Marko Nikolić

University Clinical Hospital Center "Sestre Milosrdnice", Zagrabia, Grad Zagreb, Croatia

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Publications (33)39.79 Total impact

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    ABSTRACT: To investigate the results of endoscopic treatment of postoperative biliary leakage occurring after urgent cholecystectomy with a long-term follow-up. This is an observational database study conducted in a tertiary care center. All consecutive patients who underwent endoscopic retrograde cholangiography (ERC) for presumed postoperative biliary leakage after urgent cholecystectomy in the period between April 2008 and April 2013 were considered for this study. Patients with bile duct transection and biliary strictures were excluded. Biliary leakage was suspected in the case of bile appearance from either percutaneous drainage of abdominal collection or abdominal drain placed at the time of cholecystectomy. Procedural and main clinical characteristics of all consecutive patients with postoperative biliary leakage after urgent cholecystectomy, such as indication for cholecystectomy, etiology and type of leakage, ERC findings and post-ERC complications, were collected from our electronic database. All patients in whom the leakage was successfully treated endoscopically were followed-up after they were discharged from the hospital and the main clinical characteristics, laboratory data and common bile duct diameter were electronically recorded. During a five-year period, biliary leakage was recognized in 2.2% of patients who underwent urgent cholecystectomy. The median time from cholecystectomy to ERC was 6 d (interquartile range, 4-11 d). Endoscopic interventions to manage biliary leakage included biliary stent insertion with or without biliary sphincterotomy. In 23 (77%) patients after first endoscopic treatment bile flow through existing surgical drain ceased within 11 d following biliary therapeutic endoscopy (median, 4 d; interquartile range, 2-8 d). In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven (23%) patients repeat ERC was done within one to fourth week after their first ERC, depending on the extent of the biliary leakage. In two of those patients common bile duct stone was recognized and removed. Three of those seven patients had more complicated clinical course and they were referred to surgery and were excluded from long-term follow-up. The median interval from endoscopic placement of biliary stent to demonstration of resolution of bile leakage for ERC treated patients was 32 d (interquartile range, 28-43 d). Among the patients included in the follow-up (median 30.5 mo, range 7-59 mo), four patients (14.8%) died of severe underlying comorbid illnesses. Our results demonstrate the great efficiency of the endoscopic therapy in the treatment of the patients with biliary leakage after urgent cholecystectomy.
    05/2015; 7(5):547-54. DOI:10.4253/wjge.v7.i5.547
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    Quality in endoscopy ESGE/ESDO SYMPOSIUM, Prague Czech Republik; 04/2015
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    ABSTRACT: OBJECTIVE OF THE STUDY: Family history of hereditary colorectal cancer and common variants in the genome are recognized as a risk factor in more than 20% of colorectal cancer cases at the population level. Mutation of the APC gene is early event in colorectal carcinogenesis, and can be found in 60 to 82% of adenomatous polyps. Connexin 43 (Cx43) gene is a target for APC mutant genes. Wnt signaling pathway and beta-catenin transcription enhanced Cx43 transcription, which has the possibility of feedback regulation. Cx43 or Cx43 parts act directly on the protein transcription in the cell, and in process of colorectal carcinogenesis acts as a tumor suppressor (Picture 1). To our knowledge, Cx43 expression related to hereditary predisposition to colorectal cancer so far was not defined. METHODS AND PROCEDURES: Eighty seven patients with endoscopically resected colorectal adenomatous polyps were included in the study. In all patients two biopsies from surrounding mucosa were taken. Cx43 expression was determined by immunohistochemical staining, and was assessed according to a 2-point scale: negative, <10% Cx43 positive cells; positive, ≥10% Cx43 positive cells. Cx43 expression was correlated with family history of colon cancer, and polyps characteristic. RESULTS: Cx43 expression was positive in all adenomas of the patients who have a positive family history of colon cancer among first-degree relatives (15/15, 100%), regardless of endoscopic and histopathological features of adenomas. In patients without family history for colon cancer, Cx43 was positive in 65.3% of adenomatous polyps (47/72), which was statistically significant (p=0.007)(Picture 2). Difference of Cx43 expression in colonic mucosa in corellation to family history of colon cancer was not found. CONCLUSIONS BASED ON THE RESULTS: Our data suggests connection of the Cx43 expression in colorectal adenomatous polyps and patients positive family history of colon cancer among first-degree relatives. These completely new data make the significance of the Cx43 as a tumor suppressor in the process of colorectal carcinogenesis even more interesting. This role may be independent from the APC gene function. Given the relatively small number of patients and the fact that we were not measuring APC expression in adenomatous polyps, this results require further research. 