Popliteal artery injury following traumatic knee joint dislocation in a 14-year-old boy: a case report and review of the literature.

INTRODUCTION: Posterior knee joint dislocation associated with injury of the popliteal artery in children is an extremely rare condition. Rapid diagnosis and treatment are essential for limb salvage and function. CASE REPORT: We reported a 14-year-old boy who suffered traumatic displacement of the right knee and contusion of the popliteal artery during motorcycle accident. The diagnosis was confirmed using Doppler and duplex ultrasonography and digital substraction transfemoral arteriography. The urgent surgical procedure was performed using posterior approach to the popliteal artery. During the surgical exploration, rupture of the posterior cruciate ligament associated with thrombosed popliteal artery have been found. The damaged popliteal artery was resected and replaced with autologous saphenous vein graft. The last stage of the procedure was a transosseous femoral fixation of posterior circuate ligament. A 3-year-follow-up after the surgery demonstrated intact arterial perfusion and very good function of the knee with a minimal difference as compared with the contralateral knee. CONCLUSION: Combined orthopedic and vascular injuries are very rare in children. They require combined treatment.

Predictive importance of index of asymmetry in recovery following stroke.

UNLABELLED: Quantitative electroencephalography (QEEG) has been proved as a powerfully tool for prediction of the stage of residual functional disable. For predictive value of QEEG, individual profile of every patient is most important. It has been demonstrated that Index of brain symmetry (BSI) present specific asymmetry of power spectra between two brain hemispheres and it has been normalized from 0 (perfect symmetry) and 1 (maximal asymmetry). METHOD: We included in our analysis 86 normal subjects in EEG recording. We did frequency analysis using Fast Fourier transformation (FFT) in power spectra for 16 derivations and 20 frequency bands, from 0 to 20Hz, with step of 1. On the base of that data, we got normal distribution with coefficient of variation less than 30%. We determined grades of frontier of allowance in all derivations and in all frequency bands, in the conditions with closed eyes and with eyes open in normal control. Maximal grade for each condition was 320. In this way we appointed the standard. We recorded the EEG in patient on admission and after two months of neurorehabilitation. We did the same procedure in every patients and on the base of the standard we calculated grades. On the base of calculated grades, we determine index of asymmetry using formula (l-d)/(l+d) x 100, and make the curves. Curvilinear of this curve and extent of its declination from 0 suggest on electrophysiological stage of brain. RESULTS: Index of asymmetry in patients with poor long-lasting recovery is more, equal and little bit smaller on control, after two months of rehabilitation in relation to first EEG recording on admission. On the other hand in patients with good long-lasting recovery. Index of assymmetry is reduced.

EEG study of visual reactivity in aphasic patients.

AIM: To compare patients with good and poor recovery after 1 and 3 months from onset of poststroke aphasia and to correlate the quality of recovery with quantitative EEG (QEEG) measures (frequency analysis with the limits of variability, and index of asymmetry). METHODS: The investigation was performed on the sample of 32 patients with poststroke aphasia, 15 females (46.88%) and 17 males (53.12%), mean age +/- standard deviation (SD) being 50.65 +/- 9.93 years. QEEG measures of this sample were compared with those in a group of 86 healthy controls, 39 (45.35%) females and 47 (54.65%) males, mean age +/- SD being 51.08 +/- 10.08 years. Frequency analysis was performed in eyes closed and eyes open conditions in both controls and in aphasics who were tested just before and two month after rehabilitative treatment with speech therapy. RESULTS: We have got normal distribution for all derivations and all frequency bands in the group of healthy subjects. On the basis of this finding, we determined coefficients of variation in patients with poststroke aphasia and discovered that their maximal variability scores were significantly decreased. Compared to healthy subjects, the index of asymmetry between two hemispheres and between main brain regions was significantly higher in the aphasic patients than in controls. However, the differences in the index of asymmetry and limits of variability significantly decreased after two month treatment in the subgroup of patients with good improvement compared with the subgroup of patients with poor improvement of poststroke aphasia. CONCLUSION: QEEG measures may have predicitive value in post-stroke aphasia.

Transitional cell carcinoma in orthotopic ileal neobladder 12 years after radical cystectomy.

