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Introduction: Primary extragonadal seminomas are rare tumors. There have been only a few cases of the primary retroperitoneal seminomas reported in the literature up to date., Case Report: We reported a 56-year-old man with giant primary retroperitoneal seminoma presented with the enlargement of the left side of the abdomen and deep venous thrombosis of the left leg. Computed tomography of the abdomen showed a large tumor occupying the left part of the retroperitoneal space with 23 x 13 cm in diameter. Firm tumor mass having 25 x 15 cm in diameter was surgically removed from the left retroperitoneum. The tumor adhered the tunica adventitia of the aorta and it was carefully resected from the aortic wall. The diagnosis of seminoma was made during histopathological examination. The patient underwent chemotherapy. Two years after finished chemotherapy the patient accepted left orchiectomy with the aim of eliminating the possibility of the occult malignancy of the testicle. Histopathological analysis of the testicular tissue was normal and the diagnosis of primary retroperitoneal seminoma was confirmed. CONCLUSION. Despite its small incidence in general population, the diagnosis of retroperitoneal seminoma should be considered in male patients with nonspecific symptoms and with retroperitoneal tumor mass.

Unlabelled: BACGRAUND/AIM: Most often injuries of brachial plexus and its branches disable the injured from using their arms and/or hands. The aim of this study was to investigate the etiology and mechanisms of median and ulnar forearm nerves injuries., Methods: This retrospective cohort study included 99 patients surgically treated in the Clinic of Neurosurgery, Clinical Center of Serbia, from January 1st, 2000 to December 31st, 2010. All data are obtained from the patients' histories., Results: The majority of the injured patients were male, 81 (81.8%), while only 18 (18.2%) were females, both mainly with nerve injuries of the distal forearm--75 (75.6%). Two injury mechanisms were present, transection in 85 patients and traction and contusion in 14 of the patients. The most frequent etiological factor of nerve injuries was cutting, in 61 of the patients. Nerve injuries are often associated with other injuries. In the studied patients there were 22 vascular injuries, 33 muscle and tendon injuries and 20 bone fractures., Conclusion: The majority of those patients with peripheral nerve injuries are represented in the working age population, which is a major socioeconomic problem. In our study 66 out of 99 patients were between 17 and 40 years old, in the most productive age. The fact that the majority of patients had nerve injuries of the distal forearm and that they are operated within the first 6 months after injury, promises them good functional prognosis.

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.

Background/aim: Occupational stress is a term used to define ongoing stress that is related to the workplace. The study was conducted to determine association of occupational stress index (OSI) and its aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of male professional drivers., Methods: The cross-sectional study was performed in 439 professional drivers divided into groups (city- and intercity bus drivers, truck and taxi drivers). The OSI and OSI aspects (high demands, strictness, underload, extrinsic time pressure, noxious exposure, avoidance and conflict) were calculated using the standardized questionnaire. Determination of serum lipids, blood pressure (BP) and cardiovascular risk factors were done., Results: A significant difference in prevalence of diagnosed hypertension and dyslipidemia was found along with a difference in total OSI and OSI aspects among examined subgroups of drivers. A total OSI was highest in city, high in intercity bus drivers, and the lowest one in truck and taxi drivers (82.79 +/- 3.5, 81.28 +/- 3.7, 73.75 +/- 3.5, 71.61 +/- 4.4, respectively; p < 0.01). Similar pattern showed triglycerides (TG), total cholesterol (TC) and LDL cholesterol and BP, while HDL-cholesterol showed reverse order (p < 0.01). Logistic regression analyses with multiple OSI aspects adjusted for age and years of exposure showed associations of total OSI with arterial hypertension [OR 5.5; 95% CI (2.24-7.95)] and dyslipidemia [OR 1.43 95% CI (1.09-2.80)]. Underload was the most important OSI aspect associated with the arterial hypertension [OR 1.18; 95% CI (1.04-2.58)] and elevated LDL cholesterol [1.26; 95 CI (1.19-2.1)]. A total OSI had a significant association with elevated LDL cholesterol [2.64; 95% CI (1.19-7.7)], triglycerides [OR 3.27; 95% CI (1.20-5.1)] and low HDL cholesterol [OR 3.29; 95% CI (1.8-5.8)] (p < 0.01)., Conclusion: The study provides the evidence for the significant association of total OSI and underload with lipid disorders and elevated blood pressure in professional drivers, which could be a possible link between job stress and coronary heart disease. Regular periodical examinations and workplace interventions aimed to decrease total OSI and underload are important aspects in primary prevention and additional reduction of cardiovascular risk.

