Dragan Radovanovic - Academia.edu (original) (raw)
Papers by Dragan Radovanovic
Acta Chirurgica Iugoslavica, 2003
Hepato-gastroenterology, Mar 1, 2008
Malignant Triton tumor is a malignant peripheral nerve sheat tumor with rhabdomioblastic differen... more Malignant Triton tumor is a malignant peripheral nerve sheat tumor with rhabdomioblastic differentiation. These tumors are frequently associated with Neurofibromatosis type 1, sporadic cases being exteremly rare. Retroperitoneal localization have the most unfavorable prognois due to delayed diagnosis but also due to relation to adjacant organs. Preoperative diagnosis is inaccurate, but core needle biopsy gives more promising results. Aggressive surgical management remains the most effective modality since adjuvant forms of treatment like irradiation or chemotherapy do not have reproducible results. We present a 60-year-old female patient in whom a retroperitoneal presacral mass was postoperatively diagnosed as Triton tumor. At time of diagnosis, no visible metastases were present. The posterior pelvic exenteresis was performed. Intended chemotherapy was never started since multiple pulmonary, hepatic and splenic metastases were diagnosed only a month after surgery, with rapid lethal outcome. This case demonstrates the bad prognosis of malignant retroperitoneal tumors. Diagnostic tools such as refined biopsy techniques or cytogenetic analysis might help in differentiating patients who will benefit from radical surgery.
Recently, marked improvement has been observed in prevention, early detection, and surgical manag... more Recently, marked improvement has been observed in prevention, early detection, and surgical management of carcinomas of the digestive system but the ultimate outcome of the disease remains uncertain. Recent studies in the field of lymphatic mapping and sentinel lymph node biopsy suggest that sentinel lymph node biopsy could be very important in staging and treatment of two most frequent malignancies of the digestive system, gastric and colon carcinomas. Modern diagnostic visualization techniques are unable to provide reliable data about lymph node metastasis. In addition, prediction of possible anatomic location of lymphatic metastatic spread is much more complicated and uncertain in gastrointestinal than other sites carcinomas. Because of that, we are unable to perform accurate perioperative and intraoperative staging which would allow planned and rational surgery, particularly beneficial for patients with advanced disease who otherwise undergo radical surgery. If would be ideal if...
Vojnosanitetski pregled, 2018
Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumfe... more Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of...
European Surgery, 2019
Background The aim of this study was to evaluate the effects of pneumoperitoneum on liver functio... more Background The aim of this study was to evaluate the effects of pneumoperitoneum on liver function during and after laparoscopic cholecystectomy. Methods This prospective study comprised a total of 165 patients, who were divided into two groups: The first group had low-pressure pneumoperitoneum (12 mm Hg; N = 78) and the second group had highpressure pneumoperitoneum (14 mm Hg; N = 87). A detailed statistical analysis included sex, age, operation time, and liver function tests including total bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, fibrinogen, and lactate dehydrogenase (LDH), which were obtained preoperatively and 24 h, 7 days, and 30 days postoperatively. The statistical hypotheses were tested with a t test, Mann-Whitney test, chi-square test, Friedman test, and Wilcoxon's test. Results There was no statistical difference between the two groups considering age, gender, and operation time (p = 0.740, p = 0.255, and p = 0.480, respectively). There was also no statistical difference in the median values of bilirubin, AST, GGT, LDH, albumin, and fib
Materia …, 2010
In last 10 years of colorectal surgery the most important role of serial measurement of CEA and C... more In last 10 years of colorectal surgery the most important role of serial measurement of CEA and CA 19-9 tumor markers level is possibility for detection of recidives or metastasis of colorectal carcinoma. Even thought that this role is the most important, role of measurement of serum level of CEA and Ca 19-9 before surgery is a subject of discussion. The goal of this examination was proof that correlation between CEA and CA 19-9 serum level before surgery and stage of colorectal carcinoma after surgery exist.This study was undertaken as a review of a group of 102 patients with colorectal carcinoma. Serum levels of CEA and CA 19-9 in this patients were measured before surgery. After the surgery, this levels results were analyzed comparing with Dukes stage, stage of histological differentiation of carcinomas and number of liver metastasis. Average tumor markers levels of CEA was 44,59 μg/ml. Average level of CA 19-9 was 258,8696 U/ml. In our group of patients we found high level of CEA in 74,51 % of them. High level of serum CA 19-9 was in 39,22 % of patients. Four patients had A Dukes stage of disease, 13 of them had B1 stage, 32 B2, 7 C1 and 12 of them had D stage of Dukes classification. Analysis of outcome results show that high statistical signification in correlation between CEA and CA 19-9 levels and stage of layer colon wall invasion exist as same as correlation between CEA and CA 19-9 level and stage of Dukes classification. There is not significant correlation between CEA and CA 19-9 level and level of histological differentiation. It was 12 patients with liver metastasis. High level of CEA and CA 19-9 tumor markers is truly important predictor for presents of liver metastasis. There is a high statistically significant correlation between serum level of CEA and CA 19-9 tumor markers before surgery and increasing level stage of colorectal carcinoma.
