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Biomedical subjects

S Knezević

Publications and source records attributed to S Knezević.

At least 19 recordsLinked to original sources
PubMed2005

[Endoscopic ultrasonography in choledocholithiasis].

Diagnosis of choledocholithiasis is still difficult to establish and presents a great challenge in gastroenterology and surgery of biliary tract, since it requires expensive and sophisticated examining techniques. 10 to 15% of patients with symptomatic cholelithiasis were presented with choledocholithiasis as well. By EUS is possible to establish a diagnosis of choledocholithiasis with accuracy of 90 to 100% and precisely estimate dimensions of revealed stones. The main purpose of this survey is to present a great importance and many advantages of EUS as a contemporary diagnostic method. All patients were examined by Olympus equipment for endoscopic ultrasound with radial probe working with the frequency of 7,5 and 12 MHz at the Department for Endoscopic Ultrasound of the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia. They were previously diagnosed with choledocholithiasis by ERCP method. We examined 16 patients, which were selected by estimated risk for cholelithiasis. We have tried to evaluate the importance of diameter of choledochus, defined by common ultrasonography, as well as values of alkaline phosphatase and serum ?GT. We defined 3 groups of patients: group no.1, with 2 patients presented with a low risk for choledocholithiasis; group no.2, with 6 patients with a moderate risk for choledocholithiasis, and group no.3, with 8 patients presented with significant risk for cholelithiasis. According to obtained results, EUS presents the most effective method for detecting of choledocholithiasis, which is sometimes even more efficient than ERCP. After choledocholithiasis is previously revealed by EUS, it is much easier to decide if some invasive method such as EPT or precut papillotomy has to be used. EUS is always recommended as a diagnostic method when it is necessary to avoid some expected complications, such as pancreatitis.

Choledocholithiasis↗
PubMed2005

[Assessment of the degree of maturity in the wall of pancreatic pseudocysts in relation to choice of surgical procedure].

The aim of this study is to present our experience in the diagnosis and treatment of pancreatic pseudocysts. A pancreatic pseudocyst is an incapsulated collection of pancreatic juice, enclosed by nonepithelial elements, containing a high concentration of pancreatic enzymes, bicarbonates and necrotic detritus. It is a common complication of acute pancreatitis and trauma of the pancreas. In the period between 1996 and 2001, 53 surgical procedures were performed for pancreatic pseudocyst at the Institute for Digestive Diseases (First Surgical University Hospital), 35 male patients (67%) and 17 female patients (33%) underwent surgery. In 39 (75%) patients the method of choice was cystojejunostomy by Roux. In 4 cases distal pancreatectomy for pseudocysts localized within the pancreatic tail was performed, complete pseudocyst excision only was performed in one case and complete pseudocyst excision combined with cystojejunostomy was also performed in one case. Cystogastrostomy and drainage in one case and partial cystectomy and drainage also in one case. Surgical internal drainage is the method of choice for the treatment of pancreatic pseudocysts, involving low morbidity and mortality rates.

Adult↗
PubMed2002

[Cesarean section combined with splenectomy in severely resistant immune thrombocytopenia].

Immune thrombocytopenic purpura (ITP) associated with pregnancy often involves considerable risk both for mother and child, and usually worsens in the third trimester of gestation. Pregnancy and delivery are especially difficult in patients with severe ITP (platelet count below 20 x 10(9)/L), who are resistant to prednisone and high dose intravenous immunoglobulin (IVIgG). In those cases we applied cesarean section (CS), to prevent intracranial haemorrhage due to fetal/neonatal ITP, and splenectomy at the same time as an effective therapeutic strategy for ITP. We present 5 patients (4 with chronic ITP and 1 with ITP associated with HIV infection), aged 21-35 years, with severe ITP (platelet count 2-10 x 109/L), resistant to prednisone (1-2 mg/kg), and 2/3 were resistant to IVIgG (0.4 g/kg x 5 d). Four patients with severe resistant ITP were supported with 1-2 doses of platelets from cell separator before CS and 1-3 dose during splenectomy. One patient increased platelet count to 55 x 109/L after treatment with IVIgG and splenectomy following CS were done without platelet transfusion. Splenectomy was performed immediately after CS in all patients, and two of them were hysterectomised (one with HIV infection). After splenectomy, platelet count was normalised in all patients, and they had no haemorrhage, wound haematoma formation or any adverse events. But ITP relapsed in 2/5 patients after 1-2 months. Two newborns had severe thrombocytopenia, which solved spontaneously after 3 days in one or after treatment with IVIgG in other. We propose that splenectomy following cesarean section should be considered as approach for delivery and treatment option for mothers with severe resistant ITP.

Adult↗
PubMed2002

[Surgical treatment of hematologic disorders of the spleen].