Background/aim: During choledocholitiasis inflammatory oxidant stress involves the promotion of mitochondrial dysfunction through an intracellular oxidant stress in hepatocytes leading mainly to necrosis and less to apoptosis. The product of oxidative stress, malondialdehyde (MDA), is extremely cytotoxic and damages cell membranes and intracellular macromolecules. The toxicity of MDA is based on its ability to act as a mutagenic agent in a cell. Therefore, the aim of this prospective study was to establish correlation of the parameters of inflammation and biochemical markers of cholestasis with the intensity of oxidative stress in pathogenesis of liver function disorders., Methods: Seventy adult subjects of either sex included in the study were devided into two groups: I--40 patients with obstructive icterus caused by choledocholithiasis, and II--30 healthy individuals. All the participants were subjected to a clinical, laboratory and ultrasonic check-up at the Internal Department of the Military Hospital in Nis. The parameters of oxidative stress: MDA, a measure of lipid peroxidation, and inflammation parameters: C-reactive protein (CRP), fibrinogen, albumins, number of leukocytes (Leu), granulocytes (Gr), lymphocytes (Ly) and monocytes (Mo) and biochemical markers of cholestasis: activity of gamma-glutamyltransferase (gamma-GT) and alkaline phosphatase (AP) enzymes, the level of total, direct and indirect bilirubin were determined by standard biochemical methods., Results: Lower values of albumin (p < 0.001), and significantly higher values of fibrinogen (p < 0.05) and CRP (p < 0.001) were found in the blood of the patients with cholestasis due to choledocholithiasis in relation to the controls. Significantly higher values of Leu (p < 0.01) and Gr (p < 0.001) with decreasing number of Ly (p < 0.001) and Mo (p < 0.001) were found in blood of the patients with cholestasis due to choledocholithiasis in relation to the control. Similarly, higher values of gamma-GT, and AP (p < 0.001), as well as the level of total, direct and indirect bilirubin (p < 0.001) were found in blood of the patients with cholestasis due to choledocholithiasis in relation to the controls. The concentration of MDA (p < 0.001) was increased in the patients with choledocholithiasis in relation to the controls. There was a significant positive linear correlation of the number of leukocytes (r = 0.51, p < 0.05) and the concentration of total (r = 0.87, p < 0.01), direct (r = 0.85, p < 0.01) and indirect (r = 0.88, p < 0.01) bilirubin with the concentration of MDA in the group of patients with choledocholithiasis., Conclusion: Neutrophils and the levels of total, direct and indirect bilirubin have a significant positive linear correlation with the level of lipid peroxidation in patients with choledocholithiasis. Neutrophilia and hiperbilirubinemia observed in this way represent important parameters in estimating the level of liver tissue damage in choledocholithiasis.

Introduction: Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development., Case Report: A 16-year-old boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease., Conclusion: There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

