The purpose of this study was to evaluate the spectrum of the Waldeyer’s ring tumor pathology. Waldeyer’s ring is a ringed arrangement of lymphoid tissue that surrounds nasopharynx and oropharynx. It consists of a pharyngeal tonsil, two tubal tonsils, two palatinal tonsils in the oropharynx, and lingual tonsil. The tonsils are made of heterogeneous tissues, therefore inside the tonsils proliferations could be neoplastic or reactive nature. The participants in our retrospective research were one thousand one hundred thirty patients with histopathology report of tumors of the Waldeyer’s ring. Seven hundred eleven where male and four hundred nineteen were female. The research was conducted at the Clinic for Otorhinolaryngology and Maxillofacial Surgery of the Clinical Center of Serbia from January 1, 2007 to December 31, 2017. The collected data was analyzed by descriptive and analytical statistic methods. It was found that the highest percent of participants developed reactive follicular hyperplasia (51,2%), 25.9% percent squamocellular carcinoma, 8.4% undifferentiated non keratinizing nasopharyngeal carcinoma, and 8.0% nonHodgkin lymphoma. The most malignant tumors were found among male participants over 60 years of age. The majority of malignant tumors grew in oropharynx. The most common tumor was squamous cell carcinoma.

The aim of the study was to investigate the degree of exposure to the health risk of the user by using a medical prescription reading goggles, which are classified as low risk, and whether the data from the package leaflet are correctly applied. Medical devices are instruments, apparatus, materials and other products intended to be used for humans and which do not achieve its basic purpose on the basis of pharmacological, immunological or metabolic activity, but are used alone or in combination, including the software required for proper use. Depending on the categories to which they belong, medical devices have greater or lesser risk of adverse health effects on patients. Medical devices are classified to classes according to the degree of risk for the user ranging from low risk to high risk. Research was conducted in retail stores: pharmacies, optical stores and facilities for selling consumer goods. The survey questionnaire methodology collected data on habits of customers - users of diopter reading glasses. The survey was conducted among the masters of pharmacies, opticians and retailers in the period from March to June 2019. Twenty-five facilities were included in the survey in the area of Tuzla, Sarajevo and Zenica.Statistical data processing was done in Microsoft Excel. Study showed that 35% of the respondents answered that patients visited ophthalmologists and brought medical report with needed corrective diopter, while significantly larger number of respondents – 65% answered that patients didn’t visit ophthalmologists and didn’t have a medical report with needed corrective diopter. Research has shown that 73.75% of patients don’t read the instructions for use, while only 26.25% of patients read instructions for use.

The aim of this case report was to review the therapeutic effect of therapeutic plasma exchange in the treatment of retrobulbar neuritis in relation to its side effects, in the absence of the desired therapeutic response to previously applied immunomodulatory therapy, as a justification of therapeutic plasma exchange in the treatment of patients suffering from central nervous system demyelinating diseases. Optic neuritis is an inflammatory optic nerve lesion that may lead to partial or complete loss of vision. Therapeutic plasma exchange was performed on the SPECTRA OPTIA apheresis apparatus, according to a predefined disease diagnosis (RN), which according to the 2016 AFSA criteria belongs to the III category of disease in which apheresis is accepted as the second line of treatment. Three procedures were analyzed and an average of 5050ml of blood was processed. In conclusion, this therapeutic method is absolutely justified, with the appropriate prior preparation of the patient.

Adult intussusception caused by inverted Meckel diverticulum is infrequent but important clinical entity, presenting with nonspecific symptoms. It may be observed in any age. We report a 26-year-old male patient with intussusception, who was examined several times for abdominal pain accompanied with nausea and vomiting. Basic diagnostics were inconclusive, so the patient was discharged each time with conservative therapy. After the last episode, CT scan showed suspicious intussusception, so the patient was admitted to general surgery ward. The next day there was a complete regression of all difficulties, and he was free of them in the month ahead. Finally, NMR enterography verified the presence of intussusception, and the operative procedure was performed. At laparotomy, ileo-ileal double intussusception was observed and the affected segment was resected with T-T anastomosis. Histopathological examination demonstrated an inverted Meckel diverticulum, measuring 8cm, with ectopic gastric antral type mucosa and ectopic pancreatic tissue. Postoperatively, the patient made an uneventful recovery.

