Acta chirurgica Iugoslavica最新文献

{"title":"Men with LUTS and diabetes mellitus.","authors":"G Derimachkovski,&nbsp;V Yotovski,&nbsp;V Mladenov,&nbsp;K Ianev,&nbsp;D Mladenov","doi":"10.2298/aci1401091d","DOIUrl":"https://doi.org/10.2298/aci1401091d","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic urinary bladder disfunction is a common problem. Disfunction will occur in about 80% of diabetic patients. Comon symptoms include retention, overactive bladder, sfincted dissinergy and urinary tract infections.</p><p><strong>Material and methods: </strong>In nine months period from 08.2013. to 05.2014. fourteen patients with lower urinary tract symptoms (LUTS) and diabetes were evaluated by uroflowmetry, cistotonometry with electromyography and pressure flow study. Including criteria consisted of IPSS more than 8, PSA lower than 4, RT carcinoma excluded and prostate size more than 25 cm3. REZULTS: Patient age was 50 to 77 years. In two patients due to acute retention urinary catheter was inserted. Only they were treated with alfa blockers while other patients received no therapy. Four patient had insulin dependant diabetes while ten of them had diabetes regulated with oral antidiabetics. Cistotonometry presented detrusor overactivity in two patients, treated with M cholinergics. In one patient overactive detrusor activity was in the same time presented with urge incontinence and treated in the same way. Normal detrusor activity was recorded in 14 patients on pressure flow evaluation. In 8 patients with Q max more than 15 ml/s treatment was watchfull waiting. In 4 patients with Q max more than 12 ml/s alfa blockers were introduced. In 2 patients with Q max less than 10 ml/s bipolar TURP was the treatment.</p><p><strong>Conclusion: </strong>Diabetes and diabetic bladder disfunction will have a great impact on quality of life due to an aging population. All specialities should be informed for diabetic bladder disfunction and necesssity for recognition and treatment. Further investigation is needed in terms of understanding the risk factors, mechanisms and the most adequate therapy.</p>","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1","pages":"91-4"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33020023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving complete mesocolic excision (CME) for colon cancer by laparoscopy","authors":"E. Xynos","doi":"10.2298/ACI1402017X","DOIUrl":"https://doi.org/10.2298/ACI1402017X","url":null,"abstract":"In accordance to the total mesorectal excision concept for rectal cancer, that of the complete mesocolic excision (CME) for colon cancer has been recently developed. CME involves dissection along the embryological planes, ligation and division of the supplying vessels at their origin and removal of a specimen with intact fascia and peritoneum, adequate distal and proximal bowel margin as well as the maximum number of the regional lymph nodes. CME surgery seems to achieve better oncological outcomes, in terms of local recurrence and survival, as compared to standard colectomy. CME has also been attempted by the laparoscopic approach. Provided that the tumour is located at the left or right and not at the transverse, a specimen of high quality can be resected, similar to that obtained by the open approach. There is also evidence that the oncological results of laparoscopic CME are superior to those achieved by the standard laparoscopic surgery, and similar to those achieved by open CME.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1","pages":"17-21"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68392182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation surgery in patients with localized renal cell cancer--nephron sparing surgery.","authors":"J. Djozić, S. Djozić, J. Bogdanovic, Vuk Sekulić, M. Djozić, S. Vojinov, I. Levakov, S. Zivojinov, D. Jeremić, G. Marušić, Damir Djozić","doi":"10.2298/aci1401045d","DOIUrl":"https://doi.org/10.2298/aci1401045d","url":null,"abstract":"INTRODUCTION Renal Cell Cancer ( RCC) is third most frequent urological cancer behind Prostate cancer and Bladder cancer. It represents 2-3 % of all cancers with annual increase in incidence of 2% in Europe (except Denmark and Sweden) and worldwide. Surgery is the only curative procedure, performed as radical nephrectomy (RN) or partial nephrectomy (nephron sparing surgery-NSS). Radical nephrectomy consists of nephrectomy with ipsilateral adrenalectomy and lymphadenetomy, but partial nephrectomy means resection of the tumor only with 1-3 mm of healthy surrounding tissue and preservation of the rest of the kidney as well as ipsilateral adrenal gland and lymph nodes. NSS is a method of conservation of attacked kidney and preservation of kidney's function with previous radical resection of localized RCC, respecting of all oncological principles. The aim of this study is to describe NSS procedure in details and present results of its 13 year use at Clinic of Urology in Novi Sad. MATERIAL