Scandinavian Journal of Medicine & Science in Sports, 2011
The aim of this study was to describe qualitatively and quantitatively dietary supplements (DS) a... more The aim of this study was to describe qualitatively and quantitatively dietary supplements (DS) and medication use in elite athletes. Athletes (n=912; age 23.9±6 years; 72% male) reported medications and DSs taken within 3 days before doping control. We analyzed data collected from 2006 to 2008, indentified and classified substances. Total of 74.6% athletes reported use of at least one substance, 61.2% took DS (3.17 per user) and 40.6% took medications. Among users, 21.2% reported the use of six and more different products, and one took 17 different products at the same time. Majority of medication users took non‐steroidal anti‐inflammatory drugs (NSAID) (24.7%), and 22.2% used more than one NSAID. We found no gender differences in DS use (P=0.83). Individual sport athletes used more DS (P<0.01). Our study showed widespread use of DS and drugs by elite athletes. Consumption of DS with no evident performance or health benefits, demonstrated the need for specific educational progra...
Medicus, 2004
Iz u èa va nje mul ti plih kar ci no ma ko lo na i rek tu ma ima veli ki kli niè ki i prak tiè ni... more Iz u èa va nje mul ti plih kar ci no ma ko lo na i rek tu ma ima veli ki kli niè ki i prak tiè ni znaèaj. Sma tra se da 15% svih malig nih tu mo ra u or ga ni zmu èo ve ka i oko 60 od sto svih inte sti nal nih kar ci no ma na sta je na ko lo nu i rek tu mu. Po sle obo le va nja ko že, naj ve aea uèe sta lost mul ti plih kar ci no ma za stu plje na je na ko lo nu i rek tu mu.(1,2) Uèe sta lost mul tiplih kar ci no ma ko lo na i rek tu ma, pre ma po da ci ma iz li t e ra tu re, kre aee se od dva do pet od sto, a po ne kim auto ri ma i do se dam (Tra vi e so 1972. i Eke lund 1974).(3,4) Pr ve nala ze o mul ti plim kar ci no mi ma de be log cre va da li su Czerny 1880. i Fen ger 1888. go di ne. Bil lroth je 1879. dao pr vu de fi ni ci ju ko lo rek tal nih mul ti plih kar ci no ma. Po li po za ko lo na i rek tu ma stva ra pre di spo zi ci ju za na stanak mul ti plih me ta hro nih kar ci no ma, a bo le sti po put fa-mi li jar ne po li po ze, Gard ne ro vog sin dro ma i Tor cu to vog sin dro ma naj èeš aea su obo lje nja kod po ja ve me ta hro nih kar ci no ma.(5,6) Me ta hro ni mul ti pli kar ci no mi su ko lorek tal ni kar ci no mi ko ji se ot kri va ju naj ma nje šest me se ci po sle re sek ci je pri mar nog tu mo ra, a iz meðu ra ni je ana stomo ze i no vo na sta log tu mo ra po sto ji in takt na mu ko za creva. Kla si fi ka ci ju mul ti plih kar ci no ma ko lo na i rek tu ma izvr šio je Mo er tel 1958. go di ne.(7) Cilj ove stu di je je utvrði va nje uèe sta lo sti me ta hro nih karci no ma ko lo na i rek tu ma, za tim do mi nant nih lo ka li za ci ja me ta hro nih kar ci no ma, kao i du ži na pre ži vlja va nja pa ci jena ta s mul ti plim me ta hro nim kar ci no mi ma ko lo na i rektu ma.
