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Background/Aim. Postoperative nausea and vomiting (PONV) are one of the most common causes of patient dissatisfaction in the postoperative period after general anesthesia. Hyperoxia may prevent PONV after abdominal surgery, but the effectiveness of intraoperative and early postoperative hyperoxia in preventing PONV after breast cancer surgery has not been fully elucidated. The aim of this study was to assess if the application of intraoperative hyperoxia during surgery could prevent PONV. Methods. Forty female patients with breast cancer were recruited for the study, all of whom underwent surgical treatment of breast cancer with axillary sentinel node sampling or axillary lymph node dissection. A balanced general anesthesia was conducted, which was induced with propofol and maintained with sevofluran. Out of the 40 patients, 20 (in-tervention group) received a volatile gas mixture with a fraction of inspired oxygen (FiO2) of 0.8 L/min intraoperatively and, afterward, 3 L/min of oxygen via face mask for two hours after surgery. The other 20 patients (control group) received a FiO2 of 0.4 L/min during the surgery without further administration of oxygen in the early postoperative period. The presence and severity of PONV were assessed at 30 min, 4, 24, 32, 48, and 56 hrs after surgery with the use of the PONV numerical Intensity Scale by Wengritzky for evaluating clinically significant PONV in the first six hours after surgery. Data were collected in an Excel spreadsheet and analyzed using the independent Student’s t-test. Results. The overall incidence of PONV during the 30 min after the surgery was 17.5% (15% in the group of patients receiving FiO2 of 0.8 L/min and 20% in the group of patients receiving FiO2 of 0.4 L/min intraoperatively). There was no statistically significant difference between the two groups in the frequency of PONV, as well as in the severity of PONV, measured with the PONV Intensity Scale by Wengritzky (p ≥ 0.05). Conclusion. We found no benefit of intra- and post-operative hyperoxia in reducing the incidence of PONV. The data do not support routine administration of hyperoxia, in addition to antiemetics, for the prevention of PONV in patients undergoing breast cancer surgery.

In 2013, the National Assembly of the Republic of Serbia passed amendments to the Budget System Law prescribing the measure of the moratorium on employment in public services. The implementation of this measure was directed towards controlling (i.e. cutting) expenses and reducing the number of employees in the organizations financed from the government budget. Despite the analysis of the measure under scrutiny pointing out a lack of systematic, argumented and reliable reports and objective analyses of both positive and negative consequences of this decision, it appears that its application was associated with more negative consequences than positive ones whilst the largest and most significant effects were suffered by the sectors of healthcare, social protection and education. In addition, the negative consequences of the measure had a direct impact on women and young members of the workforce. The extension of this measure, in several iterations, has manifested itself through significant obstacles in the provision of services as well as a reduction in the quality of these services. Therefore, it is worthwhile to examine the content and the consequences of the application of the measure of the moratorium on public employment, certain legal dilemmas in relation to it, as well as whether the autonomy of public services has been restored following its repeal.

The paper presents the results of research conducted on the population of refugees and internally displaced persons in Kosovo and Metohija, stationed in four collective centers of the second northernmost municipality of Zubin Potok (Gazivode, Velji Breg, Jagnjenica and Donje Varage). The survey was conducted using a questionnaire method with a survey technique using the SILC survey (Income and Living Conditions Survey) on a representative sample. The goal was to collect data from a population that is mostly excluded from social surveys and census surveys, bearing in mind the fact that the aforementioned collective centers are located in Kosovo and Metohija, where official republican surveys of marginal groups have not been conducted for more than two decades. In accordance with the scope of work, the text shows only some indicators that showed the deprivation of the population of refugees and internally displaced persons.

Introduction. Marjolin’s ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of this tumor in more than 90% of cases. The rate of this rare malignant transformation is 1–2%. Marjolin’s ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. We present a large exophytic carcinoma of the lower leg as a rare form of this tumor ac-cording to the size and type together with reconstruction results. Case report. A 52-year-old man was presented with a large exophytic tumor on the left lower leg. The tumor was located at the site of the previous gunshot in-jury. The latent period was 22 years. Tumor size was 14 × 12 cm. Wide excision was performed (2-cm surgical margin), including the deep fascia, and the defect was closed by a split-thickness skin graft from the opposite thigh. Histology showed well-differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery, there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin’s ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm, and excision should include deep fascia. Multiple and repeated biopsies of chronic wounds are advised. There is no consensus on the staging of Marjolin’s ulcer and lymph node dissection.

Taking into consideration that the geographical distribution of the specific wedding terms related to wedding customs and rituals in Serbian ethnic and dialectal regions is still rather unknown, as well as the fact that the ethnological monographic studies contain relatively detailed descriptions of the practices and the "standardized" forms used in naming, this paper presents the inventory of the terms used in naming people who take part in the wedding customs and rituals, based on the ethnic-dialectal materials collected in and around Leposavić, with the aim of placing the linguistic and ethnographic elements in the cultural and areal context.

Background/Aim. Immune checkpoint therapy is a well-established therapeutic approach in the treatment of malignant diseases and is thought to be mostly based on facilitating the adaptive immune response. However, the cells of the innate immune response, such as natural killer T (NKT) cells, might also be important for a successful anti-programmed cell death protein-1 (anti-PD-1) therapy, as they initiate the antitumor immune response. The aim of this study was to investigate the influence of anti-PD-1 therapy on the immune response against tumors. Methods. For tumor induction, 4T1 cells synergic to BALB/c back-ground were used, after which mice underwent anti-PD-1 treatment. After the mice were sacrificed, NKT cells, dendritic cells (DCs), and macrophages derived from spleen and primary tumor tissue were analyzed using flow cytometry. Results. Anti-PD-1 therapy enhanced the expression of activating molecules CD69, NKp46, and NKG2D in NKT cells of the tumor and spleen. This therapy activated NKT cells directly and indirectly via DCs. Activated NKT cells acquired tumoricidic properties directly, by secreting perforin, and indirectly by stimulating M1 macrophages polarization. Conclusion. Anti-PD-1 therapy activates changes in DCs and macrophages of primary tumor tissue towards protumoricidic activity. Since anti-PD-1 therapy induces significant changes in NKT cells, DCs, and macrophages, the efficacy of the overall antitumor response is increased and has significantly decelerated tumor growth.

