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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.

The aim of this study was to evaluate the effects of pneumoperitoneum on liver function during and after laparoscopic cholecystectomy. This prospective study comprised a total of 165 patients, who were divided into two groups: The first group had low-pressure pneumoperitoneum (12 mm Hg; N = 78) and the second group had high-pressure pneumoperitoneum (14 mm Hg; N = 87). A detailed statistical analysis included sex, age, operation time, and liver function tests including total bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, fibrinogen, and lactate dehydrogenase (LDH), which were obtained preoperatively and 24 h, 7 days, and 30 days postoperatively. The statistical hypotheses were tested with a t test, Mann–Whitney test, chi-square test, Friedman test, and Wilcoxon’s test. There was no statistical difference between the two groups considering age, gender, and operation time (p = 0.740, p = 0.255, and p = 0.480, respectively). There was also no statistical difference in the median values of bilirubin, AST, GGT, LDH, albumin, and fibrinogen between the two groups. There was a significant statistical difference between the two groups in the median values of ALT on the 30th postoperative day (p = 0.045). There was a statistical difference for all hematochemical parameters as a function of time, independent of the level of intra-abdominal pressure (IAP). There were no statistically significant differences in the values of parameters of structural damage to the liver between the two groups, but within the groups themselves. From this we conclude that both values of elevated IAP cause microstructural and functional damage to the liver.

The aim of study was to estimate the effect of acute exercise on serum growth hormone (GH) and fatty acid (FFA) levels in elite water polo players. Twelve male water polo players (20.50 ± 2.02 years) and eleven non-athletic male subjects (20.55 ± 1.04 years) participated in this study. In order to determine GH and FFA responses to acute exercise, a treadmill-running test was performed following an incremental protocol. Pre-exercise blood samples for both athletes and non-athletes were taken at 9 AM. Post-exercise samples were taken immediately after and 30 min after the treadmill running test. Water polo players had significantly lower baseline values of serum GH concentration compared to controls, whereas serum FFA concentration was significantly higher in water polo players compared to controls (p

The phrenic nerve is a nerve that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm. It controls the diaphragm which is the primary muscle involved in breathing. Injuries of the phrenic nerve can occur after trauma such as falls, blunt trauma, after penetrating injuries or in car accidents, iatrogenic nerve injury during surgery in the neck and chest. Phrenic nerve pacing (PNP), or “diaphragm pacing”, is the application of rhythmic electrical impulses to the diaphragm, resulting in respiration for patients who would be otherwise dependent on a mechanical ventilator. Phrenic nerve stimulators are indicated for selected patients with partial or complete respiratory insufficiency” and “can be only effective if the patient has an intact phrenic nerve and diaphragm, which means in patients with spinal cord injuries, central sleep apnea and in patients with lesion of central nervous system. In contrast, trauma below C2 usually does not allow pacing, because the cell bodies of the phrenic nerves are damaged. This kind of treatment can lead to a significant improvement in the quality of life of ventilator-dependent quadriplegic individuals. It can improve pulmonary function and reduce the incidence of pulmonary infections. In addition, it improves quality of speech and olfaction which leads to much better quality of life and higher rates of social participation. We would like to demonstrate a case of a nineteen years old patient that was admitted to the ER department in Clinical Center of Serbia as an emergency case with penetrating wound injury after a gunshot wound to the neck. Data from the literature, which have been also confirmed with our individual experience suggest that the phrenic nerve pacing begins in cases that there is no recovery of nerve not earlier than three and no later than six months after the injury when the results are the most appropriate. Most patients with diaphragmatic pacemakers continue to need tracheostomies and mechanical ventilators as a back-up to their pacemakers. It is important to note that diaphragmatic pace makers only improve inspiratory function and do not target expiratory functions such as coughing and clearing secretions. Finally, the extremely high cost of the device itself, with modest results of the implementation of the device, gives a basis to observe it with great criticism, especially in countries with lower economic status.

