First thousand rectal cancer cases--local recurrence and survival.

In the period 1990 - 2002, 1674 patients with colorectal carcinoma were operated in the First Surgical Clinic, Third Department for Colorectal Surgery. In 1264 cases (75.5%) rectal carcinoma was the indication for surgical treatment. Sphincter saving procedures (SSP) were performed in 824 (65.2%), abdominoperineal resections (APR) in 340 (26.9%) and resections of rectum with definitive stoma (Hartmann procedure) in 100 (7.9%) patients. We analyzed 1095 cases where curative SSP or APR were performed. All cases where curative resection was not possible because of liver metastases or inability to excise all macroscopic disease were excluded. In the group of patients where SSP was performed (767 cases), there were 26.6% high colorectal anastomoses (8cm from anal verge), 65.4% with low (4-8cm from anal verge) and 8.0% with intersphincteric coloanal anastomosis (cm from anal verge). Patohistological exam showed 5.3% Dukes A, 53.1% Dukes B, 36.5% Dukes C and 4.9% Dukes D. In the APR group (328 cases) there were 1.,5% Dukes A, 32.4% Dukes B, 62.1% Dukes C and 3.5% Dukes D. In this study we analyzed local recurrence and five-year survival in both groups. Recurrence of the disease was registered in 325 (29.6%) out of 1095 patients. Local recurrence was found in 81 (7.,4%) patients. In the SSP group recurrence occured in 215 (28.0%) out of 767 curative resections. Local recurrence alone was found in 53 patients (6.9%). SSP group was also divided into two subgroups; in the first group TME was performed and in second transection of mesorectum was carried out. Analyzing local recurrence in these two groups, in the TME group it was 7.6% and in the transection group 5.6%. In the APR group recurrence was registered in 110 (33.5%) out of 328 patients while local recurrence alone was found in 28 (8.5%) cases. Analyzing mortality we found that 234 (21.4%) out of 1095 patients died during follow-up. In the SSP group 154 out of 767 patients (20.1%) died. In the TME group mortality was 21.7% and in the transection group 16.9%. Mortality in the APR group showed that 80 out of 328 (24.4%) patients died during follow-up. Analysis by the Kaplan-Meier's test shows cumulative survival of 0.69 for all cases. In the SSP group cumulative survival is 0.72 and in the APR group 0.64 with statistically significant difference (p .001). In the TME group cumulative survival is 0.75 and in the transection group 0.,72 with statistically significant difference (p .05). We believe that performing SSP should be encouraged whenever it is possible because there is no difference in local recurrence rates and survival compared to APR. Transection of mesorectum can safely be performed in most cases with tumors located more than 8 cm form anal verge. We believe that exact preoperative staging and preoperative radiotherapy could improve results.

Ganglioside a/b ratio in different rat brain regions following chronic diazepam treatment.

Gangliosides are sialic acid-containing glycosphingolipids that play a variety of important functions in neurons. The main purpose of this study was to determine the a/b ratio of gangliosides in different rat brain regions (cerebral cortex, hypothalamus, caudate nucleus, hippocampus, thalamus and cerebellum) after prolonged diazepam treatment. Male Wistar rats were maintained on a nutritionally adequate diet and diazepam was administered in a dose of 10 mg/kg day for 180 days. Total gangliosides were extracted according to Harth and the total ganglioside-NeuAc content was determined by Svennerholm's resorcinol method, modified by Miettinen and Takki-Luukkainen. The a/b ratio remained unchanged in rat hypothalamus, thalamus and cerebellum. It was slightly decreased in the caudate nucleus and hippocampus, but this was not statistically significant. A drastic decrease ( p<0.01) in ganglioside content, compared to control animals, was found in rat cerebral cortex. Ganglioside a/b profile did not change significantly in most of the brain regions (except in cerebral cortex), which suggests that adaptive changes occurred upon prolonged exposure to diazepam, in order to maintain the physiological ratio of ganglioside a- and b-series in distinct brain areas.

Local recurrence and five year survival after abdominoperineal resection of the rectum due to rectal carcinoma.