1. Kanczuga-Koda L, Sulkowski S, Koda M, Sobaniec-Lotowska M, Sulkowska M. Expression of connexins 26, 32 and 43 in the human colon--an immunohistochemical study. Folia Histochem Cytobiol. 2004;42(4):203-7. 2. Kanczuga-Koda L, Koda M, Sulkovski S, Wincewicz A, Zalewski B, Sulkowska M. Gradual Loss of Functional Gap Junction within Progression of Colorectal Cancer – A Shift from Membranous Cx32 and Cx43 Expression to Cytoplasmic Pattern During Colorectal Carcinogenesis. In vivo 2010;24:101-108. 3. Biscanin A, Ljubicic N, Pavic I, Balicevic D, Pavic T, Budimir I, Troskot B. Connexin 43 Expression in patients with colorectal ademoatous polyps (Abstract). UEG Journal 2013;1:Suplement 1:231-2. 4. Han Y, Zhang PJ, Chen T, Yum WS, Pasha T, Furth EE. Connexin43 Expression Increases in the Epithelium and Stroma along the Colonic Neoplastic Progression Pathway: Implications for Its Oncogenic Role. Gastroenterol Res Pract 2011;10:1155. 5 Sirnes S, Bruun J, Kolberg M, i sur. Connexin43 acts as a colorectal cancer tumor suppressor and predicts disease outcome. Int J Cancer 2012;131:570-81.
    Quality in Endoscopy, Colonoscopy and Colonic Neoplasms, ESGE, ESDO,, Prague, Czech Republic; 04/2015
  • 02/2015; 6(1):297-300. DOI:10.14740/wjon762w
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    ABSTRACT: Aim To assess the seven-year trends of hospitalization incidence due to acute peptic ulcer hemorrhage (APUH) and associated risk factors, and examine the differences in these trends between two regions in Croatia. Methods The study collected sociodemographic, clinical, and endoscopic data on 2204 patients with endoscopically confirmed APUH who were admitted to the Clinical Hospital Center “Sestre Milosrdnice,” Zagreb and Clinical Hospital Center Split between January 1, 2005 and December 31, 2011. We determined hospitalization incidence rates, 30-day case fatality rate, clinical outcomes, and incidence-associated factors. Results No differences were observed in APUH hospitalization incidence rates between the regions. Age-standardized one-year cumulative APUH hospitalization incidence rate calculated using the European Standard Population was significantly higher in Zagreb than in Split region (43.2/100 000 vs 29.2/100,000). A significantly higher APUH hospitalization incidence rates were observed in the above 65 years age group. Overall 30-day case fatality rate was 4.9%. Conclusion The hospitalization incidence of APUH in two populations did not change over the observational period and it was significantly higher in the Zagreb region. The incidence of acute duodenal ulcer hemorrhage also remained unchanged, whereas the incidence of acute gastric ulcer hemorrhage increased. The results of this study allow us to monitor epidemiological indicators of APUH and compare data with other countries.
    Croatian Medical Journal 12/2014; 55(6):647-54. DOI:10.3325/cmj.2014.55.647 · 1.37 Impact Factor
  • 19th World Congress of the; 08/2014
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    ABSTRACT: Laparoscopic gastric banding (LAGB) is one of the most common surgical procedures in the treatment of morbid obesity since it provides good long-term outcomes in weight loss and decrease of comorbidities associated with obesity. Although the procedure has low morbidity and almost none-existing mortality, certain complications can occur. Erosion of the band into the gastric wall is one of the rare complications in LAGB. The reported incidence varies from 1 to 11%, however the largest study reported an incidence of 1.6%. This is in accordance with the incidence in our Centre for obesity, where only one case of erosion occurred among 112 operative procedures. The aim of this paper is to present a patient with gastric band erosion and it's removal by using the endoscopic techniques as a minimally invasive management method.
    Collegium antropologicum 03/2014; 38(1):345-8. · 0.61 Impact Factor
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    ABSTRACT: Waldenström's macroglobulinemia is a distinct clinicopathologic entity defined as a B-cell neoplasm characterized by lymphoplasmacytic infiltrate in the bone marrow, with an associated immunoglobulin (Ig) M paraprotein. Clinical manifestations are due to deposition of IgM in the liver, spleen, and/or lymph nodes, so it presents with anemia, hyperviscosity, lymphadenopathy, hepatomegaly, splenomegaly and neurologic symptoms. The main diagnostic criteria are a typical peak on serum protein electrophoresis and malignant cells in bone marrow biopsy samples. There is no standard therapy for the treatment of symptomatic Waldenstrom's macroglobulinemia and no agents have been specifically approved for this disease, but initial treatment usually starts with the monoclonal anti-CD20 antibody rituximab, either alone or in combination with other agents, rather than chemotherapy alone. This article confirms that, despite the existence of more modern imaging methods, ultrasonography still has a significant diagnostic role.
