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D Ignjatović

Publications and source records attributed to D Ignjatović.

At least 19 recordsLinked to original sources
PubMed2006

[Cystic artery anatomy characteristics in minimally invasive surgical procedures].

UNLABELLED: Large patient series undergoing laparoscopic cholecystectomy fail to show anatomic variations which lead to intraoperative bleeding. METHOD: Cadaver material was used and corrosion casting and postmortem arteriography were employed. RESULTS: Three types of cystic artery were devised according to the results. Type 1 normal anatomy. Type 2 more than one artery in Calots triangle and Type 3 no artery in Calots triangle. DISCUSSION: only 40% of the second cystic artery is present in Calots triangle. The short second cystic artery is characteristic and its most often origin is from a segmental branch of the right hepatic artery. When there is no artery in Calots triangle its origin unusual, and the artery is either on the postero-lateral side of the cystic duct or it approaches the gallbladder through hepatic tissue. The specifics of MIS approach make changes in the way we understand the anatomic variations of the cystic artery. The classification is a result of practical experience and anatomical investigations.

Adult↗
PubMed2004

[Meta-analysis on minimally invasive surgical therapy of sigmoid diverticulitis].

UNLABELLED: The bowel diverticulitis is a complication of diverticulosis, occuring in 35% patients in 20 years after diagnosis. The study purpose was analysis of the results published in world literature. METHOD: Double blind electronic search of several databases using key words: diverticulitis, laparoscopy. RESULTS: 11 studies with 415 patients that satisfy the criteria were selected. AGE: 62.7 + 14.2. Hinchey stadiums: I, IIa i IIb of these 44% I and 28% IIa i Iib each. Operative time: 197.4 +/- 49.6 min. Conversions: 11.7 +/- 10.1 (0 - 38.9%). Protective stoma: 5.5%. Bowel sounds: 2.3 - 3.2 postoperative day. Oral feeding: 2.6-5 postoperative day. Hospitalization: 6.1 2.1 dana. Anastomotic dehiscence: 2.8%, wound infection: 7.3%, iatrogen rectum perforation with stapler: 3.3%, bleeding: 3.5%, ileus: 4.4%, reoperation rate: 4.7%. CONCLUSION: Sigmoid resection with or without a protective "loop" ileostomy is technically feasable by minimally invasive surgical technique, with an acceptable ratio of benefits and complications.

Diverticulitis, Colonic↗
PubMed2002

Case report: multidisciplinary treatment of a patient with gas-producing phlegmone.

The authors present a 51-year-old patient with a severe case of gas-producing phlegmone following incision of a perianal abscess. Early diagnosis and extensive surgical excision during the first 12 hours from the onset of symptoms are crucial. Treatment of sepsis complicated by multiple organ failure: lung insufficiency (respiratory distress requiring mechanical ventilation), kidney insufficiency (requiring rehydration, furosemid, manitol), circulation (blood derivatives, saline, colloid solutions, cardio tonics, anti-arrhythmic drugs) and liver must be aggressive. Hyperbaric oxygen therapy is essential with repeated identification of aerobic and anaerobic bacteria (hemoculture, tissue sample, wound swab), their sensitivity to antibiotics and repeated surgical debridement of the wound. Following this treatment the patient was transferred to plastic surgery where Thiersh transplants covered skin defects. He survived with an abdominal wall hernia due to a team effort and aggressive multidisciplinary treatment by the general surgeon, anesthesiologist, hyperbaric medicine specialist, microbiologist and plastic surgeon. He refused hernia repair.

Abscess↗
PubMed2002

Where to incise and/or divide the cystic duct.

The study concern was to establish the position of cystic duct incision/division in circumstances of laparoscopic cholecystectomy. Seventy consecutive human cadavers were dissected. Corrosion casting (50) and post-mortem cholangiography (20) were employed. Cystic duct length was 34.6 mm, and in 88.6% cases its length was 1-5 cm. Mean cystic duct diameters next to the gallbladder neck, within the valve and 5 mm proximal to the junction with the common hepatic duct were 1.95, 0.42 and 1.85 mm, respectively. Lateral cysto-hepatic junction was identified in 78.6%, spiral in 10% and parallel in 10%. In 90% cases the cysto-hepatic junction is within 4 cm of the hepatic duct junction. One case (1.43%) of cystic duct entering the right hepatic duct was identified. The valve of Heisteri consisted of three spiral turns in 73% of the cases with a range from 0 to 5. In 3/70 specimens the spiral valve did not exist.

Adult↗
PubMed2002

[Surgical anatomy of the spleen with special emphasis on its segmental architecture].

