Browsing by Author "Stevanović, Dejan (57461284600)"

SUMARRY Introduction The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission to the surgical emergency room. The CT scan promptly demonstrated rupture of a large retroperitoneal hematoma with massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient underwent urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. Fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed with and treated for hypertension. Conclusion Rupture of pseudoaneurysms followed by hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case, in which hypovolemic shock manifested itself before the admission. We would like to highlight the importance of high blood pressure control and the importance of regular check-ups. © 2022, Serbia Medical Society. All rights reserved.

Introduction Primary angiosarcomas arising from the digestive system are rare, representing less than 1% percent of the malignant sarcomas. Only a few cases have been reported in the literature. Colorectal involvement is exceedingly uncommon and is a harbinger of a poor prognosis with widespread metastasis. Diagnosis is often delayed due to non-specific symptoms and pathology which mimics other tumors. Case outline A 52-year-old woman was presented to the emergency room in July 2021, complaining of protracted malaise, and rapid fatigue and occasional sweating. Multislice computed tomography (MSCT) of the abdomen and small pelvis revealed the existence of lobular, well vascularized, supravesical lesion, located along the anterior contour of the uterine corpus, in the convolutes of the small intestine. The patient was subjected to operative treatment with curative intent. Intraoperatively, a completely tumor-altered caecum was verified Standard histopathological examination demonstrated a high grade epithelioid angiosarcoma with severe pleomorphism and solid growth pattern. The control MSCT of abdomen and small pelvis which was done 12 months after the operation did not show the existence of any pathological lesions. Conclusion Both clinical and pathological diagnoses of colorectal angiosarcoma are challenging. Patients are presenting non-specific symptoms, which can lead to mismanagement and late diagnosis. A pathological diagnosis relies on immunohistochemical staining for endothelial markers. In limited tissue biopsies, it can be easily misdiagnosed as poorly differentiated adenocarcinoma or gastrointestinal stromal tumor. For now, surgical treatment with R0 resection seems to be the only effective treatment modality. © 2022, Serbia Medical Society. All rights reserved.

Introduction The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The surgery of resectable gastric GIST is the primary therapy for these tumors, but the decision regarding the surgical radicality of the procedures is still a point of discussion among surgeons and oncologists. Case Outline A 74-year-old patient was admitted to hospital with signs of bleeding from the upper parts of the gastrointestinal tract. Urgent gastroscopy was performed and a subepithelial gastric lesion with bleeding ulceration was noted in the region of the fornix. A computed tomography scan of the abdomen showed a tumor in the fornix region with the dimensions of 48 × 32 mm, which was growing mostly intraluminally. After an adequate preoperative preparation the patient underwent a laparoscopic wedge resection of gastric fornix with intramural tumor lesion. The histopathological analysis of the specimen showed a well differentiated GIST (histological grade G1), of the spindle cell type. Based on the immunohistochemical analysis of the specimen it was concluded that the patient was in the IA stage of the disease with a low risk of malignant progression. In the population of patients with GIST, this is the most common group (43%), with low malignant potential, and relapses present in only 3.6% of cases. The patient started with oral food intake on the first postoperative day, the first bowel movement occurred 36 hours after surgery, and the patient was released from hospital on the fourth postoperative day. Conclusion Based on the aforementioned, we consider that the laparoscopic gastric wedge resection is a safe and efficient surgical procedure. This is primary therapy for most common group of patients with resectable gastric GIST. © 2016, Serbia Medical Society. All rights reserved.

Introduction Osseous metaplasia is a heterotopic formation of bone and its appearance in benign gastrointestinal polyps is exceedingly rare. The mechanism responsible for this type of metaplasia is not fully understood, however it seems to be an innocent rare phenomenon. Case outline We present a case of a 31-year-old male with mesenchimal osseal metaplasia in a large inflamatory polyp measuring 57 × 23 × 20 mm in diameter, located in the anal canal region. Conclusion According to our knowledge, this is the largest gastrointestinal polyp with osseous metaplasia described so far. Although a rare phenomenon, there are certain characteristics of this disease, so we conducted a literature review and summarized these characteristics. © 2019 Serbia Medical Society. All rights reserved.

Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failure in susceptible individuals. Dysregulated immune response marks severe COVID-19, but the immunological mechanisms driving COVID-19 pathogenesis are still largely unknown, which is hampering the development of efficient treatments. Here we analyzed ~140 parameters of cellular and humoral immune response in peripheral blood of 41 COVID-19 patients and 16 age/gender-matched healthy donors by flow-cytometry, quantitative PCR, western blot and ELISA, followed by integrated correlation analyses with ~30 common clinical and laboratory parameters. We found that lymphocytopenia in severe COVID-19 patients (n=20) strongly affects T, NK and NKT cells, but not B cells and antibody production. Unlike increased activation of ICOS-1+ CD4+ T cells in mild COVID-19 patients (n=21), T cells in severe patients showed impaired activation, low IFN-γ production and high functional exhaustion, which correlated with significantly down-regulated HLA-DR expression in monocytes, dendritic cells and B cells. The latter phenomenon was followed by lower interferon responsive factor (IRF)-8 and autophagy-related genes expressions, and the expansion of myeloid derived suppressor cells (MDSC). Intriguingly, PD-L1-, ILT-3-, and IDO-1-expressing monocytic MDSC were the dominant producers of IL-6 and IL-10, which correlated with the increased inflammation and accumulation of regulatory B and T cell subsets in severe COVID-19 patients. Overall, down-regulated IRF-8 and autophagy-related genes expression, and the expansion of MDSC subsets could play critical roles in dysregulating T cell response in COVID-19, which could have large implications in diagnostics and design of novel therapeutics for this disease. © Copyright © 2021 Tomić, Đokić, Stevanović, Ilić, Gruden-Movsesijan, Dinić, Radojević, Bekić, Mitrović, Tomašević, Mikić, Stojanović and Čolić.

Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failure in susceptible individuals. Dysregulated immune response marks severe COVID-19, but the immunological mechanisms driving COVID-19 pathogenesis are still largely unknown, which is hampering the development of efficient treatments. Here we analyzed ~140 parameters of cellular and humoral immune response in peripheral blood of 41 COVID-19 patients and 16 age/gender-matched healthy donors by flow-cytometry, quantitative PCR, western blot and ELISA, followed by integrated correlation analyses with ~30 common clinical and laboratory parameters. We found that lymphocytopenia in severe COVID-19 patients (n=20) strongly affects T, NK and NKT cells, but not B cells and antibody production. Unlike increased activation of ICOS-1+ CD4+ T cells in mild COVID-19 patients (n=21), T cells in severe patients showed impaired activation, low IFN-γ production and high functional exhaustion, which correlated with significantly down-regulated HLA-DR expression in monocytes, dendritic cells and B cells. The latter phenomenon was followed by lower interferon responsive factor (IRF)-8 and autophagy-related genes expressions, and the expansion of myeloid derived suppressor cells (MDSC). Intriguingly, PD-L1-, ILT-3-, and IDO-1-expressing monocytic MDSC were the dominant producers of IL-6 and IL-10, which correlated with the increased inflammation and accumulation of regulatory B and T cell subsets in severe COVID-19 patients. Overall, down-regulated IRF-8 and autophagy-related genes expression, and the expansion of MDSC subsets could play critical roles in dysregulating T cell response in COVID-19, which could have large implications in diagnostics and design of novel therapeutics for this disease. © Copyright © 2021 Tomić, Đokić, Stevanović, Ilić, Gruden-Movsesijan, Dinić, Radojević, Bekić, Mitrović, Tomašević, Mikić, Stojanović and Čolić.

