an early diagnosis, therapy, follow-up and survival rate of patients with thyroid malignancy (TM). The paper presented the algorithm of early diagnosis: clinical, scintigraphic and ultrasonographic examination together with fine needle biopsy, cythologic analysis of the smear and biopsy ex tempore of the clear and suspected thyroid node to malignancy. Therapy of all TM forms was mainly surgical; postsurgical treatment was dependent on the type of malignancy: radioiodine 131-I, radiologic treatment, chemotherapy and radioimmunotherapy, (the latest one being in the phase of a clinical research). Follow-up was in accordance with the protocole and it was necessary because it contributes to the survival rate. In the presentation of survival rate for differentiated and medullar carcinomas we gave our results and literature data, while for the other malignancies only data from literature were presented. Conclusion: only an early diagnosis of the nodular goiter together with an up-to-date treatment can cure TM patients in a high percentage and prevent development of a terminal stage of the desease which is extremely severe in all forms of this malignancy.
Replacement of the aortic root by composit graft valve: Bentall procedure and its modifications
Authors: Djukanovic Bosko
Published: November 2008

Replacement of the aortic root by composite - graft valve is the most frequently used procedure for surgical treatment of dilation of aortic annulus, sinuses of Valsalve and tubular part of ascending aorta. Crucial part of the surgical procedure is the reestablishment of the coronary flow with one of the following methods: classic, Cabrol and so-called "button" technique. We have retrospectively evaluated 116 consecutive patients with aortic root replacement by composite - graft valve in a period form January 1996. to February 2002. We have applied several techniques for the restoration of coronary flow. Thirty-five patients (30%) underwent concomitant cardiac procedure, most frequently aorto-coronary bypass, whereas 7 patients had REDO operation. Deep hypothermic circulatory arrest was applied in 64 patients (55%) with acute dissection of the aorta or in cases of aortic arch resection. Classic Bentall procedure was performed in 4 patients, "button" technique in 97 patients and Cabrol (Cabrol II or modified) in 15. Total in-hospital mortality was 8,6% (10 patients). Perioperative complications occurred in 32 cases (27,5%), including early re-thoracotomy for excessive bleeding in 5 patients (4,3%). With the use of modern principles of aortic surgery, complex reconstructions of aortic root by composite - graft valve can be done with relatively low morbidity and mortality.
Our experiencies in treatment of squamous cell skin cancer of head and heck
Authors: Kovacevic Predrag , Visnjic Milan , Visnjic Aleksandar
Published: November 2008

The incidence of squamous cell skin center is the second, after basocellular skin cancer. Surgical treatment is the first and most effective therapy for this tumor. The aim of study is to present experiences of Surgical clinic in Nis in treatment of squamous cell skin cancer in head and neck. During 10-year period (1990-2000) there were operated 346 patients with squamous cell skin cancer of head and neck. We performed wide surgical exsicion with clinical free margins of 5-10 mm, and more radical excision and reconstructions for advanced tumors. We registered postoperative complications in 14 (4,04%) patients. Early diagnose and adequate treatments of squamous cell skin cancer are preperiquisite for good postoperative results and low complication rate.
Treatment of defects of soft tisue and sternum, as postoperative complications of a-c by pass: Case report
Authors: Stojicic Milan , Birovljev Sinisa , Jovanovic Milan , Colic Miodrag
Published: November 2008

Medial sternotomy is optimal approach for great number of heart surgery. Deep infection of sternum and mediastinis are very rear, but very dangerous complications followed by high rate of morbidity and mortality. Factors which can be responsible for these complications are numerous: post operation bleedings, surgery reinterventions, extended mechanical ventilation, liver chronical diseases, older age, diabetes, previous irradiation therapy, respiratory obstructions and use of steroids. Clinical signs for these complications are: red skin around the surgical wound, leaking, dehiscence, increased body temperature and instability of sternum. Early diagnosis, adequate antimicrobial therapy, and aggressive surgical and multidisciplinary approach in initial phase, are base for successful treatment. Surgical treatment most often assumes use of flaps. Our main objective in this work was to present treatment of defect of sternum and soft tissues, after triple aorto-coronary by pass. After the surgery patients got slack of sternum's ficsation and reficsation. With satisfactory respiratory function, corrections of defect was achived by omentum and bipedikular myocutan flaps. (m. pectoralis major flap). There was no complications.
Extended supraglottic laryngectomies
Authors: Petrovic Zeljko , Djukic Vojko , Mikic A. , Stankovic P. , Jesic Snezana , Dimitrijevic Milovan , Djordjevic Vladimir , Milovanovic Jovica , Pendjer Ivica
Published: November 2008

