bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperativne i postoperativne komplikacije splenektomije
Authors: Petrovic M. , Popovic Milos , Knezevic S. , Matic Slavko , Gotic Mirjana , Milovanovic Aleksandar , Zuvela M. , Artiko Vera , Dugalic V. , Rankovic Vitomir
Published: November 2008

Spleen is being surgically removed because of trauma, in diagnostic and-or therapeutical purposes because of the benignant and malignant diseases. The percentage of morbidity during and after splenectomy is relatively low. During surgery might occur bleeding, trauma of the pancreatic tail, stomach, lineal flexure of the colon, left hemidiafragm, left suprarenal gland and upper pole of the left kidney, which must be correspondingly reclaimed during the same intervention. In the early postoperative period, postoperative bleeding, subfrenic abscess, pulmonal atelectasis, bronchopneumonia and left pleural extravasations might occur. Especially is important notification of these events in due time and adequate conservative and surgical treatment. After splenectomy, there is an increase of the number of trombocytes, which might lead to the tromboembolic complications. In the prevention of these complications in the postoperative period prolonged antiagregation therapy is suggested. Postsplenectomy sepsis is very late, general complication of splenectomy, which occurs because of the lower immunity in the child age. To prevent these complications, partial splenectomies, reimplantations of the spleen, prolonged application of the penicillin medicines after splenectomy and antipneumococcal vaccine are performed.
Parcijalna resekcija slezine i spleno-renalni sant u lecenju portne hipertenzije sa splenomegalijom i hipersplenizmom
Authors: Radevic Bozina , Jesic R. , Sagic Dragan , Perisic V. , Nenezic D. , Popov P. , Ilijevski Nenad , Dugalic V. , Gajin P. , Vucurevic G. , Radak Djordje , Trebjesanin Z. , Babic D. , Kastratovic D. , Matic P.
Published: November 2008

Some of serious hepatic diseases with cirrhosis may be complicated by portal hypertension, splenomegaly and hypersplenism. Splenomegaly inhibits regenerative processes of the liver, and also intensifies sequestration of the cellular components of blood up to hypersplenism. Cytopenia caused by hypersplenism is aggravated by negative hepatic influence on bone marrow activity-hemathopoesis, and also by recurrent bleeding from oesophageal varices, and from the other site of gastrintestinal tract. This circle of pathologic conditions may be interrupted only by liver transplantation, until which patients are jeopardized by acute bleeding and chronic anemia. Partial resection of the spleen and splenorenal shunt may correct portal hypertension and hypersplenism, prevent gastrointestinal bleeding, and alleviate hepatic regenerative processes inhibition. In this study, 51 patients with partial resection of the spleen and splenorenal shunt, were analyzed.
Neuroradioloska dijagnostika kod trakcionih povreda brahijalnog pleksusa
Authors: Milosevic Svetlana , Prstojevic Branko , Vuckovic Vera , Bekerus Aleksandar
Published: November 2008

Traumatske lezije brahijalnog pleksusa vidjaju se najcesce kod mladjih osoba i u velikom procentu su rezultat saobracajnih nesreca. Kod ovih povreda radi se u osnovi o avulziji brahijalnog pleksusa koja moze biti kompletna ili ogranicena na samo prednje ili samo zadnje cervikalne korenove. Od izuzetnog je znacaja precizna dijagnoza mesta povrede. Neophodno je utvrditi da li se lezija nalazi intraduralno (ispred gangliona) ili ekstraduralno (iza gangliona). Ova dijagnoza odredjuje indikaciju za hirurski zahvat, kao i vrstu reparacije nerva (1). U dijagnostickoj obradi pacijenata sa suspektnom avulzijom brahijalnog pleksusa koriste se brojne metode od kojih se u neuroradioloskom spektru nalaze cervikalna mijelografija, CT-mijelografija i magnetna rezonansa (MR). Korisne dodatne informacije mogu dati i elektrofizioloske pretrage. Standardna mijelografija dugo je koristena kao osnovna dijagnosticka metoda, pri cemu je nalaz traumatske meningokele smatran dokazom avulzije (2). Ovo ne mora biti tacno, niti uredan mijelografski nalaz obavezno znaci da ne postoji avulzija. Znacajne dodatne informacije daje i tzv. CT - mijelografija koja moze pokazati i intraduralno ostecenje. Ipak, i ova metoda moze dati mali procenat lazno pozitivnih i lazno negativnih dijagnoza, a osim toga je invazivna kao i klasicna mijelografija. Magnetna rezonansa pruza izvrsnu vizualizaciju lezija izvan i. v. foramena, dok se intraduralne lezije teze prikazuju. Da bi se dobili optimalni rezultati, potreban je aparat vece jacine magnetnog polja, tanki slojevi, kao i potpuna saradnja pacijenta(3). I pored opisanih metoda postoji manji procenat pacijenata (oko 15%) kod kojih nijedna od njih ne moze da prikaze nervne korijenove, te je neophodan hirurski zahvat - hemilaminektomija, da bi se doslo do dijagnoze.
Nerve grafting in peripheral nerve injuries
Authors: Grujicic Danica , Samardzic Miroslav , Rasulic Lukas , Savic Dragan , Cvrkota Irena , Simic Vesna
Published: November 2008

