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Stojanović M, Marinković M, Miličić B, Stojičić M, Jović M, Jovanović M, Isaković Subotić J, Jurišić M, Karamarković M, Đekić A, Radenović K, Mihaljević J, Radosavljević I, Suđecki B, Savić M, Kostić M, Garabinović Ž, Jeremić J. The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study. J Clin Med 2024; 13:764. [PMID: 38337458 PMCID: PMC10856234 DOI: 10.3390/jcm13030764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Burn wound dressing and debridement are excruciatingly painful procedures that call for appropriate analgesia-typically multimodal. Better post-procedural pain management, less opioid use, and consequently fewer side effects, which could prolong recovery and increase morbidity, are all benefits of this type of analgesia. Intravenously administered ketamine can be effective as monotherapy or in combination with opioids, especially with procedural sedation such as in burn wound dressing. Methods: This observational study investigated the effect of ketamine administered in subanesthetic doses combined with opioids during burn wound dressing. The study was conducted from October 2018 to October 2021. A total of 165 patients met the inclusion criteria. A total of 82 patients were in the ketamine group, while 83 patients were dressed without ketamine. The main outcome was the effect of ketamine on intraprocedural opioid consumption. The secondary outcome included the effect of ketamine on postprocedural pain control. Results: Patients dressed with ketamine were significantly older (p = 0.001), while the mean doses of intraoperatively administered propofol and fentanyl were significantly lower than in patients dressed without ketamine (150 vs. 220 mg, p < 0.001; and 0.075 vs. 0.150 mg, p < 0.001; respectively). Conclusions: Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management.
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Affiliation(s)
- Marina Stojanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Biljana Miličić
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marko Jović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Isaković Subotić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Đekić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Mihaljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Radosavljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Savić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marko Kostić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Željko Garabinović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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2
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Jeremić J, Radenović K, Jurišić M, Suđecki B, Marinković M, Mihaljević J, Radosavljević I, Jovanović M, Stojanović M, Milić N, Pavlović V, Stojičić M, Inić Z, Jović M. Primary Melanoma Histopathologic Predictors of Sentinel Lymph Node Positivity: A Proposed Scoring System for Risk Assessment and Patient Selection in a Clinical Setting. Medicina (Kaunas) 2023; 59:1921. [PMID: 38003969 PMCID: PMC10673032 DOI: 10.3390/medicina59111921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The careful selection of adequate SLNB candidates not only aims at reducing the surgical risk while identifying SLN metastasis, but also plays a crucial role in identifying the patients eligible for adjuvant therapy. Objectives: The purpose of our study was to investigate the clinical and histologic aspects of primary melanomas that correlate with the likelihood of a positive SLNB result. Materials and Methods: A total of 101 primary melanoma patients who underwent sentinel lymph node biopsies were included in the study. General patient demographics were obtained as well as localization and melanoma-specific characteristics of primary melanoma from histologic reports in addition to data derived from SLNB melanoma histopathology reports. Results: The patients with positive SLN results had a statistically significant increased Breslow thickness (3.8 mm vs. 1.97 mm, p = 0.002), higher mitotic index rate (5/mm2 vs. 2/mm2, p = 0.009), as well as the presence of ulceration (68.4% vs. 31.6%, p = 0.007). Univariate regression analysis showed the Breslow thickness (p = 0.008), the mitotic index rate (p = 0.054), the presence of ulceration (p = 0.009), as well as the pT3-4 stage (p = 0.009) to be significant predictors of SLN positivity. The optimal cut-off values for Breslow thickness and the number of mitoses scores were determined based on ROC curve analysis. Using the Breslow thickness, mitotic index rate, presence of ulceration, and pT3-4 stage significant coefficients from the univariate regression model, a chance prediction score was developed. Conclusions: The newly developed and proposed scoring system can aid in patient selection for SLN biopsy by facilitating a more efficient risk assessment in the detection of lymph node metastases in melanoma patients.
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Affiliation(s)
- Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Jovan Mihaljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Ivan Radosavljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Marina Stojanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Center for Anesthesia, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nataša Milić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Zorka Inić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
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3
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Nikolić Živanović M, Jurišić M, Marinković M, Grujičić D, Stanimirović A, Šćepanović V, Milićević M, Jovićević N, Videnović G, Pavlović V, Bogunović Stojičić S, Jovanović M, Jeremić J, Jović M, Ilić R, Stojičić M. Reconstruction of Moderately and Severely Atrophic Scalp-A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm. Medicina (Kaunas) 2023; 59:1678. [PMID: 37763798 PMCID: PMC10534352 DOI: 10.3390/medicina59091678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients' characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors' experience in managing these patients.
