bluuebunny/crossref_metadata_2025 huggingface dataset:
The characteristics of mediastinal neuroblastoma and perspectives on surgical excision
Authors: Milovic Ivan , Scekic Marija , Vujic Dragana , Djuricic Slavisa , Djokic Dragomir
Published: November 2008

Thoracic (mediastinal) neuroblastomas (NB) have been reported to differ from abdominal (suprarenal and retroperitoneal) NB and to be associated with better prognosis.The comparison between them is rarely published.In this retrospective study,the characteristics of thoracic NB (17 cases) are investigated and compared with abdominal NB (51 case).Regarding the diagnosis, thoracic NB presented in lower clinical stages I and II in 35,3 percent of cases, compared to 11,7 percent of abdominal NB in stages I and II (p< 0,001).The disease was initially diagnosed at less than one year of age in 7/17 (41,2 percent) of thoracic NB and in 12/51 (23,5 percent) in abdominal cases (p< 0,001).The median age at the time of initial diagnosis was 15,3 months for thoracic NB and 27,6 months for abdominal neuroblastoma (p< 0,05).The cases with an elevated vanillylmandelic acid (VMA) and homovanyillic acid (HVA) excretion were 9/17 (52,9 percent) in the mediastinal NB, and 43/51 (84,3 percent) in the abdominal NB, respectively (p< 0,05).The quantitative values of tumour markers were significantly lower in thoracic NB (0,85 vs.2,14, p<0,001).Regarding surgery, complete tumour resection was achieved in 15/17 thoracic NB (88,2 percent) compared to 36/51 (70,6 percent) radicality in abdominal NB. Surgical complications developed in 5/17 thoracic procedures (29,4 percent) without a lethal outcome.The mean tumour mass of thoracic NB was 56,5g vs. 106,3 g of abdominal neuroblastoma (p< 0,001).The incidence of ganglioneuroblastoma in mediastinal tumours was 3/17 (17,6 percent) compared to 8/51 (15,7 percent) in abdominal NB (non significant).A favorable histology based on Shimada classification was found in 37 percent of the mediastinal neuroblastoma cases and in 22 percent in the abdominal NB cases (p< 0,05).Regarding the biological properties, genetic malformations associated with NB were identified in 2 thoracic cases ( 1p deletion and poliploidy).Genetic changes were identified in 12 cases of abdominal NB (1p deletion in 4 cases, DNA plody in 6 cases, N-myc amplification in 1 case) .One additional abdominal NB had 1p deletion, DNA ploidy and N-myc amplification.This study supports results of other investigations that thoracic NB differs significantly in many aspects from abdominal NB.Important differences in favorable histology and biological properties of thoracic NB have changed the concept of surgical treratment, although unnecessry attempts of surgical radicality still lead to serious complications. Complete excision remains the mainstay of therapy of localised thoracic NB, while in most abdominal tumours the aim of an initial operation should be sampling of tumour tissue for histology and molecular biological examination, with complete excision of the mass as the second priority.
Antibiotics in the prevention of the surgical site infection in orthopedic surgery
Authors: Vucetic Cedomir , Dulic Borislav , Vuckovic Sonja , Prostran Milica , Todorovic Zoran , Nesic Zorica , Stojanovic Radan
Published: November 2008

Surgical site infection is an actual problem of orthopaedic surgery. Despite considerable efforts that have been done during last several decades (e.g. improvements in surgical techniques, preoperative preparation of the surgical site, infection-control practice, use of preventive antibiotics) surgical site infection still affects about 0,5-2% of patients after closed fracture surgery or insertion of prosthetic devices. They are associated with substantial morbidity and mortality. The adherence to the principles of rationale preventive antibiotic therapy has an important role in the prevention of the surgical infection. In addition, it is well known that inappropriate use of antibiotic promote development of resistance, superinfections and increase the cost of the treatment. This paper focuses on the basic principles of rational use of antibiotics, i.e. appropriate selection of drug, dose, and duration of treatment in the prevention of surgical site infections in orthopaedic surgery.
Inicijalna dijagnostika intraabdominalnog krvavljenja uzrokovano izolovanom povredom slezine kod tupe abdominalne traume
Authors: Dikic Srdjan , Bilanovic Dragoljub , Randjelovic Tomislav , Radovanovic D. , Granic Miroslav , Nikolic Dejan , Zdravkovic Dj.
Published: November 2008

Diagnosis of intraabdominal bleeding caused by spleen injury must be performed in the shortest possible period of time, with little risk for the patient, and with high preciseness. By its simple performance, high preciseness and little risk for the patient, DPL imposes as the predominant method in initial diagnostic of intraabdominal bleeding. Control and monitoring of lavage may duly signalize degree of bleeding. Preciseness of this diagnostic in our series ranges up to 93.3%. DPL method is especially important in a combined neurotrauma. Ultrasonography is a sovereign method in diagnostic of bleeding source as well as in monitoring of bleeding that from the very beginning does not require urgent surgical intervention. Its importance is in monitoring both intrasplenic and subcapsulary hematomas. It is not appliable in disturbed and haemodynamically unstable patients. It is in particular important in children where a maximum conservative attitude with respect to operative treatment has been assumed. CT takes the leading place with respect to preciseness of bleeding area, and the combined thoracoabdominal trauma. Preciseness of CT in our series comes up to 96.6%, but can be applied only in haemodynamically stable patients. Same as US of abdomen so the CT of abdomen represents a prominent method in monitoring of both intrasplenic and subcapsular hematomas, which do not require urgent surgical intervention.
Pilomatrikom kao oftalmohirurski problem
Authors: Radovanovic-Bobic Anica , Latkovic Zoran
Published: November 2008

