A sense of satisfaction and well-being that covers various aspects of life can be defined as quality of life (QoL). Hypothyroidism can be clinically both latent and apparent. It is possible to evaluate general aspects of life, identify the presence and severity of diseases, and evaluate the effectiveness of treatment while QoL measurement instruments are used. The timely initiation of levothyroxine (LT4) substitution in cases with latent hypothyroidism and the evaluation of LT4 substitution quality serve as evidence of the beneficial effects of used QoL instruments. Here, we introduced GHQ12, TSQ, and ThyPRO instruments most commonly used in routine thyroid clinical practice.

Intensive Care Units (ICUs) are inevitably positioned at the top of the treatment pyramid for patients with acute and life-threatening conditions according to current medical practice. The number of critically ill patients has dramatically increased owing to better treatment quality, a longer life expectancy, and the impact of modern technologies. This has raised concerns regarding the intensive care and surveillance of these patients. Compared to colleagues in non- intensive care services, the profiles of physicians and nurses/technicians working ICUs differ considerably in their patients’ approach and skills performance. Specific indications for ICU admission have been established due to the restricted number of available ICU beds. These patients are transferred to semi-intensive care (SICUs) services within the departments that correspond to their pathology once their critical condition has stabilized. The ICU patients cannot be fully recovered, but can have their conditions stabilized to the point where they may receive further treatment outside of the ICU. Thus, ICUs and SICUs represent one functional unit. The aim of this review is to present the indications for admission to the Department of Internal Medicine ICU of the Clinical Hospital Center Zemun.

Introduction: Gastrointestinal bleeding represents a serious clinical challenge due to the complexity of diagnosis and the therapeutic options required for effective management. Small bowel bleeding, although relatively rare, poses a significant diagnostic dilemma due to the difficulty in identifying the source and the variability of causes, which differ depending on the patient's age. In the elderly population, vascular malformations are the most common causes, whereas in younger patients, the etiology can be broader, including inflammatory diseases, tumors, and congenital abnormalities. The aim of this study was to investigate the clinical characteristics and outcomes of patients with hemodynamic instability due to small bowel bleeding, with a particular focus on the application of predictive scores (GBS and CRS). Materials and Methods: This retrospective observational study, conducted from January 2023 to January 2024, included 24 hemodynamically unstable patients with diagnosed small bowel bleeding. All patients were assessed using the Glasgow Blatchford Score (GBS) and Clinical Rockall Score (CRS) to evaluate risk and predict clinical outcomes. Demographic data, clinical and diagnostic information were analyzed, with comparative analyses of preoperative, intraoperative, and histopathological findings. Results: The mean age of the patients was 69.8 years, and 79.2% presented with hematochezia. All patients had GBS > 15 and CRS > 6. Conservative treatment was effective in 62.5% of patients, while 37.5% required surgical intervention. The mortality rate was 12.5%. Statistically significant positive correlations were found between GBS and mortality (r = +0.76, p < 0.05) and between GBS and surgical intervention (r = +0.32, p < 0.05). The most common causes of bleeding were vascular lesions, although the source of bleeding was unidentified in 11 patients. Conclusion: Small bowel bleeding remains a major challenge for clinicians, requiring a multidisciplinary approach to diagnosis and treatment. The use of predictive scores such as GBS and CRS aids in assessing severity, guiding decision-making, and planning further treatment.

Introduction: The incidence of esophageal and esophagogastric junction adenocarcinomas has been increasing in developed countries, with primary risk factors including gastroesophageal reflux disease (GERD), smoking, and obesity. Chronic GERD can lead to Barrett’s esophagus (BE), a premalignant condition that elevates the risk for esophageal adenocarcinoma. Case Report: We present a case of a 63-year-old woman with nausea and epigastric pain. Her history was notable for Sjögren’s syndrome and a positive family history of prostate cancer, without smoking or alcohol use. Endoscopy revealed a distal hiatal hernia and long-segment Barrett’s esophagus (LSBE) with a 3 cm ulcerated lesion at the gastroesophageal junction, located within the hernia sac. Biopsies confirmed well-differentiated adenocarcinoma in LSBE. CT imaging showed a tumor extending through the hiatal hernia with distal esophageal wall thickening and lymph node metastases but no distant metastases. The patient underwent a subtotal esophagectomy with lymphadenectomy and esophagogastric anastomosis using the Ivor Lewis procedure. Pathology confirmed adenocarcinoma with lymph node metastasis and a close circumferential resection margin. Six cycles of postoperative chemotherapy with platinum and fluoropyrimidine were administered. The patient was recurrence-free at a three-year follow-up. Conclusion: This case underscores the association between hiatal hernia, Barrett's esophagus, and esophageal adenocarcinoma, particularly in the setting of disrupted antireflux mechanisms. The findings support the importance of early investigation and monitoring in patients with GERD and BE to mitigate cancer progression.