Unlabelled: BACKGROUND/AIM. Colorectal cancer (CRC) is one of the biggest health problems of modern humanity, especially in highly developed countries. In Serbia about 3,200 patients suffer from CRC, out of whom about 1,100 patients suffer from rectal cancer (RC), while about 2,100 patients suffer from other colon segments cancer. The aim of the study was to show the incidence genesis of one of the possible early postoperative complications regarding dehiscence of the colorectal anastomosis (CRA) with a group of patients suffering from RC and operated by using sphincter-saving procedures, in the period from 1993 to 2007, and then to compare the incidence genesis of these complications with those in the published series of the reporting colorectal institutions., Methods: The research included 242 patients radically operated on for RC in a 15-year period using some of sphincter-saving procedures following by a careful analysis of the symptoms of subclinical dehyscencias not solved with the reintervention as well as of the clinically evidented dehyscencias mostly solved by reoperation., Results: With 22 (9.1%) patients in the first 10 postoperative days there were early postoperative symptoms of CRA dehiscence. In 6 (2.47%) of the patients there were subclinical signs of raised body temperature, less quantity of feces content, and after the conservative treatment they ended in spontaneous process of rehabilitation. In 16 (6.61%) patients there was clinically evidented anastomosis dehiscence followed by abundant drainage of feces content, signs of local peritonitis, pelvic sepsis, so we had to undertake surgical intervention. CONCLUSION. Comparing the results of a few tenths of published studies with our results we proved that performing and operative technique of colorectal anastomosis in the patients suffered and radically surgically treated for RC, is quite adequate with the operative technique in reporting world institutions that are engaged in surgical treatment of RC.

Introduction: Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis., Case Report: A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up., Conclusion: Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.

Background: Small bowel hemorrhages are rare and account for 2-10% of all gastrointestinal bleedings. In case that surgery is necessary, identification of the bleeding site is the most important problem., Case Report: We presented here the case of a 65-year old man, admitted for urgent care of massive lower gastrointestinal bleeding. After reanimation and normalization of vital parameters, selective arteriography was done. A contrast extravasation site was identified at the level of jejunal branches of a. mesenterica superior and labeled by means of methylene blue application. Immediately after we performed conservative resection of the labeled jejunal loop in 10 cm length and terminoterminal anastomosis. The preparation was sent for histopathologic examination--small bowel angiodysplasia was identified. The patient was monitored in three month intervals in the next two years and new bleeding events were not observed., Conclusion: Bleeding caused by small bowel angiodysplasia is a significant diagnostic problem in cases in whom urgent surgery is required. Combined preoperative selective arteriography and methylene blue application make possible precise identification of the bleeding site as well as conservative small bowel surgery, avoiding thus the risk and danger of malabsorption syndrome.

Background/aim: Surgical treatment is the only method of abdominal aorta aneurysm (AAA) treatment. According to data of the available literature, elective open, i.e., conservative, reconstruction (OR) is followed by 3%-5% mortality, as well as by numerous comorbide conditions inside the early postoperative course (the first 30 days after the surgery) that occur in 20%-30% of the operated on. The aim of the study was to present preliminar results of a comparative clinical retrospective study of early postoperative morbidity and mortality in AAA reconstruction using endovascular (EVAR) and open surgical techniques., Method: This comparative clinical retrospective study included 59 patients, electively operated on for AAA within the period January 2008-March 2009, divided into two groups. The group I counted 29 (49%) of the patients who had been submitted to EVAR by the use of Excluder stent. The group II consisted of 30 (51%) of the patients operated on using OR. All of the patients were males, 50-87 years old (mean 67.6 year in the group I, and 54-86 years (mean 68.3 years) in the group II. All tha patients had AAA larger than 50 mm, in the group I 50-105 mm (mean 68 mm), and in the group II 50-84 mm (mean 65 mm). Preoperative comorbide conditions of any patients were similar (coronary disease, obstructive lung disease, chronical renal insufficiency). Patients operated on as emergency cases due to rupture or due to symptomatic aneurysm (threthening rupture) were excluded. The analysed parameters were the duration of surgical operation, intraoperative and operative blood substitution, postoperative morbidity, the duration of postoperative hospitalization, and hospital mortality., Results: The obtained results showed a statistically significantly shorter time taken by EVAR surgery (average 95 min, ranging 70-180 min) as compared to OR surgery (average 167 min, ranging 90-300 min). They also showed statistically significantly less blood loss in the patients operated on by the use of EVAR surgery (average blood compensation 130 mL, ranging 0-1050 mL) as compared to OR surgery (average blood compensation 570 mL, ranging 0-2.000 mL). Also, general complications as wound infection, no restoration of intestines peristalsis, febrility, proteinic and electolytic disbalance, lung and heart decompensation were statistically significantly less following EVAR than OR surgery. Postoperative hospitalization was also statistically significantly shorter after EVAR than after OR surgery (average 4.2 days, ranging 3-7 days; 10.6 days, ranging 8-35 days, respectively). Finally, within this 13-month study there was no mortality following EVAR surgery, while two patients died after OR surgery., Conclusion: In the patients with elective AAA reconstruction endovascular reconstruction is shown to be far more safer and minimally invasive procedure than open conventional aorta reconstruction.

