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Biomedical subjects

P Pesko

Publications and source records attributed to P Pesko.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Reconstruction of the hypopharynx and cervical esophagus using a free jejunal graft].

Extensive malignant tumors of the hypopharynx and cervical esophagus continue to challenge surgeons in respect to both type and extent of resection as well as type of reconstruction. In the period between November 1st, 1996 and November 1st, 1998, at our Department, five patients have been operated due to squamocellular carcinoma of the hypopharynx using a free jejunal graft reconstruction method. The first free jejunal graft operation due to hypopharyngeal carcinoma, at the same time the first operation of this kind ever done in our Country, was performed on November 13th, 1998. There were 4 female and one male patient, average age 47.75 years. Disfagia for solid foods was a leading symptom in all patients (mean duration of 3.5 months) and was always accompanied with weight loss (average of 8 kg for two months). In all patients barium swallow, endoscopy, CT as well as intraoperative endoscopy was performed. Radical surgical procedure was always accompanied with the bilateral modified lympf node neck dissection. As a arterial donor vessel superior thyroid artery was used in all patients. As a venous drainage in three patients a external jugular vein was used and in two facial vein. Reconstruction using a free jejunal graft of approximately 25 cm long was performed in all patients creating upper, oropharingeal, anastomosis end to side and distal, esophageal, end to end (in only one patients side to end) using 3/0 apsorbable sutures. Mean duration of the operation was six hours. The postoperative course in all patients was uneventful. On the 9th postoperative day gastrografin and three days later barium swallow radiography was performed as a standard control study. Regular check ups were done on three, six, nine months, year and two years. On all controls all patients were symptom free and feeling well. It is our opinion that in the patients with isolated carcinoma of the hypopharynx due to low morbidity and mortality rate, free jejunal graft method is the surgical procedure of choice.

Carcinoma, Squamous Cell↗
PubMed2000

[Surgical treatment of cardial carcinoma].

In the period from 1970 to 1996, in the Departmenf of Esophagogastric Surgery, Belgrade, Yugoslavia 562 have been operated with curative intent due to cardiac carcinoma. Since 1970 until 1985, in 182 patients a distal esophagectomy and proximal gastrectomy followed by eosphagogastro anastomosis had been performed. In the period between 1982 and 1996, a distal esophagectomy with total gastrectomy and radical or extended radical dissection and intrathoracic esophagojejuno anastomosis in 380 patients (192 hand sewn 3/0 interrupted sutures and 188 spapled anastomosis) had been performed. In our opinion for the majority of patients with advanced cardiac carcinoma distal esophagectomy and total gastrectomy, via the left thoracoabdominal approach, with D2 pancreas preserving splenectomy and dissection of lymph nodes in stations 16a1 and 16a2 is a surgical therapy of choice. Overall complications of such a procedure not differ in type and number from those after standard total gastrectomy and D2 dissection.

Adenocarcinoma↗
PubMed2000

[Surgical strategy in the treatment of primary lymphoma of the stomach].

Primary gastric lymphoma has been traditionally accounted for only 1-7% of all malignancies of the stomach. During the period 1980-1996 in Department of Esophagogastric Surgery of University Surgical Hospital in Belgrade 41 patients have been operated due to primary gastric lymphoma. Radical surgery is the only therapeutic procedure in more then 45% of patients. It is also a safe procedure with specific complication rate less then 22%, and specific mortality rate less then 5%. In our experience, total gastrectomy with systematic lymphadenectomy is a therapy of choice in most patients with primary gastric lymphoma.

Adult↗
PubMed2000

[A large duplication cyst of the proximal section of the stomach in an adult--case report].

Intestinal duplication is a rare congenital anomaly. It appears through out entire gastrointestinal tract, specially in the ileum. Gastric duplication cyst in adults is extremely rare. Diagnosis is often missed, often established at operation. Preoperative diagnosis may be suspected on CT or MRI with contrast given oraly as well as on EUS. Management of symptomatic gastric duplications is surgical. Recommended management is complete exscision of the duplication without major violation of the gastric lumen. In most cases giant cyst does not allow smaller resection but partial gastrectomy. In this report a rare case of gastric duplicatione cyst of the proximal stomach is presented. Diagnostic finding and surgical therapy are discussed.