The paper analyses the materials recorded in the regions of the Kosovo-Resava dialect and then used in the relevant monographic studies and dialect related publications with the aim of presenting the inventory and distribution of genitive plural forms. The areal data display contains the plural genitive forms of nouns of all three genders used in the regions where the three sub-dialects of the Kosovo-Resava area are spoken. The map also displays the use of archaic forms in some Kosovo-Resava regions (genitive ≤ locative forms), as well as the influences that other, non-Slavic Balkan languages have on the inflectional system, particularly in the border areas, that is, in the contact zones.

Introduction. An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor of unclear etiology, which demonstrates myofibroblastic differentiation accompanied by inflammatory cells. IMT is a frequent primary lung tumor in children and is of nonspecific symptomatology and imaging methods. Its definitive diagnosis requires histopathology and immunohistochemistry of the tissue sample obtained after a rigid bronchoscopy or after complete surgical resection. Case report. A 16-year-old male patient was admitted to our clinic for further treatment of IMT verified by rigid bronchoscopy. He had previously been treated at another institution for left-sided pneumothorax with thoracic drainage. Since it had not resulted in lung reexpansion, a chest computed tomography was performed followed by rigid bronchoscopy that eventually established IMT diagnosis in the distal part of the left main bronchus. Since the tumor sur-rounded the left lobar carina and infiltrated the pulmonary artery, pneumonectomy was undertaken. Its morphology and immunoprofile determined the IMT diagnosis. Four years after surgical resection, the patient showed no recidivism of the illness. Conclusion. IMT is one of the most frequent primary lung tumors in children and needs to always be suspected up-on. Pneumothorax can appear as an IMT manifestation. Its occurrence could be the consequence of either a visceral pleura lesion in case of peripheral tumors or a ball valve mechanism in case of endobronchial tumors. Definitive diagnosis of IMT requires not only histopathology but also immunohistochemical analysis. Complete surgical resection results in the best survival rates. Further monitoring of patients is necessary due to the risk of recurrence.

Introduction/Objective. The essence of the treatment of degenerative knee joint diseases is pain relief, restoring motion range and stability of knee joints. Methods. In this study, 35 patients participated after having surgery of the knee joint. The patients had a posterior-stabilized (PS) endoprosthesis in one joint, and a posterior cruciate ligament retaining (CR) endoprosthesis in the other. Kinematic data was collected using a 3D optical system for tracking fluorescent markers in time. Based on these data, the following parameters were determined: degree of flexion, mediolateral (ML) translation, lateral gap, medial gap, and the angle of change between the transtibial and transfemoral axes. Results. The results show a more pronounced flexion degree with the PS prosthesis compared to the CR prosthesis. Also, the results show negligible values of the ML translation, lateral gap, and medial gap in both types of prostheses. Using the non-parameter Wilcoxon test, a substantial difference in the angle change between the transtibial and transfemoral axes was confirmed, that is, in the flexion angles on the CR and PS prostheses. Conclusion. This study shows that there is no great difference in the use of the PS or CR designs of endoprostheses. Better behavior and range of motion in the knee joint were established with the implantation of the PS endoprosthesis. This conclusion is confirmed by the substantial difference in the degree of flexion of the knee joint and in the position of the transversal axes of the tibia and femur.

Background/Aim. Mechanisms responsible for the beneficial effects of aerobic exercise training on cardiovascular function are well known, but detraining effects on myocardial parameters have not been adequately elucidated. Therefore, the study aimed to determine the occurrence and speed of cardiac adaptation reversibility after the cessation of aerobic exercise and to reveal gender differences in achieved effects of training/detraining. Methods. Fe-male and male Wistar albino rats were divided into the following groups: control, trained, and two detrained groups. Hearts were perfused according to the Langendorff technique and the following cardiodynamic parameters were determined: the maximum and minimum rate of pressure development in the left ventricle (dp/dt max and dp/dt min, respectively), systolic and diastolic left ventricular pressure (SLVP and DLVP, respectively), heart rate (HR), and coronary flow. Results. Training significantly reduced values of dp/dt max, dp/dt min, and SLVP in males and females, and coronary flow in males. Detraining caused a reversion of those changes, which was gender-specific. In females, levels of SLVP were higher after 4 weeks of detraining compred to training, and after 2 weeks of detraining. Values of SLVP were lower in both detraining periods compared to training in males. Males had higher coronary flow after 2 weeks of detraining. Simultaneously, coronary flow was reduced in the 4th week of detraining in females. Conclusion. By using a model of the isolated rat heart, the present study confirmed the existence of training-induced changes in cardiac function. Cessation of training was followed by the loss of those adaptations, faster in males than females.

Background/Aim. Although considered rare, gliomas cause morbidity and mortality disproportionate to their incidence. The aim of the study was to determine whether pre and post-therapeutic metric values, derived from the FDG PET/CT maximal standardized uptake value (SU-Vmax) and calculated ratios between tumor and normal brain tissue, may provide a predictive/prognostic biomarker information in estimating overall survival of glioblastoma patients. Methods. In 26 out of 31 patients with glioblastoma treated with standard Stupp protocol after maximal safe reductive surgery, we performed a baseline 18F-FDG PET/CT examination before commencing combined and concomitant chemotherapy/radiotherapy (pre-therapy FDG PET/CT) and a second examination three months after the therapy completion (post-therapy FDG PET/CT). Two-graded SUVmax values and a calculated ratio of uptake in tumor-to-normal-tissue (T/N ratio) value, divided into two grades by the calculated cut-off value, were measured in all patients at both pre- and post-therapy FDG PET/CT studies. Data sets were statistically analyzed by the Kaplan-Meier survival test and Log-rank was calculated, with the level of confidence determined at p < 0.05. Results. Pre-therapy FDG PET/CT two-grade T/N ratio value and both pre-and post-therapy FDG PET/CT derived two-grade SUVmax values had a strong predictive impact on overall survival of glioblastoma patients. Conclusion. Based on two-grade SUVmax and T/N ratio values assessment, FDG PET/CT could provide valuable predictive survival information in glioblastoma patients and serve as a selection tool for identifying patients at higher risk from worse outcomes and shorter survival time.

