bluuebunny/crossref_metadata_2025 huggingface dataset:
Crohn’s disease: When to operate
Authors: Dziki A. , Galbfach P.
Published: November 2008

Crohn?s disease is a chronic bowel condition, which can present as a number of different clinical and pathological presentations, depending on localization and activity of the inflammatory process. The aethiology of the disease has not been explained .In each case the treatment should be individually tailored depending on the type of the changes. The indications for surgical intervention are continuous bleedings, recurrent ileus, perforation of the intestine, abscesses, fistulas, failure of pharmacological treatment, resistance to steroids and steroid dependence. In case of the mild type of the disease with few symptoms pharmacological treatment is the right choice In case of the mild type of the disease with few symptoms pharmacological treatment is the right choice process. In malign form of Crohn?s disease lack of improvement after 7-10 days of intensive treatment is generally accepted indication for surgical treatment. Fulminant form of the disease is still a clear-cut indication for immediate surgical intervention. Decision on surgical intervention is more difficult and controversial when patient presents with series of subileus recurrences subsiding after conservative treatment. Patients with stenotic form of Crohn?s disease usually require multiple operations most of which are bowel resections. Patients with stenotic form of Crohn?s disease usually require multiple operations most of which are bowel resections therapy. External and internal asymptomatic fistulas should be treated conservatively. The timing of surgical treatment is essential in Crohn?s disease however the prevention from recurrences is also fundamental. It is well proved that preventive administration of 5-ASA (especially mesalazine) and metronidazol can reduce the risk of early recurrences after surgery.
Locoregional recurrence (non hepatic abdominal recurrence) of rectal cancer
Authors: Fuzun M.
Published: November 2008

Thirty percent of deaths are related to locoregional recurrence. All patients with nonhepatic abdominal recurrence (NHAR) were considered as having locoregional failure. The aims of this study are firstly to retrospectively evaluate the results of potentially curative resection and palliative treatment modalities for a group of 25 patients with NHAR from rectal cancer. The second aim is to determine the effectiveness of R1 resection in these patients in terms of survival. In this study we have followed 25 patients with NHAR of which 10 were able to undergo potentially curative salvage resection, whilst the remaining 15 had either a palliative (R2) or no resection. The goals of treatment for recurrent rectal cancer are palliation of symptoms, a good quality of life, and if possible, cure with a low rate of treatment - related complications. Indications for salvage surgery depend on several factors in cluding the extent of disease, the presence of concomitant illness and the surgeons experience. Systemic disease, systemic disease with peritoneal implants, multiple hepatic metastases, or extensive pelvic involvement preclude surgical treatment for cure.6 Curative and noncurative surgical procedures were performed width acceptable complications in the series presented hereThe mean survival for the group undergoing R0 resection was 50 months versus 55 months for the group undergoing R1 resection (not significant). Mean survival were 7,3 and 6 months in the groups undergoing R2, NR and NS respectively. The 5-year survival for the 10 patients who had potentially curative resection was 30 per cent versus 0 per cent for 15 patients who had non-curative procedures (p=0.001). There was 1 post-operative 30 day mortality in the series of 19 patients who underwent surgery. Five patients (6 per cent) developed one or more post-operative complications. Two of them required reoperation.
Neutropenic enterocolitis in acute myeloid leukemia
Authors: Colovic Natasa , Rajic Zoran , Sretenovic Mirjana , Stojkovic Mirjana , Colovic Milica
Published: November 2008

In this report we focus on the importance of an accurate diagnosis of gastrointestinal complications during chemotherapy for acute myeloid leukemia. The leukemic infiltrtion of the digestive system may cause mucosal ulcers which can lead to bleeding or perforation. The immune system deficiency in this cohort of patients may result in necrotic enterocolitis (leukemic typhlitis), perianal inflammation, abscesses, and peritonitis. We describe a 37-year old male who presented in June 2004 with 2- month history of fever, weakness and sore throat, treated with antibiotic therapy. Physical examination demonstrated palor. The peripheral blood count at admittance was as follow: Hemoglobin 87 g/l, WBC 63 x109/l, and platelets 56 x109/l. The peripheral blood differential count showed: myeloblasts 4%, polymorphonuclear neutrophils (PMN) 20%, monocytes 60%, lymphocytes 16%. The diagnosis of acute myeloid leukemia (AML) was confirmed by bone marrow aspirate, which presented an almost total infiltration by monocytoid blasts, AML type M5 according to FAB classification. Immunophenotypic evaluation by flow cytometry showed that the blast cells reacted with antibodies to CD33, CD13, CD14, CD64, CD15, cytogenetics showed normal karyotype. Induction treatment consisting of cytarabine 2 x 200 mg intravenously in push on days 1-8, vepeside 200 mg i.v. on days 1-5, adriblastine 90 mgon days 1,3 and 5. On day 15 of chemotherapy the patient got fever 38.5oC, abdominal pain and diarrhea (10 stools daily). Broad-spectrum antibiotic therapy with ceftriaxone and amikacin was promptly instituted but condition worsened, abdominal pain extended to all abdomen while the fever and diarrhea persisted. Ultrasonography on day 18 documented bowel wall thickness of colic tract, part of duodenum and jejunum. Owing to suspicion of neutropenic enterocolitis, antibiotic therapy intensified with teicoplanin, fluconazole, metronidazole and pipril. Patient was neutropenic and thrombocytopenic, although daily platelet transfusion from a single donor were given. We started with granulocyte colony stimulating factor (G-CSF) 5 g/kg, which was adiminstered for 7 days. After 7 days neutrophil value reached 1x x109/l, but fever persisted, abdominal distension and diarrhea progressively improved. The fever peristed and central venous catheter was removed on day 30. After removal of the catheter the patient was getting better: the fever disappeared. The blood count showed Hb 91 g/l, WBC 3,4 x109/l, platelet 114 x109/l and normal leukocyte differential count. We emphesize the importance of collaboration between the hematologist and the surgeon in monitoring gastrointestinal complications during and after chemotherapy for acute leukemias and value of abdominal ultrasonography evaluation.
First thousand rectal cancer cases: Local recurrence and survival
Authors: Krivokapic Zoran , Barisic Goran , Markovic V. , Popovic Milos , Antic Sladjan , Jovanovic Dejan , Protic S.
Published: November 2008

