Biomedical subjects

Nikica Grubor

Publications and source records attributed to Nikica Grubor.

At least 19 recordsLinked to original sources

PubMed2006

[Inflammatory pseudotumor of the spleen].

BACKGROUND: Inflammatory pseudotumors are benign tumor lesions of an unknown etiology that can appear almost at any organ, sometimes along with infectious agens, like Epstein-Barr virus. They are extremely rare in the spleen, with less than 80 cases described in the world literature. It is a single, very rarely multinodal lesion. Middle aged patients are mostly affected. Symptoms are either absent or uncharacteristic, so that the tumors are discovered by chance or during investigations of other diseases. CASE REPORT: We presented a 56-year-old woman in whom a nodal lesion of 2 cm in diameter had been discovered in the spleen during a routine check-up after a mild traffic accident. The lesion had grown up to 6 cm in diameter during a 5-year follow-up causing a mild pain over the upper left abdomen and left shoulder. Fine needle biopsy failed to show the exact nature of the lesion. Splenectomy was performed due to a suspected lymphoproliferative disorder. Histology and immunohistochemistry of the lesion of the upper pole of the spleen showed inflammatory pseudotumor. Epstein-Barr virus was not present. The patient developed postsplenectomy thrombocytosis (up to 850 x 10(9)/1) which settled down within 10 weeks. CONCLUSION: . Inflammatory pseudotumors of the spleen are extremely rare. The exact diagnosis can be established only by histology and/or immunohistochemistry of the spleen removed for a suspected lymphoproliferative disorder, most frequently lymphoma. The patient was cured with splenectomy.

Diagnosis, Differential↗

PubMed2006

[Aggressive intraabdominal fibromatosis].

BACKGROUND: Intraabdominal or mesenteric fibromatosis is a rare benign nonmetastatic neoplasm that appears as a sporadic lesion or in patients with familiar polyposis. Its evolution is unpredictable. About 10% of the cases shaw a very aggressive growth. CASE REPORT: We presented a 22-year-old woman in whom an aggressive intraabdominal fibromatosis had appeared during the first pregnancy as a well circumscribed ovoid tumor, involving the terminal ileum, the caecum, the ascending colon, the right kidney, the ureter, and the right common iliac artery. The tumor was excised with right colectomy, nephroureterectomy and resection of the involved artery using arterial reconstruction with graft interposition. Two years after the surgery the patient developed an inoperable tumor recurrency with a fatal outcome. CONCLUSION: In spite of a successful surgical excision during the original surgery intraabdominal or mesenteric fibromatosis might have an aggressive evolution leading to an inoperable tumor recurrency and a fatal outcome.

Adult↗

PubMed2004

Anterior sacral meningocele with presacral cysts: report of a case.

Anterior sacral meningocele is a rare anomaly most frequently presenting as a presacral mass. Since the first description in 1837, approximately 150 cases have been reported. The case presented is a 37-year-old female in whom an asymptomatic presacral mass was discovered during her first delivery. Because normal delivery was impossible, a cesarean section was performed. A year later, in a regional hospital a "cystic presacral tumor" was treated with biopsy and drainage. Four years later, she developed constipation caused by perineal compression for which she was admitted to our department in which two anterior presacral cysts were excised. The recovery was complicated with meningitis, which was successfully treated with antibiotics. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Rectal examination and radiography of the pelvis with the sacral bone showing the "scimitar sign" are the main diagnostic methods. Myelography, computed tomography, and magnetic resonance imaging are the best methods for identifying the precise anatomy of sacral meningocele and for proper planning of the operation. Transvaginal or transrectal aspiration and drainage are not advised, because they may result in a lethal outcome caused by sepsis.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Fibroma of the root of small intestine mesentery].

Fibromas are rarely localized in the abdomen, but almost always in the mesentery or omentum. We present a 63-year old woman in whom the examination of the upper abdominal pain showed a well distinct abdominal mass at the level of the lower edge of the pancreas. During the operation a tumour, 100 x 87 x 70 mm in size, from the radix of small bowel mesentery, was excised. Seven months later the patient is symptom-free with normal ultrasonographic and CT findings.

Female↗

PubMedDate not supplied

[Microcystic adenoma of the pancreas].

