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Biomedical subjects

N Ilić

Publications and source records attributed to N Ilić.

At least 19 recordsLinked to original sources
PubMed2000

Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function.

BACKGROUND: The fact that pulmonary complications occur in 20-60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period. OBJECTIVE: The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal. PATIENTS AND METHODS: A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation. RESULTS: Six hours postoperatively, the values of ventilation parameters decreased on average by 40-50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy. CONCLUSIONS: Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.

Abdomen↗
PubMed2000

War injury to the liver. A case report.

We report a case of a war thoracoabdominal gunshot wound associated with severe injury to the liver and hemorrhagic shock. Immediately upon admission to the second Echelon Surgical Unit, the patient was operated on with two separate surgical approaches: right thoracotomy and subcostal laparotomy. The patient was transferred to rear hospital for recurrent postoperative hemorrhages. He was eventually transferred to our Department, where he underwent reoperation by the surgical approach through right thoracophrenolaparotomy. Liver lesion debridement and hepatic artery ligation were performed. The early and late postoperative course was normal, and the patient achieved satisfactory recovery on discharge. The case shows that the management of severe liver injuries requires special knowledge and experience from the surgeon.

Adult↗
PubMed1999

[Video thoracoscopic therapy of recurrent spontaneous pneumothorax].

We report our first experience in surgical treatment of recurrent spontaneous pneumothorax using video-assisted thoracic surgery (VATS). From May 1995 to April 1998, 38 cases of recurrent spontaneous pneumothorax were treated using the VATS approach. All patients were previously treated by other methods (conservative, thoracocentesis, chest-tube drainage). We successfully managed VATS procedure in all our patients (wedge resection 28, bullectomy 1, partial pleurectomy 2, pleural abrasions 36). Complications include persistent air leak (4), prolonged bleeding (1) and supraventricular tachycardia (1). The mean duration of chest drainage was 3.9 days (range 3 to 15 days). All patients received antimicrobial chemoprophylaxis with single-dose of 2 g Ceftriaxone intravenously prior to surgery and average postoperative patient-controlled analgesia with 0.15 mg of buprenorphin. Utilisation resource analysis showed great advantage in favour of VATS procedure compared to retrospectively analysed thoracotomied patients. We conclude that VATS is very useful alternative to conventional thoracotomy in managing cases of recurrent spontaneous pneumothorax.

Adult↗
PubMed1999

War injuries to the chest.

AIM: Presentation of our experiences in the treatment of war injuries to the chest at the Split University Hospital, Croatia, during the 1991-1995 war in Croatia and Bosnia-Hercegovina. METHODS: Retrospective analysis of clinical and surgical data on 439 (16.3%) patients with war injuries to the chest among 2693 treated battle casualties in general. The medical data from evacuation unit, transportation, emergency department and follow-up were observed and processed by basic statistical analysis. RESULTS: There were more explosive wounds than gunshot and puncture wounds (ratio 251/158/30). Penetrating injuries were found in 348 (79%) patients and nonpenetrating in 91 (21%) patients. There were 401 (91%) men and 38 (9%) women. Thoracotomy was performed in 98 (22.3%) patients, whereas conservative surgical methods (wound treatment, chest-tube drainage, appropriate fluid therapy, antimicrobial and atelectasis prophylaxis) were used in 341 (77.7%) patients. Mean time elapsed between injury and definitive surgical repair was seven hours (range, 1 to 48 hours). Recovery on discharge was recorded in 411 (93.6%) patients, 19 (4.3%) patients were referred to other institution for further treatment, and 9 (2%) severely wounded persons died. CONCLUSIONS: The treatment of respiratory insufficiency and haemorrhage shock, and prevention of infection are the basis of management of these injuries. Prompt transportation, appropriate diagnostic methods and an adequate surgical treatment can markedly reduce mortality and complications rate in war injuries to the chest. Most war wound of the lung can be successfully managed by "conservative" surgical treatment. The recovery of lung function was similar in conservatively and operatively treated patients.

Bosnia and Herzegovina↗
PubMed1998

Recovery of respiratory functional defects after war injuries to the chest.

