The most common and basic reason for belowknee amputation is bad nutrition of disstalnih parts of extremities, destabilization of tissue and appearing of trophic demerits,which with second infection brings gangrene. Trauma is indicated as one of often causers for amputation extremities, and in a war-conditions has an epidemical character. The goal of our article is to show experience of KBC Zemun and studing the vitality of remainded part of leg after the below-knee amputation during the war trauma. This study included 78 amputated persons in the time from 1991 to 1995, who were treated on the surgical ward in KBC Zemun. A very high percent of amputation was below-knee amputations (53,8%). In the time of surgery recovery, in 21 case the patients have had an infection of the reminded part of the leg and their ischemia. In this cases the patient were surgical treated (antibiotics, flection and HBO). Of the totally number of after surgery complicated patients, 52,3 % patients after the therapy where improving and 47,6 % of them were reamputated (in most of cases was done because of infection of bones and soft tissues).

Maligni astrocitomi su najčešći primarni tumori mozga kod odraslih i čine 2% od ukupnog broja malignih tumora. Glioblastom multiforme (GBM ) je visoko specifičan za stariju populaciju dok je kod mlađih od 14 godina izuzetno redak. GBM je malo zastupljeniji kod muškog pola nego kod ženskog u odnosu 1,6. Ovom retrospektivnom studijom obuhvaćeno je 183 pacijenata sa dijagnozom tumora mozga, operativno lečenih na odeljenju neurohirurgije KBC Zemun. U grupi mikstnih glioma postoji veća učestalost u odnosu na ostale tumore, kao i veća zastupljenost kod muškog pola 57 (60,6%), u odnosu na žensku populaciju 37 (39,4%). U odnosu na histološki tip analizirani su slučajevi koji su operisani i reoperisani (dijagnoza potvrđena PH nalazom). Od ukupno 175 operisanih i reoperisanih 40 (23%) su astrocitomi, 35 (20%) oligodendrogliomi, 94 (53,3%) multiformni glioblastomi (mikstni gliomi), i 6 (3,3%) ependimomi. Tipična lokalizacija astrocitoma i multiformnih glioblastoma je unutar temporalnog lobusa. Oligodendrogliomi su najčešće bili smešteni u prednjoj trećini velikog mozga, sa upadljivo najčešćim zahvatanjem frontalnih regiona.

Parapneumonična efuzija kod dece definiše se obično kao nakupljanje pleuralne tečnosti u toku akutne bakterijske pneumonije, a ređe u sklopu virusne pneumonije i tuberkuloznog pleuritisa. Empijem označava prisustvo purulentnog sadržaja u pleuralnom prostoru. Pleuralna infekcija je kontinuum, ali klasično postoji podela u tri stadijuma: eksudativni, fibropurulentni i organizovani. Glavni bakterijski uzročnici su Pneumococcus, Streptococcus pyogenes i Staphylococcus aureus. Postoje dve kliničke prezentacije parapneumonične efuzije. Kada sumnjamo na pleuralni izliv, sprovodi se standardizovan terapijsko-dijagnostički postupak prema smernicama BTS vodiča. Ukoliko perzistira signifikantna količina pleuralne tečnosti i dođe do kompromitovanja plućne funkcije, tada govorimo o komplikovanoj parapneumoničnoj efuziji i indikovana je torakalna drenaža. Pri pojavi septacija i lokulacija u pleuralnom prostoru, neophodna je intrapleuralna instilacija fibrinolitika. Primena Streptokinaze je bezbedna, efikasna, smanjuje potrebu za hirurškim lečenjem i zajedno sa ostalim terapijskim merama dovodi do kompletnog oporavka deteta.