In the period 1976-1998. 408 patients with supraglottic laryngeal cancer were primarily treated by surgery using the method of supraglottic laryngectomy. Classical supraglottic ' laryngectomy was performed in 355 patients, while 53 underwent extended supraglottic laryngectomy. The objective of the study was to analyze the success of the extended supraglottic laryngectomy in relation to classical supraglottic laryngectomy in indicated cases. Tl tumor was found in 171 (42%) patients, T2 in 212 (52%), while T3 was found in 25 (6%) cases. Local recurrence developed in 3 out of 53 patients operated by the extended supraglottic laryngectomy technique, and in 17 out of 355 operated by classical supraglottic laryngectomy (x2- =0,075, DF=1, p=0,784; Yates=0,00, r =1,00). Five-year survival of patients operated by the extended supraglottic laryngectomy was reported in 40 out of 53 patients, while survival of patients operated by classical supraglottic laryngectomy was noted in 270 out of 355 cases (x2=0,004, DF=1, p=0,926; Yates=0,00, p=l,00). There was no significant difference of local recurrence and five-year survival between patients treated by classical and extended supraglottic laryngectomy.
Surgery treatment of laryngeal carcinoma T1
Authors: Mikic A. , Petrovic Z. , Djukic Vojko , Dimitrijevic Milovan , Stankovic P. , Pendjer Ivica , Dudvarski Zoran
Published: November 2008

The early stage cancer of the glottis, including Tis, Tla and Tlb stages, are the most common forms with the incidence rates ranging from 25% to 85%. The therapy of early glottic cancer is usually successful for two reasons. First, true glottic cancer produces early symptoms and it is relatively easy to remove. Second, glottis is rather poor with lymph pathways so the regional metastases are rare, less than 1 %. Due to role of the larynx in phonation, respiration and swallowing, the cancer of this region and its treatment has a great impact to the quality of life. Retrospective study involved ten-year period, from January 1990 to January 2004. At the Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 858 surgical and 54 endoscopie CO2 laser-assisted resections were performed for glottic cancers of larynx of Tis-T2 stages. Glottic tumors were treated by Types III, IV and Va chordectomies according to classificaiton of endoscopie chordectomy defined by the European Laryngological Society. Analyzing the operated patients, as well as the type of the applied surgery, that is, endoscopic-laser and classic surgery, the authors attempted to clarify the dilemmas relating to the indications for one or another type of surgical intervention. The patients who had undergone primary radiotherapy were excluded from the analysis.
Rezultati hemilaringektomije u primarnom hirurskom lecenju karcinoma larinksa
Authors: Milovanovic J. , Djordjevic Vladimir , Trivic Aleksandar , Baljosevic Ivan , Milovanovic Aleksandar , Petrovic Zeljko , Djukic Vojko
Published: November 2008

Hemilaryngectomy is the resection of a true anatomic half of the larynx with preservation of the cricoid cartilage. We present a retrospective study of 438 patients with glottic carcinoma, treated with hemilaryngectomy, at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia between 1988 and 1997.The patients with positive margins (19,4% of all) were postoperatively irradiated. Local recurrences of carcinoma were found in 17,3% of subjects, and regional recurrences in 16,4% of subjects. Those patients were treated with total laryngectomy or radical neck dissection, and with radiotherapy. 5-years survival rate in our patients was 79%. Hemilaryngectomy provided acceptable percent of local and regional recurrences, and good functional results: respiration, swallowing and voice quality. Therefore it could be the first choice surgery technique in treatment of T2 laryngeal carcinoma.
Strategy in the treatment of hypo-pharyngeal and cervical esophageal carcinoma
Authors: Pesko Predrag , Djukic Vojko , Simic Aleksandar , Sabljak Predrag , Stojakov Dejan , Bjelovic Milos
Published: November 2008

