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Introduction. There is a high prevalence of psychiatric disorders, especially depression, in patients who are preparing for metabolic operations. Mini/one anastomosis gastric bypass (MGB/OAGB) is a bariatric operation with the possibility of complete restoration of the digestive tract or “tailoring” of a biliopancreatic limb if the patient regains weight. We present an obese patient with depression who underwent the first MGB/OAGB in Serbia with a follow-up period of one year. Case outline. An obese patient with a body weight of 144 kilograms and a body mass index (BMI) of 46.8 kg/m2 and depression as an accompanying comorbidity underwent MGB/OAGB with a follow-up period of one year. The operation was performed using the inventor’s technique in his presence and the recovery was uneventful. The patient completely stopped taking psychiatric or any other therapy, with no difficulties, and full occupational and social recovery. After the follow-up period, he has lost 49 kg, BMI = 30. 9 kg/m2, and the percentage of excess weight loss (%EWL) has been 73.1%. Conclusion. In psychiatric obese patients, a metabolic procedure should be carefully selected. MGB/ OAGB proved to be a successful bariatric procedure in our patient, leading to remission of depression and discontinuation of psychiatric therapy, as well as to a significant reduction in body weight in the period of one year after surgery.

While the impact of air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been widely studied, its effect on hospitalization outcomes remains less explored. This study examines the influence of short-term air pollution exposure on adverse hospitalization outcomes—mortality, mechanical ventilation use, and prolonged hospitalization—in patients with non-infectious severe AECOPD in Novi Sad, Serbia. Using a five-year time-series analysis, concentrations of selected air pollutants (PM10, PM2.5, SO2, and NO2) and meteorological data were integrated with hospitalization outcomes. Distributed lag non-linear models (DLNMs) revealed significant associations between rising air pollutant levels and some unfavorable outcomes. Exposure to rising PM2.5 (urban background) and SO2 (urban traffic) concentrations were linked to higher risks of mechanical ventilation (cumulative OR 21.95 (95% CI 1.07–449.45) and 11.37 (95% CI 1.25–103.27), respectively) and prolonged non-infectious AECOPD hospitalization (cumulative RR 2.27 (95% CI 1.14–4.52) and 2.24 (95% CI 1.38–3.64), respectively). No cumulative lag effects on mortality were observed, though specific patterns emerged in individual lag models. These findings highlight the critical role of improving air quality in reducing some COPD-related hospitalization risks. [ABSTRACT FROM AUTHOR]

Introduction/Objective. Chronic obstructive pulmonary disease (COPD) is a primary lung disease. Today, pulmonary rehabilitation (PR) is the basis for non-pharmacological treatment of these patients, with numerous confirmed effects on the most significant symptoms of the disease and the quality of life (QoL). The aim of this study was to determine the relationship between certain risk factors and the outcome of PR, as well as to determine the percentage of respondents who had a positive outcome of PR. Methods. The study included 500 patients with COPD, determined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines, all stages (I–IV), in the stable phase of the disease, who completed the outpatient PR program. Disease stage, comorbidities, forced expiratory volume in the first second, six-minute walk test (6MWT), COPD Assessment Test (CAT), and Medical Research Council dyspnea scale, body mass index, airflow obstruction, dyspnea and exercise capacity (BODE) index, were measured before and after the program. The last four parameters have been observed as risk factors that affect the outcome of PR, but also as parameters by which we monitor the outcome of PR. Results. A successful outcome of PR was achieved by as many as 452 (90.4%) patients. The following were determined as independent predictors of a positive outcome of PR: lower number of comorbidities, absence of heart failure, higher BMI, and CAT ≥ 10. Conclusions. PR in our group of patients leads to statistically significant improvements in most of the examined subjective and objective parameters, in patients in all stages of the disease.