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Affiliation(s)
- Maja Nikolić Živanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Danica Grujičić
- Faculty of Medicine, 11000 Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandar Stanimirović
- Faculty of Medicine, 11000 Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Vuk Šćepanović
- Faculty of Medicine, 11000 Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Mihailo Milićević
- Faculty of Medicine, 11000 Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Jovićević
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Goran Videnović
- Department for Maxillofacial Surgery, Faculty of Medicine, University of Priština in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Vedrana Pavlović
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, 11000 Belgrade, Serbia
| | - Rosanda Ilić
- Faculty of Medicine, 11000 Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, 11000 Belgrade, Serbia
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4
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Jović M, Marinković M, Suđecki B, Jurišić M, Bukumirić Z, Jovanović M, Stojičić M, Jeremić J. COVID-19 and Cutaneous Squamous Cell Carcinoma-Impact of the Pandemic on Unequal Access to Healthcare. Healthcare (Basel) 2023; 11:1994. [PMID: 37510435 PMCID: PMC10378852 DOI: 10.3390/healthcare11141994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Most skin tumors are not fatal, but if not treated in a timely manner, they can lead to significant morbidity. Due to the COVID-19 pandemic and in order to create more capacities for the treatment of COVID-19-positive patients as well as to contain the spread of the virus, the healthcare system was reorganized worldwide, leading to decreased access to preventive screening programs. The aim of this study was to evaluate the impact of the pandemic on healthcare accessibility to cutaneous squamous cell carcinoma patients in Serbia. This retrospective study was conducted at the Clinic for Burns, Plastic, and Reconstructive Surgery, University Clinical Center of Serbia in Belgrade. Patient demographics and pathohistological findings of tumors of patients living in and outside the capital in the period before, during, and after the pandemic were compared. The two groups did not show any differences regarding the largest tumor diameter prior and during the pandemic; however, this difference became extremely noticeable after the pandemic (15 mm vs. 27 mm; p < 0.001). While cSCCs are commonly slow-growing tumors, the impact of the COVID-19 pandemic is not negligible. This study found a population at a significant risk of cSCC metastasis, with additional evidence likely to emerge in the upcoming years.
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Affiliation(s)
- Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Zoran Bukumirić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Stojičić M, Jurišić M, Marinković M, Karamarković M, Jovanović M, Jeremić J, Jović M, Vlahović A, Jovanović M, Radenović K, Jovićević N, Vasović D. Necrotizing Fasciitis-Severe Complication of Bullous Pemphigoid: A Systematic Review, Risk Factors, and Treatment Challenges. Medicina (Kaunas) 2023; 59:medicina59040745. [PMID: 37109703 PMCID: PMC10144771 DOI: 10.3390/medicina59040745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Bullous pemphigoid (BP), the most common subepidermal autoimmune skin blistering disease (AIBD) has an estimated annual incidence of 2.4 to 42.8 new cases per million in different populations, designating it an orphan disease. Characterized by disruption of the skin barrier combined with therapy-induced immunosuppression, BP could pose a risk for skin and soft tissue infections (SSTI). Necrotizing fasciitis (NF) is a rare necrotizing skin and soft tissue infection, with a prevalence of 0.40 cases per 100,000 to 15.5 cases per 100,000 population, often associated with immunosuppression. Low incidences of NF and BP classify them both as rare diseases, possibly contributing to the false inability of making a significant correlation between the two. Here, we present a systematic review of the existing literature related to the ways these two diseases correlate. Materials and methods: This systematic review was conducted according to the PRISMA guidelines. The literature review was conducted using PubMed (MEDLINE), Google Scholar, and SCOPUS databases. The primary outcome was prevalence of NF in BP patients, while the secondary outcome was prevalence and mortality of SSTI in BP patients. Due to the scarcity of data, case reports were also included. Results: A total of 13 studies were included, six case reports of BP complicated by NF with six retrospective studies and one randomized multicenter trial of SSTIs in BP patients. Conclusions: Loss of skin integrity, immunosuppressive therapy, and comorbidities commonly related to BP patients are risk factors for necrotizing fasciitis. Evidence of their significant correlation is emerging, and further studies are deemed necessary for the development of BP-specific diagnostic and treatment protocols.
