bluuebunny/crossref_metadata_2025 huggingface dataset:
Idopathic tigeminal neuralgia: Radiophrequency rhizotomy of ganglion Gasseri
Authors: Slavik Eugen , Ivanovic S. , Spaic M. , Djurovic B.
Published: November 2008

Idiopathic trigeminal neuralgia (ITN), ( tic douloureux), may be defined as a chronic painfull disorder of the sensory divisions of the trigeminal nerve, with unexplained cause and pathogenesis. The clinical features are characterized by recurrent paroxysmal lancinating pain confined to distribution of one or more branches of the nerve. Radio frequency rhizotomy (RFR) of ganglion Gasseri is a method of choice in treatment of ITN. We present the series of 1600 patients suffering from ITN who underwent RFR between 1984 and 2001. Ages ranged from 29 to 88 years, with a mean age of 62 years. Total pain relief immediately after a single radio frequency lesion was achieved in 1469 (92%) of patients. After one year a recurrence of pain was present in 145 (10%). Age, sex and duration of illness were unrelated to outcome. Patients previously treated by open surgery appeared to receive less benefit from subsequent RFR. Clinical outcome correlated with the degree of sensory deficit created by RFR. Patients acquiring dense deficit demonstrated a reduced risk of recurrence: 203/1129 (18%) of patients with dense sensory loss and 75/258 (29%) of those with a partial deficit developed a recurrence by three years, whereas almost all patients (78/82) without initial sensory loss suffered a recurrence by three years. Serious complications resulting from RFR were infrequent and the most common was the permanent dysesthesia in 9 (0,6%) of patients. Our results suggest that the RFR is an well bearable and effective long term surgical treatment for ITN, especially for older and poor-risk patients.
Neuralgies of the lower cranial nerves: Microsurgical posterior fossa exploration
Authors: Antic Branislav , Peric Predrag , Ivanovic S. , Spaic M.
Published: November 2008

Neuralgias of the lower cranial nerves are trigeminal neuralgia (TN), glossopharingeal neuralgia (GphN), and geniculate neuralgia (GN). Microsurgical posterior fossa exploration with its variations microvascular decompression (MVD), partial sensory rhisotomy (PSR), and total sensory rhisotomy (TSR) is one of the most efficient ways of treating these neuralgias. It was performed 130 operations in 125 patients with TN, 3 in GphN patients, 1 in GN patient, 1 in GN/TN patients, 1 in GphN/GN patient, and 2 in GN/hemifacial spasm patients. Of total of 125 patients with TN, MVD was performed in 63, PSR in 18, and MVD+PSR in 44 cases. In 5 patients with recidivate TN PSR was performed. Of total 3 patients with GphN MVD was performed in 2 cases, and extirpation of a small meningeoma in 1 case (it was not seen on CT). In the patients with GN TSR of intermediate nerve was performed, in GN/TN patients TSR of intermediate nerve and PSR of trigeminal nerve was performed, in the GN/GphN patients MVD of glossopharingeal and TSR of intermediate nerve were performed, and in the GN/hemifacial spasm patients TSR of intermediate and MVD of facial nerve were performed. The results of TN patients are: excellent in 82,4%, good in 12%, and poor in 5,6% of patients. There is no difference in complete pain relief, rate of recurrence, and complications between MVD, MVD+PSR and PSR operative groups (p>0,05). Among patients with other neuralgias the following results are noted: excellent in 4, good in 3, and poor in 1 patient. Microsurgical posterior fossa exploration is the method of choice in the treatment of the neuralgias of the lower cranial nerves.
Fantomski bol i postraumatska bolna stanja
Authors: Rasulic L. , Ivanovic S. , Bascarevic V. , Simic V.
Published: November 2008

After limb or body part amputation, three different types of perceptual sensitive phenomena can be recognized. They can be all named posttraumatic neuropathies: painless sensations in phantom limb ,painful phantom limb and painful posttraumatic stump. Painless sensations in phantom limb can be seen in 90% of cases in resected body parts as soon as first postoperative day, less often during the first week, and its clinical characteristics are usually stabilized during the first year. Painful posttraumatic stump appears because of pain neuroma existing, that forms at the proximal end of amputational stump as a consequence of physiological nerve regeneration attempt. Frequency of pain significantly varies considering authors from 5 - 90%, depending on definition of this phenomena and criteria used. It is considered that 5- 10% mast be under permanent medicament treatment. Phantom pain appears more often in elderly and people with specific affective personality construction. It can bee permanent, burning, nettling, tearing (25%), or intermittent, lancerating, in the shape of electrical discharging (32%), but it can also have bizarre attributes. Phantom pain appearance usually announces its duration in the longer period. After two years it is present at 59% of patients, with decreasing intensity, and only 5- 10% suffer severe pain. In our Institute in the period from 1980-2003, 48 patients have been treated, 36 patients with medicamentous treatment, local blockades and chronic stimulations, and 12 patients, who did not react at conservative treatment were operated. In operated group in 10 patients pain disappeared, one patient it was with decreasing intensity, and one patient was without change.
Neurophysiological and clinical aspect of patients with carpal tunnel syndrome
Authors: Martic V. , Peric Predrag
Published: November 2008