In the period between January 1st, 1978 and January 1st, 2003, 82 unselected patients with hypopharyngeal and cervical esophageal squamocellular carcinoma were treated at the Department of Esophagogastric Surgery, First University Surgical Hospital, Clinical Center of Serbia. In 43 (52,4%) patients operated with curative intent, radical surgical en-block resection and functional neck dissection has been performed. In 26 (60,5%) patient reconstruction was performed with stomach, in 11 (25,6%) left colon, and 6 (14%) free jejunal transfer. The overall 2-year and 5-year survival rate were 55.88 % (19 patients) and 26.47 % (9 patients), respectively. No patient undergoing nutritive gastrostomy and radiotherapy was alive after two years. At present surgery looks like the treatment of choice for hypopharyngeal and cervical esophageal carcinoma, providing a definitive palliation of dysphagia and better long-term survival. Free jejunal transfer has become the standard technique for reconstruction of the pharynx and hypopharynx especially with proximal lesions, whereas, gastric tube interposition is the technique of choice for reconstruction of the hypopharynx and cervical esophagus when the resection extends below the thoracic inlet or when there is a presence of synchronous carcinoma of the esophageal.
Carcinoma of the external auditory meatus
Authors: Jesic Snezana , Radulovic Radomir , Djeric Dragoslava , Nesic Vladimir , Dimitrijevic Milovan , Petrovic Zeljko , Arsovic Nenad , Arsic-Mandaric Z.
Published: November 2008

Carcinoma of the external meatus is a rare disease and a challenge to treat. Demographic and clinical characteristics of this disease are discussed for 14 patients treated in the Institute of Otorhinolaryngonlogy and Maxillofacial Surgery during the period 1993-2003. using four different clasiffication of the disease. All patients were treated surgically with postoperative radiotherapy. Five years survival is 100% for the II and II stage of the disease for all clasifications, and 75% for the III stage according to Pitsburg clasiffication. Reccurence of the disease in the first year after treatment is 66,6% and, 84% in the second year. The diagnostic protocol is clinical examination, computed tomography of the tempo ral bone, nuclear magnetic resonance of the temporal bone and endocranium, ultrasound examination of the neck and parotid region and tumor biopsy. The surgical approach could be less radical, through mastoid, with postoperative radiotherapy.
Klinicka studija UCNT bolesnika sa cervikalnim nodalnim tipom bolesti
Authors: Stosic-Divjak S. , Djukic Vojko , Janosevic Ljiljana , Dudvarski Zoran , Racic Alek , Basaric D.
Published: November 2008

Indifferentiated carcinoma of the nasopharyngs is clinicaly-histological-imunologic entity which is often diagnosed in our country .There are three clinical types, but nodal cervical type of disease is the most interesting type for surgeons while the combined type is more interesting for otolaryngologist. Among seventy-seven patients diagnosed with undifferentiated carcinoma of the nasopharyngs with nodal cervical type of disease, on the Institute of Otolaryngology and Maxillofacial Surgery Clinical Center of Serbia during the period between 1993.-1997. there were N0-21%, N1-49%, N2-18% i N3-12%, no mater of the T category .The disease more often occurs between male population (2:1), mostly between age 41 -60. The rate for five year period of surviving for two different chemioterapeutical protocols is as follows: for categories NO and N1-20% for mono Zorubicin and 61% for the same category for Z-CDDP. The same rate for categories N2 and N3 is 11% for mono Zorabicin and 33% for the same category for Z-CDDP. Much better rate of survival in comparison with previous decades is achieved due to better diagnosing on time in which are systematically included epypharyngoscopy in general anesthesia with biopsy, CT and NMR and EBV serology.
Modern diagnostic procedures of nasopharyngeal carcinoma
Authors: Pendjer Ivica , Obradovic V. , Sobic-Saranovic Dragana , Kozarevic N. , Mikic A. , Petrovic Zeljko , Dimitrijevic Milovan
Published: November 2008

