Dusica Simić

University Children's Hospital, Belgrade, Serbia, Beograd, Central Serbia, Serbia

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Publications (17)3.13 Total impact

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    ABSTRACT: Posterior knee joint dislocation associated with injury of the popliteal artery in children is an extremely rare condition. Rapid diagnosis and treatment are essential for limb salvage and function. We reported a 14-year-old boy who suffered traumatic displacement of the right knee and contusion of the popliteal artery during motorcycle accident. The diagnosis was confirmed using Doppler and duplex ultrasonography and digital substraction transfemoral arteriography. The urgent surgical procedure was performed using posterior approach to the popliteal artery. During the surgical exploration, rupture of the posterior cruciate ligament associated with thrombosed popliteal artery have been found. The damaged popliteal artery was resected and replaced with autologous saphenous vein graft. The last stage of the procedure was a transosseous femoral fixation of posterior circuate ligament. A 3-year-follow-up after the surgery demonstrated intact arterial perfusion and very good function of the knee with a minimal difference as compared with the contralateral knee. Combined orthopedic and vascular injuries are very rare in children. They require combined treatment.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2014; 71(1):87-90. · 0.21 Impact Factor
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    ABSTRACT: Vitamin D, i.e., 1.25(OH)2D, is an essential factor, not only of homeostasis of calcium and phosphorus, but also of cell proliferation, differentiation and apoptosis, immune and hormonal regulation, as well as other body processes.Thus, its optimal presence in the body is of exceptional significance for health, both of children, as well as adults and elderly persons. Today, it is known that the lack of vitamin D, besides having negative effects on the skeleton and teeth, also contributes to the development of various malignancies, primarily of the large bowel, prostate and breasts, as well as of autoimmune and allergic diseases, diabetes mellitus type II, arterial hypertension and others. Considered from the biological aspect, physiological requirements in vitamin D are achieved by cutaneous synthesis from 7-dehydrocholesterol during sun exposure, while, except rarely, it is very scarce in food. Having in mind extensive evidence that sun exposure presents a high risk for the development of skin malignancies, primarily melanoma, it is clear that humans are deprived of the natural and basic source of vitamin D. In accordance, as well as based on numerous epidemiological studies showing the increase of diseases, in the basis of which vitamin D deficiency plays the important role, next led to the recommended dietary allowance of vitamin D, regardless of age. According to current attitudes, it is recommended that the daily dietary allowances of vitamin D, i.e., the quantity of oral intake that would safely cover the optimal body requirements should be 400 IU for ages 0-18 years, 600 IU for ages 19-70 years and 800 IU for persons aged over 70 years.
    Srpski arhiv za celokupno lekarstvo 01/2012; 140(1-2):110-4. · 0.23 Impact Factor
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    ABSTRACT: In spite of the wide usage of corticosteroids for the treatment of a plethora of diseases, sometimes they can induce immediate hypersensitivity reactions, which are however uncommon. We report a case of immediate allergic reaction induced by intravenous methylprednisolone given before operation for surgical repair of an arm contracture as a sequel of burns, which the child had tolerated a month before. Six weeks later the patient repeated the anaphylactic reaction during skin testing to methylprednisolone. In addition, basophile activation test with methylprednisolone (BAT) was positive. This case report describes a patient who experienced intraoperative anaphylaxis and anaphylactic reaction induced by skin testing. This is the first report on induction of both anaphylactic reactions by methylprednisolone in the same child. Clinical findings, positive BAT and positive skin tests with methylprednisolone imply that the child developed type-I hypersensitivity. The lack of crossreactivity with other corticosteroids emphasizes that the reactions were caused by the steroid molecule.
    Srpski arhiv za celokupno lekarstvo 01/2012; 140(3-4):233-5. · 0.23 Impact Factor
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    ABSTRACT: Cardiomyopathies are myocardial diseases in which there is structural and functional disorder of the heart muscle, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease. Cardiomyopathies are grouped into specific morphological and functional phenotypes: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and unclassified cardiomyopathies. Patients with dilated and hypertrophic cardiomypathy are prone to the development of congestive heart failure in the perioperative period. Also, patients with hypertrophic and arrhythmogenic right ventricular cardiomyopathy are prone to arrhythmias in the perioperative period. Preoperative evaluation includes history, physical examination, ECG, chest radiography, complete blood count, electrolytes, creatinine, glomerular filtration rate, glucose, liver enzymes, urin analysis, BNP and echocardiographic evaluation of left ventricular function. Drug therapy should be optimized and continued preoperatively. Surgery should be delayed (unless urgent) in patients with decompensated or untreated cardiomyopathy. Preoperative evaluation requires integrated multidisciplinary approach of anesthesiologists, cardiologist and surgeons.
