Nenad Ivancević

Klinički centar Srbije, Beograd, Central Serbia, Serbia

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Publications (17)12.32 Total impact

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    ABSTRACT: The aim of this study was to determine the role of serum Interleukin-12 level as early marker of severity of the SAP and correlation between IL12, SIRS score, APACHE II and Ranson score in prediction of illness severity as well as of outcome of SAP.
    Hepato-gastroenterology 01/2014; 61(129):208-11. · 0.77 Impact Factor
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    ABSTRACT: Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common, it is rarely manifested as an acute bowel obstruction secondary to ileal endometriosis. Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A 41-year-old woman presented with symptoms and signs of an acute small bowel obstruction requiring emergency surgery. A small bowel resection was performed with end-to-end anastomosis. Histological examination demonstrated endometriosis with fibrosis and stricture of the ileal segment. This case is important to report as it highlights the diagnostic difficulty this particular condition pre sents to an emergency surgeon. In the differential diagnosis, endometriosis should be taken into consideration when assessing females of reproductive age who present with abdominal pain and small bowel obstruction.
    Srpski arhiv za celokupno lekarstvo 01/2012; 140(3-4):225-8. · 0.23 Impact Factor
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    ABSTRACT: Patellofemoral (PF) disorders are a common cause of knee pain and sometimes it can be quite difficult to make a diagnosis, because, besides PF disorders due to lateral compression or instability, the pain may be caused by a parapatellar postraumatic disorder, overuse syndrome, sympathetic algodystrophy or internal knee derangement. Thus, a thorough history and careful physical examination are essential for accurate diagnosis. Besides conventional radiographic views, axial Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) or arthroscopy could sometimes be important. If physical therapy for at least 6 months fails, lateral release is performed in the lateral patellar compressive syndrome (lateral tilt), while either proximal or distal realignment of the extensor mechanism is done in the case of subluxation due to the altered Q angle or patellar height abnormality. In cases of dysplastic and shallowflat trochlea the trochleoplasty could be performed. In the presence of cartilage destruction, tibial tubercle elevation and medialisation are accompanied by arthroscopic debridement or shaving, which could diminish further cartilage symptomatology. In any case, the treatment must be addressed to the primary cause.
    Acta Chirurgica Iugoslavica. 01/2010;
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    ABSTRACT: Acutelunginjury (ALI) and its more severe form acute respiratory distress syndrome (ARDS) are syndromes with a spectrum of increasing severity of lung injury defined by physiologic and radiographic criteria. There are many clinical disorders as sociated with the development of ALI/ARDS and can be divided into those associated with direct or indirect lung injury. Early detection and protective lung ventilation strategy contribute to lowering the mortality rate.
    Acta chirurgica iugoslavica 01/2010; 57(4):25-32.
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    ABSTRACT: Helicobacter pylori infection is accepted to be associated with two mutually exclusive diseases duodenal ulcer and gastric cancer. The aim of this study was to explore the relationship and prevalence of Helicobacter pylori infection in different surgical diseases. With use of simple serologic assays for detecting IgA and IgG antibodies to HP antigen, we studied the association of infection with HP and 15 surgical diseases. The prevalence of HP was 68.60% (results of assays were positive for 142 patients out of 207). This study confirmed statistically significant correlation between HP seropositivity and pancreatic cancer (p = 0.02), hepatocellular cancer (p = 0.000), gastric cancer (p = 0.01), colon cancer (p = 0.002), rectal cancer (p = 0.001), intestinal cancer (p = 0.026), stenosis pylori (p = 0.01), ulcer diseases (p = 0.004), jaundice (p = 0.002); statistically significant inverse association between HP seropositivity and the acute appendicitis (p = 0.013) and no correlation with HP infection and cholecystitis (p = 0.716), cholelithiasis (p = 0.06), and ulcer hemorrhage (p = 0.064). The use of simple serological tests to identify patients with HP infection could help to calculate the risk of development of severe gastrointestinal diseases.
    Hepato-gastroenterology 01/2010; 57(97):167-71. · 0.77 Impact Factor
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    ABSTRACT: Development of abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) has a strong impact on the course of disease. Number of patients with this complication increases during the years due more aggressive fluid resuscitation, much bigger proportion of patients who is treated conservatively or by minimal invasive approach, and efforts to delay open surgery. There have not been standard recommendations for a surgical or some other interventional treatment of patients who develop ACS during the SAP. The aim of DECOMPRESS study was to compare decompresive laparotomy with temporary abdominal closure and percutaneus puncture with placement of abdominal catheter in these patients. One hundred patients with ACS will be randomly allocated to two groups: I) decompresive laparotomy with temporary abdominal closure or II) percutaneus puncture with placement of abdominal catheter. Patients will be recruited from five hospitals in Belgrade during two years period. The primary endpoint is the mortality rate within hospitalization. Secondary endpoints are time interval between intervention and resolving of organ failure and multi organ dysfunction syndrome, incidence of infectious complications and duration of hospital and ICU stay. A total sample size of 100 patients was calculated to demonstrate that decompresive laparotomy with temporary abdominal closure can reduce mortality rate from 60% to 40% with 80% power at 5% alfa. DECOMPRESS study is designed to reveal a reduction in mortality and major morbidity by using decompresive laparotomy with temporary abdominal closure in comparison with percutaneus puncture with placement of abdominal catheter in patients with ACS during SAP. ClinicalTrials.gov Identifier: NTC00793715.
