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Introduction. Ovarian cancer is the most lethal gynecological cancer. The most common manifestation of thoracic metastasis is pleural effusion. Pleural effusion with positive cytology is regarded as stage IVa of the International Federation of Gynecology and Obstetrics classification, and the overall five-year survival in these patients is less than 20%. We analyzed the data of patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina, in order to establish the incidence of malignant pleural effusions, laterality of pleural effusions, and clinical manifestations. Material and Methods. The study included 731 patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina from January 2012 to May 2020. The obtained data were compared with data found in the literature in the same period. Results. The incidence of malignant pleural effusion in our study was 5.75%; right-sided pleural effusion was found in 57.15% of patients, 33.33% of patients had effusion on the left side, and 9.52% had bilateral effusions. Thus, unilateral effusion was found in 90.48% of cases, and bilateral in only 9.52%. The most common symptom was dyspnea, reported in 33 patients (78.6%). Conclusion. The incidence of malignant pleural effusion in our study was most similar to data found by Zamboni et al. published in 2015; the right side was the dominant side of pleural effusions. The most common symptoms were dyspnea, shortnes of breath and chest pain.

Introduction/Objective. Chronic obstructive pulmonary disease (COPD) is a primary lung disease. Today, pulmonary rehabilitation (PR) is the basis for non-pharmacological treatment of these patients, with numerous confirmed effects on the most significant symptoms of the disease and the quality of life (QoL). The aim of this study was to determine the relationship between certain risk factors and the outcome of PR, as well as to determine the percentage of respondents who had a positive outcome of PR. Methods. The study included 500 patients with COPD, determined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines, all stages (I?IV), in the stable phase of the disease, who completed the outpatient PR program. Disease stage, comorbidities, forced expiratory volume in the first second, six-minute walk test (6MWT), COPD Assessment Test (CAT), and Medical Research Council dyspnea scale, body mass index, airflow obstruction, dyspnea and exercise capacity (BODE) index, were measured before and after the program. The last four parameters have been observed as risk factors that affect the outcome of PR, but also as parameters by which we monitor the outcome of PR. Results. A successful outcome of PR was achieved by as many as 452 (90.4%) patients. The following were determined as independent predictors of a positive outcome of PR: lower number of comorbidities, absence of heart failure, higher BMI, and CAT ? 10. Conclusions. PR in our group of patients leads to statistically significant improvements in most of the examined subjective and objective parameters, in patients in all stages of the disease.

Introduction. Two-thirds of patients with congenital pulmonary airway malformation are asymptomatic at birth, but during life they may develop symptoms such as recurrent respiratory infections. The purpose of this paper is to present three cases of adult patients in whom congenital pulmonary airway malformation was diagnosed and treated at the Institute for Lung Diseases of Vojvodina, along with the clinical course of the disease and the therapeutic procedure. Case Report 1. A 24-year-old female with a medical history of asthma and recurrent signs of lower respiratory tract infections was referred to a thoracic surgeon. Computed tomography of the chest and clinical features were consistent with a congenital lung disease. A left lower video-assisted thoracoscopic lobectomy was performed. Histopathological analysis confirmed type II congenital pulmonary airway malformation with pulmonary sequestration. Case Report 2. A 41-year-old male with a history of left-sided spontaneous pneumothorax at the age of 16 was referred to a thoracic surgeon due to moderate hemoptysis, one month after hospital treatment of left-sided bronchopneumonia. On chest computed tomography, multiple cystic lesions were found in the left lower lung lobe. Thoracotomy and left lower lobectomy were performed. Histopathological analysis confirmed type I congenital pulmonary airway malformation. Case Report 3. The third patient was a 16-year-old male with a history of juvenile asthma and recurrent right-sided bronchopneumonia. Sings of necrotizing pneumonia, lung abscess, and mediastinal lymphadenomegaly were found in the affected lobe. Thoracotomy and right lower lobectomy were performed. Histopathological analysis confirmed type II congenital pulmonary airway malformation. Conclusion. In children and young adults with recurrent small airway inflammation, congenital lung malformation should be considered in the differential diagnosis.