Splenectomy--the surgical removal of spleen is being performed in cases of: traumatic spleen rupture, as part of other surgical procedures, number of hematological, infectious and metabolic disorders. During the years 1988.-2001., there were 396 splenectomies performed at the First surgical clinic, for the cause of: autoimmune disorders 187 (47.34%), lymphoproliferative diseases 89 (22.59%). Hodgkin disease 35(8.94%), myeloproliferative disease 39 (9.95%), as part a of "staging" laparotomy 37(9.34%), other hematological disorders 7(2.20%). The spleen of [table: see text] 244 patients weighted 500-1500 g(61.62%), in 56 patients (14.14%) weighted less than 500 g, and in 96 patients (24.24%) spleen weighted more than 1500 g. Patients with thrombocytes less than 40,000/l 16 (4.04%) were perioperativly treated with fresh thrombocytes. Postoperative morbidity and mortality were registered in 54 (13.64%), i.e. 8 (2.02%) patients. Delayed results depended on primary disorder, comorbidities and supportive therapy. In this article, the particularities of the operative procedure were discussed, as well as importance of cooperation of surgeon and hematologist in perioperative treatment.

Adolescent↗
PubMed2002

[Intraoperative and postoperative complications of splenectomy].

Spleen is being surgically removed because of trauma, in diagnostic and-or therapeutical purposes because of the benignant and malignant diseases. The percentage of morbidity during and after splenectomy is relatively low. During surgery might occur bleeding, trauma of the pancreatic tail, stomach, lineal flexure of the colon, left hemidiafragm, left suprarenal gland and upper pole of the left kidney, which must be correspondingly reclaimed during the same intervention. In the early postoperative period, postoperative bleeding, subfrenic abscess, pulmonal atelectasis, bronchopneumonia and left pleural extravasations might occur. Especially is important notification of these events in due time and adequate conservative and surgical treatment. After splenectomy, there is an increase of the number of trombocytes, which might lead to the tromboembolic complications. In the prevention of these complications in the postoperative period prolonged antiagregation therapy is suggested. Postsplenectomy sepsis is very late, general complication of splenectomy, which occurs because of the lower immunity in the child age. To prevent these complications, partial splenectomies, reimplantations of the spleen, prolonged application of the penicillin medicines after splenectomy and antipneumococcal vaccine are performed.

Humans↗
PubMed2002

[Autotransplantation of the spleen].

Auto transplantation of the spleen can be performed in the patients with traumatic rupture of the spleen, in whom spleen could not be conserved in the other way. The right indication for this method is isolated rupture of the spleen (concvasation or complete devascularisation). This method is not recommended in the endangered patients, patients with previous disease of the spleen as well as in the patients with the perforation of the other abdominal organs at the same time. Auto transplantation was performed in 12 patients with isolated splenic rupture and hematoperitoneum, 11 men and one woman. The majority of patients are younger. In 8 patients, autotransplant was placed into big omentum, in three into lipomatous tissue surrounding left kidney, and in one into anterior abdominal wall. In all the patients from this group, following analysis were taken: MCV (middle volume of erythrocytes), HTC, Hb, Le, Glucose, urea, creatinin, sodium, potassium, alkali phosphatasis, target cells, Howell Jolly's bodies, Heinz's bodies, IgG, IgA, IgM, C3, C4, T3, T4, T8, B, segmentated, eosinophiles, lymphocytes, reticulocytes, thrombocytes, fibrinogen, PT, APTT, aggregation of thrombocytes and aggregation of thrombocytes on collagen. The same parameters were taken in 12 patients with surgery similar to splenectomy and in 12 after splenectomy. After splenectomy, there was decrease of the immunologic defending abilities of the organism because of the loss of the childrens function of the spleen, decreased level of the opsonines and tutsin, which leads to the impaired phagocytosis, decreased concentration of IgM and T and B lymphocytes, while in patients after auto transplantation the results were physiological. The most important thing in the assessment of the function of the autotransplanted spleen is scintigraphic investigation using 99mTc-denaturated red blood cells. In our study, auto transplant function was assessed in 10/12 patients by scintigraphy. Five years after surgery, no one patient was proved to have postsplenectomic sepsis.

Female↗
PubMed2001

[Manifestations of visceral and ocular symptoms of toxocariasis in a 6-year-old boy].

In the past 10 years we have examined 137 cases of toxocariasis, predominantly in children. Three cases were with unilateral ocular involvement. The article reviews a 6-year-old boy with left side strabismus and granulomatous chorioretinitis. Laboratory examinations revealed blood eosinophylia 24% and IgG against Toxocara canis larvae in titer 1:320 by indirect immunofluorescent assay. In epidemiologic anamnesis we concluded that about 4, 5-year-long geophagia was the source of infection.

Child↗
PubMed2000

[Metastasis of malignant melanoma in the small intestine--case report].

Small bowel metastases of the malignant melanoma are usually discovered in 2-5% of the patients with malignant melanoma of the skin during the life. They are usually being diagnosed with a complication on the small bowel, such as occlusion, bleeding, anemia and perforation of the intestine. Authors show three patients with metastases of the malignant melanoma in the small bowel, which lead to invagination, subocclusion and anemia due to bleeding. In all the patients, resection of the small bowel was performed with termino-terminal anastomosis. One of them lived 7, the other 4 months after the surgery and is in pretty well condition, while third patient was not controlled at all.

