The aim of the present study is to prospectively investigate the presentation of germ cell testicular tumors (GCCTs) in terms of clinical stage (CS) or histology, as the incidence of this malignancy in increasing. Patients diagnosed with GCTTS between 1976 and 2005 were categorized into 3 period depending on date of diagnosis of GCTTs and presentation characteristics assessed. For purpose of analysis patients were assigned into 1 of 3 similar groups in term of duration (10 years) (1976-1985, 1986-1995, 1996-2005). These 3 periods were compared statistically to identify the possible changes in the presentation of GCTTs. Among 1935 patients, the number diagnosed in each period was 111 (6%), 695 (36%) and 1129 (58%), respectively. There was substantial rise in the percentage of patients with GCTTs during the period of 30 years, particularly in 3rd vs. 2nd and 1st decade (P<0.0001). Overall, 46% of patients were diagnosed with seminoma and 54% with nonseminoma. The greater proportion of the entire cohort of patients presented in CS I (65%). Also, seminoma and nonseminoma occurred more frequently in CS I (78% and 51%, respectively). The median (range) age of the whole cohort of patients was 34 (14-80) years. The median age for developing metastatic seminoma was 4 years more than in CS I disease (38 vs. 42 years, respectively), while the median age for the presentation of CS I and metastatic nonseminoma was identical (31 years). The proportion of seminoma increased significantly in time (40% vs 55%) and this was accompanied by a significant decrease of nonseminoma (60% vs. 45%)(P<0.001). The proportion of patients in CS I disease also increased significantly with time (45% vs. 77%), while the proportion of patients with metastatic disease decreased (55% vs. 23%)(P<0.001). There was a significant rise in proportion of patients with CS I seminoma (27% vs. 47%) (P<0.001) and nonseminoma (18% vs. 30%) (P<0.001), accompanied by a significant decrease in the proportion of patients presenting with metastatic nonseminoma (46% vs. 15%)(P<0.0001). However, the proportion of patients with metastatic seminoma remained largery unchanged (13% vs. 9%). The present study shows a progressive increase of GCTTs during the observation period of 30 years, with increase in the proportion of patients with GCTTs confined to the testis, as opposed to metastatic disease. The other finding is that there has been an increase in the proportion of patients presenting with seminoma rather than nonseminoma. The reason for this remain unclear and require further investigation.

Lymphadenopathy is a common clinical finding, affecting patients of all ages. The majority of lymphadenopathies are reactive processes of lymph nodes in response to a variety of exogenous and endogenous stimulants. They are non-neoplastic conditions that can mimic lymphoma and other malignant tumors. Therefore their recognition and differential diagnosis is of great importance in order to rule-out the neoplastic disease. Signs of malignant etiology include lymph nodes >1,5cm in diameter, supraclavicular localization and generalized lymphadenopathy. A metastatic carcinoma is always in the differential diagnosis of localized lympadenophaty in older individuals. In case of generalized lymphadenopathy lymphomas, metastatic solid tumors and various benign etiologies need to be considered. The reactive lymphadenopathies are grouped into four major categories according to their predominant architectural histologic pattern: follicular-nodular, sinus, interfollicular or mixed, and diffuse. As reactive conditions of the lymph nodes are dynamic processes the predominant pattern may differ depending on when during the course of the disease the biopsy is performed. The most common reactive lymphadenopaties are follicular hyperplasia and toxoplasmic lymphadenitis. Nowdays some lymphadenopathies with foreign-body reaction are side effects of silicone prostheses (silicone lymphadenopathy) and various contrast media (lipid lymphadenopathy). A specific diagnosis and differentiation from neoplastic disease often requires correlation among the morphologic features, the clinical history, serologic studies, immunohistochemistry and molecular genetic analysis.

The aim of our study was to evaluate the possibility of ultrasonography in differentiating malignant from nonmalignant cysts in postmenopausal women. The study included 100 postmenopausal women with diagnosis of simple ovarian cysts who were treated surgically at our clinic during the study period. In the group of operated patients the histopathological diagnosis confirmed benign cysts in most cases. In 1% of patients histopathological diagnosis was borderline or malignant tumor of the ovary. The risk of malignancy ranged from 0% in the cyst with a diameter below 50 mm, to 3.57% in cysts over 80 mm. Cyst diameter smaller than 50 mm and the volume of cyst less than 50 cm3 in correlation with the values of serum CA125 and clinical findings represent good algorithm for differentiating malignant from nonmalignant simple cyst.

Gastric carcinoma is usually diagnosed using radiologic contrast methods, endoscopic examination with biopsies and histological analyses. In order to determine the stage of the disease, preoperative diagnosis requires determining presence of distant metastasis, malignant lymph node transformation, and involvement of the surrounding structures. Standards for gastric carcinoma staging have international variations, but all of them are based on the routes of metastasis. Different imaging methods are used for diagnosis and staging of gastric carcinoma, each with its advantages and shortcomings, so guidelines for diagnosis and follow-up for this malignoma are established accordingly.