Introduction. Lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis are the most common pulmonary cystic diseases. Although they differ in pathogenesis, they share several features. The aim of this paper is to present the similarities and differences between these diseases, as well as to describe two cases from our practice. Outlines of cases. The patient with lymphangioleiomyomatosis (43 years old) had pulmonary changes detected during a regular examination within the underlying disease – tuberous sclerosis. Four years after starting therapy with everolimus, she was still respiratory asymptomatic, a slight radiological deterioration of cystic changes was registered, the diffusion capacity was declining (by 12%). The second patient (23 years old) was admitted due to bilateral radiological lung changes and symptoms in the form of dry cough, quick fatigue, and chest pain. Pathohistological examination of the transbronchial biopsy showed numerous large-core histiocytes, immunohistochemically positive for CD1a and S100, so it was concluded that it was Langerhans cell histiocytosis. Cessation of smoking was advised. The follow-up examinations showed withdrawal of symptoms and an orderly finding of lung function, chest high-resolution computed tomography indicated slight regression of changes. In the meantime, the patient gave birth to a healthy child, the pregnancy and prenatal period were uneventful. Conclusion. These diseases are extremely rare and in cooperation with other specialties should be distinguished from diseases that mimic lung cysts.

The paper presents the chronological development of bariatric/metabolic surgery in Vojvodina, the region with the largest incidence of obesity in Serbia, and in which 13.2% of the population suffers from diabetes with a mortality of 15.7/100,000, which is one of the highest rates in Europe. Bariatric surgery began in the 1950s in the United States, with the consecutive development of various restrictive, malabsorptive, and combined procedures, which are intensified by the adoption of laparoscopic techniques. After initial, European knowledge and preparation of obese patients for surgery at the end of the 1970s, the first laparoscopic bariatric/metabolic interventions started in Vojvodina at the Clinical Center in Novi Sad in 2006. Next year, the multidisciplinary team for bariatric surgery was prepared in Slovenia and Austria, and the first interventions were performed in 2008 at the Clinic for Thoracic Surgery of the Institute in Sremska Kamenica, in the first-place laparoscopic sleeve gastrectomy. Since then, bariatric/metabolic surgery at this Institute have continuously been performed. By establishing international cooperation, three courses were held with demonstration operations in bariatric/metabolic surgery and the participation of eminent surgeons and other experts from the country and abroad. Several bariatric surgeries were performed on children (at the Children’s Surgery Clinic in Novi Sad), as well as in Sremska Mitrovica. Their own experience in this field has been published in the international literature and through several regional meetings dedicated to metabolic surgery.

Background/Aim. The influenza virus is often the cause of exacerbations among chronic obstructive pulmonary disease (COPD) patients, especially during the winter season. However, vaccination rates are still below recommended even in developed countries. The aim of the study was to determine the rates and examine the effectiveness of immunization against seasonal influenza in preventing exacerbations among COPD patients in Serbia. Methods. The prospective cohort study of stable COPD outpatients was conducted over three years (between October 1, 2014, and September 30, 2017) at the Polyclinic Department of Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The rates and effects of seasonal flu vaccination on COPD exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account comorbidity, age, and body mass index (BMI). Results. The study included 840 patients. The flu vaccination rate was 37.1%. Exacerbations occurred more frequently in unvaccinated patients [176 (31.9%) vs. 375 (68.1%), p = 0.043]. In elderly vaccinated patients (≥ 65 years) there were fewer exacerbations compared to unvaccinated patients [89 (56.0%) vs. 188 (69.4%), p = 0.005]. Lower frequency of exacerbations was also observed in vaccinated patients with comorbidities [165 (61.1%) vs. 327 (69.4%), p = 0.021] and low BMI [27 (64.3%) vs. 78 (83.9%), p = 0.011]. Multivariate logistic regression analysis identified BMI < 21 kg/m2 [relative risk (RR): 0.490; 95% confidence interval (CI): 0.318–0.758; p = 0.001] and heart failure (RR: 2.734; 95% CI: 1.121–6.669; p = 0.027) as independent predictors of COPD exacerbations. Conclusion. Immunization for seasonal influenza in Serbia is below recommended rates. Flu vaccination was associated with a significant reduction in COPD exacerbation rates, particularly in elderly patients and patients with heart failure and low BMI.

