Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

Introduction/Objective The aim of the study is to analyze the treatment of spontaneous pneumothorax (PSP) through our 10-year experience. Methods The study included 67 patients with PSP treated with video-assisted thoracoscopic surgery (VATS) or with thoracic drainage (TD) in the Clinic for Chest Surgery at the Military Medical Academy in Belgrade, Serbia in the 2008-2017 period. Results PSP patients with VATS were younger (33.2 ± 16.4 vs. 45.5 ± 21.5 years, p = 0.010), and both groups consisted mainly of males (69.2% vs. 78%). VATS-treated patients were hospitalized shorter and wore drains (p < 0.001, p < 0.002). Recurrence after treatment was more common after TD (61% vs. 3.8%) and in most cases it was treated with VATS (92%). The incidence of intraoperative complications is similar between groups (p = 0.599, p = 0.636, p = 0.311, p = 0.388, p = 0.388, respectively). Pain was more common in TD (p < 0.001). The early complications in the group of patients treated with TD occurred more often (p < 0.001, p < 0.001), without significant difference in the incidence of pleura infections and intercostal blockade between groups (p = 0.388, p = 0.388, respectively). Patients treated for PSP with the VATS method came to the control follow-up later, compared to patients treated with TD (p < 0.001). Conclusion VATS proved to be efficient, which was reflected in the optimal duration of surgery, length of hospitalization, tolerable postoperative pain and satisfactory cosmetic effect, and postsurgical relapse in only one case.

Introduction. The aim of this manuscript was to report a case series of three patients diagnosed with multiple primary synchronous cancers (MPSC) in the lungs who were treated multidisciplinary at a single-center institution. Outline of cases. Three male patients were referred to the Clinic for Chest Surgery, at the Military Medical Academy in Belgrade, Serbia for planned surgical treatment of previously detected lung cancers. During subsequent diagnostic procedures, second primary synchronous tumors were detected in all presented cases. All patients underwent surgical resection and chemotherapy or a combination of chemo- and radio- therapy. Two of three patients died with an average survival period of 32 months. One patient is still alive, with current disease-free interval of 21 months. Conclusion. MPSC is a rare condition. The final diagnosis should be based on clinical, radiological, histopathological, and genetic analyses. Treatment modalities of MPSC depend on the clinical staging of the disease, patient?s general medical condition, and general assessment of tumor operability and resectability.

lečenje bolesnika, osmišljavanje i pisanje rada Aleksandar Nikolić-lečenje bolesnika, saradnja pri pisanju rada Vlado Cvijanović-lečenje bolesnika, saradnja pri pisanju rada Aleksandar Ristanović-korekcije jezika, saradnja pri pisanju rada Nataša Vešovićkorekcije jezika, pronalaženje literature Dejan Stojković-tehničko ureĎivanje rada, pronalaženje literature Vanja Kostovski-pisanje apstrakta Ljubinko Đenićprevod na engleski jezik Stevan Čičićprevod na engleski jezik 3

Introduction/Objective. Besides sternotomy, video-assisted thoracoscopic surgery (VATS) is used for treatment of thymus tumors. The objective of our study is to compare oncological and perioperative outcomes in patients with I-II stage of thymic tumors treated with video-assisted thoracoscopic surgery or standard sternotomy procedures. Method: The study included only primary I-II thymoma according to the Masaoka classification treated between May 2006 and February 2018. Out of 116 treated patients that had pathohistologically verified stage, 100 (86. 2%) were matched by propensity score for sex, age, body mass index, myasthenia, tumor size, Masaoka classification stage. Oncological (direct post-operative survival, recurrence) and perioperative outcomes (intra and postoperative complications, length of hospitalization) that affect the efficacy and safety of surgical techniques have been analyzed and compared between the two groups. Results: Among 50 patients operated by VATS, 34 patients (68%) were treated by uniportal approach, 13 (26%) by biportal and three (6%) by threeportal approach. The VATS intervention had shorter intervention time (p < 0.001), duration of hospitalization (p < 0.001), and usage of thoracic drainage (p < 0.001). There was a significant difference in terms of late control (p < 0.001). There was no significant difference between the groups regarding visual analog scale score, as well as in terms of the time of recurrence (p = 0.305, p = 0.268). Conclusion: Compared to standard sternotomy, VATS thymectomy is an equally effective and significantly safer method with a minimum rate of intra and postoperative complications.

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Strategic management has applications in many areas of social life. One of the basic steps in the process of strategic management is formulating a strategy by choosing the optimal strategy. Improving the process of selecting the optimal strategy with MCDM methods and theories that treat uncertainty well in this process, as well as the application of other and different selection criteria, is the basic idea and goal of this research. The improvement of the process of the aforementioned selection in the defense system was carried out by applying a hybrid model of multicriteria decision-making based on methods defining interrelationships between ranked criteria (DIBR) and multiattributive ideal-real comparative analysis (MAIRCA) modified by triangular fuzzy numbers–“DIBR–DOMBI–Fuzzy MAIRCA model.” The DIBR method was used to determine the weight coefficients of the criteria, while the selection of the optimal strategy, from the set of offered methods, was carried out by the MAIRCA method. This was done in a fuzzy environment with the aim of better treatment of imprecise information and better translation of quantitative data into qualitative data. In the research, an analysis of the model’s sensitivity to changes in weight coefficients was performed. Additionally, a comparison of the obtained results with the results obtained using other multicriteria decision-making methods was conducted, which validated the model and confirmed stable results. In the end, it was concluded that the proposed MCDM methodology can be used for choosing a strategy in the defense system, that the results of the MCDM model are stable and valid, and that the process has been improved by making the choice easier for decision makers and by defining new and more comprehensive criteria for selection.