Zvonimir Misir - Academia.edu (original) (raw)

Papers by Zvonimir Misir

Background: in the past six months, croatia faced a short lockdown and a slow return to most hosp... more Background: in the past six months, croatia faced a short lockdown and a slow return to most hospitals’ everyday activities During the lockdown, our center, as a part of the university Hospital centre specialized for solid cancer, was enabled to maintain most of the routine practices with the one-month colonoscopy exception Aim: To determine the oscillation in the number of endoscopies and colorectal surgery for 13 months (six months pre and post cOViD-19 lockdown) Materials and methods: From august 1st, 2019, until august 31st 2020, the hospital analytics determine the number of colonoscopies, screening colonoscopies, and surgeries Results: During the given period number of detected and operated colorectal cancers was stable, except for april, when we mostly did not perform colonoscopies Conclusion: We maintained a pre-cOViD-19 pace in colorectal cancer treatment, colonoscopies, and colorectal surgery after epidemiological guidelines for colonoscopies and colorectal surgery were ap...

Bosnian Journal of Basic Medical Sciences, 2021

Gastric cancer is related to high mortality rates and advanced disease stage at the time of diagn... more Gastric cancer is related to high mortality rates and advanced disease stage at the time of diagnosis. Its carcinogenesis is extensively studied and is associated with genetic and epigenetic changes, changed the interaction between tumor and adjacent stromal cells, and changes in the microenvironment molecule status. NEDD9 affects different signaling proteins and pathways, apoptosis, adhesion, cell migration, and invasiveness. Connexin-43 also assists in intercellular communications and has several channel-independent functions. Aberrant expression of those two gap junction proteins plays an essential role in metastatic processes. Our scope was to detect the expression of connexin-43 and NEDD9 in epithelial and stromal gastric cancer compartments and its relation to tumor progression and lymph node metastases. Cancer tissue from 53 cases of node-negative and 55 cases of node-positive primary gastric carcinoma patients was analyzed for connexin-43 and NEDD9 expression by immunohistoc...

Libri Oncologici Croatian Journal of Oncology, 2020

Gastric is considered neglected cancer in terms of stage at diagnosis and success of treatment wo... more Gastric is considered neglected cancer in terms of stage at diagnosis and success of treatment worldwide. Early detection and quality of gastric cancer surgery remain the most important for successful treatment in terms of overall survival. In this paper, we focus on the overview of hospitals and volume of gastric cancer in Croatia as a possible baseline for quality assessment and implementation of existing quality guidelines. We accessed publicly available data from the Croatian Insurance Fund for the period between 1st January 2013 to 31st December 2018. For background information on gastric cancer incidence and mortality, we used Croatian Cancer Registry data available online. We obtained both the number of resected gastric cancer in all Croatian hospitals as well as the length of stay. Data analysis discovered that there is a clear volume difference between teaching hospitals and non-teaching hospitals; only the first have sufficient volume for quality audit. This overview stresses one of the most critical points in cancer surgery, volume of surgery as a quality indicator.

Libri Oncologici Croatian Journal of Oncology, 2019

Gastric cancer is a 'neglected cancer,' with significant incidence (over 900 cases annually) and ... more Gastric cancer is a 'neglected cancer,' with significant incidence (over 900 cases annually) and late-stage at the time of diagnosis in Croatia. Even in resectable cases, risk of malnutrition is high, and malnutrition-related to malignant disease presents a substantial problem in terms of compliance with treatment and complications during surgery. We retrospectively reviewed the patient records for patients operated for gastric cancer from January until December 2018. Data on sex, age, body mass index (BMI), complete preoperative blood count, postoperative recovery, and subsequent bioelectrical impedance analysis (BIA) measurements (preoperatively, on days 7, 14 and 30) were collected. All patients received nutritional support according to the Enhanced Recovery After Surgery (ERAS). Twenty-seven patients were operated for gastric cancer, eight were resected with curative intent (four total gastrectomies, one total gastrectomy with splenectomy, three distal gastrectomies and one local excision). Seven patients who had a resection were included in the perioperative nutritional protocol. All patients scored at risk according to Nutrition Score 2002 (NS2002). Two patients had tolerable initial BMIs and BIAs, only one patient with extremely low BMI and BIA had prolonged intensive care unit (ICU) stay and difficulties with peroral nutrition. Only the patients with tolerable initial values recovered those values postoperatively in the observed period but did not improve. Lean body mass is lost before surgery, and in the early postoperative period, it takes up to 3 months to compensate. However, in the late stage of the disease, routine ERAS nutritional protocol seems not to be enough. Perhaps, in gastric cancer, a more aggressive parenteral perioperative nutrition might be an option.

