Dejan Stojakov | University of Belgrade, School of Medicine (original) (raw)
Papers by Dejan Stojakov
Anesthesia & Analgesia, 2021
PubMed, 2003
Despite the marked decline in incidence during last 50 years, gastric cancer remains significant ... more Despite the marked decline in incidence during last 50 years, gastric cancer remains significant cause of mortality and morbidity worldwide. According to data in 1984. incidence in Yugoslavia was 35 per 100,000. In the United States, where incidence is not high, 24,000 new cases and 13,300 deaths had been estimated for the year 1992. Despite fact that modern diagnostic and surgical concept changed perspective for significant number of the patients with gastric carcinoma, most authors agree that Gastric cancer may be the most seriously mismanaged malignancy from a surgical perspective in the USA ... (Paul H. Sugarbaker, M.D, April 1999.) Analyzing medical literature, with special respect to domestic literature, authors analyzed historical data of gastric cancer surgery.
Medicinska istraživanja, 2015
Esophageal atresia refers to a congenitally interrupted esophagus, with one or more fistulae pres... more Esophageal atresia refers to a congenitally interrupted esophagus, with one or more fistulae present between the malformed esophagus and the trachea. The most frequent type is the one with distal tracheoesophageal fistula. If not diagnosed in time, it could cause severe respiratory complications, due to the aspiration of saliva, or direct flow of gastric secretions from below into the tracheobronchial tree. Surgical treatment of esophageal atresia demands a very precise operative technique, because of very limited possibilities for redo procedures. Results in the treatment of esophageal atresia, associated anomalies and postoperative complications are used in evaluation of both expert achievements of surgical team and institutional recommendations for certain pediatric hospitals. That is why the aim of the study is to evaluate our success in surgical treatment and to make a diagnostic and therapeutic algorithm for esophageal atresia. A retrospective study included 294 neonates treated from 1971-2013. The data are analyzed by comparing the incidence of different types of esophageal atresia, association with other congenital anomalies, treatment modalities of long-gap esophageal atresia and postoperative complications, as well as the outcome and survival rate over time. The results are analyzed using descriptive statistical method. The incidence of common esophageal atresia with distal tracheoesophageal fistula was 92,7 %; 5,1% with no fistula, 0,5% with two fistulae and 1,7% of H-type anomaly. The long-gap esophageal atresia was surgically treated in 3,4 % of cases. Various other congenital anomalies were associated in 48% of cases. The incidence of early complications including an anastomotic leak was about 5%; 1% of recurrent tracheoesophageal fistula and 7% of anastomotic structures. Gastroesophageal reflux as the main late postoperative complication, particularly problematic in patients with esophageal atresia occurs in 10% of cases in our series of patients. Developing surgical experience and neonatal intensive care units, the survival rate achieved 98%, which has certainly improved the outcome of surgical treatment, lowered the rate of postoperative complications and improved the quality of life, because most of the children who undergo a successful repair of esophageal atresia are relatively healthy.
PubMed, 1994
Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomac... more Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomach for ideal substitute in subtotal and total esophagoplasty. Additional advantages are one act surgery and possibility of single anastomosis formation. In an eighteen years' time, since 1976., two hundred nine (209) patients were operated with use of esophagogastroplasty for malignancies and benign diseases of esophagus and hyphopharinx. The esophagogastric anastomosis is most common reconstructive procedure for esophageal and hyphopharingeal malignancies. Anastomosis on pharyngeal level was made in 13 pts., on cervical esophagus level in 168 pts. and on thoracic esophagus level in the rest of 28 pts. Overall postoperative morbidity was 25,36%. Most common complication was anastomotic dehiscence (18,66%), transplant necrosis occurred in 2% of pts., whereas stenosis of the anastomosis was observed in 4,78% of pts. Overall intrahospital mortality was 14,38%, while specific mortality (anastomotic dehiscence and/or transplant necrosis) was 10,04% (21 pts.), whereas nonspecific mortality (predominantly lung insufficiency) was 4,78% (10 pts.). Anastomotic dehiscence is major disadvantage of this method.
Diseases of the Esophagus, 1996
Esophageal benign tumors of a vascular origin are extremely rare. Hemangiomas account for only 2%... more Esophageal benign tumors of a vascular origin are extremely rare. Hemangiomas account for only 2% of all benign esophageal tumors, while lymphangiomas are almost unknown. The review of the literature shows that only 9 cases (including ours) have been published up till now. In our case, the cavernous tissue infiltrated the whole thickness of the distal esophagus (from submucosa to adventitia) and the submucosal part protruded into the lumen as broadly based soft polypoid cushion. Total excision by distal esophageal resection for very large tumors and interposition of a jejunal segment is recommended.
