1
|
Resanovic V, Resanovic A, Loncar Z. A rare case of incarcerated obturator hernia in an elderly female: Importance of timely diagnosis and choice of surgical intervention - open or laparoscopic. Pak J Med Sci 2024; 40:2755-2758. [PMID: 39634874 PMCID: PMC11613406 DOI: 10.12669/pjms.40.11.9994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/27/2024] [Accepted: 09/15/2024] [Indexed: 12/07/2024] Open
Abstract
Obturator hernia is a rare clinical condition, mainly affecting the elderly and frail patients. It is often challenging to diagnose, and carries a significant morbidity and mortality risk. We aim to highlight the importance of timely and adequate diagnosis followed by early intervention that can be done as open or laparoscopic. Furthermore, through a literature review, we intend to compare two types of surgical approaches (open vs. laparoscopic). Herein, we present the case of an 83 years old female admitted as an emergency with right lower quadrant, colicky abdominal pain, followed with nausea, vomiting and constipation. Computed Tomography (CT) scan revealed a right-sided incarcerated obturator hernia with proximal bowel distension. Emergency surgery was performed, emphasizing the importance of early intervention to prevent bowel necrosis and the need for bowel resection; due to asthma we opted for open approach. Intraoperatively, a right-sided incarcerated obturator hernia was confirmed, with a segment of small bowel herniating through the obturator canal. We discuss the role of CT scanning in diagnosis, the necessity of prompt surgical management, and the possibility of open and laparoscopic approaches through a literature review. The choice between open and laparoscopic approaches should be individualized, considering the patient's clinical status and the potential risks and benefits of each technique. Further research comparing the long-term results of open versus laparoscopic repair in incarcerated obturator hernia is something to be explored in the efforts of achieving the highest standards of patient care and maximizing the chances for an optimal treatment outcome.
Collapse
|
2
|
Resanovic V, Resanovic A, Vasiljev KD, Micic D, Loncar Z. Letter to the Editor: Reducing postoperative length of stay, is it worth the effort? World J Surg 2024; 48:1562-1563. [PMID: 38588002 DOI: 10.1002/wjs.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
|
3
|
Stulic M, Culafic D, Jordovic J, Culafic M, Petrovic N, Stojimirov I, Loncar Z. West Nile Virus Infection in Liver Transplant Recipient With Neither De Novo Infection nor Donor-Derived Infection: A Case Report. EXP CLIN TRANSPLANT 2023; 21:59-62. [PMID: 36757169 DOI: 10.6002/ect.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
West Nile virus was first described in 1937 and has sinceperiodically appearedin variousparts oftheworld by infecting people and horses. Reported infection symptoms and signs may be highly variable, ranging from fever and myalgias to meningoencephalitis. A 59-year-old patient was admitted to the University Clinical Centre of Serbia, Belgrade, in September 2018, where livertransplantwasperformedtotreat cirrhosisof ethyl etiology. Immunosuppressive therapy was started immediately after successful transplant, with the patientreceiving methylprednisolone, tacrolimus, and mycophenolate mofetil. Mycophenolate mofetil was excluded from therapy on postoperative day 3 because of progressively worse white blood cell count. The patient became febrile on postoperative day 11 (39.6 °C), and arm tremor, nausea, vomiting, and frequent fluid stools occurred. He complained of pain in the muscles and joints of the lower extremities. The next day he experienced occasional disorientation. Neurological findings revealed no signs of acute focal neurological deficit. We performed culture tests to isolate pathological microorganisms, and results were negative in cultures of the blood, urine, feces, ascites, and a smear of the wound and tip of the central venous catheter. Lumbar puncture resulted in a clear cerebrospinal fluid that was sent for analysis that showed significant increases in white blood cell count (94 × 106 cells/L), total proteins (1.61 g/L), and microalbumin (504.5 mg/L), with a reduction of immunoglobulin G. On postoperative day 15, positive serology of West Nile virus immunoglobulin M in cerebrospinal fluid was verified. Intensive monitoring and symptomatic and supportive therapy resulted in clinical and laboratory improvement, and the patient was discharged in good general condition on postoperative day 22. Considering the high risk of posttransplant complications, there remains the question of whether all donors and recipients should be tested forWest Nile virus atthe onset oftransplant.