Microcystic adenoma of the pancreas is a rare benign tumour of the pancreas without malignant potential which usually appears in older women. Pain, weight loss, palpable mass and jaundice (if the tumour is localized in the head of the pancreas) are the main symptoms. Thanks to the modern imaging techniques (US, CT, FNB) the tumour is discovered and with rising frequency exactly preoperatively diagnosed. Surgical excision is the treatment of choice. In risk patients without symptoms surgery is not necessary but patients have to be regularly followed-up. The authors present a 70-year old woman in whom, because of constant epigastric pain, a multicystic mass of the pancreatic body, 58 x 40 mm in diameter, was discovered and removed by distal pancreatectomy. The spleen could not be saved. Histologic examination showed a microcystic adenoma. Three years after surgery the patient is symptom-free with normal ultrasonographic findings.

Aged↗

PubMedDate not supplied

[Inflammatory pseudotumors of the liver].

Inflammatory pseudotumours are very rare with hardly over hundred cases reported in literature. The disease is rare in children. The tumour is usually solitary, rarely multifocal. We report on two women old 48 and 49 years. One had a solitary tumour, and the other had four multifocal inflammatory pseudotumours which were surgically removed. Preoperatively both patients had pain, loss in weight, the one had attacks of low grade temperature and the other nausea and general malaise. One patient had leucocytosis. After surgery both patients stayed symptom free with normal laboratory and ultrasonographic findings 6 and 50 months respectively.

Female↗

PubMedDate not supplied

[Abdominal pregnancy with the placenta located on the spleen left in situ causing subphrenic abscess].

Abdominal pregnancy appears once in 3000 pregnancies. It usually terminates with abortion and urgent surgery. Thanks to ultrasonography and computed tomography the diagnosis is possible before surgery. Most frequently the diagnosis has been established during emergency laparotomy. Gynaecologists are not in agreement whether removal of placenta is mandatory or not, as it may include removal of parts or entire organs or may be followed with serious bleeding difficult to control. We present a 21-year old woman in whom during an urgent laparotomy performed for abdominal pregnancy placenta inserted in the spleen was left in situ. Postoperatively the patient developed subphrenic abscess which could not be solved without reoperation during which both the placenta and the spleen were removed. Ten years after surgery she is symptom-free.

Adult↗

PubMedDate not supplied

[Duodenal obstruction due to chronic pancreatitis].

Chronic pancreatitis may cause a number of obstructive complications. Obstructions of the pancreatic and common bile duct are the most frequent, obstruction of the duodenum is rare and obstruction of the colon is very rare. Duodenal stenosis caused by chronic pancreatitis is usually moderate so that the surgical treatment is not necessary except if operation is necessary for other obstructive complications. The severe isolated duodenal stenosis for which surgery is mandatory is rare. We present a 46-year old male suffering from chronic alcoholic pancreatitis causing almost complete duodenal obstruction in whom surgical treatment was necessary. The truncal vagotomy and gastroenterostomy were performed. With abstinence of alcohol, low fat diet and substitute therapy more than 3 years after surgery the patient is symptom-free. He regained the previous weight and shows tendency to become fat.

Chronic Disease↗

PubMedDate not supplied

[Long-term results of reconstruction of benign stenoses of the bile ducts].

