Clavicle fractures account for up to 4% of all adult fractures and are often the result of severe trauma in young individuals. At the Clinical Hospital Center Zemun, there have been just under 15 cases of these fractures treated surgically over the past 10 years (with the first author performing 6 of these surgeries). The relatively small number of operated patients is due to the belief that only a clavicle that does not heal on its own requires surgery. New osteosynthetic materials provide better treatment outcomes but cannot compensate for poor surgical technique, implant failure, incorrect indications, and/or choice of method, leading to treatment failure. We present an interesting case of a 45-year-old female patient who underwent surgical treatment for a clavicle fracture with multiple complications.

We present a case of a patient with recurrent sialolithiasis. Sialolithiasis is a condition characterized by mechanical obstruction of the excretory ducts of the salivary glands. The etiology of calculus formation remains unclear. Preoperative laboratory analyses indicated vitamin D deficiency. Computed tomography revealed calculi in the parenchyma of the deep lobe of the right parotid gland and in Stenson’s duct, which were surgically removed. A review of the literature shows no correlation between calcium levels of serum and saliva. However, vitamin D has an anti-inflammatory role, and its deficiency may lead to sialoadenitis, thus promoting sialolithiasis. The aim of this case presentation is to emphasize how changes in saliva composition and vitamin D deficiency may influence recurrent sialolithiasis.

This case report describes a 61-year-old female patient who presented to the emergency room of our hospital with severe dyspnea. The patient reported experiencing breathing difficulties for the past 2 weeks, with daily worsening, as well as swallowing problems persisting for about a year. She denied any comorbidities or history of neck-related injuries or surgeries. Physical examination revealed significant swelling on both sides of her neck. Computed tomography was performed to further investigate her condition. The neck CT showed a massive tumor that completely replaces both lobes of the thyroid gland and extends into the mediastinum. Urgent endotracheal intubation was carried out, followed by angiography to assess the tumor mass's vascularization. The patient was then tracheotomized, and a biopsy of the tumor mass was performed. Histopathological examination revealed insular carcinoma of the thyroid gland. The hospital stay was complicated by respiratory failure and paratracheal tumor bleeding, leading to a fatal outcome.

Cervicogenic headache is a type of secondary headache that affects 0.17-4% of the general population and is defined by a primary lesion in the cervical spine with a painful syndrome in the head and/or facial area. It is characterized by unilateral pain on the side of the primary lesion in the neck, with variable accompanying symptoms that may pose a differential diagnostic challenge compared to other types of headaches. The most widely accepted mechanism of this headache's onset is the propagation of pain from the neck to the structures of the head, sometimes even to the face, due to the convergence of afferent neurons originating from the C1-C3 spinal nerves and nociceptive fibers of the trigeminal nerve in the trigeminocervical complex. Since most of the clinical characteristics of this headache are nonspecific, in the absence of a clear chronological connection to a lesion in the cervical spine, imaging or targeted nerve blockade is required to establish a diagnosis. The response to pharmacotherapy is often modest, and therapeutic methods include physical therapy, periodic injections of analgesics and/or corticosteroids into the joints of the cervical vertebrae or their associated nerves, as well as neurosurgical methods such as radiofrequency ablation and nerve decompression.

A 67-year-old woman experienced extensive soft-tissue ulceration of the right upper lip and adjacent maxillary bone as a consequence of attempted abuse of aspirin (NSAID). All oral lesions healed within 28 days after local and systemic therapy. Oral ulceration has many potential causes ranging from physical trauma to malignancy. Chemicals are a less common cause of traumatic ulceration. Most chemical burns are characterized by mild to moderate tissue damage that heals spontaneously within seven to 15 days without scarring. The primary intervention involves discontinuing the aspirin use and addressing the underlying vascular compromise. Treatment may include supportive measures, wound care, and in severe cases, reconstructive surgery.

