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Introduction/Objective. Acute appendicitis (AA) is by far the most frequent urgent condition in abdominal surgery and numerous biomarkers may help the physician to diagnose and even predict the severity of the disease. The objective of the paper was to determine the accuracy of C-reactive protein (CRP), interleukin-6, and endotoxin level and compare it with the diagnostic value of Alvarado score (AS) in adults surgically treated for AA. Methods. Sixty-seven patients were diagnosed with AA using AS. Prior to surgery serum levels of inflammatory biomarkers were determined and together with AS were respectively compared to the results of histopathological analysis of specimens. The patients were divided into three group according to the histopathological assessment. Results. The univariate analysis revealed that the increase of CRP level by one unit increases the probability of complicated AA (CoAA) occurrence by 1% (1.00–1.02, p < 0.05). ROC curve analysis has revealed that CRP has better capacity to predict suppurative AA (SAAs)/CoAAs than catarrhal AA (CAA), with the cut-off value of 19.45. The increase of AS value by one unit produced 2.98-fold increase of the probability of CoAA occurrence (1.60–5.57, p < 0.001), while positive AS value increases the probability of CoAA occurrence 24.67 times (4.94–123.12; p < 0.001). ROC curve analysis demonstrated that AS may predict CoAAs better than CAAs/SAAs, with the cut-off value of 8.50. Conclusion. AS and CRP should be routinely used combined as powerful tools for the diagnosis and prediction of complicated AA.

Introduction. Larrey hernia is a very rare type of the left sided parasternal congenital hernia with the incidence of 1–3% of all anterior diaphragmatic hernias. Case report. The paper describes Larrey congenital diaphragmatic hernia in an adult female patient, aged 70 years. Seventeen years earlier, the patient had had problems with intermittent left side chest pain, hypertension, dyspnea, shortness of breath, fatigue, and abdominal discomfort. She had no past surgical history, and no traumatic rupture of the diaphragm. An open surgical repair was conducted, reducing the herniated organs back into the abdominal cavity, and closing the diaphragmatic defect, repaired with a non-absorbable suture. During the immediate postoperative period, as well as six months later, the patient had a remarkable postoperative recovery. Conclusion. Larrey hernia represents an extremely rare kind of the anterior diaphragm hernias, which can be symptomatically manifested in older persons over 65 years of age. The treatment in the cases of asymptomatic and symptomatic Larrey hernias is a surgical intervention.

Introduction/Objective. The elderly (age ≥ 65 years) comprise an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The objective of the paper was to determine the intra-hospital mortality rate in elderly patients undergoing emergency gastrointestinal surgical procedures. Methods. 914 elderly patients (> 65 years old) were examined, divided into two groups: emergency and elective surgery patients, treated for diseases (benign and malignant) of the stomach, duodenum, small intestine and colon. The patients were divided into four age groups and five American Society of Anesthesiologists (ASA) groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administering transfusion, and the occurrence of surgical complications during hospitalization. Results. The mortality rate among elderly patients was 17.8%. The univariate analysis in EGS patients revealed that gastro-duodenal surgical interventions (p < 0.001), ASA ≥ 3 score (p < 0.001), heart, lung, kidney diseases, and postoperative complications (p < 0.001), as well as the white cell count > 10,000/mm3 (p = 0.043) were independent risk factors for mortality. In the multivariate analysis, in EGS patients, the significant risk factors for mortality were gastric surgical interventions (p = 0.001), ASA score of 4 (p < 0.001), heart and kidney disease (p ≤ 0.001), and white cell count > 10,000/mm3 (p = 0.039). Conclusion. The characterization of independent validated risk indicators for mortality in those patients is essential and may lead to an efficient specific workup, which constitutes a necessary step towards developing a dedicated score for elderly patients.

Background/Aim. Lower-leg septocutaneous system of perforating blood vessels represents the vascular basis of fasciocutaneous flaps. Additionally, it is of a particular importance when designing distally based fasciocutaneous flaps which represent the “workhorse” in the reconstruction of the distal third of the lower leg and foot. The aim of this study was to analyse the vascular anatomy of posterior tibial artery and its septocutaneous (fasciocutaneous) perforating arterial vessels. Methods. The dissection was conducted on 20 fetuses of both sexes and of gestational age from 20 to 28 weeks. Cluster analysis was applied to the data on vascular anatomy of posterior tibial artery and its septocutaneous performating arterial vessels. Results. A total of 212 perforating arterial vessels was identified. The average number of perforating arterial vessels was 5.32 (ranging from 4 to 7). It was identified that septocutaneous perforating blood vessels are more likely to be found at certain levels (“safe levels of finding perforators”). These are: second, third, fifth and sixth tenth (measured as a distance from intermalleolar line to popliteal crease). Conclusion. The presence of septocutaneous system of perforating blood vessels and reliability of their localization even in the fetal period allows application of these findings in the lower leg reconstructions in children of early age. It also contributes to the greater level of understanding of anatomy of the lower-leg vascular system. Finally, it provides a basis for understanding the development of this system as it is now possible to compare results obtained on fetuses with those obtained on adults.