Sazetak-Karcincid tumori su cest: tumori gastrointestinalnog trakta. ali se veoma retko javljaju ... more Sazetak-Karcincid tumori su cest: tumori gastrointestinalnog trakta. ali se veoma retko javljaju na pankrcasu. Nespecificna klinicka slika kod velikog broja pacijenata sa karcinoidom pankreasa odgovorna je za kasno operativno resavanje vee uznapredovalih turnora i veoma nisku stopu pctogodisnjeg prczivljavanja od 5a1110 28.9%±16%. Analizirajuci slucaj 69 godina stare pacijcntkinje operisane zbog karcinoida tela pankreasa, vidimo da karcinoidi na ovoj lokalizaciji 1110gU dostici velike dimcnzijc od prcko 7 em u precniku, a da ne daju nikakve preoperativne simptome. lntraoperativno u ovorn stadijumu bolesti pacijenri Ll preko 60% slucajeva vee imaiu udaljene metastaze u limfne noduse iii jetru. Kod operisane pacijcntkinje ucinjena je distalna hemipankrcatektornija liZ rcgionalnu limfadenektomiju celijacnih, hepaticnih i lienalnih limfnih nodusa bez znakova za metastatske promene na jctri, Dijagnoza karcinoida postavljena je postoperativnom histopatoloskom i imunohistohcmijskorn analizom preparata, Hirurski tretman je dorninantni nacin lecenja karcinoida pankreasa. koji daje sanse za bolji ishod leccnja i duzc pctogodisnje prezivljavanje.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The prediction of outcome for patients with gastric cancer is determined largely by the presence ... more The prediction of outcome for patients with gastric cancer is determined largely by the presence of lymph node metastases, which could be detected by sentinel lymph node (SLN) biopsy (SLNB). The purpose of this work was to determine the feasibility of SLNB in patients with gastric cancer for the assessment of regional lymph node status, including performing immunohistochemical (IHC) staining of SLN tissue. We reviewed 137 consecutive patients with operable gastric cancer over a 10-year period using a retrospective (to examine skip metastases) and prospective (to evaluate successful mapping) study design. SLNs were mapped, biopsied and subsequently explored by routine hematoxylin & eosin (H&E) staining and by IHC staining using a cytokeratin 8/18 antibody. The retrospective study showed a low incidence of skip metastases (3.7%). Mapping of SLNs in the prospective study was highly successful (98.2%). During the prospective study, IHC examination of SLNs from 56 patients showed statist...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
In contrast to other thyroid carcinomas it is difficult to establish a correct preoperative diagn... more In contrast to other thyroid carcinomas it is difficult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predictive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thyroid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxyphile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diameter >30 mm were significantly more frequent in patients with oxyphile carcinoma ...
Clinical Physiology and Functional Imaging, 2015
There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of ... more There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of sympaticovagal balance. It is also used in prescription and monitoring of athletic training. The purpose of our study was to determine HRR after maximal exercise among elite athletes with respect to age. A total of 274 elite male Caucasian athletes were randomly selected from the larger sample and divided into two groups: adolescent (group Y) and adult athletes (≥18 years; group A). They performed maximal cardiopulmonary exercise testing on a treadmill. Heart rate recovery was calculated as the rate of decline of HR from peak exercise to rates 1, 2 and 3 min after cessation of exercise (HRR1, HRR2 and HRR3). A significantly higher HRR1 was found in group A (29Á5 AE 15Á6 versus 22Á4 AE 10Á8, P<0Á001), but HRR3 was higher in group Y (82Á7 AE 10Á2 versus 79Á9 AE 12Á25; P = 0Á04). Stepwise multivariate linear regression analysis showed that, among all subjects, the HRR1 alone was independently associated with age (P<0Á001). The maximal oxygen consumption (VO 2 max) was in a negative relationship with HRR1 and in a positive one with HRR3 (P<0Á05) with respect to all athletes. The HRR during 3 min postexercise should be reported for the purpose of better assessing functional adaptation to exercise among elite athletes as well as the ageassociated differences in recovery. Higher values of HRR1 should be expected in older athletes, and HRR3 could be used as an index of aerobic capacity, irrespective of age.