The authors have analyzed several aspects of the surgical anatomy of spleen, commencing with historical data, topography, peritoneal ligaments, variations in shape, embryology and accessory spleens and venous system of the spleen. The mode of splenic artery branching, variations of polar arteries, and intra- and extraparenchymatous arterial anastomoses were thoroughly analyzed. It was shown that the spleen in most cases consists of five vascular territories (segments) clearly demarcated from each other, stressing the practical significance of splenic anatomy in segmental dearterialization of the spleen.

Humans↗
PubMed2001

[Total intravenous anesthesia using remifentanil and propofol with midazolam co-induction in laparoscopic surgery of the gallbladder].

We investigated effects of total intravenous anesthesia (TIVA) with propofol and remifentanil (in two parallel continuous infusions), on 28 ASA I-II patients undergoing laparoscopic cholecystectomy. All patients received midazolame (0.05 mg/kg b.w.), and 90 sec thereafter, remifentanil (0.5 g/kg b.w.). Computer controlled intravenous infusion of propofol started at dose of 6 mg/kg/h (by Graseby 3400 Syringe Pump). Muscle relaxation was achieved by rocuronium (0.6 mg/kg b.w.). After endotracheal intubation, rate of propofol was decreased on 3 mg/kg/h and started with another infusion of remifentanil (0.5 ug/kg/min). Before (T0) and after induction (T1), after start of surgery (T2), and at the end of surgery (T3), we evaluated: systolic, diastolic, and medial arterial blood pressure (SAP, DAP, MAP), heart rate (HR), peripheral saturation of O2 (O2Sat), and capnometry (ETCO2), by Datex-Engstrome AS/3 Monitore. It was followed side effects of anaesthesia, early and complete recovery rate, and frequency of nausea and vomiting in postoperative period. Results showed haemodynamic stability of patients after induction in anaesthesia (defined as decreasing of MAP 20%, compared with preinduction values). During investigation (T0-T3), results of 0.2Sat and ETCO2 were excellent (0.60 +/- 2 and 5.1 +/- 2.4 min). There wasonly one case of postoperative nausea and vomiting, and no significant side effects of anaesthesia. TIVA remifentanil-propofol and co-induction with midazolame makes possible haemodynamic stability of patients after induction in anaesthesia, good oxygenation during surgery, fast early and complete recovery, and avoiding of side effects of anaesthesia and postoperative nausea and vomiting. We concluded that it is a good choice of anaesthesia for laparoscopic cholecystectomy.

Adult↗
PubMed2001

[Surgical importance of anatomic features of the pancreatic head and tail].

The surgical anatomy of the left pancreatic portion includes topography of this entity in relation to the peritoneum and the adjacent organs, variations of the arterial vascularization and venous drainage, and of the ductal system. A particular emphasis was on the practical significance of the variations of the pancreatic tail, the arterial anastomoses of the corporocaudeal region, and the position and morphology of the pancreatic veins. Ending remarks include a small review on distal pancreatectomy.

Humans↗
PubMed2000

Anatomoclinical significance of splenic artery anastomotic bridges.

The authors analyzed the frequency of anastomotic bridges between the terminal branches of the splenic artery, their location related to the splenic surface, length and caliber on a total of 102 autopsy specimens of human spleen and pancreatic tail. The methods applied were corrosion casting and postmortem arteriography. The incidence of cases with the splenic artery anastomotic bridges was 33.3%. They were located as follows: intrasplenic 25.5%, extrasplenic 4.9%, both intra- and extrasplenic 2.9%. The remaining two-thirds of spleens were free of anastomoses and thus hypothetically acceptable for partial and segmental splenectomy, as arterial bridges can jeopardize such surgical procedures. Intrasplenic arterial anastomotic bridges were of small caliber and ruled negligible, while the extrasplenic arterial anastomoses are of large caliber being of surgical importance.

Corrosion Casting↗
PubMed2000

New aspects in laparoscopic cystic artery anatomy.

While performing laparoscopic cholecystectomy we noticed lateral branches of the cystic artery as well as arterial bleeding from the gallbladder bed. In order to establish the nature of these blood vessels we undertook a corrosion cast study. The features analyzed were their frequency of occurrence, caliber and length. The research was performed on 50 human autopsy specimens of the liver with the hepatoduodenal ligament. Lateral branches of the cystic artery that irrigate a part of the anteromedial segment of the right liver lobe were observed in 10% cases. Anastomotic bridges between the cystic artery and the arterial system of the liver were observed in 12% cases.

Arteries↗
PubMed1999

[Necrosis of the omental flap].

