Browsing by Author "Savic, Milan (24830640100)"

Lymphangioleiomyomatosis (LAM) is a rare disease that most commonly affects women of reproductive age. The disease is manifested by diffuse destruction of the pulmonary parenchyma with the formation of cysts on a characteristic finding of multidetector computerized tomography (MD-CT) of the chest. It is thought that the presence of cells with estrogen and progesterone receptors among proliferating smooth muscle cells lead to the spread of cystic structures lined by endothelial cells. Towards the end of pregnancy and after childbirth, collapse of the lung parenchyma or rupture of the cyst wall occurs causing a dramatic clinical picture in the form of pneumothorax. Sirolimus is the only drug of choice that should improve and stabilize the patient's pulmonary function and quality of life. Unfortunately, this drug is not always effective enough, so only option for treatment is bilateral lung transplantation. The authors present the patient in the last trimester of pregnancy who was admitted to the hospital with clinical picture of bilateral spontaneous pneumothorax. Dramatic picture of pneumothorax could not be solved solely by drainage in which atypical segmental resection of the lung was performed within a few days so on these samples lymphangioleiomyomatosis were diagnosed. © 2023 Jelena Radojicic et al., published by Sciendo.

Lymphangioleiomyomatosis (LAM) is a rare disease that most commonly affects women of reproductive age. The disease is manifested by diffuse destruction of the pulmonary parenchyma with the formation of cysts on a characteristic finding of multidetector computerized tomography (MD-CT) of the chest. It is thought that the presence of cells with estrogen and progesterone receptors among proliferating smooth muscle cells lead to the spread of cystic structures lined by endothelial cells. Towards the end of pregnancy and after childbirth, collapse of the lung parenchyma or rupture of the cyst wall occurs causing a dramatic clinical picture in the form of pneumothorax. Sirolimus is the only drug of choice that should improve and stabilize the patient's pulmonary function and quality of life. Unfortunately, this drug is not always effective enough, so only option for treatment is bilateral lung transplantation. The authors present the patient in the last trimester of pregnancy who was admitted to the hospital with clinical picture of bilateral spontaneous pneumothorax. Dramatic picture of pneumothorax could not be solved solely by drainage in which atypical segmental resection of the lung was performed within a few days so on these samples lymphangioleiomyomatosis were diagnosed. © 2023 Jelena Radojicic et al., published by Sciendo.

Introduction: Pleurocutaneous fistula is a pathological communication of subcutaneous tissue with the pleural cavity, and can occur as a result of infectious, malignant processes and iatrogenic procedures. Colopleural fistula is rare and is mainly caused by processes in the abdomen. The appearance of empyema is usually described as a complication of colopleural fistulas that are the result of pathological processes in the abdomen. Case Presentation: We report an extremely rare case of colopleurocutaneous fistula with pleural empyema present, 8 years after left hemicolectomy due to colon adenocarcinoma. Radiological diagnostic procedures performed confirmed the existence of colopleurocutaneous fistula. The patient was given antibiogram therapy and regular thoracocentesis for empyema, as well as a fistulous canal toilet. Conclusions: After achieving sterility of the fistulous canal and regression of empyema, the fistulous canal was closed with fibrin glue, and during the next 6 months follow-up, there was no reopening of the fistula, nor did the patient have any other complications. Copyright © 2025 Savic et al.

Background: In spite of the progress made in neoadjuvant therapy for operable non small-cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA. Methods: Retrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum-etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed-up only. Results: The rate of N2 disease was significantly higher in the upfront surgery group (P < 0.001). The one-year relapse rate was 49.5% in the preoperative chemotherapy group compared to 65.4% in the upfront surgery group. There was a significant difference in relapse rate in relation to adjuvant chemotheraphy treatment (P = 0.007). The probability of relapse was equal whether radiotherapy was applied or not (P = 0.142). There was no statistically significant difference in two-year mortality (P = 0.577). The median survival duration after two years of follow-up was 19.6 months in the preoperative chemotherapy group versus 18.8 months in the upfront surgery group (P = 0.608 > 0.05). Conclusion: There was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo-therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd

Aim. The aim of this study was to evaluate the role of thoracic sonography in treatment of pleural effusions and to identify sonographic indicators for surgical intervention. Materials and Methods. This study included 378 patients with pleural effusions. US characteristics of effusions as the echo structure and pleural thickening were analyzed. Regarding the US finding, the diagnostic or therapeutic procedure was performed. Results. The study included 267 male and 111 female patients, an average of 56.7 years. Infection was the most frequent cause of effusion. Two hundred sixty-nine patients had loculated and 109 free pleural effusion. Most frequent echo structure of loculated effusion was complex septate, whereas free effusion was mostly anechoic. Successful obtaining of the pleural fluid without real-time guidance was in 88% and under real-time guidance in 99% patients (p < 0.012). There was no significant difference in success rate between free and loculated effusion and regarding the echo structure (p = 0.710 and 0.126, respectively). Complete fluid removal after serial thoracentesis or drainage was achieved in 86% patients. Forty-five patients with significantly thicker pleural peel and impairment of the diaphragmatic function than remaining of the group (p < 0.001) underwent surgery. Open thoracotomy and decortication was more frequently performed in patients with completely fixed diaphragm and complex, dominantly septated effusions. There is no significant difference in US parameters comparing to patients underwent VATS, but the number of VATS is too small for valid conclusion. Conclusion. Thoracic sonography is a very useful tool in the evaluation of clinical course and treatment options in patients with pleural effusions of a different origin. Copyright © 2018 Ruza Stevic et al.

