Biomedical subjects

Zoran Roganović

Publications and source records attributed to Zoran Roganović.

6 recordsLinked to original sources

PubMed2005

Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs.

OBJECT: Very few extensive studies regarding the repair of missile-induced tibial nerve or tibial division complete lesions have been published to date. In this prospective study, the outcomes of such repairs as well as factors influencing them are presented. METHODS: Between 1991 and 1994, 119 patients with missile-induced complete lesions of the tibial nerve or tibial division were treated in the neurosurgical department of the Military Medical Academy, Belgrade. After at least 4 years of follow up, the final outcome was defined as poor, insufficient, good, or excellent, based on sensorimotor recovery, electromyoneurography-demonstrated recovery, and patient judgment. Good and excellent outcomes were considered to be successful. The influence of the repair level, length of the defect, and preoperative interval on final outcome was also tested. A successful outcome was obtained in 30.3% of high-level, 50% of intermediate-level, and 85.7% of low-level repairs (p < 0.001). On average, the nerve defect and preoperative interval were significantly shorter in patients with a successful outcome. Significant worsening of the outcome was related to a nerve defect longer than 5 cm and a preoperative interval longer than 4 months. Repair level, preoperative interval, and length of the defect were independent predictors of a successful outcome. CONCLUSIONS: A successful outcome is most probable following the low-level repairs, within the first 4 months after injury, and using grafts shorter than 5 cm. Other repairs can also be beneficial in preventing dangerous anesthesia of the sole of the foot and enabling almost normal walking.

Adolescent↗

PubMedDate not supplied

[Treatment of aneurysms in the anterior cerebral circulation].

OBJECTIVES: To analyze the outcome of either surgical or conservative treatment of patients with aneurysms on cerebral arteries. DESIGN: Retrospective study on 114 patients (89 operated and 25 not operated). METHODS: Clinical state was graded from 0 to V, according to Hunt & Hess (HHG), and the treatment outcome was defined as favorable or poor, according to the modified Glasgow Outcome Score. The outcome was correlated with the type of treatment (operative or conservative), clinical state and aneurysmal localization. RESULTS: Aneurysm was localized mostly on the anterior communicating (33.6%) and middle cerebral arteries (32.8%) and the patients were mostly in HHG II or III (34.4% and 25.2%). HHG after the aneurysmal rupture did not depend on the aneurysmal location (p > 0.05). Favorable treatment outcome was noted: in 74.1% of all operated and in 60% of all conservatively treated patients (p > 0.05); in 81.6% of operated and in 33.3% of not operated patients with HHG = II-III (p < 0.01); in 78.8% of aneurysms of the middle cerebral artery and in 66.7% of those of the anterior communicating artery (p > 0.05); in 73.1% of patients with HHG = III and in 25% of patients with HHG = IV (p < 0.01). CONCLUSIONS: Clinical state after the aneurysmal rupture did not depend on its localization. Results were better after the surgical, than after the conservative treatment. Outcome after the surgery depended on the clinical state of the patient, but not on the aneurysmal localization.

Aneurysm, Ruptured↗

PubMedDate not supplied

[Multiple cerebral aneurysms].

BACKGROUND: To define risk factors for the multiplicity of cerebral aneurysms, as well as clinical and therapeutical characteristics of patients with single aneurysms (SA) and multiple aneurysms (MA). METHODS: Retrospective study on 95 patients with SA and 22 patients with MA. For patients with SA and MA the following parameters were compared: gender, age, clinical state, aneurysmal localization and size, incidence of rebleeding and vasospasm, manner and outcome of treatment, preoperative interval, intraoperative rupture and postoperative complications. RESULTS: Aneurysms on anterior communicating artery existed in 37.4% of SA and in 17.8% of all MA (p < 0.05). As much as 44.2% of all aneurysms on middle cerebral artery and only 19% of all aneurysms on anterior communicating artery were associated with some other aneurysm (p < 0.02). The average size of SA was 15.4 +/- 11.8 mm, and 9.8 +/- 9 mm for MA (p < 0.05). Surgery was performed in 77.3% of patients with MA and 78.9% of patients with SA (p > 0.05), but complete surgical clipping was performed in 89.3% of patients with SA and in 47.1% of patients with MA (p < 0.01). Among operated patients with MA and SA, intraoperative rupture occurred in 36% and 17.6% of cases, respectively (p < 0.05) and ischemic postoperative complications were found in 29.4% and 17.3% of the cases (p > 0.05). Among 72.7% of all patients with MA and in 69.5% of all patients with SA the outcome was good, while among surgically treated patients it was good in 76.5% and 70.7% of cases, respectively. CONCLUSION: The treatment outcome was similar for patients with MA and SA, but complete operative treatment is significantly more frequent for SA. Multiple aneurysms were considerably smaller and with different anatomical distribution in relation to solitary aneurysms.

Aneurysm, Ruptured↗

PubMedDate not supplied

[Complications and mortality in surgery of cerebral aneurysms].

