Browsing by Author "Juloski, Jovan (57216998788)"

Introduction/Objective The aim of this study is to identify and evaluate the use of New Mobility Score (NMS) in estimating functional recovery three months after total hip arthroplasty (THA). Methods In total, 70 patients, aged > 60 years, underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and NMS, and secondary one by Medical Outcomes Health Survey (Short-Form Health Survey – SF-36). Questionnaires were collected before and three months after hip surgery. Results Treatment group showed significant improvement three months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506. © 2022, Serbia Medical Society. All rights reserved.

Colorectal cancer (CRC) is a significant public health problem. There is increasing evidence that the host’s immune response and nutritional status play a role in the development and progression of cancer. The aim of our study was to examine the prognostic value of clinical markers/indexes of inflammation, nutritional and pathohistological status in relation to overall survival and disease free-survival in CRC. The total number of CRC patients included in the study was 111 and they underwent laboratory analyses within a week before surgery. Detailed pathohistological analysis and laboratory parameters were part of the standard hospital pre-operative procedure. Medical data were collected from archived hospital data. Data on the exact date of death were obtained by inspecting the death registers for the territory of the Republic of Serbia. All parameters were analyzed in relation to the overall survival and survival period without disease relapse. The follow-up median was 42 (24−48) months. The patients with the III, IV and V degrees of the Clavien–Dindo classification had 2.609 (HR: 2.609; 95% CI: 1.437−4.737; p = 0.002) times higher risk of death. The modified Glasgow prognostic score (mGPS) 2 and higher lymph node ratio carried a 2.188 (HR: 2.188; 95% CI: 1.413−3.387; p < 0.001) and 6.862 (HR: 6.862; 95% CI: 1.635−28.808; p = 0.009) times higher risk of death in the postoperative period, respectively; the risk was 3.089 times higher (HR: 3.089; 95% CI: 1.447−6.593; p = 0.004) in patients with verified tumor deposits. The patients with tumor deposits had 1.888 (HR: 1.888; 95% CI: 1024−3481; p = 0.042) and 3.049 (HR: 3.049; 95% CI: 1.206−7.706; p = 0.018) times higher risk of disease recurrence, respectively. The emphasized peritumoral lymphocyte response reduced the risk of recurrence by 61% (HR: 0.391; 95% CI: 0.196−0.780; p = 0.005). Standard perioperative laboratory and pathohistological parameters, which do not present any additional cost for the health system, may provide information on the CRC patient outcome and lay the groundwork for a larger prospective examination. © 2023 by the authors.

Colorectal cancer (CRC) is a significant public health problem. There is increasing evidence that the host’s immune response and nutritional status play a role in the development and progression of cancer. The aim of our study was to examine the prognostic value of clinical markers/indexes of inflammation, nutritional and pathohistological status in relation to overall survival and disease free-survival in CRC. The total number of CRC patients included in the study was 111 and they underwent laboratory analyses within a week before surgery. Detailed pathohistological analysis and laboratory parameters were part of the standard hospital pre-operative procedure. Medical data were collected from archived hospital data. Data on the exact date of death were obtained by inspecting the death registers for the territory of the Republic of Serbia. All parameters were analyzed in relation to the overall survival and survival period without disease relapse. The follow-up median was 42 (24−48) months. The patients with the III, IV and V degrees of the Clavien–Dindo classification had 2.609 (HR: 2.609; 95% CI: 1.437−4.737; p = 0.002) times higher risk of death. The modified Glasgow prognostic score (mGPS) 2 and higher lymph node ratio carried a 2.188 (HR: 2.188; 95% CI: 1.413−3.387; p < 0.001) and 6.862 (HR: 6.862; 95% CI: 1.635−28.808; p = 0.009) times higher risk of death in the postoperative period, respectively; the risk was 3.089 times higher (HR: 3.089; 95% CI: 1.447−6.593; p = 0.004) in patients with verified tumor deposits. The patients with tumor deposits had 1.888 (HR: 1.888; 95% CI: 1024−3481; p = 0.042) and 3.049 (HR: 3.049; 95% CI: 1.206−7.706; p = 0.018) times higher risk of disease recurrence, respectively. The emphasized peritumoral lymphocyte response reduced the risk of recurrence by 61% (HR: 0.391; 95% CI: 0.196−0.780; p = 0.005). Standard perioperative laboratory and pathohistological parameters, which do not present any additional cost for the health system, may provide information on the CRC patient outcome and lay the groundwork for a larger prospective examination. © 2023 by the authors.