  • Endocrine 10/2013; 45(2). DOI:10.1007/s12020-013-0069-x · 3.53 Impact Factor
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    ABSTRACT: Strictures are one of the most common complications of Crohn's disease. If symptomatic and resistant to medical anti-inflammatory therapy, and especially in cases of acute obstruction, surgical correction may be unavoidable. Although surgical treatment is dramatically effective in curing Crohn's disease strictures, a high rate of postsurgical restenosis has been recognized, ultimately requiring additional surgery. To avoid the risks and costs entailed by repeated surgical resection, endoscopic balloon dilatation (EBD) has been proposed as a conservative treatment option for intestinal strictures in Crohn's disease, in which the stricture is pneumatically dilated with through-the-scope balloons of different diameters. The main clinical indication for EBD is the appearance of obstructive symptoms associated with the stricture, especially if they are postoperative and shorter than 4 centimeters. Usually more than one dilatation session is required for every stricture. EBD is applied infrequently, possibly due to the perceived risk of perforation and early stricture recurrence, but studies have demonstrated that EBD has a high success rate, a low chance of complications, excellent symptomatic response, as well as good short-term and long-term outcomes, proving that it is a relatively simple and successful technique that provides long-term effective palliation of the symptoms with minimal risk in patients with simple strictures, and offers a reasonable alternative to surgery.
    Acta clinica Croatica 09/2013; 52(3):374-9. · 0.42 Impact Factor
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    ABSTRACT: A giant retroperitoneal liposarcoma that incorporated the descending colon was presented clinically as a palpable abdominal mass in a 37-year-old male patient. Complete surgical resection with adjacent partial colectomy was performed. Total tumor mass was 10.7 kg and pathological examination revealed well differentiated ("lipoma-like") liposarcoma. Literature review shows that aggressive surgical resection remains the mainstay of treatment for retroperitoneal liposarcoma, although there are some promising results that support the use of adjuvant combination chemotherapy in advanced metastatic disease.
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    ABSTRACT: BACKGROUND: Peptic ulcer bleeding remains an important cause of morbidity and mortality. AIM: The aim of this study was to evaluate the prevalence of non-steroidal anti-inflammatory drugs (NSAID) use, Helicobacter pylori infection and non-H. pylori-non-NSAIDs causes of peptic ulcer bleeding and to identify the predictive factors influencing the rebleeding rate and in-hospital mortality in patients with bleeding peptic ulcer. METHODS: A total of 1,530 patients with endoscopically confirmed peptic ulcer bleeding were evaluated consecutively between January 2005 and December 2009. The 30-day mortality and clinical outcome were related to patient's demographic data, endoscopic and clinical characteristics. RESULTS: The age-standardized 1-year cumulative incidence for peptic ulcer bleeding was 40.4 cases/100,000 people. The proportion of patients over 65 years increased from 45.7 % in 2005 to 61.4 % in 2009 (p = 0.007). Overall 30-day mortality rate was 4.6 %, not significantly different for conservatively and surgically treated patients (4.9 vs. 4.1 %, p = 0.87). Mortality was significantly higher in patients over 65 years of age and those with in-hospital bleeding recurrence. Patients with non-H. pylori-non-NSAID idiopathic ulcers had significantly higher 30-day mortality rate than those with H. pylori ulcers and NSAID-H. pylori ulcers (7.1 vs. 0 vs. 0.8 %, p = 0.001 and p = 0.007, respectively). There was no statistically significant difference between patients with NSAID ulcers and non-H. pylori-non-NSAID idiopathic ulcers in terms of 30-day mortality rate (5.3 vs. 7.1 %, p = 0.445). CONCLUSION: The incidence of peptic ulcer bleeding has not changed over a 5-year observational period. The overall 30-day mortality was positively correlated to older age, underlying comorbid illnesses, in-hospital bleeding recurrence and the absence of H. pylori infection.
