Browsing by Author "Stojanović, Dragoš (7007127826)"

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.

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.

This year Zemun Hospital – Clinical Hospital Center Zemun celebrates 230th anniversary of continuous work, thus becoming the oldest medical facility in Serbia. The exact date of the hospital founding has been often questioned in history. Various dates appeared in the literature, but the most frequent one was 25th of February 1784. Until now, the document which confirms this has never been published. This article represents the first official publication of the document which confirms that Zemun Hospital was indeed founded on this date. The first hospitals started emerging in Zemun when the town became a part of the Habsburg Monarchy. The first sanitary facility ever formed was the “Kontumac” – a quarantine established in 1730. Soon after, two more confessional hospitals were opened. The Serbian (Orthodox) Hospital was founded before 1769, whereas the German (Catholic) Hospital started working in 1758. Both hospitals were financed, amongst others, by the Town Hall – the Magistrate. In order to improve efficiency of these hospitals, a decision was made to merge them into a single City Hospital. It was founded on 25th February 1784, when the General Command ordered the Magistrate of Zemun to merge the financess of all existing hospitals and initiate the construction of a new building. Although financially united, the hospitals continued working in separate buildings over a certain period of time. The final, physical merging of these hospitals was completed in 1795. © 2014, Srp Arh Celok Lek. 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.