In the period 1990 - 2002, 1674 patients with colorectal carcinoma were operated in the First Surgical Clinic, Third Department for Colorectal Surgery. In 1264 cases (75,5%) rectal carcinoma was the indication for surgical treatment. Sphincter saving procedures (SSP) were performed in 824 (65,2%), abdominoperineal resections (APR) in 340 (26,9%) and resections of rectum with definitive stoma (Hartmann procedure) in 100 (7,9%) patients. We analyzed 1095 cases where curative SSP or APR were performed. All cases where curative resection was not possible because of liver metastases or inability to excise all macroscopic disease were excluded. In the group of patients where SSP was performed (767 cases), there were 26,6% high colorectal anastomoses (8cm from anal verge), 65,4% with low (4-8cm from anal verge) and 8,0% with intersphincteric coloanal anastomosis (cm from anal verge). Patohistological exam showed 5,3% Dukes A, 53,1% Dukes B, 36,5% Dukes C and 4,9% Dukes D. In the APR group (328 cases) there were 1,5% Dukes A, 32,4% Dukes B, 62,1% Dukes C and 3,5% Dukes D. In this study we analyzed local recurrence and five-year survival in both groups. Recurrence of the disease was registered in 325 (29,6%) out of 1095 patients. Local recurrence was found in 81 (7,4%) patients. In the SSP group recurrence occured in 215 (28,0%) out of 767 curative resections. Local recurrence alone was found in 53 patients (6,9%). SSP group was also divided into two subgroups; in the first group TME was performed and in second transection of mesorectum was carried out. Analyzing local recurrence in these two groups, in the TME group it was 7,6% and in the transection group 5,6%. In the APR group recurrence was registered in 110 (33,5%) out of 328 patients while local recurrence alone was found in 28 (8,5%) cases. Analyzing mortality we found that 234 (21,4%) out of 1095 patients died during follow-up. In the SSP group 154 out of 767 patients (20,1%) died. In the TME group mortality was 21,7% and in the transection group 16,9%. Mortality in the APR group showed that 80 out of 328 (24,4%) patients died during follow-up. Analysis by the Kaplan-Meier?s test shows cumulative survival of 0,69 for all cases. In the SSP group cumulative survival is 0,72 and in the APR group 0,64 with statistically significant difference (p,001). In the TME group cumulative survival is 0,75 and in the transection group 0,72 with statistically significant difference (p,05). We believe that performing SSP should be encouraged whenever it is possible because there is no difference in local recurrence rates and survival compared to APR. Transection of mesorectum can safely be performed in most cases with tumors located more than 8 cm form anal verge. We believe that exact preoperative staging and preoperative radiotherapy could improve results.
Continent appendicostomy in the treatment of fecal incontinence
Authors: Lukac Marija , Krstic Zoran , Sindjic S. , Perovic S.
Published: November 2008

Background: Fecal incontinence is common in children with anorectal anomalies or spina bifida. If it is possible to achieve fecal control, patients are given a large volume of enema once a day. Retrograde enemas are often unpleasant in children, particularly in adolescents. Malone procedure of antegrade appendicostomy achieves antegrade colonic irrigation. Material and Methods: From 1996 to 2003 Malone antegrade appendicostomy was performed in 10 patients with fecal incontinence. The patients were aged from 5 to 24 years. In 4 patients fecal incontinence was due to an anorectal anomaly, and in 6 patients spina bifida. Preoperatively, all patients were given a clysma to control fecal incontinence. The patients, who remained clean with regular usage of the clysma for 24 hours or longer, fulfilled the criterion for the formation of continent appendicostomy. In 9 patients the cecal appendix was used to create a stoma, while in another one a lateral tubularized cecal flap was applied. In 3 patients a continent conduit was also done due to urinary incontinence. The follow-up period was from 1 to 8 years. A patient was reoperated due to stenosis of the stomal aperture, while another one has not been using the stoma because of social reasons. Conclusion: Continent appendicostomy is a simple surgery, which is effective in the control of fecal incontinence in most children. It is indicated only in patients in whom the rerograde clysma successfully cleans the colon and if patient and parents are motivated to use it. Possible complications, among which stenosis is the most frequent, can be solved with a reoperation.
Reducing the incidence and managing the consequences of anastomotic leakage after rectal resection
Authors: Meade B. , Gen Moran
Published: November 2008