UNLABELLED: Over 27 year period (1.01.1974-31.12.2001) a 168 patients (pts) were operated on for benign bile duct strictures of types I to IV according to Bismuth's classification. Reconstruction of fresh lesions and lesions and strictures of sectorial or segmental ducts were not taken into account. The later are to be the subject of separate publication. There were 107(63.7%) women and 61(36.3%) men of average age of 46 years (ranging from 14 to 76 years). The average time from injury to our reconstruction was 8.2 years. In 162 pts (96.4%) an operative injury was the cause of the stricture, in 150 (89.3%) during cholecystectomy, in 8 (4.76%) during distal gastrectomy for duodenal ulcer and in 4 (2.38%) during surgery of the central hydatid cyst of the liver. In 112 (66.66%) pts 1 to 6 previous attempts of reconstructions had been performed elsewhere. According to the Bismuth, s classification there were 27 (16.07%) strictures of type I, 46 (27.38%) of type II, 66 (39.28%) of type III and 29 (17.26%) of type IV. The most frequent preoperative complications were intrahepatic lithiasis (34%), fibrosis or cirrhosis of the liver in 9.5%, liver abscesses in 6%, bilioduodenal fistula in 4.16%, biliary peritonitis in 4.16% and incisional hernia in 8.9% of pts. Suture mucosa-to-mucosa hepaticojejunostomy with 75 cm long Roux-en-Y jejunal limb described by Blumgart was performed in 161 (95.8%), choledochoduodenostomy in 3 (1.8%) and strictureplasty in 2 (1.2%) while in 2 pts the reconstruction was not technically possible. Three pts died during the first 6 months, 2 in whom the reconstruction was not possible and 1 with chronic endemic nephropathy. Eight of the rest 165 pts were lost from follow up being from Bosnia and Croatia due to well known war events. Six out of the 157 pts died in the mean time, 2 due to variceal bleeding (they had cirrhosis and portal hypertension at the time of reconstruction) an 4 due to unrelated causes (2 due to pancreatic carcinoma, 1 due to myocardial infarction and 1 due to stroke). Out of 151 alive fully followed pts, good result (pts symptom-free as after standard cholecystectomy) was achieved in 121 (80.13%), satisfactory (mild occasional symptoms but not cholangitis) in 27 (17.88%) and unsatisfactory result in 3 pts (2%), 2 of which were successfully reoperated (1 passed into group with good and 1 into group with satisfactory results). CONCLUSION: With properly performed suture mucosa-to-mucosa hepaticojejunostomy with 75 cm long Roux-en-jejunal limb good or satisfactory results can be achieved in almost all patients with benign bile duct stricture, provided it was not performed too late before the patient develop a secundary bilary cirrhosis and portal hypertension.

Adolescent↗

PubMedDate not supplied

[Two cases of pancreatic head polypeptide tumors, one with a central cavity which fistulized into the duodenum].

PP omas are rare, usually malignant tumours of the PP cells of the Langerhan's islets which secrete pancreatic polypeptide. The authors present two women operated for PP-omas of the pancreas. The first was 55 year-old woman in whom we did a cephalic duodenopancreatectomy (Whipple's procedure) for the tumor of the head of the pancreas with central cavity containing gas due to communication with the duodenum. Immunohistochemistry showed a PP oma with strong generalised immunoreactivity with antibodies against Chromogramin A, neuron specific enolasa and PP with more the 95% of tumor cells and coexpression of somatostatine in 35% and VIP in less then 5% of tumor cells. Following uneventful recovery the patient stayed symptom free so far and put 20 kilograms in weight. The second patient was 19 year-old girl with a multinodal tumor of almost the entire pancreas in whom a local excision of the nodal mass of the head of the pancreas had been carried out in the other hospital, three years ago and relaparotomy and tumor biopsy a month before admission to our institution. In her we did a total duodenopancreatectomy and standard lymphadenectomy for a multinodal mass occupying almost the entire pancreas. Immunohistochemistry showed a strong generalised immunoreactivity with antibodies against Chromographin A, Neuron specific enolasa and PP for more then 95% of tumors, cells. Glucagon was expressed in few focuses (in less then 1% of cells), somatostatin was expressed very rarely in single cells while the rest of tumor markers did not show a visible immunologic reactions in the majority of tumors, cells. Three years after surgery she died due to multiple liver secondaries.

Adult↗

PubMedDate not supplied

[Echinococcosis damaging the junction of the hepatic duct and causing severe obstructive icterus].

Complications of the hydatid cyst of the liver on bile ducts appear in 5-25% representing almost two third of all complications of the hydatid liver cysts. Fortunately a damage to the bile ducts causes only an infection of the cyst usually without major consequences. More serious complications such as cholangitis and deep obstructive jaundice are much rarer. The defect of the bile duct usually is a periferal one. Damage to the major ducts are rarer and those on the confluence of hepatic ducts itself are the rarity. In that case biliary reconstruction may be a serious challenge. The authors present a 23 year-old man in whom a centrally localised hydatid cyst made a major damage of the confluence of all three hepatic ducts causing deep obstructive jaundice. After standard procedure for hydatid cyst an intracavital mucosa to mucosa hepaticojejunostomy was carried out with excellent success. More then six years after surgery the patient stayed symptom-free with bilirubin and alkaline phosphatase within normal limits.

