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M Zuvela

Publications and source records attributed to M Zuvela.

15 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↗
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

[The role of endoscopic ultrasonography in diagnostic and estimation of common bile duct carcinoma invasion].

The main purpose of this survey is to present the importance of EUS in establishing a diagnosis of tumor of the choledochus. It is also important to emphasize that EUS is the most suitable diagnostic method for determination of tumor invasion to choledochus, i.e. to determine TN patient status and to predict if tumor could be successfully resected. The author would like to present his own experience in using of EUS as a contemporary method for establishing a diagnosis and effective treatment of patients with tumor of choledochus. All patients were examined by Olympus equipment for endoscopic ultrasound with radial probe working with the frequency of 7,5 and 12 MHz at the Department for Endoscopic Ultrasound of the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia. All examined patients were subjected to surgical exploration after that. Therefore it was possible to compare preoperative estimation of tumor invasion with a final result obtained by surgical exploration. Five patients were diagnosed with tumor of choledochus localized at the distal part of choledochus. TN status of examined patients was specified by standard criteria. Estimated TN status for two patients was defined as T2N1a and T2N0, which indicate the possibility of excessive surgical treatment, what was confirmed by surgical exploration as well. A small number of patients was not possible to use for statistical evaluation. Our conclusion is that EUS presents the most effective method to estimate a degree of tumor invasion to choledochus, since it provides an accurate definition of TN patient status and predicts if tumor could be successfully resected.

Common Bile Duct↗
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

[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

[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

[Surgical treatment of hematologic disorders of the spleen].

Splenectomy--the surgical removal of spleen is being performed in cases of: traumatic spleen rupture, as part of other surgical procedures, number of hematological, infectious and metabolic disorders. During the years 1988.-2001., there were 396 splenectomies performed at the First surgical clinic, for the cause of: autoimmune disorders 187 (47.34%), lymphoproliferative diseases 89 (22.59%). Hodgkin disease 35(8.94%), myeloproliferative disease 39 (9.95%), as part a of "staging" laparotomy 37(9.34%), other hematological disorders 7(2.20%). The spleen of [table: see text] 244 patients weighted 500-1500 g(61.62%), in 56 patients (14.14%) weighted less than 500 g, and in 96 patients (24.24%) spleen weighted more than 1500 g. Patients with thrombocytes less than 40,000/l 16 (4.04%) were perioperativly treated with fresh thrombocytes. Postoperative morbidity and mortality were registered in 54 (13.64%), i.e. 8 (2.02%) patients. Delayed results depended on primary disorder, comorbidities and supportive therapy. In this article, the particularities of the operative procedure were discussed, as well as importance of cooperation of surgeon and hematologist in perioperative treatment.

Adolescent↗
PubMed2002

[Intraoperative and postoperative complications of splenectomy].

Spleen is being surgically removed because of trauma, in diagnostic and-or therapeutical purposes because of the benignant and malignant diseases. The percentage of morbidity during and after splenectomy is relatively low. During surgery might occur bleeding, trauma of the pancreatic tail, stomach, lineal flexure of the colon, left hemidiafragm, left suprarenal gland and upper pole of the left kidney, which must be correspondingly reclaimed during the same intervention. In the early postoperative period, postoperative bleeding, subfrenic abscess, pulmonal atelectasis, bronchopneumonia and left pleural extravasations might occur. Especially is important notification of these events in due time and adequate conservative and surgical treatment. After splenectomy, there is an increase of the number of trombocytes, which might lead to the tromboembolic complications. In the prevention of these complications in the postoperative period prolonged antiagregation therapy is suggested. Postsplenectomy sepsis is very late, general complication of splenectomy, which occurs because of the lower immunity in the child age. To prevent these complications, partial splenectomies, reimplantations of the spleen, prolonged application of the penicillin medicines after splenectomy and antipneumococcal vaccine are performed.

