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ABSTRACT: The purpose of this study was to estimate the volume of normal pancreas in adults using the CT volumetry (summation of the areas technique), analyze the correlation between the volume and the diameters of pancreas, which are measurable by the cross-sectional imaging, and assess the relationship with the gender, age, and body constitution.
220 CT examinations were analyzed retrospectively (102 females, 118 males; age 16-82, average 56). Following diameters were measured: cranial-caudal-CC(pancreas), CC(body&tail), CC(body), CC(head); anterior-posterior-AP(tail), AP(body), AP(head); lengths-LL(head), L(body&tail); and maximal transversal diameter of the L1 vertebral body (LL(L1)) and thickness of the abdominal subcutaneous fat (AP(ASF)), as markers of body constitution.
The average volume of the pancreas was 79.2 ± 24.1 cm(3) (ranging from 37.4 to 168.2 cm(3)). Pancreatic volume strongly correlated with all measured diameters of the pancreas (P < 0.0001). Pancreatic volume significantly correlated with gender (M:F = 86.1:72.8 cm(3), P = 0.002) and the LL(L1) (r = 0.185, P = 0.008), and did not correlate with the age (r = -0.110, P = 0.151) and the AP(ASF) (r = -0.115, P = 0.104). Correlation of vertebral body-pancreas volume ratio of each subject and the age was strongly negative (r = -0.202, P = 0.006).
Marked individual variations in normal pancreas volume were observed. Pancreatic volume could be computed using the diameters measurable by the cross-sectional imaging employing the formula: V = (AP(tail) + AP(body))/2 × L(body&tail) × CC(body) + (AP(head)/2)(2) × 3.14 × CC(head).
Anatomia Clinica 03/2012; 34(9):811-7. · 0.93 Impact Factor
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Journal of Gastroenterology and Hepatology 03/2012; 27(3):619. · 2.87 Impact Factor
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Journal of Gastroenterology and Hepatology 06/2010; 25(6):1180. · 2.87 Impact Factor
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Journal of Gastroenterology and Hepatology 05/2010; 25(6):1180 - 1180. · 2.87 Impact Factor
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ABSTRACT: The goal of the study was to evaluate the outcome and complications after percutaneous nephrostomy (PCN) insertion in advanced and terminal-stage gynecological malignancies with ureteral obstruction (UO).
We analyzed data of 117 patients with UO due to gynecological malignancies, who had undergone PCN between 1996 and 2006. Cervical cancer was evidenced in 108 patients, uterine carcinoma in six and ovarian cancer in three patients. Eighty-nine had UO at the initial manifestation of the disease, 22 had persistent or recurrent cancer, and six were disease-free after initial therapy. Oliguria was observed in 22.2% and creatine elevation in 79.5%. Mean follow-up was 11.43 months (range 0-112).
The median age was 51 years (range 28-85). Bilateral nephrostomy was performed in 36.7% and unilateral in 63.3%. Renal function normalization occurred in 24.8%. Overall two-year survival (OS) was 16.8%. Higher OS occurred in patients without initial azotemia versus those with azotemia (26.8% vs 13.9%). Median survival time for all the patients was seven months, eight in primary cases versus six in recurrent ones, and eight months in patients after initial therapy. Complications appeared in 53.85%. Most frequent were the loss of the nephrostomy catheter in 37.61% and urinary tract infections in 19.6%.
Improvement of renal function after PCN can be of clinical benefit in patients who might be cured or for prolonged palliative care. Azotemia seems to be poor prognostic sign.
European journal of gynaecological oncology 01/2010; 31(6):645-50. · 0.47 Impact Factor
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Journal of Gastroenterology and Hepatology 04/2009; 24(3):496. · 2.87 Impact Factor
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ABSTRACT: The modern concept of type-related individualized groin hernia surgery imposes a demand for precise and accurate preoperative determination of the type of groin hernia. The aim of this prospective study was to evaluate the accuracy of ultrasonography in classification of groin hernias, according to the criteria of the unified classification system. Unified classification divides groin hernias into nine types (grades): type I (indirect, small), II (indirect, medium), III (indirect, large), IV (direct, small), V (direct, medium), VI (direct, large), VII (combined-pantaloon), VIII (femoral), and O (other).
One hundred and twenty-five adult patients with clinically diagnosed or suspected groin hernias were examined. Ultrasonography of both groins was performed with a 5 to 10-MHz linear-array transducer. Preoperative ultrasonographic findings of type of groin hernia were compared with the intraoperative findings, which were considered the gold standard.
Total accuracy of ultrasonography in determination of type of groin hernia was 96% (119 of 124 correct predictions of type of groin hernia compared with surgical explorations). All hernias of types I, IV, V, VII, and VIII were correctly identified with ultrasonography (sensitivity and specificity 100%). In the remaining five cases of the 124 (4%), hernia was incorrectly classified with ultrasonography: type VI (direct, large) was misdiagnosed as type III (indirect, large) in three cases, type III as type VI in one case, and type III as type II (indirect, medium) in one case. The sensitivity and the specificity of ultrasonography in classifying type II were 100 and 99%, respectively, for type III, 85 and 97%, and for type VI, 90 and 99%.
Ultrasonography of the groin regions could be used with great accuracy for precise classification of groin hernias in adults. Each type of groin hernia, according to the unified classification system that we used for classification, has a characteristic ultrasonographic presentation, which is demonstrated in this study.