Poznat je uticaj aeropolutanata na pogoršanje astme kod dece. Cilj ovog rada je da se prikaže kako tipični aeropolutanti (čađ, TSP, NO2, SO2, NH3 i benzen) utiču na egzarcerbaciju akutnog napada astme. Praćeni su dnevni podaci koncentracija aeropolutanata i dnevni broj dece sa akutnim napadom astme za januar, februar, oktobar, novembar i decembar u 2009. i 2010. godine.Ostale mesece nismo uključili zbog povišenih koncentracija polena. Za navedeni period se za 117 dana prekoračenja GVI (granična vrednost imisije) aeropolutanata obratilo lekaru zbog akutnog napada astme 2675 dece ili dnevno 23, a za 185 dana bez prekoračenja GVI lekaru se obratilo 2839 dece ili dnevno 15. Ova razlika je visoko statistički značajna sto je potvrđeno χ2 testom i testom korelacije. Aeropolutanti kumulativno su značajno povezani sa egzarcebacijom akutnog napada astme kod dece, a samim tim i dovode do njenog pogoršanja.

Cilj našeg istraživanja je bio da utvrdimo u kom procentu je D weak antigen prisutan kod primaoca i trudnica u našoj ustanovi, kao i koji Rh fenotip dominira kod tako tipiziranih eritrocita. Za određivanje RhD antigena koristili smo dve različite serije monoklonskih antiD test reagenasa. Uzorci koji su u Indirektnom antiglobulinskom testu bili pozitivni označeni su fenotipom D weak. Dalje ispitivanje fenotipa D weak je sprovedeno sa dva monoklonska IgM anti-D test reagensa različitih proizvođača. Ispitivanim eritrocitima označenim kao D weak određen je i Rh fenotip korišćenjem monoklonskih test seruma anti-C, anti-c, anti-E i anti-e. U toku 2009. godine 11779 uzoraka bolesnika i trudnica je rutinski tipizirano na prisutnost RhD antigena. Nakon izvođenja Indirektnog antiglobulinskog testa 42 uzorka su određena kao D weak fenotip (0,35%). Dominantni Rh fenotipi kod D weak pozitivnih eritrocita su bili CcDw ee (78,5%) i CCDw ee (16,6%). Aglutinacije sa dva IgM anti-D test reagensa u pokazivale različit intezitet i stepen aglutinacije. Eritrociti 14 uzoraka (33,3%) su pokazali odsustvo aglutinacije (negativan rezultat) sa oba reagensa. Samo eritrociti 6 uzoraka (14,2%) su imale skor aglutinacije od +3 do +4. Našim ispitivanjem smo ustanovili da je procenat pojavljivanja fenotipa D weak u saglasnosti sa podacima objavljenim u literaturi. Pravilnim odabirom anti-D test seruma, kao i poštovanjem savremenih preporuka za testiranje RhD antigena moguće je serološkim testiranjem odrediti slabiju varijantu D antigena. Jedini pozudani testovi koji omogućavaju razrešavanje antigen D diskrepance su molekularni testovi, koji na žalost u našoj zemlji još uvek nisu implementirani.

Prenatal diagnosis of congenital heart disease is crucial to optimal obstetric and neonatal care. In utero identification of heart anomalies allows a variety of treatment options to be considered, including delivery at an appropriate facility, termination of pregnancy, and in some cases in utero therapy. Specific indications and risks have been classified and patients considered at high risk have been offered detailed fetal echocardiography, commonly at a center with appropriate expertise and facilities. However, most children are born to mothers who have no known risk features during pregnancy. Screening in the low-risk population has been reported to have lower accuracy rates then in high-risk population. The most common indication for performing a fetal echocardiogram is a prior family history of congenital heart disease. A number of drugs have been implicated as causes of various malformations, including heart anomalies. Therefore, their use during pregnancy is considered as indication for echocardiography. Several maternal conditions also carry an inherited risk to the fetus and their presence is also indication for this diagnostic procedure. The incidence of congenital heart disease is increased fivefold among infants of diabetic mothers, whereas phenylketonuria has reported risk of 12 to 16%. Chromosomal anomalies, extracardiac malformations and monozigotic twins are also indications for fetal echocardiography.