Anastomotic dehiscence is a serious, life-threatening complication of any rectal anastomosis and may be associated with an increased risk of local cancer recurrence. The leak rate following low anterior resection is in the region of 10% as reported in the recent randomised Dutch rectal cancer trial. Although accurate prediction of risk is impossible, certain factors are known to influence leak rates. There is an inverse relationship between the height of the anastomosis from the anal verge and the leak rate, with the lower anastomoses carrying the highest risk. Proximal defunctioning by a loop stoma mitigates the consequences of leakage and probably reduces, but does not abolish, the risk. There is little difference in rates of dehiscence between stapled and sutured colorectal anastomoses. A short colon pouch may reduce the chance of leakage. The highest risks are in unprotected anastomoses less than 5 cm from the anal verge in men who smoke and/or drink excessively, particularly if they have received pre-operative chemotherapy or chemo-radiotherapy. A high index of suspicion is required in detecting the early non-specific signs of a leak and urgent surgical intervention is usually required to avert a life-threatening situation. Faecal diversion should be regarded as the optimal safety measure to reduce the consequences of leakage and to mange leakage of an unprotected anastomosis.
Medial rotation deformity of the hip in cerebral palsy: Surgical treatment by derotation femoral osteotomy
Authors: Cobeljic Goran , Djordjic I. , Bajin Zoran , Vukasinovic Zoran , Lesic Aleksandar
Published: November 2008

Medial rotation deformity of the hip is a problem to patients handicapped by cerebral palsy who are able to walk, because the knees point inward during gait ("kissing patellae") and cause falls and frequent injuries, knee and ankle distorsions. The deformity is a result of an increased femoral neck anteversion. The purpose of the paper is to present the results of an original method of precise determination of the degree of rotation for derotation femoral osteotomy. Indications for this operation were set in pa- tients with spastic form of cerebral palsy over 10 years of age, able to walk, who had difficulties in gait and whose lateral rotation was less than 15 along with the medial rotation of over 70 in the hip on the side of the deformity. Twenty hips in 17 patients able to walk were operated on. The average age was 21 (11 - 42), the average follow-up was 11 years (3-17). The assessment of the results was based on the comparison of the rotational abilities of the hip and individual problems before and after the operation. Excellent result was achieved in 12 (70.6%) patients i.e. 15 (75%) hips; good result was achieved in 3 (17.6%) patients i.e. 3 (15%) hips; unsuccessful result in 2 (11.8%) patients i.e. 2 (10%) hips. Complications aroused in 6 patients i.e. 6 (30%) hips. The conclusion is that derotation osteotomy of the femur is a successful procedure for the treatment of the medial rotation deformity of the hip in patients with the spastic form of cerebral palsy who are able to walk. The above mentioned indications must be respected and the original method of determining the degree of derotation applied. Due to a relatively high percentage of complications, e.g. osteitis, the operation is suggested to patients aged 10 to 15 when possible complications can more easily be cured.
Clinical and urodynamic outcomes of tension: Free vaginal tape procedure
Authors: Hadzi-Djokic Jovan , Stoiljkovic J. , Basic Dragoslav , Basic B. , Petrovic G. , Colovic V. , Stamenkovic V.
Published: November 2008

The tension - free vaginal tape procedure (TVT) has been regarded as a safe, minimally invasive method for the treatment of female stress urinary incontinence. In a prospective multicenter study we evaluated safety and efficacy of TVT procedure for the treatment of female stress incontinence. From 1998. to 2003, a total of 42 patients, mean age 60 years (range 34-76) with urodynamically verified stress urinary incontinence underwent the TVT procedure. The mean follow-up period was 28 months (range 14 to 32). Intra- and postoperative complications were few, including bladder perforations (4.7%), vaginal hematoma (2.4%), complete urinary retention (2.4%), transient urinary retention (19%) and urinary tract infection (7.1%). Postoperatively, voiding time and functional urethral length significant increased. The subjective and objective cure rates were 85.7% and 90.5%, respectively. We conclude that the TVT procedure is associated with high cure rate and low morbidity.
Korelacija dijagnostickih procedura sa operativnim nalazom kod karotidnih stenoza
Authors: Pejic Miljko , Milic Dragan , Stanojevic M. , Zivic Sasa , Lucic N. , Lazarevic D.
Published: November 2008

Authors are discussing dilemma about necessary diagnostic procedure in making decision for surgical treatment of the carotid disease. Attitudes are changing and the old opinion of the necessity for angiogram of extra cranial blood vessels is substituted by the opinion that CDS (Color Duplex Scan) is satisfactory in the majority of cases to indicate of the surgical treatment. Comparing the invasive and noninvasive diagnostic?s with operative findings, authors empirically confirm the given hypotheses, looking back to the cases where angiogram is necessary. The following issues were discussed: Estimate of the locaton of maximal shrinking, degree of shrinking, length of shrinking and characteristics of plaque as the most important parameters for indication and operative tactics. Diagnostics with CDS is shown as reliable with high degree of matching with operative findings.
The significance of hepatopulmonary syndrome in liver transplantation
Authors: Culafic Djordje , Djukic Vladimir , Jesic Rada
Published: November 2008

