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Introduction: Emphysematous cholecystitis is a rare gallbladder pathology characterized by gas accumulation in the gallbladder wall as a result of severe inflammation, mostly caused by bacteria known as Clostridium species., Case Report: This is a case report of a 59 year-old male diabetic, with typical anamnestic, clinical, ultrasonographic and radiological findings, pointing to acute cholecystitis of emphysematous form. Surgical and bacteriological procedures confirmed the preoperative findings., Conclusion: Reliable findings considering clinical status, ultrasonographic and radiological differential diagnosis, adequate and quick preoperative preparation, cholecystectomy and drainage with appropriate antibiotic treatment and hyperbaric oxygenation, represent the basic principles in diagnostics and treatment of this disease.

Introduction: Malignant lymphoma of the thyroid gland can be defined as a lymphoma arising from the thyroid gland. Lymphomas of the thyroid gland represent less than 5% of primary thyroid neoplasms and are two to three times more common in women than in men, whereas the median age is usually close to 60 years. Majority of thyroid lymphomas are diffuse, large-cell lymphomas. The incidence of thyroid lymphomas in patients with Hashimoto thyroiditis has markedly increased and this phenomenon is probably related to their pathogenesis., Clinical Presentation: Unlike most other thyroid neoplasms, lymphomas are usually rapidly enlarging masses and local symptoms are common: pain, hoarseness, dysphagia, and dyspnea or stridor., Diagnosis: To evaluate the extent of disease, a chest x-ray and CT scans of the head and neck, chest, abdomen, and pelvis are necessary. An excisional or large-needle biopsy may also be necessary to make the correct diagnosis. Occasionally, these tumors can be confused with anaplastic thyroid carcinomas, which can lead to serious mistakes in management. A gallium scan or a positron emission tomography (PET) scan can help later to establish whether any residual abnormality, observed on x-ray studies after treatment, contains active lymphoma or scar tissue. After diagnosis, patients are clinically staged (without surgery) using appropriate computed tomography scans or magnetic resonance imaging., Therapy: Assessment of the extent of thyroid lymphomas is crucial for prognosis and treatment. Total thyroidectomy may improve the prognosis in patients with intrathyroidal disease only. It is very important to identify patients with favorable prognostic factors and to treat them with standard chemotherapy (CHOP) and radiotherapy protocols. Patients with diffuse large-cell primary thyroid lymphomas should not be treated with radiation therapy alone., Conclusion: The best treatment results for malignant lymphomas of the thyroid gland are achieved using a combined-modality therapy.

Introduction: Celiac disease (nontropical sprue, gluten-sensitive enteropathy, chronic intestinal malabsorption disorder) is caused by gluten intolerance. This hereditary disorder is caused by sensitivity to gliadin. Because the body's own immune system causes the damage, celiac disease is considered to be an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny finger-like protrusions, called villi, on the lining of the small intestine are lost. The diagnosis is suspected on the basis of symptoms and signs, enhanced by laboratory and x-ray studies, and confirmed by biopsy revealing flat mucosa and subsequent clinical and histologic improvement on a gluten-free diet. Gluten must be excluded from diet. Supplementary vitamins, minerals and hematinics may be given depending on deficiency., Case Report: This is a case report of a 23-year old female patient with a mineralization defect (osteomalacia) and secondary osteoporosis caused by long-time unrecognized celiac disease. The patient had many symptoms: short stature, steatorrhea, anemia, weight loss and chronic bone pain. Laboratory and x-ray studies and jejunal biopsy revealed a chronic intestinal malabsorption disorder caused by gluten intolerance. Gluten-free diet and supplementary vitamins, minerals and hematinics were included with apparent clinical remission., Discussion and Conclusion: Some people with celiac disease may not have symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for complications of celiac disease. Biopsy of the small intestine is the best way to diagnose celiac disease. Decreased bone density (osteoporosis and osteomalacia) is a serious problem for celiacs. If calcium is not absorbed, due to small intestinal damage caused by untreated celiac disease, bones are not as dense. The only treatment for celiac disease is gluten-free diet, that is, avoiding all foods that contain gluten. For most people, this diet stops symptoms, heals the existing intestinal damage, and prevents further damage.

