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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.

This paper examines the legal framework for the protection of human rights in situations of extreme crisis in the European legal area, in order to achieve a coherent understanding of legal standards that will lead to their more uniform application. Through an in-depth analysis of the meaning and scope of the provisions of Article 15 of the European Convention, as well as the corresponding practice of the European Court of Human Rights, the authors determine under what conditions the suspension of certain rights and freedoms is legally permissible, and which state measures adopted in extraordinary circumstances represent the protection of the public interest, and which go beyond the scope of the most necessary measure required by the given situation and represent a violation of the rights and freedoms of the individual. This work is based on the idea that specific limitations for the enjoyment of human rights are necessary and justified. It is a well-known that only a limited number of human rights are absolute and as such are immune to any restrictions regardless of the circumstances and justifications. However, this does not reduce the need for the measures that the state resorts to in times of crisis to be strictly controlled.

A malignant peripheral nerve sheath tumour (MPNST) is a highly aggressive sarcoma. This disease develops in a number of people with neurofibromatosis type 1 (NF1), which is a common genetic disease. The paper presents a patient with typical manifestations of a malignant tumour of the peripheral nerve sheath, in the form of a large tumour of primary localisation in the distal part of the left thigh and left popliteal fossa and with significant dissemination into the lung parenchyma, which was accompanied by respiratory risk. The first operation of the tumour was done four years earlier, after which the patient did not come for regular check-ups. Nine cycles of chemotherapy were performed by Doxorubicin / Ifosfamide / Mesna protocol with clinical improvement and stabilisation, but without a significant impact on the dynamics of the disease and the overall survival was 14 months. It is of utmost importance to early recognise clinical presentation of the malignant form of this tumour and active supervision of a patient with a benign form by experts. In this way, it is possible to apply the optimal treatment modality in a timely manner.

Background / Aim: Up until ten years ago stage four melanoma was considered a disease with extremely poor prognosis. Standard therapy during this period of time was dacarbazine chemotherapy. Patients with better performance status were treated with immunotherapy cytokine IL-2. In the last ten years eight medications have been approved by the FDA for the therapy of melanoma. The goal of this study was to determine objective response rate (ORR), median overall survival (OS), median progression free survival (PFS) and safety in patients with advanced and metastatic cutaneous melanoma treated with targeted therapy and immunotherapy at the University Clinical Centre of the Republic of Srpska (Centre). Methods: A non-randomised observational retrospective/prospective trial was conducted to investigate first experiences with the use of targeted therapy and immunotherapy at the Centre and compare the results with the literature data. A total of 23 patients received BRAF targeted therapy for the treatment of metastatic cutaneous melanoma in the first line of treatment. Nine patients received vemurafenib, fourteen patients received a combination of BRAF/MEK inhibitor. Nine patients were treated with pembrolizumab immunotherapy. The trial was performed in a period from May 2017 until December 2020. Results: In patients receiving vemurafenib ORR was 44.4 %, median PFS was 5 months (95 % CI, 1 to 11) and the median OS was 9 months (95 % CI, 2 to 17). In the vemurafenib/cobimetinib group ORR was 71.4 %. Median PFS was 9 months and median OS was 12 months. ORR in patients receiving pembrolizumab was 22.9 %, median PFS was 3 months (95 % CI, 1 to 11) and the median OS was 4.5 months (95 % CI, 2 to 12). Results in all three groups were inferior compared to the results from the literature except for ORR in patients receiving vemurafenib and vemurafenib/cobimetinib. Adverse events were tolerable and manageable and were similar to those described in the literature. Conclusion: Based on the experience with the targeted and immunotherapy in the Centre, which was presented in this study, it was concluded that in conditions when there is limited access to drugs, the greatest benefit have the patients who meet the inclusion criteria in clinical trials.

On the eastern slope of Slog Hill in Ravna, some 400 m to the west of the Roman fortification of Timacum Minus, a multilayered necropolis was investigated from 1994 to 1996 and from 2013 to 2015. There are two main horizons of the necropolis - Late Roman and Early Medieval. The late Roman necropolis has three phases dated from the middle of the 4th to the middle of the 5th century. The early medieval necropolis, according to the new excavations, has two phases, the earlier dated to the 8th - 9th centuries and the later from the end of the 9th to the beginning of the 11th century. An interesting grave (G 159), belonging to the earlier medieval phase of necropolis, was discovered in 2014. It is a unique burial of a woman and a fox, which has its only analogy in a disturbed woman and fox grave (grave 16) at the early Avar necropolis in Bečej. The burial with a fox could be interpreted in two ways - that the animal has a cult - ritual - magic meaning or that the fox was a pet of the deceased.

Introduction/Objective. Presbycusis, elderly hearing loss, is a progressive, bilateral sensoryneural hearing loss characterized by reduced sensitivity of hearing and understanding speech in a noisy environment, thereby impairing communication and inducing anxiety. The objective was to examine the impact of hearing amplification on subjective hearing disability assessment and anxiety in people with presbycusis. Method. Sample consisted of 120 respondents aged 47–85 with presbycusis, 60 subjects with and 60 subjects with no auditory amplification. The standardized Hearing Handicap Inventory for the Elderly and the Spielberger State Trait Anxiety Inventory were used in the study. Results. In subjects with hearing amplification, test/retest has no statistical significance in the STAI and HHIE scales and subscales, except the HHIE-S (p = 0.004) with a lower score on the retest. Respondents in whom hearing amplification was performed during the year was statistically significant in HHIE (p = 0.016), HHIE-S (p = 0.004) and STAI-S (p = 0.029) which speaks of favorable effect of hearing amplification. In the group with no hearing amplification, statistical significance was observed in relation to the HHIE scores (p = 0.002), HHIE-E (p = 0.000), STAI (p = 0.000), STAI-S (p = 0.001) and STAI-T (p = 0.001) and it was noticed that anxiety, loss of emotional contacts, and more pronounced degree of hearing impairment were the result of unassisted hearing rehabilitation. Conclusion. Audiological practice should include tests for assessment of hearing disability and anxiety in order to preserve health in later life. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. OI178027 and Grant no. 179055]