Pilomatricoma, relativly rare benign tumour of the hair matrix cells, is usually misdiagnosed preoperativly. This result in unnecessary extensive surgery. In order to improve diagnosis and treatment of pilomatricoma, autors discusse their ten years experience (28 cases) with this tumour.
Kombinacija opste anestezije i visoke torakalne epiduralne analgezije u revaskularizaciji miokarda na kucajucem srcu u bolesnika na hemodijalizi
Authors: Neskovic Vojislava , Milojevic Predrag , Dimkovic Nada
Published: November 2008

Terminal renal failure is often associated with severe coronary artery desease that should be treated with surgical myocardial revascularization. Since perioperative morbidity and mortality rates in these patients are high, the best way and the time for surgical intervention are still uncertain. We present the patient with end-stage renal disease, on chronic program of hemodyalisis, who had underwent off-pump coronary artery bypass grafting and high thoracic epidural anaesthesia, followed by early extubation. To our knowledge, off-pump surgical myocardial revascularization in patients on hemodyalisis using this anaesthetic technique has not yet been presented in our literature.
Ipsilateralna operacija primarnog pterigijuma, senzorne ezotropije i konjuktivalni autotransplatant u istom aktu
Authors: Risovic Dusica , Nikolic Lj.
Published: November 2008

The purpose of this study was to find out whether a conjunctival autograft over the recessed bulbomotor muscle can prevent a recidive of an inflamatory internal pterygium associated with strabismus. The fast growing internal pterygium (crossing corneoscleral limbus of the right eye 3-4mm towards the centre of the cornea) in a 42 years old patient, was removed by superficial keratectomy, while strabismus was corrected by the recession of the internal rectus muscle and covered with an autograft of the upper bulbar conjunctiva. Neither collagen vascular diseases, nor dry eye were present. Horizontal deviation was lessened from +12 to +6, after surgery, and the regrowth of the inflamatory pterygium was not observed during a five years follow up. The risk of the reapperance of pterygium at the site of muscle surgery for strabismus might have been avoided by creating a smooth ocular surface over a thin conjunctival autograft without Tenon's capsule. We believe that conjunctival autograft in such eyes, carrying a higher risk for pterygium regrowth, may help in the avoidance of the use of cytostatic drugs and on their untoward effects.
Dilemmasand controversies related to cancers of the anterior laryngeal commissure
Authors: Djukic Vojko , Stankovic P. , Stevandic N. , Janosevic Ljiljana , Pavlovic B.
Published: November 2008

From diagnostic and therapeutical aspect, the cancers of the anterior laiyngeal commissure are the separate category in glottic cancers. But, they have not been individually classified in the majority of statistical reports, and, therefore, the incidence of the anterior commissural cancer should be taken with precaution. The issue of therapeutical strategy is controversial, considering the options and limitations of resections of the anterior commissural tumors, within the conception of oncological radicalism. Dilemmas are being especially faced with in radiotherapy, given the failures and unsatisfactory radiotherapeutical results. The prospective clinical study included the analysis of the incidence of primary and secondary cancers of the anterior commissure of the larynx. The follow-up of five-year survivals allowed for the establishment of efficiency of the applied therapeutical methods. The results of five-year survival in patients treated by primary surgery were highly more significant in relation to results obtained by radiotherapy of patients.
Onco-surgical significance of anatomomorhological specificity of glottic region of the larynx
Authors: Stankovic P. , Djukic Vojko , Petrovic Zeljko , Mikic A. , Djordjevic Vladimir , Janosevic Ljiljana
Published: November 2008

Glottis is a medium level of the larynx, involving the vocal cords, vocal process of arytenoid cartilage, and the anterior and posterior commissures. This region of heterogeneous histomorhological structure has specific characteristics: the internal striated muscles, the outer and inner perichondrium, atypical intra-cartilaginous areas of ossification, and unusual muscular insertion to cartilage. Microtomy of 3 thick successive sections was performed at the level of the upper surface of vocal cords. Standard histological staining methods were used. Microphotographs were taken by light microscope under different magnification along with histomorphometric measurements. Cancer spread is partially restricted by anatomic barriers: vocal ligament and tendon of the anterior commissure, and subsequently by the elastic cone. Easier tumor extension may be due to absence of the internal perichondrium and ossification of thyroid cartilage. Microvascularization of the anterior commissure is significant for tumor spread in glottis and paraglottic space. The role of commissural lymph network in local spread of the cancer is completely vague. It is certain that there are causes, still unrecognized, which have an effect on the pathways and direction of malignant tumor spread.
Radical surgery of the malignantlaryngeal tumors
Authors: Djordjevic Vladimir , Milovanovic Jovica , Petrovic Zeljko , Dudvarski Zoran , Petrovic B. , Stankovic P.
Published: November 2008

