Goran Plavec

Military Medical Academy, Beograd, Central Serbia, Serbia

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Publications (31)6.22 Total impact

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    ABSTRACT: Pulmonary alveolar proteinosis is an uncommon disease characterized by the accumulation of surfactant proteins and phospholipids within the alveolar spaces. Acquired disease can be idiopathic (primary) and secondary. The prevalence of acquired pulmonary alveolar proteinosis is about 0.37 per 100,000 persons. Common symptoms are dyspnea and cough. Chest X-ray shows bilateral perihilar infiltrates. Open-lung biopsy is the gold standard for the diagnosis. Treatment includes whole-lung lavage, application of granulocyte-macrophage colony-stimulating factor and lung transplantation. We reported a 51 year-old man with primary form of the disease. It was the second case of this extremely rare disease in the past 30 years in our clinic. The symptoms were long-lasting dry cough, fever and physical deterioration. Chest Xray revealed bilateral pulmonary infiltrates; computed tomography showed patchy ground-glass opacification with interlobular thickening. The diagnosis was established by open lung biopsy. Additional tests were performed to exclude secondary form of the disease. We presented a rare clinical entity with typical clinical features and clinical and radiological course of the disease, in order to improve differential diagnostic approach to patients with bilateral lung infiltrations. In patients with pulmonary alveolar proteinosis timely diagnosis and adequate treatment can improve a prognosis.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 11/2012; 69(11):1005-8. · 0.21 Impact Factor
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    ABSTRACT: Nitrofurantoin, a furan derivative, introduced in the fifties has widely been used as an effective agent for the treatment and prevention of urinary tract infections (UTI). Spectrum of adverse reactions to nitrofurantoin is wide, ranging from eosinophilic interstitial lung disease, acute hepatitis and granulomatous reaction, to the chronic active hepatitis, a very rare adverse effect, that can lead to cirrhosis and death. We presented a 55-year- old female patient with eosinophilic interstitial lung disease, severe chronic active hepatitis and several other immune- mediated multisystemic manifestations of prolonged exposure to nitrofurantoin because of the recurrent UTI caused by Escherichia coli. We estimated typical radiographic and laboratory disturbances, also restrictive ventilatory changes, severe reduction of carbon monoxide diffusion capacity and abnormal liver function tests. Lymphocytic-eosinophylic alveolitis was consistent with drug-induced reaction. Hepatitis was confirmed by liver biopsy. After withdrawal of nitrofurantoin and application of high dose of glicocorticosteroids, prompt clinical and laboratory recovery was achieved. Adverse drug reactions should be considered in patients with concomitant lung and liver disease. The mainstay of treatment is drug withdrawal and the use of immunosuppressive drugs in severe cases. Consideration should be given to monitor lung and liver function tests during long term nitrofurantoin therapy.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 06/2012; 69(6):536-40. · 0.21 Impact Factor
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    ABSTRACT: The Mounier-Kuhn syndrome (MKS) or tracheobronchomegaly (TBM) is a rare condition of unknown frequency, up to now about 100 cases have been reported. It presents by marked dilatation of the trachea and major bronchi, recurrent respiratory infections and consecutive bronchiectasis and scars in lung parenchyme. Sometimes enlargement of transversal colon may be present. Diagnosis is usually made radiologically. We rewieved two patients 77 and 72 years old with typical clinical presentation and enlarged upper airways, in whom diagnosis of MKS was established by chest multislice computed tomography (MSCT). Transversal diameter of trachea was 30 mm in the first patient and 33 mm in the other one. Complications of syndrome (tracheal diverticulosis in the first patient, and pulmonary fibrosis, bulous emphysema and bronchiectasis in both patients) also were seen. Lung function tests showed mixed ventilation disorder, and disturbance of respiratory gases values in arterial blood samples. The Mounier-Kuhn syndrome is rare disorder, although diagnosis is often missed. Clinical presentation is similar to chronic obstructive pulmonary disease or bronchiectasis. Computed tomography is gold standard for diagnosis. Therapy is presumely supportive.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 10/2010; 67(10):867-70. · 0.21 Impact Factor
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    ABSTRACT: BECKGROUND/AIM: K-ras oncogene is mutated in about 20% of lung cancer. The purpose of this study was to investigate the predictive significance for therapeutic response of K-ras mutations in advanced non-small cell lung cancer (NSCLC) patients. Bronchial aspirate samples were assessed prior to platinum-based chemotherapy start in 39 patients with stage IIIb or IV NSCLC. K-ras mutations at codons 12 and 13 were analyzed by single strand conformation polymorphisam (SSCP) and allele specific oligonucleozide hybridisation of polymerase chain reaction (PCR) of the patient's DNA present in bronchial aspirate. After two cycles of chemotherapy the patients were subjected to response evaluation. Of 39 patients 10 (25.5%) demonstrated K-ras mutations, while 29 (74.4%) patients had not. There were no significant differences between these two groups of patients with respect to baseline patient caracteristics. Partial response to the therapy had 16 (41%), no changes 14 (36%), and progressive disease 9 (23%) patients. There was a tendency to higher response rate for patients without K-ras mutations versus those with mutations, but not statistically significant (p = 0.14). There was no significant predictive value for therapeutic response of K-ras mutations for advanced non-small cell lung cancer.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 03/2009; 66(2):149-55. · 0.21 Impact Factor