Acta chirurgica iugoslavica
European Surgery, 2015
Introduction The goal of this review article is to present the relationship between the theory of... more Introduction The goal of this review article is to present the relationship between the theory of herniosis and Saint's triad through the two philosophical stand points frequently encountered in diagnostic medicine, Ockham's razor and Hickam's dictum. The Saint's triad was recognized when association between hiatal hernia, colonic diverticular disease, and gallstones have been proven to appear more often than just by pure chance alone. Methodology A systematic review of the literature was performed using MEDLINE (PubMed search), EMBASE, and the Cochrane databases, and it included papers published from 1948 until 2014. Results The data obtained by search are presented to analyze the theory of herniosis. Connective tissue disorder is being recognized as a cornerstone beneath the Saint's triad, and the facts backing up this stand point are now systematically displayed to readers. Special emphasis is given on review of current literature reports on origin of hiatal hernia and its influence on everyday surgical perceptive. Conclusion Saint's triad, once the most cited example of Hickam's dictum is now being put to trial with the theory of herniosis, proving a sharper edge to Ockham razor stand point. It is upon the reader, from the arguments given, to choose which principle will prevail, in further thinking about this particular problem.
Acta chirurgica Iugoslavica, 2000
In the period from 1970 to 1996, in the Departmenf of Esophagogastric Surgery, Belgrade, Yugoslav... more In the period from 1970 to 1996, in the Departmenf of Esophagogastric Surgery, Belgrade, Yugoslavia 562 have been operated with curative intent due to cardiac carcinoma. Since 1970 until 1985, in 182 patients a distal esophagectomy and proximal gastrectomy followed by eosphagogastro anastomosis had been performed. In the period between 1982 and 1996, a distal esophagectomy with total gastrectomy and radical or extended radical dissection and intrathoracic esophagojejuno anastomosis in 380 patients (192 hand sewn 3/0 interrupted sutures and 188 spapled anastomosis) had been performed. In our opinion for the majority of patients with advanced cardiac carcinoma distal esophagectomy and total gastrectomy, via the left thoracoabdominal approach, with D2 pancreas preserving splenectomy and dissection of lymph nodes in stations 16a1 and 16a2 is a surgical therapy of choice. Overall complications of such a procedure not differ in type and number from those after standard total gastrectomy a...
Anaesthesia, 2021
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Medical review
Introduction. The role of tracheotomy in the treatment of patients with prolonged intubation in i... more Introduction. The role of tracheotomy in the treatment of patients with prolonged intubation in intensive care units is known and confirmed. In light of the global pandemic of severe acute respiratory syndrome coronavirus-2 infection and consequent coronavirus disease 2019, we present our experiences with tracheotomy in infected patients. Material and Methods. A retrospective observational study of patients treated in intensive care units at the Clinical Hospital Center ?Dr. Dragisa Misovic Dedinje? was carried out in the period from March 21, 2020 to May 14, 2020. Results. A total of 970 coronavirus disease 2019-positive patients were treated and out of that number, 116 patients were treated in intensive care units (12%), of which 49 patients (42%) were on non-invasive mechanical ventilation and 67 patients (58%) on intensive mechanical ventilation. The average age of the patients was 59.3 years; the youngest patient was 46, and the oldest 73 years old. Tracheotomy was performed in...