Background/Aim. Duodenogastric reflux occurs after gastroenteroanastomosis, with or without resection of the stomach (Billroth I, Billroth II), after vagotomy and pyloroplasty, gastroduodenostomy as well as in conservatively treated patients. The aim of this study was to analyse the effect of carcinogenic N-nitroso compounds (MNNG) influence in conjunction with duodenogastric reflux, in the function of time for precancerous lesions development in gastric mucosa. A particular purpose of the study has been to suggest some effective surgical procedures, which could prevent the harmful effects of duodenogastric reflux on gastric mucosa, as a potential activator of carcinogenesis. Methods. The research included 90 experimental, male Wistar rats, divided into 3 groups. The two experimental groups were subjected to two surgical procedures: Billroth II gastric resection (group B2), and the Roux-en-Y reconstruction (group RY), respectively. The control group (group C) animals did not receive any surgical treatment. All groups were administered per os chemical cancerogen MNNG. All anastomoses were performed by extra mucosal suture with monofilament polypropilene 7–0, and 8–0. The animals were sacrificed consecutively, and subjected to total gastrectomy after 8, 16 and 24 weeks. Results. Pathohistological analysis was performed on defined regions of the rat stomach in three time period. The B2 group, at the end of our experiment, showed predominant incidence of severe lesions: hyperplasia (0%), gastritis (0%), metaplasia (6.7%), dysplasia (46.7%), early carcinoma (20%) and carcinoma (26.7%). At the end of our experiment, the RY and C groups showed the similarities of the obtained results related to time with predominant incidence of mild lesions: hyperplasia (13.3% vs 0%, respectively), gastritis (13.3% vs 13.3%, respectively), metaplasia (6.7% vs 13.3%, respectively), dysplasia (66.7% vs 66.7%, respectively), with an extremely low incidence of early carcinoma (0% vs 6.7%, respectively) and no incidence of carcinoma (0% vs 0%, respectively). Conclusion. Without the presence of duodenogastric reflux, MNNG causes a low degree of precancerous gastric lesions. However, direct contacts of MNNG with gastric mucosa, including the presence of duodenogastric reflux, induce precancerous lesions and carcinoma. The percentage of reversible changes decreases with time, while the percentage of irreversible lesions and carcinoma increases. A lack of distinction in the findings between the RY and C groups confirms a gastroprotective role of the Roux-en-Y procedure.

Background/Aim. Choledochoduodenostomy has been reported as an effective treatment of benign biliary obstructions, but associated with a certain percentage of complications, (primarily cholangitis and the “sump” syndrome), as the consequence of duodenobiliary reflux which may occur. The aim of our study was to evaluate the safety, effectiveness and technical feasibility of choledochoduodenostomy for the treatment of distal benign biliary obstruction and to present its minimal postoperative complications. Methods. This propective study included 50 operated patients who had choledochoduodenal anastomosis created for benign biliary obstructions. The symptoms, biochemical and echosonographic parameters of cholestasis, operative technique, recovery features and complications were analayzed and compared. Based on the analysis of obtained data, safety, efficacy and competence of choledochoduodenal anastomosis were determined. Results. Specific early anastomosis- related complications were observed in 12.0% of patients (mostly minor surgical complications). During the immediate postoperative course, aerobilia as an indirect sign of duodenobiliary reflux, occurred in 91.7% of patients, but it was reduced to 16.7% after 30 days (and was not always associated with symptomatology). Choledochoduodenostomy was associated with a low incidence of cholangitis (2%) and anastomosis dehiscence (2%). Transitory duodenogastric reflux was identified in 6% of patients. The rate of intrahospital mortality was very low, considering patients’ very complex conditions (4%). During early postoperative period, the “sump” syndrome was not identified. Conclusion. Choledochoduodenostomy is a simple and effective method in the management of certain types of biliary obstruction. Serious complications can be avoided by proper selection of patients and careful surgical technique. This type od anastomosis has to be included in basic skills of every general surgeon.

