Nebojsa Mitrović - Academia.edu (original) (raw)

Papers by Nebojsa Mitrović

Research paper thumbnail of Clinical application of sentinel lymph node biopsy for staging, treatment and prognosis of colon and gastric cancer

Hepato-gastroenterology, Nov 1, 2009

We want to estimate the feasibility of lymphatic marking and clinical significance of sentinel no... more We want to estimate the feasibility of lymphatic marking and clinical significance of sentinel node biopsy for colon and gastric cancer. The goal of the present article is to contribute to surgical treatment individualization and early discovering of micro-metastases for digestive system carcinomas using a sentinel node biopsy. The prospective clinical trail included 116 operated patients, 60 with colon cancer, and 56 with gastric cancer admitted to Surgery Clinic "dr Dragisa Misovic" in Belgrade. Sentinel lymph-node mapping is being performed by subserous injection 1% of Lymphazurin.(colon "ex vivo", and gastric "in vivo"). Ultra-staging by immunohistochemical analysis was performed in those SLN which did not have metastases (stained with standard H-E method- negative). Then, these results were analyzed and correlated with lymphonodal status and clinicopathological factors. Sentinel lymph nodes (SLN) were successfully identified in 58 (96.64%) cases of colon cancer and 100% in cases of gastric cancer. Total number of identified SLN accounted for 428, of which 232 (4.14 per patient) for colon, and 196 (3, 54 per patient) for gastric cancer. Aberrant lymph drainage is more frequent in colon cancer (23.8%) than in gastric (14.3%). In 26 cases with metastases negative colon SLN immunohistochemical (IHC) analysis was done, and in 26.9% micro-metastases were present. When it comes to gastric cancer 62.5% (128.4) SLN were metastatically changed, and metastases were found in non-SLN only in cases when SLN were positive, which means that…

Research paper thumbnail of Thromboembolic complications in patients with COVID-19 - experiences of the General Surgery Department of Zemun Clinical Hospital Center

Srpski arhiv za celokupno lekarstvo

Introduction/Objective. More than three years have passed since the discovery of the new virus st... more Introduction/Objective. More than three years have passed since the discovery of the new virus strain SARS-CoV-2, and the virus is still a challenge for all medical specialties. One of the most important characteristics is the tendency to develop thromboembolic complications, which are often lethal. The aim of this paper is to present the experience of the General Surgery Department of the Zemun Clinical Hospital Centar in the surgical treatment of patients with thromboembolic complications. Methods. The research was conceived as a retrospective study conducted in the period from March 2020 to March 2021. A total of 42 patients participated in the study and were divided into a group diagnosed with small and large bowel ischemia and a group diagnosed with acute limb ischemia. Results. In both groups, males were predominantly represented. The first group consisted of nine patients, all of whom had a clinical finding of acute abdomen and ileus, while seven of them also had a severe com...

Research paper thumbnail of Adenocarcinoma of the duodenojejunal flexure: our recent experience

European Surgery-acta Chirurgica Austriaca, Feb 1, 2023

Research paper thumbnail of Angiosarcoma of the caecum

Srpski arhiv za celokupno lekarstvo

Introduction. Primary angiosarcomas arising from the digestive system are rare, representing less... more Introduction. Primary angiosarcomas arising from the digestive system are rare, representing less than 1% percent of the malignant sarcomas. Only a few cases have been reported in the literature. Colorectal involvement is exceedingly uncommon and is a harbinger of a poor prognosis with widespread metastasis. Diagnosis is often delayed due to non-specific symptoms and pathology which mimics other tumors. Case outline. A 52-year-old woman was presented to the emergency room in July 2021, complaining of protracted malaise, and rapid fatigue and occasional sweating. Multislice computed tomography (MSCT) of the abdomen and small pelvis revealed the existence of lobular, well vascularized, supravesical lesion, located along the anterior contour of the uterine corpus, in the convolutes of the small intestine. The patient was subjected to operative treatment with curative intent. Intraoperatively, a completely tumor-altered caecum was verified Standard histopathological examination demonstr...

