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V Marković

Publications and source records attributed to V Marković.

At least 19 recordsLinked to original sources
PubMed2004

Histopathology of residual rectal carcinoma following preoperative radiochemotherapy.

Preoperative radiotherapy with (CRT) or without chemotherapy (RT) in the management of patients with locally advanced rectal carcinoma is increasingly accepted as therapeutic modality to reduce local recurrence and improve survival, decrease tumor size and/or stage, has less toxicity compared to postoperative therapy, improves sphincter preservation and the ability to perform a curative resection. In a brief review of literature we discussed the possible prognostic role of most important pathologic parameters and their clinical implications. At present, predictive value of tumor response to neoadjuvant therapy remains uncertain, whether evaluated as five-point histological tumor regression grade (TRG) or recently proposed three-point rectal cancer regression grade (RCRG). However, most reports emphasize reduced local reccurence rates and disease-free survival advantage in patients with complete tumour regression or tumour down-staging, occuring in up to 20% and 60% of cases, respectively. Patients with advanced post-treatment tumour stage (ypT3/4), positive lymph nodes (ypN1/2), vascular invasion, positive circumferential resection margin, clearance < 2mm, or absence of tumor regression are shown to have poor clinical outcome. Among CRT-induced morphological features, only "fibrotic-type" stromal response with minimal inflammatory infiltrates and absence of surface ulceration are correlated to recurrence-free survival. Preliminary unpublished results of a pilot study from our multidisciplinary prospective trial relate to correlation of histopathologic parameters and morphologic changes to rectal cancer regression grade (RCRG). Therefore, we studied 22 consecutive patients, mean age 56 (range 23-69) years, with transmural cT3/4 stage and were subgrouped as follows: RCRG-1 (7 patients, 31.8%), RCRG-2 (9 patients, 40.,9%) and RCRG-3 (6 patients, 27,2%). In addition, 14 patients (63%) showed tumour downstaging and only 1 patient (4.5%) nodal down-staging after ypTNM restaging. There was the predominance of fibrotic-type stroma (16 patients, 72.8%) versus fibro-inflammatory response (6 patients, 27.2%), frequent tumoral necrosis (13 patients, 59%) but infrequent surface ulceration (5 patients, 22.7%) and peritumoural eosinophylic infiltration as well as endocrine cell differentiation (4 patients, 18%). The second aim of our study was to investigate determinants of radiosensitivity, i.e. the relationship between proliferative activity indices (Ki-67 and PCNA) as well as the induction of apoptosis (p53) and the tumour regression (RCRG) after neoadjuvant CRT. The interaction between Ki-67 and PCNA immunoexpression levels and the benefit of CRT was significant for Ki-67 (p = 0.03), but not for PCNA (p = 0.08) and p53 levels (p = 0.4). In a conclusion, high percentage of Ki-67-positive tumor cells in the preoperative biopsy predicts an decreased treatment response after preoperative CRT of rectal cancer. However, long-term follow-up and large studies are necessary to establish the value of regression grade and the need for its prediction by reliable biological markers.

Adult↗
PubMed2002

Double mucinous cystadenoma of the pancreas associated with thecoma of the ovary.

Cystadenomas of the pancreas are rare single and isolated tumors, usually appearing in young and middle aged women. Thecomas are rare usually unilateral, benign, estradiol, much rarer androgens producing ovarian tumors. We present a 19 year old girl in whom we removed two mucinous cystadenomas of the tail of the pancreas, 7 and 2 cm in diameter as well as a thecoma of the right ovary. As far as we know this combination of tumors have not been reported before.

Adult↗
PubMed2002

Local recurrence and five year survival after abdominoperineal resection of the rectum due to rectal carcinoma.