The objective of the study is to determine the diagnostic role of pulmonary functional tests and perfusion pulmonary scintigraphy for quantifying the oxygenation and vascular abnormality in patients with liver cirrhosis. The prospective study included 70 patients with liver cirrhosis. Arterial blood gases analysis were performed in both supine and sitting positions while inhaling room air, and 15 minutes after exposure of hyperoxic mixture. Perfusion pulmonary scintigraphy using albumin macroagregate labelled with radioactive technetium (99mTc- MAA) was performed for the visualisation of intrapulmonary vascular dilatation. The diagnosis of hepatopulmonary syndrome was made in 10 (14.3%) patients. The patients with hepatopulmonary syndrome had severe hypoxemia (Pa,O2 7.41 +1.81 kPa), and poor response to 100% oxygen inhalation (Pa,O2 21.07 + 14.41 kPa) and higher alveolo-arterial gradient (5.73 + 2.65 kPa). Radioisotope marker 99mTc-MAA skipped intrapulmonary circulation in all patients with HPS and in no one without pulmonary vascular dilatations. The combined approach of 100% inspired oxygen and perfusion pulmonary scintigraphy may identify early oxygenation disorders and alter the priority for liver transplantation, especially in view of potential syndrome resolution.
Dynamic internal fixation of the periprosthetic femoral fractures after total hip arthroplasty
Authors: Milenkovic Sasa , Stanojlovic Milos , Mitkovic Milorad , Radenkovic Mile
Published: November 2008

Periprosthetic fractures of the femur after total hip arthroplasty are a big orthopaedic problem, particularly in elderly patients and quite a challenge for orthopaedic surgeons. There is no universal method in treating these fractures. Rigid plates fixation can be limited and aggravated especially in the proximal part of the femur where the endoprosthesis stem does not allow for an undisturbed fixation of both femur cortexes by means of screws. Mitkovic?s dynamic internal fixator is an original implant allowing for an undisturbed fixation of both femur cortexes regardless of the presence of the endoprosthesis stem. Fixation is made possible by means of movable clamps and a convergent possibility to place screws. A dynamic internal fixator can fix all types of periprosthetic femoral fractures. The paper shows the early experience in fixating periprosthetic femoral fractures after total hip arthroplasty in 14 patients, average age 69,7. According to Vancouver classification, 3 patients had the type A fracture, 9 patients had the type B fracture, and 2 patients had the type C fracture. All fractures were fixed by Mitkovic?s dynamic internal fixator. The fracture occurred 2-12 years after primary total hip arthroplasty. The follow- up of the operated patients was 12 months. The method is less invasive than the methods described in books. Mechanical complications are not likely to appear due to the fracture dynamics along the femoral shaft axis, which is made possible by this implant. Our initial experience in femur fracture fixation after hip arthroplasty ahows that it is modern and effective dynamic implant which will contribute significantly to the improving of the treatment of these often very complicated fractures.
Intrapartalne rupture uterusa, uzroci i zbrinjavanje
Authors: Gojnic M. , Jeremic K. , Mostic T. , Petkovic Spasoje
Published: November 2008

During 3 year period there were over 20 000 deliveries at the Institute for Gynecology and Obstetrics. Considering the fact that our clinic?s maternity hospital is the largest in the Balkans and that we are at the top of medical practice, the largest number of deliveries in Serbia and Monte Negro is performed in our institution. For the number of uterus ruptures dramatically increased, we analyzed the way of their repair and possible measures for preventing postpartum hysterectomies. We compared patients with performed hysterectomies or uterus sutures. We analyzed the possibility to approach more conservatively to such complications. 30 patients were subjected to interventions. In the group A there were 25 women subjected to more conservative therapy. In the group B there were 5 patients with total hysterectomy with conservation of one or both adnexes.
Our experience of the use of Martius method to eliminate the vesicovaginal fistula
Authors: Djordjevic M. , Stanojevic Dusan , Perovic S.
Published: November 2008

Sometimes after delivery, gynecological or other surgeries, radiological therapy, or destructions of vesico-vaginal septum due to the tumor or trauma, the unnatural communication between the bladder and vagina occurs. Those are fistulas that occur after the delivery (tocogenic) caused by the prolonged delivery or some obstetrics operations 1,2. Some fistulas are high, coming from the fundus of the bladder, medium, if they come just behind the trigonum of the bladder, and low, if they are in the level of trigonum and the neck of the bladder3. The purpose of this paper is to show the operative technique of elimination of medium and low vesicovaginal fistula and the results of the treatment. Material and method The elimination of the vesicovaginal fistula by original Martius technique is done through vagina4. The catheter is inserted through the fistula(figure 1). Than the mucosis of the vagina is cut around the fistula and the vaginal wall is separated from the bladder. The catheter is pulled out and the fistula on the bladder is sown with resorptive stitches. Than the labia maiora nearer to the fistula is cut along from Mons Veneris to the middle and the lipoid tissue is taken with vascular pedicle Than the catheter is inserted in the bladder that should stay there for four weeks. This is the method we used to make surgery in twenty patients with vesicovaginal fistula. The first one had the fistula as the result of the Caesarean section. She was operated twice through the bladder without success. The second patient was a fourteen years old girl that cut herself on the glass and damaged anal sfincter, rectum, vagina and the bladder. The fistula appeared later in the level of trigonum of the bladder. The other eighteen patients got fistula after hysterectomy. All patients were treated as described above and fistulas disappeared. The first patient had another baby a year after the operation by Caesarean section. The other patients have regular miction (figure 4 and 5). Discussion and the conclusion Vesicovaginal fistula are serous complications, for the patients and for the doctors. The only treatment of the vesicovaginal fistula is surgical5,6,7. If any damage of the bladder occurs during any operation it should be treated immediately, otherwise the fistula will appear. The treatment depends of the localization of the fistula. Low fistulas and some medium and urethrovaginal fistulas should be approached through vagina and according to our experience Martius,s method is very efficient. The only important thing is when the fistula is detected to wait at least for two or three months for the fistula to "consolidate" and also to cure the infection.
Foley catheter and deep hypothermic circulatory arrest to control bleeding in redo cardiac surgery
Authors: Nezic Dusko , Borovic S. , Cirkovic Milan , Lausevic-Vuk Ljiljana , Kenkovski A. , Knezevic Aleksandar , Djukanovic Bosko
Published: November 2008