Hernia 03/2008; 12(4):395-400. · 1.84 Impact Factor
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ABSTRACT: Visualisation of the rectum, rectoanal junction and adjacent structures is very demanding and challenging both with technical and medical side. Local staging of rectal and anal tumor and perianal neoplasm by conventional and sibgle slice CT or by barium enema study is not so valuable. These methods can not visualise fistulous communication in inflamatory bowel diseases and have not any role in evaluation of fecal incontinence. During last decade, endoscopic ultrasound and magnetic resonance imaging have been recognised as methods of choice in establishing diagnosis of rectal, perirectal, anal and perianal diseases. The aim of this article is to review the possibilities of endoanal ultrasound in evaluation of fecal incontinence.
Acta chirurgica iugoslavica 02/2007; 54(3):159-62.
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ABSTRACT: Prostate cancer is an age related neoplasm, with high incidence in the group of elderly man. The correct management must to be balanced between the benefits of the treatment and its disadvantages. Radiotherapy as definitive treatment is commonly reserved for older patients and patients with high surgical risk and is widely used as a treatment of choice.
The aim of this study was to determine the role of radical radiotherapy for localized prostate carcinoma in patients 70 years age or older concerning treatment morbidity, local control, disease free and overall survival.
A clinical prospective non-randomized study was performed including 103 elderly patients with an age 70 or above, between January 1991 and April 2005, at the Institute for Oncology and Radiology of Serbia. Median age of patients was 74,89 years (range 70- 80 years). Stage distribution was as follows: stage A--3 patients (2.9%), stage B--69 patients (67%) and stage C--31 patients (30.1%). Out of 103 patients, initial PSA value was noted in 87 patients. The mean value of initial PSA was 18,06 ng/ml. Radical radiotherapy was conducted on megavoltage linear accelerators with high energy photons (10, 18 MeV) and total tumor dose of 65 Gy.
Low grade acute complications were registered in 70 patients (65%). Mean follow up time was 40, 13 months. The disease outcome at the last follow up show that 79 patients (76.7%) had no evidence of disease and 24 patients (23.3%) relapsed. Overall survival rates were 65, 29% and 44, 52% and disease free survival 66, 59% and 63, 26% at 5 and 10 years. Disease specific survival was at 5 and 10 years 73,32% and 65, 42% respectively. Late sequelas (gradus I and II) are registered in 22 patients (21.36%), out of 103.
Radical radiotherapy for localized carcinoma of the prostate is effective treatment option in elderly patients with good local control, present treatment tolerance providing good quality of life and long-term cure.
Acta chirurgica iugoslavica 02/2005; 52(4):103-7.
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ABSTRACT: Anatomic radical retropubic prostatectomy is an effective method for long-term control of the prostatic carcinoma. In the current era of the anatomic prostatic surgery, blood loss is reduced, complication rate is low and control of the disease may be excellent. Some authors reported cancer-specific survival rate after the radical retropubic prostatectomy of 85-90% over the 10-year period and 82% over the 15-year period. The survival may be more favorable in the patients with lower Gleason scores. The former indicates that radical retropubic prostatectomy is an excellent therapeutic option for treatment of the localized prostatic carcinoma, while selection of patients is a crucial factor for true success of therapy based on this method.
Acta chirurgica iugoslavica 02/2005; 52(4):75-6.
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ABSTRACT: The aim of this retrospective study was to present and compare the results of using two different types of esophageal self-expanding stents (uncovered and covered) for palliative treatment of patients with inoperable malignant stenosis of the esophagus and cardia. Over a period of 8 years, 152 patients underwent fluoroscopically guided insertion of metal esophageal stents. We inserted uncovered esophageal nitinol Strecker stents in 54 patients (group I) and covered esophageal Ultraflex stents in the remaining 98 patients (group II). The stent insertion procedure was successively performed in all patients. Closure of esophageal fistula by covered stents was achieved in 8/8 patients. Mean dysphagia score was significantly decreased in both patient groups at 4 weeks follow-up: from 2.73 before stent insertion to 0.15 in group I, and from 2.67 to 0.05 in group II (on 0-4 scale). Eighty-eight per cent of patients with covered stents and 54% with uncovered type were free of symptoms during follow-up. Complications occurring during follow-up and their comparative frequency in the two groups of patients were as follows (group I: group II%): stent migration (0:10%); tumor or granulation tissue ingrowth (100:53%); overgrowth at the ends of stents (17:30%); restenosis causing recurrent dysphagia (37:8%); and appearance of esophageal fistulas (8:6%). In conclusion, fluoroscopically guided insertion of self-expandable esophageal stents is a safe and comfortable method of palliation for patients suffering with malignant dysphagia. In selection of a stent, covered types should be given priority for prevention of restenosis.
Diseases of the Esophagus 02/2005; 18(4):230-8. · 1.81 Impact Factor
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ABSTRACT: Surgery continues to have a major role in the management of ulcerative colitis because it may save the patient's life, eliminate the long-term risk of cancer, and most important, abolish the disease. Treatment of ulcerative colitis still remains the challenge despite growing knowledge about the disease, advances in medical treatment and surgical techniques. Indications and optimal timing for surgery are the mainstays of good outcome and are as important as the quality of medical therapy and surgery. Ulcerative colitis is a complex disease where medical and surgical treatment frequently overlap and clinical decision making should be in hands of well trained and experienced team consisting of surgeon, gastroenterologist, radiologist and pathologist. Recently developed drugs, with high potential in the treatment of severe attacks of ulcerative colitis brought some changes in therapy and indications for surgical treatment. Although as many as half of patients with inflammatory bowel disease require at least one surgical procedure to address complications derived from their disease, the decision in favor of a surgical approach and its timing is rarely an easy one.
Acta chirurgica iugoslavica 02/2004; 51(2):123-6.