Introduction. Necrotizing soft tissue infection (NSTI) is a life-threatening condition, characterized by widely spread necrosis of skin, subcutaneous fat, fascia and muscles. Treatment involves surgical debridement and broad-spectrum antimicrobial therapy. Mortality is still high due to diagnostic delays. NSTI is rare in general population, there are even less literature data of this condition in pregnancy. Timely diagnosis and therapy is crucial for outcome of these patients. Clinicians should have in mind NSTI in patients with perianal infections, especially in cases where immunosuppressive role of pregnancy is present. Case outline. We present a case of a 21-year-old pregnant woman with NSTI spreading from perianal region. The patient was admitted to hospital in the 31st week of otherwise healthy twin pregnancy one day after incision of perianal abscess. At admission she was examined by a gynecologist; vital signs were stable, laboratory results showed the presence of infection. She was referred for another surgical procedure and broad-spectrum antibiotics were prescribed. The next morning the patient complained of intense abdominal pain. Clinical exam revealed only discrete redness of the skin tender on palpation, crepitating. She was immediately referred to surgery. Intraoperative findings revealed massive soft tissue infection spreading up to the chest wall. Wide skin incisions and debridement were performed. The patient developed septic shock and after initial resuscitation gynecologist confirmed intrauterine death of twins and indicated labor induction. Over the next few days the patient’s general condition improved. On several occasions the wounds were aggressively debrided under general anesthesia, which left the patient with large abdominal wall defect. Twenty-three days after the initial operation, the defect was reconstructed with partial-thickness skin grafts, providing satisfactory results. Conclusion. Diagnosis and outcome of NSTI are challenging for many reasons. Course of the disease is rapid and hidden. Chances of survival depend on early recognition and prompt treatment.

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.

Introduction/Objective. Necrotizing soft tissue infection is a life-threatening condition, characterized by widely spread necrosis of the skin, subcutaneous adipose tissue, fascia, and muscle. This study aimed to determine the risk factors associated with lethality due to necrotizing soft tissue infection of perianal and perineal region, for all patients surgically treated at a tertiary referral hospital. Methods. A retrospective review of 38 patients with necrotizing soft tissue infection of the perianal and perineal region, in the period between January 2007 and December 2014, was performed. We reviewed sex and age of the patients, the presence of known risk factors (diabetes mellitus, obesity, alcoholism), localization of necrotizing soft tissue infection, duration of symptoms, length of hospitalization, the number of necessary operations done, the performance of the stoma, and the outcome. We used logistic regression to identify the predictors of lethal outcome in a univariate analysis with estimated odds ratios and 95% confidence intervals. Results. There was a significantly higher fatality rate in the group of patients over 60 years of age (p < 0.05), with more than 10 days from the onset of symptoms to the treatment (p < 0.05), with a perianal localization (p < 0.05), and stoma creation (p < 0.05). The overall fatality rate was 18.4%. Conclusion. Patients’ age, time passed between the onset of the symptoms and the initiation of the treatment, perianal localization, and stoma creation were related to higher lethality risk.

Background/Aim. During choledocholitiasis inflammatory oxidant stress involves the promotion of mitochondrial dysfunction through an intracellular oxidant stress in hepatocytes leading mainly to necrosis and less to apoptosis. The product of oxidative stress, malondialdehyde (MDA), is extremely cytotoxic and damages cell membranes and intracellular macromolecules. The toxicity of MDA is based on its ability to act as a mutagenic agent in a cell. Therefore, the aim of this prospective study was to establish correlation of the parameters of inflammation and biochemical markers of cholestasis with the intensity of oxidative stress in pathogenesis of liver function disorders. Methods. Seventy adult subjects of either sex included in the study were devided into two groups: I - 40 patients with obstructive icterus caused by choledocholithiasis, and II - 30 healthy individuals. All the participants were subjected to a clinical, laboratory and ultrasonic check-up at the Internal Department of the Military Hospital in Niš. The parameters of oxidative stress: MDA, a measure of lipid peroxidation, and inflammation parameters: C-reactive protein (CRP), fibrinogen, albumins, number of leukocytes (Leu), granulocytes ( Gr), lymphocytes (Ly) and monocytes (Mo) and biochemical markers of cholestasis: activity of γ-glutamyltransferase (γ-GT) and alkaline phosphatase (AP) enzymes, the level of total, direct and indirect bilirubin were determined by standard biochemical methods. Results. Lower values of albumin (p < 0.001), and significantly higher values of fibrinogen (p < 0.05) and CRP (p < 0.001) were found in the blood of the patients with cholestasis due to choledocholithiasis in relation to the controls. Significantly higher values of Leu (p < 0.01) and Gr (p < 0.001) with decreasing number of Ly (p < 0.001) and Mo (p < 0.001) were found in blood of the patients with cholestasis due to choledocholithiasis in relation to the control. Similarly, higher values of γ-GT, and AP (p < 0.001), as well as the level of total, direct and indirect bilirubin (p < 0.001) were found in blood of the patients with cholestasis due to choledocholithiasis in relation to the controls. The concentration of MDA (p < 0.001) was increased in the patients with choledocholithiasis in relation to the controls. There was a significant positive linear correlation of the number of leukocytes (r = 0.51, p < 0.05) and the concentration of total (r = 0.87, p < 0.01), direct (r = 0.85, p < 0.01) and indirect (r = 0.88, p < 0.01) bilirubin with the concentration of MDA in the group of patients with choledocholithiasis. Conclusion. Neutrophils and the levels of total, direct and indirect bilirubin have a significant positive linear correlation with the level of lipid peroxidation in patients with choledocholithiasis. Neutrophilia and hiperbilirubinemia observed in this way represent important parameters in estimating the level of liver tissue damage in choledocholithiasis.