Collapse
|
4
|
Loncar Z, Vasin D, Ristic M, Popovic D, Tiosavljevic D, Dugalic S, Doklestic K. Multidisciplinary treatment of massive trichobezoar caused an acute gastric outlet obstruction. SRP ARK CELOK LEK 2023; 151:89-93. [DOI: 10.2298/sarh221017116l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Introduction. Trichobezoars presents a rare form of bezoar made of swallowed hair, with clinical manifestation of gastric or intestinal obstruction, gastric ulceration, bleeding, and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters, who eating their own hair which is clinically known as trichophagia. Patients often deny eating their own hair which makes diagnosis difficult. Case report. We present a case of acute gastric outlet obstruction caused by a giant gastric trichobezoar made of a long thin hair, in a 20-year young female. Although patient had a long history of trichophagia, she did not think her behavior was unusual and she had not been treated before. Following the initial diagnostic procedures, exploratory laparotomy was indicated. After anterior gastrotomy was performed, a massive stomach-shaped trichobezoar was removed. Postoperatively, the patient had a psychiatric consult exam. She recovered well and was discharged without complications. She was referred for further psychiatric follow-up. Conclusion. Trichobezoars are non-digestible collections that usually accumulates in stomach and can extend to small bowel, causing mechanical injury such as hollow viscus obstruction. Patients with acute gastric obstruction caused by a giant trichobezoar require urgent removal of the trichobezoar, to preserve the stomach and avoid further, catastrophic consequences.
Collapse
|
5
|
Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. OC-012 THE COMBINATION OF THE THREE MODIFICATIONS OF THE COMPONENT SEPARATION TECHNIQUE IN THE MANAGEMENT OF COMPLEX SUBCOSTAL WALL DEFECT. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall defect.
Material and Methods
Between January 2010 and January 2022, seven patients with complex subcostal hernia defects compromised by infection, radiation, or chemotherapy underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the “method of wide myofascial release” at the side of the hernia defect; (b) “openbook variation” of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position.
Results
The median (range) length and width of the complex subcostal hernias were 15 cm (10–19) and 15 cm (8–24), respectively. The overall morbidity rate was 57.1% (wound infection, seroma and skin necrosis). There was no hernia recurrence during the median follow-up time of 19 (range 3–84) months.
Conclusion
The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall defect.
Collapse
|
6
|
Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. The combination of the three modifications of the component separation technique in the management of complex subcostal abdominal wall hernia. Hernia 2022; 26:1369-1379. [PMID: 35575863 DOI: 10.1007/s10029-022-02622-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The purpose of this study is to present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall hernia. METHODS Between January 2010 and January 2020, seven patients presenting at the high-volume academic center with complex subcostal hernia underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the "method of wide myofascial release" at the side of the hernia defect; (b) "open-book variation" of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position. RESULTS The median length and width of the complex subcostal hernias were 15 cm (10-19) and 15 cm (8-24), respectively. The overall morbidity rate was 57.1% (wound infection occurred in three patients, seroma in two patients, and skin necrosis in one patient). There was no hernia recurrence during the median follow-up period of 19 months. CONCLUSION The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall hernia.
Collapse
|
7
|
Micic D, Doklestic K, Gregoric P, Ivancevic N, Arsenijevic V, Milin-Lazovic J, Maricic B, Loncar Z. Outcomes of Open Surgery for Retroperitoneal Hematoma in Covid-19 Patients: Experience from a Single Centre. Chirurgia (Bucur) 2022; 117:526-534. [PMID: 36318682 DOI: 10.21614/chirurgia.2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Background: Spontaneous retroperitoneal hematoma is a severe and potentially fatal complication that appears in the course of anticoagulation therapy. Therapeutic doses of low molecular weight heparin (LMWH) are used for the prevention of thrombosis in patients seriously ill with Covid-19. Methods: We describe 27 (0.14%) patients with retroperitoneal hematomas who required emergency surgery out of 19108 patients with Covid-19 who were hospitalized in Batajnica COVID Hospital between March 2021 and March 2022. All the patients were on therapeutic doses of LMWH. The existence of retroperitoneal hematoma was confirmed by abdominal ultrasound and computed tomography scans. Results: Open surgery was performed on 27 patients with spontaneous retroperitoneal hematomas (12 female and 15 male). The mean age of the study population was 71.6+-11.9 years. D-dimer was significantly elevated two days before the surgery in comparison with the values on the day of surgery (p=0.011). Six patients (22.23%) survived, while 21 (77.77%) patients died. Conclusion: Bleeding in Covid-19 patients treated by LMWH is associated with an increased risk of developing retroperitoneal hematoma. Open surgery for retroperitoneal hematoma in Covid-19 patients on anticoagulation therapy is a procedure associated with a high rate of mortality.