The aim of this research is to review the frequency of the omental flap necrosis comparing the vascularized omental flaps based on the left or right gastroepiploic vessels. The first 100 patients, with injuries of spinal cord on different levels, are included in this prospective clinical study with follow-up from 12 to 24 months. The special surgical technique was used for preparation of omental pedicled graft, for its lengthening and transposition to the level of the spinal cord injury and direct and indirect signs of the omental flap necrosis were studied. In our patients there was no necrosis of the omental grafts based on the left gastroepiploic artery. The insufficiency of the left gastroepiploic artery was not present in any patient and so it was not the reason of the omental flap necrosis. Devascularisation of the great gastric curvature until to the root of the left gastroepiploic artery, administration of the prophylactic doses of the Heparin and to put gently pressure on the omental flap do not contribute to the appearance of the omental flap necrosis. Based on our experiences and on results of this research we conclude that this way of forming the omental graft can be used for the other omentopexies.

Adolescent↗
PubMed1996

Morphologic characteristics of primary nonperforative intestinal blast injuries in rats and their evolution to secondary perforations.

Five hundred and fifty Wistar rats were investigated to determine the frequency of secondary intestinal perforations after exposure to nonperforating blasts and the evolution of the morphological changes from hematoma through to necrosis and gangrene. The animals were observed at different times for a period of 14 days from the moment that the injury was inflicted. Microscopic findings showed that alterations began in the mucosal layer where they were most extensive, then spread to the submucosal layer, muscular layer, and serosal layer, respectively. Examination of the intestinal wall revealed an evolution of the injury from hematoma to necrosis to gangrene, resulting in secondary intestinal perforation. The secondary wounds had centrifugal patterns, opposite those of the original wound pathways. Based on these observations, the mechanism of evolution of primary nonperforating intestinal blast injury into secondary intestinal perforations is presented.

Animals↗
PubMed1996

Early plasma amino acid pool alterations in patients with military gunshot/missile wounds.

Plasma amino acid profiles in patients during the early period (first 18 hours) following military gunshot/missile wounds were investigated. Patients (n = 29) were casualties from the war in the former Yugoslavia with injury severity scores ranging from 4 to 18. They were divided into three groups: soft tissue (muscle) damage, wounds with fractures, and vital structures injured. Controls were normal blood donors (n = 17). Free amino acids were analyzed in venous plasma. Increased concentrations of phenylalanine and glutamine associated with increased molar phenylalanine/tyrosine ratio in plasma indicated increased net protein catabolism in the peripheral tissues, regardless of the type of injured tissues. Decreased plasma arginine, ornithine and citrulline levels, accompanied with increased molar glutamine/valine ratio, suggested disturbance in urea cycle activity, although urea level was not altered. We concluded that early changes in plasma amino acid pool characteristics after wounds were of systemic origin, not related to the type of injured tissues.

Adolescent↗
PubMed1996

Treatment of wounded in the combat zone.

Authors presented their own experiences in treating 735 wounded in high-intensity combat zones in the territories of former Yugoslavia during 1991 to 1992. The mobile field hospital with surgical crews was situated 5 to 10 km from the front line, and its basic task had been continuous triage, immediate resuscitation with vital surgical aid, as well as organization of adequate primary and secondary air evacuation. At the field hospital level, fresh wounds were explored according to principles of war surgery, and major surgical interventions were performed in 3.3% of the wounded. Patients with massive hematothorax were treated with autotransfusion. Mortality at this primary level, field hospital was 0.75% with primary immediate resuscitation and 1.9% with immediate evacuation. We concluded that immediate resuscitation with delayed transport had advantages, compared with fast evacuation of only the wounded.

Blast Injuries↗
PubMedDate not supplied

[Surgical treatment of toxic adenoma].

In the period ranging from 1985. to 1994. a total number of 86 patients have been treated for toxic adenoma (TA). Hyperthyroidism was more often present in males (70.83% versus 51.61%) and in enlarged adenomas (more then 2 cm in diameter). Pathohistologic type of adenoma influenced degenerative changes. Three carcinoma have been observed, two papillary and one follicular. Surgical treatment is the method of choice. Complications are rare (3.49%) and mild.

Adenoma↗
PubMedDate not supplied

[Malignant disease of the appendix].

The authors shows case report 81 old patient, underwent surgical treatment on Surgical Clinic KBC DR Dragisa Misović because of malignant appendix. Primary symptoms of illness was acute abdomen. Histology confirm nature of illness. The authors discusses about different types of malignant appendix and ways of their treatment, and propose operative procedures which are need to be done in these cases.

Adenocarcinoma↗