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    ABSTRACT: The diagnosis of bronchial asthma, a chronic inflammatory disease of the respiratory tract, is made on the basis of anamnesis, pathologic auscultatory findings of the lungs, lung function disturbances, skin tests, as well as the basic indices of immunologic condition in bronchial trunk. The aim of the study was to find out correlation of objective indices of the disease and than relation with the symptoms in the patients with bronchial asthma. The study included 60 young male non smokers with long lasting symptoms of bronchial asthma including shortness of breath, wheezing, hard breathing, nonproductive or productive cough, weakness and night hard breathing. There were no symptoms of respiratory infection over the past two months and lung radiography and spirometry were normal Based on the results of nonspecific bronchoprovocative test two groups of the patients were formed, group I (n=30) with positive histamine test (average value of the inhaled histamine concentration with FEV1 drop by 20% in regard with the initial value (PC20) = 2.99 +/- 0.51 mg/ml of histamine) and group II (n=30) with negative histamine test (PC20(a) = 14.58 +/- 6.34 mg/ml of histamine). The obtained spirometry results revealed a statistically significant difference in values of FEV1 between groups: I group--FEV1 3.2%; II group--EV1 = 101.8%; (p .05, Wilcoxon test), although all the FEV1 values were normal Regarding the presence of the most common symptoms there was not statistically significant difference between the groups (p>0.05, chi-square test). Pathologic auscultatory lung findings were found in 73.4% of the patients in the group I and 27.5% of the patients in the group II. There was statistically significant difference (p<0.05, chi-squared test). A positive correlation between the degree of hypersensitivity and lung physical findings was confirmed (p<0.05 Spearman's rho), but there was no correlation with FEV1 values. There is a correlation with lung pathologic physical findings, lower values of FEV1 (in a range of normal values) and the degree of nonspecific bronchial sensitivity as objective indices of activity of bronchial asthma. There is no correlation of these parameters with patient's symptoms as subjective indices of bronchial asthma.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2009; 66(1):39-43. · 0.21 Impact Factor
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    ABSTRACT: Systemic connective tissue diseases (SCTD) are chronic inflammatory autoimmune disorders of unknown cause that can involve different organs and systems. Their course and prognosis are different. All of them can, more or less, involve the respiratory sistem. The aim of this study was to find out the frequency of respiratory simptoms, lung function disorders, radiography and high-resolution computerized tomography (HRCT) abnormalities, and their correlation with the duration of the disease and the applied treatment. In 47 non-randomised consecutive patients standard chest radiography, HRCT, and lung function tests were done. Hypoxemia was present in nine of the patients with respiratory simptoms (20%). In all of them chest radiography was normal. In five of these patients lung fibrosis was established using HRCT. Half of all the patients with SCTD had simptoms of lung involment. Lung function tests disorders of various degrees were found in 40% of the patients. The outcome and the degree of lung functin disorders were neither in correlation with the duration of SCTD nor with therapy used (p > 0.05 Spearmans Ro). Pulmonary fibrosis occures in about 10% of the patients with SCTD, and possibly not due to the applied treatment regimens. Hypoxemia could be a sing of existing pulmonary fibrosis in the absence of disorders on standard chest radiography.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 09/2008; 65(9):688-91. · 0.21 Impact Factor
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    ABSTRACT: To determine the frequency of neuron specific enolase (NSE) tissue expression and its possible influence on survival of patients treated for advanced non small cell lung cancer (NSCLC). We studied 158 patients with histological diagnosis of NSCLC (stage III/IV). Combined chemoradiotherapy was used in stage III disease (without pleural effusion), whereas chemotherapy only was used in stage III (with pleural effusion) as well as in stage IV disease. Immunohistochemical analysis of NSE expression was determined using antibodies to NSE (DAKO, Den). One- and 2-year overall survival were assessed. 45 (28.5%) patients had positive NSE expression. The most frequent NSE expression was seen in 6/9 (66.7%) patients with large cell carcinoma and in 23/50 (46%) with adenocarcinoma. One- and 2-year survival rates were 70% and 30% in the group of patients with positive NSE expression compared to 26% and 3% in the group with negative NSE expression (p=0.000). The median survival time was 16.4 vs. 11.4 months in the groups of patients with and without NSE expression, respectively (p < 0.001). One-and 2-year survival rate was higher in NSCLC patients with more than 50% of NSE positive cancer cells (p=0.0004 and 0.000, respectively). A total of 28.5% of advanced NSCLC patients had positive NSE expression. Median 1- and 2-year survival time was significantly longer in patients with positive NSE expression.