The aim of this study was to describe qualitatively and quantitatively dietary supplements (DS) and medication use in elite athletes. Athletes (n=912; age 23.9 ± 6 years; 72% male) reported medications and DSs taken within 3 days before doping control. We analyzed data collected from 2006 to 2008, identified and classified substances. Total of 74.6% athletes reported use of at least one substance, 61.2% took DS (3.17 per user) and 40.6% took medications. Among users, 21.2% reported the use of six and more different products, and one took 17 different products at the same time. Majority of medication users took non-steroidal anti-inflammatory drugs (NSAID) (24.7%), and 22.2% used more than one NSAID. We found no gender differences in DS use (P=0.83). Individual sport athletes used more DS (P

Lymph node metastasis in patients with colorectal carcinoma is bed prognostic factor. High level of CEA and CA 19-9 tumor markers before surgery have had a high sensitivity and also is a combination of high specification, especially in late stage cases. Considering that, general attention was to proof a correlation between level of CEA and CA 19-9 tumor markers before surgery and number of nodal metastasis in these patients. Our study included 102 patients with colorectal carcinoma. We measured level of CEA and ca 19-9 tumor markers before surgery and compared it with number of dissected lymph node metastasis after surgery as same as comparing with Duke's stage of carcinoma. Average level of CEA tumor marker before surgery was 44,59 μg/mol. Lowest rate was 0,8 μg/mol ant the higher was 551 μg/mol. Average level of CA 19-9 before surgery was 258, 8696 U/mol. Average number of dissected lymph nodes per patient was 14,62 within average 2,5895 was nodal metastasis. There is a high statistically signification between CEA and CA 19-9 tumor markers level before surgery and level of Duke's classification stage after surgery. Number of nodal metastasis is correlated with level of CEA before surgery. Level of CA 19-9 before surgery is not statistically significant for number of nodal metastasis. During this examination we noticed a high increasing of CEA and CA 19-9 tumor marker levels before surgery in patients with C2 Duke's stage with more than 4 lymph nodal metastasis found after surgery. In this patients level of CEA was higher 45,78 μg/ml comparing with patients in C1 Duke's stage who have had CEA level 6,07 μg/ml. In patients with C2 Duke's stage average value of CA 19-9 was extremely high - 71 U/ml. High level of CEA and CA19-9 is statistically significant for staging of colorectal malign disease as same as for number of nodal metastasis.

Pulmonary artery intimal sarcoma (PAS) is a rare mesenchymal tumor mostly diagnosed in middle-aged women. In a 63-year-old female, the radiological findings showed cavitation in the left upper lobe of the lung and infiltrative tumor mass around the left pulmonary artery. PAS consisted of small, round tumor cells with about 80% of mitotic activity and with myxoid background and specific immunoprofile and diagnosed as undifferentiated sarcoma with round cell features type. The final diagnosis of PAS was established according to the pathohistological, chest computed tomography scan, and surgery finding.

Presence and extent of regional nodal metastasis predict outcome in patients with colon adenocarcinoma. Completeness of nodal resection and staging accuracy has significant implications in terms of diagnosis, treatment, and survival in patients with this disease.1 Up to 30% of patients with node-negative colon cancer staged by standard pathologic techniques ultimately suffer disease recurrence and tumor-related mortality following potentially curative primary resection.2 Variations in outcome among patients with node-negative early stage disease may reflect inadequate nodal resection and inaccuracies of pathologic staging. Standard pathologic evaluation may overlook low volume nodal metastasis, thereby failing to identify nodes imperative to accurate staging. Inconsistencies in number of nodes harvested at time of pathologic processing impact significantly colon cancer staging accuracy. This nodal sampling error serves as the basis for guidelines establishing a 12 node minimum for adequate staging utilizing conventional techniques.3 Up to 78% of metastases are identified in subcentimeter nodes that may be overlooked during standard gross pathologic dissection of resected specimens.3–5 Microscopic examination of 1 or 2 hematoxylin and eosin-stained sections of a 5-mm node limits pathologic assessment to