Introduction Over the last few months the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians around the world. While much has been described in the literature about lung infiltrates and respiratory failure associated with infection of coronavirus 2 (SARSCoV-2), pneumothorax is reported as a rare (a rate of 1%) but a life-threatening complication of COVID-19 pneumonia. Late bilateral spontaneous pneumothorax has been described in few cases. The aim of the report is to consider pneumothorax as a possible complication of COVID-19 pneumonia, which is also one of the causes of respiratory deterioration and potentially fatal outcome in these patients. Case оutline This article describes the clinical course of the patient who tested positive for SARS-CoV-2 on reverse-transcriptase polymerase chain reaction (RT-PCR) testing of nasopharyngeal and oropharyngeal swab specimens and who presented with COVID-19 pneumonia complicated by bilateral, spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. He had no underlying lung disease nor risk factors for pneumothorax, except administered non-invasive ventilation/continuous positive airway pressure during first hospitalization. The patient was successfully treated with surgical (chest drainage, thoracoscopy and pleural abrasion) and non-surgical methods (by application of drugs and other supportive therapies). Conclusion This review demonstrates that the possibility of a late pneumothorax should be kept in mind in patients with, or recovering from, COVID-19 disease with progressive dyspnea. The timely diagnosis and management of pneumothorax will reduce COVID-19 associated mortality. © 2021, Serbia Medical Society. All rights reserved.

Introduction. Exogenous lipoid pneumonia (ELP) is caused by inhalation or aspiration of different oily substances of animal, vegetable, or mineral origin. It can be in acute or chronic form. Herein, we report a case of ELP in its chronic form, confirmed in surgical lung biopsy. Case outline. A 47-year-old male locomotive engineer, former smoker, without clinical symptoms, with a history of pneumonia two years previously, was referred to our institution. The operating diagnosis of multifocal subpleural tumors was made based on the chest computed tomography. A surgical lung biopsy confirmed a diagnosis of ELP. Conclusion. Diagnosis of ELP is frequently made after surgical biopsy performed for suspected neoplasm, because of neglecting profesional exposure to mineral oils.

Introduction. Solitary fibrous tumor is a neoplasm that arises most commonly from the pleura, but can occur at other sites. Intrapulmonary solitary fibrous tumor has been rarely reported and therefore is not well recognized. Case outline. We report a case of an asymptomatic 63-year-old woman in whom a large, well-circumscribed mass was incidentally revealed on chest X-ray during preparation for ergometric cardiac testing. Chest computed tomography revealed an abnormal nodule in the lower right lung lobe. Mediastinal and hilar lymphadenopathy was not detected. After transthoracic fine needle aspiration, cytology showed a finding suspicious for spindle cell tumor. Consequently, right anterolateral thoracotomy with right lower lobectomy was performed. On gross examination, the lower right lobe was almost completely replaced with abnormal, white-yellow, well-demarcated solid nodule measuring 13.5 cm in its largest diameter surrounded by a pseudocapsule. After histological examination and applied immunohistochemical analysis, a diagnosis of intrapulmonary solitary fibrous tumor of low malignant potential was set. Due to the presence of unfavorable prognostic parameters (tumor size, as well as the presence of hypercellularity), more frequent follow-up check-ups were recommended. Eighteen months after surgery, the patient remained uneventful, with no evidence of tumor recurrence. Conclusion. Intrapulmonary solitary fibrous tumor is a rare entity challenging for diagnosis, because variegated histology and variability of its growth patterns can resemble other soft tissue tumors. The treatment of choice is complete excision with clear surgical margins, but since morphology cannot be a reliable predictor of clinical behavior, the patients need a long-term follow-up.

