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Background: Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Methods: Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Results: Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p

Background/Aim. Establishing a preoperative diagnosis of thyroid follicular tumors is difficult due to the fact that the cell morphology of adenomas and carcinomas are similar and that capsular and vascular invasion cannot be determined by cytology. We analyzed predictive factors of follicular carcinoma in order to enable a surgeon to indicate operative treatment and to perform an adequate operation for each patient with a follicular neoplasm. Methods. In this retrospective study, we analyzed medical records of all patients with follicular thyroid tumors operated at an endocrine surgery unit of a tertiary referral academic hospital, between 2008 and 2012. A total of 263 operated patients were included and divided into follicular adenomas (n = 97) and follicular carcinomas (n = 166) based on the histopathology results. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results. In adenoma group (19 males, 78 females) age range was 19–79, mean age 50. In carcinoma group (35 males, 131 females) age range was 15– 78, mean age 48. Univariate analysis showed that thyroglobulin concentration ≥ 500 ng/mL, tumor diameter < 30 mm, presence of more than one thyroid nodule and an afunctional/hypofunctional nodule were significantly more frequent in follicular carcinoma than in follicular adenoma. Independent predictive factors of malignancy were: elevated preoperative thyroglobulin concentration (≥ 500 ng/mL) and presence of more than one nodule. Based on our results we formed a nomogram, a two-dimensional diagram designed to enable estimation of preoperative probability of malignancy. Conclusion. Elevated preoperative thyroglobulin concentration, ≥ 500 ng/mL, and the presence of more than one nodule are independent predictors of malignancy for follicular thyroid carcinomas.

Introduction/Objective. Adrenocortical carcinomas (ACCs) are very rare tumors with grave prognosis despite multimodal treatment. The aim of our study was to determine the incidence and mortality of ACCs in Central Serbia. Methods. The study period was from 1999 to 2012. We used data from the Cancer Registry of Central Serbia. Incidence and mortality rates were sex- and age-standardized according to Segi’s world population. Results. In the defined period of the study, 128 patients with a diagnosis of ACC were registered and the female-to-male ratio was 1.3:1. The median age of affected individuals was 42.3 years. There were two main age peaks – one in childhood (0–9 years), and the other in the fifth and sixth decade of life. In this period, the average standardized incidence rate of ACC amounted to two per million people with slightly increasing trend. The largest number of male patients with ACC (22; 39.2%) was registered in the age group of 0–9 years, while the largest number of patients in females was shown to be in the age group of 40–49 years (29; 40.3%). During the study period, there were 35 deaths registered in patients with ACC (mean age of 61.2 years). The average mortality rate of ACC was 0.3 per million people. The male-to-female ratio was 1.5:1. Most fatal outcomes were registered in the age groups of 50–59 and 60–69 years, so 91.4% of all deaths took place in the age groups 50+. Conclusion. ACC is an extremely rare tumor that occurs more often in women than in men. However, fatal outcomes occur more frequently in males. [Project of the Ministry of Education, Science and Technological Development of the Republic of Serbia, Grant no. 175042]

Backgraund/Aim. The Thyroid Specific Patient Reported Outcome Measure (ThyPRO) questionnaire is self-administered and intended to measure quality of life of thyroid patients. The aim of this study was to investigate the validity and reliability of the translated new, ThyPRO questionnaire in Serbian patients with thyroid disease. Methods. The translation process followed an internationally accepted methodology. The questionnaire was validated in 100 consecutive thyroid patients hospitalized in a tertiary level hospital, between April and August 2012. Internal reliabilities of ThyPRO scales were assesessed using Cronbach’s α coefficient. Association between age, gender, education, marital and employment status, place of living, diagnosis, current treatment, hormonal status and patient quality of life were determined using Pearson’s (r) and Spearman’s (q) correlation coefficients. Results. Internal consistency and reliability for ThyPRO scales were satisfactory. Cronbach’s α coefficients of 13 multi-item scales of the ThyPRO were > 0.83 (range 0.83-0.95). The scores, obtained by this questionnaire, correlated significantly with patients gender, employment status, diagnosis, current treatment and place of living. A highly significant inverse relationship was found between scores and hormonal status as well as between scores and disease duration. Patients’ age, marital status and thyroid-stimulating hormone level did not influence any scale score. Conclusion. The ThyPRO may be useful in measuring health-related quality of life in patients with thyroid disease in Serbia. [Projekat Ministarstva nauke Republike Srbije, br. 175 042]

