Browsing by Author "Filipović, Aleksandar (55015822600)"

Percutaneous nephrolithotomy (PCNL) is frequently used as the first-line treatment of large and complex stones. The key point for successful complex stone removal with minimal risk of complications is to establish the most appropriate access route. Understanding the three-dimensional (3D) relationship of kidney stones and renal collecting systems is crucial for planning and creating an optimal access route. By using a 3D volume segmentation tool a more accurate approach to the renal collecting system and stone treatment could be planned. The objective of this study was assessing the impact of 3D software in getting the desired access. Copyright © 2022 Durutović, Filipović, Milićević, Somani, Emiliani, Skolarikos and Janković.

Introduction Primary hepatic lymphoma (PHL) is a rare disease and represents lymphoproliferative disorder confined to the liver parenchyma. This condition is difficult to distinguish from other liver diseases. Histopathology is essential and confirms the diagnosis. Treatment options for PHL include surgery, chemotherapy, radiation, or combinations of these modalities. The objective of this this report is to present a case of PHL and to discuss disease features and treatment options in order to facilitate diagnostics and therapy. Case outline A 72-year-old female was presented with abdominal pain, nausea, weight loss, and fatigue. Computed tomography (CT) revealed hypoattenuating solitary lesion in liver segment VIII. The detected liver lesion showed elevated 2-[fluorine 18] fluoro-2-deoxy-D-glucose uptake on positron emission tomography/CT examination. Extrahepatic disease was not detected. The tumor board opted for surgery, and atypical resection of liver segments VII and VIII was performed. Pathohistological examination of the resected tumor demonstrated liver infiltration with non-Hodgkin’s lymphoma, diffuse large B-cell type. Postoperative recovery was complicated by fluid collections in the right subphrenic space, successfully managed by percutaneous drainage. Subsequently, the patient was treated with chemotherapy and attained a complete remission documented by negative CT findings. Conclusion PHL can easily be misdiagnosed as another more frequent primary liver tumor due to its non-specific clinical manifestations, laboratory and imaging findings, and therefore should be considered in the differential diagnosis of a hepatic lesion. © 2020, Serbia Medical Society. All rights reserved.

Background and Objectives: Hepatocellular carcinoma (HCC) most frequently metastasizes in the lungs, abdominal lymph nodes and adrenal glands. Metastatic spread to the head and neck area is extremely rare. In the presented case, an uncommon site of solitary metastatic spread of HCC to the mandible confirmed after the core biopsy of the lesion is reported. There have been only about 80 cases of mandibular HCC metastases described in the literature to date. We contribute our experience to the pool of data. Case presentation: A 65-year-old female with HCV-related liver cirrhosis was diagnosed with an HCC that was successfully treated with liver resection. Subsequently, the patient had developed COVID-19 disease, which was associated with a painless swelling in the left jaw. A neck MDCT scan demonstrated an osteolytic soft-tissue mass in the left mandible, with the characteristics consistent for the metastasis of HCC. In order to confirm the diagnosis, a core biopsy of the mandibular mass was performed. The pathohistological evaluation confirmed the presence of a metastatic HCC in the mandible. No other sites of disease dissemination were identified in extensive MDCT scans. Despite considering various treatments, including symptomatic and palliative, the patient’s overall prognosis remained poor. Conclusions: Isolated metastases of HCC to the orofacial region are extremely rare; however, it should be considered in patients with known risk factors for HCC development. Early diagnosis is critical, and clinicians should consider this possibility of HCC spread when assessing patients with orofacial swelling, among those patients with risk factors for HCC. The overall prognosis for such patients remains poor, emphasizing the challenges in managing these cases. © 2023 by the authors.

Background and Objectives. Cholestasis activates complex mechanisms of liver injury and as a result has an increased production of matrix metalloproteinases (MMP). Depending on the stage of liver disease, different matrix metalloproteinases expressions have been detected and could serve as indirect biomarkers as well as therapeutic targets. MMP-9 proteolytic activity has a proven role in both liver regeneration and neoplastic cell invasion in various malignancies. The purpose of this prospective cohort study was to evaluate the effect of external biliary drainage on enzyme activity of MMP-9 in the serum of patients with malignant hilar biliary obstruction. Materials and Methods. Between November 2020 and April 2021, 45 patients with malignant hilar biliary obstruction underwent percutaneous biliary drainage following determination of serum MMP-9 enzyme activity (before treatment and 4 weeks after the treatment) by gelatin zymography. Results. MMP-9 values decreased statistically significantly 4 weeks after percutaneous biliary drainage (p = 0.028) as well as the value of total bilirubin (p < 0.001), values of direct bilirubin (p < 0.001), aspartate aminotransferase (AST) (p < 0.001), alanine transaminase (ALT) (p < 0.001), and gamma-glutamyl transferase (GGT) (p < 0.001). Conclusions. In patients with malignant hilar biliary obstruction treated by external percutaneous biliary drainage for cholestasis resolution, a significant reduction in MMP-9 serum values was noted 4 weeks after the treatment. © 2023 by the authors.