Research paper thumbnail of Difference in Predictors of Anastomotic Leakage Depending on the Level of Anastomosis after Colorectal Cancer Surgery

Acta Clinica Croatica, 2021

-Anastomotic leak (AL) after colorectal cancer surgery is one of the most serious postoperative c... more -Anastomotic leak (AL) after colorectal cancer surgery is one of the most serious postoperative complications which has major impact on outcomes. The aim of this study was to investigate preoperative and intraoperative risk factors for AL, as well as to examine whether there are differences in risk factors for AL depending on the primary tumor location. We retrospectively reviewed records of patients having undergone colorectal surgical procedures for malignancies between January 2013 and December 2017 in a single institution. Only procedures with primary anastomosis were included. Of the 153 patients, AL occurred in 10.6% of patients with primary tumor in the sigmoid colon and rectum, and in 8.2% of patients with primary tumor in the proximal sections of the colon. On univariate analysis, delayed oral intake and more advanced histologic stages of the tumor were significantly correlated with AL in patients with tumors in the sigmoid colon and rectum, and multiorgan resection and distant metastases in patients with tumors in the proximal sections of the colon. In conclusion, risk factors for the occurrence of AL vary depending on the primary tumor location and further investigation is needed to provide better insight into these differences.

Research paper thumbnail of Anastomotic leak after colorectal cancer surgery - risk factors in 21thcentury

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2020

PURPOSE The purpose of our study was to investigate preoperative and intraoperative risk factors ... more PURPOSE The purpose of our study was to investigate preoperative and intraoperative risk factors for anastomotic leak (AL) after elective colorectal resections performed for malignancies. In addition, we studied some features of postoperative recovery and their influence on AL occurrence. METHODS We retrospectively reviewed the records of patients that underwent colorectal surgical procedures for malignancies between January 2013 and December 20017 in a single institution. Only procedures with primary anastomosis were included. RESULTS Of the 153 patients, 56.2% were male. The mean age was 67.5 years. AL occurred in 15 patients (9.8%). In univariate analysis, multiorgan resection, delayed postoperative bowel movement and delayed onset of per oral intake were significantly correlated with AL. Gender, preoperative albumin level, primary cancer site and surgery duration did not have significant correlation with AL. CONCLUSIONS Risk factors described in the literature of the 20th centur...

Research paper thumbnail of Clinical significance of neoangiogenesis and index of proliferation in the signet ring type of gastric adenocarcinoma

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2018

PURPOSE The purpose of this study was to examine whether microvascular density and the level of p... more PURPOSE The purpose of this study was to examine whether microvascular density and the level of proliferation in gastric signet ring cell carcinoma (SRCC) are important factors in the locoregional control of the disease. METHODS Over a period of eight years, gastric resection specimens from 37 patients were examined. The proliferative index (labelled by Ki67) and microvascular density (MVD) index (mvdIDX) (labelled by CD105) were determined for each case of SRCC. RESULTS Gastric SRCC was diagnosed more often in female than in male patients (21 females, 16 males ; p≤0.05) . The average age of female patients was 63 years, while the male patients were 62 years old on average (p=0.702). Immunohistochemical analysis showed that the median numbers of Ki67 positive cells and CD105 positive blood vessels were higher in tumors compared to surrounding non-tumor tissue. Higher proliferative index and higher mvdIDX were also established relative to tumor stage. Correlation analysis showed a hi...

Research paper thumbnail of Laparoscopic management of a giant simple hepatic cyst

Introduction: Congenital simple hepatic cysts are extremely rare and are usually asymptomatic. Th... more Introduction: Congenital simple hepatic cysts are extremely rare and are usually asymptomatic. The best therapeutic approach to treating simple liver cysts remains the subject of scientific debate. Case report: We present the case of a giant liver cyst removed with a minimally invasive, laparoscopic approach in a 68-year-old woman, who presented with rapid weight loss. Conclusion: Due to the lack of randomized clinical trials comparing minimally invasive (laparoscopic) and open surgery approaches in liver cyst treatment, we recommend a personalized medical approach, applied after analyzing the characteristics of both the cyst and the patient.