Introduction. Radiofrequency ablation is a new invasive procedure that is being increasingly used in the treatment of colorectal liver metastases. Resection as the only potential cure for colorectal liver metastases is limited by the size and the itrahepatic localization of lesions. Radiofrequency ablation may extend the limitations of classic surgery. In this work we analyzed the combination of surgical liver resection and radiofrequency ablation of liver metastases. Material and methods. This study included 11 patients with colorectal metastases. Colon resection and radiofrequency ablation have been performed in five (5) patients, three (3) patients underwent liver resection and radiofrequency ablation, and in three (3) patients colon resection, liver resection and radiofrequency ablation were performed. Results. In our study group, there were 6 (54.54%) men and 5 (45.45%) women aged 55 to 66 years and 52 to 67 years of age, respectively. During operations, we treated 30 liver metastases, 2.72 metastases per patient. There were from 2 to 4 ablation metastases. The diameter of colorectal metastases was between 11 mm and 44 mm. Most of ablation metastases (12 or 40%) were between 2.1 cm and 3 cm in diameter. Only 10% of ablation metastases were over 40 mm in diameter. Discussion. The majority of patients with metastatic colorectal hepatic tumors are not candidates for surgical resection, due to tumor size, location and multifocality. However, we can treat advanced colorectal cancers and colorectal liver metastases with a combination of liver resection and radiofreqency ablation. In this way we can operate and give a chance to patients with multifocal metastases and metastases with a diametar over 40 mm. Conclusion A combination of liver resection and radiofreqency ablation in treatment of advanced colorectal cancers with liver metastases is a good treatment modality which increases the number of operable cases.

Introduction Surgical techniques and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity and mortality rates after gastrectomy for gastric cancer have been reduced or not in recent years is still unclear. In this study we would like to point out the role of systematic lymphadenectomy in postoperative mortality and morbidity. Material and methods In this investigestion we analyzed two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy D1. The second group of 114 patients with gastric carcinoma underwent more radical types of lymphadenectomy (D2, D2%, D3). In this study we analyzed differences between these two groups of patients in regard to:1) early postoperative mortality, 2) early postoperative complications and 3) long-term postoperative complications. Results Early postoperative mortality rate was 4.76% in D1 group and 5,26% in group with systematic lymphadenectomy (SL). 14.3% of patients in D1 group and 15.7% of patients in SL group had postoperative complications. The most frequent complications in D1 group were non-surgical complications of the respiratory system. In SL group the most common postoperative complications were anastomotic leakage (5/18, 27.77%) and wound infection (6/18. 33.3%). The most common long-term complications in both groups were: ventral postoperative hernia, anemia, small bowel obstruction and gallbladder calculosis. Discussion Early postoperative death occurred in patients with stage IV gastric cancer. The rates of anastomotic leakage, as main cause of early postoperative mortality and morbitity in patients with systematic lymphadenectomy, were reduced in the last few years with stapling surgery. Conclusions There were no significant differences in the postoperative mortality and morbidity rates between the two analyzed groups in our investigation.

