Procena vrednosti holedohoduodeno anastamoze (HDA) u hiruškom lečenju benignih opstruktivnih oboljenja žučnih puteva

Benign biliary obstruction (BBO) is the most common group of biliary disorders, following gallbladder calculosis. Interrupted or reduced bile flow into the duodenum, especially long-term, induces mechanic obstructive syndrome with all its consequences (primarily cholestasis) that requires prompt treatment (surgical or endoscopic). Regardless of the significance and opportunities of endoscopic treatment, it is still applicable in limited number of indications in only 15-25% of BBO patients. BBO surgery is very versatile and one of its forms is biliodigestive anastomosis (BDA) which represents surgically created communication between biliary tree and gastrointestinal tract aiming to maintain adequate bile drainage into the duodenum or jejunum. Choledochoduodenostomy (ChDA) is one of the BDA that is characterized by fast and simple technique of creation and small blood loss. These features make it very useful, especially in elderly and other patients with high operative risk. ChDA is used in distal benign biliary obstruction (papillary stenosis, chronic pancreatitis, common bile duct calculosis) and in patients with multiple, recurrent, residual or intrahepatic calculosis. It is also useful in patients that underwent unsuccessful endoscopic procedures or in cases when endoscopy is not available. On the other hand, it is considered that ChDA is associated with certain percent of complications, primarily cholangitis and „sump“ syndome that occur as a consequence of duodeno-biliary reflux that may be present after ChDA creation. In surgery Clinic in Nis there is a huge experience in BBO treatment. Our study included 100 operated patients in whom ChDA was created for BBO (50 were analyzed retrospectively and 50 prospectively). Some of the analyzed parameters were determined preoperatively, some intraoperatively (duration of surgery, operative technique, blood loss) and some postoperatively (during postoperative recovery and five years after surgery). After the analysis of the data obtained the safety, efficiency and competence of ChDA were determined, both during the postoperative recovery period and long-term, five years after surgery. The data analysis was done using contemporary methodology and it was determined that ChDA was fast, simple and efficient anastomosis useful in treatment of certain forms of BBO. Serious complications occur in a small percentage and it is possible to avoid them with adequate choice of indication and meticulous operative technique. Complications during postoperative recovery occurred in 14,3% of our patients, with predominance of minor surgical complications (grade I and II, transient conditions that did not require invansive treatment). Immediately after the ChDA creation, duodeno-biliary reflux occur in almost all of the cases (registered in 91,7% of our patients). After 5 years the percentage of this reflux decreases to 21,9% and is not always associated with pathophysiological consequences. Although defined as “reflux” anastomosis, ChDA is associated with small incidence of cholangitis both during postoperative recovery period (3,1%) and long-term postoperatively (4,88%). Dehiscence and stenosis are rare complications of this anastomosis (3,1% and 2,4% respectively). Serious bleeding after ChDA occurred in 1,03% of our patients (in one retrospectively analyzed patient). Intrahospital mortality was very low considering the complex health condition of patients that underwent ChDA (2%). After 5 years period 70,73% of patients were without any complications, 82,92% have declared no health problems and symptoms or had very few complaints that did not required intensive nor invasive treatment. “Sump” syndrome was detected in one of our patients analyzed retrospectively (2,43%); chronic gastritis as a long-term consequence of ChDA was detected in two of our patients analyzed retrospectively (4,87%). Scintigraphy in our study patients during early and late postoperative course confirmed the competence of the anastomosis and did not show statistically significant difference between the groups, proving that ChDA is not only fast but also definitive treatment of cholestasis syndrome. Due to its indisputable efficiency in the treatment of certain types of biliary obstruction, learning precise indications and technique of performing ChDA have to be included in every general surgeon basic skills

Krvne grupe, hematološki i biokemijski pokazatelji u autohtonih pasmina pasa. I. Hrvatski ovčar