In the period 01.01.1991-12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65.2%. In the middle third, there were 28.9% and in the upper, intraperitoneal third 5.9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4.9% cased with Dukes D stage). There were 74.3% males and 23.7% females median age 59.2 years. According to Dukes classification there were 4.9% in stage A, 47.2% in stage B, 43.1% stage C, and 4.9% stage D. There were 4(2.7%) postoperative deaths. Recurrence of the disease was registered in 44 (30.5%) patients. Local recurrence alone was found in 14 (9.7%) patients, while distant spread was registered in 30 (20.8%) patients. At present, the median follow-up is at 72.9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63.4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; survival after 60 months of follow up shows cumulative Survival of 0.35 while Dukes B has far better prognosis (0.86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0.36 after 60 months), while stage B has much better prognosis (0.84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84.9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1.00% disease free survival for cases in stage A, 0.94 for Dukes B and 0.66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p-0.005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

[New surgical approaches in splenic diseases]. / Novi terapijski pristupi u hirurgiji oboljenja slezine.

To improve the success of postoperative results, in the surgeries of the spleen diseases new procedures had been developed from hematological pretreatment to further operative and postoperative treatment of the patient. Elective splenectomy is quite a big anesthetic challenge. In the period from 1996 to 1998 in the Institute for digestive diseases 147 splenestomies had been done as a consequence of the spleen diseases. Before the operation there is no reason for compensate the platelets if their number is equal or bigger than 50 x 10(9)/l unless the patient is bleeding. If the patient has less than 50 x 10(9)/l the operation shouldn't postponed if we have previously prepared enough doses of platelets from the separator the pool, or the ordinary platelets. Now days at our clinic we operate the patients with extremly plateleptema. The operations have been very successful. The team work of surgeons, anestehsiologists and hemathologist is the most important thing.

Long-term results after low anterior stapled anastomosis.

In the period 01.01.1991-12.31.1996, 286 low anterior stapled resections of the rectum due to rectal carcinoma were performed at the First Surgical Clinic, the Third Department for Colorectal Surgery, Belgrade. There were 57% males and 43% females, median age 59.6 years. The most common localization of tumor was in the distal third of the rectum 181 (63%). In the middle third, there were 89 (31%) and in the upper, intraperitoneal third 16 (6%). Histopathological examination revealed adenocarcinoma in all cases. All operative specimens were examined by one pathologist and classified according to the Gunderson-Sosin modification of Dukes classification. There were 14 (4.9%) in stage A, 167 (58.4%) in stage B (B1,B2,B3), 89 (31.1%) stage C (C1,C2,C3) and 16 (5.6%) stage D. According to Broders classification, there were 129 (45%) well differentiated, 142 (50%) moderately and 15 (5%) poorly differentiated tumors. Anastomotic dehiscence was found in 17 patients (5.95%), mostly conservatively treated, except in 6 cases where spreading peritonitis developed requiring operative treatment. There were 9 (3.1%) postoperative deaths, a half of them with specifically operation related mortality. Recurrence of the disease was registered in 47 (18%) patients, out of 260 who were regularly followed up (26 were lost). Local recurrence alone was found in 21 (8.0%) patients, while distant spread was registered in 22 (8.46%) patients. Local and distant spread was found in 4 (1.5%) cases. At present, the median follow-up is at 54 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 66% at 71 months of the follow-up. Seventy four percent of patients with curative operations exhibit no signs of recurrence at 5 years.

Ganglioside content and composition in rat cerebellum after prolonged diazepam treatment.

