bluuebunny/crossref_metadata_2025 huggingface dataset:
New biological method of internal fixation of the femur
Authors: Mitkovic Milorad , Bumbasirevic Marko , Golubovic Z. , Mladenovic D. , Milenkovic Sasa , Micic Ivan , Lesic Aleksandar , Bumbasirevic V. , Pavlovic P. , Karalejic S. , Kuljanin G.
Published: November 2008

One of the main goals in fracture treatment is preservation of both intramedular and periosteal vascularisation. The aim of this paper is to show a new method of internal fixation which accomplishes these goals. The paper presents the results of clinical application of Mitkovic Internal Fixator, new self-dynamisable device, which provides fixation of the femur using minimally invasive technique. This device has been investigated experimentally on 60 animals. It has been applied to 267 patients. Here is presented a series of 92 fixations of femoral diaphyses after fresh fractures and after unsuccessful treatment using other methods. Follow-up was 3.1 years (2 to 7 years). Bone healing was achieved in all patients within 3.5 months (2.7-9 months) with big amount of periosteal callus formation. There were no complications in all patients seen. It can be concluded that this method and device meet biological and biomechanical requirements for safe fracture treatment.
Congenital psedoarthrosis of the tibia treated with the free microvascular fibula
Authors: Bumbasirevic Marko , Brdar R. , Djukic V. , Milicevic M. , Tomic Slavko , Bumbasirevic V. , Lesic Aleksandar
Published: November 2008

Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5- year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.
The radial artery for coronary artery bypass grafting
Authors: Nezic D. , Milojevic P. , Cirkovic M. , Knezevic A. , Novakovic A. , Gojkovic-Bukarica Lj. , Jovic M. , Djukanovic B.
Published: November 2008

Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Previous long-term studies have shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularisation, compared with internal mammary artery grafts. Recently, the use of radial artery for CABG has enjoyed a revival, on the basis of the belief that it will help improving long-term results of coronary operations. The recent reports of encouraging mid-term and long-term patency rates of the radial artery, supports its continued use as a bypass conduit. In this paper, we review the current knowledge about the radial artery as a bypass graft, with special emphasis on the clinical results.
The significance of lymphonodal micrometastasis in the patients with gastric adenocarcinoma
Authors: Bjelovic Milos , Pesko Predrag , Micev Marijan , Todorovic V. , Stojakov D. , Sabljak P. , Simic A. , Ebrahimi K. , Velickovic D. , Spica B.
Published: November 2008

Micrometastasis is defined as microscopical deposit of malignant cells, less than 2mm in diameter, separated from the primary tumor. This does not include discontinous growth in peritumoral region, but include microinolvement of regional lymph nodes. The literature on micrometastases, with special respect to nodal micrometastasis, and their implications in gastric adenocarcinoma have been reviewed. Immunohistochemical detection offer the best accuracy for detection of nodal micrometastasis. Molecular techniques are more sensitive than method of immunohistochemical detection, but methods are compromised with false positive results caused by various sources of biological contamination. It is more than obvious that there is no definite agreement neither about risk factors, nor definitive clinical significance of micrometastatic node involvement in the patients with gastric adenocarcinoma. At present, the role of occult lymph node involvement proved its significance in two major fields: defining criteria for limited surgical dissection in the patients with early (sm) carcinoma in respect to detection of micrometastatic tissue in sentinel lymph node, and distinguishing the category of pN0 (Mi+) patients with potential benefit of postoperative adjuvant therapy.
Selection and perioperative management of patients undergoing an orthotopic ileal bladder substitution
Authors: Basic D.T. , Studer U.E.
Published: November 2008

Orthotopic ileal bladder substitution (Studer pouch) has gained much popularity during the last decade, offering the best form of urinary diversion in appropriately selected patients. The superiority of this procedure is well known, with a low complication and high success rate. In the present study the most important details in patient selection, surgical technique, perioperative management with short- and long-term postoperative follow-up are described. Adequate preoperative assessment results in a proper indication for surgery and appropriate patient selection. The cystectomy should be performed with atraumatic dissection and preservation of the urethral autonomic innervation and sphincter apparatus. The bladder substitute is constructed from a terminal ileal segment of proper length formed into a spherical shape. Implantation of the ureters into the reservoir should not be performed using an anti- reflux technique to avoid a high stricture rate. Anastomosis of the bladder substitute to the urethra must be flat and wide open, avoiding a funnel- shaped outlet. In the immediate postoperative period, careful monitoring is necessary to minimize metabolic complications of acidosis and salt loss. To achieve successful voiding rehabilitation, with complete reservoir emptying, good functional reservoir capacity and satisfactory continence, it is necessary to educate the patients as to the physiological functioning of the bladder substitute. Careful lifelong follow up is essential for the successful outcome. Respecting strict patient selection criteria and proper surgical technique are of utmost importance for the successful outcome of the procedure, but only if combined with regular follow-up.
Colonization of central venous catheter in the intensive care units at the Institute of Cardiovascular Disease "Dedinje": One year study
Authors: Cirkovic Ivana , Mijac Vera , Svabic-Vlahovic Milena , Dukic S. , Ilic I. , Stepanovic S.
Published: November 2008

