The aim of this retrospective study was to create guidelines for therapy of severe sepsis in surg... more The aim of this retrospective study was to create guidelines for therapy of severe sepsis in surgical intensive care unit (ICU) for unknown causative agent based on antimicrobial susceptibility of causative bacteria. Seventy-four patients with severe sepsis from surgical ICU in 2003.-2005. were included in study. Their clinical and microbiological data were analyzed from the medical records. Antimicrobial susceptibility of the strains isolated from the blood-culture was tested by disk diffusion method according to CLSI (Clinical Laboratory Standard Institution). APACHE II score was used to predict the severity of illness. Statistical significance difference between results was tested by Mann-Whitney test and chi2 test. Important problem remained type of sepsis: mono-agent sepsis presented less therapeutic problem than sepsis caused with two or more agents (mixed sepsis). Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii were predominant causative agents in both type of sepsis. There was remarkable increase of A. baumannii prevalence in 2005 compared to 2004 and to 2003. There was also decrease of MRSA prevalence in 2004 and 2005 compared to 2003. P. aeruginosa were the predominant causative agents in 2004. MRSA displayed good susceptibility to vancomycin and linezolide, whereas P. aeruginosa showed excellent susceptibility to ceftazidime and carbapenems. A. baumannii, third predominant causative agent, exhibited excellent susceptibility to ampicillin+ sulbactam and carbapenems. The recommended therapy is empirical and should cover all important pathogens.
Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was acc... more Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was accepted in our Centre as a significant progress in the surgical treatment of gallbladder disease. Our experience, after the first thirty-two cases, is that a well prepared surgical team and trained surgeons provide procedure performance with insignificant number of complications.
Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was acc... more Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was accepted in our Centre as a significant progress in the surgical treatment of gallbladder disease. Our experience, after the first thirty-two cases, is that a well prepared surgical team and trained surgeons provide procedure performance with insignificant number of complications.
In this paper, the authors present the definition, etiology, clinical features, diagnosis and pre... more In this paper, the authors present the definition, etiology, clinical features, diagnosis and preparations for the surgical treatment of colovaginal fistulas. A ten year experience with 11 female patients with colovaginal fistulas divided according to the causes is reviewed. The fistulas commonly resulted from the surgical treatment, radiotherapy, parturition injuries and Crohn's disease. In the discussion, each group is evaluated with respect to the therapeutic procedure giving some general remarks on this rare clinical condition. Besides the surgical treatment of the fistula, in most cases, the contemporary colostomy is required.
The purpose of our study was to evaluate initial results following introduction of Hyperthermic I... more The purpose of our study was to evaluate initial results following introduction of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CS). Twenty two patients with intraperitoneal malignancy undergone cytoreductive surgery (CS) and hyperthermic intraoperative chemotherapy (HIPEC) between January of 2007 and January 2010. Nine patients had adenocarcinoma of colorectal origin, 8 patients had ovarian cancer, and 5 had pseudomyxoma peritonei. Inclusion criteria were diagnosis of peritoneal carcinomatosis based on intraoperative assessment during first operative procedure for intraabdominal malignancy or follow-up diagnostic imaging proof Excluded were patients with known malignant proliferation outside abdomen, liver metastasis and ASA score 4 and higher. All patients with pseudomyxoma peritonei diagnosis are alive, with mean follow-up time 24.8 months (range 15-35). In group of patients with adenocarcinoma from colorectal origin, 3 died, resulting in mean survival time 7.6 months (range 1-16). In group of patients with ovarian cancer, 2 died, resulting in mean survival time 13.8 months (range 0-31). Two patients died in early postoperative period. Most of the patients had some sort of mental disorder. Although HIPEC with CS improves survival, during introduction period higher morbidity and mortality could be expected.
Hemorrhoids are a common condition in adult population with prevalence of about 4%. Only a third ... more Hemorrhoids are a common condition in adult population with prevalence of about 4%. Only a third of patients with symptomatic hemorrhoids seek medical help. The annual rate of office visits for hemorrhoids is 12 for every 1000 patients in the United States. Hemorrhoids consist of connective tissue cushions surrounding direct arteriovenous communication. They can cause bleeding, pain and itching but other anorectal diseases should be ruled out. Current guidelines recommend a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding. Care depends on the extent of hemorroids. First-degree hemorrhoids can be managed with medical treatment. Surgery is reserved for patients with third and fourth-degree hemorrhoids and failure of nonoperative treatment. A new method of the stapled hemorrhoidectomy has been introduced which significantly reduces postoperative pain, hospital stay and use of analgesics with results that are equal to excisional hemorrhoidectomy.