INTRODUCTION: Some cases of secondary adenocarcinoma developing in the replaced bowel segment of urinary diversions have been reported so far. Secondary adenocarcinoma develops 20 years after surgery in about 0.5% of those in whom an ileal segment is used. There have been several reports in the literature describing extensions of transitional cell carcinoma (TCC) from the distal urether into an ileal conduit. Histology of loop tumor in 50% was TCC. The site of tumors in the majority of cases is the area at the uretheral orifices or the stoma. CASE REPORT: We presented a rare case of transitional cell carcinoma in an orthotopic ileal neobladder 12 years after radical cystoprostatectomy and ileal neobladder with the substitution by the procedure Camey II. A 65-year-old man with high-grade urothelial carcinoma of neobladder underwent partial resection of neobladder and right nephroureterectomy. Pathological analysis revealed high-grade urothelial carcinoma to the ileal neobladder (G II, Stage T2b). The patient died of laryngeal cancer a year after the surgery. CONCLUSION: Surgery of tumors in orthotopic neobladders is possible if diagnosed in time. In the presented case surgery resulted only in a decrease in the capacity of the neobladder without having an effect on the continence itself.

Repeated endoscopic treatments of multiple recurrent ureteral tumors following 15-year-long history of bladder tumors in the patient from endemic nephropathy region.

Ureteral urothelial tumors (UUT) are uncommon; their incidence is higher in areas affected by Balkan endemic nephropathy (BEN), with low-grade lesions prevalent. In these patients, the efficacy of conservative surgery is comparable to that of nephroureterectomy. Endoscopic treatment is indicated for single, small and low grade UUT, in older patients with significant comorbidity. The case of an 84-year-old lady from an area affected by BEN is presented. Over 20 years, the patient underwent five endoscopic interventions for multiple UUT, and numerous endoscopic interventions for recurrent bladder tumors. Among a highly select group of patients, endoscopic treatment of multiple small superficial low-grade ureteral tumors may prove successful.

[Friedrich von Esmarch--surgeon, one career].

Friedrich von Esmarch was born in 1823 in Germany and he is one of the greatest surgeons of the Germany of that time. Fridrich von Esmarch introduced the Esmarch tourniquet, which enables operative field bloodless. This revolutionary innovation is still present in the orthopaedic surgery all around world, as well as for the first line hemostasis. Beside this, Esmarch also improves others fields of surgery: immobilizations, methods of antiseptic surgery, modified Esmarch mask for anesthesia. He joined few wars and had a rang surgeon-general. Although his experience was primary from the trauma, he also introduced the training courses of the First aid for the ordinary people, making medicine of that time more modern and efficient

Tumors of the horseshoe kidney--characteristics and literature review.

The aim of this paper is to point out the significance of the rare urinary system anomaly such as horseshoe kidney. Tumors of the horseshoe kidney are rarely described as single cases in literature. Bilateral tumors of the horseshoe kidney can present a health and therapeutically challenge. In this paper we have analyzed characteristics of the horse shoe kidney tumors and their diagnostics. Primary means of the horseshoe kidney tumors treatment are surgical with different techniques depending on the size, presentation of the tumor and other indications. The review of the available literature is also included.

Malignant disease in renal transplant recipients--our experience.

Kidney transplantation is a treatment of choice for patient with end stage renal disease. Chronic renal failure is characterized with weak cellular and humoral immunity. In our paper we present our experience with presence of malignancy in renal transplant patients. Urology clinic in Belgrade transplanted 411 patients over the period of 16 years. Living donor transplantation was performed for 272 and cadaveric kidney transplant for 139 patients. In the postoperative follow up, malignancies were diagnosed in 7 of the transplanted patients. Three patients developed basal cell skin carcinoma, one was diagnosed with adenocarcinoma of the transplanted kidney, one developed transitional cell carcinoma of the bladder and testicular tumors were diagnosed in two patients. Postoperative immunosuppressive therapy usually double or triple when patients are in the immunological high risk group. Incidence of malignancy according to big health centers is around 1 in every 1000 transplanted patients. It is also noted the rise of incidence of malignancies in transplanted patient in over 50%.