Modem therapeutical protocols for treatment of T3 and T 4 malignomas of the larynx are not adjusted, because there are attempts to treat these diseases with non-operative methods (such as chemo- and radiotherapy) in order to preserve the organ. The aim of the study was to establish today's results of the surgical treatment of patients with T3 and T4 laryngeal malignoma. We studied the group of patients with laryngeal carcinoma, who had undergone total laryngectomy, during the period of eight years (1990-1997). The patients' data was submitted from medical documentation, it was filled in specially designed questionnaires and was statistically reviewed. During this eight-year-period. 1054 total laryngectomies were done. The five-years survival rate, established in the group of patients who had undergone total laryngectomiy is 308/794 (39%). In the patient group where total laryngectomy was salvage surgery after radiotherapy, the five-years survival rate is 47/172 (27%). In the patient group where total laryngectomy was salvage surgery after conservative or reconstructive surgery, the five-years survival rate is 28/84 (33%). Despite diagnostical and therapeutical achievements, prognosis for T3 and T4 malygnoma of the larynx was not significantly approved in the last few decades.
Uticaj obima hirurske resekcije kod totalne laringektomije na uspostavljanje ezofagusnog glasa i govora
Authors: Stankovic P. , Djukic Vojko , Vukasinovic M. , Janosevic Ljiljana
Published: November 2008

The study of functional results of total laryngectomy carmot be separated from articulation of esophageal voice and speech. To achieve success of phoniatric rehabilitation in laringectomized patients, it is necessary to be well aware of pathological sequelae of the veiy operation, long-term adverse effect of oncological risk factors as well as postoperative anatomo-physiological changes. Anatomic results of total laryngectomy depend on the type of surgical intervention and probable radiotherapy. The extent of surgical procedure, primary dictated by oncological indications, has the essential effect to articulation of esophageal voice and speech. If possible for oncological reasons, hyoid bone should be particularly left intact. Extensive surgical interventions of hypopharynx and the base of the tongue during laryngectomy, neck dissection - especially the radical one, and subsequent radiotherapy, all of them significantly reduce the possibility to produce esophageal voice and speech. Total laryngectomy eliminates the creator of voice and vibrations, which are acoustically perceived as esophageal voice, proceeding at the level of pharyngoesophageal junction. For this reason, the quality of newly created vibrating narrowing is especially important.
The analysis of the quality of life in laryngectomized patients
Authors: Stankovic P. , Djukic Vojko , Janosevic Ljiljana , Arsovic Nenad
Published: November 2008

Total laryngectomy, as extremely mutilating surgical intervention, results in drastic changes of the style and quality of life. The trauma of laryngectomy is huge, both to patients and their environment. The most pronounced changes of the quality of life of laryngectomized patients are seen at marital, familial, professional, business and communication aspects. Malignant disease and total laryngectomy significantly reduce working capacity, producing, besides professional, the economical difficulties. Psychological implications associated with total laryngectomy are the most severe, comprehensive ones and require multidisciplinary approach. The study analyzes the frequency and distribution of factors affecting the quality of life of laryngectomized patients (sex, age, psychic status, probable history of chronic diseases, impairment of hearing and social-family environment of patients). Significant improvement of the quality of life of laryngectomized patients is achieved by systemic, planned and multidisciplinary rehabilitation of patients as well as their immediate environment. The need for the association of laryngectomized patients is stressed.
Occult metastases of oral cavity cancers
Authors: Dimitrijevic Milovan , Mikic A. , Petrovic Z. , Pendjer Ivica , Jesic Snezana , Trivic Aleksandar
Published: November 2008

Despite new approaches to treatment and lower mortality, malignant tumors of the head and neck, including the malignant tumors of the oral cavity, still represent significant oncological problem because long-term survival has not been significantly prolonged. The growth of tumors of this localization is fast and infiltrative. while early metastases of regional lymph nodes are rather frequent. Malignant tumors of the oral cavity account for 1.1% of population in our community (Dimitrijvic, 2001). The objective of the study was to analyze regional metastases of the cancers of the tongue and the floor of mouth in 101 patients with planocellular cancers treated in the period 1991 to 1995.Clinically positive regional lymph nodes were found in 67.3% of patients, while the most commonly involved regions were submandibular (47.4%) and upper jugular region (46.1%). They were more frequent in localization of the floor of mouth than in case of tongue cancer. Three types of neck dissections were used for surgical treatment of patients. In the group of patients with clinically negative results of the neck (NO) who underwent neck dissection, occult metastases of regional lymph nodes were verified pathohistologically in 19.2% of the time. Malignant tumors of the oral cavity are always the indication for neck dissection, even in NO category, on account of high proportion of occult metastases.
Klasifikacija hronicnih inflamacija gornjih disajnih puteva na bazi alergijskog statusa
Authors: Janosevic Ljiljana , Janosevic Slobodanka , Stankovic P. , Djukic V. , Stosic-Divjak S. , Dotlic Jelena , Racic Alek
Published: November 2008

