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Giant basal cell carcinomas (GBCCs) are rare neoplastic lesions with an incidence less than 0,5% and destructive capabilities higher than their precursors. Mushroom-like growth of cutaneous tumors described in 1806. by Albert, is still a rare phenomenon. GBCC's with mushroom-like macroscopic characteristics were hardly reported. We present a mushroom-like GBCC, treated successfully with wide surgical excision. An 85-year-old male with a progressively growing skin lesion was admitted to our clinic. He came seeking medical care with a bleeding painful skin lesion. The tumor developed from a small papule into an exophytic pedunculated lesion with a fetid, ulcerated, exudative surface. Physical examination revealed 7x5x1.5cm mushroom-like, exophytic, pedunculated mass with rolled borders and partial cutaneous necrosis, signs of secondary infection and bleeding. The lesion was surgically removed. Histopathology showed basal carcinoma cell (BCC). Two months post-operatively there was no signs of tumor recurrence and secondary metastases without a need for additional treatment. GBCCs can still be identified in the 21st century. It arises due to neglecting of the lesion, inconspicuous localization usually covered by clothing. Mushroom-like morphology is rare in BCCs. Treatment is usually surgical excision, with a high success rate and an improvement in quality of life.

Introduction. Full-thickness burns pose a significant challenge in terms of surgical management, particularly when concurrent trauma of other organs is involved. Traditional treatment of deep burns includes early excision or debridement of necrotic tissue, followed by skin grafting or flap reconstruction. There are numerous challenges such as poor overall general condition, polytrauma, questionable wound bed viability, limited donor sites. Thus, we have to consider skin substitutes. INTEGRAR is an acellular dermal substitute which creates a native dermis. The aim of this case was to share our experience of the treatment by skin substitutes in a polytraumatized burn patient. Case outline. We present a case report of a 46-year-old man with severe work-related contact burn wounds associated with multiple rib and vertebral fractures, as well as lungs contusion with localized bilateral hemothorax. Patient suffered from third-degree burns to the lower extremities, extending to scrotal and gluteal area, which included 15% of the total body surface area. The patient underwent early excision of necrotic tissues with subsequent skin autografting on the right leg; however, due to partial failure of autografts, we had to perform allografting followed by autografting because of limited local donor sites and poor general condition. Successive debridement and partial osteotomy resulted in the left knee defect with exposed patella. Therefore, in order to reconstruct the consequent defect and prevent joint contracture, the defect was finally covered by INTEGRAR. Conclusion. Our experience has highlighted that INTEGRAR prevents functional disability and furthermore, it leads to optimal aesthetic results.

Vocal fold polyps represent one of the most common benign organic disorders affecting the larynx in the general population, and a relatively frequent cause of long-standing hoarseness. The exact etiology is unclear, but poor vocal behavior has been suggested as the principal etiologic factor. Histopathologically they are characterized by various structural alterations in the vocal fold superficial lamina propria, and typical clinical finding is of a solitary, unilateral and well-defined vocal fold lesion. Vocal fold polyps usually require surgical removal using microlaryngoscopy with cold steel excision in general anesthesia, which has been the practice standard for the last 60 years. Microlaryngoscopy offers the surgeon an unparalleled magnified view of the vocal folds and very precise work on a still operative field without a specific time limit. The introduction and technological development of ambulatory endoscopy and various laser systems provided the surgeon with ample therapeutic opportunities, including operating some of the patients in the office setting in local anesthesia. These outpatient procedures are technically simple and cost-effective, require fewer medical personnel, exclude general anesthesia-related risks, and are less time-consuming both for the patient and the physician. Nevertheless, the contemporary laryngologist should be able to perform both conventional microlaryngoscopy and office-based surgery for vocal fold polyps, depending on the clinical situation.

Early detection of disease and accurate assessment of its extent are of paramount importance for the course of treatment and prognosis of larynx cancer. Machine learning and artificial intelligence tools have the potential to accelerate and improve diagnostic procedures in medicine, as well as to predict disease outcomes and response to specific therapies. Computer algorithms can analyze two-dimensional images obtained during procedures such as laryngeal spectroscopy and endoscopy. Radiological images can be evaluated using appropriate algorithms to determine whether the laryngeal tissue is benign or malignantly altered. In recent years, machine learning tools have been developed to determine the precise radiation doses, predict tumor radiosensitivity, as well as the possibility and severity of complications based on radiological image analysis. In the field of pathology, significant progress has been made by creating digital records of histopathological preparations, which can be further analyzed. This allows changes in intercellular interaction and tissue architecture that cannot be detected by conventional microscopic methods to be identified. With innovative computer techniques, it is possible to quantify tissue and cell structure parameters, which are calculated based on mathematical formulas and used to measure structural homogeneity and uniformity in both normal and pathologically altered tissue. Future multidisciplinary research aimed at developing new and innovative biosensors for the detection of discrete morphological changes characteristic of squamous cell carcinoma of the larynx will make a significant contribution to the advancement of diagnosis and treatment in the field of otolaryngology. In the future, the use of artificial intelligence and machine learning could enable the fusion of algorithms that combine data obtained from radiological, endoscopic, and histopathological findings, which could significantly increase the accuracy and precision of diagnosis, facilitate the process of deciding on therapeutic options, and improve the success rate of larynx cancer treatment.

Introduction. Intrahepatic lithiasis (IHL) is a disease that occurs in middle-aged and elderly people. Presentations of IHL in the young are rare, and considerations in the differential diagnosis include primary sclerosing cholangitis, recurrent pyogenic cholangitis, bile acid transporter defect, Caroli’s disease, and other known genetic diseases. Treatment is often complex, all in order to prevent complications. In this report, we describe the diagnosis and treatment, with the application of a flexible ureteroscope of 4 Fr, of a younger patient with intra-hepatic lithiasis. Case report. A 25-year-old man appeared with a known diagnosis of IHL and a recurrent attack of abdominal pain that required medical treatment. Magnetic resonance imaging of the abdomen showed segmental stenosis of the left bile duct and segmental bile duct for the lateral section with intraductal calculi and its proximal dilatation and mild dilatation of the bile ducts for liver segments II and III. During surgery, a cholangiography and ultrasonography of the liver were performed. Through choledochotomy, the bile ducts were flushed, and extirpation of the several calculi was performed. The bile ducts were examined with a chole-dochscope, and the remaining concrements were removed with a flexible ureteroscope. Conclusion. Segmental liver bile ducts may be explored with a flexible ureteroscope without bile duct injury or trauma. In selected cases, with isolated lithiasis in one liver lobe and the absence of concomitant diseases, IHL can be treated surgically without liver resection. This case is unique because we did not perform liver resection but duct stone extraction, which was an appropriate treatment since there was no recurrence during the two-year follow-ups.