Introduction/Objective. Locally advanced lung cancer is often accompanied by atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients’ quality of life, the length of the progression-free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced lung cancer or endobronchial metastasis of other malignancy were treated with the high-dose-rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients’ clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p < 0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the quality of life of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Reaeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 Ѓ} 8.45, current or ex-smokers 94.9%; 21 ≥ BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307–0.577); p < 0.001) and BMI ≥ 21kg/m2 (RR 0.605; 95% CI (0.380–0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720–3.280); p < 0.001) and FEV1 < 80% (RR 2.021; 95% CI (1.303–3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion. Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.

Introduction. Frequency of pediatric mandibular fractures is relatively uncommon. Apart from rare exceptions, there is minimal invasive access in the treatment of those injuries in order to avoid the future developmental disorders. Case report. During the game with a colt, a 6-year-old boy was kicked by hoof in the chin. The child did not lose consciousness and did not experience nausea or vomiting. According to clinical examination and radiological analysis, diagnosis was assigned as dislocated mandibular fracture in the parasymphysis part of the jaw and luxation injury of teeth 31 and 72. The surgical treatment under general anesthesia encompassed reduction and bimanual manipulation of bone fragments up to the optimal restoration of the dental occlusion, along with osteosynthesis with titanium miniplates. Luxated deciduous tooth 72 at the fracture line was extracted and luxated permanent tooth 31 was fixed to tooth 41 with wire. The patient was given antibiotic therapy. Additional immobilization of the luxated tooth 31 and mandibular fracture was performed after surgery by composite resin splint. During five-month follow-up period there were no signs of pathological movements in the fracture line, no luxation of tooth 31 and no restriction in mouth opening. Conclusion. Osteosynthesis with miniplates is adequate and very efficient treatment method in dislocated mandibular fracture that is recommended in children with both deciduous and mixed dentition. It is necessary to remove miniplates after fracture consolidation.

Langerhans cell histiocytosis (LCH) is a rare disease of unknown aetiology characterized by abnormal monoclonal proliferation of CD1a+/ CD207+ myeloid dendritic cells (Langerhans cells) in various organs, including bones, skin, lymph nodes, liver, lungs, central nervous system (CNS). Pulmonary Langerhans cell histiocytosis (PLCH) may occur as single-system disease or the lungs may be affected within a multisystemic disease. This paper presents cases of two patients with multisystemic LCH, with predominant lung involvement. In the first patient, the disease is in the terminal stage, with chronic respiratory failure requiring long-term oxygen therapy at home and development of severe pulmonary hypertension, so the lung transplantation may be considered as the only potentially effective therapeutic procedure at this moment. The second patient is in the initial stage of the disease, with satisfactory pulmonary function for now, so it could be considered to use some new targeted therapy to prevent the progression of the disease. Thus, it is essential to consistently apply, as soon as possible, all available pharmacological treatments, as well as adequate palliative and health care, to ensure a decent quality of life for these patients.

Introduction. The aim of this paper was to presents long-term results of a laparoscopic gastric sleeve resection in a “super super” obese patient and a follow-up period of eight years. Case Outline. A patient with Body Mass Index (BMI) of 70 kg/m2 and Stage 3 obesity according to “King’s Obesity Staging Criteria” (KOSC), with metabolic syndrome and cardiovascular risk of over 20%, and a pronounced severe obstructive sleep apnea, underwent a laparoscopic gastric sleeve resection (LGS). After two years, the patient reached BMI of 28.4 kg/m2 and eight years after the surgery has BMI of 34.3 kg/m2, and %EBMIL (% Excess BMI Loss) of 79.3%. According to the KOCS, he falls under Stage 0. Conclusion. LGS resection may be performed as a stand-alone procedure in “super super” obese patients, with excellent long-term results.