Autologous nerve grafting is the most commnly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient?s age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.
Neurosurgical treatment of posttraumatic intracerebral haematomas
Authors: Djurovic B. , Jovanovic V. , Tasic Goran , Kacar Aleksandra , Krunic-Protic R.
Published: November 2008

From January 1st to August 31st 2002 yr., Neurosurgical department of the Trauma Center, Clinical Center of Serbia, has operated 43 patients with posttraumatic intracerebral haemathoma (PTIH). From that number, 9 patients survived and 34 died. Only 4 patients with acute PTIH were in terminal state of incarceration and in spite they were operated immediately, all died. Other 39 patients have delayed PTIH where secondary CT cerebral scans showed the development of posttraumatic intracerebral haematoma that has not been verified at the incipient scanner. Indication for repeated CT scan was found for 19 patients for their focal or general neurological deterioration. 20 patients had no delayed neurological disturbances. Survivers were younger, in lower grade of coma and were mostly with temporal localization of haemathoma.
Keratoacanthoma
Authors: Radovanovic-Bobic Anica , Latkovic Zoran
Published: November 2008

Keratoacanthoma is a rapidly growing cutaneous neoplasia of adult persons that may regress spontaneously. It is believed to arise from the hair follicles. It is sometimes difficult to distinguish keratoacantoma from squamous cell carcinoma either clinically or histologically. During ten years period (1992- 2001) we were treating 18 patients with keratoacanthoma of the skin. We discuss here our experience with this tumor, and we conclude that early, complete excision is the treatment of choice for it.
Advantage and shortage of planned staged reoperative necrosectomy using “zipper technique” in the treatment of necrotizing pancreatitis
Authors: Radenkovic Dejan , Bajec Djordje , Karamarkovic Aleksandar , Gregoric Pavle , Milicevic Miroslav
Published: November 2008

The rationale of surgical intervention during acute necrotizing pancreatitis is to remove necrotic tissue preserving healthy glandular parenchyma and other adjacent structures, thus limiting severe complications. Necrosectomy and debridment are crucial in surgical management, further treatment of pancreatic bad and peripancreatic tissue are still matter of debate among pancreatic surgeons. Zipper technique is one of the three recognized methods for the surgical management of necrotizing pancreatitis. The aim this study was to review the literature date about treatment using this technique, as well to compare the results of treatment with other techniques, in order to present the advantage and shortage of zipper technique.
Mediastinitis due to tonsillitis: Case report
Authors: Stamenkovic Dusica , Randjelovic Tomislav , Ivanovic Nebojsa
Published: November 2008

We report case of 50-year-old female with mediastinitis due to tonsillitis. Mediastinitis was diagnosed after five days according to clinical signs, radiological examination and computerized tomography scan. The patient underwent mediastinal drainage through a cervical incision and bilateral thoracic drainage because of bilateral pleural empyema. Initial broad-spectrum antibiotic therapy was replaced with imipenem, amicacin and vancomycin after the bacteriological investigation revealed susceptibility to isolated acinetobacter spp, staphylococcus spp coagulase-negative, enterococcus and staphylococcus. After 46 days of hospitalization patient went home.
Phytobezoars as a cause of small bowel obstruction associated with a carcinoid tumor of the ileocecal area: Report of a case
Authors: Pitiakoudis Michael , Koukourakis Michael , Giatromanolaki Alexandra , Tsaroucha Alexandra , Polychronidis Alexandros , Simopoulos Costantinos
Published: November 2008

Background: Carcinoid tumors are slowly growing malignant neoplasms associated with an indolent clinical course. About 60% of such tumors are located within the gastrointestinal tract. Case Report: We describe an unusual case of small bowel obstruction associated with of a carcinoid tumor of the ileum. A 70-year-old woman was presented with abdominal pain, vomiting, and clinical signs of mechanical bowel obstruction. X-ray and CT-scan of the abdomen showed hydroaeric levels and the presence of intraluminal hyper-dense ?stones?, presumably of gallbladder origin. A diagnostic laparotomy revealed that a large part of the final ileus was edematous, with prominent evidence of intestinal loop adhesions. The edematous part of the ileum was resected. Incision of the intestinal wall revealed a 2-cm soft mass at 8 cm from the ileocecal valve, where the presence of ten fruit pits obstructed the intestinal cavity. Histopathological examination confirmed the diagnosis of a carcinoid tumor. Conclusion: An interesting case of small-bowel obstruction with a double cause is presented: an ileal carcinoid and fruit pit bezoars. The pathophysiology of the obstruction is discussed.
Schwanoma of the gallbladder
Authors: Colovic Radoje , Grubor Nikica , Jancic-Zguricas Marija , Zogovic Segrej
Published: November 2008

Schwanomas of the biliary tract are very rare with about 55 reported cases. Schwanomas of the gallbladder are the rarest, probably with less then ten reported cases. We reported a 61 old woman in whom we did a cholecystectomy for a tumor of gallbladder 6,5x9 cm in diameter with a central softness which showed a histologic apearance of schwanoma. Ten years after surgery the patient is symptom-free and with no sighns of recurrency.
Rational diagnosis and surgical management of thyroid nodule
Authors: Paunovic Ivan , Diklic Aleksandar , Krgovic Ksenija , Zivaljevic Vladan , Tatic Svetislav , Havelka Marija , Kalezic Nevena , Todorovic-Kazic Milena , Bozic Vesna
Published: November 2008

