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Search Results: 1 - 10 of 482 matches for " Jevti? Miodrag "
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Tertiary blast injury to the intestines
Ignjatovi? Dragan,?uk Vladimir,JevtiMiodrag
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0511857i
Abstract: Background. To present the first case of the tertiary blast injury to the intestine, and the tertiary blast injury in general. Case report. A parachutist of the Army of Serbia and Montenegro was injured when descended from the 1 200m height by parachute which did not expand. The force of stroke to the ground, caused the reactive transfer of energy and the subsequent blast injury to the intestine. After 24 hours, the secondary perforation of the small intestine, contusioned by the blast, developed which was the indication of explorative laparotomy. The resectioned small intestine showed the histologic characteristics of a blast injury, so the tertiary blast injury was diagnosed on the basis of these and of the mechanism of the injury. Conclusion. Tertiary blast injuries fall into the group of indirect blast injuries. The only difference between indirect injuries as compared to direct ones, is in the manner of inflicting, otherwise the traumatic mechanisms are alike, and include the transfer of the energy of stroke through the tissue of different density.
Indirect blast rupture of the pancreas with a primary unperforated blast injury of the duodenum
Ignjatovi? Dragan,Ignjatovi? Mile,JevtiMiodrag
Vojnosanitetski Pregled , 2006, DOI: 10.2298/vsp0602177i
Abstract: Background. To present a patient with an indirect blast rupture of the head of pancreas, as well as with a blast contusion of the duodenum following abdominal gunshot injury. Case report. A patient with the abdominal gunshot injury was submitted to the management of the injury of the liver, gaster and the right kidney in the field hospital. The revealed rupture of the head of the pancreas and the contusion of the duodenum were managed applying the method of Whipple. Conclusion. Indirect blast injuries require extensive surgical interventions, especially under war conditions.
Prolonged survival of a female patient with total pelvic exenteration
Ignjatovi? Dragan,JevtiMiodrag,Mirkovi? Darko
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0512927i
Abstract: Background. To present a female patient who lived 5 years after total pelvic exenteration (TPE). Case report. The female patient underwent TPE due to retrovesicovaginal fistula as a consequence of locoregional irradiation after the operation for the malignoma of the vaginal part of the uterus. In the formation of Bricker conduit, the ureter antireflux was achieved by the application of the “tobacco sack muff” made of the intestines around the ureter. By the use of this technique, the occurrence of pyelonephritis, as the leading cause of death in such patients, was prevented. Conclusion. TPE is a hope for significantly prolonged survival of patients with advanced pelvic malignomas, or with a postirradiatiation fistula.
Gangrene of the right colon after blast injury caused by abdominal gunshot wounds
Ignjatovi? Dragan,Mi?ovi? Sidor,JevtiMiodrag
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0506483i
Abstract: Aim. To present a patient with an indirect secondary nonperforating blast injury of the right colon following abdominal gunshot injury, which led to necrosis and the right colon gangrene, and was surgically managed. Case report. A 26-year-old male was shot in the abdomen by four projectiles causing the secondary indirect blast injury of the right colon that turned into gangrene after 24 hours. Two days after admission, laparotomy was performed, but the primary anastomosis was not done because of the stomach and pancreatic injury, and the resection of the colon with terminal ileostomy was done instead. Three months later, the reconstruction of the colon was performed using ileocolotransverso-terminolatetral anastomosis. Conclusion. Secondary blast injuries should be anticipated in gunshot injuries, and could be expected to any organs, particularly the air filled ones.