The aim of this study is a research of single photon emission tomography (SPET) values with talium 201 and tehnetium 99m MIBI, comparing it with other methods CT, MRI and ultrasonography. In our investigation there were two groups of patients 24 treated with Tl-201 and 17 with Tc-99m-MIBI. Before the therapy 7 patients had been tested with Tl 201 and was 100% proved the sensibility, specificity, sensitivity and also 6 patients as really positive TP and 1 patient really negative TN. The same result was gotten in the group where TC 99m was used, where 3 of them were really positive and 1 negative. All discoveries were confirmed pathohistologically and leaning on this we determined the status of really positive and really negative patients. After the therapy there were 7 positive and 7 negative patients, and also one positive, and 2 negatives that were false, who were threaded by thalium. On the basis of formula of sensibility these findings show that 77,8%, if it observed only a group of patients who were being tested after the therapy, while all sensibility of method is 86,7%, where in the analyze was included a group of patients at whom was registered the primary tumor. The specificity of the method for this group of patients after the therapy is 87,5% , and the whole 88,9% where the accuracy is 82,4% in the group after therapy and the whole is 87,5%.
Distribucija cervikalnih metastaza karcinoma cervikofacijalne regije
Authors: Trivic Aleksandar , Krejovic-Trivic S. , Milovanovic Jovica , Djukic Vojko , Arsovic Nenad , Dimitrijevic Milovan , Petrovic Zeljko , Mikic A.
Published: November 2008

The primary goal in the therapy of patients with cervico-facial cancers has been always the control of loco-regional disease. It is more difficult to control metastasis than primary tumor. According to numerous authors, metastases to cervical lymphonodus reduce the survival of patients with planocellular cancer of the upper aero-digestive pathways for about 50%. Precise classification of primary tumor and regional lymphonodus is highly significant for adequate and timely treatment of patients with cancers of cervico-facial region. The objective of our study was to make clinical classification of cervico-facial tumors and to establish the distribution of nodes according to node groups and cervical levels. In our series of 319 subjects, T2 category of primary tumors was most prevalent accounting for 40.44%. Clinically palpable lymphonodes were found in 87.15%, with most prevalent N1 category accounting for 42.95%. The incidence of clinically negative cervical nodus (NO) was reported in 12.85%. The nodes of the upper, medium and lower jugular group were most frequent in cancers of the larynx and pharynx. In cancer of the oral cavity, submental and submandibular nodes were the most commonly involved. In distribution of nodes based on oncological cervical levels, 45.86% of nodes at level II of the neck were found in laryngeal cancer, while 40% the neck level I was involved in the cancer of the oral cavity. In epipharyngeal cancer, 3.15% of cervical metastases were detected in the posterior triangle of the neck. The incidence of cervical metastases in specific primary localizations has a significant role for indications of one of the dissections of the neck.
Iatrogenicperforations of the esophagus and hypopharynx: 5 years experience of single institution
Authors: Stojakov Dejan , Sabljak Predrag , Bjelovic Milos , Dunjic M. , Nenadic B. , Ebrahimi K. , Spica B. , Velickovic D. , Djukic Vojko , Saranovic Djordjije , Djuric-Stefanovic A. , Pesko Predrag
Published: November 2008