The research involved 95 pure breed Croatian sheepdogs, 48 females and 47 males ranging in age from 1 to 12 years. Blood samples were taken to establish certain biochemical indicators (urea, creatinine, total proteins, glucose, total bilirubin, AST, ALT, alkaline phosphatase, creatine kinase, amylase, Ca, P). No changes were observed through comparison of average values. Blood samples of 30 dogs, from that group, also were taken to establish blood group DEA (Dog Erythrocyte Antigen) 1.1. and standard haemogram. In 27 dogs (90.0%) the blood group DEA 1.1., was found, which is a significantly higher percentage than in all investigations to date. It was observed that the average values of all haematological indicators were within physiological parametersU uzorcima krvi 95 pasa hrvatskih ovčara, 48 ženki i 47 mužjaka u dobi od jedne do 12 godina istraženi su neki biokemijski pokazatelji (ureja, kreatinin, ukupne bjelančevine, glukoza, ukupni bilirubin, AST, ALT, alkalna fosfataza, kreatinska kinaza, amilaza, Ca, P). Vrijednosti biokemijskih pokazatelja bile su unutar fizioloških granica. U 30 pasa iz te skupine također je određivana krvna grupa (DEA, engl. Dog Erythrocyte Antigen) 1.1. i standardni hemogram. U 27 pasa (90%) utvrđena je krvna grupa DEA1.1., što je značajno više od do sada objavljenih rezultata. Vrijednosti hematoloških pokazatelja bile su unutar fizioloških granica

Kinetic profile of the antioxidant activity of propolis extract: 2,2-diphenyl-1-picrylhydrazyl radical bleaching assay

The objective of this paper was to assess the antiradical effectiveness of propolis extract (PE) based on 2.2-diphenyl-1-picrylhydrazyl radical (DPPH center dot) bleaching assay kinetic profile. The kinetic profile of scavenging DPPH center dot for PE exhibited one kinetic period characterized by one kinetic constant. The second-order rate constant (k(2)) for the oxidation of PE by DPPH center dot, determined for the first time in this study, was 0.17 dm(3)g(-1)s(-1). The obtained k(2) value was compared to that of synthetic antioxidants and natural extracts used in the food industry. Kinetic analysis of PE antiradical effectiveness showed that the k(2) was within the range values for natural colorants of fruit extracts and should be considered as a fast acting natural antioxidant source. The k(2) parameter indicates the extent of oxidation inhibition that is based on all of the kinetic profiles of DPPH bleaching rather than single point measurements. For this reason, the kinetic analysis should become a necessary step for more precise antioxidative characterization of propolis

PERINEAL HERNIA AFTER ABDOMINOPERINEAL LAPAROSCOPIC RESECTION – CASE REPORT

A perineal hernia can severely affect everyday activities. We represent a case of a sixty-five-year-old with perineal hernia after abdominoperineal resection for rectal cancer. Bulging in the perineum appeared 24 months following operation with uneventful postoperative course. She felt pain and difficulty while sitting. At physical examination the defect in perineum was approximately 3x3 cm. After cancer recurrence had been excluded, hernioplasty was planned. A 10x15 cm composite mesh was used for pelvic floor reconstruction. The mesh was sutured through urogenital diaphragm. Postoperative course was uneventful. Three years after surgery, there was no recurrence of cancer or hernia. Repair of perineal hernia is challenging, with limitation regarding guidelines in literature

SURGICAL TREATMENT OF ADVANCED GASTRIC CANCER

Patients with advanced gastric cancer generally have poor overall prognosis as well as survival rate. Unfortunately, in the West, gastric cancer typically occurs at an advanced stage and many of these patients have tumor invasion into adjacent structures (International Union Against Cancer [UICC]/American Joint Committee on Cancer [AJCC] Stage T4). Although T4 gastric cancer patients often have peritoneal dissemination or distant metastasis, many do not have M1 disease and are therefore candidates for surgery with the curative intent. A multivisceral resection (MVR) or gastrectomy with resection of adjacent organs is needed in T4 gastric cancer patients to achieve an R0 resection that is one of the most powerful forecasters of gastric cancer surgery results. Spleen, distal pancreas, liver, and large intestine (mostly transverse colon) were the most commonly resected organs. The therapeutic choice with acceptable postoperative morbidity and mortality rates in locally advanced patients with gastric cancer should be gastrectomy with MVR, where complete resection could be realistically obtained and where metastatic involvement of the lymph node is not evident. MVR is done with a curative R0 resection to provide advanced gastric cancer patients with the best survival chance. It was found that resections involving the pancreas, transverse colon and liver were associated with increased survival rate in comparison to MVR with resection of other structures. It was shown that survival rate significantly decreased in patients who had undergone MVR without complete resection compared to those who had an R0 resection. Nevertheless, the extent of the surgical resection required and further advantages of MVR are disputable