Almost one third to one half of all patients in otorhinolaryngologic practice experience some kind of inflammation of the upper respiratory tract out of which allergic mechanisms, either as primary factors or secondary ones, appear in 30-40% of adults and 60-80% of children and adolescents. The objective of this study was to analyze inflammatory conditions of the upper airways on the basis of allergic state of the patient and to establish the classification that will respect the actual immunological alteration level (subclinical allergy, clinical allergy) and spreading (localized allergy, generalized allergy). Inclusion criteria for all sixty nine patients were the diagnosis of chronic upper airway inflammation and their exposition just lo ubiquitous allergens. Diagnostic procedure included anamnesis, physical examination and allergic in vivo testing of the skin and nasal mucosa to inhalant allergens. The certain categories of results were established for the skin prick-test (positive, negative, indefinite), specific nasal provocation test (positive, negative, hyperreactive) and nasal symptoms (present, absent). By using a strictly determined combination of results, we were able to define the six groups in our classification: nasal clinical allergy (30% of patients), non-nasal clinical allergy (19% of patients), localized nasal allergy (11% of patients), latent allergy (3% of patient), nonspecific nasal hyperreactivity (12% of patient) and non-allergic inflammation (25% of patients). Our classification takes into consideration the modem knowledge in the field of allergology and may bring an additional quality in respect to selection of therapy options, long-term follow-up of allergy status evolution in the individual person as well as intragroup and intergroup analysis of parameters important to evaluate the effects of antiallergic prevention or therapy.
Mastoiditis in adults: Diagnostic and therapeutic aspects
Authors: Krejovic-Trivic S. , Djeric Dragoslava , Trivic Aleksandar
Published: November 2008

The purpose of the present study is to report our experience in the diagnosis and treatment of mastoiditis in adults. Five patients with an active chronic otitis and mastoiditis were presented. All of them had a history of chronic ear discharge for long period of time and have been diagnosed and treated sufficiently. All relevant data were analyzed from the medical records. The most common symptoms of the disease were otalgia, otorrhea and hearing loss, but the physical signs of mastoiditis (swelling, erithema and tenderness of the retroauricular region) were presented in all cases. Localization and enlargement of the pathological process within the middle ear spaces was determined by CT. All patients were treated surgically and with intravenous antibiotics. In one patient the other treatment was applied due to a specific (TBC) process in the ear. Early diagnosis and adequate treatment (surgeiy combined with an effective antibiotics therapy) is most important to prevent a serious complications of mastoiditis (extracranial and/or intracranial).
Clinical study of pathways rising inflammatory diseases in the maxillary sinuses
Authors: Racic Alek , Janosevic Ljiljana , Stosic-Divjak S. , Djukic Vojko , Radulovic Radomir , Babic Dragan , Janosevic-Dotlic S.
Published: November 2008

Pathways of the maxillary sinus diseases is an interesting issue investigated by many authors during the past decades. The goal of this research was to study the pathways of infection spreading into the maxillary sinuses and to compare them in relation to their frequency, underlying causes and general epidemiologic characteristics of the involved population. A total number of 150 adult patients of both gender suffering different diseases of maxillary sinuses were included into the study. Pathways rising maxillary sinuses diseases were diagnosed on the basis of standard clinical procedures including CT sceau and MRI of the region. We found inflammatory processes to dominate the tumorous ones (107:43 patients). Rhinogenic type of sinusitis was the most frequent disease (72 patients) while odontogenic sinusitis (35 patients) was significantly less frequent. No case of traumatic or hematogenic maxillary sinusitis was found. Rhinogenic maxillary sinusitis is characterized by spontaneous onset while odontogenic one is mostly of arteficial origin after surgical procedures in the oral cavity (88% of patients). In contrast to rhinogenie type, odontogenic maxillary sinusitis is far more frequent in younger patients.
Radioloska evaluacija maligne bolesti larinksa
Authors: Markovic Z. , Djukic Vojko
Published: November 2008

Dijagnosticki imidzing sistemi: kompjuterizovana tomografija, magnetna rezonanca, ultrazvucna dijagnostika visoke rezolucije i pozitron emisiona tomograflja, znacajno su doprinele celishodnijem sagledavanju brojnih patoloskih stanja larinksa. Kontinuirani razvoj dijagnostickih aparata ucinio je da radioloska dijagnostika postane vazan deo dijagnostickih algoritama regije larinksa. Osnovni klinicki kvalitet primene radioloskog imidzinga larinksa je mogucnost eksploracije svih tkivnih struktura kao mesta potencijalnih inflltrativnih lezija, a ne samo laringoskopski dostupne sluznice. Mogucnost morfoloske eksploracije submukoznih promena daje nove mogucnosti u ranoj i diferencijalnoj dijagnostici, planiranju i pracenju lecenja. Isti znacaj ove metode imaju u evaluaciji limfnih nodusa vrata kod bolesnika sa karcinomom larinksa. Opisani najcesci nalazi, tehnika pregleda i dijagnosticka senzitivnost kod atipicnih promena.
Salvage surgery after restorative proctocolectomy
Authors: Nicholls R.J.
Published: November 2008

Restorative proctocolectomy is now the elective surgical procedure of choice for most patients with ulcerative colitis or familial adenomatous polyposis. There are four causes of failure including acute and chronic sepsis, poor function for mechanical or functional reasons, mucosal inflammation (including pouchitis and retained rectal mucosa) and neoplastic transformation. Failure rates themselves range from 5% to nearly 20%. Followed over a period of 20 years, the failure rate can be summarised approximately as 5% at five years, 10% at ten years and 15% at 15 years.
Validity of current experimental evidence on laparoscopic surgery for colorectal cancer
Authors: Bergamaschi R.
Published: November 2008