Emphysematous pancreatitis represents the presence of gas within or around the pancreas on the ground of necrotizing pancreatitis due to superinfection with gas-forming bacteria. This entity is diagnosed on clinical grounds and on the basis of radiologic findings. Computed tomography is the preferred imaging modality used to detect this life-threating condition. The management of emphysematous pancreatitis consists of conservative measures, image-guided percutaneous catheter drainage or endoscopic therapy, and surgical intervention, which is delayed as long as possible and undertaken only in patients who continue to deteriorate despite conservative management. Due to its high mortality rate, early and prompt recognition and treatment of emphysematous pancreatitis are crucial and require individualized treatment with the involvement of a multidisciplinary team. Here, we present a case of emphysematous pancreatitis as an unusual occurrence and discuss disease features and treatment options in order to facilitate diagnostics and therapy. © 2024 by the authors.

Fibromyalgia (FM) is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions. The etiopathogenesis of FM is not sufficiently known, and regardless of numerous research, the clinical presentation is nonspecific, which makes it difficult to approve a timely diagnosis and, subsequently, an adequate therapeutic approach. Genetic, hormonal, immunological, and environmental factors are cited as potential factors in the development of this condition. Diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions. The heterogeneity of FM significantly impacts both diagnosis and treatment, as it presents a wide spectrum of symptoms that vary in severity, combinations, and underlying contributing factors. This variability is a challenge for clinicians and requires a holistic, comprehensive, multidisciplinary, patient-centered approach. According to The European League Against Rheumatism (EULAR) from 2016, treatment begins with patient education and involves the simultaneous application of pharmacological and nonpharmacological treatments. The application of only pharmacological or nonpharmacological treatment is most often not successful. Due to differences in pain threshold, psychological factors, and comorbidities, patients may respond differently to the same interventions. Although there is no universal treatment, this review brings up the fact that the timely recognition of symptoms and a tailored treatment with a patient-centered plan can significantly improve the quality of life of patients. © 2025 by the authors.

Background and Objectives: Treatment of cancer patients during the COVID-19 pandemic has been a challenge worldwide. In accordance with the current recommendations for hepatocellular carcinoma (HCC) management during the COVID-19 pandemic, loco-regional therapy such as transarterial chemoembolization (TACE) was proposed with the purpose of achieving local tumor control and improving overall survival. The aim of this prospective cohort study was to evaluate the outcomes of TACE treatment in patients with HCC during the COVID-19 pandemic in comparison with the outcomes of patients treated in the pre-pandemic period. Materials and Methods: Between September 2018 and December 2021, 154 patients were managed by serial TACE procedures for different liver tumors. Ninety-seven patients met the study criteria and were divided into two groups: the study group n = 49 (patients treated from May 2020 to December 2021); the control group n = 48 (patients treated from September 2018 to May 2020). Results: The mean waiting time for TACE was significantly longer in the study group compared to the control group (p < 0.001). No significant difference in survival between the groups is noted (log-rank test p = 0.823). In multivariate analysis, the MELD score (HR 1.329, 95% CI 1.140–1.548, p < 0.001) remained a significant predictor of mortality. Conclusions: COVID-19 pandemic did not affect the final outcome of TACE treatment. © 2022 by the authors.

Introduction/Objective Radiofrequency ablation (RFA) is a minimally invasive treatment modality for primary and metastatic liver tumors. It can be performed percutaneously or as a laparoscopic or open surgical procedure under ultrasound or computerized tomography guidance. The objective of the study was to evaluate the clinical outcome of the initial 16 patients with hepatocellular carcinoma (HCC) managed by percutaneous RFA at a tertiary institution and to assess the efficacy of this procedure in the management of selected patients with HCC. Method From June 2011 until December 2013, 16 patients with early-stage HCC were managed by percutaneous radiofrequency ablation at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. All the patients were treated by the same team composed of an interventional radiologist and a liver surgeon. We analyzed the clinical outcome and the biologic effect of this treatment by comparing the pre- and post-treatment levels of alpha-fetoprotein (AFP). Results Post-treatment values of liver transaminase levels returned to the pre-treatment values from Day 3. Post-treatment hospital stay was two days. Post-procedural complications included mild pain in all patients, skin necrosis at the site of the electrode puncture in five patients, and transient hepatic decompensation in one patient. In all the patients the AFP level correlated with the findings of liver imaging (ultrasound and/or magnetic resonance imaging with liver-specific contrast agent) indicating viability of the treated tumor. Conclusion RFA is a feasible and effective procedure providing favorable clinical outcome in patients with early-stage HCC. © 2017, Serbia Medical Society. All rights reserved.

