We reviewed our experience with retroperitoneal lymphadenectomy (RPLA) after multiple cisplatin-based chemotherapy regimens in nonseminomatous testicular tumors (NSTT) patients and specifically evaluated clinicopathologic and treatment trend in addition to potential predictors of survival. Fort-one patients with NSTT underwent their RPLA between 1982 and 2005 after ≥ 2 regimens of chemotherapy. Thirteen patients (32%) necessitate redo-RPLA, combined with nephrectomy in 6 patients. 13 extra-RP (ERP) resections were performed in 11 patients (27%), including pulmonary (7), neck (4) and liver (2) sites. Thirty patients (73%) are rendered free of disease and 26 (63%) obtained serologic remission. Nine patients who relapse, necessitated new salvage chemotherapy+surgery (3 teratoma, 6 vital carcinoma [VC]). Four of 9 relapsing patients (44%) are currently free of disease with redoRPLA. Alive, free of disease are 19 pts (46%) at median follow-up of 131 months. Study of RP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and VC in 46%, with survival in 67%, 56% and 32%, respectively. Different histology occurred in 38% at redo-RPLA and in 64% at ERP resection in comparison to previous RP pathology. Univariate analysis of clinicopathologic parameters associated with VC at RPLA included RP masses ≥ 5 cm (p<0.05), elevated AFP (p<0.001) or HCG (p<0.05) and ERP resection (p<0.04). On univariate analysis survival was worse in patients with RP masses ≥ 5 cm (p<0.04), elevated AFP (p<0.05) or HCG (p<0.007), ERP resection (p<0.01) and VC (p<0.004). On multivariable analysis, a RP masses ≥ 5 cm (p<0.03) and VC (p<0.005) predicted a worse prognosis. Our data support the continued use of salvage RPLA in three separated groups of patients: 1. Patients who achieved a complete response (CR) to 2nd -line chemotherapy and have no radiologic evidence of disease should undergo RPLA; 2. Patients who achieved a partial response (PR) to chemotherapy should undergo RPLA with ERP surgery, as indicated; 3. Highly selected group of patients with residual masses and elevated serum tumor markers (STM), particularly AFP, after chemotherapy may be candidate for surgery.

Cilj našeg istraživanja je bio da utvrdimo u kom procentu je D weak antigen prisutan kod primaoca i trudnica u našoj ustanovi, kao i koji Rh fenotip dominira kod tako tipiziranih eritrocita. Za određivanje RhD antigena koristili smo dve različite serije monoklonskih antiD test reagenasa. Uzorci koji su u Indirektnom antiglobulinskom testu bili pozitivni označeni su fenotipom D weak. Dalje ispitivanje fenotipa D weak je sprovedeno sa dva monoklonska IgM anti-D test reagensa različitih proizvođača. Ispitivanim eritrocitima označenim kao D weak određen je i Rh fenotip korišćenjem monoklonskih test seruma anti-C, anti-c, anti-E i anti-e. U toku 2009. godine 11779 uzoraka bolesnika i trudnica je rutinski tipizirano na prisutnost RhD antigena. Nakon izvođenja Indirektnog antiglobulinskog testa 42 uzorka su određena kao D weak fenotip (0,35%). Dominantni Rh fenotipi kod D weak pozitivnih eritrocita su bili CcDw ee (78,5%) i CCDw ee (16,6%). Aglutinacije sa dva IgM anti-D test reagensa u pokazivale različit intezitet i stepen aglutinacije. Eritrociti 14 uzoraka (33,3%) su pokazali odsustvo aglutinacije (negativan rezultat) sa oba reagensa. Samo eritrociti 6 uzoraka (14,2%) su imale skor aglutinacije od +3 do +4. Našim ispitivanjem smo ustanovili da je procenat pojavljivanja fenotipa D weak u saglasnosti sa podacima objavljenim u literaturi. Pravilnim odabirom anti-D test seruma, kao i poštovanjem savremenih preporuka za testiranje RhD antigena moguće je serološkim testiranjem odrediti slabiju varijantu D antigena. Jedini pozudani testovi koji omogućavaju razrešavanje antigen D diskrepance su molekularni testovi, koji na žalost u našoj zemlji još uvek nisu implementirani.