Morbidity and mortality in the early postoperative course following elective reconstruction of abdominal aorta aneurysm using endovascular and open surgical techniques
Marjanovi? Ivan,JevtiMiodrag,Mi?ovi? Sidor,?oli? Miodrag
Vojnosanitetski Pregled , 2010, DOI: 10.2298/vsp1008665m
Abstract: Backgroud/Aim. Surgical treatment is the only method of abdominal aorta aneurysm (AAA) treatment. According to data of the available literature, elective open, ie conservative, reconstruction (OR) is followed by 3%-5% mortality, as well as by numerous comorbide conditions inside the early postoperative course (the first 30 days after the surgery) that occur in 20%-30% of the operated on. The aim of the study was to present preliminar results of a comparative clinical retrospective study of early postoperative morbidity and mortality in AAA reconstruction using endovascular (EVAR) and open surgical techniques. Method. This comparative clinical retrospective study included 59 patients, electively operated on for AAA within the period January 2008 - March 2009, divided into two groups. The group I counted 29 (49%) of the patients who had been submitted to EVAR by the use of Excluder stent. The group II consisted of 30 (51%) of the patients operated on using OR. All of the patients were males, 50-87 years old (mean 67.6 year in the group I, and 54-86 years (mean 68.3 years) in the group II. All tha patients had AAA larger than 50 mm, in the group I 50-105 mm (mean 68 mm), and in the group II 50-84 mm (mean 65 mm). Preoperative comorbide conditions of any patients were similar (coronary disease, obstructive lung disease, chronical renal insufficiency). Patients operated on as emergency cases due to rupture or due to symptomatic aneurysm (threthening rupture) were excluded. The analysed parameters were the duration of surgical operation, intraoperative and operative blood substitution, postoperative morbidity, the duration of postoperative hospitalization, and hospital mortality. Results. The obtained results showed a statistically significantly shorter time taken by EVAR surgery (average 95 min, ranging 70-180 min) as compared to OR surgery (average 167 min, ranging 90-300 min). They also showed statistically significantly less blood loss in the patients operated on by the use of EVAR surgery (average blood compensation 130 mL, ranging 0-1050 mL) as compared to OR surgery (average blood compensation 570 mL, ranging 0-2.000 mL). Also, general complications as wound infection, no restoration of intestines peristalsis, febrility, proteinic and electolytic disbalance, lung and heart decompensation were statistically significantly less following EVAR than OR surgery. Postoperative hospitalization was also statistically significantly shorter after EVAR than after OR surgery (average 4.2 days, ranging 3-7 days; 10.6 days, ranging 8-35 days, respectively). Finally,
The influence of sepsis as a complication after trauma on immune response to injury
?urbatovi? Maja,Mirkovi? Darko,Radakovi? Sonja S.,JevtiMiodrag
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1104179s
Abstract: Introduction. Mortality rate in trauma complicated with sepsis is exceeding 50%. Outcome is not determined only by infection or trauma, but also by the intensity of immuno-inflammatory response. Objective. The aim of this study was to determine the influence of sepsis on the immuno-inflammatory response, in the group of 35 traumatized men, of which in 25 cases trauma was complicated with sepsis. Methods. Cytokines were measured by ELISA test in plasma. Blood samples were drown on the first, third and fifth day after ICU admission. Results. Proinflammatory cytokine IL-8 was 230-fold higher in trauma + sepsis group (1148.48 vs. 5.05 pg/ml; p<0.01), and anti- inflammatory cytokine IL-1ra was 4-fold higher (1138.3 vs. 310.05 pg/ml; p<0.01), whereas IL-12 and IL-4 showed no significant difference between the groups. Conclusion. We concluded that sepsis, as a complication after trauma, drastically enhances immuno-inflammatory response to insult, as indicated by IL-8 and IL-1ra, but not IL-12 and IL-4.
Takayasu arteritis
Mi?ovi? Sidor,Dra?kovi? Miroljub,JevtiMiodrag,?arac Momir
Medicinski Pregled , 2005, DOI: 10.2298/mpns0502073m
Abstract: Introduction. Giovanni Battista Morgani reported the first case with Takayasu arteritis (TA) in 1761. The disease affects the aortic arch and large blood vessels. It is found in every race and in every age-group, predominantly in female population aged 20-40 years. There are four types of TA: type I affects blood vessels of aortic arch; Type II is syndrome of middle aorta (thoracal and abdominal aorta); Type III affects aortic arch and abdominal aorta; Type IV affects pulmonary artery. Clinical manifestations. TA has three phases; 1. weakness, fever, anemia, loss of appetite: 2. inflammation of blood vessels: 3. symptoms of stenosis and occlusive lesions. Pathoanatomical disorder includes inflammation of all three layers of blood vessels. Case report. This is a case report of a 41-year-old woman with TA. She suffered from chest pain, fatigue and pain in both legs, predominatly in the right. Clinical presentation of the disease varies whereas development of 1A is unpredictable. Angiograplty is an important method in diagnosis of the disease and in planning surgical treatment. In our patient five arterial stenoses were established by angiography. ECHO Color Doppler angiography may be useful. Diagnostic criteria include: age under 40 years, occlusion of the right and left subclavian artery and nine minor criteria. Corticosteroid and anti-inflammatory therapy is indicated. One third of patients needs surgery. Discussion and conclusion. In our opinion surgical treatment should be delayed until acute phase is over. Surgical treatment in our patient included: aortobifemoral bypass and left carotid-axillary bypass grafting. Some patients need multiple surgical treatments, like our patient. They also need post-surgical controls. .