Single-incision laparoscopic cholecystectomy--initial experience with different multichannel ports.

Single-incision laparoscopic cholecystectomy is a relatively new minimally invasive surgical technique in treatment of benign gallbladder diseases. It is considered a bridge technique between conventional laparoscopic cholecystectomy (LC) and NOTES. We are presenting our initial experiences in SILC (single-incision laparoscopic cholecystectomy). Seventeen patients underwent SILC (11 women and 6 men) with an average age of 43 years. Mean BMI score was 29,4 kg/m2. The mean operative time was 93,5 minutes. There were conversions to conventional LC in two cases (11,6%). Average pain score measured on visual-analogue scale (VAS) 8 h after the operation was 2,00. All patients expressed satisfaction with achieved cosmetic effect. We conclude that SILC is safe and feasible procedure, with excellent cosmetic effect, but further prospective studies are required before SILC can be generally accepted.

Radical retropubic prostatectomy--experience of two urological departments.

UNLABELLED: We have analyzed oncological and functional results of the patients who underwent radical retropubic prostatectomy for treatment of localized prostate cancer. MATERIAL AND METHODS: In the period of 4 years, from 2007. to 2011. on two analyzed urological departments there have been 32 patients who underwent surgical treatment for treatment of localized prostate carcinoma. All of the patients underwent radical retropubic prostatectomy. Patient age was in range from 57 to 70 years of age, with average value of 63 years of age. Gleason score values were: GS 8--2 patients, GS 7--6 patients, GS 6--10 patients, GS 5--9 patients, GS 3--4 patients GS 10--1 patient. Duration of the surgery was in the range of 55 to 95 minutes with the average blood loss between 220 and 640 ml. Fifty percent of the patients did not required blood transfusion. RESULTS: After radical retropubic prostatectomy all patients are continent. Average urinary catheter removal time was 12 days after surgery. Postoperative surgical wound healing was prolonged for 4 patients. One patient had stenosis of urethrovesical anastomosis with was resolved with urethral dilatation. Control PSA values for 29 patients tree months after surgery was under 0, 2 ng/ml. Three patients were diagnosed with local tumor recurrence who underwent radiotherapy and latter on with hormonal therapy protocol. All patients are alive. CONCLUSION: Results of surgical treatment of localized prostate carcinoma have shown that the radical retropubic prostatectomy is the safe method for treatment of the localized prostate cancer, with good oncological response and small amount of postoperative complications.

Evaluation of comparative results of rehabilitation of patients with acromioclavicular dislocation of the third degree treated by surgical techniques by Phemister and Vukov.

INTRODUCTION: In terms of access to treatment of acromioclavicular joint injuries, there are many controversies, especially after the appearance of works that promote "neglecting of injury". GOAL: The aim of this paper is to give a comparative analysis of the results of rehabilitation of patients after acute injury of the acromioclavicular joint of the third degree, treated by two surgical techniques: by Phemister and Vukov. MATERIAL AND METHODS: In this study, we investigated a total of 60 operated patients: 30 patients were operated by Phemister techniq-ue, and 30 by Vukov technique. RESULTS: Postoperative follow-up lasted for one year. Between these two groups, the time when the rehabilitation process began is significantly different p < 0.01. With technique by Vukov, the rehabilitation begins on the first postoperative day and with technique by Phemister it begins later (after 7 weeks outpatient). With technique by Phemister, rehabilitation lasted on average 60 days, and with technique by Vukov on average 40 days. The duration of recovery is also significantly different p < 0.01, with technique by Vukov the duration time is shorter, and therefore the process of rehabilitation in days--is shorter than with the other technique. Both techniques gave good stability of the lateral end of clavicle. The difference was not statistically significant p > 0.05, which means that both techniques can be applied depending on the indication and the experience of the surgeon.

Rehabilitation of a patient after operationally treated idiopathic recurrent, posterior shoulder subluxation.

