Faculty of Medicine

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Обзор классификаций внутрипротоковых папиллярных муцинозных неоплазий, показаний к хирургическому вмешательству и его результатов
(VIDAR Publishing House, 2025)
Đorđević V.
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Markovic M.
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Protić M.
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Knežević Đ.
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Basarić D.
Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cystic lesions with malignant potential. This review outlines current guidelines, surgical indications, outcomes, and surveillance strategies. It also highlights recent advances in minimally invasive surgery and emerging biomarkers aimed at improving risk stratification and reducing unnecessary resections.
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Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
(Wiley-Blackwell, 2021-11)
COVIDSurg Collaborative et al.
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We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
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Variation in level of entry of the vertebral artery into the transverse foramen
(Macedonian Association of Anatomists and Morphologists, 2011)
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Aliji, Vjolca
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The aim of this study was to analyze the variable level of entrance into the transverse foramen and to point the risks of injury of the vertebral artery during accomplishing surgical procedures. For that purpose we examined 40 patients with CT angiography and analyzed the level of entrance into the transverse foramen. The vertebral artery entered the C6 transverse foramen in 38 (95%) patients. Abnormal level of vertebral artery entrance was observed in two (5%) patients, with entrance into the C4 and C5 transverse foramen. The incidence of abnormal level of entrance into the transverse foramen is relatively high, and this potentially dangerous condition should be detected on preoperative imaging in order to avoid vertebral artery injury.
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Tortuosity of the vertebral artery
(Macedonian Association of Anatomists and Morphologists, 2011)
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Aliji, Vjolca
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Gjoreski, Aleksandar
The aim of this study was to analyze the tortuosity of the vertebral artery and to emphasize the clinical importance of tortuosity. The data derived from this study will add important contribution to our anatomical knowledge, but they will also find clinical applications in radiology and surgery. We examined 40 patients with CT angiography and analyzed the tortuosity of the vertebral artery. Of the vessels examined, 22 (55%) followed a relatively straight course from their origin to their entry into the transverse foramen. The other 18 (45%) patients showed some form of tortuosity. Both vertebral arteries showed high incidence of tortuosity. Our study has highlighted the possible role of vertebral artery tortuosity in diagnostic and surgical procedures in order to prevent vertebral artery injury.
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Surgeons' fear of getting infected by COVID19: A global survey
(John Wiley & Sons Ltd, 2020-08)
An Y
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Bellato V
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Konishi T
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Pellino G
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Sensi B
During the last three months, COVID-19 pandemic had led to a serious backlog of operations globally, and plans for restarting operation are imperative1–3. Recommendations for surgical activities were studied, aiming to protect the surgical staff from being infected4,5. In the meantime, it is also important to give attention to the surgeon's personal feeling during work. We conducted a survey to investigate global surgical practices during the COVID-19 pandemic6, and the surgeon's personal feeling was also investigated in the survey. In this special letter, we performed multivariate analysis to explore factors that associated with surgeon's fear of getting infected by COVID-19. In total, 1124 surgeons from 936 centers in 71 countries replied to the questions. Regarding surgeon's satisfaction towards hospital's preventive measures, 612 of the respondents (54·4%) agreed that their centers were taking enough preventive measures to avoid in-hospital transmission. With respect to the results by nations, respondents from the UK reported lowest satisfaction (6/27, 22·2%), while those from China (70/73, 95·9%) and the Netherland (26/33, 78·8%) reported higher satisfaction. When asked about the personal fear of getting sick or infecting others (1 point = never, 5 points = always), the respondents in overall reported a relatively high score (the mean ± SD of all respondents: 3·7 ± 1·3). The respondents from Mexico (4·7 ± 0·6, n = 31), the US (4·2 ± 1·2, n = 51) and Turkey (4·2 ± 1·0, n = 38) had higher scores, while those from the Netherlands (2·5 ± 1·2, n = 33) and China (2·6 ± 1·4, n = 73) had lower scores. In order to explore factors that were associated with surgeon's fear of getting infected, univariate and multivariate analysis were performed using the data from the entire survey (including content about COVID-19 testing policies, protective measures and COVID-19 caseload) (Table 1). Surgeons with personal fear were defined as those with 4 or 5 points in the question “Have you ever been afraid of getting sick or infecting others because of your work?”. The factors with P values < 0·1 in the univariate analysis were high risk country (P = 0·067), shortage of gloves (P = 0·077), shortage of gowns (P = 0·096), shortage of surgical masks (P < 0·001), satisfaction to hospital's measures (P < 0·001), available guideline (P = 0·019), episodes with asymptomatic patients in surgical settings (P = 0·001), experiencing in-hospital infections (P = 0·002), and staff infections (P = 0·006). The multivariate analysis of these parameters revealed that shortage of surgical masks (OR: 1·605, 95%CI: 1·120-2·299, P = 0·01), unsatisfaction towards hospital's preventive measures (OR: 2·155, 95%CI: 1·650-2·813, P < 0·001) and experiencing in-hospital infections (OR: 1·457, 95%CI: 1·052-2·018, P = 0·024) were independently associated with surgeon's fear of getting infected. It is noteworthy that high caseload (>10 cases) of COVID-19 in the centers (P = 0·544 in univariate analysis) and countries' pandemic status of high risk (P = 0·729 in multivariate analysis) were not related to surgeon's fear. (High risk countries are defined as the ones with death case number of COVID-19 being more than 5000 on 8th April.)
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Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices
(International Society of Global Health, 2020-12)
Bellato V
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Konishi T
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Pellino G
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An Y
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Piciocchi A
Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions.

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