Introduction. Lung carcinoids are considered a rare and uncommon group of lung tumors, making about 1% of all primary lung tumors. Atypical carcinoids are more aggressive than typical ones, with higher metastatic potential and worse prognosis and a 10-year survival rate of less than 60%. Case outline. In 2012, a 61-year-old male underwent the right lower lobectomy and the histopathological finding was an atypical lung carcinoid tumor. At the beginning of 2016, radiological and bronchoscopic progression of the disease was reported. Magnetic resonance imaging revealed enhanced nodular lesions compatible with liver metastases. The patient received endoluminal brachytherapy. Subsequently, the first line chemotherapy according to the cisplatin/etoposide (PE) protocol was applied. In August 2016, the somatostatin receptor scintigraphy (SRS) revealed secondary deposits with somatostatin receptor (SR) expression in the liver and lungs. The treatment with lanreotide injections was initiated. After five treatment courses, progression of the disease in the bronchial tree was verified and electro-cauterization and argon plasma cauterization of the tumor in the right main bronchus were performed. In September 2017, progression of the disease was verified again. The Oncology Board introduced the third line therapy with everolimus. Conclusion. The evidence supporting optimal treatment strategies for an atypical lung carcinoid tumor is lacking, but some recent publications indicate that multimodal treatment is associated with prolonged survival.

Introduction. Fibrous dysplasia is a noninherited benign skeletal disorder associated with abnormal bone development. Single bone involvement, the monostotic form, accounts for 70 ? 80% of cases, while the polyostotic form, with multiple bone involvement, accounts for 20 ? 30% of cases. Cystic degeneration and occasional aneurysmal bone cyst formation may be found in fibrous dysplasia lesions, particularly in the costal lesions. Case Report. A 51-year-old man presented with acute shortness of breath after sustaining simple chest wall injury. Chest computed tomography showed multiple massive osteolytic rib lesions, as well as a massive left-sided pleural effusion with compression atelectasis of the lung parenchyma. Osteolytic lesions of the anterior 2nd and 7th thoracic vertebral body were found, along with a well defined osteolytic lesion in the body of the sternum. Video-assisted thoracoscopy of the left pleural space was performed and frozen sections, collected using endoscopic biopsy forceps of the cystic wall and solid parts of the tumors, were sent for ex tempore histopathological analysis. Results showed fibrous dysplasia with suspected malignancy. Talc pleurodesis was performed based on the obtained results. At present, the patient is asymptomatic with his daily routine uninterrupted by his medical condition. Conclusion. Treatment of pleural effusion caused by a cyst rupture of unresectable degenerated polyostotic fibrous dysplasia of the ribs represents a surgical challenge. Surgical drainage of the cysts followed by chemical pleurodesis seems to be a reasonable solution in cases where pulmonary functions are impacted by combined effects of pleural effusion and cystic compression.

Introduction. Tracheobronchial disruption is a rare disorder, usually accompanied by a severe blunt chest trauma that quite rarely appears as an isolated event. Case Report. This is a case report of a right main bronchus disruption, due to an injury to the right hemithorax, caused by a falling tree trunk. The disruption was accompanied by mediastinal emphysema, fractures of the 4th and 5th ribs on the right side and compound sternal fracture. The patient was operated in general anesthesia, through right thoracotomy approach, followed by successful right main bronchus reconstruction by interrupted suture technique, without anatomic resection of the lung parenchyma. Conclusion. Although this injury is rare, with suspicion of bronchial rupture, bronchoscopy confirms the diagnosis and leads to better prognosis.