Experimental animal studies can provide crucial evidence for the evaluation and refinement of the controversial area of many areas of surgery. Recently, during the surge in interest in laparoscopic surgery, in particular for colorectal cancer, 72 animal studies have been published between 1995 and 2001. However, the question remains as to which of theses data can be suitably extrapolated to the human population. Forty-five of 47 studies, which use cell suspensions, relied on percutaneous intraperitoneal injection of cancer cells to induce peritoneal carcinomatosis. One study described a laparotomybased model with injection of tumor cells into the cecal lumen while a different study3 presented the cancer cells via enema. In this study, sigmoid resection was performed before colorectal solid tumor growth.
Recurrence rates at minimum five-year follow-up: Laparoscopic versus open sigmoid resection for uncomplicated diverticulitis
Authors: Thaler K. , Weiss E.G. , Nogueras J.J. , Arnaud J.P. , Wexner S.D. , Bergamaschi R.
Published: November 2008

The aim of the study was to compare the impact of surgical access to sigmoid resection on recurrence rates in patients with uncomplicated diverticulitis of the sigmoid (UDS) at a minimum follow- up of five years. Recurrence after surgery was defined as left lower quadrant pain, fever and leucocytosis with consistent CT and enema findings on admission and at 6 weeks, respectively. Outcome measures included splenic flexure mobilization, specimen length, inflammation at proximal resection margin and presence of teniae coli at distal resection margin. Seventy-nine patients undergoing laparoscopic sigmoid resection (LSR) were compared with 79 matched controls with open sigmoid resection (OSR) operated on at two institutions during the same period. Patients were well matched for age, gender, body mass index, ASA grading and symptoms duration, but not for follow-up length (81.9 vs. 86.9 months, p = 0.046). The rate of splenic flexure mobilization (19 vs. 41, p 0.001), specimen length (16.1 vs. 18.3 cm, p = 0.048), presence of inflammation at proximal resection margin (21 vs. 4, p 0.001), and presence of teniae coli at distal resection margin (4 vs. 53, p 0.001). Three LSR patients and 7 OSR patients had one recurrence (p = 0.19). There were no significant differences in rates of flexure mobilization, specimen length, and rates of inflammation present at proximal resection margin in 10 recurring and 145 non-recurring patients. The rate of teniae coli present at distal resection margin was significantly increased in recurring patients (7 vs. 43, p = 0.03). Surgical access to sigmoid resection for UDS is unlikely to have an impact on recurrence rates provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid.
Genetic testing and surgeon decision
Authors: Guanti G.
Published: November 2008

Colorectal cancer is a highly treatable and often curable disease when localized to the bowel. Traditional pathological staging systems have been useful in predicting the outcome of colorectal cancer, but is now evident that colorectal cancer is heterogeneous and its natural story strongly correlates with genetic alterations that occur during progression from adenoma to carcinoma to metastatic disease. The goal of many studies is to define a marker, or set of markers, on which therapeutic decisions could be made with greater precision for given individuals. In investigations in which at least 100 patients with locally advanced colon cancer have been studied, those in which monoclonal antibodies to p53 (PAB 1801/DO-7/D0-1) were used have generally demonstrated that mutant or overexpression of p53 is associated with a worse clinical outcome.
Quality of life after sphincteroplasty
Authors: Pfeifer J.
Published: November 2008

The operative technique of sphincteroplasty is only for isolated disruption of the sphincter muscle. Patients best suited for surgical corrections are those in whom incontinence is secondary to an anterior (obstetrical) sphincter defect. Due to the disappointing long-term results, the operation may be postponed if appropriate. At present, firstline treatment often is a biofeedback training program. It is well known that a persistent defect after repair is associated with an immediate poor outcome From 1995 - 2003 we have performed 40 sphincteroplasty on 38 patients with a mean age of 34 (range 19 - 71) years. The long-term results the of sphincteroplasty are not so promising. 3 techniques are available for measuring quality of life: Descriptive measures. Severity measures, Impact measures Sphincteroplasty, despite poor long-term results, is the best surgical treatment option for isolated, preferably anterior sphincter defects.
Should we treat hemorrhoids according to the stage
Authors: Pfeifer J.
Published: November 2008

Hemorrhoidal disease is a very common and widespread disease, and it is estimated that about one subject out of three may suffer from this pathology. Hemorrhoids generally cause symptoms when enlarged, inflamed, thrombosed, or prolapsed. Internal hemorrhoids arise above the dentate line (in comparison to external hemorrhoids - perianal phlebothrombosis) and are covered by transitional or columnar epithelium. Scleotherapy is one of the oldest therapy forms mainly for bleeding hemorrhoids. The so called Barron ligature is an office procedure in which a small rubber band is placed at the base of the internal hemorrhoid with a special applicator.
Ambulatory surgery in proctology
Authors: Kosorok P.
Published: November 2008