Few subjects in endocrine surgery have generated as much contraversy as the management of thyroid nodule. The contraversial issues include evaluation of labaratory findings and imaging diagnostic procedures in the patient with solitary thyroid nodule. The major issue in relation to controversies is choice of optimal diagnostic workup.
Pathohistologic and immunohistochemical features of thyroid carcinoma
Authors: Havelka Marija , Tatic Svetislav , Paunovic Ivan , Diklic Aleksandar , Krgovic Ksenija , Bozic Vesna , Zivaljevic Vladan
Published: November 2008

Numerous pathohistologic criteria, difficultes and pitfalls in the process of diagnosing of thyroid carcinoma are discussed. Benign hyperplastic papillae may be present in colloidal cystic goiter and hyperplastic goiter. These structures are lined by cells with normochromatic nuclei and do not disturb the thyroid tissue architecture. Papillae in papillary thyroid carcinoma have cells with ground-glass, hypochromatic nuclei. Follicles inspissated in capsula of follicular or even colloidal adenoma may be evaluated as capsular invasion - diagnostic feature of follicular carcinoma. Undifferentiated thyroid carcinoma is sometimes similar to fibrosarcoma and reveal cellular pleomorphism, anaplasia and numerous foci of necrosis. Medullary thyroid carcinoma with scanty stromal amyloid, its papillary variant and carcinoid-like histologic type consist of oval cells with eosinophilic cytoplasm and dark nuclei.
Differential expression of Galectin-3 in papillary projections of malignant and non-malignant hyperplastic thyroid lesions
Authors: Cvejic Dubravka , Savin-Zegarac Svetlana , Petrovic Ivana , Paunovic Ivan , Tatic Svetislav , Havelka Marija
Published: November 2008

Galectin-3 is a a beta-galactoside binding protein recently proposed to be a promising presurgical molecular marker for distinguishing benign from malignant thyroid neoplasms. We analyzed galectin-3 expression immunohistochemically in papillary areas of hyperplastic lesions of benign thyroid tissue in comparison with malignant papillary projections of papillary thyroid carcinoma (PTC). A monoclonal antibody to galectin-3 and ABC immunohistochemical technique were used to evaluate galectin-3 expression in 26 cases of benign papillary hyperplasia (8 cases of hyperplastic adenoma, 8 cases of hyperplastic colloid goiter, 10 cases of Graves disease) in comparison with 25 cases of PTC. Immunohistochemical results showed no reactivity for galectin-3 in papillary areas of benign hyperplastic lesions. Strong cytoplasmic galectin-3 immunoreactivity was found in all 25 cases of PTC. These results show that galectin-3 expression is a feature of malignant papillary projections but not of benign papillary hyperplasia. Thus, the immunohistochemical evaluation of galectin-3 might contribute to differential diagnosis between malignant and benign thyroid lesions with papillary projections.
Papillary 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

Papillary thyroid cancer is after ovarian cancer the most frequent malignant disease of the endocrine system and because of this fact, early detection and appropriate surgical treatment is essential. Radical surgical treatment lower the risk of the disease relapse and postoperative adjuvant therapy with radio iodine is possible as well as postoperative follow up with tireoglobulin measurement. If the total thyroidectomy is performed in highly specialized institution the risk of postoperative complications is acceptable and therefore is the treatment of choice for papillary thyroid cancer. Only the patients with occult papillary thyroid cancer can be treated with hemythyroidectomy. In our series of 410 patients the majority of the patients (85,12%) were in the early phase of the disease and the degree of successfully performed radical surgery for papillary thyroid cancer was very high (tumor reduction was performed in only 1,46% of cases).
Medullary thyroid carcinoma: Genetic screening and prophylactic thyroidectomies
Authors: Bergant Damijan , Hocevar Marko
Published: November 2008

Medullary thyroid carcinoma (MTC) occurs sporadically or is inherited as a characteristic component of MEN 2A, MEN 2B and familial MTC. Germ/line point mutations in RET proto/onkogene are responsible for tumor arise and inheritance. Genetic screening provides information of these RET mutations in family members even before pathologic changes of C-cells progress to MTC. The aim of our study was to identify carriers of RET gene mutations in our patients with MTC and their kindred. Surgical therapy was based on genetic testing results and clinical features. Prophylactic thyroid surgery was the subject of interest. From 1969-2002 105 patients with MTC (88 families), were treated and/or diagnosed at the institute of Oncology Ljubljana, Slovenia. Genetic testing was so performed in 58/88 MTC index patients (24 males (16 - 93y) and 34 females (23 -77y)) and their 50 kindred, aged 8 - 67y. Twentyfive/50 kindred were from affected families. Germline mutations of RET proto-onkogene were found in 12/58 (20, 6%) MTC index patients - 2 males (16 and 65 y) and 10 females (23-55y, median 36y) and in 14/25 kindred from 12 affected families - 5 males aged 18-57 years (median 21) and 9 females aged 12-54 years (median 41) but were absent in 11/25 kindred. Genetic screening results indicate thyroid surgery in all 14 kindred; also MTC was clinically suspected or diagnosed in 11/14 patients and 3/14 were candidates for prophylactic thyroidectomy. Total thyroidectomy with central neck dissection was the minimal surgical procedure. Prophylactic thyroidectomy based on genetic testing results allows earlier diagnosis and treatment of patients, even before pathologic changes of C-cells occur. Patient?s age and codon mutation influence the timing of surgery and even it?s extend.
Ptimary thyroid lymphomas and other rare thyroid tumors
Authors: Diklic Aleksandar , Zivaljevic Vladan , Paunovic Ivan , Krgovic Ksenija , Zivic Rastko , Kazic Milena , Kalezic Nevena , Tatic Svetislav , Havelka Marija , Bozic Vesna
Published: November 2008