The thyroid gland is the largest endocrine organ with the highest frequency of disorders of all the endocrine organs. A successful treatment of both benign and malignant diseases of the thyroid is connected with adequate pre-operative evaluation, a precise operative technique and the knowledge of surgical anatomy. Complications that may occur due to the insufficient knowledge of the surgical anatomy of the thyroid and parathyroid glands permanently damage the health of the patient and cause his lifelong disability. Therefore it is necessary that the surgeon performing a thyroid and/or parathyroid glands operation should have sufficient knowledge of the surgical anatomy of these endocrine organs despite the wide availability of instruments which enable better visualization of the operative field, coagulation of blood vessels and intraoperative neuromonitoring.

Introduction: In spite of the fact that thyroid nodules are frequent, thyroid malignancies are rare. The most common are differentiated thyroid cancers, which usually have favourable prognosis due to exact diagnosis, adequate operative procedure followed by adjuvant radioiodine therapy and routine supressive L-tiroxine administration. Successful treatment of differentiated thyroid cancers is the reason for dimishing the rate of anaplastic tumors. Material and method: This is a retrospective clinical study on 1845 patients, operated because of differentiated thyroid cancer in Center for Endocrine Surgery, Clinical Center of Serbia, in Belgrade, in period from 1995 to 2008. Results: Papillary cancer was found in 1650 patients (79%), among which papillary microcarcinoma in 694 smaller than 1cm (33%), follicular cancer in 51 (2%), Hurthle cell cancer in 144 (7%). Total thyroidectomy was performed in 1249 patients (89%), one side total with opposite subtotal lobectomy in 137, bilateral subtotal lobectomy in 27, one side lobectomy in 399. Neck dissection was performed in 188 cases (15%). After surgery, recurrent nerve palsy was noted in 25 patients (1.2%), hypparathyroidism in 24 (1.2%), postoperative bleeding occurred in 7 (0.4%). Discussion: The most useful preoperative diagnostic procedure is FNA. Unfortunately it is not sufficient for follicular lesions because it cannot distinguish malignant from benign tumors, meaning that all suspected follicular lesions should be operated. Imaging studies, mostly ultrasound, but also CT and MR are used to show tumor, enlarged involved neck and mediastinal lymph nodes. 'Adequate surgical procedure' for thyroid cancer consists of complete tumor excision all together with all reachable lymph node metastases (en bloc thyroidectomy with central neck dissection between hyoid bone and major mediastinal blood vessels). If jugular lymph nodes are enlarged, modified lateral neck dissection should be performed. Extended procedures should not be performed if the same result could be achieved with less aggressive procedures. The size of the incision is to be distinguished from the extension of surgery: extensive procedure can be performed even through a small incision while an inadequate procedure is performed if a remnant is left in the field even through a large incision. Complications are rare in specialized centers (about 1%). If malignancy is spread beyond local field, even the most extensive surgery cannot control it. Adjuvant radioiodine therapy is to be applied in patients with positive whole-body radioiodine scan after surgery otherwise the results of treatment are less favourable. After primary treatment, all patients receive L-thyroxin in suppressive doses. In aggressive tumor types that do not bond iodine, external beam radiotherapy and chemotherapy should be applied. In patients with risk inheritance, accumulated malignant potential, history of irradiation, prolonged stimulation with cancer risk factors, in dubious nodules in hypothyroid or endemic goiter, prophylactic thyroidectomy should be considered. Conclusion: Surgery of most thyroid differentiated malignancies is effective and safe if all adequate procedures and modalities are performed.

