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S Kovacević

Publications and source records attributed to S Kovacević.

At least 19 recordsLinked to original sources
PubMed2001

Survival advantage for carboplatin substituting cisplatin in combination with vindesine and mitomycin C for stage IIIB and IV squamous-cell bronchogenic carcinoma: a randomized phase III study.

This communication represents the definitive report of a randomized phase III study comparing cisplatin and carboplatin, in combination with vindesine and mitomycin C in stage IIIB and IV squamous-cell bronchogenic carcinoma. A total of 221 patients entered the study and were randomized into two arms. Of these, 114 patients (109 evaluable for activity) were randomized to arm A, receiving cisplatin 120 mg/m(2), mitomycin C 8 mg/m(2) and vindesine 3 mg/m(2) per cycle; 107 patients (101 evaluable for activity) were randomized to arm B receiving carboplatin 500 mg/m(2) with the same doses of mitomycin C and vindesine per cycle. Patients with progressive disease (PD) were excluded from the study after the 2nd cycle, and those with stable disease (SD), partial response (PR) and complete response (CR) received six cycles of chemotherapy (or less in case of early progression). Patients were stratified according to the clinical stage (IIIB vs. IV), performance status (0+1 vs. 2+3) and tumor histological grade (I+II vs. III). In the cisplatin arm two patients (1.9%) achieved a CR, 38 (34.9%) a PR, 45 (41.2%) a SD and 24 (22.0%) had PD; the overall response rate was 40/109 (36.8%). In the carboplatin arm five patients (5.0%) achieved a CR, 31 (30.7%) a PR, 40 (39.6%) a SD, and 25 (24.7%) had PD; the overall response rate was 36/101 (35.7%). No statistically significant difference in response rate was present between the two arms, and the response rate was not influenced by performance status, histological grade or clinical stage. The Kaplan-Meyers curves displayed a significant advantage both for time to progression (P=0.005) and overall survival (P=0.008) for patients in the carboplatin arm. The advantage for patients receiving carboplatin instead of cisplatin appeared evident in univariate setting for patients with a good performance status and clinical stage IV, and occurred irrespectively of tumor histological grade; response duration and survival of responders was identical in the two arms. Patients achieving a stable disease survived longer in the carboplatin than in the cisplatin arm (P=0.012). Thus, substitution of cisplatin by carboplatin in the combination chemotherapy regimen, although more hematologically toxic (but less emetogenic) resulted in a similar response rate, but a significantly longer time to progression and overall survival.

Adult↗
PubMed2001

Single-day loading dose of oral amiodarone for the prevention of new-onset atrial fibrillation after coronary artery bypass surgery.

BACKGROUND: Various regimens have been proposed for the prevention of postoperative atrial fibrillation, including the use of intravenous and oral amiodarone. The purpose of this study was to determine the effectiveness of a single-day loading dose of oral amiodarone in prophylaxis of atrial fibrillation during the 7 days after coronary artery bypass surgery. METHODS: We conducted a double-blind, randomized, placebo-controlled study encompassing 315 consecutive patients who underwent coronary artery bypass surgery. They received either amiodarone (159 patients) or placebo (156 patients). Therapy consisted of a single oral loading dose of 1200 mg of amiodarone 1 day before surgery, followed by the maintenance dose of 200 mg daily during the next 7 days. Only episodes of atrial fibrillation lasting more than 1 hour or associated with hemodynamic compromise were taken into consideration. RESULTS: Overall, the incidence of atrial fibrillation was similar in patients who received amiodarone (31/159, 19.5%) and placebo (33/156, 21.2%) (P = .78). However, amiodarone reduced the incidence of atrial fibrillation in elderly patients (age > or = 60 years): it occurred in 20 of 75 (26.7%) patients on amiodarone and in 28 of 65 (43.1%) patients in the placebo group (P = .05). There were no differences between the study groups regarding the postoperative intrahospital morbidity and mortality and the duration of hospital stay. CONCLUSIONS: A single-day loading dose of oral amiodarone (1200 mg) does not prevent postoperative atrial fibrillation in a general population of patients undergoing coronary artery bypass surgery. However, it appears that this regimen reduces the occurrence of postoperative atrial fibrillation in elderly patients.

Administration, Oral↗
PubMed1993

Clinical relevance of serum amyloid A protein monitoring in urinary tract infections.

We have evaluated the clinical relevance of monitoring acute phase proteins in severe urinary tract infection. Body temperature, white blood cell count, erythrocyte sedimentation rate, serum amyloid A protein (SAA), C-reactive protein (CRP), alpha-1-antichymotrypsin (ACT) and alpha-1-acid glycoprotein (AGP) were determined daily in sera from 18 treated patients. Two patterns of response could be identified: responders and non-responders whose therapy had to be changed. Mean values for each acute phase protein were calculated daily in both responders and non-responders. Statistical evaluation of the significance between the means for each protein was also performed on a daily basis and showed P < 0.01 for SAA and CRP on day 3, for ACT on day 5, and for AGP on day 6. SAA and CRP appear to be the most reliable markers for antimicrobial therapy monitoring in patients with urinary tract infections.

Adult↗
PubMed1990

[Anesthesia in peritoneovenous shunt placement].

