Zemun hospital, the present-day Clinical Hospital Zemun-Belgrade, was founded in 1784, is the oldest hospital in the Serbia. For over two centuries, it blazed the trial and still pioneers in the application of numerous advanced medical achievements and knowledge in this region.

The development of Zemun Hospital in the 19th century was followed by better work conditions and an increasing number of patients. The arrival of doctor Vojislav Subotić to the hospital and his work were key moments in the general improvement of the hospital. Since 1887, the hospital was administered by a society known as „Sisters of Charity of Saint Vincent De Paul“. By the end of 1891, they had constructed a new hospital building.

The 20th century was the most eventful period in the history of Zemun Hospital and it brought many changes. Working through out both world wars, the hospital staff aided those who were wounded or ill, both soldiers and civilians. Throughout this period, the hospital worked in three different countries, under various administrations and owners.

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: Determination of frequency of patologic findings and types of pathologic findings in enteric nerve plexus (ENP) in colon biopsies in children with impaired bowel motility, specifically chronic constipation. Introduction: Chronic constipation is relatively common in children, and is most often a functional disorder that is responsive to dietary regime treatment. Rarely, some cases require biopsy and histopathologic analysis of ENP. Materials and Methods: Research consists of 299 colon biopsies taken from children with impaired bowel motility. Biopsies were analysed in Institute of pathology, Medical faculty in Belgrade, in the period of time from the year 2008 to 2018. Data analysis included standard methods of descriptive and analytic statistics. Results: Number of analysed biopsies was 588. Biopsies were taken from 184(61,5%) boys and 115(38,5%) girls. Most common referral diagnosis for biopsy was Hirschspung’s disease (HD) (153/299, 51,2%). Pathologic changes in ENP were found in 46,1% of patients (138/299). Histopathologic analysis confirmed clinical suspicion for HD in 48,4%(74/153) of patients. Most frequent pathologic finding secondary to HD were immature ganglion cells (26/299, 8,7%), ectopic position of ganglia in muscle layer of colonic wall (6/299, 2%), and unclassified dysganglioses (5/299, 1,7%). In six patients, cause of constipation was eosinophilic proctitis and/or mienteric ganglionitis. Acetilcholin esterase as diagnositic metod was applied in 29 patients. Immunohistochemical analises were used in 24 patients. Conclusion: HD and immaturity of ganglion cells are by far most frequently diagnosed causes of constipation in colon biopsies in pediatric patients. Eosinophilic proctitis and/or mienteric ganglionitis are rare causes of constipation in children.

Pathologists often have a dilemma is a lymph node biopsy reactive or corresponds to a lymphoproliferative or other malignant disease. In everyday routine work, we rely on morphologic criteria and immunohistochemical analyzes. In better-equipped labs additional cytogenetic and molecular methods are used if morphology and immunohistochemical analyzes are not sufficient for getting correct diagnoses. It is important to know clinical presentation and the opinion of a clinician who runs the case. In reactive lymph nodes general morphology is mostly preserved. Distribution of B and T cells, histiocytes, dendritic cells and proliferation is adequate. Foreign cells are not present. Ways of reaction in lymph nodes are follicular hyperplasia, paracortical expansion, sinus histiocytosis and granuloma formation. If metastases are present, most often from carcinomas and melanomas, the initial deposits are usually sub capsular or less often in sinuses. One should be careful to differentiate sinus histiocytes and metastatic tumor cells, what can easily be verified by immunohistochemical stains.If it is a lymphoma, one should decide is it a Hodgkin or a non-Hodgkin lymphoma. In non-Hodgkin lymphomas, one should decide between small cell and large cell lymphomas. In non-Hodgkin lymphomas, tumor cells are dominant and background inflammation is scant and mostly consisted of small T cells and rare histiocytes. In T cell lymphomas background inflammation can be quite various. In Hodgkin lymphomas background inflammation most often is various and almost always outnumbers tumor cells. Tumor cells are large, with lobulated or multiple nuclei and conspicuous nucleoli. The immunophenotype is usually clearly different from non-Hodgkin lymphomas. The differentiation of small cell and large cell non-Hodgkin lymphomas is easily made by comparing cell sizes. If tumor cell size is closer to size of histiocytes or endothelium it is a large cell lymphoma, but if it SPECIJALNA SESIJA: KATEDRA ZA PATOLOGIJU MEDICINSKOG FAKULTETA, UNIVERZITETA NOVI SAD, SRBIJA 31 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. is closer to small lymphocytes and red blood cells it is a small cell lymphoma. Differentiation of small cell lymphomas is based on morphology, distribution of cells and on immunophenotype. Differentiation of large cell non-Hodgkin lymphomas requires immunohistochemical analyzes because morphology is often very similar among entities. Correct diagnosis is important due to application of optimal therapy and reaching the best prognosis for the patient.

Moebius syndrome is rare and complex disorder which due to clinical expression poses a great challenge for pediatric anesthesiologist. The most significant problem for anesthesia, due to craniofacial malformations, is difficulties to provide a safe airway. The need for anesthesia is imposed sometime in the age of the newborn and later in childhood because of necessary diagnostic and surgical procedures. We present the case of a two-month old infant with Moebius syndrome, potential anesthetic implications, as well as the safe application of the caudal block as an anesthetics technique for operations of Achilles tendons and correction of congenital deformities of both feet.