Objectives: The application of Central Venous Catheters (CVC) is associated with increased risk of microbial colonization and infection. The aim of present study was to assess the frequency of pathogens colonizing CVC and to determine their susceptibility pattern to various antimicrobial agents. Materials and methods: A total of 253 samples of CVC from intensive care units (ICU) patients were received for culture during 2003. All microorganisms were identified by standard microbiological methods and the susceptibility to antimicrobial agents was determined according to NCCLS recommendations. Results: A total of 184 (72.7%) cultures were positive and 223 pathogens were isolated. Coagulase negative staphylococci (CNS) were the dominant isolates (24.7%), followed by Enterobacter spp. (12.1%), Pseudomonas spp. (11.7%), Enterococcus spp. (9.9%), Klebsiella spp. (8.6%), Candida spp. (7.6%), Acinetobacter spp. (7.6%), other Gram negative nonfermentative bacilli (5.8%), Serratia spp. (4.5%), Staphylococcus aureus (2.6%), Proteus mirabilis (2.2%), E. coli (1.8%) and Citrobacter spp. (0.9%). Meropenem (84.5%) and vancomycin (100%) remain the most effective antimicrobial agents against Gram negative and Gram positive bacteria, respectively. Conclusion: Gram negative bacilli and CNS are the commonest microorganisms colonizing CVC from ICU patients. The increasing resistance of the bacteria to antimicrobial agents is the major problem in spite of restricted policy of using antimicrobial agents in ICU.
Axillary recurrence after modified radical mastectomy
Authors: Karanikolic Aleksandar , Djordjevic N. , Filipovic S. , Pesic M. , Milic D. , Budjevac Dragana , Djordjevic I.
Published: November 2008

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990- 1995. All patients underwent modified radical mastectomy. Axillary recurrence was diagnosed in 43(3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30(69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p<0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.
Novi pristupi nezi rana posle vaginalnog i operativnog porodjaja
Authors: Gojnic Miroslava , Jeremic K. , Pervulov Miroslava , Mostic T.
Published: November 2008

Tokom tri godine, na Institutu za ginekologiju i akuserstvo je bilo preko 20000 porodjaja. Uporedili smo razlicite pristupe negama rana nakon operativnog porodjaja i porodjaja zavrsenog carskim rezom. Ukoliko se rana nakon vaginalnog porodjaja (epizotomija) odmah neguje sapunom i vodom i izbegava se koriscenje uljanih rastvora i konstanto navlazivanje rane, utoliko ce rana brze zarasti, bez sekundarnih inflamatornih reakcija. Isto tako, ukoliko se rani nakon carskog reza omoguci da sto pre dise, i bude u kontaktu sa vazduhom, onda ce se izbeci komplikacije inflamacije i sekundarnog zarascivanja. Isto tako, uz adekvatne uslove antisepse i asepse, ovim smanjujemo bolnicke dane lezanja, nepotrebno koriscenje multiplih parenteralnih antibiotika, davanje infuzionih rastvora prvih postoperativnih dana u stanjima carskog reza.
Uticaj klasicne abdominalne i vaginalne histerektomije na funkciju donjeg urinarnog trakta
Authors: Argirovic Rajka , Vilendecic Z. , Likic-Ladjevic I. , Berisavac M. , Ciric R. , Vrzic-Petronijevic Svetlana
Published: November 2008

Organi male karlice (mokracna besika sa pelvicnim delom uretera, uterus sa adnexima i rektum) su medjusobno u vrlo bliskom kontaktu, tako da uklanjanje jednog organa nesumnjivo utice na funkciju ostalih organa. Cilj rada je bio da se utvrdi uticaj abdominalne i vaginalne histerektomije na funkciju donjeg urinarnog trakta, sa posebnim osvrtom na razlicite tipove inkontinencije. Analizirani su odgovori dve grupe bolesnica (74 koje su podvrgnute abdominalnoj histerektomiji i 61 koje su podvrgnute vaginalnoj histerektomiji) neposredno pre operacije, mesec dana i 6 meseci nakon operacije. Analiza odgovora je pokazala da 6 meseci nakon abdominalne histerektomije dolazi do porasta stres inkontinencije za 11% (p>0,05), dok se nakon vaginalne histerektomije smanjuje ucestalost stres inkontinencije sa 79% na 8% (p<0,01) zbog primene Kelly-evih suburetralnih plikacija. Niti jedna od analizirane operativne tehnike nije bitno uticala na povecanje niti na smanjenje ucestalosti urgentne inkontinencije, dnevnog i nocnog mokrenja.
Patient with double cancer: Successfully treated
Authors: Djukic V.B. , Kastratovic Dragana , Pendjer I.P. , Majstorovic Branislava , Nikolic Lj.I. , Boricic Ivan , Vujicic Z.N.
Published: November 2008