AIM: Assessment of lung function before, during, and after surgical treatment of war injuries to the chest, and comparison of conservative and operative surgical approach. PATIENTS AND METHODS: A retrospective study of 439 patients with war injuries to the chest inflicted during the wars in Croatia and Bosnia and Herzegovina was performed. Patients were classified by injury mechanism and by physiologic scoring on admission, according to the cardiovascular-respiratory elements of the Injury Severity Score (ISS). "Conservative" surgical treatment with chest tube drainage, appropriate fluid therapy, and antimicrobial and atelectasis prophylaxis was performed in 358 (81.5%) and operations in 81 (18. 5%) patients. Blood gases were analyzed before, during, and after surgical treatments. Pulmonary function was assessed after the stabilization of patients' clinical condition and 3-6 months after the injury. RESULTS: On admission, blood gas profiles showed slight to moderate hypoxemia with consecutive hypercapnia related to the severity of injuries. Surgical treatment left a minimum degree restrictive disorder of ventilation without an obstructive pattern. Definitive repair of lung function presented with normalization of blood gas data, and significantly improved restrictive pattern (p<0.05). There was no difference in definitive lung function between conservatively and operatively treated patients. Mortality was 2%. CONCLUSION: The success of surgical resuscitation was related to ISS scoring. Recovery of respiratory function defects after the injury was not significantly related to the mechanism of injury or the patient's condition at arrival. The recovery of lung function was similar in conservatively and operatively treated patients.

Adult↗
PubMed1998

[Our initial experience with video-assisted thoracoscopic surgery (VATS)].

Diagnostic and therapeutic potentials and our first two-year experience with video-assisted thoracic surgery (VATS) are reported. From May 1995 to April 1997, at the Department of Surgery, University Hospital Split, VATS approach was planned in 55 cases (recurrent pneumothorax in 23, tension pneumothorax in 1, traumatic effusion in 5, malignant metastatic lung tumor in 1, benignant lung tumor in 11, traumatic effusion in 5, suspected mediastinal lymph nodes in 4, long lasting unconfirmed pleural effusion in 9, foreign body in 1, mediastanal cyst in 1). Of these, 48 procedures (87.2%) were performed using VATS (diagnostic thoracoscopy in 12, wedge resection with or without pleural abrasion in 21, partial pleurectomy in 1, decortications in 3, mediastinal lymph nodes biopsy in 4, lung biopsy in 7). Seven patients (12.7%) underwent conventional posterolateral thoracotomy. Complications included persistent air leak in three patients, prolonged bleeding in one patient and supraventricular tachycardia in one patient. The mean duration of chest tube drainage after the procedure was 3.7 days (range 2 to 19 days), and mean hospital stay was 5.1 days (range 3 to 15 days). All patients received routine antimicrobial chemoprophylaxis with single-dose ceftriaxone 2 g intravenously immediately prior to the surgery, and average postoperative patient-controlled analgesia with buprenorphine 0.15 mg. We conclude that VATS is a very useful alternative to conventional thoracotomy in managing cases of exploration, recurrent spontaneous pneumothorax, benign pulmonary lesions, solitary pulmonary nodes, early decortications and different intrathoracic biopsies.

Endoscopy↗
PubMed1996

Functional effects of typical lung resections for primary bronchogenic carcinoma.

In 60 patients with primary bronchogenic carcinoma undergoing surgery, pulmonary function studies were performed before, and then 10 days and 3 to 6 months after typical lung resection. Preoperative profiles showed a slight restrictive pattern without air trapping and slightly disturbed gas exchange. The restrictive pattern was not related to clinical, X-ray and endoscopy findings. The alveoloarterial oxygen gradient was smaller in the patients requiring lobectomy than in pneumonectomy patients. After surgery, the volume loss was related to the amount resected, being greater after right pneumonectomy than after left pneumonectomy, smaller after bilobectomy and the least after lobectomy. The obstructive pattern remained unchanged. Diffusion of carbon monoxide decreased significantly less than the volumes after pneumonectomy, but proportionally after lobectomy and bilobectomy. Those with increased alveoloarterial oxygen gradient or increased physiologic dead space showed a significant improvement of their gas exchange after surgery.

Carbon Dioxide↗
PubMed1995

Penetrating war injuries of the heart.

