Marko Spasic

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.

CFTR IVS8 Poly-T Variation Affects Severity of Acute Pancreatitis in Women

BackgroundCystic fibrosis transmembrane conductance regulator (CFTR) is important for normal pancreatic function. Its coding gene is polymorphic, and the variations have been associated with the increased risk for acute pancreatitis. However, their impact on the disease severity is still unknown. Therefore, the aim of our study was to determine the functional importance of common cystic fibrosis transmembrane conductance regulator variations IVS8-poly T, R117H, and M470V for the severity of acute pancreatitis.MethodThe study involved 98 acute pancreatitis patients. The severity of the disease was determined based on the Atlanta Classification system. IVS8-poly T, R117H, and M470V genotyping was performed using PCR-RFLP method.ResultsIVS8-5T, IVS8-7T, IVS8-9T, and M470V alleles were found at the frequencies of 5.7, 75.5, 18.9, and 55.7%, respectively, while R117H was not observed. Among women, the severe form of the disease was more frequent in carriers of at least one IVS8 9T allele (RR for 9T/9T + 9T/non-9T vs. non-9T/non-9T: 2.115; 95% CI: 1.241–3.605). This association was not detected in men and was not affected by M470V. In addition, co-morbidities increased the severity of acute pancreatitis (p = 0.022).ConclusionOur study reveals that IVS8 poly-T variation affects severity of acute pancreatitis in women and that existent co-morbidities worsen the clinical course of the disease.

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.

Clinical and laboratory parameters associated with death in acute pancreatitis

Introduction. Acute pancreatitis is an inflammatory condition having the significant mortality rate in the case of severe forms of disease. The aim of this study was to investigate putative factors of increased mortality with contradictory prior evidence, and to reveal factors that were insufficiently explored previously. Methods. A prospective cohort study with nested case/control design included all adult patients treated for acute pancreatitis in Clinical Center of Kragujevac, Serbia, during the 3-year period (from October 2011 to December 2014). The cases (n=19) were patients who died, while the controls (n=113) were patients who survived. The associations between putative risk factors and the study outcomes were tested by univariate and multivariate logistic regressions, and expressed as crude and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI). Results. Significant association with the lethal outcome in acute pancreatitis was found for advanced age (adjusted OR 1.12, 95%CI 1.02-1.23), presence of significant comorbidities (adjusted OR 10.62, 95%CI 1.01-111.39), higher interleukin-8 (IL-8) value on third day from onset of symptoms (adjusted OR 1.05, 95%CI 1.02-1.08), use of tramadol and/or morphine (adjusted OR 47.34, 95%CI 3.21-699.08), BISAP score ≥ 3 in the first 24 hours (adjusted OR 48.11, 95%CI 3.14-736.29), and prophylactic use of antibiotics (adjusted OR 0.07, 95%CI 0.01-0.85). Conclusion. Advanced age, significant comorbidities, use of tramadol and/or morphine and more severe disease as assessed by BISAP score can increase the risk for death in acute pancreatitis, while prophylactic use of antibiotics may have a protective role. [Projekat Ministarstva nauke Republike Srbije, br. 175007]

Accessory Auricles - Report of Two Cases

Abstract Accessory auricle is a rare anomaly with an estimated incidence rate of 0.2-0.5%. The most common form of this malformation is the accessory tragus. It may be a sign of other syndromes, such as oculo-auriculo-vertebral dysplasia (Goldenhar’s syndrome). In this paper, we describe two cases of accessory auricle with a focus on diagnosis and surgical treatment.

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.

In Regard to Nagata et al

To the Editor: I read with interest the article by Nagata et al (1) on stereotactic body radiation therapy (SBRT) in 100 inoperable and 64 operable patients with clinical stage T1N0M0 non-small cell lung cancer (NSCLC) treated with 48 Gy in 12 fractions. For the 100 inoperable patients, the 3-year overall survival (OS) rate was 59.9%, and for the 64 operable patients, the 3-year OS rate was 76.5%. Although the authors also provided corresponding data for a number of additional endpoints, the cancer-specific survival (CSS) data were missing. CSS might particularly be important in this setting because RT reports, of both conventional RT and SBRT, have almost always included a significant proportion of patients with concomitant diseases such as those of the heart and lung. Hence, in series studying the use of RT, an excess of cancer-unrelated deaths, attributable to preexisting comorbidities, has always been reported. Therefore, RT studies should include CSS as an important endpoint. When CSS was reported, the results of RT for earlystage NSCLC were always much better than when only OS was reported. In a most comprehensive review on the use of conventionally planned and executed RT to date, Jeremic et al (2) highlighted this problem and documented that in a number of studies, the CSS was much greater than the OS, with the difference between the 2 usually at the order of 15% to 20%. They showed that intercurrent deaths directly correlated with age and pre-existing comorbidities (3-5) but inversely correlated with a patient’s refusal to undergo surgery (6-8). Observations from conventional RT studies about the important difference between OS and CSS are also possible in modern SBRT studies. In the prospective phase 2 study by Fakiris et al (9), patients with T1-T2N0M0 NSCLC were treated with 60 to 66 Gy in 3 fractions. Although the