Publications by authors named "Milan D Jovanovic"

8 Publications

  • Page 1 of 1

Predictive value of calcium test for preoperative diagnosis of medullary thyroid carcinoma in patients with moderately elevated basal calcitonin.

Endocr Pract 2021 Jun 30. Epub 2021 Jun 30.

Center for Endocrine surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia, Doktora Subotica 8, 11000 Belgrade, Serbia.

Introduction: Medullary thyroid carcinoma (MTC) can be very aggressive, and the early diagnosis is based on the routine measurement of serum calcitonin (CT) and on the RET genetic testing for hereditary forms. Basal serum CT concentrations (bCT) are helpful in the early detection of MTC, while it is still unclear whether they can be used also for the differential diagnosis between MTC and C cell hyperplasia (CCH). Since false-positive results can be gained with the basal measurement of calcitonin, a provocative test to evaluate stimulated calcitonin (sCT) is often needed.

Aim: The objective of this study was to investigate the utility of calcium gluconate test for CT in distinguishing MTC from CCH, a precancerous condition in hereditary forms of MTCs, but with unclear significance in sporadic MTCs.

Method: A total of 74 patients underwent the calcium loading test before thyroidectomy, and basal and stimulated calcitonin levels were compared with histological results by receiver operating characteristic (ROC) plot analyses.

Results: A peak of calcitonin after stimulation with calcium gluconate of 388.4 pg/ml was able to significantly distinguish patients with MTC from patients with CCH and patients without C cell pathology, with 81.8% sensitivity and 36.5% specificity. Basal calcitonin of 16.1 pg/ml was able to distinguish these two group of patients with 90% sensitivity.

Conclusion: High dose calcium test is potent procedure that can be applied for differential diagnosis of MTC and CCH. Reference ranges for calcium sCT levels and CT thresholds in different group of patients have been identified.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eprac.2021.06.011DOI Listing
June 2021

Reuse of the Masseteric Nerve for Dynamic Reanimation in Facial Palsy Patients with Previously Failed One-Stage Dynamic Smile Reanimation.

Plast Reconstr Surg 2019 12;144(6):1123e-1125e

Faculty of Medicine, University of Belgrade, and, Clinic for Neurosurgery, Clinical Centre of Serbia, Belgrade, Serbia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0000000000006235DOI Listing
December 2019

Case report of parathyroid carcinoma in a pediatric patient.

Int J Pediatr Otorhinolaryngol 2019 Sep 5;124:120-123. Epub 2019 Jun 5.

Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine University of Belgrade, Serbia.

Parathyroid carcinoma is extremely rare in pediatric population. The authors report a case of 15-year-old girl with extremely elevated serum calcium (4.1 mmol/L) and parathyroid hormone (1170 pg/mL), with palpable neck mass. After en bloc resection, the patient remained normocalcemic within the next 2 years. To the best of our knowledge, this is the fourteenth documented case of parathyroid carcinoma in patients younger than 16 years. Even though parathyroid carcinoma is very uncommon in children with good prognosis, this diagnosis has to be considered when a child has severe hypercalcemia, elevated parathyroid hormone and palpable neck mass.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2019.06.003DOI Listing
September 2019

Risk Factors for Intraoperative Hypertension during Surgery for Primary Hyperparathyroidism.

Med Princ Pract 2017 10;26(4):381-386. Epub 2017 Apr 10.

Objective: To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT).

Subjects And Methods: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure ≥20% compared to baseline values which lasted for 15 min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH.

Results: Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR = 2.080, 95% CI: 1.102-3.925, p = 0.024) and age (OR = 0.569, 95% CI: 0.360-0.901, p = 0.016).

Conclusion: In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000475597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768112PMC
June 2018

Surgical treatment of concomitant thyroid and parathyroid disorders: analysis of 4882 cases.

Eur Arch Otorhinolaryngol 2017 Feb 12;274(2):997-1004. Epub 2016 Sep 12.

Center for Endocrine Surgery, Clinical Center of Serbia, Koste Todorovica Street 8, Belgrade, Serbia.