The most common tumor in the cerebellopontine angle (CPA) are vestibular schwannomas and meningiomas. The purpose of this study is to present proportional representation according to gender and age, incidence of histological type, as well as relation between tumor magnitude, clinical symptoms and prognosis. A group of 38 patients with PCA expansion were examined and treated in time interval from 2006 until 2010 at clinical-hospital center “KBC Zemun – Belgrade”. Gender proportion was 22 female (57,1%) and 16 male (42,9%). Middle-aged patients (from 30 to 60 years) were predominant in age proportion 20(52,6%). The most frequent tumor in the study was vestibular schwannoma (63,1%) followed by meningioma (31,6%). The rest were various histological type tumors like cholestatoma, plexus papilloma, glioma etc. (5,3%). Tumor magnitude proportion showed that the most of the scwanoma (over 95%) were grades III and IV (according to Koss classification). The leading admission symptoms were: deferent degrees of hearing loss, cerebellar disorders and trigeminal lesions. The analysis of postoperative results for 38 patients have shown: mortality rate of 13,2%, complete lesion of facial nerve(39,4%), partial lesion(33,3%) and (27,3%) without lesion of facial nerve. Lesions of lower group of cranial nerves (IX, X and XI) had 3 patients (9%) and pyramid deficit had 6(17,3%) patients. This study showed that typical PCA vestibular schwannoma is predominantly in female and elder population presented. Recommended treatment is surgical (total or subtotal extirpation), followed by adjuvant therapy for elder patients. The most frequent causes of lethal outcome are infections and hematomas in tumor bed. The leading neurological deficit after tumor extirpation is total or partial lesion of facial nerve.

We reviewed our experience with retroperitoneal lymphadenectomy (RPLA) after multiple cisplatin-based chemotherapy regimens in nonseminomatous testicular tumors (NSTT) patients and specifically evaluated clinicopathologic and treatment trend in addition to potential predictors of survival. Fort-one patients with NSTT underwent their RPLA between 1982 and 2005 after ≥ 2 regimens of chemotherapy. Thirteen patients (32%) necessitate redo-RPLA, combined with nephrectomy in 6 patients. 13 extra-RP (ERP) resections were performed in 11 patients (27%), including pulmonary (7), neck (4) and liver (2) sites. Thirty patients (73%) are rendered free of disease and 26 (63%) obtained serologic remission. Nine patients who relapse, necessitated new salvage chemotherapy+surgery (3 teratoma, 6 vital carcinoma [VC]). Four of 9 relapsing patients (44%) are currently free of disease with redoRPLA. Alive, free of disease are 19 pts (46%) at median follow-up of 131 months. Study of RP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and VC in 46%, with survival in 67%, 56% and 32%, respectively. Different histology occurred in 38% at redo-RPLA and in 64% at ERP resection in comparison to previous RP pathology. Univariate analysis of clinicopathologic parameters associated with VC at RPLA included RP masses ≥ 5 cm (p<0.05), elevated AFP (p<0.001) or HCG (p<0.05) and ERP resection (p<0.04). On univariate analysis survival was worse in patients with RP masses ≥ 5 cm (p<0.04), elevated AFP (p<0.05) or HCG (p<0.007), ERP resection (p<0.01) and VC (p<0.004). On multivariable analysis, a RP masses ≥ 5 cm (p<0.03) and VC (p<0.005) predicted a worse prognosis. Our data support the continued use of salvage RPLA in three separated groups of patients: 1. Patients who achieved a complete response (CR) to 2nd -line chemotherapy and have no radiologic evidence of disease should undergo RPLA; 2. Patients who achieved a partial response (PR) to chemotherapy should undergo RPLA with ERP surgery, as indicated; 3. Highly selected group of patients with residual masses and elevated serum tumor markers (STM), particularly AFP, after chemotherapy may be candidate for surgery.

Ultrasound examination of the fetal arches is important to highlight babies at greatest risk of perinatal collapse, those with ductus-dependent lesions. Diagnosis of those anomalies before discharge from home is difficult because the arterial duct is patent. Routine incorporation of the three vessel and tracheal view at screening is essential to better detect this important sub-group of babies with congenital heart disease in a timely manner.