bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic ultrasound guided aspiration biopsy, neurolysis of coeliac plexus and punctures: Personal experience
Authors: Milinic Nikola
Published: November 2008

Endoscopic ultrasonography, as relatively new diagnostic procedure, has made a significant progress in detection and presentation of small lesions of digestive tract, as well as in other organs. By introducing linear ultrasonography in clinical practice, the possibilities of this procedure became even more apparent, enabling even more precise diagnosis and various therapeutic procedures. With endoscopic ultrasound (EUS) guided aspiration biopsy it is possible to obtain samples in specific, well defined layer of gastrointestinal tract wall, and also from different parts of other organs and formations, which finally enables establishing definite patohystologic diagnosis. First linear EUS procedure in this part of south-east Europe, was performed in University Clinical Center "Bezanijska Kosa" (N. Milinic, M. Petrovic) in 1999, and first EUS guided aspiration biopsy was performed on July 4th 2000 (N. Milinic - biopsy of pancreas). Using "Pentax " FG-36UX linear echo-endoscope, until now, 40 pancreas biopsies, 34 stomach biopsies, 9 biopsies of mediastinal lymph nodes, cysts and tumors, 22 biopsies of masses in retroperitoneal region, 7 biopsies of papilla Vateri, 4 biopsies of left suprarenal gland, 2 punctures of renal cysts, 14 biopsies of focal liver lesions, 2 punctures of liver cysts, and 5 neurolyses of coeliac plexus was performed. From 134 EUS guided biopsy samples, 114 was, according to pathologist, adequate for patohystologic evaluation, and in 96 cases obtained samples was essential for obtaining definite diagnosis. The major problem in this issue was a lack of well trained and experienced cytologist, as also is the current problem in Western countries with more experience and practice in this field. EUS guided aspiration biopsy, as the procedure itself, was successful in all cases. There were no major complications during the procedures, mainly because of using Colour-Doppler technique in differentiating vascular from other structures. Results so far are showing that linear endoscopic ultrasonography is extremely precise diagnostic method, and should be used in establishing definite diagnosis in many well defined indications, and also is showing the consecutive need for specially trained and experienced citologists.
Phlebodia (diosmine): A role in the management of bleeding nonprolapsed hemorrhoids
Authors: Kecmanovic D. , Pavlov M. , Ceranic M. , Sepetkovski A. , Kovacevic P. , Stamenkovic A.
Published: November 2008

The aim of this study is to describe a role of diosmine in the management of bleeding nonprolapsed hemorrhoids. From November 2003 to January 2004, 60 patients were treated with Phlebodia (diosmine). Total colonoscopy was performed at the discretion of the authors according to the age, symptoms and genetic factors of the patient. Patients were treated with Phlebodia (diosmine, 3x1, 5 days) and in addition a bulk agent (3,26 g plantago ovata sachet, twice daily, for the period of next three months). Hemorrhoidal bleeding stopped after 3,2 days. Diosmine, used with fiber supplements, rapidly and safely stops bleeding from nonprolapsed hemorrhoids.
Idiopathic avascular necrosis of the femoral head in adolescents: Diagnostics and management
Authors: Slavkovic Slobodan , Bumbasirevic Marko , Tomic Slavko , Lesic Aleksandar , Slavkovic Nemanja
Published: November 2008

Idiopathic avascular necrosis of the femoral head still represents incompletely explained clinical entity. In the period 1978-2003. we have treated sixteen hips in ten patients with this condition in the IOHB "Banjica". Diagnosis have been founded on clinical and radiographic features, in addition to MRI findings. One patient have been operated, curretaging necrotic part of the femoral head and placing homografts instead. The other fifteen patients have been treated by the same procedure: skin traction for several months following immediate rehabilitation of the hip. The goal of treatment was reducing the pain, increasing the range of movements and preservation of the normal joint space. Evaluation of the treatment was based on unique criteria founded on Howorth-Ferguson index, clinical and radiographic features. The follow-up period was 2-7 years. The authors have stressed the following advantages of the non-operative treatment in adolescents with idiopathic avascular necrosis if the femoral head: increased range of joint movements, decreased pain and low risk rate of any complications following surgical procedures. Formed changes in the femoral head are irreversible, and they are real basic for premature arthrosis of the hip.
Rigid-fix Pins fixation and LCA reconstruction with semitendinosus/gracilis autograft
Authors: Blagojevic Z. , Stevanovic V. , Radulovic N. , Kadija M.
Published: November 2008

ACL reconstruction techniques highly developed during the decades and biomechanical tests for hamstrings graft showed much in advance loading and stiffness comparing BPTB grafting. We have made joint analysis of 30 patients with semitendinosus/gracilis ACL reconstruction. Choice for proximal fixation was Mitek Rigid-fix Pins technique and bioactive screws for distal fixation; in 18 cases bioactive screws were used for femoral and tibial graft fixation. Lysholm score and knee clinical tests were parameters used for outcome evaluation. Follow up averaged 6 months with assessment after 1, 3, 6 and 12 months. Our results showed excellent postoperative Lysholm score in 85% and very good in 15% of cases. Postoperative Lachman was 1+ in 15% and postoperative pivot shift was 0%. Full rehabilitation achieved 85% and with modifications in everyday activities 15% of patients. Donor localization morbidity was markedly reduced and we have no complications. On the basis of the improved results in graft compression as well as stability with this technique, applied method is highly recommended for the reconstruction in ACL deficient knees.
Takayasu’s aortoarteritis
Authors: Davidovic Lazar , Sindjelic R. , Jovanovic Z. , Bozic V. , Markovic D.
Published: November 2008