Adult↗
PubMed2000

[Localized plano-cellular type of Castleman's disease].

Castleman was first to study lymphoid tumour of the mediastinum with characteristic histologic features which had until then been mistaken for thymommas grossly, radiologically and histologically. It was soon evidented that the condition occurred in regions other then the mediastinum and even in places where lymph nodes are not normally presents. Localised plasma cell type is rare variant of Castlemans disease, especially as an intraabdominal variant. Most patients present with local symptoms, but general malaise or fever, anaemia, elevated sedimentation rate, polyclonal hypergamaglobulinemia etc. can be present. Using preoperative imaging procedures solid, well-circumscribed expansive mass can be detected. After surgical excision and patohistological examination diagnosis can be established. In this paper we report rare case of localised plasma cell type of Castlemans disease. Other types of disease, diagnostic findings and therapeutic possibilities are discussed.

Abdominal Neoplasms↗
PubMed2000

Significance of duodenogastric reflux in patients with erosive esophagitis.

The role of duodenogastric reflux (DGR) in producing esophageal mucosal injury across the spectrum of GERD is still controversial. Our objective was to assess the role of DGR in the genesis and evolution of erosive esophagitis. Forty patients are presented who meet the criteria for the diagnosis of erosive esophagitis. Symptom scoring, endoscopy and mucosal biopsy with patohistologic classification of erosive esophagitis and a quantification of DGR, using scintigraphic imaging after intravenous injection of 99mTc-labeled HIDA, was performed. DGR was demonstrated in half of the patients. Both groups of patients (with and without DGR) were treated with life style changes, cisapride and nizatidine for a period of six weeks. After this period, symptom scoring, endoscopy and biopsy were performed again in both groups. There has been a significant decrease in the level of symptom scoring and endoscopic inflammation after the therapy, but without statistically significant difference between these two groups. Patohistologic finding after the medical treatment showed a marked difference between the two groups concerning the presence of DGR, indicating that the level of inflammation is statistically significantly higher in the group with DGR. This study showed that even if symptom scoring and endoscopy revealed improvement after the therapy in both groups of patients, patohistologic mucosal damage in patients with erosive esophagitis is greatly dependent of the presence of DGR. We conclude that alkaline component of GERD should be considered in the evaluation of patients with erosive esophagitis so that appropriate surgical therapy can be instituted.

Adult↗
PubMed1999

[Epidural analgesia in total gastrectomy--combination of bupivacaine with ketamine or fentanyl].

The effects of intraoperative epidural administration of ketamine added to bupivacaine were compared with fentanyl added to bupivacaine in patients undergoing total gastrectomy. Prospective, randomized, double blind study was designed to compare: group F: 20 patients (pts) receiving 20 ml of 0.125% bupivacaine and 50 ug of fentanyl and group K: 20 pts in whom 20 ml of 0.125% bupivacaine was combined with 50 mg of ketamine. Pts received an epidural injection through peridural catheter introduced through either T7-8 or T8-9 interspinous space. Non invasive arterial blood pressure, heart rate and ECG were recorded every 5 mins. We measured supplementary fentanyl requirement, ephedrine consumption, first postoperative complain on pain, tracheal extubation time. The groups were comparable with regard to patients characteristics, operation and anaesthesia related factors. There were no difference between groups in mean intraoperative fentanyl requirements (F vs. K = 118.5 (122.5) ug vs. 122.5(122.5)ug) (p n > 0.05), in the duration of epidural pain relief (F vs. K = 393.72 (98.75)min vs.403.63 (111.41)min, in the tracheal extubation time (F vs.K = 52.31 (50.4) vs.46.75 (48.35) min), postoperative sedation score (F vs.K = 1.26 (0.73) vs.1.11 (0.32)) (p > 0.05). Significantly higher systolic blood pressure was measured in group K comparing with group F in 20, 75, 105, 120, 150 min (p > 0.05). Statistically significant more ephedrine was applied in F group (F vs.K = 0.88(1.76)ml vs.0.05(0.23)ml) (p > 0.05). There were no statistically significant differences between groups in heart rate during the operation. None of the pts complained of bad dreams or awakeness during operation. Both fentanyl and ketamine added to bupivacaine and given as a bolus provided good intraoperative analgesia in combination with general anaesthesia, minimal sensorimotor disturbance and early tracheal extubation. In our study fentanyl added to bupivacaine caused higher incidence of hypotension than ketamine added to bupivacaine.