Introduction: Etiology of thrombosis in malignant diseases is multifactorial, and mechanisms that lead to thrombosis include release of the procoagulants from tumor cells (PC), factor related to bed rest, infections, as well as oncological therapy - chemotherapy, hormones, radiotherapy and surgical treatment. Thrombocytosis has frequently been found to be associated with various malignancies. Case report: 53 years old female patient hospitalized because of hypopharingeal cancer with metastasis in the left neck. Her state was complicated with deep leg vein thrombosis and pseudomonas infection. Persistent thrombocitosis in laboratory monitoring indicated more adequate diagnostic procedures, which led to discovering of Chorioidal Malignant Mellanoma as a second cancer. She was treated: Surgically, with antibiotics, with anticoagulants and radiotherapy. Patient was discharged from the hospital in good health condition, free of any other symptom of the malignant disease. Conclusion: Presence of thrombocytosis and idiopatic thrombosis can suggest occult malignancy. It would be prudent to further evaluate the relationship of trombotic events, trombocitosis and head and neck tumors. We suggest anticoagulants to prevent thromboembolic complications, affect the angiogenesis and prevent development of metastatic disease. It may lead to lower mortality rate.
Transmandibular approach to polycentric recurrent pleomorphic adenoma of the parapharyngeal space
Authors: Grubor A. , Jovanovic M. , Said M. , Vlastarakou V. , Galea J. , Littlejohn Gingell
Published: November 2008

Surgery for tumors of the parapharyngeal space (PPS) requires adequate exposure to identify and protect vital structures. Thus transcervical and transcervical-transparotid approaches to the PPS may be enhanced by mandibulotomy for better visualization. We have chosen this approach with single mandibulotomy just in front of foramen mental and without lip incision. We present a 39 years old male who was undergone surgery for policentric recurrency of a pleomorphic adenoma of the parapharyngeal space.
Delayed hemolytic transfusion reaction due to anti-JKa
Authors: Vucelic D. , Savic N. , Djordjevic R.
Published: November 2008

Background: Kidd antibodies are very heterogeneous and difficult to detect. They have been frequently implicated in delayed hemolytic transfusion reactions (DHTRs). Case report: A 64year old female (6 pregnancies, 2 deliveries, 4 abortions) with none red cell (RBC) transfusions in the history was admitted to hospital due to pneumonia and severe anemia. On admittance hemoglobin (Hb) level was 63g/L and hematocrit (Ht) 0,21L/L. The blood sample of the patient was sent to laboratory for serologic testing since RBC transfusions were required. Patient appeared to beO Rh(D)+ with negative both direct antiglobulin (DAT) and routine antibody screen (ID-DiaCell I+II+III-P). Three units of packed RBCs with negative crossmatch (tube method) were prepared. Patient received two units on Day 2 and one more on Day3 without any discomfort. Hematological values after the third unit were: Hb 116g/L and Ht 0,37L/L. On Day 6 she started to feel week, tired, with nausea and mild jaundice. Her Hb and Ht had dropped to 99g/L and 0,33L/L respectively, with tendency of dropping further (Day 7: Hb 83g/L,Ht 0,26L/L). Total serum bilirubin was 58,9 umol/L (normal range 20,5 umol/L) and direct fraction was 14,9 umol/L (normal range 7 umol/L). DTHR was suspected. Antibody identification performed by ID-DiaMed Gel Techique (GT) showed the presence of anti-Jka with dosage phenomenon. All three previously transfused units were typed Jka and the patient?s RBCs were Jk(a-b+). She received two units of Jka negative packed RBCs and was well enough to be discharged on Day 14. Conclusion: It is important to monitor clinical effect of transfusion regularly and to provide good team work between specialists of transfusion medicine and related medical staff. The policy of transfusion practice is to keep pretransfusion sample for three weeks and to perform cross-match tests on the samples no older then 24h and 48h respectively.
Standardization of transrectal ultrasound-guided biopsy
Authors: Acimovic Miodrag , Tulic Cane , Dzamic Zoran , Radosavljevic R. , Filimonovic J. , Jovanovic M. , Mitrovic D. , Govedarevic V. , Hadzi-Djokic J.
Published: November 2008

Ultrasound-guided biopsy is more sensitive to biopsy performed under the digital control, because 29% of prostatic cancers are not palpable. On the other hand, at least 30% of cancers are isoechogenic, so they cannot be viewed by transrectal ultrasound examination. It means that target biopsy is not sufficient for diagnosis of localized prostatic cancer, i.e., randomized samples are needed as well. More than ten years ago, the technique of sampling the six specimens became a standard procedure to which previously harvested target specimens from suspected growths were added. Today, the expansion of biopsy protocol is recommended, by obtaining the additional specimens from peripheral lateral area, four plus two samples if the prostate has volume over 50 ml. Larger number of biopsies requires anesthesia. In order to reduce complication, the cleaning of rectal ampulla and prophylactic use of quinolone are suggested.
An evaluation of high-doses ketoconazole with hydrocortisone substitution in hormone-refractory prostate cancer
Authors: Argirovic Djordje
Published: November 2008

We investigated the efficacy of ketoconazole, an inhibitor of testicular and adrenal biosynthesis, for treating patients with progression of hormonerefractory prostate cancer. The study comprised 35 patients with progressive disease despite salvage treatment with estramustine with or without vinblastine. Treatment consisted high-doses ketoconazole (400 mg three times daily) and hydrocortisone substitution. Patients were monitored clinically and with serial PSA measurements every 3 months. The principal endpoint of the study was PSA response to applied therapy. Of the 35 patients, 18 (51.4%) showed a decrease in PSA 50% with a median duration of 30 weeks (range 6-60 weeks). A PSA reduction 50% was seen in 15 of 31 patients (48.4%) with established metastasis. Twelve patients (34.2%), all of whom had metastasis, exhibited a PSA decrease 80% with median duration of 9 months (range 3-48 months). The median time to progression was 6.3 months (range 0-27 months) and the median survival time was 12.5 months (range 3-48 months). Twelve (34.3%) reported toxicity related to ketoconazole, whereas no patients required discontinuation of therapy. It is apparent from this study that a reasonable percentage of patients failing salvage chemotherapy (estramustine with or without vinblastine) respond favorably to high-dose ketoconazole and that toxicity is mild. In the absence of studies demonstrating better survival with chemotherapy, we believe that a trail of ketoconazole should be considered when progression of PSA occurs, following initial hormonal androgen deprivation.
The nerve sparing radical prostatectomy: A step to better quality of life: Surgical aspects
Authors: Djozic J.
Published: November 2008