The thyroid gland disease incidence in hyperparathyroidism (HPT) is higher than the incidence of thyroid disease in general population. Likewise, HPT is more frequent in patients primary admitted due to thyroid disease, than in general population. The aim of this study was to determine the incidence and clinical characteristics of concomitant HPT and thyroid disease, based on a single center experience. From 2009 to 2014, a total of 4882 patients underwent thyroidectomy and/or parathyroidectomy at the Center for Endocrine Surgery, Belgrade. We reviewed the database to find out indications for surgery, clinical characteristics, operative and histopathological findings. Out of 4033 patients, who underwent thyroidectomy, in 114 cases (2.8 %) parathyroidectomy was simultaneously performed. Out of these 114 patients, 42 patients (37 %) had normocalcemic HPT. Among 849 patients primary operated due to HPT, thyroid gland disease that required surgery was found in 224 (26.4 %). In patients primary seen for HPT, thyroid cancer was found in 22 (9.8 %), Hashimoto's thyroiditis in 41 (18.3 %) and micropapillary carcinoma in 36 cases (16.1 %). Due to residual or recidivant HPT, 16 patients (15 who primary underwent parathyroidectomy and 1 primary seen for thyroid disease) needed a reoperation. There are a considerable number of patients with concomitant thyroid and parathyroid disease; this justifies the routine analyses of calcemia and PTH level in patients preparing for thyroidectomy, and sets up the ground for the thyroid investigations in HPT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-016-4303-zDOI Listing
February 2017

Surgical treatment and dilemmas in the treatment of basal cell carcinomas with intracranial propagation.

Vojnosanit Pregl 2014 Nov;71(11):1045-8

Background/aim: Basal cell carcinoma (BCC) is one of the most common malignant skin tumors on the head in 90% of cases and is characterized by a high local infiltrating potential and destructive growth. The aim of this study was to show the characteristics of a correlation between pathohistological types of basal cell carcinoma and the size of this lesion, aggressiveness and infiltration of basal cell carcinoma, and its effect on the course of the therapy.

Methods: We analyzed 27 patients operated on for BCC that affected the scalp and the bone. We described and considered the clinical characteristics (size, depth of invasion), duration and speed of intracranial propagation and then made comparison with the type of BCC. We described the extent of surgical treatment and the width of excision to determine the best course of the treatment. The patients went through examinations during the next three years.

Results: According to the histopathological type the most common tumors were: infiltrative (60.2%), noduloinfiltrative (37.2%), and morpheaform (2.6%). Tumors were clinically manifested as ulcerative lesions, ulcus rodens and ulcus terebrans. Tumor diameters ranged from 2 to 25 cm. The depth of intracranial propagation depended on the histological type and tumor size. Most relapses (35%) occurred with morpheaform type of BCC. In 17 of the cases, BCC affected the bone without intracranial propagation. In 10 of the cases, basalioma infiltrated intracranial space--in 8 of the cases it infiltrated the dura and in 6 of the cases the brain parenchyma, of which in two of them, the superior sagittal sinus was affected and had to be surgically tied off.

Conclusion: The aggressiveness and infiltration of basal cell carcinoma into the brain parenchyma is directly linked to the histological type and the size of the tumor. The larger the basalioma or if histopathological findings confirm morpheaform type of basalioma the larger surrounding healthy tissue, sometimes more than 3 cm in diameter, needs to be removed. In cases of these tumors postoperative radiotherapy is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/vsp1411045rDOI Listing
November 2014

Personal approach to the correction of prominent ears.

Plast Reconstr Surg 2013 Apr;131(4):663e-664e

Department of Plastic and Reconstructive Surgery, University of Belgrade School of Medicine, and Institute for Burns, Plastic, and Reconstructive Surgery, Clinical Center of Serbia, Belgrade, Serbia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0b013e31828278e0DOI Listing
April 2013

Design of the Limberg flap by a specially designed ruler: a personal approach.

Plast Reconstr Surg 2004 Feb;113(2):653-8

Department of Plastic and Reconstructive Surgery, Belgrade University School of Medicine, Institute for Burns, Serbia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.PRS.0000101534.00262.C6DOI Listing
February 2004
-->