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: 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.

Aim: Pathohistological diagnostics (PD) of the Yolc Sac tumor (YST) of primary mediastinal localization. Introduction: YST are malignant germ cell tumors of primitive endodermal gonadal differentiation. In 1% -5% of cases their localization is extragonadal, including mediastinal in 50% -70% published cases. Case report: A 30-year-old man was admitted to the Thoracic Surgery Clinic for diagnosis and treatment of mediastinal tumor with lungs and liver metastases. Laboratory analyzes revealed high elevations in serum alpha-fetoprotein (AFP), in addition moderate elevation of beta-chorionic gonadotropin (ß-HCG). No pathological changes in testis and retroperitoneum have been found. An open biopsy of the mediastinal change was made for PD. Histologically, tumor tissue showed a significant degree of necrosis. There were reticular, microcystic and pseudopapillary forms of neoplastic cell growth, surrounded by myxomatosis stroma. Tumor cells cytoplasm was scarce and vacuolated with high nuclear polymorphism and hyperchromasia. Positive immunohistochemical (IMH) reaction was obtained for panCK, AFP, PLAP. Immunoreactivity for TTF-1 was found in about 50% of tumor cells, as well as the focal reaction for ß-HCG in rare multinuclear cells. Reactions for D2-40, CD5, CK-7, CK-20, p63, CD117, CD30, napsin A and calretinin were negative. Conclusion: The results of our analysis showed the expression of divergent endodermal linear markers in the mediastinal YST, especially TTF-1 expression. The diagnosis of YST in small biopsies can be difficult and requires using of a wide range of IMH markers in order to closer the differentiation of primary tumor localization and the application of appropriate chemotherapy

Case 1: Clinical History -The patient was an 18-year-old woman with a history of primary amenorrhea. The physical examination revealed normal female external genitalia, moderate breast development, scarce pubic hair, and scant axillary hair. Pelvic examination revealed an absence of a uterus. The vagina ended in a blind pouch and measured 6cm in length. An abdominal ultrasonogram showed solid bilateral gonadal structures measuring 31x15mm right, and 30x 6mm left in the pelvic cavity without any evidence of a uterus. These findings were confirmed by MRI scan. Serum levels of estradiol and testosterone were 45.7pg/mL and 7.5nmol/L, respectively. FSH and LH levels were 8.46mlU/ml and 20.2mlU/ml. Cytogenetic analysis of peripheral blood lymphocytes revealed a 46,XY karyotype, with translocation t(13,14) inherited from her father. The molecular investigation confirmed active SRY with amplification of 6 nonpolymorphic loci on AZFa, AZFb, and AZFc regions on Y chromosome. Three months after her first referral the patient underwent bilateral prophylactic laparoscopic gonadectomy. The patient is being followed up regularly and she has no complaints after five years. Pathological Findings- Grossly, the right gonad was 4.3x1.8x1.8cm and the left gonad was 4.5x2.0x1.7cm. The right fallopian tube was 3.8cm long and 0.2cm in diameter, while the left one was 1.5cm long and 0.2cm in diameter. In addition, 4 cysts measuring 0.3- 1cm in diameter were found in the fat tissue on the surface of the left fallopian tube. The cut surface of the right gonad resembled testicular tissue showing two discrete, firm, well-demarcated, slightly bulging, homogenous, light grey-tan colored nodules, measuring 0.1 and 0.9cm in maximal dimension. Three similarly looking nodules were present in the left gonad measuring 0.4-0.5cm in diameter. In addition, a white whorled, firm, smooth muscle body fused to one pole of the gonad was found bilaterally measuring 1.2cm right, and 1.3cm left. Microscopically, both gonads were composed of varying proportions of small and solid, or less frequently larger, with early lumen formation seminiferous tubules lined by immature Sertoli cells, surrounded with fibrous, focally edematous stroma in which prominent Leydig cells were present. Rare tubules contained Sertoli cells with abundant cytoplasm filled with coarse, eosinophilic granules. The nodules were composed of solid immature tubules lined by cylindrical immature Sertoli cells separated by fibrous stroma containing fewer Leydig cells. Fallopian