Radical surgical procedure (Radical Retropubic Prostatectomy) is treatment of choice for patients with localized (T1, T2) prostatic cancer. By radiologists, radical radiotherapy (brachi and external beam or only brachi therapy) could, also, be rational radical option for T1, T2. But, long term survival is better after surgical procedure which is confirmed by many authors. Nerve sparing radical prostatectomy should be considered as a step to better life in all cases where it could be done. With this presentation we would like to point out the critical moments (the places of our-surgical mistakes), where Neurovascular Bundle (NVB) could be injured during the procedure (RRP). If those injures could be avoided urologist would be able to enhance the quality of life of these patients. The possible injures of NVB may happen during: 1. Dissection of the posterior wall of urethra 2. Separation-dissection of external urethral sphincter 3. Putting of sutures on urethra 4. Preparation of the posterior side of prostate 5. Dissection of the seminal vesicles Conclusion: Careful surgical work of experienced urologist concerning all surgical tips mentioned above will result in an excellent continence(100%),preserved potency (more than 70%),and better quality of life for patients with localized prostate cancer.
The predictive value of PSA in diagnosis of prostate cancer in non screened population
Authors: Vukotic V. , Cerovic S. , Kozomara M. , Lazic M.
Published: November 2008

INTRODUCION : PSA is the most important tumor marker in all solid tumor, indispensable in the management of prostate cancer. Screening for prostate cancer is still not recommended, although performed in many countries, which introduced questions about the usefulness of PSA in detection of prostate cancer. The PSA threshold has also been changed, the value of PSA derivatives revised. Whether such changes are applicable in non screened population is questionable. Aim of this study was to evaluate the predictive value of PSA, free/ total PSA and PSA density in our non screened population. Patients and methods: TRUS guided prostate biopsy was performed in 579 patients. The number of cores was 6-12. Mean age of the patients was 67.5 years (30-90). PSA was ranging from 0.41 to 2250 ( mean 38.6ng/ml, median: 11.95, SD 140,45). Digitorectal examination was considered positive in 351 patients. Free PSA was measured in 352 patients with the index ranging from 0.02 to 0.88 ( mean free/total PSA: 0.14, median:0.13, ). The volume of the prostate was measured in all patients according the prostate ellipsoid model, and PSA density calculated according to the formula PSA/PV. Patients were stratified in 6 groups according to PSA value ( I: PSA ng/ml, II: PSA 2.5-4, III: PSA 4-10, IV: PSA 10-20, V: PSA:20 to 50, Group 6: PSA 50 ). RESULTS: Non homogenicity of the patients can be seen through the wide range of PSA which was from 0.4 to 2025). Prostate cancer was diagnosed in 233 pts (40.2%). As expected, the probability of detecting cancer was raised with PSA (p), and was extremely rare in pts with PSA below 4 ng/ml. PSA, free/total PSA, volume of the prostate and PSA density were significantly different according to the presence of cancer. Most of our patients had PSA between 4 and 20 ng/ml. Predictive value of PSA was 20.6% for pts with PSA from 4 to 10 and 32.7% for those with PSA from 10 to 20 ng/ml. Sensitivity, specificity, positive and negative predictive values for different cut off?s of PSA (4, 10 and 20) was performed. The best results were obtained for PSA cut off of 10 ng/ml. In the group of patient with PSA, PSA density more reliable than free/total PSA index. CONCLUSION: PSA is still valuable marker for detection of prostate cancer in our non screened population. According to our results PSA threshold should not be lowered below 4 ng/ml. PSA density is a reliable PSA derivative, free/total PSA index having less importance in pts with PSA below 20 ng/ml.
Hepatobilijarna scintigrafija u proceni funkcije transplantirane jetre
Authors: Obradovic V. , Artiko V. , Radevic B. , Dapcevic B. , Petrovic N.
Published: November 2008

