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Introduction. About 5%?10% of mediastinal tumors in adults are teratomas and about 85% of them are benign. Case report. We report a case of extragonadal malignant teratoma in a 39-year old man. The computed tomography (CT) scan of the chest revealed the soft-tissue density mass in the middle lobe of the lung. The posterolateral thoracotomy was performed and a mediastinal tumor of 25 cm was completely resected. Histopathological findings confirmed malignant teratoma. One month after the resection the positron emission tomography- computed tomography (PET/CT) scan of the whole body was performed and showed progression of the disease. Patient developed signs of the superior vena cava obstruction and received radiotherapy of the mediastinum and the metastatic lesion of the lumbal vertebra. After radiotherapy, the patient developed paraplegia and urinary incontinence and received the best supportive treatment. Conclusion. Primary extragonadal germ cell tumors have poor prognosis due to their relative chemoresistance and frequent findings of advanced disease after establishing the diagnosis.

Introduction. The exacerbation of chronic obstructive pulmonary disease is most often induced by an infection of bacterial origin in over 50% of the cases (or mixed bacterial and viral infection). This study was aimed at evaluating clinical effects of antibiotics co-amoxiclav. Amoxiicillin with clavulanic acid in the treatment of patients with severe chronic obstructive pulmonary disease exacerbation. Material and Methods. The investigation included 38 patients with severe chronic obstructive pulmonary disease exacerbation hospitalized at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. The patients were randomly selected for the antibiotic treatment with Amoxiclav twice a day in 12 hour intervals. The clinical effects of the applied treatment were evaluated by analyzing certain laboratory findings, microbiological sputum findings and improvement of subjective symptoms. Results. Of the examined subjects, 65% were males and 35% were females, their mean age being 66.4+8.86, and who were mostly smokers (73%). After the completion of applied antibiotic treatment, a significant reduction and normalization of all inflammation markers were recorded, as well as a significant improvement of the patients’ subjective symptoms. The positive microbiological sputum findings (Haemophilus influenzae, Pseudomonas aeruginosa and Streptococcus pneumoniae) were recorded in 13.58% of the patients. The bacterial agent was eradicated on the third day of the applied treatment. The mean length of the treatment was 7.07+0.91 days, with no undesirable treatment side effects observed. Conclusion. The antibiotic therapy is justifiable as the initial treatment regimen of severe chronic obstructive pulmonary disease exacerbation and amoxicillin with clavulanic acid is reported as the first-line antibiotic drug in most pharmacotherapy guidelines.

Introduction. Chronic necrotizing pulmonary aspergillosis (CNPA) is a cavitary, infectious process of lung parenchyma with slow progressive course. Vascular invasion and dissemination to other organs are unusual. Case report. We presented a 25-year old man with bilineal acute leukaemia who developed pulmonary and systemic symptoms. Chest CT showed nodular consolidations and cavitary lesions in both lungs. Bronchial biopsy revealed necrotic hyphae but it was negative for Aspergillus by culture. Serum was positive for antibodies to Aspergillus, but it was negative for antigens. A thoracoscopic lung biopsy of the upper left lobe revealed necrosis of lung tissue, with acute and chronic inflammation of the cavity wall and the presence of hyphae consistent with Aspergillus species. Conclusion. Although confirmation of the diagnosis is difficult, a combination of characteristic clinical, radiological and histological findings and either serological results positive for Aspergillus or the isolation of Aspergillus from respiratory samples are highly indicative of CNPA.

Introduction. Inflammatory intestinal diseases are often accompanied with extraintestinal and even pulmonary manifestations. The treatment of these intestinal diseases includes sulphasalazine and mesalazine, which may have undesirable allergic and other side effects, including hypersensitive pneumonitis. Case report. Having performed colonoscopy due to abdominal pains and mushy stools, the diagnosis of ulcerous colitis was established in a 20-year old female patient and the treatment with mesalazine initiated. However, the patient developed slimy and bloody stools, slightly increased body temperature, dry cough and bilateral lung lesions. The bronchological exploration established interstitial and organizing pneumonia. Despite the treatment with antibiotics, corticosteroids and mesalazine, dry cough, fever and bloody stools persisted, accompanied with bilateral inhomogeneous lesions of the pulmonary parenchyma. Upon discontinuation of the treatment with mesalazine, clinical symptoms and pulmonary lesions disappeared. Conclusion. The differential diagnosis of pulmonary lesions in patients with ulcerous colitis may be a problem. In the reported case, pulmonary lesions were interpreted as interstitial pneumonitis accompanying ulcerous colitis. However, they are most probably a consequence of allergic response to mesalazine.

