Bojan Milosevic

The impact of pain on functionality and health related quality of life in patients with knee osteoarthritis

Aleksandra Jurišić-Škevin1,2, Vesna Grbović1,2, Ivana Stanković3, Aleksandar Radunović4, Jasmin Nurković5, Bojan Milošević6,2, Aleksandar Cvetković6,2, Ana Divjak1, Maja Vulović7 1University of Kragujevac, Faculty of Medical Sciences, Department of Physical medicine and rehabilitation, Kragujevac, Serbia; 2Clinical center Kragujevac, Kragujevac, Serbia; 3University of Defence in Belgrade, Military Medical Academy, Institute for Medical Research, Belgrade, Serbia; 4Military medical academy, Clinic for orthopedic surgery and traumatology, Belgrade, Serbia; 5State University of Novi Pazar, Department of Biomedical Sciences, Novi Pazar, Serbia; 6University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia; 7University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy, Kragujevac, Serbia;

Esophageal Mobilization in the Treatment of Short Esophagus

Abstract Short esophagus is well known complication of a long term gastroesophageal disease. There are several ways to solve this problem intraoperatively. One of the first steps is extensive esophageal mobilisation. In this review we emphasize different approaches and types of this procedure, with their advantages and disadvantages.

The Collis Procedure and the Acquired Short Esophagus

Abstract One of the most intriguing problems in modern esophageal surgery is the acquired short esophagus. While some authors recognize this entity, others deny its existence. There is a consensus about types of the short esophagus, its etiology and pathophysiology. Definitive diagnosis can be established only intraoperatively. There are a few surgical procedures for this problem, and most frequently is used Collis gastroplasty with fundoplication. In this review we emphasize recent literature data and further perspectives of the Collis procedure.

Total Endoprothesis of Hip Joint: Characteristics and Application in Patients in the Central Region of Serbia

Total hip arthroplasty is a surgical procedure in which the hip joint is replaced with an artificial one. Performance of this procedure requires knowledge of the anatomical features of the joint, the characteristics of the endoprosthesis, and the needs and pathological and physiological characteristics of the patient. This retrospective analysis includes the data contained in 874 medical histories of patients of both sexes implanted with a unilateral total hip endoprosthesis who were treated at the Orthopedic Clinic of the Clinical Center, Kragujevac, from January 1st, 2009 to December 1st, 2014. Analysis of the data revealed that 69.3% of the patients were women. The most common type of implanted prosthesis was the cementless one, and the most frequent indication was degenerative joint damage. Total arthroplasty of the hip joint has become one of the most common interventions in orthopedic surgery. The increasing need for this method of treatment required the development of new biomaterials, as well as new types of prosthesis, which, in the future, will decrease the occurrence of adverse reactions and complications during and after implantation of the prosthesis, as well as extending their useful life.

Flail chest in a polytraumatized patient: Management and treatment: Case report

Introduction. Management of a polytraumatized patient is a problem that requires a multidisciplinary approach, in order to optimise patient’s outcome. The purpose of this study is to show the approach in the treatment of a patient with a severe life-threatening polytrauma, including a personalized healthcare approach, after the inadequate initial treatment with the positive outcome. Case report. We present a case of a young polytraumatized patient with trauma as a result of road traffic accident. The patient had chest injuries, abdominal injuries and right arm injuries. He was diagnosed of hepatic rupture with conquasation and retroperitoneal hematoma and the patient underwent liver tamponade. Chest trauma was treated by chest drainage. After the adequate multidisciplinary interventions for the patient, the patient was discharged. Conclusion. This case report is of great importance since it shows that severe polytraumatized patients with bad initial prognosis can successfully receive a life - saving treatment.

New Therapeutic Concepts in Post-Resuscitation Care

Abstract After the return of spontaneous circulation (ROSC), as a result of global ischaemia due to cardiac arrest followed by reperfusion, a condition develops called post-cardiac arrest syndrome. It manifests, alongside the pathology that caused the cardiac arrest, as a systemic inflammatory response, including severe cardio-circulatory and neurological dysfunction, leading to a fatal outcome. Th e aim of post-resuscitation care is to reduce the consequences of circulatory arrest, reperfusion, and the inflammatory response of the body on vital organ functions. The basis of post-resuscitation care comprises application of therapeutic hypothermia and early coronary angiography with PCI. However, after the initial enthusiasm, the validity of applying these aggressive methods in all comatose post-cardiac arrest patients was questioned. Currently, instead of therapeutic hypothermia, a strategy of maintaining a targeted body temperature, usually 36 °C, is being applied because there is no clear evidence of benefit for maintaining a lower body temperature in relation to the outcome. Additionally, patients with an obvious cardiac aetiology of cardiac arrest do not undergo early coronarography unless there is a clear indication of coronary artery occlusion. In the post-resuscitation period, the maintenance of adequate ventilation, maintaining levels of oxygen and carbon dioxide in the normal range, haemodynamic stability, control of blood glucose and electrolytes, and epileptic attack prevention are all strongly recommended measures. Th ere is no evidence to suggest that the application of the so-called neuroprotective agents affects the outcome of cardiac arrest.

Predictive significance of myeloperoxidase for the occurrence of postoperative vascular complications

New findings on the activity of myeloperoxidase in the course of an inflammatory process associated with infections and vascular lesions indicate its role in the state of oxidative stress and endothelial dysfunction as well as its predictive value for cardiovascular insults. The products of actions by myeloperoxidase represent an integrative mechanism connecting the tissue lesions, infectious, inflammatory processes, oxidative stress, endothelial dysfunction and the development of vascular insult (the most common are the arterial and venous thrombosis and consecutive embolism). The most common complications of an operative surgical treatment are vascular. Seen from a conservative standpoint the most common are arterial and venous thrombosis, but more broadly suture dehiscence could be considered as a consequence of the impaired microcirculation. Operational procedures as well as the underlying pathology lead to the activation of inflammatory cascade with the activation of myeloid lineage cells whereby a release and activation of myeloperoxidase, which in addition to antimicrobial exerts multiple vascular operations. Increased concentrations of myeloperoxidase in the plasma up to three months before the clinical expression of vascular insult indicates its predictive value. Current research portrays the possibility of adjusting the successful result of the action of myeloperoxidase and prevention of vascular complications.

The role of hyperhomocysteinemia in the development of postoperative vascular complications

Hyperhomocysteinemia is one of the unconventional risk factors of cardiovascular morbidity - it is causally associated in both directions with oxidative stress, endothelial dysfunction, mechanisms of cell signaling and apoptosis. Numerous clinical and experimental studies have explained the mechanisms and clinical expression of atherosclerotic and prothrombotic effects of homocysteine. The main pathological substrate, previous therapy, and surgical procedure-intervention itself are associated with the state of oxidative stress and endothelial dysfunction, which is one of important factors for elevated plasma homocysteine levels. Recent studies point to the possibility of a successful correction of hyperhomocysteinemia, especially secondary one.