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A Petricević

Publications and source records attributed to A Petricević.

At least 19 recordsLinked to original sources
PubMed2005

Technique and survival after laparoscopically assisted right hemicolectomy.

BACKGROUND: The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects. METHODS: Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17-92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner. RESULTS: There were no conversions to open. The mean operating time was 119 +/- 38 min, the mean length of resected colon was 27.8 +/- 4.48 cm, and the average width of the clear margins was 6.8 +/- 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage. CONCLUSIONS: Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.

Adenocarcinoma↗
PubMed2001

Primary echinococcosis of the sternocleidomastoid muscle.

Muscular echinococcosis accounts for 0.5% to 5.4% of all hydatid disease cases, with very little data on the incidence of muscular echinococcosis of the head and neck. We report a unique case of primary echinococcosis of the right sternocleidomastoid muscle in a 56-year-old man. Preoperative assessment by ultrasound and fine needle aspiration did not point to echinococcosis. We suspected the right diagnosis intraoperatively and confirmed it postoperatively by pathohistology and serologic tests. Echinococcosis of the liver and the lungs was also excluded postoperatively. Combination of operative treatment and postoperative albendazole herapy in two 28-day cycles one month apart resulted in complete regression of the disease. Echinococcosis should be considered as differential diagnosis of a multicystic mass in neck, particularly if it is of longstanding duration. Serologic tests for echinococcosis should be included in differential diagnostic procedures for each multicystic formation on the neck, especially in endemic areas.

Albendazole↗
PubMed2000

Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function.

BACKGROUND: The fact that pulmonary complications occur in 20-60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period. OBJECTIVE: The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal. PATIENTS AND METHODS: A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation. RESULTS: Six hours postoperatively, the values of ventilation parameters decreased on average by 40-50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy. CONCLUSIONS: Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.

Abdomen↗
PubMed2000

War injury to the liver. A case report.

We report a case of a war thoracoabdominal gunshot wound associated with severe injury to the liver and hemorrhagic shock. Immediately upon admission to the second Echelon Surgical Unit, the patient was operated on with two separate surgical approaches: right thoracotomy and subcostal laparotomy. The patient was transferred to rear hospital for recurrent postoperative hemorrhages. He was eventually transferred to our Department, where he underwent reoperation by the surgical approach through right thoracophrenolaparotomy. Liver lesion debridement and hepatic artery ligation were performed. The early and late postoperative course was normal, and the patient achieved satisfactory recovery on discharge. The case shows that the management of severe liver injuries requires special knowledge and experience from the surgeon.

Adult↗
PubMed1999

[Video thoracoscopic therapy of recurrent spontaneous pneumothorax].

We report our first experience in surgical treatment of recurrent spontaneous pneumothorax using video-assisted thoracic surgery (VATS). From May 1995 to April 1998, 38 cases of recurrent spontaneous pneumothorax were treated using the VATS approach. All patients were previously treated by other methods (conservative, thoracocentesis, chest-tube drainage). We successfully managed VATS procedure in all our patients (wedge resection 28, bullectomy 1, partial pleurectomy 2, pleural abrasions 36). Complications include persistent air leak (4), prolonged bleeding (1) and supraventricular tachycardia (1). The mean duration of chest drainage was 3.9 days (range 3 to 15 days). All patients received antimicrobial chemoprophylaxis with single-dose of 2 g Ceftriaxone intravenously prior to surgery and average postoperative patient-controlled analgesia with 0.15 mg of buprenorphin. Utilisation resource analysis showed great advantage in favour of VATS procedure compared to retrospectively analysed thoracotomied patients. We conclude that VATS is very useful alternative to conventional thoracotomy in managing cases of recurrent spontaneous pneumothorax.

Adult↗
PubMed1999

War injuries to the chest.