In the group of patients with carpal tunnel syndrome (CTS), besides paresthesias in their fingers, we can see paresthesias in forearm; pain in elbow, shoulder and neck, which is a reason for complicated diagnosis of it. This kind of complexnost of differential diagnosis pain in hand, is a reason for complete and strict diagnostic procedure. There are 30 patients with clinical and neurophysological findings for CTS in this paper who made provocative tests. Analyzing their results we made diagnosis of KTS.
Strategies for postoperative pain relief in neurosurgical intensive care unit
Authors: Milakovic B. , Dostanic M. , Ivanovic S.
Published: November 2008

Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be under treated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.g. opioids, nonsteroidal antiinflammatory agents) analgesic options. They still remain the most widely used method for providing pain relief in acute surgical situations. The exact choice or combination of analgesics utilized for a particular patient will depend on the riskbenefit profile and patient preferences. Especially is crucial to promptly involve the analgesics when an opioidtolerant patient requires aggressive pain treatment. But, opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Combinations of drugs acting on different mechanisms of nociceptive modulation will decrease the incidence of adverse effects and offer additive and/or sinergistic effects. Analgesic concentrations of ketamine infusions remain a valuable addition to opioid administration. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and improve postoperative distress. Neuromuscular blocking agents (NMB) in the intensive care unit (ICU) patient facilitate intubation and ventilatory support, decrease oxygen consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. Ideally, analgesics, sedatives and/or muscle relaxants should be combined into a multimodal approach to facilitate patient recovery after surgery. Although a great deal is known about specific drugs and dosage requirements, further research is needed that clearly examines optimal scheduling regimens if we are to maximize patient care. The most important rule of pain management is that pain is what the patient says it is.
Infekcija u hirurgiji kila
Authors: Zuvela M. , Milicevic M. , Galun D. , Lekic N. , Basaric D. , Tomic D. , Petrovic M. , Palibrk I.
Published: November 2008

Traditionally, the operation of hernia is considered as a clean operation due to expected, low incidence of infection, on the spot of surgical work (SSI). The incidence of SSI in hernia surgery is more frequent then it is assumed. The important risk factors for SSI are the following: type of hernia (inguinal, incisional), operative approach (open - laparoscopic), usage of the prosthetic material and drainage. Comparing to inguinal hernia repair, incisional hernia repair, is more frequently followed by the infection. The laparoscopic operations are followed with the lower incidence of SSI then in the case of open operation. The usage of the mesh does not increase the incidence of SSI, although the consequences of the mesh infection may be severe. A type I of the prosthesis is more resistant to the infection then prosthesis II and III. The mesh infection (type I) never involves its body but it is present around sutures and bended edges. The mesh infection Type II involves entire prosthesis while in the case of Type III it is present in its peripheral part. In the case of SSI, a prosthesis Type I is possible to be saved, while prosthesis Type II must be removed completely; and the same is for the Type III (the partial removal is rarely suggested). The defect that remained after excision of non-resorptive prosthesis is a long-term and very complicated surgical problem. In regard to the position of the mesh, SSI is more common if the mesh is placed subcutaneously then in the case of sub-aponeurotic peri-muscular, pre-aponeurotic retromuscular or pre-peritoneal mesh placemen. If the infection is present the non-tension techniques using non-resorptive prosthetic implants are not recommended. the presence of drainage and its duration increases the incidence of SSI. It is more common for incisional hernioplasty then for inguinal hernia repair. If there is an indication for drainage it should be as short as possible. The cause of SSI for elective operations are bacteria?s that arrives from the skin, while in the case of opening of various organs dominant bacteria?s originate from them. The superficial infection does not lead to the recurrence, while it is very possible in the case for deep infection. There are no prospective studies that justify the usage of antibiotic prophylaxes in hernia surgery. The antibiotic prophylaxis in hernia surgery. The antibiotic prophylaxis is indicated for the clean operations when placing the implants and when severe complication is expected. The appearance of SSI increases the price of treatment and may lead to the recurrence.
The role of endoscopic ultrasonography in diagnostic and estimation of common bile duct carcinoma invasion
Authors: Tomic D. , Krstic M. , Pavlovic A.R. , Dugalic P. , Jesic R. , Zuvela M. , Krstic S.
Published: November 2008