In the period 01.01.1991-12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65.2%. In the middle third, there were 28.9% and in the upper, intraperitoneal third 5.9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4.9% cased with Dukes D stage). There were 74.3% males and 23.7% females median age 59.2 years. According to Dukes classification there were 4.9% in stage A, 47.2% in stage B, 43.1% stage C, and 4.9% stage D. There were 4(2.7%) postoperative deaths. Recurrence of the disease was registered in 44 (30.5%) patients. Local recurrence alone was found in 14 (9.7%) patients, while distant spread was registered in 30 (20.8%) patients. At present, the median follow-up is at 72.9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63.4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; survival after 60 months of follow up shows cumulative Survival of 0.35 while Dukes B has far better prognosis (0.86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0.36 after 60 months), while stage B has much better prognosis (0.84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84.9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1.00% disease free survival for cases in stage A, 0.94 for Dukes B and 0.66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p-0.005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

Adenocarcinoma↗
PubMed2001

[Cholecystitis associated with milk of calcium] ].

Milk of calcium cholecystitis is a rare disease predominantely of adults. The term designates a pathologic accumulation of calcium carbonate in the gallbladder, much rarer in the common bile duct as well. The patient may be symptom-free. If present the symptoms may be very mild or as an acute biliary pain, transient jaundice and mild attack of pancreatitis. Calcium in the bile may be liquid or it may form a paste-like mass. Both may be seen on a plain X-ray of the abdomen. The stone or stones of calcium carbonate may be formed so that they may cause an obstruction of the gallbladder outflow tract or cystic duct or pass into the common bile duct or into the duodenum. [figure: see text] We present a 71 year old male who was admitted for inguinal hernia repair but in whom a mild hiperbilirubinaemia was found and then on ultrasonography a gallbladder stone was diagnosed. We performed a hernia repair as well as cholecystectomy and operative cholangiography which turn to be normal. Within an almost normal gallbladder a gray-whitesh paste-like mass was found composed of calcium carbonate. The postoperative recovery was uneventful and serum bilirubin become normal. Histology of gallbladder showed chronic nonspecific cholecystitis.

Aged↗
PubMed2000

[Surgical treatment of ulcerative colitis--"pouch" or ileorectal anastomosis].

Treatment of Ulcerative Colitis was always a challenge for a therapeutist. The therapy of the disease is usually conservative but when refractory or complications occur, surgical treatment is the only appropriate solution. Evolution of surgical techniques in treatment of Ulcerative colitis from bipolar colostomies, by-pass procedures, partial resections, colectomies, proctocolectomies to recent restorative procedures with the ileal-pouch and preservation of the continuity of digestive tract, shows the severity of the disease and explains the dilemmas which surgeons had in choosing the appropriate operation. Inauguration of ileal reservoir in late seventies, brought a new advancement in postoperative results measured by better function and quality of life. Even the ileal reservoir proved its superiority in surgical treatment of Ulcerative colitis, some dilemmas still persist. Should be rectum and continuity of digestive tract preserved by ileal-rectal anastomosis or by restorative coloproctocolectomy and ileal-pouch-anal anastomosis?

Anastomosis, Surgical↗
PubMed2000

Long-term results after low anterior stapled anastomosis.

In the period 01.01.1991-12.31.1996, 286 low anterior stapled resections of the rectum due to rectal carcinoma were performed at the First Surgical Clinic, the Third Department for Colorectal Surgery, Belgrade. There were 57% males and 43% females, median age 59.6 years. The most common localization of tumor was in the distal third of the rectum 181 (63%). In the middle third, there were 89 (31%) and in the upper, intraperitoneal third 16 (6%). Histopathological examination revealed adenocarcinoma in all cases. All operative specimens were examined by one pathologist and classified according to the Gunderson-Sosin modification of Dukes classification. There were 14 (4.9%) in stage A, 167 (58.4%) in stage B (B1,B2,B3), 89 (31.1%) stage C (C1,C2,C3) and 16 (5.6%) stage D. According to Broders classification, there were 129 (45%) well differentiated, 142 (50%) moderately and 15 (5%) poorly differentiated tumors. Anastomotic dehiscence was found in 17 patients (5.95%), mostly conservatively treated, except in 6 cases where spreading peritonitis developed requiring operative treatment. There were 9 (3.1%) postoperative deaths, a half of them with specifically operation related mortality. Recurrence of the disease was registered in 47 (18%) patients, out of 260 who were regularly followed up (26 were lost). Local recurrence alone was found in 21 (8.0%) patients, while distant spread was registered in 22 (8.46%) patients. Local and distant spread was found in 4 (1.5%) cases. At present, the median follow-up is at 54 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 66% at 71 months of the follow-up. Seventy four percent of patients with curative operations exhibit no signs of recurrence at 5 years.