Adult↗

PubMedDate not supplied

[Anomalous choledocho-pancretic ductal junction in a choledochal cyst--a case report].

Choledochal cysts are rare congenital anomalies, mostly detected in adults. Pathogenesis of these cysts seems to be in anomalous junction between pancreatic and common bile duct, above the papillary sphincter and outside of the duodenal wall. The absence of the sphincter above the junction is followed by reflux of the pancreatic juice into the bile duct leading to dilatation and fibrous changes of bile duct wall. A 38-year-old female is presented in whom a choledochal cyst was found 11 years earlier, during the operation performed for obstructive jaundice, when cystojejunostomy with Roux-en Y Jejunal limb was carried out. In February 1990, she was admitted to our Institution forjaundice and biliary colic. The patient was reoperated. Operative cholangiography showed an anomalous pancreatobiliary junction, choledochal cyst, dilated cystic duct and moderate dilatation of intrahepatic bile ducts. Cholecystectomy, desanastomosis with partial excision of choledochal cyst, and retrocolic choledochojejunostomy with the same Roux-en-Y jejunal limb were performed. Total excision of choledochal cyst was too risky due to chronic inflammatory changes in the hepatoduodenal ligament. Postoperative recovery was uneventful and the patient remained symptom-free so far.

Adult↗

PubMedDate not supplied

[Floating spleen with chronic torsion of the pedicle causing splenomegaly and secondary hypersplenism].

If the spleen is not fixed within the left subphrenic space, it gradually passes into the lower abdomen, where is much more exposed to trauma. Torsion of the splenic pedicle can also occur, causing the infarct necessitating an immediate surgery. Venous stasis causes splenomegaly and sometimes secondary hypersplenism. The authors present 16.5-year old girl with torsion of the splenic pedicle of floating spleen for 720 degrees: in spite of that, the patient had neither splenic infarct nor splenic vein thrombosis, possibly due to thrombocytopenia, but she had splenomegaly and secondary hypersplenism with pancytopenia causing bleeding, sideropenic anemia and mild jaundice. After treatment with iron, the patient underwent splenectomy which resulted in almost immediate rise of the number of all blood cells, and even thrombocytosis. The authors suggest early surgical treatment of the floating spleen, preferably splenopexy, before development of severe complications when splenectomy had to be performed in the majority of patients. Accessory spleens, if present, should be saved.

Adolescent↗

PubMedDate not supplied

[Abscess of the spleen].

Splenic abscess is a rare disease but with increasing frequency. The authors present 9 patients with splenic abscess treated at the Institute of Digestive System Diseases, Clinical Centre of Serbia, in a period from January 1, 1986 to May 15, 2004. Splenic abscess was the complication of septic endocarditis in 4, trauma in 2, dental infection in 1, while in 2 cases it was the complication of chemotherapy in myeloproliferative disorders. All 9 patients had fever, 7 - abdominal pain, 4 - left shoulder pain, and 1 patient had nausea and vomiting. Higher white blood count was found in 6 patients, pleural effusion in 4, elevated left hemidiaphragm in 1 and basal pneumonia in 1 patient as well. Ultrasonography and CT were the most reliable diagnostic procedures. CT was superior in diagnosis of multiple small abscesses. Culture of the pus recovered the Enterococcus in 3 cases, Streptococcus a hemolyticus in 1, Staphylococcus epidermidis and Candida albicans in 1, Staphylococcus aureus, E. Coil and Candida albicans in 1, Staphylococcus aureus i Salmonella enteritidis in 1 case. Eight patients underwent splenectomy and 1 was cured by combined antibiotics in high doses. One patient died postoperatively due to septic endocarditis that had been present before surgery. The authors believe that splenectomy and antibiotics administered according to drug susceptibility test as well as management of underlying disease are the method of choice for splenic abscess treatment. Conservative antibiotic treatment is indicated in selected cases only.

Abscess↗

PubMedDate not supplied

[Biliary mucinous cystadenoma of the liver with focal malignant alteration].