Collapse
|
8
|
Antic A, Kmezic S, Nikolic V, Radenkovic D, Markovic V, Pejovic I, Aleksic L, Loncar Z, Antic S, Kovac J, Markovic-Denic L. Quality of life following two different techniques of an open ventral hernia repair for large hernias: a prospective randomized study. BMC Surg 2022; 22:99. [PMID: 35300651 PMCID: PMC8932116 DOI: 10.1186/s12893-022-01551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background We compare the health-related quality of life (QoL) of patients with incision hernias before and after surgery with two different techniques. Methods In this prospective randomized study, the study population consisted of all patients who underwent the first surgical incisional hernias repair during the 1-year study period. Patients who met the criteria for inclusion in the study were randomized into two groups: the first group consisted of patients operated by an open Rives sublay technique, and the second group included patients operated by a segregation component technique. The change in the quality of life before and 6 months after surgery was assessed using two general (Short form of SF-36 questionnaires and European Quality of Life Questionnaire—EQ-5D-3L), and three specific hernia questionnaires (Hernia Related Quality of Life Survey-HerQles, Eura HS Quality of Life Scale—EuraHS QoL, and Carolinas Comfort Scale—CCS). Results A total of 93 patients were included in the study. Patients operated on by the Rives technique had a better role physical score before surgery, according to the SF-36 tool, although this was not found after surgery. The postoperative QoL measured with each scale of all questionnaires was significantly better after surgery. Comparing two groups of patients after surgery, only the pain domain of the EuraHS Qol questionnaire was worse in patients operated by a segregation component technique. Conclusion Both techniques improve the quality of life after surgery. Generic QoL questionnaires showed no difference in the quality of life compared to repair technique but specific hernia-related questionnaires showed differences.
Collapse
|
9
|
Parapid B, Kanjuh V, Kostic V, Polovina S, Dinic M, Loncar Z, Lalic K, Gojnic-Dugalic M, Nedeljkovic M, Lazic B, Milosevic M, Simic D, Neskovic A, Harrington R, Valentine M, Santos V, Lewis S, Djukic-Dejanovic S, Mitchell S, Bond R, Waksman R, Alasnag M, Bairey-Merz N, Gaita D, Mischie A, Karamarkovic N, Rakic S, Mrkic M, Tasovac M, Devrnja V, Bubanja D, Kass W. Women’s health in Serbia - past, present, and future. SRP ARK CELOK LEK 2021. [DOI: 10.2298/sarh211208105p] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cardiovascular and reproductive health of women have been going hand in hand since the dawn of time, yet links have been poorly studied. Still, once basis of their connections started to be established, it depended on local regional abilities and level of progressive thinking to afford women comprehensive care beyond the ?bikini medicine?. Further research identified different associations rendering more conditions sex-specific and launching therefore a slow, yet initial turn around in clinical trials? concept as the majority of global cardiovascular guidelines rely on the results of research conducted on a very modest percentage of women and even less on the women of color. Currently, the concept of women?s heart centers varies depending on the local demographics? guided needs, available logistics driven by budgeting and societal support of a broad-minded thinking environment, free of bias for everyone: from young adults questioning their gender identity, via women of reproductive age both struggling to conceive or keep working part time when healthy and line of work permits it during pregnancy, up to aging and the elderly. Using ?Investigate-Educate-Advocate-Legislate? as the four pillars of advancing cardiovascular care of women, we aimed to summarize standing of women?s health in Serbia, present ongoing projects and propose actionable solutions for the future.
