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Background/Aim. Taking into consideration the justified popularity of total arterial revascularization, the saphenous vein graft (SVG) is still one of the most utilized conduits in coronary artery bypass grafting (CABG). One of the determining factors of this conduit’s durability is its endothelial integrity at the time of surgery. The aim of the study was to investigate the effect of different storage solutions on SVG endothelial integrity in patients with diabetes mellitus (DM) type 2 (T2DM) and non-T2DM patients undergoing CABG. The solutions under evaluation were heparinized saline solution (0.9% NaCl), heparinized autologous whole blood, Bretschneider (histidine-tryptophan-ketoglutarate – HTK) solution, and fresh frozen plasma (FFP) solution. Methods. Forty patients were included in this study and were divided into two groups: group A with 23 T2DM patients and group B with 17 non-T2DM patients. The effects of these solutions were examined by immunohistochemical staining with anti-CD34 antibodies and morphometric comparison in histologic samples of T2DM patients undergoing CABG between July 2021 and September 2022 with samples provided by non-T2DM patients. Results. In this study, the FFP solution showed the most prominent positive effect on the preservation of SVG endothelial integrity, with an average cell integrity preservation of 92.2%. HTK solution was found to be the least effective, with an endothelial cell preservation integrity of 26.77%. There was no marked statistically significant difference in results from groups A and B. There was a noticeable contrast in preserving SVG endothelial integrity between the two patient groups, T2DM and non-T2DM patients, although it was not statistically significant. Conclusion. The storage solution with the most beneficial effect on SVG endothelial integrity preservation was the FFP solution when harvested via the conventional open method in CABG.

Background/Aim. Type IV collagen belongs to the group of nonfibrillar collagens and is an important component of the basement membranes, where it accounts for approximately 50% of its structural elements. The aim of the study was to describe the expression and distribution of collagen type IV in the embryonic and fetal metanephric kidney and to determine the volume density of collagen type IV in kidney tissue in each trimester of development. Methods. The material consisted of 19 human embryos/fetuses, in the gestational age from 8th to 37th week. Kidney tissue specimens were routinely processed to paraffin molds, stained immunohistochemically using polyclonal anti-collagen IV antibody and counterstained with Mayer hematoxylin and eosin. Stained slides were examined using a light microscope, and images of the selected areas under different lens magnification were captured with a digital camera. Volume density of collagen type IV was determined using ImageJ 1.48v and a plugin of the software, which inserted a grid system with 336 points. For the data comparison, the One-Way Analysis of Variance (ANOVA) was used. Results. Strong collagen IV immunopositivity was seen in all specimens, with a distribution in the basement membranes of urinary bud, parietal leaf of Bowman’s capsule, glomerular basement membrane, basement membrane of interstitial blood vessels, and basement membranes of nephron tubules and collecting ducts. No statistically significant difference in the volume density of type IV collagen was found among the different trimesters of the embryonic and fetal development. Conclusion. The synthesis and secretion of collagen type IV simultaneously follow the development of nephron structures, collecting system and blood vessels. The volume density of collagen type IV remains constant throughout all the trimesters of metanephric kidney development, indicating that it plays a crucial role in the normal development of nephron and collecting system structures, as well as in maintaining the normal kidney function.

Introduction. Implantation of left ventricular assist device (LVAD) improves survival and quality of life in patients with end-stage heart failure. We reported a case of a severe gastrointestinal bleeding as a life threatening complication in early recovering postoperative period of continuous blood flow LVAD implantation. Case report. The patient had a history of heart failure due to ischemic cardiomyopathy with low systolic function, as an indication for LVAD implantation. The operation and the postoperative course were uneventful. On the 17th postoperative day, the patient developed severe anemia, which was followed by melena with blood clots. Endoscopic examinations revealed diffuse colonic bleeding. Oral anticoagulation therapy was discontinued, and fresh frozen plasma, K vitamin substitution, and human prothrombin complex were administered. The LVAD speed was reduced and subcutaneous administration of somatostatin analog octreotide was initiated. These measures successfully stopped the bleeding and the patient was stabilized. Due to a multidisciplinary team approach, the bleeding was successfully managed and the patient re-covered. Conclusion. Acute gastrointestinal bleeding represents a serious, life-threatening condition that can develop after LVAD implantation, but with timely and appropriate measurements, it can be successfully treated.

