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The right to life is indisputably the most important human right. It is safeguarded in almost all international human rights conventions which envisage the right to life before all other rights. Thus, in the European Convention on the Protection of Human Rights and Freedoms (ECHR), the right to life is enshrined in Article 2, which provides for the protection of this right and obligations stemming thereof. Under Article 2, a State is obliged to refrain from violating the right to life by the actions of its state bodies. On the other hand, the jurisprudence of the European Court of Human Rights (ECtHR) has established additional obligations for states, aimed at protecting human rights. One of them is the positive obligation which implies taking measures by the State in order to protect the right to life from the actions of third parties, which are not state bodies. According to the so-called Osman test, when asked to establish whether there has been a violation of Article 2 of the Convention, the Court will examine whether the State was aware of the existence of a real and imminent risk to life, which the State knew or could have known of, and whether the State had undertaken adequate measures to eliminate that risk. The Court's case law also recognizes the principle that the Convention is to be interpreted as a "living instrument", in light of contemporary circumstances. By applying this principle, the Court has expanded the scope of the positive obligation of the State to protect the right to life of persons under its jurisdiction, which is evident in the recent practice of the Court. First, based on the Mastromatteo and Maiorano cases, the Court has established the criterion that there shall be a risk to society, instead of a risk to the life of a specific or at least identifiable person. Then, based on the Bljakaj case, the Court introduced an additional criterion of "a critical moment in the development of events" which the State clearly identified as bearing a risk to human life. Finally, in the case of Kotilainen and Others v. Finland, the Court introduced the criterion of "due diligence". In this paper, the author analyzes the case law of the Court in an attempt to determine the actual limits of the positive obligation to protect the right to life. The author also seeks to establish whether the Court views on the scope of the positive obligation in the recent case law are in line with other previously established principles and positions in the ECtHR jurisprudence. Upon the analysis, the author concludes that the limits of the positive obligation to protect the right to life have already been determined in certain sentences from the Court's judgments. Thus, it is unnecessary to introduce additional and insufficiently specified criteria, which can negatively affect legal certainty and impose an excessive burden on state authorities.

Introduction/Objective. Revascularization in multivessel coronary artery disease (MVD) in patients with ST elevation myocardial infarction (STEMI) is a matter of debate. We sought to compare outcomes between revascularization strategies based on angiographic lesion severity or inducible ischemia. Methods. In prospective study, first ever STEMI patients with MVD, defined as > 70% stenosis in non-culprit vessel, treated with culprit only primary PCI were randomized to: A. Complete revascularization of all nonculprit significant lesions during initial hospitalization; B. Complete revascularization after 30 days, or C. Revascularization based on non-invasive testing for inducible ischemia. The study explored occurrence of major adverse cardio-cerebral events (MACCE) (cardiac death, repeated MI, cerebrovascular event). Results. The study enrolled 120 patients with door to balloon time within appropriate limits (A 51 ± 26 vs. B 47 ± 33 vs. C 44 ± 29 min, p = 0.604) The patients in group A underwent complete revascularization at 6 [4–7] days after primary PCI, while in the group B it was 35 [32–39] days. In group C, 16/43 (37.2%) patients underwent PCI at 82 [66–147] days after infarction (p < 0.001). The patients were followed for 2.7 ± 0.8 years. The events occurred less frequently in patients that underwent planned complete revascularization compared to those who underwent ischemia testing (7.8 vs. 20.9%, p = 0.040). Kaplan–Meier analysis favored complete delayed revascularization (MACCE A 8.8 vs. B 6.9 vs. C 20.9%, log rank p = 0.041). Conclusions. Planned, angiography guided, complete revascularization after initial event may be favorable strategy compared to single stress test for MVD in STEMI.