The main purpose of this survey is to present the importance of EUS in establishing a diagnosis of tumor of the choledochus. It is also important to emphasize that EUS is the most suitable diagnostic method for determination of tumor invasion to choledochus, i.e. to determine TN patient status and to predict if tumor could be successfully resected. The author would like to present his own experience in using of EUS as a contemporary method for establishing a diagnosis and effective treatment of patients with tumor of choledochus. All patients were examined by Olympus equipment for endoscopic ultrasound with radial probe working with the frequency of 7,5 and 12 MHz at the Department for Endoscopic Ultrasound of the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia. All examined patients were subjected to surgical exploration after that. Therefore it was possible to compare preoperative estimation of tumor invasion with a final result obtained by surgical exploration. Five patients were diagnosed with tumor of choledochus localized at the distal part of choledochus. TN status of examined patients was specified by standard criteria. Estimated TN status for two patients was defined as T2N1a and T2N0, which indicate the possibility of excessive surgical treatment, what was confirmed by surgical exploration as well. A small number of patients was not possible to use for statistical evaluation. Our conclusion is that EUS presents the most effective method to estimate a degree of tumor invasion to choledochus, since it provides an accurate definition of TN patient status and predicts if tumor could be successfully resected.
Vascularised osteocutaneous scapular flap in the reconstruction of mandibular defects after war wounding
Authors: Stosic Srboljub , Jovic Nebojsa , Stosic-Opincal Tatjana , Kozomara R. , Panajotovic Lj.
Published: November 2008

Vascularized osteocutaneous scapular flaps belong into the most convenient ones in reconstruction of mandibular defects followed by massive loss of adjacent skin and mucous membrane due to its vascular supply, bulkiness, suitability and mobility of cutaneous component of the flap. In seven wounded patients such defects of the mandible and adjacent soft tissues after war wounding have been reconstructed at the Clinic for Maxillofacial Surgery of the Military Medical Academy - Belgrade during the six years period with vascularized osteocutaneous scapular grafts. Here we present localization and structure of the defect, features of harvested compound graft, the procedure of reestablishment of mandibular continuity, immediate and late complications during the consolidation period, as well as the analysis of the success rate.
The role of enterostomy in the management of colonic injuries
Authors: Lazovic R. , Krivokapic Z.
Published: November 2008

The circumstances, evaluation and results of the management of 67 colonic and rectal injuries during the period 1992-2003 in Clinical Centre of Podgorica are presented. In 32 war and 37 civilian injuries to colon, several systems of the severity trauma determination, as well as systems of grading and classification of injuries of colon were evaluated, and the surgical access according to achieved results was investigated in order to determine the use of enetrostomy in the management of these injuries. From the presented and statistically evaluated results, it can be concluded that Flint?s 3 grade classification can be used as the most reliable indicative and prognostic system. For the success of One stage surgical procedure, the most critical fact is differentiation between Flint?s Grade I and II (Chi Square 4.514; P) as well between Grade II and III. That means that by using One stage procedure, unfavourable results may be expected not only in Grade II, but as well in border cases between II and III. Also, according to the presented results, there were not differences observed in the success of management between Grade II and III (Chi Square 0.678; P0.05). That means that using Two stage procedure, unfavorable results can be prevented not only in the borderline cases between Grades II and III, but also in the Grade III. Two stage surgical approach in the repair of injured colon remains valuable and useful surgical procedure, even in spite of success of surgical technology and operative technique, in cases with severe and multiple abdominal injuries, and in borderline decision making. These procedures are also inevitable in the management of any complication of primary repair of the colonic wound. Using rational evaluation and good surgical technique, primary repair of can be used in almost 50% of civilian and war injuries of colon.
Endoskopska ultrasonografija (EUS) u preoperativnoj lokalizaciji neuroendokrinih tumora (NET) pankreasa
Authors: Krstic M. , Sumarac M. , Diklic A. , Tatic S. , Pavlovic A.R. , Tomic D. , Micic D. , Kendereski A. , Milinic Nikola , Petakov Milan
Published: November 2008

Background: Preoperative localization of pancreatic neuroendocrine tumors (NET) is usually very difficult. Noninvasive, imaging tests, such as abdominal ultrasound, CT or MRI are not sensitive enough as well as selective angiography. The aim of the study was to clarify the usefulness of the EUS in preoperative localization of the pancreatic NET. Methods: From September 1998 - March 2005, EUS was performed in 1600 patients. Among them, in 10 (0,7%), this examination was carried out due to previous biochemical tests, which diagnosed the pancreatic NET. We studied the location, the size and echo-pattern of the neoplasm. The results were compared with operation and histology or EUS- FNA guided pancreatic biopsy in 9/10 patients. All EUS examinations were performed using Olympus GIF-130 videoecho-endoscope with 7,5 /12MHz switch able radial probe. Results: EUS correctly localized the pancreatic NET in 7/8 cases, (sensitivity:87,5%). In 2 patients, EUS accurately excluded pancreatic NET. There were no false positive findings (specificity 100%). Six tumors were benign (75%), and two were malign (25%). We localized 6 insulinomas and single pancreatic carcinoid tumor. The median tumor size detected by EUS was 21mm. Conclusion: EUS is highly accurate in preoperative localization of the pancreatic NET-s and We confirmed it in our study. EUS presents the method of choice for preoperative localization of the pancreatic NET.
Modern aspects of shoulder injury treatment
Authors: Bumbasirevic Marko , Lesic Aleksandar , Tomic Slavko , Milicevic M. , Djukic V. , Ivancevic N. , Mitkovic Milorad , Bumbasirevic V. , Sudjic V.
Published: November 2008