The aim of the study is evaluation of hepatocellular function, as well as morphology and patency of the biliary three of the liver transplants by dynamic hepatobiliary scintigraphy. The study was performed in 10 controls and 10 patients after orthotopic transplantation (up to two years). Sixty minutes dynamic acquisition (1 frame/min) was performed with scintillation camera after injection of 360 MBq 99mTc-diethyl-IDA. Hepatobiliary scintigrams were analysed for morphology, and parenchymal and hepatobiliary TA curves were generated and analysed as regard to the time to maximal acitivity (Tmax) and the time to half of maximum acitivity (T1/2). Uptake of the radiopharmaceutical was slightly but not significantly delayed (Tmax=18.5+2.9 min) in comparison to the controls (Tmax=14.2+ 3.4min), while excretion was significantly prolonged (T1/2=59.5+ 12.1 min) than physiological (Tmax=34.2+4.1min). Intrahepatic bile flow was nonsignificantly prolonged (Tmax=31.3+3.7 min) in comparison to the controls (Tmax=25.7+ 3.5 min) while extrahepatic one is high significantly prolonged (T1/2=89.0+14.3 min) than physiological (T1/2 =45.0+ 7.2 min). Biliary phase of hepatobiliary scintigraphy showed increased accumulation of radiopharmaceutical in the left (n=1) or right (n=2) hepatic duct. Radionuclide methods are noninvasive, and apear to be sensitive and valuable for the monitoring of liver transplants.
Ambulatory surgery of umbilical, epigastric and small incisional hernias: open preperitoneal flat mesh technique in local anaesthesia
Authors: Zuvela M. , Milicevic M. , Galun D. , Lekic N.N. , Bulajic P. , Raznatovic Z. , Basaric D. , Radak V. , Palibrk I. , Petrovic M.
Published: November 2008

Introduction. The dilemma whether to use the mesh or non mesh technique in the management of umbilical, epigastric and small incisional hernia is slowly fading away. The open preperitoneal "flat mesh" technique performed as ambulatory surgery may be one of the solutions. The Aim. The aim of this retrospective study is to present the results of open preperitoneal "flat mesh" technique in the management of umbilical, epigastric and small incisional hernia within Material and methods. This study included 34 patients (11 of them with umbilical, 13 with epigastric and 8 of them with small incisional hernia) operated by one surgeon in the period January 2004 - January 2006. Results. The median operative time was 52 minutes for umbilical hernia?s, 43 minutes for epgastric and 54 minutes for incisional hernia?s. The ambulatory surgery was performed at 91% of patients. The median hospitalization was 4h for patients with umbilical hernia?s, 3,7h for patients with epigastric and, 7,7h for patients with small incisional hernia. The follow up is 10,5 months. Apart of one superficial infection other complications were absent. Conclusion. The open preperitoneal "flat mesh" technique performed in local anesthesia as an ambulatory surgery provides good results in the management of umbilical, epigastric and small incisional hernia.
Endotracheal intubation in prehospital treatment of children with craniocerebral injuries
Authors: Stanic-Canji D. , Popovic N. , Draskovic B.
Published: November 2008

Background - Intubation and airway control of injured children is of vital importance, but despite its advantages is associated with many risks when is performed outside the hospital and by the untrained physicians. Aim of this study was to determine the importance for the survival of the children with craniocerebral injuries, and also for final outcome of treatment. Methods -This study is a clinical, partly prospective, partly retrospective that includes 60 patients (two groups with 30 patients) with isolated craniocerebral injures, aged up to 17 years, and with GCS under 8, that did not require surgical treatment. The first group included patients that were endotracheal intubated, and the other group included patients that were not intubated. Results - There was no statistically difference between groups regarding the sex, age and GCS. Regarding the endotracheal intubation there was a statistically significant difference, in the first group 86,7% of the patients were intubated during the prehospital treatment, while 16,7% of the patients from group II were intubated. A greater percentage of patients from group I underwent controlled (66,7%) or assisted (20%) mode of ventilation, and 13,3% of patients were on spontaneus breathing. Conclusion - Endotracheal intubation should be performed by an experienced physician with an adequate equipment.
Surgical methods for the treatment of breast phylodes tumors - a report of 319 cases
Authors: Granic M. , Opric D. , Pupic G. , Babic D. , Ivanovic N. , Nikolic D. , Dikic S. , Opric S.
Published: November 2008

Breast phyllodes tumors (FT) belong the fibroapitelial group of breast tumors arising in terminal ductulo-lobular unit (TDLU). Their incidence do not exceed 1% of all breast tumors. Biologicaly they can be divided into benign, borderline and malignant group. Incomplete tumor excision can be the reason for local reccurence. Malignant form of FT metastazise hematogenous most often in the lung. There is no uniform surgical opinion about the treatment FT. Methods: We analyzed histopathology features of 319 FT of the breast surgically removed on Department of surgery Institut of oncology and radiology of Serbia between 1.1.1985.- 31.12.1994 . Retrospective study of surgical treatment 84 patients with FT of the breast (69 benign ,4 borderline and 11 malignant ) and 5 year follow up after surgery we analyzed. Results: local recurrence after surgery was found in 17 (20,2 %) patients(14 benign , 2 borderline and 1 malignant FT ), pulmonary metastases in 6 (7,1%) patients with malignant FT. DFI was 21,3 months for local recurrences and 25,1 months for pulmonary metastases . DFS for al forms of FT was 71 % ( p =0,7104 ) in 5- year follow up . Conclusion: According to biological behavior we propose wide excision for benign and borderline forms and simple mastectomy for malignant FT, and voluminous benign and borderline forms. Axillary disection is not necessary because lymphatic spread of malignant FT is unfrequent.
Outcome of Burch retropubic urethropexy and the effect of concomitant abdominal hysterectomy
Authors: Argirovic R. , Likic I. , Kadija S. , Milenkovic V. , Ilic-Mostic T. , Arsenijevic Lj.
Published: November 2008