AIM: Presentation of our experiences in the treatment of war injuries to the chest at the Split University Hospital, Croatia, during the 1991-1995 war in Croatia and Bosnia-Hercegovina. METHODS: Retrospective analysis of clinical and surgical data on 439 (16.3%) patients with war injuries to the chest among 2693 treated battle casualties in general. The medical data from evacuation unit, transportation, emergency department and follow-up were observed and processed by basic statistical analysis. RESULTS: There were more explosive wounds than gunshot and puncture wounds (ratio 251/158/30). Penetrating injuries were found in 348 (79%) patients and nonpenetrating in 91 (21%) patients. There were 401 (91%) men and 38 (9%) women. Thoracotomy was performed in 98 (22.3%) patients, whereas conservative surgical methods (wound treatment, chest-tube drainage, appropriate fluid therapy, antimicrobial and atelectasis prophylaxis) were used in 341 (77.7%) patients. Mean time elapsed between injury and definitive surgical repair was seven hours (range, 1 to 48 hours). Recovery on discharge was recorded in 411 (93.6%) patients, 19 (4.3%) patients were referred to other institution for further treatment, and 9 (2%) severely wounded persons died. CONCLUSIONS: The treatment of respiratory insufficiency and haemorrhage shock, and prevention of infection are the basis of management of these injuries. Prompt transportation, appropriate diagnostic methods and an adequate surgical treatment can markedly reduce mortality and complications rate in war injuries to the chest. Most war wound of the lung can be successfully managed by "conservative" surgical treatment. The recovery of lung function was similar in conservatively and operatively treated patients.

Bosnia and Herzegovina↗
PubMed1998

Recovery of respiratory functional defects after war injuries to the chest.

AIM: Assessment of lung function before, during, and after surgical treatment of war injuries to the chest, and comparison of conservative and operative surgical approach. PATIENTS AND METHODS: A retrospective study of 439 patients with war injuries to the chest inflicted during the wars in Croatia and Bosnia and Herzegovina was performed. Patients were classified by injury mechanism and by physiologic scoring on admission, according to the cardiovascular-respiratory elements of the Injury Severity Score (ISS). "Conservative" surgical treatment with chest tube drainage, appropriate fluid therapy, and antimicrobial and atelectasis prophylaxis was performed in 358 (81.5%) and operations in 81 (18. 5%) patients. Blood gases were analyzed before, during, and after surgical treatments. Pulmonary function was assessed after the stabilization of patients' clinical condition and 3-6 months after the injury. RESULTS: On admission, blood gas profiles showed slight to moderate hypoxemia with consecutive hypercapnia related to the severity of injuries. Surgical treatment left a minimum degree restrictive disorder of ventilation without an obstructive pattern. Definitive repair of lung function presented with normalization of blood gas data, and significantly improved restrictive pattern (p<0.05). There was no difference in definitive lung function between conservatively and operatively treated patients. Mortality was 2%. CONCLUSION: The success of surgical resuscitation was related to ISS scoring. Recovery of respiratory function defects after the injury was not significantly related to the mechanism of injury or the patient's condition at arrival. The recovery of lung function was similar in conservatively and operatively treated patients.

Adult↗
PubMed1998

[Our initial experience with video-assisted thoracoscopic surgery (VATS)].

Diagnostic and therapeutic potentials and our first two-year experience with video-assisted thoracic surgery (VATS) are reported. From May 1995 to April 1997, at the Department of Surgery, University Hospital Split, VATS approach was planned in 55 cases (recurrent pneumothorax in 23, tension pneumothorax in 1, traumatic effusion in 5, malignant metastatic lung tumor in 1, benignant lung tumor in 11, traumatic effusion in 5, suspected mediastinal lymph nodes in 4, long lasting unconfirmed pleural effusion in 9, foreign body in 1, mediastanal cyst in 1). Of these, 48 procedures (87.2%) were performed using VATS (diagnostic thoracoscopy in 12, wedge resection with or without pleural abrasion in 21, partial pleurectomy in 1, decortications in 3, mediastinal lymph nodes biopsy in 4, lung biopsy in 7). Seven patients (12.7%) underwent conventional posterolateral thoracotomy. Complications included persistent air leak in three patients, prolonged bleeding in one patient and supraventricular tachycardia in one patient. The mean duration of chest tube drainage after the procedure was 3.7 days (range 2 to 19 days), and mean hospital stay was 5.1 days (range 3 to 15 days). All patients received routine antimicrobial chemoprophylaxis with single-dose ceftriaxone 2 g intravenously immediately prior to the surgery, and average postoperative patient-controlled analgesia with buprenorphine 0.15 mg. We conclude that VATS is a very useful alternative to conventional thoracotomy in managing cases of exploration, recurrent spontaneous pneumothorax, benign pulmonary lesions, solitary pulmonary nodes, early decortications and different intrathoracic biopsies.