Introduction/Objective. This prospective, randomized study was done to determine the efficiency and safety of the administration of intrathecal morphine chloride combined with the local anesthetic levobupivacaine given to female patients subjected to hysterectomy to ensure postoperative analgesia. Methods. The study sample consisted of 50 patients who were to undergo hysterectomy with adnexectomy and they were divided into two groups of 25 each. The patients in group A were given the combination of 0.3 mg of morphine chloride with 1.7 ml of 0.5% levobupivacaine immediately before the surgery, whereas the patients in group B were intravenously administered 5 mg of morphine chloride before the end of surgery, and after the surgery at certain time intervals. The postoperative pain was assessed at the first, sixth, 12th, and 24th hour by Numeric Rating Scale (NRS). Side effects, such as nausea, vomiting, itching and respiratory depressions were followed as well. Results. The postoperative pain was less expressed at any time interval both at rest and on exertion in group A (p < 0.001) and therefore the need for additional analgesia was less in group A (p < 0.001). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in group A (p < 0.001). Conclusion. Intrathecal administration of morphine chloride combined with levobupivacaine ensures better postoperative analgesia after hysterectomy than intravenous morphine chloride, their side effects being equally frequent..

Introduction. Accessory spleen represents ectopic spleen tissue separated from the body of the spleen, with the percentage share of 10–15% in a population. Case outline. We present a female patient in which immune thrombocytopenic purpura was diagnosed 12 years previously and, after a failed initial treatment, it was decided by a hematologist to perform a laparoscopic splenectomy. The mentioned operation was carried out in a safe and efficient manner wherein the accessory spleen was detected and removed intraoperatively. The operative and postoperative course passed without any complications. The definitive histopathological findings confirmed previously set hematological diagnosis. Conclusion. The laparoscopic approach is a superior modality in terms of diagnostic and therapeutic procedures when it comes to surgical removal of the accessory spleen. Taking into consideration the advantages of this approach presented and proven in literature, even in the case of diagnostically or intraoperatively overlooked accessory spleen or de novo discovered after the operation, there should be no dilemma which surgical approach should be applied.

Introduction/Objective. This study aimed to investigate the effects of preoperative dexamethasone use on the incidence and severity of postoperative nausea and vomiting (PONV), postsurgical pain, and vocal impairment after thyroid surgery. Methods. We performed a prospective, randomized, double-blind study with 50 patients who underwent thyroid surgery. Group A patients (n = 25) received 0.9% NaCl solution (2 ml) before anesthesia, patients in Group B (n = 25) were administered 8 mg of dexamethasone. All the patients preoperatively received 4 mg of ondansetron. During the first 48 hours after surgery, postoperative complications were monitored in defined periods. Results. PONV rate and severity was significantly lower in Group B than in Group A (p < 0.05). Patients in Group B reported less pain in resting and in activity (p < 0.05) and lower vocal impairment (p < 0.05) than patients in Group A in each defined time period. Conclusion. Preoperatively adding dexamethasone to ondansetron is more effective than use of ondansetron alone in the prevention of PONV. Dexamethasone significantly reduces the pain and improves voice function; therefore, we could advise routine single-dose dexamethasone use before thyroid surgery.

In this paper we are analyzing the idea of the Brusseles agreement as a political idea which was supposed to normalize ethnic relations between Serbia and "Kosovo", with everyday ethnic relations in the Kosovo and Metohija region. According to documents from " Republic od Serbia's report on the progress in the Belgrade - Pristina dialogue", there is visible contradiction for the reader where progress in the dialogue in Brusseles resulted in regression in ethnic relations. On the account of numeros acts of violence by Albanian extremists to Serbian minorty, such as house burning, rapeing, kidnapping women and children and tearing down religious and cultural monuments thruout the Brusseles agreement, with benevolent watch international community and EU, comes the conclusion that the agreement is mildly said an insufficient solution for the Kosovo situation. Besides that, constant outbursts of violence explicitly on Serbian people, with elements of destroying Serbian nationality. Subsequently saying, this problem demands compromised solution with effective participation of the International community in finding a solution.

Background/Aim. Gastric cancer (GC) is fourth most frequent malignant tumor worldwide, frequently diagnosed at advanced stages with poor prognosis. The aim of study was to determine expression of interleukin (IL)-32, proinflammatory and angiogenic mediators in the tumor, peritumor and healthy tissue, in patients with intestinal gastric cancer and the relationship with the disease severity. Methods. The tissue samples of intestinal type of the tumor of 60 patients with GC were analyzed. Expression of IL-32, vascular endothelial growth factor (VEGF), IL-17 and CD31 were measured by immunohistochemistry. Results. IL-32, VEGF and IL-17 expression as well as microvascular density (MVD) were diminished in adjacent tumor tissues compared with the tumor ones. Further, more intense expression of IL-32 and VEGF and enhanced MVD were noticed in patients with severe (TNM stages III and IV) and more progressive GC (lymph vessel invasion). Conclusion. Higher expression of IL-32, VEGF and intense MVD in the tumor tissue of GC patients with detectable lymph vessel invasion may be considered as a sign of the tumor’s malignant progression. This indicates a protumorogenic and proangiogenic role of IL-32 in biology of intestinal type of gastric cancer.

High flexibility of hydrometallurgical operations as well as economic and environmental acceptability, offer the opportunity to selectively obtain metals in the early stages of the processing. This enables the application of hydrometallurgical operations in processing of ores which, due to their complex composition or low copper content, are not suitable for pyrometallurgical treatment. In contrast to sulfide minerals, leaching of oxide ores does not requires presence of oxidizing agent. This paper presents the results of influence of temperature on the leaching degree of copper from pyritechalcopyrite concentrate by sulfuric acid solution at atmospheric pressure. According to the obtained results, it was found that an increase in the leaching temperature significantly contributes to the increase in the leaching efficiency, where after 6 hours of leaching at 40°C achieved efficiency was 90.6%.

Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of Anesthesiologists (ASA) score, tumor localization, tumor size, and type of surgical operation performed. According to localization of the tumor, the most commonly performed operation was anterior resection of the rectum (60.7% vs. 59%). There was no case of the tumor involvement of the distal margin. Average proximal distance from the tumor on the fixed specimen was 100 vs. 120 mm with statistical significance (p < 0.001). Distal margins were not significantly different, 40 mm in both groups (p = 0.143). In two cases we had circumferential resection margin (CRM) of 1 mm (7.7%) in the laparoscopic group, and in three cases operated conventionally CRM was 1 mm (8.8%). The average number of removed lymph nodes was 15 vs. 16, respectively. Length of hospital stay for patients assigned to the laparoscopic surgery was significantly shorter than for patients operated on by the open approach. Concerning postoperative complications, no significant difference was found between groups. The overall postoperative morbidity was 18% vs. 21.3%, respectively. Conclusion. With laparoscopic approach it is possible to provide all parameters of oncological radicality similarly to the open surgery of colorectal cancer.

