Clavicle fractures account for up to 4% of all adult fractures and are often the result of severe trauma in young individuals. At the Clinical Hospital Center Zemun, there have been just under 15 cases of these fractures treated surgically over the past 10 years (with the first author performing 6 of these surgeries). The relatively small number of operated patients is due to the belief that only a clavicle that does not heal on its own requires surgery. New osteosynthetic materials provide better treatment outcomes but cannot compensate for poor surgical technique, implant failure, incorrect indications, and/or choice of method, leading to treatment failure. We present an interesting case of a 45-year-old female patient who underwent surgical treatment for a clavicle fracture with multiple complications.

In setting of still present Covid19 infection, the aim was the analysis of epidemiological and demographical characteristics of Covid19 positive patients that were treated in our triage centre from September until December 2021. They had positive antigen or RT-PCR test on SARS-CoV2. Randomly selected patients in our triage centre were offered to fill in an anonymous questionnaire specifically designed for this study. The questionnaire examined demographic and socio-epidemiological characteristics of these patents, and the questions were of closed type. Hospitalised patients were noted. The group of 226 patients answered questionnaire. Statistic shows 55.8% were woman. Patients older than 60 years made 53.1% of the group with average alter of 58.35 ± 16 years. Most patients were vaccinated with Sinopharm ™ vaccine (66.3%). Majority of patients had Covid19 infection for the first time, used personal protection equipment, practice proper hygiene and respected epidemiological measurements. Employed and patients in pension were almost equally distributed (43.1% employed, 45.3% in pension). Among hospitalised patients (20.5%), it was statistically significant distribution of older patients mean alter 66.8 years, and non- vaccinated patients 67.5%. Statistical analysis has shown a significance regarding the previous lung diseases and hospitalisation (p-vrednost=0,008). There was no statistical significance in vaccination status in whole group. Older people with more comorbidities are in higher risk of getting more severe form of Covid19 infection, and as such, are at a higher risk for hospitalisation. Patients that were vaccinated had a lower degree of hospitalisations, and therefore a milder form of the disease. Considering this data, we would recommend vaccination for Covid19, especially in older patients with comorbidities.

We present the case of a 70-year-old female patient who sought consultation with an otolaryngologist due to a mass protruding from the left nasal cavity. The patient reported that she had noticed the mass for the past two months, although she had experienced nasal breathing difficulties for over ten years. Upon examination, a large pink mass was observed protruding from the left nostril. Anterior rhinoscopy revealed complete obstruction of both the left and right nasal cavities by the tumor mass. Computed tomography showed that the mass entirely filled both nasal cavities and all paranasal sinuses. Surgical treatment was performed, involving endoscopic sinus surgery, which resulted in the complete removal of the mass. Histopathological analysis confirmed that the mass was a case of massive sinonasal polyposis. At the six-month follow-up, no signs of recurrence were observed. Although sinonasal polyposis is a relatively common condition in rhinologic surgery, such pronounced polyposis with prolapse of polyps through the nostril is a rare presentation that can initially mimic benign or malignant tumors of the nasal cavities.

This case report describes a 61-year-old female patient who presented to the emergency room of our hospital with severe dyspnea. The patient reported experiencing breathing difficulties for the past 2 weeks, with daily worsening, as well as swallowing problems persisting for about a year. She denied any comorbidities or history of neck-related injuries or surgeries. Physical examination revealed significant swelling on both sides of her neck. Computed tomography was performed to further investigate her condition. The neck CT showed a massive tumor that completely replaces both lobes of the thyroid gland and extends into the mediastinum. Urgent endotracheal intubation was carried out, followed by angiography to assess the tumor mass's vascularization. The patient was then tracheotomized, and a biopsy of the tumor mass was performed. Histopathological examination revealed insular carcinoma of the thyroid gland. The hospital stay was complicated by respiratory failure and paratracheal tumor bleeding, leading to a fatal outcome.

Cervicogenic headache is a type of secondary headache that affects 0.17-4% of the general population and is defined by a primary lesion in the cervical spine with a painful syndrome in the head and/or facial area. It is characterized by unilateral pain on the side of the primary lesion in the neck, with variable accompanying symptoms that may pose a differential diagnostic challenge compared to other types of headaches. The most widely accepted mechanism of this headache's onset is the propagation of pain from the neck to the structures of the head, sometimes even to the face, due to the convergence of afferent neurons originating from the C1-C3 spinal nerves and nociceptive fibers of the trigeminal nerve in the trigeminocervical complex. Since most of the clinical characteristics of this headache are nonspecific, in the absence of a clear chronological connection to a lesion in the cervical spine, imaging or targeted nerve blockade is required to establish a diagnosis. The response to pharmacotherapy is often modest, and therapeutic methods include physical therapy, periodic injections of analgesics and/or corticosteroids into the joints of the cervical vertebrae or their associated nerves, as well as neurosurgical methods such as radiofrequency ablation and nerve decompression.