Endoscopy↗
PubMed1996

Functional effects of typical lung resections for primary bronchogenic carcinoma.

In 60 patients with primary bronchogenic carcinoma undergoing surgery, pulmonary function studies were performed before, and then 10 days and 3 to 6 months after typical lung resection. Preoperative profiles showed a slight restrictive pattern without air trapping and slightly disturbed gas exchange. The restrictive pattern was not related to clinical, X-ray and endoscopy findings. The alveoloarterial oxygen gradient was smaller in the patients requiring lobectomy than in pneumonectomy patients. After surgery, the volume loss was related to the amount resected, being greater after right pneumonectomy than after left pneumonectomy, smaller after bilobectomy and the least after lobectomy. The obstructive pattern remained unchanged. Diffusion of carbon monoxide decreased significantly less than the volumes after pneumonectomy, but proportionally after lobectomy and bilobectomy. Those with increased alveoloarterial oxygen gradient or increased physiologic dead space showed a significant improvement of their gas exchange after surgery.

Carbon Dioxide↗
PubMed1995

Advances in diagnostics and successful repair of proximal posttraumatic superior mesenteric arteriovenous fistula.

Posttraumatic arteriovenous fistulas affecting the superior mesenteric artery and vein are extremely rare. Twenty-four cases of posttraumatic superior mesenteric arteriovenous fistulas (SMAVFs) have been reported. We presented two cases of SMAVFs occurring in a young woman and man secondary to a gunshot and a grenade shrapnel wound in the epigastrium, respectively. Nausea, heartburn, emesis, and cramping abdominal pain were the clinical signs of SMAVF. Abdominal pains, particularly after meals, tense and meteoristic abdomen, frequent liquid bowel movements, oliguria, subfebrility, abdominal thrill, and bruit were also present. Abdominal duplex ultrasonic scanning and computed tomograms with a contrast agent were especially useful screening tools. As our results demonstrated, those methods were not only suitable for clinical use, but were also as good as arteriography in defining both the exact location and the extent of the mesenteric vessel involvement. However, the superior mesenteric arteriogram remains mandatory for complete preoperative evaluation. Arteriovenous fistulas were successfully treated by suturing the arterial and venous sides of the fistula in one case, and resectioning the fistula and end-to-end anastomosis in the other case.

Adult↗
PubMed1995

Penetrating war injuries of the heart.

Treatment of 12 penetrating heart war wounds were described. Ten wounded (83.3%) died on the spot or during transportation. Only two (16.7%) were brought to the clinic with signs of life, operated on and released from the hospital. The two wounded had not received any therapy before the arrival. The two cases described indicate the importance of a rapid transportation, adequate reanimation and the fastest possible cardiorrhaphy either by means of thoracotomy or medial sternotomy.

Adult↗
PubMed1994

A war injury to the thoracic trachea.

The authors present a case of war injury to the thoracic trachea with the defect involving more than half of its circumference. After minor difficulties in establishing the right diagnosis, we passed to the surgical procedure and managed the lesion by simple suture. The patient's postoperative course at the Intensive Care Unit was uneventful. Both early and late follow-up roentgenograms, computerized tomography of the trachea and bronchoscopy showed normal findings.

