The aim of our work is to acquaint other fellow physicians with our experience in prescribing high doses of ALA to which there was only a therapeutic response in terms of significant reduction of neuropathic ailments in our patients. We continued the therapy for six months after the introduction, because the difficulties are still maintained, now in a very mild form. COVID-19 disease caused by the SARS-CoV-2 virus was first described in December 2019 in Wuhan, China, but has since spread rapidly globally. Although the number of cases and deaths has attracted a lot of media attention, less attention is paid to the long-term tribute taken by those who survived the disease Since the discovery, there have been more and more reports linking SARSCoV-2 infection to various nervous system disorders. These disorders can be broken down into processes that affect the brain and spinal cord that make up the central nervous system or CNS, as well as those that affect the peripheral nervous system or PNS. Every day we learn more about the spectrum of neuromuscular disorders that develop after COVID-19 disease. We present two patients with polyneuropathy after proven SARSCoV-2 virus infection, aged 37 and 45, without previous chronic diseases that may be associated with peripheral nerve damage. The dominant symptoms in both patients are weakness and unpleasant sensations in the hands and feet, fatigue and general weakness. Therapy with high doses of alpha-lipoic acid has led to a significant reduction in discomfort and improved quality of life of patients.

We present a 21 years-old patient with congenital monorchism, diagnosed and emergency operated for testicular torsion. In combination, testicular torsion and monorchism represent an extremely rare finding. In any case of monorchism, testicular sparing surgery is one of the main goals, and that is why fast and accurate diagnosis is mandatory, since delayed diagnosis lead to loss of only gonade.

Medicinska sestra (tehničar) ima značajnu ulogu u lečenju i nezi pacijenata obolelih od malignih bolesti. Tokom primene radioterapije, medicinska sestra preduzima sve mere i postupke, realizuje intervencije u cilju pružanja adekvatne nege, duhovne i psihosocijalne podrške1 . Odnos između medicinske sestre i pacijenta treba da bude interaktivan i pun poverenja, a to je moguće postići pružanjem kvalitetne zdravstvene nege, što zahteva posedovanje praktičnih veština, ličnih kvaliteta i znanja. Takođe, medicinska sestra predstavlja važanu kariku u multidisciplinarnom timu. Ona najviše vremena provodi sa pacijentom i njegovom porodicom, najkompetentnija je u proceni pacijenta i njegovih simptoma2 . Takođe je najčešći prenosilac informacija između pacijenta i drugih članova tima, u tome mora biti konkretna i tačna.

Mnogi pacijenti se plaše zračenja, što čini pripremu pacijenta i njegove porodice još značajnijom. Sestre bi trebalo da daju informacije o koristima zračne terapije u lečenju raka, procesu planiranja zračenja, šemi zračenja, kao i o aktivnosti samog pacijenta u cilju preveniranja propratnih neželjenih efekata zračenja, u odnosu na svakog pojedinog pacijenta. Od naročitog je značaja posvetiti vreme razgovoru sa pacijentom, njegovom porodicom i pružiti podršku3 . Neophodno je da se zadovolje mere zaštite bazirane na principima vremena, udaljenosti i metalnih blokova. Zdravstveno osoblje treba da provede što manje vremena u blizini pacijenta, sa radioaktivnim izvorima, kao i njegovoj sobi, uz maksimalno korišćenje olovne zaštite. Stepen sporednih efekata zavisi od mnogih faktora, što uključuje volumen tkiva koji se zrači, ukupne dnevne doze zračenja, metode zračenja i određene individualne faktore4 . Akutna reakcija, na primer kod kože, dešava se tokom zračenja i uopšteno govoreći, povlači se za 2-4 nedelje po završetku kompletnog zračenja. Kasni sporedni efekti mogu da se pojave nekoliko meseci nakon kompletnog zračenja i mogu trajati duži vremenski period.

Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy in the absence of abnormal cardiac loading conditions. Apical hypertrophic cardiomyopathy (Yamaguchi syndrome) is a relatively rare HCM phenotype. It is characterized by apical left ventricular hypertrophy, often with the absence of left ventricular outflow tract obstruction. In patients with HCM symptoms of angina are quite common, mostly due to microvascular dysfunction or oxygen supply demand mismatch. Here we present a case of apical hypertrophic cardiomyopathy with concomitant severe coronary artery disease.

In this paper, we describe the case of an adult male with a pulmonary valve blood cyst. Blood cysts are benign primary heart tumors, common in neonates, but very rare in adults, mostly asymptomatic, and detected incidentally. Ultrasound (transthoracic transephophageal echocardiography) is crucial in detecting lesion, with the help of other diagnostic methods (MRI, CT). Further treatment, conservative or surgical, depends on the effect of the cyst on heart function. Although the diagnosis of cardiac lesions using routine imaging is available, definitive diagnosis is possible only by pathohistological and immunohistochemical analysis of the surgical sample.