COVID-19 is characterized by a wide spectrum of disease severity, whose indicators and underlying mechanisms need to be identified. The role of extracellular vesicles (EVs) in COVID-19 and their biomarker potential, however, remains largely unknown. Aiming to identify specific EV signatures of patients with mild compared to severe COVID-19, we characterized the EV composition of 20 mild and 26 severe COVID-19 patients along with 16 sex and age-matched healthy donors with a panel of eight different antibodies by imaging flow cytometry (IFCM). We correlated the obtained data with 37 clinical, prerecorded biochemical and immunological parameters. Severe patients’ sera contained increased amounts of CD13+ and CD82+ EVs, which positively correlated with IL-6-producing and circulating myeloid-derived suppressor cells (MDSCs) and with the serum concentration of proinflammatory cytokines, respectively. Sera of mild COVID-19 patients contained more HLA-ABC+ EVs than sera of the healthy donors and more CD24+ EVs than severe COVID-19 patients. Their increased abundance negatively correlated with disease severity and accumulation of MDSCs, being considered as key drivers of immunopathogenesis in COVID-19. Altogether, our results support the potential of serum EVs as powerful biomarkers for COVID-19 severity and pave the way for future investigations aiming to unravel the role of EVs in COVID-19 progression. © 2022 The Authors. Journal of Extracellular Vesicles published by Wiley Periodicals, LLC on behalf of the International Society for Extracellular Vesicles.

COVID-19 is characterized by a wide spectrum of disease severity, whose indicators and underlying mechanisms need to be identified. The role of extracellular vesicles (EVs) in COVID-19 and their biomarker potential, however, remains largely unknown. Aiming to identify specific EV signatures of patients with mild compared to severe COVID-19, we characterized the EV composition of 20 mild and 26 severe COVID-19 patients along with 16 sex and age-matched healthy donors with a panel of eight different antibodies by imaging flow cytometry (IFCM). We correlated the obtained data with 37 clinical, prerecorded biochemical and immunological parameters. Severe patients’ sera contained increased amounts of CD13+ and CD82+ EVs, which positively correlated with IL-6-producing and circulating myeloid-derived suppressor cells (MDSCs) and with the serum concentration of proinflammatory cytokines, respectively. Sera of mild COVID-19 patients contained more HLA-ABC+ EVs than sera of the healthy donors and more CD24+ EVs than severe COVID-19 patients. Their increased abundance negatively correlated with disease severity and accumulation of MDSCs, being considered as key drivers of immunopathogenesis in COVID-19. Altogether, our results support the potential of serum EVs as powerful biomarkers for COVID-19 severity and pave the way for future investigations aiming to unravel the role of EVs in COVID-19 progression. © 2022 The Authors. Journal of Extracellular Vesicles published by Wiley Periodicals, LLC on behalf of the International Society for Extracellular Vesicles.

Introduction Medical studies bring many stressful activities to students. Prolonged stress can make adverse effects to mental health and lead to further professional burnout. Objective The aim of this study was to assess the association of stress impact and adverse effects of medical studies with psychological distress among medical students. Methods The cross sectional study was conducted on 367 fourth-year medical students of the Faculty of Medicine in Belgrade, by means of the anonymous questionnaire, containing: socio-demographic data, self-reported health status and stressful influences of studying activities. Mental health status was estimated by General Health Questionnaire (GHQ-12). Results More than 50% of students perceive frequent feeling of psychic tension, and one third has problems with insomnia. Nearly one-half of students assessed their general stress level as moderate or high. Exams were estimated as high stressor in 63.1% of all students. Stressful effects of communication with teaching staff were reported by one quarter of the examinees. The scores of GHQ-12 were above the threshold in 55.6% of all students. Mental health problems among students were most significantly associated with stressful experience during exams and contacts with teaching staff. Conclusion Academic stress makes great influence on mental health of medical students. Reduction of stress effects should be directed to optimization of the examination process and improvement of communication skills.

