Acta chirurgica iugoslavica (Acta Chir Iugosl)

Publications in this journal

• Article: The microsurgical anatomy of the basal perforating branches of the anterior complex of the circle of Willis and its clinical significance

  Milenković Z, Vucetić R, Filipović V, Penev G
  Acta chirurgica iugoslavica 02/2013; 26 :((2)):79-88..
• Article: Knowledge and occupational exposure to blood and body fluids among health care workers and medical students.

  Ljiljana Marković Denić, Irena Ostrić, Andrija Pavlović, Kalimanovska Ostrić Dimitra
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  ABSTRACT: Health workers and medical students are at occupational risk of blood-borne diseases during the accidents, that is, via percutaneous injury or entry of blood or body fluids through the mucosa or injured skin. to review and analyze the knowledge, attitudes and perception of risks of bloodborne diseases of the clinical course students and health workers as well as the frequency of accidents. Cross-sectional study was carried out among the students of the Faculty of Medicine in Belgrade, and health workers of the Clinical Center of Serbia. The subjects responded anonymously to questionnaire specially designed for the study. Both students and health workers were aware, in a high percentage, of the fact that the risk of hepatitis B spread was about 30%. Significantly more students gave affirmative reply that blood as biological material was a potential hazard of HIV infection spread (p = 0.001), and significantly more students knew that HIV would not be spread by sweat (p = 0.001). Hepatitis B vacci-nation was administered only to 24.1% of students and 71.4% of health workers. About 10% of students and 65.5% of health workers experienced some accident. There was no significant difference of accidents bet-ween nurses/technicians and physicians (p > 0.05), as well as of accidents and a total length of service (p > 0.05). The majority of accidents occurred during the use of needle/sharp object (in 27.3% of students and 33.1% of health workers). About 40% of students and slightly over a half of the workers reported the accidents to appropriate authorities. Additional education in this field is considered necessary by 73% of students. During the studies and via continuous medical education it is necessary to upgrade the level of knowledge on prevention of accidents, what would, at least partially, influence their reduction.
  Acta chirurgica iugoslavica 01/2012; 59(1):71-5.
• Article: Multiple port-site metastasis of incidental gallbladder carcinoma after laparoscopic cholecystectomy.

  Zoran J Raznatović, Nemanja D Zarić, Danijel A Galun, Nebojsa S Lekić, Marjan Micev, Vladimir R Djordjevic, Ljubomir M Djurasic, Mirko D Kerkez
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  ABSTRACT: Laparoscopic cholecystectomy is a surgical procedure of choice for benign gallbladder diseases. In about 1-2% of cases histopathological examination demonstrate incidental gallbladder cancer (GBCA). We report a case of a 61 year old woman who developed port site metastases after laparoscopic cholecystectomy for adenocarcinoma of the gallbladder. Metastases appeared on all four port sites. Review of literature regarding incidental GBCA an port site metastases was also performed. We conclude that the retrieval bag should be routinely used in laparoscopic cholecystectomy; the procedure should be performed with minimal trauma; in cases of incidental GB carcinoma, full thickness excision of the abdominal wall of the port sites demands additional studies; additional liver bed excision and local lymphadenectomy for T1b carcinoma are yet to be considered.
  Acta chirurgica iugoslavica 01/2012; 59(1):105-9.
• Article: Evaluation of comparative results of rehabilitation of patients with acromioclavicular dislocation of the third degree treated by surgical techniques by Phemister and Vukov.

  Tatjana Radovanović, Vladimir Vukov, Marko Bumbasirević, Mirjana Manojlović-Opacić, Mirko Grajić, Ljubomir Djurasić
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  ABSTRACT: In terms of access to treatment of acromioclavicular joint injuries, there are many controversies, especially after the appearance of works that promote "neglecting of injury". The aim of this paper is to give a comparative analysis of the results of rehabilitation of patients after acute injury of the acromioclavicular joint of the third degree, treated by two surgical techniques: by Phemister and Vukov. In this study, we investigated a total of 60 operated patients: 30 patients were operated by Phemister techniq-ue, and 30 by Vukov technique. Postoperative follow-up lasted for one year. Between these two groups, the time when the rehabilitation process began is significantly different p < 0.01. With technique by Vukov, the rehabilitation begins on the first postoperative day and with technique by Phemister it begins later (after 7 weeks outpatient). With technique by Phemister, rehabilitation lasted on average 60 days, and with technique by Vukov on average 40 days. The duration of recovery is also significantly different p < 0.01, with technique by Vukov the duration time is shorter, and therefore the process of rehabilitation in days--is shorter than with the other technique. Both techniques gave good stability of the lateral end of clavicle. The difference was not statistically significant p > 0.05, which means that both techniques can be applied depending on the indication and the experience of the surgeon.
  Acta chirurgica iugoslavica 01/2012; 59(1):81-5.
• Article: [Friedrich von Esmarch--surgeon, one career].