Tumor nije moguće apsolutno korektno definisati. Tumori se prepoznaju po jednom parametru, a to je abnormalni rast ćelija, tako da se one razlikuju od normalnih ćelija po tome što više ne reaguju na normalne mehanizme kontrole rasta. Tumori se karakterišu stalnom, patološkom i autonomnom proliferacijom ćelija. Po biološkim karakteristikama dele se u dve velike grupe: benigni i maligni tumori. Maligni tumori rastu brzo, vrše razaranje okolnog tkiva i ukoliko se na vreme ne otkriju i ne leče, dovode do smrti. Najveći broj karcinoma nastaje spontano, kao odgovor na nepoznati stimulus, ali za nekolicinu su odgovorni sledeći faktori: hemijski ili fizički karcinogeni agensi, virusi, nasledna predispozicija, hormonski poremećaji i dugotrajne hronične bolesti. Maligni tumori mogu da budu dobro, srednje ili loše diferentovani. Ukoliko su građeni od nediferentovanih ćelija, grupišu se u anaplastične tumore. Maligni tumori rastu brzo, uz infiltraciju, invaziju i destrukciju okolnog tkiva. Nemaju kapsulu, nisu jasno ograničeni i retko se odstranjuju u potpunosti. Pored metastaziranja, invazivnost je druga najvažnija karakteristika malignih tumora. Postoje tri osnovna pristupa lečenju malignih tumora: hirurška ekscizija, zračenje i hemioterapija, a uloga pojedinačnih pristupa zavisi od tipa i stadijuma razvoja tumora1 .

Medicinske sestre i tehničari koji rade sa pacijentima obolelim od malignih tumora vrše procenu stanja pacijenta, edukaciju, menadžment simptoma i negu pacijenta. Onkološki pacijent spada u grupu pacijenata kojima bi trebali pristupati samo kvalitetno edukovani medicinski radnici2,3.

U radu je analizirana uloga medicinske sestre i tehničara u pripremi citostatske terapije, kao i klinički problemi i intervencije sa kojima se susreću i obavljaju medicinske sestre i tehničari prilikom lečenja onkoloških pacijenata.

Acute coronary syndrome is common term for various clinical conditions such as unstable angina (UA), myocardial infarction without ST segment elevation (NSTEMI) and myocardial infarction with ST segment elevation (STEMI). ACS is one of the leading cause of morbidity and mortality worldwide. The most serious manifestation of this syndrome is STEMI. The main goal of treatment is rapid restoration of blood flow in the infarct related artery. This can be achieved either with conservative (thrombolysis) or invasive (primary or rescue percutaneous coronary intervention – pPCI or rPCI) approach. Based on the data from varoius registries, the rate of complications of these type of interventions is low and they can be safely performed in centers without on site cardiac surgery. The main goal of this paper is to assess in-hospital mortality as well as demographic, clinical and angiographic characteristics of patients with STEMI treated in cardiac catheteterisation lab in the Clinical Hospital Center Zemun during the first year of implementation of pPCI program. The study included 284 consecutive STEMI patients. Total in-hospital mortality was 4.9% and, depending of the severity of heart failure at admission (Killip/Kimball class), the highest mortality was in cardiogenic shock (54,5%). The most common intrahospital complications were complicated infections unrelated to the pPCI procedure (3.5%), vascular complications (2.8%) and early stent thrombosis (2.1%). No patient was reffered to emergency cardiac surgery due to unsuccesfull or complicated pPCI procedure. Our study showed that performing pPCI during the first year of the implementation of pPCI program in the center without on-site cardiac surgery support was safe end effective and resulted in low in-hospital mortality.

Thyroid nodules are among the most common thyroid diseases, with higher female gender prevalence. The crucial clinician’s diagnostic dilemma is to distinguish benign and malignant thyroid nodules. Benign nodules are far more common than malignant, while papillary thyroid carcinoma predominates among malignant nodules. There is no unique and completely accurate diagnostic test, method, or even biomarker that would indicate with great certainty the malignant nature of thyroid nodules. Most thyroid tumors developed due to changes in genes, where protein products regulate mitogen activated protein kinase/ extracellular signal-regulated kinases and protein kinase B/ phosphoinositide 3-kinase signaling pathways that stimulate proliferation and inhibit apoptosis of cells. Today, we know a certain number of point mutations and chromosome rearrangements present in malignant tumors, but their diagnostic usage is not significant yet. Phospholipids, free fatty acids, and nitric oxide are essential for the thyroid gland function. Thus, deranged levels of such parameters in serum and thyroid aspiration biopsy washout could have a prognostic impact on malignant thyroid diagnostics.

Classical colorectal cancer surgery has been considered the gold standard in the surgical treatment of this disease for decades. Advances in technology and modern medicine have led to the emergence and progression of minimally invasive surgery in the treatment of this malignancy. Surgical procedures differ in relation to the localization of the tumor, as well as in relation to the pathways of hematogenous and lymphogenic spread of the disease. These surgical procedures are applied to the same extent during both classical and laparoscopic surgery. Regarding the indications for the laparoscopic approach in the elective treatment of colorectal cancer, there are no differences compared to classical colorectal surgery. The specificity of the method of work and visualization in laparoscopic colorectal surgery has developed the existence of two characteristic approaches: a) the lateral approach is taken from the classical-open colorectal surgery (“lateral-to medial approach”). It implies that the operation itself begins with the separation and preparation of the adjacent lateral peritoneum from the colon (rectum), and only then is the vascular structures approached from the medial side; b) medial-to-lateral approach, is an approach where after the creation of the pneumoperitoneum and access to the abdomen, the operation begins with the preparation of vascular elements (a.mesentericae inferior and v.mesenterice inferior, for example), and only then access to the lateral associated peritoneum. Most laparoscopic surgeons apply a more medial approach given the numerous advantages of this approach over the medial one that have been proven in comparative analyzes of these two approaches on a large sample of patients. At the same time, these studies did not show statistically significant differences in terms of postoperative complications, mortality, and malignant recurrence rate between the two approaches.