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Biomedical subjects

M Micev

Publications and source records attributed to M Micev.

36 records · Page 2Linked to original sources
PubMed2000

Long-term results after low anterior stapled anastomosis.

In the period 01.01.1991-12.31.1996, 286 low anterior stapled resections of the rectum due to rectal carcinoma were performed at the First Surgical Clinic, the Third Department for Colorectal Surgery, Belgrade. There were 57% males and 43% females, median age 59.6 years. The most common localization of tumor was in the distal third of the rectum 181 (63%). In the middle third, there were 89 (31%) and in the upper, intraperitoneal third 16 (6%). Histopathological examination revealed adenocarcinoma in all cases. All operative specimens were examined by one pathologist and classified according to the Gunderson-Sosin modification of Dukes classification. There were 14 (4.9%) in stage A, 167 (58.4%) in stage B (B1,B2,B3), 89 (31.1%) stage C (C1,C2,C3) and 16 (5.6%) stage D. According to Broders classification, there were 129 (45%) well differentiated, 142 (50%) moderately and 15 (5%) poorly differentiated tumors. Anastomotic dehiscence was found in 17 patients (5.95%), mostly conservatively treated, except in 6 cases where spreading peritonitis developed requiring operative treatment. There were 9 (3.1%) postoperative deaths, a half of them with specifically operation related mortality. Recurrence of the disease was registered in 47 (18%) patients, out of 260 who were regularly followed up (26 were lost). Local recurrence alone was found in 21 (8.0%) patients, while distant spread was registered in 22 (8.46%) patients. Local and distant spread was found in 4 (1.5%) cases. At present, the median follow-up is at 54 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 66% at 71 months of the follow-up. Seventy four percent of patients with curative operations exhibit no signs of recurrence at 5 years.

Adenocarcinoma↗
PubMed2000

Postoperative pathological examination of colorectal cancer.

The close cooperation of the surgeon and the pathologist in clinical practice and research of colorectal cancer was far established. The histopa-histopathological report has to include all important information in relation to tumour classification, prognostic factors and surgical procedure. This is the starting point for further treatment, estimation of prognosis and treatment results, indicator of oncological quality of surgical procedure and the most important contribution to increasing knowledge of clinical pathobiology related to colorectal cancer. To reach these goals the pathologist should follow some of up-dated histopathological protocols for the examination of specimen removed from patients with colorectal carcinoma. Most of the proposals and international standards are presented in detail. The applying of three main classifications for colorectal carcinoma is mandatory, i.e. histopathological classification, the disease stage (pathoanatomic extension) classification and residual disease classification. It seems that the first and most important step is R (residual disease) classification, serving as the most reliable determinant in further treatment, prognosis and in assessment of surgical treatment. The focus of surgery on R0 category subgroup of patients is presented in relation to the disease stage as second proven prognostic factor, strongly influencing the prognosis and adjuvant therapy options. The detection and significance of minimal residual disease, mainly occult micrometastases in examined lymph nodes are essential for more accurate staging of the disease. Our own data from pilot study confirmed the significant stage migration (Will Rogers phenomenon of "up-grading"). Using combination of serial sectioning and immunohistochemical reactivity of anti-cytokeratin antibody to scattered micrometastatic foci in lymph nodes and perirectal fat, we have shown the presence of minimal residual disease in 23.53% of R0 pT3 pN0 primary classified cases. Correlation to other probable and possible histological independent prognostic factors is discussed, as well as the most significant molecular prognostic markers.

Carcinoma↗
PubMed1999

A paraesophageal bronchogenic cyst with esophageal communication.

Paraesophageal bronchogenic cysts are a rare developmental anomaly of the upper digestive tract. Although often asymptomatic, their growth can cause severe symptoms and complications because of the location. The diagnosis is difficult and is mostly by histopathologic findings after extirpation of the cyst. The authors present a case of a paraesophageal bronchogenic cyst, of typical histologic structure (ciliated epithelium and hyaline cartilage) connected with the esophageal lumen by a narrow canal composed of stratified squamous epithelium. According to the available literature, only three cases of bronchogenic paraesophageal cysts with esophageal communication have been reported.

Bronchial Diseases↗
PubMed1998

Gastrin producing G-cells after chronic ethanol and low protein nutrition.

Male Wistar rats, (2 months old), randomly divided according to the diet offered to four groups (C-control; A- alcoholized, PD-protein-deprived, A-PD- alcoholized protein-deprived). In group A and A-PD rats, the number of gastrin producing G-cells was significantly lower. The volume density of G-cells was significantly decreased in alcoholic rats. Fasting serum gastrin level (FSGL) significantly raised due to combined effect of alcohol consumption and protein malnutrition. In group A rats, the profile area of G-cells and their nuclei increased. In PD rats, the profile area of G cells also increased. There were no differences in nucleus/cell ratio due to alcohol ingestion alone, but it decreased significantly in PD and A-PD rats. Pale and lucent types of granules were predominantly seen in G-cells of animals of group A and A-PD. Mean diameter of granules increased in A, PD and A-PD rats. Other endocrine cells (ECL, D, EC) also decreased in number in A rats. Somatostatin producing D-cells decreased significantly in A-PD rats, both in fundic and pyloric mucosa.