Background/Aim. A short-term high-intensity noise from a gunshot impulse that occurs when using infantry weapon, can result in onset of auditory symptoms such as tinnitus, impaired hearing or feeling of pressure in one or both ears. The aim of this study was to examine the effect of live ammunition shooting from an automatic rifle on the hearing sense in professional military personnel. The examination was done in correlation with the conditions of the common shooting practice procedure. Methods. The research has been conducted on 22 professional soldiers serving in the Serbian Military, during their regular peacetime training shooting from the automatic rifle AP 7.62 mm M70. The training was conducted on the formational shooting field “Bubanj Potok”. The written consent from all subjects was acquired. All subjects were submitted to medical examination prior and after the shooting session. The medical examination consisted of anamnesis, clinical otorhinolaryngological examination, audiometry and impedancemetry. All subjects filled out the following questionnaire forms: “The Questionnaire prior to shooting” and “The questionnaire after shooting.” Subjects who were incapable to undergo shooting practice, whether from psychological or physical reasons were excluded from this study. Results. After the assessment of received data from 22 subjects, the results were as followed: in 2 (9%) subjects hearing impairment was diagnosed. Tinnitus was registered in 5 (22.7%) patients. One (4.5%) patient reported the feeling of pressure in one ear. One of two cases of one ear hearing impairment was on the rifle holding side and second case was on opposite lateral side. In both cases, hearing loss was of sensorineural type of milder degree, with a scotoma at 4,000 Hz in one case up to 50 dB and the second up to 55 dB. Conclusion. Auditory effects of impulse noise that occurs when shooting from automatic rifles cause hearing impairment, tinnitus and a feeling of pressure in the ears. The practical significance of this study lies in prevention which includes the mandatory use of personal protective equipment and functional arrangement of the practice shooting field.

Background/Aim. Development of imaging techniques, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), made great impact on radiotherapy treatment planning by improving the localization of target volumes. Improved localization allows better local control of tumor volumes, but also minimizes geographical misses. Mutual information is obtained by registration and fusion of images achieved manually or automatically. The aim of this study was to validate the CT-MRI image fusion method and compare delineation obtained by CT versus CT-MRI image fusion. Methods. The image fusion software (XIO CMS 4.50.0) was applied to delineate 16 patients. The patients were scanned on CT and MRI in the treatment position within an immobilization device before the initial treatment. The gross tumor volume (GTV) and clinical target volume (CTV) were delineated on CT alone and on CT+MRI images consecutively and image fusion was obtained. Results. Image fusion showed that CTV delineated on a CT image study set is mainly inadequate for treatment planning, in comparison with CTV delineated on CT-MRI fused image study set. Fusion of different modalities enables the most accurate target volume delineation. Conclusion. This study shows that registration and image fusion allows precise target localization in terms of GTV and CTV and local disease control.

Bacground/Aim. Alternative medicine is a set of therapeutic procedures which are no part of official practice. At present, the use of alternative medicine among cancer patients is significant and the purpose of this study was to get more information on the methods and products of alternative medicine. Thus, the aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients. Methods. The research was conducted using an anonymous questionnaire in writing. We included 205 patients with the diagnosis of gastrointestinal malignancy in the study but the questionnaire was fulfilled by 193 patients and the presented data were based on their answers. The questions were about the sociodemographic characteristics of the patients, the reasons for their use of alternative medicine, and their information sources about alternative medicine. We divided existing alternative therapies into 6 categories: herbal therapy, special diets, psychotherapy, body-mind therapy, spiritual therapy, and other supplements. Results. A total of 48 (24.9%) patients did not use any type of alternative therapy; 145 (75.1%) patients used at least one product and 124 (64.25%) patients used herbal preparations (beetroot juice was consumed by 110 [56.99%] patients); 136 (70.5%) patients were informed about alternative therapies by other patients.; 145 (75.1% ) used alternative medicine to increase the chances for cure; 88 (45.6%) of interviewed patients would like to participate in future research in this field. Conclusion. The use of alternative medicine is evidently significant among cancer patients. Further research should be conducted in order to find out interactions of these products with other drugs and potential advantages and disadvantages of this form of treatment.