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Affiliation(s)
- Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Vlahović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, 11000 Belgrade, Serbia
| | - Mladen Jovanović
- Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Jovićević
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dolika Vasović
- Clinic for Eye Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Jeremić J, Suđecki B, Radenović K, Mihaljević J, Radosavljević I, Jovanović M, Milić N, Pavlović V, Brašanac D, Jović M. Impact of the COVID-19 Pandemic on Melanoma Diagnosis: Increased Breslow Thickness in Primary Melanomas-A Single Center Experience. Int J Environ Res Public Health 2022; 19:16806. [PMID: 36554683 PMCID: PMC9779520 DOI: 10.3390/ijerph192416806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Early melanoma diagnosis plays a key role in ensuring best prognosis with good survival rates. The ongoing global COVID-19 pandemic has greatly impacted global and national healthcare systems, thus making it a real challenge. The aim of this study was to evaluate the impact of the pandemic on diagnostic delay in melanoma patients in Serbia. In this retrospective study, we included patients treated at the university hospital in Serbia's capitol over a period of five years and three months. We compared the prepandemic (01/JAN/17-14/MAR/20) and pandemic periods (15/MAR/20-31/MAR/22) by evaluating patient demographic data, melanoma subtype, Breslow thickness, Clark level, ulceration status, mitotic index rate and pT staging. We observed a significant reduction in the number of diagnosed patients (86.3 vs. 13.7%; p = 0.036), with melanomas having an increased median Breslow thickness (1.80 vs. 3.00; p = 0.010), a higher percentage of Clark IV-V level lesions (44.0% vs. 63.0%; p = 0.009), an increase in median mitotic index rate (2 vs. 5; p < 0.001) and a trend of increase in lesions thicker than 2 mm (37.8% vs. 53.7%; p = 0.026). We believe that this study can be a useful scenario guide for future similar events, highlighting the importance of preventive measures and timely diagnosis for the best patient outcomes.
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Affiliation(s)
- Jelena Jeremić
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Kristina Radenović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Mihaljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Radosavljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nataša Milić
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dimitrije Brašanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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7
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Stojanović M, Miličić B, Purić N, Jeremić J, Jović M, Stojčić M, Omčikus M, Trboljevac N, Velickovic J. Survival of critically ill patients with COVID-19 pneumonia-a single-center experience. J Infect Dev Ctries 2022; 16:1424-1431. [PMID: 36223617 DOI: 10.3855/jidc.16650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/22/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The aim of the study was to determine the survival probability of critically ill patients with COVID-19 infection who needed mechanical ventilation and to determine the efficacy of Tocilizumab use. METHODOLOGY The study was designed as a retrospective analysis of consecutive patients older than 18 years, treated in an intensive care unit. The criteria for admission to the intensive care unit was severe respiratory failure requiring mechanical ventilation. All patients received corticosteroid therapy (methylprednisolone 1-2 mg/kg). Tocilizumab was used at a dose of 8 mg/kg in patients with a severe form of the disease (onset, or developed ARDS), followed by cytokine storm (IL-6 ≥ 40 ng/L and CRP ≥ 50 mg/L). RESULTS 88 patients were included in the study. Intrahospital mortality was 48.86%. No statistically significant difference was observed between patients with and without tocilizumab therapy. In the group of patients in whom this therapy was applied, the values of intrahospital survival were 45.7%, while in the group without this therapy the probability of intrahospital survival was only 0.93%. The probability of survival in the group with noninvasive mechanical ventilation (NIV) was 94.7%, while in the group with invasive mechanical ventilation (IMV) 0.78%. The duration of symptoms before hospitalization (RR-1.088 CI 1.025-1.155, p < 0.05), as well as the duration of IMV (RR-0.906 CI 0.841-0.976, p < 0.05), were shown to be an independent predictor of poor outcome. CONCLUSIONS The mortality of patients with the most severe form of respiratory failure caused by COVID-19 infection remains high. Independent predictors of poor outcomes were needed for invasive mechanical ventilation and the duration of symptoms before hospitalization or late initiation of appropriate therapy.