Alcoholism↗
PubMed1998

[New prognostic parameters and categories of colorectal carcinoma--correlation with standards].

The proper staging of colorectal cancer was discussed with emphasis on the most relevant pathological parameters. Standard staging classifications i.e. Dukes', Astler-Coller's and international TNM classifications are defined by a few basic parameters, namely local invasion and lymph node metastasis, along with the histological grade of differentiation. Advances in diagnosis and treatment and modern aspects of tumor biology introduced other prognostic factors regarding proliferative activity of tumor, its local and systemic effects, host defense mechanisms and metastatic potential. Independent prognostic significance was shown and/or new criteria recommended for: resection margin and peritoneal involvement, vascular invasion, tumoral mucin production activity, presence of extranodal (micro) metastasis, extent of presented (extra) mural tumor spread, peritumoral lymphocytic infiltration, character of tumoral invasive margin and presence of peritumoral Crohn's-like lymphoid reaction. The se pathological parameters, discussed in detail, were partly contained in new revision of TNM or other classifications, not widely accepted, such as Jass', Japanese JSCCR, British UKCCCR classification, or new prognostic categories proposed by Harrison and coworkers. Our own first experiences and primary results showed variable agreement most of the mentioned parameters with special respect to reproducibility of Harrison's new prognostic categories. Many newly developed methods and novel tumor markers with some predictive values on clinical outcome are recently recognized, still uncertain for routine clinical usage. We reviewed in brief most important and/or most studied pathobiological predictors, such as: DNA ploidy, markers of proliferative activity, expression of tumor-specific and tumor-associated antigens or receptors. Among many of hereditary and genetic markers we stressed the importance of RER phenotype, mutations of tumor suppressor genes and some oncogenes, allelic loss of 18q, 17p and other chromosomal alleles as prognostic and screening tools or therapeutic targets. In conclusion, more new insights in carcinogenesis and new therapeutic agents will require new classification systems, never considered as definitive.

Colorectal Neoplasms↗
PubMed1994

[Leiomyosarcoma of the duodenum (case report)].

Leiomyosarcomas of the duodenum are rare tumors, usually presented with gastrointestinal bleeding and/or symptoms of duodenal obstruction, rarely with obstructive jaundice. If successfully removed, these tumors have better prognosis than carcinomas of duodenum or head of the pancreas. A 62 year old man in whom leiomyosarcoma of the duodenum was successfully removed by cephalic duodenopancreatectomy (Whipple's procedure) is presented.

Duodenal Neoplasms↗
PubMedDate not supplied

[Giant epithelioid leiomyosarcoma of the stomach].

Epithelioid leiomyosarcoma of the stomach is an uncommon tumour, predominantly in old persons. The majority of tumours are small, giant tumours are rare. A tumour is more frequent in the upper part of the stomach. It rarely gives secondary deposits, almost only large ones. In a few big published series of patients, secondary deposit were not found in lymph nodes or other organs. Gastrointestinal bleeding, easy fatigue and pain are the usual symptoms of the disease. Endoscopic and fine needle biopsy was successful in single cases. A limited wedge gastric resection is considered as one of the most appropriate surgical treatments. Major resections are reserved for giant tumours infiltrating surrounding organs, and for recurrencies. Due to rare involvement of lymph nodes, systematic lymph node dissection is not regarded as a necessary procedure. The recurrencies can be successfully removed in a number of cases. Chemo- and radiotherapy are generally regarded as useless. We present a 61-year old male patient who had discomfort in the upper abdomen. CT scan was performed but radiologist missed to diagnose an obvious mass in the upper mid-abdomen. Three years later he came with high temperature and leukocytosis. The preoperative examination showed conflicting results, ultrasonography that the tumour did not belong to the liver but CT scan showed that the tumour arose from the left lobe of the liver. Barium swallow showed signs of external pressure on the stomach from the right toward left and downwards. During the operation, a giant gastric tumour (215 x 139 x 135 mm) originating in the antral part of the small gastric curvature was removed with distal 2/3 of the stomach. Histologic examination showed epithelioid leiomyosarcoma of the stomach with umbilical ulceration. About 50% of the tumour was necrotic. There were no lymph node deposits. Temperature and WBC count dropped to the normal value soon after surgery. The patient stayed symptom-free so far, five months after the operation.

Humans↗
PubMedDate not supplied

[Solid and cystic-papillary tumor of the pancreas].

