There is no doubt that obstetrics carries high medical liability risk. In many countries, gynecologists-obstetricians who attend childbirths and perform complex obstetric procedures are faced with increasing malpractice insurance premiums and litigation risk. The American College of Obstetricians and Gynecologists (ACOG) publishes its Survey of Professional Liability since 1983, with the objective to analyze the effect that malpractice litigation has had on the practice of obstetrics and gynecology in the United States1. According to the 2003 ACOG survey, 76.3% of the members who answered the questionnaire have been involved in a lawsuit at least once in their professional career; gynecologists/obstetricians have been sued a total of 2.64 times per individual over the course of their careers1,2. In the 2006 ACOG Survey, 89% of respondents indicated that they had been sued during their careers. The average number of claims per obstetrician was 2.6 (3). The ACOG’s 2009 Survey on Professional Liability showed that nearly 91% of gynecologists/obstetricians had experienced at least one liability claim filed against them during their professional careers, with an average of 2.69 claims per physician. In 2009, 62% percent of the total reported claims were for obstetric care as opposed to gynecology, the same as in the 2006 Survey3,4. In the 2003 ACOG survey, fetal monitoring, neurologically impaired children, neonatal death, shoulder dystocia, uterine rupture, and “decision-to-incision” time were identified as clinical factors frequently present in obstetric malpractice cases1. In both 2006 and 2009 Surveys the reasons for claim were neurologically impaired infant (in 31% of cases in both Surveys), stillbirth/neonatal death (with 16 % of cases in both Surveys), and delay or failure in diagnosis (in 11% of cases in 2009 vs. 14% in 2006)3,4. In all the Surveys, neurological impair is the leading cause of the reasons for liability claim, with the cerebral palsy being the most serious damage. The possible etiologies have been discussed for years, and although the damage to neural tissue is undebatable, there is still no agreement upon the timing of the damage. Some authors think that 90% of the cases of cerebral palsy are not due to intrapartum events, while in the opinion of others most of the devastating events occurred in the perinatal period5,6. It is still impossible to firmly determine in each single case whether the hypoxic insult has developed during delivery, in the first few hours after birth, or was already present before the labor began, as a consequence of long lasting hypoxia during pregnancy. Careful gross and histopathological examination of the placenta in chosen cases can elucidate the events that occurred some time before labor, and help to connect and reconstruct the course of disease7,8.

In this paper we present the experience with 162 consecutive neuromuscular biopsies analyzed in the period from 2009 to 2012. Neuromuscular diseases are a large group of inherited and acquired diseases that are characterized by loss of muscle mass and muscle weakness. Distinguishing myopathies from peripheral neuropathy, diseases of the anterior horn cells of the spinal cord and the diseases of the neuromuscular junction requires careful clinical evaluation, laboratory, neurophysiological and electromyographical examination, radiological tests, muscle biopsy and genetic testing. Muscle biopsy results can solely be interpreted in the context of the above tests. In Serbia, 2009. in Department of Clinical Pathology Clinical Hospital Center Zemun, a decision by the Serbian Ministry of Health, began a routine diagnostic biopsy specimens in the NMB muscles, nerves and skin.

The balance between analytical (low) and clinical (high) sensitivity is crucial for the specificity of a routine HPV test as limited specificity will be harmful due to unnecessary treatment of healthy women. Up to now HPV diagnostics is mainly based on DNA detection for which target and signal amplification methods are available. PCR techniques can be divided into type-specific and consensus PCRs. Due to its high clinical sensitivity and its relatively high specificity the HC2 test is still regarded as the gold standard in routine HPV testing. It hybridizes 13 (near) full-length stabilized RNA probes of high-risk HPV types to denatured target DNA followed by detection via antibodies and chemiluminescence. To avoid costly validation studies for each new HPV test standards for evaluation have been defined. Recently several new HPV detection assays have been commercialized. They all show promising data in first published studies but still await full validation according to the criteria mentioned above. Among them only the cobas HPV test has already been fully validated for use in triage and as adjunct to cytology. HPV 16 and 18 confer a much higher risk for development of a CIN 2+ compared to the other HPV high-risk types. It is therefore appropriate to test for these HPV types independently. Apart from that testing for individual HPV types is of very limited clinical value up to now.HPV RNA testing is a promising option with potentially higher specificity. As a first system, the APTIMA test has now received an FDA approval.