Introduction: Choanal atresia is a rare anomaly of the nasal cavity, which is associated with other congenital malformations in half of the cases. The diagnosis is usually made immediately after birth, but late diagnoses are not rare in otorhinolaryngology practice. Case report: We are presenting the case of an eighteen-year-old woman with a history of difficulty in breathing through her left nostril that lasted for many years, increased secretion from the nostril and frequent headaches. During preoperative preparation, computerized tomography of the paranasal sinuses revealed left-sided choanal atresia and obstruction in the region of the left osteomeatal complex, which was then successfully resolved using a modern surgical approach. She was observed postoperatively. A control examination with an endoscope was performed one month after the operation, indicating that both choanae were passable. Choanal atresia can be an isolated craniofacial malformation or associated with CHARGE, Teacher Collins, Down, Crouson and Pfeiffer syndromes. Bilateral choanal atresias are life-threatening. Unilateral choanal atresias can present with a variety of symptoms depending on the type of atresia and the age of the patient. Conclusion: The diagnosis is made with a clinical otorhinolaryngological examination, nasal endoscopy and computerized tomography of the paranasal sinuses and the skull base. The therapy is surgical.

Introduction: Inverted papilloma is the most common benign tumour of the sinonasal region characterized by a locally destructive growth pattern, a tendency to recur, and a risk of malignant alteration. It grows from the epithelium of the sinonasal mucosa. One of its clinical signs is epistaxis, which is an emergency condition. This case report aims to acquaint Emergency Medicine physicians with inverted papilloma as an emergency condition in some patients. Case report: A 75-year-old woman presented to our Ear, Nose and Throat Emergency Room complaining of repetitive left-sided nose bleeds. Clinically, histopathologically, and using radiology scans, we confirmed the diagnosis of inverted papilloma and the patient was surgically treated. Conclusion: In patients with recurrent nose bleeds, an accurate diagnosis of inverted papilloma is needed for planning surgical treatment to avoid recurrence, local destruction and malignant alteration of the tumour.

Background: The aim was examination of the intimamedia thickness of carotid arteries in COVID-19 infection. Methods: In 50 patients, the thickness of the intimomedial complex (IMT) in the common carotid arteries was measured. The values were compared with the control group in 2006-9. The condition of the lungs was assessed by ultrasound score (It score) (0-42) as mild (0-14) or mediumsevere (15-28) Covid. IMT thickening risk factors and the value of fibrinogen, IL-6 and CRP were recorded. Two IMT prediction models were formed. The socio-epidemiological model predicts the development of IMT based on epidemiological factors. Apart from these factors, the second model also includes the values of the mentioned biomarkers. Results: It score 20±6, IMT values right: median 0.99 mm, p25=0.89, p75=1.14; left: 1±0.22 mm. Control: IMTright: median 0.7 mm, p25=0.68 mm; p75=0-9 mm; left: median=0.75 mm, p25=0.6 mm, p75=1.0 mm. The group/control difference is highly significant. Epide mio - logical model: logit (IMT)= 4.463+(2.021+value for GEN)+(0.055x AGE value)+(-3.419x RF value)+(-4.447x SM value)+(5.115x HTA value)+(3.56x DM value)+ (22.389x LIP value)+(24.206x CVD value)+(1.449x other value)+(-0.138x It score value)+(0.19xBMI value). Epidemiological-inflammatory model: logit (IMT)=5.204+ (2.545x GEN value)+(0.076x AGE value)+(-6.132x RF value)+(-7.583x SM value)+(8.744x HTA value)+(6.838x DM value)+(25.446x LIP value)+(28.825x CVD value)+ (2.487x other value)+(-0.218xIt score value)+(0.649x BMI value) +(-0.194x fibrinogen value)+(0.894x IL-6 value)+(0.659x CRP value). Values for both models Exp(B)=4.882; P of sample=0.83; logit=-0.19; OR= 23.84; model accuracy for the first model 87% and for the second 88%; Omnibus test of the first model c2=34.324; p=0.000; reliability coefficient -2LogLH=56.854; Omnibus test of the second model c2=39.774; p=0.000; and -2LogLH=51.403. Conclusions: The ageing of blood vessels in COVID-19 can be predicted.

Introduction. An arteriovenous fistula is one of the complications that can occur during percutaneous liver biopsy (PLB). Hepatic arteriovenous fistula with chronic bleeding from the puncture site on the skin is an extremely rare complication following PLB. Case report. We present a 35-year-old woman with secondary anemia caused by chronic bleeding at the site of a granuloma caused by a previous liver biopsy performed 7 years ago. The patient was examined and treated for several years due to anemic syndrome. The pathological communication between the right hepatic vein, the anterior sectional branch of the portal vein, and the posterior arterial sectional branch were detected on a computed tomography scan and proven by fistulography. Due to the failed embolization, a laparotomy was performed, where a tumor mass was found in the VI and VII segment of the liver, which communicates with the skin. The tumor mass was removed by atypical resection of the VI and VII liver segments. Due to hemorrhage, reexploration was performed, where the bleeding was found from the surface of the resected liver parenchyma. The patient was released for home treatment two weeks after the last operation. Conclusion. Although PLB is a safe procedure, a complication in the form of bleeding sometimes occurs but with spontaneous cessation. In the presented patient, there was a complicated intra-hepatic arteriovenous-portal fistula with the formation of communication with the puncture site on the skin. That is the first published case of complications of this type after PLB.

Introduction. The number of patients in the world who have undergone heart transplantation is increasing, with better and longer survival rates, and therefore the number of patients who undergo various surgical interventions after transplantation is also increasing. This presents a challenge for anaesthesiologists. Case outline. A 45-year-old female patient underwent a total thyroidectomy due to suspected thyroid cancer. She had a heart transplant three years earlier. Preoperative preparation included evaluation of cardiac function, consultative examinations by a transplant cardiologist, laboratory and other diagnostic procedures, as well as a detailed analysis of all 20 medications that the patient uses in daily therapy. Common drugs were used for premedication and general endotracheal anaesthesia, with careful dose titration. Medicines were also prepared for the occurrence of heart rhythm disorders, bearing in mind that the heart is denervated, but there was no need for their use. The operation and postoperative course went smoothly and on the third postoperative day the patient was discharged from the hospital in good general condition. Conclusion. Preoperative preparation, anaesthesia, and postoperative treatment of this patient represented a challenge for our team, which was successfully overcome, considering that this is the first case of operative treatment of a patient with a transplanted heart in Serbia.

The text is about the life and work of one of the most influential economists of the last century - Milton Friedman. The paper discusses some of Friedman's greatest contributions to economic theory and practice, starting with the earliest life of Milton Friedman, and the historical circumstances that were of decisive influence on his life. An analysis of several of Friedman's most significant works, written mainly in the years spent at the University of Chicago, examines Friedman's contribution to economic theory. Friedman's contribution to the reaffirmation of quantitative money theory and consumption analysis, controversial interpretation of the causes of the Great Depression, critique of the Phillips curve, with reference to the Keynesian-monetarist debate and Friedman's contribution to the methodology of economics are discussed. The last part of the paper presents the position on Friedman's socio-political influence on a global level. There is talk of Friedman's contribution to strengthening the concept of liberalism, affirmation of the ideas of the free market, individual freedom and personal integrity, while reducing the regulatory role of the state in the economy.