Research paper thumbnail of The importance of laparoscopic surgery for early postoperative course in patients with colorectal carcinoma

Srpski arhiv za celokupno lekarstvo, 2021

Introduction/Objective. The aim of our study was to compare early postoperative recovery in patie... more Introduction/Objective. The aim of our study was to compare early postoperative recovery in patients operated on using laparoscopically assisted and open method in colorectal carcinoma surgery. Methods. The study involved 60 patients, divided into two groups of 30 patients each, treated with open or laparoscopically assisted colorectal surgery. Three groups of factors were collected and analyzed for all the patients. The first group of factors were as follows: age, sex, the American Society of Anesthesiologists score, preoperative hemoglobin, localization. The second group of factors were the following: intraoperative complications, the duration of operations, blood and blood derivatives? compensation. The third group were as follows: complications, length of stay in intensive care, rate of peristaltic establishment, and the time needed for unobstructed oral intake, number of hospitalization days, analgesic use, and verticalization time. Results. The patients who underwent laparosco...

Research paper thumbnail of The role of surgeons during the COVID-19 pandemic: The experience of the Surgery Clinic of the Clinical Hospital Center 'Zemun

Srpski medicinski casopis Lekarske komore, 2021

Introduction: In December 2019, the existence of a new type of disease, caused by SARS coronaviru... more Introduction: In December 2019, the existence of a new type of disease, caused by SARS coronavirus 2 (SARS-CoV-2), was discovered in the city of Wuhan, the Republic of China. The disease itself is characterized by a large number of patients with moderate and severe clinical presentation, who require hospital treatment. The organization of the healthcare system of Serbia, during the aforementioned pandemic, has required the engagement of all doctors, regardless of their specialty, in the treatment of patients with COVID-19. Surgeons of all branches, from the Surgery Clinic of the Clinical Hospital Center Zemun, were directly engaged in the treatment of both primary manifestations of the virus and the numerous surgical complications arising in the wake of this disease, but also in the treatment of primary acute surgical diseases in COVID-19-positive patients. Aim: The aim of this paper is to present the functioning of the Surgery Clinic of CHC Zemun, in the conditions of the COVID-19 ...

Research paper thumbnail of A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Srpski arhiv za celokupno lekarstvo, 2021

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually as... more Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission to the surgical emergency room. The CT scan promptly demonstrated rupture of a large retroperitoneal hematoma with massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurys...

Research paper thumbnail of Reduced Expression of Autophagy Markers and Expansion of Myeloid-Derived Suppressor Cells Correlate With Poor T Cell Response in Severe COVID-19 Patients

Frontiers in Immunology, 2021

Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failur... more Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failure in susceptible individuals. Dysregulated immune response marks severe COVID-19, but the immunological mechanisms driving COVID-19 pathogenesis are still largely unknown, which is hampering the development of efficient treatments. Here we analyzed ~140 parameters of cellular and humoral immune response in peripheral blood of 41 COVID-19 patients and 16 age/gender-matched healthy donors by flow-cytometry, quantitative PCR, western blot and ELISA, followed by integrated correlation analyses with ~30 common clinical and laboratory parameters. We found that lymphocytopenia in severe COVID-19 patients (n=20) strongly affects T, NK and NKT cells, but not B cells and antibody production. Unlike increased activation of ICOS-1+ CD4+ T cells in mild COVID-19 patients (n=21), T cells in severe patients showed impaired activation, low IFN-γ production and high functional exhaustion, which correlate...

Research paper thumbnail of Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

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...