Introduction. Leiomyomas are benign smooth muscle tumors that usually arise from the uterus. Case report. We present a patient with a 6-month history of vague abdominal discomfort, occasional nausea, vomiting and urinary incontinence. On examination, there was an extremely large firm unpainfull palpable abdominal mass. Laboratory investigation revealed mild leukocytosis and blood creatinine elevation. Abdominopelvic ultrasonography and computed tomography revealed a massive well bordered, encapsulated intraabdominal tumor, extending from the pelvis to epigastrium and almost completely fulfilling the pelvic and abdominal cavity. At laparotomy, tumor arising from the retroperitoneum was excised in toto. Histopathological examination disclosed that the tumor was composed mainly of smooth muscle cells and very rare fibrous connective tissue elements with myxomatous alteration and with no mitotic activity. The negative results of numerous additional parameters analyzed (pancytokeratin, epithelial membrane antigen, S100 protein, CD68, CD34, desmin, aktin) ruled out different origin of a tumor. One year after resection the patient had no complaints and no radiological evidence of tumor recurrence. Conclusion. Considering current limitations in radiological diagnosis, in toto resection of these tumors is necessary to rule out malignancy.

Background/Aim. Incarcerated inguinal hernias surgical treatment represents one of the most frequent surgical treatments in elderly patients. The percentage of incarcerated inguinal hernias urgent surgical treatments is growing exponentially with the age in patients over 50. The aim of the study was to investigate some of the factors that may have impact on the incarcerated inguinal hernias surgical treatment outcome in elderly patients. Methods. The study included 180 patients classified in two groups: the study group (> 65 years of age) and the control group (≤ 65), managed in the period from January 2005 till March 2009 at the General Surgery Clinic, Clinical Center Niš. Results. Most of the patients had right inguinal hernia (52.6%, the study group; 59.1%, the control group). All the study group patients suffered from some of accompanying chronic diseases (100%), opposite to 39 (59%) patients of the control group. Synthetic material was implanted in 124 (68.9%) patients, while the tension technique was performed in 65 (31.1%) patients. The duration of incarceration more than 24 h (p = 0.015), previous abdominal surgery (p = 0.001), the American Society of Anesthesiologists physical status classification system (ASA classification) (p = 0.033) and the presence of chronic diseases (p = 0.01) appeared to be statistically significant risk factors for performing intestinal resection in the study group, while in the control group they represented risk factors, but not at the level of statistical significance (p

Background. Small bowel hemorrhages are rare and account for 2-10% of all gastrointestinal bleedings. In case that surgery is necessary, identification of the bleeding site is the most important problem. Case report. We presented here the case of a 65-year old man, admitted for urgent care of massive lower gastrointestinal bleeding. After reanimation and normalization of vital parameters, selective arteriography was done. A contrast extravasation site was identified at the level of jejunal branches of a. mesenterica superior and labeled by means of methylene blue application. Immediately after we performed conservative resection of the labeled jejunal loop in 10 cm length and terminoterminal anastomosis. The preparation was sent for histopathologic examination - small bowel angiodysplasia was identified. The patient was monitored in three month intervals in the next two years and new bleeding events were not observed. Conclusion. Bleeding caused by small bowel angiodysplasia is a significant diagnostic problem in cases in whom urgent surgery is required. Combined preoperative selective arteriography and methylene blue application make possible precise identification of the bleeding site as well as conservative small bowel surgery, avoiding thus the risk and danger of malabsorption syndrome.