General physiology and biophysics, 2009
Body mass index (BMI) is widely used as an index of obesity in adults. In trained population, ind... more Body mass index (BMI) is widely used as an index of obesity in adults. In trained population, individual with low body fat could be classified as overweight by BMI. To evaluate this problem, the purposes of this study were to determine the BMI and body fat percentage (BF%) of trained and untrained subjects and to evaluate the accuracy of BMI classification (> or =25 kg.m(-2)) as a prediction of overweight/obesity in trained subjects. The total number of 299 trained (basketball players) and 179 untrained male subjects participated in this study. Body height and body mass were measured; BMI was calculated for all subjects. BF% was determined via Tanita bioimpedance body composition analyzer. BMI >or = 25 kg.m(-2) and BF% > 20% were used to define overweight. There was no significant age differences. Body mass, height (p < 0.01) and BMI (p < 0.05) were significantly higher, although BF% was significantly lower (p < 0.01) in trained group when compared to untrained. Ei...
Srpski arhiv za celokupno lekarstvo, 2012
Introduction. Specific morphological and functional characteristics of athletes have a significan... more Introduction. Specific morphological and functional characteristics of athletes have a significant role in determining athletes? sports results and can be also used to assess the athlete?s individual potential. Objective. The aim of the study was to compare anthropometric characteristics and cardiovascular parameters in trained subjects to those of untrained subjects. Methods. A total number of 25 trained (17.30?0.83 years) and 21 (18.52?1.52 years) untrained male subjects participated in this study. Body weight and height were measured and these values were used to compute body mass index (BMI). The bioelectrical impedance analysis (BIA) method was used to estimate body fat percentage (%BF). Cardiovascular parameters were monitored in rest (rest heart rate, systolic and diastolic blood pressure) during ergospirometric testing (maximal oxygen consumption, maximal heart rate) and in recovery (heart rate in the first and third minute of recovery). Results. Body mass, height and BMI (p...
AIM The purpose of this prospective study was to highlight some new findings about anatomical and... more AIM The purpose of this prospective study was to highlight some new findings about anatomical and morphological variations of the thyroid pyramidal lobe and to emphasise the necessity and importance of exploration of the visceral compartment of the neck and resection of this structure in primary thyroid operations. METHOD We analysed 100 consecutive primary thyroid operations with additional pathological examination of the specimens. RESULTS A pyramidal lobe was found in 61% of the cases. The lobe of Lalouette was found more often in women (61.96%) than in men (50%) and more often (67.3%) in patients less than 50 years old than in those older than 50 (54.2%). The lobe branched off more frequently from the midline (49.18%) than from other parts of the isthmus; its length ranged from 8 - 40 mm, with a median length of 20.13 mm. In diffuse thyroid diseases, the lobes were always pathologically involved and significantly longer. CONCLUSION Since the pyramidal lobe is a normal component ...
Medicinski pregled
Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tr... more Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality. In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 year old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST. In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment. The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.
Medicinski pregled
Formation of lymphatic metastasis is an important prognostic factor in treatment of gastric carci... more Formation of lymphatic metastasis is an important prognostic factor in treatment of gastric carcinoma. In this paper we would like to point to the importance of systematic lymphadenectomy in regard to extent of metastatic lymph node involvement in patients with gastric carcinoma. This investigation included 114 patients with diagnosis of gastric carcinoma undergoing systematic lymphadenectomy. We analyzed metastatic lymph node involvement considering: 1. tumor localization; 2. histopathologic type; 3. depth of tumor invasion; 4. extent of lymph node resection; 5. stage of disease. In the course of this study, 2100 lymph nodes were extracted by systematic lymphadenectomy (18.42 lymph nodes per patient on average). Out of this number, about 27% of lymph nodes were involved with metastasis, and 60% of positive lymph nodes belonged to the first, 25.7% to the second, 10.2% to the third and 3.8% to the fourth drainaged group. The most frequent localization (over 56%) of tumors was the distal third region of stomach. Histopathologically, most common type of carcinoma was intestinal carcinoma, with metastasis in first and second drainage group. A great number of patients have tumors with infiltration of the serosa. Those patients had metastases in lymph nodes in over 42%. Most patients (58%) belonged to IV stage of disease and presented with highest number of involved metastatic lymph nodes in all drainage groups. In our patients high metastatic involvement of all four drainage groups of lymph nodes was established. Up to date standard lymphadenectomy (D1) which has been performed increased the length of survival of these patients. By systematic lymphadenectomy we removed a great number of metastatic lymph nodes with beneficial effect on survival of patients with gastric carcinoma.
Medicinski pregled
Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis... more Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Common bile duct calculi represent a common disease of the digestive system. Endosco...