Biliary mucinous cystadenoma of the liver is a rare tumor that develops almost exclusively in women. Its typical localization is near the hepatic hilus. It may become malignant, and therefore careful histological examination of the entire resected specimen is mandatory. Incomplete excision results in recurrence and occasionally in malignant alteration. The authors present a 66-year old woman who presented with the right upper abdominal pain and occasional vomiting, and who was diagnosed with cystic lesion of the right lobe of the liver. The lesion was totally excised by an open operation. It was filled with mucinous viscous fluid and there was proliferation in one part of the internal surface. The cystic lesion communicated with the common hepatic duct through a tiny duct (above the cystic duct), but in spite of that, it did not contain bile. Histological examination showed mucinous cystadenoma with focal malignant alteration. After the uneventful recovery, the pain and vomiting were eliminated and she has remained symptom free so far.

Aged↗

PubMedDate not supplied

[Primary pancreatic non-Hodgkin's lymphoma].

Diffuse large-cell B lymphoma of the pancreas is a rare disease, representing less than 1% of all non-Hodgkin's lymphomas and less than 0.9% of all malignant tumours of the pancreas. About 150 cases of the disease have been observed so far. The tumours are more frequent in the head of the pancreas then in other parts of the organ. They are usually larger (average size of 8 cm) and are non-resectionable. As a rule, exact diagnosis is based on the histology and the immunohistology of the specimen taken during open surgery performed for general diagnosis of the pancreatic tumour. Very rarely can a very reliable and experienced cytopathologist establish a proper diagnosis based on material obtained from a fine needle biopsy. The disease usually responds positively to immunochemotherapy according to protocol R-CHOP. Occasionally, additional radiotherapy may be required. We present two women, 66 and 49 years old, in whom a diagnosis of large-cell B lymphoma of the pancreas was established, based on the histology and the immunohistochemistry of a specimen taken during open surgery performed in order to remove pancreatic tumours, which turned out to be non-resectionable. After immunochemotherapy, the symptoms disappeared and the tumours shrank, in one patient after additional radiotherapy. The authors would like to point out the importance of a proper histological diagnosis, which permitted the application of immunochemotherapy alone or together with additional radiotherapy with at least temporarily favourable results.

Aged↗

PubMedDate not supplied

[Bronchogenic cyst of the abdomen].

A bronchogenic cyst is a rare congenital anomaly that appears in the thorax, usually the lungs or the mediastinum, being much rarer in the retrosternal space, within the pericardium or the diaphragm, as well as in the neck, while localisation within the abdomen is extremely rare, with only about 30 reported cases. We present the case of a 68-year-old woman. During an investigation for an epigastric pain, a cystic lesion in the area of the body and tail of the pancreas was found. During open surgery, a cystic lesion, spanning 95 x 75 x 70 mm, above the body and tail of the pancreas was excised. The wall of the cyst was 8-12mm thick; it contained viscous fluid, the culture of which stayed sterile. Histology determined that it was a bronchogenic cyst. After an early uneventful recovery, the patient developed a left colonic fistula, which healed spontaneously within 3 weeks, probably because of the unnoticed operative damage to the splenic flexure of the colon during splenectomy, which was adherent to the cystic mass and impossible to save during excision. Six months after surgery, the patient continued to remain symptom free.

Aged↗

PubMedDate not supplied

[Focal nodular hyperplasia].

Thanks to ultrasonography, computed tomography, and nuclear magnetic resonance, not only symptomatic but also asymptomatic liver tumours are discovered more frequently than before. Focal nodular hyperplasia (FNH) is one such tumour, most frequently an asymptomatic tumour of the liver, which predominantly appears in women during the generative period, who have taken oral contraceptives for several years. We present a 27-year-old woman, who has never taken either oral contraceptives or other hormones, in whom a left lobe liver tumour was unexpectedly discovered during a routine investigation performed for psychiatric complaints. The tumour, removed by left lateral bisegmentectomy (segments II and Ill), was composed of two tumoural nodes: 70x58x47 mm and 20x20x20 mm, the bigger one of which had a light grey central stellate scar. Histology revealed a focal nodular hyperplasia. The postoperative recovery was uneventful and the patient stayed symptom free for more than three years after surgery.

Adult↗