Background/Aim. Percutaneous coronary interventions (PCI) in bifurcation lesions having more than 50% stenosis of both the main branch (MB) and the side branch (SB) remain challenging. Measurements of the vessel diameters and angles using quantitative coronary angiography (QCA) software have been used in evaluating PCI outcomes. We investigated potential effects of provisional stenting of the MB on SB coronary blood flow by determining quantitative vessel parameters in “true” non-left main coronary bifurcation lesions using conventional two-dimensional QCA. Methods. The study was prospective and conducted in a highvolume university PCI center. Study included patients with “true” native coronary artery bifurcations (Medina 1.0.1; 0.1.1; 1.1.1) treated with “provisional” stenting of the MB. Patients were excluded from the study if having left ventricular ejection fraction of less than 30%, having renal failure with creatinine clearance below 30 mL/kg/m2 or bifurcation lesions within the culprit artery causing myocardial infarction, grafted surgically or previously treated by PCI. QCA analysis included measurements of reference vessel diameters (RVD), diameter stenosis (DS) and bifurcation angles. Results. The study included 70 patients with 72 “true” non-left main bifurcations. Most of the bifurcations were located in the left anterior descending (LAD) – diagonal (Dg) territory. Compromise of the SB ostium defined as thrombolysis in myocardial infarction (TIMI) < 3 coronary flow occurred in 17/72 (23.6%) bifurcations. It was treated by either balloon angioplasty only of the SB ostium (9/17, 52.9%) or stent implantation [8/17 (47.1%)]. In a logistic regression analysis, including previously recognized predictors of SB compromise (bifurcation’s angles, RVD, DS and ratio of MB RVD to stent diameter ratio), only MB RVD to stent diameter ratio after PCI remained independent predictor of SB coronary flow compromise after stent implantation in the MB [OR 2.758 (95% CI 1.298–5.862); p = 0.008]. Conclusions. It appears that SB decreased coronary blood flow after “provisional” stenting in “true” non-left main bifurcations is associated with greater MB to stent diameter ratio.

Introduction. Since clinical and electrocardiographic features of various cardiac disorders may overlap, the differential diagnosis of left ventricular (LV) dysfunction may be difficult even for the most experienced physicians. Recent advances in cardiac imaging may help clinicians to establish an accurate diagnosis and initiate adequate treatment. The aim of this case report is to raise awareness of a very short-lasting LV dysfunction during respiratory infections and to underline the importance of multimodality imaging in this clinical setting. Case outline. A previously healthy 37-year-old male presented with atypical chest pain and ST-segment elevation in the inferolateral leads during severe mental stress and acute respiratory infection. Acute myocardial infarction, myocarditis, coronary vasospasm and stress cardiomyopathy were all considered as a differential diagnosis. A rapid onset of severe LV dysfunction and a complete recovery within 4 days was detected by echocardiography and further evaluated by multimodality imaging, including multislice computed tomography and cardiac magnetic resonance imaging. Conclusion. Severe, but very short-lasting LV dysfunction may be triggered by various causes, including upper respiratory tract infections. Since the symptoms of respiratory infections may obscure those of LV dysfunction, myocardial dysfunction in these patients may go undetected with possible serious consequences.

Reopening of criminal proceedings is a legal way to examine the factual basis of a final judgment based on an extraordinary legal remedy. The examination of the factual basis of the final judgment is initiated by the submission of a request for reopening the proceedings. This extraordinary remedy was established with the aim of establishing the truth in the criminal procedure, and is contrary to the principle of ne bis in idem. The factual deficiencies of a final judgment are remedied on the basis of new, or newly discovered facts, or evidence that arose after the finality of the judgment. Article 473 of the Criminal Procedure Code envisages the reasons for repeating the criminal proceedings. They can be grouped in various ways. One of the groups includes new facts and evidence, as a reason for repeating the proceedings. First of all, there are new facts and evidence that per se or in concert with other evidence may lead to a acquittal, or a repudiation judgment, or condemnation on a more lenient law (Article 473, para. 1, point 3 of the CPC). This group also includes new facts and evidence indicating that the defendant did not commit any of the actions of an extended criminal offense, or other offence, which includes several acts (Article 473, para. 1, point 5 of the CPC). The new facts and evidence, which would lead to a milder criminal sanction, are another reason that we classify in this group (Article 473, para. 1, point 6 of the CPC). Finally, there are also new facts and evidence that the defendant was not properly summoned for the main trial, which was held in his/her absence (Article 473, para. 1, point 7 of the CPC). Compared with the procedural laws of other states, our CPC provides a lot of grounds for reopening the procedure. In this way, an adequate legislative framework was provided for making a more favorable decision on the defendant in the procedure for this extraordinary legal remedy. Although the envisaged grounds for reopening criminal proceedings constitute a satisfactory basis for instituting proceedings under this extraordinary legal remedy, further clarification de lege ferenda is necessary. Our procedural law prohibits reopening criminal procedure to the detriment of the defendant. The prescription of the repetition of the proceedings to the detriment of the defendant, in some future revision of the procedural code, would not be contrary to the Constitution, except that, in the case of the merits of the request, the outcome would have been the adoption of the declaratory judgment. There are also interpretations that the Constitution allows both the conduct of the proceedings and rendering the decision at the detriment of the defendant in the procedure for extraordinary legal remedies. In that case, in the future, a reduced number of grounds for reopening the proceedings should be envisaged at the detriment of the defendant.