A prospective follow-up study was performed to evaluate the effect of Burch colposuspension alone and a concomitant abdominal hysterectomy with Burch colposuspension. Twenty seven women underwent Burch colposuspension and 34 women colposuspension with abdomina hysterectomy. Subjective outcome was assessed with questionnaire at 4 weeks, 6 months and 1 year. In the 1 year follow-up 81,4% were subjectively cured or improved in the Burch group and 76,4% in the hysterectomy group. No statistically significant difference in the frequency of any subgroup of complications was found.
Myomectomy by vaginal route
Authors: Zamurovic M. , Stanojevic D. , Srbinovic P. , Cerovic M. , Stanojevic M.
Published: November 2008

Myomectomy by vaginal route is the least invasive of all methods for myoma removal. Compared to classical, abdominal myomectomy, it has numerous advantages, especially in cases of fundal and posterior wall myomas, but still it is relatively rarely performed. This study provides an analysis of operative and postoperative course of patients subjected to myomectomy by vaginal route in the period from 01/01/2003 to 01/11/2005 as well as the corresponding control group of patients which had undergone classical, abdominal myomectomy. The study points out to significance and advantages of application of surgical technique for removal of myoma through the posterior wall of the vagina as opposed to classical, abdominal myomectomy. Transvaginal myomectomy eliminates trauma of laparotomy, intraoperative blood loss is reduced, postoperative complications are down to minimum, postoperative recovery is shorter, and so is the number of days spent in hospital. Thus, by performing this type of surgery, a positive cost-benefit effect is obtained not only for the patient but for health authorities as well.
Acute renal failure after cesarean section as a consequence of hematoma of the retropubic space of retzius
Authors: Boskovic V. , Berisavac M. , Petronijevic M. , Vrzic-Petronijevic S. , Likic-Ladjevic I.
Published: November 2008

Acute renal failure is rare postoperative complication of cesarean section. Postrenal acute renal failure is corectible ant it should be done immediately in order to avoid secondary destruction of renal parenchim. Surgical techniques should be directed to achieve adequat haemostasis, espetialy at low transverse Pfannenstiel incision, as well as in tender manipuliating with tissues to prevent unnecessary formation of dead space and tissues devitalisation. Authors are presenting the case of acute renal failure after cesarean section as a consequence of hematoma of the retropubic space of Retzius and way of treatment.
Clinical anatomy of the pelvic floor
Authors: Aigner Felix
Published: November 2008

The pelvic floor forms the supportive and caudal border of the human?s abdominopelvic cavity. A detailed anatomical understanding of its complex architecture is mandatory for the pelvic floor surgeon (general surgeon, gynaecologist and urologist) and for fundamental mechanisms of anorectal as well as urogenital dysfunctions as different anatomical systems join here. The diagnosis and treatment of complex anorectal disorders, however, require a multidisciplinary approach.
Dysplasia in chronic ulcerative colitis: More problems and few solutions
Authors: Haboubi Najib
Published: November 2008

Dysplasia in ulcerative colitis was defined as an unequivocal neoplastic change that is intraepithelial and within the confinement of the glandular basement membrane1. Although that definition has stood the test of time and the classification is still the golden standard, the recommendations of treatment and follow up has significantly debated and changed. The purpose of this lecture is to outline the difficulties and controversies associated with dysplasia.
Combined parasacral, vaginal and endorectal approach in surgical treatment of giant rectocele
Authors: Korcek J. , Bakos E. , Farkas A.
Published: November 2008

Authors operated on their Surgical department 67 years old women with incomplete evacuation, and digital support during defecation, giant rectocele and massive vaginal vault prolaps. Authors realized cinedefecography and detected giant rectocele, depth was 8 cm, anorectal angle was 120 degrees. They stated Resting pressure 40 cm H2O, and Maximum squeeze pressure 50cm H2O by anorectal manometry. Authors verified external anal sphincters defect by endoanal ultrasound and determined Pudendal nerve terminal motor latency (PN TML) and recorded pathologic values of n.pudendal latency ( left branch 2,7 msec., right branch 4,3 msec). In concerning massive vaginal vault prolaps, huge rerectocele and clinical incompletely evacuation with self digital support during defecation with present defect od external anal sphincters and pathologic values of PN TML, authors indicated and made combined transvaginal, endorectal and perineal reconstructive operative performance. the present time two years after the surgery radiologic mean depth of the rectocele was significantly reduced (preoperatively 8cm; postoperatively 1 cm). Anorectal angle is 100 degrees. Values of the PN TML normally (left branch of n. pudendalis 1,7 msec and right branch of n. pudendalis 1,9 msec). Authors recorded Resting pressure 60 cm H2O and Maximum squeeze pressure 110 cm H2O by anorectal manometry. They didnt visualized any external anal sphincters defect by anal ultrasound. Postoperatively difficult evacuation completely disappeared and digital support was no longer necessary during evacuation.
Multimodal treatment of metastatic colorectal cancer
Authors: Kuehrer Irene
Published: November 2008

Background: Metastases to the liver is the leading cause of death in patients with colorectal cancer. Methods: The authors review the data on diagnosis and management of this clinical problem, and they discuss management options that can be considered. Results: Complete surgical resection of metastases from colorectal cancer that are localized to the liver results in 5-year survival rates ranging from 26% to 40%. Conclusions: By adding modalities such as targeted systemic therapy and other "local" treatments for liver metastases, further gains in survival are anticipated.
The T/G mutation in exon 8 of HMSH2 gene in the sporadic colon cancer patients
Authors: Langner Eva , Przybyzowska Karolina , Przemyszaw Galbfach , Kunierz Janusz , Smolarz Beata , Romanowicz-Makowska Hana , Migileski Janusz , Kulig Andrzej , Dziki Adam
Published: November 2008