Srpski arhiv za celokupno lekarstvo, 2015
Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the... more Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors.The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8x5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.
Acta Chirurgica Iugoslavica, 2003
Hepato-gastroenterology, Mar 1, 2008
Malignant Triton tumor is a malignant peripheral nerve sheat tumor with rhabdomioblastic differen... more Malignant Triton tumor is a malignant peripheral nerve sheat tumor with rhabdomioblastic differentiation. These tumors are frequently associated with Neurofibromatosis type 1, sporadic cases being exteremly rare. Retroperitoneal localization have the most unfavorable prognois due to delayed diagnosis but also due to relation to adjacant organs. Preoperative diagnosis is inaccurate, but core needle biopsy gives more promising results. Aggressive surgical management remains the most effective modality since adjuvant forms of treatment like irradiation or chemotherapy do not have reproducible results. We present a 60-year-old female patient in whom a retroperitoneal presacral mass was postoperatively diagnosed as Triton tumor. At time of diagnosis, no visible metastases were present. The posterior pelvic exenteresis was performed. Intended chemotherapy was never started since multiple pulmonary, hepatic and splenic metastases were diagnosed only a month after surgery, with rapid lethal outcome. This case demonstrates the bad prognosis of malignant retroperitoneal tumors. Diagnostic tools such as refined biopsy techniques or cytogenetic analysis might help in differentiating patients who will benefit from radical surgery.
Recently, marked improvement has been observed in prevention, early detection, and surgical manag... more Recently, marked improvement has been observed in prevention, early detection, and surgical management of carcinomas of the digestive system but the ultimate outcome of the disease remains uncertain. Recent studies in the field of lymphatic mapping and sentinel lymph node biopsy suggest that sentinel lymph node biopsy could be very important in staging and treatment of two most frequent malignancies of the digestive system, gastric and colon carcinomas. Modern diagnostic visualization techniques are unable to provide reliable data about lymph node metastasis. In addition, prediction of possible anatomic location of lymphatic metastatic spread is much more complicated and uncertain in gastrointestinal than other sites carcinomas. Because of that, we are unable to perform accurate perioperative and intraoperative staging which would allow planned and rational surgery, particularly beneficial for patients with advanced disease who otherwise undergo radical surgery. If would be ideal if...
Vojnosanitetski pregled, 2018
Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumfe... more Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of...
European Surgery, 2019
Background The aim of this study was to evaluate the effects of pneumoperitoneum on liver functio... more Background The aim of this study was to evaluate the effects of pneumoperitoneum on liver function during and after laparoscopic cholecystectomy. Methods This prospective study comprised a total of 165 patients, who were divided into two groups: The first group had low-pressure pneumoperitoneum (12 mm Hg; N = 78) and the second group had highpressure pneumoperitoneum (14 mm Hg; N = 87). A detailed statistical analysis included sex, age, operation time, and liver function tests including total bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, fibrinogen, and lactate dehydrogenase (LDH), which were obtained preoperatively and 24 h, 7 days, and 30 days postoperatively. The statistical hypotheses were tested with a t test, Mann-Whitney test, chi-square test, Friedman test, and Wilcoxon's test. Results There was no statistical difference between the two groups considering age, gender, and operation time (p = 0.740, p = 0.255, and p = 0.480, respectively). There was also no statistical difference in the median values of bilirubin, AST, GGT, LDH, albumin, and fib
Materia …, 2010
In last 10 years of colorectal surgery the most important role of serial measurement of CEA and C... more In last 10 years of colorectal surgery the most important role of serial measurement of CEA and CA 19-9 tumor markers level is possibility for detection of recidives or metastasis of colorectal carcinoma. Even thought that this role is the most important, role of measurement of serum level of CEA and Ca 19-9 before surgery is a subject of discussion. The goal of this examination was proof that correlation between CEA and CA 19-9 serum level before surgery and stage of colorectal carcinoma after surgery exist.This study was undertaken as a review of a group of 102 patients with colorectal carcinoma. Serum levels of CEA and CA 19-9 in this patients were measured before surgery. After the surgery, this levels results were analyzed comparing with Dukes stage, stage of histological differentiation of carcinomas and number of liver metastasis. Average tumor markers levels of CEA was 44,59 μg/ml. Average level of CA 19-9 was 258,8696 U/ml. In our group of patients we found high level of CEA in 74,51 % of them. High level of serum CA 19-9 was in 39,22 % of patients. Four patients had A Dukes stage of disease, 13 of them had B1 stage, 32 B2, 7 C1 and 12 of them had D stage of Dukes classification. Analysis of outcome results show that high statistical signification in correlation between CEA and CA 19-9 levels and stage of layer colon wall invasion exist as same as correlation between CEA and CA 19-9 level and stage of Dukes classification. There is not significant correlation between CEA and CA 19-9 level and level of histological differentiation. It was 12 patients with liver metastasis. High level of CEA and CA 19-9 tumor markers is truly important predictor for presents of liver metastasis. There is a high statistically significant correlation between serum level of CEA and CA 19-9 tumor markers before surgery and increasing level stage of colorectal carcinoma.