Background/Aim. Linear radiofrequency device (LRFD) is disposable tool designed for liver parenchyma transection using controlled radiofrequency to 'seal' blood vessels and bile ducts, making liver resection easier and safer compared to classical resectional techniques. The aim of this study was to determine real value of the LRFD compared to the standard 'keliclasia' technique. Methods. This prospective study analyzed the significant intraoperative parameters and postoperative results of the 200 patients who underwent surgery at the Surgery Clinic of Clinical Centre in Niš, between January 1, 2001, and January 1, 2009. The patients were divided into two groups: the control Keli group (144 patients) with the 'keliclasia' resection technique and the control RF group (with resection performed using LRFD - Tissue Link / Dissection Sealer (DS - 3.0) (56 patients). The following parameters were analyzed: duration of liver ischemia, liver parenchyma transection time, intraoperative blood loss, significant intraoperative and postoperative complication rate, duration of hospitalization and mortality. Results. LRFD was used in 56 liver resections. The average duration of liver ischemia in the RF group was shorter than in the Keli group (7 versus 22 minutes). Parenchymal liver transection was significantly slower in the RF group than in the Keli group (2.05 versus 4.34 cm2/minutes, respectively). There was less intraoperative bleeding using LRFD 'Keliclasia' tehniquethan in the control group (390 mL compared to 420 mL, respectively). After the use of LRFD two cases of biliary leak and 4 pleural effusions were registered. Conclusion. LRFD is simple device for safe liver transection with decreased need for liver ischemia and singificant reducing of the intraoperative blood loss. High price for disposable device and slow parenchyma transection are disadvantages of this device.

Background/Aim. Nipple discharge syndrome is a clinical entity capable of presenting various disorders such is mammary infection (nonpuerperal and puerperal mastitis), intraductal papillomas, fibrodenoma, breast cancer and hyperprolactinemia syndrome. The aim of the study was to determine differencies in cytological features of mammary secretion in patients with hyperprolactinemia and those with normal serum prolactin levels and to define the role of growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone in creating cellular profile of breast secretion. Methods. The study included 50 patients with nipple discharge syndrome. The patients were devided into the clinical group (27 patients with hyperprolactinemia and nipple discharge) and the control group I (23 patients with normal serum prolactin and nipple discharge). The control group II included the patients of the clinical group achiving normalised serum prolactin levels after the treatment of hyperprolactinemia. Serum prolactin, follicle-stimulating hormone and luteinizing hormone levels were assessed by RIA using commercial kits IRMA hPRL, hLH and hFSH, (INEP, Zemun, Serbia) while serum growth hormone and thyroid-stimulating hormone levels were assessed by RIA using commercial kits LKB-wallac. Cytologic evaluation of samples, taken from all the patients with mammary secretion, was done using standard techniques of staining Haemathoxilin-eozine and May- Grünwald/Giemsa. Results. Our results showed a significantly higher presence of lipid and protein material in clinical group, in comparison with the control group I (p < 0.01). Also, our data demonstrated significantly higher number of ductal epithelial cells (p < 0.05) and ductal histiocities (p < 0.001) in the clinical group, compared with the control group I. Macrophagies frequency was proportionally higher in clinical group (44.44%) compared the control group I (17.39%). Erythrocites were significantly lower in the clinical group (p < 0.001) than in the control group I. Significantly decreased mammary secretion (p < 0.01), lower lipid (p < 0.01) and protein synthesis (p < 0.01), and less presence of all cellular categories (p < 0.01) were obtained after normalization of serum prolactin levels. Conclusion. Growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone did not show significant influence on creating cytological features of mammary secretion. The most expressive role, hyperprolactinemia demonstrated in the domain of mammary ductal secretory activity, making mammary secretion reach in lipid and protein material and simultaneously increasing number of ductal epithelial cells, ductal histiocytes and 'foam cells'- macrophages. These cytological findings indicate that hyperprolactinemia promote periductal and intraductal steril inflammation which withdraws after serum prolactin normalization.