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Affiliation(s)
| | - Biljana Miličić
- Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Purić
- Department of Anesthesiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Jeremić
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Marko Jović
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milan Stojčić
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Maja Omčikus
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Nikola Trboljevac
- Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
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Jeremić J, Jeremić K, Stefanović A, Gojnić M, Stojnić J, Nikolić Z. Pregnancy associated with melanoma and fetal anomalies: a case report and review of literature. CLIN EXP OBSTET GYN 2015; 42:386-387. [PMID: 26152019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The estimated incidence of melanoma complicating pregnancy has ranged from 0.1 to 2.8 per 1,000 pregnancies. Here the Authors present a case of a 40-year-old pregnant woman, who was admitted to the Clinic of Obstetrics and Gynaecology in 26 weeks of gestation, with diagnosis of melanoma and suspected with fetal anomaly, as possible bowel obstruction, and polyhydraminos. The melanoma was asported with a wide local excision under local anesthesia. Histological evaluation revealed melanoma Stage Ib (Clark IV, Breslow thickness 1.2 mm, pT2a). Lymph node sonography of neck, axilla, inguinum, abdomen, and pelvis as well as chest radiography did not demonstrate any evidence of metastatic disease. After vaginal delivery at 37 weeks of gestation, the female preterm hypotrophic newborn was transferred to the Institute for Neonatology and underwent resection of duodenojejunal atresia with tapering duodenoplasty and duodenojejunal termino-terminal anastomoses due to intestinal obstruction. No evidence of the melanoma was found in the placenta. Two years later the child was healthy and the mother was disease-free.
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Stefanović A, Jeremić J, Jeremić K, Likić I, Mitrović M, Stojnić J. Primary melanoma of the vagina: a case report and review of literature. EUR J GYNAECOL ONCOL 2015; 36:755-757. [PMID: 26775368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Summary Primary melanoma of the vagina is a rare and very aggressive tumor with an incidence of only 0.46 per one million women per year and less than 250 cases reported in the literature. Here the authors present a case of a 60-year-old woman, gravida 5, para 5, post-menopausal by 28 years, admitted to the Clinic for Obstetrics and Gynecology, with recurrent vaginal bleeding for the last year and with the complaint of a palpable tumor near the vaginal introitus. The preoperative biopsy revealed melanoma. CT scan did not prove she had distant metastasis. The patient was treated surgically, with wide local excision of four x five cm measured lesion and safety margins of two cm. Bilateral inguinal lymphadenectomy was performed. Follow-up five months after initial diagnosis, revealed no evidence of local recurrency or distant metastasis.
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Jeremiç K, Stefanović A, Milincić N, Mitrović M, Jeremić J, Mircić A. Intestinal surgery and surgery of urinary tract in treatment of recurrent cervical cancer--case report. EUR J GYNAECOL ONCOL 2011; 32:460-462. [PMID: 21941980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A case of a 31-year-old patient admitted to the Institute with a diagnosis of recurrent cervical cancer after radical hysterectomy and radiation therapy 12 months before. The patient had intestinal and urinary obstruction and also the tumor compressed the iliac blood vessels superficially. She underwent clinical examination, pelvic and abdominal ultrasound and multislice CT scan. A recurring tumor with a diameter of 7 cm was diagnosed. It was localized in the left parailiac and obturator region and infiltrated the left ureter, left bladder side wall, sigmoid colon and iliac blood vessels superficially. The patient had left pelvic sidewall relapse, so she underwent a palliative surgical procedure. We evacuated the complete tumor together with the infiltrated parts of the left ureter, sigmoid colon and bladder. At the end of operation left ureterocystoneostomy was performed as well as the Hartmann procedure with anus praeter insertion. There were no significant postoperative complications. After the surgical treatment of the recurrence, we suggested that the patient continue treatment of her disease with chemotherapy.
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Affiliation(s)
- K Jeremiç
- Institute for Gynecology and Obstetrics, Institute for Reconstructive and Plastic Surgery, Medical University of Belgrade Clinical Center of Serbia, Belgrade, Serbia.
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Petković S, Jeremić J, Jeremić K, Nikolić Z, Stefanović A, Maksimović M. Vulvar neoplasm and reconstruction of a lesion with a vertical rectus abdominis myocutaneous flap: case report. EUR J GYNAECOL ONCOL 2009; 30:460-462. [PMID: 19761148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 41-year-old nulliparous woman was admitted to the Institute of Gynecology and Obstetrics in 2007 with a painless tumor mass invading the whole vulvoperineal and gluteal region. Pathohistological biopsy revealed FIGO Stage II squamocellular invasive carcinoma, but clinically it was Stage IVa verucal vulvar carcinoma because of malignant infiltration to the distal part of the vagina and bilateral gluteal region. The patient underwent radical vulvectomy with bilateral inguinofemoral lymphadenectomy and partial vaginectomy. Reconstruction was performed after three weeks using a distally based vertical rectus abdominis myocutaneous flap (VRAM). A new entrance of the vagina was created. The patient was further treated with radiation therapy.