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.
Modern aspects of the ankle fracture treatment
Authors: Lesic Aleksandar , Tomic S. , Cobeljic G. , Milicevic M. , Djukic V. , Slavkovic Nemanja , Mitkovic Milorad , Bumbasirevic V. , Bumbasirevic Marko
Published: November 2008

The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modern diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.
Anterior cruciate ligament (ACL)
Authors: Lesic Aleksandar , Bumbasirevic Marko , Malobabic Slobodan , Milicevic M. , Ivancevic N. , Slavkovic Nemanja
Published: November 2008

The anterior cruciate ligament or ACL (ligamentum cruciatum anterius) is often injured, either alone or within complex ligament injuries of the knee. Therefore, the knowledge of detailed anatomic (macro- and micro-morphological) characteristics of this ligament is of key importance in therapy. The anatomy, structure, insertions, vascularization and innervations of the anterior cruciate ligament of the knee are described from the aspect of modern treatment and rehabilitation methods.
Thoracic disc herniation causing myelopathy: Our experience using transthoracic approach
Authors: Slavkovic Slobodan , Bumbasirevic Marko , Tomic Slavko , Lesic Aleksandar , Slavkovic Nemanja
Published: November 2008

The authors have reported six cases of thoracal discus hernia in five patients. All the patients have recently been examined in neurosurgery institutions. They had different degrees of neurological deficit, with tendency to aggravation. The same procedure has been applying: thoracotomy, large decompression of neural structures, and obligatory spondylodesis with the patient?s own rib. In three cases a full recovery has been achieved, a partial recovery in other two. Complete and definitive paraplegia developed in one patient. The degree of the neurological recovery was between one and two points by Frankel scale. Better results have been obtained where symptoms were present for a short period of time, and myelopathic signs were mild. The follow up period was between 43 and 68 months. Three of the patients have been returned to their professional work. In one patient, three years after the first surgery, there has been diagnosed another discus hernia, one level below. She was treated with the same surgical technique as described, for the second time. Multilevel symptomatic thoracic disc herniations are extremely rare. Although a small series, it is clearly pointed the need to think of a discus hernia, and its early diagnostics and adequate surgical treatment. The first experience with the operative technique described, demonstrated that this procedure is good and justified.
Paraliticka dislokacija kuka kod cerebralne paralize - hirursko lecenje mekotkivnim postupcima
Authors: Cobeljic Goran , Bajin Zoran , Milickovic S. , Lesic Aleksandar , Krajcinovic O.
Published: November 2008

Results of a combination of soft tissue procedures performed for the first time in treating paralytic dislocation of the hip in cerebral palsy are presented. All hip flexors and adductors release, along with possible transposition or elongation of knee flexors on the side of the dislocation (if knee contracture exceeded 20) were performed. 75 hips in 57 patients were operated on. 54 patients were analyzed. The average age of the patients was 6.6 years, the average follow-up was 7 years. Excellent result was achieved in 33patients (61%), good in 10 (18,6%), fair in 4 (7,4%) poor in 7 patients (13%). Poor results were registered in patients over 10 years of age and in patients with athetosis. Results were assessed according to clinical finding, radiological finding (migrational percentage) and the ability of patients to walk. When based on radiological findings only, excellent results were achieved in 63 hips (84%). This combination of soft-tissue procedures which includes all muscles that take part in the dislocation proved to be very successful in achieving reposition. It can be recommended to patients suffering from the spastic form of cerebral palsy up to 10 years of age.
Triple pelvic osteotomy in our practice: Eight years later
Authors: Vukasinovic Zoran , Spasovski Dj. , Cobeljic Goran
Published: November 2008

Authors have reviewed their eight years long experience with triple pelvic osteotomy. They are explaining the way of introduction of this procedure in everyday clinical practice. Sixty six hips were operated using Tonnis-Vladimirov method in fifty five patients of the average age of 15 years and four months. Treatment results were evaluated, both anatomically and functionally. Anatomic improvement was detected by measuring CE angle of Wiberg. Preoperatively it ranged from -6 to 33 degrees (16,4+10,8 degrees), at the end of treatment it ranged from 15 to 68 degrees (43,6+11,8 degrees) - the difference has proven to be statistically highly significant (Student test t=-14,36, p<0,01). Functional improvement (absence of waddling gait or limp, as well as better range of motion) was detected in almost all the cases, although the difference wasn't statistically significant. Also, they are presenting some, very rare, complications - asymptomatic pubic and/or ischial nonunion in seven patients.
Neoperativno lecenje preloma baze prve metakarpalne kosti - Bennettov prelom
Authors: Milosevic I. , Sudjic V. , Bumbasirevic V. , Lesic Aleksandar , Damjanovic G. , Bumbasirevic Marko
Published: November 2008