Background/Aim. Despite a huge success in decrease rate of recurrences of inguinal hernia in mesh and ?plug in? techniques, a new problem appears such as chronic pain and other complications. The aim of this paper was to present the original modification of bilayer patch device (Prolene Hernia System?, Ethicon) insertion in ?non-plugged? fashion and 11-year experience with this open technique for the indirect hernia repair in a male. Methods. This retrospective study included 96 male patients with 103 indirect unilateral and bilateral inguinal hernias, operated due to a primary or recurrent hernia in an 11-year interval (2004?2015). In all operation an extended Prolene Hernia System? (PHS) bilayer patch device was inserted medially of inferior epigastric vessels through a small incision in Hasselbach's triangle, thus avoiding plug component of device connector into the internal ring. All data were taken from the medical records, operative protocols, and telephone questionnaire. Results. Non-plugged technique of bilayer patch device insertion was presented in details. Mean age of patients was 59 years. There were 3 (2.91%) patients with procedure-related complications, two patients with postoperative seroma and one with scrotal ecchymosis. There were 86 (89.6%) patients who answered on the questionnaire. During 11 years of following, recurrence of a hernia occurred in 1 patient, one had funiculocele and only one had chronic pain during 6 months. Almost all patients (97.68%) were satisfied with the procedure and results of hernia surgery. Conclusion. Nonplugged insertion of bilayer patch device is a safe technique for solving the primary and recurrent indirect inguinal hernias. The low incidence of the recurrence and chronic pain many years after the operation justifies this technique even in hospitals not specialized for the hernioplasty.

Pulmonary inflammatory myofibroblastic tumor encompasses a heterogeneous spectrum of reactive, infectious, and neoplastic entities. It is composed of spindle-shaped myofibroblastic cells in a background of inflammatory cells and collagen fibres. Actinomycosis is a bacterial infection. It infects the lower respiratory tracts by inhalation or aspiration of oropharyngeal or upper gastrointestinal materials. Only eight cases of pulmonary IMT associated with actinomycosis have been reported in the literature so far. This is the ninth case reported.

Background The clear cell “sugar“ tumor of the lung is an extremely rare benign mesenchymal tumor. Aim: To report a case of the sugar tumor and discuss diagnostic differentiation of the tumor.

Primary hyperhidrosis affects approximately 3% of the world’s population, particularly young female adults. It is defined as excessive, profuse sweating of the palms, soles, armpits and face. Conservative treament includes diverse modalities, however, surgical treatment has shown the best long-term results. The objective of this study was to assess some disease-specific epidemiological characteristics in a pre-selected group of patients seeking surgical therapy, as well as outcomes of thoracoscopic sympathectomy. The severity and impact of hypehidrosis was assessed, using Hyperhidrosis Disease Severity Scale (HDSS: patients rate the serverity of symptoms on a scale from 1 to 4). Thoracoscopic sympathectomy was performed using a double lumen endotracheal tube, via bilateral 5 mm dual port videothoracoscopic camera 0°, and an endoscopic ultrasound activated harmonic scalpel. The sympathetic chain was resected on both sides at the level of the second and the third thoracic ganglion (T2 and T3), using an ultrasound knife. The extirpated chain was also at the level T3-T4 and sent forex temporeanalysis.There were 162 patients undergoing thoracoscopic sympathectomy: 39.51% were males and 60.49% females; at presentation their mean age (± SD) was 30.5 (±8.3), range 16 - 58 years. Axillary hyperhidrosis occurs later than palmar-axillary-plantar (pIn conclusion, nowadays videothoracoscopic sympathectomy is a standard treatment for primary hyperhidrosis with a high success rate.

This work is concerned with the potential promotive action of 12-monoketocholic acid (12-MKC) on the analgesic effect of morphine and tramadol. The investigation was carried out on laboratory Wistar rats divided into five test groups, each treated with either morphine (2 mg/kg), tramadol (9.6 mg/kg), 12-MKC (2 mg/kg), morphine + 12-MKC, or tramadol + 12-MKC, the control group receiving physiological solution (2 mg/kg). The effect of 12-MKC on the analgesic action of morphine and tramadol was determined by radiation heat method. Morphine and tramadol, given in equimolar doses, did not show significant difference in the degree of analgesia. In combination with morphine, 12-MKC increased significantly the analgesic effect compared with the group treated with morphine alone. However, 12-MKC caused no change in the action of tramadol. The 5-day intravenous application of 12-MKC in combination with the two analgesics caused no changes in the biochemical parameters nor pathohistological changes in the liver parenchyma of tested animals.