Primary thyroid lymphomas are rare. Surgery is seldom indicated. The aim of the study is to find out the main characteristics of primary thyroid lymphomas in our patients, indications for surgery and the possibility of treatment, frequency and characteristics of rare thyroid tumors. Method: retrospective study of 1044 patient operated for malignant thyroid tumor. Results: From 1995 to may 2003, we operated upon 15 patients with primary thyroid lymphomas, 2 men and 13 women mean age of 50.12 years (from 22 to 74 years), also one patient of age 69 with insular thyroid cancer. Reason for surgery was thyroid tumor in all, compressive disturbances in 9, among them 4 with asphyxia. Radical total thyroidectomy was performed in 4 (26.7%), whole in others some residual tumor tissue was could not be removed in spite of thyroidectomy in 3, hemithyroidectomy in 2, tumor debulking in 5 and only open biopsy was performed in one patient. There was no operative mortality, no postoperative hypocalcaemia and no recurrent nerve palsy. Histological type of tumor was Non-Hodgkin lymphoma in 13 patients, Hodgkin disease in 2 female patients of age 22 and 24. Hashimoto thyroiditis was present in 3 patients. After surgery, 13 patients were treated with chemotherapy, one patient died one month after the operation and one patient refused chemotherapy. Follow-up data are available for 9 patients and the mean follow-up period was 20 months (1-48months). Three patients died after a month, 2 and 3 years after surgery. Six patients are without local relapse. In one patient who refused chemotherapy, a year after thyroid surgery, resection of large intestine was performed because of lymphoma of the colon. Conclusion: Malignant thyroid lymphomas are rare. They present with rapidly growing thyroid tumor, compression and asphyxia. Surgery is only temporarily effective and it is necessary to start with chemo-radiotherapy as soon as possible. Rare forms of thyroid cancer have to be histological recognized in order to choose the best way of treatment.
Surgical treatment of pancreatic pseudocysts in the 2000s: The laparoscopic approach
Authors: Andrén-Sandberg Åke , Dervenis Chirustos
Published: November 2008

A pseudocyst present as a cystic cavity bound to the pancreas by inflammatory tissue (1). Typically the wall of a pancreatic pseudocyst lacks an epithelial lining, and the cyst contains pancreatic juice or amylase-rich fluid (2, 3). Today the mostly used definitions make a difference between peripancreatic fluid collections, pseudocysts after acute and chronic pancreatitis and pancreatic abscess as in the Atlanta classification system for acute pancreatitis (4). Distinction between pseudocyst and acute fluid collection leads to a better understanding of the natural history of peripancreatic fluid collections and facilitates the progress of the treatment of these two separate entities even though they are a part of a continuous pathological process. The presence of a well-defined wall composed of granulation or fibrous tissue is what distinguishes a pseudocyst from an acute fluid collection. A pseudocyst is usually rich in pancreatic enzymes and is most often sterile. Formation of a pseudocyst requires usually 4 or more weeks (many clinicians state six) from the onset of acute pancreatitis (5). The differentiation in the Atlanta classification between acute and chronic pseudocyst is important, but it invite to confusion. It is important to note that in the classification the terms ?acute? and ?chronic? refers to the pancreatitis behind the pseudocyst and not to the mode of symptomatology of the pseudocyst itself. This means that an acute pseudocyst may have be known for months, whereas a chronic pseudocyst in the next patient has been documented only a week or two.
Acute cholecystitis
Authors: Milicevic Miroslav
Published: November 2008

Only 20 - 30% of patients with gallstones have symptoms and the probability of a patient with silent gallstones developing biliary-related pain is 1- 2% while the risk of developing a serious complication (e.g. empyema, perforation, peritonitis etc.) is less than 0.1% per year. Imaging techniques are important in establishing the diagnosis and evaluating the patient. Laparoscopic cholecystectomy (LC) is the golden standard for the management of symptomatic gallstones and there are two surgical treatment options: early cholecystectomy (same hospital admission) and interval (delayed) cholecystectomy (6-8 weeks after resolution of acute attack). Early LC has medical and socioeconomic advantages over interval LC. LC can be undertaken for the majority of patients with AC and in some high risk groups the postoperative mortality can even be reduced. LC in AC is associated with longer operating time, a higher rate of conversion and bile damage. Early diagnosis and early operation can prevent the development of complications associated with AC.
Procena vrednosti lokalnih protektivnih metoda latex proteze i fibrinskog lepka na anastomozama kolona
Authors: Stanojevic Goran , Stojiljkovic Miroslav , Jovanovic Milan , Stojiljkovic Danilo , Stojanovic Miroslav , Konstantinovic Slavko
Published: November 2008