The subject of the authors' attention is the principle of ne bis in idem in the penal law of the Republic of Serbia. In this work the authors analyse positive laws in order to answer the question in which cases the repetition of sentencing is forbidden. In connection with this, international documents governing this principle, as well as the Constitution of the Republic of Serbia are analysed. Apart from that, the authors critically analyse the provisions of the current penal laws which govern this principle, which are the Criminal Procedure Code, the Misdemeanour Law and the Law on Economic Offenses. In the paper all the vague and contradictory provisions of the laws in this domain are highlighted, but concrete de lege ferenda solutions are proposed as well. The accused against whom a criminal procedure is completed for one punishable act has to be certain that the procedure will not be repeated against him for the same act. Therefore, one of the basic principles of modern penal law is the prohibition of repeated sentencing for the same punishable act. Considering that crimes, misdemeanours and economic offenses belong to penal law, it is common in practice that after the completion of a procedure for one punishable act, a procedure begins for a second punishable act. This means that when a criminal procedure has not proven that the accused has committed a crime, the prosecutor will next initiate a misdemeanour procedure in which he will attempt to prove that the accused has attempted a misdemeanour, or vice-versa. Similarly, the same case exists when economic offenses, the third category of crimes are in question. In connection with this, if there is no prohibition from repeated sentencing for the same or other punishable act, then there is no legal security in penal law. The Constitution of the Republic of Serbia states clearly: 'No person may be prosecuted or sentenced for a criminal offence for which he has been acquitted or convicted by a final judgment for which the charges have been rejected or criminal proceedings dismissed by final judgment, nor may court ruling be altered to the detriment of a person charged with criminal offence by extraordinary legal remedy. The same prohibitions shall be applicable to all other proceedings conducted for any other act punishable by law.' On the other hand, the Misdemeanour Law allows the initiation of a procedure despite the fact that a criminal procedure has previously been led, and the same solution is prescribed when a procedure for an economic offence was previously led. A similar provision is prescribed by the Law on Economic Offenses. In this way the principle of legal security is infringed upon because the accused is not certain whether the prosecutor will initiate a procedure for a different punishable act, which is, according to our opinion inadmissible. We believe that it is necessary to change the legal provisions highlighted in the work, in order to prevent multiple procedures to be led for the same punishable act and to provide legal security in penal law.

Introduction. Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce. Objective. We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center. Methods. A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients’ status was assessed by an office visit or telephone interview. Results. Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n=217). Groups had similar total ischemic time (319 ± 276 vs. 333±372 min; p=0.665), but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p15, as a marker of severe diastolic dysfunction (TA+ 23.1% vs. TA- 15.2%; p=0.050). During average follow-up of 14Ѓ}5 months, major adverse cardiac/ cerebral events occurred at the similar rate (log rank p=0.867). Conclusion. Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn’t influence the incidence of major adverse cardiovascular events. [Projekat Ministarstva nauke Republike Srbije, br. 175099]

Introduction. Adherence to proposed lifestyle changes and prescribed medication in patients with stable coronary artery disease (SCAD) is poor. Objective. We sought to investigate the influence of adjusting guideline proposed medications on relief of angina in a large group of patients with SCAD in Serbia. Methods. The study included a total of 3,490 patients from 15 cardiology clinics with symptoms of stable angina and at least one of the following criteria: abnormal electrocardiogram (ECG), history of myocardial infarction (MI), positive stress test, significant coronary artery disease on coronary angiogram or previous revascularization. All the patients underwent comprehensive evaluation at initial visit and after two months. The relief of angina was study end-point defined as any reduction in Canadian Cardiology Society (CCS) class, number of angina attacks per week and/or number of tablets of short-acting nitrates per week. Results. Most patients were included based on abnormal ECG (48.4%). At Visit 1, the average number of prescribed classes of medications to a single patient increased from 4.16 ± 1.29 to 4.63 ± 1.57 (p < 0.001). At the follow-up, the patients had significantly lower blood pressure (141 ± 19 / 85 ± 11 vs. 130 ± 12 / 80 ± 8 mmHg; p < 0.001) and most of them reported CCS class I (63.3%). The average weekly number of angina attacks was reduced from 2.82 ± 2.50 at Visit 1 to 1.72 0 ± 1.66 at Visit 2, as well as average weekly use of short-acting nitrates to treat these attacks (2.69 ± 2.53 to 1.74 ± 1.47 tablets; p < 0.001 for all). Conclusion. Adjustment of prescribed medications to guideline recommendations in a large Serbian patient population with prevalent risk factors led to significant relief of angina.