Iatrogenic perforations of the esophagus and hypopharynx are important problem, due to diagnostic difficulties, controversies about adequate treatment, and high morbidity and mortality rate. Incidence of iatrogenic perforations is from 50 to 75% of all perforations. In the period from April 1999. to April 2004, 15 patients with iatrogenic perforation of the esophagus and hypopharynx were treated at the Department of esophageal surgery, First University Surgical Hospital in Belgrade. In majority of patients iatrogenic perforation occured during endoscopie interventional procedure (endoscopie removal of ingested foreign body - 10 pts, endotracheal intubation -2 pts, intraoperative iatrogenic perforation - 2 pts. pneumatic dilatation - 1 pt). Surgical treatment was performed in 12 (80%) pts and 3 (20%) pts were treated conservatively. Surgical approach was cervicoabdominal, thoracoabdominal and cervicothoracoabdominal in 9.1 and 2 pts. respectively. Among 12 operated pts, primary repair of the esophagus was performed in 5 pts. and esophageal resection or exclusion in 7 pts. Overall mortality rate was 13.3% (2 pts), in surgical group 8,3% (1 pt) and in conservatively treated group 33,3% (1 pt). latrogenic perforations of the esophagus and hypopharynx are diagnostic and therapeutic problem. Awareness of the possibility of esophageal perforation during instrumental manipulations and early diagnosis is essential for successful, individually adapted, and in most cases surgical, treatment.
Surgery of cholesteatoma: Surgical technique and cholesteatoma recurrences
Authors: Arsovic Nenad , Radulovic Radomir , Jesic Snezana , Krejovic-Trivic S. , Stankovic P. , Djukic Vojko
Published: November 2008

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11,9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13,4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.
The posterior sagittal trans-sphincteric approach
Authors: Pena A. , Hong A.
Published: November 2008

The posterior sagittal, transphincteric approach to treat different pelvic problems has been known since last century. Although some surgeons have embraced it and have enthusiastically advocated it s use, it has never become an overly popular technique. The purpose of this study is to evaluate the advantages and disadvantages of the approach, both from an historical perspective and from the authors experience. The international literature on the subject was reviewed since 1877 up to the present date. A retrospective evaluation of the authors experience was conducted, and the results reviewed. Specific attention was paid to the final result obtained in the treatment of the original condition, surgical complications and the effect of the surgical approach on bowel and urinary control. The experiential review included 114 cases. They were divided into two groups. A included 85 patients who underwent a posterior sagittal transphincteric approach that included 49 cases of Hirschsprung s disease (primary 21, secondary 28), 15 presacral masses; 10 rectaltumors; 7 acquired rectogenito- urinary fistulae; and 4 cases of idiopathic rectal prolapse. Group B included 29 patients who underwent a posterior sagittal trans-anorectal approach, in which theanterior wall of the rectum and the sphincter was divided as well.. This group included 12 cases of urogenital sinuses; 8 acquired urethral stricture or atresia after trauma; and 9 posterior urethralmasses. Post-operative bowel control was normal all cases except in those patients whose basiccondition had resulted in fecal incontinence, or who had sustained an irreversible injury prior tothe operation. Urinary control was normal except in cases with pre-operative incontinence. Complications included recurrence ofrecto-genitourinary fistulae in 3 cases, recto-cutaneous fistula in 3 Hirschsprung s patients and 2 partial wound dehisences. The posterior sagittal trans-sphincteric approach represents a useful technical alternative. It seems to be particularly useful to treat complications after surgery for Hirschsprung s disease, pre-sacral masses, acquired recto-genito-urinary fistula and idiopathic rectal prolapse. Thetransanorectal approach provides excellent exposure to the posterior urethra and vagina. Boweland urinary control are not compromised.
Sphincter repair: Its present place
Authors: Nicholls R.J.
Published: November 2008

Faecal incontinence has become a condition of interest only in the last 30 years. In 1970 at St Mark?s Hospital, there were four admissions and over the next 20 years this had risen to 55 per year. Today faecal incontinence forms a significant part of colorectal practice. The original approach in the 1970s over a 20 year period was sphincter repair. Gynaecologists and general surgeons had for many years been occupied in the reconstruction of the anal sphincter after localized traumatic injury. In the 1970s, diffuse weakness of the pelvic floor was identified and characterized by neuromuscular histology to show evidence of denervation.
Preoperative evaluation and postoperative follow-up for patients with rectal cancer
Authors: Paty P.B. , Wong Douglas
Published: November 2008