Background/aim: Deep venous thrombosis (DVT) is a life-threatening condition, which could be manifested with discrete symptoms (silent DVT). High mortality and disability of patients with DVT indicate the importance of early diagnosis, especially of "silent" DVT. The aim of this paper was to evaluate of reliability of early detection model for diagnosing DVT in ambulatory patients by using clinical probability of DVT presence, D-dimmer test (DD) and ultrasound evaluation (US)., Methods: Ambulatory patients with suspected DVT were classified as "unlikely" and "likely" DVT by the Wells clinical model. The patients were randomly divided into the control and DD group. In the control group (629 patients) only US examination of lower limbs deep vein was done. All patients in the DD group (643 patients), with "unlikely" TDV, had DD, and in the positive patients US examination was done. In the "likely" patients US examination was done and negative US finding indicated DD test. Positive DD test was an indication for US examination after 7 days. The patients with initially excluded DVT were evaluated during 3 months., Results: A total number of 1 272 patients were examined; 117 (9.19%) patients were with DVT--62 (9.640%) in the DD and 55 (8.74%) in the control group. During the follow-up periods in the DD group (with 582 initially excluded DVT) we registered DVT in only one patient (0.17%). It was significantly lower (p < 0.05) compared to the control group where we registered 7 (1.10%) DVT (a group with 581 initially excluded DVT). The applied DD diagnostic strategy for 70.7% (p < 0.001) reduced the need for US examination., Conclusion: The applied DD strategy in the diagnostic of DVT reduces the need for US examinations and reduces frequency of false negative results, with direct impact on cost and efficacy of procedures. DD diagnostic model should replace serial US examination in patients with suspect DVT.

Introduction: Schwannomas are tumors of neurogenic origin, that arise from Schwann cells which surround peripheral, cranial and autonomic nerves. Schwannomas account for only 5% of all benign soft tissue tumors, and 25-45% of extracranial schwannomas are present in the head and neck region. They are usually classified according to the nerve of origin and the site within the head and neck., Case Report: We presented extremely rare extracranial localizations of schwannomas and discussed about diagnosis and management of these tumors., Conclusion: Schwannomas are slow-growing tumors and late symptoms appearance may cause a delay in diagnosis and treatment of patients with these tumors. An appropriate diagnostic protocol is indispensable tool in performing a differential diagnosis of malignant from benign lesions. Choice of surgical approach depends on schwannomas localization.

Background/aim: Hyperbaric oxygenation (HBO) is a medical treatment of a patient with 100% oxygen inspiration under the pressure higher than atmospheric in a special unit designed to let the whole patient's body rest in a chamber. The aim of the study was to determine the effect of the application of HBO treatment on the patient's lower extremities with chonic inoperabile occlusive disease by measning the parameters of perfusion scintigraphy (perfusion reserve, relative perfusion)., Methods: This investigation included 22 patients (19 males and 3 famales). Following clinical assessment of lower extremities condition according to the skin appearance and its adnexa, claudication distance was performed. Clinical condition was graded by the use of 5-point nominal scale. In all of the patients 99mTc-tetraphosmine lower extremities scintigraphy was done ten days prior to the treatment start and ten days after the treatment with HBO. Lower legs were imaged from the posterior view. Prior to imaging the patients were obligatory lying approximately half an hour., Results: In 18 (86%) of the patients there was an improvement manifested as better subjective condition and better skin and its adnexa appearance. Following HBO treatment there was a statistically significant change in collecting the radiopharmac at rest. This finding indicates an increased viability of muscles as well as an increased perfusion reserve. Perfusion reserve mean values increased from 39.99 to 50.86%, and from 38.46 to 49.33% for the right and the left lower leg, respectively. This parameter clearly indicates favorable effects of HBO treatment pertaining neoangiogenesis and, consequently, increased viability of the lower leg muscles. It was also obvious in visual analysis of the obtained images., Conclusion: The obtained results confirm that muscle perfusion measured by the parameters of perfusion scintigraphy using 9mTc-tetrophosmine (perfusion reserve, relative perfusion) in patients with inoperabile occlusive disease of the lower leg arteries significantly increases after the application of HBO treatment.