Background/Aim. The incidence of difficult intubation (DI) is 1-10%, and DI leading to inability to intubate occurs in 0.04% of the population. The aim of this study was to evaluate the incidence of DI in thyroid surgery and to assess possible correlation of difficult tracheal intubation with sex and primary diagnosis. Methods. We studied 2 000 consecutive patients (1 705 females) scheduled for thyroid surgery who were assessed for DI prior to general anesthesia, with respect to primary disease diagnosis and sex. Patients were divided into four groups: patients with nodal goiter (group A), polynodal goiter (group B), hyperthyroidism (group C) and thyroid carcinoma (group D). Difficult intubation was predicted using the scoring system which included 13 parameters ranged from 0 to 2. Additive score > 5 was accepted as a predictor of DI. True DI was defined as impossible visualization of glottis with direct laryngoscopy (grade III and IV). Results. Difficult intubation was observed in 110/2 000 patients (5.5%). The incidence of DI was higher in males (26/295, 8.8%) then females (84/1 705, 4.9%) (p < 0.01). The incidence of DI was highest in the group B (6.2%). Extremely DI occurred in 15/2000 patients (0.75%), the most of them in the group C (1.1%). Sensitivity of used scoring system was 91.8% and specificity 86.5%. Conclusions. The incidence of DI was highest in patients with polynodal goiter but extremely DI was present mostly in patients with hyperthiroidism. Men seem to be at higher risk for DI than women. Scoring system used in this study for prediction of DI may be useful in this patient population.

Tuberculous lymphadenitis is an uncommon form of extrapulmonary tuberculosis We report on a case of isolated Cervicomediastinal tuberculous lymphadenitis without parenhimal involvement. A 49-year old woman was hospitalized with a four week history of night sweats and weight loss. Plain chest radiography disclosed mediastinal mass of the right side. Echocardiographic examination revealed a soft tissue mass below the ascending aorta and aortic arch causing moderate narrowing of the right ventricular outflow tract and the main pulmonary artery. Computed tomographic scanning showed soft tissue mass in the middle mediastinum surrouding the great vessels extending posteriorly with moderate compression of trachea. Histological examination of the cervical mass revealed caseating granuloma containing acidalcohol fast bacillus. Antituberculous chemiotherapy was started.

Background: Difficult intubation (DI) occurs in 1% to 3% in general population, and unsuccessful intubation in 0.04%. DI may cause a lot of undesirable effects during prolonged intubation period, including lethal outcome. The aim of the study was to establish the incidence of DI in thyroid gland surgery and to compare the incidence of DI to predicted DI due to different DI screening testes. Methods: Prospective study included 2000 patients, which underwent thyroid gland surgery in Center for endocrine gland surgery, Clinical Center of Serbia, Belgrade, during 1999-2001. 436 of them were thyroid carcinomas 525 were nodal goiter, 671 polynodal goiter and 368 hyperthyreosis; 1705 female, 295 men, average age 48.1 year. According to ASA classification (American Society of Anesthesiologist's classification for correlation between co-existing diseases and perioperative complications) there were 886 ASA I, 901 ASA II and 213 ASA III. We used Mallampathi classes, Wilson criteria and Cormack-Lehane (CL) criteria to predict DI, and CL criteria to define DI. The complications during DI were analyzed and the ratio of DI to predicted DI was established. Results: There were 110 DI- 84 women, 26 men. Considering diagnosis there were T 24, PS 42 H 22. ASA III were 9.38%, ASAII 5.77, ASAI 4.28%. There were 3 unsuccessful intubations. Complications during DI were noted in 32 patients. Ratio between expected DI and DI, and unexpected DI and DI were: 12.77% failed positive and 0.45% failed negative results. Conclusion: Incidence of DI in thyroid gland surgery is twice more in men than in women. Screening tests for prediction DI showed higher specify than sensitivity.