Introduction. Unilateral absence of pulmonary artery is a rare vascular malformation. Because of this anomaly, the lungs are supplied by the system of collateral arteries. Case outline. We present a case of the right pulmonary artery agenesis in a female patient. She was admitted to the hospital because of hemoptysis. A computed tomography scan revealed a congenital malformation – the right lung was smaller in size, the right principal pulmonary artery had not been developed along with aberrant tortuous blood vessels. Conclusion. Symptomatic therapy was applied in the case of our patient. There was no need for any surgical treatment. However, in case of massive hemoptysis embolisation or lobectomy/ pneumonectomy will probably be applied.

Considering their incomplete psychophysical, ethical, social and intellectual development, minors under the age of 15 may not be employed. Young persons aged 15 to 18 are allowed to enter into an employment agreement under rectrictive conditions, designed in such a way as to protect their personality and interests concerning the choice of job or employment, health, morality, and education. A person who has turned 15 is allowed to sign an employment contract if the type of work does not endanger his/her health, ethics or education, i.e provided that such work is not prohibited by law; moreover, an employment relationship may be established only with a written consent of a legal representative and on the basis of the findings of the authorized health authority confirming that the younger person is able to perform the job as described in the agreement, and that the job is not harmful for his health. If these conditions are fulfilled, the employment relationship is established by signing an employment agreement.

Housing tradition is an important aspect of life in the country. It reflects the living standard of the household, personal attitudes towards the living space and the ways to furnish it. The paper analyses important aspects of the housing tradition and organization of life within the households in Valjevska Podgorina. The inventory of lexemes, terms related to house and household, bears testimony to a traditional culture that combines a variety of historical, ethnocultural, and linguocultural elements and factors.

Introduction: Preoperative examination and recognizing the risk factors for a difficult airway gives us the time for optimal preparation for difficult airway management. For goiter patients, in addition to the standard risk factors, there are goiter-related factors that may address to suspect of difficult intubation. Case report: Through this case report we summarize the presentation, airway examination and management of a patient with huge goiter. About 25-years earlier he noticed a swelling on the neck which increased in size progressively. Over the years he developed compressive symptoms, such as dysphagia, hoarseness and change in voice quality. All classical risk factors for difficult intubation, as well as goiter-related factors, were preoperatively evaluated. The neck circumference, the left displacement of the larynx and the radiological findings all pointed to a possible difficulty in airway management. The plan was to perform a direct laryngoscopy using a video-laryngoscope, without using a muscle relaxant, whereas the alternate plan was to use a flexible fibreoptic bronchoscope. The patient's airway was anesthetized with lignocaine spray into the laryngo-pharynx 30 minutes and 10 minutes before intubation. Oxygen was administered via facemask. The nasal catheter was placed to provide apnoic oxygenation during laryngoscopy and intubation. After induction of anesthesia a smooth video laryngoscopy was performed without using a muscle relaxant. A reinforced endotracheal tube with an intubating stylet was inserted without any difficulties in passing and placing the tube. Conclusion: Careful planning and detailed preoperative preparation are of crucial importance for a safe intraoperative and postoperative outcome in thyroid patients.

Stara Moldava is a micro area of speech in Banatska Klisura (Clisura Dunării) which is a subject of disputes in dialectology. As a contribution to the study of southern speeches in Romanian Banat, the paper analyses some significant morphological features of this speech by using the materials collected and recorded in the given area.

Measurements of radon concentrations in drinking waters conducted on wider territory of the town of Kruševac included 16 public fountains, of which 4 are in the city itself and 12 in the surrounding area. Measurements of radon concentrations in water were carried out using radon detector RAD7 (DURRIDGE Co.). The values of radon concentrations in water are in the range of (5.3 ± 0.8) Bq l-1 to (71.0 ± 7.2) Bq l-1 and are below the reference level of 100 Bq l-1, recommended by the European Commission. Since radon represents one of the most important causes of malignant diseases, annual effective doses of ingestion and inhalation are determined, whose mean values are in the range of 0.04 mSv y-1 to 0.52 mSv y-1, and from 14.84 μSv y-1 to 198.8 μSv y-1, respectively. During sampling, water temperatures and their pH values were measured. These results are the first results of measuring radon in water in this area by this method. The aim of this paper is to evaluate whether there is, or not, a radiological risk to people's health due to the use of water primarily for drinking, but also for other purposes.

Drawing on the materials that treat dialects collected in the region of Valjevo Podgorina, the author of the paper considers the presence of the u + genitive form that is regularly used in this area to express possession and spatiality. The use of this and the competing forms in three speech areas of Podgorina provides the grounds for linguo-geographic analysis, not only with relation to these speech areas, but also within a wider (north)west Serbian region and over the regional boundaries. In addition, the analysis shows that the situation in Serbian dialects represents a fragmented continuation of a number of elements rooted in the historical background. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 178020: Dijalektološka istraživanja srpskog jezičkog prostora]

Background/Aim. Multimodal approach to locally advanced rectal cancer treatment results in better disease outcome. Preoperative chemoradiotherapy improves disease local control, reduces risk of local recurrence and in the majority of patients with complete or substantial regression of the tumors significantly improves survival rates. According to the literature data, approximately 20% of patients had achieved complete histopathological response (pCR) after neoadjuvant chemoradiation therapy. The aim of this study was to evaluate overall survival in rectal cancer patients treated with preoperative chemoradiotherapy and sphincter preserving surgery. Methods. This retrospective study included 191 patients. Patients received preoperative radiation therapy and chemotherapy-chemoradiation therapy (CRT) followed by operation that favorized sphincter preservation with total mesorectal excision (TME) from June 2000 until December 2010. Diagnosis was established according to the following algorithm: patient history, digital rectal examiantion, colonoscopy with biopsy and histopathology verification, and preoperative clinical staging. Patients with tumors located below promontorium were included in the study and patients with metastatic disease and local recurrence were excluded from the study. For tumors located below the promontorium preoperative radiotherapy was used with total dose of 50.4 Gy, divided into daily doses of 1.8 Gy, during 28 days. Chemotherapy followed radiotherapy with 5- fluorouracil and folic acid (Leucovorin®) on days 1, 2, 10, 11, 20 and 21. Six to ten weeks after neoadjuvant therapy, magnetic resonance imaging (MRI) to restage tumors and operation were performed. Results. Of all patients that received preopertive chemoradiation, 163 had radical sphincter preservig surgery and 28 patients had paliative operations. Histopathological examination of the specimens showed that the complete histopathological regression was achieved in 21.4% of the patients, downstaged was found in 63.2% of them and unchanged stage was found in 15.3% of the patients. The five-year survival rate was 63.3% and 50.5 % in the patients with pCR and patients with incomplete histopathological regression, respectively. Survival rates between two groups were not statistically significant (p > 0.05). Conclusion. The preoperative chemoradiotherapy is very important in achieving optimal clinical care for patients with locally advanced rectal cancer.

