Biomedical subjects

M Milićević

Publications and source records attributed to M Milićević.

At least 19 recordsLinked to original sources

PubMed2006

[Ambulatory surgery of umbilical, epigastric and small incisional hernias: open preperitoneal flat mesh technique in local anaesthesia].

INTRODUCTION: The dilemma whether to use the mesh or non mesh technique in the management of umbilical, epigastric and small incisional hernia is slowly fading away. The open preperitoneal "flat mesh" technique performed as ambulatory surgery may be one of the solutions. THE AIM: The aim of this retrospective study is to present the results of open preperitoneal "flat mesh" technique in the management of umbilical, epigastric and small incisional hernia within MATERIAL AND METHODS: This study included 34 patients (11 of them with umbilical, 13 with epigastric and 8 of them with small incisional hernia) operated by one surgeon in the period January 2004-January 2006. RESULTS: The median operative time was 52 minutes for umbilical hernia's, 43 minutes for epgastric and 54 minutes for incisional hernia's. The ambulatory surgery was performed at 91% of patients. The median hospitalization was 4h for patients with umbilical hernia's, 3,7h for patients with epigastric and, 7,7h for patients with small incisional hernia. The follow up is 10,5 months. Apart of one superficial infection other complications were absent. CONCLUSION: The open preperitoneal "flat mesh" technique performed in local anesthesia as an ambulatory surgery provides good results in the management of umbilical, epigastric and small incisional hernia.

Adult↗

PubMed2006

[Retrohepatic veins of the posterior section of the right hepatic lobe--terminology and surgical significance].

Three main hepatic veins: right, middle and left are constant, but there is a variable number of retrohepatic vessels called accessory or minor hepatic veins. The most important of them are veins reffered to as middle right hepatic vein (MRHV) draining segment VII and inferior right hepatic vein (IRHV) draining segment VI. The incidence of large MRHV and IRHV reaching or exceeding a caliber of 5mm, their arrangement in the liver and drainage territories were investigated in our collection of 142 injection-corrosion specimens of the liver. In 1/5 of the cases with large IRHV this vein drains small part of segment VI, sometimes its insignificant marginal part so it couldn't be used for segment VI preservation when it is necessary. A precise knowledge of the vein anatomy of right posterior sector of the liver and its vein drainage territories is very important during complex dissections of the retrohepatic areas, resections and preservation liver parenchima.

Adult↗

PubMed2005

[Infection in hernia surgery].

Traditionally, the operation of hernia is considered as a clean operation due to expected, low incidence of infection, on the spot of surgical work (SSI). The incidence of SSI in hernia surgery is more frequent then it is assumed. The important risk factors for SSI are the following: type of hernia (inguinal, incisional), operative approach (open - laparoscopic), usage of the prosthetic material and drainage. Comparing to inguinal hernia repair, incisional hernia repair, is more frequently followed by the infection. The laparoscopic operations are followed with the lower incidence of SSI then in the case of open operations. The usage of the mesh does not increase the incidence of SSI, although the consequences of the mesh infection may be severe. A type I of the prosthesis is more resistant to the infection then prosthesis II and III. The mesh infection (type I) never involves its body but it is present around sutures and bended edges. The mesh infection Type II involves entire prosthesis while in the case of Type III it is present in its peripheral part. In the case of SSI, a prosthesis Type I is possible to be saved, while prosthesis Type II must be removed completely; and the same is for the Type III (the partial removal is rarely suggested). The defect that remained after excision of non-resorptive prosthesis is a long-term and very complicated surgical problem. In regard to the position of the mesh, SSI is more common if the mesh is placed subcutaneously then in the case of sub-aponeurotic premuscular, pre-aponeurotic retromuscular or pre-peritoneal mesh placemen. If the infection is present the nontension techniques using non-resorptive prosthetic implants are not recommended. The presence of drainage and its duration increases the incidence of SSI. It is more common for incisional hernioplasty then for inguinal hernia repair. If there is an indication for drainage it should be as short as possible. The cause of SSI for elective operations are bacteria's that arrives from the skin, while in the case of opening of various organs dominant bacteria's originate from them. The superficial infection does not lead to the recurrence, while it is very possible in the case for deep infection. There are no prospective studies that justify the usage of antibiotic prophylaxes in hernia surgery. The antibiotic prophylaxis is indicated for the clean operations when placing the implants and when severe complication is expected. The appearance of SSI increases the price of treatment and may lead to the recurrence.

Anti-Bacterial Agents↗

PubMed2005

[Modern aspects of shoulder injury treatment].

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.

Humans↗

PubMed2005

[Modern aspects of the ankle fracture treatment].

The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modem diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.

Ankle Injuries↗

PubMed2005

[Anterior cruciate ligament (ACL)].