The synchronous occurrence of a gastrointestinal stromal tumor (GIST) and pancreatic ductal adenocarcinoma (PDAC) is exceptionally rare and poses significant diagnostic and therapeutic challenges. We report a 67-year-old female presenting with biliary obstruction, right upper quadrant pain, and dyspeptic symptoms. CT imaging revealed a pancreatic head mass, while a submucosal gastric lesion was identified only intraoperatively. Laparotomy enabled excision of a pedunculated gastric GIST, whereas the unresectable pancreatic tumor involved critical vascular structures, necessitating a palliative double bypass comprising cholecystectomy, hepaticojejunostomy, gastrojejunostomy, and enteroenterostomy. Histopathology confirmed a low-risk GIST and a moderately differentiated PDAC with distinct immunohistochemical profiles, supporting the presence of two independent primary tumors.

This case underscores the critical importance of meticulous intraoperative exploration, particularly in the presence of atypical or incidentally discovered lesions, and demonstrates the durable palliation afforded by surgical bypass in unresectable PDAC. Beyond the clinical context, potential molecular overlaps—activation of MAPK/ERK and PI3K/AKT/mTOR pathways, VEGF-mediated angiogenesis, and defects in DNA repair—provide a plausible biological basis for the synchronous occurrence of these otherwise unrelated neoplasms, informing potential strategies for personalized therapy

Background: Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A), represents an important component of systemic therapy for metastatic colorectal cancer (mCRC). By inhibiting angiogenesis and promoting vascular normalization, bevacizumab enhances the efficacy of cytotoxic drugs. However, despite proven benefits, some uncertainties remain regarding its safety profile, particularly the risk of gastrointestinal perforation and other vascular toxicities. Materials and Methods: This retrospective, single-center, observational study included patients with histologically confirmed mCRC treated with combination chemotherapy and bevacizumab (FOLFOX/FOLFIRI + bevacizumab) at the Oncology Department of Zemun Clinical Hospital Center between July 2022 and July 2025. Efficacy was assessed according to RECIST 1.1 criteria, including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and duration of response (DoR). Adverse events were classified according to CTCAE v6.0. Results: A total of 74 patients were analyzed (56.8% male; mean age 67 ± 9 years). The median PFS was 6.5 months (IQR 3–9.8), and DoR 7.3 months (95% CI 5.2–9.5). ORR was 35.1%, and DCR 82.4%. The most common toxicities were hypertension (12.2%) and proteinuria (10.9%), while gastrointestinal perforation was observed in 4.1% of patients—slightly higher than in larger real-world series, which may be related to locally advanced disease, peritoneal carcinomatosis, or an intact primary tumor. Conclusion: Bevacizumab-based therapy demonstrated consistent efficacy and an acceptable safety profile in patients with mCRC. Although the incidence of perforation and fistula formation was somewhat higher, the therapy remained safe with careful patient selection and monitoring.

The aim of this review article is to provide an overview of available literature data on serum basal calcitonin (bCT) and stimulated calcitonin (sCT) cut-off values, highlighting them as a valuable diagnostic tool in everyday thyroidology practice. During the diagnostic evaluation of thyroid nodular disease, mildly elevated bCT values ​​are frequently encountered. If bCT values ​​remain above the reference range but are <100 pg/ml on repeated measurements, further evaluation is warranted. In addition to the usual diagnostic procedure for thyroid nodular disease (medical history, family history of thyroid malignancy, clinical examination, thyroid function tests, and thyroid ultrasonography), a stimulation test, most often a calcium test, is performed to assess the response by measuring the sCT levels. A precise diagnostic threshold, the so-called cut-off for clinically significant pathological values ​​of bCT and sCT that indicate medullary thyroid carcinoma (MTC), is still lacking. However, there are studies that recommend appropriate cut-off values ​​for bCT and sCT that allow a clear and safe distinction between healthy individuals and individuals with C-cell hyperplasia (CCH) from those with MTC. The aim of this review article is to present the latest literature data on existing cut-off values ​​for bCT and sCT in blood, which can certainly be useful to clinicians in everyday practice.