Collapse
|
10
|
Resanovic V, Resanovic A, Loncar Z, Djukic V, Pajic SS, Randjelovic T. Letter to the Editor: Stenting in Palliation of Unresectable Esophageal Cancer. World J Surg 2019; 43:1867-1868. [DOI: 10.1007/s00268-018-4782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
11
|
Latic D, Pejic S, Savic S, Loncar Z, M Nikolic I, Nikolic G, Pavlovic I, Radojevic-Skodric S. Cyclin D1 and p57 expression in relation to clinicopathological characteristics and overall survival in patients with renal cell carcinoma. JOURNAL OF B.U.ON. : OFFICIAL JOURNAL OF THE BALKAN UNION OF ONCOLOGY 2019; 24:301-309. [PMID: 30941985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE There is a need for identifying molecular prognostic biomarkers to better predict clinical outcomes in patients with renal cell carcinoma (RCC). This study investigated the pattern of cyclin D1 and p57 expression in RCC patients and evaluated their relation with clinicopathological characteristics and overall survival (OS). METHODS Immunohistochemistry was applied to paraffin-embedded tissue sections of 74 RCC patients. Two cut-off groups were defined by the fraction of positive cells as follows: ≤10% and >10% positive cells for cyclin D1, and ≤5% and >5% positive cells for p57. RESULTS Cyclin D1 expression in >10% of positive cells was observed mostly in the clear cell RCC, while p57 expression in ≤5% of positive cells was found in 86% of chromophobe RCC specimens. The higher expression of cyclin D1 and lower expression of p57 were more frequent in grade I-II tumors. OS was associated with unfavorable clinicopathological characteristics. However, cyclin D1/p57 expression did not influence the survival rates. CONCLUSION Although cyclin D1 and p57 expression did not affect survival rates in RCC patients, proper validation and establishment of the qualitative cut-off point are needed for these tumors.
Collapse
|
12
|
Tomic I, Dragas M, Vasin D, Loncar Z, Fatic N, Davidovic L. Seat-Belt Abdominal Aortic Injury-Treatment Modalities. Ann Vasc Surg 2018; 53:270.e13-270.e16. [PMID: 30081170 DOI: 10.1016/j.avsg.2018.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 05/05/2018] [Accepted: 05/10/2018] [Indexed: 11/27/2022]
Abstract
Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as "seat-belt aorta". We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis.
Collapse
|
13
|
Galun D, Bogdanovic A, Djokic Kovac J, Bulajic P, Loncar Z, Zuvela M. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative-intent surgery for hepatocellular carcinoma: experience from a developing country. Cancer Manag Res 2018; 10:977-988. [PMID: 29765248 PMCID: PMC5942394 DOI: 10.2147/cmar.s161398] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of the study was to evaluate a prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) on long-term survival of cirrhotic and noncirrhotic hepatocellular cancer (HCC) patients managed by a curative-intent liver surgery in a developing country. Patients and methods During the study period between November 1, 2001, and December 31, 2012, 109 patients underwent potentially curative hepatectomy for HCC. Data were retrospectively reviewed from the prospectively collected database. The median follow-up was 25 months. NLR was estimated by dividing an absolute neutrophil count by an absolute lymphocyte count from the differential blood count. Receiver operating characteristic curve was constructed to assess the ability of NLR to predict long-term outcomes and to determine an optimal cutoff value for all patients group, the subgroup with cirrhosis, and the subgroup without cirrhosis. The optimal cutoff values were 1.28, 1.28, and 2.09, respectively. Results The overall 3- and 5-year survival rates were 49% and 45%, respectively, for low NLR group and 38% and 26%, respectively, for high NLR group. The difference was statistically significant (p=0.015). Overall survival was similar between low and high NLR groups in patients with cirrhosis; no difference was found between the groups (p=0.124). In patients without cirrhosis, low NLR group had longer overall survival compared with high NLR group (p=0.015). Univariate analysis identified four factors as significant predictors of long-term survival: cirrhosis, Child-Pugh score, platelet count, and NLR. On multivariate analysis, only platelet count and NLR were independent prognostic factors of long-term survival. Conclusion Prognostic value of NLR was confirmed in noncirrhotic HCC patients who underwent curative-intent liver surgery. In HCC patients with cirrhosis, the prognostic role of NLR was not confirmed.
Collapse
|
14
|
Galun D, Srdic-Rajic T, Bogdanovic A, Loncar Z, Zuvela M. Targeted therapy and personalized medicine in hepatocellular carcinoma: drug resistance, mechanisms, and treatment strategies. J Hepatocell Carcinoma 2017; 4:93-103. [PMID: 28744453 PMCID: PMC5513853 DOI: 10.2147/jhc.s106529] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is characterized by a growing number of new cases diagnosed each year that is nearly equal to the number of deaths from this cancer. In a majority of the cases, HCC is associated with the underlying chronic liver disease, and it is diagnosed in advanced stage of disease when curative treatment options are not applicable. Sorafenib is a treatment of choice for patients with performance status 1 or 2 and/or macrovascular invasion or extrahepatic spread, and regorafenib is the only systemic treatment found to provide survival benefit in HCC patients progressing on sorafenib treatment. Other drugs tested in different trials failed to demonstrate any benefit. Disappointing results of numerous trials testing the efficacy of various drugs indicate that HCC has low sensitivity to chemotherapy that is in great part caused by multidrug resistance. Immunotherapy for HCC is a new challenging treatment option and involves immune checkpoint inhibitors/antibody-based therapy and peptide-based vaccines. Another challenging approach is microRNA-based therapy that involves two strategies. The first aims to inhibit oncogenic miRNAs by using miRNA antagonists and the second strategy is miRNA replacement, which involves the reintroduction of a tumor-suppressor miRNA mimetic to restore a loss of function.