The anterior cruciate ligament or ACL (ligamenturn cruciatum anterius) is often injured, either alone or within complex ligament injuries of the knee. Therefore, the knowledge of detailed anatomic (macro- and micro-morphological) characteristics of this ligament is of key importance in therapy. The anatomy, structure, insertions, vascularization and inervation of the anterior cruciate ligament of the knee are described from the aspect of modern treatment and rehabilitation methods.

Anterior Cruciate Ligament↗

PubMed2005

[Congenital pseudoarthrosis of the tibia treated with the free microvascular fibula].

Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5-year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.

Child, Preschool↗

PubMed2003

[The Rives technique (direct inguinal approach) in treatment of large inguino-scrotal and recurrent hernias].

In solving inguinal hernias, surgeons today have in front of them many variations of different operative procedures (both tensional and non-tensional techniques). They are performed through operative or endoscope approach. Classical tension techniques present the operation of choice for smaller indirect, direct or femoral hernias among younger patients while non/tensional techniques are the best solution for all types of inguinal hernia among older patients with big destruction of transversal fascia and the best solution for most of recurrent hernias. Positioning of mesh with non-tensional techniques can be completed on different levels, with big hernias where the biggest part of transversal fascia of miopectineal orifitium is destroyed it is anatomically the most useful to place the mesh in preperitoneal space. Rives technique is the base of that concept and it presents one of good solutions in that kind of situations. In the period January 2001 until december 2002 using different operative techniques the authors treated 99 inguinal hernias of which 78 were primary and 21 recurrent hernias. Rives technique was performed in 46 cases (46.5%) among which 26 cases were primary inguinoscrotal hernias (3 patients IIIA, 22 patients IIIB, 1 patient IIIC, according to Nyhus classification) and 20 cases were recurrent hernias (6 patients IVA, 11 IVB, 3 IVD). Complications after Rives technique were the following: 1 recurrence (2.17%), 1 ischemic orchitis (2.17%) and 1 scrotal hematoma (2.17%). Infections and chronic pain were not present. The follow up was from 30 days to 2 years. Authors have shown that Rives technique is reliable solution for primary indirect, direct and femoral hernias with big hernial defect (especially for big, so called "giant" inquinoscrotal hernias) and for all types of recurrent hernias. The advantage of the technique is an easy performance without some previous special training because of the fact that dissection and preparation is the same as for the tension techniques. With small amount of prosthetic material all weak points of miopectineal orifitium are closed. The real risks of this technique are ischemic orchitis and chronis neuralgia in treatment of recurrent hernias and the presence of polypropylene mesh in Bogras space.

Hernia, Inguinal↗

PubMed2003

[Advantages and disadvantages of planned staged relaparotomy using the zipper technique in surgical treatment of necrotizing pancreatitis].

The rationale of surgical intervention during acute necrotizing pancreatitis is to remove necrotic tissue preserving healthy glandular parenchyma and other adjacent structures, thus limiting severe complications. Necrosectomy and debridement are the crucial in surgical management, further treatment of pancreatic bed and peripancreatic tissue are still a matter of debate among pancreatic surgeons. Zipper technique is one of the three recognized methods [table: see text] for the surgical management of necrotizing pancreatitis. The aim this study was to review the literature data about treatment using this technique, as well to compare the results of treatment with other techniques, in order to present the advantage and disadvantage of zipper technique. The main advantage of this technique is a high level of control of intraabdominal infection and other septic complications associated with necrotizing pancreatitis and its surgical management. Increased risk of development of gastrointestinal and pancreatic fistulas as well of intraabdominal bleeding is probably the main disadvantage. A flexible approach focused on the individual patients is a reasonable solution in the surgical management of the necrotizing pancreatitis.

Humans↗

PubMed2003

[Prevention and treatment of organ injury in acute pancreatitis].

Acute pancreatitis is illness with unpredictable outcome. In some patients course of illness is progressive and leading to multiple organ dysfunction syndrome often resulting with lethal outcome. During last decade the treatment protocols have changed. Basic pathophysiologic mechanisms leading to progression of the illness, as well as, contemporary diagnostic and treatment possibilities that can prevent occurrence of severe consequences and improve outcome are presented.

Acute Disease↗

PubMed2003

[Modified Rives technic in the treatment of recurrent inguinal hernia].