The DNA mismatch repair (MMR) system guards against genomic instability, therefore the mutations in the human MMR genes cause the majority of the hereditary nonpolyposis colorectal cancer (HNPCC) and a small percentage of the sporadic colon cancer. hMSH2 is one of MMR genes involved in the correction of mispairing during replication and its mutations are associated with both - microsatellite instability and the hereditary and sporadic colon tumor genesis. The aim of this study was to analyze the T/G mutation (codon 458) in exon 8 of hMSH2 gene in the sporadic colon cancer cells. We also examined the relationship between the T/G mutation of hMSH2 gene, and the selected prognostic factors such as Dukes? stage, histological grade and lymph node metastasis. We analyzed samples of tumor from 75 patients with sporadic colorectal cancers. The mutation in the hMSH2 gene ware determined by the RFLP-PCR. We found T/G mutation in exon 8 of hMSH2 gene in 5 patients (6,7%). There was no statistically significant difference between this mutation and selected clinical parameters. The results of our studies revealed that mutations of hMSH2 gene may lead to development of colorectal cancer. No dependence between the mutation of hMSH2 gene and clinical parameters, suggests that the mutation of hMSH2 gene may have a critical significance for the first steps of carcinogenesis in colon epithelial.
Holistic approach to chronic constipation
Authors: Pescatori Mario
Published: November 2008

By "holistic approach" (greek "olos" = "all") we mean a clinical approach which is not only confined to the diseased segment of the body, say the inert large bowel or the spastic pelvic floor in case of constipation, but takes under consideration the whole "mind and body complex", which is a unique indivisible entity. According to a prospective study carried out in our Unit and under press in Colorectal Disease, 66% of the patients with obstructed defecation suffer either from anxiety or depression, thus showing the major role played by an altered psyche in the etiology of their constipation.
Colon polyposis syndromes: Indications to surgery
Authors: Skricka Tomas
Published: November 2008

Familial polyposis syndromes create a group of hereditary syndromes of gastrointestinal tumors. We shall focus on those, touching mostly large bowels and need radical surgery.
Treatment results of colorectal cancer: 10-years series of UMC Ljubljana (1991-2000)
Authors: Stor Z. , Juvan R. , Jelenc F. , Repse S.
Published: November 2008

In Slovenia the incidence of colorectal cancer is growing rapidly. In 1998 1022 new cases were registered. Our study compares results of two groups of patients with colorectal cancer. Patients and methods. In the period from 1.1.1991 to 31.12.2000 1478 patients with a colorectal carcinoma underwent potentially curative resection. We divided them in two groups, one operated in the first 5-years and second in later 5-years period. 5- years survival was estimated with Kaplan-Meier statistical analysis. Patients who died within 30 days after the operation were censored. Differences in survival curves between both groups were assessed by the log rank test. Results. We resected 1478 /1599 (92,4%) patients. There was 913 (61,7%) patients resected with colon cancer and 528 (35,8%) with rectal cancer and 37 (2,5%) with sinhronius tumors. R0 resection was performed in 1174 (79,4%) patients, R1 in 29 (2,0%), and R2 in 273 (18,5%) patients. Postoperative mortality rate in resected patients was 5,48% (81/1478), in the group with paliative operations was 17,35% (21/121). Overall five-years survival rate was 54,9% (56,18% for colon cancer and 52,4% for rectal cancer Five years survival rate for the patients with radical resection (R0) was 66,54% for colon cancer and 59,47% for rectal cancer. Conclusion. 5-years survival for R0-resected patients with colon cancer was in the last period from 1996 to 2000 statistically significantly better compared with the period from 1991 to 1995 (76% vs 60%) in stage I (p=0,04048) and in stage III (p=0,01842). 5-years survival for R0-resected patients with rectal cancer was significantly better in the same period (63% vs 55%) (p= 0,03627) in stage III (p=0,01663).
Hirschsprung’s disease in adults
Authors: Vorobyov G.I. , Achkasov S.I. , Biryukov O.M.
Published: November 2008

Hirschsprung?s disease is the malformation of the hindgut characterized by the absence of intramural ganglion cells in the submucosal and myenteric plexuses and manifested by megacolon. Congenital character of this disease stipulates its belonging in general to the scope of activity of the pediatric clinics. Thanks to the progress of the pediatricians problems of diagnosis and treatment of Hirschsprung?s disease have been successfully resolved.
Surgery for patients with mechanical heart valves: Adjustment and tailoring of anticoagulant therapy
Authors: Obrenovic-Kircanski B. , Subotic S.
Published: November 2008

