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.

A sense of satisfaction and well-being that covers various aspects of life can be defined as quality of life (QoL). Hypothyroidism can be clinically both latent and apparent. It is possible to evaluate general aspects of life, identify the presence and severity of diseases, and evaluate the effectiveness of treatment while QoL measurement instruments are used. The timely initiation of levothyroxine (LT4) substitution in cases with latent hypothyroidism and the evaluation of LT4 substitution quality serve as evidence of the beneficial effects of used QoL instruments. Here, we introduced GHQ12, TSQ, and ThyPRO instruments most commonly used in routine thyroid clinical practice.

Intensive Care Units (ICUs) are inevitably positioned at the top of the treatment pyramid for patients with acute and life-threatening conditions according to current medical practice. The number of critically ill patients has dramatically increased owing to better treatment quality, a longer life expectancy, and the impact of modern technologies. This has raised concerns regarding the intensive care and surveillance of these patients. Compared to colleagues in non- intensive care services, the profiles of physicians and nurses/technicians working ICUs differ considerably in their patients’ approach and skills performance. Specific indications for ICU admission have been established due to the restricted number of available ICU beds. These patients are transferred to semi-intensive care (SICUs) services within the departments that correspond to their pathology once their critical condition has stabilized. The ICU patients cannot be fully recovered, but can have their conditions stabilized to the point where they may receive further treatment outside of the ICU. Thus, ICUs and SICUs represent one functional unit. The aim of this review is to present the indications for admission to the Department of Internal Medicine ICU of the Clinical Hospital Center Zemun.

Introduction: Gastrointestinal bleeding represents a serious clinical challenge due to the complexity of diagnosis and the therapeutic options required for effective management. Small bowel bleeding, although relatively rare, poses a significant diagnostic dilemma due to the difficulty in identifying the source and the variability of causes, which differ depending on the patient's age. In the elderly population, vascular malformations are the most common causes, whereas in younger patients, the etiology can be broader, including inflammatory diseases, tumors, and congenital abnormalities. The aim of this study was to investigate the clinical characteristics and outcomes of patients with hemodynamic instability due to small bowel bleeding, with a particular focus on the application of predictive scores (GBS and CRS). Materials and Methods: This retrospective observational study, conducted from January 2023 to January 2024, included 24 hemodynamically unstable patients with diagnosed small bowel bleeding. All patients were assessed using the Glasgow Blatchford Score (GBS) and Clinical Rockall Score (CRS) to evaluate risk and predict clinical outcomes. Demographic data, clinical and diagnostic information were analyzed, with comparative analyses of preoperative, intraoperative, and histopathological findings. Results: The mean age of the patients was 69.8 years, and 79.2% presented with hematochezia. All patients had GBS > 15 and CRS > 6. Conservative treatment was effective in 62.5% of patients, while 37.5% required surgical intervention. The mortality rate was 12.5%. Statistically significant positive correlations were found between GBS and mortality (r = +0.76, p < 0.05) and between GBS and surgical intervention (r = +0.32, p < 0.05). The most common causes of bleeding were vascular lesions, although the source of bleeding was unidentified in 11 patients. Conclusion: Small bowel bleeding remains a major challenge for clinicians, requiring a multidisciplinary approach to diagnosis and treatment. The use of predictive scores such as GBS and CRS aids in assessing severity, guiding decision-making, and planning further treatment.

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.