    Journal of B.U.ON.: official journal of the Balkan Union of Oncology 01/2008; 13(1):93-6. · 0.76 Impact Factor
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    ABSTRACT: BECKGROUND/AIM: In 40-50% of patients with non-small cell lung cancer (NSCLC) at the time of making a diagnosis, the disease is yet at IIIb and IV stage. Standard in the treatment of these patient is the application of systemic chemiotherapy based on CIS/Carboplatin preparations. The aim of this study was to determine the influence of two different chemiotherapeutic protocols and neuroendocrine differentiation on treatment response and survival in patients with metastatic NSCLC. We examined 85 patients with metastatic NSCLC, of which 51 with stage IIIb, and 34 with stage IV of the disease. The histologic diagnosis of NSCLC was determined by tissue assays using hematoxylin eosin method. Neuroendocrine differentiation was determined by immunohistochemical analysis of neuron-specific enolase (NSE), chromogranin A, and synapthophysin expression using monoclonal mouse anti-human bodies (DAKO, Denmark). According to chemiotherapeutic protocol, the patients were randomly assigned into combined Taxol + Cisplatin group (Tax + Cis, n = 35), and Cyclophosphamide + Etoposide + Carboplatin group (CEP, n = 50). The treatment was conducted within 4-6 chemiotherapeutic cycles. The efficacy was assessed after the therapy regimen and median survival time was assessed after the randomization. A total of 31 (36.47%) patients had a favourable therapeutic response, both partial and complete response (54.2% in the Tax + Cis group and 24% in CEP group of patients, respectively, p < 0.001). The median survival time in both groups was 13.1 months (15.3 months in the Tax + Cis group and 10.6 months in the CEP group, respectively, p < 0.001). A one-year follow-up survival period was confirmed in 40% of patients (60% only in the Tax + Cis group). A total of 23 (27.05%) patients with metastatic NSCLC had neuroendocrine differentiation. The disease progression or stable disease was noted only in patient with NSCLC without neuroendocrine differentiation (n = 42, 67.7%, p < 0.001). The median survival time in patients with NSCLC and neuroendocrine differentiation was 14.8 months, without neuroendocrine differentiation 10.7 months (p < 0.001). The patients with NSCLC and neuroendocrine differentiation in the CEP group had a longer one-year follow-up survival period than patients in Tax + Cis group (p < 0.001). In Tax-Cis group of patients, there was no significant difference in one-year follow-up survival period with neuroendocrine differentiation. Better therapeutic response and longer median survival time in metastatic NSCLC was obtained using Tax + Cis as compared to CEP protocol. Similar effect was noted using CEP protocol in patients with NSCLC and neuroendocrine differentiation.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 09/2007; 64(9):591-6. · 0.21 Impact Factor
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    ABSTRACT: Cholesterol and carcinoembryonic antigen (CEA) levels in pleural effusion and sera, were measured in 199 patients with pleural effusions of various origins. Malignant cause was found in 93, and nonmalignant in 106 patients. Mean cholesterol level in sera of patient with malignant disease was 5.0 +/- 0.93 mmol/L, and in nonmalignant group 4.34 +/- 1.32 mmol/L. The difference was not statistically significant. Mean cholesterol level in nonmalignant pleural effusions was higher thAn those in malignant (2.51 +/- 1.23 mmol/L; and 2.28 +/- 1.06 mmol/L), but the difference was also not significant. Average pleural fluid/serum cholesterol ratio (Holl/S) in nonmalignant group was 0.61 +/- 0.32 and in malignant group 0.46 +/- 0.22. The difference between those mean values was significant. Higher ratio, at the cut off value of 0.5 was found in 79/106 and in 25/93 malignant patients. Calculated sensitivity was 75%, specificity 73%, positive predictive value 76%, negative predictive value 65% and accuracy 69%. Significant negative correlation between Holi/S and pleural fluid CEA was found (p < 0.05). It was assumed that pleural fluid/serum cholesterol ratio lower than 0.5 could be of great benefit, as an additional test in the differentiation of malignant from benign pleural effusion.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2004; 61(6):607-11. · 0.21 Impact Factor
  • G Plavec, V Dangubić, V Tatić
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2000; 44(3):206-8. · 0.21 Impact Factor