Introduction/Objective Nutritional status is related to the prognosis of colorectal cancer (CRC) patients. The CONUT (The Controlling Nutritional Status) score is a recent nutritional marker. This study aimed to examine the association of preoperative CONUT score with overall survival (OS) and disease-free survival (DFS), while the secondary aim was to assess the importance of preoperative nutritional status for the development of postoperative complications. The total number of CRC patients included in the study was 111. All patients underwent laboratory analyses within a week before surgery. Medical data were collected from archived data at the Zvezdara University Medical Centre. The CONUT score was analyzed in relation to the OS and DFS. Using the Kaplan-Meier survival curve and Log-rank test, a statistically significant difference in OS and DFS between groups of patients with different CONUT scores was observed. Patients with higher CONUT scores have a longer duration of hospitalization after surgery, a longer total length of stay, and a more severe degree of postoperative complications. The CONUT score is related to short-term treatment outcomes, such as the length of intrahospital treatment and frequency and severity of postoperative complications, but also to long-term prognostic parameters. Early nutritional screening may be of prognostic significance. © 2023 Editura Celsius. All rights reserved.

The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. Extrafascial dissection of Glissonean pedicle without opening the liver substance, proposed by Takasaki, represents an effective and safe technique of anatomic liver resection. Presented approach allows early and easy ischemic delineation of appropriate anatomic liver territory (hemiliver, section or segment) to be removed with selective inflow vascular control. It is not time consuming and it is very useful in re-resection, as well as oncological reasonable. According to the Sugioka’s proposal, for technical standardization, it is important to recognize the four anatomical landmarks; the Arantius plate, the umbilical plate, the cystic plate and the Glissonean pedicle of the caudate process (G1c), and six Gates defined by the four anatomical landmarks. For the right extrahepatic Glissonean pedicle isolation, the cystic plate cholecystectomy should be the first procedure, whereas for the left, Arantius plate or the umbilical plate should be detached from Laennec’s capsule at first. Pedicles can be isolated by connecting Gates each other. Further peripheral pedicles could be pulled out to the hepatic hilum and transected safely. In conclusion, the extrahepatic Glissonean pedicle approach based on Laennec’s capsule would standardize anatomical liver resection including laparoscopic and robotic liver resection. Copyright © Celsius Publishing House

Pancreatectomies with arterial resections were initially characterized by high postoperative mortality and poor long-term survival as reported by Fortner et al. and then abandoned. The introduction of new efficacious chemotherapy regimens (FOLFIRINOX) along with the extensive experience in venous resection for borderline pancreatic tumors has brought renewed interest in extended pancreatic resection for locally advanced malignancy. The experience needed for performing such complex resections goes beyond pancreatic surgery alone and entails skills in vascular surgery. Reconstructing arterial vessels might need autologous and/or heterologous vascular substitutes which should be available immediately and accurate preoperative planning and simulation on the basis of cross-sectional imaging should be the rule. Resection of the superior mesenteric artery could be seen as one of the most challenging arterial resection at the time of pancreatectomy because of: (1) the frequent presence of an associated venous invasion; (2) the variable degree of tumoral infiltration downward through the mesentery; (3) the necessity of a mesenteric approach and complete mesenteric dissection; (4) the need for reconstructing several jejunal and ileal branches; (5) the high mortality rates (20%) reported so far. In this chapter we will describe step-by-step the surgical technique of our standardized approach for superior mesenteric artery resection during pancreaticoduodenectomy. © International Association of Surgeons, Gastroenterologists and Oncologists 2022.

Introduction. Mucormycosis is a life-threatening opportunistic infection whose incidence has significantly risen during the last two decades. The gastrointestinal form is very rare, with the stomach as the most common site of infection, followed by the colon and ileum. Risk factors include uncontrolled diabetes mellitus, corticosteroid use, and organ transplantation. We report a patient with a history of rheumatoid arthritis who has developed gastrointestinal mucormycosis. To the best of our knowledge, this is the first such case reported in the literature. Case report. A 53-year-old female patient with a prior medical history of rheumatoid arthritis was admitted to the hospital due to persisting diarrhea. Physical examination revealed diffuse abdominal tenderness to palpation without meteorism and peritoneal signs. Laboratory results demonstrated systemic inflammation, so antibiotic therapy was administered. Abdominal computed tomography findings revealed inflammation of the rectum and the left colon. Colonoscopy findings were indicative of Crohn’s disease. Additionally, the patient had developed profuse rectal bleeding and consequently underwent emergency surgery. Subtotal colectomy with ileostomy and partial gastrectomy was performed. The patient’s condition rapidly worsened after the operation, and she died due to multi-organ failure. Histologic findings of resection specimens discovered chronic active colitis and extensive gastric necrosis associated with dense mixed inflammatory infiltration and numerous non-septate and 90-degree branching hyphae. Diagnosis of invasive gastric mucormycosis was obtained, but unfortunately, several days after the patient’s death. Conclusion. It is very important to obtain high awareness among clinicians of this deadly infection to achieve a prompt diagnosis and effective therapy. © The Author(s) 2022.