Introduction: Voice dysfunction represents a significant postoperative complication following total thyroidectomy, particularly in patients whose profession depends on their voice (singers, lecturers). The main causes include injury to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN), as well as vocal cord trauma during intubation or the occurrence of postoperative edema. Methods: A systematic search of PubMed and Cochrane databases was conducted for studies published between 2014 and 2025. Included studies comprised randomized controlled trials, meta-analyses, systematic reviews, and relevant clinical guidelines. Data were analyzed regarding the incidence of voice dysfunction, mechanisms of nerve injury, surgical and anesthetic risk factors, prevention strategies, and postoperative management, including the use of intraoperative neuromonitoring (IONM). Results and Discussion: Recurrent laryngeal nerve paresis leads to dysphonia and reduced phonatory power, whereas superior laryngeal nerve injury decreases the high-frequency vocal range and vocal endurance. The risk is increased in reoperations, large retrosternal goiters, and invasive tumors. The use of IONM reduces the risk of permanent RLN injury, although its reliability may be compromised by improper use of neuromuscular blockers or anesthetic protocols. Anesthetic factors, including improper intubation, excessive cuff pressure, and multiple intubation attempts, significantly contribute to voice changes. Prevention includes careful anesthetic management, precise intubation technique, and coordinated work between surgeons and anesthesiologists. Early postoperative evaluation, fiberendoscopic examination, acoustic analysis, and speech therapy contribute to preserving vocal cord function. Conclusion: Voice dysfunction following total thyroidectomy arises from both surgical and anesthetic factors. Prevention of complications requires a multidisciplinary approach, coordination between surgeons and anesthesiologists, and the use of intraoperative neuromonitoring. Therapy and rehabilitation, including otolaryngological assessment and speech therapy, aim to preserve and restore vocal function.

Introduction: Primary adenocarcinoma of the appendix is a rare and heterogeneous malignancy, most commonly presenting as mucinous adenocarcinoma. Due to its nonspecific clinical manifestations, the diagnosis is often established at an advanced stage, frequently with already present peritoneal dissemination. Standard treatment for advanced mucinous appendiceal carcinoma involves cytoreductive surgery with HIPEC followed by systemic chemotherapy, or initial systemic therapy for downstaging, followed by repeat CRS and HIPEC. In cases where radical surgery is not feasible, the average survival is less than one year. Case report: We report a case of a 72-year-old woman with no relevant family history, who presented with acute right lower abdominal pain and distension. Imaging revealed multiple cystic peritoneal implants, ascites, and small bowel obstruction. Palliative emergency surgery demonstrated an appendiceal mass invading the right ovary, with widespread peritoneal mucinous deposits. Histopathological analysis confirmed mucinous adenocarcinoma of the appendix with peritoneal carcinomatosis. Postoperatively, the patient received 12 cycles of bevacizumab plus FOLFOX chemotherapy, achieving marked radiologic and biochemical improvement. Maintenance therapy with bevacizumab plus 5-FU/LV led to sustained disease stabilization. After 32 cycles, the patient developed an entero-vaginal fistula, which was surgically managed due to poor quality of life. Intraoperatively, the decision was made for cytoreductive surgery and fistulectomy. Postoperative imaging showed no evidence of disease. The patient remains progression-free for nearly three years, and disease-free for one year. Conclusion: This case highlights the potential for long-term survival in initially inoperable patients with advanced mucinous appendiceal adenocarcinoma and peritoneal carcinomatosis when treated with combined cytoreductive surgery and bevacizumab plus chemotherapy. Multimodal and individualized treatment strategies may significantly improve outcomes in this rare malignancy.

Introduction: Parasitic leiomyomas are extremely rare benign smooth muscle tumors that develop independently of the uterus. They may arise spontaneously from pedunculated subserosal fibroids that detach and establish an independent blood supply from surrounding structures, or they may develop iatrogenically following laparoscopic morcellation. Owing to their nonspecific clinical and radiologic features, they are often misdiagnosed preoperatively. Surgical excision with histopathological verification remains the standard of care. Case report: We present the case of a 51-year-old postmenopausal woman with progressive abdominal distension and a sensation of pelvic pressure. Imaging revealed a large heterogeneous abdominopelvic mass measuring 30 × 20 cm, compressing adjacent bowel loops and major vessels. The uterus was myomatous but of normal size, and both ovaries appeared unremarkable. The patient underwent open surgical resection of the mass with total hysterectomy, bilateral adnexectomy, and omentectomy. Intraoperatively, a giant tumor connected to the uterine fundus by a thin pedicle was identified. Histopathological examination confirmed a benign leiomyoma without atypia or necrosis and a Ki-67 proliferation index below 1%. The postoperative course was uneventful, and the patient remained asymptomatic three months after surgery. Conclusion: Primary parasitic leiomyomas are exceedingly uncommon, particularly in patients without a history of prior gynecologic surgery. They should be considered in the differential diagnosis of large abdominopelvic masses. This case emphasizes the importance of comprehensive diagnostic evaluation and highlights that parasitic leiomyomas can attain remarkable size while maintaining benign histological features.