Introduction In the last few years there have been arguments between the Japanese and West European surgeons about benefits of systematic lymphadenectomies in surgery of gastric cancer. In this paper we would like to point out effects of systematic lymphadenectomies on survival of patients with gastric carcinoma. Material and methods This investigestion included two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy Dl. The second group of 114 patients with gastric carcinoma underwent more radical types of lympadenectomy (D2, D2%, D3). Survival analysis included investigation of the following:1 depth of tumor invasion, 2. metastatic involvement of the lymph nodes 3. tumor stage, 4. tumor recurrence. Results Most of examined patients presented with invasion and serosal and subserosal penetration (about 75% in both groups). More than 42% of lymph nodes had metastases and patients with systematic lymphadenctomy had better survival. Patients without subserosal invasion did not have metastatic lymph nodes in H, III, IV drianaged groups. There was no difference in regard to length of survival between the two analyzed group. 5-year survival rate "was highest in stage I of gastric carcinoma (86%), but in stage IV 5-year survival rate was only 3.8%. Local recurrence (26%) and lymph node metastases (53%) were common causes of tumor recurrence in group with peritumor lymphadenectomy. In all groups of patients with advanced gastric cancer patients undergoing systematic lymphadenectomy presented with higher survival rate. Discussion Patients with advanced gastric cancer presented with higher number of metastatic lymph nodes in III and IV drainaged groups. In this stage systematic lympadenectomy played the main role. In the group of early gastric cancer there were no patients with metastatic lymph nodes in drainaged groups. Conclusion D2 lympahedenectomy is a standard procedure for a great number of patients with gastric carcinoma, with high survival rate. Only in the group of advanced gastric cancer, patients un?dergoing more radical types of lymphadenectomies (D2%, D3) presented with better survival rates.

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.

Diagnosis of intraabdominal bleeding caused by spleen injury must be performed in the shortest possible period of time, with little risk for the patient, and with high preciseness. By its simple performance, high preciseness and little risk for the patient, DPL imposes as the predominant method in initial diagnostic of intraabdominal bleeding. Control and monitoring of lavage may duly signalize degree of bleeding. Preciseness of this diagnostic in our series ranges up to 93.3%. DPL method is especially important in a combined neurotrauma. Ultrasonography is a sovereign method in diagnostic of bleeding source as well as in monitoring of bleeding that from the very beginning does not require urgent surgical intervention. Its importance is in monitoring both intrasplenic and subcapsulary hematomas. It is not appliable in disturbed and haemodynamically unstable patients. It is in particular important in children where a maximum conservative attitude with respect to operative treatment has been assumed. CT takes the leading place with respect to preciseness of bleeding area, and the combined thoracoabdominal trauma. Preciseness of CT in our series comes up to 96.6%, but can be applied only in haemodynamically stable patients. Same as US of abdomen so the CT of abdomen represents a prominent method in monitoring of both intrasplenic and subcapsular hematomas, which do not require urgent surgical intervention.

Introduction Formation of lymphatic metastasis is an important prognostic factor in treatment of gastric carcinoma. In this paper we would like to point to the importance of systematic lymphadenectomy in regard to extent of metastatic lymph node involvement in patients with gastric carcinoma. Material and methods This investigation included 114 patients with diagnosis of gastric carcinoma undergoing systematic lymphadenectomy. We analyzed metastatic lymph node involvement considering: 1. tumor localization; 2. histopathologic type; 3. depth of tumor invasion; 4. extent of lymph node resection; 5. stage of disease. Results In the course of this study, 2100 lymph nodes were extracted by systematic lymphadenectomy (18.42 lymph nodes per patient on average). Out of this number, about 27% of lymph nodes were involved with metastasis, and 60% of positive lymph nodes belonged to the first, 25.7% to the second, 10.2% to the third and 3.8% to the fourth drainaged group. The most frequent localization (over 56%) of tumors was the distal third region of stomach. Histopathologically, most common type of carcinoma was intestinal carcinoma, with metastasis in first and second drainage group. A great number of patients have tumors with infiltration of the serosa. Those patients had metastases in lymph nodes in over 42%. Most patients (58%) belonged to IV stage of disease and presented with highest number of involved metastatic lymph nodes in all drainage groups. Discussion In our patients high metastatic involvement of all four drainage groups of lymph nodes was established. Up to date standard lymphadenectomy (D1) which has been performed increased the length of survival of these patients. Conclusion By systematic lymphadenectomy we removed a great number of metastatic lymph nodes with beneficial effect on survival of patients with gastric carcinoma.