Since 1984 the peritoneovenous shunt has been installed in 33 patients because of resistant ascites. The aim of this study was to find the optimal type of anesthesia in our conditions on our own clinical-patient material. All patients were classified by the ASA, Goldman, Child and Child-Puigh score. The patient, surgeon and anesthesiologist were polled about the quality of anesthesia, and all observed complications were followed, like after different premedications as well as in the course and after different types of neuroleptic anesthesia. General neuroleptic anesthesia was applied in 23 patients (69.7%), one was operated on in ketamine anesthesia (3.0%) and 9 (27.3%) in local anesthesia with 2% Xylocaine. After premedication with Thalamonal in all patients there came to a fall in arterial pressure for more than 20% of initial values and the feeling of uneasiness and fear was present. All patients with local anesthesia absolutely needed additional application of sedation or analgesia, especially during the formation of the subcutaneous tunnel, and neither patient nor surgeon were satisfied with the achieved comfort. During the course of neuroleptic anesthesia with Thalamonal hypotension developed, in 17/20 patients an in 2/20 the presence of prolonged apnea demanded additional artificial ventilation. In the patient operated on in ketamine anesthesia, an acute psychotic reaction developed, followed by visual and acustic hallucinations without signs of metabolic encephalopathy. On the basis of our own experience, we conclude that general neuroleptic anesthesia with the use of Flormidal as an anesthetic and Fentanil as an analgetic, is the method of choice, and that local anesthesia can be recommended only on one operative site (except the subcutaneous tunnel).

Anesthesia↗
PubMedDate not supplied

[Preemptive analgesia in cholecystectomy using pethidine].

INTRODUCTION: Preemptive analgesia given before noxious stimulation prevents or reduces subsequent pain. Pain associated with central sensitization is called pathological pain. Preemptive analgesia could be defined as analgesia that prevents the development of pathological pain. The clinical significance of central sensitization lies in prediction that preemptive analgesia may prevent the establishment of central sensitization and reduce pain experienced following peripheral injury. Various pharmacological agents and methods have a potential in prevention of acute postoperative pain by blocking the somatosensory system and abolishing hypersensitivity. But the role of preemptive analgesia in postoperative pain is still controversial. The goal of the present study was to examine whether pethidine administration before skin incision is more effective in reducing postoperative pain than the same dose of pethidine given intraoperatively. MATERIAL AND METHODS: Thirty patients (ASA 1 to 2), aged from 40 to 65 years, admitted for elective laparotomic cholecystectomy entered the study. Group 1 (n = 15) received 1 mg/kg of pethidine i.v. 5 minutes before induction of anaesthesia (before skin incision) and 0.9% NaCl of equal volume intraoperatively (after peritoneal opening). Group 2 (n = 15) received pethidine and 0.9% NaCl in a reverse manner. Premedication was omitted. No other analgesics were administered at induction and intraoperatively. Anaesthesia was induced with midazolam, thiopentone and succinylcholine for tracheal intubation. Pancuronium was administered for muscle relaxation and halothane with O2/N2O for maintenance of anaesthesia. The duration of surgery (time from skin incision to skin closure) and time from skin closure to the first analgesic request were measured and recorded. In the ward, patients were given metamizol (2500 mg) i.m. at request during the first 12 h. If the regimen was not sufficient, piritramide (2 mg) i.m. was given at request. The intensity of pain was estimated before the first analgesic request and 4, 8, 12 and 24 h thereafter. Pain scores were recorded using VAS (0 = no pain; 10 = worst pain). Data are presented as mean values with their standard deviations and as the ranges of each parameter. The differences in data between two groups were evaluated with Student's t-test. P > 0.05 was considered statistically significant. RESULTS: Demographic data, duration of surgery and time from skin closure to the first analgesic request are presented in Table 1. No significant difference was found between the two groups. The postoperative analgesic requirements in two groups were similar and piritramide requirement was omitted. VAS scores at each time (Table 2) did not differ between the two groups. DISCUSSION: The findings of many clinical investigations remain controversial. Some clinical studies comparing the same analgesic intervention before and after the painful stimulus have shown a benefit of preemptive analgesia. The results of our study did not show a significant difference in pain scores neither in analgesic requirements of patients who received systemic pethidine before the painful stimulus compared with the patients treated with the opioid intraoperatively. However, epidural opioid administration may be more effective (17,18). It is important to say that inhalational anaesthetics, including N2O and some i.v. anaesthetic agents may have preemptive effects themselves, significantly reducing spinal sensitization (19,20). In clinical studies when the preemptive effect of analgesics is under investigation, inhalational and i.v. anaesthetics which are administered to induce and maintain anaesthesia are given before surgery. Therefore development of central sensitization may be attenuated or prevented by the anaesthetics overlapping the preemptive effect of analgesics. CONCLUSION: The results of this study did not demonstrate a preemptive effect of pethidine. (ABSTRACT TRUNCATED)

Adult↗
PubMedDate not supplied

[Resection of post-intubation tracheal stenosis].

The management of a patient with post-intubation circumferential stenosis and tracheostomy was presented. Tracheal resection and reconstruction were performed. The length of resection was four centimeters. The tracheostomy was included in the resected part. The problems of tracheal dissection and mobilization and approximation of the tracheal ends due to the anastomosis were presented. The possibilities of the intubation and adequate ventilation across the operative field were shown.

Adult↗