Treatment of 12 penetrating heart war wounds were described. Ten wounded (83.3%) died on the spot or during transportation. Only two (16.7%) were brought to the clinic with signs of life, operated on and released from the hospital. The two wounded had not received any therapy before the arrival. The two cases described indicate the importance of a rapid transportation, adequate reanimation and the fastest possible cardiorrhaphy either by means of thoracotomy or medial sternotomy.

Adult↗
PubMed1994

A war injury to the thoracic trachea.

The authors present a case of war injury to the thoracic trachea with the defect involving more than half of its circumference. After minor difficulties in establishing the right diagnosis, we passed to the surgical procedure and managed the lesion by simple suture. The patient's postoperative course at the Intensive Care Unit was uneventful. Both early and late follow-up roentgenograms, computerized tomography of the trachea and bronchoscopy showed normal findings.

Adult↗
PubMed1994

[Advantages and disadvantages of esophagogastroplasty in reconstruction of malignant and benign esophageal stenosis].

Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomach for ideal substitute in subtotal and total esophagoplasty. Additional advantages are one act surgery and possibility of single anastomosis formation. In an eighteen years' time, since 1976., two hundred nine (209) patients were operated with use of esophagogastroplasty for malignancies and benign diseases of esophagus and hyphopharinx. The esophagogastric anastomosis is most common reconstructive procedure for esophageal and hyphopharingeal malignancies. Anastomosis on pharyngeal level was made in 13 pts., on cervical esophagus level in 168 pts. and on thoracic esophagus level in the rest of 28 pts. Overall postoperative morbidity was 25,36%. Most common complication was anastomotic dehiscence (18,66%), transplant necrosis occurred in 2% of pts., whereas stenosis of the anastomosis was observed in 4,78% of pts. Overall intrahospital mortality was 14,38%, while specific mortality (anastomotic dehiscence and/or transplant necrosis) was 10,04% (21 pts.), whereas nonspecific mortality (predominantly lung insufficiency) was 4,78% (10 pts.). Anastomotic dehiscence is major disadvantage of this method.

Anastomosis, Surgical↗
PubMed1994

[Anastomosis suture technic and complications of esophagocoloplasty in corrosive lesions].

For the reconstruction of the esophagus due to a corrosive stenosis a colon transplant is usually used. In all esophagocoloplastics three anastomosis are necessary: anastomosis that continues the alimentary tract, anastomosis of the distal part of transplant with the stomach or duodenum, and the most important proximal anastomosis of the esophagus (or pharynx) with the transplant. In the period of 29 years (from January 1, 1964 until December 31, 1993) on the Institute for digestive diseases in Belgrade 250 esophagocoloplastics were performed with 750 anastomosis, in the patients with corrosive stenosis of the esophagus. All the anastomosis are sewn in two layers with the interrupted or continuous stitch, except for the anastomosis with the pharynx where due to a structure of the wall a one layer continuous stitch was only possible. From 750 anastomosis in 30 patients or 4% an anastomotic leakage occurred and in only 4 patients or 0.5% it ended lethaly. Stenosis of the anastomosis occurred in 18 patients or 2.4%.

Anastomosis, Surgical↗
PubMed1992

Maximal oxygen uptake in trained and untrained 15-year-old boys.

The purpose of this study was to assess maximal aerobic power (VO2max) in trained and untrained 15-year-old boys. The trained subjects (18) were junior swimmers from a Belgrade swimming team, and the untrained ones (12) were from a Belgrade high school. VO2max was directly measured during progressive cycle ergometer exercise using open circuit spirometry. No significant differences in height, mass, percentage fat and vital capacity were noted between the trained and untrained groups. Maximal aerobic power (overall, relative and in relation to lean body mass) in absolute values, and expressed per kilogram of body mass and lean body mass, was 31.5%, 21.2% and 20.6%, respectively, higher in the trained than in the untrained group (P less than 0.05). These data suggest that physical training significantly increases maximal aerobic power in young subjects.

Adolescent↗
PubMed1990

[Splenorrhaphy and partial splenectomy as an alternative to splenectomy in trauma--overview].

