Morphologic predictors of in hospital mortality in acute type III aortic dissection. / Morfologicheskie prediktory gospital'noi smertnosti u bol'nykh s ostrym rassloeniem aorty III tipa.

INTRODUCTION: In-hospital mortality of acute aortic type III dissection ranged about 12%. Complicated dissections represent about 18% of all cases, and require open surgery or TEVAR. More morphological predictors of in hospital mortality are needed to differentiate patients who should be selected for immediate, surgical or endovascular intervention. METHODS: From January 2009 to December 2014, 74 patients with acute aortic type III dissection were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade Serbia and retrospectively analyzed. Every MSCT was observed in regard to morphologic characteristics of dissection. RESULTS: By analyzing morphologic parameters in patients between survival and non-survival group only localization of intimal tear showed statistical significance (p=0,020). The size of the intimal tear didn't reach statistical significance with the tendency of doing so in a larger sample of patients (p=0,063) with the cut-off value of 9.55mm. The shape of the true lumen was on the border of statistical significance (p=0,053). CONCLUSION: Inner curvature intimal tear localization, huge intimal tear as well as elliptic shape of the true lumen together should raise awareness to a subgroup at risk for in hospital mortality. More liberal endovascular treatment in this subgroup of patients is advocated.

[Penetrant injuries of colon--our experience].

In attemption to determine the place of primary repair in management of colon injuries, an open, non randomized clinical study was performed. Retrospective (RS) group of 62 patients according to exclusion criteria by Stone (S/F) and Flint (F1) was managed by one or two stage surgical procedure. Prospective (PR) group of 34 patients was managed using one stage repair non-selectively: two stage procedures were performed in 3 cases of advanced peritonitis and multi-segmental lacerations with impaired circulation of colon. In RS group 36 patients were managed by primary repair and in PR group, 31 were managed by primary repair. Both groups were of similar age/sex. Indexes of trauma severity were similar (TS, ISS, PATI). The latent time was shorter in PR group. Associated injuries to other body regions and abdominal organs were similar in both groups. S/F criteria and Flint grading in both (RS vs. PR) groups were similar. Comparison of attempted and successful primary repairs justifies the more liberal use of primary repair in early management of colon injuries.

[The role of enterostomy in the management of colonic injuries].

The circumstances, evaluation and results of the management of 67 colonic and rectal injuries during the period 1992-2003 in Clinical Centre of Podgorica are presented. In 32 war and 37 civilian injuries to colon, several systems of the severity trauma determination, as well as systems of grading and classification of injuries of colon were evaluated, and the surgical access according to achieved results was investigated in order to determine the use of enetrostomy in the management of these inuries. From the presented and statistically evaluated results, it can be concluded that Flintzs 3 grade classification can be used as the most reliable indicative and prognostic system. For the succes of One stage surgical procedure, the most critical fact is differentiation between Flintzs Grade I and II (Chi Square 4.514; P) as well between Grade II and III. That means that by using One stage procedure, unfavourable results may be expected not only in Grade II, but as well in border cases between II and III. Also, according to the presented results, there were not differences observed in the success of management between Grade II and III (Chi Square 0.678; P0.05). That means that using Two stage procedure, unfavourable results can be prevented not only in the borderline cases between Grades II and III, but also in the Grade III. Two stage surgical approach in the repair of injuried colon remains valuable and usefull surgical procedure, even in spite of success of surgical technology and operative technique, in cases with severe and multiple abdminal injuries, and in borderline decision making. These procedures are also inevitable in the management of any complication of primary repair of the colonic wound. Using rational evaluation and good surgical techniqe, primary repair of can be used in almost 50% of civilian and war injuries injuries of colon.

[Endoscopic perforations of colon and rectum]. / Endoskopske perforacije kolona i rektuma.

Although fiberoptic examination of the colon is nowdays considered to be safe procedure, endoscopic perforation remains rare, but serious and potentially life threatening complication. General incidence od diagnostic and interventional perforations of colon ranges, according to the literature between 0.1-0.9%, or for diagnostic procedure about 0.17%, and for interventional 0.41%, with general mortality rate of 0.006%. In spite of the general trend for diminishing this occdurence, it is necessary to compare various experiences in order to achieve an algorrhithm of early diagnostic and the way of the surgical management of this particular kind of perforation. The aim of this work is to present the experience in 1995-2004 period, upon 7 (0.12%) cases of surgically treated perforations of colon after 5,680 performed diagnostic colonoscopies. In all 7 cases the reason for perforation was not basically pathologiocal process. 4 cases of perforations were recognized immediately, and they were managed by direct suture of the perforation. In 3 cases diagnosis was late from 1 to 3 days, and two-step operative procedure was performed in septic condition. Subjective and clinical signs of perforations were not always unifrom, but in all 7 cases there were clear X-ray signs of free intraabdominal air. Surgical treatment was successfull, and without deaths. In the algorrhithm of surgical diagnostic and procedure, the same principles and criteria used for civilian injuries of colon are to be used.

[Multicystic mesothelioma of the peritoneum]. / Multicisticnih mezoteliom peritoneuma.

Benign multicystic mesothelioma (MCM) of the peritoneum is a rare lesion that occurs predominantly in middle aged women with previous history of pelvic surgery. We report a case of MCM of the peritoneum in a 25-year-old man in whom cystic masses were twice surgically removed in an interval of 1.5 year. Ultrasonography and computer assisted tomography of the abdomen revealed a multicystic abdominal and pelvic mass. At first laparotomy, a multiple, thin-walled cysts ranging 0.5-7 cm in diameter were found involving the abdominal and pelvic peritoneum. After removal of all visible cysts we made histopathological diagnosis of the multilocular cavernous lymphangioma, without immunohistochemical examinations. The recurrent tumor was clinically and pathologically identical, but the final diagnosis, established upon immunohistochemical staining, was MCM: the tumor cells were strongly positive for cytokeratin, weakly positive for vimentin, and negative for Factor VIII. Management of the MCM surgical excision, unfortunately not always curative, since there is a high recurrence rate.