Surgical treatment of two female patients aged 32 and 41 years, with neurological problems causes by type I Takayasu?s aortoarteritis, are presented here. both of them were treated with by pass from ascending aorta to left common carotid and left subclavian arteries, using transsternal approach. During the follow up period (3.5 years for the first, and 2 years for the second patient) both patients were free of neurological symptoms. Corticosteroid therapy was given to the first patient for controlling of active diseases, immediately after the operation and during the first three postoperative months. By this reason an infection at the proximal part of sternal wound was developed. MRI showed involvement of the vascular graft. Due to high risk of reoperation, medical treatment was performed. Takayasu?s aortoarteritis is very uncommon in our country, as well as in other countries which don?t belong to Far East. In cases with hemodinamic important arterial lesions produced disabling symptoms, a standard PTA and reconstructive vascular procedures are indicated. Takayasu?s aortoarteritis is a complex disease. It requires combined diagnostic and therapeutic approaches which produce satisfied long-term results.
Clinical correlation, ecographic and levels of prostate specific antigen in patients with prostate cancer
Authors: Salirrosas Victor , Armborgo Jose , Mostacero Mario
Published: November 2008

Purpose: this report provides information about clinical correlation, ecographic and levels of prostate specific antigen in patients with prostate cancer in the Regional Hospital from Trujillo, Peru. Materials and Methods: retrospective, descriptive observation study of all the clinical histories from patients with histopathology diagnosis of prostate cancer during the period of January 2000 - December 2004. The sample was constituted by 60 patients with clinics histories, study by image based on the prostate ecography and the prostate specific antigen results. The average of age found was of 75.4 years old; the most frequent clinical case reported a 91.6% of patients with obstructive and irritative symptoms. In the levels of prostate antigen the PSA found values between 10-50 ng/ml, in 48.78% of the patients. In the ecography prostate study there where evidence of hypoecogenic images in 56%, hyperecogenics images 12%, heterogenics images 20% and 12% homogenics images. In the TNM classification the higher percentage is located in T stage with an 81.67%, and in smaller proportions in the N1 and M1 stages with 8.33% and 10.0% respectively. According to Gleason it was found levels from 2-4 with 36.67%, in the level 5-7 with 23.33% and in the level 8-10 with 40.0%. Conclusions: All the patients with prostate cancer showed a clinical symptoms about, obstructive and irritative and in other organs a less percentage of symptoms that shows metastases; in more than a half of the patients, the digital rectal examination showed nodules and irregularities in its surface; in the prostate ecography it is report a higher percentage of hypoecogenics images suggestive of neoplasia. The levels of specific prostate antigen in more than 70% of the patients where over of 10 ng/ml; in the totally of the patients the histological type most frequent is the Adenocarcinoma, with a high grade of percentage of patients who had been bad prognosticated according to the Gleason score. According the NTM, more of the two thirds parts of patients with prostate cancer are in T stage, with a high percentage extending on the prostatic capsule.
Ultrasound guided biopsy, a gold standard diagnostical test of the prostate cancer
Authors: Romics I.
Published: November 2008

The author discusses preparations for ultrasound guided prostate biopsy, its technique conditions and the process of performing a biopsy. Every author proposes the use of preoperative antibiotics based prophylaxis. Differences may be found in the type, dosage and the time span of preoperative application. For anesthesia mostly lidocaine was proposed, which may be a gel applied in the rectum or used in the form a prostate infiltrate. The widest debate goes on in respect of defining the number of biopsies needed. Recently 8 or rather 10 samples are proposed to be taken. Twelve biopsies do offer an advantage compared to 6 although in case of 8 this isn?t so. According to the site of sample taking the apex, the base and the middle part are proposed. In case of a palpable nodule or any lesion, made visible by TRUS an additional, targeted, biopsy has to be performed. Certain new techniques like the 3D Doppler, contrast, intermittent and others shall also be presented. A repeated biopsy shall be necessary in case of PIN atypia, beyond that the author also discusses other indications for a repeated biopsy. We may expect the occurrence of direct postoperative complications and it is necessary to know how to treat these.
Determination of biochemical relapse after radical prostatectomy by biological detection limit (BDL) after cystoprostatectomy using two PSA assays
Authors: Hadzi-Djokic Jovan , Lalic N. , Dzamic Z. , Acimovic M. , Tulic C. , Markovic Z.
Published: November 2008

The monitoring of PSA values following prostatectomy demands for the use of highly sensitive tests with low detection level. The possibilities to use the EIA Dialab test to monitor the PSA values after radical prostatectomy for early detection of persistent diseases were investigated by determining the biological detection limit (BDL) in serum of patients who unrewent cystoprostatectomy. The obtained values were compared with Abbott Imx test for PSA determination. A good correlation between the two studied methods was established, r = 0.9827 with the regression curve Yx = 0.20463 + 0.96277. Test indicated that there was no significant difference (p<0.001) between the investigated methods.
Radical radiotherapy for localized prostate cancer in elderly
Authors: Stojanovic S. , Radosevic-Jelic Lj. , Tulic C. , Popov I. , Babic D. , Acimovic M. , Masulovic D.
Published: November 2008