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    ABSTRACT: In 47 patients with pleural effusions of different etiology concentrations of the tissue polypeptide antigen (TPA) and tumour trypsin inhibitor (TATI) were measured. Malignant disease was found in 24 patients and benign one in 23 patients. In a group of patients with malignant pleural effusion the average concentration of TPA was 3102 U/L and of TATI 76.8 ug/L. In a group of patients with nonmalignant effusion these concentrations of TPA were 2381.8 U/L and of TATI 28.3 ug/L. Higher concentration of TPA was found in pleural effusion of malignant nature with specificity of 96% but with a small sensitivity of 12.5% and positive predictive value of 43%. TATI concentrations were also higher in malignant pleural effusion with good sensitivity and specificity (78%, 50% respectively) and positive predictive value of 66%.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/1992; 49(4):325-9. · 0.21 Impact Factor
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    ABSTRACT: In 105 patients with chronic obstructive pulmonary disease the bronchodilator response to salbutamol aerosol (ventolin) has been studied. According to the initial values of FEV1 (forced expiratory volume in one second) the patients were divided into four groups. Patients with bronchitis in the first group had the initial FEV1 between 600 and 1000 ml and in the second group between 100 and 2000 ml, while asthmatics in the third group had between 100 and 2000 ml and in the fourth group more than 2000 ml. The largest bronchodilator response was obtained in the groups of asthmatics (mean FEV1 increase was 473 +/- 258 ml in the third group and 609 +/- 334 ml in the fourth group). For evaluation of reversibility of obstruction of the respiratory ways after bronchodilatator tests and for better differentiation of chronic obstructive bronchitis and asthma the criteria have been proposed depending on the initial FEV1 values.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/1991; 48(1):19-22. · 0.21 Impact Factor
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    ABSTRACT: The concentration of neuron-specific enolase (NSE) was measured in the serum and pleural fluid of 42 patients with pleural effusions of different etiology. High levels (above 13.0 micrograms/l) of NSE in pleural fluid of 9 patients with malignant disease were observed (sensitivity 57%). However, pleural fluid NSE levels were also increased in 14 with non-malignant diseases (specificity 45%). Increased pleural fluid NSE activity is not specific for malignancy.
    Plućne bolesti: casopis Udruzenja pneumoftiziologa Jugoslavije = the journal of Yugoslav Association of Phthisiology and Pneumology 01/1990; 42(1-2):88-91.
  • Vojnosanitetski pregled. Military-medical and pharmaceutical review 61(4):433-8. · 0.21 Impact Factor
  • V Dangubić, S Kamenica, G Plavec
    Plućne bolesti: casopis Udruzenja pneumoftiziologa Jugoslavije = the journal of Yugoslav Association of Phthisiology and Pneumology 37(1-2):97-101.
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    ABSTRACT: 178 new cases of tuberculosis of the lungs and pleura have been treated within the period of four years (1985-1988) in military medical institutions of the Y.P.A. The patients were classified by random selection in two therapeutical groups. Two six-month regimens were applied with the same drugs except for the fourth one which was used in the initial period only (EHRZ and SHRZ). Both applied therapeutical combinations were equally successful. All patients achieved negative cultures at least three months after onset of chemotherapy. Relapses occurred in 4 (2.3%) of patients during the period of follow-up for at least 2 and the most 5.5 years after the end of therapy. The toxic effects were tolerable. The drug resistance was found in 25 of 134 (18.6%) patients, the most common to one drug.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 49(1):3-7. · 0.21 Impact Factor
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    ABSTRACT: Allergic granulomatous angiitis (AGA)--Churg-Strauss syndrome, is a rare autoimmune disease characterized by three distinct clinical phases: prodromal, eosinophilic, and vasculitic, and most of respiratory symptoms and signs begin in the first two phases of the disease. Two female patients of different age, who fulfilled the diagnostic criteria for AGA, and were in different phases and with the different duration of the disease are presented. The first patient (24 years of age) was admitted to the hospital due to aggravation of asthma, heart failure, and polyneuropathy. The second one (45 years of age) was also hospitalized due to the worsening of asthma, polyneuropathy, and fever. Both were treated continuously with glucocorticoids. The older patient also received a total of six pulse doses of cyclophosphamide. Satisfactory response to such a treatment was achieved in both cases.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 61(3):321-5. · 0.21 Impact Factor
  • Vojnosanitetski pregled. Military-medical and pharmaceutical review 45(2):109-13. · 0.21 Impact Factor
  • Plućne bolesti: casopis Udruzenja pneumoftiziologa Jugoslavije = the journal of Yugoslav Association of Phthisiology and Pneumology 40(1-2):18-21.
  • Vojnosanitetski pregled. Military-medical and pharmaceutical review 45(3):183-7. · 0.21 Impact Factor