Introduction. Malignant fibrous histiocytoma is a fast spreading pleomorphic sarcoma with a high malignant potential. Its spreading is characterized with local invasion and distant metastazes with early onset. Most common localisations of development are extremities, trunk and retroperitoneum. Given the line of rare case and specimen, lack of a clear etiology and mechanisms of this disease, as well as adequate histopathologic findings and intraoperative documentation, we presented current status, discuss putative etiology, histopathology with variant morphology, differential diagnosis and treatment modalities. Case report. We presented a 56-years-old female Serbian with tumor in the thigh that clinically resembles incapsulated hematoma. Computed tomography revealed intramuscular tumor with a heterodense structure and compression on surround tissue. Ex tempore biopsy specimen showed malignant potential of the tumor. Wide and radical excision of the nodule has been done, and definitive histopathological verification revealed malignant fibrous histiocytoma. Conclusion. Malignant fibrous histiocytoma is a most common type of soft tissue sarcomas in adults. Frequent localization is on lower extremities, and every rapidly enlarging nodule in this localization that on computed tomography is like incapsulated hematoma with necrotic zone should alert suspicion on presence of this type of sarcoma.

Background/Aim. Patients with pneumonia who require mechanical ventilation (MV) are associated with several poor outcomes such as prolonged hospitalization, higher rate of mortality and increased spread of antibioticsresistant pathogens. MV in patients with communityacquired pneumonia (CAP) could cause development of psychological symptoms, often neglected in the Intensive Care Units (ICU) as well as decreased quality of life after the withdrawal of the MV. The aim of the study was to evaluate the quality of life in patients with CAPs treated with MV in ICU. Methods. The study was designed as a cohort study of hospital-treated patients with CAP with prospective data collection. The quality of life was defined as the primary outcome, while the use of MV was assumed as the primary prognostic factor that adversely affected the outcome. The patients were recruited from the population of patients with CAPs who were hospitalized at the ICU, Clinical Center Kragujevac, Serbia, from January 2013 to January 2014. The experimental group consisted of patients who were on MV while the control group included patients who were treated for CPAs in the ICU, but were not subjected to MV. The quality of life was assessed by using patient-rated Euro Quality of Life (EuroQoL) Group-EQ-5D index. The calculation of the total EQ-5D-5L score values was performed by using the predefined, validated mapping key according to response combinations. Statistical analysis was performed by using χ2 test, Student's t-test, univariate and multivariate logistic regression analyses. Results. The patients with MV had worse EQ5D-5L values in comparison to the control group for all 5 domains. Mobility, self-care and usual activities were negatively affected during the whole follow-up period. Pain or discomfort and anxiety or depression differed significantly between the study group and the control group at days 7 and 30. Conclusion. Patients with MV tend to have poorer quality of life, especially in 3 domains. The main reasons are the presence of chronic comorbidities in the population that require MV. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007]

Background/Aim. In the last two decades there has been a significant progress in rectal cancer surgery. Preoperative radiotherapy, the introduction of staplers and largely improved surgical techniques have greatly contributed to better treatment outcomes, primarily by reducing the frequency of early surgical complications and the rate of local recurrence. The aim of this study was to compare operative and postoperative results in the treatment of rectal cancer between the two groups of surgeons – those who are closely engaged in colorectal surgery and those who deal with these issues sporadically. Methods. This retrospective study included 146 patients who had underwent rectal cancer surgery at the Institute of Oncology of Vojvodina in the period from January 1, 2008 to December 31, 2010. The patients were divided into two groups, the group N1 of 101 patients operated on by trained colorectal surgeons, and the group N2 of 45 patients operated on by surgeons without training in totalmesorectal excision (TME). Results. Preoperative chemoradiotherapy was received by 49 (33.56%) of the patients. A statistically significant difference between the two groups was noted in the duration of surgery and the need for blood transfusion during surgery. Anastomotic leakage occurred in 3 patients from the group N1 and in 10 patients from the group N2. Seven (4.79%) of the patients developed local recurrence after surgical treatment. There were significant differences in local recurrence rate and anastomotic leakage rate between the compared groups. Conclusion. It is necessary to continue education and training in surgery for rectal cancer to master new technologies and surgical techniques and to improve the results of surgical treatment.

Introduction. Pulmonary sequestration is a rare congenital anomaly and most intralobar sequestrations were located in lower lobes. Case report. We reported an unusual 28-yearold female patient with intralobar pulmonary sequestration on the left lower lobe, successfully treated with lobectomy. Computed tomography (CT) of the chest with intravenous contrast revealed multiple clustered cystic lesions in the left lower lobe with aberrant artery from descedenting aorta. Additional aortography showed an aberrant artery (3 mm in diameter) arising from the abdominal aorta and flowing into the lesion. Conclusion. Standard therapy regimen for pulmonary sequestration includes surgery. CT scan of thorax with intravenous contrast and aortography represent the gold standard for its diagnosis. Tumor-like shadows seen on the chest radiography or CT scans should not be always suspected on malignant lesions.