Adenocarcinoma↗
PubMed2000

The role of overlapping sphincteroplasty in traumatic fecal incontinence.

Fecal incontinence is one of the most distressing conditions. Even there is a great variety of etiologic factors, they can be systematized in two main categories; fecal incontinence with normal and fecal incontinence with abnormal function of pelvic floor muscles. The latter is more interesting for surgeons since this category includes the great majority of surgically caused and surgically correctable fecal incontinences. Disruption of the anal sphincter caused by obstetric injury, anorectal operations or external trauma is the commonest cause of fecal incontinence. In the period 1990-1999, 53 patients with fecal incontinence caused by sphincter injury were treated on the third department for colorectal surgery, First Surgical Clinic. There were 43 females and 10 males with a mean age of 36.1 years (range 18-64). Causes of fecal incontinence were: obstetric trauma 38 patients. (71%), fistulotomy 9 (17%), war injuries 3 (6%) and nonspecific 3 (6%). The severity of incontinence was graded by Browning--Parks's classification. There were no patients in group A and B, in group C were 11 patients and in D group 37 patients. Wexner score system was also utilized preoperatively and postoperatively to determine continence function more precisely. Clinical exam, anoscopy and special investigations, such as anal manometry, EMG and defecography were carried out in all cases. Period between injury and repair was between 6 months and 20 years. Severe pudendal neuropathy was present in 17 patients. Five patients had oostomies performed at the time of injury. In three cases was present traumatic cloaca and in one case rectovaginal fistula. Overlapping sphincter repair technique was carried out in all cases. Full bowel preparation and antibiotics were prescribed. Anterior sphincteroplasty was performed in 39 cases, lateral in 7, posterior in 3 and anterior sphincteroplasty + posterior plication of puborectalis (Parks operation) in 4 patients. Protective colostomy was not performed in any case. The outcome of the procedure was considered as excellent, good, fair and poor (excellent when full control of solid and liquid stool and flatus was achieved, good when there was continence to feces but not to flatus, fair when patients could control only solid feces and poor when only partial control of solid feces was obtained). The overall functional results were as follows: Excellent in 25 patients (47.2%), good in 12 (22.7%), fair in 11 (20.7%) and poor in 5 (9.4%). Wound infection occurred in 9 (16.9%) patients, leading to disruption of sutures in three patients with consequent poor results. Two of them were reoperated. The duration of follow-up was from 5 to 60 months. We conclude that an overlapping sphincteroplasty is a method of choice in treating fecal incontinence caused by trauma. The best results are achieved with anterior sphincteroplasty. Results of posterior sphincteroplasty were disappointing. If present, pudendal neuropathy directly influences the outcome of sphincteroplasty. Manometric studies correlate with the clinical outcome.

Adolescent↗
PubMed1998

[New prognostic parameters and categories of colorectal carcinoma--correlation with standards].

The proper staging of colorectal cancer was discussed with emphasis on the most relevant pathological parameters. Standard staging classifications i.e. Dukes', Astler-Coller's and international TNM classifications are defined by a few basic parameters, namely local invasion and lymph node metastasis, along with the histological grade of differentiation. Advances in diagnosis and treatment and modern aspects of tumor biology introduced other prognostic factors regarding proliferative activity of tumor, its local and systemic effects, host defense mechanisms and metastatic potential. Independent prognostic significance was shown and/or new criteria recommended for: resection margin and peritoneal involvement, vascular invasion, tumoral mucin production activity, presence of extranodal (micro) metastasis, extent of presented (extra) mural tumor spread, peritumoral lymphocytic infiltration, character of tumoral invasive margin and presence of peritumoral Crohn's-like lymphoid reaction. The se pathological parameters, discussed in detail, were partly contained in new revision of TNM or other classifications, not widely accepted, such as Jass', Japanese JSCCR, British UKCCCR classification, or new prognostic categories proposed by Harrison and coworkers. Our own first experiences and primary results showed variable agreement most of the mentioned parameters with special respect to reproducibility of Harrison's new prognostic categories. Many newly developed methods and novel tumor markers with some predictive values on clinical outcome are recently recognized, still uncertain for routine clinical usage. We reviewed in brief most important and/or most studied pathobiological predictors, such as: DNA ploidy, markers of proliferative activity, expression of tumor-specific and tumor-associated antigens or receptors. Among many of hereditary and genetic markers we stressed the importance of RER phenotype, mutations of tumor suppressor genes and some oncogenes, allelic loss of 18q, 17p and other chromosomal alleles as prognostic and screening tools or therapeutic targets. In conclusion, more new insights in carcinogenesis and new therapeutic agents will require new classification systems, never considered as definitive.