Introduction: In our institution we?ve had a lot of exerience in proctology. Ten years ago, we introduced one day surgery in our practice and had really good results in treating practically all patients who needed proctologic surgery. Materials, methods and results: During this period of time 9.636 out of 73.235 outpatient cases were chosen for surgery. Among them, 2664 were patients with operations of perianal haematomas. We had some experiences with minor anal surgery (excisions of skin tags in 537 patients, excisions of papillas in 545 patients); patients with haemorrhoids, operated classically on Milligan- Morgan procedure (1116) or by the new PPH - Longo procedure (270) and HAL technique (12). We also treated patients with fistulas - either with fistulotomy or excision of fistulae - and 1007patients with minor surgery. We made excisions of anorectal polyps in 265 patients, excisions of pilonidal cysts in 421 patients and treated 211 patients with anal abscesses. We had 282 patients with anal warts, 310 patients with anal fisures. In 35 patients we made some other small proctological interventions. In addition to proctology we made tension free operations of groin hernias in 627 patients, corrections of epigastric and umbillical hernias (26 patients) and corrections of stomas in 11 patients. The rest of our peogramm were small aseptic interventions (operations of fibromas, atheromas, verrucas, ganglions, lipomas etc.). Conclusion: We have experienced ambulatory surgery (i.e. day surgery hospital) as an appropriate choice for treating the patients with proctologic pathology. However, it used to be the practice to treat all these patients in hospitals, where they occupied bed facilities that could be intended for other patients. To conclude, our present results have confirmed the decision for ambulatory surgery to be correct in the field of proctology.
Surgical strategy in massive colorectal bleeding
Authors: Bartha I. , Danya T. , Nemeth A.
Published: November 2008

Several pathologic disorders can become a sou-rce of severe gastrointestinal bleeding. The most frequently observed entities responsible for massi-ve colorectal bleeding are diverticulae, intestinal angiodysplasias, inflammatory bowel diseases and cancers. In order to choose the best - surgical - method to stop the hemorrhage and cure the disease; it is mandatory to properly identify the origin and location of the bleeding. It is a common experience that the usually advised diagnostic methods often yield disappointing results in urgent cases. The presented case shows that selective angiography can lead to the fastest diagnosis in angiodysplasia and with surgery a definitive result can be obtained.
Rectal cancer: Is the surgeon the variable in the outcome
Authors: Ignjatovic D. , Bergamaschi R.
Published: November 2008

Four factors influence the outcome of rectal surgery: tumour biology, stage of lesion, type of surgery performed and the performing surgeon himself1. Tumour biology and tumour stage depend on each other and are not influenced on by the surgeon, while he seems to have a great influence on the latter two factors. This influence mainly consists of the following: training, volume, individual skill and experience.
Anorectal function after low anterior resection
Authors: Matzel K.E. , Bittorf B. , Stadelmaier U.
Published: November 2008

Most patients with rectal carcinoma can now be treated with sphincter-sparing procedures. The quality of life after sphincter-sparing procedures is better than after abdominoperineal excision. However, morphology and physiology of the neorectum/ sphincter complex are challenged and enthusians towards restorative surgery in rectal cancer was tempered by concerns over functional deficits: after low anterior resection a substantial portion of patients experience impaired anorectal function, in particular fecal leakage and urgency of defecation and report disturbed sexual function. The aim of our work was to investigate functional outcome and anorectal physiologic function as measured by manometry after the three most commonly used reconstructions of intestinal continuity: anterior rectal resection, low anterior rectal, and intersphincteric rectal resection.
The histological diagnosis of dysplastic and neoplastic lesions in inflammatory bowel disease: A pathological perspective
Authors: Usaj-Knezevic Slavica , Tarabar Dino , Cuk Vladimir , Cerovic Snezana , Brajuskovic Goran , Panisic M. , Klem Istvan , Eric Z.
Published: November 2008

Patients with inflammatory bowel disease (IBD), both ulcerative colitis (UC) and Crohn?s disease (CD), are at an increased risk for developing colorectal carcinoma (CRC). The accurate diagnosis of dysplasia in biopsies taken during periodic surveillance of long-standing IBD patients is most important in prevention of UC and CD related cancer. Distinction of low from high grade IBD-related dysplasia and differential diagnosis between IBD-related dysplasia and dysplasia in sporadic adenoma as well as distinction from pseudodysplastic lesions in inflammatory pseudopolyps or reparative lesions is often very subtle and difficult and demands expertise of second experienced gastrointestinal pathologist. Although surveillance colonoscopy with multiple biopsies does not reduce the cancer mortality, it offers a reasonable chance of detecting precancer and performed prophylactic colectomy. Novel methods of detecting dysplasia are continuously being evaluated, including chromoscopy and molecular biology markers. In the future, one may expect, from these new markers to detect the dysplasia in IBD patients before development of histological evidence of neoplastic changes.
Surgical resection and high dose rate intraoperative radiation therapy for locally recurrent rectal cancer
Authors: Idrees K. , Minsky B. , Alektiar K. , Guillem J. , Weiser M. , Temple L. , Wong W.D. , Paty P.
Published: November 2008

For intra-pelvic recurrence of rectal cancer, surgical resection is technically difficult and must be aggressive to achieve a high rate of negative resection margins. Resection with clear margins can be curative, particularly for those patients with true anastomotic recurrence. HDR-IORT is a safe, feasible, versatile, logistically sound modality that is highly reliable in delivering radiation to at-risk surgical margins in the pelvis. Despite surgery and IORT, overall local failure rates in this population are 33 to 50 percent. The most important prognostic variable is the state of surgical resection margins. At our institution, in patients with negative and positive resection margins the 2-year actuarial local recurrence rates are 33 percent versus 73 percent and 5-year survival rates are 51 percent versus 16 percent, respectively. On subset analysis, the most favorable outcome was seen in patients with true anastomotic recurrences (78 percent 5-year survival).
Meta-analysis on minimally invasive surgical therapy of sigmoid diverticulitis
Authors: Ignjatovic D. , Zivanovic V. , Vasic G. , Ilic I.
Published: November 2008