Collapse
|
15
|
Oluic B, Paunovic I, Loncar Z, Djukic V, Diklic A, Jovanovic M, Garabinovic Z, Slijepcevic N, Rovcanin B, Micic D, Filipovic A, Zivaljevic V. Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience. BMC Cancer 2017; 17:371. [PMID: 28545571 PMCID: PMC5445517 DOI: 10.1186/s12885-017-3370-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hurthle cell carcinoma makes up 3 to 5% of all thyroid cancers and is considered to be a true rarity. The aim of our study was to analyze clinical characteristics and survival rates of patients with Hurthle cell carcinoma. METHODS Clinical data regarding basic demographic characteristics, tumor grade, type of surgical treatment and vital status were collected. Methods of descriptive statistics and Kaplan-Meier survival curves were used for statistical analysis. Cox proportional hazards regression was used to identify independent predictors. RESULTS During the period from 1995 to 2014, 239 patients with Hurthle cell carcinoma were treated at our Institution. The average age of the patients was 54.3, with female to male ratio of 3.6:1 and average tumor size was 41.8 mm. The overall recurrence rate was 12.1%, with average time for relapse of 90.74 months and average time without any signs of the disease of 222.4 months. Overall 5-year, 10-year and 20-year survival rates were 89.4%, 77.2%, 61.9% respectively. The 5-year, 10-year and 20-year cancer specific survival rates were 94.6%, 92.5%, 87.4%, respectively. When disease free interval was observed, 5-year, 10-year and 20-year rates were 91.1%, 86.2%, 68.5%, respectively. The affection of both thyroid lobes and the need for reoperation due to local relapse were unfavorable independent prognostic factors, while total thyroidectomy as primary procedure was favorable predictive factor for cancer specific survival. CONCLUSION Hurthle cell carcinoma is a rare tumor with an encouraging prognosis and after adequate surgical treatment recurrences are rare.
Collapse
|
16
|
Nesic S, Loncar Z, Jovanovic M. Canine Brachial Plexus Neuritis. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
17
|
Banovic M, Iung B, Bartunek J, Asanin M, Beleslin B, Biocina B, Casselman F, da Costa M, Deja M, Gasparovic H, Kala P, Labrousse L, Loncar Z, Marinkovic J, Nedeljkovic I, Nedeljkovic M, Nemec P, Nikolic SD, Pencina M, Penicka M, Ristic A, Sharif F, Van Camp G, Vanderheyden M, Wojakowski W, Putnik S. Rationale and design of the Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR trial): A randomized multicenter controlled event-driven trial. Am Heart J 2016; 174:147-53. [PMID: 26995381 DOI: 10.1016/j.ahj.2016.02.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022]
Abstract
Aortic valve replacement (AVR) therapy is an obvious choice for symptomatic severe aortic stenosis (AS) patients as it improves symptoms, left ventricular function, and survival. The treatment decisions and indication for AVR in asymptomatic patients with severe AS and normal left ventricular ejection fraction are less well established and the subject of ongoing debate. Many efforts have been made to define the best treatment option in asymptomatic AS patients with normal left ventricular ejection fraction. Retrospective and observational data imply that elective AVR for asymptomatic severe AS may lead to improvement in outcomes in comparison to surgery performed after onset of symptoms. The AVATAR trial will aim to assess outcomes among asymptomatic AS patients randomized to either elective early AVR or medical management with vigilant follow-up. In the latter group, AVR would be delayed until either the onset of symptoms or changes in predefined echocardiographic parameters. To the best of the authors' knowledge, it will be the first large prospective, randomized, controlled, multicenter clinical trial that will evaluate the safety and efficacy of elective AVR in this specific group of patients.