The American Surgeon, 2010
Letters to the Editor should be submitted online to www.editorialmanager.com/ amsurg. (See detail... more Letters to the Editor should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 3 double-spaced pages excluding an Abstract and sub-headings with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
European Surgery, 2019
Background Esophageal cancer (EC) surgery is associated with relatively high morbidity and mortal... more Background Esophageal cancer (EC) surgery is associated with relatively high morbidity and mortality rates and poor overall survival (OS). The impact of allogeneic blood transfusion (aBT) on OS is still a matter of debate. We aimed to investigate the impact of aBT on OS in a homogeneous population of patients undergoing surgical treatment for EC in a single center during a 15-year period. Methods In total, 409 patients who had undergone surgical resection for EC were studied. The clinicopathological parameters and OS were compared between 170 patients (41.6%) who received perioperative aBT and 239 patients (58.4%) who did not. Results Compared with the non-transfused patients, patients who received aBT had lower preoperative hemoglobin levels, more comorbidities, and a more advanced stage of disease as reflected by tumor diameter, nodal metastases, perineural invasion, and the need for multiorgan resection. Transfused patients suffered more frequently from major postoperative complications (26/170 [21.5%] vs. 13/239 [5.7%], p < 0.001) and had a significantly longer hospital stay (17 vs. 15 days, p < 0.001). Multivariate analysis identified tumor grade (p = 0.02), perineural invasion (p = 0.001), N stage (p < 0.001), major postoperative
Acta chirurgica Iugoslavica, 2001
In an retrospective analysis of documentation and printed paper in period between 1964-1998 168 p... more In an retrospective analysis of documentation and printed paper in period between 1964-1998 168 patients required reoperations in benign esophageal lesions. Failed initial interventions were found in 66 (39.28%) pts. operated in our clinic and 102 (60.71%) pts operated in other institutions in our country. The corrective procedure was possible in 140 (83.33%) pts and impossible in 11 (6.54%). Post-operative mortality was 7.73% so the definitive failed corrections were 14.27%. The main cause of failure were: Defective operative technique, wrong preoperative diagnosis and indications including inadequate initial procedure. Among the 168 pts undergoing corrective surgery, more than a half of pts had obstructive lesions requiring resections and reconstructions. Dilatation of the stricture was possible in 16% followed by total diversion, particularly in previous gastric surgery. Malignant degeneration of benign lesions were found in 10.71%. Only 4 pts (2.3%) refused suggested operations....
Langenbeck's Archives of Surgery, 2014
The aim of this study is to estimate the incidence and clinical impact of lymph node micrometasta... more The aim of this study is to estimate the incidence and clinical impact of lymph node micrometastases in hypopharyngeal squamous cell cancer (HSCC). In this retrospective study, we enrolled 58 patients who have undergone surgery for HSCC (between January 2004 and January 2011). Pharyngolaryngectomy and oesophagectomy with selective bilateral neck dissection was performed in all patients. Based on standard histological examination, 17 patients met N0 and 8 patients met N1 criteria and were further evaluated for the presence of micrometastases and isolated tumour cells (ITC). Following immunohistochemical analysis, the patients were grouped according to the presence of micrometastases and ITCs. In the pN0 group, cytokeratin-positive cells were detected in five patients, and they were marked as N0/CK+. Among these five patients, two were found to harbour micrometastases and ITCs, whilst in three, only ITCs were found. Two patients (11.75 %) were upstaged to pN1. The patients marked as N0/CK+ had a statistically significant worse overall survival rates than pN0 patients with tissue samples read as negative for cytokeratin immunostaining (p = 0.019, p < 0.05). In the pN1 group, cytokeratin-positive cells were detected in two patients, with one patient showing micrometastases and ITC, and the other showing ITC only. One patient was upstaged to pN2. Patients with lymph node micrometastases and ITC had worse overall survival rates, which may indicate that more aggressive post-operative treatment regimens should be considered for these HSCC patients.
Hepatobiliary & Pancreatic Diseases International, 2019
A 44-year-old male patient was initially presented with pain in the upper abdomen. Weight loss, j... more A 44-year-old male patient was initially presented with pain in the upper abdomen. Weight loss, jaundice and digestive disorders were not reported. Blood analysis showed white blood cell count 9.02 × 10 9 , C-reactive protein (CRP) 3 mg/L, and gastrin 38 ng/L. Abdominal ultrasonography revealed tumor in the projection of duodenum and pancreatic head. Colonoscopy and tumor markers (CA19-9, CEA, CA72-4, and AFP) were all negative. Additionally, abdominal contrast enhanced computed tomography (CT) examination was performed which demonstrated hypervascular tumor lesion, size 43 × 38 × 34 mm, in the lateral aspect of the pancreatic head (Fig. 1). No evidence of extra-pancreatic disease was found. Radical surgical resection of the tumor was conducted through medial laparotomy. Frozen section biopsy finding of well circumscribed nodular tumor mass was at that moment interpreted as nonmalignant hyperplastic peripancreatic lymph node (Fig. 2). Histology showed nodular architecture of lymphoid infiltrate, mostly composed of follicle-like structures with hyalinized and vascularized centers and onion skin-like distribution of surrounding small lymphoid cells (Fig. 3). Immunostaining showed B-cell phenotype (CD20 + , CD5 − , CD10 − , and CD43 −) with CD21 + rich dendritic cell networks, focally mantle zone-like areas (focal expression of CD10 + and Bcl-6 +) and a lack of Bcl-2 immunoexpression in germinal centers, but CD3 + /CD5 + small T lymphocytes among polymorphous interfollicular lymphoid infiltrate (Fig. 3). After an adequate recovery, without complications, the patient was discharged on postoperative day 11. He is now under diagnostic surveillance without the need for further treatment. Castleman's disease is a rare atypical lymphoproliferative disorder that can easily be misdiagnosed. The etiology is still uncertain and it is thought that the cause is viral infection of the B cell pool and the lymphovascular compartment of lymph nodes [1]. It was first described as a single case by Benjamin Castleman, an American physician and pathologist [2]. Symptoms that can occur are fatigue, high fever, night sweats and loss of appetite. Castleman's disease can be clinically characterized by leucocytosis, increased erythrocyte sedimentation and CRP. In unicentric form * Corresponding author.