    BMC Surgery 01/2010; 10:22. · 1.97 Impact Factor
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    ABSTRACT: Originally the main idea was to obtain a stable patella, i.e., to stabilize the "slipping patella". In the past many conditions like patella alta, ligamentous laxity, PF bone hypoplasia, weakness of the quadriceps muscle, genu valgum or genu recurvatum were thought to predispose to patellar instability. For a long period muscle exercises were instituted to strengthen the weak m.vastus medialis and to make vastus lateralis stronger. This pulls the patella laterally, especially during running or jumping, when lateral luxation of the patella occurs. Muscle imbalance as well as anatomical abnormalities are the basis both for patellar instabilities and reasonable surgical procedures were: proximal extensor mechanism realignment, proximal capsular reefing, patellar tendon splitting and its medial transfer. On the other hand bone procedures on the hypoplastic lateral femoral condyle were also performed by Albee, as well as tibial tubercle transfer and trochleoplasty by deepening of the trochlea (Dejour). An understanding of the pathoanatomic basis is the corner stone for
    Acta chirurgica iugoslavica 01/2010; 57(4):39-45.
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    ABSTRACT: Laparoscopic diagnostics provides fast, reliable, clear, and obvious information on extent and depth of abdominal organs injury with minimizing additional trauma to the patient. It is performed without any specific preparations and, if needed, it may be promptly converted into conventional laparotomy. Through use of optical equipment with various refraction angles and through variable patient positioning, laparoscopic technique enables visualization of whole abdominal cavity. In approximately 20% of cases of unclear findings, and after other performed diagnostic procedures, laparoscopy provides definitive diagnosis. Abdominal surgeons are familiar with this method, making interpretaion of the results very fast and reliable and, what is the most important, this method avoids additional trauma caused by conventional laparotomy.
    Acta chirurgica iugoslavica 01/2010; 57(4):33-8.
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    ABSTRACT: Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.
    Hepato-gastroenterology 01/2010; 57(98):349-53. · 0.77 Impact Factor
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    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.
    Acta chirurgica iugoslavica 01/2010; 57(4):53-6.
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    ABSTRACT: The liver is the most commonly injured abdominal organ. Severe hepatic trauma continue to be associated with high mortality. Management of liver injuries has changed significantly over the last two decades. Nonoperative management of hemodynamically stable patients has become the first treatment of choice. In unstable patients immediate control of bleeding is critical. In the management of severe injuries of the liver, particularly for patients who had developed a metabolic insult (hypothermia, coagulopathy, and acidosis), perihepatic packing has emerged as the key to effective damage control (DCS). The surgical aim is control of hemorrhage, preservation of sufficient hepatic function and prevention of secondary complications. Currently available surgical methods include hepatorrhaphy, resectional debridement, anatomical/nonanatomical resection, selective hepatic artery ligation, Pringle maneuver, total vascular exclusion, liver transplatation. This review discusses available diagnostic modalities and the best management options for liver injury, based on literature search and authors experience.
    Acta chirurgica iugoslavica 01/2010; 57(4):57-67.
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    ABSTRACT: Intra-abdominal compartment syndrome (ACS) are increasingly recognised to be a contributing cause of organ dysfunction and mortality in critically ill patients. The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra abdominal pressure (IAP). This syndrome is most commonly observed in the setting of severe abdominal trauma. ACS affects mainly the respiratory, cardiovascular, renal, gastrointestinal and central nervous system. Preventing ACS by the identification of patients at risk and early diagnosis is paramount to its successful management. Because of the frequency of this condition, routine measurement of intra abdominal pressure should be performed in high risk patients in the intensive care unit. Surgical decompression is definitive treatment of fully developed abdominal compartment syndrome, but nonsurgical measures can often effectively affect lesser degrees of IAH and ACS.
    Acta chirurgica iugoslavica 01/2010; 57(4):75-81.