The main purpose of this study was to determine the content and composition of cerebellar gangliosides after prolonged diazepam treatment and their possible recovery after diazepam withdrawal. Male Wistar rats were administered diazepam in a dose of 10 mg/kg/day in drinking water for 3, 5 or 6 months. A additional group of rats had a one-month recovery period after five months of diazepam treatment. Control animals were age-matched and pair-fed. At the end of the experiment, the animals were sacrificed and the total cerebellar contents of ganglioside-NeuAc as well as its content in particular ganglioside fractions were estimated. After three months of diazepam consumption, no changes of ganglioside-NeuAc in investigated fractions (G(Q1b), G(T1b), G(D1b), G(D1a), G(M1), G(M2), and G(M3)) were observed. Five months of diazepam treatment caused a significant decrease in the total amount of gangliosides, which was evident in most of the investigated fractions, with the exception of the monosialoganglioside G(M2). Six months of treatment induced a generalized decrease in all the investigated ganglioside fractions. The diazepam-induced ganglioside reduction found after five months of treatment was also present after a one-month recovery period. The only fraction, which recovered and reached its control value, was monosialoganglioside G(M3).

[Gamma aminobutyric acid--its function, disorders and their sequelae]. / Gama-aminobuterna kiselina--funkcija, poremecaji i posledice.

Gama-Aminobutyric acid (GABA) is an important neurotransmitter that mediates inhibition in the central nervous system. Approximately 30-50% of all synapses are defined as GABA-ergic. GABA is a neurotransmitter in cortical and hippocampal interneurones. GABA-RECEPTORS: Till today, three receptor subtypes have been known: GABAA, GABAB and GABAC, which are pharmacologically different. GABAA receptor is postsynaptic and localized in central and peripheral sympathetic neurones. Its agonist is muscimol and is antagonized by bicucculline. GABAB is a presynaptic receptor of vegetative and central nerve terminals. Its agonist is baclofen. The main difference between these two subtypes is that the first one acts directly on Cl ionphore, while GABAB activity is mediated by Gi protein. GABAC receptors are the integral part of the membrane, which stabilise the resting potential of the cell by increasing conductivity for Cl. Their most effective agonist is TACA. GABA ACTIVITY ON SYNAPSES: GABA is the most powerful inhibitory neurotransmitter in CNS. Synaptic inhibition decreases cell's ability to communicate with other cells and it is realised by various inhibitory mechanism of GABA, such as preventing of stimuluss generation, dendritic inhibition and dendro-dendritic inhibition. GABA AND NEUROENDOCRINE REGULATION: Besides physiological significance in maintaining regular excitation and inhibition balance. GABA plays an important role in neuroendocrine regulation of the following hormones: LH, FSH, PRL, STH, SS, ACTH, TSH, TRH, MSH, VP and OX. GABA IN NEUROLOGICAL DISEASES: Increasing or decreasing of GABA-ergic tone, due to different reasons, may lead to numerous neurodegenerative disorders (epilepsy, hepatic encephalopathy, Huntington's chorea, spinocerebellar degeneration, dementia and psychosis).

[Gangliosides as neurobiochemical markers]. / Gangliozidi kao neurobiohemijski obelezivaci.

Gangliosides are primary brain membrane lipids which, due to their localization, present specific markers of certain nerve cells. Their structure and content is tightly connected with cytogenesis and histogenesis of brain in mammals. Their biologic function, at the surface of the neurons' membrane, is important for bioelectric neuronal activity and synaptic transmission. Apart from that, gangliosides are important as receptors of bacterial toxins. Effects that gangliosides may have on dendrites' and axons' growth have been studies and it can be concluded that they have a significant impact on recovery of ischemic brain lesions. They are also important therapeutic and diagnostic markers of certain malignant tumors. The most valuable results are expected in future by examination of gangliosides metabolism in neurologic diseases by application of cell cultures.

[Supplementary feeding--additional food in daily infant nutrition]. / Prihranjivanje--dodatna hrana u dnevnoj formuli ishrane odojceta.

A group of 707 children aged 1 to 24 months from the territory of Vojvodina (10 rural and urban settlements) was examined regarding additional food (nonmilk and milk food), time of introduction, infant's age and frequency of consumption. It has been concluded that supplementary feeding, including all food, starts early. Fruit and vegetable are introduced at the age of 34 months. As for the introduction of yolk (first given at about 4 months) it differs from the modern attitudes regarding the intake of this food. Milk formulae, meat and chicken liver are usually introduced about the fifth month. Analyses of the type of food and the way of preparation point to some extremities. Special emphasis is given to the environmental specificities which determine the recommendations.