Acta clinica Croatica, 2013

According to AO classification, 33-C3 (complete articular multifragmentary) fracture of distal fe... more According to AO classification, 33-C3 (complete articular multifragmentary) fracture of distal femur is characterized by complex articular involvement, along with short distal femoral block with multiple small fragments and usually with severe soft tissue abruption. In such cases of complex articular fracture of distal femur with extensive comminution of the femur condyle that is often seen in these fractures, anatomical reduction is quite difficult. Minimal fixation strategies sometimes do not provide an optimal degree of reduction and stability of the distal femoral block osteosynthesis. We describe 5 cases of treatment of the 33-C3 distal femoral fractures using arthrotomy of the knee joint by osteotomy of the distal pole of the patella and internal fixation with basket plate as an alternative approach for anatomical reduction of the comminuted articular surface.

Acta clinica Croatica, 2013

Despite recent advances in operative techniques, internal fixation of (3- and 4-part) displaced p... more Despite recent advances in operative techniques, internal fixation of (3- and 4-part) displaced proximal humeral fractures in elderly patients with osteoporotic bone remains controversial, sometimes followed by poor results. The aim of the present study was to evaluate outcomes of internal fixation with locking plate of multi-fragment proximal humeral fractures in elderly patients. The study cohort comprised 59 consecutive patients (mean age 70.1) with 3- and 4-part fractures who had undergone open reduction and internal fixation with locked plate at Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients were invited for follow-up examinations and underwent standard x-ray examination preoperatively to assess fracture pattern in the operating theatre as well as at 6 weeks, 3 and 6 months, 1 year, and then annually after surgery to assess fracture healing or complications. Clinical outcomes were measured by constant score. Patients were followed-up for 14 to 36...

Journal of Endourology, 2000

Background and Purpose: Laparoscopic surgery for adrenal gland tumors is the gold standard operat... more Background and Purpose: Laparoscopic surgery for adrenal gland tumors is the gold standard operative approach now. Adrenal-sparing surgery has special indications. We demonstrated the safety and feasibility of performing adrenal-sparing surgery by means of laparoscopy for aldosterone-producing adenoma (Conn's syndrome). Patients and Methods: Between 1995 and 1999, seven patients with Conn's syndrome had laparoscopic adrenal-sparing resection of their tumors. These patients were followed up by means of radiology and biochemistry. Results: All seven patients had successful laparoscopic surgery without complications. Most patients were discharged in 2 to 6 days (mean 3 days). At follow-up, the six patients investigated had normal blood pressure. No recurrences have been encountered with a median follow-up of 12 months in these six patients. Conclusions: Adrenal-sparing resection of tumors causing primary hyperaldosteronism is technically feasible by means of laparoscopy. This procedure has the advantage of keeping a greater reserve of normal adrenal tissue and of rapid postoperative recovery.

Background: in the past six months, croatia faced a short lockdown and a slow return to most hosp... more Background: in the past six months, croatia faced a short lockdown and a slow return to most hospitals’ everyday activities During the lockdown, our center, as a part of the university Hospital centre specialized for solid cancer, was enabled to maintain most of the routine practices with the one-month colonoscopy exception Aim: To determine the oscillation in the number of endoscopies and colorectal surgery for 13 months (six months pre and post cOViD-19 lockdown) Materials and methods: From august 1st, 2019, until august 31st 2020, the hospital analytics determine the number of colonoscopies, screening colonoscopies, and surgeries Results: During the given period number of detected and operated colorectal cancers was stable, except for april, when we mostly did not perform colonoscopies Conclusion: We maintained a pre-cOViD-19 pace in colorectal cancer treatment, colonoscopies, and colorectal surgery after epidemiological guidelines for colonoscopies and colorectal surgery were ap...

Bosnian Journal of Basic Medical Sciences, 2021

Gastric cancer is related to high mortality rates and advanced disease stage at the time of diagn... more Gastric cancer is related to high mortality rates and advanced disease stage at the time of diagnosis. Its carcinogenesis is extensively studied and is associated with genetic and epigenetic changes, changed the interaction between tumor and adjacent stromal cells, and changes in the microenvironment molecule status. NEDD9 affects different signaling proteins and pathways, apoptosis, adhesion, cell migration, and invasiveness. Connexin-43 also assists in intercellular communications and has several channel-independent functions. Aberrant expression of those two gap junction proteins plays an essential role in metastatic processes. Our scope was to detect the expression of connexin-43 and NEDD9 in epithelial and stromal gastric cancer compartments and its relation to tumor progression and lymph node metastases. Cancer tissue from 53 cases of node-negative and 55 cases of node-positive primary gastric carcinoma patients was analyzed for connexin-43 and NEDD9 expression by immunohistoc...

Libri Oncologici Croatian Journal of Oncology, 2020

Gastric is considered neglected cancer in terms of stage at diagnosis and success of treatment wo... more Gastric is considered neglected cancer in terms of stage at diagnosis and success of treatment worldwide. Early detection and quality of gastric cancer surgery remain the most important for successful treatment in terms of overall survival. In this paper, we focus on the overview of hospitals and volume of gastric cancer in Croatia as a possible baseline for quality assessment and implementation of existing quality guidelines. We accessed publicly available data from the Croatian Insurance Fund for the period between 1st January 2013 to 31st December 2018. For background information on gastric cancer incidence and mortality, we used Croatian Cancer Registry data available online. We obtained both the number of resected gastric cancer in all Croatian hospitals as well as the length of stay. Data analysis discovered that there is a clear volume difference between teaching hospitals and non-teaching hospitals; only the first have sufficient volume for quality audit. This overview stresses one of the most critical points in cancer surgery, volume of surgery as a quality indicator.