MOLECULAR MECHANISMS OF ISCHEMIC-REPERFUSION INJURY DURING LIVER RESECTION FOR COLORECTAL CANCER METASTASES- STUDY PROTOCOL

Bleeding during liver resection is a significant threat to the clinical outcome. Portal triad occlusion with complete ischemia of the liver flow of hepatoduodenal ligament is a well-documented, safe and useful way to reduce this problem. Although the technique is efficient in limiting blood loss, there is still controversy concerning potential disadvantages and subsequent reperfusion liver injury. A prospective analysis will include at least 30 patients 18-75 years old, who are undergoing liver resection due to metastases of the colorectal carcinoma. After signing the informed consent, the parameters will be analyzed in three phases, pre-, intra- and postoperatively. During surgery (indicated by a surgical/oncological team of doctors not related to our study) liver tissue samples will be taken of the “healthy liver” (not involved in the tumor process) in which after tissue homogenization, analysis of parameters will be done responsible for the development of liver injury. This research will not affect the clinical practice, course and outcome of the treatment in patients who are included. The study may be useful for future patients who will undergo liver resections. The application of modern research methods with scientific validity of statistical processing of data and the use of appropriate literature, significant data will be obtained about the character, i.e. intensity of damage of the liver tissue in patients undergoing liver resections

PILONIDAL DISEASE

Pilonidal disease is a common and well-recognized medical condition. It affects people in reproductive age, especially men and in combination with in-patient and outpatient treatment and absence from work it causes a considerable socioeconomic loss. This fact led to a renewed interest in understanding of the disease and search for the ideal method of treatment. The purpose of this review was to provide update on therapeutic options for patients with pilonidal disease. In case of chronic or recurrent pilonidal disease various treatment options exist, addressing different measures of surgical outcome. Like for many conditions, there is increase in the use of minimally invasive techniques in the treatment, which could be alternative to surgical excisions for pilonidal disease. Procedures for treatment of pilonidal disease can be divided in two large groups: minimally invasive treatment and excisional procedures. Although various treatment options exist nowadays, surgery is still preferred as definitive treatment. The optimal closure of the wound following an excision is still under debate since outcome measures depend mostly on type of closure selected. Most of the procedures fail to achieve the goals altogether. The final decision on treatment should be made based on surgeon and the patient’ preference

Supplementary data for the article: Stupar, S.; Dragićević, M.; Tešević, V.; Stanković-Jeremić, J.; Maksimović, V.; Ćosić, T.; Devrnja, N.; Tubić, L.; Cingel, A.; Vinterhalter, B.; Ninković, S.; Savić, J. Transcriptome Profiling of the Potato Exposed to French Marigold Essential Oil with a Special Emphasis on Leaf Starch Metabolism and Defense against Colorado Potato Beetle. Plants 2021, 10 (1), 172. https://doi.org/10.3390/plants10010172.

Supplementary material for: [https://doi.org/10.3390/plants10010172]Related to published version: [https://cherry.chem.bg.ac.rs/handle/123456789/4499

THE FREQUENCY OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) IN HEALTHY NASAL CARRIERS IN POMORAVLJE DISTRICT

S. aureus is a frequent cause of infections both in hospital setting and outside it. The growing resistance of this pathogen to beta-lactam and other antibiotics complicates the treatment. The aim in this study was to investigate the frequency of nasal carriage of S. aureus among healthy population who can be the source of infection, as well as a share of MRSA colonisation. We analyzed 5.776 throat and nose swab samples taken from adult healthy population; the swabs were analyzed in microbiology labs of the Public Health Institute Ćuprija. The isolates were identifided by standard procedures based on clumping factor production and using manitol-salt agar with novobiocin disk. Methicillin resistance was determined by disk-diffusion with a 30 mcg cefoxitin disk. The prevalence of nasal MRSA colonisation was 3,63%; 4,29% of subjects were nasal carriers of S. Aureus.The values obtained in this paper are in keeping with data obtained in other European countries. The prevalence of MRSA among carriers is low, and the treatment to complete absence of germs and implementing measures to prevent the spread of infection are therefore urgently needed