Background/aim: Lumbar sympathectomy (LS) increases pheripheral blood flow primarily by the arteriolar vasodilatation within the skin vascular net. Increase in tissue nutrition takes place only in the distal blood vessels of the skin. Nevertheless, in some patients sympathectomy brings about improvement in ischemic ulcerations healing. Hyperbaric oxigenation (HBO) is a medical treatment in which a patient breathes 100% oxygen under pressure higher than atmospheric implemented in special units allowing the whole body be in a chamber. The aim of the study was to determine efficacy of the applied therapies for the treatment of inoperable occlussive lower extremities (LE) arteries diseases according to the obtained results., Methods: The study included 30 patients divided into two grups (15 patients each) in which stenosis level of the lower extremities arteries had been determined using aortography due to further treatment with HBO and LS. All the patients were clinically examined, their objective condition evaluation based on claudication distance, pain in rest, skin and skin adnexa atrophy, and temperature and LE functionality, as well as exposed to perfusion scintigraphy prior to the treatment and within 30 days after the treatment finishing., Results: Analysing patients' status prior to and after the treatments applied the number of patients with obvious improvement was higher in those treated by HBO than those treated by LS. Measuring claudication distance revealed significantly greater changes in patients treated by HBO (from 178.57 m to 754.76 m) than in those treated by LS (from 229 m to 253 m). Other clinical symptoms, such as parasthesia, status of the skin adnexes (hair, nails), skin colour and temperature were also improved after the treatment by HBO., Conclusion: The results obtained in this study confirm the advantages of HBO over LS in therapy of inoperable occlussive LE disease, so LS could be definitely abandoned as a choice for treating such disease.

Background/aim: Colorectal lymphoma is a rare tumor representing 1.4% of human lymphomas, 10-20% of gastrointestinal lymphomas, namely 0.2-0.6% of all malignancies in the colon. The aim of this study was to review clinical characteristics of primary colorectal lymphoma and overall survival., Methods: A detailed analysis of 16 surgically treated patients included patients age, symptoms and signs, tumor site, type of surgery, histopathologic findings, diagnosis of the disease, disease stage, type of surgery related to the degreee of emergency (elective or urgent), applied adjuvant therapy, patient follow-up and treatment outcomes. Survival was expressed by the Kaplan-Meier curve, while the difference in survival among the two groups by the Log-rank test., Results: The all patients were on an average followed-up for a median of 29 months (range 2-60 months), while those with chemotherapy 48 months (range 4-60 months). An overall mean survival time was 38.65 months., Conclusion: Primary colorectal lymphoma is a rare malignant tumor of the large bowel. Therapy usually involves resection of the affected colon or rectum and regional lymphovascular structures, followed by adjuvant therapy. Survival period is short and, therefore, timely diagnosis is crucial in early disease stages when the probability of cure is high.