INTRODUCTION: involuntary, idiopathic, recurrent posterior shoulder subluxation is a rare entity. Subluxation of the shoulder joint occurs with every elevation movement of the hand with a certain level of pain. Active abduction and anteflexion are possible only to 90 degrees. Only surgical treatment produces results. GOAL: The goal is to show that timely commenced, continuously conducted rehabilitation of the shoulder after surgically repaired involuntary, idiopathic, recurrent posterior subluxation of the shoulder, leads to restitution of function. Case outline R.M. patient 24 years old, was admitted to the Institute for Orthopaedic Surgery and Traumatology, Clinical Center in Belgrade, for surgical treatment. Previously was treated conservatively. ROM (anteflexion 700 abduction 60 degrees) with persistant pain in shoulder. Rehabilitation started first postoperative day. RESULT: - 2.5 months post surgery- ROM (active movement) antetlexion 165 degrees, abduction 140 degrees, without pain and no tendency of posterior subluxation. - 3.5 months post surgery,full active movements were achieved, except external rotation of -20 degrees. - 5 months post surgery, the patient had full range of motion in all directions.The last control was performed one year after surgery. The patient has no symptoms, lives normal life and is engaged with sports.

Multiple port-site metastasis of incidental gallbladder carcinoma after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a surgical procedure of choice for benign gallbladder diseases. In about 1-2% of cases histopathological examination demonstrate incidental gallbladder cancer (GBCA). We report a case of a 61 year old woman who developed port site metastases after laparoscopic cholecystectomy for adenocarcinoma of the gallbladder. Metastases appeared on all four port sites. Review of literature regarding incidental GBCA an port site metastases was also performed. We conclude that the retrieval bag should be routinely used in laparoscopic cholecystectomy; the procedure should be performed with minimal trauma; in cases of incidental GB carcinoma, full thickness excision of the abdominal wall of the port sites demands additional studies; additional liver bed excision and local lymphadenectomy for T1b carcinoma are yet to be considered.

The effect of low frequency pulsing electromagnetic field in treatment of patients with knee joint osteoarthritis.

Pulsing electromagnetic field represents effective rocedure in treating of diverse diseases and p pathologic conditions, especially in rheumatology, orthopaedics and traumatology. The goal of this research is the objective evaluation of the treapeutic effect of low frequency pulsing electromagnetic field (LFEMF), in comparison with the effect of the other physical procedure: interfererence currents (IFC) and the medicamentous therapy, in treating of patients with knee joint osteoarthritis. This study was made as experimental, randomized, controlled clinical trial, opened type. The examination included 60 patients (40 females and 20 males) with osteoarthritis of the knee joint. All patients were divided in three groups. The first group of 20 persons, composed of patients treated with medicamentous therapy (Diklofenak of 100 mg, 2 tablets per day). The second group consisted of 20 patients treated by LFPEMF and the third group consisted of 20 patients treated by IFC. All procedures were implemented during 10 days All of patients had also the same duration therapeutic exercise. As observing parameter was used: Lattinen test for the evaluation of the pain sensitivity, before and after therapy. For the statistical analysis of the aquired data, was used Student's t-test. After therapy the pain was considerably reduced in each group, but this effect was the most significant in the II group of the examinees, treated by LFPEMF (p< 0.001), than the effects in other groups of patients: I group (p< 0.05) and III group (p< 0.01). According to the results of this study it can be concluded that LFPEMF is very effective therapeutic procedure in treatment of patients with knee joint osteoarthritis.

The effects of early rehabilitation in patients with surgically treated colorectal cancer.

Colorectal cancer is one of the most common cancer. Caught early, it is often curable. The important role in functional recovery of these patients, have enhanced recovery after surgery (ERAS) clinical care protocol and early rehabilitation. The goal of this research is the objective evaluation of the effects of early rehabilitation in patients after surgical treatment of colorectal cancer, respecting their functional recovery and quality of life, before and after rehabilitation. Tis study was made as experimental, randomized, controlled clinical trial, opened type.The examination included 58 patients (39 males and 19 females), age from 36 to 85 years, average 63.3, with surgically treated colorectal cancer. All patients had appropriate early multimodal accelerated rehabilitation program.The mean value of this program was 7,24 days. As observing parameter was used short form, 36 items health related questionnaire (SF-36), with two summary measures-Physical component summary (PCS) and Mental component summary (MCS), for the evaluation of quality of life, before and after treatment. For the statistical analysis of the aquired data, before and after therapy, was used Student's t-test. Afer therapy, the quality of life of patients was significantly improved, physical health (p< 0.01), as well as mental health (p<0,01). SF36 score after rehabilitation, show important improvement of quality of life in early treated patients. These results show exellent therapeutic possibilities of enhaced recovery clinical care protocol and early rehabilitation procedures. Acording to the results of this study, it can be concluded that early rehabilitation accelerated program is very effective in treatment of patients with surgically treated colorectal cancer.