Background: Secondary thyroid cancer is much less frequent than primary and in the majority of cases represents disseminated disease where operation on thyroid is useless or thyroid tumor is not operable, infiltrating surrounding structures. Methods: Five case reports of patients operated for secondary thyroid cancer. Results: Case 1: In male patient aged 64 years thyroidectomy was done for thyroid solid tumor 5 years after lung lobectomy for bronchogenic planocellular cancer. FNB suspected nonthyroid cancer histological analysis revealed planocellular cancer (Grimelius staining excluded medullar cancer) and multinodular goiter. Case 2: In female patient aged 65 years, thyroidectomy was done 4 years after left mastectomy with the history of long standing multinodular toxic goiter. Infiltrate remained in trachea and esophagus, histology revealed breast cancer metastasis in thyroid, confirmed with special mucin I, and estrogen receptor staining with negative thyroglobulin staining. Case 3: In female patient aged 76 years thyroidectomy was performed for metastatic lucidocellular kidney cancer in recurrent goiter (with Vimentin staining), a year after nephrectomy and 50 years after first goiter operation. Case 4: In female patient aged 58 years thyroidectomy was performed for planocellular infiltration of esophagus into the left thyroid lobe. Case 5: In female patient aged 77 years thyroidectomy was done for hemorrhage into thyrotoxic goiter, histology revealed metastasis of planocellular cancer of unknown origin into thyroid. Case 6: In male patient aged 54 years, thyroidectomy was done for thyroid metastatic lucidocellular cancer of kidney, 2 years after nephrectomy. Conclusion: Although prognosis of secondary thyroid cancer is poor, in rare cases aggressive surgery with adjuvant therapy may be successful.

Background: Anaplastic thyroid cancer is relatively rare but extremely aggressive neoplasm. The aim of the present paper was to study the possibility of surgery for anaplastic thyroid cancer. Methods: During 5-year period (from 1998 to 2002) in the Center for endocrine surgery, we found anaplastic thyroid cancer in 65 patients (44 female and 21 male patients) of median age 63 years (range: 37-88 years). Diagnosis was determined on the basis of histological analysis in operated patients or on cytology findings in case of patients who were not operated. Histological analysis confirmed anaplastic transformation of papillary thyroid cancer in 18 cases. Results In 50% patients we performed only fine needle biopsy, and in 37% patients operative biopsy or tumor reduction. We performed radical surgery hemithyroidectomy or total thyroidectomy, in 13% patients with anaplastic thyroid cancer. Thyroid goiter was present in 35% patients longer than a year before diagnosis of anaplastic cancer was made. Conclusion: Possibility of surgery for anaplastic thyroid cancer is very limited. In about one third of patients there were longstanding goiter or histological verified dedifferentiation of papillary thyroid cancer. These patients should have been operated before anaplastic transformation.