The authors emphasize that violence in sport can be defined as a violation of the rules of the sport, along with causing damage, where such a behavior does not aspire to achieving the goal of sport. The phenomenon of violence in sport is also known in ancient times, when they were held gladiator fights. At the same time, violence in sport was observed in all epochs, but a systematic study of sports violence occurs only in the second half of the twentieth century. Neither Serbia was not an exception to the exercise of violence at sporting events. The first recorded case of violence in sport took place in 1936 in Zemun. However, an organized response of the state in the form of adoption of a special law to regulate this type of crime violence occurred only in 2003 - then the Act on the Prevention of Violence and Misbehavior at Sports Events. After that, the authors analyses the international documents on prevention of violence in sport, as well as the domestic legal framework. Furthermore, the authors analyzed data on criminal offense of violent behavior at sports events at the level of the Republic of Serbia and the city of Niš. The time frame of the research is limited to the period from 2010 to 2012, since before 2010. The Republic Statistical Office has not kept separate records of this criminal act, but it is counted in the so-called 'other offenses'. During the processing of data on the number of entries, prosecuted or convicted of offenses of violent behavior at sports events used a statistical method. The results of empirical research, which covers the area of High public prosecutor and High Court in Nis, indicating mild penal policy towards the perpetrators of violence at sporting events, avoiding the application of criminal prosecution conditional delay institute. In addition, the possibility of being subjected to psychosocial treatment, in order to eliminate the causes of violent behavior, in general, does not exist. The court reprimand like the mildest sanction dominates in the range of sanctions imposed. Bearing in mind that the offense of violent behavior at sports events includes elements of violence, according to the perpetrators is expedient to react by imposing certain specific obligations, for example the inclusion of individual or group treatment in a health institution or counseling. Bearing in mind that one of the educational orders, by its content, is identical to the above mentioned special obligation, it is also possible to apply these measures sui generis to minors.

The subject matter of criminal proceedings (the criminal subject matter) is determined by the indictment raised by the authorized prosecutor. This is a direct consequence of the application of the accusation principle, whose essence is embodied in the old Latin maxim: nemo iudex son actore. The subjective and objective identity of judgment and indictment must be correlated. The subjective identity means that the judgment may refer only to the person who has been identified in the indictment. The objective identity indicates that the factual grounds provided in the indictment must be identical with the factual grounds specified in the criminal court judgment. It implies the substantive element (i.e. identical factual grounds) of the judgment and indictment, whereas the formal element does not have to be present because the court is not bound by the prosecutor's legal qualification. The legislator sets out clear limitations by stipulating that the verdict shall refer only to the person and to the specific criminal offence which is specified in the submitted indictment or court-amended indictment modified in the course of trial proceedings (Article 420, paragraph 1 of the CPC). In compliance with the mutatis mutandis principle, the prosecutor has the authority to modify the indictment in the course of trial if the defendant is established to have committed a different criminal offence than the one which he has been charged with. The question of subjective and objective identity is one of the most complex criminal procedure issues both in legal theory and in judicial practice. According to an earlier theoretical conception, identity exists if the judgment is related to the same past event. The supporters of a narrower (stricto sensu) conception assert that identity exists if the subject matter of a judgment is a different criminal offense in relation to the one the defendant has been charged with; hence, identity does not exist if there is another offense. The recent procedural theory has yielded the factual grounds theory which entails the most rigid interpretation of the judgment and the indictment correlation. In the statement of facts, the prosecutor lays down the factual grounds for the indictment which must remain the same in the judgment. This link between the judgment and the indictment provides for the effective exercise of the defendant's right to defense in criminal proceedings. As a matter of fact, the right to defense is the key to solving the dilemma about exceeding the scope of indictment. The scope of indictment may be exceeded if the court alters the facts contained in the indictment and enters a different set of fact in the judgment, thus endangering the defendant's right to defence. In resolving the dilemma whether the scope of indictment has been exceeded, the governing premise is that the court is bound by the factual grounds specified in the indictment, but it is not bound by anything that falls within the scope of legal qualification. Taking into account these two pivotal points, the author concludes that the examination of the exceeded scope of indictment would largely facilitate the decision on this procedural issue, which is a stumbling block in jurisprudence.