    Acta chirurgica iugoslavica 01/2011; 58(2):39-43.
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    ABSTRACT: Chronic obstructive pulmonary disease is a risk factor for development of intraoperative and postoperative pulmonary complications. Regarding the type and the extent of surgical procedure, patients with COPD are at risk of aggravation of pulmonary function which leads to complicated perioperative course. In order to reduce perioperative complications, preoperative evaluation and preoperative patient preparation are of great importance. Goals of preoperative preparation and anesthesia in patients with COPD are maintaining ventilation-perfusion ratio, preventing development of hipoxemia, intraoperative brochospasm, pneumothorax and disturbances of cardivascular system.
    Acta chirurgica iugoslavica 01/2011; 58(2):71-5.
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    ABSTRACT: Idiopathic ulcerative colitis (IUC) represents a rare disease of childhood. It usually occurs at age over 10 years, and below that exceptionally rarely. The aim of the paper was to analyze the clinical signs, symptoms and therapeutic procedures in children with IUC. The aims of the paper were based on a sample of 17 children (11 male and 6 female, mean age 11.90 +/- 3.50 years; range 3.8-17.5 years) with IUC. The disease diagnosis was based on characteristic endoscopic and pathohistological findings. The basic signs of the disease involved chronic mucosal haemorrhagic diarrhoea which was confirmed in 16 of 17 patients, with body weight deficiency (10), recurrent abdominal pain (6), fever (5), slowed-down maturation (5), marked anorexia (4), and tenesmus (3).Two patients had recurrent aphthous stomatitis, 2 anal fissures, 2 arthralgia, one autoimmune hepatitis and one pyoderma gangrenosum. None of the children had longitudinal growth retardation. Elevated sedimentation rate and C-reactive protein in blood were registered in 11, sideropenia in 10, anaemia in 6 and hypoalbuminemia in 3 patients. The remission of proctosigmoiditis and left-sided colitis was achieved with aminosalicylates, and of pancolitis with the combination of aminosalicylates and glucocorticoids, except in cases of steroid-dependent colitis, which additionally required azathioprine. The main signs of IUC in children are chronic mucous haemorrhagic diarrhoea, body weight loss and sideropenic anaemia, while the basic therapy consists of aminosalicylates, and in more severe cases of the disease the initial use of glucocorticoids and later azathioprine.
    Srpski arhiv za celokupno lekarstvo 01/2011; 139(3-4):170-3. · 0.23 Impact Factor
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    ABSTRACT: Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and functional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient. During the preoperative assessment, the risk-benefit ratio should be estimated and preoperative plan established in order to optimize the preoperative status. An anaesthesiologist must also understand pharmacology of drugs being used and should tailor anaesthetic management to the type of surgery. An interdisciplinary team approach is the cornerstone for the safe delivery of anaesthesia to this paediatric patient population. The team should comprise an anesthesiologist, a paediatric cardiologist, a surgeon, a cardio-surgeon and a neonatologist. This review is meant to explain the classification of congenital heart diseases and to equip the anaesthesiologist with the necessary information about preoperative assessment, anaesthesiology management, monitoring tools important for the safe non-cardiac surgery procedures as well as therapeutic strategies during the postoperative period.
    Srpski arhiv za celokupno lekarstvo 01/2011; 139(1-2):107-15. · 0.23 Impact Factor
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    ABSTRACT: In patients with respiratory pathology changes in respiratory physiology may lead to clinical problems during the conduct of anesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anesthesiologist to account for the potential complications of these conditions and manage the anesthetic accordingly. This article describes the initial evaluation of a patient with respiratory problems. A thorough medical history, physical examination and some functional tests are the keys in decision-making in preparation for anesthesia and surgery. The burden of respiratory disease is reviewed, and some important areas of current interest are highlighted.
    Acta chirurgica iugoslavica 01/2011; 58(2):63-9.