BACKGROUND: In the published literature there is scarce data on the importance of acute rehabilitation in patients suffering from COVID-19 disease. AIM: Evaluation of the feasibility of respiratory and neuromuscular rehabilitation treatment in stable acute COVID-19 inpatients. DESIGN: The study was designed as an observational prospective investigation of two cohorts respectively identified as Mild/Moderate and Stable Severe COVID-19 disease. All patients received a rehabilitation treatment consisting of breathing exercises, range of motion exercises and strengthening exercises, with the main difference in intensity and progression of treatment, depending on individual capacity of patient. SETTING: Inpatients with diagnosed mild to moderate, or stable severe COVID-19 infection were included in the study. POPULATION: Acute COVID-19 inpatients. METHODS: Patients were divided into two groups depending on the severity of disease: “mild to moderate group” (MMG) and “stable severe group” (SSG). Functional outcomes included the Barthel Index (BI), Six Minute Walk Test (6MWT), Borg Scale for dyspnea, “Time Up and Go” Test (TUG), “Sit To Stand” test (STS), “One Leg Stance Test” (OLST) and Beck Depression Inventory (BDI) were evaluated at baseline and after rehabilitative treatment, on discharge. RESULTS: We included 147 acute COVID-19 inpatients (75 male and 72 female), mean aged 63.90±13.76 years. There were noticeable statistically significant improvements in all observed measurements in both groups. Comparison between groups showed significant difference in MMG compared to SSG in all functional outcomes: TUG (P<0.001), STS (P<0.001), OLST (P<0.001), BDI (P=0.008), BI (P<0.001), and Borg scale for dyspnea (P<0.001). Despite the significant improvements of BI in SSG, the obtained values showed that the patients were still not functionally independent. CONCLUSIONS: Acute respiratory and neuromuscular rehabilitation program is a feasibile, but also effective and safe method for improving functional status in patients with COVID-19 infection. CLINICAL REHABILITATION IMPACT: Results of the present study implicate that a supervised early rehabilitation program, implemented in the treatment of patients with COVID-19 disease in the acute phasis a feasible way for significant improvement of patient’s functional outcomes. Early rehabilitation should be included into clinical protocols for the treatment of patients with COVID-19. © 2023 THE AUTHORS.

BACKGROUND: In the published literature there is scarce data on the importance of acute rehabilitation in patients suffering from COVID-19 disease. AIM: Evaluation of the feasibility of respiratory and neuromuscular rehabilitation treatment in stable acute COVID-19 inpatients. DESIGN: The study was designed as an observational prospective investigation of two cohorts respectively identified as Mild/Moderate and Stable Severe COVID-19 disease. All patients received a rehabilitation treatment consisting of breathing exercises, range of motion exercises and strengthening exercises, with the main difference in intensity and progression of treatment, depending on individual capacity of patient. SETTING: Inpatients with diagnosed mild to moderate, or stable severe COVID-19 infection were included in the study. POPULATION: Acute COVID-19 inpatients. METHODS: Patients were divided into two groups depending on the severity of disease: “mild to moderate group” (MMG) and “stable severe group” (SSG). Functional outcomes included the Barthel Index (BI), Six Minute Walk Test (6MWT), Borg Scale for dyspnea, “Time Up and Go” Test (TUG), “Sit To Stand” test (STS), “One Leg Stance Test” (OLST) and Beck Depression Inventory (BDI) were evaluated at baseline and after rehabilitative treatment, on discharge. RESULTS: We included 147 acute COVID-19 inpatients (75 male and 72 female), mean aged 63.90±13.76 years. There were noticeable statistically significant improvements in all observed measurements in both groups. Comparison between groups showed significant difference in MMG compared to SSG in all functional outcomes: TUG (P<0.001), STS (P<0.001), OLST (P<0.001), BDI (P=0.008), BI (P<0.001), and Borg scale for dyspnea (P<0.001). Despite the significant improvements of BI in SSG, the obtained values showed that the patients were still not functionally independent. CONCLUSIONS: Acute respiratory and neuromuscular rehabilitation program is a feasibile, but also effective and safe method for improving functional status in patients with COVID-19 infection. CLINICAL REHABILITATION IMPACT: Results of the present study implicate that a supervised early rehabilitation program, implemented in the treatment of patients with COVID-19 disease in the acute phasis a feasible way for significant improvement of patient’s functional outcomes. Early rehabilitation should be included into clinical protocols for the treatment of patients with COVID-19. © 2023 THE AUTHORS.