Hepatoid adenocarcinoma of the stomach is a rare type of gastric carcinoma with an extremely poor... more Hepatoid adenocarcinoma of the stomach is a rare type of gastric carcinoma with an extremely poor prognosis. We describe a 72-year-old man who underwent esophagogastroduodenoscopy which revealed 50 mm exulcerated lesion with a central necrosis on the lesser curvature and the posterior wall of the body of the stomach. Gastric biopsy revealed a poorly differentiated (anaplastic) adenocarcinoma. The serum level of alpha-fetoprotein (AFP) was (3220 ng/mL). After diagnosis of AFP-producing gastric adenocarcinoma, total gastrectomy, with splenectomy, was performed. The tumor showed immunohistochemical positivity for AFP and Hep Par 1. According to these histopathological and immunohistochemical findings, the tumor was diagnosed as hepatoid adenocarcinoma. At 24 months postoperatively the patient is still alive without metastatic disease on repeated abdominal CTs. Because of the poor prognosis for this histological type of tumor, accurate diagnosis of hepatoid adenocarcinoma is important, and long-term follow-up is required.
Various types of benign and malignant splenic tumours including hemangiomas, lymphagiomas, hamart... more Various types of benign and malignant splenic tumours including hemangiomas, lymphagiomas, hamartomas, hemangiosarcomas, malignant lymphomas and metastatic carcinomas share radiological characteristics making it impossible for a physician to determine the definite aetiology of splenic masses noninvasively without histopathological evaluation. It is important that physicians recognize the importance of a careful and continuous follow-up since inflammatory pseudotumours (IPT) are considered to be tumours with an intermediate malignant potential based on their behaviour when they arise in other locations. Our patient, a 60-year-old woman was evaluated using laboratory, gastroscopy, computed tomography and surgical methods. The resected tumour was evaluated using immunohistochemical methods. The patient presented with weight loss, nausea and vomiting, symptoms lasting over a course of a few months. The splenic mass was found incidentally at the time of work up for gastritis and cholelithiasis. Histologically, the tumour differed from typical splenic architecture being composed of atypical spindle cells with inflammatory elements; numerous plasma cells, macrophages, eosinophils and lymphocytes. Although very difficult to diagnose at initial presentation, it is very important for the physician to be aware of the importance of a careful diagnosis since IPT of the spleen are rare and considered to be tumours with an intermediate malignant potential.
The aim of this retrospective study was to create guidelines for therapy of severe sepsis in surg... more The aim of this retrospective study was to create guidelines for therapy of severe sepsis in surgical intensive care unit (ICU) for unknown causative agent based on antimicrobial susceptibility of causative bacteria. Seventy-four patients with severe sepsis from surgical ICU in 2003.-2005. were included in study. Their clinical and microbiological data were analyzed from the medical records. Antimicrobial susceptibility of the strains isolated from the blood-culture was tested by disk diffusion method according to CLSI (Clinical Laboratory Standard Institution). APACHE II score was used to predict the severity of illness. Statistical significance difference between results was tested by Mann-Whitney test and chi2 test. Important problem remained type of sepsis: mono-agent sepsis presented less therapeutic problem than sepsis caused with two or more agents (mixed sepsis). Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii were predominant causative agents in both type of sepsis. There was remarkable increase of A. baumannii prevalence in 2005 compared to 2004 and to 2003. There was also decrease of MRSA prevalence in 2004 and 2005 compared to 2003. P. aeruginosa were the predominant causative agents in 2004. MRSA displayed good susceptibility to vancomycin and linezolide, whereas P. aeruginosa showed excellent susceptibility to ceftazidime and carbapenems. A. baumannii, third predominant causative agent, exhibited excellent susceptibility to ampicillin+ sulbactam and carbapenems. The recommended therapy is empirical and should cover all important pathogens.
Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was acc... more Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was accepted in our Centre as a significant progress in the surgical treatment of gallbladder disease. Our experience, after the first thirty-two cases, is that a well prepared surgical team and trained surgeons provide procedure performance with insignificant number of complications.
Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was acc... more Laparoscopic cholecystectomy, as the innovative surgical procedure of gallbladder removal was accepted in our Centre as a significant progress in the surgical treatment of gallbladder disease. Our experience, after the first thirty-two cases, is that a well prepared surgical team and trained surgeons provide procedure performance with insignificant number of complications.
In this paper, the authors present the definition, etiology, clinical features, diagnosis and pre... more In this paper, the authors present the definition, etiology, clinical features, diagnosis and preparations for the surgical treatment of colovaginal fistulas. A ten year experience with 11 female patients with colovaginal fistulas divided according to the causes is reviewed. The fistulas commonly resulted from the surgical treatment, radiotherapy, parturition injuries and Crohn's disease. In the discussion, each group is evaluated with respect to the therapeutic procedure giving some general remarks on this rare clinical condition. Besides the surgical treatment of the fistula, in most cases, the contemporary colostomy is required.