Background: Prostate cancer is an age related neoplasm, with high incidence in the group of elderly man. The correct management must to be balanced between the benefits of the treatment and its disadvantages. Radiotherapy as definitive treatment is commonly reserved for older patients and patients with high surgical risk and is widely used as a treatment of choice. Aim: The aim of this study was to determine the role of radical radiotherapy for localized prostate carcinoma in patients 70 years age or older concerning treatment morbidity, local control, disease free and overall survival. Material and methods: A clinical prospective non-randomized study was performed including 103 elderly patients with an age 70 or above, between January 1991 and April 2005, at the Institute for Oncology and Radiology of Serbia. Median age of patients was 74,89 years (range 70- 80 years). Stage distribution was as follows: stage A - 3 patients (2.9 %), stage B - 69 patients (67%) and stage C - 31 patients (30. l%). Out of 103 patients, initial PSA value was noted in 87 patients. The mean value of initial PSA was 18,06 ng/ml. Radical radiotherapy was conducted on megavoltage linear accelerators with high energy photons (10, 18 MeV) and total tumor dose of 65 Gy. Results: Low grade acute complications were registered in 70 patients (65%). Mean follow up time was 40, 13 months. The disease outcome at the last follow up show that 79 patients (76.7%) had no evidence of disease and 24 patients (23.3%) relapsed. Overall survival rates were 65, 29% and 44, 52% and disease free survival 66, 59% and 63, 26% at 5 and 10 years. Disease specific survival was at 5 and 10 years 73,32% and 65, 42% respectively. Late sequels (gradus I and II) are registered in 22 patients (21.36%), out of 103. Conclusion: Radical radiotherapy for localized carcinoma of the prostate is effective treatment option in elderly patients with good local control, present treatment tolerance providing good quality of life and long term cure.
Splenic artery aneurysms
Authors: Colovic R. , Davidovic L. , Bilanovic D. , Krivokapic Z. , Grubor N. , Cvetkovic S. , Radak V. , Markovic M.
Published: November 2008

Although the third most frequent aneurysm in the abdomen, after aneurysms of the aorta and iliac arteries, and most frequent aneurisms of visceral arteries, splenic artery aneurysms are rare, but not very rare. Thanks to the new imaging techniques, first of all ultrasonography, they have been discovered with increasing frequency. We present a series of 9 splenic artery aneurysms. Seven patients were female and two male of average age 49 years (ranging from 28 to 75 years). The majority of affected women were multiparae, with average 3 children (ranging from 1 to 6). One patient had a subacute rupture, and 2 had ruptures into the splenic vein causing portal hypertension. The spleen was enlarged in 7 out of 9 patients. The average size of aneurysms was 3,2 cm (ranging from 2 to 8 cm). The preoperative diagnosis of splenic artery aneurysm was established in 6 patients while in 3 patients aneurism was accidentally found during other operations, during splenectomy in 2, and during the excision of a retroperitoneal tumor in 1 patient. Aneurysmectomy was carried out in 7 patients, while a ligation of the incoming and out coming wessels was performed in 2 patients with arteriovenous fistula. Splenectomy was performed in 6 patients, while pancreatic tail resection, cholecystectomy and excision of the retroperitoneal tumor were performed in 3 patients. Additional resection of the abdominal aortic aneurysm with reconstruction of aortoiliac segment was performed in 2 patients. There were no mortality and the postoperative recovery was uneventful in all patients.
The impact of diabetes mellitus on postoperative morbidity in laryngeal surgery
Authors: Jovanovic M. , Perovic J. , Grubor A.
Published: November 2008

The main aim of this study was to analyze risk factors of postoperative morbidity after extended laryngeal surgery comparing patients with diabetes mellitus and non-diabetic patients. In retrospective study 69 patients (63 male and 6 female), who underwent partial laryngo-pharyngectomy and total laryngectomy between 2003 and 2004, were evaluated. 13 % of the total group of examined patients had concurrent diabetes, while 87% were nondiabetic patients. We performed partial laryngopharyngectomy in 39 out of 69 patients (56.5%) and total laryngectomy in 30 patients (43.5%). Secondary wound infections (88.9%) and pharyngocutaneus fistula (44.5%) had a significantly higher rate in diabetic patients (p<0.001). Among diabetics the cases with intraoperative or postoperative blood transfusions were more frequent - 44.4%(p<0.001). Diabetic patients with laryngectomy procedures had more frequently prolonged postoperative anemia (55.5%, p<0.001) and electrolitic disbalance (66.6%, p<0.001). Our results have confirmed that diabetes mellitus is an important independent general clinical factor, which increases postoperative morbidity and hospitalization time in laryngeal surgery. Our data indicate the need to make a very serious plan and clinical assessment for laryngeal surgical therapy in diabetic patients.
Posebnosti anatomije arterije cistike kod minimalno invazivnog hirurskog pristupa
Authors: Ignjatovic D. , Zivanovic V. , Vasic G. , Kovacevic-Mcilwaine I.
Published: November 2008