Acta chirurgica Iugoslavica, 2017
Esophageal resection with reconstruction is complex surgical procedure with high rate of postoper... more Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset ...
Hepato-gastroenterology, 2009
BACKGROUND/AIM Aim of this paper is to report a 40 years experience in performing colon interposi... more BACKGROUND/AIM Aim of this paper is to report a 40 years experience in performing colon interposition for pharyngoesophageal caustic injury. METHODOLOGY In the period between 1965 and 2005, 83 colon interpositions were performed due to the pharyngeal and high esopahageal injuries. Patients were classified according to the uppermost level of stricture in 3 groups: supraglotic, hypopharyngeal and esophageal ostium. In most of the patients (89.1%) an extrapleural retrosternal by-pass colon interposition was performed, while in the remaining 10.9% a colon interposition with esophagectomy had to be done. Long-term follow-up results were obtained in the period between one and up to 30 years. RESULTS Early postoperative complications occurred in 16.8% of patients, among which anastomotic leakage was the most common. Overall intrahospital mortality rate was 6%, while late postoperative complications were present in 14.4% of patients. Long-term follow-up was obtained in 84.2% of patients, wi...
PURPOSE To estimate whether the computed tomography (CT) perfusion imaging could be useful to pre... more PURPOSE To estimate whether the computed tomography (CT) perfusion imaging could be useful to predict the pathological complete response (pCR) of esophageal cancer to the neoadjuvant chemoradiotherapy (NACRT). METHODS Twenty-seven patients with the advanced squamous cell esophageal carcinoma, who were treated with concomitant CRT (CIS/5-FU/LV and 45-50 Gy total radiation dose), were re-evaluated using CT examination, which included the low-dose CT perfusion study. CT perfusion series were analysed using the deconvolution-based CT perfusion software (Perfusion 3.0, GE), and color parametric maps of the blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface area product (PS) were displayed. All patients were operated and histopathological analysis of the resected esophagus considered the gold standard for pathologic complete response (pCR). RESULTS BFpost-NACRT, BVpost-NACRT, and PSpost-NACRT were significantly lower, and MTTpost-NACRT significantly high...
Vojnosanitetski pregled
Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of cor... more Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of corrosive esophageal stricture is a very rare and serious condition. Life threatening aspiration pneumonia requests urgent lungs' protection, but overall treatment strategy is not clearly defined. Case report. Twenty-month-old female child accidentally ingested a household bleach. Caustic injury of esophagus was healing with development of strictures of cervical and proximal thoracic esophagus. TEF was developed during the third BD. Healing of TEF and pulmonary infection was achieved by exclusion of the esophagus (pharyngostoma and feeding gastrostomy together) with prolonged tracheobronchial intubation and toilette. Retrosternal colon interposition was performed a year later, with excellent functional results over four-year follow-up. Conclusion. Esophageal exclusion in the first stage, and pharyngoesophageal reconstruction in the second stage, is a useful therapeutic option in the tre...
Acta chirurgica Belgica, 2021
BACKGROUND Apart from being a rare endocrine tumor, parathyroid carcinoma is also one of the rare... more BACKGROUND Apart from being a rare endocrine tumor, parathyroid carcinoma is also one of the rarest malignancies in human beings. Parathyroid carcinoma is even more uncommon in haemodialysis patients with end-stage renal disease. The pathogenesis of parathyroid hyperplasia in haemodialysis patients is well known, but the mechanism of development of parathyroid carcinoma in these patients remains unclear. METHODS Three cases of parathyroid carcinoma in haemodialysis patients are presented in this study: a 69-year-old male patient and two female patients (67 and 61 years old). In all cases parathyroid carcinoma infiltrated the ipsilateral thyroid lobe and in one patient the right laryngeal nerve was involved as well. One patient underwent three surgical procedures. RESULTS After surgical treatment, all patients were normocalcaemic and showed a significant reduction in PTH levels. CONCLUSION In patients with secondary hyperparathyroidism, who develop parathyroid carcinoma, surgical res...