    Digestive Diseases and Sciences 06/2012; 57(12). DOI:10.1007/s10620-012-2273-6 · 2.55 Impact Factor
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    ABSTRACT: To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer. Between January 2005 and December 2009, 150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed (Forrest IIa) were included in the study. Patients were randomized to receive a small-volume epinephrine group (15 to 25 mL injection group; Group 1, n = 50), a large-volume epinephrine group (30 to 40 mL injection group; Group 2, n = 50) and a hemoclip group (Group 3, n = 50). The rate of recurrent bleeding, as the primary outcome, was compared between the groups of patients included in the study. Secondary outcomes compared between the groups were primary hemostasis rate, permanent hemostasis, need for emergency surgery, 30 d mortality, bleeding-related deaths, length of hospital stay and transfusion requirements. Initial hemostasis was obtained in all patients. The rate of early recurrent bleeding was 30% (15/50) in the small-volume epinephrine group (Group 1) and 16% (8/50) in the large-volume epinephrine group (Group 2) (P = 0.09). The rate of recurrent bleeding was 4% (2/50) in the hemoclip group (Group 3); the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution (P = 0.0005 and P = 0.045, respectively). Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups. Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.
    World Journal of Gastroenterology 05/2012; 18(18):2219-24. DOI:10.3748/wjg.v18.i18.2219 · 2.43 Impact Factor
  • World Journal of Gastroenterology 05/2012; 18(18-14):2219-24. · 2.43 Impact Factor
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    ABSTRACT: Arterio-enteric fistula is a rare, but potentially deadly cause of gastrointestinal bleeding. The disease occurs in two forms: primary as a result of atherosclerotic aortic aneurysm, aortitis, trauma, radiation, tumor invasion or penetrating ulcer, and secondary as a consequence of surgical aortal reconstruction. The clinical manifestation is mostly gastrointestinal bleeding, rarely back pain, fever and sepsis. Computed tomography with contrast medium is the most suitable diagnostic test, however, the diagnosis frequently requires explorative laparotomy. A case is presented of secondary arterio-enteric fistula, found two years after surgical treatment of chronic pancreatitis with pseudocystojejunostomy, which clinically manifested with gastrointestinal bleeding. Although there was strong suspicion of arterio-enteric fistula, the diagnosis was not verified by routine workup, but only on explorative laparotomy.
    Acta clinica Croatica 03/2012; 51(1):79-82. · 0.42 Impact Factor
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    ABSTRACT: Obesity is chronic disease with multiple health consequences and among the most severe health problems worldwide. According to public health records around 65% of population in Croatia are overweight and 20% obese. National physicians chamber with support of Health and Social Welfare Ministry gave recommendations on diagnosing and treating of obesity in form of national consensus. Treatment of obesity is complex and enrolls multiple clinical specialties. Change of life style, strenuous physical activity and pharmacotherapy are part of conservative treatments. Patients are treated more efficiently by minimally invasive endoscopic procedures or bariatric surgery depending on starting body mass index score. Implantation of intragastric balloons is conceptually simple method of obesity treatment. Modern devices as Bio-Enterics intragastric balloons (BIB), (Inamed Health, USA) are gaining wide popularity among both patients and physicians. BIB intragastric offers the best gains with individuals ranging BMI from 35 to 40. Efficiency has relative timeline dependance from 85% at 6 months to 24% at 36 months. BIB offers substantial ameliorative influence on obesity comorbidities, particularly cardiovascular risk. Treatment with BIB is also efficient but transient treatment modality in morbidly and superobese individuals to reduce preoperative risks of general and bariatric surgery. Obesity treatment with BIB is well tolerated and safe, offering better quality of life. Nevertheless, due to relative poor results of conservative obesity treatments on long-term follow up further investigations defining new clinical parameters for solving treatment resistance. In order to provide resourcefully individualized approach modern perspectives are focused on endocrine constitutes of obesity. Hormonal effects of BIB treatment in compare to bariatric surgery are potentially interesting for the prospect studies.
    Collegium antropologicum 12/2011; 35(4):1353-62. · 0.61 Impact Factor
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    ABSTRACT: Morbid obesity is currently one of the leading problems worldwide. More than 1 of 5 adults in Croatia are considered obese, with a body mass index (BMI) higher than 30 kg/ m(2), with no sex differences. Indications for bariatric surgery are BMI >40 kg/m(2) or BMI >35 kg/m(2) with comorbidities. Bariatric procedures are divided into restrictive, malabsorptive, and combined procedures. The Roux-en-Y gastric bypass is a combined bariatric procedure, already being accepted as the standard one in the USA and gaining ground in Europe as well. A 47-year-old woman with BMI of 48.2 kg/m(2) (105.5 kg) was hospitalized at our department. Her increasing attempts to lose weight using conservative methods showed no success. She also suffered from glucose intolerance, gastritis, chronic obstructive pulmonary disease, hypertension and depression as comorbidities. Based on our experience in bariatric surgery (gastric banding, sleeve gastrectomy, duodenal switch), we decided for the first time in our hospital to perform laparoscopic Roux-en-Y gastric bypass. The patient was released on the fifth postoperative day with BMI of 40.56 kg/m(2) (100 kg body weight), excess weight loss 12.5%. One month after the procedure, her BMI was 38.54 kg/m(2), excess weight loss 23.92% (body weight 95 kg).