Large patient series undergoing laparoscopic cholecystectomy fail to show anatomic variations which lead to intraoperative bleeding. Method: Cadaver material was used and corrosion casting and postmortem arteriography were employed. Results: Three types of cystic artery were devised according to the results. Type 1 normal anatomy. Type 2 more than one artery in Calots triangle and Type 3 no artery in Calots triangle. Discussion: only 40% of the second cystic artery is present in Calots triangle. The short second cystic artery is characteristic and its most often origin is from a segmental branch of the right hepatic artery. When there is no artery in Calots triangle its origin unusual, and the artery is either on the postero-lateral side of the cystic duct or it approaches the gallbladder through hepatic tissue. The specifics of MIS approach make changes in the way we understand the anatomic variations of the cystic artery. The classification is a result of practical experience and anatomical investigations.
The tunneld supracla vicular island flap - a fasciocutaneous flap for head and neck reconstructions
Authors: Jeremic J. , Nikolic Z. , Colic M. , Jeremic K.
Published: November 2008

Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. We have found that the shoulder is a region providing an optimum skin texture match to the neck and face. Fasciocutaneous island flap, nourished by the supraclavicular artery is used purely as a subcutaneously tunneled island flap. The tunneling maneuver significantly improves the donor site by reducing scarring. The flap is characterized by a long subcutaneous pedicle of up to 20 cm. The pivot point is in the supraclavicular region and allows the flap to be used in the upper chest, neck, chin, and cheek. In this article we present clinical cases in reconstructive procedures with supraclavicular flap and its expanded indications.
Cytoreductive approach to peritoneal carcinomatosis originated from colorectal cancer: Turkish experience
Authors: Füzün Mehmet , Sökmen Selman , Terzi Cem , Emre-Canda Aras
Published: November 2008

Peritoneal carcinomatosis (PC) in contrast to lymph nodes and liver metastases was assumed as a terminal condition with no curative treatment options having a 5 to 9 months median survival rate until recently. Today, in properly selected patients, curative surgical treatment of PC is possible like resection of lymph nodes and liver metastases. Between 1996 and 2005, 29 patients who underwent cytoreductive surgery combined with intraperitoneal chemotherapy for PC originated from colorectal cancer (CRC) were analyzed prospectively at the Department of Surgery in Dokuz Eylul University Hospital. Mean age was 54 year (range, 23-75 years). There was no peroperative mortality in 29 patients. The morbidity rate was 41% (12/29) and 6 (20%) patients required reoperation(s) for major complications. Mean and median survival time was 34 and 21 months, respectively. The overall 1-year, 3-year, and 5-year survival rates were 72%, 13%, and 7%, respectively. Mean survival time was 56 months in patients with peritoneal cancer index (PCI) <10, and 22 months in patients with PCI >10 (P=0.075). The mean survival time was 62 months in patients with complete cytoreduction (CC)-0 score, 21 months in patients with CC-1 score, and 7 months in patients with CC-2 and 3 scores. Patients who had CC-0 score had better survival than patients having CC-1 and CC-2 scores (P = 0.003 and P = 0.000, respectively). Patients who had CC-0 and 1 scores had better survival than patients with CC-2 score (P = 0.000). The overall 1-year, 3-year, and 5-year survival rates for patients with CC-0 score were 87%, 37%, and 25%, respectively. There was a positive correlation between the PCI and CC score (P = 0.001, correlation coefficient = 0.585 with correlation is significant at level 0.01). Cytoreductive approach combined with intraperitoneal chemotherapy and systemic chemotherapy prolongs survival in selected patients with PC of CRC with acceptable morbidity and mortality. Prognosis is better in patients with limited disease and in whom complete cytoreduction is achieved. In patients with PC of CRC, the key issue is to select the patients in whom complete cytoreduction is feasible. Better patient assessment with new diagnostic tools such as (PET)-CT or PET-magnetic resonance imaging will be used to detect more precisely the patients with low tumor burden in the new feature.
Recto-vaginal/urethral fistula: Repair with gracilis muscle transposition
Authors: Rabau Micha , Zmora Osnat , Tulchinsky Hagit , Gur Eyal , Goldman Gideon
Published: November 2008

This study was designed to assess the efficacy of gracilis muscle transposition in repairing rectovaginal and rectourethral fistula. All patients had fecal diversion as a preliminary or concurrent step to fistula repair. Success was defined as healed fistula after stoma closure. Results: Six females and four males underwent gracilis muscle transposition from 1999 to 2006. Gracilis muscle transposition is a viable option for repairing fistulas between the urethra, vagina and the rectum, especially after failed perineal or trans-anal repair. It is associated with low morbidity and good success rate. Underlying Crohn?s disease and previous radiation are associated with poor prognosis.
Parastomal hernia repair: Bielañski hospital experience
Authors: Szczepkowski Marek , Gil Grzegorz , Kobus Adam
Published: November 2008