Postoje kontroverze vezane za vreme, vrstu i metod skrininga gestacionog dijabetesa, kao i za populaciju trudnica koju treba podvrgnuti skriningu. Iako najšire primenjen, glucose chalenge test, kao i alternativne metode skrininga različitim glikemijskim vrednostima, ne pokazuju dovoljno visoku specifičnost. Zato se traže alternativne metode skrininga. Osim o kontroverzama skrininga, ovaj pregledni članak razmatra u

We compared the safety and efficacy of transurethral vapor resection (TUVRP) and transvesical prostatectomy (TVP) for prostate > 50 ml in retrospective study. Ninety patients with urodynamic obstruction and prostate volume (PV) in range between 50 and 100 ml were analyzed according to the mode of operative treatment (TUVRP vs. TVP). Patients were assessed preoperatively and followed-up at 3 and 12 months postoperatively. All patients underwent general and urological standard evaluation before surgery, including urine analysis, urine culture, blood samples tests, with determination of PSA, DRE, abdominal and minor pelvis ultrasound (US), transrectal ultrasound (TRUS), maximal flow rate (Qmax), postvoid residual urine(PVR), and self assessment by International Prostate Symptom Score (IPSS) and Quality of Life Score (QoLS). Urethrocystoscopy was obligatory done before TUVRP. TRUS-guided biopsies of the prostate were performed in patients with PSA > 4 ng/ml, abnormal DRE, and/or suspicious echogenicity on TRUS. IPSS, QoLS, Qmax and PVR were obtained at each follow-up. Of 90 patients eligible to participate, 69 patients completed 12 months of follow-up (TUVRP, n=35; TVP, n=36). TUVRP procedure was not faster than TVP procedure (P=0.41); 43.6% and 84.8% of prostatic tissues were resected after TUVRP and TVP, respectively (P<0.001). In TVP group, IPSS, QoLS, Qmax and PVR volume were significantly better than those in TUVRP group at 3 and 12 months of followup. At 12 months postoperatively, IPSS improved 62.7% and 87.9% (P<0.001), QolS decrease by 41.9% and 71.9% (P<0.001), mean Qmax increased by 6.3 ml/s (102.0%) and 11.4 ml/s (230.2%) (P=0.001) and mean PVR volume decreased by 65.4 ml (70.5%) and 71.2 ml (88.6%) (P=0.001) in TUVRP and TVP group, respectively. Two TUVRP patients developed urethral stricture and 1 bladder neck sclerosis postoperatively, requiring internal urethrotomy and TUIP, respectively. TVP may be more effective and safer than TUVRP for benign prostatic hyperplasia (BPH) patients whose PV is > 50 ml.

Prezentujemo slučaj obolele od akromegalije, sa prisutnim kožnim visuljcima na vratu i aksilama, kod koje su kolonoskopski detektovani brojni polipi kolona. Akromegalija je hronična endokrinopatija, najčešće uzrokovana adenomom hipofize koji sekretuje hormon rasta (somatotropinom). Povezanost akromegalije sa nastankom neoplazija još uvek je stvar debate i pored brojnih in vitro i in vivo dokaza. Ipak, maligniteti su na trećem mestu uzroka smrti u obolelih od akromegalije. Najučestalije neoplazije se detektuju u kolonu. Prisustvo izvesnih kliničkih znakova (npr. kožnih visuljaka), može ukazati kliničaru na postojanje prevage proliferativnoneoplastične IGF1 aktivnosti (npr. u kolonu). Sa tim u vezi, dužnost kliničara je da preduzme odgovarajuće dijagnostičke procedure u cilju detekcije neoplazija.

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.

The present study is performed to determine whether retroperitoneal lymphadenectomy (RPLA) perioperative mortality (PM) rates reported from center of excellence [Indiana University: 0% for primary and 0.8% for postchemotherapy (PC) RPLA] are applicable to institution at large. Between 1975 and 2005, 327 assessable patients with nonseminomatous testicular tumors (NSTT) were treated with RPLA: primary in 134 (41%) and PC-RPLA in 193 (59%) patients. The observed PM rates were stratified according to age, clinical stage (CS) and type of RPLA. The median age at RPLA was 28 years (range 16-54) : < 29 years in 194 (56.3%), 30-39 years in 90 (30.3%) and > 40 years in 44 (13.4%) patients. Of 327 RPLA patients, 81 (27.8%) were performed for localized (CS-I), 179 (54.7%) for regional (CS-II) and 57 (17.5%) for metastatic (CS-III) disease. Ten (3.1%) patients died during initial 90 days after RPLA: 1 patient from pulmonary embolism, 2 of chemotherapyrelated toxicity and 7 of progressive disease due to preoperative worse prognostic factors. Of the entire cohort 30, 60 and 90-day PM rate was 0.3%, 1.0% and 1.3%, respectively. PM rate increase with increasing age: < 39 years 0%, 30-39 years 5.0% and > 40 years 9.3% (x2 trend test, P=0.002). PM rate also increased with CS: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p<0.001). PM rate at primary and PC-RPLA was increased with CS: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p<0.001). PM rate at primary and PC-RPLA was 0.7% and 3.1% 9P<0.001). RPLA was associated with virtually no or low (2.8%) PM rate in patients with localized and regional disease, respectively. In contrast, the PM rate of 8.8% for patients with distant metastases and group > 40 years of age (9.3%) implies that RPLA for these patients should be performed at centers of excellence, with intent of reducing PM rate.