Biomedical subjects
Publications and source records attributed to P Kovacević.
Plantago ovata is a high fibre bulk forming laxative. It absorbs water and expands to provide increased bulk and moisture content to the stool. The increased bulk encourages normal peristalsis and bowel motility. Clinical Indications: Constipation, Fecal Incontinence, Hemorrhoids, Ulcerative Colitis, Appetite, Hyperlipidemia, Diabetes mellitus.
The aim of this prospective randomized study is to describe the effects of laxative plantago ovata after open hemorrhoidectomy (Milligan-Morgan). Sixty patients divided into 2 equal groups were included in this study. The first group was treated postoperatively with 2 sachets of bulk agent Laxomucil (3.26 g plantago ovata), twice daily, for a period of twenty days, while the control group was treated with glycerin oil. The p.ovata group patients had a statistically significant shorter postoperative length of hospital stay (2.9 v.s. 4.1 days). Pain after stool was statistically significant more tolerable in the p.ovata group. In conclusion, the application of bulk agent plantago ovata after hemorrhoidectomy shortens the mean postoperative hospital stay, expedites digestive function recovery and lessens the pain after stool.
Large defects of abdominal wall (greater than 8 cm in diameter) related to different cause, are still difficult problem of modern surgery. The best results in order to obtain safe and permanent anatomical and functional abdominal wall integrity are reached by autogenous dermal and synthetic grafts. Controversies concerning quality of these procedures are still presents. Our work is based on two equal experimental groups of 20 Vister rats each, with large artificial abdominal wall defects: one treated with autogenous dermal graft, another with synthetic Mersilene mesh graft. The animals from both groups were sacrificed in previous planned time intervals (3rd, 7th, 14th and 48th days). Afterwards detailed microscopic and gross examination of abdominal wall reparation and quality of reconstructed abdominal wall defects had been performed. According to our results both methods are easy to be performed and safety surgical procedures. Overestimated usage of synthetic grafts should be diminished because of advantages of autologous dermal graft--availability, substitution of firmly fibrosis tissue and endurance against infection.
The aim of this work is to present existence of the lateral lymphatic spread of metastases in patients with Dukes C low rectal carcinoma (60% of all patients), located at or bellow peritoneal reflexion. Prospective clinical investigation analyzed the group of 64 patients (32 underwent lateral lymphadenectomy and 32 didn't), all treated at Ist Surgical Clinic, Clinical Center of Serbia. Lateral lymphatic spread of metastases was proven by frozen section in 8 cases, so extensive lateral lymphadenectomy was performed. In the group of patients who underwent lateral lymphadenectomy, positive lymph nodes were registered in 18 patients (56.2%); in group of patients operated without lateral lymphadenectomy, metastatic lymph nodes were registered in 12 patients (37.5%). According to results of this investigation, method of lateral lymphadenectomy, as well as extensive lateral lymphadenectomy, is significant for exact determination of postoperative stage of the disease. Also, there is a significant increase in number of patients with Dukes C stage of the disease. In those patients, mesorectectomy alone is not sufficient.
The incidence of squamous cell skin center is the second, after basocellular skin cancer. Surgical treatment is the first and most effective therapy for this tumor. The aim of study is to present experiences of Surgical clinic in Nis in treatment of squamous cell skin cancer in head and neck. During 10-year period (1990-2000) there were operated 346 patients with squamous cell skin cancer of head and neck. We performed wide surgical excision with clinical free margins of 5-10 mm, and more radical excision and reconstructions for advanced tumors. We registered postoperative complications in 14 (4.04%) patients. Early diagnose and adequate treatments of squamous cell skin cancer are prerequisite for good postoperative results and low complication rate.