The paper presents the importance of acute postoperative pain, the risk factors for its occurrence and intensity, instruments for its measurement and assessment, as well as the possibilities of prevention and treatment. The fact that post-surgical pain represents not only a subjective unpleasant experience for the patient, but also a factor that significantly contributes to complications and unfavorable outcomes of surgical treatment is well known. Despite that, postoperative pain can be seen very often. To successfully prevent and relieve pain, it is necessary to establish a possible cause-and-effect relationship between the occurrence and intensity of postoperative pain, type of surgical intervention, anesthesia technique, demographic characteristics of patients, comorbidities, chronic therapy, and family and socioeconomic factors. Besides the application of recommendations from the current guidelines and protocols for the prevention and treatment of post-surgical pain to achieve positive treatment outcomes, an individual approach to each patient and the application of multimodal analgesia techniques that include the use of different classes of analgesics, co-analgesics, and non-pharmacological measures, based on modern ERAS-protocols aimed at accelerated recovery after surgical intervention should also be employed.

Introduction/Objective. Epidemiology of melanoma including the number of new cases and mortality have been established in most developed countries, but data on pathohistological features are mostly missing. The objective of the study was to investigate epidemiological, clinical, and pathohistological features of melanoma patients and compare the results with trends in other countries. Methods. Our sample comprised patients surgically treated for skin melanoma at the Hospital for Burns, Plastic and Reconstructive Surgery during the 2015–2017 period. Pathohistological, clinical, and demographic features of melanoma were studied. Results. The retrospective study comprised 201 patients (109 men and 92 women) aged 25–87 years. Melanoma was more common in men than in women (54.2% vs. 45.8%). Melanoma in male population most commonly presented on the trunk, while in females presentation on the trunk and lower extremities was almost equal. Superficial spreading melanoma was the most common type of melanoma (68.7%), without correlation to the sex. No correlation was observed in relation to the stage of the disease and the patient’s sex (p = 0.294). A statistical difference was observed in relation to the type of melanoma and the Breslow classification (p < 0.001). Breslow’s thickness correlated with neither age nor sex. In relation to tumor invasiveness, 12.4% of the lesions were classified as in situ lesions, while 87.6% of the lesions were invasive. The majority of patients were identified as stage pT1a. Conclusion. This study can help to identify patients at high risk for melanoma and contribute to optimize screening efforts in a defined target population.

Background/Aim. Chronic pancreatitis (CP) causes inflammatory changes in the tissue of the pancreas, resulting in irreversible tissue damage. Pain, endocrine, and exocrine pancreatic insufficiency develop, thereby reducing the quality of life (QoL) of patients. The aim of the study was to determine the significance of surgical treatment in improving the QoL of patients with CP. Methods. QoL assessment of 50 patients diagnosed with CP was per-formed using a certified Euro Quality of Life-5 Dimension-5 Level (EuroQol-5D-5L) Questionnaire translated into Serbian. According to the method of treatment, patients completed the questionnaire. Patients were divided into two groups (conservatively treated – CT and surgically treated – ST), and all comparisons were made between groups. Results. Patients in stage B of CP were divided into two groups of 25 patients. The mean age in the ST group was 48.56 ± 11.91, and in the CT group was 51.08 ± 11.61 (p = 0.452). The male/female ratio in the ST group was 18/7, and in the CT group was 22/3 (p = 0.289). Pain in the ST group was present in 23 patients, and in the CT group was present in 18 patients (p = 0.141). Loss of appetite in the ST group was present in 7 patients and in the CT group in 10 patients (p = 0.256). Weight loss in both groups was equal (p = 1.000). Based on the EuroQol-5D-5L Questionnaire, significant differences were found (p < 0.001) between groups in Mobility and Pain/Discomfort, in Anxiety/Depression (p = 0.003), in Self-care (p = 0.004), and in Usual activities (p = 0.008). Conclusion. CP significantly reduces the QoL of patients treated either conservatively or by surgical approach. This study showed that surgical treatment is more beneficial for the QoL of patients with CP than the conservative approach.

Pheochromocytoma is a tumor that arises from adrenal medulla and it is characterized by increased secretion of catecholamines. The incidence of pheochromocytoma is 3 to 8 cases per million inhabitants, of which about 10 to 20% of diagnosed pheochromocytomas occurs in the pediatric population, with a higher frequency in boys. In 1.7% of the pediatric population with hypertension, the cause of hypertension is pheochromocytoma. Due to headaches and verified hypertension on twenty-four-hour holter blood pressure monitoring, the 13-year-old female patient underwent ultrasound, followed by scintigraphy and magnetic resonance imaging of the abdomen, which described an oval change above the right kidney about 4.5 cm in diameter suspected of pheochromocytoma. Twenty-four-hour urine cateholamines showed elevated noradrenaline values as much as 45 times higher than the reference range, as well as elevated Dopamine values. After adequate preparation with phenoxybenzamine and bisoprolol for two weeks, a right laparoscopic adrenalectomy was performed at the University Children's Clinic in Tirsova, which is also the first operation of this type in the pediatric population. Intraoperatively, the maximum value of tension was 180/120 mmHg. Pathohistological findings confirmed pheochromocytoma. Although a rare cause of hypertension in the pediatric population, young patients with newly diagnosed hypertension should be examined for possible pheochromocytoma. Laparoscopic adrenalectomy through both the lateral transabdominal and posterior retroperitoneoscopic approach is the gold standard for the treatment of pheochromocytomas in both the adult and pediatric populations.

Background: Patients with colorectal cancer (CRC) have anemia often present as a consequence of chronic bleeding from tumor. The exact role of lL-33, Galectin-l and IL-l in the pathological genesis of anemia in colorectal cancer patients has not been elucidated yet. The main goal of this research was to analyze Gal-l, IL-l and lL-33 systemic values in anemic and non-anemic CRC patients. Methods: Concentrations of IL-33, Galectin-1 and IL-1 have been studied in blood samples of 55 CRC patients (27 without anemia and 28 with anemia). Results: CRC patients with anemia had more severe and local advanced disease compared to CRC non-anemic patients. Anemia positively correlated with higher nuclear grade, lymph and blood vessel invasion, as well as with higher TNM stage, detectable metastatic lesions in lung and liver and peritoneal carcinomatosis. Significantly higher IL-33, Gal-1 and IL-1 concentration have been found in sera of patients with CRC and detected anemia. CRC patients mostly had microcytic anemia, while ferritin values were in normal range. Analysis revealed positive mutual correlation between serum values of galectin-1, IL-1 and IL-33 in CRC patients. Level of hemoglobin negatively correlated with serum IL-33, Gal-1 and IL-1. We have analyzed the Receiver Operating Characteristic (ROC) curves of serum IL-33, Gal-1 and IL-1 showed that these cytokines can be treated as additional markers for anemia of inflammation in CRC patients. Conclusions: Predomination of Galectin-1, IL-1 and IL-33 in anemic CRC patients implicates on their potential role in anemia genesis and further development.