Collapse
|
18
|
Vicentic S, Sapic R, Damjanovic A, Vekic B, Loncar Z, Dimitrijevic I, Ilankovic A, Jovanovic AA. Burnout of Formal Caregivers of Children with Cerebral Palsy. THE ISRAEL JOURNAL OF PSYCHIATRY AND RELATED SCIENCES 2016; 53:10-15. [PMID: 28079032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Burnout syndrome is under-researched within caregivers (CGs) of children with cerebral palsy. The primary aim was to determine the burnout level of formal CGs of children with cerebral palsy (G1) and to compare it with a control group (G2) of professional pediatric nurses, and second, to correlate the level of depression and anxiety with the burnout level. METHOD In a total sample of 60 CGs, the Maslach Burnout Inventory Human Services Survey (MBI-HSS), consisting of three structural units - emotional exhaustion (MBIEE) subscale, depersonalization (MBI-DP) subscale and personal accomplishment (MBI-PA) subscale - was used to measure burnout. The Beck Anxiety Inventory (BAI) was used for the assessment of anxiety, and the Beck Depression Inventory (BDI) for depression. RESULTS A significant difference was shown on the MBI-EE subscale and on the BDI test (p<0.05), in both cases higher scores were obtained by G1. High burnout was observed in all subscales, on the MBI-EE subscale registered 50% of CGs in G1, and 17% in control G2. Correlation of the MBI-EE subscale with BDI and BAI tests was highly significant (p<0.01). CONCLUSIONS These findings indicate the need for future research aimed at formulating preventive strategies for caregivers' mental health. Better care for caregivers would provide them with better professional satisfaction, and consequently would lead to better care for patients.
Collapse
|
19
|
Banovic M, Loncar Z, Behfar A, Vanderheyden M, Beleslin B, Zeiher A, Metra M, Terzic A, Bartunek J. Endpoints in stem cell trials in ischemic heart failure. Stem Cell Res Ther 2015; 6:159. [PMID: 26319401 PMCID: PMC4552990 DOI: 10.1186/s13287-015-0143-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite multimodal regimens and diverse treatment options alleviating disease symptoms, morbidity and mortality associated with advanced ischemic heart failure remain high. Recently, technological innovation has led to the development of regenerative therapeutic interventions aimed at halting or reversing the vicious cycle of heart failure progression. Driven by the unmet patient need and fueled by encouraging experimental studies, stem cell-based clinical trials have been launched over the past decade. Collectively, these trials have enrolled several thousand patients and demonstrated the clinical feasibility and safety of cell-based interventions. However, the totality of evidence supporting their efficacy in ischemic heart failure remains limited. Experience from the early randomized stem cell clinical trials underscores the key points in trial design ranging from adequate hypothesis formulation to selection of the optimal patient population, cell type and delivery route. Importantly, to translate the unprecedented promise of regenerative biotherapies into clinical benefit, it is crucial to ensure the appropriate choice of endpoints along the regulatory path. Accordingly, we here provide considerations relevant to the choice of endpoints for regenerative clinical trials in the ischemic heart failure setting.
Collapse
|
20
|
Loncar Z, Djukic V, Zivaljevic V, Pekmezovic T, Diklic A, Tatic S, Dundjerovic D, Olujic B, Slijepcevic N, Paunovic I. Survival and prognostic factors for adrenocortical carcinoma: a single institution experience. BMC Urol 2015; 15:43. [PMID: 26013141 PMCID: PMC4443614 DOI: 10.1186/s12894-015-0038-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/19/2015] [Indexed: 12/24/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is aggressive, but rare tumours that have not been sufficiently studied. The aim of our study was to present the demographic and clinical characteristics of patients with ACC, to determine the overall survival rates, analyse the effect of prognostic factors on survival, as well as to identify favorable and unfavourable predictors of survival. Method The study included 72 patients (42 women and 30 men) with ACC. We analysed the prognostic value of the demographic and clinical characteristics of the patients, tumour characteristics, therapy administered and survival rates. Kaplan-Meier survival curves and the log-rank test were used to estimate the overall and specific survival probabilities and the Cox regression model was used to identify independent prognostic factors for survival. Results The patients had mean age of 50 years. The 1-, 5-, and 10-year probabilities of survival in patients with ACC were 52.5 %, 41.1 %, and 16.4 %, respectively. The median survival time was 36 months. The results of multivariate Cox regression analysis showed that the presence of lymphatic metastases (HR = 7.37, 95 % CI = 2.31-23.48, p = 0.001) and therapy with mitotane (HR = 0.11, 95 % CI = 0.04-0.27, p = 0.001) were independent prognostic factors for survival. Conclusion The presence of lymphatic metastasis is an unfavourable prognostic factor, while postoperative therapy with mitotane is a favorable prognostic factor for survival in patients with ACC.
