Miodrag Krstic

University of Belgrade, Belgrade, SE, Serbia

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Publications (28)47.2 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire (CLDQ). The questionnaire was validated in 103 consecutive CLD patients treated between October 2009 and October 2010 at the Clinic for Gastroenterology, Clinical Centre of Serbia, Belgrade (Serbia). Exclusion criteria were: age < 18 years, psychiatric disorders, acute complications of CLD (acute liver failure, variceal bleeding, and spontaneous bacterial peritonitis), hepatic encephalopathy (grade > 2) and liver transplantation. Evaluation of the CLDQ was done based on the following parameters: (1) acceptance is shown by the proportion of missing items; (2) internal reliabilities were assessed for multiple item scales by using Cronbach alpha coefficient; and (3) in order to assess whether the allocation of items in the domain corresponds to their distribution in the original questionnaire (construction validity), an exploratory factor analysis was conducted. Discriminatory validity was determined by comparing the corresponding CLDQ score/sub-score in patients with different severity of the diseases. The Serbian version of CLDQ questionnaire completed 98% patients. Proportion of missing items was 0.06%. The total time needed to fill the questionnaire was ranged from 8 to 15 min. Assistance in completing the questionnaire required 4.8% patients, while 2.9% needed help in reading, and 1.9% involved writing assistance. The mean age of the selected patients was 53.8 ± 12.9 years and 54.4% were men. Average CLDQ score was 4.62 ± 1.11. Cronbach's alpha for the whole scale was 0.93. Reliability for all domains was above 0.70, except for the domain "Activity" (0.49). The exploratory factor analysis model revealed 6 factors with eigenvalue of greater than 1, explaining 69.7% of cumulative variance. The majority of the items (66%) in the Serbian version of the CLDQ presented the highest loading weight in the domain assigned by the CLDQ developers: "Fatigue" (5/5), "Emotional function" (6/8), "Worry" (5/5), "Abdominal symptoms" (0/3), "Activity" (0/3), "Systemic symptoms" (3/5). The scales "Fatigue" and "Worry" fully corresponded to the original. The factor analysis also revealed that the factors "Activity" and "Abdominal symptoms" could not be replicated, and two new domains "Sleep" and "Nutrition" were established. Analysis of the CLDQ score/sub-score distribution according to disease severity demonstrated that patients without cirrhosis had lower total CLDQ score (4.86 ± 1.05) than those with cirrhosis Child's C (4.31 ± 0.97). Statistically significant difference was detected for the domains "Abdominal symptoms" [F (3) = 5.818, P = 0.001] and "Fatigue" [F (3) = 3.39, P = 0.021]. Post hoc analysis revealed that patients with liver cirrhosis Child's C had significantly lower sub-score "Abdominal symptoms" than patients without cirrhosis or liver cirrhosis Child's A or B. For domain "Fatigue", patients with cirrhosis Child's C had significantly lower score, than non-cirrhotic patients. The Serbian version of CLDQ is well accepted and represents a valid and reliable instrument in Serbian sample of CLD patients.
    World Journal of Gastroenterology 08/2013; 19(30):4950-7. · 2.55 Impact Factor
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    ABSTRACT: Purpose: Duodenal tumors are rare and require a different management from that of esophagogastric neoplasia. The present study retrospectively analyses the endoscopic ultrasound (EUS) features of duodenal tumors of both epithelial and subepithelial origin.Materials and Methods: During a 12 year period, all duodenal tumors with histologic confirmation by surgery or biopsy were collected including endoscopic and endosonographic images. EUS images were analyzed for specific features (echogenicity, wall layer structure and relation, outer margins) to possibly distinguish epithelial (polyps and carcinoma versus lymphoma) and subepithelial (tumor type) tumors. Results: 53/80 cases had histologic confirmation (mean age 53.1 ± 11.4 years, m:f = 33:20), 31 were epithelial (13 adenomas, 12 carcinomas, 6 lymphomas) and 22 subepithelial (11 GISTs, 7 Brunneromas, 1 lipoma, 3 NETs). EUS did not recognize carcinomas in 2/13 adenomas. EUS features suggesting carcinoma were loss of wall layers and irregular margins. 5/6 lymphomas showed inhomogeneous thickening with layers partially recognizable. Tumor type of subepithelial lesions correlated with echogenicity: GIST tumors were mostly (62.5 %) hypocheoic with the 3 malignant cases being characterized by heterogeneous echopattern with irregular outer margins. Of the hyperechoic lesions, lipomas had a homogeneous whitish appearance, while NET and Brunneromas were less hyperechoic. In the latter, the endoscopic aspect was also helpful for differential diagnosis. Accuracy of combined endoscopic/EUS imaging for all duodenal lesions was 84.9 % (45/53). No procedural complications occurred among all patients that received EUS examinations.Conclusion: EUS contributes to the differential diagnosis of epithelial lesions known to be malignant; in subepithelial tumors, tissue confirmation is still required.