In this experimental study on small animals (Wister rats) the evaluation was performed of local protective methods - endoluminal latex prosthesis and fibrine adhesive - on colon anastomosis healing - prevention of dehiscence. Ninety experimental animals in whom segmental left colon resection was done in general anaesthesia were divided into three groups of 30 animals. In the control group after segmental resection, termino-terminal anastomosis with single-layer elongated suture was performed. In the second and third group with the animals treated in the same way, anastomosis protection was performed with endoluminal latex prosthesis and extraluminal application of fibrin adhesive. In the postoperative course with animals monitored for 21 days, in the control group 3 (10%) animals died of acute diffuse peritonitis as the consequence of anastomosis dehiscence; in the latex prosthesis group 2 animals (6,6%) died, while in the extraluminally applied fibrin adhesive group all animals survived. The results of this experiment demonstrate that local protective measures for colon anastomoses may produce better results, with fibrin adhesive administration as the best treatment modality.
111 in labeled antibodies in the detection of colorectal carcinoma
Authors: Artiko Vera , Obradovic V. , Davidovic Branka , Petrovic N. , Petrovic Milorad , Krivokapic Zoran , Kecmanovic Dragutin , Adanja G. , Sobic D. , Pavlovic S. , Rebic Radmila
Published: November 2008

The aim of the study is detection of the recurrences and metastases of colorectal carcinomas using 111-In labelled antibodies B72.3 in 14 patients. With tomography, we can access better distinction of tumour in comparison to other structures and estimation of its size. Other imaging methods (CT,US) have advantage in detection of liver metastases, while immunoscintigraphy is more specific for the assessment of malignant abdominal tumours and extrahepatic metastases. The first results point out that Oncoscint CR-103 can be useful in diagnosis of recurrences and metastases of colorectal carcinoma, viability assessment after radiotherapy and in the choice of the adequate surgical treatment in dependence of the spread of the disease.
D-dimer u ranom otkrivanju tromboze dubokih vena donjih ekstremiteta
Authors: Milic Dragan , Zivic Sasa , Pejic Miljko , Stojiljkovic Danilo , Karanikolic Aleksandar , Mihailovic Dragan , Ignjatovic Nebojsa , Zlatic Aleksandar , Visnjic Aleksandar
Published: November 2008

Deep vein thrombosis is important social and health care problem for its high incidence, pulmonary embolism-related mortality, and long-term sequel which may be disabling (post-thrombotic syndrome and ulceration). The aim of our work was to determine the diagnostic potential and importance of D dimer in the early detection of deep vein thrombosis of lower extremities. Prospectively we have analyzed a group of 47 patients who were admitted to vascular department of Surgical Clinic in Nis during the period from 1.8.2001. to 31.3. 2003. with echosonographicaly verified deep vein thrombosis of no more than 48 hours of duration. D dimer was measured before anticoagulant treatment started using commercial Nycomed test. The activation of coagulation process was detected with increase in D dimer values in 44 out of 47 examined patients (93,61%). D dimer is highly sensitive diagnostic tool that should be routinely used in the patients with suspected deep vein thrombosis of leg.
Enteral nutrition and surgical patient
Authors: Stamenkovic Dusica , Basic Marica , Palibrk I. , Jankovic Zorica
Published: November 2008

Enterai nutrition can be applicated alone or in combination with, parenteral nutrition. Enterai feeding should be applicated as early as possible in preoperative preparation or in postoperative period in respect of contraindications and everyday evaluation of patients. Immunomodulatory substances like arginin, 3-o-fat acids, ribonucleic acid and glutamine are incorporated in "ready to use" solution for enterai feeding. Enterai feedings oral or via tubes are safe if some precautions are taken: like sitting position and control of feeding tubes position. Use of jejunostomy and promotility agents improved enterai feeding after major abdominal surgery and acute pancreatitis. Enterai feeding and immunonutrition improved postoperative course in reduction of hospital stay, incidence of postoperative complications especially infections. The aim of this review article is to validate pro and con for enterai nutrition in preoperative and postoperative course.
Fasciokutani reznjevi u rekonstrukciji mekotkivnih defekata potkolenice
Authors: Trenkic Srbobran , Visnjic Milan , Stevanovic Goran , Stojiljkovic Danilo
Published: November 2008

Reconstruction of soft tissue defects of the lower leg from 1966.-2003. using fasciocutaneus flaps is discussed in this paper. Our experience with soft tissues defects in 69 patients is shown here. Different types of fasciocutaneus flaps were used (proximaly and distaly based fasciocutaneus flap, island, fasciosubcutaneus?) based on septocutaneus perforators of all 3 main arterial trunks of the lower leg. We had complete or almost complete necrosis in only 4 patients, whereas in other patients flaps survived. Results obtained using fasciocutaneus flaps, even in reconstruction of war wounds convinced us that fasciocutaneus flaps are reliable method of reconstruction of the soft tissue defects of the lower leg, especially its distal third and regions of malleoli.
ErbB-1 experssion in experimental model of inflammatory bowel disease in rats
Authors: Trzcinski R. , Bry M. , Krajewska W. , Kulig M. , Dzyiki A.
Published: November 2008