  Marko Z Bumbasirevic, Slavisa G Zagorac, Radovan D Manojlović, Ljubomir M Djurasić, Aleksandar R Lesić
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  ABSTRACT: Friedrich von Esmarch was born in 1823 in Germany and he is one of the greatest surgeons of the Germany of that time. Fridrich von Esmarch introduced the Esmarch tourniquet, which enables operative field bloodless. This revolutionary innovation is still present in the orthopaedic surgery all around world, as well as for the first line hemostasis. Beside this, Esmarch also improves others fields of surgery: immobilizations, methods of antiseptic surgery, modified Esmarch mask for anesthesia. He joined few wars and had a rang surgeon-general. Although his experience was primary from the trauma, he also introduced the training courses of the First aid for the ordinary people, making medicine of that time more modern and efficient
  Acta chirurgica iugoslavica 01/2012; 59(1):13-7.
• Article: Fistula in ano: an overview.

  R John Nicholls
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  ABSTRACT: Perianal fistula is a very unpleasant condition. It is also quite difficult to be solved without recurrence or with complete preservation of sphincter function. This paper summarizes the etiology, classification of fistulas along with the long-term surgical experiences in the approach and the treatment of this condition.
  Acta chirurgica iugoslavica 01/2012; 59(2):9-13.
• Article: Functional results after surgery for obstructed defecation.

  Evaghelos Xynos
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  ABSTRACT: Obstructed defecation (OD) syndrome is associated with several abnormalities of the pelvic organs, namely anterior rectal mucosa prolapse, anterior rectocele, recto-anal intussusception, and a deep Douglas pouch which predisposes to enterocele or rectocele. Surgical repair of the anatomical deformities should be attempted, only after thorough selection of patients and conservative treatment has been exhausted. Transperineal procedures include resection-plication of the anterior rectal wall and stapled transanal rectal resection, and are indicated for the treatment of anterior rectocele and internal rectal prolapse. Functional results are satisfactory in approximately 75 percent of the cases. Transabdominal procedures include posterior prosthesis rectopexy, resection suture-rectopexy and ventral prosthesis colporectopexy. These procedures are indicated in patients with large rectocele and rectal intussusception and enterocele or sigmoidocele. The rate of repair of anatomical deformities is very high and improvement of symptoms is accounted in more than 80 percent of the cases. Ventral prosthesis colporectopexy seems a very promising approach, but further evidence is mandatory.
  Acta chirurgica iugoslavica 01/2012; 59(2):25-9.
• Article: Laparoscopic restorative proctocolectomy technical notes and postoperative results.

  Dursun Bugra
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  ABSTRACT: Laparoscopic colon surgery has become a proved method for the resection of both benign and malignant disease. With the advance of technological innovations and surgical experience, more complex laparoscopic procedures including restorative proctocolectomy have become increasingly used in the treatment of ulcerative colitis with safe and feasible results. When these operations are realized in a stepwise fashion, the complexity of the procedure becomes simplified. The technical aspects of laparoscopic restorative proctocolectomy in patients with ulcerative colitis are reviewed in this article. A J-pouch with a stapled anastomosis has been the preferred technique because it is quicker and safer. In all patients diverting loop ileostomy is regularly created at the time of ileal pouch-anal anastomosis. In this review the postoperative results are also revised. Postoperative fasting time, postoperative hospital stay, and overall complication rate are in favor of laparoscopic technique when compared to open approach. However, clinical value of laparoscopic surgery for ulcerative colitis needs further evaluation with more well-designed randomized controlled trials along with long-term follow-up.
  Acta chirurgica iugoslavica 01/2012; 59(2):39-45.
• Article: Metastatic colorectal cancer--what about the primary?

