Browsing by Author "Lausevic, Zeljko (6603003365)"

The key to the successful management of pancreatic cystic neoplasm (PCN), among which intraductal papillary mucinous neoplasm (IPMN) is the one with the highest risk of advanced neo-plasia in resected patients, is a careful combination of clinical, radiological, and histopathological findings. This study aims to perform the comparison of a preoperative evaluation with pathological reports in IPMN and further, to evaluate and compare the diagnostic performance of European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) and Fukuoka Consensus guidelines (FCG). We analyzed 106 consecutive patients diagnosed with different types of PCN, among whom 68 had IPMN diagnosis, at the Clinical Center of Serbia. All the patients diagnosed with IPMNs were stratified concerning the presence of the absolute and relative indications according to EEBGPCN and high-risk stigmata and worrisome features according to FCG. Final histopathology revealed that IPMNs patients were further divided into malignant (50 patients) and benign (18 pa-tients) groups, according to the pathological findings. The preoperative prediction of malignancy according to EEBGPCN criteria was higher than 70% with high sensitivity of at least one absolute or relative indication for resection. The diagnostic performance of FCG was shown as comparable to EEBGPCN. Nevertheless, the value of false-positive rate for surgical resection showed that in some cases, overtreating patients or treating them too early cannot be prevented. A multidisciplinary approach is essential to adequately select patients for the resection considering at the same time both the risks of surgery and malignancy. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Trauma is one of the most serious and most expensive health problems and most common cause of death in youth. In last decade, non operative treatment is the standard treatment strategy in blunt liver injuries in haemodynamic stable patients. Methods: restrospective study included patients with liver injury admitted between May 2005 and May 2012. in the Center for Emergency Surgery of the Clinical Center of Serbia. Total number of patients was 224. Results: Out of 224 patients with liver injuries, 183 had blunt injury, and only 41 had penetrant injury. Isolated injury was found in 25.9% of patients, and 74.1% had multiple injuries. Average Injury Severity Score (ISS) was 22.48 (SD=12.16). Patients underwent intraoperative classification according to Moore. In 2% of patients who were haemodynimically instable we used "damage control surgery". Out of 224 patients, 89,7% were successfully treated, 2,7% died as "mors in tabula", or within first 24 hours, and 7.6% died during hospitalization. Conclusion: Modern diagnostic procedures provided a much more precise verification of liver injuries associated with polytrauma and reduced mortality. Higher percentage of patients with nonoperative treatment was among patients with ISS lower than 10, and among those with injuries grades I and II.

Aim: Acute kidney injury (AKI) worsens the outcome in a significant number of hospitalized patients. Risk models mainly address cardiac surgery, while significantly less attention is paid to AKI after major abdominal surgery (MAS). This study aims to evaluate the incidence, along with risk factors, and intrahospital outcomes of AKI after MAS. Material and methods: Our retrospective study included 200 adult patients treated with MAS (in the same institution). Exclusion criteria were obstructive nephropathy, contrast-induced nephropathy, and dialysis dependence whether due to end-stage renal disease (ESRD) or AKI before MAS. Data on preoperative, intraoperative, as well as postoperative variables were collected from patients’ medical history and electronic medical records. Results: AKI was diagnosed in 33 (16.5%) patients, with 2 patients treated with hemodialysis. The multivariate logistic regression model showed that the number of intraoperative blood transfusions (p = 0.01), pneumonia (p < 0.001), and vasoactive drug use (p = 0.02) were independently associated with postoperative AKI. Each blood transfusion administered increased the risk of developing AKI by 1.41, vasoactive drug use by 4.13, and the risk of AKI in those with pneumonia was 15.32 times higher. The lethal outcome was observed significantly more frequently in patients with AKI (39.4 vs. 4.8%, p < 0.001). Conclusion: Identification of independent predictors of AKI after MAS such as the number of transfusions during surgery, sepsis, pneumonia, and the need for vasoactive drug therapy could help prevent AKI and lower the probability of lethal outcomes after MAS. © 2024 Dustri-Verlag Dr. Karl Feistle. All rights reserved.