Background/Aim. Immune checkpoint therapy is a well-established therapeutic approach in the treatment of malignant diseases and is thought to be mostly based on facilitating the adaptive immune response. However, the cells of the innate immune response, such as natural killer T (NKT) cells, might also be important for a successful anti-programmed cell death protein-1 (anti-PD-1) therapy, as they initiate the antitumor immune response. The aim of this study was to investigate the influence of anti-PD-1 therapy on the immune response against tumors. Methods. For tumor induction, 4T1 cells synergic to BALB/c back-ground were used, after which mice underwent anti-PD-1 treatment. After the mice were sacrificed, NKT cells, dendritic cells (DCs), and macrophages derived from spleen and primary tumor tissue were analyzed using flow cytometry. Results. Anti-PD-1 therapy enhanced the expression of activating molecules CD69, NKp46, and NKG2D in NKT cells of the tumor and spleen. This therapy activated NKT cells directly and indirectly via DCs. Activated NKT cells acquired tumoricidic properties directly, by secreting perforin, and indirectly by stimulating M1 macrophages polarization. Conclusion. Anti-PD-1 therapy activates changes in DCs and macrophages of primary tumor tissue towards protumoricidic activity. Since anti-PD-1 therapy induces significant changes in NKT cells, DCs, and macrophages, the efficacy of the overall antitumor response is increased and has significantly decelerated tumor growth.

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Introduction/Objective. Alcohol abuse influence on developing thyroid cancer is controversial. While some studies consider it a protective factor, others deny any impact on thyroid cancer. The objective of the paper was to establish a possible link between alcohol abuse and certain types of thyroid cancers. Methods. The retrospective study included 502 patients with thyroid cancer and a control group of 600 patients with benign forms of thyroid diseases (e.g. nodular, multinodular, and toxic nodular goiter). Thyroid cancer patients were divided into four groups: I – papillary, II – medullary, III – anaplastic, and IV – follicular carcinoma, and grouped by sex, age (< 30 years; > 30 years) and alcohol abuse, as defined by the World Health Organization. Results. Thyroid cancer patients were predominantly male of younger age. This distribution difference was statistically significant in groups I and II (p < 0.001). Of total 10 (0.9%) patients with chronic alcohol abuse, eight (1.6%) had thyroid cancer, while two (0.3%) belonged to the control group (p < 0.001). In thyroid cancer patients, chronic alcohol abuse was absent from groups III and IV. Distribution in groups I and II was six (1.6%) and two (2%), respectively (p < 0.001). Conclusion. Alcohol abuse deserves to be considered as a risk factor for papillary and medullary forms of thyroid cancer, while it does not stay the same for anaplastic and follicular thyroid cancers.

Background/Aim. Reactive thrombocytosis, as a paraneoplastic syndrome, is often observed in cancer patients. A variety of tumor-related humoral factors and cytokines con-tribute to tumor-stimulated thrombopoiesis. However, the exact role of these cytokines in the pathogenesis of thrombocytosis remains unclear. The aim of this study was to analyze systemic values of cytokines and clinical-pathological characteristics in colorectal carcinoma (CRC) patients with and without thrombocytosis. Methods. Fifty nine CRC patients were involved in this study and divided into two groups according to the number of platelets. We recorded and analyzed the data about: age, gender, size of the cancer, localization, metastasis, vascular or lymph vessel invasion, nuclear grade, histological differentiation rate, tumor, nodus, metastasis (TNM) stage and concentration of cytokines [interleukin (IL)-1, IL-33, IL-12, IL-17 and interferon (IFN)-γ] in both groups. Results. CRC patients with thrombocytosis had significantly higher nuclear grade of the cancer (p = 0.002); higher percentage of detectable metastatic lesions in the liver (p = 0.002), lung (p = 0.001), peritoneal carcinomatosis (p = 0.001), detectable invasion of blood (p = 0.012) and lymph vessels (p = 0.010). Concentrations of tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9)] and se-rum values of IL-1 a nd I L-33 were significantly higher in CRC patients with thrombocytosis. IL-1/IL-12 (p = 0.016), IL-1/IFN-γ (p = 0.007), IL-1/IL-17 (p = 0.006), IL-33/IL- 12 (p = 0.001), IL-33/IFN-γ (p = 0.001), IL-33/IL-17 (p = 0.002), and IL-33/IL-1 (p = 0.006) ratios were significantly higher in CRC patients with thrombocytosis in comparison to CRC patients without thrombocytosis. Analysis of Receiver Operating Characteristic (ROC) curves showed that values of IL-1 [area under curve (AUC) = 0.718; 95% confidence interval (CI): 0.567–0.868; sensitivity 69.2%, specificity 62.9%] and IL-33 (AUC = 0.763; 95% CI: 0.614– 0.911; sensitivity 84.6%, specificity 65.7%)], could be serve as possible markers for paraneoplastic thrombocytosis in CRC patients. Conclusion. IL-1 a nd I L-33 significantly correlated to high thrombocyte number in patients with more aggressive CRC.

This article analyses the context that led to a dialogue on electoral conditions between the Serbian government and the opposition by applying the methodological matrix of standards for "free and fair" elections as defined by international organizations. Serbian electoral law has implemented international standards, but all electoral cycles have shown a certain level of irregularities that call into question the integrity of a number of electoral processes in the 2012-2017 interval. Two rounds of interparty dialogue produced only partial results. By amending a number of laws, certain election procedures were improved, but they remained in the shadow of unresolved crucial problems. Public broadcasting services remained closed to opposition parties and alternative policies, and the pressure on voters remained present. Instead of improving election conditions, major electoral reform was carried out. The electoral threshold was lowered from 5% to 3%. This form of electoral engineering carried out by the government did not diminish the boycott of the opposition, but it brought about significant changes in the electoral system, the effects of which were felt in the next elections. The epilogue of the dialogue was a boycott of the election by a part of the opposition parties, a politically unrepresentative parliament, and the Serbia's return to the ranks of authoritarian, hybrid regimes in index bases that measure the quality of democracy. The announcement of early elections immediately after the constitution of the national parliament and a new round of dialogue on electoral conditions show that the problem of electoral integrity is still waiting for a solution.

Introduction Silicone implants have been used ever since the second half of the 20th century. Over that period several generations of implants have been developed that differed in thickness of the shell and viscosity of the silicone gel. Development of these generations of implants was accompanied with different complication rates. The first-generation implants had the lowest tendency to rupture, but were more prone to capsular contracture and calcification formation. Case outline An 81-year-old female patient had her silicone implants placed in 1983. After a chest injury in 2015. on the lateral aspect of the left breast a tumefaction becomes palpable and she complains of pain. She denies any subjective problems before the injury. After pertinent diagnostic procedures and clinical examination, silicone implant rupture was suspected. Surgical findings confirmed ruptures of both implants so that they were extracted, capsulectomy was performed and the surrounding tissue imbibed with silicone removed. Samples were sent for histopathological examination. Conclusion Implant rupture is one of late complications of breast augmentation. The incidence of ruptures has changed with development of newer generations of silicone implants. We believe that our patient had the first-generation silicone implants, knowing the time from their placement to the occurrence of symptoms and macroscopic appearance of the shell after extraction. The fact is that these implants have proved to be very durable, but regardless of the lack of symptoms, current guidelines recommend regular screening for rupture, while possible preventive extraction, particularly in case of so old implants should be considered.