Lymph node metastasis in patients with colorectal carcinoma is bed prognostic factor. High level of CEA and CA 19-9 tumor markers before surgery have had a high sensitivity and also is a combination of high specification, especially in late stage cases. Considering that, general attention was to proof a correlation between level of CEA and CA 19-9 tumor markers before surgery and number of nodal metastasis in these patients. Our study included 102 patients with colorectal carcinoma. We measured level of CEA and ca 19-9 tumor markers before surgery and compared it with number of dissected lymph node metastasis after surgery as same as comparing with Duke’s stage of carcinoma. Average level of CEA tumor marker before surgery was 44,59 μg/mol. Lowest rate was 0,8 μg/mol ant the higher was 551 μg/mol. Average level of CA 19-9 before surgery was 258, 8696 U/mol. Average number of dissected lymph nodes per patient was 14,62 within average 2,5895 was nodal metastasis. There is a high statistically signification between CEA and CA 19-9 tumor markers level before surgery and level of Duke’s classification stage after surgery. Number of nodal metastasis is correlated with level of CEA before surgery. Level of CA 19-9 before surgery is not statistically significant for number of nodal metastasis. During this examination we noticed a high increasing of CEA and CA 19-9 tumor marker levels before surgery in patients with C2 Duke’s stage with more than 4 lymph nodal metastasis found after surgery. In this patients level of CEA was higher 45,78 μg/ml comparing with patients in C1 Duke’s stage who have had CEA level 6,07 μg/ml. In patients with C2 Duke’s stage average value of CA 19-9 was extremely high – 71 U/ml. High level of CEA and CA19-9 is statistically significant for staging of colorectal malign disease as same as for number of nodal metastasis.

The most common tumor in the cerebellopontine angle (CPA) are vestibular schwannomas and meningiomas. The purpose of this study is to present proportional representation according to gender and age, incidence of histological type, as well as relation between tumor magnitude, clinical symptoms and prognosis. A group of 38 patients with PCA expansion were examined and treated in time interval from 2006 until 2010 at clinical-hospital center “KBC Zemun – Belgrade”. Gender proportion was 22 female (57,1%) and 16 male (42,9%). Middle-aged patients (from 30 to 60 years) were predominant in age proportion 20(52,6%). The most frequent tumor in the study was vestibular schwannoma (63,1%) followed by meningioma (31,6%). The rest were various histological type tumors like cholestatoma, plexus papilloma, glioma etc. (5,3%). Tumor magnitude proportion showed that the most of the scwanoma (over 95%) were grades III and IV (according to Koss classification). The leading admission symptoms were: deferent degrees of hearing loss, cerebellar disorders and trigeminal lesions. The analysis of postoperative results for 38 patients have shown: mortality rate of 13,2%, complete lesion of facial nerve(39,4%), partial lesion(33,3%) and (27,3%) without lesion of facial nerve. Lesions of lower group of cranial nerves (IX, X and XI) had 3 patients (9%) and pyramid deficit had 6(17,3%) patients. This study showed that typical PCA vestibular schwannoma is predominantly in female and elder population presented. Recommended treatment is surgical (total or subtotal extirpation), followed by adjuvant therapy for elder patients. The most frequent causes of lethal outcome are infections and hematomas in tumor bed. The leading neurological deficit after tumor extirpation is total or partial lesion of facial nerve.

The aim of the present study is to analyse fate and survival in patients with pure testicular teratoma (PTT) according to clinical stage (CS) and applied therapy. Among a survey of 1275 patients with nonseminomatous germ cell testicular tumors (NSGCT) observed from January 1982 and June 2005, we indentified 49 (4%) patients with PTT. In CS I, 3 (15%) of 20 patients on surveillance relapsed. Complete response (CR) is achieved with chemotherapy in 1 patient and combined with postchemotherapy retroperitoneal lymphadenectomy (PC RPLA) in 2 patients (fibrosis 1, teratoma 1). Four patients managed with primary RPLA had universal survival. Among 4 patients treated initially with primary chemotherapy due to persistently elevated serum tumor markers (STMs) postorchiectomy, 1 patient died at 18 months. In CS I, 27 (96%) of 28 patients are alive and free of disease (AFD) at median follow-up (MFU) of 161.6 months. In the PC group, 1 patient with partial response (PR) is lost to follow-up at 6 months, 1 patient died of disease at 27 months. Eight patients achieved CR with induction chemotherapy, whereas only 1 patient relapsed at 24 months and is rendered free of disease with RPLA (teratoma). Twelve patients underwent PC RPLA due to PR following induction chemotherapy, combined with thoracic cytoreductive surgery in 2 patients. RP histology demonstrated the finding of fibrosis in 2, teratoma in 8, teratoma with malignant transformation in 1, and vital carcinoma in 1. The patients with fibrosis, teratoma and teratoma with malignant transformation are AFD, whereas the patient with vital carcinoma on desperation RPLA died. According to initial CS IIB, IIC and III PC surgery was indicated in 20%, 91% and 50%, relapse rate was 0%, 18% and 20%, with disease specific survival (DSS) in 100%, 90% and 100%, respectively. At MFU of 189.7 months, 19 (95%) of 20 fully available patients are AFD. Overall, 46 (94%) patients had no evidence of disease (NED) at last follow-up. These data underscore the metastatic potential of PTT. A significant proportion (32%) of patients with low-stage PTT had RP disease. Furthermore, a high proportion (36%) presented initially with advanced disease and demonstrated a considerable risk of relapse despite complete resection or favorable histologic features in the resected surgical specimen.