Introduction. Hemoptyses may be very often due to bronchiectases. Although these bleedings are usually spontaneously resolved recurrent and massive hemoptyses may vitally endanger a patient. Therefore, an urgent diagnosis and treatment of hemoptyses is required. Case report. A 56- year old patient was admitted to the hospital due to massive hemoptyses, presented with a non-homogenous shadowing, paracardially on the left. The chest Computerized Tomography finding delineated atelectasis of the lower left lobe and bronchiectases. Bronchoscopy sampling of the left lung airways provided the fresh blood. The multislice angiography and embolization of the bronchial arteries was carried out, entirely ceasing hemoptyses so the patient was discharged with no symptoms. On the control examination one month later, he was well, with normal radiological finding and inflammation markers. Conclusion. In our patient, the life-threatening bleeding due to inflamed bronchiectases was successfully resolved by bronchial arterial embolization, thus avoiding surgery.

Background. Legionnaires' disease (LD) is a pneumonia caused by Legionella pneumophila (LP). The disease occurs more often in immunocompromised persons and can be manifested by severe pneumonia, multiple organ failure and has a high mortality. Case report. Immunocompetent patient, male, 53- year old, with severe form of LB had fever, cough, weakness and diarrhea as the initial symptoms of the disease. Laboratory results showed increased number of leukocytes, increased values of acute phase proteins, liver enzymes and hyponatremia. Computed tomography of the chest showed the marked inflammatory lesions on both sides. Pathohystological analysis of the samples retrieved by bronchoscopy pointed to a pneumonia, and diagnosis of LD was confirmed by positive urine test for LP antigen. Later, the disease was complicated by acute adult respiratory distress syndrome (ARDS). Treatment with antibiotics (erythromycin, rifampicin, azithromycin) combined with ARDS treatment led to a clinical recovery of the patient together with complete resolution of inflammatory lesions seen on chest radiography. Conclusion. In severe pneumonias it is necessary to consider LD in differential diagnosis, perform tests with aim of detecting LP and apply adequate antibiotic treatment in order to accomplish positive outcome of the therapy and prevent complications.

Introduction Anorexia and cachexia are the most common symptoms in cancer patients. They increase morbidity and mortality among cancer patients as well as complications of surgery, radiotherapy and chemotherapy. The most common drugs for treatment of cancer cachexia are corticosteroids and megestrol acetate. Material and Methods The purpose of this study was to determine the influence of dexamethasone on appetite loss and weight loss in lung cancer patients treated with chemotherapy. Group A (30 patients) was treated with cisplatin, etoposide and standard supportive therapy, while group B (30 patients) received, in addition to this treatment, dexamethasone in the dose of 8 mg intravenously per day (1-3 day of chemotherapy). Results There was a statistically significant difference in appetite loss between two groups after the second chemotherapy cycle favoring group A. The analysis of weight loss showed a statistically significant difference between two groups after both chemotherapy cycles, once again in favor of group A. Concerning the improvement of appetite and weight gain, there was no statistically significant difference between two groups after both chemotherapy cycles. Discussion Many double-blind randomized controlled studies showed beneficial symptomatic effect of corticosteroids in cancer cachexia, especially on the improvement of appetite, food intake and performance status. In most of the studies the weight gain was not recorded. The most effective type of corticosteroids, dose and route of administration have not been established. Conclusion Dexamethasone significantly decreases appetite loss and weight loss in lung cancer patients treated with chemotherapy, while it has no influence on appetite improvement and weight gain.