Several Serratia species are widely distributed in nature, but Serratia marcescens is the only species frequently isolated in hospitals. This pathogen is mainly responsible for nosocomial infection, mostly in immunocompromised hosts. A 26-year-old woman with a twin pregnancy, regularly controlled, was hospitalized at 24 + 5 weeks of gestation due to scant vaginal bleeding, lower abdominal pain, and body temperature up to 37.5°C. Gynecological examination revealed bleeding accompanied by dilatation of the cervix. The laboratory analyses revealed leukocytosis with elevated C-reactive protein (CRP). Treatment was initiated with intravenous antibiotic administration. After admission, fetal membranes spontaneously ruptured, and an extremely preterm dichorionic female twin birth occurred at 25 + 0 weeks of gestation. Both infants died two days after labor. Pathological and microbiological analyses revealed chorioamnionitis caused by S. marcescens. According to the antibiogram, antibiotic treatment was continued for the next 7 days. The examination of cervical and vaginal discharge samples was negative three days and two weeks after therapy. S. marcescens may cause spontaneous miscarriages and, in this important case, caused loss of discordant twins in an extremely preterm birth by an immunocompetent patient. Infection by S. marcescens cannot be excluded as a cause of discordant growth and needs to be confirmed by further research.

Introduction. Inclusion body myositis (IBM) is a rare form of inflammatory myopathy with a slowly progressive course. It is manifested by early weakness and atrophy of skeletal muscles, especially forearm muscles and the quadriceps. At the very beginning of the disease, clinical symptoms are not pronounced, therefore it is difficult to diagnose. Case report. A forty-eight-year-old female patient visited her doctor due to the weakness of muscles in arms and legs. Five years prior to this, she was treated by a neurologist and a physiatrician on several occasions with different diagnoses for progressive muscle weakness. During the last hospitalization, IBM was diagnosed after the muscle biopsy findings. After the diagnosis, the patient underwent intensive physical therapy in order to preserve the ability to independently perform everyday activities and stability of walk. Conclusion. IBM is a rare clinical entity which often takes several years to be diagnosed. Progressive muscle weakness in elderly should point to possible IBM diagnosis, which is only confirmed by muscle biopsy. Physical therapy has a significant role in the treatment as it leads to improvement of functional abilities of the patients in their daily activities, thus reducing the disability degree.

Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.

Background/Aim. Gastric cancer (GC) is fourth most frequent malignant tumor worldwide, frequently diagnosed at advanced stages with poor prognosis. The aim of study was to determine expression of interleukin (IL)-32, proinflammatory and angiogenic mediators in the tumor, peritumor and healthy tissue, in patients with intestinal gastric cancer and the relationship with the disease severity. Methods. The tissue samples of intestinal type of the tumor of 60 patients with GC were analyzed. Expression of IL-32, vascular endothelial growth factor (VEGF), IL-17 and CD31 were measured by immunohistochemistry. Results. IL-32, VEGF and IL-17 expression as well as microvascular density (MVD) were diminished in adjacent tumor tissues compared with the tumor ones. Further, more intense expression of IL-32 and VEGF and enhanced MVD were noticed in patients with severe (TNM stages III and IV) and more progressive GC (lymph vessel invasion). Conclusion. Higher expression of IL-32, VEGF and intense MVD in the tumor tissue of GC patients with detectable lymph vessel invasion may be considered as a sign of the tumor’s malignant progression. This indicates a protumorogenic and proangiogenic role of IL-32 in biology of intestinal type of gastric cancer.

The text deals with the analysis of the doctrine of neoliberalism as the dominant political-economic direction of a modern capitalist society. The paper first points to the meaning of the term itself, taking into account the numerous specificities and contradictions that this direction brings with it. An analysis of the works of the most significant representatives of neoliberal thought attempts to determine the basic values and principles governing neoliberal theorists, and whether neoliberalism can be considered the successor to classical liberalism or if it is a completely new direction in the development of economic thought. It pointed to the historical circumstances that led to the seemingly forgotten policy of economic liberalism becoming the mainstay of economic science in the 1980s. Also, the policy of neo-liberalism has had its practical operationalization, first in Latin American countries, but above all in the United States and Great Britain, where it is also known as "reganomics" or "Thatcherism". The transition of post-socialist economies has emerged as a major issue at the end of the last century, with a considerable number of countries approaching this problem in line with the recommendations of international financial institutions and programs based on the principles of neoliberalism. In this regard, the paper analyzes the main values of the neoliberal trend, as well as the historical circumstances that led to neoliberalism becoming the dominant socio-economic doctrine.

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/Objectives. The objective of our study was to investigate the structure of the cosmetic procedures’ acceptance attitudes and differences in acceptance between persons who had undergone minimally invasive cosmetic procedures and those who had not. Methods. The study included 245 subjects (treatment group), 21–73 years old (42.02 ± 12.12). The control group included 250 subjects who had not previously undergone cosmetic procedures, also 21–73 years old (40.19 ± 11.71). The control group was balanced with the treatment group according to category distribution of demographic variables. The Acceptance of Cosmetic Surgery Scale, adjusted for cosmetic procedures in general, was used for the evaluation of participants’ attitudes towards these procedures. Results. Internal consistency of the scale was α = 0.963, the split-half coefficient of validity was 0.861/0.810, and test–retest correlation coefficient was 0.892. The treatment group has shown overall higher acceptance (t(478) = 27.024, p < 0.001, η2 = 0.6), and higher scores in all three dimensions. No demographic variable has shown significant differences in total or individual factor scores in either group. Conclusion. Subjects from both groups had scored higher on items dealing with the advantages of cosmetic procedures on a personal level (Intrapersonal Factor).

Introduction/Objective. The development of safer cosmetic medical procedures has lead to an increase in the number of minimally invasive esthetic procedures. The main aim of the current paper is to examine the connection of the number/location of esthetic procedures with the overall body image dissatisfaction, affective temperament traits, and the index of self-esteem in persons who have undergone several minimally invasive cosmetic procedures for esthetic reasons. The subsidiary aim is to compare the predominance of the abovementioned traits in the sample with the results in the general population. Methods. The study included 228 participants, aged from 21 to 73 years, who had multiple minimally invasive cosmetic procedures, purely for esthetic reasons. Data were collected using a socio-demographic questionnaire, medical documentation, the Body Image Assessment Scale-Body Dimensions, TEMPS-A temperament scale, and Rosenberg Self-Esteem Scale. Results. Overall body image dissatisfaction was moderate in our patients (11.56 ± 11.877). With an increase of dissatisfaction, the number of procedures did not grow (r = 0.075, p = 0.263); however, the number of body parts on which the procedures had been performed did. The patients who had their body parts altered most were found to have deeper dissatisfaction with their overall body image (F(2,225) = 4.963, p = 0.008, η2 = 0.04), and the most prominent temperament was wound to be hyperthymic (F(2,225) = 3.408, p = 0.035, η2 = 0.03), similar to the Serbian general population. Conclusion. Through establishing potential relations between physical, social, and psychological variables, like body image dissatisfaction, temperament, and self-esteem, we could provide a better insight into a mental state of individuals who frequently undergo minimally invasive cosmetic procedures.