Aged↗
PubMed2000

[A large duplication cyst of the proximal section of the stomach in an adult--case report].

Intestinal duplication is a rare congenital anomaly. It appears through out entire gastrointestinal tract, specially in the ileum. Gastric duplication cyst in adults is extremely rare. Diagnosis is often missed, often established at operation. Preoperative diagnosis may be suspected on CT or MRI with contrast given oraly as well as on EUS. Management of symptomatic gastric duplications is surgical. Recommended management is complete exscision of the duplication without major violation of the gastric lumen. In most cases giant cyst does not allow smaller resection but partial gastrectomy. In this report a rare case of gastric duplicatione cyst of the proximal stomach is presented. Diagnostic finding and surgical therapy are discussed.

Adult↗
PubMed1997

Adsorption-desorption processes of aluminium, zinc and copper on plastic tubing in haemodialysis monitors.

This study was performed to identify the source of contamination of dialysate with trace elements which had been observed in some haemodialysis centres in Slovenia. A possible explanation of this phenomenon was adsorption-desorption processes occurring on the plastic tubing in which dialysate was circulating in the haemodialysis monitors during dialysis. To confirm this, contamination of tubing with trace elements was simulated in vitro. After contamination, acetate or bicarbonate dialysates were prepared by the conventional procedure and samples of each dialysate collected in 1 ml fractions. Trace elements were measured by atomic absorption spectrometry. The haemodialysis tubing was contaminated for 0.5 or 4.5 h with 1.85 or 7.41 mumol/l of aluminium, 38.24 or 76.48 mumol/l of zinc and 7.87 or 15.74 mumol/l of copper. Steady state concentrations were reached after 5 min and ranged for aluminium from 0.18 to 0.67 mumol/l, for zinc from 0.31 to 0.92 mumol/l and for copper from 0.13 to 0.28 mumol/l in acetate dialysate, and 0.15 to 0.56 mumol/l of aluminium, 0.46 to 1.53 mumol/l of zinc and 0.06 to 0.47 mumol/l of copper in bicarbonate dialysate. The results suggested that adsorption-desorption processes are a probable source of contamination of the dialysate that could affect the health of haemodialysis patients.

Adsorption↗
PubMed1995

[Ectopic spleen--2 case reports].

Wandering spleen occurs consequently to the embryonal disturbances in the development of ligaments connecting the spleen with surrounding tissue. It is rarely the cause of abdominal discomfort, which is usually mild, but nevertheless it can be expressed within the signs of acute abdomen. In our study, two cases of wandering spleen are presented, the diagnosis was put according to the intermittent pain in lower abdomen, echotomography, radionuclide imaging and selective angiography. Splenectomy revealed subjective discomfort. In women, wandering pelvic spleen might be mis-diagnosed as a gynecological disease.

Adult↗
PubMed1994

[Causes of dehiscence in the anastomosis between the stomach and small intestine in our clinical data 1970-1990].

Gastrojejunal anastomotic leakage occurred in our clinical material of 4284 gastric resections Billroth II type with an incidence of 0.93 percent. 62 cases with anastomotic dehiscence were analyzed, with 22 from other clinics. The most critical part of the anastomosis was the upper angle of Billroth II Hoffmeister Finsterer anastomosis. The causes were mostly local; reoperations and resuture with necrotic and devitalized tissue, impaired vascularization of the stomach and small intestine due to rough manipulation, too narrow anastomosis and too tight securing of ligatures, as well as too massive tissue aglomeration in more layers. Stomach obstruction is a significant cause, as it is dista obstruction to anastomosis, duodenal dehiscence, peritonitis or pancreatitis. Some of the local causes are likely to be solved with using of one layer of resorptive suture material or using of a stapling device. General conditions are also important, but only as factors that stress the local conditions of risk. The mortality rate in this serial is high as 70.9%, in spite of the reoperations and complex conservative treatment.

Anastomosis, Surgical↗
PubMed1994

[Surgical treatment of peroperative injuries of the duodenum].

Operative duodenal lesions are rare, but often fatal complications of certain abdominal procedures. This was reported in small series with an incidence of 0.2% of all abdominal operations. The management of these injuries requests the surgeon to be familiar with a number of specific operative approaches, which are to be used according to the operative situation. In the 1985-1992, year period, 21 cases of the operative injury of duodenum were managed without mortality, and with 3 cases of transient postoperative fistula, which healed spontaneously. The most important factors in the management of this complication are the early operative recognition of duodenal injury, or early reoperation, if, in a case of duodenal fistula, distal outflow is considered insufficient. The particularities of the duodenal suture and perioperative treatment are to be well understood. Roux en Y covering of the duodenal defect by open jejunal loop is the best method in management of these injuries.

Adult↗