The bowel diverticulitis is a complication of diverticulosis, occuring in 35% patients in 20 years after diagnosis. The study purpose was analysis of the results published in world literature. Method: double blind electronic search of several databases using key words: diverticulitis, laparoscopy. Results: 11 studies with 415 patients that satisfy the criteria were selected. Age: 62,7 + 14.2. Hinchey stadiums: I, IIa i IIb of these 44% I and 28 % IIa i Iib each. Operative time: 197.4+ 49.6 min. Conversions: 11.7+10,1 (0-38,9%). Protective stoma: 5,5%. Bowel sounds: 2,3 - 3,2 postoperative day. Oral feeding: 2,6-5 postoperative day. Hospitalization: 6.1 2.1 dana. Anastomotic dehiscence: 2,8%, wound infection: 7,3%, iatrogen rectum perforation with stapler: 3,3%, bleeding: 3,5%, ileus: 4,4%, reoperation rate: 4,7%. Conclusion: Sigmoid resection with or without a protective "loop" ileostomy is technically feasable by minimally invasive surgical technique, with an acceptable ratio of benefits and complications.
Comparation of influence general and regional anesthesia on basic haemodynamic parameters during carotid endarterectomy
Authors: Sindelic R. , Vlajkovic G. , Davidovic Lazar , Vujanac B. , Vjestica M.
Published: November 2008

Carotid endarterectomy (CEA) is a preventive operation to reduce the incidence of embolic and thrombotic cerebral stroke. CEA carries a significant perioeperartive mortality rate from stroke and myocardial infarction, which may even approach 5%. Thus, anesthetic and surgical techniques are constantly under scrutiny to try to reduce this relatively high incidence of morbidity and mortality. Anesthetic technique for CEA is divided to general (GA) and regional (RA) anesthesia, performed by cervical plexus block. The aim this study was to examine changes of basic haemodynamic parameters, which routinely fallows during CEA in condition of GA and RA. After obtaining institutional approval and informed consent, we randomized 50 patients scheduled for CEA (Tab.1) in two groups (GA and RA). We fallow blood pressure: systolic (BPs), mean (BPm), diastolic (BPd), heart rate (HR), and RPP index at the examined patients. The examination performed in six control times: before induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes after cross clamping of arteria carotis (T3), 5 minutes after declamping arteria carotis (T4), 10 minutes (T5) and 2 hours after operation (T6). The results of study shows significant changes of blood pressure (BPs and BPm) and RPP index in T2 time in patinets undergoing GA. The changes occurred under influence of induction agent thio- pental. These changes were in homeostatic range. In RA patinets, no haemodynamic changes registrated in control times. Therefore, from haemodynamic aspect RA was superior to GA.
Determination of beta-endorphin plasma concentrations in surgical patients with acute abdominal pain
Authors: Popovic Nada , Kojic Zvezdana , Bumbasirevic Vladimir , Pavlovic A. , Stefanovic Branislav , Karamarkovic Aleksandar , Radenkovic Dejan , Nikolic V.
Published: November 2008

Abdominal pain and surgery, frequently associated with this kind of pain, modify plasma levels of stress-hormones and initiates the response of endogenous analgesics system. The aim of this study was to determine serum concentration of beta-endorphine in patients with acute abdominal pain (n=12), which were surgically treated. Serum concentration of beta-endorphin was measured on five data points: before, during and after surgery. During abdominal surgery serum concentration of beta-endorphin was increased by 7% compared to preoperative period; in postoperative period the concentration continued to rise and remained increased within next hours. The maximal levels of beta-endorphine were not observed during, and immediately after surgery. Postoperatively, between 6 and 8 p.m. on the day of surgery, maximal level of beta-endorphin was noted, which was even ten times higher than to preoperative value. Plasma level of beta-endorphin fell to the baseline values 24 hours after surgery. In conclusion, abdominal surgery induces a postponed (delayed) increase in serum beta-endorphine levels, which are associated with modulation of preoperative, intraoperative and postoperative pain perception.
Neurosurgical treatment of spontaneous intracerebral haematomas
Authors: Djurovic B. , Tasic Goran , Jovanovic V. , Krunic-Protic R.
Published: November 2008

There have been 34 patients with spontaneous intracerebral haematomas (ICH) operated, from the 1st January 2002.Yr to the 31st December 2002. Yr., at the Neurosurgical Department of Trauma Centre (Clinical Centre of Serbia). They all were with the serious disturbance of consciousness. none of these patients had angiography, so preoperatively we didn?t know the reason of bleeding. From 34 operated patients, 22 or 64.7% died and 12 or 35.3% survived. There were 14 patients in the deepest state of coma, where preoperatively GCS score was 3 to 5. Only one patient age 25 survived postoperatively. Other survivors have less disturbed state of consciousness, CT findings without intraventricular bleeding and were also in younger age group.
Transvaginalna sakrospinalna kolpopeksija u resavanju uterovaginalnog prolapsa i prolapsa vaginalnih zidova
Authors: Argirovic R. , Likic-Ladjevic I. , Pantovic S.
Published: November 2008