Humans↗
PubMed1998

[Surgical treatment of liver metastases of colorectal carcinoma].

Colorectal carcinoma metastasizes into the liver, but liver-only metastases are infrequent. Liver-only metastases are seen mainly from colorectal carcinoma. This is the only metastatic disease where treatment aimed only or mainly at the liver metastases is employed with curative intent. If liver resection for colorectal metastases is done by an experienced team, adhering to predefined indications, five year survival ranges from 30-40%, operative mortality is 3-5% and the postoperative morbidity is acceptable. New diagnostic techniques have been introduced and indications for liver resection extended. This paper presents the current limitations and possibilities for the surgical management of colorectal metastases in the liver.

Carcinoma↗
PubMed1991

[Use of taurolin in the prevention of septic complications in emergency abdominal surgery].

The purpose of the study was to evaluate effectiveness of local application of Taurolin in prevention of septic complications after abdominal emergency surgery. Group A included 30 patients in whom intraoperative peritoneal lavage was performed with 0.5% solution of taurolin. In the first 12 postoperative hours peritoneal lavage was repeated through the drain. Group B included 30 patients in whom intraoperative lavage was performed with either physiologic saline or Povidon solution. All patients had suppurative peritonitis provoked by perforation of some of the abdominal organs. Intraoperatively samples of abdominal pus were taken for bacteriological analysis, while postoperatively samples were taken from drains placed abdominally and subcutaneously. Twelve hours after the surgery therapy was conducted according to the operative findings, postoperative course, x-ray and laboratory findings and results of sensitivity testing. Analysis of the results revealed significant differences in postoperative morbidity and mortality between the two groups. No fatal outcomes were recorded in the immediate postoperative course in group A where only one case of recurrent intraperitoneal infection occurred and three cases of wound infection. In group B, however, three patients died in the immediate postoperative course, recurrent intraperitoneal infection developed in four cases and wound infection in 12. Intraoperative and early postoperative local application of Taurolin in addition to appropriate surgical treatment and postoperative care has an important role in prevention of postoperative septic complications and decrease of postoperative mortality.

Abdomen↗
PubMed1990

The role of membrane water permeability in characterization of pathologically altered human stomach tissues: NMR studies.

Comparative NMR studies of normal and pathologically altered human stomach tissues were performed on the basis of proton T1 relaxation time measurements in the presence of high external concentrations of relaxation (contrast) agents manganese ethylenediaminetetraacetic acid (Mn-EDTA) and gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Diffusion permeability of the cell membrane to water, Pd, was determined by measuring the longest proton T1 component sensitive to the exchange of water molecules through the cell membrane. Pathologically altered tissues showed substantially higher (2 to 10 times) average cell membrane permeabilities to water.

Cell Membrane Permeability↗
PubMed1989

[Early postoperative complications in elective splenectomy in hematologic diseases].

This study analyses frequency of complications and mortality after elective splenectomy done for various hematological diseases, dependent on the spleen weight. From 1979 to 1988 year, 236 patients were treated by splenectomy for various haematological disorders, including: autoimmune disorders (90), Hodgkin's disease (34), lymphoproliferative diseases (96) and myeloproliferative diseases (16 patients). In the early postoperative period, complications occurred in 51 (21.61%) patients, 10 of which (4.24%) died. Considering the size of the spleen (more or less than 1500 gr) there was no difference in the early postoperative mortality (p greater than 0.05; 3.30%:5.38%), while postoperative complications occurred significantly more often in patients with massive splenomegaly (p greater than 0.05; 1259%:3548%). The most frequent complications were septical (8.90%), prolonged fever (5.51 x), and postoperative bleeding (2.97%), while cardial, pulmonary and urinary complications occurred seldom, but more often caused patient's death. Defining the appropriate indications for splenectomy, performing suitable preoperative preparations and postoperative care, mortality was diminished from 7.14% in the period, 1979-1983 year, to 2.17% in the period 1984-1988.

Adolescent↗