AIM: To establish the risk factors for complications and fatal outcome after the operative occlusion of cerebral aneurysms. METHODS: Retrospective study on 91 (lethality rate) and on 72 operated patients (complications). For survived and dead patients, as well as for patients with and without complications, following parameters were compared: gender, age, clinical condition, preoperative interval, use of temporary clips, vasospasm, outcome, as well as localization, size and intraoperative rupture of the aneurysm. RESULTS: Complications existed: in 54.5% of aneurysms of middle cerebral and 13.6% of aneurysms of internal carotid artery (p < 0.01); in 18.2% of patients in the first and 45.8% of patients in the third clinical Hunt and Hess group (p < 0.05); in 57.9% of patients with and 20.5% of patients without intraoperative rupture (p < 0.01); in 50% of patients with and 18.7% of patients without vasospasm (p < 0.05). Average aneurysmal size was 18 mm in group with complications and 10.8 mm in patients with no complications (p < 0.05), while average preoperative intervals in these two groups were 20 and 8.7 days (p < 0.05). Lethality rate was 25% for the third and 83.3% for the fourth and fifth clinical group (p < 0.01), and the existence of complications significantly increased mortality (from 15.7% to 50%, p < 0.01). Good outcome existed in 19.2% of operated patients with complications and in 78.3% of those without complications (p < 0.01). CONCLUSIONS: Incidence of complications depended significantly on preoperative clinical condition, duration of preoperative interval, size, localization and intraoperative rupture of aneurysm. Complications significantly minimized the surgical treatment outcome and increased the lethality rate mortality.

Female↗

PubMedDate not supplied

Factors influencing the outcome after the operative treatment of cerebral aneurysms of anterior circulation.

BACKGROUND: The influence of various factors on the outcome after the operative occlusion of the cerebral aneurysm was to be defined through the retrospective study on 111 surgically treated patients with aneurysm of anterior cerebral circulation. METHODS: Preoperative clinical condition was graded from 0 to V, according to Hunt & Hess. Postoperative outcome, defined as good or bad according to modified Glasgow Outcome Scale, was correlated in homogenous experimental groups with the following factors: gender, age, aneurysmal size, preoperative interval, nimodipine therapy, experience of surgical team and existence of chronic vascular diseases. RESULTS: Surgical outcome was good in 74.4% of males and 71.4% of females (p > 0.05); in 83.3% of patients with and 41.2% of patients without chronic diseases (p < 0.01); in 71.4% of patients underwent early, 83.3% of ones underwent postponed and 85% of those underwent late surgery (p > 0.05); in 81.5% of patients treated by nimodipine and in 41.7% of those untreated by the same drug (p < 0.01); in 78.9% of patients operated by the experienced surgical team and in 40% of those operated by less experienced surgical team (p < 0.01). In patients with both good and bad outcome, the mean age was 50.6 and 47.6 years (p > 0.05), and the mean aneurysmal size was 12.3 mm and 13.3 mm, respectively (p > 0.05). Before rupture, the mean size for aneurysms on the bifurcation of the middle cerebral artery was 14.3 mm, and for posterior communicating artery aneurysms only 9.7 mm (p < 0.05). CONCLUSION: Surgical outcome was significantly influenced by the existence of chronic diseases, nimodipine therapy and experience of surgical team, whereas gender, age, timing for surgery and aneurysmal size were not of significant influence.

Adult↗

PubMedDate not supplied

[Outcome of surgical treatment of malignant astrocytoma of the brain].

BACKGROUND: The aim of this study was to analyze the outcome after the surgical treatment of patients with malignant brain astrocytomas, as well as the factors influencing the outcome. Retrospective study was performed on 145 operated patients (102 with glioblastoma multiforme, and 43 with anaplastic astrocytomas). METHODS: Clinical state was graded according to the Yasargil scale (grades I-IV) and the Karnofski score, and the outcome was defined either as good (better or unchanged clinical state) or as poor (deteriorated state or death). The outcome was correlated with patients age and preoperative clinical condition, as well as with the localization, extensiveness and the extent of resection of the tumor. RESULTS: Preoperative clinical state of patients most frequently corresponded to grades II-III (75.9%). Radical resection was done in 48.3%, subtotal in 15.2%, partial in 30.3%, and biopsy was performed in 6.2% of patients, with the total operative mortality of 16.5%, morbidity of 9.7%, and good postoperative outcome in 73.8% of the patients. The incidence of good postoperative outcome did not significantly depend on the tumor location (42.6-78.3%), cortical presentation, the extent of resection (68.2-75.7%), and preoperative clinical state (67.8-81.5%). Good outcome was seen in 82.7% of patients with one, and in 53.8% of patients with three or more infiltrated lobes (p < 0.01). Patients with poor outcome were significantly older in average than the patients with good outcome (58.9 +/- 12.1 and 50.9 +/- 13.4 years of age, respectively; p < 0.05). Operative mortality was 7.4%, and 27.3% for clinical grades II and IV (p < 0.05), namely 11% and 23.8% for the patients with the Karnofski score above and under 50 (p < 0.05), respectively. CONCLUSION: The outcome after the operative treatment of malignant cerebral astrocytomas significantly depended on patients age and the extensity of the tumor. For such patients operative mortality was also significantly influenced by clinical preoperative state.

Adult↗