Biomedical subjects

D Ignjatovic

Publications and source records attributed to D Ignjatovic.

7 recordsLinked to original sources

PubMed2002

Anatomical rationale for spleen salvage by lobe/segment dearterialization in inferior pole spleen injury during left hemicolectomy: a post-mortem study.

The aim of this study was to determine the rationale for spleen salvage by lobe/segment dearterialization without resection for inferior pole injury during left hemicolectomy. One hundred and two consecutive human cadavers were dissected. Corrosion case and post-mortem arteriography with computerized planimetry were employed. Lobe/segment size, artery diameter and length and anastomoses between arteries were measured. The mean inferior terminal splenic artery had a significantly smaller diameter than the superior (2.8 vs. 3.4 mm, p<0.01). An inferior polar artery was found in 22.5% of the specimens (mean diameter, 1.9 mm; mean length, 33 mm). The inferior lobe and inferior polar segment comprised 41.3% and 12.6% of the spleen, respectively. Anastomoses were detected in 34 of 102 spleens (3% extraparenchymal, 88% intraparenchymal, 9% combined). The mean diameter and length of intrasplenic anastomoses were 0.3 mm and 20 mm, respectively. In conclusion, there was a positive correlation between diameters of lobar/segmental arteries and vascular zones ( p<0.05). The rationale for splenic lobe/segment dearterialization without resection is found in the presence of intrasplenic anastomoses.

Adult↗

PubMed2002

What role, if any, for laparoscopic surgery in Crohn's disease of the hindgut?

An outsider to the field of surgery would probably take it for granted that surgeons have a highly developed rationale for choosing a laparoscopic approach to Crohns disease. After all, an increasing number of surgeons are performing laparoscopic surgery for Crohns disease as witnessed by several articles published in the 1990s (Table). In fact this is not quite true. Most papers are case reports or series without controls, capable only of suggesting feasibility. Furthermore, comparison studies often feature selection flaws, and therefore beg the question of whether laparoscopic surgery should or not be considered as standard care. An attempt is made herein to give readers a concise insight of the evidence available in the English language literature. It does not pretend to offer a comprehensive review of the topic rather, it highlights some relevant issues, and then outlines what role, if any, laparoscopic surgery should play in Crohn's disease. There are at least 6 categories for discussion.

Colitis↗

PubMed2002

Preserving the superior rectal artery in laparoscopic [correction of laparoscopis] anterior resection for complete rectal prolapse.

Anterior resection for the treatment of full thickness rectal prolapse has been around for over four decades. 1 However, its use has been limited due to fear of anastomotic leakage and related morbidity. It has been shown that high anterior resection is preferable to its low counterpart as the latter increases complication rates. 2 Although sparing the inferior mesenteric artery in sigmoid resection for diverticular disease has been shown to decrease leak rates in a randomized setting, 3 vascular division is current practice. We shall challenged this current practice of dividing the mesorectum in anterior resection for complete rectal prolapse developing a technique that allows the preservation of the superior rectal artery.

Digestive System Surgical Procedures↗

PubMed2001

Is splenic lobe/segment dearterialization feasible for inferior pole trauma during left hemicolectomy?

We discuss splenic salvage by lobe/segment dearterialization, without resection, after intraoperative trauma, and present two cases. We performed a retrospective analysis of 163 patients in whom the colon splenic flexure was mobilized. Patients with ileo-rectal anastomosis or urgent cases were excluded. Surgical operations included left hemicolectomy and anterior resection of the rectum. Splenic procedures were splenorrhaphy, dearterialization and splenectomy. Spleen lesions occurred in 4 (2.45%) cases. One capsular tear was managed with splenorrhaphy. Three mechanical lesions to capsula and tissue of the inferior pole were managed by either splenectomy (the first case) or dearterialization. Overall mortality in the series was 4.3%. Among the patients with splenic procedures, the splenectomized patient died due to pulmonary embolism. The two cases treated by inferior splenic branch and inferior polar artery ligature are presented. In operative trauma to the inferior splenic pole, bleeding can be controlled by lobe/segment dearterialization and by methods of local hemostasis in most cases.

Adult↗

PubMed2000

More than two structures in Calot's triangle. A postmortem study.

BACKGROUND: Large laparoscopic cholecystectomy series often fail to report the rate at which a third structure is encountered in Calot's triangle. METHODS: During a 6-month period, the liver and hepatoduodenal ligament of 90 consecutive human cadavers underwent corrosion casting (n = 50), postmortem arteriography (n = 20), and postmortem cholangiography (n = 20). RESULTS: Third structures within Calot's triangle were arteries (0.6-5.7 mm diameter) in 36.2% (early division of the right hepatic artery, 8.6%; caterpillar hump right hepatic artery, 12.9%; liver branch of the cystic artery, 10%; double cystic arteries, 5.7%), bile ducts (0.3-1.6 mm diameter) in 5. 7% (small-caliber sectoral ducts, 1.4%; right posterior hepatic ducts, 4.3%), and veins (0.9-1.6 mm diameter) merging with the portal vein in 4% of the specimens. CONCLUSION: Knowledge of the aforementioned anatomy is critical to surgeons facing more than two structures within Calot's triangle during laparoscopic cholecystectomy.

Adult↗

PubMed1999

Blast injury from explosive munitions.

OBJECTIVE: To evaluate the effect of blast in common war injuries. METHODS: One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. Of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not. RESULTS: Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A2 (TxA2), prostacyclin (PGI2), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury. CONCLUSION: In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.

Adult↗

PubMed1999

Anatomic rationale for arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy: a postmortem study.

The aim of this study was to establish an anatomic rationale for liver bed arterial bleeding during laparoscopic cholecystectomy. Fifty consecutive human cadavers were dissected. A corrosion cast method was used. Six anastomotic branches (12%) of the cystic artery to the right or left hepatic artery ran underneath the gallbladder serosa surface and entered liver parenchyma after crossing the medial or lateral edge of the liver fossa without passing through the areolar tissue of the liver bed. Their mean length was 18.3 mm (range 4-60), and the mean diameter was 0.38 mm (range 0.2-0.8). Two cystic arteries that ascended in the midline between the gallbladder and liver bed were identified in 50 (4%) casts. Their lengths were 16 and 18 mm, and their diameters were 1.9 and 2.2 mm. Five and seven branches encircling the gallbladder arose radially. These two arterial branching patterns can cause arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy.

Adult↗