Anesthesia & Analgesia, 2021
PubMed, 2003
Despite the marked decline in incidence during last 50 years, gastric cancer remains significant ... more Despite the marked decline in incidence during last 50 years, gastric cancer remains significant cause of mortality and morbidity worldwide. According to data in 1984. incidence in Yugoslavia was 35 per 100,000. In the United States, where incidence is not high, 24,000 new cases and 13,300 deaths had been estimated for the year 1992. Despite fact that modern diagnostic and surgical concept changed perspective for significant number of the patients with gastric carcinoma, most authors agree that Gastric cancer may be the most seriously mismanaged malignancy from a surgical perspective in the USA ... (Paul H. Sugarbaker, M.D, April 1999.) Analyzing medical literature, with special respect to domestic literature, authors analyzed historical data of gastric cancer surgery.
Medicinska istraživanja, 2015
Esophageal atresia refers to a congenitally interrupted esophagus, with one or more fistulae pres... more Esophageal atresia refers to a congenitally interrupted esophagus, with one or more fistulae present between the malformed esophagus and the trachea. The most frequent type is the one with distal tracheoesophageal fistula. If not diagnosed in time, it could cause severe respiratory complications, due to the aspiration of saliva, or direct flow of gastric secretions from below into the tracheobronchial tree. Surgical treatment of esophageal atresia demands a very precise operative technique, because of very limited possibilities for redo procedures. Results in the treatment of esophageal atresia, associated anomalies and postoperative complications are used in evaluation of both expert achievements of surgical team and institutional recommendations for certain pediatric hospitals. That is why the aim of the study is to evaluate our success in surgical treatment and to make a diagnostic and therapeutic algorithm for esophageal atresia. A retrospective study included 294 neonates treated from 1971-2013. The data are analyzed by comparing the incidence of different types of esophageal atresia, association with other congenital anomalies, treatment modalities of long-gap esophageal atresia and postoperative complications, as well as the outcome and survival rate over time. The results are analyzed using descriptive statistical method. The incidence of common esophageal atresia with distal tracheoesophageal fistula was 92,7 %; 5,1% with no fistula, 0,5% with two fistulae and 1,7% of H-type anomaly. The long-gap esophageal atresia was surgically treated in 3,4 % of cases. Various other congenital anomalies were associated in 48% of cases. The incidence of early complications including an anastomotic leak was about 5%; 1% of recurrent tracheoesophageal fistula and 7% of anastomotic structures. Gastroesophageal reflux as the main late postoperative complication, particularly problematic in patients with esophageal atresia occurs in 10% of cases in our series of patients. Developing surgical experience and neonatal intensive care units, the survival rate achieved 98%, which has certainly improved the outcome of surgical treatment, lowered the rate of postoperative complications and improved the quality of life, because most of the children who undergo a successful repair of esophageal atresia are relatively healthy.
PubMed, 1994
Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomac... more Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomach for ideal substitute in subtotal and total esophagoplasty. Additional advantages are one act surgery and possibility of single anastomosis formation. In an eighteen years' time, since 1976., two hundred nine (209) patients were operated with use of esophagogastroplasty for malignancies and benign diseases of esophagus and hyphopharinx. The esophagogastric anastomosis is most common reconstructive procedure for esophageal and hyphopharingeal malignancies. Anastomosis on pharyngeal level was made in 13 pts., on cervical esophagus level in 168 pts. and on thoracic esophagus level in the rest of 28 pts. Overall postoperative morbidity was 25,36%. Most common complication was anastomotic dehiscence (18,66%), transplant necrosis occurred in 2% of pts., whereas stenosis of the anastomosis was observed in 4,78% of pts. Overall intrahospital mortality was 14,38%, while specific mortality (anastomotic dehiscence and/or transplant necrosis) was 10,04% (21 pts.), whereas nonspecific mortality (predominantly lung insufficiency) was 4,78% (10 pts.). Anastomotic dehiscence is major disadvantage of this method.
Diseases of the Esophagus, 1996
Esophageal benign tumors of a vascular origin are extremely rare. Hemangiomas account for only 2%... more Esophageal benign tumors of a vascular origin are extremely rare. Hemangiomas account for only 2% of all benign esophageal tumors, while lymphangiomas are almost unknown. The review of the literature shows that only 9 cases (including ours) have been published up till now. In our case, the cavernous tissue infiltrated the whole thickness of the distal esophagus (from submucosa to adventitia) and the submucosal part protruded into the lumen as broadly based soft polypoid cushion. Total excision by distal esophageal resection for very large tumors and interposition of a jejunal segment is recommended.
