Publications (9)7.01 Total impact
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Article: Criteria and procedures for breast conserving surgery.
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ABSTRACT: Emphasizing circumstances that determine increasingly popular surgical approach of breast conserving surgery (BCS), used in lower grade breast tumors, while maintaining survival that is found when more radical procedures are used. Several leading oncological protocols in the world are compared, using PubMed database, and our own experience. Data gathered are compared to conclusions of Consensus Conference on Breast Conservation (Milan, 2005). Furthermore, surgical contraindications found in our everyday work are considered, having in mind satisfactory cosmetic outcome, as well as keeping the 1 cm border of "clear" edges. Such more practical problems of edge detection can compromise BCS results. After observing several relevant protocols, we found very high frequency of mastectomy vs. BCS, despite the fact that stage of disease was low. We also found only 20% of absolute contraindications for BCS. Most frequent contraindication for BCS was multicentricity of the tumor (with micro calcifications), especially in ductal in situ carcinoma. BCS followed by radiation therapy with tumor-free edges is standard procedure in treatment of T1 and small T2 breast cancers. This approach implies higher risk of local recurrence (LR), although local recurrence is low (1% per year), with rates of survival similar to radical procedures.Acta Informatica Medica 03/2013; 21(1):16-9. -
Article: The effect of epineurotomy on the median nerve volume after the carpal tunnel release: a prospective randomised double-blind controlled trial.
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ABSTRACT: The purpose of this study was to evaluate the effects of epineurotomy on the post-surgical median nerve volume and clinical outcomes in carpal tunnel syndrome (CTS) patients with a prominent nerve narrowing. This was a prospective, randomised, double-blind controlled trial. Patients (n = 50) were randomised (1:1) to open-field surgical carpal tunnel release followed by a longitudinal epineurotomy of the nerve (test), or to open-field release without epineurotomy (control). The nerve volume was slightly larger in the test group 90 days post-surgery (by 10.5 %, p = 0.157) but not 180 days post-surgery. No relevant electropyhsiological or clinical difference between groups and no effect of the nerve volume was observed. The subjective pain reduction was slightly more prominent in the control group at 180 days. Larger post-surgical nerve volume was associated with lower pain, but only in the control group. Even in selected CTS patients, longitudinal epineurotomy confers no benefit regarding the nerve volume or clinical outcomes over a simple carpal tunnel release.International Orthopaedics 05/2012; 36(9):1885-92. · 2.03 Impact Factor -
Article: Arthroscopic decompression of suprapatellar cyst: case report.
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ABSTRACT: Bursae around the knee reduce friction between moving structures. When involution of suprapatellar septum fails to occur ("complete septum"), then suprapatellar bursa may stay completely separated from the knee joint cavity to form a cystic cavity. In the case of the increased volume, suprapatellar bursitis can cause painful suprapatellar swelling. The aim is to point to the possibility of arthroscopic decompression of suprapatellar cyst. In the case presented, the indication for knee arthroscopy was based on clinical examination, ultrasonography and magnetic resonance studies. The preoperative diagnosis was verified intra-operatively, and intra-articular cyst decompression was performed by arthroscopy. At the final examination 8 months postoperatively, the patient still had no pain, swelling and had full range of motion. This minimally invasive operative procedure resulted in a satisfactory anatomic and functional outcome. In this case report, we present a patient with suprapatellar cyst submitted to arthroscopic cyst decompression.Knee Surgery Sports Traumatology Arthroscopy 01/2012; 20(11):2325-8. · 2.21 Impact Factor -
Article: Fournier gangrene: our approach and patients.
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ABSTRACT: This retrospective analysis presents our experience in treating Fournier gangrene (FG) and aims to bring in focus diagnostic and therapeutic problems as well as early and aggressive treatment. A total of 16 male patients were included in the study. The gastrointestinal form was seen in 5 and the urogenital form in 11 patients. The subjects ranged in age from 39 to 74 years (average 61) for the urogenital, and from 48 to 72 (average 58) for the gastrointestinal form. Other conditions were seen in 9 patients (diabetes mellitus was most common). Most patients were infected with several bacteria. We performed colostomy in 1 patient, orchidectomy in 2 patients, cystostomy in 2 patients and penis amputation in 1 patient. Ultrasound-guided biopsy or aspiration, and CT was also used. Aggressive surgical necrectomy and aggressive antimicrobial therapy was used. Treatment was successful in 14 of 16 patients (87.5%). The length of hospitalization was 19-58 days (average 48) for the urogenital form and 24-56 days (average 41) for the gastrointestinal form. Mortality was 12.5%. A lethal outcome was recorded in two patients infected with methicillin-resistant Staphylococcus aureus. The average time between onset and hospitalization was 3-11 days (5 on average) for urogenital FG and 4-10 days (average 6) for gastrointestinal FG. Treatment was significantly longer in patients with a comorbidity, such as diabetes or liver cirrhosis due to alcohol abuse. Early diagnosis as well as intensive and aggressive treatment are key to successful treatment of FG. Comorbidity increases length of therapy and lowers the chance for recovery. Disease can be seen again several years after the initial outburst.Urologia Internationalis 08/2011; 87(2):186-91. · 0.99 Impact Factor -
Article: Microdochectomy in the management of pathologic nipple discharge.