Colorectal Neoplasms↗
PubMed1997

Spirometric disorders in women with genital descensus.

BACKGROUND: We hypothesized that abnormalities in connective tissue, found in women with genital descensus, could impact their pulmonary function. METHOD: Therefore we compared lung flows and volumes between women with (n = 100) and without (n = 100) descensus. RESULTS: Patients exhibited highly significant decrements in all expiratory flows, especially in the peak expiratory flow (-35%) and other flows at large lung volumes. The forced vital capacity and forced expired volume at 1 second, but not their ratio, were also decreased (-16% and -17%, respectively). These differences were exaggerated in postmenopausal subjects and in patients with third degree of descensus, but did not depend on the presence of stress incontinence. Lung flows and volumes did not change between follicular and luteal phase of the cycle, either in patients or in controls. The forced vital capacity decreased with increasing years past the menopauses in patients (65 +/- 10 ml per year), but not in controls. CONCLUSION: In women with genital descensus deteriorations in lung ventilatory function were observed in association with the presence and duration of postmenopauses.

Adult↗
PubMed1996

Living related kidney donors over 60 years old.

The lack of available cadaveric organs for transplantation has resulted in an increased number of kidney transplants from living donors. During a period of 6 years, 149 kidney transplantations were performed from living related donors in our institute, 33.5% of whom were older than 60 years of age. In this study we examined the survival of patients and grafts as well as the graft function in 50 patients with transplants from donors over 60 years (mean age 65 years) as compared with those of 99 patients with transplants from donors younger than 60 years (mean age 47 years). There were no significant differences in the course of donor nephrectomy, postoperative complications, or remnant kidney function. However, delayed graft function occurred more frequently in recipients of transplants from older donors. Improvement in graft function was also slower in recipients of kidneys from older donors, with significant differences in serum creatinine levels observed during the first 12 months after transplantation. More frequent acute complications and more progressive chronic graft failure, irrespective of the causes, occurred during the 1st post-transplant year in recipients with grafts from older donors. Five-year patient survival (77% vs 92%) and kidney graft survival differed significantly for the same period with worse results for patients receiving grafts from older donors. It may be concluded that kidney grafts from donors older than 60 years -- and especially those older than 70 years -- may be used for living related kidney transplantation, but with precautions.

Adult↗
PubMed1996

The role of direct radionuclide cystography in evaluation of vesicoureteral reflux.

The validity of voiding cystourethrography (VCUG) for detecting vesicoureteral reflux in children and assessing its extent was compared with that of direct radionuclide cystography (DRNC). Of 131 patients with recurrent urinary tract infection, all underwent DRNC and most also VCUG. Vesicoureteral reflux was found at DRNC in nine renal units (9 patients) in which VCUG was negative. In 17 renal units (15 patients) VCUG showed reflux to the ureter, but not to the renal pelvis, whereas DRNC revealed backflow from the bladder up to the renal pelvis. Reflux visualized at DRNC but not at VCUG was defined as grade Io. In all cases with reflux of grade I according to current classifications, DRNC showed reflux up to the renal pelvis. These observations make the distinction between grades I and II reflux in presently used classification less relevant and indicated the possible pathway of renal infection in patients with grade I vesicoureteral reflux and in so-called "elusive" reflux. We propose the addition of an extra grade (Io) of vesicoureteral reflux.

Child↗
PubMed1995

Radiotherapy plus fifth day carboplatin in locally advanced bladder cancer.