Acta chirurgica iugoslavica
European Surgery, 2015
Introduction The goal of this review article is to present the relationship between the theory of... more Introduction The goal of this review article is to present the relationship between the theory of herniosis and Saint's triad through the two philosophical stand points frequently encountered in diagnostic medicine, Ockham's razor and Hickam's dictum. The Saint's triad was recognized when association between hiatal hernia, colonic diverticular disease, and gallstones have been proven to appear more often than just by pure chance alone. Methodology A systematic review of the literature was performed using MEDLINE (PubMed search), EMBASE, and the Cochrane databases, and it included papers published from 1948 until 2014. Results The data obtained by search are presented to analyze the theory of herniosis. Connective tissue disorder is being recognized as a cornerstone beneath the Saint's triad, and the facts backing up this stand point are now systematically displayed to readers. Special emphasis is given on review of current literature reports on origin of hiatal hernia and its influence on everyday surgical perceptive. Conclusion Saint's triad, once the most cited example of Hickam's dictum is now being put to trial with the theory of herniosis, proving a sharper edge to Ockham razor stand point. It is upon the reader, from the arguments given, to choose which principle will prevail, in further thinking about this particular problem.
Acta chirurgica Iugoslavica, 2000
In the period from 1970 to 1996, in the Departmenf of Esophagogastric Surgery, Belgrade, Yugoslav... more In the period from 1970 to 1996, in the Departmenf of Esophagogastric Surgery, Belgrade, Yugoslavia 562 have been operated with curative intent due to cardiac carcinoma. Since 1970 until 1985, in 182 patients a distal esophagectomy and proximal gastrectomy followed by eosphagogastro anastomosis had been performed. In the period between 1982 and 1996, a distal esophagectomy with total gastrectomy and radical or extended radical dissection and intrathoracic esophagojejuno anastomosis in 380 patients (192 hand sewn 3/0 interrupted sutures and 188 spapled anastomosis) had been performed. In our opinion for the majority of patients with advanced cardiac carcinoma distal esophagectomy and total gastrectomy, via the left thoracoabdominal approach, with D2 pancreas preserving splenectomy and dissection of lymph nodes in stations 16a1 and 16a2 is a surgical therapy of choice. Overall complications of such a procedure not differ in type and number from those after standard total gastrectomy a...
Anaesthesia, 2021
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Medical review
Introduction. The role of tracheotomy in the treatment of patients with prolonged intubation in i... more Introduction. The role of tracheotomy in the treatment of patients with prolonged intubation in intensive care units is known and confirmed. In light of the global pandemic of severe acute respiratory syndrome coronavirus-2 infection and consequent coronavirus disease 2019, we present our experiences with tracheotomy in infected patients. Material and Methods. A retrospective observational study of patients treated in intensive care units at the Clinical Hospital Center ?Dr. Dragisa Misovic Dedinje? was carried out in the period from March 21, 2020 to May 14, 2020. Results. A total of 970 coronavirus disease 2019-positive patients were treated and out of that number, 116 patients were treated in intensive care units (12%), of which 49 patients (42%) were on non-invasive mechanical ventilation and 67 patients (58%) on intensive mechanical ventilation. The average age of the patients was 59.3 years; the youngest patient was 46, and the oldest 73 years old. Tracheotomy was performed in...
