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Introduction/Objective. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. The aim of this study was to evaluate the usefulness of preserving the duodenal passage in subsequent improvement of body weight (BW) and body mass index (BMI) in patients with gastric cancer after total gastrectomy. Methods. A total of 30 patients with gastric cancer were prospectively randomly divided into a group of reconstruction with double-tract (n = 15) and a group of reconstruction with simple Roux-en-Y after total gastrectomy. They were stratified by sex, age, their anthropometric measurements (BW, BMI), primary tumor localization, Lauren’s classification, TNM stage classification, length of hospital stay, operation duration, postoperative complications, and mortality. Postoperatively, BW and BMI were measured at three, six, and 12 months and compared between the two groups. Results. The clinical group of double-tract patients had significantly higher the values of BW in the postoperative period after six (66.6 ± 4.9 vs. 61.7 ± 7.6; p < 0.05 paired Student’s t-test) and after 12 months (67.0 ± 4.9 vs. 62.3 ± 7.2; p < 0.05 paired Student’s t-test) compared to the group of Roux-en-Y patients. On the other hand, the clinical group of double-tract patients also had significantly higher the values of BMI in postoperative period after 12 months (23.6 ± 1.1 vs. 22.5 ± 1.6; p < 0.05 paired Student’s t-test) in relation to the Roux-en-Y group of patients. Conclusion. Reconstruction procedure carried out after total gastrectomy which implies preserving the duodenal passage has significant increase of BW and BMI, compared to reconstruction procedure without the preservation of the duodenal passage.

Background/Aim. Although the characteristics of the treatment are the most researched determinants of quality of life of opiate addicts, it is indisputable that there is a certain influence of the characteristics of addicts and addiction, too. The aim of this study was to determine which addicts characteristics, as well as the characteristics of the addiction and treatment have predicative influence on the quality of life of the opiate addicts treated in the methadone maintenance program and those treated with buprenorphine. Methods. The epidemiological cross-sectional study was carried out in 2013 at the Clinical Center Niš, on a total of 64 opiate addicts, both sexes, aged 18 and older (32 addicts in the methadone program, chosen by random selection, and 32 addicts treated with buprenorphine, matched by sex and age). Necessary data were collected in a “face to face” interview with the examinees, based on the autonomous kind of a questionnaire, together with the use of the standardized World Health Organization (WHO) instruments: for health status, for the level of severity of addiction and for the quality of life measuring) based on which the health index (EQ-5D), Addiction Severity Index (ASI) and the quality of life index (WHOQOL-BREF) were calculated. The data were described by the methods of descriptive statistics, while the differences between groups were analyzed by applying χ2 and t-test. Multiple regressions were used to determine the predictors. Results. The addicts in the methadone program showed much worse perception of quality of life than those treated in another way, although, according to the values of quality of life, they did not differ significantly. The most numerous predictors of the level of quality of life were health characteristics, characteristics of the socioeconomic position of the examinees, as well as different consequences of addiction. The influence of treatment was less noticeable. Participating in the methadone program had predicative influence on perception and the level of quality of life of the addicts in mental area and that of the environment. The influence of the characteristics of methadone treatment in physical and social area was insignificant. Conclusion. Variations in the perception and level of the quality of life of opiate addicts in different areas cannot be explained using only one predictor. The number of determining variables is large, and its impact complex.

Background/Aim. Rectal cancer is a major health problem throughout the world, despite the great progress in the treatment and control of the disease. The aim of this study was to determine the effect of mesorectal excision type on local recurrence in patients operated on for rectal cancer within a 3- year period. Methods. The clinical retrospective study was conducted at the Clinic for General Surgery at the Clinical Center in Niš, Serbia, and included 225 patients with rectal cancer. Postoperatively, the patients were observed 36 months. Total mesorectal excision (TME) method was used in 129 (57.33%) patients, and partial mesorectal excision (PME) in 96 (42.66%). There were 145 (64.44%) man and 80 (35.55%) women, average age 66.8 years. Results. In 58 (25.77%) of the patients cancer was localized in the proximal third of the rectum, in 99 (44%) in the medium third, in 68 (30.22%) it was 8 cm of the anocutaneous line. In 167 (74.22%) patients rectal cancer was in T3 stadium. TME was performed in all the patients with cancer in the distal third of the rectum and in 61.61% of the patients with cancer in the medium third of the rectum. PME was performed in all the patients with localized cancer in the proximal third and in 38.38% of the patients with cancer in the medium third of the rectum. Local recurrence occurred in 20 (8.88%) patients, 12 (9.30%) in the TME group and 8 (8.33%) in the PME group, which was not a statistically significant difference. In 75% of the cases, relapse occurred in the patients in T3 stage. Relapse occurred in 55% of the cases in the second year after the surgery. The median survival of all the patients amounted to 35 months. The total mortality of all respondents in a 3-year period amounted to 5.3%. Conclusion. There were no statistically significant differences in the incidence of local recurrence and survival among patients who underwent TME and those underwent PME. The type of mesorectal excision does not affect the incidence of local recurrence in node-negative disease stages.

