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Biomedical subjects

A Simić

Publications and source records attributed to A Simić.

35 records · Page 2Linked to original sources
PubMed1994

[Complications in esophagojejunal anastomosis].

In the period between January 1, 1982 until December 31 1993, in the Center for Esophageal Surgery, Institute for Digestive Disease - 1 st Surgical clinic in Belgrade, 345 esophago-jejuno anastomosis (EJA) were performed. In 326 pt's EJA, with the Roux-en-Y reconstruction with the segment of the small intestine, was performed after a total gastrectomy due to a malignant disease of stomach or cardia and in 7 due to an extensive corrosive changes of the stomach. In 12 pt's a resection of the distal esophagus due to an undilatable stricture and the reconstruction with the short segment of the small intestine (Merendino) was performed. In all 345 pt's a terminolaternal EJA was performed. In 149 pt's EJA was done mechanically by staplers (e.g., the EEA instrument) and in 196 an interrupted two layer suture was performed. In 326 pt's (operated due to a malignant disease) complications occurred in 29 of them (8.89%) while in the group of patients with benignant disease only in 2 pt's or 10.52%. A dehiscention of EJA occurred only in the group of pt's with malignant disease. Comparing the way of performing EJA a higher percentage of anastomotic leaks was found in the group of hand sewn anastomosis (18/8.16%) while in the group with a stapler performed anastomosis anastomotic leak was found only in 7 pt's (4.69%). In two pt's where a stapler anastomosis was performed there was a hemorrhage from the anastomosis during the operation, and in 8 pt's or 5.36% an unsuccessful anastomosis using a stapler was performed. Overall mortality was 6.66% or 23 pt's. Due to anastomotic leak 13 pt's died (3.76%). In 5 pt's 4 to 14 months after the operation a stenosis of anastomosis developed on EJA that severely compromised EJA and needed further medical treatment. None of the pt's was reoperated.

Anastomosis, Surgical↗
PubMed1994

[Advantages and disadvantages of esophagogastroplasty in reconstruction of malignant and benign esophageal stenosis].

Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomach for ideal substitute in subtotal and total esophagoplasty. Additional advantages are one act surgery and possibility of single anastomosis formation. In an eighteen years' time, since 1976., two hundred nine (209) patients were operated with use of esophagogastroplasty for malignancies and benign diseases of esophagus and hyphopharinx. The esophagogastric anastomosis is most common reconstructive procedure for esophageal and hyphopharingeal malignancies. Anastomosis on pharyngeal level was made in 13 pts., on cervical esophagus level in 168 pts. and on thoracic esophagus level in the rest of 28 pts. Overall postoperative morbidity was 25,36%. Most common complication was anastomotic dehiscence (18,66%), transplant necrosis occurred in 2% of pts., whereas stenosis of the anastomosis was observed in 4,78% of pts. Overall intrahospital mortality was 14,38%, while specific mortality (anastomotic dehiscence and/or transplant necrosis) was 10,04% (21 pts.), whereas nonspecific mortality (predominantly lung insufficiency) was 4,78% (10 pts.). Anastomotic dehiscence is major disadvantage of this method.

Anastomosis, Surgical↗
PubMed1994

[Primary suture of the esophagus with reinforcement using autologous tissue in the therapy of perforation of the thoracic esophagus].

Perforations of the esophagus are the serious problem and only promptly diagnosis and treatment with effective operation can change the fatal destiny of this patients. The most effective operations of early diagnosed perforations are the primar suture with buttresses with circumferential wrap of parietal pleura. Authors discuss 15 patients with perforations of thoracic esophagus. In six patients the perforation was only sutured, and in nine patients the suture line was buttressed with Grillo pleural wrap. In this group one patient had a leak at the suture line and died after reoperation. This data indicate that the pleural wrap should be used routinely.

Esophageal Perforation↗
PubMed1994

[Anastomosis suture technic and complications of esophagocoloplasty in corrosive lesions].

For the reconstruction of the esophagus due to a corrosive stenosis a colon transplant is usually used. In all esophagocoloplastics three anastomosis are necessary: anastomosis that continues the alimentary tract, anastomosis of the distal part of transplant with the stomach or duodenum, and the most important proximal anastomosis of the esophagus (or pharynx) with the transplant. In the period of 29 years (from January 1, 1964 until December 31, 1993) on the Institute for digestive diseases in Belgrade 250 esophagocoloplastics were performed with 750 anastomosis, in the patients with corrosive stenosis of the esophagus. All the anastomosis are sewn in two layers with the interrupted or continuous stitch, except for the anastomosis with the pharynx where due to a structure of the wall a one layer continuous stitch was only possible. From 750 anastomosis in 30 patients or 4% an anastomotic leakage occurred and in only 4 patients or 0.5% it ended lethaly. Stenosis of the anastomosis occurred in 18 patients or 2.4%.

Anastomosis, Surgical↗
PubMed1994

[Mechanical sutures in resection of the rectum in carcinoma].