The American Surgeon, 2010
Letters to the Editor should be submitted online to www.editorialmanager.com/ amsurg. (See detail... more Letters to the Editor should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 3 double-spaced pages excluding an Abstract and sub-headings with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
European Surgery, 2019
Background Esophageal cancer (EC) surgery is associated with relatively high morbidity and mortal... more Background Esophageal cancer (EC) surgery is associated with relatively high morbidity and mortality rates and poor overall survival (OS). The impact of allogeneic blood transfusion (aBT) on OS is still a matter of debate. We aimed to investigate the impact of aBT on OS in a homogeneous population of patients undergoing surgical treatment for EC in a single center during a 15-year period. Methods In total, 409 patients who had undergone surgical resection for EC were studied. The clinicopathological parameters and OS were compared between 170 patients (41.6%) who received perioperative aBT and 239 patients (58.4%) who did not. Results Compared with the non-transfused patients, patients who received aBT had lower preoperative hemoglobin levels, more comorbidities, and a more advanced stage of disease as reflected by tumor diameter, nodal metastases, perineural invasion, and the need for multiorgan resection. Transfused patients suffered more frequently from major postoperative complications (26/170 [21.5%] vs. 13/239 [5.7%], p < 0.001) and had a significantly longer hospital stay (17 vs. 15 days, p < 0.001). Multivariate analysis identified tumor grade (p = 0.02), perineural invasion (p = 0.001), N stage (p < 0.001), major postoperative
Acta chirurgica Iugoslavica, 2001
In an retrospective analysis of documentation and printed paper in period between 1964-1998 168 p... more In an retrospective analysis of documentation and printed paper in period between 1964-1998 168 patients required reoperations in benign esophageal lesions. Failed initial interventions were found in 66 (39.28%) pts. operated in our clinic and 102 (60.71%) pts operated in other institutions in our country. The corrective procedure was possible in 140 (83.33%) pts and impossible in 11 (6.54%). Post-operative mortality was 7.73% so the definitive failed corrections were 14.27%. The main cause of failure were: Defective operative technique, wrong preoperative diagnosis and indications including inadequate initial procedure. Among the 168 pts undergoing corrective surgery, more than a half of pts had obstructive lesions requiring resections and reconstructions. Dilatation of the stricture was possible in 16% followed by total diversion, particularly in previous gastric surgery. Malignant degeneration of benign lesions were found in 10.71%. Only 4 pts (2.3%) refused suggested operations....
Langenbeck's Archives of Surgery, 2014
The aim of this study is to estimate the incidence and clinical impact of lymph node micrometasta... more The aim of this study is to estimate the incidence and clinical impact of lymph node micrometastases in hypopharyngeal squamous cell cancer (HSCC). In this retrospective study, we enrolled 58 patients who have undergone surgery for HSCC (between January 2004 and January 2011). Pharyngolaryngectomy and oesophagectomy with selective bilateral neck dissection was performed in all patients. Based on standard histological examination, 17 patients met N0 and 8 patients met N1 criteria and were further evaluated for the presence of micrometastases and isolated tumour cells (ITC). Following immunohistochemical analysis, the patients were grouped according to the presence of micrometastases and ITCs. In the pN0 group, cytokeratin-positive cells were detected in five patients, and they were marked as N0/CK+. Among these five patients, two were found to harbour micrometastases and ITCs, whilst in three, only ITCs were found. Two patients (11.75 %) were upstaged to pN1. The patients marked as N0/CK+ had a statistically significant worse overall survival rates than pN0 patients with tissue samples read as negative for cytokeratin immunostaining (p = 0.019, p < 0.05). In the pN1 group, cytokeratin-positive cells were detected in two patients, with one patient showing micrometastases and ITC, and the other showing ITC only. One patient was upstaged to pN2. Patients with lymph node micrometastases and ITC had worse overall survival rates, which may indicate that more aggressive post-operative treatment regimens should be considered for these HSCC patients.
Hepatobiliary & Pancreatic Diseases International, 2019
A 44-year-old male patient was initially presented with pain in the upper abdomen. Weight loss, j... more A 44-year-old male patient was initially presented with pain in the upper abdomen. Weight loss, jaundice and digestive disorders were not reported. Blood analysis showed white blood cell count 9.02 × 10 9 , C-reactive protein (CRP) 3 mg/L, and gastrin 38 ng/L. Abdominal ultrasonography revealed tumor in the projection of duodenum and pancreatic head. Colonoscopy and tumor markers (CA19-9, CEA, CA72-4, and AFP) were all negative. Additionally, abdominal contrast enhanced computed tomography (CT) examination was performed which demonstrated hypervascular tumor lesion, size 43 × 38 × 34 mm, in the lateral aspect of the pancreatic head (Fig. 1). No evidence of extra-pancreatic disease was found. Radical surgical resection of the tumor was conducted through medial laparotomy. Frozen section biopsy finding of well circumscribed nodular tumor mass was at that moment interpreted as nonmalignant hyperplastic peripancreatic lymph node (Fig. 2). Histology showed nodular architecture of lymphoid infiltrate, mostly composed of follicle-like structures with hyalinized and vascularized centers and onion skin-like distribution of surrounding small lymphoid cells (Fig. 3). Immunostaining showed B-cell phenotype (CD20 + , CD5 − , CD10 − , and CD43 −) with CD21 + rich dendritic cell networks, focally mantle zone-like areas (focal expression of CD10 + and Bcl-6 +) and a lack of Bcl-2 immunoexpression in germinal centers, but CD3 + /CD5 + small T lymphocytes among polymorphous interfollicular lymphoid infiltrate (Fig. 3). After an adequate recovery, without complications, the patient was discharged on postoperative day 11. He is now under diagnostic surveillance without the need for further treatment. Castleman's disease is a rare atypical lymphoproliferative disorder that can easily be misdiagnosed. The etiology is still uncertain and it is thought that the cause is viral infection of the B cell pool and the lymphovascular compartment of lymph nodes [1]. It was first described as a single case by Benjamin Castleman, an American physician and pathologist [2]. Symptoms that can occur are fatigue, high fever, night sweats and loss of appetite. Castleman's disease can be clinically characterized by leucocytosis, increased erythrocyte sedimentation and CRP. In unicentric form * Corresponding author.
