Reliable preoperative staging of cervical cancer is important to evaluate and compare the results of different therapeutic modalities, including, surgical treatment, chemotherapy and radiation therapy. The diagnostic reliability of preoperative staging of cervical cancer by cervical biopsy and endocervical curettage was evaluated by a retrospective diagnostic study. The results of this preoperative staging were compared with the stage of cancer set on the basis of histopathological examination of the samples. Only patients who were clinically staged as early (operable) to the disease stage were included in the study. Postoperative diagnosis in 98 patients was exocervical cancer, in 12 endocervical cancer in 5 it was H-SIL (CIN III), and in 4 patients it was chronic cervicitis. The diagnostic reliability of preoperative staging of cervical cancer by cervical biopsy and endocervical curettage was 76.9%. In order to reduce errors in the staging of cervical cancer, it is advised that it be performed in specialized cancer centers by an experienced oncology gynecologist.

We are the witnesses of a significant increase in chronic kidney diseases (CKD) occurrence. There is scarce literature evidence about functional integrity and natural adaptation of endocrine system axes in patients with different stages of always progressive CKD. Such a problem is growing with the beginning of renal replacement treatments (peritoneal and hemodialysis) or even with renal transplantation. The close monitoring of CKD patients by nephrologist and endocrinologist is mandatory because the natural adaptation of the endocrine system in CKD patients must be differed out of endocrine dysfunction, which has to be treated. Endocrine dysfunction management principles are mostly the same as for the patients with no CKD, except for close drug dose monitoring, especially in the circumstances with concomitant renal replacement treatment.

Breast cysts are the most common benign changes at women aged 35 to 50 years old. Usually there isn’t highest risk for breast cancer in women with cystic changes, but in the rare cases cancer can be found in association with a cyst. We reported two patients aged 33 and 45 years old. Both of them had breast cystic changes. We performed Fine Needle Aspiration (FNA) with cytological examination of the aspirated content, the breast ultrasound examination and mammography for second patient. Cysts were surgically removed and sent to the final histopathological verification. Patient 33 years old was diagnosed medullary breast cancer and undergone axillary dissection and breast sentinel node biopsy (SNB) with histopathological (HP) and immunohistochemical (IHC) findings, after that patient was treated with adjuvant chemotherapy. In patient 44 years old was diagnosed mucinous breast cancer, performed partial breast resection with axillary dissection and applied adjuvant hormonal therapy. Radiotherapy was conducted on both patients and they were followed for 3 years by a regional oncologic dispensary. Although malignant cells wasn’t find by cytological examination we have to be careful because in the wall of the cyst may be malignant cells, so histopathological (HP) and immunohistochemical (IHC) findings are the most relevant diagnostic procedures. Primary treatment of breast cancer is surgery, but important role in management have postoperative radiotherapy, chemotrerapy and hormonal therapy. Survival depends on the size, type of tumor and affected lymph nodes. Prognostic parameters which should be considered are: menopausal status, tumor size, tumor location, lymph node status, tumor type, nuclear grade, histological grade,
hormone receptors and tumor markers.

Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. High hormons level (estrogen, progesteron and prolactin) during this specific period make structural changes, increase breast volume and density and make the diagnosis often very difficult. We present the case of 38 old women, who noted a painless breast mass during first month of breastfeeding.

This study aimed to evaluate the degree of involvement and infiltration of the pelvic lymph glands in endometrial cancer. The retrospective study included patients who were diagnosed with endometrial cancer after exploratory curettage, and who were then referred for surgical treatment with partial or total pelvic lymphadenectomy. We analyzed 99 patients who met the inclusion criteria. Pelvic lymphadenectomy is the treatment of choice in patients with medium and high risk endometrial cancer for disease recurrence. Given the importance of the evaluated issue, it is necessary to perform randomized studies to examine the therapeutic effect of pelvic and paraaortic lymphadenectomy, especially in patients at medium and high risk for recurrence of endometrial cancer.

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.

Fat embolism syndrome represents a life-threatening condition in which blood vessels become clogged by fat droplets coming from fractured parts of the bones seldomly seen in patients with orthopedic trauma. Absence of specific diagnostic criteria and varying degree of presentation symptoms makes it hard to be diagnosed. We present a 20-years-old male injured in road traffic accident as a pedestrian, diagnosed with polytrauma and lethal outcome on the second day of admission. Autopsy and pathohistological findings confirmed death due to damage of important brain centers, as well as signs of massive fat embolism with fat particles found in lungs blood vessels as well as in systemic circulation, suggesting paradoxical embolism throughout exceedingly uncommon pulmonary right to left shunt capillaries, since completely closed heart foramen ovale was also found.

Hyponatremia is an electrolyte disorder frequently encountered in clinical practice. The first step in the diagnostic evaluation of hyponatremia is the volume assessment (clinical estimation of hypo/hypervolemia presence). In the cases of euvolemic hyponatremia, followed by decreased plasma osmolality (<275mOsm/kg) with urine osmolality >100mOsm/kg, urine sodium >30mmol/L along with normal intake of salt and water, preserved pituitary, adrenal, thyroid, adrenal function as well as no recent use of diuretics, syndrome of inappropriate diuresis (SIAD) is diagnosed. In symptomatic, especially acute hyponatremia, careful and gradual substitution by 3 (10) % sodium-chloride infusion is advised with liquid intake restriction, the administration of demeclocycline, urea, or vaptans, as well as causal treatment of SIAD. SIAD is often transient and etiologically clear. In this paper, we present two cases with idiopathic, chronic SIAD with poor outcomes. During the diagnostic follow-up, the cause of SIAD was not found. The autopsy finding was also adverse. In most cases, euvolemic hyponatremia in patients with chronic, idiopathic SIAD is an ominous sign.