Female patient, 68, hospitalized due to vaginal bleeding, anaemia and defecation disorder. We have done examinations as follows: clinical and laboratory exams, which confirmed severe anaemia. Explorative curretage of uterus--PH findings: malignant tissue. Rectoscopy: extraluminal compression at lo cm from the anal verge. Irigography: spasticity and extraluminal compression to proximal third of rectum and distal sigmoid colon. Ultrasound of abdomen: solid lobular formation 10 x 7 cm in diameter, on the left side of the urinary bladder, surrounded by thin layer of ascites. Ultrasound of liver: without signs of malignant disease. CT-scan of pelvis and abdomen: metastatic lymph nodes, up to 40 mm in diameter, alongside abdominal aorta; solid-lobular tumor, 10 x 7 cm, on the left side of urinary bladder, which fills the central portion of pelvic cavum. Secundary malignant deposits on the pelvic parietal peritoneum with minimal quantity of ascites (peritoneal carcinomatosis). Intraoperative findings confirmed malignant deposits on the right colon serosa, so we performed right hemicolectomy with ileo-colo anastomosis, omentectomy, hysterectomy, bilateral adnexectomy, low anterior resection of the rectum, peritonectomy of pelvis and reconstruction of digestive tubus by colo-rectal anastomosis with circular stapler ILS 33. Duration of operation was 6:45 hours, blood loss was 1100 ml. Intraoperatively was intraperitonealy applicated Adriamycin. One month after the operation, systemic chemotherapy consisting of Endoxan and Karboblastin was administered, for the duration of 6 months, once monthly. Twelve months after the operation NMR showed normal findings, patient was without evidents of recurrent disease.
Pelvic exenteresis (total, anterior and posterior) is operative procedure reserved for the local advanced malignancies of the pelvis. In the period 1995-2001, we have treated 54 patients (20 male, 34 female) by this procedures. By anterior pelvic exenteresis we have treated 6 females for: Ca vesicae urinary (4 pts). Ca PVU after irradiation therapy (1 patient), Ca urethrae (1 patient). By posterior pelvic exenteresis we have treated 2 females for primary advanced Ca of the rectum. By total pelvic exenteresis we have treated 46 pts (20 male, 26 female): Ca PVU after irradiation therapy (10 females), recidivant Ca PVU (8 females), primary advanced Ca of the rectum (7 male, 1 female), recidivant Ca of the rectum (10 male, 7 female), recidivant Schwanoma (1 male), recidivant Sa stromae endometrii (1 female), recidivant Ca vesicae urinary (1 female). The median survival time of all 54 patients was 24 months. Early postoperative mortality was 18% (10 pts). Twenty patients died with median survival of 18 months (range 4-48 months). Twenty one patients are alive without evidence of disease with median follow up period of 41 months (range 6-60 months). Three patients were lost from follow up. Exenteresis pelvis is very complicate operative procedure and it should be limited to perform only in couple surgical centers.
A retrospective study was performed on patients with histologically proven gastric adenocarcinoma during the periods 1972 to 1976 (n = 368) and 1986 to 1990 (n = 870) to analyse the potential changes in tumour distribution within the stomach. A recent increase in gastric cancer patients admitted to our institution represents a change in the referral patterns of the patients. The mean age and male:female ratio according to site distribution of the tumour were not found to differ between the two periods. The proportion of carcinomas of the upper third of the stomach was, however, significantly increased (P less than 10(-6)) in the recent series (36.4%) compared with the old series (20.6%). Since the incidence of gastric cancer in our population seems to be unchanged, this may suggest a true increase in proximal gastric tumours. The data may indicate possible changes in aetiological influences.
The variations of arterial and venous hillar blood vessels in human kidneys are numerous and surgical transplant teams have to know them. It is very important during doner-nephrectomy for transplantation. Sometimes, after doner, nephrectomy and kidney cold perfusion with Collins, there is a need for vascular repair of kidney hillar blood vessels, using microvascular surgical technique. The aim of this repair is: to have a kidney with main renal artery of good length and size and with main renal vein of good length and size. This procedure is called: extracorporeal "ex-situ" vascular repair of kidney hillar blood vessels. In the period 1987-1988, in our Experimental Surgery Unit a total of 20 dogs were operated on (kidney autotransplantation) and only in four (4) dogs we found variations in numbers of kidneys arterial and venous hillar blood vessels (20%) and repaired those vessels after cold perfusion of kidney. One dog had kidney with double renal arteries and double renal veins, and we had to make fusion the both arteries into the main renal artery of good size (5 mm) and the both veins into the renal vein of good size (12 mm). Three dogs had kidneys with main trunk of renal artery and one important separate polar renal artery, and we had to make implantation of separate polar renal artery into the main trunk of renal artery (end-te-side vascular anastomosis). For those vascular reconstructions we used polipropilene 6-o or -o as suturae material and binocular (magnification 2.5 x). The hemodynamically results of those reconstructions immediately after kidney implantation were very satisfactory.