The most common occurred long-term stoma complication is parastomal hernia (PH). The incidence of this complication reaches 50% and, according to Goligher1, the parastomal hernia is an inevitable consequence in a certain percentage of all cases of stoma formation. The factors that may affect the incidence of parastomal hernia include the site of stoma, particularly its position relative to the rectus muscle of abdomen, preoperative mapping out of the stoma site, stoma diameter, intraperitoneal or extraperitoneal bringing out of the intestine and its fixation to fascia, closing of the area around the stoma opening, the mode of operation - planned or emergency, and finally the kind of stoma - ileostomy, colostomy, end stoma and loop stoma. None of these factors, however, has been identified to have the key importance in parastomal hernia formation. It seems that the only factor that significantly increases the incidence of parastomal hernia is the length of post-operative period.
Endorectal ultrasound (ERUS) in pelvic disorders
Authors: Barisic G. , Krivokapic Z. , Markovic V. , Saranovic D. , Kalezic V. , Sekulic A.
Published: November 2008

Endorectal ultrasound (ERUS) imaging is a complex process using electronic devices to control ultrasound waves and produce images of anatomic structures. It is a simple, cheep and well-tolerated procedure that provides excellent images of rectal and anal canal wall and pelvic floor muscles together with surrounding organs and tissues. The direct imaging of anal canal and pelvic floor muscles with surrounding tissues allows one to identify sphincter defects, anorectal abscesses and fistulas as well as great variety of benign and malignant pathology of the pelvis. Basically, techniques for ERUS are very similar, but there are some slight modifications regarding equipment, indications, and localization of pathologic process. We describe the technique, indications, results and pitfalls of ERUS with the Bruel & Kjaer type 1850 endosonic probe with 7 and 10 MHz transducers in benign pelvic disorders. .
Diagnostic and therapy of locally advanced rectal cancer
Authors: Breberina M. , Petrovic T. , Radovanovic Z. , Bokorov B. , Vujosevic B. , Jankovic Lj. , Kukic B. , Miucin-Vukadinovic I. , Manic D. , Plzak A. , Patrnogic A. , Selakovic V.
Published: November 2008

The aim of the study was to check the results of the protocol with neoadjuvant chemoirradiation for the treatment of locally advanced rectal cancer. The value of preoperative methods for staging of rectal cancer was also studied. In the period 1st 0f June 2000 - 31st of December 2005, 116 patients were included into the study, all with histologically proven rectal cancer up to 12 cm from anal verge and all with T3/T4 No-2 M0 stage. Median follow up was 48 months. Operability rate was 90,1%, local recurrence 12%, and survival 78%, though only 66% without sign of local or distant recurrence.
Laparoscopic treatment for acute diverticular disease
Authors: Pignata Giusto
Published: November 2008

Diverticular disease of the sigmoid colon involves more than 50% of population over 60 years, and much more in people older than 80 years. Most patients remain asymptomatic, but, about 10-20% develop complications requiring surgery. Colonic diverticulitis represents an acute bowel inflammation, in many cases, confined only to the sigmoid and descending colon. Recurrent attacks and complications of diverticulitis require surgical procedure, although most cases can be managed medically. The cause of acute diverticulitis remains obscure. It has been speculated that obstruction at the mouth of the diverticulum results in diverticulitis, similar to appendicitis, but this is no longer the accepted theory, and some feel that chronic inflammation precedes clinical diverticulitis. .
The influence of duration of Kleinert immobilization on the functional recovery of primarily reconstructed flexor tendons in children and adult patients
Authors: Jeremic J. , Vucetic C. , Golubovic Z. , Petronic I. , Jeremic K.
Published: November 2008

Flexor tendon repair in the hand is very often complicated by the formation of peritendinous adhesions that result in loss of normal tendon gliding, digital stiffness and functional disability. While stability is critical for a successful tendon repair, mobility is also important, as motion of the repaired tendon decreases the formation of postoperative adhesions and increases the strength of the repair. Immobilization and its duration, can ensure the integrity of the repair but can also lead to scaring, stiffness, and joint contractures. This study included 20 children and 39 adult patients, in the period from January 2000 to April 2003., with flexor tendon ruptures of the hand. Tendons were primary repaired using direct tennoraphy, and postoperately patients were treated with Kleinert dynamic immobilization. The aim of this study was to investigate the influence of the duration of the dynamic immobilization on successful postoperative functional recovery, separately in children and adult patients. Research in this area has been directed at achieving the optimal balance between stability and mobility, without compromising one for the other. .
Rizicni faktori i hronicni ishemijski pankolitis
Authors: Golubovic G. , Tomasevic R. , Knezevic P. , Obradovic M. , Radic O. , Pavlovic A.
Published: November 2008

Ischaemia of the colon wall leads to lesions that are gathered under entity of ischaemic colitis. Acute or chronic tissue hypoxia is caused by various vascular disorders which could be divided into two large groups: occlusive or non-occlusive. Chronic ischaemic colitis is manifested with necrosis of colon wall, with consequent stenosis of the affected area. Clinically, it is manifested with increased number of bloody stools and abdominal pain. Treatment of choice is surgery, and resection of the affected segment is often life saving. We present a case of a patient with chronic ischaemic pancolitis, due to atheromathosis of upper and lower mesenterial artery branches, correlated with age, cardiovascular diseases, chronic opstipation and drug-intake. .
Gangrena Fournier i rekonstrukcija nastalih defekata
Authors: Sretenovic N. , Colic M. , Lazic R. , Bosic S. , Stojadinovic N.
Published: November 2008