The following the average and extreme values of climatic elements, specific climatic indices and field research, we can select three climatic types in Kosovo and Metohija - the altered Mediterranean, continental and mountainous type. The altered Mediterranean type is present in southern and western Metohija, to be specific, it affects the Prizren Field, the Suva Reka and Orahovac Valley as well as the right bank of the Beli Drim from Pećka Bistrica to the Serbia - Albania border. Gradually and practically unnoticeably, it transforms itself into a moderate continental type which dominates over the remaining valley and mountainous parts of Kosovo. It affects parts of northern Metohija, Drenica and the entire Kosovo valley along with smaller sidelong dells - Malo Kosovo and Kosovsko Pomoravlje. Because of their exquisite heights, the mountains that complete the Kosovo Metohija Valley have a specific climatic type, at their lower slopes it is sub - mountainous and at the higher ones it is typically mountainous. Within these climatic types, several climatic sub regions are present. Their frontiers are not precise or sharp. Rather, their climatic changes are gradual and moderate from one sub-region to the other.

Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8Ч5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

Maps are miniature graphic representation of distinct area and as not being completely real require generalization. Cartographic generalization represents a specific investigation method in cartography. Generalization includes the processes of selection, simplification, and symbolization of details according to the purpose and the map scale. The river generalization requires the phase classification, selection, magnification and simplification to being used. Linear symbols are given on the map by their corresponding/characteristic length and remained unchanged even after the generalization. Particular cartographic criterions need to be applied during generalization. In the given case of the Sitnica river drainage system were applied the computer supported generalization based on the software Global Mapper 16.1 and the Open source software QGIS 2.6.1. The Sitnica drainage system is generalized in three levels. The first included digitalization of all linear objects related to the river Sitnica and its tributaries. Second level resulted in vector generalized data that indicate on polluted tributaries, whereas the final, third stage led to construction of multilayered vector map of the Sitnica catchments area with polluted tributaries.

Introduction. Propofol is a widely used intravenous anesthetic with a number of advantages over intravenous anesthetics used so far. The leading side effect is pain on injection. Objective. Aim of the study was to determine the impact of ondansetron, nitrous oxide and alfentanil on reducing pain during propofol application. Methods. The paper presents a prospective, randomized, single blind study. The study included 120 patients of ASA class I and II, who underwent elective surgery under general anesthesia using propofol for the induction of anesthesia. The patients were divided into four equal groups of 30 patients. The control group received a few milliliters of saline, N group the mixture of nitric oxide and oxygen, O group ondansetron and group A received alfentanil. In all patients, venous occlusion was performed for 60 seconds. Pain assessment was based on the criteria and the score by McCrirrick and Hunter. Results. Pain after the application of propofol was present in 47 (39.2%) patients. The highest frequency of pain was recorded in the control group (18, 60%), and significantly lower (p=0.009) in the patients who received ondansetron (8; 26.7%) and (p=0.020), alfentanil (9; 30%). The statistical analysis proved that there was a significant relationship between the groups and the scale of pain (χ2=13.849, p=0.031). Conclusion. Based on the results of our study we can conclude that intravenous ondansetron and alfentanil with venous occlusion can effectively prevent pain during IV use of propofol.

Introduction. Metastatic renal cell carcinoma (RCC) frequently spreads not only to neighboring lymph nodes, but also to distant organs, including the lungs, liver, bones and brain. Case report. We presented three cases of RCC with colon metastasis. In the first, 63-year-old patient, after left nephrectomy followed with lyphadenectomy in paraaortic lymph node, left hemicolectomy was done due to RCC metastasis in rectosigmoid colon. In the second, 35-year-old patient, left radical nephrectomy was followed two years later with partial right nephrectomy, lung metastasectomy, small bowel and coecum resection and right orchiectomy all as separate procedures in different time intervals. The patient died from brain and bone metastases two years after the first surgery. The third, 35-year-old patient, had right nephrectomy followed by repeted lymphadenectomies after 6, 12 and 24 months. Four years later RCC spreaded to coecum and right hemicolectomy was performed. Conclusion. RCC treated with nephrectomy should be carefully followed up with imaging methods as a proper treatment of RCC metastases to distant organs could be important for a patient survival.

Introduction. Klippel–Trénaunay syndrome (KTS) is a very rare congenital anomaly of blood vessels, characterized by the following clinical triad: varicose superficial veins, port-wine stain and usually bony and soft tissue hypertophy of extremities, most often located in the lower extremities. It is often accompanied by visceral manifestations, and rarely combined with splenomegaly. Case Outline. A 30-year-old female patient came to the Surgery Clinic because of occasional left hypochondrial pain. After she was diagnosed with KTS combined with splenomegaly, splenectomy was performed. Macroscopic and microscopic spleen examination indicated the presence of tumor of vascular origin, presenting a combination of lymphangioma and hemangioma. Conclusion. Diagnosed KTS demands a thorough clinical examination of the patient because of the potential presence of visceral manifestations. When splenomegaly is present, even though being often benign, splenectomy is usually performed to alleviate accompanying symptoms which occur as a result of organ enlargement and compression, to prevent rupture and consequential bleeding when the vascular spleen tumor is large, and finally to avoid a possibility of malignant transformation.

Introduction. Specific morphological and functional characteristics of athletes have a significant role in determining athletes’ sports results and can be also used to assess the athlete’s individual potential. Objective. The aim of the study was to compare anthropometric characteristics and cardiovascular parameters in trained subjects to those of untrained subjects. Methods. A total number of 25 trained (17.30±0.83 years) and 21 (18.52±1.52 years) untrained male subjects participated in this study. Body weight and height were measured and these values were used to compute body mass index (BMI). The bioelectrical impedance analysis (BIA) method was used to estimate body fat percentage (%BF). Cardiovascular parameters were monitored in rest (rest heart rate, systolic and diastolic blood pressure) during ergospirometric testing (maximal oxygen consumption, maximal heart rate) and in recovery (heart rate in the first and third minute of recovery). Results. Body mass, height and BMI (p

Biological invasions are seen as a major threat to biodiversity at a global level, while the number of new invasions is increasing at an alarming rate. Raising the awareness of the public, academic world and policy makers about the dangers caused by invasive species, is essential for the creation of the support needed to implement and coordinate the policies necessary to address this problem. The aim of this study is to determine the level of local public awareness of the existence of these plant species, examine the public attitude towards alien invasive plant species and willingness to get involved in the prevention of their spreading. The survey was conducted in four nurseries on the territory of the City of Belgrade and the investigation dealt only with alien invasive woody plant species. Thirty customers were questioned in each of the four nurseries. The results show that local public is uninformed on the issue of invasive plant species. It is necessary to constantly and intensively raise their awareness of this issue, as well as the awareness of harmful consequences that may occur due to the uncontrolled spreading of alien invasive species. This refers not only to the population that visits the nurseries and buys the plants there and to those employed in plant production and selling, but also to the whole local public and decision makers.