AND METHODS In the last 13 years there were 868 patients (pts) with RCC. NSS has been performed in 242 pts (27.88%). Bilateral tumors: synchronous 8 pts, asynchronous 3 pts. Better kidney has been operated, first. Indications for NSS were: absolute--34 pts (15.0%), relative--58 pts (23.1%) and elective--150 pts (61.9%).Surgery was performed according to esta- blished protocol for this procedure based on recommendation of Prof. A. Novick, Cleveland, USA. RESULTS All patients underwent surgery under general anesthesia through lumbothomy, mostly.Tumor size was between 2.5-4.5 cm: over 4.5 cm (4-7 cm): 4 pts. Average age of pts--63.5 years (37-84), male: 148 (61.1%), female: 94 (38.9%). From 2001-2005, 2006-2010 i 2011-2013, 39,111 i 92 NSS has been done, respectively. It represented 13.5%, 36.6% , 50.54% of all pts with RCC underwent surgery in that period, respectively. There was an increase of NSS in that period compared to RN for localized RCC. There were no death outcomes inpts underwent NSS, local recurrence was seen in 1 patient (0.6%), urine leakage > 2 weeks 5 pts (5/242 = 2.06%),severe hemorrhage: 3 pts (1.23%), nephrectomy has been done. We do not have patients with von Hippel Landau (VHL) disease. CONCLUSION Nephron sparing surgery Is the first choice of surgery for patients with low grade kidney tumors (up to 4.5 cm, even 7 cm), has excellent onco- logical results-comparable with radical nephrectomy, but with preservation of renal function and should be done by an experienced urological team in specialized urological centers with good anesteziological support.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1 1","pages":"45-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68392347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical options in treatment of pilonidal sinus and hidradenitis suppurativa","authors":"E. Balik, D. Bugra","doi":"10.2298/ACI1402097B","DOIUrl":"https://doi.org/10.2298/ACI1402097B","url":null,"abstract":"Treatment of PS is depends on the disease presentation. Abscess, chronic sinus, complexity of sinus, chronic recurrent of pilonidal abscess affects the treatment strategy. Each statement has different management option but wide, meticulous shaving and hygiene always should be main part of the all of the management options. In patients, presenting initially with simple midline pits or sinus tracts without acute abscess shaving can be offered as the initial treatment. During both primary and postoperative healing phase, shaving should be continued on a weekly treatment. Patients with acute pilonidal abscess require incision and drainage, ideally making the incision lateral to the midline. Dressing change, baths and shaving should be continued until the wound has healed. The majority of acute abscess treated in this way do not occur. Many patients will present initially with chronic pilonidal sinus. Location of the sinus will help to choice to management way. In the case where all the disease sinuses and pits are located near and in the midline, the conservative midline excision or unroofing with curettage may be the first step treatment. However if the multiple draining sinuses exist and they are located far away from the midline, the simple excision may cause large wound defects. In these situations cleft lift procedures (Bascom) or excision with a rhomboid flap recon- and scarring. Management of the wound after total excision should be tailored to the individual patient. Although the incidence of squamous cell carcinoma is rare but it is the most serious complication of HS. The diagnosis and treatment of anal fistula and anorectal infection is a cornerstone of any busy and dedicated colon and rectal surgeons’ practice. Pilonidal sinus (PS) is not strictly a disease of the anus, because of its proximity to the anus and the occasional difficulty in differentiation from anal fistula, these patients commonly referred to a colon and a rectal surgeon for the treatment1. Hidradenitis suppurativa (HS) which occurs more frequently in other areas of the body can be a diagnostic problem when it has seen and suspected in perineal area1,2. Both PS and HS may present as a prolonged and long-suffering course of treatment for the patient and surgeon. This paper reviewed the treatment options of PS and HS briefly.