Background/Aim. Different techniques of general anesthesia are used for laparoscopic cholecystectomy (LC). The aim of the study was to establish the best anesthetic technique for achieving better results during awakening affecting not only patient's recovery, but activities of anesthesiological team, as well. Methods. The study was conducted as a prospective comparative clinical trial. The patients (n=90) were classified according to the applied anesthetic technique into two groups: Volatile Induction and Maintenance Anesthesia (VIMA) with sevofluran and Target Controlled Infusion (TCI). The results relating to parameters of recovery after anesthesia and surgery were compared between these two groups. The following parameters were analyzed: demographic patients' characteristics, duration of anesthesia, the times to eye opening, to respond to a command, to extubation, and to orientation, from the last anesthetic dose receiving until post anesthesia discharge (PAD), frequency of postoperative nausea, vomiting and agitation (PONVA). Results. In the examined groups there were no statistically significant differences in the duration of anesthesia (68.29 ± 6.47 vs 66.29 ± 11.97 min, p = 0.327). The time to eye opening was significantly shorter in the group VIMA compared to the group TCI (4.49 ± 1.20 vs 7.42 ± 1.25 min, p = 0.000), as well as the time to respond to a command (5.93 ± 1.12 vs 8.47 ± 1.08 min, p = 0.000). The patients anesthetized with VIMA technique were statistically significantly extubated earlier (6.84 ± 1.19 vs 9.69 ± 1.31 min, p = 0.000). Considering orientation time, there was also statistically significant difference between the two groups (7.51 ± 0.97 vs 11.60 ± 1.75 min, p = 0.000). There was no statistically significant difference in PAD time duration (19.42 ± 5.99 vs 20.80 ± 1.59 min, p = 0.142). There were no statistically significant differences in PONVA events between the examined groups. Conclusion. This study showed that VIMA technique with sevofluran in LC provides faster and more qualitative recovery of patients. Thus this technique should be applied in everyday anesthesiological procedures in LC, as well as in other minimally invasive videoendoscopic surgical procedures.

Background/Aim. Surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer (CRC) remains controversial. The aim of this study was to assess safety of simultaneous colon and liver resections and the direct effects of this type of treatment upon morbidity and mortality of the patients with synchronus hepatic metastases of CRC. Methods. Intraoperative and postoperative data of 31 patients with simultaneous liver and colorectal resection were compared with the data of 51 patients who had undergone colon and hepatic resection in the staging setting. Analyzed were demographic data, number of metastases, type of the liver resection, operation time, intraoperative blood loss, percentage of postoperative complications, morbidity and mortality and length of hospitalisation. Results. In the group of the patients operated simultaneously 5 hepatectomies, 3 sectionectomies, 2 trisegmentectomies, 3 bisegmentectomy, 6 segmentectomies, and 12 metastasectomies were combined with colon resection. In this group operation time (280 vs. 330 minutes) and intraoperative blood loss (450 vs. 820 ml) were lower than those in the two staged operation group. Postoperative complication rate was lower in the simultaneous group (19.35%) than in the two-staged operation group (19.60%), without statistical significance. There was no hospital mortality in both groups. The patients having simultaneous resection required fewer days in the hospital (median 10.2 days) than the patients undergone operation in the two stage (18.34 days). Conclusion. By avoiding a second laparotomy, overall operation time, blood loss, hospital stay and complication rate are reduced with no change in hospital mortality, so simultaneous colon and hepatic resection performed by the competent surgeons are safe and efficient for the treatment of synchronous colorectal liver metastases.

Background: The study was conducted to determine whether prolactin (PRL) influences radiological features of benign breast lesions. Methods: During the 4-year period, we observed 50 patients with nipple discharge: 23 with normal serum prolactin levels (group 1) and 27 with hyperprolactinemia (group 2a before hyperprolactinemia treatment and group 2b after hyperprolactinemia treatment). Patients observed during this study underwent breast ultrasonography (US) and mammography. Radiological findings in group 1, group 2a and group 2b were compared. Results: The most frequent radiological findings in group 2a were dilated lactiferous ducts and cystic lesions with statistical significances p

Systemic inflammatory response syndrome and sepsis are common in surgically treated patients. Systemic inflammatory response syndrome represents a major factor of morbidity and mortality in these patients. The pathogenesis of these syndromes has been increasingly clarified. The objective of this review is to present an overview of our current understanding of the physiology underlying these conditions.

Mesenteric cysts are rare abdominal findings. Due to absent or unspecific clinical presentation, very low incidence, and lack of adequate classification these cysts may sometimes represent a diagnostic and therapeutic challenge. We report a case of 37-year-old man with vague palpatory tenderness in left hypochondrium and paraumbilically and with palpable large intra-abdominal mass in whom mesenteric cyst was diagnosed using US and CT imaging. He was operated and cyst was extirpated in toto. Histopathological examination revealed a thick fibrous cyst wall with the signs of chronic inflammation and without inner epithelial lining, which suggested its traumatic origin. Considering the possibility of malignancy mesenteric cysts should be radically resected (with resection of adjacent organs if necessary) due to their strong relapsing potential and a tendency for sudden, progressive local enlargement if not removed in toto.