Hyperhidrosis is defined as excessive sweating beyond the physiologic needs of a person. Palmar hyperhidrosis in the adolescent period may have an impact on school work and may cause psychological problems. Thoracoscopic sympathectomy is now used routinely to treat patients with disabling primary hyperhidrosis or facial blushing.From January 2008 to December of 2009 bilateral thoracoscopic sympathectomy Th2-Th4 was performed to 79 patients aged from 17 to 55, who suffered from palmar, axillar or craniofacial hyperhidrosis. For the first 39 patients (group A) thoracoscopic sympathectomy was performed using electric scalpel and for the next 40 patients (group B) thoracoscopic sympathectomy was performed using harmonic scalpel.Based on our results we did not find any significant differences between electric or harmonic scalpel usages for thoracoscopic sympathectomy. Moreover, there was no significant difference between complications and the severity of pain, with slightly higher intensity of pain with harmonic scalpel usage. Both electric and harmonic scalpel provided adequate treatment for primary hyperhidrosis, with the fact that non-disposable electric scalpel costs were less than that of the disposable harmonic scalpel.Sympathectomy should be preferred for palmar hyperhidrosis treatment, as it is much technically shorter, simpler to implement, and also easier to learn. Thoracoscopic sympathectomy is safe and effective for the treatment of primary palmar hyperhidrosis in the adolescent period without any major side effects.

The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the “central venous oxygen saturation”), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

The aim of this study is to compare usefulness of Semi-Fowler position vs. lateral decubitus position for thoracoscopic sympathectomy in treatment of primary focal hyperhidrosis.From January 2009 to January 2010, 263 consecutive patients with palmar and axillar hyperhidrosis underwent thoracoscopic sympathectomy Th2-Th4. Patients were divided into two groups: group A (n=133) underwent thoracoscopic sympathectomy through lateral decubitus using double lumen endotracheal intubation, and group B (n=130) underwent thoracoscopic sympathectomy through Semi-Fowler supine position (semi sitting with arm abducted) using single lumen endotracheal intubation without insufflation of CO2, but with short apnea period. All operations were performed through two 5 mm operating ports, videothoracoscopic camera 0° and endoscopic ultrasound activated harmonic scalpel.There were 107 males and 156 females with median age 30.31±8.35 years. Two groups were comparable in gender, age, severity of sweating. All operations were successfully performed with no complications or perioperative morbidity. For group A average operation time for both sides was 31.2±3.87 min and for group B average time was 14.19±4.98 min. In group B apnea period per one lung lasts 2.86±1.15 min and during that period observed saturation was 92.65%±5.66% without significant cardiorespiratory disturbances. Pleural drains were taken off on operation table after forced manually lung reexpansion. Patients were discharged from hospital for few hours, after the operation and radiologic confirmation of complete lung reexpansion.Based on this data (shorter operating time, lack of incomplete lung collapse, insignificant apnea and better reexpansion of lungs) we concluded that thoracoscopic sympathectomy through Semi-Fowler supine position is highly effective and easy to perform for primary hyperhidrosis.

Pneumothorax occurs when air enters the pleural space. Currently there is increasing incidence of road traffic accidents, increasing awareness of healthcare leading to more advanced diagnostic procedures, and increasing number of admissions in intensive care units are responsible for traumatic (non iatrogenic and iatrogenic) pneumothorax. Pneumothorax has a clinical spectrum from asymptomatic patient to life-threatening situations. Diagnosis is usually made by clinical examination and imaging techniques. In our current work we focus on the treatment of penetrating trauma.