Adult↗
PubMed1999

[Hernia of the foramen Morgagni].

Left-side Morgagni's hernia described in this paper is a quite rare in surgery. Its usually asymptomatic and its almost always discovered accidentally, as a secondary medical findings. That was a case with our patient too. Diagnosis is usually confirmed by chest and abdominal X-rays or barium radiography. To prevent possible complications, surgical treatment is advised in all cases. We used transabdominal approach which was recommended in the literature. Surgical treatment was easy to perform and gave favourable results. There were no postoperative complications and in two years term there were no relapse.

Adult↗
PubMed1998

Evaluation of gallbladder motility in patients following total gastrectomy (Roux-en-Y) by infusion cholescintigraphy.

BACKGROUND: The aim of the study is to evaluate gallbladder (GB) motor function, by infusion cholescintigraphy, in patients after total gastrectomy (Roux-en-Y) with expected disturbances in the physiological regulation of biliary tract motility. METHODS: The study was done in 10 controls, as well as in 12 patients early (less than 2 months) and in 14 late (6 months-2 years) after surgery. Anterior abdominal imaging by gamma camera and computer acquisition was performed during three-hours infusion of 150 MBq, preceded by the loading dose of 50 MBq of 99mTc-EHIDA in bolus injection. The test meal stimulation was done in the 120th min of the study. GB TA curve was obtained and five parameters of GB motility were analysed: durations of filling (ascending) and emptying (descending) phases, filling and emptying rate ratio and ejection fraction and rate. RESULTS: Our results have shown that in the early period after the operation GB filling is prolonged and emptying impaired, while after several months GB motor function is normalised. CONCLUSIONS: It can be concluded that the infusion cholescintigraphy is potentially useful in patients after such surgery to decide on the specific treatment introduction in order to prevent GB calculosis and other complications.

Journal Article↗
PubMed1995

[Gallbladder motor function studied by modified infusion cholescintigraphy method after gastric and duodenal surgery].

Estimation of the gallbladder (GB) motility disorders after gastric surgery has not yet been assessed because of the shortage of the reliable diagnostic methods. The aim of the study is introduction, modification and establishment of the infusion cholescintigraphy into clinical practice and its performance in the groups of patients with gastric resection (RVBI i RVBII), total gastrectomy and patients after gastroplasty. Obtained data produced information about motility disorders caused by billateral truncal vagotomy, lack of the food transit through duodenum and if the motility disorders are the same in different time periods after operation. In groups of patients without truncal vagotomy (RVBI and RVBII), minor motility disorders are registered in comparison to the groups after truncal vagotomy. In the period of 6 months after surgery, higher motility disorders are registered in the group of patients with total gastrectomy, while after 9-12 months GB motility completely recovers. Groups with preserved transit of food through duodenum (RVBI and gastroplasty), has minor motility disorders in comparison to the group without transit of food through duodenum (RVBII and total gastrectomy). By introducing infusion cholescintigraphy, reliable method for the GB motility assessment is obtained.

Adult↗
PubMed1994

Prevalence and clinicopathologic features of multiple squamous cell carcinoma of the esophagus.