After the introduction of prosthetic material in hernia surgery the fundamental changes in operative strategy occurred. This is because the coverage of myopectineal orifitium with non-absorbable prosthesis decreases the incidence of recurrences. Because of the appearance of lateral re-recurrences after the classical Rives procedure, we modified the operative technique. The modified Rives technique consists of the following: always polypropilen mesh 15x10 cm; creation of the new internal inguinal ring between Poupart's ligament and mesh; no lateral notching the mesh and anchoring mesh 2-3 cm from the medial, inferior, lateral and superior edge. During the period January 2001-December 2003, 34 cases of recurrent hernias were operated on 7th dept. of I Surgical Clinic of CCS. The recurrences were managed by classical (10/34) or modified Rives technique through direct inguinal approach (22/34), less frequently Lichtenstein procedure (1/34) and McVay (1/34) technique. Among 10 patients with recurrent inguinal hernias managed by classical Rives technique 2 re-recurrences appeared (indirect and interstitial) and 2 cases of infection (immediately after the operation or 7 months after the operation), and in the group of 22 cases with recurrent inguinal hernias managed by modified Rives technique the aim complications didn't appear. Using the modified Rives technique we managed the primary hernias in 56 cases without recurrences and infections. The modified Rives technique, because of the way of mesh fixation (all around), no lateral notching of mesh and remaining hem in all directions secures abdominal wall protection 2-3 cm from the line of fixation and prevents any movement of the mesh. This procedure enables management of all inguinal hernias regardless to their size and full protection of the medial, femoral and lateral inguinal triangle. The modified Rives technique is the technique of choice for big multiple defects (giant inguino-scrotal and re-recurrences), especially among patients with increased intra-abdominal pressure when other techniques may be insufficient because of mesh protrusion.

Digestive System Surgical Procedures↗

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↗

PubMed2002

[Elective resection of the spleen--overview of resection technics and description of a new technic based on radiofrequency coagulation and dessication].

The authors present a short overview of the development of elective splenic resections. Past and present indications are presented. Contemporary hemostatic technique for elective splenic resection are discussed. An original new technique for transsegmental partial splenic resection using RF generator Radionic Cool Tip(without any aditional hemostatic procedures is presented. This technique is inovative and when use properly it is a practically zero blood loos technique. A patient with transsegmental splenic resection using RF generator is presented. Further clinical application of the technique is necessary.

Catheter Ablation↗

PubMed2002

[Laparoscopic splenectomy--indications, specifics of surgical procedures and surgical technics].

The surgical management of splenic disorders has changed considerably over past few years. The increased use of laparoscopic approach for general surgical problems has prompted surgeons to investigate feasibility of laparoscopic splenectomy. However, some unique anatomical features of disordered spleen may limit the application of laparoscopic techniques for this procedure. In this article we analyzed indications for laparoscopic a surgery of the spleen, some surgical particularities of laparoscopic splenectomy, as well as the techniques to accomplish this procedure.

Contraindications↗

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↗

PubMed2001

[Protoscolecides in the surgical treatment of hepatic echinococcosis--myth or reality].

Traditionally protoscolicidal agents have been used during conservative surgery for cystic liver hydatidosis to sterilize the cyst cavity and to avoid dissemination. Many surgeons questions the effect of the procedure due to lack of objective data and possible complications for their use. Recently introduced minimally invasive techniques--percutaneous (PAIR), endoscopic and laparoscopic--have reestablished the need for the evaluation of protoscolocidal agents.

Anthelmintics↗

PubMed2001

[Evaluation of enterogastric reflux in relation to functional status of the gallbladder].

The aim of the study was estimation of the relation between the gallbladder (GB) motility function and the presence and quantity of enterogastric reflux (EGR). We investigated 172 patients with: physiological GB function (filling and emptying)(FGB), impaired GB function (prolonged filling and ejection fraction < 45%) and afunctional gallbladder (AGB)(without visualization). The study was performed during 90 min (1 f/min) after i.v. application of 185 MB 99mTc-dietil IDA. After 30 min. test meal was given while at the end stomach was marked. According to the parameters from time activity curves over stomach and hepatobiliary system, the index of ERG was calculated, while GB filling and ejection fraction were estimated from the GB time/activity curve. We can conclude that EGR occurs more frequently in the patients with afunctional GB in comparison to those with functional and decreased motor function. Also, EGR quantity is in correlation with the impairment of the GB function.

Duodenogastric Reflux↗

PubMed2001

[Topographic and structural characteristics of the minor duodenal papilla].

The study of minor duodenal papilla topography and structure was carried out on 36 fresh autopsy specimens of human duodenopancreas. We performed precise measurements of its distance to the major duodenal papilla and to the superior duodenal flexure. There was no correlation between the position of the minor papilla and the incidence of duodenal ulcer disease. Microdissection and histological staining of the minor papilla did not reveal an anatomically defined sphincter around the terminal portion of the accessory pancreatic duct. All the specimens of the minor papilla contained within acini of pancreatic tissue. A terminal dilation of the accessory pancreatic duct was found in 22% of the cases.

Adult↗