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Affiliation(s)
- S Petković
- Institute for Gynecology and Obstetrics, University of Belgrade, Clinical Center of Serbia, Belgrade, Serbia
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Jeremić J, Vucetić C, Golubović Z, Petronić I. [The influence of duration of Kleinert immobilization on the functional recovery of primarly reconstructed flexor tendons in children and adult patients]. Acta Chir Iugosl 2007; 53:73-8. [PMID: 17338204 DOI: 10.2298/aci0603073j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Flexor tendon repair in the hand is very often complicated by the formation of peritendinous adhesions that result in loss of normal tendon gliding, digital stiffnes and functional disability. While stability is critical for a successful tendon repair, mobility is also important, as motion of the repaired tendon decreases the formation of postoperative adhesions and increases the strength of the repair. Immobilization and its duration, can ensure the integrity of the repair but can also lead to scaring, stiffness, and joint contractures. This study included 20 children and 39 adult patients, in the period from January 2000 to April 2003., with flexor tendon ruptures of the hand. Tendons were primary repaired using direct tennoraphy, and postoperately patients were treated with Kleinert dynamic imobilization. The aim of this study was to investigate the influence of the duration of the dynamic immobilization on successful postoperative functional recovery, separately in children and adult patients. Research in this area has been directed at achieving the optimal balance between stability and mobility, without compromising one for the other.
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Affiliation(s)
- J Jeremić
- Centar za opekotine, plasticnu i rekonstruktivnu hirurgiju, KCS, Beograd
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Jeremic K, Gojnic M, Milenković V, Petković S, Stojnić J, Lazović G, Berisavac M, Jeremić J. Treatment for infertility and risk of invasive epithelial ovarian cancer--a case report. CLIN EXP OBSTET GYN 2006; 33:190-1. [PMID: 17089588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 30-year-old women was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia in April 2004 with the following diagnosis: adnexal mass soon after in vitro fertilization. Her history revealed salpingo-oophorectomy for mucinous cystadenofibroma of the left ovary eight years before and cystectomy of the right ovary three years before. At admission, the most remarkable findings were high temperature and elevated white blood cells with erythrocyte sedimentation rate. After the antibiotic treatment, laparatomy was performed and a multilocular right adnexal tumor was found. The right salpingo-oophorectomy was performed and pathological diagnosis was mucinous ovarian adenocarcinoma. Two weeks later, radical surgery was carried out and chemotherapy was applied. There is an urgent need for clear interpretation of the link between ovarian stimulation and ovarian cancer. An association between ovarian stimulation treatment and ovarian cancer has still not been completely proven.
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Affiliation(s)
- K Jeremic
- Institute of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
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Jeremić K, Gojnic M, Bosković V, Argirović R, Milenković V, Jeremić J. Treatment of choriocarcinoma metastases by surgery and polychemotherapy - case report. EUR J GYNAECOL ONCOL 2006; 27:162-4. [PMID: 16620061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Choriocarcinoma is present in one out of every 40,000 pregnancies. There is a great risk for incidence of the disease in women who become pregnant after 45 years of age. The clinical picture may vary and is related to the destruction of tissue and bleeding. New chemo protocols containing etoposide, cisplatin, ifosfamide, together with a resection of the focus resistant to chemotherapy, lead in most cases to the complete recovery.
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Affiliation(s)
- K Jeremić
- Institute of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
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Petković S, Jeremić K, Vidakovic S, Jeremić J, Lazović G. Paget's disease of the vulva--a review of our experience. EUR J GYNAECOL ONCOL 2006; 27:611-2. [PMID: 17290594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The aim of our study was to review our experience with Paget's disease of the vulvar relative to initial examination, treatment and oncological outcome. METHODS Ten women with extramammary Paget's diseases of the vulva were treated during the 10-year period. The charts of these patients were reviewed and data were collected regarding patient demographics, symptoms, previous Paget's disease, surgical treatments and time to recurrence. RESULTS Eight women (80%) were treated with wide local excision or partial vulvectomy, and two patients (20%) required radical resection for invasive adenocarcinoma. The group of women who had invasive diseases also underwent inquinofemoral lymphadenectomy and no lymphatic metastases were noted. Three women (30%) experienced recurrence. The mean time to relapse was 30 months (range 3-88 months). CONCLUSION Recurrence is very common and long-term monitoring is recommended with careful examination of any abnormal vulvar lesion.