Background/Aim. Cytokeratins (CK) 5/6 and 17, myoepithelial markers, are also expressed in a proportion of breast carcinomas. Breast carcinomas expressing basal epithelium cytokeratins constitute a tumor subgroup that shows common but heterogeneous morphological, genetical, and immunophenotypical features and is associated with poor clinical outcome. The aim of this study was to determine the incidence of basal expression of cytokines CK5/6 and CK17 in the tested samples of ductal invasive breast cancers, as well as to test the presence of a correlation of tumor expression of basal cytokines and clinicopathological prognostic factors: age, the level of histological differentiation, hormone receptor status, HER2 (human epidermal prowth factor receptor 2) protein expresion and HER2 gene amplification in tumorous tissue. Methods. Immunohistochemistry (IHC) was used to evaluate the CK5/6 and CK17 status of 121 ductal invasive breast cancers. The results thus obtained were compared with clinicopathological characteristics. Results. From the 117 analyzed tumor specimens, 22% and 30% were immunohistochemically positive for CK5/6 and CK17, respectively. Basal cytokeratins showed significant inverse relationship with estrogen and progesterone receptor status and HER2 protein expression. CK5/6 and CK17 immunoreactivities were directly associated with triple-negative phenotype and higher histological grade. Conclusion. Our findings are similar to reports that tumours expression of basal cytokeratins are correlated with adverse pathological parameters. Given the limited number of emerging therapeutic targets in these tumors, routine IHC identification of basal-like subtype as a poor prognostic group of breast cancer could be based on the expression of basal CKs.

Introduction. Carcinoma of the esophagus is in the eighth place by the frequency of malignant diseases and the sixth cause of death from cancer worldwide. It usually metastasizes to regional lymph nodes, liver, lungs, central nervous system, and bones, but metastases can appear to unusual locations such as facial skin and lips. Case report. We presented a 56- year-old man who reported to his physician because of upper lip swelling. A physical checkup of the patients also showed a lesion on the skin of the left temporal region and both lesions were biopsied. Based on the results of histopathological and immunohistochemical analyses of the samples a diagnosis of metastatic adenocarcinoma to the skin was established. Additional diagnostic procedures, including esophagogastroduodenoscopy, detected the infiltration into the distal part of esophagus, which was histopathologically confirmed as adenocarcinoma of esophagus. The results of positron emission tomography/computed tomography (PET/CT) examination showed the invasion of the disease. Because of the disease expansion, a multidisciplinary oncology team suggested chemo- and radiotherapy treatment. The patient has received 4 cycles of platinum-based chemotherapy so far. Conclusion. The physicians should always consider unusual skin lesions as the first sign of cancer spreading.

Introduction. Breast cancer is one of the most common malignancies in women and the main leading cause of cancer death. The most frequent sites of metastases from breast cancer are bones, lungs, the central nervous system, the liver and soft tissue. Colonic metastases from breast cancer are rare. Case report. We presented a 70-year-old woman with bulky obstructing lesion of sigmoid colon. A physician in charge on our department examined the patient and past history of breast cancer was found up. Surgery was performed with removal of sigmoid colon and three of six lymph nodes were positive. Pathological examination, including immunohistochemical stains, confirmed the diagnosis of metastatic breast cancer to sigmoid colon. The multidisciplinary oncology team suggested postoperative chemotherapy. The patient received four cycles of chemotherapy with paclitaxel followed by anastrozole. On the first control visit no disease activity was detected. Conclusion. In patients with the past history of breast cancer the symptoms of hematochezia or anemia may indicate colonic metastases.