Collapse
|
21
|
Jovanovic D, Loncar Z, Doklestic K, Karamarkovic A. Intra-abdominal infection and acute abdomen-epidemiology, diagnosis and general principles of surgical management. SANAMED 2015. [DOI: 10.5937/sanamed1501069j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
22
|
Krstic S, Resanovic V, Alempijevic T, Resanovic A, Sijacki A, Djukic V, Loncar Z, Karamarkovic A. Hartmann's procedure vs loop colostomy in the treatment of obstructive rectosigmoid cancer. World J Emerg Surg 2014; 9:52. [PMID: 25324896 PMCID: PMC4198663 DOI: 10.1186/1749-7922-9-52] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/01/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction Colorectal carcinoma is the most common malignant gastrointestinal tumour. There is still a considerable controversy when it comes to urgent surgical treatment of obstructive carcinoma of the left colon and rectum. Methods Seventy-five patients from the randomized trial were followed up. This study was designed as a stratified randomized trial with four stratums according to age and ASA score (older/younger than 60 years and ASA score <>3). Each of the four groups is then divided into two sub-groups according to the operating technique: loop colostomy or Hartmann’s procedure. Results There were no difference found in hospitalization among the groups (loop colostomy vs. Hartmann’s procedure) in the same stratus (P = 0.3192, P = 0.5760, P = 0.9023 respectively), except in the case of doing reconstructive procedure after loop colostomy (P = 0.0049) in the fourth stratum (patients younger than 60 years with ASA score lower than 3). Type of operation had no influence over the blood test values observed on admittance and during hospitalization (P = 0.319, P = 0.871, P = 0.7, P = 0.843, P = 0.52 respectively for the blood values). In terms of surgical and non-surgical complications it has been shown that there is no statistically significant difference between patients treated by two methods. Age, gender, ASA score, type of operation and surgical complications were not singled out as a risk factor for fatal outcome (P = 0.199, P = 0.155, P = 0.764, P = 0.452 and P = 0.724 respectively). The only factors that are singled out as a risk factor for death are the emergence of non-surgical complications and angina pectoris (P = 0.006, P = 0.001). Conclusions There is no difference in surgical treatment of large bowel obstruction caused by rectosigmoid carcinoma. Neither of those two methods showed significant advantage in treatment of large bowel obstruction caused by rectosigmoid cancer.
Collapse
|
23
|
Vidovic A, Arsic-Arsenijevic V, Tomin D, Djunic I, Jakovic R, Loncar Z, Barac A. Proven invasive pulmonary mucormycosis successfully treated with amphotericin B and surgery in patient with acute myeloblastic leukemia: a case report. J Med Case Rep 2013; 7:263. [PMID: 24299522 PMCID: PMC3879024 DOI: 10.1186/1752-1947-7-263] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/11/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction Invasive mucormycosis (zygomycosis) is the third most frequent fungal infection in patients with hematologic malignancies. It often results in a fatal outcome mainly due to the difficulty of early diagnosis and its resistance to antimycotics. Case presentation A 52-year-old Caucasian man was diagnosed with acute myeloblastic leukemia. Following the induction chemotherapy he developed febrile neutropenia. Meropenem (3×1000mg/day) was introduced empirically. A chest computed tomography showed soft-tissue consolidation change in his right upper lobe. A bronchoscopy was performed and the histology indicated invasive pulmonary aspergillosis based on fungal hypha detection. Also, high risk patients are routinely screened for invasive fungal infections using commercially available serological enzyme-linked immunosorbent assay tests: galactomannan and mannan (Bio-Rad, France), as well as anti-Aspergillus immunoglobulin G and/or immunoglobulin M and anti-Candida immunoglobulin G and/or immunoglobulin M antibodies (Virion-Serion, Germany). Galactomannan showed low positivity and voriconazole therapy (2×400mg/first day; 2×300mg/following days) was implemented. The patient became afebrile and a partial remission of disease was established. After 2 months, the patient developed a fever and a chest multi-slice computed tomography showed soft-tissue mass compressing his upper right bronchus. Voriconazole (2×400mg/first day; 2×300mg/following days) was reintroduced and bronchoscopy was repeated. Histologic examination of the new specimen was done, as well as a revision of the earlier samples in the reference laboratory and the diagnosis was switched to invasive pulmonary mucormycosis. The treatment was changed to amphotericin B colloidal dispersion (1×400mg/day). The complete remission of acute myeloblastic leukemia was verified after 2 months. During his immunerestitution, a high positivity of the anti-Aspergillus immunoglobulin M antibodies was found in a single serum sample and pulmonary radiography was unchanged. A lobectomy of his right upper pulmonary lobe was done and the mycology culture of the lung tissue sample revealed Rhizopus oryzae. He remained in complete remission for more than 1 year. Conclusions Invasive mucormycosis was successfully treated with amphotericin B, surgery and secondary itraconazole prophylaxis. As a rare disease invasive mucormycosis is not well understood by the medical community and therefore an improvement of education about prevention, diagnosis and treatment of invasive mucormycosis is necessary.