Use of presternal catesters for peritoneal dialysis in obese patients
Dra?kovi? Miroljub,JevtiMiodrag,Mi?ovi? Sidor,Zoranovi? Uro?
Medicinski Pregled , 2006, DOI: 10.2298/mpns0602079d
Abstract: Introduction. Patients with terminal kidney failure represent an important socio-medical problem not only in our country, but also in most countries of the world. There are three options of treatment: transplantation, hemodialysis and peritoneal dialysis. Each of them has advantages and disadvantages. Case report. This is a case report of an extremely obese woman on pentoneal dialysis. Due to obesity, we decided to use a presternal catheter. We wished to report our dilemmas, opinions and experiences associated with this problem, as well as opinion from available medical literature. .
Abdominal aortic aneurysm: Rupture of the anterior wall
Dra?kovi? Miroljub,Mi?ovi? Sidor,JevtiMiodrag,?arac Momir
Medicinski Pregled , 2007, DOI: 10.2298/mpns0702080d
Abstract: Introduction An aneurysm is a focal dilatation of an artery (aorta), involving an increase in diameter of at least 50% as compared to the expected normal diameter (over 3 cm). Abdominal aortic aneurysms (AAA) cause thousands of deaths every year, many of which can be prevented with timely diagnosis and treatment. AAA can be asymptomatic for many years, but in one third of patients whose aneurysm ruptured, the mortality rate is 90%. In the past, palpation of the abdomen was the preferred method for identifying AAA. However, diagnostic imaging techniques, such as ultrasonography and computed tomography are more accurate and offer opportunities for early detection of AAA. Case report This paper is a case report of an 83-year old female patient. She was admitted due to severe pain in the abdomen. We already knew about the AAA (from her medical history). After using all available diagnostic procedures, rupture or dissection of the AAA were not confirmed. The patient underwent emergency surgery. During the operation, rupture of the anterior wall of the aneurysm was found. The anterior wall was filled with parietal thrombus, which hermetically closed the perforation. The patient was successfully operated and recovered. Conclusion The aim of this case report was to point out that our diagnostic procedures failed to confirm the rupture of AAA. We decided to apply surgical treatment, based on medical experience, clinical findings, ultrasonography and computed tomography and during operation rupture of AAA was confirmed. Patients with an already diagnosed AAA, or patients with clinical picture of rupture or dissection, are in urgent need for surgery, no matter what diagnostic tools are being used.
Intrathrombus embolization of giant mesenteric inferior artery to prevent type II endoleak
?arac Momir,Marjanovi? Ivan,Zoranovi? Uro?,JevtiMiodrag
Medicinski Pregled , 2012, DOI: 10.2298/mpns1206255s
Abstract: Introduction. One of the most common complications of endovascular repair of abdominal aortic aneurysm is type II endoleak - retrograde branch flow. Case report. A 76-year-old man with abdominal aortic aneurysm, 7. 1cm in diameter and aneurysm of the right common iliac artery, 3. 2cm in diameter was admitted to our Department with abdominal pain. The patient had no chance of having open repair of abdominal aortic aneurysm because of high perioperative risk (cardiac ejection fraction of 23%, chronic pulmonary obstructive disease). Multislice computed angiography also revealed a large inferior mesenteric artery, 6mm in diameter with the origin in thrombus of aneurysm. We decided to repair abdominal aortic aneurysm with GORE EXCLUDER stent-graft with crossed right hypogastric, but first we decided to embolize the inferior mesenteric artery. Angiography was performed through the right femoral approach and the good Riolan arcade was found. After that the inferior mesenteric artery was embolized with two coils, 5 mm in diameter, at the origin of artery in aneurysm thrombus. At the end of procedure, abdominal aortic aneurysm was repaired with GORE stent-graft, and the control angiography was performed. There was no endoleak, and the Riolan arcade was very good. The patient was discharged after 5 days. There were no signs of ischemia of the left colon, and peristaltic was excellent. Control multislice computed angiography was done after 1 and 3 months. There were no signs of endoleak. On the control colonoscopy there were no signs of ischemia of the colon. Conclusion. Endovascular repair of symptomatic abdominal aortic aneurysm in high risk patients with preoperative embolization of large branch is the best choice to prevent rupture of abdominal aortic aneurysm and to prevent type II endoleak.
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