Solid and cystic-papillary tumour of the pancreas is a rare neoplasm. About 420 cases seem to have been reported as yet. It appears almost exclusively in young women, although it may appear in males in all ages. This is a tumour of benign or low malignant potential with vary rare invasion of surrounding tissues and organs. Metastases of the tumour are rare. Local recurrence after surgical excision is also rare. About 50% of patients have no symptoms. The others may have upper abdominal pain or palpable abdominal mass. Complications such as rupture, bleeding or secondary infection, are rare. The average size of the tumour is cca 10 cm in diameter. The tumour is more frequent in the body and tail of the pancreas. New imaging techniques make diagnosis of the tumour very easy, but exact diagnosis is based on histological findings. Surgical excision is the treatment of choice. We report on a 23-year-old woman with a two-year history of upper abdominal pain and occasional fever, in whom ultrasonographic and CT scan examinations revealed a well defined mass of 5 cm in diameter. The mass was excised with limited resection of the pancreas along with removal of the spleen which was adherent to the mass so that it could not have been saved. Histological findings established a solid and cystic-papillary neoplasm of the pancreas. The recovery was uneventful. The patient was symptom-free, with normal clinical findings and laboratory results.

Adult↗
PubMedDate not supplied

[Retropancreatic hematoma mimicking a tumor in a female patient with liver amyloidosis].

Bleeding in patients with amyloidosis is considered as a frequent complication appearing in up to 40% of cases. It may be spontaneous or provoked. Spontaneous bleeding in the skin or in the gastrointestinal tract is the most frequent. Spontaneous bleeding in the retroperitoneum is rare. It may be diffuse, with possible lethal outcome, or localised, causing haematoma, as in our patient. We present a 62-year old woman with a three-month history of spontaneous, subcutaneous bleeding. No laboratory or other findings could explain the cause of bleeding, as the haemostatic tests were within or close to normal limits. US and CT performed for right subcostal pain discovered a tumour attached to the back of the head of pancreas. Due to mild coaugated hyperbilirubinaemia the "tumour" was held to be the cause of patient's difficulties. However, at operation it turned out to be a retropancreatic haematoma, which was removed and drained. Because of conjugated hyperbilirubinaemia cholecystectomy with operative cholangiography (which was normal) were performed. Due to steatotic appearance of the liver a biopsy was performed. Histological examination revealed amyloidosis. The recovery was uneventful and the patient was transferred to hepatology unit for further treatment where she died 3 months later due to gradual deterioration of kidney and heart function. To our knowledge, retroperitoneal haematoma in liver amyloidosis mimicking retropancreatic tumour has not been reported so far.

Amyloidosis↗
PubMedDate not supplied

[A retroperitoneal bronchogenic cyst].

Bronchogenic cyst is a rare congenital (developmental) anomaly. It is usually asymptomatic but its enlargement and localization may cause serious symptoms. Exact preoperative diagnosis is rarely established. As a rule, it is established during histological examination of the resected specimen. We present a patient with a subdiaphragmatic retroperitoneal bronchogenic cyst in whom exact diagnosis was documented by histological examination of excised cyst. To our knowledge this is the third such case ever reported.

Adult↗
PubMedDate not supplied

Colonic vasoactive intestinal polypeptide (VIP) in ulcerative colitis--a radioimmunoassay and immunohistochemical study.

BACKGROUND/AIMS: In this study, we present radioimmunoassay data describing the concentration of Vasoactive Intestinal Polypeptide (VIP) in both plasma and colonic biopsies, as well as immunostaining of VIPergic innervation in mucosal biopsies of normal subjects and patients with ulcerative colitis (UC). PATIENTS AND METHODS: Thirty three patients with UC and 17 healthy subjects were investigated. All UC patients suffered from active disease. Fasting circulating levels of VIP in plasma as well as tissue concentrations were measured by radioimmunoassay. For the immunohistochemistry, polyclonal antibody against VIP and the streptavidin-biotin peroxidase complex technique were carried out. RESULTS: Overall plasma VIP concentrations in the UC patients were similar to those in the controls. Significantly decreased concentrations of VIP were found in UC of rectum compared to the normal tissue. However, both plasma VIP values and tissue concentrations were found to be significantly lower in patients expressing minimal or mild active disease according to clinical activity index (AI) and histological activity index (HAI), but marked increase of plasma VIP was clear in UC patients with moderate or severe AI and HAI. There was a trend towards increased tissue concentrations of VIP in the group of patients with moderate or severe AI and HAI. Our immunohistochemical analysis of VIP fibers and nerve cell bodies revealed consistently weaker VIP-immunoreactivity in the rectum in UC patients with minimal or mild HAI. Simultaneously, in the rectal biopsies from UC patients with moderate and severe disease, the fibers in the lamina propria and ganglion cells in the submucous plexus were markedly increased in density and in degree of immunostaining. Very strong immunoreactivity was also found in inflammatory cells of the lamina propria as well as in the epithelial layer of the biopsies from UC patients with obvious disease. CONCLUSIONS: Our study shows clearly the heterogeneity in the response of VIP plasma level as well as rectum concentration and distribution in UC patients at different stages of the active disease. The possible role of VIP in the colon suggests that further studies of the alterations of this gut peptide may be useful in the understanding of UC pathophysiology.

Adult↗