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Affiliation(s)
- S Petković
- Institute of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade (Serbia and Montenegro)
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Jeremić K, Lazović G, Tulić I, Gojnić M, Stojnić J, Jeremić J. Effects of tibolone on the risk factors for cardiovascular diseases in postmenopausal women. VOJNOSANIT PREGL 2006; 63:387-91. [PMID: 16683408 DOI: 10.2298/vsp0604387j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Tibolone is a preparation that belongs to the group of steroidal substances. The effects of the use of the use of tibolone are the consequence of the activities of its metabolities, considering that their hormonal activity depends on the type of tissue in which they develop. The aim of this study was to evaluate the influence of the use of tibolone on risk factors for the development of cardiovascular diseases in postmenopausal women. Methods. A prospective observational stady included 94 patients who had the concentration of l7? estradiol < 50 pg/ml, and who was in menopause more than a year. Out of the total number of patients, 63 accepted to receive tibolone 2.5 mg daily (tibolone group), while 31 of the patients refused to take tibolone (control group). We measured the concentration of lipids (cholesterol, LDL cholesterol, HDL cholesterol, triglicerides), antitrombin III, fibrinogen, and C-reactive protein, before and after the treatment within a 6-month period. Then, we compared the difference between the values of concentrations and tested the statistical significance of the difference. We also evaluated the changes of values in the concentrations of the examinated parameters inside a 6-month period in the control group. Results. In 31 patients of the control group, from the control group there were no significant changes in the values of the defined parameters as compared to their initial values after six months. But there were changes of statistical significance (p < 0.001) in values of the concentrations of the exeminated parameters before and after the treatment in the tibolone group. In fact, we recorded decreases in the total cholesterol by 17.8%, HDL cholesterol by 27%, LDL cholesterol by 4% (without statistical significance p > 0.05) and triglicerids by 35%. There were no statistical differences in the concentrations of antitrombin III, fibrionogen, and C-reactive proteine in the tibolone group before and after the treatment. Conclusion. The use of tibolone dose decrease the concentration of the total cholesterol, triglicerides, HDL cholesterol, without a significant decrease of LDL cholesterol. Also, the use of tibolone does not have any significant effect on the concentrations of antitrombin III, fibrinogen and C-reactive proteine. The number of serum parameters measured in this study was limited, thus that was the reason to discuss only about the metabolism of lipids in the patients from the tibolone group. The final conclusion about the risk for cardiovascular diseases in the patients on tibolone, howerer, reqnires were extensive further clinical exeminations.
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Affiliation(s)
- Katarina Jeremić
- Klinicki centar Srbije, Institut za ginekologiju i akuserstvo, Beograd
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Abstract
Background/aim: In the field of contemporary head and neck reconstructive surgery, free vascularized tissue transfer is becoming a gold standard. The aim of this study was to review our clinical results and experience, with use of free microvascular flaps and compare them with the recently published patient series. Methods. During the period from 2001 to 2005, 37 patients underwent microsurgical reconstruction after the tumor ablation in the region of head and neck. Flap viability was monitored intraoperatively with the Ackland test and postoperatively by the clinical observation and mini-Doppler test. Results. The overall success rate was 83.8%. The complications that appeared were: one complete flap necrosis due to venous thrombosis, and five late flap ischemic necroses, in the period from the 10th to 14th postoperative day. Conclusion. Free flap reconstruction of the head and neck is a surgical technique that provides the reconstruction of complex and extensive defects, that could not be performed by using local or regional flaps.
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Affiliation(s)
- Zivorad Nikolić
- Stomatoloski fakultet, Klinika za maksilofacijalnu hirurgiju, Dr Subotića 4, 11 000 Beograd, Srbija.
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Jeremić J, Nikolić Z, Colić M, Jeremić K. The tunneld supracla vicular island flap - a fasciocutaneous flap for head and neck reconstructions. ACTA ACUST UNITED AC 2006; 53:67-72. [PMID: 16989150 DOI: 10.2298/aci0601067j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. We have found that the shoulder is a region providing an optimum skin texture match to the neck and face. Fasciocutaneous island flap, nourished by the supraclavicular artery is used purely as a subcutaneously tunneled island flap. The tunneling maneuver significantly improves the donor site by reducing scarring. The flap is characterized by a long subcutaneous pedicle of up to 20 cm. The pivot point is in the supraclavicular region and allows the flap to be used in the upper chest, neck, chin, and cheek. In this article we present clinical cases in reconstructive procedures with supraclavicular flap and its expanded indications.
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Affiliation(s)
- J Jeremić
- Centar za opekotine i PRH, Klinicki centar Srbije, Beograd
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