Introduction/Objective. Hair transplantation is one of the fastest evolving procedures in aesthetic surgery and is accompanied by continuous improvement of new techniques. Hairline planning is one of the most important steps in hair transplantation. The shape of the hair also varies depending on the variation of facial shape so it is very important when determining hair direction and making holes for future grafts. Methods. We used ordinary 18 gauge injection needles whose number was the same as the number of micrographs we planned for transplantation. Needles are administered in pile growth direction and angle, starting from the first row, and then proceeding to the second one and so on, until we insert all prepared needles. We insert them one in front of the other with a precision ease for future follicles. Results. In all 56 patients, we obtained natural hair growth. Inserting the needles reduced bleeding and the average time of the operation was three hours. The success of grafting was 95%. We only had one infection in one patient. Hair growth corresponded to the needle insertion. After a year of transplantation at the last control, the patient’s satisfaction was 100%. Conclusion. By using the same number of needles as the number of grafts we reduced operating time, we had a better determination of the direction of hair growth, we can prevent follicular extraction that can be caused by new needle insertion, and this technique achieved a good aesthetic result.

Introduction/Objective. Frostbite is a cold-induced injury of the tissue caused by the freezing of intraand extracellular water, and characterized by thrombosis and ischemic necrosis. Although individual, socioeconomic, and environmental factors are all considered fundamental determinants of human health in general, their role in the occurrence of frostbite remains largely unknown. The aim of this study was to examine the associations among these factors and frostbite for patients in Belgrade, Serbia. Methods. We investigated a total of 24 patients that were hospitalized and treated for frostbites at the Clinic for Burns, Plastic, and Reconstructive surgery, Clinical Center of Serbia, 2008–2017. Results. The majority (88%) of the patients were male, 58% were long-term alcohol consumers, 46% were long-term smokers, and one patient was drug addict. Of the patients, 14 (58%) had no income and depended on government support, 10 (42%) were employed in physical labor or work on the field, and three (13%) of the patients were homeless. Of the 24 frostbite patients identified, deep frostbite accounted for 18 (75%), of whom 17 (70.8%) had an operative outcome. A majority of patients (42%) sustained frostbite when the temperature was in the range of -5–0°C on the date of occurrence. Conclusion. The results of our study showed that individual, social, and environmental factors were important determinants of frostbite. Our results will contribute to existing evidence for risk factors related to frostbite and will allow for comparisons across countries where these factors have been examined.

Background/Aim. Colorectal cancer (CRC) represents one of the most common cancers worldwide. CRC is frequently diagnosed at advanced stages with poor prognosis, indicating the need for new diagnostic and prognostic markers. The aim of this study was to determine systemic and fecal values of galectin- 1 (gal-1) and ratios between gal-1 and proinflammatory cytokines: tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interferon gamma (IFN-γ), in the patients with CRC and the relationship with clinicopathological aspects of the disease. Methods. The blood samples and feces liquid fraction of 58 patients with CRC were analyzed. The serum and fecal levels of TNF-α, IL-1β and IFN-γ and gal-1 were measured using sensitive enzyme-linked immunosorbent assay (ELISA) kits. Results. The fecal level of gal-1 was increased in the CRC patients with higher nuclear grade and poor tumor tissue differentiation. The gal-1/TNF-α ratio in the serum and feces had a higher trend in the patients with the advanced tumor-nodemetastasis (TNM) stage as well as the detectable lymphatic and blood vessel invasion. The gal-1/TNF-α and gal-1/IFN-γ ratios were increased in the serum of patients with presence of lung/liver metastasis or peritoneal carcinomatosis, while the enhanced gal-1/IL-1 ratio was detected only in the serum of patients with lung metastasis. A positive correlation between the gal-1 value in feces and histological differentiation of tumor and biomarkers alpha-fetoprotein (AFP) and cancer antigen- 19-9 (CA 19-9), respectively, was also observed. The fecal values of gal-1 higher than 13,708.29 pg/g presented a highly sensitive and specific marker for histological differentiation of tumor tissue. Conclusion. We believe that the predomination of gal-1 over pro-inflammatory cytokines TNF-α, IL-1β and IFN- γ in the patients with advanced and progressive CRC may implicate on an immunomodulatory role of gal-1 in the limiting ongoing proinflammatory processes. The fecal values of gal-1 can be used as a valuable marker for the severity of CRC. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175071, Grant no. 175069 and Grant no. 175103]

Introduction. Elevated cardiac troponin gives excellent accuracy in the identification of myocardial damage in children, but it can also be elevated in a series of other diseases. Case report. We presented two children thirteen years of age with a high serum level of troponin-I after an acute episode of supraventricular tachycardia. We analyzed troponin- I levels in correlation with the maximum heart rate, duration of tachycardia and systolic left ventricular function (ejection fraction and fractional shortening). Conclusion. Abnormal troponin level can be seen in children with sustained supraventricular tachycardia and normal heart. Caution is advised in diagnosing cardiac dysfunction in children with supraventricular tachycardia and elevated troponin levels.

Background/Aim. The most frequent form of sternal defects is a single foramen, usually located at the distal half of the sternal body, with prevalence that varies among different ethnic populations. Clinical importance of these defects arises from various diagnostic and therapeutic sternal treatments and close location of heart, lungs and other vital organs of the chest cavity. The aim of this study was to determine the prevalence and morphometric characteristics of the sternal midline foramen in the population of central Serbia. Methods. The multidetector computed tomography (MDCT) chest images of 422 patients of both genders were analyzed. The radiological imaging was performed on 64- slice MDCT scanner (Aquilion 64, Toshiba, Japan). All scans were performed in the axial plane, with subsequent multiplanar reconstruction (MPR). Due to the angulation of the sternal body coronal curved-planar, the images were obtained in order to show the whole length of the sternum and the vertical diameter of the sternal foramen. The measurements were done using the commercially available software (Imaging Software ver. 4.1.14.0, Vital-Images). Results. The solitary foramen, located in the distal segment of the sternal body, was detected in 24 patients, representing 5.9% of the observed population with slightly higher prevalence in males. The average size of foramen was 3.9 × 4.2 mm. The mean distance from the skin was 12.7 ± 3.3 mm, the distance from skin to pericardium was on average 37.3 ± 8.2 mm, while the average distance from skin to pleura was 25 ± 5.9 mm. The average depth of foramen 8.7 ± 2 mm, while the mean distance from the posterior surface of foramen to pericardium was 12.7 ± 9.1 mm. Conclusion. The results presented in this paper confirmed the prevalence of 5.9% regarding the midline sternal foramen in the observed population. Serious complications of the sternal puncture could be prevented by prior MDCT imaging.