Introduction. Super obese group of patients with body mass index (BMI) ≥ 50kg/m2 have higher technical intraoperative problems, higher morbidity and mortality. Indications for the metabolic procedure are widening and minimally invasive operation dictate both patients and surgeons to face with previously assumed “general contraindication” for surgical bariatric/metabolic procedure. Case outline. We present a super obese patient with restenosis of the trachea, chronic obstructive pulmonary disease, sleep apnea and cardiomyopathy with panniculus grade IV, in whom as a multidisciplinary team we did simultaneously permanent tracheostomy, laparoscopic sleeve gastrectomy and panniculectomy. Conclusion. Quality of life after the bariatric operation is a factor which must be leading in concern how to approach a difficult patient, with operation adaptable to fit all demands.

Introduction. Achalasia is a rare esophageal disorder which, due to frequent presence of both respiratory and gastrointestinal symptoms, can initially be referred either to pulmonologist or gastroenterologist. Case Outline. A 50-year-old patient was initially referred to gastroenterologist with the following symptoms: nausea, vomiting, occasional hiccups, weight loss, chest pain, dysphonia, and dry cough. After chest X-ray, the patient was referred to pulmonologist with differential diagnosis for pulmonary infiltration and thoracic aortic aneurysm. Pulmonologist interpreted chest X-ray as showing paratracheal mediastinal enlargement with air-fluid levels, thus suspecting achalasia. Computed tomography scan of the thorax with per os contrast showed extremely dilated esophagus with food stasis. The patient was then referred to thoracic surgeon, who ordered additional diagnostics (esophageal passage with contrast, esophagomanometry, esophagogastroduodenoscopy), and finally performed Heller myotomy. Postoperatively there were no complications, and the patient was symptom free during the follow-up. Conclusion. Although achalasia can also result in respiratory symptoms, fastidious anamnesis and accurate radiological interpretation are essential for the correct diagnosis.

Introduction. This paper presents a case of a patient with a benign splenic cyst, which was removed by way of partial resection of the spleen. Case outline. The patient’s benign cyst in the lower pole of the spleen was excised using single CooltipTM radiofrequency ablation electrode (Cool-tip RF Ablation System, CovidienTM, Dublin, Ireland). More than half of the spleen was excised without setting stitches to the splenic parenchyma and without any other hemostyptics. This way, the function of the spleen was preserved, which was proven with scintigraphy and computed tomography two years after the intervention. Conclusion. Radiofrequency ablation system with internally cooled needles can be used successfully and without any consequences to the organ, especially in case of large benign splenic cysts, when it is necessary to preserve the function of the spleen.

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Introduction. Eagle’s syndrome is defined as elongation of the styloid process or the stylohyoid ligament mineralization complex which consist of styloid process, stylohyoid ligament and lesser horn of hyoid bone. It is a rare entity, is not commonly suspected in clinical practice. It is characterized by recurrent facial and throat pain, dysphagia, odynophagia, parapharingeal foreign body sensation, otalgia and neck pain. Eagle’ş syndrome can be treated conservatively (lacing local anesthetic into the styloid process and stylomandibular ligament attachment) or surgically. Its pathogenesis and threatment modalities are still being debated while different theories have been presented. Case report. The two traditional surgical approaches to styloidectomy (removal of the elongated portion of the styloid process) were presented the intraoral approach and the extraoral approach. We presented two cases (49 years and 34 years old males), with bilateral and unilateral elongated styloid process. The surgical treatment included unilateral right side stiloidectomy by intraoral approach in the first case and right styloidectomy by extraoral approach in the second case. In both eases post-operative course passed regularly with no complaints at regular postoperative control. Conclusion. Surgical techniques for treatment of Eagle’s syndrome have many advantages and disadvantages. We believe that the length of the styloid process or the calcified ligament is a decisive parameter for the selection of techniques and approach.