Koža vulve se razlikuje od koze drugih regija po različitoj bakterijskoj flori I uslovima trenja. Dermatološke bolesti vulvarne kože i mukoze se dele u dve grupe. Prvu grupu čine dermatoze slične ekstravulvarnim dermatozama, a drugu čine dermatoze koje zahvataju predominantno vulvarnu regiju. Spečificne dermatoze vulve su kontaktni dermatitis, lichen planus, lichen sclerosus. Infektivne bolesti vulve se mogu preneti direktnim kontaktom. Prepoznavanje tipičnih mikroskopskih karakteristika pomaze u dijagnostici scabiesa, herpes virusne infekcije i molluscum contagiosuma. Humani papilloma virusi (HPV) su epiteliotropni virusi i mogu uzrokovati premalgnu i malignu transformatciju epitelnih ćelija. Sledeći kriterijumi kao što su virusne promene, klinički parametri i mikroskopski nalaz upućuju na postojanje dva puta u karcinogenezi skvamoznog karcinoma vulve i to HPV-zavisni put udružen sa Vulvarnom intraepitelialnom neoplazijom/VIN/ klasičnog tipa i ne -HPV sa VIN diferentovanog (simlex) tipa često udruženim sa lichen sclerosusom i/ili vulvarnom hiperplazijom.Invazivni planocelularni karcinom je najčešći karcinom vulve. Procena prognostičkih faktora je neophodna komponenta patohistoloskog izveštaja. Visoki gradus tumora, vaskularna invazija, veće dimenzije tumora i dubina invazije zaslužuju imunohistohemijsku analizu limfnih čvorova radi nalazenja metastaskih ćelija karcinoma. Extramamarna Pagetova bolest je retka. Može biti primarnog kožnog porekla ili udružena sa nekožnim tumorima gastrointestinalnog ili porekla mokraćne bešike. Imunohistohemijskla analiza je važna za odredjivanje primarnog porekla tumora.

The aim of our study was analyzing data on concentrations of hazardous and noxious substances in the soil in Belgrade, identifying the most common pollutants, as well as proposing measures for reducing pollution of the soil in Belgrade. 60 soil samples from 30 locations were sampled and tested. The samples were taken in locations in the zone of sanitary protection Belgrade waterworks, near the roads, land within the municipal environment and land in the industrial zones. Deviations are primarily related to the presence of increased concentrations of nickel in the soil, while increased values of other parameters were registered in individual samples at specific locations. In order to improve the current state of soil pollution in Belgrade and prevent further degradation, it is necessary to continue with the systematic monitoring of soil contamination, and implement measures to minimize pollution of land and measures aimed at rehabilitation of existing pollution.

The presence of free fluid in the pleural space can be a sign of many pathological processes. Some of them may be of inflammatory or hemodynamic origin but others are caused by a malignant neoplasm spreading either in the pleural cavity or from distant site. The importance of establishing the origin of the cells in the pleural fliud lies not only in the fact that a correct diagnosis leads to a correct therapy, but it also is essential in the staging of a malignant tumor. The aims of this study were to evaluate the frequency of various types of pleural effusion and to discuss the value of reactive atypia of mesothelial cells in longstanding effusions. The introduction of a third cathegory of pleural effusion called reactive, would be helpful to the general pathologists to avoid making false-positive diagnosis in the presence of atypical reactive mesothelial cells or missing the diagnosis of a malignant effusion in case when malignant cells are scarse or look like an activated mesothelial cell. In this study, a total of 157 patients from the thoracic department of the General Hospital in Kruševac were examined. Of this number, 33 patients or 21% had the so-called reactive type of pleural effusion. In the everyday practice, one in five patients could be expected to have reactive mesothelial atypia, which may be quite confusing in inexperienced hands.

The present study was performed to establish the socioepidemiological caracteristics (mean age, male to female ratio), the prevalence of various histological types of meningiomas in the groups of primary and recidivant tumors as well as Cathepsin D immunoexpression. We analysed 50 patients with primary and recidivant intracranial and intraspinal meningiomas who underwent surgery in KBC Zemun during the year 2004, with a two years follow-up. All surgical specimen were evaluated for histologic type of tumor and representative slides were immunostained with the anti-Cathepsin D antibody. In both primary and recidivant meningioma groups the number of mitosis, as factor tumor agressivness, was counted on 10 and 20 HPF and those results were statistically analyzed. A considerable difference was found when the number of mitosis and the histologic tumor grade have been compared with the Cathepsin D immunoexpression. The result lead to conlusion that the immunopositivity of Cathepsin D decreases with higher mitosis count and higher tumor grade.

Utvrditi učestalost i postojanje depresivnosti u porodici HIV pozitivnih osoba u odnosu na pol, starost, socijalne karakteristike i strukturu porodice. Retrospektivnom studijom je obuhvaćeno 124 članova porodice HIV pozitivnih osoba, koji su bili u programu rada savetovališta na Infektivnoj klinici KCS u Beogradu u toku 2010 godine.Nivo depresivnosti utvrđen Beckovom i Hamiltonovom skalom je povećan kod ženskih članova porodice, posebno majki HIV pozitivnih. Depresivni simptomi su više zastupljeni i kod nezaposlenih članova, kao i onih koji procenjuju kvalitet života kao loš, a nezadovoljni su svojim zdravstvenim stanjem.HIV infekcija je savremena bolest današnjice i povezana je sa socijalnom izolacijom i stigmatizacijom kako obolelih tako i njihovih porodica. Ovakav status porodice može da vodi u razvoj depresije što utiče na kvalitet života porodice. Ove studije su pokazale da nivo depresivnosti raste kod ženskih članova porodice koja živi sa HIV infekcijom i da socijalni status, a ne HIV status utiče na nivo depresivnosti u porodici. Preventivno delovanje u osnovi mora da ima socijalnu podršku na različitim nivoima društvene zajednice porodicama HIV pozitivnih osoba kako bi se razvoj depresije sprečio.

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.