    Acta clinica Croatica 06/2011; 50(2):239-43. · 0.42 Impact Factor
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    ABSTRACT: Ghrelin and leptin recently emerged as the most influential neuroendocrine factors in the pathophysiology of obesity. The said peptides act in reciprocity and are responsible for regulation of appetite and energy metabolism. Intragastric balloons acquired worldwide popularity for obesity treatment. However, the roles of ghrelin and leptin in intragastric balloon treatment were still not systematically studied. A prospective single-center study included 43 Caucasians treated with BioEnterics intragastric balloon, with age range of 18-60, and divided to non-morbid (body mass index cutoff 40 kg/m(2)) or morbid type of obesity, with 12 months follow-up. Serum hormonal samples were taken from fasting patients and kept frozen until analyses. Significant differences were observed in anthropometrics and there were no differences between genders or comorbidities. The baseline weight for non-morbid vs. morbid was 104 kg (90-135) vs. 128.5 kg (104-197). Weight loss was statistically different between the studied groups during the study course with a median control weight at 6 months of 92 kg (72-121) vs. 107 kg (84-163), p < 0.001. Treatment was successful for 18 (94.7%) vs. 16 (66.7%) patients, p = 0.026. Ghrelin varied from 333.3 to 3,416.8 pg/ml and leptin from 1.7 to 61.2 ng/ml, with a statistically significant time-dependent relationship. A significant difference (p = 0.04) with emphasized ghrelin peak was found in the 3rd month of treatment for non-morbidly obese subjects. The importance of ghrelin and leptin in treatment-induced changes was reaffirmed. Ghrelin hyper-response in non-morbidly obese subjects characterized greater short-term treatment efficiency and landmarked an inclination to weight regain. The results suggest a potential pattern of individualization between obese patients according to body mass index towards intragastric balloon or bariatric surgery. Further studies are needed in order to get better insights in the pathophysiologic mechanisms of obesity.
    Obesity Surgery 04/2011; 21(10):1597-604. DOI:10.1007/s11695-011-0414-1 · 3.74 Impact Factor
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    ABSTRACT: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors with variable malignant potential. Connexin-43 (Cx43) is the commonest gap-junction protein and has been frequently investigated in oncology. Our aim was to establish the immunohistochemical expression of Cx43 in relation to GIST location, size, Ki67 index, tumor grade and follow-up.? The study included postoperative samples of 46 patients treated for GIST in the 1999-2010 time frame. Complete clinical workup was available for 38 patients (82.6%); total surgical resection was carried out in 32 (84.2%) patients, while 13 (34.2%) patients underwent chemotherapy. Median follow-up was 40.7 months (range, 1-134). ? The calculated incidence of GIST in our setting was 11.5 per million. Cx43 was expressed in 43/46 (93.5%) GIST cases, with a significant difference between stomach- and small intestine-derived tumors (p=0.006). Ki67 was 10% on average (range, 1-22) and was not correlated with tumor location (p=0.194). Cx43 did not show significance with regard to tumor size (p=0.264) or higher tumor grade (p=0.658), as opposed to Ki67, which significantly correlated with both (p=0.0048 and p<0.001, respectively). Cx43 and Ki67 were not significantly correlated (p=0.708). Ki67 correlated with time to recurrence (p=0.022). Ki67 >11% was taken as the indication to start imatinib chemotherapy (sensitivity 61.5%, specificity 92.0%, p=0.022). Ten (66.7%) of 15 patients with long-term (>5 years) follow-up were in remission.? Cx43 was frequently expressed in GISTs regardless of tumor site. However, no significant relationships to histopathological parameters suggestive for prognosis were found. Further investigations might clarify the roles of Cx43 in GIST oncogenesis.
    The International journal of biological markers 04/2011; 26(2):124-8. DOI:10.5301/JBM.2011.8358 · 1.36 Impact Factor

Publication Stats

31 Citations
39.79 Total Impact Points

Institutions

  • 2010–2015
    • University Clinical Hospital Center "Sestre Milosrdnice"
      • Department of Gastroenterology, Hepatology and Nutrition
      Zagrabia, Grad Zagreb, Croatia
  • 2008–2014
    • University of Zagreb
      • Department of Internal Medicine
      Zagrabia, Grad Zagreb, Croatia
  • 2011
    • General Hospital Zabok
      Забок, Krapinsko-Zagorska, Croatia