Background/Aim. Long-term intensive training is associated with distinctive cardiac adaptations which are known as athlete’s heart. The aim of this study was to determine whether the use of anabolic androgenic steroids (AAS) could affect echocardiographic parameters of left ventricular (LV) morphology and function in elite strength and endurance athletes. Methods. A total of 20 elite strength athletes (10 AAS users and 10 non-users) were compared to 12 steroid-free endurance athletes. All the subjects underwent comprehensive standard echocardiography and tissue Doppler imaging. Results. After being indexed for body surface area, both left atrium (LA) and LV end-diastolic diameter (LVEDD) were significantly higher in the endurance than strength athletes, regardless of AAS use (p < 0.05, for both). A significant correlation was found between LA diameter and LVEDD in the steroid-free endurance athletes, showing that 75% of LA size variability depends on variability of LVEDD (p < 0.001). No significant differences in ejection fraction and cardiac output were observed among the groups, although mildly reduced LV ejection fraction was seen only in the AAS users. The AAS-using strength athletes had higher A-peak velocity when compared to steroidfree athletes, regardless of training type (p < 0.05 for both). Both AAS-using and AAS-free strength athletes had lower e’ peak velocity and higher E/e’ ratio than endurance athletes (p < 0.05, for all). Conclusions. There is no evidence that LV ejection fraction in elite athletes is altered by either type of training or AAS misuse. Long-term endurance training is associated with preferable effects on LV diastolic function compared to strength training, particularly when the latter is combined with AAS abuse.

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

The main characteristic of the new Code of Criminal Procedure, 2011, which is based on adversial principle, is changed position of the main subjects. The public prosecutor gets more active role. It is head of the pre-investigative procedure and the investigation. At trial, the role of the parties emphasized, while the role of the court passivated. The Court adjudicate and manage the process, while in the presentation of evidence, for the proper and complete determination of the facts, his role significantly diminished. The court is not obliged ex officio to determine the truth, and the principle of truth is omitted from the basic principles of criminal procedure. Evidentiary initiative is, largely, up to the parties, while the court granted subsidiary role. Basis of the work is the thesis that the Code of Criminal Procedure from 2011, based on the truth principle, which is also the goal of the procedure. In fact, while working on the development of the legal text, and after of the adoption, to the beginning of its application in full range, in professional community there were lots of papers, which cast doubt on the principle of truth existence, in the currently valid procedural law of Serbia. Although this principle is not actually explicitly stipulated in the text of the new CPC, the author proves his existence by analyzing of certain provisions of the law, which has significantly altered the position of the main criminal procedural subjects, in terms establishing the facts in criminal proceedings. The author argues that the truth about a criminal matter remains the highest goal of the procedure, despite the fact that the concept of criminal proceedings is set on the adversial model od criminal proceedings.

Violence against children is often designated as the worst form of domestic violence, and violence in general. Such a conclusion is a result of multiple factors: children's age and vulnerability, the distinctive features in their physical and mental development which makes them inferior to adults, the kinship (blood relations] and emotional bonds between parents and children, etc. The positive trend in the evolution of the social response to violence against children is reflected in the effort to discover and prevent the abuse, to punish the offenders and to protect the child/victim from secondary victimization during the criminal proceedings. In the Republic of Serbia, the procedural measures governing the protection of juvenile victims/witnesses are set out in Part III of the Juvenile Justice Act (Act on the Juvenile Offenders and Criminal Law Protection of Minors]. However, it was soon evident that there was a need to provide a better legislative framework than the one envisaged in this Act, particularly in terms of ensuring a better protection of minors in the course of criminal proceedings involving children who are victims of abuse and neglect. For this purpose, in 2004, the legislator adopted the National Action Plan on Children in Adversity. This document envisaged the adoption of the General Protocol on the protection of children from abuse and negligence, as well as the adoption of subject-specific protocols which would further regulate the specific procedures for the protection of children-victims in particular social circumstances (health, education, justice] by different social institutions (police, social services]. In this paper, the author analyses the legal framework governing the procedural protection of juvenile victims in the course of criminal proceedings. In addition, the author also explores the statutory provisions (by-laws] adopted in order to establish specific standards and ensure a higher level of protection of juvenile victims against abuse and neglect. In the final part of this paper, the author analyzes the issues pertaining to the practical implementation of the envisaged legislative framework on the procedural protection of juvenile victims. The author concludes that the envisaged measures are insufficiently applied in practice. For this reason, the judicial authorities should be further encouraged to use them more frequently and more efficiently in the course of criminal proceedings.