Adult↗
PubMed1994

Military injuries to the popliteal vessels in Croatia.

OBJECTIVE: The paper reviews military popliteal vascular injuries in Croatia. SUMMARY BACKGROUND DATA: Popliteal vascular injuries still pose difficult problems for vascular surgeons despite improvements in resuscitation, surgical techniques and wound coverage. Popliteal vascular injuries, both arterial and venous, with a high incidence of associated musculoskeletal injuries are presented in patients with military injuries in South Croatia. METHODS: 26 wounded with popliteal vascular injuries are presented. Explosive injuries are found in 21 and associated fractures in 9 cases. In immediate repair group the time interval between trauma and surgery was 2 to 30 hours (average 9.8 hours). In the delayed repair group the interval between trauma and surgery was 11 days to 24 days. RESULTS: 21 out of 26 patients with popliteal vascular injuries had combined arterial and venous injuries; 4 patients had isolated popliteal arterial injuries, while 8 patients had other vascular injuries along with the popliteal ones; 8 amputations resulted (30.8%). CONCLUSION: Popliteal vascular injuries caused by typical military mechanism during the war in Croatia present large and extensive defects of tissues and bones, are often associated with other injuries and require more extensive surgical therapy. Evacuation of the wounded under very difficult conditions as well as considerable organization and transportation problems are characteristic for this war and greatly affect the success of vascular reconstruction. Hyperbaric oxygen therapy offers a safe noninvasive method of improving wound healing and decreasing edema formation in popliteal vascular injuries.

Adult↗
PubMed1989

[Bilateral malignancy of the breast].

The breast cancer is the most common malignant disease in women, and makes 26 percent of all malignant diseases in women. Bilateral breast cancer is very rare, especially simultaneous one. We analyzed 420 operated breast cancers in Surgical Clinic in Split within five years period. There were 8 patients with simultaneous or metachronous bilateral breast cancer. Their incidence, difficulties in diagnostics and treatment, pathologic findings and prognosis are discussed. It is justifiable to follow the contralateral breast of patients with the breast cancer.

Adult↗
PubMed1989

[Echinococcosis of the lungs].

The echinococcosis is the parasitic infection caused by the larval form of the echinococcus in a human or an animal organism. The infection can take part in any organ or tissue. About 20 percent of the echinococcosis of all locations are situated in the lungs. We present the results of the surgically treated lung echinococcosis. Various surgical methods of treatment were used, from the most economic ones to the most radical ones. In the last 32 years 234 patients were treated of lung echinococcosis. 224 of them were treated surgically, using the standard preoperative proceedings. Surgical methods based on the intraoperative patho-anatomic structure of the hydatid cysts were used with very sufficiently results. We preferred the economic, sparing surgical methods and used more radical ones just in a few cases. Five patients had a letel issue (2.23%), and three patients (1,34%) had a recidive of the lung echinococcosis.

Adult↗
PubMed1983

[Fibrosarcoma as a cause of cardiac tamponade].

Primary malignant tumours of the heart are exceptionally rare, what makes them particularly interesting for their research; on the other hand, clinical diagnosing of these tumours is even rarer. The authors present a patient with fibrosarcoma of the heart, which provoked the acute pericardial tamponade. The patient was successfully operated upon. The diagnosis was confirmed during the surgery itself with temporary biopsy. After the surgery the authors administered chemotherapy according to the VAC scheme (vincristine++, actinomycin D and cyclophosphamide ).

Cardiac Tamponade↗
PubMed1982

[Surgical treatment of iatrogenic lesions of the trachea in a case study].

The author's present a case of patient with a circular tracheal stenosis caused by the cuff being for too long period of time (27 days). The stenosis caused progressive respiratory insufficiency threatening the patient's life, despite tracheotomy. An operation was performed whereby the narrowed section of the tracheal was resected and an (end to end) anastomosis was preformed. In the author's opinion, increased use of mechanical respirators will increase the number of such patients and the need for this type of operation.

Adult↗