Background/Aim. Ulcerative colitis (UC) is a chronic, relapsing inflammatory disease affecting the distal colon and rectum with complex pathogenesis and diagnosis, indicating the need for new diagnostic and prognostic markers. The aim of this study was to determine the fecal values of TNF- α, IL-17, IL-10 and soluble protein ST2 (sST2) in the patients with UC and their relationship with clinicopathological aspects. Methods. The samples of stool of 80 patients with UC were analyzed. Concentrations of TNF-α, IL-17, IL-10 and sST2 were measured by ELISA. Results. Concentrations of TNF-α, IL-17 and sST2 were significantly increased in the feces of patients with the higher endoscopic, clinical and total Mayo score, as well as in the patients with an intense crypt destruction, erosion of the mucous membranes, architectural changes, neutrophil infiltration and eosinophil infiltration. The local value of anti-inflammatory cytokine IL-10 in liquid fraction of feces was increased in the patients with an advanced endoscopic stage of UC. The moderate positive correlation between the fecal sST2/IL-17 and the clinical and histological parameters of disease severity and also the strong correlation between sST2 and IL-17 was also observed in the feces of patients with UC. The analysis of receiver operating characteristic (ROC) curves showed that the optimal cut-off value for sST2 of 624.0 pg/g allows the discrimination of clinical stages of UC. Conclusion. The increased fecal value of sST2 in the UC patients with a higher endoscopic, clinical and histological stage of disease may be considered as a sign of the disease severity. The fecal values of sST2 can be used as a valuable marker for UC severity. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175071, Grant no. 175069 and Grant no. 175103]

The importance of the activation of phosphatidylinositol-3-kinase (PI3K) in the processes of tumor cell formation and growth has brought great interest in the development of new antitumor drugs that inhibit the PI3K-Akt signaling pathway. Recent studies have shown that in most tumors the activity of p110α isoform of PI3K kinase has been altered, and today special emphasis is placed on developing specific PI3K-α inhibitors. In a series of 92 PI3K-α inhibitors, whose data on experimentally determined inhibitory activity were collected from literature, 3D quantitative structure-activity relationship studies (3D-QSAR) were carried out. All molecular structures were previously optimized using semiempirical PM3 and ab initio Hartree-Fock / 3- 21G methods, and modeling was performed using PLS regression analysis. Calculated parameters of internal (R2=0.84; Q2=0.67) and external (R2pred=0.681; r2m=0.594; Δr2m=0.00039)validation indicate on good reliability and predictive power of created 3D-QSAR model. The analysis of the variables enabled pharmacophore structure determination, which implies: presence of hydrogen bond donor and hydrogen bond acceptor at a distance of 18-18.4Å or 12- 12.4Å, presence of hydrophobic domain and hydrogen bond donor at a distance of 15.2-15.6Å, and presence of steric hotspot at optimal distance from hydrogen bond donor and acceptor. These results will have the relevance in selecting the lead compounds for targeted structural modifications in order to design new selective PI3K-α inhibitors as potential antitumor drugs.

Introduction. Asymptomatic Bochdalek hernia in adults is a rarity. The aim of this paper is to present a rare case of Bochdalek hernia among adults and to point out to significance of clinical suspicion and important role of imaging techniques in reaching the exact diagnosis of this abnormality. Case report. A patient, aged 68 years, came to the Clinic of Pulmonology complaining of constant dyspnea, coughing and fatigue. Computed tomography (CT) findings were dominated by the large rear right diaphragmatic hernia with the hernial sac that reached the carina trachea and urged the principal bronchi. The stomach, duodenum and proximal part of jejunal winds, as well as a greater amount of omental and mesenteric adipose tissue were localized in hernial sac. Radiography of gastroduodenum showed: entry of the esophagus into the cardia was in the level of the right main bronchus. Stomach was mainly located in the chest (cardia, upper corpus half - to the level of the right main bronchus). Operation was indicated. First, we made right thoracotomy and the hernia sac was separated from the right lung and then we performed median laparotomy and the contents of the hernia sac were returned to the abdominal cavity; diaphragm defect was reconstructed with prolen mesh. Conclusion. We presented a rare case of right sided Bochdalek hernia which was discovered at late age and surgically treated with success.

Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work. [Projekat Ministarstva nauke Republike Srbije, br. III 41017: Virtual human osteoarticular system and its application in preclinical and clinical practice]

Introduction. Malignant fibrous histiocytoma is a fast spreading pleomorphic sarcoma with a high malignant potential. Its spreading is characterized with local invasion and distant metastazes with early onset. Most common localisations of development are extremities, trunk and retroperitoneum. Given the line of rare case and specimen, lack of a clear etiology and mechanisms of this disease, as well as adequate histopathologic findings and intraoperative documentation, we presented current status, discuss putative etiology, histopathology with variant morphology, differential diagnosis and treatment modalities. Case report. We presented a 56-years-old female Serbian with tumor in the thigh that clinically resembles incapsulated hematoma. Computed tomography revealed intramuscular tumor with a heterodense structure and compression on surround tissue. Ex tempore biopsy specimen showed malignant potential of the tumor. Wide and radical excision of the nodule has been done, and definitive histopathological verification revealed malignant fibrous histiocytoma. Conclusion. Malignant fibrous histiocytoma is a most common type of soft tissue sarcomas in adults. Frequent localization is on lower extremities, and every rapidly enlarging nodule in this localization that on computed tomography is like incapsulated hematoma with necrotic zone should alert suspicion on presence of this type of sarcoma.

Background/Aim. The values of the Böhler’s angle (BA) are relevant parameters for diagnosis, management and prognosis of the calcaneal fracture and the outcome. Range of normal values of Böhler’s angle (BA) in adults varies depending on the examined population, age, gender or ethnicity. The aim of this study was to determine the range of normal values of the Böhler’s angle in the central part of Serbia. Methods. The lateral foot radiographs of 225 subjects (111 males and 114 females) without calcaneal fractures, divided into 6 age groups were observed to determine the normal values of the Böhler’s angle by using the IMPAX 6.5.2.114 Enterprise software. Obtained values for Böhler’s angle were compared among gender and groups using appropriate statistical tests. Results. The mean of Böhler’s angle in observed population was 34.06°, ranging from 25.1° to 49.5° and was higher in males than in females included in our study. Gender difference was statistically significant. The distribution of the mean BA across the age groups showed tendency of decreasing with age and the highest BA was found in the youngest group. Conclusion. The findings presented in this paper confirmed the existence of wide range of BA values as well as its gender and age differences.