A 67-year-old woman experienced extensive soft-tissue ulceration of the right upper lip and adjacent maxillary bone as a consequence of attempted abuse of aspirin (NSAID). All oral lesions healed within 28 days after local and systemic therapy. Oral ulceration has many potential causes ranging from physical trauma to malignancy. Chemicals are a less common cause of traumatic ulceration. Most chemical burns are characterized by mild to moderate tissue damage that heals spontaneously within seven to 15 days without scarring. The primary intervention involves discontinuing the aspirin use and addressing the underlying vascular compromise. Treatment may include supportive measures, wound care, and in severe cases, reconstructive surgery.

The synchronous occurrence of a gastrointestinal stromal tumor (GIST) and pancreatic ductal adenocarcinoma (PDAC) is exceptionally rare and poses significant diagnostic and therapeutic challenges. We report a 67-year-old female presenting with biliary obstruction, right upper quadrant pain, and dyspeptic symptoms. CT imaging revealed a pancreatic head mass, while a submucosal gastric lesion was identified only intraoperatively. Laparotomy enabled excision of a pedunculated gastric GIST, whereas the unresectable pancreatic tumor involved critical vascular structures, necessitating a palliative double bypass comprising cholecystectomy, hepaticojejunostomy, gastrojejunostomy, and enteroenterostomy. Histopathology confirmed a low-risk GIST and a moderately differentiated PDAC with distinct immunohistochemical profiles, supporting the presence of two independent primary tumors.

This case underscores the critical importance of meticulous intraoperative exploration, particularly in the presence of atypical or incidentally discovered lesions, and demonstrates the durable palliation afforded by surgical bypass in unresectable PDAC. Beyond the clinical context, potential molecular overlaps—activation of MAPK/ERK and PI3K/AKT/mTOR pathways, VEGF-mediated angiogenesis, and defects in DNA repair—provide a plausible biological basis for the synchronous occurrence of these otherwise unrelated neoplasms, informing potential strategies for personalized therapy

Background: Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A), represents an important component of systemic therapy for metastatic colorectal cancer (mCRC). By inhibiting angiogenesis and promoting vascular normalization, bevacizumab enhances the efficacy of cytotoxic drugs. However, despite proven benefits, some uncertainties remain regarding its safety profile, particularly the risk of gastrointestinal perforation and other vascular toxicities. Materials and Methods: This retrospective, single-center, observational study included patients with histologically confirmed mCRC treated with combination chemotherapy and bevacizumab (FOLFOX/FOLFIRI + bevacizumab) at the Oncology Department of Zemun Clinical Hospital Center between July 2022 and July 2025. Efficacy was assessed according to RECIST 1.1 criteria, including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and duration of response (DoR). Adverse events were classified according to CTCAE v6.0. Results: A total of 74 patients were analyzed (56.8% male; mean age 67 ± 9 years). The median PFS was 6.5 months (IQR 3–9.8), and DoR 7.3 months (95% CI 5.2–9.5). ORR was 35.1%, and DCR 82.4%. The most common toxicities were hypertension (12.2%) and proteinuria (10.9%), while gastrointestinal perforation was observed in 4.1% of patients—slightly higher than in larger real-world series, which may be related to locally advanced disease, peritoneal carcinomatosis, or an intact primary tumor. Conclusion: Bevacizumab-based therapy demonstrated consistent efficacy and an acceptable safety profile in patients with mCRC. Although the incidence of perforation and fistula formation was somewhat higher, the therapy remained safe with careful patient selection and monitoring.

The aim of this review article is to provide an overview of available literature data on serum basal calcitonin (bCT) and stimulated calcitonin (sCT) cut-off values, highlighting them as a valuable diagnostic tool in everyday thyroidology practice. During the diagnostic evaluation of thyroid nodular disease, mildly elevated bCT values ​​are frequently encountered. If bCT values ​​remain above the reference range but are <100 pg/ml on repeated measurements, further evaluation is warranted. In addition to the usual diagnostic procedure for thyroid nodular disease (medical history, family history of thyroid malignancy, clinical examination, thyroid function tests, and thyroid ultrasonography), a stimulation test, most often a calcium test, is performed to assess the response by measuring the sCT levels. A precise diagnostic threshold, the so-called cut-off for clinically significant pathological values ​​of bCT and sCT that indicate medullary thyroid carcinoma (MTC), is still lacking. However, there are studies that recommend appropriate cut-off values ​​for bCT and sCT that allow a clear and safe distinction between healthy individuals and individuals with C-cell hyperplasia (CCH) from those with MTC. The aim of this review article is to present the latest literature data on existing cut-off values ​​for bCT and sCT in blood, which can certainly be useful to clinicians in everyday practice.

Fractal dimension is a mathematical parameter that quantifies the complexity and irregularity of biological structures. In medical sciences, fractal analysis enables quantitative differentiation between normal and pathological tissues, as well as the detection of subtle structural alterations associated with senescence, inflammation and carcinogenesis. Integration with artificial intelligence and machine learning approaches further enhances its diagnostic potential and brings it closer to clinical practice. Despite current limitations related to methodological standardization and interpretation, accumulating evidence suggests that fractal dimension may evolve into a valuable component of digital pathology, otolaryngology and personalized medicine.