Although described as early as in 1882, the fracture of the metacarpal bone basis is still a therapeutic challenge for first orthopedic surgeons. Several nonoperative and operative methods in the treatment of this fracture have been described. The goal of this paper is to analyze nontreated patients with Bennett?s fracture. A group of 50 patients of both sexes, with the fracture of the first metacarpal bone basis fractures and with the average follow-up of 9 (6-13) years, has been analyzed. After an orthopedic reposition, immobilization lasting 5 weeks was applied, followed by a physical therapy in the duration of 4 to 8 weeks. Numerically, according to Steel, both the subjective and objective state of the hand, as well as an x-ray finding, were assessed. The total hand function was excellent and good in 42 patients, satisfactory in 8, and none of the patients had unsatisfactory function of the hand. Regardless of present degenerative changes, the function of the hand was good, especially if reposition with fragment dislocation less than 2 mm was achieved.
Development of degenerative changes in the wrist with nonunion oh the scaphoid bone
Authors: Miric Dragan , Bumbasirevic Marko , Vuckovic Cedo , Lesic Aleksandar
Published: November 2008

In patients with symptomatic scaphoid nonunion there was an increased evidence of progressive osteoarthrosis expressed as instability of the wrist1,2; it is defined as a scapholunate angle more than 70 degrees or a radiolunate angle of more than 10 degrees. We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. In this study 40 patients with painful nonunion of the scaphoid were analyzed. Duration of nonunion was not in correlation with development of osteoarthritic changes (p=0,644; p>0,05). Progressive degenerative changes correlated well with radiolunate angle (p=0,398; p<0,05), kapitolunate angle (p=0,381; p<0,05) and carpal index (p=0,392; p<0,05). The average values of intercarpal angles increased with progression of osteoarthritic changes. There was a statistically strong correlation between location of fracture in proximal third and presence of degenerative changes (p=0,341; p<0,01). Intensity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p=0,665; p>0,05). We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.
Of hip fractures in the population of Belgrade during the period 1990- 2000. Projections for 2020
Authors: Lesic Aleksandar , Bumbasirevic Marko , Jarebinski Mirjana , Pekmezovic Tatjana
Published: November 2008

The aim of this survey was estimation of incidence of hip fractures in the population of Belgrade during the period from 1990 to 2000, as well as the estimation of expected numbers and incidence of hip fractures for 2010 and 2020, based on linear trend models. Our investigation included 8139 subjects (29% males and 71% females) with hip fractures aged 50 and more, who hospitalized at all Clinics and Departments of Orthopedics and Traumatology in Belgrade, during the period 1990-2000. In epidemiological analysis, sex- and age-specific incidence rates and standardized (according to the US standard population) rates were calculated. The average number of hip fractures in male and female populations of Belgrade aged 50 and more were 214 and 525 new cases per year, respectively (total 739). The average incidence rates were 84.9/100,000 for males, 167.3/100,000 for females, and 118.6/100,000 for both sexes. During the period observed, incidence of hip fractures showed statistically significant increase (y=111.88+3.11x, p=0.024), especially among females (y=135.94+5.23x, p=0.007). Age-specific incidence rates of hip fractures strongly related with age, and the highest values were registered in the age group 80 and more for both sexes (505.2/100,000-for males and (1042.8/100,000 for females). Among Belgrade inhabitants aged 50 and more, the increasing number of hip fractures could be expected up to 2020, 23.7% for males and 128.8% for females.
External fixation device in treatment of the upper third femoral open fractures caused by firearms
Authors: Miric Dragan , Bumbasirevic Marko , Radulovic N. , Lesic Aleksandar
Published: November 2008

Seventeen patients with open fractures of the upper third of the femur were treated using a pelvifemoral external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Sciatic nerve injury was present in five (29.4%); abdominal viscera and thoracic wall injuries were present in two patients (11.8%). There were no major arterial injuries. Full weight bearing was allowed after clinical and radiological bone healing (average 11.5 months). Chronic osteitis with fistula and sequestra developed in two (11.8%) patients. There were no nonunions and no refractures. Minor painless limitation of hip motion persisted in all patients. Upper-third femoral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted ; therefore, stable fixation is difficult or impossible to achieve using external fixation with transfixation of the fracture site. On the other hand, the risk of infection is high following intramedullary nailing. Pelvifemoral external fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early patient mobilization.
Reconstructive procedures on lower extremities using Mitkovic external fixation system
Authors: Mitkovic Milorad , Bumbasirevic Marko , Golubovic Z. , Mladenovic D. , Milenkovic S. , Micic Ivan , Lesic Aleksandar , Bumbasirevic V. , Pavlovic P. , Karalejic S. , Kuljanin G. , Petkovic D. , Abdala K.
Published: November 2008