U pedijatrijskoj praksi poslednjih godina uočena je povećana učestalost pleuralnih efuzija. Prema načinu nastanka pleuralne efuzije su podeljene na eksudate i transudate. U grupi eksudata najčešće se sreću parapneumonične efuzije i empijem. Parapneumonična efuzija kod dece definiše se obično kao nakupljanje pleuralne tečnosti u toku akutne bakterijske pneumonije, a ređe u sklopu virusne pneumonije i tuberkuloznog pleuritisa. Empijem označava prisustvo purulentnog sadržaja u pleuralnom prostoru. Glavni bakterijski uzročnik pneumonija udruženih s izlivom je Streptococcus pneumoniae serotip 1. Kod 10% bolesnika ne dolazi do povlačenja pleuralne efuzije i pored konzervativnog lečenja. Tada sprovodimo standardizovan postupak prema smernicama BTS vodiča, sa algoritmom dijagnostičko-terapijskih mera. Signifikantna količina pleuralne tečnosti koja perzistira i kompromituje plućnu funkciju čini komplikovanu pleuralnu efuziju i indikovana je torakalna drenaža. Pri pojavi septacija i lokulacija u pleuralnom prostoru, neophodna je intrapleuralna instilacija fibrinolitika. Primena Streptokinaze je bezbedna, efikasna, smanjuje potrebu za hirurškim lečenjem i zajedno sa ostalim terapijskim merama dovodi do kompletnog oporavka deteta. Rana video-asistirana torakoskopija u kombinaciji sa fibrinoliticima verovatno će u budućnosti biti metoda izbora.

Tuberculous peritonitis is a specific inflammatory disease of the peritoneum, rare in developed countries, often in developing countries. Symptoms usually have a chronic character and appearance of ascites is often the initial symptom of the disease. Symptomatology may not be typical. It occurs most often anorexia, weight loss, abdominal pain and subfebrile temperature Presented 23-year-old patient, after elective surgery on the right inguinal hernia, when the changes in the peritoneum and omentum were observed and 2l of ascites were evacuated, was admitted to Hospital for emergency surgery, Clinical Centre of Serbia, Belgrade for further diagnostic and therapeutic treatment. The patient noted occasional mild abdominal pain, bloating, fatigue and general weakness. Chest radiography showed a small pleural effusion in the right and laminar athelectasis in the lower right lung field. On performed EHO and MSCT of the abdomen is visible easily enlarged liver, with a discrete dilation of intrahepatic bile ducts, gallbladder with calculuses. Portal and spleen vein dilated, enlarged spleen. Right subphrenic and interintestinally present clear liquid. Other findings in order. Exploratory laparotomy was perfomed. Histopathological examination, of the slices of the peritoneum, confirmed changes typical for tuberculous peritonitis.

Congenital heart disease is the most important cause of infant mortality. Abnormalities of the heart and great arteries are the most common congenital defects. Congenital heart disease is often fallow by extracardiac malformations. Many studies revailed positive impact of prenatal diagnosis and timelly treatment on pre-operative condition and outcome of surgery and long term prognosis. Neverthelles, structural cardiac anomalies were also among the most frequently missed abnormalities by prenatal ultrasonography at mid-trimester scan. The 4-chamber view has a Detection Rate of 6-50%, with a reasonable figure of 20% in community setting screening programs. The addition of the outflow determines a significant increase of the Detection Rate which, in most studies, ranges 20-40%. The three-vessel view allows to detect major abnormalities of the arches, the neck vessels and the thymus. The prenatal detection of specific types of congenital heart disease, such as Transposition of great arteries, Hypoplastic left heart syndrome, Tetralogy Fallot, seems to have a significant impact on survival, hospital stay and pre-operative conditions of the affected neonates. Hence, fetal cardiac screening is a must for all health professionals involved in prenatal diagnosis.