This study analyses frequency of complications and mortality after elective splenectomy done for various hematological diseases, dependent on the spleen weight. From 1979 to 1988 year, 236 patients were treated by splenectomy for various haematological disorders, including: autoimmune disorders (90), Hodgkin's disease (34), lymphoproliferative diseases (96) and myeloproliferative diseases (16 patients). In the early postoperative period, complications occurred in 51 (21.61%) patients, 10 of which (4.24%) died. Considering the size of the spleen (more or less than 1500 gr) there was no difference in the early postoperative mortality (p greater than 0.05; 3.30%:5.38%), while postoperative complications occurred significantly more often in patients with massive splenomegaly (p greater than 0.05; 1259%:3548%). The most frequent complications were septical (8.90%), prolonged fever (5.51 x), and postoperative bleeding (2.97%), while cardial, pulmonary and urinary complications occurred seldom, but more often caused patient's death. Defining the appropriate indications for splenectomy, performing suitable preoperative preparations and postoperative care, mortality was diminished from 7.14% in the period, 1979-1983 year, to 2.17% in the period 1984-1988.
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In the period 1982-1996, 7,476 aortocoronary bypass surgeries were performed at the University Clinic for Cardiovascular Surgery in Novi Sad with perioperative mortality of 2.85%. In 242 patients (3.24%) an additional thrombendarterectomy procedure of carotid arteries was performed with indications such as: positive neurologic symptoms; critical morphology of carotid lesions according to Wesley-Moore symptomatology and critical stenosis. The cardiac status of patients was as follows: poor left ventricular function (EF--ejection fraction--30%) in 42 patients (19.2%), left main coronary artery stenosis in 31 patients (12.8%), endarterectomy of coronary arteries due to diffuse and distal coronary occlusive disease in 93 patients (38.5%) and isolated aortocoronary bypass in 149 patients (61.8%). The status of carotid arteries was as follows: unilateral stenosis in 156 patients and bilateral stenosis in 63. Depending on the carotid or cardiac finding, our surgical strategies differed: 65 patients (26.8%) underwent simultaneous operation, 141 patients (58.2%) underwent two-stage operation and in 36 patients (14.9%) three-stage operation was performed. Postoperative complications included: neurological deficit in 4 patients (1.7%); Transient ischemic attacks in 5 patients (2.1%); myocardial infarction in 6 patients (2.7%); hemorrhage in 2 patients (0.9%); gastrointestinal hemorrhage in 3 patients (1.4%); pulmonary complications in 2 patients (0.9%); serious rhythmic disorders in 1 patient (0.5%) and therapeutically resistant hypertension in 1 patient (0.5%). Ten patients (4.1%) died. Causes of death: cardiac in 3 patients (1.4%), neurological in 3 patients (1.4%), pulmonary embolism in 1 patient (0.5%) and other causes in 3 patients (1.4%). The operative risk in this group of polyvascular patients is higher than in the "group with isolated aortocoronary disease". Appropriate indications for surgery in one, two or three stages significantly decrease mortality in these patients. Simultaneous operation is reserved for patients with severe neurological symptoms and unstable angina.
INTRODUCTION: In recent years, with development of carotid surgery and significant decrease of central neurological complications, more and more attention has been paid to the occurrence of peripheral neurological complications. Most frequent neurological lesions are as follows: auricularis magnus nerve, hypoglossal nerve, vagal nerve, inf. laryngeal nerve, sup. laryngeal nerve, glossopharyngeal nerve and spinal nerve. MATERIAL AND METHODS: In the period from May 1995 to January 1997, 97 patients underwent surgery because of carotid arteries lesions. Bilateral lesion of carotid arteries was treated in 27 patients. Standardized surgical procedures were performed while neurological examinations were performed postoperatively to check for possible peripheral neurological deficit. RESULTS: Cerebrovascular insult was the cause of death in one patient (1.2%). Transitory ischemic attack also occurred in one patient (1.2%). Peripheral nerve lesions were observed in 13 patients that is in 11.3% of cases; auricularis magnus nerve lesion in 9 patients (8.3%); sup. laryngeal nerve lesion in 3 patients (2.8%); mandibular branch of the facial nerve lesion in one patient (0.9%). DISCUSSION: The global incidence of postoperative peripheral neurological complications after carotid surgery was 11.3% cases, while according to the literature data it is from 10.5% to 13%. The most frequent are the lesions of auricularis magnus nerve and sup. laryngeal nerve. CONCLUSION: The incidence of peripheral neurological complications is higher than it is thought to be. Majority of these lesions are with transitory effect. Good knowledge of the precise surgical technique is a prerequisite to decrease the rate of these complications.