  Irinel Popescu, Sorin Tiberiu Alexandrescu
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  ABSTRACT: Approximately 25% of patients with colorectal cancer present synchronous metastases, most frequently located in the liver. The assessment of optimal therapeutic strategies for the primary tumor in such patients. We analyzed the outcomes of 209 patients who underwent simultaneous or delayed resection of the primary tumor and liver metastases, the survival rates of patients with initially unresectable liver metastases that were rendered resectable, and the prognostic factors related to the primary tumor. The outcomes of simultaneous resections were similar to those of delayed resection. In patients with initially unresectable liver metastases that were rendered resectable, the survival rates were similar to those of patients with initially resectable metastases. The survival rate of N2 patients was significantly lower than those of N1 and N0 patients. Simultaneous resection provides a safety profile and survival rate similar to that of delayed resection. The N category allows for prognostic estimation in metastatic colorectal patients.
  Acta chirurgica iugoslavica 01/2012; 59(2):47-55.
• Article: Minor vs complete excision of pilonidal sinus--early postoperative period.

  Jelena Petrović, Ivan Dimitrijević, Zoran Krivokapić
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  ABSTRACT: Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair. It is predominantly a condition of younger people. When presenting as an abscess it usually requires surgical incision and drainage, or bursts spontaneously. In general, there are various surgical approaches to this condition, from very simple to complex ones. Each technique has its supporters and justifications. In the 3 years period, from 2009-2011, 110 treatments of the pilonidal disease were performed on our department. Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done. The average discharge time was 1.14 days. Failure to heal occurred in 15 patients (13.63%). During that period we saw recurrence in 4 patients (3.63%). All the patients were coming to our department for postoperative care. The shortest healing time was 4 weeks and longest 21 weeks. During the period may 2011-May 2012 we performed 17 less extensive excisions. All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks. In only one patient with the extensive excision healing time was 8 weeks. Although we had a short follow up period of 11.11 months, we saw no recurrence yet. Our results show that simple individual approach to every patients gives fastest and most comfortable results.
  Acta chirurgica iugoslavica 01/2012; 59(2):81-5.
• Article: Single access laparoscopic right hemicolectomy.

  Umberto Bracale, Srdjan Mijatovic, Fabrizio Lazzara, Fabrizio Perna, Francesco Badessi, Giusto Pignata
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  ABSTRACT: Single Access Laparoscopic Colectomy (SALC) were reported in several studies. The first Single Access laparoscopic right colectomy was descibed by Remzi et Al. We report our experience in SALC describing our approach for Right Colectomy. In our experience we perform as well an extracorporeal side-to-side anastomosis, in contrast wit a conventional laparoscopic right colectomy in which we perform an intra-corporeal anastomosis. We think that an important limit of this approach is represented by the difficult to perform a safe intra-corporeal anastomosis. In conclusion we think that right SALC is a safe and feasible approach. However, many issues will be established, as well as technological, economical and educational aspects, before its introduction in the daily clinical practice.
  Acta chirurgica iugoslavica 01/2012; 59(2):103-6.
• Article: Influence of second or multiple tumours on the prognosis of patients with colorectal cancer.

  Philipp Hildebrand, Janina Humke, Elisabeth Oevermann, Erik Schloericke, Conny Bürk, Uwe Johannes Roblick, Hans-Peter Bruch, Ralf Czymek
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  ABSTRACT: Colorectal cancer is one of the most common forms of cancer in the Western world. A wide variety of prognostic factors for colorectal cancer have been identified. There is, however, a paucity of literature addressing the influence of multiple primary carcinomas on prognosis. We conducted the present study in order to investigate the influence of second or multiple primary tumours on the prognosis of colorectal cancer patients. From 1992 to 2005, 1500 patients underwent surgery for colorectal cancer at the University Hospital of Luebeck. Of these, 276 patients (19%) had multiple primary malignant tumours. We performed statistical analyses only on patients who underwent surgery with curative intent in order to minimise additional prognostic factors. The patients were divided into groups according to the time of multiple primary tumour occurrence. Data were analysed for various variables. We did not detect any significant differences in survival either between the various groups or between patients with and without multiple primary tumours. The presence of multiple primary carcinomas is not an independent prognostic factor in patients with an index tumour of the colorectum. Multiple primary tumours are thus not necessarily associated with a poorer outcome and patients should receive curative intent surgery and appropriate follow-up care.
  Acta chirurgica iugoslavica 01/2012; 59(1):31-8.
• Article: [Effects of carbonic anhydrase inhibitors on pseudophakic corneal edema].