The goal of our prospective nonrandom study was to improve treatment results in advanced bladder cancer and possibility of cure with acceptable toxicity and reduced rate of late complications. Fifty-three patients with locally advanced bladder cancer (clinical stage T3a and b) treated by radical radiotherapy (65 Gy, conventional fractionation) and concomitant carboplatin (150 mg in bolus infusion, once a week, every fifth day an hour prior to the irradiation, up to total dose of 900 mg, during the treatment course. Out of 53 evaluable patients, complete response was achieved in 47/53 (88.7%) and partial response in 2/53 patients (3.8%). Hematological toxicity grade I and II occurred in the majority of patients. Mean follow-up was 16 months (range 4-24), 2-year overall survival has been achieved in 85% and disease free survival of 49 responding patients in 84%.

Adult↗
PubMed1994

[Mechanical sutures in resection of the rectum in carcinoma].

In the period between January 1, 1992, and January 1, 1994, on the 3rd Department of the 1st Surgical Clinic, Clinical Center in Belgrade, 116 pt's has been operated due to a rectal carcinoma. In all of these pt's an anterior resection of the rectum and a colorectal stapled anastomosis was performed. Colorectal anastomosis was performed using an American EEA stapler on the different segments of the rectum. Overall, a 30 or 25.86% intraperitoneal anastomosis have been performed, 18 (15.51%) were done on the medium third of the rectum and ultra low anastomosis were performed in 68 pt's (58.63%). In our group there was 6 pt's with the anastomotic leakage and a leakage occurred only in the group of pt's with ultra-low colorectal anastomosis. In three pt's after conservative treatment a spontaneous healing of the anastomosis happened while in the other three pt's an explorative laparatomy with loop ileostomy had to be performed. One patient died during the postoperative treatment. The patient died on the second postoperative day due to a mesenteric thrombosis and gangrene of the intestines.

Colon↗
PubMed1993

[Exposure to benzene and hematologic changes in workers at the Ina-Oki Drnisplast factory in Drnis].

In the summer of 1984 workers in the "INA-OKI Drnisplast" factory frequently complained about headaches, weight loss and irregular menstrual cycles. According to the factory engineers that might have been due to an altered composition of the paints and glues that were used in the manufacturing process that year. Those had been found to lack specifications of chemical composition. Experts from the Institute for the Safety at Work from Zagreb were called in to perform measurements of organic solvents content in the workroom air. Benzene concentrations were found to be up to five times higher than the maximum permissible levels, those of toluene up to three times and of cyclohexane up to ten times higher. The polluted part of the factory was closed down, changes were introduced into the working process (use of paints was stopped, only glues without benzene content were allowed and proper ventilation was installed) and all the workers, twenty in all, received medical treatment. After three months the working process was resumed. In 1989 all the twenty workers underwent a control medical examination. All showed signs of recovery, both objective and subjective. Their blood tests values were within normal range. All the workers continued working, save one who retired in 1988 upon recommendation of a disability commission. The cause of disablement was occupational disease--benzene poisoning. On the basis of this experience emphasis is placed on the importance, in working with benzene, of complying with the Legislation on working capacity assessment for jobs requiring special working conditions and with the Safety at work act.

Adult↗
PubMed1992

Increasing incidence of adenocarcinoma of the proximal stomach.

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.

Adenocarcinoma↗
PubMed1990

[Kidney transplantation in high-risk patients].

Immunosuppression with Cyclosporine A in kidney transplantation, triple therapy (CyA + Imuran + corticosteroids) and plasmapheresis before and after kidney transplantation in high risk recipients (positive cytotoxic antibody, MLC at the level of non related persons), also in high risk patients (juvenile diabetes, patients over 50 years old). In 1988 we had done in our Centre, kidney transplantation in 52.8% (28: 53) in high and increased risk patients. Triple therapy with plasmapheresis before and after kidney transplantation (if the level of cytotoxic antibodies is over 15%) allows successful kidney transplantation in high risk kidney recipients. Patients with juvenile diabetes are also available kidney recipients with therapy and permanent regulation of blood sugar. The patients of the age group between 50-60 years should be considered as suitable for kidney transplantation.

Graft Survival↗