Background: Budd-Chiari syndrome (BCS) represents partial or total occlusion of the hepatic veins with or without simultaneous obstruction of vena cava inferior (VCI). The symptoms of BCS are abdominal pain, hepatomegaly, ascites, varices of the abdominal wall, sometimes bleeding from the upper part of gastointestinal tract (GIT), lower limbs swelling and jaundice. Primary BSC is a relatively rare condition occuring in one per 100,000 of the population worldwide., Case Report: A male patient, 25-year-old, facing tooth postextraction complications, was presented with acute BCS. On admission, physical examination revealed pale-grayish complexion, more pronounced veins over the thorax and abdomen, ascites, enlarged liver rising 8 cm below the right costal arch and having a minor pleural effusion by the right side. The patient was submitted to Doppler sonography and computed tomography (CT) that verified the right leg deep veins thrombosis, as well as the presence of a thrombus in the intrahepatic portion of the VCI. Multislice computed tomography (MSCT) showed occlusion of hepatic veins (Budd-Chiari syndrome) and thrombosis of the VCI in the retrohepatic part 6 cm long. Also, increased values of transaminases and gamma GT and reduced values of albumines and serum ferrum were registered. Molecular examination revealed Factor V Leiden mutation--heterozygote. After preoperative preparations a mesocaval shunt was made using Gore-Tex ring graft of 12 mm. Intraoperatively, the blue enlarged liver was found with almost black zones of tense capsule. After a graft making, liver congestion decreased followed by the change of colour and volume. Within postoperative course metabolic and synthetic liver functions were obvious., Conclusion: In patients with BCS medicamentous treatment does not yield adequate results, but even causes worsening of general condition. Surgical therapy in the presented patient was performed timely regarding the stage of the disease due to which irreversible liver changes were prevented while decompression of the portal system provided time overbridging up to liver transplantation.

Background/aim: Surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer (CRC) remains controversial. The aim of this study was to assess safety of simultaneous colon and liver rese cions and the direct effects of this type of treatment upon morbidity and mortality of the patients with synchronus hepatic metastases of CRC., Methods: Intraoperative and postoperative data of 31 patients with simultaneous liver and colorectal resection were compared with the data of 51 patients who had undergone colon and hepatic resection in the staging setting. Analized were demographic data, number of metastases, type of the liver resection, operation time, intraoperative blood loss, percentage of postoperative complications, morbidity and mortality and lenght of hospitalisation., Results: In the group of the patients operated simultaneously 5 hepatectomies, 3 sectionectomies, 2 trisegmentectomies, 3 bisegmentectomy, 6 segmentectomies, and 12 metastasectomies were combined with colon resection. In this group operation time (280 vs. 330 minutes) and in traoperative blood loss (450 vs. 820 ml) were lower than those in the two staged operation group. Postoperative complication rate was lower in the simultaneous group (19.35%o) than in the two-staged operation group (19.60%), without statistical significance. There was no hospital mortality in both groups. The patients having simultaneous resection required fewer days in the hospital (median 10.2 days) than the patients undergone operation in the two stage (18.34 days)., Conclusion: By avoiding a second laparotomy, overall operation time, blood loss, hospital stay and complication rate are reduced with no change in hospital mortality, so simultaneous colon and hepatic resection performed by the competent surgeons are safe and efficient for the treatment of synchronous colorectal liver metastases.

Background: Central nervous system hemangioblastomas (HBs) are uncommon, highly vascularized tumors that are predominantly found in the cerebellum. They occur sporadically or in association with von Hippel-Lindau (VHL) disease. HBs are of unknown histogenesis, and the origin of stromal cells is still a subject of debate. The aim of this study was to investigate the immunoprofile of neoplastic stromal component, and to determine whether the profile of the expression of immunomarkers used can contribute to the elucidation of the histogenesis of HBs., Methods: A series of eight cerebellar HBs were histochemically examined for the detection of mast cells and immunohistochemically for the expression of factor VIII-related antigen (FVIII-RAg), CD34, vimentin, factor XIIIa (FXIIIa), S-100 protein, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), neurofilaments (NF), synaptophysin, chromogranin, and somatostatin., Results: Mast cells were present in all hemangioblastomas, and were particularly abundant in one tumor. Immunohistochemically, intense reactivity for vimentin and NSE in the stromal cells was constantly seen. Immunoreactivity with S-100 protein and FXIIIa was variable, but generally many HBs stromal cells were negative for these markers. However, stromal cells were uniformly negative for FVIII-RAg in all HBs investigated. They were negative for CD34, GFAP, NF, synaptophysin, chromogranin, as well as somatostatin. GFAP-positivity of the occasional stromal type cells, located only peripherally, was interpreted as "pseudopositivity"., Conclusion: The immunoprofile of neoplastic stromal component in this study suggested a possible origin from undifferentiated multipotential mesenchymal cells. High expression of NSE (glycolytic and hypoxia-inducible enzyme) in the HBs stromal cells might be related to the loss of the VHL protein function.