  Abazi Zihret, Lidija Magarasević, Aleksandar Marković, Dusia Risović
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  ABSTRACT: Acetazolamide as inhibitor of carbonic anhydrase, in glaucoma therapy, has an effect on lowering intraocular pressure. In addition to this primary effects, we attempted to determine the effect on the cornea after phacoemulsification. In our study, we determined the effects of systemically applied dose of 500 mg of acetazolamide on the edema, thickness, and corneal morphology after phacoemulsification ,with the Anterior Segment Optical Coherence Tomography (AS OCT). The study included 53 patients who were divided into two groups. Groups were stratified by type of cataract (nuclear), age (62+/-1.5), preoperative visual acuity (5/60) Snellen table,and preoperative findings on AS-OCT. Phacoemulsification has done the same surgeon, with the same ultrasound probe length using ultrasonic force of the average value of 14 for a period of 72+/-2.5 seconds. Group of 33 patients were administered systemic acetazolamide at a dose of 250 mg per scheme 01 hours +24 hours after phacoemulsification (group I). Another group of 20 patients did not receive acetazolamide(group II). AS OCT recordings were performed before surgery, 6 hours and 24 hours after surgery. The mean value in both groups was 549+/-9 microm before surgery. Group I had average value of 648+/-6 microm after 6h, and the mean value was 612+/-4 microm after 24h. The group II,had a mean thickness of the cornea after 6 hours of 720+/-5 microm, and after 24 hours 708+/-4 microm. Morphological changes in the tomograms of the group I showed minimal creases Descemet's membrane. Postoperative visual acuity was 0,6,24h after the surgery in the I group of patients,and 0,3 in the II group. In our study the patients who administered systemic acetazolamide had significant reduction of central corneal thickness. The folds of Descemet's membrane and endothelial dysfunction in AS OCT tomograms showed less structural changes in group I. Significant better postoperative visual acuity in these patients is probably because of the smaller corneal edema after 24 h, which improves patients' comfort.
  Acta chirurgica iugoslavica 01/2012; 59(3):27-32.
• Article: The effects of early rehabilitation in patients with surgically treated colorectal cancer.

  Ljubomir Djurasić, Aleksandar Pavlović, Nemanja Zarić, Ivan Palibrk, Dragan Basarić, Vladimir R Djordjević
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  ABSTRACT: Colorectal cancer is one of the most common cancer. Caught early, it is often curable. The important role in functional recovery of these patients, have enhanced recovery after surgery (ERAS) clinical care protocol and early rehabilitation. The goal of this research is the objective evaluation of the effects of early rehabilitation in patients after surgical treatment of colorectal cancer, respecting their functional recovery and quality of life, before and after rehabilitation. Tis study was made as experimental, randomized, controlled clinical trial, opened type.The examination included 58 patients (39 males and 19 females), age from 36 to 85 years, average 63.3, with surgically treated colorectal cancer. All patients had appropriate early multimodal accelerated rehabilitation program.The mean value of this program was 7,24 days. As observing parameter was used short form, 36 items health related questionnaire (SF-36), with two summary measures-Physical component summary (PCS) and Mental component summary (MCS), for the evaluation of quality of life, before and after treatment. For the statistical analysis of the aquired data, before and after therapy, was used Student's t-test. Afer therapy, the quality of life of patients was significantly improved, physical health (p< 0.01), as well as mental health (p<0,01). SF36 score after rehabilitation, show important improvement of quality of life in early treated patients. These results show exellent therapeutic possibilities of enhaced recovery clinical care protocol and early rehabilitation procedures. Acording to the results of this study, it can be concluded that early rehabilitation accelerated program is very effective in treatment of patients with surgically treated colorectal cancer.
  Acta chirurgica iugoslavica 01/2012; 59(3):89-91.
• Article: The effect of low frequency pulsing electromagnetic field in treatment of patients with knee joint osteoarthritis.