Libri Oncologici Croatian Journal of Oncology, 2019

Gastric cancer is a 'neglected cancer,' with significant incidence (over 900 cases annually) and ... more Gastric cancer is a 'neglected cancer,' with significant incidence (over 900 cases annually) and late-stage at the time of diagnosis in Croatia. Even in resectable cases, risk of malnutrition is high, and malnutrition-related to malignant disease presents a substantial problem in terms of compliance with treatment and complications during surgery. We retrospectively reviewed the patient records for patients operated for gastric cancer from January until December 2018. Data on sex, age, body mass index (BMI), complete preoperative blood count, postoperative recovery, and subsequent bioelectrical impedance analysis (BIA) measurements (preoperatively, on days 7, 14 and 30) were collected. All patients received nutritional support according to the Enhanced Recovery After Surgery (ERAS). Twenty-seven patients were operated for gastric cancer, eight were resected with curative intent (four total gastrectomies, one total gastrectomy with splenectomy, three distal gastrectomies and one local excision). Seven patients who had a resection were included in the perioperative nutritional protocol. All patients scored at risk according to Nutrition Score 2002 (NS2002). Two patients had tolerable initial BMIs and BIAs, only one patient with extremely low BMI and BIA had prolonged intensive care unit (ICU) stay and difficulties with peroral nutrition. Only the patients with tolerable initial values recovered those values postoperatively in the observed period but did not improve. Lean body mass is lost before surgery, and in the early postoperative period, it takes up to 3 months to compensate. However, in the late stage of the disease, routine ERAS nutritional protocol seems not to be enough. Perhaps, in gastric cancer, a more aggressive parenteral perioperative nutrition might be an option.

Acta clinica Croatica, 2013

According to AO classification, 33-C3 (complete articular multifragmentary) fracture of distal fe... more According to AO classification, 33-C3 (complete articular multifragmentary) fracture of distal femur is characterized by complex articular involvement, along with short distal femoral block with multiple small fragments and usually with severe soft tissue abruption. In such cases of complex articular fracture of distal femur with extensive comminution of the femur condyle that is often seen in these fractures, anatomical reduction is quite difficult. Minimal fixation strategies sometimes do not provide an optimal degree of reduction and stability of the distal femoral block osteosynthesis. We describe 5 cases of treatment of the 33-C3 distal femoral fractures using arthrotomy of the knee joint by osteotomy of the distal pole of the patella and internal fixation with basket plate as an alternative approach for anatomical reduction of the comminuted articular surface.

Acta clinica Croatica, 2013

Despite recent advances in operative techniques, internal fixation of (3- and 4-part) displaced p... more Despite recent advances in operative techniques, internal fixation of (3- and 4-part) displaced proximal humeral fractures in elderly patients with osteoporotic bone remains controversial, sometimes followed by poor results. The aim of the present study was to evaluate outcomes of internal fixation with locking plate of multi-fragment proximal humeral fractures in elderly patients. The study cohort comprised 59 consecutive patients (mean age 70.1) with 3- and 4-part fractures who had undergone open reduction and internal fixation with locked plate at Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients were invited for follow-up examinations and underwent standard x-ray examination preoperatively to assess fracture pattern in the operating theatre as well as at 6 weeks, 3 and 6 months, 1 year, and then annually after surgery to assess fracture healing or complications. Clinical outcomes were measured by constant score. Patients were followed-up for 14 to 36...

Journal of Endourology, 2000

Background and Purpose: Laparoscopic surgery for adrenal gland tumors is the gold standard operat... more Background and Purpose: Laparoscopic surgery for adrenal gland tumors is the gold standard operative approach now. Adrenal-sparing surgery has special indications. We demonstrated the safety and feasibility of performing adrenal-sparing surgery by means of laparoscopy for aldosterone-producing adenoma (Conn's syndrome). Patients and Methods: Between 1995 and 1999, seven patients with Conn's syndrome had laparoscopic adrenal-sparing resection of their tumors. These patients were followed up by means of radiology and biochemistry. Results: All seven patients had successful laparoscopic surgery without complications. Most patients were discharged in 2 to 6 days (mean 3 days). At follow-up, the six patients investigated had normal blood pressure. No recurrences have been encountered with a median follow-up of 12 months in these six patients. Conclusions: Adrenal-sparing resection of tumors causing primary hyperaldosteronism is technically feasible by means of laparoscopy. This procedure has the advantage of keeping a greater reserve of normal adrenal tissue and of rapid postoperative recovery.