Scandinavian Journal of Medicine & Science in Sports, 2011
The aim of this study was to describe qualitatively and quantitatively dietary supplements (DS) a... more The aim of this study was to describe qualitatively and quantitatively dietary supplements (DS) and medication use in elite athletes. Athletes (n=912; age 23.9±6 years; 72% male) reported medications and DSs taken within 3 days before doping control. We analyzed data collected from 2006 to 2008, indentified and classified substances. Total of 74.6% athletes reported use of at least one substance, 61.2% took DS (3.17 per user) and 40.6% took medications. Among users, 21.2% reported the use of six and more different products, and one took 17 different products at the same time. Majority of medication users took non‐steroidal anti‐inflammatory drugs (NSAID) (24.7%), and 22.2% used more than one NSAID. We found no gender differences in DS use (P=0.83). Individual sport athletes used more DS (P<0.01). Our study showed widespread use of DS and drugs by elite athletes. Consumption of DS with no evident performance or health benefits, demonstrated the need for specific educational progra...
Medicus, 2004
Iz u èa va nje mul ti plih kar ci no ma ko lo na i rek tu ma ima veli ki kli niè ki i prak tiè ni... more Iz u èa va nje mul ti plih kar ci no ma ko lo na i rek tu ma ima veli ki kli niè ki i prak tiè ni znaèaj. Sma tra se da 15% svih malig nih tu mo ra u or ga ni zmu èo ve ka i oko 60 od sto svih inte sti nal nih kar ci no ma na sta je na ko lo nu i rek tu mu. Po sle obo le va nja ko že, naj ve aea uèe sta lost mul ti plih kar ci no ma za stu plje na je na ko lo nu i rek tu mu.(1,2) Uèe sta lost mul tiplih kar ci no ma ko lo na i rek tu ma, pre ma po da ci ma iz li t e ra tu re, kre aee se od dva do pet od sto, a po ne kim auto ri ma i do se dam (Tra vi e so 1972. i Eke lund 1974).(3,4) Pr ve nala ze o mul ti plim kar ci no mi ma de be log cre va da li su Czerny 1880. i Fen ger 1888. go di ne. Bil lroth je 1879. dao pr vu de fi ni ci ju ko lo rek tal nih mul ti plih kar ci no ma. Po li po za ko lo na i rek tu ma stva ra pre di spo zi ci ju za na stanak mul ti plih me ta hro nih kar ci no ma, a bo le sti po put fa-mi li jar ne po li po ze, Gard ne ro vog sin dro ma i Tor cu to vog sin dro ma naj èeš aea su obo lje nja kod po ja ve me ta hro nih kar ci no ma.(5,6) Me ta hro ni mul ti pli kar ci no mi su ko lorek tal ni kar ci no mi ko ji se ot kri va ju naj ma nje šest me se ci po sle re sek ci je pri mar nog tu mo ra, a iz meðu ra ni je ana stomo ze i no vo na sta log tu mo ra po sto ji in takt na mu ko za creva. Kla si fi ka ci ju mul ti plih kar ci no ma ko lo na i rek tu ma izvr šio je Mo er tel 1958. go di ne.(7) Cilj ove stu di je je utvrði va nje uèe sta lo sti me ta hro nih karci no ma ko lo na i rek tu ma, za tim do mi nant nih lo ka li za ci ja me ta hro nih kar ci no ma, kao i du ži na pre ži vlja va nja pa ci jena ta s mul ti plim me ta hro nim kar ci no mi ma ko lo na i rektu ma.