Background/Aim. In order to reduce the risk of cerebrovascular insults (CVI), the latest recommendations suggest that carotid endarterectomy (CEA) is strongly indicated in patients scheduled for coronary surgery when significant carotid artery stenosis is symptomatic and/or bilateral. The best results are obtained in small studies with CEA performed immediately prior to off-pump coronary bypass (OPCAB). We present 16 consecutive patients who underwent synchronous CEA and OPCunder general anesthesia combined with high thoracic epidural anesthesia (TEA) in order to evaluate the safety and potential benefits of such anesthetic management. Methods. A total of 16 consecutive patients scheduled for simultaneous CEA and OPCwith no contraindication for TEA were enrolled in the study. All the patients were anesthetized with TEA combined with general anesthesia. Early extubation was planed in all the patients for early assessment of neurological outcome. Demographics, comorbidity, quality of postoperative recovery, duration of mechanical ventilation, successful early extubation, outcome, length of Intensive Care Unit (ICU) and hospital stay were recorded. Results. Only two patients did not fulfill the criteria for early extubation. The average duration of mechanical ventilation for patients who fulfilled criteria for early extubation was 87.9 ± 85.0 (0-255) min. Five (31.25%) patients were extubated in the operating theater at the end of surgery. There were no deaths, nor neurological complications of TEA. Seven (43.7%) patients had at least one of the postoperative complications considered significant. None of them had CVI. None of the early extubated patients was reintubated or had postoperative respiratory failure. Conclusion. Our study revealed that a combination of general anesthesia with TEA appears to be good choice in synchronous CEA and OPCdue to advantages of early extubation and early neurological assessment. Larger studies are necessary to determine real benefits on both short and long-term outcomes of such anesthetic management in synchronous CEA and OPCAB.

Background/Aim. Nipple discharge syndrome is a clinical entity capable of presenting various disorders such is mammary infection (nonpuerperal and puerperal mastitis), intraductal papillomas, fibrodenoma, breast cancer and hyperprolactinemia syndrome. The aim of the study was to determine differencies in cytological features of mammary secretion in patients with hyperprolactinemia and those with normal serum prolactin levels and to define the role of growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone in creating cellular profile of breast secretion. Methods. The study included 50 patients with nipple discharge syndrome. The patients were devided into the clinical group (27 patients with hyperprolactinemia and nipple discharge) and the control group I (23 patients with normal serum prolactin and nipple discharge). The control group II included the patients of the clinical group achiving normalised serum prolactin levels after the treatment of hyperprolactinemia. Serum prolactin, follicle-stimulating hormone and luteinizing hormone levels were assessed by RIA using commercial kits IRMA hPRL, hLH and hFSH, (INEP, Zemun, Serbia) while serum growth hormone and thyroid-stimulating hormone levels were assessed by RIA using commercial kits LKB-wallac. Cytologic evaluation of samples, taken from all the patients with mammary secretion, was done using standard techniques of staining Haemathoxilin-eozine and May- Grünwald/Giemsa. Results. Our results showed a significantly higher presence of lipid and protein material in clinical group, in comparison with the control group I (p < 0.01). Also, our data demonstrated significantly higher number of ductal epithelial cells (p < 0.05) and ductal histiocities (p < 0.001) in the clinical group, compared with the control group I. Macrophagies frequency was proportionally higher in clinical group (44.44%) compared the control group I (17.39%). Erythrocites were significantly lower in the clinical group (p < 0.001) than in the control group I. Significantly decreased mammary secretion (p < 0.01), lower lipid (p < 0.01) and protein synthesis (p < 0.01), and less presence of all cellular categories (p < 0.01) were obtained after normalization of serum prolactin levels. Conclusion. Growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone did not show significant influence on creating cytological features of mammary secretion. The most expressive role, hyperprolactinemia demonstrated in the domain of mammary ductal secretory activity, making mammary secretion reach in lipid and protein material and simultaneously increasing number of ductal epithelial cells, ductal histiocytes and 'foam cells'- macrophages. These cytological findings indicate that hyperprolactinemia promote periductal and intraductal steril inflammation which withdraws after serum prolactin normalization.