Background Ulcerative colitis (UC) and Crohn?s disease (CD) belong to inflammatory bowel disease (IBD). The etiology of IBD is still unknown. Therapy remains empiric or is used for the relief of specific symptoms. The erbB-1 oncogene coding epidermal growth factor receptor (EGFR) is typed as a prognostic marker in several benign and malignant tissues. The aim of our study was to examine the erbB-1 expression in experimental surgically performed model of IBD in rats and to find out if there is any correlation between severity of the intestinal inflammation and altered level of erbB-1 expression. After inducing an experimental colitis samples were taken from different parts of the intestine in all studied groups of rats for histopathology. ErbB-1 mRNA expression was estimated by RT-PCR. PCR products were separated on a 1,5% TBE-agarose gel and visualized with ethidium bromide. The integrated optical density (IOD) of electrophoretically separated amplification products was measured using a video densitometer and Gel-Pro 3.0 software. Nonparametrical statistical test has been used throughout in analyzing the results. Relative erbB-1 expression was determined by comparing to cyclophiline expression. Results Microscopic changes were similar to those observed in IBD. ErbB-1 expression was significantly higher in inflamed tissues of the bowel ( P=0.04 for the transverse colon and P=0.027 for the cecum). Significantly higher erbB-1 expression in inflamed tissues of the bowel suggests that EGFR overexpression may play a role in the pathogenesis of IBD. Overexpression of erbB-1 correlates with the severity of inflammation in bowel tissues.
Systemic treatment of colorectal cancer in Serbia: What have we done and what can offer in the new centry
Authors: Popov Ivan
Published: November 2008

The treatment of patients with metastatic colorectal cancer (mCRC) has changed dramatically over recent years in Serbia. The more optimal use of 5- fluorouracil (5-FU) in association with leucovorin (LV), the development of new drugs such as oxaliplatin and irinotecan and of the oral fluoropyrimidines, such as capecitabine, have increased therapeutic options and to the improved outcome of patients with mCRC. Throughout our 10- years published papers in international journals, we presented development of chemotherapy for mCRC and improvement in treatment outcome in Serbia. It is shown that combination therapy with 5-FU/LV and oxaliplatin or irinotecan is more active than 5-FU/LV in first line treatment of mCRC. Sequential therapy with FOLFIRI+FOLFOX was the most efficacious combination in comparison to any other 2 drugs combinations. The combination protocols in second line were superior to mono irinotecan and equal to LV5FU2 in terms of time to progression. The oral fluoropyrimidines seems to have an activity comparable to that of i.v. 5-FU/LV. New agents acting on novel targets are under development. Angiogenesis inhibitors, epidermal growth factor inhibitors, COX-2 inhibitors and farnesyl transferase inhibitors might play a role in the future in the treatment of CRC. We will present our first experience with bevacizumab, vascular endothelial growth factor inhibitor.
Ulcerative colitis indications and timing for surgery
Authors: Barisic Goran , Krivokapic Zoran , Markovic V. , Saranovic Djordjije , Masulovic Dragan
Published: November 2008

Surgery continues to have a major role in the management of ulcerative colitis because it may save the patient?s life, eliminate the long-term risk of cancer, and most important, abolish the disease. Treatment of ulcerative colitis still remains the challenge despite growing knowledge about the disease, advances in medical treatment and surgical techniques. Indications and optimal timing for surgery are the mainstays of good outcome and are as important as the quality of medical therapy and surgery. Ulcerative colitis is a complex disease where medical and surgical treatment frequently overlap and clinical decision making should be in hands of well trained and experienced team consisting of surgeon, gastroenterologist, radiologist and pathologist. Recently developed drugs, with high potential in the treatment of severe attacks of ulcerative colitis brought some changes in therapy and indications for surgical treatment. Although as many as half of patients with inflammatory bowel disease require at least one surgical procedure to address complications derived from their disease, the decision in favor of a surgical approach and its timing is rarely an easy one.
Protective - ventilation strategy in the acute respiratory distress syndrome
Authors: Bumbasirevic Vladimir , Bukumirovic V. , Popovic Nada , Nikolic V. , Kalezic Nevena , Vlajkovic G. , Karamarkovic Aleksandar , Sijacki Ana , Bajec Djordje , Rankovic Vitomir
Published: November 2008

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) contribute to progressive hypoxemia in critically ill patients. It has been proved that conventional mechanical ventilation with physiological respiratory volume contributes to further lung damage. In this respect, application of protective ventilatory strategy - pulmonary ventilation with limited volume and pressure can avoid mentioned consequences. The aim of this paper is to discuss mechanims by which elements contained in protective mechanical ventilation of patients with ALI/ARDS prevent further progrssive lung injury, to argue the effects of positive end - expiratory pressure and present insturctions for its application.
Primary liver cancer mortality in Belgrade population
Authors: Kanazir M. , Jarebinski Mirjana , Delic Dragan , Boricic Ivan , Gledovic Zorana , Pekmezovic Tatjana
Published: November 2008