The dissolution of multiple renal uric acid stones via percutaneous nephrostomy in the patient with a solitary kidney.

INTRODUCTION: The dissolution of urinary stones could be performed in the patients with urinary obstruction caused by phosphate, or uric acid stones, through the percutaneous nephrostomy (PCN). CASE REPORT: A 27-year-old woman with complete obstruction of the solitary left kidney due to uric acid stones is presented. The woman was admitted in emergency unit due to anuria. Five days after PCN, irrigation with 1.6% sodium bicarbonate solution was initiated. Due to complete ureteral obstruction, the "Y" extension with the valve was connected to PCN and to the urinary bag, which enabled the patient to perform intermittent self-irrigation. After 12 days of irrigation, all the stones dissolute and ceased. CONCLUSION: In the era of ESWL, PCNL and ureterorenoscopy, PCN-dissolution of urinary stones is rare procedure. However, this minimally invasive procedure could be successfully performed in selected cases.

A 10-cm big stone formed in ileal conduit six years after cystectomy.

INTRODUCTION: Ileal conduit (IC) is the standard urinary diversion following radical cystectomy. The formation of stone in the IC is one of the relatively common late complications of the procedure. CASE REPORT: The case of 69-year-old man who developed 10-cm large stone in the IC, six years after cystectomy is presented. CONCLUSION: The majority of patients with the stone in IC can be treated with minimally invasive techniques, like manual extraction, or endoscopic procedures.

Gigantic transitional cell carcinoma of the renal pelvis in the region of endemic nephropathy.

AIMS: To present the rare case of transitional cell carcinoma of the renal pelvic in the region of endemic nephropathy. PATIENT REPORT: A 64-year old man with gigantic urothelial carcinoma in renal pelvis and ureter. Patient underwent right nephrectomy. Hystopathological analysis after right nephrectomy revealed urothelial transitional cell carcinoma, grade III-IV with infiltration of right ureter. After one month, because of the hystopatological findings, patient underwent ureterectomy on the right side. RESULTS: Two years after surgery there are no signs of primary disease or metastasis and the cystoscopy findings are normal. CONCLUSION: Despite the poor prognosis, two years after surgery patient is without signs of primary disease or metastasis.

Simultaneous ipsilateral testicular seminoma with pelvic ectopy and hematovesicula seminalis.

We present a rare case of 24 years old male who was diagnosed with simultaneous testicular tumor with pelvic ectopy and ipsilateral hematovesicula seminalis. Hemospermia was the only presented symptom. Patient underwent surgery and removal of the testicular tumor and right vesiculectomy were performed. Histopathological analysis revealed seminoma of the right testis and dilated right vesicula seminalis filled with hemorrhagic fluid and sings of chronic inflammation. Postoperatively irradiation of the abdomen was performed using standard protocol. Ten years after surgery there was no signs of decease recurrence.

Osteo-articular diseases as comorbidity in non-orthopaedic surgery.

Osteo-articular diseases have significant presence among general population. Osteo-articular disorders can be caused by disease or by trauma. There are many osteo-articular diseases which have influence on general state of the organysm and on other present diseases in a various level. The influence appears by increasing risk of main disease complications, limited movement complicates postoperative treatment of main disease and medicament therapy of osteo-articular disease sometimes modifies perioperative therapy of main disease. Trauma as comorbidity needs urgent care and, in the same time, it is a huge complication for the injured condition. Osteoarticular trauma healing usually lasts several weeks, so it prolongs the healing of intercurrent surgical disease. Osteo-articular changes as comorbidity during the acute surgical disease healing need proper preoperative preparing, With the aim to minimise perioperative morbidity and mortality.