Fournier?s gangrene is remarkably rare but severe, life threatening condition. Thanks to better early recognition of disease in past few years, the percentage of patients which survive this condition is considerable, but consequence of this fact is large number of patients with defects of cutis and subcutis in perineal and scrotal regions. Reconstruction of this defects is complicate and require healthy, well vascularised tissue from another anatomical region which is not involved in gangrenous process. Authors present two cases of reconstruction of defects in perineal and scrotal regions. First case is large defect which is covered by transposition of musculus gracilis musculo-cutaneous flap. Second case is lesser defect which is enclosed by mobilization of local skin flaps. .
Developmental dislocation of the hip is still important problem: Therapeutic guidelines
Authors: Vukasinovic Z. , Vucetic C. , Cobeljic G. , Bascarevic Z. , Slavkovic N.
Published: November 2008

The authors are describing currently important problem - developmental dislocation of the hip. Guidelines for the treatment have been given according to literature date and upon their own experience. Therapeutic suggestions for the first twelve months of life are based on the ultrasound typing - it is advised to perform nonoperative treatment (abduction devices, "over head" traction, Pavlik harnesses). During the second year of life a pause in the treatment should be advised in order to avoid postreduction avascular hip necrosis as a very important complication. After that period surgical treatment has to be done (open reduction, pelvic and femoral osteotomies). Special suggestions have been given for the treatment of consecutive leg length inequality and the deformities caused by postreduction avascular hip necrosis.
Anterior cruciate ligament reconstruction: Comparison of male and female athletes using the patellar tendon and hamstring autografts
Authors: Stevanovic V. , Blagojevic Z. , Basarevic Z. , Tomic S. , Crnobaric A.
Published: November 2008

Few authors have studied the effects of gender on the outcome of ACL reconstruction in athletes. This retrospective- prospective study compared the treating results using the patellar tendon (LP) and hamstring (StG) techniques in men and women. We followed 40 athletes (23 males, 17 females) from population of 120 patients operated at Institute for Orthopedic Surgery Banjica". There were 13 males and 7 females in the LP group and 11 males and 9 females in the StG group. Patients were operated by the same surgeons within 6 month from injury and underwent the same rehabilitation program. After an average of 24 months they were assessed by clinical evaluation, knee laxity analysis and standard knee scores. Among LP patients there were no significant differences between males and females regarding knee evaluation form, laxity or functional tests. Females in the hamstring group had significantly grater laxity and significantly higher deficit in flexion and extension. We suggest further studies on the clinical significance of these findings, particularly on their ramifications of return to sports and rehabilitation of female athletes.
Masivno krvavljenje i mehanizmi koagulopatije u traumi
Authors: Popovic N. , Blagojevic Z. , Nikolic V. , Arsenijevic Lj. , Karamarkovic A. , Stefanovic B. , Kojic Z.
Published: November 2008

Trauma is disease of the young, mainly affecting people between 15-40 years of age. Uncontrolled massive bleeding is the leading cause of early in-hospital mortality, within 48h of admission, and the second leading cause of prehospital death in victims of both military and civilian trauma, accounting for 40-45% of the total fatalities. Coagulopathy develops early after injury and is present in 25- 36% of trauma victims upon admission to the emergency department. Coagulopathy correlates to the severity of trauma and is associated with an increased risk of mortality. The aim of this paper is to explain pathophysiology of developing coagulopathy in trauma. The coagulopathy in the trauma patient is complex and multifactorial. It includes: dilutional coagulopathy, hypothermia, acidosis, hyperfibrinolysis, anemia and consumption coagulopathy. When the patient develops the so called ?lethal triad? of hypothermia, acidosis and coagulopathy, surgical restoration of vascular integrity may be insufficient to achieve a definitive control of blood loss and non-mechanical bleeding from small vessels, usually terminated by spontaneous coagulation, becomes a life-threatening condition.
Primena digitalne video tehnike u ortopediji
Authors: Vucetic C. , Milovanovic D. , Dulic B. , Dimitrijevic I. , Kalezic N. , Tulic G.
Published: November 2008

Digital video technologies are new and powerful tools with wide applications in orthopedic. Already integral to several common medical devices, digital images can be used for case documentation and presentation as well for diagnostic and surgical patient care information. Digital technologies allow easy manipulation of photographic, video and graphic materials in ways that were impossible with conventional techniques. Educational presentation has been transformed by use of computers and digital projectors. Understanding the basic foundations of digital imaging technology is important for effectively creating digital images, videos and presentations. In this review, we are going to discuss some of the issues that are raised by digital imaging in orthopedics, digital image processing, as well as, we are giving some recommendations for good quality of pre-, post- and intra-operative photographs in clinical use.
Znacaj profilakse akutne mukozne lezije kod pacijenata u jedinici intenzivnog lecenja
Authors: Popovic N.M.
Published: November 2008