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    ABSTRACT: This article explains the most frequent psychiatric disorders such as co-morbidity in the acute surgical treatment, along with its position and importance for the surgical procedure. Besides basic features of these disorders, epidemiology and clinical expression, this article holds the latest therapeutic approach, side effects, toxicity and drug interactions, during the surgical procedure. Frequent postoperative problems, delirium, and postoperative cognitive disorders are noted in these patients. To avoid these complications, it is recommended to use a mini-mental score examination to re-evaluate the decision and indication for high risk surgery patient.
    Acta chirurgica iugoslavica 01/2011; 58(2):143-9.
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    ABSTRACT: Osteo-articular diseases have significant presence among general population. Osteo-articular disorders can be caused by disease or by trauma. There are many osteo-articular diseases which have influence on general state of the organysm and on other present diseases in a various level. The influence appears by increasing risk of main disease complications, limited movement complicates postoperative treatment of main disease and medicament therapy of osteo-articular disease sometimes modifies perioperative therapy of main disease. Trauma as comorbidity needs urgent care and, in the same time, it is a huge complication for the injured condition. Osteoarticular trauma healing usually lasts several weeks, so it prolongs the healing of intercurrent surgical disease. Osteo-articular changes as comorbidity during the acute surgical disease healing need proper preoperative preparing, With the aim to minimise perioperative morbidity and mortality.
    Acta chirurgica iugoslavica 01/2011; 58(2):157-62.
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    ABSTRACT: Reperfusion of previously ischemic tissue leads to injuries mediated by reactive oxygen species. The aim of the study was to investigate the effects of different anesthesia techniques on oxidative stress caused by tourniquet-induced ischemia-reperfusion (IR) injury during extremity operations at children's age. The study included 45 patients American Society of Anesthesiologists (ASA) classification I or II, 8 to 17 years of age, undergoing orthopedic procedures that required bloodless limb surgery. The children were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release (BTR), 5 and 20 min after tourniquet release (ATR). Postischemic reperfusion injury was estimated by measurement of concentration of malondialdehyde (MDA) in plasma and erythrocytes as well as catalase (CAT) activity. Plasma MDA concentration in the group S was significantly higher at 20 min ATR in comparison with the groups T and R (6.78 +/- 0.33 micromolL-1(-1) vs. 4.07 +/- 1.53 and 3.22 +/- 0.9. micromolL-1(-1), respectively). There was a significant difference in MDA concentration in erytrocythes between the groups S and T after 5 min of reperfusion (5.88 +/- 0.88 vs. 4.27 +/- 1.04 nmol/mlEr, p < 0.05). Although not statistically significant, CAT activity was slightly increased as compared to baseline in both groups S and R. In the group T, CAT activity decreased at all time points when compared with baseline, but the observed decrease was only statistically significant at BTR (34.70 +/- 9.27 vs. 39.69 +/- 12.91 UL-1, p < 0.05). Continuous propofol infusion and regional anesthesia techniques attenuate lipid peroxidation and IR injury connected with tourniquet application in pediatric extremity surgery.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 08/2010; 67(8):659-64. · 0.21 Impact Factor
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    ABSTRACT: Natural rubber latex is the second most implicated agent in intraoperative anaphylactic reactions. This report describes a case of intraoperative anaphylaxis occurring in a non-atopic fourteen-year-old girl undergoing multiple surgical procedures, but without spina bifida, in which latex surgical gloves were the main culprit for the anaphylactic reactions. Clinical manifestations of an anaphylactic reaction were also experienced during the examination of the possible cause of intraoperative anaphylaxis by skin prick testing with a latex allergen extract. Skin tests with anesthetics were negative. Specific IgE to latex was positive at 92.9 kUA/L (class 5). The molecular basis for the reported intraoperative anaphylaxis was ascribed to three low-molecular mass latex allergens (10-15 kD) detected in the brand of latex surgical gloves used during the operation. Given the potential of a dramatic outcome, latex allergy testing as a regular preoperative measure may contribute to the reduction of anaphylactic reactions during surgical interventions.
