The aim was to determine the incidence of fetal breech presentation at term, the factors that determine how the impact of labor and mode of delivery on neonatal outcome in pregnancies with a fetus in breech presentation pelvic presentation is a form of the longitudinal position of the fetus, which leads the pelvis and occurs in approximately 3% of pregnancies. Numerous studies have shown contradictory results regarding the optimal mode of delivery in breech presentation of fetus. A retrospective study at the Hospital of Gynecology and Obstetrics, University Hospital Zemun-Belgrade in the period 01.01.2009-31.12.2011 year. We analyzed data obtained from the delivery protocol, computer databases and annual reports.study involved 111 pregnant women in the forward singleton pregnancy (37-41 weeks gestation) with fetal pelvis. We analyzed and compared the group of patients who delivered their babies vaginally and the group of patients who delivered their babies by caesarean section (emergency and planned). Analyzed and compared the following parameters: maternal age, parity, gestational age tudnoće, premature rupture of membranes, weight and head circumference fetus at birth, Apgar score and neonatal complications. The data were analyzed by descriptive and analytical statistics. Results are presented tables and graphs. The study period was performed 4665 deliveries, with 111 deliveries in futures fetuses in breech presentation, which is 2.4%. Women delivered vaginally was 79(71%), emergency caesarean section 17(15%), a planned caesarean section 15(14%) pregnant women. The study showed a statistically significant difference in parity (C2=6.23 p<0, 05), with greater participation in the group of primiparas cesarean section, gestational age (t=5.23 p<0,01), weight and head circumference (t=4.37, t=2.47 p<0,01), premature rupture of membranes, (C2=7.72 p<0,01) and gender structure (C2=4.03 p<0,05). The most common indication for elective Caesarean section was prolonged pregnancy, and for an emergency cesarean section because of the delivery routes. There was no statistically significant difference in age of the mother t=1.08, p>0,05, the values of Apgar score in 5 minutes t=1.67 p>0,05, neurological changes p=0.292 and birth trauma, p=0.292 between two groups of neonates. The values of ul minute Apgar score were at the limits of statistical significance p=1.97 p≥0.05. Vaginal delivery in breech presentation, fetal, obstetric an acceptable range, while respecting the principles of good obstetric practice, there is no increase in neonatal morbidity.

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.

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.

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.

Congenital heart disease is the most important cause of infant mortality. Abnormalities of the heart and great arteries are the most common congenital defects. Congenital heart disease is often fallow by extracardiac malformations. Many studies revailed positive impact of prenatal diagnosis and timelly treatment on pre-operative condition and outcome of surgery and long term prognosis. Neverthelles, structural cardiac anomalies were also among the most frequently missed abnormalities by prenatal ultrasonography at mid-trimester scan. The 4-chamber view has a Detection Rate of 6-50%, with a reasonable figure of 20% in community setting screening programs. The addition of the outflow determines a significant increase of the Detection Rate which, in most studies, ranges 20-40%. The three-vessel view allows to detect major abnormalities of the arches, the neck vessels and the thymus. The prenatal detection of specific types of congenital heart disease, such as Transposition of great arteries, Hypoplastic left heart syndrome, Tetralogy Fallot, seems to have a significant impact on survival, hospital stay and pre-operative conditions of the affected neonates. Hence, fetal cardiac screening is a must for all health professionals involved in prenatal diagnosis.

Tracking of anatomical and functional results obtained after non-surgical treatment of the distal radius including 51 patients. Tracking of the results was based upon Anatomical Score System and Gartland-Werley Score System. The final numerical results obtained through Anatomical Score were the following:excellent in 12 cases (23.52%), good in 30 cases (58.82%), satisfactory in 8 cases (15.68%), dissatisfactory in 1 case (1.96%). According to the Gartland-Werley Score System, the final results included: excellent in 19 cases (37.25%), good in 24 cases (47.00%), satisfactory in 7 cases (13.72%), dissatisfactory in 1 case (1.96%). This work also presents correlation between Residual Deformity score, Subjective Hardship score and Objective dysfunction, with the results obtained by Anatomical score and Gartland-Werley total score. The possibility of dissatisfactory results obtained by radiological screening followed by dissatisfactory outcome is described in literature; however, dissatisfactory screening results could be found in up to 31.7% of cases with satisfactory clinical findings. Our work records 15.7% of the latter cases. We might say that non-surgical treatment is not to be accepted as the only and exclusive approach to distal radius fracture. Thus, proper evaluation is mandatory.

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.