At least three-quarters of critically ill patients develop mucosal lesion as a direct consequence of stress within the first 24 hours following the admission to intensive care unit. These mucosal lesions occur as superficial or deep mucosal lesions which can lead to massive gastrointestinal bleeding and it can put at risk the life of critically ill patient. There are multiple risk factors for the occurence of mucosal lesion such as: respiratory failure requiring mechanical ventilation, sepsis, hypotension, burns, severe trauma, neurotrauma, ileus, coagulopathy, renal and hepatic failure, myocardial infarction etc. The incidence of silent (ocult) bleeding in critically ill patients is almost 100%, but only about 5% of patients have clinically apparent (overt) hemorrhage and 1-2% have clinically significant bleeding which requires blood transfusions. In patients who are at the greatest risk of developing mucosal lesion, prophylactic treatment ought to be started immediately in order to achieve pH4 with adequate perfusion and coagulation. Today several groups of medications are used for the prevention of mucosal gastrointestinal lesion and they include: antacids, sucralfate, hisamine-2 receptor antagonists and proton pump inhibitors.
Role of Helicobacter pylori infection and use of NSAIDs in the etiopathogenesis of upper gastrointestinal bleeding
Authors: Sokic-Milutinovic A. , Krstic M.N. , Popovic D. , Mijalkovic N.S. , Djuranovic S. , Culafic Dj.
Published: November 2008

Introduction: Non-steroid antiinflammatory drugs (NSAIDs) and Helicobacter pylori (Hp) infection are two most important independent risk factors involved in the etiopathogenesis of gastroduodenal mucosal injury with a clear and critical role in both uncomplicated and complicated peptic ulcer disease. It is estimated that up to 90% of all peptic ulcers result from the effect of one or both of these factors. AIM: To determine the frequency of NSAIDs use and Hp infection in patients with acute upper gastrointestinal bleeding. Patients and methods: Study evaluated data from 500 patients in whom esophagogastroduodenoscopy was performed following presentation in emergency unit with acute upper gastrointestinal bleeding. Anamnestic data was collected together with detailed information on previous salicilates and/or NSAIDs use. Hp status was determined and anatomic localization of bleeding lesion was also registered. Results: Acute upper GIT bleading was caused solely by NSAIDs in 55 (11%), by aspirin in 66 (13.2%), while combined NSAID/aspirin therapy was identified in 19 (3.8%) of patients. In total NSAID and/or aspirin use were diagnosed in 139 (27.8%). while in 122 (24.4%) only Hp infection was diagnosed. Both risk factors were identified in 144 (28.8%) patients (Hp+NSAIDs in 12.2%, Hp+aspirin in 10.8% and Hp+aspirin+NSAIDs in 5.8%) . In 19.8% of the cases (14% of males and 27% of females) neither NSAID/aspirin use nor presence of Hp infection was noted. Out of 500 patients enrolled, 63% were mails. In females, bleeding lesion was most frequently localized in gastric mucosa, while males had equal chance of bleeding from either gastric or duodenal mucosa. Fortunately, only 5 to 7% of patients were bleeding from both gastric and duodenal lesion. Conclusion : Prevention of acute upper gastrointestinal bleeding can be achieved trough strict and limited use of aspirin and NSAIDs, eradication of Hp infection and use of gastroprotective therapy in well-defined risk patients that need chronic NSAIDs and/or aspirin therapy. In all patients starting long-term NSAID and/or aspirin therapy and all patients already on long-term aspirin therapy test and treat strategy for Hp infection should be used. On the other hand, only in high risk patients (more than 65 years, history of peptic ulcer disease, concomitant corticosteroid, aspirin, clopidogrel or warfarin therapy) already on chronic NSAID therapy long-term PPI therapy should be prescribed after testing and treating of Hp infection.
Hemorrhagic shock
Authors: Bumbasirevic V.M. , Jovanovic B. , Palibrk I. , Karamarkovic A.R. , Radenkovic D. , Gregoric P. , Djukic V.R. , Stevanovic R. , Simic D. , Ivancevic N.N.
Published: November 2008

Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and can be rapidly fatal. Despite improved understanding of the pathophysiology and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the state of shock is well establish and the compensatory mechanisms have started to fail. The primary goal is to stop the bleeding and restore the intravascular volume. This review addresses the pathophysiology and treatment of hemorrhagic shock.
Iron deficiency anemia and its importance in gastroenterology clinical practice
Authors: Vucelic D. , Nenadic B. , Pesko P. , Bjelovic M. , Stojakov D. , Sabljak P. , Ebrahimi K. , Dunjic S. , Velickovic D. , Spica B.
Published: November 2008

Iron deficiency anemia (IDA) is a universal problem involving individuals of all ages and both sexes and is a common cause of referral to medical departments. This anemia is one of the most common types of anemia. IDA impairs growth and intellectual development in children and adolescent. In women IDA is most common in reproductive period because of menstrual and pregnancy iron losses. IDA affects roughly 10-30% of all pregnancies and, among others morbidities, may contribute of developing postpartum depression. Among other adult patient, chronic occult gastrointestinal bleeding is the leading cause of IDA. Approximately, one third of patients with anemia have iron deficiency and up to two thirds of patients with IDA have serious gastrointestinal lesions detected with esophagogastroduodenoscopy and colonoscopy, including 10-15% with malignancy. However, in practice not all anemic patients undergo appropriate diagnostic tests to detect iron deficiency. Furthermore, a substantial proportion of patients with IDA do not undergo endoscopic evaluation. The approach to its investigation and subsequent therapy depends upon a comprehensive understanding of iron metabolism and heme synthesis. Once diagnosis of iron deficiency or IDA is established, evaluation for the cause of anemia must be appropriate performed and treatment must include corrective replenishment of body stores.
Gastrointestinal stromal tumors (GIST) of the stomach as a cause of upper gastrointestinal bleeding
Authors: Ebrahimi K. , Velickovic D. , Spica B. , Sabljak P. , Bjelovic M. , Stojakov D. , Micev M. , Dunjic M. , Pesko P.
Published: November 2008