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1","pages":"97-105"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68392670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy as an initial factor of the clinical presentation of arteriovenous malformations of the brain - natural history and risk factors","authors":"Marina Radosavljević, R. Repac, M. Nikolic, B. Djoric, M. Janicijevic, P. S. Matic, D. Scepanovic, T. Jovanovic, S. Milić, M. Tasic","doi":"10.2298/aci1404027r","DOIUrl":"https://doi.org/10.2298/aci1404027r","url":null,"abstract":"We present the results of treatment of 15 patients with brain arteriovenous malformation initially presented by epilepsy in Neurosurgery, Clinical Center of Serbia in Belgrade, in the period 2004-2010 year. Results: Most of the patients had a grand mall type of epilepsy, 14 of them, while one was present petit mall epilepsy. The attacks are manifested individually in 14, and in 1 case series. Response to treatment was good in 11 and 4 patients with refractory. In 26.7% of cases, seizures alternated with bleeding. Anatomical features of malformations did not show a significant difference in the predisposition to epilepsy treatment response . Conclusion: Good control of epilepsy by medication supports the view that there is no need for urgent surgical treatment of brain AVM so we can generally conclude that brain AVM in relation to a wide range of neurosurgical patients are in benign lesions, which requires patience and good workmanship and strategic therapeutic approach.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"39 1","pages":"27-31"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68393372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance with treatment of patients with glaucoma","authors":"Nevena Bjelović, I. Sencanic, G. Trajkovic","doi":"10.2298/aci1404047b","DOIUrl":"https://doi.org/10.2298/aci1404047b","url":null,"abstract":"Introduction: Glaucoma is progressive, chronic optic neuropathy, causing visual field damage and progressive loss of sight. This is a leading cause of preventable blindness and most often asymptomatic disease. Recommended management of glaucoma typically includes the use of medication(s). Compliance rates vary between 25 and 59%. Patient reported outcomes (PRO's) are an umbrella term, covering a broad range of health data reported by patients. PRO's self reported questionnaires are developed to assess several aspects of patient health status, including treatment satisfaction and adherence. Study objective: To assess patient satisfaction with medication effectiveness, medication side effects, convenience and overall treatment satisfaction. Material and method: Using a crosssectional study design, glaucoma patients had been recruited, and examined at the Centre for Sight \"Oftalmika\" in Belgrade, Serbia in the period between May 15th and June 15th 2011. The questionnaire used in research was the Treatment Satisfaction Questionnaire for Medication Version ii (TSQM). Results: Total of 73 glaucoma patients filled out the Treatment Satisfaction Questionnaire. The mean age was 62.8 years. Satisfaction score for TSQM subscales: Effectiveness, Side Effects, and Convenience and Overall Satisfaction have not showed statistically significant difference between the subscales. The participants are satisfied with the treatment effectiveness, independently on gender, age, level of the education, and the difference within the family life style. Participants from the secondary educational level (iSCED levels) showed significantly lower satisfaction with the side effects than others. Also, there is a significantly higher level of satisfaction with treatment, for the people who live alone. Overall, the study determined that there is a statistically significant positive linear correlation between overall satisfaction with treatment and its determinants. Conclusion: Our respondents showed a high level of satisfaction with therapy. Patients' satisfaction with treatment was higher in patients who believe that the therapy is effective, who are not bothered with the influence of side effects and are satisfied with the therapeutic schemes.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1","pages":"47-53"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68393439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of JJ stent-related symptoms.","authors":"Athanasios Papatsoris,&nbsp;Athanasios Dellis,&nbsp;George Daglas,&nbsp;Francesco Sanguedolce","doi":"10.2298/aci1401073p","DOIUrl":"https://doi.org/10.2298/aci1401073p","url":null,"abstract":"<p><p>Ureteric JJ stents are inserted in numerous pa- tients as a routine procedure. Nevertheless, the ideal JJ stent that does not cause any lower urinary tract symptoms has not been developed yet. Even special validated ques- tionnaires have been used for the assessment of JJ stent-related symtoms. For the management of such symtoms usually alpha-blockers are admin- istered. Also, studies have examined the efficacy and safety of anticholinergics and calcium channel blo- ckers. In this article we review the literature upon the management of JJ stent-related symptoms.