Introduction: Colorectal cancer (CRC) is among the most common malignancies, with a rising global incidence. Synchronous tumors refer to the presence of multiple tumors simultaneously in different segments of the colon or rectum, while metachronous tumors occur during follow-up after initial treatment. These tumors are often undetected during standard diagnostic procedures, making intraoperative exploration and postoperative monitoring crucial for timely diagnosis and successful treatment. Case Report: A 63-year-old patient was admitted for sideropenic anemia and weight loss. Colonoscopy revealed a tumor in the cecum, confirmed as adenocarcinoma. During surgery, two additional tumor lesions were discovered in the ascending and transverse colon. Following an extended right hemicolectomy and adjuvant chemotherapy according to the FOLFOX protocol, the patient remained disease-free until May 2023, when a metachronous tumor in the rectum was detected. The lesion was removed via transanal excision, and histopathological findings indicated intramucosal carcinoma. Continuous follow-up until November 2024 showed no disease progression. Conclusion: Intraoperative exploration enabled the identification of previously undetected synchronous tumors, influencing the extent of surgery and the postoperative treatment plan. Regular monitoring, including colonoscopy and radiological methods, is essential for the early detection of metachronous tumors and achieving optimal outcomes. This case highlights the importance of a multidisciplinary approach in managing patients with synchronous and metachronous CRC.

Introduction: Esophageal cancer is one of the ten most common cancers globally with a high mortality rate. The etiology is multifactorial, non-hereditary risk factors are smoking, alcohol consumption, obesity, and hereditary risk factors are Lynch syndrome, Plummer-Vinson syndrome, Peutz-Jaegers syndrome, and Li-Fraumeni syndrome. The treatment is multidisciplinary, and combined, chemotherapy, radiotherapy, immunotherapy, and surgery are applied. From the moment of diagnosis, supportive therapy is necessary to alleviate and eliminate the symptoms of the disease. Dysphagia is present in almost all patients with esophageal cancer. A loss greater than 5% of total body weight is associated with a worse prognosis. Discomfort and vague chest pain, hoarseness, cough, and sore throat are less common. Locally invasive tumors cause other symptoms such as hematemesis, hemoptysis, melena, dyspnea, cough, and pleural effusion. Horner's syndrome and superior vena cava syndrome may also occur in advanced tumors. The involvement of large blood vessels can lead to fatal bleeding. In the case of metastatic disease, different symptoms may be present depending on the location. Objective: The objective of this literature review is to indicate the importance of supportive therapy in the treatment of patients with esophageal cancer. Supportive therapy in esophageal cancer: The purpose of good supportive therapy is to ensure the best possible quality of life for patients. In esophageal cancer, the reduction of symptoms significantly contributes to the extension of life. Esophageal cancer treatment is actually the treatment of symptoms. Given that the most common symptom of these cancers is dysphagia, treatment of the underlying disease will also lead to an improvement in symptoms. Patients who have a complete or severe obstruction at any level of the esophagus must be provided with adequate nutrition. Oral nutrition contributes to a better quality of life. Before starting pain therapy, it is necessary to assess the cause and characteristics of pain. A step-by-step approach involves the gradual introduction of analgesic therapy. Dosing of opioids and determining the therapeutic dose should be in accordance with the current guidelines of the World Health Organization. Conclusion: supportive therapy contributes to longer survival in esophageal cancer at an advanced stage of the disease, and better tolerance of aggressive treatment regimens, reducing the toxicity, which leads to improved quality of life.

Introduction: Voice dysfunction represents a significant postoperative complication following total thyroidectomy, particularly in patients whose profession depends on their voice (singers, lecturers). The main causes include injury to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN), as well as vocal cord trauma during intubation or the occurrence of postoperative edema. Methods: A systematic search of PubMed and Cochrane databases was conducted for studies published between 2014 and 2025. Included studies comprised randomized controlled trials, meta-analyses, systematic reviews, and relevant clinical guidelines. Data were analyzed regarding the incidence of voice dysfunction, mechanisms of nerve injury, surgical and anesthetic risk factors, prevention strategies, and postoperative management, including the use of intraoperative neuromonitoring (IONM). Results and Discussion: Recurrent laryngeal nerve paresis leads to dysphonia and reduced phonatory power, whereas superior laryngeal nerve injury decreases the high-frequency vocal range and vocal endurance. The risk is increased in reoperations, large retrosternal goiters, and invasive tumors. The use of IONM reduces the risk of permanent RLN injury, although its reliability may be compromised by improper use of neuromuscular blockers or anesthetic protocols. Anesthetic factors, including improper intubation, excessive cuff pressure, and multiple intubation attempts, significantly contribute to voice changes. Prevention includes careful anesthetic management, precise intubation technique, and coordinated work between surgeons and anesthesiologists. Early postoperative evaluation, fiberendoscopic examination, acoustic analysis, and speech therapy contribute to preserving vocal cord function. Conclusion: Voice dysfunction following total thyroidectomy arises from both surgical and anesthetic factors. Prevention of complications requires a multidisciplinary approach, coordination between surgeons and anesthesiologists, and the use of intraoperative neuromonitoring. Therapy and rehabilitation, including otolaryngological assessment and speech therapy, aim to preserve and restore vocal function.