BACKGROUND: The occurrence of independent synchronous esophageal carcinoma in patients with grossly invasive esophageal cancer (GEC) is well known. Although multiple primary carcinoma of the esophagus is not uncommon, the exact prevalence is controversial, and its clinicopathologic features remain relatively unknown. METHODS: Fifty-four patients with squamous cell GEC who underwent transthoracic esophagectomy with systematic lymphadenectomy between 1987 and 1991 at the Institute for Digestive Diseases, Belgrade University Clinical Center, were included in the study. RESULTS: Detailed histopathologic examination of the esophagus resected for squamous cell carcinoma was performed in 54 patients and revealed 17 patients (31%) with associated cancer independent of the main tumor. The second lesion was significantly less invasive than the main tumor. There was no significant difference (P = 0.06) in sex, age, main tumor site, tumor differentiation, tumor diameter, lymph node involvement, or tumor stage between patients with multiple cancer and patients with solitary cancer, but there was a significant difference in the depth of invasion (P < 0.01). The tumor stage in patients with multiple cancer was determined by the main tumor stage and was not influenced by the associated lesion. The prevalence of multiple primary cancer of the esophagus is lower in other reports than in this series. CONCLUSIONS: The patients in this study had significantly more invasive main tumors. It seems likely that a higher prevalence of multiple cancer may be expected in patients with advanced main tumor penetration. These results support the concept that the entire esophagus may be considered as one entity of field cancerogenesis.

Carcinoma, Squamous Cell↗
PubMed1994

Paraoesophageal hernia repair with and without concomitant fundoplication.

There is currently no consensus as to whether an antireflux procedure should accompany surgical repair of paraoesophageal hernia. Forty consecutive patients with paraoesophageal hernia were studied. Surgery routinely included transabdominal hernia reduction, excision of the sac and crural repair. The addition of fundoplication was based on the presence of preoperative endoscopic evidence of oesophagitis. Twenty-three patients without endoscopic oesophagitis had no antireflux procedure whereas 17 with oesophagitis underwent concomitant antireflux surgery. Thirty-six patients were followed for 1-7 years. Patients without endoscopic oesophagitis had no postoperative reflux problems. All patients with oesophagitis who underwent fundoplication were improved or cured of reflux. The selection of patients for antireflux repair can satisfactorily be based on preoperative endoscopic findings.

Endoscopy, Gastrointestinal↗
PubMed1994

[Complications in esophagojejunal anastomosis].

In the period between January 1, 1982 until December 31 1993, in the Center for Esophageal Surgery, Institute for Digestive Disease - 1 st Surgical clinic in Belgrade, 345 esophago-jejuno anastomosis (EJA) were performed. In 326 pt's EJA, with the Roux-en-Y reconstruction with the segment of the small intestine, was performed after a total gastrectomy due to a malignant disease of stomach or cardia and in 7 due to an extensive corrosive changes of the stomach. In 12 pt's a resection of the distal esophagus due to an undilatable stricture and the reconstruction with the short segment of the small intestine (Merendino) was performed. In all 345 pt's a terminolaternal EJA was performed. In 149 pt's EJA was done mechanically by staplers (e.g., the EEA instrument) and in 196 an interrupted two layer suture was performed. In 326 pt's (operated due to a malignant disease) complications occurred in 29 of them (8.89%) while in the group of patients with benignant disease only in 2 pt's or 10.52%. A dehiscention of EJA occurred only in the group of pt's with malignant disease. Comparing the way of performing EJA a higher percentage of anastomotic leaks was found in the group of hand sewn anastomosis (18/8.16%) while in the group with a stapler performed anastomosis anastomotic leak was found only in 7 pt's (4.69%). In two pt's where a stapler anastomosis was performed there was a hemorrhage from the anastomosis during the operation, and in 8 pt's or 5.36% an unsuccessful anastomosis using a stapler was performed. Overall mortality was 6.66% or 23 pt's. Due to anastomotic leak 13 pt's died (3.76%). In 5 pt's 4 to 14 months after the operation a stenosis of anastomosis developed on EJA that severely compromised EJA and needed further medical treatment. None of the pt's was reoperated.

Anastomosis, Surgical↗
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↗