    Ultraschall in der Medizin 11/2012; · 4.12 Impact Factor
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    ABSTRACT: Portal hypertension and development of esophageal varices is one of the major complications of liver cirrhosis. The aim of our study was to evaluate the possibility of the presence of esophageal varices and their size using biochemical and ultrasonography parameters in patients with alcoholic liver cirrhosis. We included in our study 86 patients (74 males, mean age 55±7) with alcoholic liver cirrhosis. The control group consisted of 102 patients with cirrhosis of other etiologies. All patients underwent a complete biochemical workup, upper digestive endoscopy and ultrasonography examination. The right liver lobe diameter/albumin and platelet count/spleen diameter ratios were calculated. The correlation of the calculated ratios with the presence and degree of esophageal varices in patients with liver cirrhosis was also determined. The mean value of right liver lobe diameter-albumin ratio was 6.15±1.77, and statistically significantly differed from values determined in the control group (4.97±1.68). The mean platelet count-spleen diameter ratio was 972.5±599.0 in alcoholic liver cirrhosis and 1055.9±821.3 in controls (p>0.05). In patients with alcoholic liver cirrhosis, none of the analyzed noninvasive markers was shown to be a good predictor of the presence and size of esophageal varices. Despite the important role of noninvasive markers in providing information pertinent to determination of esophageal varices in patients with liver cirrhosis, these markers have limited relevance in patients with alcoholic cirrhosis.
    The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 06/2012; 23(3):239-46. · 0.48 Impact Factor
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    ABSTRACT: The term autoimmune pancreatitis (AIP) was first used in Japan in 1995 to describe a newly recognized form of chronic pancreatitis, after the description of Yoshida and colleagues. But Sarles in 1961, first described a form of idiopathic chronic inflammatory sclerosis of the pancreas, suspected to be due to an autoimmune process. AIP has become a widely accepted term because clinical, serologic, histologic, and immunohistochemical findings suggest an autoimmune mechanism. Most affected patients have hypergammaglobulinemia and increased serum levels of IgG, particularly IgG4. Recently published International Consensus Diagnostic Criteria for Autoimmune Pancreatitis include Guidelines of the International Association of Pancreatology, classifying AIP into types 1 and 2, using five cardinal features of AIP, namely imaging of pancreatic parenchyma and duct, serology, other organ involvement, pancreatic histology, and an optional criterion of response to steroid therapy. Extrapancreatic presentations can include sclerosing cholangitis, retroperitoneal fibrosis, sclerosing sialadenitis (Küttner tumor), lymphadenopathy, nephritis, and interstitial pneumonia. Increased IgG4+ plasma cell infiltrate has been reported in sclerosing lesions from other organ sites, including inflammatory pseudotumors of the liver, breast, mediastinum, orbit, and aorta, and it has been observed with hypophysitis and IgG4-associated prostatitis. Abundant IgG4+ plasma cells were also confirmed in Riedel thyroiditis, sclerosing mesenteritis, and inflammatory pseudotumor of the orbit and stomach. Extrapancreatic lesions could be synchronously or metachronously diagnosed with AIP, sharing the same pathological conditions, showing also a favorable result to corticosteroid therapy and distinct differentiation between IgG4-related diseases from the inherent lesions of the corresponding organs.
    Digestive Diseases 01/2012; 30(2):220-3. · 2.73 Impact Factor
  • Endoscopy 03/2011; 43 Suppl 2 UCTN:E91-2. · 5.74 Impact Factor
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    ABSTRACT: We aimed to determine differences in gastroduodenal damage related to the presence of Helicobacter pylori (Hp) in patients starting long-term NSAID therapy. Seventy-one candidates for chronic NSAIDs therapy (33 Hp negative and 38 Hp positive) entered the study and underwent upper GI endoscopy before, and 8 and 16 weeks after, continuous NSAID therapy. Lanza score increased in both Hp positive and negative patients in the course of NSAID therapy (P < 0.001), being significantly higher in Hp positive than Hp negative (4.31 ± 1.33 vs 3.15 ± 1.95, P < 0.05) after 16 weeks of follow-up. In gastric mucosa, no significant difference in mean Lanza score was observed between the two groups. Duodenal ulcer was diagnosed in 18 (36.8%) Hp positive and 1 (3%) Hp negative patient (P < 0.05). Hp is more closely related to duodenal than gastric mucosal injury in NSAID users. Risk for duodenal ulcer in Hp-infected individual increases after 4 months of NSAID therapy.