Sazetak-Karcincid tumori su cest: tumori gastrointestinalnog trakta. ali se veoma retko javljaju ... more Sazetak-Karcincid tumori su cest: tumori gastrointestinalnog trakta. ali se veoma retko javljaju na pankrcasu. Nespecificna klinicka slika kod velikog broja pacijenata sa karcinoidom pankreasa odgovorna je za kasno operativno resavanje vee uznapredovalih turnora i veoma nisku stopu pctogodisnjeg prczivljavanja od 5a1110 28.9%±16%. Analizirajuci slucaj 69 godina stare pacijcntkinje operisane zbog karcinoida tela pankreasa, vidimo da karcinoidi na ovoj lokalizaciji 1110gU dostici velike dimcnzijc od prcko 7 em u precniku, a da ne daju nikakve preoperativne simptome. lntraoperativno u ovorn stadijumu bolesti pacijenri Ll preko 60% slucajeva vee imaiu udaljene metastaze u limfne noduse iii jetru. Kod operisane pacijcntkinje ucinjena je distalna hemipankrcatektornija liZ rcgionalnu limfadenektomiju celijacnih, hepaticnih i lienalnih limfnih nodusa bez znakova za metastatske promene na jctri, Dijagnoza karcinoida postavljena je postoperativnom histopatoloskom i imunohistohcmijskorn analizom preparata, Hirurski tretman je dorninantni nacin lecenja karcinoida pankreasa. koji daje sanse za bolji ishod leccnja i duzc pctogodisnje prezivljavanje.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The prediction of outcome for patients with gastric cancer is determined largely by the presence ... more The prediction of outcome for patients with gastric cancer is determined largely by the presence of lymph node metastases, which could be detected by sentinel lymph node (SLN) biopsy (SLNB). The purpose of this work was to determine the feasibility of SLNB in patients with gastric cancer for the assessment of regional lymph node status, including performing immunohistochemical (IHC) staining of SLN tissue. We reviewed 137 consecutive patients with operable gastric cancer over a 10-year period using a retrospective (to examine skip metastases) and prospective (to evaluate successful mapping) study design. SLNs were mapped, biopsied and subsequently explored by routine hematoxylin & eosin (H&E) staining and by IHC staining using a cytokeratin 8/18 antibody. The retrospective study showed a low incidence of skip metastases (3.7%). Mapping of SLNs in the prospective study was highly successful (98.2%). During the prospective study, IHC examination of SLNs from 56 patients showed statist...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
In contrast to other thyroid carcinomas it is difficult to establish a correct preoperative diagn... more In contrast to other thyroid carcinomas it is difficult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predictive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thyroid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxyphile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diameter >30 mm were significantly more frequent in patients with oxyphile carcinoma ...
Clinical Physiology and Functional Imaging, 2015
There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of ... more There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of sympaticovagal balance. It is also used in prescription and monitoring of athletic training. The purpose of our study was to determine HRR after maximal exercise among elite athletes with respect to age. A total of 274 elite male Caucasian athletes were randomly selected from the larger sample and divided into two groups: adolescent (group Y) and adult athletes (≥18 years; group A). They performed maximal cardiopulmonary exercise testing on a treadmill. Heart rate recovery was calculated as the rate of decline of HR from peak exercise to rates 1, 2 and 3 min after cessation of exercise (HRR1, HRR2 and HRR3). A significantly higher HRR1 was found in group A (29Á5 AE 15Á6 versus 22Á4 AE 10Á8, P<0Á001), but HRR3 was higher in group Y (82Á7 AE 10Á2 versus 79Á9 AE 12Á25; P = 0Á04). Stepwise multivariate linear regression analysis showed that, among all subjects, the HRR1 alone was independently associated with age (P<0Á001). The maximal oxygen consumption (VO 2 max) was in a negative relationship with HRR1 and in a positive one with HRR3 (P<0Á05) with respect to all athletes. The HRR during 3 min postexercise should be reported for the purpose of better assessing functional adaptation to exercise among elite athletes as well as the ageassociated differences in recovery. Higher values of HRR1 should be expected in older athletes, and HRR3 could be used as an index of aerobic capacity, irrespective of age.