Summary There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of sympaticovagal balance. It is also used in prescription and monitoring of athletic training. The purpose of our study was to determine HRR after maximal exercise among elite athletes with respect to age. A total of 274 elite male Caucasian athletes were randomly selected from the larger sample and divided into two groups: adolescent (group Y) and adult athletes (≥18 years; group A). They performed maximal cardiopulmonary exercise testing on a treadmill. Heart rate recovery was calculated as the rate of decline of HR from peak exercise to rates 1, 2 and 3 min after cessation of exercise (HRR1, HRR2 and HRR3). A significantly higher HRR1 was found in group A (29·5 ± 15·6 versus 22·4 ± 10·8, P

We report a case of successful transcatheter arterial embolization of a pancreaticoduodenal artery pseudoaneurysm (PSA) caused by erosion of the pancreatic pseudocyst content near pancreaticoduodenal arteries. A 55-year-old man was admitted to a local hospital for investigation of severe, stabbing epigastric pain confined to the upper abdomen. He had a history of previous alcohol abuse, chronic pancreatitis, and a duodenal ulcer. Upper gastrointestinal endoscopy revealed narrowing in the pyloric channel along with an ulcer located at the first and second portions of the duodenum with oozing beneath an adherent cloth and duodenal distortion. Computed tomography additionally revealed an enlarged head of the pancreas with numerous spot calcifications and round cystic formation inside, with a diameter of 30 × 25 mm. Following two surgical procedures for duodenal ulcers, selective angiography revealed a PSA located inside the pancreas head and high-grade stenosis > 90% of the celiac trunk and hepatic artery that rose separately from the aorta. Fiber coil embolization was used to occlude the PSA sac successfully. There was no complication after completion of the last embolic procedure. The patient was doing well after 26 months.

Introduction Multiorgan resection for a malignancy is a very comlicated procedure, but there is always the question: does it work? In everyday clinical practice gastric cancer in phases III and IV is rather frequent. Unfortunately, our patients are under the age of 55 years. D2 lymphadenectomy is not as extensive as D2 %/ or D3, so one must ask himself if multiorgan resection is worth the risk. Material and methods We evaluated two groups of patients: group I consisted of 34 patients who underwent total or subtotal gastrectomy, systematic lymphadenectomy and resection of one or more organs; group II (control) consisted of 167 patients who underwent total or subtotal gastrectomy and systematic lymphadenectomy. These two groups of patients were analzyed in regard to: Bormann's classification, histopathologic type, early mortality, early postoperative complications, lymph node dissection and long-term survival. Results According to Bormann's classification the most common type of carcinoma in both groups was ulcerovegetativ tumor (70.6% in I and 58% in II). In the first group of patients a great number of patients had poorly differentiated adenocarcinomas (47%), while in the second group the most common histologic type was well differentiated intestinal carcinoma (28%). Patients with multiorgan resections had higher rates of early postoperative mortality and morbiditiy (mortality - 14.7% and complications - 26.5%) than patients in control group (mortality - 4.8% and complications - 11.4%). The most frequent causes of postopertive mortality and morbidity were anastomotic leakage and wound infections in both groups. Metastatic lymph node invelvement was higher in the first group (41%), than in the second (28%). Long-term survival was best in the control group (38.5 months). Patients with multiorgan resection had better survival (25.4 months) than inoperable cases (only 5 months). Discussion Patients undergoing multiorgan resection usually have advanced gastric cancer with tumor infiltration in surrounding structures. Only these cases are absolute indications for this radical operation, because patients have better chances fo survival. Conclusion Multiorgan resections are extensive procedures with high rates of postoperative mortality and morbiditiy, but represent the only way for better survival of patients with advanced gastric cancer.

Introduction Small bowel neoplasms are relatively rare, considering digestive system neoplasms. The aim of this case report was to point to clinical manifestations, significance and treatment patterns of small bowel lymphomas. Material and methods This is a case report of a sixty-eight year old patient who had undergone surgical treatment due to clinical and radiological findings of small bowel obstruction. Results Histological findings revealed a malignant lymphoma. Primary small intestine lymphomas are treated by radiochemotherapy followed by surgical treatment (partial resection).