    Digestive Diseases and Sciences 10/2010; 55(10):2887-92. · 2.26 Impact Factor
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    ABSTRACT: STATE OF THE ART: Europe comprises only one eighth of the total world population but has around one quarter of the global total of cancer cases--some 3.2 million new patients per year. While the disproportionate cancer burden is readily apparent, the disease patterns in Europe cannot simply be generalized--overall cancer incidence and mortality rates vary at least two-fold between European countries and the differences are often far greater for specific cancers. With 1.7 million deaths each year, cancer currently represents the second most important cause of death in Europe. The range of survival rates is similarly wide. For individual cancers, the variation across Europe is even greater. This reflects a wide range of social and epidemiological factors in different countries: cancer prevention programmes; screening programmes; cancer control plans; individual lifestyles and occupational exposures; the existence and accessibility of health-care facilities and technological infrastructure; and the availability of human, financial and material resources for health and economic development. Europe has some of the richest countries in the world, but also some of the poorest. In 2002, 168 million people were living below the poverty line, about 46% of the European population. The time trends in cancer risk also vary between European countries and some cancers show different trends between men and women, or young and old, or poor and rich. The public health profile of cancer in Europe is complex. Trends in the incidence and mortality rates are also influenced by successes in health promotion (e.g. tobacco control), efficient screening (e.g. breast, bowel, cervix) and better treatment. These have been reflected in lower incidence, reduced mortality, higher survival, improved life expectancy and a better quality of life for cancer survivors. CONCLUSIONS: Cancer of the gastrointestinal (GI) tract is the most common cancer in Europe. More than half of GI cancer cases arise from the colon. They can remain asymptomatic until late in the natural history of the disease, and as this is the stage at which they can be cured, screening has been advocated for well members of the population and surveillance for those with conditions predisposing to cancer.
    European review for medical and pharmacological sciences 04/2010; 14(4):259-62. · 1.09 Impact Factor
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    ABSTRACT: Chronic pancreatitis (CP), defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphological changes which typically cause abdominal pain and/or permanent impairment of pancreatic function, has proved resistant to categorization. The disease may present clinically either with an individual symptom or a combination of symptoms associated with loss of pancreatic function. The single most frequent symptom of CP is pain, either in the form of intermittent episodes or in a more chronic or persistent pattern. The natural history of CP is usually characterized by progression of tissue damage and various degrees of exocrine and endocrine pancreatic insufficiency, which will become apparent over time. The main reason for the lack of guided strategies in the therapeutic management of CP is the absence of a clinically applicable classification of CP. In the past, several classifications have certainly contributed to a better understanding of the pathogenesis and pathophysiology of CP. The meetings in Marseilles (1963 and 1984), Cambridge (1984) and in Rome (1985) added a great deal of information to our knowledge of the pathogenesis and evolution of CP. More recent work on understanding the temporal course of CP led to the Zurich international classification which has been used to define patient cohorts in recent studies of patients undergoing surgery for CP. In order to combine clinical experience in the field of CP with progress in diagnostic methods and new molecular technologies for the assessment of CP, a classification of CP based on key clinical aspects is crucial. A new classification should first be validated to determine whether it can be applied to the majority of patients with CP, and then the value of such a classification needs to be tested in our understanding of the natural course in different etiologies (progression, arrest, regression) and most importantly, to study the clinical outcome when different therapeutic strategies are applied.
    Digestive Diseases 01/2010; 28(2):330-3. · 2.73 Impact Factor
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    ABSTRACT: To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS). A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed. Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank = 0.056, P > 0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t = 2.558, P = 0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244, P < 0.05). The analysis of factors interfering with survival (by the Kaplan-Meier method) revealed that gender, general symptoms, clinical stage, and spleen infiltration type (nodular vs diffuse) had no significant (P > 0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a c2 test (P > 0.05). Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to confirm our findings.