Two cases with catastrophic hemorrhage in redo cardiac surgery are described. In the first one tearing of right ventricle with uncontrolled bleeding occurred during sternal reentry. In the second one, tearing of the right atria occurred while the patient was on cardiopulmonary bypass. In both cases we were able to control bleeding using Foley catheter, which enabled us to proceed to deep hypothermic circulatory arrest to repair heart chambers (due to dense adhesions it was impossible to m?nage it in any other way). We have found this combined technique to be extremely useful tool to control catastrophic hemorrhage during redo cardiac surgery.
An acute pancreatitis in a child caused by Na-valproate: Case report
Authors: Stojanovic M.P. , Zivanovic Dragoljub , Madic Jelica , Karadzic Dragana , Stanojevic Goran , Jovanovic Milan , Jeremic Lj.
Published: November 2008

Na-valproat (Apilepsin, Eftil), is is a commonly prescribed medication approved for treatment of epilepsy, trigeminal neuralgy, migraine, and bipolar disorder. Although the common adverse effects associated with Navalproat are usually benign, more serious and fatal complication like liver failure and acute pancreatitis (AP) can occur. Acute pancreatitis may take place in all ages, regardless of dose and serum levels of the medicine. An acute pancreatitis is relatively common after intravenous administration. The authors presented a case of acute opancreatitis in 13-years girl caused by Na-valproat.
Granulocytic sarcoma of the brain in a patient with acute myeloid leukemia
Authors: Colovic Natasa , Colovic Milica , Cemerikic-Martinovic Vesna , Terzic Tatjana , Ivanovic Svetlana , Skender-Gazibara Milica , Boskovic Darinka
Published: November 2008

Granulocytic sarcoma is extramedullary tumor composed of immature leukemic cells most frequently located in close proximity to bone, but it also can be found in the skin, breast, gastrointesti- nal tract, ovaries and brain. Granulocytic sarco- ma may arise during the course of leukemia or precede its development in the bone marrow. The majority of reported cases of granulocytic sarcomas in acute myleoid leukemia have chromosome translocation t(8;21). We report a 46-year-old man with acute myeloid leukemia, type M2 involving the marrow and peripheral blood and chromosome t(8;21) who developed granulocytic sarcoma in the brain, as a first manifestation of relapse 6 months after complete remission was achieved. During a neurosurgical operation a cortically located tumor (3.5x5 cm) in the brain was partially removed. Histology showed tumor consisted of homogenous infiltrate of blasts, admixed with more mature haematopoietic cells. The blasts have large round to oval nuclei, delicate chromatin, one or more small well-defined nucleoli and scant basophilic cytoplasm. Immunohistochemistry showed that blast cells were myeloperoxidase positive, confirming the diagnosis of myeloblastic sarcoma in the brain. The patient died two days after surgery.
Gastrointestinal stromal tumor of small intestine: Case report
Authors: Alempijevic Tamara , Spuran M. , Djuranovic Srdan , Kovacevic Nada , Popovic Milos , Cemerikic-Martinovic Vesna
Published: November 2008

Gastrointestinal stromal tumor is a form of mesenchimal neoplasm that may be present in all parts of gastrointestinal system. We are reviewing diagnostic and therapeutic algorithms for patient with diagnosed gastrointestinal neoplasm of small intestine, experiencing repeated episodes of painful bleeding from gastrointestinal trackt.
DREZ surgery for the treatment of the postherpetic intercostal neuralgia
Authors: Spaic M. , Ivanovic S. , Slavik Eugen , Antic Branislav
Published: November 2008

Postherpetic intercostal neuralgia proved to be an incapacitating pain often recalcitrant to therapy. Acute pain that accompanied Herpes zoster usually subsides spontaneously but in 10% of patients the pain persists and intensifies. The incidence of postherpetic neuralgia incises up to 50% among elder patients. We report the case of the two 42 and 48 yers old male patient who were successfully relieved from the chronic postherpetic intercostal neuralgia employing the DREZ surgery (Dorzal Root Entry Zone lesion). DREZ surgical treatment of this pain should be considered when medical therapies failed in controlling pain. Subjective sensory nature of the pain should play an important role in setting the indication for DREZ surgical treatment. The most favorable pain pattern for DREZ operation is the pain of intermittent rhythm, confined territory accompanied with the phenomenon of alodinic pain that could be provoked from the pain territory.
Biomehanicke karakteristike tkiva kicmene mozdine - osnov za razvoj modifikovane tehnike DREZ operacije
Authors: Spaic M. , Mikicic Dusan , Ilic S. , Milosavljevic I. , Ivanovic S. , Slavik Eugen , Antic Branislav
Published: November 2008