The aim of this analysis was to estimate death rates for primary liver cancer (PLC) and their secular trends in the population of Belgrade during the period 1982-2001. Mortality data (number of deaths caused by PLC) in Belgrade were obtained from the Belgrade Municipal Institute of Statistics (unpublished data). Death rates per 100,000 population were adjusted by direct method using world population as a standard. Regression coefficient was assessed by Fisher?s test.,Average annual age-adjusted mortality rate for PLC in Belgrade was 5.7/100,000 (95%CI-confidence interval 5.3-6.0), for males 7.5/100,000 (95%CI 7.0-7.9), and for females 4.2/100,000 (95%CI 3.8-4.7). The lowest mortality for PLC was in the age up to 45 (bellow 1/100,000) for both sexes, and the highest values were registered in the age group over 75, 71.1/100,000 (95%CI 62.2-84.0) for males, and 52.9/100,000 (95%CI 45.6-60.3) for females. Mortality trends for PLC in Belgrade in the period 1982-2001 showed increasing tendency in males (y=7.079+0.039x, p=0.331) and decreasing tendency in females (y=4.747- 0.048x, p=0.199).
Plantago ovata (Laxomucil) after hemorrhoidectomy
Authors: Kecmanovic Dragutin , Pavlov Maja , Ceranic Miljan , Sepetkovski Aleksandar , Kovacevic Predrag , Stamenkovic Aleksandar , Masirevic Vesna , Rankovic Vitomir
Published: November 2008

The aim of this prospective randomized study is to describe the effects of laxative plantago ovata after open hemorrhoidectomy (Milligan-Morgan). Sixty patients divided into 2 equal groups were included in this study. The first group was treated postoperatively with 2 sachets of bulk agent Laxomucil (3,26 g plantago ovata), twice daily, for a period of twenty days, while the control group was treated with glycerin oil. The p.ovata group patients had a statistically significant shorter postoperative length of hospital stay (2,9 v.s. 4,1 days). Pain after stool was statistically significant more tolerable in the p.ovata group. In conclusion, the application of bulk agent plantago ovata after hemorrhoidectomy shortens the mean postoperative hospital stay, expedites digestive function recovery and lessens the pain after stool.
Cancer pain: Classification and pain syndromes)
Authors: Slavik Eugen , Ivanovic S. , Grujicic Danica
Published: November 2008

In spite the new information's about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of which vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullar pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.
Cancer pain: Neurosurgical management
Authors: Slavik Eugen , Ivanovic S.
Published: November 2008

The management of cancer pain represents a difficult diagnostic and therapeutic problem for the clinician. In a multidisciplinary approach to the management of cancer pain, neurosurgical methods are an essential part of the therapy. Frequently, patients with advanced cancer suffer from an increasing pain, requesting ever higher dosage of narcotics, and finally seeming to respond only to high dosage of intravenous narcotics. Gradually, the opioids produce less satisfactory analgetics effects an more serious side manifestations. These patients can be considered for surgical management of pain. Historically, surgery for cancer pain began with destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative. In past two decades, with the help of the current knowledge of cancer pain mechanisms and some of the technological developments, such as microsurgical and stereotactic techniques, computerized tomography and magnetic resonance imaging, the majority of ablative procedures have been replaced by new methods. Among them a few are selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone operation, limited midline myelotomy) and the others ones are neuroaugumentative operations ( deep brain structures and spinal cord stimulation, drugdelivery systems).
Avulzije zavrsnih grana trigeminalnog nerva
Authors: Ivanovic S. , Bascarevic V. , Samardzic M. , Rasulic L. , Misovic M.
Published: November 2008

There are variety of surgical methods in treating trigeminal neuralgia. They can all be devided in two large groups: less invasive procedures and decopmressive procedures in the region of pontocerebelar angle. Peripheral neurectomy, exeresis or avulsion of peripheral branches of trigeminal nerv are methods for elderly patients with serious cardiopulmonal disturbances. We performed avulsion of peripheral branches at 58 patients, all older than 60 years. In 32 patients we did avulsion of only one of three branches of trigeminal nerv, while in 26 patients the combined avulsion of two branches was performed. There were no postoperative complications.
Hordotomija u lecenju bolnih stanja
Authors: Ivanovic S. , Slavik Eugen , Spaic M. , Antic Branislav , Samardzic M. , Rasulic L.
Published: November 2008

During the time interval from January 1978 to January 2003, total of 128 chordotomy procedures have been done due to cancer?s pain at the Institute of neurosurgery in Clinical Center of Serbia. That pain has been mostly of uncontrolled intensity and it was resistant on applied conservative treatment. Bilateral chordotomy has been performed in 6 patients only in exceptional cases when fixed paraplegia has proved; unilateral chordotomy has been performed in 122 cases. Bilateral chordotomy is much more dangerous than unilateral one because of greater possibility of appearance of motor deficits, sphincteral disturbances or subsequent formed pain. This procedure has several negative aspects. Firstly, it is an opened surgical intervention in general anesthesia and therefore, there is no communication with patient. We had a habit to perform DREZ surgery rather than chordotomy when ever it has been indicated. In 80.1% of all cases, the successfulness of surgery has been marked as excellent, in 15.2% of all cases, it has been marked as good, and in 4.7% of all cases, bad outcome has been detected. The rate of complication was 4.4%.
Terapijski pristup bolnim sindromima posle povreda perifernih nerava
Authors: Bascarevic V. , Samardzic M. , Ivanovic S. , Micovic M. , Cvrkota I.
Published: November 2008