Valvular surgery in patients (pts) with long history of cardiac valve disease is accomplishing improvement of symptoms, functional status and longevity. The numbers are very big also in our country. Our census numbers are not reliable, but estimation of above 15000 pts with prosthetic heart valve implants is close to correct. Since significant increase in survival and longevity of those pts, the possibility and necessity for non cardiac operative procedures are also increased. Because of specificity and complex constant regular anticoagulation therapy in order to prevent catastrophic prosthetic valve thrombosis and common thromboembolic complication good, but safe reduction of anticoagulation status to accomplish also safe haemostatic condition necessary for all surgical procedures. Individual adjustment and tailoring of anticoagulant and anti aggregation therapies according to accepted international protocols should be carefully done with necessary variation depending on the non cardiac organ and system involved: urgent either minor or major surgical interventions; bleeding peptic ulcer; elective surgery including ophthalmic and common dental procedures with risk of bleeding. .
Preoperative procedures in diagnosis of central and peripheral lung cancer
Authors: Mandaric D. , Stojiljkovic D. , Miletic N. , Inic M. , Djordjevic J.
Published: November 2008

Background: Actual problem in diagnostics and therapy of lung cancer is early diagnostic and choice of diagnostic procedure. The aim of this work was to assess the sensitivity of various histocytologic methods in diagnosis of central and peripheral lung cancer lesions. Material and methods: During 2003-2004, 348 patients with lung infiltrates suspect for malignancy were treated in University of Kragujevac Clinical Center. For the preoperative diagnostics, their sputum, bronchoaspirate, aspirate obtained by fine needle percutaneous biopsy and specimens obtained by forceps biopsy during fiberbronchoscopy were analyzed using standard cytohistology methods. RESULTS: Lung cancer was diagnosed in 155 out of 348 patients. The malignant lesions were centrally located in 123 patients (79,4%), while peripheral localization was found in 32 patients (20,6%). In the former patients, forceps biopsy was positive in 89,4%, and when combined with bronchoaspirate analysis, positive results were obtained in 91,9% of patients. In patients with peripherally located lesions, fine needly biopsy was positive in 68,8%, while citological analysis of sputum and bronchoalveolar aspirate were positive in only three (9,4%) patients. When all three methods were combined, positive results were found in 25 (78,1%) patients. Conclusion: The central localization of tumors was four times greater than the peripheral one. In the patients with central tumour site, the best results were obtained when forceps biopsy specimens and sputum were analysed cytologically. The combination of transcutaneous fine-needle biopsy, bronchoscopy and sputum gave the best results in the group of patients whose lesions were located peripherally. .
Importance of the length of excised optic nerve in enucleations for uveal melanoma
Authors: Bobic-Radovanovic A. , Vlatkovic Z.
Published: November 2008

The importance of a length of excised optic nerve in eyes enucleated for uveal melanoma isn't finally discussed. We analyzed 473 eyes enucleated for uveal melanoma between 1995. and 2004. at Institute of ophthalmology in Belgrade, 16 (3,7%) of which extended into the optic nerve or its meningeal sheaths. Peripapillary melanomas and large melanomas in eyes with increased intraocular pressure and poor vision were associated with optic nerve invasion. This tumors, as a rule, require an enucleation as a treatment of choice. Authors suggest that a long piece of optic nerve should be excised when eyes with uveal melanomas are enucleated. .
The excision width in surgical treatment of basal cell carcinoma
Authors: Jovanovic M. , Brasanac D. , Rasulic L. , Colic M. , Stojicic M. , Malis M.
Published: November 2008

Basal cell carcinoma originates from pluripotent cells of basal layer of epiderm, external covering of hair follicles, sebaceous glands or other skin adnexa. It is characterized by local infiltrating and sometimes destructive growth. There are several types of basal cell carcinomas that may be manifested in over 12 clinical forms. Surgical treatment depends to a large extent on the histological type, localization and its clinical manifestation. The analysis included 250 patients of both gender and different age, operated for basal cell carcinoma. Clinical characteristics of basal cell carcinoma and the width of the excision were described. It was concluded that the width of the excision of basal cell cancer was in relation to histological type. .
Palliative operations for lung cancer
Authors: Subotic D. , Mandaric D.
Published: November 2008

The goal of the palliative resection can be threefold: relief of symptoms without expected survival benefit, obviation of an urgent situation and maintenance or restoration of a good quality survival. Clear distinction should be made between this type of operation and incomplete resection: in spite of a curative intent, the latter type of operation is characterized either by residual disease or positive most distal lymph node station. Classification of palliative operations for lung cancer based on the underlying pathology seems to be most suitable for clinical use: 1) tumors without extrapulmonary extension; 2) tumors with direct involvement of adjacent organs; 3) metastatic involvement of intrathoracic or distant organs; 4) lung tumors associated with nonmalignant pathology (lung suppuration, pleural empyema). Although palliative operations for lung cancer can be considered in carefully selected patients, they should always be avoided if other, less aggressive non-surgical procedures offer the same quality of palliation. .
Visceral metastases of melanoma: Single institution experience an analysis of 15 cases
Authors: Opric D. , Bilanovic D. , Granic M. , Randjelovic T. , Milinic N. , Opric S. , Babic D. , Petrovic Z. , Radovanovic D.
Published: November 2008

Authors analyzed 15 cases with visceral metastasis of melanoma. In eight cases the primary was unknown but in seven cases the data about primary was known. From 15 patients 10 were male and 5 female. All metastases were in abdominal cavity (liver-3, abdominal lymph nodes-4. stomach-2, bowel- 4, omentum-1, spleen-1, oesophagus-1, adrenal- 2 cases. In one case metastatic deposit was in brain and in one case and the vertebral body. In 6 cases visceral metastases were in more than one location. .