The aim of this research was to determine the swimming program effects on the gross motor function, mental adjustment to the aquatic environment and the ability to move in the water and swim in children with cerebral palsy. The sample consisted of seven children (4 boys and 3 girls) with spastic cerebral palsy and an average age of 9y 5mo ± 1y 3 mo. The swimming program lasted 6 weeks, with two swimming sessions per week. Each session lasted 45 minutes. The swimming program included the application of the Halliwick Method and swimming exercises which are used in a healthy population. The GMFM test was used for the assessment of gross motor functions. The WOTA2 test was applied to assess mental adjustment and swimming skills. The Wilcoxon matched pairs test was used to determine the statistically significant differences between the initial and final measuring. The results have indicated that there was statistically significant differences in the E dimension (p=0.04) and the total score T (p=0.03) of the GMFM test, then for mental adjustment to the aquatic environment WMA (p=0.02), ability to move in water andswimming skills WSW (p=0.03) and the overall result WTO (p=0.02) of the WOTA2 test. The applied swimming program had a statistically significant effect on the improvement in walking, running and jumping as well as the overall gross motor functions of children with cerebral palsy. The applied program also contributed to a statistically significant influence on the increase in mental adjustment to the aquatic environment and the ability to move in water and swim.

Backgraund/Aim. Gene p53, or “cell genome keeper”, has a preventive effect on the occurrence of genetic aberrations and prevents abnormal expansion of (tumor) cells. In gastric cancer cells in most cases we register high expression of mutated p53 gene, which correlates with prognosis and specific clinicalpathological characteristics of gastric cancer. Methods. Using the imunohistochemical method we determined the level of expression of p53 protein in 62 gastric cancers and 30 precancerous conditions (intestinal metaplasia of the stomach). We analyzed the relationship of the level of p53 expression and clinical pathological characteristics of gastric cancer. Results. Expression of p53 was positive in 42 (67.7%) tumor cases and in 7 (14.3%) cases of intestinal metaplasia. Expression of P53 and stomach cancer were in direct correlation (p = 0.000). Sensitivity for p53 in stomach cancer cases was 67.7% (42/62), and specifility was 76.7% (23/30). Expression of mutated p53 protein was in direct correlation with the invasion of lymph nodes (p = 0.034) and with invasion of blood vessels by carcinoma cells (p = 0.042). Conclusion. There is a direct correlation between p53 expression and gastric cancer and it indicates the ability of carcinoma cells to invade blood vessels.

Avtory v nastojaščej rabote ukazyvajut na nedostatočnuju issledovannost' narodnyh govorov šumadijsko-voevodinskogo dialekta metodami tradicionnoj i urbanistskoj dialektologii. V rabote kartografičeski predstavleny oblasti, v kotoryh issledovanija zakončeny (oni prednaznačeny dlja nužd monografičeskih opisanij, Serbskogo dialektologičeskogo atlasa i Obščeslavjanskogo lingvističeskogo atlasa). Odnovremenno vydvinuty geografičeskie i administrativnye punkty s inventarem dereven', kotorye dolžny byt' podvergnuty issledovaniju. Karty pokazali, čto voevodinskoj poddialekt issledovan polnost'ju, pri naličii gustoj seti punktov. Ishodja iz togo, čto govory Bački i Srema issledovalis' let pjat'desjat tomu nazad, a material banatskih govorov zaregistrirovan primerno v to že samoe vremja, a opublikovan tol'ko v poslednie gody HH veka, sledovalo by ustanovit' napravlenija v razvitii dannyh govorov, a takže nastupivšie izmenenija. Odnako, ëtnografičeskie i jazykovye punkty na territorii šumadijsko-voevodinskogo dialekta ne issledovany v podhodjaščej stepeni. Do sih por issledovany govory časti Mačvy, Šumadijskoj Kolubary, Kraguevackoj Lepenicy i Gruži. Sporadičeskaja issledovannost' nalico v Kačere, Valevskoj Kolubare, Pocerine i v okrestnostjah Belgrada. Neissledovannymi ostalis' govory Jadara, Radževiny, Valevskoj Podgoriny, Posavotamnavy, Tamnavy Takovo, a takže čast' govorov meždu Dragačevom i Gružej.

Altitude training in various forms is widely practiced by athletes and coaches in an attempt to improve sea level endurance. Training at high altitude may improve performance at sea level through altitude acclimatization, which improves oxygen transport and/or utilization, or through hypoxia, which intensifies the training stimulus. This basic physiological aspect allows three training modalities: live high and train high (classic high-altitude training), live low and train high (training through hypoxia), and live high and train low (the new trend). In an effort to reduce the financial and logistical challenges of traveling to high-altitude training sites, scientists and manufactures have developed artificial high-altitude environments, which simulate the hypoxic conditions of moderate altitude (2000-3000 meters). Endurance athletes from many sports have recently started using nitrogen environments, or hypoxic rooms and tents as part of their altitude training programmes. The results of controlled studies on these modalities of high-altitude training, their practical approach, and ethics are summarized.

Aim: In this study we want to point out the existence and significance of skip metastasis of rectosimoid cancer. Material and methods: Seventy patinents with verified rectosigmoidal adenocarcinoma, treated in 5- years period, are included in this study. Diagnose was made upon physical examination, barium enema, rectosigmoidoscopy with positive biopsy and finding of isolated lymph node metastasis. Results: Skip metastasis were found within 6 patients (8.6%); 4 of them were males and 2 females, with average age 67 years. Overall, 13 metastasis were isolated; one patient had them 3 and five patinets had 2 skip metastasis. Conclusion: Radical lymphadenectomy of patinets with rectosimoidal cancer requires dissection of lymph nodes along inferior mesenteric artery and its legation on origin, as much as dissection of paraaortal and paracaval lymph nodes.