Background/Aim. Mammary phyllodes tumors (MPT) are uncommon fibroepithelial (biphasic) neoplasms whose clinical behavior is difficult to predict on the basis of histological criteria only. They are divided into benign, borderline malignant and malignant groups. Sometimes it appears difficult to distinguish these tumors from other types of soft tissue sarcomas. Because of the relatively scant data on the role of biological markers in MPT histogenesis, we have decided to undertake the following study, trying to shed more light on the issue by investigating the following elements that make up MPT: their histological patterns, biological behavior, enzymohistochemical, histochemical and immunohistochemical characteristics (ICH) together with the mast cell analysis. Methods. We examined the biopsy material of 35 MPT in our laboratory. Enzymohistochemistry was performed on frozen sections (method of Crowford, Nachlas and Seligman). The used methods were classical hematoxylin-eosin (H&E); histochemical Massontrichrome, Alcian-blue, Periodic acid Schiff and immunohistochemical LSAB2 method (DacoCytomation). Ki-67, ckit, vimentin, estrogen receptor (ER), progesterone receptor (PR) and Her-2 oncoprotein immunohistochemistry was performed on all tumors. Results. The patients were ranged per age from 30-62 years (mean 43.3 years, median 39 years). A total of 35 cases of MPT were included: 20 benign (57%), 6 borderline malignant (17%) and 9 malignant (26%). Twenty-two patients (62.8 %) underwent segmental mastectomy, while 13 (37.2%) had total mastectomies. Twenty-eight patients had negative surgical margins at original resection. The mean size of malignant MPT (7.8 cm) was larger than that of benign MPT (4.5 cm). Significant features of the malignant MPT were: stromal cellularity, stromal cellular atypism, high mitotic activity, atypic mitoses, stromal overgrowth, infiltrative tumor contour and heterologous stromal elements. Benign MPT showed strong enzymohistochemical Leucine Amino Peptidase (LAP) activity in both epithelial and stromal components while it was weak or absent in the epithelial parts of the malignant tumors. Acid mucopolysacharides were present in the stromal component of all types of these tumors. Benign MPT had a lower Ki-67 than did borderline malignant MPT (4 versus 28). Malignant MPT had a greater than 8-fold higher Ki-67 activity than did benign tumors (35 versus 4). Intracytoplasmatic c-kit expression was associated with a pathological diagnosis of malignant MPT, correlating with increasing grade (p < 0.05). In hypercellular stroma of borderline malignant and especially malignant forms of MPT, high activity of ER in mast cells was confirmed. Oncoprotein Her-2 activity, mostly in epithelial components, correlated with the degree of malignant progression of MPT (p < 0.05). Conclusion. Besides the well-known malignant features additional parameters have been found to be high Ki-67 and ckit stromal expressions, and weak LAP activity in the epithelial part of malignant MPT, as well as mast cells with a high expression of ER.

Background. Granular cell tumor (GCT) is a rare variant of mammary tumor beset with diagnostic dilemmas that may be resolved by using numerous, very complex, enzymohistochemical and immunohistochemical methods. Case reports. We reported three female patients 16, 21 and 65 years old, operated on for mammary tumor at the Surgical Clinic of the School of Medicine in Niš, over the period of thirty years, 1977 to 2007. During this period 14.022 mammary tumors were diagnosed, including these three cases. These tumors had benign characteristics, without associated tumors in other localizations. A typical histological feature of GCT was a granular cytoplasm in large ovoid cells, organized like nests or like a trabecular arrangement. The tumors were analyzed by sets of histochemical, enzymohistochemical, immunohistochemical methods as well as ultrastructural examination. Protein, S-100 neuron-specific enolase and vimentin expressed a diffuse and intensive immunohistochemical activity, while expression of estrogen and progesterone receptors, as well as HER-2 oncoprotein was negative. The ultrastructural analysis confirmed that the tumor cells were enriched by lysosomes and consequential disorganization of cytoplasm. Conclusion. The reported enzymo- and immunohistochemical combined methods provide a precise diagnosis and confirm the GCT's neural origin, which has been disputed for years.

