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Background/Aim. The incidence of nodular thyroid dis-ease increases significantly with age as well as the incidence and aggressiveness of thyroid cancers. The aim of the study was to determine whether thyroid surgery for geriatric patients is safe in a short hospital stay surgery set-ting. Methods. In this retrospective study, medical histories of all operated geriatric patients (65 years and older), in whom a total thyroidectomy (TT) or hemithyroidectomy (HT) was performed from January 2012 to December 2018, were analyzed. A total of 976 patients were operated on for thyroid diseases in the mentioned period, out of which 247 geriatric patients fulfilled the inclusion criteria. Patients with thyroid reoperations and simultaneous neck lymph node dissections were excluded from the study. The geriatric patients were divided into two groups: the HT group (33 patients) and the TT group (214 patients). Each of these two geriatric groups, HT and TT, had two additional paired control groups. Control group I consisted of younger subjects from 20–44 years, and control group II included middle-aged subjects from 45–64 years. Results. All three TT groups – geriatric, control I, and control II, had 214 patients each, and all three HT groups had 33 patients each. In all three HT groups, the average hospital stay was 24 hrs, while in the TT geriatric group, 150 (70.1%) of 214 patients spent 24 hrs at the hospital. In the geriatric population, the incidence of neck swelling and in-creased drainage output were higher compared to both control groups, and thus the need for longer hospitalizations. When the age was compared, it was shown that sub-jects with each subsequent year of intervention had a 22% lower chance of developing complications, and regarding the pathohistological finding, benign thyroid hyperplasia was less likely to develop complications compared to malignant hyperplasia. Conclusion. According to the study, TT can be safely performed within the concept of a short hospital stay in patients under 65 years, while in the elder-ly, hospitalization days may be extended due to more frequent surgical and nonsurgical complications. Speaking of HT, the short hospital stay is safe for all age groups.

Background/Aim. Health indicators provide comparable in-formation relevant to defining health goals. The aim of this study was to perform a forecasting analysis of the selected indicators, which could help anticipate the future necessities in the health economy and prevent the problems that would predictively grow in the future. Methods. Health indicators are collected from publicly available databases of the World Health Organization and Eurostat. We used the quantitative forecasting technique, commonly used for historical data, to predict several years in the future concerning selected health- and economy-related indicators. Results. Total health expenditures as a percentage of gross domestic product (GDP) by 2025 will increase in most of the 17 surveyed countries. The percentage of direct household budget payments (out-of-pocket) for health services will decrease in half of the countries, while values of GDP expressed in US$ will increase significantly com-pared to the last surveyed year (2017), except in Greece. The infant mortality indicator shows that the numbers will decrease in each surveyed country, while the urban population percent-age will rise almost in each country except Estonia. Life expectancy will increase in each surveyed country. Conclusion. Health- and economy-related indicators must be monitored over time, as they provide significant information concerning the relevant issues in the health care system. Moreover, they may indicate changes that should be made in order to accomplish progress in each individual country.

Background/Aim. Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors and a leading cause of cancer-related deaths. The aim of this study was to assess the impact of biological markers on the overall survival rate in surgically treated NSCLC patients who received adjuvant chemotherapy and/or radiation therapy. Methods. This retrospective case series study included patients with NSCLC treated in the period between 2008 and 2017 at the Pulmonology Clinic and the Clinic for Chest Surgery, Military Medical Academy, Belgrade, Serbia. The survival analysis performed was based on immunohistological findings, histology type, and tumor, node, metastasis (TNM) stages. Results. The mortality rate was higher in the adenocarcinoma patient group compared to the squamous cell carcinoma group, albeit without statistical significance (58.3% vs. 31.2%, respectively; p = 0.175). Overall survival was shorter in the adenocarcinoma patient group compared to the squamous cell carcinoma group by approximately 750 days. Likewise, overall survival was shorter in the adenocarcinoma patient group compared to the squamous cell carcinoma group for CD31 positive (p = 0.029), p-63 positive (p = 0.049), MMP-9 positive (p = 0.032), and matrix metalloproteinase (MMP)-2 positive patients (p = 0.016). Conclusion. Adenocarcinoma is a more aggressive cancer type compared to squamous cell carcinoma with shorter overall survival. Our research showed a poorer overall survival in the adeno-carcinoma group of patients compared to the squamous cell carcinoma group in CD31, p-63, MMP-9, and MMP-2 positive patients.