For many year splenectomy was considered to be the only possible surgical treatment for all laceration of the spleen, whether resulting from abdominal contusion or not. Such factors have led to changes in practical attitudes to splenic lacerations but it would seem that indications for a conservative approach must be based upon the underlaying condition and the precise nature of the lesions. Splenectomy should be done promptly in cases of concomitant splenic and cerebral injury and in patients with injury of multiple organ systems. Present knowledge of the complications of anesplenia has led to new surgical techniques for conservation of splenic tissue. Splenorrhaphy was a frequently used treatment in the non-complicated traumatic lesions. The decision of whether or not to remove an injured spleen is one which must be made intraoperatively by the surgeon. Operative splenic repair and preservation of the spleen often requires considerable experience. We conclude that surgical splenic preservation is a viable and safe procedure, especially in infants and young children.

Humans↗
PubMed1989

[Bilateral malignancy of the breast].

The breast cancer is the most common malignant disease in women, and makes 26 percent of all malignant diseases in women. Bilateral breast cancer is very rare, especially simultaneous one. We analyzed 420 operated breast cancers in Surgical Clinic in Split within five years period. There were 8 patients with simultaneous or metachronous bilateral breast cancer. Their incidence, difficulties in diagnostics and treatment, pathologic findings and prognosis are discussed. It is justifiable to follow the contralateral breast of patients with the breast cancer.

Adult↗
PubMed1989

[Fatal postsplenectomy sepsis (OPSI syndrome)].

The cases of postsplenectomy sepsis are described at the Clinical Hospital Centre Split. Overwhelming postsplenectomy infection is a unique clinical entity distinguishable from other infections. It may occur during the lifetime of any asplenic patient. The aggressive approach to splenic preservation is a way by reducing the risk of subsequent overwhelming postsplenectomy sepsis. In the case of necessary splenectomy, should be given long-term prophylactic antibiotics preoperative and polyvalent pneumococcal vaccine to it would be given shortly after operation. Autologous splenic implantation is generally recommended when total splenectomy is necessary.

Adolescent↗
PubMedDate not supplied

Biological and chemical quality control of spermicidal raw material nonoxynol-9 and nonoxynol-9 containing vaginal contraceptive (ABF contraceptive film): determination of spermicidal activity and assay of nonoxynol-9.

The paper presents a routine biological and chemical quality control of nonoxynol-9 raw material and pharmaceutical formulation containing nonoxynol-9 (ABF contraceptive film). The biological control performed based on the determination and comparison of the spermicidal activities different dilutions of the standard raw materials solution and assay raw material or nonoxynol-9 pharmaceutical formulation solution on the human or breeding bull sperm using a modified Sander-Cramer method. The test preparations of the nonoxynol-9 raw materials or pharmaceutical formulation should show equal or higher spermicidal activity than the standard. The spermicidal activity should not be lower than dilution 1:90. The chemical control is performed based on the determination and comparison of nonoxynol-9 content in the standard raw material solution and assay raw material or nonoxynol-9 pharmaceutical formulation solution using UV-spectrophotometric method determining and comparing the absorbances at the maximum absorbance wavelength (275 nm). The content of nonoxynol-9 in the raw material assay solution or pharmaceutical formulation (ABF contraceptive film) should be within 90-110% of the declared value.

Animals↗
PubMedDate not supplied

[Colonic sphincters--Hirsch's sphincter].

Anatomic and physiological sphincters of the colon are localized narrowness of the colon with adequate name. These sphincters appear due to the thickening of longitudinal and circular muscle fibers in the wall of colon or due to the reflex irritation of the autonomous nervous system which innervates the colon. If they appear isolated, their radiographs look similar to those of an organic stenose of the colon. This leads to a false diagnosis and the patient has to undergo an operation. It is not so rare to find the sphincter of the colon instead of a malignant process during the operation. The authors present a patient with Hirch's sphincter of the colon addressed to their institution with the diagnosis: Tucoli ascendentis based on irrigoscopy and irrigography previously performed in another institution. On repeated irrigoscopy and irrigography with double contrast in hopotonia with Glucagon the ascendent part was clearly enlarged with normal wall contours and mucous pattern. The patient had been discharged with the diagnosis of anatomic Hirsch's sphincter and she is in quite good condition.

Aged↗