Introduction: Association between endocrine and mental disorders has been recognized a long time ago, as well as their mutual dependence. The aim of this study was to evaluate the psychological structure of patients with thyroid nodule before and after surgical treatment., Material and Methods: In order to establish the type and degree of psychological disorders, we have examined 60 patients with thyroid nodule before and after surgical treatment by using DSM-IV classification of mental disorders and psychological instruments: semistructured psychiatric interview, MMPI, Zung Depression Scale and a list of panic symptoms. Patients with nonautonomous ("cold") nodules presented as euthyroid, and those with autonomous ("hot") nodules (after a period of drug therapy if they were hyperthyroid), required surgery. After a period of drug therapy two groups of patients were compared: group 1--euthyroid with "cold" nodules and group 2--euthyroid with "hot" nodules. Before surgical treatment both groups underwent psychological evaluation. Group 2 presented with: anxiety, depression and panic disorder with or without agoraphobia (72%, 46%, 28%) while group 1 presented with following results: 48%, 23%, 14% respectively. After surgical treatment patients from group 1 presented with psychologic disorders in less than 1%., Discussion and Conclusion: In some physical disorders, psychologic factors contribute directly or indirectly to the etiology, in others, psychologic symptoms are the direct results of a lesion affecting neural or endocrine organs. One of the key etiological factors is often a short-time or long-time stress and its direct consequence is altered functioning of various hormonal systems. Unexpected high percentage of psychological disorders in patients with thyroid disorders suggests that psychological evaluation before and after surgical treatment is unavoidable for good assessment and choice of treatment.

Use of arterial grafts represent the new approach in coronary artery bypass grafting (CABG) surgery these days. This article represents our experience in use of two or more arterial grafts in combination (internal mammary artery--IMA and right gastroepiploic artery--RGEA). Between March 2000 February 2002, 10 patients underwent CABG with exclusive use of left or both IMAs and RGEA, with or without extracorporal circulation (ECC). In the group without ECC fast truck anesthesia was used. Post CABG catheterization was performed in three patients. There were no 30 day mortality or morbidity. Post CABG catheterization in two patients showed excellent graft patency. One patient continued to have chest pain and after the catheterization we found ostial narrowing of the celiac trunck which was successfully dilated. One of participants had abdominal hernia repair. Our opinion is that use of arterial grafts in CABG surgery has much lower risk, excellent patency and good long term prognosis.

Primary Objective: To build and test a simple vibroacoustic foetal stimulator., Research Design: A vibroacoustic foetal stimulator was constructed and subjected to bench testing. Clinical trial was carried out in comparison to an electro laynx., Main Outcome and Results: Screening specificity of 98% and 100% sensitivity was achieved, with no decrease in specificity due to user's maladjustments. The device was characterized by simple use, maintenance and disinfection., Conclusions: The device is a good screening instrument for foetal health in prenatal care, despite its simplicity and low price.

Objective: To estimate the shape of epithelial nuclei in bronchial mucosa., Study Design: Bronchoscopic mucosal samples from 12 patients with chronic bronchitis and 14 patients with squamous cell bronchial carcinoma were routinely processed and stained with the hematoxylin and eosin method. Fields with stratification and squamous metaplasia were selected. The roundness of epithelial nuclei was estimated using Lucia, version 3.51 ab, with an objective of 40:1 (NA = 0.65) and final magnification of 1,900:1. The images were manually edited. Roundness was calculated from area and perimeter., Results: The mean roundness in stratification and squamous metaplasia in bronchial mucosa from carcinoma patients (0.90 +/- 0.04) was significantly greater than in bronchial mucosa from chronic bronchitis patients (0.80 +/- 0.006) (P < .05)., Conclusion: Our results indicate that cell nuclei in stratification and squamous metaplasia in patients without bronchial cancer are more elongated than nuclei found under the same conditions in patients with squamous cell carcinoma.

ELISA was used for follow-up of protozoa Toxoplasma gondii infection in 2,778 pregnant women in the Timok region during the five-year period (1989-1993). The study included 16.66% of all pregnant women in the region. Acute infection was registered in 17 (0.61%) and chronic infection in 1.266 (45.57%). Spontaneous abortions were registered in only 12 (0.43%) tested pregnant women. In relation to the total number of spontaneous abortions (865) in all pregnant women in the region spontaneous abortions in the studied group occurred in only 1.38% of cases. Anomalies in newborns were registered in a total of 3 (0.11%) cases. In relation to the total number of anomalies in newborns (194) from all deliveries in the region, the number of anomalies in newborn in the studied group was only 1.54%. Toxoplasma gondii infection did not significantly affect the frequency of spontaneous abortions and anomalies in newborns of the Timok region during five-year period.