Research paper thumbnail of SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

Research paper thumbnail of Osseous metaplasia in an inflammatory polyp of the anal canal: A case report and a review of literature

Srpski arhiv za celokupno lekarstvo, 2019

Introduction. Osseous metaplasia is a heterotopic formation of bone and its appearance in benign ... more Introduction. Osseous metaplasia is a heterotopic formation of bone and its appearance in benign gastrointestinal polyps is exceedingly rare. The mechanism responsible for this type of metaplasia is not fully understood, however it seems to be an innocent rare phenomenon. Case outline. We present a case of a 31-year-old male with mesenchimal osseal metaplasia in a large inflamatory polyp measuring 57 ? 23 ? 20 mm in diameter, located in the anal canal region. Conclusion. According to our knowledge, this is the largest gastrointestinal polyp with osseous metaplasia described so far. Although a rare phenomenon, there are certain characteristics of this disease, so we conducted a literature review and summarized these characteristics.

Research paper thumbnail of P-0235 * Individualization of Surgical Treatment for Digestive Carcinoma Based on Sentinel Lymph Node Biopsy

Research paper thumbnail of Laparoscopic gastric wedge resection as the method of choice in the treatment of gastrointestinal stromal tumors: A case report

Srpski arhiv za celokupno lekarstvo, 2016

Introduction. The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors... more Introduction. The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The surgery of resectable gastric GIST is the primary therapy for these tumors, but the decision regarding the surgical radicality of the procedures is still a point of discussion among surgeons and oncologists. Case Outline. A 74-year-old patient was admitted to hospital with signs of bleeding from the upper parts of the gastrointestinal tract. Urgent gastroscopy was performed and a subepithelial gastric lesion with bleeding ulceration was noted in the region of the fornix. A computed tomography scan of the abdomen showed a tumor in the fornix region with the dimensions of 48 ? 32 mm, which was growing mostly intraluminally. After an adequate preoperative preparation the patient underwent a laparoscopic wedge resection of gastric fornix with intramural tumor lesion. The histopathological analysis of the specimen showed a well differentiated GIST (histolog...

Research paper thumbnail of The feasibility of sentinel lymph node biopsy for gastric cancer: the experience from Serbia

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...

Research paper thumbnail of Malignant giant cell type fibrohistiocitom of the abdominal wall

Research paper thumbnail of Dietary supplements and medications in elite sport – polypharmacy or real need?

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...

Research paper thumbnail of Clinical application of sentinel lymph node biopsy for staging, treatment and prognosis of colon and gastric cancer

Hepato-gastroenterology, Nov 1, 2009

We want to estimate the feasibility of lymphatic marking and clinical significance of sentinel no... more We want to estimate the feasibility of lymphatic marking and clinical significance of sentinel node biopsy for colon and gastric cancer. The goal of the present article is to contribute to surgical treatment individualization and early discovering of micro-metastases for digestive system carcinomas using a sentinel node biopsy. The prospective clinical trail included 116 operated patients, 60 with colon cancer, and 56 with gastric cancer admitted to Surgery Clinic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;dr Dragisa Misovic&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in Belgrade. Sentinel lymph-node mapping is being performed by subserous injection 1% of Lymphazurin.(colon &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;ex vivo&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, and gastric &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;in vivo&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;). Ultra-staging by immunohistochemical analysis was performed in those SLN which did not have metastases (stained with standard H-E method- negative). Then, these results were analyzed and correlated with lymphonodal status and clinicopathological factors. Sentinel lymph nodes (SLN) were successfully identified in 58 (96.64%) cases of colon cancer and 100% in cases of gastric cancer. Total number of identified SLN accounted for 428, of which 232 (4.14 per patient) for colon, and 196 (3, 54 per patient) for gastric cancer. Aberrant lymph drainage is more frequent in colon cancer (23.8%) than in gastric (14.3%). In 26 cases with metastases negative colon SLN immunohistochemical (IHC) analysis was done, and in 26.9% micro-metastases were present. When it comes to gastric cancer 62.5% (128.4) SLN were metastatically changed, and metastases were found in non-SLN only in cases when SLN were positive, which means that…

Research paper thumbnail of Thromboembolic complications in patients with COVID-19 - experiences of the General Surgery Department of Zemun Clinical Hospital Center