</p>","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1","pages":"73-4"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33020019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversion-to-open of laparoscopic surgery for rectal cancer: Impact on outcomes","authors":"E. Xynos","doi":"10.2298/aci1402031x","DOIUrl":"https://doi.org/10.2298/aci1402031x","url":null,"abstract":"Low anterior resection of the rectum (LARR) with total mesorectal excision (TME) for rectal cancer by laparoscopy is considered very technically demanding, particularly at the stages of dissection around the mesorectal fascia deep into the pelvis and transection of the rectum distally to the tumour. These technical difficulties translate to an increased conversion-to-open rate, higher than that seen after laparoscopic surgery for colon cancer. Conversion-to-open is considered as a technical limitation of the approach rather than a complication. There are reports claiming that converted cases are associated with higher morbidity rates than the laparoscopically completed. However, a review of the published articles indicates that conversion-to-open shows similar overall morbidity and mortality rates to those seen in the laparoscopically completed LARR-TME cases, and only duration of surgery is longer and wound infection rate is higher in the former group. Similarly, the overall oncological outcomes, namely local recurrence, distant metastasis and overall survival rates, are similar between the two groups.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1","pages":"31-33"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68392246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical care vesicovaginal fistulas in women with malignant gynecological disease.","authors":"Z. Džamić, M. Radovanović, M. Acimovic, U. Babić, D. Jovanović, T. Pejčić","doi":"10.2298/ACI1401025D","DOIUrl":"https://doi.org/10.2298/ACI1401025D","url":null,"abstract":"Vesicovaginal fistulae (VVF)represents one of the most frequent complications of various gynecological and obstetric procedures. In presence of a gynecological malignant tumor, fistula could be the outcome of surgical complications, radiotherapy or consequence of the tumor process. Reparation of these fistulae is a very complex problem. Our aim was to analyze the results of surgical care VVF-s occurred in women with malignant gynecological disease which was treated surgically or with radiotherapy. Out of the 48 surgically treated patients with primary VVF, in 28 of them fistula occurred after hysterectomy, and in 20 patients after radiotherapy. In 15 patients (31.25%) transvaginal approach was applied, and in 33 patients (68.75%) abdominal approach was applied, with the interposition of a well vascularized lobe being used in 25 patients. All the VVFs that occurred after radiotherapy were repaired by using the abdominal approach. The efficiency of surgical treatment of VVFs after hysterectomy due to a malignant disease was 78.5%, and after radiotherapy 65%. In patients that have not been subjected to radiotherapy, depending on the characteristics of the fistula, transvaginal or abdominal approach is applicable in VVF reparation, while the abdominal approach remains a golden standard in post-radiation fistula treatment, despite the fact that it has not solved the problem after the first medical treatment in as far as 35% of patients.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1 1","pages":"25-7"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68392267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of the long urethral strictures with the buccal mucosal free graft.","authors":"I. Ignjatovic, D. Basic, J. Stanković, M. Potić, L. Dinić","doi":"10.2298/aci1401041i","DOIUrl":"https://doi.org/10.2298/aci1401041i","url":null,"abstract":"INTRODUCTION Reconstruction of the long urethral strictures is a difficult task in urology. The most frequently usedmethod is augmentation with the free buccal mucosal graft. MATERIAL AND METHODS Restrospective analysis of 57 patients with the long urethral stricture was performed. All patients were evaluated endosco- pically and radiologically before the surgery. Buccal mucosal graft harvested from the inner side of the cheek (unilateral or bilateral) was used for the urethral reconstruction in all patients. Follow-up was one year. RESULTS Complete follow up is achieved in 44/57 (77.2%) patients. The most important etiology of the strictures was previous iatrogenic trauma (instrumentation). The strictures were the most frequently located in the bulbar urethra. Preoperative exact evaluation of the stricture length was possible in only 35/57 patients (61.4%). Overall success rate of the surgery was 38/44 (86.3%). Complications occurred in 6/44 (13.7%) of patients--primary graft failure and urinary fistula. Mean preoperative IPSS was 19.2 ± 5.2, and postoperative 10.3 ± 3.2 (p < 0.0001). IPSSQOL was 4.9 ± 3.7 before the surgery, 2.9 ± 1.1 after the surgery (p < 0.001). Persistent urinary infection was present in 12/44 (27.2%) patients. CONCLUSION Buccal mucosal free graft could be successfully used in the reconstruction of long urethral strictures. However, complications are not uncommon, and residual symptoms still exist after the surgery, and could not be neglected.","PeriodicalId":75377,"journal":{"name":"Acta chirurgica Iugoslavica","volume":"61 1 1","pages":"41-4"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68392331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}