Most high-mountain regions worldwide are susceptible to snow avalanches during the winter or all year round. In this study, a Universal Snow Avalanche Modeling Index is developed, suitable for determining avalanche hazard in mountain regions. The first step in the research is the collection of data in the field and their processing in geographic information systems and remote sensing. In the period 2023–2024, avalanches were mapped in the field, and later, avalanches as points in geographic information systems (GIS) were overlapped with the dominant natural conditions in the study area. The second step involves determining the main criteria (snow cover, terrain slope, and land use) and evaluating the values to obtain the Snow Avalanche Formation Index (SAFI). Thresholds obtained through field research and the formation of avalanche inventory were used to develop the SAFI index. The index is applied with the aim of identifying locations susceptible to avalanche formation (source areas). The values used for the calculation include Normalized Difference Snow Index (NDSI > 0.6), terrain slope (20–60°) and land use (pastures, meadows). The third step presents the analysis of SAFI locations with meteorological conditions (winter precipitation and winter air temperature). The fourth step is the modeling of the propagation (simulation) of other parts of the snow avalanche in the Flow-R software 2.0. The results show that 282.9 km2 of the study area (Šar Mountains, Serbia) is susceptible to snow avalanches, with the thickness of the potentially triggered layer being 50 cm. With a 5 m thick snowpack, 299.9 km2 would be susceptible. The validation using the ROC-AUC method confirms a very high predictive power (0.94). The SAFI–Flow-R approach offers snow avalanche modeling for which no avalanche inventory is available, representing an advance for all mountain areas where historical data do not exist. The results of the study can be used for land use planning, zoning vulnerable areas, and adopting adequate environmental protection measures. [ABSTRACT FROM AUTHOR]

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Copyright of Timocki Medicinski Glasnik is the property of Timocki Medicinski Glasnik 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.)

The gut microbiota plays an important role in host metabolism, immunity, digestibility and even behaviour. Candida spec. is common resident of the gastrointestinal tract and integral part of the microbiota. The aim of the study was to evaluate if positive Candida cultures in the stool influence metabolic parameters in type 2DM patients. 46 patients with type 2 DM and oral antidiabetic treatment, were divided into a study group (S=18 patients with positive Candida sp. cultures in stool) and the control group (C= remaining 28 patients). Besides medical history and clinical examination, all patients were tested for coproculture, fasting glycaemia (FPG), HbA1C, total cholesterol (CL) triglycerides (TG), high-density lipoproteins (HDL) and low-density lipoproteins (LDL). Study group patients had a significantly higher BMI (31.41 ± 5.29 vs. 25.18 ± 3.58; p<0.001); HbA1C (9.8 % ± 1.74 vs 6.9% ± 1.89; p<0.05) as well as FPG (10.87 ± 1.35 vs 7.47 ± 1.03; p<0.01), compared to the control group. Even though the study group patients had higher TG, CL, LDL and HDL, compared to the control group, there was no statistical significance verified. Uncontrolled glucoregulation is one of the host condition which favours candida colonization and subsequent infection. This may be related to the decrease in commensal bacteria, probably as the result of yeast-bacterial competition. On the other hand, we have to keep in mindthat a significantly increased number of Candida colonies can affect the rate of digestion and absorption of carbohydrates and consequently increase the level of glycaemia in patients with diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Timocki Medicinski Glasnik is the property of Timocki Medicinski Glasnik 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.)

Skin melanoma is a relatively rare malignant tumor with a raising incidence in last decades. Biological course is characterized by lymphatic and hematogenous spread, but metastases in intestine and mesenteric lymph nodes are frequent. These metastases can lead to acute intestinal occlusion as a sign of acute abdomen requiring surgical emergency. Patient 68 year old, admitted with clinical and radiology signs of acute intestinal occlusion, underwent emergency surgery. The jejuno-jejunal intussusception was found and the lead point of intussusception was intramural melanoma metastasis 4cm in diameter. The small bowel resection length was 40cm. Postoperative course was without complications. Five years before, patient underwent surgery for melanoma of the skin of left scapular region. Acute intestinal occlusion in patients operated from skin melanoma could seldom be caused by hematogenous intra-abdominal metastases of skin melanoma. [ABSTRACT FROM AUTHOR]