Srpski arhiv za celokupno lekarstvo

Introduction/Objective. More than three years have passed since the discovery of the new virus st... more Introduction/Objective. More than three years have passed since the discovery of the new virus strain SARS-CoV-2, and the virus is still a challenge for all medical specialties. One of the most important characteristics is the tendency to develop thromboembolic complications, which are often lethal. The aim of this paper is to present the experience of the General Surgery Department of the Zemun Clinical Hospital Centar in the surgical treatment of patients with thromboembolic complications. Methods. The research was conceived as a retrospective study conducted in the period from March 2020 to March 2021. A total of 42 patients participated in the study and were divided into a group diagnosed with small and large bowel ischemia and a group diagnosed with acute limb ischemia. Results. In both groups, males were predominantly represented. The first group consisted of nine patients, all of whom had a clinical finding of acute abdomen and ileus, while seven of them also had a severe com...

Research paper thumbnail of Adenocarcinoma of the duodenojejunal flexure: our recent experience

European Surgery-acta Chirurgica Austriaca, Feb 1, 2023

Research paper thumbnail of Angiosarcoma of the caecum

Srpski arhiv za celokupno lekarstvo

Introduction. Primary angiosarcomas arising from the digestive system are rare, representing less... more Introduction. Primary angiosarcomas arising from the digestive system are rare, representing less than 1% percent of the malignant sarcomas. Only a few cases have been reported in the literature. Colorectal involvement is exceedingly uncommon and is a harbinger of a poor prognosis with widespread metastasis. Diagnosis is often delayed due to non-specific symptoms and pathology which mimics other tumors. Case outline. A 52-year-old woman was presented to the emergency room in July 2021, complaining of protracted malaise, and rapid fatigue and occasional sweating. Multislice computed tomography (MSCT) of the abdomen and small pelvis revealed the existence of lobular, well vascularized, supravesical lesion, located along the anterior contour of the uterine corpus, in the convolutes of the small intestine. The patient was subjected to operative treatment with curative intent. Intraoperatively, a completely tumor-altered caecum was verified Standard histopathological examination demonstr...

Research paper thumbnail of Difference in Predictors of Anastomotic Leakage Depending on the Level of Anastomosis after Colorectal Cancer Surgery

Acta Clinica Croatica, 2021

-Anastomotic leak (AL) after colorectal cancer surgery is one of the most serious postoperative c... more -Anastomotic leak (AL) after colorectal cancer surgery is one of the most serious postoperative complications which has major impact on outcomes. The aim of this study was to investigate preoperative and intraoperative risk factors for AL, as well as to examine whether there are differences in risk factors for AL depending on the primary tumor location. We retrospectively reviewed records of patients having undergone colorectal surgical procedures for malignancies between January 2013 and December 2017 in a single institution. Only procedures with primary anastomosis were included. Of the 153 patients, AL occurred in 10.6% of patients with primary tumor in the sigmoid colon and rectum, and in 8.2% of patients with primary tumor in the proximal sections of the colon. On univariate analysis, delayed oral intake and more advanced histologic stages of the tumor were significantly correlated with AL in patients with tumors in the sigmoid colon and rectum, and multiorgan resection and distant metastases in patients with tumors in the proximal sections of the colon. In conclusion, risk factors for the occurrence of AL vary depending on the primary tumor location and further investigation is needed to provide better insight into these differences.

Research paper thumbnail of Anastomotic leak after colorectal cancer surgery - risk factors in 21thcentury

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2020

PURPOSE The purpose of our study was to investigate preoperative and intraoperative risk factors ... more PURPOSE The purpose of our study was to investigate preoperative and intraoperative risk factors for anastomotic leak (AL) after elective colorectal resections performed for malignancies. In addition, we studied some features of postoperative recovery and their influence on AL occurrence. METHODS We retrospectively reviewed the records of patients that underwent colorectal surgical procedures for malignancies between January 2013 and December 20017 in a single institution. Only procedures with primary anastomosis were included. RESULTS Of the 153 patients, 56.2% were male. The mean age was 67.5 years. AL occurred in 15 patients (9.8%). In univariate analysis, multiorgan resection, delayed postoperative bowel movement and delayed onset of per oral intake were significantly correlated with AL. Gender, preoperative albumin level, primary cancer site and surgery duration did not have significant correlation with AL. CONCLUSIONS Risk factors described in the literature of the 20th centur...