We have observed 428 patients with hemorrhages of the upper gastrointestinal tract; 7% of patients with stress lesions of the gastroduodenal mucosa being the cause of hemorrhages (4.9% were erosional stress hemorrhages and 2.1% were stress ulcera). Surgery is the most common cause of stress hemorrhages of the stomach and duodenum. They occur during the first 5 days after the surgery, whereas 70.59% (n = 12) occur during the first 72 hours. The localization of erosional hemorrhages of the stomach mucosa is mostly diffuse and that is why they are numerous (78.6% of the third degree) and hemorrhages are mostly heavy (the case with stress hemorrhages). Chronic peptic ulcera, especially duodenal (62.5% duodenal ulcera and 37.5% stomach ulcera) present an expressed risk factor for the occurrence of hemorrhagic erosions under the influence of the stress factor. The most common localization of the stress hemorrhagic ulcus is duodenum (66.7%) which is a potential danger for occurrence of the heaviest arterial hemorrhages. After major surgeries and during postoperative periods patients must be preventively protected by "antiulcus therapy" (especially patients with ulcera).

Solitary thyroid gland nodes have presented an entity in thyroid surgery and endocrinology for a long period of years mostly due to frequent occurrence of malignomas and other changes of thyroid gland as well as to insufficient and uncertain clinical diagnostics. The only certain diagnostics is still the intraoperative exploration and ex tempore biopsy of the change, which means that surgery presents both a diagnostic and therapeutic procedure. At the Clinical-Hospital Center "Dr Dragisa Milosevic" in Belgrade, Department of Surgery, 100 patients with preoperatively diagnosed solitary thyroid gland nodes underwent surgery during a 4 year period. In all patients a uniform clinical diagnostics was performed, and then, on the basis of intraoperative findings and ex tempore biopsy, gathered results were compared and reliability of certain preoperative diagnostic procedures was considered in regard to intraoperative findings. The aim of this study was to point to necessity of application of all relevant indexes in diagnostics with a special review on the intraoperative finding as the most relevant in making the decision about the range of surgery and further postoperative treatment.

During the observed 5 year period 428 patients were hospitalized because of upper digestive tract hemorrhages. The commonest cause of hemorrhage was the peptic ulcer (46.5%). The bleeding duodenal ulcer occurs more often than the stomach ulcer (55.2% to 44.8%). These patients are usually of older age (more than 50% of men and 46% women in whom duodenal ulcer bleeding occurs are older than 60 years of age). In about half of ulcers (40%) acute bleeding occurs during the urgent endoscopic procedure. Oozing type of bleeding occurs most frequently (82.5%), while the most serious type of bleeding, aortic pulse, is much less frequent (7%). Fibrinous coagulum recidives in bleeding in about one fifth of cases. Active pulse bleeding is the cause of surgery in 66.7% as well as two thirds (75%) of recidivant bleedings. More than 80% of patients in whom gastroduodenal bleeding occurs are being conservatively treated and this percentage may be taken as an adequate choice of the therapy modality.

The authors describe a case of gastric carcinoma coupled with pregnancy, the only such case they encountered in 80,064 deliveries over a period of 30 years. The pregnancy was complicated by pronounced anemia and general weakness. By administering roborants, antianemic therapy, and blood transfusion to improve the patient's general condition, the pregnancy was completed by the birth of a clinically healthy at-term live child, weighing 3150 g. The patient lived only 6 months after delivery.

Nothing seems to slow down the postoperative passage of the intestines so much as an empty stomach. For this reason the authors have for three years been giving special attention to early food provision following cesarean section as a stimulus to peristaltic movements. They analysed 150 deliveries of women with cesarean section to whom light parenteral diet was applied immediately after the operation and compared the results obtained with those from the control group of 150 women with cesarean section treated from 1972 to 1973 when only intravenous infusion was administered. A significantly quicker appearance of gases was observed in the women on early parenteral diet than in the control group (the average time 34:74h) and the first stool was recorded much earlier in the first than in the second group (56:67h). Prostigmin was administered only exceptionally. Neither in the first nor in the second group did surgical intervention for postoperative ileus prove necessary.

Cysticercosis cerebri involving the lateral ventricle is very rare. Two cases with such localization are presented. One of the patients, with occlusion of the foramen of Monro, was successfully treated by operation. A larval form in the lateral ventricle was revealed incidentally at autopsy in the second patient after rupture of a large basilar artery aneurysm.