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Uvod: Štitasta žlezda je najveći endokrini organ, dostupan fizikalnom pregledu, kao i ehosonografskom pregledu, što je čini vrlo privlačnom kako pacijentima tako i njihovim doktorima. Anatomija, embriologija, fiziologija i patologija štitaste žlezde dobro su proučene. Promene u štitastoj žlezdi su toliko brojne da je potrebno dobro predznanje kako bi se razlučile one ozbiljne koje mogu da ugroze pacijenta, od manje opasnih i onih koje nemaju klinički značaj. Tokom vremena, u postupcima u dijagnostici i operativnom lečenju primećuju se promene koje nagoveštavaju pravce daljeg razvoja. Indikacije za operaciju: Razlog za operaciju može biti kompresija na okolne organe voluminoznim patološkim procesima, hipertireoza, benigni i maligni tumori štitaste žlezde, kao i estetski narušen izgled velikom štitastom žlezdom. U toku poslednje dve decenije, broj operacija na štitastoj žlezdi raste, a procentulano je sve veći udeo malignih tumora i operacija zbog hipertireoza, a sve manji udeo benignih i degenerativnih oboljenja. Među malignim tumorima sve je manji udeo anaplastičnih, dok je papilarnih znatno više zbog preciznije dijagnostike, ali i promenjene klasifikacije, koja se tokom vremena obogaćuje novim kategorijama tumora (npr. NIFTP, Neinvazivna folikularna tiroidna papilarnom slična neoplazma). Tumori su danas manji, limfonodopatija češća nego ranije. Vrste operacija: U poslednje dve decenije raste udeo totalnih i skoro totalnih tirodektomija koje danas čine 2/3 intervencija na štitastoj žlezdi čak i kod benignih oboljenja, posle čega su pacijenti na punoj supstituciji L-tiroksinom. Istovremeno, jednostrane operacije su u blagom padu, ali su i dalje zastupljene u više od 1/4 slučajeva. Bilateralne suptotalne lobektomije, koje su u prošlom veku bile najčešće primenjivana procedura, više se ne primenjuju zbog rizika od recidiva patološkog procesa čije bi rešavanje zahtevalo veći rizik od komplikacija zbog rada u ožiljku. Operativni pristupi: Savremena operativna tehnika danas razdvaja pojam veličine incizije od pojma opsežnosti operativnog postupka, naime, i kroz malu inciziju može da se načini adekvatna operacija i totalna tiroidektomija, kao i obrnuto. Razvijene su i razne tehnike minimalno invazivne tiroidne hirurgije, koje se, međutim, retko primenjuju kod voluminoznih struma ili infiltrativnih tumora. Danas se samo izuzetno retko koriste materijali koji ostaju neresorbovani u operativnoj rani kao npr. neresorbujući konci. U hemostazi se, osim resorptivnih ligatura, koriste različiti izvori energije, termokauteri, radiofrekventni i ultrazvučni noževi, bipolarni i kombinovani instrumenti. Primena raznih izvora energije zahteva pažljivo čuvanje bitnih anatomskih struktura na sigurnoj udaljenosti jer postoji rasipanje energije oko izvora. Neuromonitoring: Danas se sve više koristi intraoperativno praćenje očuvane funkcije donjih laringealnih nerava, neuromonitoring, koji je u nekim državama obavezno primenjivati. Kod nas se još uvek koristi samo kod rizičnih slučajeva, recidiva i kod preoperativno dokazanog oštećenja rekurensa, kako bi se sigurnije sačuvao zdravi nerv. Anestezija: Najčešće primenjivana anestezija je opšta endotrahealna, ali se koristi i lokalna, sprovodna anestezija, u cervikalnom bloku, obično kod jednostranih, a ređe kod obostranih operacija koje kraće traju, kod odabranih pacijenata. Boravak posle operacije: Posle tiroidektomije boravak u bolnici je danas sve kraći, 24-48h pa čak i manje (nekoliko sati posle lokalne anestezije). Komplikacije: Komplikacije su retke u specijalizovanim slučajevima. Kao posledica primene niskomolekularnog heparina poslednje decenije u prevenciji tromboembolijskih komplikacija, zabeležen je vrlo blagi porast postoperativnog krvavljenja, disfonije i hipoparatiroidizma. Prevencija komplikacija: Danas se ne čeka da se komplikacije manifestuju, već se u preoperativnoj pripremi preduzimaju mere da se one ne dogode. Ako se već dogode ne treba čekati da se manifestuju nego treba odmah početi sa njihovim lečenjem, naročito sa supstitucijom kalcijumom i D-vitaminom kod rizika hipoparatiroidizma. Kvalitet života: Danas se sve više pažnje poklanja poboljšanju kvaliteta života pacijenta, koji je poboljšan posle odstranjenja patološkog procesa čak i kod pacijenata sa komplikacijama. Zaključak: Savremeno hirurško lečenje danas karakteriše sve tačnija dijagnoza, adekvatnija operacija, sve manje invazivne metode, praćene malom učestalošću komplikacija koje se rano otkrivaju i leče, što je praćeno boljim kvalitetom života operisanih pacijenata. [ABSTRACT FROM AUTHOR]