Background: It is still not clear whether an intrapericardial pneumonectomy indicates a more advanced stage of the disease compared to a standard pneumonectomy. Methods: This was a retrospective study of 164 patients who underwent a pneumonectomy for lung cancer. The first group consisted of 82 patients who had a standard pneumonectomy and the second group was 38 patients who had a intrapericardial pneumonectomy, for both groups in the latest 5-year period. The third group was 44 patients with had a sleeve pneumonectomy in the latest 10-year period. The groups were compared in relation to the overall and stage-related survival, influence of T and N factors, operative morbidity and mortality. The statistics used were Kaplan-Meier, U-test, t-test, χ2 test. Results: There was no statistically significant difference in stage distribution between standard and intrapericardial pneumonectomies; stages I, II, IIIA and IIIB occurred for 10.9% vs 2.6%, 30.5% vs 26.3%, 46.4% vs 65.8% and 12.2% vs 5.3% of patients, respectively. For patients who had a sleeve pneumonectomy, stage IIIA was significantly more frequent. Although the overall survival (63.5% vs 57.6%) and stage-related 5-year survival were better in the first compared to the second group, especially for stage IIIA (58.6% vs 42.6%), these differences were not statistically significant. There were no significant differences in operative morbidity and mortality between groups 1 and 2, but both were significantly higher in the third group (35.7% and 15.9%). Conclusions: An intrapericardial pneumonectomy does not always indicate a more advanced stage of the disease. The need for an intrapericardial pneumonectomy, either established preoperatively or during the operation, as a single factor, even for marginal surgical candidates, is not strong enough to reject these patients for surgery. © 2014 Subotic et al.

Background and Objectives: In this study, we aimed to evaluate the effects of six weeks of pulmonary rehabilitation on functional and psychological outcomes in long-COVID patients. Material and Methods: The prospective clinical study included 46 patients that were diagnosed with COVID-19. A respiratory rehabilitation program was implemented for six weeks. Further valuables were tested before the beginning of the rehabilitation program (admission) and six weeks after (discharge): SpO2, heart rate, respiratory rate, Visual Analogue Scale (VAS) score, Borg score, Sit-to-Stand (StS) test number of repetition, distance of 6-Minute Walking Test (6MWT), Patient Health Questionnaire (PHQ) 9 score and Generalized anxiety disorder (GAD) anxiety score. These parameters were tested before the rehabilitation program on admission and at discharge and after the rehabilitation program on admission and at discharge. The results were presented with standard descriptive and analytical methods. Differences between the continuous variables before and after physical rehabilitation intervention were tested using the Wilcoxon test. Graphical analysis is presented with a box plot. Results: On discharge, in comparison with admission, the values of SpO2 were significantly lower (p = 0.007) before the 6MWT, and VAS scores were significantly higher (p = 0.036), while after the 6MWT, VAS scores were significantly lower (p < 0.001) as were Borg scores (p = 0.016). On discharge, in comparison with admission, the respiratory rate was significantly higher (p = 0.005) before the StS test, and Borg scores were significantly lower (p = 0.001), while after the StS test, SpO2 levels were significantly higher (p = 0.036) and VAS scores were significantly lower (p < 0.001), as were Borg scores (p = 0.008). After discharge, the values of the StS test were significantly higher (p = 0.011), PHQ9 scores were significantly lower (p < 0.001) and GAD anxiety scores were significantly lower as well (p = 0.005), while the distances measured in meters on the 6MWT were significantly increased (p < 0.001). Conclusions: A structured rehabilitation program in our study was shown to have beneficial effects on physiological, psychological and functional improvements in patients with long-COVID, and therefore it is advisable for these patients. © 2024 by the authors.

Background: The prediction of postoperative respiratory function is necessary in identifying patients that are at greater risk of complications. There are not enough studies on the effect of the diaphragm on postoperative respiratory function prediction in lung cancer surgical patients. The objective of this study is to estimate the precision of machine learning methods in the prediction of respiratory function in the immediate postoperative period and how diaphragm function contributes to that prediction. Materials and methods: Our prospective study included 79 patients who underwent lung cancer surgery. Diaphragm function was estimated by its mobility measured both ultrasonographically and radiographically and by noninvasive muscle strength tests. We present a new machine learning multilayer regression metamodel, which predicts FEV1 for each patient based on preoperative measurements. Results: The proposed regression models are specifically trained to predict FEV1 in the immediate postoperative period and were proved to be highly accurate (mean absolute error in the range from 8 to 11%). Predictive models based on resected segments give two to three times less precise results. Measured FEV1 was 44.68% ± 14.07%, 50.95% ± 15.80%, and 58.0%1 ± 14.78%, and predicted postoperative (ppo) FEV1 was 43.85% ± 8.80%, 50.62% ± 9.28%, and 57.85% ± 10.58% on the first, fourth, and seventh day, respectively. By interpreting the obtained model, the diaphragm contributes to ppoFEV1 13.62% on the first day, 10.52% on the fourth, and 9.06% on the seventh day. Conclusion: The machine learning metamodel gives more accurate predictions of postoperative lung function than traditional calculations. The diaphragm plays a notable role in the postoperative FEV1 prediction. © 2023, The Author(s).