Collapse
|
24
|
Petrovic M, Jankovic Z, Jaukovic L, Artiko V, Šobic-Šaranovic D, Antic A, Žuvela M, Radovanovic N, Palibrk I, Galun D, Matic S, Loncar Z, Bojovic P, Ajdinovic B, Obradovic V. Clinical value of immunoscintigraphy in the rectal carcinomas: immunoscintigraphy of rectal carcinomas. HEPATO-GASTROENTEROLOGY 2013; 60:1355-9. [PMID: 23340231 DOI: 10.5754/hge121035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the clinical reliability of the immunoscintigraphy with radiolabeled monoclonal antibodies for the detection of metastases and recurrences of rectal carcinomas. METHODOLOGY A total of 65 patients underwent immunoscintigraphy with radiolabeled monoclonal antibodies. Indication for that examination was suspicious rectal cancer or suspicious rectal cancer recurrence and/or metastases. RESULTS The method proved to have 92.7% sensitivity, specificity 83.3%, positive predictive value 90.5%, negative predictive value 87.0% and accuracy 89.2%. There was a statistically significant relationship between immunoscintigraphy findings and rectoscopy findings (rs=0.415, p=0.013), as well as significant relationship between immunoscintigraphy findings and US findings (rs=0.332, p=0.001). Tumor marker levels were in positive correlation with findings of immunoscintigraphy (rs=0.845, p=0.001), especially raised CEA level (rs=0.816, p=0.004). Patients with higher CA19-9 level had higher Duke's stage (p=0.025). CONCLUSIONS We can conclude that immunoscintigraphy can be helpful in the detection of metastases and recurrences of colon carcinomas.
Collapse
|
25
|
Djukić VR, Karamarković AB, Radenković DV, Gregorić PD, Jeremić V, Ivancević ND, Loncar Z, Stepić D, Micić D, Oluić B, Bajec DD. [Hanging manuever in liver trauma]. ACTA CHIRURGICA IUGOSLAVICA 2010; 57:53-56. [PMID: 21449137 DOI: 10.2298/aci1004053d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The phylosophy of aggressive surgical approach, its complete implementation in liver trauma surgery did not appear efficient. No matter of permanenent development of diagnostic imaging methods, anesthesia, intensive therapy, medical technology and suture materials, operational theater and operative tchniques, major liver resections in trauma had mortality rate up to 60%. With introduction of computerized tomography (CT, 1981) in everyday clinical praxis and with better evaluation of trauma patients, the whole approach to liver trauma patient has been redesigned. Based on AAST-OIS classification, almost 70% of traumatized with grade I, II and III sholud be treated non-operatively, hospitally, with repeating FAST (focused abdominal ultrasound in trauma) and abdominal CT scans. The rest of traumatized patients, with grade IV and V injuries of juxtahepatic structures demand complexive surgical treatment. The modalities of surgical treatment depend on trauma mechanisms, extensivity, anatomical localisation and affection of vascular structures. Hanging Manuevr--the Method of French surgeon Belghiti bases on anterior approach in liver resection is a try for fast solution for fatal bleeding in liver trauma. It consists of placing the elastic cord throughout the anterior surface of VCI or ligamentum venosusm, of upper end of the cord is located in superior part of VCI where hepatic veins are emerging. Lower end of the cord is located in subhepatic part of VCI between 3 Glisonian pedicles. Concerning hepatic veins liver is divided in 3 sections, which derives blood in right hepatic vein RHV, middle hepatic vein MHV and left hepatic vein LHV. Belghiti proposed the usage of hanging maneuver when resecting the right liver, while the cord is placed throughout retrohepatic VCI, lower end between elements of Glisonian pedicle and upper end between hepatic veins. Complications like bleeding from caudal veins are minimal, then speed in liver resection in hemodynamic unstable and ishemic patient, defects like bleeding because compressing tapes or lesions IVC tile mobilazion of liver for conventional resection.
Collapse
|