    World Journal of Gastroenterology 09/2009; 15(32):4009-15. · 2.55 Impact Factor
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    ABSTRACT: To evaluate different biochemical markers and their ratios in the assessment of primary biliary cirrhosis (PBC) stages. This study included 112 patients with PBC who underwent a complete clinical investigation. We analyzed the correlation (Spearman's test) between ten biochemical markers and their ratios with different stages of PBC. The discriminative values were compared using areas under receiver operating characteristic (ROC) curves. The mean age of patients included in the study was 53.88 +/- 10.59 years, including 104 females and 8 males. We found a statistically significant correlation between PBC stage and Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) to platelet ratio (APRI), ALT/platelet count, AST/ALT, ALT/AST and ALT/Cholesterol ratios, with the values of Spearman's rho of 0.338, 0.476, 0.404, 0.356, 0.351 and 0.325, respectively. The best sensitivity and specificity was shown for AST/ALT, with an area under ROC of 0.660. Biochemical markers and their ratios do correlate with different sensitivity to and specificity of PBC disease stage. The use of biochemical markers and their ratios in clinical evaluation of PBC patients may reduce, but not eliminate, the need for liver biopsy.
    World Journal of Gastroenterology 03/2009; 15(5):591-4. · 2.55 Impact Factor
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    ABSTRACT: Cystic dystrophy in heterotopic pancreas (CDHP) is a rare condition. It has been recently reported as one of the etiologic obstructive factors of chronic pancreatitis. The aim of our study was to evaluate diagnosis and management of CDHP in the duodenal wall in a surgical series. We retrospectively reviewed 13 patients with available clinical data. There were 11 male and 2 female patients, median age 42 years. The average duration of symptoms was 7.5 months. 6 of them (46%) were alcoholics, and 10 (75%) had signs of chronic pancreatitis. Almost all of them (12/13; 92%) revealed disabling pain, while 4 (31%) had associated jaundice. In 4 of 7 patients (57%), weight loss was observed. Most often the patients were suspected of having pancreatic head mass with or without signs of chronic pancreatitis. All patients underwent surgical treatment. Pathological examination showed the presence of cysts surrounded by inflammation and fibrosis in the duodenal wall, as well as the presence of chronic pancreatitis in the pancreas proper. Cystic dystrophy of the duodenal wall represents a significant proportion of patients undergoing surgery for chronic pancreatitis. Pancreatoduodenectomy is the best therapeutic option.
    Digestive surgery 08/2008; 25(4):262-8. · 1.37 Impact Factor
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    ABSTRACT: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. Thirty four patients with primary gastric mucosa associated lymphoid tissue (MALT) lymphoma (Ann Arbor stages I to IV) were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment (histology and serology). After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. Histological regression of the lymphoma was complete in 22/34 (64.7%) and partial in 9 (26.5%) patients. Median follow up time for these 31 responders was 60 mo (range 48-120). No regression was noted in 3 patients. Among the 25 (73.5%) H pylori positive patients, the eradication rate was 100%. Using univariate analysis, predictive factors for overall survival were international prognostic index (IPI) score, hemoglobin level, erythrocyte sedimentation rate (ESR), and platelet numbers (P < 0.005). In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.
    World Journal of Gastroenterology 05/2008; 14(15):2388-93. · 2.55 Impact Factor
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    ABSTRACT: A glomus tumor is a rare neoplasm derived from glomus cells, specialized cells that surround small blood vessels which are important in regulating peripheral blood flow. Glomangiomas are a subset of glomus tumors. They are usually localized in the skin and subcutaneous tissue. They have also been reported in viscera, most notably in the gastrointestinal tract. A case of gastric multicentric glomangioma is described in an 18-year-old male who presented with chronic continuous abdominal pain over a 4-6 month period. Preoperative diagnosis, operative findings, histology, and immunohistochemistry of the tumor are discussed in detail. Case reports of this rare tumor are important because of the paucity of studies noted in the gastro-intestinal literature as a result of poor identification prior to the advent of modern immunohistochemistry. The significance of accurately diagnosing a gastrointestinal glomangioma is crucial for appropriate treatment.