  Aleksandar S Pavlović, Ljubomir M Djurasić
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  ABSTRACT: Pulsing electromagnetic field represents effective rocedure in treating of diverse diseases and p pathologic conditions, especially in rheumatology, orthopaedics and traumatology. The goal of this research is the objective evaluation of the treapeutic effect of low frequency pulsing electromagnetic field (LFEMF), in comparison with the effect of the other physical procedure: interfererence currents (IFC) and the medicamentous therapy, in treating of patients with knee joint osteoarthritis. This study was made as experimental, randomized, controlled clinical trial, opened type. The examination included 60 patients (40 females and 20 males) with osteoarthritis of the knee joint. All patients were divided in three groups. The first group of 20 persons, composed of patients treated with medicamentous therapy (Diklofenak of 100 mg, 2 tablets per day). The second group consisted of 20 patients treated by LFPEMF and the third group consisted of 20 patients treated by IFC. All procedures were implemented during 10 days All of patients had also the same duration therapeutic exercise. As observing parameter was used: Lattinen test for the evaluation of the pain sensitivity, before and after therapy. For the statistical analysis of the aquired data, was used Student's t-test. After therapy the pain was considerably reduced in each group, but this effect was the most significant in the II group of the examinees, treated by LFPEMF (p< 0.001), than the effects in other groups of patients: I group (p< 0.05) and III group (p< 0.01). According to the results of this study it can be concluded that LFPEMF is very effective therapeutic procedure in treatment of patients with knee joint osteoarthritis.
  Acta chirurgica iugoslavica 01/2012; 59(3):81-3.
• Article: [Surgical treatment of degenerative cervical spine diseases: analyses of 90 patients clinical study].

  M Marković, N Zivković, D Stojanović, M Samardzić
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  ABSTRACT: The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation.
  Acta chirurgica iugoslavica 01/2012; 59(3):61-8.
• Article: Surgical management of macular holes - indications and complications.

  Miroslav Stamenković
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  ABSTRACT: Macular hole surgery is very demand surgery performed due to fullthickness macular rupture characterized by abscence of all retinal layers. Indications for surgery includes stages 3 and 4 regarding to Gass classification. Some authors sugest surgery for stage 2 but results are promissing only in anatomical reconstruction. Complications are evident such as cataract, late macular reopening, retinal tears and detachment, visual field defect etc. With improving surgical techniques, the rate of complications became lower.
  Acta chirurgica iugoslavica 01/2012; 59(3):85-8.
• Article: [Results of asymmetric bilateral medial rectus retroposition in unilateral Duane retractionsyndrome's type I].

  Milorad V Ljutica, Miroslav Stamenković, Dusica Risović, Nebojsa Nikitović, Branko Stankov
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  ABSTRACT: To describe the results of asymmetric bilateral medial rectus retroposition in unilateral Duane retraction syndrome-this type I. This is a retrospective study involving 18 patients, mean age 11.2 years (3-37 years) with unilateral Duane retraction syndrome's type who were operated in 2009 up to 2011 year. The aim was to investigate the existence of ocular torticollis, size deviation before and after surgery and presence of amblyopia, anisometropia, type of refractive errors and lateralization. All 18 patients were surgically treated by asymmetric retroposition of internal rectus (for 1-2mm more on the healthy eye). All patients preoperatively demonstrated ocular torticollis. Size of mean preoperative deviation was +22.2 pD of primary angle PD and +46 pD of secondary angle. Postoperative finding: deviation of > +10 PD is noted to the presence of mild torticollis in one patient. Intermediate follow-up period was 9.8 months. Unilateral Duane's syndrome is common among members of women (67%) compared to males (33%). Lateralization of Duane's syndrome is more common in the left eye compared to the right (83% vs. 17%). Amblyopia was present in two patients and anisometropia (11.1%). As for refractive errors: hyperopia was found in 9 patients (50%), hypermetric astigmatism in 7 cases (39%), myopia and 1 (5.5%) and emmetropia (5.5%). None of the patients had no pathological changes in the fundus and anterior segment. Asymmetric bilateral medial rectus retroposition is extremely effective in the treatment of ocular torticollis and esotropia in patients with unilateral Duane retraction syndrome-this type I.
  Acta chirurgica iugoslavica 01/2012; 59(3):77-80.