In the period between January 1, 1992, and January 1, 1994, on the 3rd Department of the 1st Surgical Clinic, Clinical Center in Belgrade, 116 pt's has been operated due to a rectal carcinoma. In all of these pt's an anterior resection of the rectum and a colorectal stapled anastomosis was performed. Colorectal anastomosis was performed using an American EEA stapler on the different segments of the rectum. Overall, a 30 or 25.86% intraperitoneal anastomosis have been performed, 18 (15.51%) were done on the medium third of the rectum and ultra low anastomosis were performed in 68 pt's (58.63%). In our group there was 6 pt's with the anastomotic leakage and a leakage occurred only in the group of pt's with ultra-low colorectal anastomosis. In three pt's after conservative treatment a spontaneous healing of the anastomosis happened while in the other three pt's an explorative laparatomy with loop ileostomy had to be performed. One patient died during the postoperative treatment. The patient died on the second postoperative day due to a mesenteric thrombosis and gangrene of the intestines.

Colon↗
PubMed1993

Aging and ethnic identity: a refutation of the double-jeopardy theory.

Ethnic identity has been commonly stereotyped in the gerontological literature as a disability for the elderly, placing them in so-called double jeopardy. However, new knowledge and changing attitudes in American society have resulted in a far more positive attitude toward the role of cultural pluralism. Ethnographic field research strongly suggests that ethnic affiliation can proffer the elderly a spectrum of psychological, social, and cultural resources not generally available to them in the larger society. For case managers with largely ethnic client populations, understanding the dynamics of ethnicity can enhance their ability to meet client needs successfully with resources from both within and outside the client's culture.

Aged↗
PubMedDate not supplied

[Paraesophageal hiatal hernia of the diaphragm].

Paraesophageal hernia (type II hiatal hernia) accounts for less than 5-10% of all herniation through the esophageal hiatus. Anatomically, it is distinguished from the more common sliding variety (type I hiatal hernia) by the position of the gastroesophageal junction. The management of paraesophageal hiatal hernia is influenced by the tendency of the herniated stomach to develop volvulus, which potentiates life-threatening complications that include complete gastric obstruction, bleeding, infarction and perforation. In a cases with gastroesophageal reflux one of the antireflux procedures had to be done. In the Institute of Digestive Diseases, in the 16 years period from 1980-1996, 37 patients had treated of paraesophageal hernia. Authors discuss their management strategies, especially the using of antireflux procedures.

Female↗
PubMedDate not supplied

Isolated hydatid cyst of the adrenal gland.

Hydatide disease of the adrenal gland is extremely rare, even in disseminated disease. Isolated cyst of the gland is even more rare. Only 9 of such cases seem to have been described so far. We present a 49 year old woman in whom a hydatide cyst of the right gland was found during the investigation for the dull pain in the area. She was successfully operated. Hydatide etiology was confirmed at operation and by histology. She had an uneventful recovery. The preoperative pain disappeared postoperatively.

Adrenal Gland Diseases↗
PubMedDate not supplied

[Surgical and nonsurgical therapy of malleolar fractures].

Subjective and objective parameters after the treatment of malleolar fractures were studied in 116 patients during a five-year-period. Nonoperative treatment was used in 48 patients and 68 patients were operated. Nonoperative treatment was successful in both supination-eversion and supination-adduction types of fractures, whereas in pronation fractures the operative treatment provided better results. The results were significantly influenced by residual lateral shortening, altered talocrural angle, talar subluxation and the size of posterior fragment. In all types of fractures but in supination-adduction type anatomical reduction and clinical findings correlated. Subjective results are sometimes influenced by factors which cannot be visualized on radiographies.

Adolescent↗
PubMedDate not supplied

[Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes: the POEMS syndrome].

We present a case of an unusual multi-systematic disorder whose cardinal signs were severe progressive sensorimotor polyneuropathy, hepatomegaly, endocrinopathy, plasma cell dyscrasia with osteosclerotic bone lesions and M-protein production as well as skin lesions (termed POEMS Syndrome) whose pathophysiology is still unknown, as well as its relationship with myeloma multiplex. The patient, 67 years old, had a history of progressive weakness and numbness of the lower legs, clinically revealed as sensomotor polyneuropathy, hepatomegaly, IgG lambda monoclonal protein in the serum, endocrine abnormalities and skin lesions. The final and definite diagnosis was established by open, surgical biopsy of the second lumbal vertebra.

Aged↗
PubMedDate not supplied

[Lesions of the peripheral nerves associated with pseudoaneurysms of the major arteries caused by gunshot wounds].

Ten wounded persons, operated on for gunshot-induced peripheral nerve lesion in which pseudoaneurysm of the main artery was found intraoperatively, were presented. Preoperative clinical course, intraoperative neurovascular topography and pathoanatomy, operative procedures and postoperative results were analyzed. The correlation was established between preoperative neurologic deficit and intraoperative findings on arteries and nerves. It was concluded that such patients have to be operated on as soon as possible, but not later than five days from the beginning of neurologic aggravation, to prevent the development of irreversible neural damage.

Adult↗