Introduction. Foreign body aspiration into tracheobronchial tree represents an urgent condition at high level of risk. Etiology is different, and this condition is typical for all ages with highest incidence in pediatric population. Case report. A successful foreign body removal (partial denture) in a 34-year old man was presented. Radiography and computerized tomography of the chest showed a foreign body localized at the level of the right bronchus including the right middle lobe bronchus. By the use of rigid bronchoscopy, a foreign body was visualized and mobilized from the segmental bronchus in the first act, and then completely extracted. Conclusion. Efficient diagnostics and extraction are imperative for the aspirated foreign body preventing life-threatening complications.

Solitary fibrous tumors are relatively frequent. They may occur throughout the body. About 20% of tumors develop in the thorax, out of which vast majority is localized on its wall. Within thorax, they usually originate from pleura, most frequently the visceral one. Authors present a 67- year old male in whom the tumor was diagnosed during the investigation for dyspnea. During operation, solitary, well circumscribed, firm, rubber-like tumour, 11x10x9 cm in diameter, covered with serosa, arising from the visceral pleura of the base of the right lung was easily excised. The classical histological and immunohistochemical examinations confirmed the diagnosis of benign fibrous tumor. Postoperative recovery was uneventful. Preoperative symptoms disappeared.

Introduction: Specific morphological and functional characteristics of athletes have a significant role in determining athletes' sports results and can be also used to assess the athlete's individual potential., Objective: The aim of the study was to compare anthropometric characteristics and cardiovascular parameters in trained subjects to those of untrained subjects., Methods: A total number of 25 trained (17.30 +/- 0.83 years) and 21 (18.52 +/- 1.52 years) untrained male subjects participated in this study. Body weight and height were measured and these values were used to compute body mass index (BMI).The bioelectrical impedance analysis (BIA) method was used to estimate body fat percentage (%BF). Cardiovascular parameters were monitored in rest (rest heart rate, systolic and diastolic blood pressure) during ergospirometric testing (maximal oxygen consumption, maximal heart rate) and in recovery (heart rate in the first and third minute of recovery)., Results: Body mass, height and BMI (p<0.01) were significantly higher, although BF% was lower in trained group when compared to untrained, but the difference was not statistically significant. Heart rate in rest and recovery were significantly lower (p<0.05) in trained group when compared to untrained, although maximal oxygen consumption and maximal heart rate were significantly higher in trained group (p<0.01, p<0.05, respectevely)., Conclusion: Our results show that in trained subjects, water polo players, regular intense physical activity lead to adaptive changes of anthropometric parameters and adaptive changes on the cardiovascular system.

Introduction: Carcinoid tumors are very common tumors of gastro-intestinal tract even though they are very rare in pancreatic area. A large number of patients with pancreatic carcinoma have nonspecific symptoms of disease which is the main cause of late operative treatment of advanced tumors as well as for a low rate of 5-years surviving (28,9% +/- 16%)., Case Report: A 69-year-old female patient was operated for a 7 cm large carcinoid in pancreatic corpus. Prior to the operation the patient did not have any symptoms of disease. Serotonin and 5-HIAA level was normal before the operation as well as afterwards. In this case distal hemipancreatectomy was done along with celiac, hepatic and lienal lymphadenoctomy. Liver metastasis was not found. The diagnosis of carcinoid was verified by postoperative histopathologic and imunohistochemical analysis., Discussion: According to the experience of other authors, the operative treatment of pancreatic carcinoid is very often undertaken when dimensions of tumor exceed 7 cm. In this stage of disease distant metastases are present in more than 60% of patients. Only 23% of examinated patients have had carcinoid syndrome symptoms. According to this conclusion, the main role of diagnostic procedures is attributed to the computer tomography of abdomen as well as ERCP. The radical resection of pancreas with lymphadenectomy is recommended in order to have a precise histological examination and detect occult lymph node metastases. With radical surgical procedures even at this stage of disease the operation may be curative., Conclusion: Any kind of radical surgical treatment (depending of localizations of tumor, proximal or distal) is the main therapeutic procedure in pancreatic carcinoid.

Introduction: Preoperative staging of rectal cancer is considered essential to select patients adequately for different therapeutic regimes. The aim of the present study was to evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal cancer., Materials and Methods: Fifty rectal cancer patients (31 men, 19 women) underwent endorectal ultrasonography with a 7.5-MHz probe. Thirty-eight of these patients had preoperative chemoradiation and in these patients examination was done before and after the radiotherapy treatment. The results of examinations were compared with the histological findings of the resected specimens., Results: Histopathology showed 4 stage TO, 3 stage T1, 12 stage T2, 30 stage T3, and one stage T4 tumor. Nodal metastases were seen in 17 patients. The overall accuracy of endorectal ultrasonography for determining the depth of invasion (T stage) was 66% (33/50). The accuracy rate of T1 was 100% (1/1), T2 was 45% (9/20), T3 was 79% (22/28), and T4 was 100% (1/1). Overstaging was 18% (9/50) and understaging 16% (8/50). In staging lymph node metastasis, the overall accuracy rate was 70% (18/25) with 18% (9/50) overstaged and 12% (6/50) understaged With regard to nodal involvement, sensitivity was 65% and specificity 73%. Regarding penetration of the rectal wall (stages T1 and T2 vs stages T3 and T4/Dukes' classification A versus B), endorectal sonography showed sensitivity, specificity, and accuracy of 74%, 68%, and 72%, respectively., Conclusion: Endorectal ultrasonography is a valuable diagnostic modality for rectal cancer staging. It is fast, safe, accurate, well tolerated by the patient and cheap procedure and therefore should be used as a diagnostic modality of the first choice in rectal cancer staging although one must take into consideration possible limitations in cases of preoperative chemoradiation.

Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative) cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical procedure, age, presence of concurrent deseases. A total of 100 patients with cardiac diseases undergoing noncardiac surgery were included in the prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery). The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of cardiac events. Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction) occurred in 64% of the patients. One of the 100 patients (1%) had postoperative myocardial infarction which was fatal. Systemic arterial hypertension occured in 57% of patients intraoperatively and 33% postoperatively, abnormalities of cardiac rhythm in 31% of patients intraoperatively and 17% postoperatively, perioperative myocardial ischemia in 23% of patients intraoperatively and 11% of postoperatively. The most often cardiac complications were systemic arterial hypertension, abnormalities of cardiac rhythm and perioperative mvocardial ischemia. Factors independently associated with the incidence of cardiac complications included the type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes.

Introduction: Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality., Material and Methods: In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 year old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST., Discussion: In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment., Conclusion: The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.