Adrenal gland tumours, revealed during radiological procedures in patients without previous suspicion for adrenal disease, are known as adrenal incidentalomas (AI). Asymptomatic pheochromocytoma-incidentaloma is usually smaller than 10 mm. Incidentally found large pheochromocytoma without any clinical signs is the rarity. Herein, a young woman is presented, with a tumour in the right adrenal gland, size 60x70 mm, discovered on the abdominal sonogram, performed during a regular systematic examination. Computed tomography confirmed "giant" tumour, size 70x74 mm, with cystic and necrotic areas and inhomogeneous contrast captivity. Besides discrete elevated vanillymandelic acid (VMA) level in 24 hours dieresis, all the results of the endocrine evaluation were in normal range. The patient underwent [131I]-meta-iodobenzylguanidine ([131I]-MIBG) scintigraphy which was indicative for right pheochromocytoma. After adequate preoperative preparation, right adrenalectomy was performed. The procedure and postoperative course went without complications, and pheochromocytoma was confirmed by histopathological examination. It appears that frequency of AI is constantly rising in the last few decades, thanks to widely used radiological diagnostic techniques. Even though the most of AI are nonfunctional, we should always keep in mind that under clinical "mute" adrenal tumours, malignant or secreting lesions could hide. A thorough examination of each incidentally revealed adrenal mass can prevent potential oversight and provide proper treatment. [ABSTRACT FROM AUTHOR]

The key features of any suture material, such as its tensile strength, knot security, resorbability, handling characteristics and biological behavior must be taken into account during the selection process. These biomechanical features may be variable in different microenvironmental conditions in the human body in which the sutures are placed due to the influence of numerous local biohumoral factors. We have reviewed the data on the impact of pancreatic juice and bile, various pH conditions, chemotherapy and heat on different suture materials behavior. It is suggested that in pancreatic and biliary surgery polydioxanone sutures should be used. The review has also demonstrated that absorbable suture materials were more sensitive to pH than non-absorbable sutures. In addition, polyglyconate sutures were the strongest of all absorbable synthetic sutures when exposed to heat and cytotoxic drugs. This review provides a better basis for the selection of suture materials for specific applications. [ABSTRACT FROM AUTHOR]

Percutaneous liver biopsy (PLB) is an important diagnostic procedure in routine clinical practice because it allows for a fast pathohistological diagnosis. The aim of this study was to assess the importance of PAB in the diagnosis of newly recognized diffuse and focal liver lesions. This retrospective study included 277 patients who underwent PLB between January 2006 and December 2015. After the initial single dose of midazolam sedation, interventions were conducted using local infiltrative anesthesia (2-8 mL lidocaine 2% with adrenaline) under the guidance of ultrasound or computerized tomography, using the transabdominal or transthoracic approach, depending on the lesion site. Fine 14-20 gauge needles were used. In 52 patients referred with the diagnosis of indeterminate diffuse liver lesions who underwent PLB and histopathological analysis, the following results were obtained: 35 patients had steatosis hepatis (67.3%), 12 patients were with cirrhosis (23.7%), and 5 patients had hepatocellular carcinoma (9%). Of 164 with the diagnosis of primary liver tumors (164), the presence of malignant tumors was confirmed in 140 patients (85.3%), while the remaining 24 patients (14.7%) had benign lesions. From the total of 42 patients with the referral diagnosis of metastatic liver disease, colorectal carcinoma metastases were confirmed in 31 patients (73,8%), while ovarian cancer metastases were diagnosed in 6 patients (14,3%). As a minimally invasive interventional radiology procedure, PLB is an indispensable tool that allows for a fast diagnosis and decision-making in patients with diffuse and focal liver lesions. [ABSTRACT FROM AUTHOR]

Sarcomas are soft tissue tumors arising from primitive mesenchyme. Small incidence (4-5/100 000 in Europe) is the reason their pathogenesis is relatively unknown. Patient (38) complained of a growth on the upper part of right thigh, the size of a child's head. A magnetic resonance imaging (MRI) scan was done and tumefaction was described: oval shape, 13.5 x 7.5 x 11cm in diameter, without infiltration of surrounding tissue. The tumor was surgically removed and was pathohistologically verified as low grade liposarcoma myxoides. After initial presentation the patient presented a series of recurrences and metastases in the abdominal wall, extremities and liver. Soft tissue metastasis from the lower extremities to the liver occur in 0.5% of cases and they are usually small and multiple, as in the presented patient. The European Sarcoma Medical Oncologist's guide recommends that every extremity tumor larger than 5cm and suspicious of malignancy should be evaluated using biopsy and imaging methods. A biopsy should be done before excision under ultrasound or computerized tomography (CT) guidance with the goal of planning the best therapy protocol and prevention of a generalized disease with metastases. The recommended imaging method is an MRI scan, although sarcomas can have a benign presentation. Standard therapy includes surgical resection with local radiotherapy. Liposarcoma myxoides, a rare soft tissue tumor, demands biopsy and complete surgical removal with detailed and continuous postoperative imaging follow-up and oncological therapy. The therapeutic goal is to increase survival and preserve extremity function. [ABSTRACT FROM AUTHOR]