    Iranian journal of allergy, asthma, and immunology 07/2008; 7(2):97-9. · 0.65 Impact Factor
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    Dusica Simić, Simon Dragović, Ivana Budić
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    ABSTRACT: Among advances in medicine during the past 150 years, certainly the introduction of surgical anesthesia must be considered the greatest gifts of medical profession to mankind, especially to children. Pediatric anesthesia has progressed rapidly throughout the years. Since the first recorded case of pediatric anesthesia in 1842 to the latest advancement in training, technology, medicine and equipment in the last decades of this century, many historic moments have been following each other. Throughout the first decades of 20th century, most physicians treated children as miniature adults. It is believed that the development of modern pediatric anesthesia started in 1930. To offer a historic perspective, the evolution of new field through its rapid growth was divided into two chronologic categories: first (1930-1950) and second (1950-present). During the first period (1930-1950), the anesthesia techniques and equipment adjusted to different children's age were developed. In the second, together with further technique and equipment refinement, modern anesthetics and vital system surveillance (monitoring) were introduced into everyday practice. The keyto the advances in pediatric anesthesiology was difficulties leading to new inventions with consequent improvement of techniques and methods. This article reviews the origins and development of anesthesia for infants and children in the world and Serbia, emphasizing the contributions of many devoted physicians that represented the major force leading to inevitable evolution of pediatric anesthesia.
    Srpski arhiv za celokupno lekarstvo 01/2007; 135(1-2):111-7. · 0.23 Impact Factor
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    ABSTRACT: The progress of anesthesiology and surgery makes it possible for most of the interventions to be preformed during day surgery. The objective of this study was, by the analysis of patients who had undergone day surgery and with respect of procedure and patients selection criteria, to show that this mode of treatment is efficient, safe and money saving. Retrospective study consisted of 2078 children, aged 6 months to 14 years, ASA I-II, subjected to various interventions at the Day Surgical Department of the University Children's Hospital in Belgrade. The analysis of the results demonstrated that just few patients had postoperative complications, unrelated to applied anesthesia and premedication. No case was reported to be hospitalized due to postoperative complications. Temporary and rare postoperative complications, short separation of children from their parents, and reduced treatment costs indicate that such trend of management should be continued.
    Srpski arhiv za celokupno lekarstvo 11/2004; 132 Suppl 1:54-7. · 0.23 Impact Factor
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    ABSTRACT: The American Committee, followed by the British, consisting of experts in various fields, in 1968 and 1976, respectively, reached the following consensus: "If a brain stem is dead, a brain is dead, if a brain is dead, a person is dead..." In the last few years, definition of brain death was necessary due to organ transplantation. Most of criteria verifying brain death do not include the specific determinants of brain death in children. This paper specifies the most up-to-date guidelines for diagnosis of brain death in children of various ages.
    Srpski arhiv za celokupno lekarstvo 11/2004; 132 Suppl 1:125-7. · 0.23 Impact Factor
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    ABSTRACT: Ileostomy represents a necessary procedure to solve various surgical diseases in children. As the result of increased fluid loss and colonic exclusion in its regulation, it is often followed, particularly during the first months after birth, by chronic dehydration and failure to thrive. The aim of the paper was to present our experience related to the application of oral rehydration solution (ORS) to compensate the intestinal loss of water and electrolytes in infants with ileostomy. Treatment was performed with ORS containing 65 mmol/L of sodium in five infants aged 1.5-8 months (3.8+/-2.46 months) with dehydration and undernutrition after ileostomy performed in the first five days after birth. After rehydration, the continual application of ORS in the daily dosage of 63.90+/-25.03 ml/kg, i.e. approximately matching the volume of intestinal content elimination (57.00+/-19.23 ml/kg), resulted in all infants in optimal water and electrolyte homeostasis, and in further course also in the improvement of their nutritional status (p=0.023). Our experience indicates that continual application of reduced sodium content of ORS in the approximate equal quantity of intestinal content loss represents the method of choice in water and electrolyte homeostasis maintenance in infants with ileostomy.
    Srpski arhiv za celokupno lekarstvo 141(5-6):325-8. · 0.23 Impact Factor
  • Dusica Simić, Nebojsa Djurisić
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    ABSTRACT: Short bowel syndrome most commonly result after bowel resection for necrosis of the bowel. It may be caused by arterial or venous thrombosis, volvolus and in children, necrotizing enterocolitis. The other causes are Crohn's disease, intestinal atresia. The factors influencing the risk on short bowel syndrome are the remaining length of the small bowel, the age of onset, the length of the colon, the presence or absence of the ileo-coecal valve and the time after resection. Besides nutritional deficiencies there some other consequences of extensive resections of the small intestine (gastric acid hypersecretion, d-lactic acidosis, nephrolithiasis, cholelithiasis), which must be diagnosed, treated, and if possible, prevented. With current therapy, most patients with short bowel have normal body mass index and good quality of life.
    Srpski arhiv za celokupno lekarstvo 131(1-2):77-81. · 0.23 Impact Factor