tubes were hypoplasic, while the cysts were lined by a single layer of cuboidal to columnar cells some of which had cilia. Thus, the clinical, laboratory, imaging, genetic and histological findings confirmed the diagnosis of complete androgen insensitivity syndrome with bilateral testicular hamartomas.Discussion Androgen insensitivity syndrome (AIS) is a disorder where there is resistance to androgen actions influencing both the morphogenesis and differentiation of androgen-responsive body structures. It is the most common type of male pseudohermaphroditism, characterized by an absence of androgen receptor activity due to a mutation at Xq11–q12 localization on the androgen receptor gene. the. In the largest series of 43 patients with the AIS published by Rutgers and Scully hamartomas were present in 63% of the cases, while Sertoli cell adenomas were reported in 23% and malignant tumors including two seminomas, one intratubular germ cell neoplasm with early stromal invasion and a malignant sex cord tumor in 9% of the cases. Case 2: Clinical History- The patient was a 17-year-old girl with primary amenorrhea. On external examination, she had an unambiguous female phenotype albeit with poor breast development. Her external genitalia had a normal appearance but internal examination showed a hypoplastic uterus. Ultrasonography failed to show follicular activity in the gonads. Her gonadotropins were high (FSH, 55.6mU/ml; LH, 18.3mU/ml) and estradiol was low (20.0pg/ml). Nonmosaic 46,XY karyotype was detected in patient’s leukocytes by cytogenetic analysis. Under the tentative clinical diagnosis of pure gonadal dysgenesis, a prophylactic bilateral laparoscopic gonadectomy with bilateral salpingectomy was performed. A biopsy specimens from the gonads were sent for cytogenetic analysis. The sequencing of the SRY gene of the proband revealed a C/G substitution at the first nucleotide of codon 133, leading to Arg/Gly replacement in the SRY protein. The mutation was also present in patient’s father, who is a phenotypically normal male. APSTRAKTI 77 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. The patient is alive and well 12 years after the operation without any evidence of disease. Pathological Findings- Macroscopically, both fallopian tubes were 4cm long and 0.4cm in diameter, while the gonads were measuring 3x2.2x1.2cm the right, and 2.2x0.8x1cm the left. Upon dissection, both gonadal streaks had a similar, variegated appearance with multiple areas of microcalcification. The histological evaluation of the gonads confirmed a gonadoblastoma of 3cm in diameter in the right gonad and a predominantly “burnt-out” gonadoblastoma of 2.2cm in the left gonad with only a microscopic focus of recognizable gonadoblastoma less than 1mm in diameter. The tumors were composed of primordial germ cells intimately admixed with sex cord elements, which surrounded round spaces filled with eosinophilic basement membrane-like material. The atypical germ cells had abundant clear or pale, slightly granular cytoplasm and round vesicular nuclei with prominent nucleoli. The small, often fusiform sex cord element cells had uniform round or oval nuclei with indiscernible nucleoli and scant cytoplasm. The uninvolved gonadal tissue bilaterally had the morphology of a streak gonad composed largely of ovarian-type stroma, with extended calcification and small germinal inclusion cysts present, without any follicles. The fallopian tubes were infantile. Therefore, the histopathological findings confirmed the diagnosis of bilateral gonadoblastoma in streak gonads, FIGO Stage IB, in a patient with a XY gonadal dysgenesis (Swyer syndrome). Discussion: XY gonadal dysgenesis (GD) is a result of abnormal testis development in utero. Pure 46,XY GD should be considered when an adolescent presents as a phenotypic female with delayed puberty and primary amenorrhea. Rarely, they may present with a detectable abdominal or pelvic gonadoblastoma mass. When the presumptive diagnosis suggests GD, further criteria may strengthen the diagnosis, while ultimately, the most definitive diagnosis is through biopsy of the gonads. Bilateral streak gonads are seen in pure XY GD. The risk of otherwise undetected gonadoblastoma in XY GD patients is high, and prophylactic or therapeutic gonadectomy is therefore often indicated when XY GD is diagnosed.