Research paper thumbnail of Clinical significance of neoangiogenesis and index of proliferation in the signet ring type of gastric adenocarcinoma

Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2018

PURPOSE The purpose of this study was to examine whether microvascular density and the level of p... more PURPOSE The purpose of this study was to examine whether microvascular density and the level of proliferation in gastric signet ring cell carcinoma (SRCC) are important factors in the locoregional control of the disease. METHODS Over a period of eight years, gastric resection specimens from 37 patients were examined. The proliferative index (labelled by Ki67) and microvascular density (MVD) index (mvdIDX) (labelled by CD105) were determined for each case of SRCC. RESULTS Gastric SRCC was diagnosed more often in female than in male patients (21 females, 16 males ; p≤0.05) . The average age of female patients was 63 years, while the male patients were 62 years old on average (p=0.702). Immunohistochemical analysis showed that the median numbers of Ki67 positive cells and CD105 positive blood vessels were higher in tumors compared to surrounding non-tumor tissue. Higher proliferative index and higher mvdIDX were also established relative to tumor stage. Correlation analysis showed a hi...

Research paper thumbnail of Laparoscopic management of a giant simple hepatic cyst

Introduction: Congenital simple hepatic cysts are extremely rare and are usually asymptomatic. Th... more Introduction: Congenital simple hepatic cysts are extremely rare and are usually asymptomatic. The best therapeutic approach to treating simple liver cysts remains the subject of scientific debate. Case report: We present the case of a giant liver cyst removed with a minimally invasive, laparoscopic approach in a 68-year-old woman, who presented with rapid weight loss. Conclusion: Due to the lack of randomized clinical trials comparing minimally invasive (laparoscopic) and open surgery approaches in liver cyst treatment, we recommend a personalized medical approach, applied after analyzing the characteristics of both the cyst and the patient.

Research paper thumbnail of The importance of laparoscopic surgery for early postoperative course in patients with colorectal carcinoma

Srpski arhiv za celokupno lekarstvo, 2021

Introduction/Objective. The aim of our study was to compare early postoperative recovery in patie... more Introduction/Objective. The aim of our study was to compare early postoperative recovery in patients operated on using laparoscopically assisted and open method in colorectal carcinoma surgery. Methods. The study involved 60 patients, divided into two groups of 30 patients each, treated with open or laparoscopically assisted colorectal surgery. Three groups of factors were collected and analyzed for all the patients. The first group of factors were as follows: age, sex, the American Society of Anesthesiologists score, preoperative hemoglobin, localization. The second group of factors were the following: intraoperative complications, the duration of operations, blood and blood derivatives? compensation. The third group were as follows: complications, length of stay in intensive care, rate of peristaltic establishment, and the time needed for unobstructed oral intake, number of hospitalization days, analgesic use, and verticalization time. Results. The patients who underwent laparosco...

Research paper thumbnail of The role of surgeons during the COVID-19 pandemic: The experience of the Surgery Clinic of the Clinical Hospital Center 'Zemun

Srpski medicinski casopis Lekarske komore, 2021

Introduction: In December 2019, the existence of a new type of disease, caused by SARS coronaviru... more Introduction: In December 2019, the existence of a new type of disease, caused by SARS coronavirus 2 (SARS-CoV-2), was discovered in the city of Wuhan, the Republic of China. The disease itself is characterized by a large number of patients with moderate and severe clinical presentation, who require hospital treatment. The organization of the healthcare system of Serbia, during the aforementioned pandemic, has required the engagement of all doctors, regardless of their specialty, in the treatment of patients with COVID-19. Surgeons of all branches, from the Surgery Clinic of the Clinical Hospital Center Zemun, were directly engaged in the treatment of both primary manifestations of the virus and the numerous surgical complications arising in the wake of this disease, but also in the treatment of primary acute surgical diseases in COVID-19-positive patients. Aim: The aim of this paper is to present the functioning of the Surgery Clinic of CHC Zemun, in the conditions of the COVID-19 ...