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Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ciljevi: Hipotireoidoza trudnica može dovesti do neželjenih ishoda trudnoće. Posle opsežnih operacija na štitastoj žlezdi, najčešće je neophodna trajna supstitucija (kod svih pacijenata sa totalnom tireoidektomijom, kao i 13%-35% pacijenata sa manje opsežnim operacijama), a u slučaju diferentovanih tumora potrebna je i supresija tiroksinom. Cilj rada je bio ispitati učestalost potrebne korekcije supstitucije/supresije u trudnoći kod bolesnica operisanih zbog različitih tiroidnih oboljenja. Metoda: U studiju je uključeno 40 trudnica, srednje starosti 30 godina (17 do 43 godine), koje su ranije operisane (1-10 godina ranije, u proseku 3 godine), zbog različitih oboljenja štitaste žlezde (14 zbog Graves-ove bolesti, 14 zbog papilarnog karcinoma i 12 sa drugim tireoidnim oboljenjima). Rezultati: Supstitucija/supresija u trudnoći je korigovana kod 13 bolesnica ili 32.5% (57.1% bolesnica sa Graves-ovom bolešću, kod 21.4% bolesnica sa papilarnim karcinomom štitaste žlezde i 16.7% bolesnica sa drugim oboljenjima štitaste žlezde). Najčešća korekcija je bila povećanje doze tiroksina za 25 mikrograma (9 bolesnica), za 50 mikrograma (2 bolesnice) i smanjenje doze kod 2 bolesnice (za 25 i 50 mikrograma dnevno). Zaključak: U našoj studiji korekcija supstitucije bila je potrebna kod trećine pacijenata, to jest više od polovine bolesnica operisanih zbog Graves-ove bolesti, dok mnogo ređe kod operisanih zbog drugih bolesti štitaste žlezde. [ABSTRACT FROM AUTHOR]

Dugotrajna hipertireoza oštećuje ceo kardiovaskularni sistem i zato je neophodno lečenje u kome hirurgija danas ima značajnu ulogu. Dva najčešća tipa hipertireoza su: autoimuna Graves-ova bolest i neautoimuna toksična nodozna ili polinodozna struma, dok su ostali tipovi mnogo ređe zastupljeni. Za poslednjih 15 godina u Centru za endokrinu hirurgiju operisano je skoro 11000 bolesnika zbog različitih oboljenja štitaste žlezde od kojih četvrtinu čine hipertireoze, najčešće Graves-ova bolest, sa vrlo malim procentom trajnih komplikacija. Hirurgija zasniva svoj efekat na smanjenju količine tkiva efektornog organa, štitaste žlezde, a najčešće primenjivana procedura, obostrana opsežna subtotalna lobektomija treba da onemogući recidive, ali da obezbedi dovoljnu sopstvenu produkciju tireoidnih hormona. Pokazalo se da ovakva operacija obezbeđuje funkciju samo kod trećine operisanih, a recidivi se javljaju kod značajnog broja, tako da u poslednjoj dekadi primenjujemo najčešće totalnu tireoidektomiju, posle koje praktično nema recidiva, a postiže se stabilna supstitucija, ali su nešto češće komplikacije i pacijent ostaje bez sopstvenog organa. Hemitireoidekotmija se primenjuje kod toksičnih adenoma, a kog Graves-ove bolesti i polinodozne toksične strume primenjuju se sve vrste obostranih operacija. Izbor procedure zavisi od mnogo činilaca, ali najviše od toga kojim procedurama hirurg vlada bezbedno. Totalna tireoidektomija je neophodna u slučaju maligniteta, preporučuje se kod izražene oftalmopatije i kad je potrebna specifična komplikovana priprema zbog drugih oboljenja. Ostaviti deo tkiva neophodno je kad pacijent ne može da uzima supstituciju ili ne prihvata da ostane bez organa. [ABSTRACT FROM AUTHOR]

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)