The effect of hyperbaric oxygenation on the treatment of ischemic ulcers on patients with diabetic angiopathy is known, but the effect of HBO t (hyperbaric oxygen therapy) on diabetic claudicates is less known, i.e. to those that havethe second stage of peripheral vascular disease (without ulceration). In this study, we tried to point out the impact of hyperbaric oxygen (HBO) on the development of collateral arteries, i.e. the process of arteriogenesis, and consequently the symptom of claudication. 30 subjects in total were included in the case-control study. Inclusion criteria were: diagnosis of diabetes mellitus for at least five years, as well as Doppler-verified distal angiopathy. The respondents were randomly divided into two groups. The control group (n = 15) was treated by standard methods only.The respondents in the experimental group received 20 HBOTs each in a single-chamber hyperbaric chamber for 70 minutes at a pressure of 2.0 ATA. In this regard the assumptions of the arteriogenic effect of hyperbaric oxygenation, the eventual development of new arterial collaterals it was monitored by Doppler. after 20 HBO treatments and at the follow-up, 3 months after HBO therapy. It was observed that there was a statistically highly significant difference before treatment, in the number of registered functional small blood vessels of the lower leg and three months later, and after 20 HBO sessions, both on the left and the right leg, within the experimental group. There was observed also a highly statistically significant difference in the number of newly formed blood vessels on experimental patients in comparison with the patients from the control group. Our study shows that HBO therapy has a positive effect on the development of collateral blood vessels of the legs and that it may find application in the treatment of patients with diabetes mellitus with angiopathy and claudication disorders. Our study shows that HBO therapy has a positive effect on the development of collateral blood vessels of the legs and that it may find application in the treatment of patients with diabetes mellitus with angiopathy and claudication disorders.

The liver is an organ with many indispensable functions in the body. Liver diseases can be caused by numerous ethiological factors, and are divided into two basic groups, according to an anatomical substrate which is primarily affected – on hepatocellular (parenchymal) and billiard diseases. Approximately 10% of patients with liver disease require a surgical procedure (not including a liver transplant) in the last 2 years of life. Because of its reserves and regenerative abilities, the liver can suffer a great deal of damage before the clinical manifestations of its own dysfunction, which is a challenge for the pre-operative assessment of its condition. The goal of preoperative screening is to determine the presence of preexisting liver disease without the need for extensive or invasive testing. Routine testing of liver function has a low prediction value. The post-operative outcome depends on the nature and severity of the existing liver disease, as well as the type of the operation. It is often necessary to treat complications of severe liver damage, such as coagulopathy, thrombocytopenia, ascites, kidney failure, encephalopathy and malnutrition. Predisposition for infections of patients with cirrhosis requires prophilactic use of antibiotics. Induction of anesthesia, bleeding during surgery, hypoxia, hypotension, the use of vasoactive drugs, and even positioning of patients and surgical techniques can reduce intraoperative and perioperative delivery of oxygen in liver and increase the risk of hepatic dysfunction. Pharmacokinetic parameters of anesthetic agents, muscle relaxants, painkillers and sedatives may be altered in connection with plasma proteins, detoxification in liver etc.. The postoperative liver dysfunction depends on surgical trauma, ischemia during surgery or loss of hepatocite mass, and it can be divided into three groups – hepatocelulcular, cholesterol and mixed liver dysfunction. Posthepatectomy liver failure is one of the most serious complications after the liver resection and is a post-operative deterioration of liver capability to maintain its main functions. In recent years, liver function support systems have been developed. Molecular recirculation system with absorption (MARS), modified fractional plasma separations and adsorption (Prometheus) and bioartifical liver and extracorporal device for assistence of liver activity. Extensive clinical studies are needed to prove the effectiveness of these artefical systems for temporary replacement of the edible functions to its recovery or to transplantation.

Colorectal cancer, as one of the leading oncological causes of disease worldwide, is a major challenge in terms of treatment and patient access. Technological advances have made it possible to apply a minimally invasive laparoscopic surgical technique that has proven superior to open surgery. In order to optimize treatment, reduce mortality and morbidity, a perioperative strategy has been developed summarized in the principles of ERAS protocol (Enhanced Recovery After Surgery). The basic postulates of the ERAS protocol include prehabilitation, comorbidity control, prevention of postoperative nausea and vomiting, minimally invasive surgical method, multimodal analgesia, achieving euvolemia, prevention of hypothermia and early mobilization of the patient. The principles of the ERAS protocol are based on evidence to support safety, applicability and effectiveness, however, there are not yet enough studies to examine the long-term benefits of their implementation. The implementation of the ERAS protocol at KBC “Dr Dragisa Misovic -Dedinje” is not complete, but there is significant compliance with the guidelines of the 2018 ERAS Association, which has reduced inpatient stays and the number of postoperative complications. Although there is ample evidence to support the safety and effectiveness of this treatment approach, a multimodal strategy poses a major challenge to traditional surgical doctrine, making its implementation slow and incomplete in practice.