Mechanical properties of the spinal cord tissue - biological basis for the development of the modality of the DREZ surgery lesioning technique Successful treatment of the chronic neurogenic pain of spinal cord and cauda equina injury origin remains a significant management problem. The mechanism of this pa-in phenomenon has been shown to be related to neurochemical changes that lead to the state of hypereactivity of the second order dorsal horn neurons. The DREZ surgery (Dorsal Root Entry Zone lesion), designed to destroy anatomy structures involved in pain generating thus interrupting the neurogenic pain mechanism, as a causative procedure in treating this chronic pain, has been performed by using different technical modalities: Radiofrequency (RF) coagulation technique, Laser, Ultrasound and Microsurgical DREZotomy technic. The purpose of the study was to assess the possibility for the establishment of the lesioning technique based on the natural difference in the mechanical properties between the white and gray cord substance. We experimentally determinate mechanical properties of the human cadaveric cord white versus gray tissue for the purpose of testing possibility of selective suction of the dorsal horn gray substance as a DREZ lesioning procedure. Based on the fact of the difference in tissue elasticity between white and gray cord substance we established a new and simple DREZ surgical lesioning technique that was tested on cadaver cord. For the purpose of testing and comparing the size and shape of the DREZ lesion achieved the DREZ surgery has been performed on cadaver cord by employing selective dorsal horn suction as a lesioning method. After the procedure cadaver cord underwent histological fixation and analysis of the DREZ lesions achieved. Our result revealed that the white cord substance with longitudinal fiber structure had four time higher dynamical viscosity than gray substance of local neuronal network structure (150 PaS versus 37,5 PaS) that provided possibility for the safe and selective suction of the gray substance of the dorsal horn. Technique includes incision of the dorsolateral sulcus according to Sindous Microsurgical DREZotomy technique than suction under visual control of the dorsal horn gray matter using sucker adopted from the lumbar puncture nidle. Operative experimental testing and hystological analysis confirmed expected size and shape of the DREZ lesion performed by dorsal horn suction as DREZ lesioning technique. The utility, selectivity and safety of this technique has been provided by the natural mechanical properties of the cord tissue itself. Application of the Dorsal horn suction as a DREZ lesioning in humans confirmed this technique as a safe and reliable DREZ lesioning method.
Surgical management of cervical neurinomas with extraspinal extension
Authors: Radulovic Danilo , Ivanovic S. , Misovic M.
Published: November 2008

Neurinomas are the most common type of tumor that cause medullary compression at the cervical level. About 15% of all cervical neurinomas have extradural and extraspinal extension. Their resection raises the problems of nerve root preservation, vertebral artery control and spinal stability. Three patients with cervical neurinomas with significant exstraspinal components are presented in this report. They all had raducular pains and signs of medullary compression. Preoperative neuroimaging revealed cervical intraspinal and extramedullary mass with extraspinal extension. Complete tumor resection was achieved in all three patients by using staged posterior and anterolateral approach. Postoperative results were favorable. The complete removal of cervical neurinomas with extraspinal components is still a real surgical challenge. They can be completely resected by using staged posterior and anterolateral approach.
Endoskopska ultrasonografija u holedoholitijazi
Authors: Tomic D. , Krstic M. , Pavlovic A.R. , Krstic S. , Dugalic P. , Jesic R. , Knezevic S.
Published: November 2008

Diagnosis of choledocholithiasis is still difficult to establish and presents a great challenge in gastroenterology and surgery of biliary tract, since it requires expensive and sophisticated examining techniques. 10 to 15% of patients with symptomatic cholelithiasis were presented with choledocholithiasis as well. By EUS is possible to establish a diagnosis of choledocholithiasis with accuracy of 90 to 100% and precisely estimate dimensions of revealed stones. The main purpose of this survey is to present a great importance and many advantages of EUS as a contemporary diagnostic method. All patients were examined by Olympus equipment for endoscopic ultrasound with radial probe working with the frequency of 7,5 and 12 MHz at the Department for Endoscopic Ultrasound of the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia. They were previously diagnosed with choledocholithiasis by ERCP method. We examined 16 patients, which were selected by estimated risk for cholelithiasis. We have tried to evaluate the importance of diameter of choledochus, defined by common ultrasonography, as well as values of alkaline phosphatase and serum GT. We defined 3 groups of patients: group no.1, with 2 patients presented with a low risk for choledocholithiasis; group no.2, with 6 patients with a moderate risk for choledocholithiasis, and group no.3, with 8 patients presented with significant risk for cholelithiasis. According to obtained results, EUS presents the most effective method for detecting of choledocholithiasis, which is sometimes even more efficient than ERCP. After choledocholithiasis is previously revealed by EUS, it is much easier to decide if some invasive method such as EPT or precut papillotomy has to be used. EUS is always recommended as a diagnostic method when it is necessary to avoid some expected complications, such as pancreatitis.
Procena stepena maturacije zida pseudociste pankreasa u odnosu na izbor operativne procedure
Authors: Djordjevic Z. , Knezevic S. , Ceranic M. , Bulajic P. , Ostojic S. , Stefanovic D. , Knezevic Dj. , Pavlov M. , Stamenkovic A.
Published: November 2008