Introduction: Primary adenocarcinoma of the appendix is a rare and heterogeneous malignancy, most commonly presenting as mucinous adenocarcinoma. Due to its nonspecific clinical manifestations, the diagnosis is often established at an advanced stage, frequently with already present peritoneal dissemination. Standard treatment for advanced mucinous appendiceal carcinoma involves cytoreductive surgery with HIPEC followed by systemic chemotherapy, or initial systemic therapy for downstaging, followed by repeat CRS and HIPEC. In cases where radical surgery is not feasible, the average survival is less than one year. Case report: We report a case of a 72-year-old woman with no relevant family history, who presented with acute right lower abdominal pain and distension. Imaging revealed multiple cystic peritoneal implants, ascites, and small bowel obstruction. Palliative emergency surgery demonstrated an appendiceal mass invading the right ovary, with widespread peritoneal mucinous deposits. Histopathological analysis confirmed mucinous adenocarcinoma of the appendix with peritoneal carcinomatosis. Postoperatively, the patient received 12 cycles of bevacizumab plus FOLFOX chemotherapy, achieving marked radiologic and biochemical improvement. Maintenance therapy with bevacizumab plus 5-FU/LV led to sustained disease stabilization. After 32 cycles, the patient developed an entero-vaginal fistula, which was surgically managed due to poor quality of life. Intraoperatively, the decision was made for cytoreductive surgery and fistulectomy. Postoperative imaging showed no evidence of disease. The patient remains progression-free for nearly three years, and disease-free for one year. Conclusion: This case highlights the potential for long-term survival in initially inoperable patients with advanced mucinous appendiceal adenocarcinoma and peritoneal carcinomatosis when treated with combined cytoreductive surgery and bevacizumab plus chemotherapy. Multimodal and individualized treatment strategies may significantly improve outcomes in this rare malignancy.

Introduction: Parasitic leiomyomas are extremely rare benign smooth muscle tumors that develop independently of the uterus. They may arise spontaneously from pedunculated subserosal fibroids that detach and establish an independent blood supply from surrounding structures, or they may develop iatrogenically following laparoscopic morcellation. Owing to their nonspecific clinical and radiologic features, they are often misdiagnosed preoperatively. Surgical excision with histopathological verification remains the standard of care. Case report: We present the case of a 51-year-old postmenopausal woman with progressive abdominal distension and a sensation of pelvic pressure. Imaging revealed a large heterogeneous abdominopelvic mass measuring 30 × 20 cm, compressing adjacent bowel loops and major vessels. The uterus was myomatous but of normal size, and both ovaries appeared unremarkable. The patient underwent open surgical resection of the mass with total hysterectomy, bilateral adnexectomy, and omentectomy. Intraoperatively, a giant tumor connected to the uterine fundus by a thin pedicle was identified. Histopathological examination confirmed a benign leiomyoma without atypia or necrosis and a Ki-67 proliferation index below 1%. The postoperative course was uneventful, and the patient remained asymptomatic three months after surgery. Conclusion: Primary parasitic leiomyomas are exceedingly uncommon, particularly in patients without a history of prior gynecologic surgery. They should be considered in the differential diagnosis of large abdominopelvic masses. This case emphasizes the importance of comprehensive diagnostic evaluation and highlights that parasitic leiomyomas can attain remarkable size while maintaining benign histological features.

Introduction: Pseudoaneurysm (PSA) is defined as a defect in the arterial wall at the puncture site, leading to an extraluminal blood collection surrounded by fibrous tissue, and represents the most common vascular complication after coronary angiography. The aim of this study was to identify risk factors for PSA development after coronary interventions and to define criteria for surgical treatment. Materials and Methods: A retrospective analysis was conducted on 32 patients treated at CHC Zemun over a ten-year period (2012–2022). During the observed period, 16,787 coronary procedures were performed (10,498 coronary angiographies, 6,289 PCIs). The study group included 17 patients with PSA, and 15 patients in the control group with a hematoma that did not progress to PSA. Demographic data, comorbidities, laboratory parameters, therapy, smoking habits, procedural details, and PSA characteristics were recorded, with comparison between surgically and conservatively treated patients. Results: The mean time to PSA diagnosis was 3.29 ± 4.7 days, whereas hematomas were diagnosed within 24 hours. No significant differences in sex or age were observed between groups. More than half of the patients had hypertension, hyperlipidemia, and chronic cardiac or renal diseases. Low hemoglobin, thrombocytopenia, and INR >3 were identified as independent risk factors. Most interventions were performed via the right femoral artery, with PSA most commonly located in the common femoral artery. Median PSA diameter was 44 mm in surgically treated patients and 19 mm in conservatively treated patients. No deaths occurred; the most common postoperative complication was residual hematoma. Conclusion: The first 72 hours after intervention represent the most critical period for PSA detection. PSA diameter is a key factor in therapy selection, lesions >2 cm and complicated ones require surgical intervention, while smaller lesions can be treated conservatively. Timely diagnosis and treatment improve outcomes, and our findings may help optimize patient monitoring protocols and early surgical intervention selection.