Introduction: Chronic limb ischemia (CLI) and diabetic foot significantly impact patients’ quality of life, with high rates of amputation and mortality. Angiosome-oriented revascularization represents an anatomically precise approach, targeting the artery that directly supplies the lesion area. Direct revascularization (DR) is increasingly considered superior to indirect revascularization (IR) due to potentially better wound healing and limb salvage outcomes. Methods: A narrative literature review was conducted using PubMed, Cochrane Library, and Google Scholar, with the keywords: angiosome, critical limb ischemia, diabetic foot, direct revascularization, endovascular, bypass surgery. Studies published between 2020 and 2025 were included, focusing on systematic reviews, meta-analyses, and prospective cohort and clinical studies. In addition to clinical studies, anatomical data on the distribution of foot and lower leg angiosomes were analyzed, including a table illustrating the correlation between wound location and target artery. Results: Six main angiosomes of the lower limb were identified, each corresponding to a specific artery. DR was associated with higher rates of wound healing and limb preservation, reducing the risk of amputation by 20–30% compared to IR. Optimal candidates for DR are those with localized lesions, patent distal target arteries, and adequate microcirculation. DR is less effective or technically unfeasible in patients with diffuse microvascular disease, multisegment occlusions, poor distal vessels, or active severe infections. Advanced technologies such as hyperspectral imaging and indocyanine green (ICG) mapping improve intraoperative perfusion assessment. Conclusion: Angiosome-oriented revascularization is a logical and anatomically grounded approach for treating CLI and diabetic foot. When feasible, DR of the target artery provides better clinical outcomes than IR. Success requires precise diagnostics, patient selection, and multidisciplinary collaboration. Further randomized studies are needed to define optimal application algorithms for this concept.

Introduction: Esophageal cancer is one of the ten most common cancers globally with a high mortality rate. The etiology is multifactorial, non-hereditary risk factors are smoking, alcohol consumption, obesity, and hereditary risk factors are Lynch syndrome, Plummer-Vinson syndrome, Peutz-Jaegers syndrome, and Li-Fraumeni syndrome. The treatment is multidisciplinary, and combined, chemotherapy, radiotherapy, immunotherapy, and surgery are applied. From the moment of diagnosis, supportive therapy is necessary to alleviate and eliminate the symptoms of the disease. Dysphagia is present in almost all patients with esophageal cancer. A loss greater than 5% of total body weight is associated with a worse prognosis. Discomfort and vague chest pain, hoarseness, cough, and sore throat are less common. Locally invasive tumors cause other symptoms such as hematemesis, hemoptysis, melena, dyspnea, cough, and pleural effusion. Horner's syndrome and superior vena cava syndrome may also occur in advanced tumors. The involvement of large blood vessels can lead to fatal bleeding. In the case of metastatic disease, different symptoms may be present depending on the location. Objective: The objective of this literature review is to indicate the importance of supportive therapy in the treatment of patients with esophageal cancer. Supportive therapy in esophageal cancer: The purpose of good supportive therapy is to ensure the best possible quality of life for patients. In esophageal cancer, the reduction of symptoms significantly contributes to the extension of life. Esophageal cancer treatment is actually the treatment of symptoms. Given that the most common symptom of these cancers is dysphagia, treatment of the underlying disease will also lead to an improvement in symptoms. Patients who have a complete or severe obstruction at any level of the esophagus must be provided with adequate nutrition. Oral nutrition contributes to a better quality of life. Before starting pain therapy, it is necessary to assess the cause and characteristics of pain. A step-by-step approach involves the gradual introduction of analgesic therapy. Dosing of opioids and determining the therapeutic dose should be in accordance with the current guidelines of the World Health Organization. Conclusion: supportive therapy contributes to longer survival in esophageal cancer at an advanced stage of the disease, and better tolerance of aggressive treatment regimens, reducing the toxicity, which leads to improved quality of life.