The aim of this study is to present our experience in the diagnosis and treatment of pancreatic pseudocysts. A pancreatic pseudocyst is an incapsulated collection of pancreatic juice, enclosed by nonepithelial elements, containing a high concentration of pancreatic enzymes, bicarbonates and necrotic detritus. It is a common complication of acute pancreatitis and trauma of the pancreas. In the period between 1996 and 2001, 53 surgical procedures were performed for pancreatic pseudocyst at the Institute for Digestive Diseases (First Surgical University Hospital), 35 male patients (67%) and 17 female patients (33%) underwent surgery. In 39 (75%) patients the method of choice was cystojejunostomy by Roux. In 4 cases distal pancreatectomy for pseudocysts localized within the pancreatic tail was performed, complete pseudocyst excision only was performed in one case and complete pseudocyst excision combined with cystojejunostomy was also performed in one case. Cystogastrostomy and drainage in one case and partial cystectomy and drainage also in one case. Surgical internal drainage is the method of choice for the treatment of pancreatic pseudocysts, involving low morbidity and mortality rates.
Endoscopic ultrasonography in pancreatic carcinoma
Authors: Tomic D. , Pavlovic A.R. , Krstic M. , Jesic R. , Jankovic G. , Ugljesic Milenko , Krstic S. , Alempijevic Tamara
Published: November 2008

Even though pancreatic cancer is not such a common diagnosis, its treatment is very expensive and it has a great economic impact to the health system. 5-year survival rates after excessive surgical treatment is only 5%, which imposes more careful selection of patients that have to be surgically treated. According to experience from some medical centers all over the world, EUS is considered as a high sensitive diagnostic method for establishing a diagnosis of pancreatic cancer and evaluation of TNM staging. The main purpose of this survey is to present our experience in using of EUS as a diagnostic method in establishing a diagnosis of pancreatic cancer, as well as to evaluate how reliable this method is in preoperative evaluation if tumor could be successfully resected. We examined the group of 63 patients with pancreatic cancer, which were surgically explored after EUS examination. We wanted to compare TNM status before and after the penetration ability of the probe working with the frequency of 7,5 MHz, EUS is not a suitable method for evaluation of M stage (figure 8,9). Patients were divided in different groups, specified by TNM status. For 10 patients resection was estimated as a probably successful solution, but only 8 of them was surgically treated. According to this, our estimation was 79,7% accurate, which is in accordance to results obtained from other medical centers all over the world.
The results of surgical treatment for cervical spondylotic myelopathy
Authors: Radulovic Danilo , Ivanovic S. , Jokovic M. , Tasic G.
Published: November 2008

Objective: Cervical spondylotic myelopathy is the most serious consequence of cervical intervertebral disc degeneration. The purpose of this study is to evaluate functional results of surgical treatment of patients with cervical spondylotic myelopathy who underwent anterior or posterior decompressive operations. Methods: we prospectively analyzed 57 patients with cervical spondylotic myelopathy who were operated in Institute for Neurosurgery in Belgrade (1995-2002). The severity of myelopathy is graded by Nurick myelopathy grading system. The average follow-up period was 20 months. Results: Postoperative improvement showed 75% of patients and 21% remained unchanged. Myelopathy worsening was observed in two patients, 4%. We didn't have serious operative complications. Selection of surgical approach was not significantly correlated with surgical outcome. Conclusion: surgical decompression of cervical medulla is safe treatment that gives good chances for functional recovery in patients with cervical spondylotic myelopathy.
The role of endoscopic ultrasound(EUS) in differential diagnosis of subepithelial oesophago-gastric lesions
Authors: Krstic M. , Pesko Predrag , Pavlovic A.R. , Tomic D. , Micev M. , Krstic S. , Lausevic Z. , Jovanovic D. , Spuran Milan
Published: November 2008

Background: Endoscopic ultrasonography(EUS) allows high-resolution demonstration of the entire gut wall. The aim of the study was to clarify the usefulness of the EUS in differential diagnosis of upper gastro-intestinal subepithelail lesions(SEL). Methods: From September 1998- March 2005, EUS was performed in 1600 patients. Among them, in 206pts (13%), this examination was carried out due to previous upper endoscopy, which revealed the suspicion to SEL or extraluminal compression. We studied the location, the size, echo pattern and originating layer of SEL. The results were compared with CT, angiography and operation with histology when possible. All EUS examinations were performed using Olympus GIF-130 videoecho-endoscope with 7,5/12MHz switch able radial probe. Results: EUS accuracy in separating intramural masses from extraluminal compression was 96 %( 44/46). Among 160 pts with true SEL, in 95(59, 3%), EUS revealed the existence of a stromal tumor arising from muscularis propria (92) or muscularis mucosae (3). The size of the tumor varied from 5-75mm; depth: 8- 40mm. 33 patients were operated on. In 14/16(87%), the EUS diagnosis of benign stromal tumor was confirmed on operation. In 18/19(95%), EUS correctly disclosed the malignant tumor. EUS accuracy in predicting malignancy was 91,5%(32/35). Findings suggestive for malignancy were: size 40mm; inhomogenicity with microcysts and irregular outer margin. In 12 pts, EUS revealed lypoma. Aberrant pancreas was correctly diagnosed in all 22pts. In 16 persons, EUS disclosed submucosal cysts: 6 of them were operated on and EUS diagnosis was confirmed in all. In 10 patients EUS visualized varices. The finding was confirmed on angiography. Conclusion: The EUS appears to be very effective in differential diagnosis of SEL in upper gastro-intestinal tract. Tumor size greater than 40mm, inhomomogenous echo pattern and irregular outer margin are very suggestive for malignancy.
Transaortic double valve replacement in difficult mitral valve exposure
Authors: Nezic D. , Knezevic A. , Milojevic P. , Jovic M. , Djukanovic B.
Published: November 2008