There are a variety of reasons that pain might persist beyond the period of normal healing, and usually these reasons are complex and multifactorial. The acute phase of denervation of muscles, especially that of large ones, can be quite painful. Also, during the early months of regenerative process patient may experience associated paresthesias or dysesthesias. Such a pain pattern is self limited, just as is the regenerative process. Neuropathy is a condition in which pain impulses are generated and perpetuated by injured, malfunctioning nervous tissue itself. Causalgia and reflex sympathetic dystrophy are terms reserved to describe a very characteristic burning pain, accompanied by hyperesthesia and autonomic disturbances. In this study we analyzed a series of 727 patients operated on Institute of neurosurgery with injury of one or more peripheral nerves, and 170 patients with brachial plexus injury.
The role of endosonography (EUS) in preoperative staging of patients with stomach cancer
Authors: Pavlovic A.R. , Krstic M. , Tomic D. , Bjelovic Milos , Pesko Predrag , Stojakov D. , Krstic S.
Published: November 2008

Background: To evaluate the diagnostic accuracy of endosonography (EUS) in preoperative staging of stomach cancer. Methods: Sixty-two patients with gastric carcinoma were investigated by endosonography. 49 underwent surgery. EUS reports were compared with operative and histology findings. Tumours were staged according to the 2000. TNM classification. Results: EUS had a diagnostic accuracy of 89,8% for the T category, 83,7% for the N category. Conclusion: EUS is an excellent clinical procedure for the staging of local-regional spread of gastric cancer and useful complement to the other gastrointestinal examinations for evaluation of these tumours.
Changes in concentrations of sera proteins in war wound
Authors: Radakovic Sonja , Surbatovic Maja , Stankovic Nebojsa , Filipovic N.
Published: November 2008

During the general reaction to trauma, substantional changes in protein composition of sera occur. The aim of the prospective study was to investigate net change in total protein and albumin concentrations, as well as albumin/ globulin ratio in sera of war casualties during the first 14 posttraumatic days, and to establish the correlation between these changes and severity of trauma. Subjects were 79 war casualties. Controls: 33 blood donors. Methods: Injury severity was determined according to ISS and blood samples were collected 12 hours after trauma, then on the 1st, 2nd, 5th and 14th posttraumatic day. In war casualties values of total protein and albumin concentrations and albumin/globulin ratio were significantly decreased. Minimal concentrations were measured on 2nd posttraumatic day (589.04 g/l for total proteins, p; 36.66.21 g/l for albumins, p) or on 5th day (0.860.2 for albumin/globulin ratio, p). Conclusions: During the acute-phase response to trauma, significant changes in concentration of total proteins, albumins and albumin/globulin ratio occur in sera of war casualties. These changes are the most prominent during the first 5 days, with tendency for normalization after that. Intensity of these changes depends of the severity of trauma.
Endoscopic ultrasound (EUS) in staging and follow-up of patients with malt lymphoma treated conservatively
Authors: Pavlovic A.R. , Krstic M. , Tomic D. , Bjelovic Milos , Jesic R. , Suvajdzic Nada
Published: November 2008

Background: Endoscopic ultrasonography (EUS) is an important tool for diagnosis and pretreatment staging of primary gastric lymphoma. The aim of the study was to evaluate the diagnostic importance of endosonography (EUS)in gastric lymphoma; to assess the depth of tumoral infiltration in low-grade gastric lymphoma of mucosa-associated lymphoid tissue (MALT) and to assess EUS response to medical treatment (Cyclophosphamid/Mabtera and/or anti-Helicobacter pylori therapy). Methods: 26 patients with MALT gastric lymphoma were investigated by EUS. Six of them were evaluated after the eradication of Helicobacter pylori infection and 20 after and during the cyclophosphamide/Mabtera and anti H.pylori treatment. EUS staging was compared with histopathology. Tumors were staged according to the 2000 TNM and modified Ann Arbor classification. Results: Six patients were treated with anti - Helicobacter pylori eradication therapy. Full regression of lymphoma was observed in 2 of 6 (33.3%) patients, which was endoscopicaly and histologicaly proved. EUS correlated with histology in all (6/6). In 20 patients treated with cyclophosphamide/Mabtera therapy, EUS revealed regression of lymphoma in 14 cases. Positive correlation with histology was found in 11 patients (11/14; 78%). The initial EUS showed an increased wall thickness more than 5mm in 24 of 26 patients (92%). The thickening was predominantly of mucosa and submucosa and in 11 patients extended the muscularis propria. After the therapy, the gastric wall thickening returned to normal in 14 patients, however, 3 of them still had positive histology findings. In 2 cases, during the follow-up, the EUS showed remained thickening of gastric wall, whereas biopsies were negative. Six months later histology revealed progressive low-grade MALT lymphoma in this cases. Conclusion: EUS appears to be a sensitive procedure for initial staging and assessment of treatment response and long-term follow up in patients with gastric lymphoma. The importance of EUS lies in ability to detect relapse early, too.