Gastrointestinal stromal tumors (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. GIST is currently defined as a gastrointestinal tract mesenchymal tumor containing spindle cells (less commonly epitheloid cells or rarely both) and showing CD 117 (c-kit protein) positivity in more than 95% of cases. Although they may arise throughout the gut, the commonest site are stomach (60-70%), small intestine (20-30%), colorectum (5%) and esophagus (up to 5%). Rarely, GISTs develop in the retroperitoneum, omentum or mesentery. GIST originates from the intestinal cell of Cajal (ICC). ICCs are located in and around the myenteric plexus and are thought to function as intestinal pacemaker cells. Historically, GIST were often misclassified as leiomyomas or leiomyosarcomas. Subsequently, it has been determined that GISTs have distinct ultrastructural features and immunophenotypical markers compared with smooth muscle and smooth muscle tumors. GIST predominantly occur in middle aged and older patients, with no significant difference in the sex incidence. Data from the recent population study suggest an incidence of about 10-22 cases per million persons per year. Clinical presentation of GIST varies widely, and depends on tumor size and location. GISTs that caused symptoms tended to be larger with an average size of 6cm versus 2cm for asymptomatic GISTs. Symptoms are most commonly related to mass effect or bleeding. GISTs can grow very large before producing symptoms. Commonest symptom of gastric GIST is manifest or occult bleeding. Abundant, life-threatening bleeding that require urgent surgery is rare. For patient with primary, localized, nonmetastatic GIST, complete surgical resection represents the only chance for cure. Lymhadenectomy is not necessary, because lymph node metastasis is very rare. The 5 year survival rate in patients with resected primary GISTs ranges from 48-65%. Conventional che- Br. 1 GIST zeluca kao uzrok krvarenja iz gornjih partija 117 digestivnog trakta motherapy and radiation therapy is ineffective in the treatment of GIST. Imatinib mesilate (a tyrosine kinase inhibitor) was confirmed to be effective against metastatic or unresectable GISTs.
Less frequent causes of upper gastrointestinal bleeding
Authors: Sabljak P. , Velickovic D. , Stojakov D. , Bjelovic M. , Ebrahimi K. , Spica B. , Sljukic V. , Pesko P.
Published: November 2008

Upper gastrointestinal (GI) bleeding represents emergency which despites modern advances in treatment still carry substantial mortality. Mortality remained relatively constant in the last 50 years at approximately 12%. Peptic ulcers remain the most common cause of upper GI bleeding and account approximately 50% of all cases. Next leading causes are esophageal and gastric varices, and gastroduodenal erosions. Mallory Weiss tears, angiodysplasia and gastric antral vascular ectasia (GAVE)-Watermelon stomach are less frequent but important causes of upper GI bleeding that contribute substantially to the overall morbidity and mortality. Recognition of such lesions is crucial to provide effective hemostasis. In most cases endoscopic therapy is procedure of choice which significantly improved the outcome of patients. In cases where endoscopic hemostasis is not effective, or patients rebleed after initial control surgical therapy may be required. This article will review recent advances in diagnosis and therapy of upper GI bleeding caused by Mallory Weiss tears, angiodysplasia or Watermelon stomach.
Dieulafoy’s lesion: Rare cause of massive upper gastrointestinal bleeding
Authors: Stojakov D. , Velickovic D. , Sabljak P. , Bjelovic M. , Ebrahimi K. , Spica B. , Sljukic V. , Pesko P.
Published: November 2008

Dieulafoy?s lesion is an unusual and potentially lifethreatening cause of massive, recurrent gastrointestinal bleeding. Its reported incidence as a source of upper gastrointestinal bleeding ranges from 0,3-6,7%. Dieulafoy?s lesion is most commonly located in the proximal stomach (75% of cases). Lesion typically occur within 6 to 10 cm of the esophagogastric junction, generally along the lesser curvature of the stomach. Similar lesions have been identified in the esophagus, duodenal bulb, jejunum, ileum, colorectum, anal canal, even in bronchus. Detection and identification of the Dieulafoy?s lesion as the source of bleeding can often be difficult, especially because most present with massive bleeding. Because of intermittent nature of bleeding, initial endoscopy is diagnostic in 60% of the cases, so repeated endoscopies are often necessary. If the lesion can be endoscopically documented, attempts should be made to achieve hemostasis using one or a combination of several endoscopic modalities. Success has been reported with multipolar electrocoagulation, heater probe, noncontact laser photocoagulation, injection sclerotherapy, endoscopic hemoclipping and band ligation. Surgery is reserved for lesions that cannot be controlled by endoscopic techniques. When localized, a wide wedge resection of entire area traversed by the large submucosal artery is recommended because rebleeding has been described after simple coagulation and ligation.