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ABSTRACT: There is a debate in the literature whether a pathologic nipple discharge is a distinct sign of breast carcinoma. Our own results obtained by the use of microdochectomy as a minimally invasive operative procedure in 184 patients with pathologic nipple discharge were analysed. The aim of this retrospective 20-year study was to assess the efficacy of microdochectomy in detecting early stages of intraductal breast carcinoma. The study included data on 184 patients aged 24-77 years (median 46.6) divided into two groups of premenopausal (n = 123) and postmenopausal (n = 61) women. There were 139 patients with unilateral single-duct sanguinolent discharge and 45 patients with other types of nipple discharge. The operative procedure consisted of the discharging duct excision by use of a guide probe, preceded by cytology and ductography studies. Histopathology of the excised ducts revealed only three carcinomas in premenopausal women and ten carcinomas in postmenopausal women. In a total of 13 carcinomas, there were 4 ductal carcinomas in situ, detected in patients aged 41-72 (median 66) years. Twelve carcinomas were associated with sanguinolent nipple discharge. Papilloma was the most common histology finding (56.5%). Results of the study suggested mainly the association of sanguinolent single-duct nipple discharge and papilloma, whereas the rate of malignancies detected (7.0%) was consistent with literature reports. Microdochectomy proved to be a highly efficient operative method free from any impairment of the breast integrity. Conservative treatment with close clinical monitoring of the patient with cytology and ultrasonographic assessment might be possible in selected cases.Archives of Gynecology 05/2010; 283(4):851-4. · 0.91 Impact Factor -
Article: Phyllodes tumors of the breast diagnostic and therapeutic dilemmas.
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ABSTRACT: This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature. From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes. Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%. Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.Onkologie 04/2007; 30(3):113-8. · 0.87 Impact Factor -
Article: [Posterior horn cyst of the medial meniscus].
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ABSTRACT: We will present a rare case of a large symptomatic cyst of the medial meniscus, conjoined with a horizontal tear of a posterior meniscal horn. After clinical, radiological and ultrasound examination, a diagnosis was confirmed with MRI examination of the knee. Literature supports surgical therapy, which includes complete arthroscopic technique, meniscectomy and decompression of the cyst. In our case, it showed that arthroscopic partial meniscectomy and opened cystectomy were the efficient way of treatment.Lijec̆nic̆ki vjesnik 129(10-11):333-5. -
Article: [Osteochondral fracture of the patella after acute dislocation].
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ABSTRACT: Acute patellar dislocation is a common injury in young athletes, which occurs due to inappropriate biomechanical relations and anatomic deviations in the area of knee joint. In these unfavorable conditions, abrupt and vigorous strain of the quadriceps muscle of the thigh may result in lateral patellar dislocation. A case is presented of a young male athlete with acute patellar dislocation and consequential osteochondral fracture. Although x-ray showed normal knee finding, typical history, clinical examination and magnetic resonance image of the knee indicated arthroscopy, which confirmed the diagnosis ofpatellar dislocation. The osteochondral fragment was found and fastened by screws, thus reconstructing the articular surface of the patella. Medial patellar stabilizers were strengthened and lateral stabilizers loosened, thus re-establishing its anatomic slide way. On second-look operation, the screws were removed. In this case, good anatomic and functional outcome was achieved by timely operative treatment, joint surface reconstruction and rehabilitation.Lijec̆nic̆ki vjesnik 133(5-6):187-9. -
Article: RAK DOJKE I TRUDNOĆA – Dileme i kontroverze
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ABSTRACT: The incidence of breast cancer during pregnancy and breast-feeding is a very rare but challenging clinical problem whose solution, along with medical, also involves legal, ethical, religious and psychosocial standards. In this study, the evolution of medical views on the subject has been presented. From extremely pessimistic ones, which were prevalent in the past, to modern views which are valid today when pregnancy is considered a mere coincidence and not a cause for the disease. However, the doctor is faced with them in the way of a number of dilemmas. Inspite of the rare incidence of breast cancer among pregnant women, there are only 0.2% to 3.8% cancerstricken patients, that is 1:3,000–1:10,000 pregnancies, there appear still numerous dilemmas and controversies regarding breast cancer diagnostics, treatement¬ and other aspects that are of crucial interest both for the doctor and the patient. From the correct approach to solving many of those dilemmas arise many prognostic implications both for the mother and the child. Despite adequately conformed views on this multidisciplinarily pervading problem in medicine, the aim of this study is to point to the most fundamental dilemmas which draw the attention of the medical profession.Gynaecologia et Perinatologia; Vol.12 No.1.