Introduction. Langerhans cell histiocytosis (LCH) is an uncommon disease of unknown etiology characterized by uncontrolled proliferation and infiltration of various organs by Langerhans cells. Case report. We presented a 54-year-old man, heavy smoker, with dyspnea, cough, hemoptysis, headache and ataxia, who died shortly after admission to our hospital. On the autopsy, tumor was found in the posterior segment of the right upper pulmonary lobe as well as a right-sided occipitoparietal lesion which penetrated into the right ventricle resulting in internal and external hematocephalus. Histologically and immunohistohemically, the diagnosis of primary lung adenocarcinoma with brain metastasis was made (tumor cells showed positivity for CK7 and TTF-1 which confirmed the diagnosis). In the lung parenchyma around the tumor, as well as in brain tissue around the metastatic adenocarcinoma histiocytic lesions were found. Light microscopic examination of the other organs also showed histiocytic lesions involving the pituitary gland, hypothalamus, spleen and mediastinal lymph nodes. Immunohistochemical studies revealed CD68, S-100 and CD1a immunoreactivity within the histiocytes upon which the diagnosis of Langerhans' cells histiocytosis was made. Conclusion. The multisystem form of LCH with extensive organ involvement was an incidental finding, while metastatic lung adenocarcinoma to the brain that led to hematocephalus was the cause of death.

Introduction. Parapneumonic effusions, as a complication of inflammatory processes in the lungs, usually have a good course, but they sometimes progress into pulmonary empyema, thus becoming a significant clinical problem. Objective. To review clinical and radiological features, as well as diagnostic and therapeutic options in parapneumonic effusions. Methods. The analysis included 130 patients with parapneumonic effusions hospitalized at the General Pulmonology Clinic of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica during 2013. Results. Of 385 patients with pneumonia, 130 (33.8%) had parapneumonic effusion, 78 (60.0%) of whom were males. Most patients (36l; 27.7%) were 60-69 years of age. The most common symptoms included fever (92; 70.8%) and cough (91; 70.0%). Hypertension was the most common comorbidity registered in 81 (62.3%) patients, and chronic obstructive pulmonary disease present in 33 (25.4%) patients. Pleural puncture was performed in 62 (47.7%) patients. Macroscopically, effusion was clear in most cases (31; 50.0%), and cytologically the mixed type was most frequently established (26; 41.9%). Bronchoscopy was performed in 52 (40.0%) patients, and video-assisted thoracoscopy in 9 (6.9%) patients. Empyema signs were registered in 13 (10.0%) patients; in all a thoracic drainage with administration of intrapleural streptokinase was performed. Conclusion. Patients with a parapneumonic effusion have the symptoms of acute respiratory infection and frequent concomitant diseases. Further diagnostic and therapeutic treatment depends on pleural fluid features and chest CT finding.

Introduction. Autofluorescence bronchoscopy (AFB) is a diagnostic procedure that is included in all diagnostic algorithms discovering precancerous lesions in the large airways. Case report. We presented a 71-year-old patient submitted to exploration due to prolonged cough. Both noninvasive and invasive pulmonary diagnostic management was carried out. On bronchoscopy, an endobronchial mass was detected in the apical bronchus. A positive endoscopy finding indicated AFB which disclosed a fluorescence alteration of the tumor mucosa and the former bronchoscopy site. Histopathological analysis of the catheter biopsy obtained samples from the right upper lobe confirmed fibrinous purulent pneumonia in organization. The applied treatment resulted in regression of both symptoms and the lesion in the right upper lobe. Due to a positive AFB finding, the patient was regularly observed over the following three years, having had three control AFB to monitor the initial finding. Conclusion. AFB may be utilized in the routine of everyday practice to assess the spread of the disease, as well as in the postsurgical and long-term follow-up of operated patients. The procedure may also be applied to enable an easier and more reliable observation of patients with suspicious endobronchial lesions, smokers with altered fluorescence of the bronchial mucosa, and chronic patients.

Introduction. Patients' age and concomitant diseases are relevant for the development and treatment outcome of pneumonia. Objective. To establish the frequency and relevance of concomitant diseases in patients over 65 years of age hospitalized for community acquired pneumonia. Methods. The research included 550 patients hospitalized at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica due to community acquired pneumonia. Data on concomitant diseases and mortality rate was correlated with the patients' age limit of 65 years, and then statistically analyzed and presented in tables. Results. There were 446 (81.45%) patients under and 102 (18.55%) over the age of 65 years. Dyspnea, impaired consciousness, cyanosis, tachycardia and arterial hypertension were significantly more common in patients over 65 years of age, who also had a higher prognostic score. Mortality was significantly higher (21.6% vs. 6.0%) in the patients aged over 65 years (p