Introduction Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor that occurs in the gastrointestinal tract, most commonly in the stomach or the small intestine. The surgery of the stomach is the dominant way of treatment of these tumors. The synchronous detection of adenocarcinoma and gastric GIST is not a very common condition, which is often diagnosed intraoperatively and has a significant impact on the prognosis of these patients. Outline of cases We herein report two cases of gastric GIST with synchronous adenocarcinoma tumors, which were detected incidentally, intraoperatively, while the patients were undergoing surgery for a primary gastric adenocarcinoma. The first case was of a 76-year-old female patient. The histopathological analysis of the operative specimen firstly showed a poorly differentiated advanced gastric adenocarcinoma. The second tumor, from the gastric serosa, was a spindle cell GIST of low risk. It was diffusely positive for DOG1, CD34, and CD117. Its proliferative index was established using the Ki67 antibody. The number of mitoses was one per 5 mm 2 . The second case was of a 65-year-old male patient. The histopathological analysis revealed an early, well-differentiated, intestinal type adenocarcinoma of the gastric mucosa. The synchronous tumor from the serosa of the stomach was a spindle cell gastrointestinal stromal tumor (CD34, DOG1, and CD117 diffusely positive) of low risk. The proliferative index of this tumor, labeled with the Ki67 antibody, was very low. Necrosis was not present, nor was mitosis. Conclusion Synchronous adenocarcinomas and GIST of the stomach are not very commonly associated, and are usually detected intraoperatively and after an immunohistochemical analysis. Recognition of this condition has a very important role in a differential diagnosis and the exclusion of metastases of malignant tumor deposits. Based on the tumor severity, the radicalness of the surgical intervention is determined, which affects the outcome of these patients. © 2019, Serbia Medical Society. All rights reserved.

Introduction/Objective The aim of our study was to compare early postoperative recovery in patients operated on using laparoscopically assisted and open method in colorectal carcinoma surgery. Methods The study involved 60 patients, divided into two groups of 30 patients each, treated with open or laparoscopically assisted colorectal surgery. Three groups of factors were collected and analyzed for all the patients. The first group of factors were as follows: age, sex, the American Society of Anesthesi-ologists score, preoperative hemoglobin, localization. The second group of factors were the following: intraoperative complications, the duration of operations, blood and blood derivatives’ compensation. The third group were as follows: complications, length of stay in intensive care, rate of peristaltic estab-lishment, and the time needed for unobstructed oral intake, number of hospitalization days, analgesic use, and verticalization time. Results The patients who underwent laparoscopically assisted surgery showed significant advantages in the early postoperative recovery compared with those who underwent open surgery, in terms of the number of postoperative days of hospitalization (p < 0.001), the duration of the operation (p < 0.001), the day of establishment of peristalsis (p = 0.009), and the day of establishment of unobstructed oral intake (p < 0.001), the time of verticalization of the patients (p = 0.001), the use of analgesics (p < 0.001). Conclusion Laparoscopically assisted surgery has an advantage over open surgery colorectal cancer, as regards of early postoperative recovery of the patient. © 2021, Serbia Medical Society. All rights reserved.

Introduction Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1–3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8×5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period. © 2015, Serbia Medical Society.

Introduction/Objective More than three years have passed since the discovery of the new virus strain SARS-CoV-2, and the virus is still a challenge for all medical specialties. One of the most important characteristics is the tendency to develop thromboembolic complications, which are often lethal. The aim of this paper is to present the experience of the General Surgery Department of the Zemun Clinical Hospital Centar in the surgical treatment of patients with thromboembolic complications. Methods The research was conceived as a retrospective study conducted in the period from March 2020 to March 2021. A total of 42 patients participated in the study and were divided into a group diagnosed with small and large bowel ischemia and a group diagnosed with acute limb ischemia. Results In both groups, males were predominantly represented. The first group consisted of nine pa-tients, all of whom had a clinical finding of acute abdomen and ileus, while seven of them also had a severe computed tomography image of bilateral pneumonia. In the second group, a smaller number of patients were initially candidates for thrombectomy, while in others, primary amputation treatment was approached. Mortality from the underlying disease in both groups was high. Conclusion Moderate and severe forms of SARS-CoV-2 infection are associated with an inflammatory response leading to endothelial dysfunction accompanied by a high incidence of thromboembolic complications despite pharmacological prophylaxis. The current consensus supports the use of antico-agulants in all hospitalized patients with moderate to severe disease, as well as in critically ill patients. © 2023, Serbia Medical Society. All rights reserved.