Rectal cancer has a wide variety of presentations. In most cases, it is the surgeon who is faced with the challenge of determining the extent of disease and advising the patient how to proceed with treatment. Utilizing diagnostic tests of the highest accuracy and relevance will help in the selection of the best initial therapy, which is critical for achieving the highest cure rate while also avoiding over-treatment and unnecessary morbidity. Following curative treatment, surveillance testing for detection of recurrence is traditionally done, but the efficacy of this practice has been questioned. Surveillance will detect a number of asymptomatic recurrences that are treatable by potentially curative salvage surgery, but to what extent early detection improves salvage therapy is not well established. In this brief review, the goals, methods, and expected benefits of rectal cancer staging and surveillance are assessed.
Proctology in day surgery: Surgical technique
Authors: Pezzangora V. , Ramuscello S. , Viola G.
Published: November 2008

In 2002 the law number 112 defined in Italy the Elementary Assistance Levels (Livelli Essenziali di Assistenza - L.E.A.), which are the medical procedures provided to all Italian citizens by the National Health System (Servizio Sanitario Nazionale), for free or after payment of a small fee. Each Italian Regional Government has to define for each pathology (as already categorized in Disease Related Groups - D.R.G.) a benchmark, which is the percentage of cases of each pathology which should be treated in Day Surgery. The benchmarks are thresholds that should not be exceeded to avoid fines or other penalties to the hospital. In order to meet the objectives required by Italian law, a Day Surgery Unit must be able to perform as many operations as possible with high quality, high effectiveness, high efficiency, low costs and a low percentage of complications (?zero defect? objective). To get as close as possible to this objective it is necessary to seek the best organisation and the best surgical technique.
Sacral nerve stimulation
Authors: Matzel K.E. , Stadelmaier U. , Besendörfer M.
Published: November 2008

The current concept of recruiting residual function of an inadequate pelvic organ by electrostimulation involves stimulation of the sacral spinal nerves at the level of the sacral canal. The rationale for applying SNS to fecal incontinence was based on clinical observations of its effect on bowel habits and anorectal continence function in urologic patients (increased anorectal angulation and anal canal closure pressure) and on anatomic considerations: dissection demonstrated a dual peripheral nerve supply of the striated pelvic floor muscles that govern these functions. Because the sacral spinal nerve site is the most distal common location of this dual nerve supply, stimulating here can elicit both functions. Since the first application of SNS in fecal incontinence in 1994, this technique has been improved, the patient selection process modified, and the spectrum of indications expanded. At present SNS has been applied in more than 1300 patients with fecal incontinence limited.
Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse
Authors: Bergamaschi R. , Lovvik K. , Marvik R.
Published: November 2008

Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use however has been limited due to fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During 30 months data on 33 selected patients with CRP were prospectively collected. Three patients were withdrawn from the analysis, as they had neither resection nor anastomosis. Twenty-nine women and one man (median age 55 range 21-83 years) underwent LSR with preservation of SRA for a median CRP of 8 (3- 15) cm. There were 20 ASA I and 10 ASA II patients. Ten patients had undergone previous surgery. Four patients complained of dyschezia, whereas incontinence was present in 26 patients. Anal ultrasound showed isolated internal sphincter defects in two patients. Four young adults (21-32 years) had normal CTT, whereas 26 older patients had a median CTT of 5 (4-6) days. Defecography demonstrated 10 enteroceles, two sigmoidoceles, and one rectal hernia through the levator ani muscle. Mortality was nil. Median operating room time was 180 (120-330) min, suprapubic incision length 5 (3-7) cm, estimated blood loss 150 (50-500) ml, specimen length 20 (12-45) cm, solid food resumption 3 (1-6) days, and length of stay 4.5 (2-7) days. Thirty-day complications were not related to anastomosing and occurred in 20% of the patients. Although the evidence provided by the present study suggests that sparing SRA has a favorable impact on anastomotic leak rates, these nonrandomized results need further evaluation. The division of the mesorectum at the rectosigmoid junction seems not necessary, and its sparing should therefore be considered as it may contain anastomotic leak rates.