Adequate open exposure of the mitral valve is necessary to accomplish reconstruction or replacement of the diseased mitral valve apparatus. The technique employed by most cardiac surgeons for mitral valve access involves median sternotomy and vertical left atriotomy posterior to the interatrial sulcus. However, certain conditions can sometimes make this approach very difficult. Different approaches are discussed with particular emphasis on our case in which the transaortic double valve replacement have been performed.
Istorijat ortopedske hirurgije u Beogradu - 100 godina ortopedije u Srbiji (1905-2005)
Authors: Bumbasirevic Marko , Lesic Aleksandar , Sudjic V.
Published: November 2008

The history of orthopedics in Serbia is related to a hand x-ray made in 1905 by dr. Nikola Krstic. The first orthopedic word was founded in 1919, to be enlarged into a full-fledged orthopedic surgical ward of the General State Hospital in 1932. Until 1941, the ward headed by Dr. Nikola Krstic. The Orthopedics course was headed by Dr. Borivoje Gradojevic, who also wrote the first textbook in our country in 1934. In 1947, the ward became the Clinic for Orthopedic Surgery and Traumatology in Belgrade which is the orthopedic basis of Serbia, together with the Special Orthopedic Surgery Hospital Banjica, even today.
The treatment of "critical ischemia" of the limbs in endarteritis obliterans by thickening of the tibial bone
Authors: Tomic Slavko , Krajcinovic O. , Lesic Aleksandar , Bumbasirevic V. , Bumbasirevic Marko
Published: November 2008

The authors report their experience in the treatment of the "critical ischemia" in 8 patients with arterial occlusion of the lower limbs in endarteritis obliterans. All patients were treated by thickening of the tibia using the Ilizarov apparatus for distraction osteosynthesis. In all cases the operative treatment ensured lowering of the amputation level, forming of the functional stump and long-lasting remission of the illness.
Parcijalne proteze zglobova ramena - nase iskustvo
Authors: Harhaji V. , Ercegan G. , Miljkovic N.
Published: November 2008

Hemiarthroplasty of the shoulder is a treatment of choice for severe types of proximal humeral fractures. From 2001 to 2003, 8 hemiarthroplasties were performed at the University Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Novi Sad. The aim of this study was to retrospectively assess functional outcomes of those patients. By determining the factors that affected the outcome, we would try to improve results of future patients.
Poredjenje klinickih rezultata rekonstrukcije prednjeg ukrstenog ligamenta koriscenjem dvaju razlicitih postupaka
Authors: Ninkovic S. , Savic D. , Stankovic M. , Radic S. , Milicic A. , Milankov Miroslav
Published: November 2008

During the last two decades the "golden standard" in reconstruction of anterior cruciate ligament knee was the middle third of patellar tendon, but now are more used hamstrings tendon autograft. The aim of this work was to compare our results of the artroscopic reconstruction ACL ( anterior cruciate ligament) of the knee using two different techniques. We were controling 60 patients within the period of two years after operation. Group A was composed of 39 patients which had reconstructed ACL done with bone-patella tendon-bone autografts, in the group B were 21 patients and at them as autographts have been used hamstring tendon. Difference between health and the ill knee by the Lachman?s test after operation, in the group A was 2,4mm , but in the group B was 2,2mm (p> 0,05 ). Postoperative middle value of the Lysholm and Gillquist score in the group A was 97,74, in the group B it was 96,67 (p>0,05). IKDC score results are following: Group A- mark A 32 patients (84,6%); mark B 5 (12,8%); mark C 1 (2,6%) and in the group B: mark A 17 patients (81%); mark B 3 (14,28%): mark C 1 (4,72%) (p> 0,05). Postoperative value for the Tegner and Lyscholm score activity in the A group was 8,23, in B group it was 8,81. The reconstruction of ACL with bone-patella tendon-bone grafts gave better results then the reconstruction with the hamstring tendon only according to Tegner score values. In other parameters between those two groups there was no statistically significant difference.
New concept in external fixation
Authors: Mitkovic Milorad , Bumbasirevic Marko , Golubovic Z. , Micic Ivan , Mladenovic D. , Milenkovic Sasa , Lesic Aleksandar , Bumbasirevic V. , Pavlovic P. , Karalejic S. , Kuljanin G. , Petkovic D.
Published: November 2008

A new concept in external skeletal fixation is presented. A 3D unilateral system developed by Mitkovic has widely been investigated biomechanically in AO institute in Davos (Switzerland). Consists of three components only providing extremely simple application and dynamic fixation of bones and different joints. This simple external fixator functions as an accurate reduction device at the same time, minimizing need for fluoroscopy. Clinically this system has been applied to mere then 13 thousand patients in 43 clinics. This paper presents the results of its application for treatment of open fractures, war wounds with fractures and for comminuted and intraarticular closed fractures in the series of 597 patients. Overall average time for union time was 3.2 months. Overall success of fracture healing was 96.8% including open and closed fractures. Our study suggests that the use of this 3D unilateral system is suitable for routine use.