The purpose of our study was to evaluate initial results following introduction of Hyperthermic I... more The purpose of our study was to evaluate initial results following introduction of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CS). Twenty two patients with intraperitoneal malignancy undergone cytoreductive surgery (CS) and hyperthermic intraoperative chemotherapy (HIPEC) between January of 2007 and January 2010. Nine patients had adenocarcinoma of colorectal origin, 8 patients had ovarian cancer, and 5 had pseudomyxoma peritonei. Inclusion criteria were diagnosis of peritoneal carcinomatosis based on intraoperative assessment during first operative procedure for intraabdominal malignancy or follow-up diagnostic imaging proof Excluded were patients with known malignant proliferation outside abdomen, liver metastasis and ASA score 4 and higher. All patients with pseudomyxoma peritonei diagnosis are alive, with mean follow-up time 24.8 months (range 15-35). In group of patients with adenocarcinoma from colorectal origin, 3 died, resulting in mean survival time 7.6 months (range 1-16). In group of patients with ovarian cancer, 2 died, resulting in mean survival time 13.8 months (range 0-31). Two patients died in early postoperative period. Most of the patients had some sort of mental disorder. Although HIPEC with CS improves survival, during introduction period higher morbidity and mortality could be expected.
Hemorrhoids are a common condition in adult population with prevalence of about 4%. Only a third ... more Hemorrhoids are a common condition in adult population with prevalence of about 4%. Only a third of patients with symptomatic hemorrhoids seek medical help. The annual rate of office visits for hemorrhoids is 12 for every 1000 patients in the United States. Hemorrhoids consist of connective tissue cushions surrounding direct arteriovenous communication. They can cause bleeding, pain and itching but other anorectal diseases should be ruled out. Current guidelines recommend a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding. Care depends on the extent of hemorroids. First-degree hemorrhoids can be managed with medical treatment. Surgery is reserved for patients with third and fourth-degree hemorrhoids and failure of nonoperative treatment. A new method of the stapled hemorrhoidectomy has been introduced which significantly reduces postoperative pain, hospital stay and use of analgesics with results that are equal to excisional hemorrhoidectomy.
Hepatoid adenocarcinoma of the stomach is a rare type of gastric carcinoma with an extremely poor... more Hepatoid adenocarcinoma of the stomach is a rare type of gastric carcinoma with an extremely poor prognosis. We describe a 72-year-old man who underwent esophagogastroduodenoscopy which revealed 50 mm exulcerated lesion with a central necrosis on the lesser curvature and the posterior wall of the body of the stomach. Gastric biopsy revealed a poorly differentiated (anaplastic) adenocarcinoma. The serum level of alpha-fetoprotein (AFP) was (3220 ng/mL). After diagnosis of AFP-producing gastric adenocarcinoma, total gastrectomy, with splenectomy, was performed. The tumor showed immunohistochemical positivity for AFP and Hep Par 1. According to these histopathological and immunohistochemical findings, the tumor was diagnosed as hepatoid adenocarcinoma. At 24 months postoperatively the patient is still alive without metastatic disease on repeated abdominal CTs. Because of the poor prognosis for this histological type of tumor, accurate diagnosis of hepatoid adenocarcinoma is important, and long-term follow-up is required.
Various types of benign and malignant splenic tumours including hemangiomas, lymphagiomas, hamart... more Various types of benign and malignant splenic tumours including hemangiomas, lymphagiomas, hamartomas, hemangiosarcomas, malignant lymphomas and metastatic carcinomas share radiological characteristics making it impossible for a physician to determine the definite aetiology of splenic masses noninvasively without histopathological evaluation. It is important that physicians recognize the importance of a careful and continuous follow-up since inflammatory pseudotumours (IPT) are considered to be tumours with an intermediate malignant potential based on their behaviour when they arise in other locations. Our patient, a 60-year-old woman was evaluated using laboratory, gastroscopy, computed tomography and surgical methods. The resected tumour was evaluated using immunohistochemical methods. The patient presented with weight loss, nausea and vomiting, symptoms lasting over a course of a few months. The splenic mass was found incidentally at the time of work up for gastritis and cholelithiasis. Histologically, the tumour differed from typical splenic architecture being composed of atypical spindle cells with inflammatory elements; numerous plasma cells, macrophages, eosinophils and lymphocytes. Although very difficult to diagnose at initial presentation, it is very important for the physician to be aware of the importance of a careful diagnosis since IPT of the spleen are rare and considered to be tumours with an intermediate malignant potential.
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Papers by Mate Majerović