General physiology and biophysics, 2009
Body mass index (BMI) is widely used as an index of obesity in adults. In trained population, ind... more Body mass index (BMI) is widely used as an index of obesity in adults. In trained population, individual with low body fat could be classified as overweight by BMI. To evaluate this problem, the purposes of this study were to determine the BMI and body fat percentage (BF%) of trained and untrained subjects and to evaluate the accuracy of BMI classification (> or =25 kg.m(-2)) as a prediction of overweight/obesity in trained subjects. The total number of 299 trained (basketball players) and 179 untrained male subjects participated in this study. Body height and body mass were measured; BMI was calculated for all subjects. BF% was determined via Tanita bioimpedance body composition analyzer. BMI >or = 25 kg.m(-2) and BF% > 20% were used to define overweight. There was no significant age differences. Body mass, height (p < 0.01) and BMI (p < 0.05) were significantly higher, although BF% was significantly lower (p < 0.01) in trained group when compared to untrained. Ei...
Srpski arhiv za celokupno lekarstvo, 2012
Introduction. Specific morphological and functional characteristics of athletes have a significan... more Introduction. Specific morphological and functional characteristics of athletes have a significant role in determining athletes? sports results and can be also used to assess the athlete?s individual potential. Objective. The aim of the study was to compare anthropometric characteristics and cardiovascular parameters in trained subjects to those of untrained subjects. Methods. A total number of 25 trained (17.30?0.83 years) and 21 (18.52?1.52 years) untrained male subjects participated in this study. Body weight and height were measured and these values were used to compute body mass index (BMI). The bioelectrical impedance analysis (BIA) method was used to estimate body fat percentage (%BF). Cardiovascular parameters were monitored in rest (rest heart rate, systolic and diastolic blood pressure) during ergospirometric testing (maximal oxygen consumption, maximal heart rate) and in recovery (heart rate in the first and third minute of recovery). Results. Body mass, height and BMI (p...
AIM The purpose of this prospective study was to highlight some new findings about anatomical and... more AIM The purpose of this prospective study was to highlight some new findings about anatomical and morphological variations of the thyroid pyramidal lobe and to emphasise the necessity and importance of exploration of the visceral compartment of the neck and resection of this structure in primary thyroid operations. METHOD We analysed 100 consecutive primary thyroid operations with additional pathological examination of the specimens. RESULTS A pyramidal lobe was found in 61% of the cases. The lobe of Lalouette was found more often in women (61.96%) than in men (50%) and more often (67.3%) in patients less than 50 years old than in those older than 50 (54.2%). The lobe branched off more frequently from the midline (49.18%) than from other parts of the isthmus; its length ranged from 8 - 40 mm, with a median length of 20.13 mm. In diffuse thyroid diseases, the lobes were always pathologically involved and significantly longer. CONCLUSION Since the pyramidal lobe is a normal component ...
Medicinski pregled
Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tr... more Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality. In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 year old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST. In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment. The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.
Medicinski pregled
Formation of lymphatic metastasis is an important prognostic factor in treatment of gastric carci... more Formation of lymphatic metastasis is an important prognostic factor in treatment of gastric carcinoma. In this paper we would like to point to the importance of systematic lymphadenectomy in regard to extent of metastatic lymph node involvement in patients with gastric carcinoma. This investigation included 114 patients with diagnosis of gastric carcinoma undergoing systematic lymphadenectomy. We analyzed metastatic lymph node involvement considering: 1. tumor localization; 2. histopathologic type; 3. depth of tumor invasion; 4. extent of lymph node resection; 5. stage of disease. In the course of this study, 2100 lymph nodes were extracted by systematic lymphadenectomy (18.42 lymph nodes per patient on average). Out of this number, about 27% of lymph nodes were involved with metastasis, and 60% of positive lymph nodes belonged to the first, 25.7% to the second, 10.2% to the third and 3.8% to the fourth drainaged group. The most frequent localization (over 56%) of tumors was the distal third region of stomach. Histopathologically, most common type of carcinoma was intestinal carcinoma, with metastasis in first and second drainage group. A great number of patients have tumors with infiltration of the serosa. Those patients had metastases in lymph nodes in over 42%. Most patients (58%) belonged to IV stage of disease and presented with highest number of involved metastatic lymph nodes in all drainage groups. In our patients high metastatic involvement of all four drainage groups of lymph nodes was established. Up to date standard lymphadenectomy (D1) which has been performed increased the length of survival of these patients. By systematic lymphadenectomy we removed a great number of metastatic lymph nodes with beneficial effect on survival of patients with gastric carcinoma.
Medicinski pregled
Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis... more Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Common bile duct calculi represent a common disease of the digestive system. Endosco...
Srpski arhiv za celokupno lekarstvo, 2015
Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the... more Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors.The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8x5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.