Introduction. Hepatocellular carcinoma (HCC) is the most frequent type of liver malignancy. As a carcinogen, aflatoxin B1 (AFB1) causes HCC by inducing deoxyribonucleic acid adducts that lead to genetic changes in liver cells and may be the cause of HCC in up to 30% of cases. The incidence of HCC has been on the rise and is an issue in the countries of the Western Balkans. Case Outline. This paper presents a case of a 37-year-old woman who was diagnosed with HCC, without hepatitis B, hepatitis C, or liver cirrhosis. The patient consumed milk and dairy products in quantities of over two liters per day over the course of 20 years, which indicates the impact of aflatoxin in milk on HCC. A positive signal for the presence of AFB1 was detected by ELISA (enzyme-linked immunosorbent assay) in-house using immunoperoxidase screening test. Conclusion. As carcinogenic difuranocoumarin derivative, aflatoxin B1 is the most likely cause of malignant transformation of hepatocytes, which resulted in hepatocellular carcinoma in this patient.

Introduction. Li-Fraumeni syndrome (LFS) is a very rare familial disease with the predisposition to the development of malignant tumors, such as osteosarcoma, breast cancer, brain neoplasm, leukemia, and adrenal tumors. Inheritance is autosomal dominant and is caused by heterozygous mutations in the p53 gene. The diagnosis is based on clinical criteria: a person under the age of 45 years suffering from sarcoma, the closest relative younger than 45 years diagnosed with cancer and a relative of the first or second degree, which is up to 45 years, was diagnosed with cancer and was diagnosed with sarcoma at any age. Case report. The presented family with three members diagnosed with malignant disease typical for LFS suggests the need to carefully follow those diagnosed with LFS related tumor. A 24-yearold man diagnosed and treated for osteosarcoma of the maxilla died in the first year. His younger brother was submitted to surgery due to osteosarcoma of the mandible three years later, and a year later in his 24 year he had no signs of locoregional recurrence. Their mother was operated in 1996 for glioblastoma multiform brain cancer and ductal carcinoma, and died two years later at the age of 33. Conclusion. The presented family highlights the need for careful examination, inspection and notification of the risks of family members diagnosed with LFS related tumors.

Background/Aim. Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. Methods. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people’s (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. Results. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p ≤ 0.01). The patients whose blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p < 0.01). Conclusion. Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

Introduction. Acute renal infarction as a consequence of renal artery occlusion often goes unrecognized, mostly due to the non-specific clinical features. A quick diagnosis, ideally within three hours of presentation, is a key to renal function recovery. Case Outline. A 62-year-old male patient was admitted with a sudden abdominal pain, right flank pain and nausea. He had a diastolic hypertension at admission and his previous medical history showed atrial fibrillation. Initial clinical diagnosis was aortic dissection. Laboratory findings included elevated lactate dehydrogenase (LDH) and serum creatinine levels. There were no signs of aortic dissection or aneurismatic lesions registered during a multislice computed tomographic (MSCT) angiography. However, MSCT angiography demonstrated left “upper” renal artery thrombosis and renal infarction - avascular area of the upper two thirds of the left kidney sharply demarcated from the surrounding parenchyma. Both kidneys excreted the contrast. Anticoagulant therapy was initiated, along with antiarrythmic and antihypertensive medications. The follow-up by computed tomography was performed after nine weeks, and it showed a partial revascularization of the previously affected area. Conclusion. Concomitant presence of flank/abdominal pain, an increased risk for thromboembolism and an elevated LDH suggested a possibility of renal infarction. MSCT angiography is a non-invasive and accurate method in the diagnosis of renal artery occlusion and the resulting renal infarction.