The results of limb lengthening, correction of limb deformities and solving of bone loss, by the use of Mitkovic external fixation system and minimally invasive technique on the series of 96 operations in 89 patients are shown. Only lower extremities were included in this series. The advantages of this external fixation system in comparison to other systems are pointed out. The main advantages are the optimal biomechanical conditions including unilateral but 3-dimensional frame, which provides conditions very similar to natural biomechanical features of the human long bones, simplicity of application and low cost. The received result was excellent or very good in 98.4%. Maximal limb lengthening was 18 cm (at the same time in the femur and the tibia). Angular deformity correction is extremely simplified with minimized possibility of complications. The frame for bone transport is very simple. It can be concluded that presented methods are suitable for routine use.
ACL reconstruction with BTB graft: Unusual evolution of knee arthrofibrosis case report
Authors: Blagojevic Z. , Stevanovic V. , Radulovic N.
Published: November 2008

Knee arthrofibrosis, which usually occurs after trauma or surgery, can inhibit joint biomechanics. An elaborated interaction of growth factors and other inflammatory mediators initiates and coordinates this deleterious tissue proliferation. Knowledge of risk factors can aid clinicians in helping patients avoid knee arthrofibrosis. Once the condition is present, a history and examination are imperative to institute the most appropriate treatment regimen. Nonoperative measures can be used as therapy, though surgery is often necessary for optimal results. We have analyzed problems in patient with uncommon evolution of knee arthrofibrosis following ACL recontruction with BTB autograft.
Treatment of gigantocellular tumor of the tibia metaphysis by means of the Ilizarov method: A case study
Authors: Tomic Slavko , Lesic Aleksandar , Bumbasirevic V. , Krajcinovic O. , Slavkovic Nemanja , Bumbasirevic Marko
Published: November 2008

The authors show a 36-year old female patient with a gigantocellular tumor of the distal metaphysis of the left tibia (stage III by Campanacci). A 7.6 cm long distal articular defect of the tibia has been formed by radical segmentary resection. The defect was compensated by the extension of the rest of the tibia; whereas the support function of the limb was provided through tibio-talar arthrodesis. 5.5 years after the surgery, there are no signs of local relapses; the patient walks without any orthopedic aids and works at the same job as prior to the operation.
Off-pump myocardial revascularization (OPCAB) in patients with post-infarction unstable angina, low ejection fraction and renal dysfunction
Authors: Kacar S. , Stanic M. , Putnik S. , Pejkic S. , Davidovic Lazar , Ristic M.
Published: November 2008

The purpose of this study is to present our experience in off-pump myocardial revascularization in patients with post-infarction unstable angina, left ventricular low ejection fraction and renal dysfunction. Material and methods. From January 1998. until march 2002., at the Institute for Cardiovascular Diseases in Clinical Centre of Serbia, we have operated 20 patients with post infarction unstable angina, echocardiographicaly proved low ejection fraction (less than 30%) and renal dysfunction (Serum Creatinin 150 micrograms per liter) using this method. All patients were male and they were between 52 and 79 years old. Preoperative characteristics, surgical treatment and postoperative course are presented. Results. There was no hospital mortality, as well as important morbidity. There was no worsening of the renal and myocardial function. Postoperative ICU stay was from 1 to 2 days. Postoperative hospital stay was between 3 and 7 days. Conclusion. Off-pump myocardial revascularization is safe and effective procedure in all patients with left ventricular low ejection fraction and renal dysfunction.
Rani rezultati operativnog lecenja torakoabdominalnih aneurizmi Crawford tip IV
Authors: Davidovic Lazar , Markovic M. , Sindjelic R. , Savic N. , Kostic D. , Cinara I. , Cvetkovic S.
Published: November 2008

Objective: The aim of the study was to present the outcome of surgical treatment of patients with thoracoabdominal aortic aneurysm Crawford type IV, operated on between January 2001 and April 2004. Methods: This study included 42 subsequent patients (40 males, 2 females, age 41-76 years). All patients underwent ultrasonography, angiography, computed tomography or magnetic resonance imaging (MRI). Surgical treatment was performed under combined anesthesia (continuous thoracic epidural analgesia and general endotracheal anesthesia). In two patients thoracophrenolumbotomy was performed at the level of X rib, while others were operated through left lumbotomy after the extra pleural resection of XI rib. We did not perform any spinal cord protection procedures in this type of aneurysm. Reconstruction included interposition of Dacron graft in 20 patients, aortobiiliac bypass in 18, and aortobifemoral bypass in 4 patients with different varieties of visceral branches reimplantation. Results: Thirty - days mortality was 31% (13 patients, two of them intraoperatively). Causes of death were: pulmonary embolism - in 1 patient; hemorrhage - in 2; myocardial infarction - in 4 (two intraoperative); acute renal failure - in 2; multi system organ failure (MSOF) - in 4 patients. Respiratory failure dominated in all cases of MSOF. One patient with acute renal failure had paraplegia also, and that was the only case of neurological complication in whole group. All female patients (2), all patients with ruptured aneurysm (4), acute myocardial infarction (4) and acute renal failure (2) have died. Advanced age (over 70 years) and the need for extensive operative procedure with bifurcated graft use significantly influenced their mortality (p<0.01 and p<0.05 respectively). Conclusions: Surgical treatment of thoracoabdominal aortic aneurysm Crawford IV type was successful in 69% of our patients. There was no need for spinal cord protection measures, and extra peritoneal approach with XI rib resection under the combined anesthesia was preferred.
Razlike u hirurskom lecenju maksilarnih sinuzitisa
Authors: Racic Alek , Dimitrijevic M. , Stosic-Divjak Svetlana , Pendjer I.P. , Basaric D.
Published: November 2008