All acute conditions in surgery are clinically presented as acute abdomen. The aim of this study was to identify the most common causes of emergency conditions in surgery. We included 165 patients operated in the Emergency Centre, Clinical Center Niš for intra-abdominal perforation with a final diagnosis of diffuse peritonitis and bleeding. There were 92 (56%) women and 73 (44%) men. Appendicular perforation was the cause of peritonitis in 29 (27.9%) patients, gastric perforation in 24 (23.1%) patients, jejunum perforation in 5 (4.8%) patients, and ileum perforation in 7 (6.7%) patients. Large bowel perforation was the cause of peritonitis in 20 (19.2%) patients, rectum perforation in 6 (5.8%) patients and perforation of gall bladder in 13 (12.5%) patients. Gastric ulcer bleeding was found in 24 (39.3%) patients, duodenal ulcer in 18 (29.5%) patients, 11 (18.1%) patients had splenic injury and bleeding, in 5 (8.2%) patients liver bleeding occurred, and in 3 (4.9%) patients, the bleeding was caused by esophageal varices. The overall mortality was 20.6% (n = 34). Due to the consequences of septic condition (SC) 14 (41.2%) patients died, and 20 (58.8%) died of complications of gastrointestinal bleeding (GIB). The morbidity and mortality rates of emergency conditions are still unacceptably high. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute intestinal obstruction is a complex pathological condition which is in 90% of the cases caused by colorectal cancer (CRC). Unfortunately, despite the advances in diagnostics, in 20% of patients with this cancer the diagnosis is made on the operating table during the emergency surgery for acute obstruction of the colon. Mortality in emergency operations is 15-20%, while the morbidity is reported in 40-50% of the cases. The aim of this study was to determine the incidence of acute intestinal obstruction caused by CRC, the localization of obstruction and types of applied surgical procedures. A prospective clinical study was conducted at the Department of General Surgery, Clinical Center Niš and included patients treated for acute intestinal obstruction caused by colorectal cancer, in the period from 2011 to 2014. Due to acute intestinal obstruction caused by CRC, a total of 129 patients underwent surgery. The mean age of treated patients was 60.2 years, the youngest patient was 42, and the oldest one was 80 years old. The largest number of patients was in T3 stage. Obstructive cancer was localized in the right colon in 34 (26.35%) patients, in the left colon in 53 (41.08%) patients, and in the rectum in 42 (32.55%) patients. Total colectomy was performed in 2 (1.55%) patients, subtotal colectomy in 4 (3.1%) patients, right hemicolectomy was performed in 16 (12.40%) patients, left hemicolectomy in 6 (4.65%) patients, Hartmann's procedure in 29 (22.48%) patients, ileotransverse anastomosis in 11 (8.52%) patients, ileo-sigmoid anastomosis in 4 (3.10) patients, Miles' procedure in 3 (2.32%) patients, ileostomy in 2 (1.55%) patients, colostomy in 47 (36.43%) patients, and resection of the sigmoid colon in 5 (3.87%) patients. Out of 129 patients operated for acute intestinal obstruction due to CRC, 25 patients died, representing the morbidity rate of 35.65%, and the mortality rate of 19.37%. The final decision on the type of surgical procedure is made on the basis of surgical findings, general condition of patients, and experience of the surgeon. Each of these surgical procedures in the treatment of CRC has its advantages, disadvantages and indication areas. [ABSTRACT FROM AUTHOR]