Background/Aim. Asthma is one of the most common chronic pulmonary diseases. The number of asthmatics has been continuously increasing all over the world. Depending on its causing agent, asthma is classified as allergic and nonallergic. Asthma is often associated with other allergic diseases, and it is most commonly preceded by the symptoms of rhinitis. The aim of this study was to establish the type and frequency of allergic sensitization to inhalatory allergens, frequency of concomitant rhinitis, gender and age-related distribution of asthma, and the presence of some risk factors in patients with diagnosed asthma. Methods. This retrospective and partially prospective analysis included 733 patients with asthma diagnosed in the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica over the period January, 2004-December, 2008. The obtained date were statistically processed. Results. Females were significantly more often affected by asthma (p < 0.05), most frequently at 20-29 years of age. A hereditary predisposition to the diseases in terms of atopy was registered in 34.9% of the examined subjects. Most patients had allergic asthma (79.5%). Sensitization to internal and external inhalatory allergens was verified in 77.5% and 67.6% of the patients respectively, and combined hypersensitivity to both allergen types in 48.8% of the patients. Rhinitis was registered in 63.9% and 28% of the patients with allergic and nonallergic asthma, respectively. Rhinitis symptoms preceded the occurrence of asthma in 60% of the patients, with the precedence of rhinitis ranging from 1 to 27 years. A high correlation between rhinitis and asthma was established for the disease of both allergic (r = 0.92) and nonallergic (r = 0.88) etiology. Conclusion. The majority of the patients have allergic asthma, and they are females at 20-29 years of age. Senstization to internal allergens is most common, and then to external ones. Rhinitis is the most common concomitant disease, usually preceding the occurrence of asthmatic symptoms.

Background: Liver metastases are the leading cause of death in patients with colorectal cancer. Despite advances in chemotherapy, surgical resection of hepatic metastases is still considered the only curative options. However, the majority of patients have inoperable disease at presentation. Perioperative chemotherapy is the most successful way for improved selection of patients for resection. The aim of the study was to demonstrate if and to what extent does bevacizumab, introduced in chemotherapy, increase response rates, and development of liver metastases. Methods: Our study included 50 patients who were divided in two groups. The experimental group included patients who were treated with bevacizumab plus chemotherapy, and the control group included patients who were treated with chemotherapy only. Results: The comparison showed that the patients who were treated with bevacizumab became candidates for resection of liver metastases in higher percentage (85%:52%). In addition, distribution of patients regarding the development of metastases resulted in statistically significant difference. Ratio between the patients with good response from the experimental and the control group was 67%:39%. Ratio of patients with stable disease was 26%:48%, and of patients with progressive disease, it was 7%:3%. The estimate of margin after resection was statistically insignificant. Conclusion: Bevacizumab in combination with chemotherapy in therapy of liver metastases from primary colorectal cancer improves and increases response rates and development of liver metastases.

Background: The aim of the study was to determine the microbial presence and type in the biofilms present on the surface of oral squamous cell carcinomas and benign lesions of oral mucosa. Methods: Thirty new (untreated) patients with oral squamous cell carcinoma were examined. The control group consisted of thirty subjects with benign lesions of oral mucosa. Swab samples were taken from the superficial layer of the carcinoma and benign lesions for bacteriological examination. Swabs were transported within 2 hours and immediately sown and incubated. Oral health index was assessed in all patients. Results: The prevalence of pathological bacterial microflora was significantly higher in cancer patients (p0.05). Poor oral hygiene was also registered in cancer patients. Conclusion: Possibility of microflora retention on irregular oral carcinoma surface possibly contributes to chronic inflammation often observed on the surface of oral carcinomas.

A subject infected by tubercle bacilli may immediately develop the disease (primary tuberculosis), witch occurs in a few number of infected persons, or may overcome the primary infection (a latent carrier of the infection). Nowadays there are about two milliard people with a latent tubercular infection. About 10% of them will develop active tuberculosis during their lifetime. Detection of latent tuberculosis and its treatment decreases the risk of developing the active form of the disease. Until recently, the tuberculin test was a single screening method to identify the subjects with tubercular infection. In recent years, some novel in vitro tests to diagnose the tubercular infection have been designed. These tests measure the cell-mediated immune response quantifying the emission of interferon gamma by T cells in response to stimulation by Mycobacterium tuberculosis specific antigens. These tests are more sensitive and specific than the tuberculin skin test, but they are just an accessory tool, i.e. a link in the diagnostic chain of the tubercular infection.