Background/Aim. Preservation of an adequate posterior tibial slope (PTS) during total knee arthroplasty is crucial for the biomechanical stability and function of the knee joint. Studies that investigated anatomical features of the tibial plateau found significant gender and inter-population differences in all components of the PTS. The aim of this study was to establish reference values of PTS in Serbian population and to explore if there is any difference in the tibial plateau inclination between genders. Methods. We retrospectively reviewed 161 magnetic resonance images (MRIs) of the knee of adult patients examined in Medical Military Academy in Belgrade, Serbia, in a period from November 2011 to September 2014. Measurements of PTS components: medial tibial slope (MTS), lateral tibial slope (LTS), and coronal tibial slope (CTS) were performed through several steps, according to the suggestions in the recent literature. Obtained values for each tibial slope were compared between gender subgroups using appropriate statistical tests. Results. Mean values of each component of the posterior tibial slope for male vs. female subgroups were as follows: MTS 3.7° ± 2.8° vs. 5.1° ± 2.9°, LTS 4.2° ± 2.8° vs. 4.3° ± 2.7°, and CTS 3.9° ± 2.4° vs. 3.3° ± 1.9° respectively. The medial tibial slope was significantly higher in females than in males (p = 0.005). The mean value of the coronal tibial slope was greater in males without statistically significant difference (p = 0.105). Conclusion. This study demonstrated significant difference in MTS of the tibial plateau between males and females, being higher in the female subgroup.

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]

Background/Aim. Damage of any element of pelvic floor leads to its functional damages, reflected in the occurrence of urinary incontinence, prolapse of pelvic organs, fecal incontinence and sexual dysfunction. Basic aim of our paper was to investigate the influence of various risk factors on pelvic floor muscle strength in women. Methods. The study included 90 female patients and examined how age, job, body weight and height, number of deliveries, sports activities, incontinence occurrence, previous prolapse-caused gynecological surgeries, other gynecological surgeries and other conservatively treated gynecological diseases influence the value of pelvic floor muscle strength. Pelvic floor muscle strength was measured using vaginal dynamometer. Results. Univariate regression analysis showed that parameters such as age, demanding job, body height, number of deliveries, sports activities, prolapse-caused gynecological surgeries, other gynecological surgeries and other gynecological diseases were in positive correlation with the values of pelvic floor muscle strength. In multivariate regression model, incontinence and gynecological operation of prolapse were singled out as independent risk factors. Conclusion. If risk factors that cause damage to pelvic floor muscle are known, it is possible to prevent the damages and improve the quality of women's life.

This paper deals with experimental and analytical investigations of the influence of thermomechanical processing conditions on the mechanical properties and electrical conductivity of PdNi5 alloy, in the form of wire Ø 0.15 mm, for making catalysts-catchers. Obtained results showed that mechanical properties and electrical conductivity depend on the applied regime of thermomechanical processing. Knowing the dependence of influence of parameters of thermomechanical processing regime on these properties enables the production of PdNi5 alloy with required characteristics for use in the process of catalytic oxidation of ammonia, that is solving problems of loss of platinum metals, especially platinum. The results of analytical investigations of influence of thermomechanical processing regime, by software package SPSS, on tensile strength, elongation and electrical conductivity of PdNi5 alloy in the form of wire Ø 0.15 mm showed that using a linear regression model the mutual influences of selected parameters of thermomechanical treatment on mechanical properties and electrical conductivity of PdNi5 alloy, can be adequately described and analyzed. The results showed that tensile strength and electrical conductivity were only slightly affected with a change of temperature and time of annealing while annealing time has significant influence on the elongation value. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. TR34029: Razvoj tehnologije proizvodnje Pd katalizatora-hvatača za smanjenje gubitaka platine u visokotemperaturnim procesima katalize]

Introduction. Castleman disease is a rare disease of the unknown etiology, occuring in two clinical forms: unicentric or multicentric. It is characterized by the hyperplasia of lymph glands. In literature the four pathohistological forms were described: hyaline vascular type, plasma cell type, mixed type and a recently recognized plasmablastic type. The most frequent changes are localized in the mediastinum, while the abdominal localization is with significatly rare occurrence, and that was the motive for presentation of this case. Case report. In a 41-year old male magnetic resonance (MR) enterography showed a change in the ileocecal area without the presence of subjective symptoms of digestive tract and without loss of body mass. Due to the suspicion of stromal tumor, surgical intervention was indicated. Pathohistological findings showed Castleman lymphadenopathia reactiva mesenterii (plasma cell type) which was in the unicentric form. There were present only anaemia and the increased value of sedimentation from the laboratory analyses. Conclusion. Abdominal localization of unicentric plasma cell form occurs rarely and the surgical method of treatment presents the golden standard as it was shown in the presented case.

Introduction. Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis (IM). It occurs in only 0.1–0.5% of cases of this disease. The aim of this paper was to present a case with spontaneous splenic rupture after IM. Case outline. A 22-year-old female patient was feeling better one month after she was treated for infectious mononucleosis, and started training volleyball. Two weeks after starting the training, she felt severe abdominal pain. The diagnosis of rupture was confirmed with computer tomography. Splenectomy was successfully performed. The postoperative course was uneventful and the patient recovered with no need for blood transfusion. Conclusion. Timely diagnosis and setting indications for surgical treatment are crucial in healing. Patients should wait to start with sport activities at least two months if the size of the spleen is within normal range.

This study investigated whether the L-arginine-NO system participates in the analgesic effect of flunixin meglumine in the rat. Hyperalgesia was induced by intraplantar (i.pl.) administration of carrageenan (500 μg) into the rat’s hind paw. Electronic von Frey apparatus was used to determine paw withdrawal threshold induced by pressure as the painful stimulus, measured in grams (g). Flunixin meglumine (FM; 0.09-0.1 mg/kg; s.c.) and NG-nitro-L-arginine methyl ester (L-NAME; 10 mg/kg; i.p.), given separately as a pre-treatment, i.e. 15 min before i.pl. injection of carrageenan, produced a significant antinociception. When FM (0.09 mg/kg) and a sub-effective dose of L-NAME (5 mg/kg) were co-administered, the antinociceptive effect was significantly increased in comparison with the effect of FM alone. L-arginine (L-ARG;10 mg/kg; i.p.) itself did not produce significant effect on carrageenan-induced hyperalgesia, but significantly reduced the antinociceptive effects of both FM and FM + L-NAME combination. The inhibition of the production of NO might be involved in the mechanism of the analgesic effect of FM.

Parathyroid glands are small endocrine gland in the neck that men secrete parathyroid hormone , or PTH ( PTH) , which together with calcitonin and vitamin - D has a primary role in regulating the concentration of calcium and phosphate in the body. The most common disease of the parathyroid gland presents increased and uncontrolled secretion of PTH , which can be defined as primary hyperparathyroidism, if occurs as a result of enhanced functions of one or more of the parathyroid glands , or secondary hyperparathyroidism, which occurs most often in chronic renal failure or as a result of the deficiency of vitamin D. In our case report we describe a patient with cancer paratioidnih gland , which is a very rare disease and is the rarest malignant endocrine tumor.