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    ABSTRACT: Question of missed injuries is more often a question of human errors: task execution errors, procedural errors, communication errors, decision errors and noncompliance. Missed injuries are those which are not idetified in the first three days of hospitalisaation. This theme is not popular among physicians. Literature data mention percent from 3-29% missed injuries overall. The underlying causes errors are: false attributin, false negative prediction and false lebeling. False attribution involves a tendency to incorrectly link a clinical observation with an arroneous cause. This tendency also ignores one of the fundamental principles of the management of traumatic injury: that the index of suspicion should proceed on the basis of assumed wors resonable case scenario. Weaknesses of trauma systems: high patients volume, high-risk patients, long hours, changing set of resources, and problems sush bad admission planing, defficite anamnesis, defficite diagnostic procedures, bad communication, improvisation etc.
    Acta chirurgica iugoslavica 01/2010; 57(4):83-6.
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    ABSTRACT: Anemia is common in critically ill patients and carries risk of reduced oxygen carriage and worse outcomes. Transfusion, however, carry their own risk, and the physician must balance the risks of anemia with the risk of transfusion in each patient. Some recent studies compared a liberal with a restrictive approach to transfusion, and a clinical practice guidelines were made. This protocols consider that acute hemorrhage has been controlled, the initial resuscitation has been completed, and the patient is stabile in the intensive care unit without ongoing bleeding. The trigger for PRBC transfusion in patients without severe cardiovascular disease is hemoglobin g/dL (or a hematocrit %).
    Acta chirurgica iugoslavica 01/2010; 57(4):87-93.
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    ABSTRACT: Studies on the clinical value of parameters of hemostasis in predicting pancreatitis-associated complications are still scarce. The aim of this prospective study was to identify the useful hemostatic markers for accurate determination of the subsequent development of organ failure (OF) during the very early course of acute pancreatitis (AP). In 91 consecutive primarily admitted patients with AP, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, protein C, plasminogen activator inhibitor 1, D-dimer, and plasminogen were measured in plasma within the first 24 hours of admission and 24 hours thereafter. Two study groups comprising 24 patients with OF and 67 patients without OF were compared. Levels of prothrombin time, fibrinogen, and D-dimer on admission were significantly different between the OF and non-OF groups, and all these parameters plus antithrombin III were significantly different 24 hours later. A D-dimer value of 414.00 microg/L on admission was the best cutoff value in predicting the development of OF with sensitivity, specificity, and positive and negative predictive values of 90%, 89%, 75%, and 96%, respectively. Measurement of plasma levels of D-dimer on the admission is an accurate method for the identification of patients who will develop OF in the further course of AP.
    Pancreas 06/2009; 38(6):655-60. · 2.95 Impact Factor
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    ABSTRACT: To determine overall mortality and timing of death in patients with severe acute pancreatitis and factors affecting mortality. This was a retrospective, observational study of 110 patients admitted to a general intensive care unit (ICU) from January 2003 to January 2006. The overall mortality rate was 53.6% (59/110); 25.4% (n = 15) of deaths were early (<or=14 days after ICU admission). There were no significant differences in age, sex, or surgical/medical treatment between survivors and nonsurvivors. Median Acute Physiology and Chronic Health Evaluation (APACHE) II score was higher among nonsurvivors than survivors (score = 26 vs 19, respectively; P < 0.001), and the duration of hospitalization before ICU admission was significantly longer (4 vs 1 day; P < 0.001). Among the 59 patients who died, those in the early-mortality group were admitted to the ICU significantly earlier than those in the late-mortality group (3 vs 6.5 days; P < 0.05). Overall mortality and median APACHE II score were high. Death predominantly occurred late and was unaffected by patient age, length of stay in the ICU, or surgical/medical treatment. An APACHE II cutoff of 24.5 and pre-ICU admission time of 2.5 days were sensitive predictors of fatal outcome.
    Pancreas 10/2008; 38(2):122-5. · 2.95 Impact Factor
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    ABSTRACT: The present study attempted to identify the diagnostic significance of procalcitonin (PCT) in acute abdominal conditions as well as the range of concentrations relating to diagnosis of abdominal sepsis. This was prospective clinical study. The study included 98 consecutive patients with acute abdominal conditions, divided in sepsis and systemic inflammatory response syndrome (SIRS) group. PCT concentrations on admission were significantly higher in the sepsis group than in the SIRS group (median [interquartile range] 2.32 [7.41] vs 0.45 ng/ml [2.62]). A cutoff value of 1.1 ng/ml yielded 72.4% sensitivity and 62.5% specificity. In a group of patients with abdominal symptoms lasting for more than 24 h, a cut-off value of 1.1 ng/ml yielded higher sensitivity (82.9%) and higher specificity (77.3%). Our results suggest that PCT measurements may be useful for early, preoperative diagnosis of abdominal sepsis.
    Langenbeck s Archives of Surgery 06/2008; 393(3):397-403. · 1.89 Impact Factor