Ceruminous gland tumors are infrequent lesions of the external auditory canal (EAC). Controversy exists regarding several aspects of these tumors. In this report we presented a case of 63 years old woman with an 8-year history of a painless mass in the left EAC. Physical examination showed a skin-covered mass, occupying all its lumen. First superficial biopsy led to an initial erroneous diagnosis of papilloma. Local wide resection of the lesion was performed one month later. Histological examination revealed a lesion composed of solid nests and papillomatous and cystic glands surrounded by a hyaline sheath. Immunohistochemically, two different cell layers were demonstrated: a luminal epithelial cell layer with positive staining with cytokeratin 7 (CK7) and an outer myoepithelial cell layer, with positive staining with actin and S-100 protein. The proliferative index (Ki-67) was very low. The diagnosis was ceruminous gland adenoma. Two years after the operation, the patient is in good health and with normal ultrasound and laboratory results. We believe that conservative surgery seems to be ideal treatment in case of ceruminous adenoma.

Coeliac disease (CD) is an immune-mediated systemic disorder mostly presented in the form of small intestine enteropathy caused by gluten and related prolamins intake, from cereals such as wheat, barley, and rye. The diagnosis of CD is currently based on clinical presentation, pathohistological evaluation of the small intestine biopsies and positive serology. The aim of our study was to investigate histological abnormalities in the villous architecture of the duodenal bulb and postbulb segment in patients diagnosed with CD and in those biopsies sent for examination but the diagnosis was not confirmed. Morphometric analysis was performed on 35 duodenal samples obtained from patients with the initial clinical diagnosis of CD while some patients had dyspepsia as a primary diagnosis. The obtained data of villus width measured in the bulbar and postbulbar part of the duodenum were found to be statistically significantly different (p = 0.0226). The width of the duodenal villi in the bulbar part was significantly thicker than the one in the postbulbar part, while the value of the villous height at the examined places was not statistically significant. Also, none of the cases in this study showed any extensive abnormalities in villous architecture. Besides pathohistological examination which remains the gold standard in diagnosing, morphometric analysis may also be helpful in the detection of the latent forms of this entity. Having in mind that the chronic persistence of this disease may indicate various systemic dysfunction, long-term follow-up of these patients is necessary. [ABSTRACT FROM AUTHOR]

Selenium (Se) is an essential trace element. Depending on concentration, Se can manifest both beneficial and harmful effects on the cell and can have both oxidative and antioxidant effects. Because the therapeutic index for Se is very narrow and it can depend on the form of Se used, we aimed to investigate the potential safety and side effects of inorganic Se on kidney function and structure in rats. After 8 days of treatment, no detectable signs of microscopic changes or oxidative stress in kidney tissue were observed. We detected a moderate increase in urea and creatinine levels in the blood as a sign of a slight decrease in kidney function. The most notable changes in our study were morphometric alterations in proximal tubules and glomeruli, both of which were considerably enlarged. The short-term application of inorganic Se to rats in a supratherapeutic dose induced mild functional and ultrastructural changes in the kidneys. The dose of inorganic Se used could be considered relatively safe for short-term application in situations where Se could be beneficial to the organism, such as the usage of known nephrotoxicants or high levels of oxidative stress in the body. [ABSTRACT FROM AUTHOR]

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The technical complexity of gene expression profiling in routine practice has necessitated the use of surrogate molecular classification of breast cancer, based on immunohistochemical analyses. Background and objectives: The aim of this study was to compare the differences between histological and molecular subtypes of invasive lobular carcinoma (ILC) of the breast, in order to be able to predict the behavior and prognosis of the disease, as well as to effectively determine therapy. Material and Methods: This study included 263 cases of breast ILC diagnosed over a seven-year period. The diagnosis of invasive lobular carcinoma is based on the characteristic growth pattern and phenotype of cancer cells with the respective subtypes: classic, alveolar, solid, tubulolobular, pleomorphic and mixed lobular type. The examined cases were divided into five groups according to molecular classification based on the expression of ER, PR, HER2 and Ki67 immunohistochemical markers. Results: It was found that the pleomorphic subtype occurred statistically significantly less often as the luminal A subtype compared to others (p = 0.00027), and the HER2-enriched subtype occurred statistically significantly more often in the pT4 stage (p = 0.024). Conclusions: The results of this study significantly singled out the luminal A subtype, and among them classic ILC, as the subtype with the most favorable expression ratio of the investigated predictive/prognostic immunohistochemical markers. [ABSTRACT FROM AUTHOR]