The biological potential of teratoma remains unpredictable, therefore identifying its presence in the retroperitoneum remains important. We evaluated patients undergoing post-chemothe rapy retroperitoneal lymphadenectomy (PC-RPLA) for nonseminomatous testicular tumors (NSTT), to determine predictors of teratomatous elements in the retroperitoneum. We identified 161 patients from 1982 to 2005 who underwent PC-RPLA for metastatic NSTT. Multiple clinical and pathological variables were reviewed from out RPLA database. Of the 161 patients in our series, 112 (70%) received only induction chemotherapy and 49 (30%) required 2nd line chemotherapy. Studies of retroperitoneal pathology demonstrated the presence of fibrosis in 44 (27%), teratoma in 82 (51%) and vital carcinoma in 35(22%).Among 82 patients (51%) with finding of teratomatous elements at PC-RPLA, we revealed the presence ofmature teratoma in 85%, immature teratoma in 12% and teratoma with malignant transformation in 3%. Of the 99 patients (61%) with teratomatous elements in the primary NSTT, 61 (62%) had teratoma at PC-RPLA. Even in the absence of teratoma in the primary NSTT, teratoma was present in the retroperitoneum in 21 of 62 patients (32%)(p<0.0001). All patients had normal values of serum tumor markers (STM) at PC-RPLA. Post-chemotherapy retroperitoneal residual mass measuring <2 cm, from 2.1-5.0 cm and > 5 cm in diameter occured in 30%, 52% and 55%, respectively. By multivariate analysis , teratoma in the orchiectomy specimen (p<0.005), relative change in nodal size before and after chemotherapy (p<0.005), and no requirement for 2nd line chemotherapy (p=0.33) were independent predictors for the presence of the teratoma in the retroperitoneum. Teratoma remains a common histologic finding in the retroperitoneal lymph nodes following chemotherapy. We have identified several pre-RPLA variables that predict the finding of teratoma in the retroperitoneum for men treated with chemotherapy for metastatic NSTT.

Cilj rada je da pokažemo metode dijagnostike, terapiju i uspešnost lečenja infertiliteta u manjim sredinama. Retrospektivnom studijom analizirali smo dijagnostiku, terapiju i uspešnost lečenja infertiliteta u periodu od 2002-2006. godine. Pratili smo kupno 94 para sa problemom infertiliteta. Kod 30 parova problem dijagnostike i lečenja infertiliteta nije ozbiljno shvaćen, tako da su u startu bili osuđeni na neuspeh. Preostala 64 para su aktivno učestvovala u dijagnostici i lečenju tako da je studija zasnovana na njima. Analizirajući anovulaciju, odnosno stimulaciju ovulacije, kod 64 pacijentkine pratili smo: uspešnost stimulacije ovulacije, trudnoće i njihov ishod, nadzor ovulacije folikulometrijom i određivanjem progesterona 20 dc, komplikacije - hiperstimulirajući ovarijalni sindrom,prosečnu starost pacijentkinja, vrstu i trajanje infertiliteta,dužinu stimulacije, prisustvo bakterija u cervikalnom kanalu, nalaz HSG, hormonski status, ishod urađenih laparoskopija, spermogram muževa i mesto lečenja infertiliteta. Uzroci steriliteta kod ispitivanih pacijentkinja su poremećaji ovulacije, oštećenje jajovoda, bakterije u cervikalnom brisu, muški faktor, godine starosti. Poremećaji ovulacije su uzroci infertiliteta u oko 30-40% slučajeva. Stimulacijom ovulacije kod 73% pacijentkinja je došlo do trudnoće a kod 62% pacijentkinja je trudnoća završena uspešno.

Razlike u polu su pronađene u mnogim oboljenjima srca, kod moždanog udara i tumora.Razlike u poluu depresiji kod pacijenata satumorommozga su retko istraživane. Cilj rada Cilj ovog rada je bio da se utvrdi odnos između ispoljene depresivne epizode i pola kod pacijenata sa tumorom mozga. Metode rada Podaci se sastoje od 115 pacijenata sa primarnim tumorommozga, 61 muškaraca i 54 žena. Depresija pacijenata je procenjena Hamiltonov skalom depresivnosti (HADS). Nivo depresije kod žena je bila veća u odnosu namuškarce. Nije bilo statistički značajne razlike između muške i ženske grupe, iako je depresija češća kod žena. Naši podaci su slični kao i većina rezultata iz epidemioloških studija koje pokazuju da je depresija češća kod žena.Dalje studije su potrebne da pronađu konekciju između biološkog uzroka tumora mozga i depresije. Razlike u polu pomažu nam da razumemo prirodu neuropsihijatrijskih poremećaja, koje će nam pomoći da pronađemo specifične tretmane i strategije prevencije.

Mucinous aenocarcinoma is one of the least common variant of prostate cancer. The prognosis of this variant of prostate cancer remains controversial. We report the case of 67-year old men with severe lower urinary tract symptoms (LUTS), bladder outlet obstruction (BOO), and sense of urinary retention. The serum level of prostate specific antigen (PSA) was 10.4ng/mL. Prostate was large (56mL), hard, lobulated, with extraprostatic extension and infiltration of surrounding structures, unsuitable for radical operative treatment. The patient demonstrated poor response to complete androgen blockade (CAB) (bilateral orchiectomy, steroidal antiandrogen) after 6 months of treatment with minimal decline of PSA (7.1ng/mL) and progressive growth of the primary tumor (110mL). The patient is submitted to antiandrogen withdrawal consisted of simultaneous addition of ketoconazole with hydrocortison substitution, resulting in normalisation of PSA (<1.0ng/mL) and diminution of prostate volume (PV) (63 mL) after 2 months, followed by adjunctive radiotherapy. Ketoconazole in reduced doses was stopped 6 months after completion of radiotherapy with PSA level < 0.002ng/mL and PV 16mL. The patient is alive with no evidence of disease more than 9 years after diagnosis of primary tumor. This case demonstrated modest hormonal sensitivity of mucinous adenocarcinoma of the prostate, whereas ketoconazole combined with radiotherapy, resulted in long term survival.

Subtrochanteric fractures these days are about one quarter of all femur fractures. Mostly, they occur with the elderly which demand certain speed when it comes to operation procedures and quick verticalisation. These are fractures that extend from the distal part of the small trochanter and about 5 cm distally. A 88 year old patient underwent surgery in our hospital because of the fracture of the femur, sustained in a fall. On the basis of anesthesiology overview it was concluded that there is a very high risk. Stabilization of the fracture with self-locking wedge was done. Not in this or in other cases is not necessary to achieve perfect anatomical reposition, axle and length of the extremities are enough. This is achieved with the stabilization of the proximal and distal screws. Method of administration justifies its use for the most critical moments in the surgical treatment of the elderly population: the speed of execution and minimal approach.