Aim: The aim of this study was to establish the expression and the significance of angiogenic markers in T1 bladder cancer with concomitant carcinoma “in situ”. Introduction: It has been determined that overexpression of hypoxia-inducible factor 1-alpha (HIF-1alfa), vascular endothelial growth factor (VEGF), and vascular endothelial growth factor receptor1 (VEGFR1) correlates with tumor grade, disease progression and recurrence, as well as poor overall survival. Carcinoma in situ (CIS) is frequently seen in conjunction with bladder tumors and represents an additional obstacle for management of T1 bladder cancer patients. Material and Methods: The immunohistochemical expressions of HIF-1alfa, VEGF, and VEGFR1 were evaluated in 295 T1 bladder cancer samples, incorporated in tissue microarrays. HIF1-alpha was assessed through nuclear staining, while the angiogenic profile was estimated through cytoplasmatic positivity of the VEGF and VEGFR1. Microvessels were identified by immunostaining of endothelial cells for CD34 and microvessel density (MVD) was presented as the average number of counted microvesels. Results: After a mean followup of 53 months, we found that T1 bladder cancer patients, who had concomitant carcinoma in situ had worse overall survival (p<0.05), furthermore, those tumor samples less expressed HIF-1alfa (p<0.05), and VEGFR1 (p<0.05). Expression of VEGF, VEGFR1, HIF-1alfa, as well as MVD, did not have significant impact to survival rate and further outcome. Conclusion: Worse overall survival and decreased expression for angiogenic markers in samples with accompanying CIS were established. Estimation of HIF-1alfa and VEGFR1 expression emerged as potential diagnostic supplement, selecting the T1 bladder cancer patients that could require an intensive follow-up.

Aim: The goal was to examine the effects of direct exposure of stomach tissue to  acrylamide. Introduction: Acrylamide is a toxic chemical substance discovered in foods rich in starch, prepared at high temperatures. Material and Methods: The research was carried out 6 groups of 5 experimental animals (Wistar rats). Two control groups orally implicated distilled water. Two experimental groups orally administrated PLENARNE USMENE PREZENTACIJE 21 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. acrylamide in a daily dose of 25 mg/kg, and two dose of 50 mg/kg. Three groups were sacrificed after 24h and three after 72h, On histological gastric tissue material is applied qualitative and semi-quantitative histological analysis, stereological measurements of individual compartments of the stomach wall, linear measuring the number of mast cells in the mucosa and submucosa. Results: Slight damage of the surface epithelium, accompanying mild inflammatory reaction and degranulation of mast cells are results of histological damages in the stomach tissue. Reconstruction of the epithelium follows directly toxic effect on epithelium, and it is confirmed by the presence of immature form of mucoproductive cells. Examined inflammatory and degenerative parameters show a positive correlation with respect to dose and/or a time of exposition to acrylamide. Conclusion: Understanding the mechanism of action of acrylamide allows to apply adequate prevention and make an appropriate choice of therapeutic methods.

Aim: To compare sensitivity, specificity and accuracy of bronchial brushing (BB) and transbronchial needle aspiration (TBNA) cytology in diagnosing lung cancer and to correlate and compare them with corresponding histopathology. Introduction: Lung cancer is a leading cause of death worldwide in both genders. Various cytological techniques such as BB and aspirate, TBNA, bronchoalveolar lavage, transthoracic and pleural puncture can aid in early diagnosis of lung malignancies. Material and Methods: One-year retrospective study included 359 patients with suspected lung cancer who underwent bronchoscopy. During bronchoscopy, cytopathological samples were obtained for smears using BB and TBNA as well as biopsy for histopathological examination that was considered the  gold standard .  All the samples were microscopically examined and statistically analyzed using descriptive methods and non-parametric Kendal-tau correlation coefficient (the level of significance p<0.05). Results: Sensitivity of BB and TBNA cytology comparing to histopathology was 97.17% and 98.32% respectively whereas specificity was 97.26% and 97.75 % respectively. Positive predictive value was 97.14% in BB and 99.66% in TBNA and negative predictive value was 93.23% in BB and 98.77% in TBNA. The accuracy of BB was 96.51% and 99.14% of TBNA cytology. Discordance of BB cytological and histopathological diagnosis was in 3.21%, whereas discordance of TBNA was in 2.03% cases. There was no statistically significant difference neither between BB (p=0.550) nor between TBNA (p=0.602) cytology and histopathological diagnosis. Conclusion: Cytology is valuable and useful in establishing lung cancer diagnosis, which yields almost the same information as histopathology no matter which method of cytological sampling is used.