Research paper thumbnail of A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Srpski arhiv za celokupno lekarstvo, 2021

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually as... more Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission to the surgical emergency room. The CT scan promptly demonstrated rupture of a large retroperitoneal hematoma with massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurys...

Research paper thumbnail of Reduced Expression of Autophagy Markers and Expansion of Myeloid-Derived Suppressor Cells Correlate With Poor T Cell Response in Severe COVID-19 Patients

Frontiers in Immunology, 2021

Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failur... more Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failure in susceptible individuals. Dysregulated immune response marks severe COVID-19, but the immunological mechanisms driving COVID-19 pathogenesis are still largely unknown, which is hampering the development of efficient treatments. Here we analyzed ~140 parameters of cellular and humoral immune response in peripheral blood of 41 COVID-19 patients and 16 age/gender-matched healthy donors by flow-cytometry, quantitative PCR, western blot and ELISA, followed by integrated correlation analyses with ~30 common clinical and laboratory parameters. We found that lymphocytopenia in severe COVID-19 patients (n=20) strongly affects T, NK and NKT cells, but not B cells and antibody production. Unlike increased activation of ICOS-1+ CD4+ T cells in mild COVID-19 patients (n=21), T cells in severe patients showed impaired activation, low IFN-γ production and high functional exhaustion, which correlate...

Research paper thumbnail of Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

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...

Research paper thumbnail of SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

Research paper thumbnail of Osseous metaplasia in an inflammatory polyp of the anal canal: A case report and a review of literature

Srpski arhiv za celokupno lekarstvo, 2019

Introduction. Osseous metaplasia is a heterotopic formation of bone and its appearance in benign ... more Introduction. Osseous metaplasia is a heterotopic formation of bone and its appearance in benign gastrointestinal polyps is exceedingly rare. The mechanism responsible for this type of metaplasia is not fully understood, however it seems to be an innocent rare phenomenon. Case outline. We present a case of a 31-year-old male with mesenchimal osseal metaplasia in a large inflamatory polyp measuring 57 ? 23 ? 20 mm in diameter, located in the anal canal region. Conclusion. According to our knowledge, this is the largest gastrointestinal polyp with osseous metaplasia described so far. Although a rare phenomenon, there are certain characteristics of this disease, so we conducted a literature review and summarized these characteristics.

Research paper thumbnail of P-0235 * Individualization of Surgical Treatment for Digestive Carcinoma Based on Sentinel Lymph Node Biopsy

Research paper thumbnail of Laparoscopic gastric wedge resection as the method of choice in the treatment of gastrointestinal stromal tumors: A case report

Srpski arhiv za celokupno lekarstvo, 2016

Introduction. The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors... more Introduction. The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The surgery of resectable gastric GIST is the primary therapy for these tumors, but the decision regarding the surgical radicality of the procedures is still a point of discussion among surgeons and oncologists. Case Outline. A 74-year-old patient was admitted to hospital with signs of bleeding from the upper parts of the gastrointestinal tract. Urgent gastroscopy was performed and a subepithelial gastric lesion with bleeding ulceration was noted in the region of the fornix. A computed tomography scan of the abdomen showed a tumor in the fornix region with the dimensions of 48 ? 32 mm, which was growing mostly intraluminally. After an adequate preoperative preparation the patient underwent a laparoscopic wedge resection of gastric fornix with intramural tumor lesion. The histopathological analysis of the specimen showed a well differentiated GIST (histolog...

Research paper thumbnail of The feasibility of sentinel lymph node biopsy for gastric cancer: the experience from Serbia

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...

Research paper thumbnail of Malignant giant cell type fibrohistiocitom of the abdominal wall

Research paper thumbnail of Dietary supplements and medications in elite sport – polypharmacy or real need?

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...