    Medical science monitor: international medical journal of experimental and clinical research 02/2008; 14(1):CS5-8. · 1.36 Impact Factor
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    ABSTRACT: Paragangliomas are tumors arising from the extra-adrenal paragangliar neural crest cells. The sympathoadrenal neuroendocrine system consists of extra-adrenal paragangliar cellular layer along the paravertebral and para-aortic axis, and the adrenal medullae. Paraganglioma should be included in the differential diagnosis of secondary erythrocytosis due to its possible ectopic erythropoietin (EPO) secretion. Thus, in this report we present a 24-year-old female patient with onset of unregulated ectopic EPO secretion, and consecutive erythrocytosis followed by hypertension, secondary to paraganglioma of multifocal retroperitoneal localization. Clinical, laboratory, and radiological investigations confirmed both an elevated EPO level and the presence of multiple paraganglioma. This paraneoplastic-mediated medical condition with high risk of cellular hyperviscosity syndrome (CHVS) requires prompt diagnosis and rapid therapeutic interventions. Initially, simple phlebotomy procedures were used; following that, tumors were surgically removed. In the course of the disease, this tumor relapsed, and urgent apheresis, as a treatment of life-threatening state, was used. The therapy performed resulted in a rapid blood viscosity depletion and a significant (P < 0.01) serum EPO reduction, as well as the general clinical benefit. Therefore, we conclude that the use of our own "multi-manner" apheresis (erythrocythapheresis plus plasma exchange), for long-time interval (until further causative therapy), effectively cross-bridged the possible hazards of EPO-dependent CHVS.
    Medical Oncology 01/2008; 25(2):148-53. · 2.15 Impact Factor
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    ABSTRACT: To study the value of biochemical and ultraso-nographic parameters in prediction of presence and size of esophageal varices. The study includes selected cirrhotic patients who underwent a complete biochemical workup, upper digestive endoscopic and ultrasonographic examinations. Albumin/right liver lobe diameter and platelet count/spleen diameter ratios were calculated. The correlation between calculated ratio and the presence and degree of esophageal varices was evaluated. Ninety-four subjects (62 males, 32 females), with a mean age of 52.32 +/- 13.60 years, were studied. Child-Pugh class A accounted for 42.6%, class B 37.2%, whereas class C 20.2%. Esophageal varices (OE) were not demonstrated by upper digestive endoscopy in 24.5%, while OE grade I was found in 22.3% patients, grade II in 33.0%, grade III in 16.0%, and grade IV in 4.3%. The mean value of right liver lobe diameter/albumin ratio was 5.51 +/- 1.82 (range from 2.76 to 11.44), while the mean platelet count/spleen diameter ratio was 1017.75 +/- 729.36 (range from 117.39 to 3362.50), respectively. Statistically significant correlation was proved by Spearman's test between OE grade and calculated ratios. The P values were 0.481 and -0.686, respectively. The right liver lobe diameter/albumin and platelet count/spleen diameter ratios are non-invasive parameters providing accurate information pertinent to determination of presence of esophageal varices, and their grading in patients with liver cirrhosis.
    World Journal of Gastroenterology 11/2007; 13(40):5331-5. · 2.55 Impact Factor
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    ABSTRACT: Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspecific gastrointestinal complaints. Ultrasonography and subsequent endosonography diagnosed a large (4.5 cm), hyperechoic, sessile polyp with numerous pedicles. An open cholecystectomy was performed and revealed a villous adenoma with several foci of carcinoma in situ. Detailed investigations showed no other tumors of the gastrointestinal tract. After five years of follow-up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.
    World Journal of Gastroenterology 07/2007; 13(22):3144-6. · 2.55 Impact Factor
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    ABSTRACT: Insulinoma is a rare pancreatic endocrine tumour and is typically sporadic and solitary. Over 90% of all insulinomas are benign. Cystic insulinomas are also rare. It is not difficult to determine the site of such neoplasm, as cystic insulinomas are usually 4-10 cm in diameter. We present the case of a patient with a histologically confirmed cystic insulinoma diagnosed after approximately 10 years of hypoglycaemia symptoms. This case is unique because of the small size (2.2 cm) of the tumour. Endoscopic ultrasound (EUS) was useful for localizing this tumour.
    Journal of Medical Case Reports 02/2007; 1:181.
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    ABSTRACT: Among the various congenital anomalies of the biliary system, an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain, followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultrasonography (EUS), which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery. As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain, choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.
    World Journal of Gastroenterology 09/2005; 11(32):5068-71. · 2.55 Impact Factor
  • Acta chirurgica iugoslavica 01/2005; 52(1):97-100.
  • Acta chirurgica iugoslavica 01/2005; 52(1):27-32.

Publication Stats

73 Citations
47.20 Total Impact Points


  • 2012
    • University of Belgrade
      • School of Medicine
      Belgrade, SE, Serbia
  • 2004–2010
    • Klinički centar Srbije
      • Institute of Digestive Diseases
      Beograd, Central Serbia, Serbia