From September 2001. to February 2004. in the Institute for ENT and Maxillofacial Surgery were investigated 107 patients with the inflammatory diseases of the maxillary sinuses. Patients with sinusitis were separated into group of patients with rhinogenic (72) and patients with odontogenic maxillary sinusitis (35). We found that the etiology of odontogenic sinusitis was mostly artificial caused after some dental surgery (88%), what is totally opposite to the spontaneous etiology of rhinogenic sinusitis. Surgical treatment of rhinogenic sinusitis mostly was endonasal polypectomy with operation by Caldwell-Luc or FESS. Odontogenic sinusitises were mostly treated by FESS and surgical ? closing? of oral-antral fistula by local mucogingival flap (51%).
New viewpoint to histological classification of malignant epithelial tumors of nasopharynx
Authors: Stosic-Divjak Svetlana , Kanjuh Vladimir , Djukic V. , Racic Alek , Nesic V. , Basaric D.
Published: November 2008

Malignant tumors of nasopharyngeal epithelium differ clinically depending on the course of disease and applied therapy. They are presented in regard to the sex, age, smoking habits, alcohol usage and nutrition factors. Various studies already showed various etiological-causal links with Epstein- Barr virus (EBV). This leads to diversity of various morphological and histological types of diseases belonging to various classifications. In this work we presented 60 diagnosed and treated cases with malignant tumor of nasopharyngeal epithelium in the Institute for Otorynolaringology and maxillofacial surgery of Clinical Center of Serbia. All of them were pato-histologicaly examined and 24 of them received serological examination in regard to the concept of association between malignant epithelial tumor and EBV. An important correlation between histopathology and serology was found. Finally, the terminology used by WHO classification is not optimal for further histological determination of nasopharyngeal malignancy; therefore we recommend the French classification of C. Micheaua.
Diet in bladder cancer ethiopathogenesis
Authors: Radosavljevic V. , Ilic M. , Jankovic Slavenka , Djokic M.
Published: November 2008

The aim of this paper is to show influence of different foods on bladder cancer appearance, as well as possible consequent ways of prevention. Consumption of food rich in animal fat and cholesterol, fried foods, especially several times used cookin oil for frying, processed meat with additives (nitrates, nitrites, azo-colourrs) can influence bladder cancer occurrence. Regularly, continuous consumption of fermented milk products, which contains come types of milky - acids bacterias, is considered as protective factor in developing bladder cancer. Reports that fruit and vegetable are protective food items are pretty consistent. Data about mineral intake and bladder cancer are obscure.
Predictive factors for recurrent haemorrhagies in patients with brain cavernoma
Authors: Jovanovic V. , Tasic G. , Djurovic B. , Janicijevic M. , Antunovic V.
Published: November 2008

Haemorrhage is most important sequelae of brain cavernoma, so the surgical treatment is very important for treatment that complication. There are two types of bleeding - chronic subclinical microhaemorrhage and acute real hemorrhage. Patophisiologycal factors which are reasponsible for bleeding are not still understanding. The reason for this study is understanding of clinical curse of cavernomas and identification of factors of influence. This is retrospective and prospective study. We analyzed 36 patients with symptomatic brain cavernoma, surgically treated in Institute of neurosurgery KCS in 10 years period (1987-1997). Female were dominant but without statistical significance (p>0,05). Male patients were older (32,1:29,8), but without statistical significance (p>0,05). Almost 75% lesions were supratentorial, 25% infratentorial (p<0,05). Focal neurological deficit (FND) was dominant clinical presentation in 52,8%. FND was dominant in 52,6% female, but without statistical singnificans (p>0,05). Clinical presentation according the age was not statistically significant (p>0,05). Clinical presentation was very different according the size of lesion (p<0,001). FND as a sign of bleeding was in 57,9% supratentorial cavernomas and in 42,1% infratentorial (p<0,005). More than 1/3 patients have recurrent bleeding with 21 attack of haemorrhage or almost 2 attack per patient. We find that dominant predictive factors for recurrent haemorrhages are localization and size of lesion.
Mathematical modeling in preoperative planning for reconstructive and plastic surgery
Authors: Pavlovic I. , Potkonjak V. , Djuricic S.
Published: November 2008