Acta chirurgica Iugoslavica, 2017
Esophageal resection with reconstruction is complex surgical procedure with high rate of postoper... more Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset ...
Hepato-gastroenterology, 2009
BACKGROUND/AIM Aim of this paper is to report a 40 years experience in performing colon interposi... more BACKGROUND/AIM Aim of this paper is to report a 40 years experience in performing colon interposition for pharyngoesophageal caustic injury. METHODOLOGY In the period between 1965 and 2005, 83 colon interpositions were performed due to the pharyngeal and high esopahageal injuries. Patients were classified according to the uppermost level of stricture in 3 groups: supraglotic, hypopharyngeal and esophageal ostium. In most of the patients (89.1%) an extrapleural retrosternal by-pass colon interposition was performed, while in the remaining 10.9% a colon interposition with esophagectomy had to be done. Long-term follow-up results were obtained in the period between one and up to 30 years. RESULTS Early postoperative complications occurred in 16.8% of patients, among which anastomotic leakage was the most common. Overall intrahospital mortality rate was 6%, while late postoperative complications were present in 14.4% of patients. Long-term follow-up was obtained in 84.2% of patients, wi...
PURPOSE To estimate whether the computed tomography (CT) perfusion imaging could be useful to pre... more PURPOSE To estimate whether the computed tomography (CT) perfusion imaging could be useful to predict the pathological complete response (pCR) of esophageal cancer to the neoadjuvant chemoradiotherapy (NACRT). METHODS Twenty-seven patients with the advanced squamous cell esophageal carcinoma, who were treated with concomitant CRT (CIS/5-FU/LV and 45-50 Gy total radiation dose), were re-evaluated using CT examination, which included the low-dose CT perfusion study. CT perfusion series were analysed using the deconvolution-based CT perfusion software (Perfusion 3.0, GE), and color parametric maps of the blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface area product (PS) were displayed. All patients were operated and histopathological analysis of the resected esophagus considered the gold standard for pathologic complete response (pCR). RESULTS BFpost-NACRT, BVpost-NACRT, and PSpost-NACRT were significantly lower, and MTTpost-NACRT significantly high...
Vojnosanitetski pregled
Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of cor... more Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of corrosive esophageal stricture is a very rare and serious condition. Life threatening aspiration pneumonia requests urgent lungs' protection, but overall treatment strategy is not clearly defined. Case report. Twenty-month-old female child accidentally ingested a household bleach. Caustic injury of esophagus was healing with development of strictures of cervical and proximal thoracic esophagus. TEF was developed during the third BD. Healing of TEF and pulmonary infection was achieved by exclusion of the esophagus (pharyngostoma and feeding gastrostomy together) with prolonged tracheobronchial intubation and toilette. Retrosternal colon interposition was performed a year later, with excellent functional results over four-year follow-up. Conclusion. Esophageal exclusion in the first stage, and pharyngoesophageal reconstruction in the second stage, is a useful therapeutic option in the tre...
Acta chirurgica Belgica, 2021
BACKGROUND Apart from being a rare endocrine tumor, parathyroid carcinoma is also one of the rare... more BACKGROUND Apart from being a rare endocrine tumor, parathyroid carcinoma is also one of the rarest malignancies in human beings. Parathyroid carcinoma is even more uncommon in haemodialysis patients with end-stage renal disease. The pathogenesis of parathyroid hyperplasia in haemodialysis patients is well known, but the mechanism of development of parathyroid carcinoma in these patients remains unclear. METHODS Three cases of parathyroid carcinoma in haemodialysis patients are presented in this study: a 69-year-old male patient and two female patients (67 and 61 years old). In all cases parathyroid carcinoma infiltrated the ipsilateral thyroid lobe and in one patient the right laryngeal nerve was involved as well. One patient underwent three surgical procedures. RESULTS After surgical treatment, all patients were normocalcaemic and showed a significant reduction in PTH levels. CONCLUSION In patients with secondary hyperparathyroidism, who develop parathyroid carcinoma, surgical res...