Investigation has been performed upon 29 patients of average age of 62,7 years who have undergone sacrospinous colpopexy because of different degree of uterovaginal prolapse (26 patients) and vaginal vault prolapse (3 patients) after having abdominal or vaginal hysterectomy. In patients with uterovaginal prolapse, 23 of them have vaginal hysterectomy with high ligation of the enterocele sac, anterior et posterior vaginal repair and sacrospinous colpopexy, while 3 patients had conservation of uterus following previous reparation of vaginal walls and cervi- cosacrocolpopexy. Only in one patient we had intraoperative lession of the bladder with no other intraoperative complications so far.Aveage time duration of the operation was 112 minutes.All patients were scheduled to be seen at 4 weeks, 6 months and 12 months after operation and then yearly therafter.The mean follow-up period was 16,8 months (6-27). We have achieved satisfactory results in 25 patients while 4 patients have bladder instability, 3 patients suffered from urinary infection, 2 have febrile morbidity and 2 bottock pain. Sacrospinous colpopexy can be performed together with vaginal hysterectomy and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse and low intra and post-operative complication rates.
Intrahepatic segmental bile duct B3 cholangiojejunostomy in the palliative management of high unresectable malignant biliary obstruction
Authors: Karamarkovic Aleksandar , Milic Natasa , Djukic Vladimir , Radenkovic Dejan , Jeremic Vasilije , Bumbasirevic Vladimir , Popovic Nada , Kojic Zvezdana , Bajec Djordje
Published: November 2008

Palliating the effects of biliary obstruction is a major goal of therapy in patients with unresectable cancer at the hepatic duct confluence. We reviewed our expirience with intrahepatic holangioenteric bypass to the segmental bile duct B3 as a palliative therapy in patients with unresectable malignant diseases involving the ductal confluence or the common hepatic duct. Since March 2001, we have performed intrahepatic segmental bile duct B3 cholangiojejunostomy by Roux-en-Y fashion utilizing a round ligament approach in 13 patients with malignant obstructive jaundice due to unresectable hilar holangiocarcinoma (8 cases) and gallbladder cancer (5 cases). Mean hospital stay was123 days and mean blood loss was 25060 mL. Postoperative complications occurred in 3 patients (23 %), but there was no surgical complications such as postoperative bleeding, bile leakage or abscess formation. 30-day mortality was 7.7% (1 patient). Late complications (37.5 %) were observed in 3 of the 8 patients who survived for more than 5 months after the surgery. Median survival after B3 cholangiojejunostomy was 9 months (range, 10 days-22 months). Median survival time was significantly greater in patients with hilar cholangio-carcinoma (11.8 months; range: 2-22 months) compared with those with gallbladder cancer (4.6 months; range: 10 days-11.5 months) ( P-0.032 log rank test; P-0.049 Tarone-Ware test). Intrahepatic B3 cholangiojejunostomy when combined with careful patient selection, can provide useful palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates.
Endoscopic perforations of colon and rectum
Authors: Lazovic R. , Krivokapic Zoran
Published: November 2008

Although fiberoptic examination of the colon is nowdays considered to be safe procedure, endoscopic perforation remains rare, but serious and potentially life threatening complication. General incidence od diagnostic and interventional perforations of colon ranges, according to the literature between 0.1- 0.9%, or for diagnostic procedure about 0.17%, and for interventional 0.41%, with general mortality rate of 0,006%. In spite of the general trend for diminishing this occdurence, it is necessary to compare various experiences in order to achieve an algorrhithm of early diagnostic and the way of the surgical management of this particular kind of perforation. The aim of this work is to present the experience in 1995-2004 period, upon 7 (0,12%) cases of surgically treated perforations of colon after 5,680 performed diagnostic colonoscopies. In all 7 cases the reason for perforation was not basically pathologiocal process. 4 cases of perforations were recognized immediately, and they were managed by direct suture of the perforation. In 3 cases diagnosis was late from 1 to 3 days, and two-step operative procedure was performed in septic condition. Subjective and clinical signs of perforations were not always uniform, but in all 7 cases there were clear X-ray signs of free intraabdominal air. Surgical treatment was successful, and without deaths. In the algorrhithm of surgical diagnostic and procedure, the same principles and criteria used for civilian injuries of colon are to be used.
Indikacije za hirursko lecenje bola i vrste operacija
Authors: Ivanovic S. , Slavik Eugen , Antic Branislav , Spaic M. , Rasulic L.
Published: November 2008

During the period from 1978 to 2003 in Institute for neurosurgery CCS and Neurosurgical hospital of MA in Belgrade, 3057 patients with pain syndromes in different localizations were operated. Before operation all conservative methods were exhausted. We made 248 microvacular decompressions in fossa cranii posterior, 1600 radiophrequent lessions of ggl.Gasseri and 64 avulsions of distal trigeminal branches in patients with trigeminal and glossopharingeal neuralgia, 128 chordotomies in patients with neurogenic and cancer pain, 62 DREZ operations in patients with paraplegia, cancer pain and postherpetic intercostal neuralgia. More than 900 patients have been operated because of neuropathic pain and trauma of peripheral nerves, and 48 patients were operated due to Phantomzs pain. We compared results of two alternative methods in treatment of trigeminal neuralgia (radiophrequent lesion of ggl. Gasseri and microvascular decompression in posterior fossa).