Social importance of skin emphasizes an importance of quality of methods of planning for reconstructive and plastic surgery. With modern technical improvement the usage of complex mathematical model based on biomechanical characteristics of tissue is possible. Two and three-dimensional model, expert systems and mechanical analysis are used. In this work we tested the system for mechanical analysis in preoperative planning of a simple procedure of the Z-plastic, named the finite-element method. Computer model simulates tissue coverages. With geometrical data some physical characteristics are added. Complex surface of skin is marked by the grid divided in quadrangular elements. Mechanical consequences and definitive results of surgical procedure are analyzed during the computer simulation of the action of tension of skin and suture material. In our analysis we found the finite-element method of great usefulness and noticed that "surgery simulators" might be an efficient way to speed-up learning curve in reconstructive surgery.
Peritoneal hepatobiliary cystadenoma: Case report
Authors: Krstic M. , Alempijevic Tamara , Krstic S. , Lausevic Z. , Micev Marijan , Saranovic Djordjije , Tomic D.
Published: November 2008

Hepatobiliary cystadenoma with mesenchymal stroma are infrequent form of cystic neoplasm that may be found in females only. It is difficult to reach correct diagnosis prior to surgery. We are presenting a case of 32 years-old female referred to our institution for revealing a cause of discomfort and pain in right subcostal region whereas peritoneal hepatobiliary cystadenoma has been determined. Abdominal ultrasonography and computerized tomography revealed cystic lesion adjacent to gall bladder, which was initially thought to be of echynococcal origin. At surgery, a mesenterial cystic neoplasm has been revealed, having a close contact with gall bladder, without signs of its infiltration. Patohystology discovered hepatobiliary cystadenoma with mesenchymal stroma. Pre-surgical differential diagnosis in hepatobiliary cystadenoma may be very difficult, especially if, like in the presented case, neoplasm has extra hepatic localization. Radical surgical excision is treatment of choice, concerning malignant potential of these neoplasms.
Combined spinal-epidural anesthesia for urgent Hartmann’s procedure
Authors: Stamenkovic D. , Masirevic R. , Jankovic Z. , Bursac R. , Slavkovic Z. , Rankovic V.
Published: November 2008

A 46- year old patient without previous history of general anaesthesia was admitted for urgent Hartman?s procedure. The suspected tumor of sigmoid colon caused the obstructive ileus with extreme abdominal distension and threatened colon perforation. After induction of anesthesia and adequate muscle relaxation it appeared that endotrhileus because of possible regurgitation and aspiration.
Screening for prostate cancer: How to manage in 2006
Authors: Lobel B.
Published: November 2008

National Societies usually recommend screening for Prostate Cancer (PC) with Serum Prostate Specific Antigen (PSA) and digital rectal examination annually beginning at age 50. In high risk population including men with a family history of PC or African population screening should start at age of 45 years. PSA has been widely used to detect PC despite the fact that PSA is not specific for PC. Over the years serum PSA level of greater than 4,0ng/ml was considered the threshold to perform prostate biopsy, searching for PC. In 2005 the Prostate Cancer Prevention Trial (PCPT) demonstrated that the cut-off of 4,0ng/ml for PSA is not anymore adapted1 due to the fact that this survey found in 15% of men with PSA < or = 4,0ng/ml a prostate cancer on sextant biopsies. Today the value of PSA and the cut-off for Prostate biopsy is questioned suggesting that PSA level higher than 2,6ng/ml must be the case to propose Prostate Biopsy. Catalona confirms that approximately 25% to 30% of men with PSA 2,6 to 4,0ng/ml have prostate cancer2. Schr?der and Gosselaar3 assert that screening for PC at low PSA levels (<4,0ng/ml) risks to detect clinically insignificant cancers which are no threat to man. So far in the year 2006 screening for PC demonstrates accumulating evidences of efficacy but persistent uncertainty4. The major question for an urologist at work when facing a young men searching early diagnosis of PC is: at which level of PSA do we have to perform rectal biopsy ?.
Clinically significant and non significant prostate cancer an ongoing question
Authors: Becopoulos T.
Published: November 2008

One of the most important problems in urological practice is how to differentiate clinically significant and non significant prostate cancer (Pca) i.e. how to avoid over treatment of tumors with low malignant potential in one hand, and inappropriate less aggressive treatment of significant tumors, on the other hand. At the first place, one should estimate precise local clinical stage and the grade of the disease. Transrectal ultrasound - guided prostate biopsy id the golden standard, but there are few dilemmas concerning prostate biopsy: the number of biopsy cores, inter and intra-observer variations in the grading, the significance of PIN, multifocal character of Pca etc. Our opinion is that sextant or octane biopsy is quite sufficient for the exact detection of clinically insignificant cancers. An additional problem is the discrepancy in grade between biopsy and radical prosatectomy specimen. Second, the treatment should not be the same for every patient and it is guided by the age and general condition of the patient. The aggressive treatment is recommendable for younger patients, younger than 70-72 years, even for tiny area of cancer in one of the biopsy samples. On the other hand, it is an ethical question, should we insist on detection of small cancer foci at older patients, and make them anxious and unhappy in their last years of life.