Prenatal diagnosis of congenital heart disease is crucial to optimal obstetric and neonatal care. In utero identification of heart anomalies allows a variety of treatment options to be considered, including delivery at an appropriate facility, termination of pregnancy, and in some cases in utero therapy. Specific indications and risks have been classified and patients considered at high risk have been offered detailed fetal echocardiography, commonly at a center with appropriate expertise and facilities. However, most children are born to mothers who have no known risk features during pregnancy. Screening in the low-risk population has been reported to have lower accuracy rates then in high-risk population. The most common indication for performing a fetal echocardiogram is a prior family history of congenital heart disease. A number of drugs have been implicated as causes of various malformations, including heart anomalies. Therefore, their use during pregnancy is considered as indication for echocardiography. Several maternal conditions also carry an inherited risk to the fetus and their presence is also indication for this diagnostic procedure. The incidence of congenital heart disease is increased fivefold among infants of diabetic mothers, whereas phenylketonuria has reported risk of 12 to 16%. Chromosomal anomalies, extracardiac malformations and monozigotic twins are also indications for fetal echocardiography.

Lekar koji učestvuje u prenatalnom skriningu i dijagnostici kongenitalne srčane bolesti mora biti familijaran sa potencijalnim uticajem tehničkih faktora u postizanju najboljih diagnostičkih prikaza srca i njegovih struktura, a sve u okviru prihvatljivih termalnih i mehaničkih sigurnosnih limita ultrazvučnih procedura u obstetriciji. Znanje adekvatne optimizacije gain-a, uvećanja ultrazvučne slike, korišćenje compound imaging-a i harmonic imaging-a su preduslovi kvalitetnog pregleda. Ostali važni faktori koji utiču na pregled i koji treba da se uzmu u obzir su gestaciona starost u momentu pregleda, maternalni telesni habitus, fetalni pokreti i pozicija i primenjena frekvenca ultrazvučnog talasa. Nekad je neophodno da se sačeka optimalni fetalni položajda bi prikazali željene strukture, a da bi se to postiglo nekad se pacijent mora ponovo pregledati nekom drugom prilikom.

Funkcionalna definicija matične ćelije podrazumeva da je to najmladja ćelija ljudskog organizma koja poseduje izvanredan kapacitet samoobnavljanja i sposobnost diferenciranja u specijalizovane tipove ćelija. Osnovna podela je na embrionalne matične ćelije i adultne matične ćelije. Embrionalne matične ćelije predstavljaju najmladje ćelije ljudskog organizma. One su pluripotentne i imaju sposobnost da se pretvore u otprilike 220 vrsta ektoderma, mezoderma i endoderma. Adultne matične ćelije su nediferentovane ćelije koje se pojavljuju u odraslom tkivu.. I one imaju sposobnost da se samoobnavljaju i proizvode diferentovane potomke, ali su one multipotentne i kapacitet diferentovanja im je ograničen. Njihova osnovna funkcija je obnavljanje oštećenog tkiva. Obzirom da kardiovaskularna oboljenja predstavljaju jedan od najčešćih uzroka morbiditeta i mortaliteta čitavog čovečanstva, interesovanje za korišćenje matičnih ćelija kod kardioloških oboljenja je u žiži interesovanja naučnika.

Although the first balloon dilation of aortic stenotičnog valve in the fetus was performed successfully as early as 1989th , the fetal cardiac intervention procedures are still in experimental medicine and performed in a few centers in the world. Interventional cardiology procedures at this time in the application of the fetuses with aortic stenosis, fetuses with stenosis / atresia of the pulmonary artery and hypoplasia of fetuses with left ventricle and restrictive međupretkomorskim hole.

Ultrasound examination of the fetal arches is important to highlight babies at greatest risk of perinatal collapse, those with ductus-dependent lesions. Diagnosis of those anomalies before discharge from home is difficult because the arterial duct is patent. Routine incorporation of the three vessel and tracheal view at screening is essential to better detect this important sub-group of babies with congenital heart disease in a timely manner.

The overall survival rate in infants affected by congenital heart disease remains low. The poor outcome may be related to the increased association with extracardiac anomalies and aneupoloidy. Since most types of CHD are now amenable to surgery, it is essential that any fetus with congenital structural heart defect should be completely evaluated, noting in particular congenital extracardiac defects which may adversely affect the prognosis. Noncardiac malformations have been reported to occur in up to 50% of patients with congenital heart disease. The combination of cardiac anomalies with other organ abnormalities appears in genetic syndromes and after exposure to environmental factors. Fetuses with prenatally diagnosed cardiac malformations need to have offer structural abnormalities ruled out. They should be evaluated thoroughly by ultrasound exam, because the detection of an extracardiac anomaly may dramatically affect prognosis. Also, fetuses in which an extracardiac anomaly or chromosome abnormality is diagnosed deserve a complete evolution with full fetal echocardiography. Fetal caryotype analysis should be performed since the risk of aneuploidy approaches 40% in cases of prenatally diagnosed CHD.