Background/Aim. The key to successful anterior cruciate ligament reconstruction lies in the proper positioning of the femoral tunnel within the anatomical footprint and in providing for an adequate length of this tunnel without perforation to the lateral cortex. The aim of this study was to determine the change in the length of the femoral tunnel drilled during anatomic anterior cruciate ligament (ACL) reconstruction, depending on: the position of the limb being operated on, the degree of knee flexion, as well as the angle between the drill and the medial aspect of the lateral condyle. Methods. This study was performed on 16 cadaveric knees (6 male and 10 female) of the average age of 83. After the subcutaneous tissue was dissected, the femoral insertion of the ACL was identified. Then, 18 tunnels were drilled through the center of the femoral insertion with the help of 2 mm thick Kirschner wires. This was performed in two stages. In the first phase the leg was positioned on an arthroscopic leg holder, while in the second phase the leg was positioned on the table. In each phase the knee was placed in three different flexion positions (110°, 120° and 130°) and for each position three tunnels were drilled (70°, 60° and 50°) in relation to the medial aspect of the lateral condyle. Results. The average length of the femoral tunnel drilled with the leg positioned on the operating table (36.6 ± 4.7 mm) was highly statistically significantly greater (p = 0.000) in comparison with the length of the femoral tunnel obtained by positioning the leg on a fixed arthroscopic leg holder (35.4±4.3 mm). The greatest lengths of the femoral tunnel were obtain with the leg flexed at 130º and the reamer positioned at 50º angle in relation to the medial aspect of the lateral condyle (43 mm on the operating table and 41 mm on a fixed leg holder), while the shortest tunnel (33 mm on the operating table and 31 mm on a fixed leg holder) was obtained with the lower leg flexed at 110º and the reamer positioned at a 70º angle. Conclusion. The optimal position of the leg on a fixed leg holder for obtaining a femoral tunnel of sufficient length requires lower leg flexion of 120º and the position of the medial portal which enables the positioning of the reamer at a 60º angle in relation to the medial aspect of the lateral condyle. With the leg positioned on the operating table, it becomes unnecessary to push the leg into flexion greater than 110º; rather a longer femoral tunnel is achieved by lateralization of the medial portal.

Introduction. Anorectal melanoma (ARM) is a rare and aggressive neoplasm with predisposition for early infiltration, distant spread, and unfavorable prognosis. It has been speculated that Malassezia yeasts could possibly have an impact on skin carcinogenesis and development of melanoma, especially in patients with seborrheic dermatitis (SD), due to production of aryl hydrocarbon receptor (AhR) agonists. Case Outline. A 52-year-old man with intensive SD complained of a four-month-long rectal bleeding, tenesmus, pain, and difficulty during defecation. On examination, a rectal tumor was detected and histopathology of tumor tissue revealed ARM with positive protein S100, melanoma antigen HMB45 and melan-A expression. After the diagnosis was established, abdominoperineal resection of the anus and rectum was performed, since the tumor was large, obstructive, and the anal sphincter was invaded. Conclusion. Because of the possible impact of intensive SD to the cross-link between Malassezia yeasts AhR agonists and skin carcinogenesis, we discussed on this matter and reviewed the literature data regarding ARM. In addition to “pathogenic” and “non-pathogenic” Malassezia subtypes based on AhR agonist production, future studies on Malassezia metabolites, their carcinogenic effect in the skin and development of melanoma are needed. If the cross-link between Malassezia AhR agonists and skin carcinogenesis exists, timely prevention of ARM could be done with Malassezia eradication, especially in patients with severe SD. [Projekat Ministarstva nauke Republike Srbije, br. OI 175034]

Introduction. Extragonadal intraperitoneal teratomas are very rare, especially those arising from mesentery and mesocolon. In the contemporary literature only 22 cases of such tumors have been published and described. Case Outline. We report a case of a 52-year-old woman with a benign cystic teratoma of the mesosigmoid. The patient presented with mild clinical signs of intestinal obstruction. Computerized tomography of the pelvis and abdomen showed a large 9.7 × 8.9 × 9.4 cm calcified tumor in the lower part of the left hemiabdomen. Extraluminal obstruction was verified by colonoscopy at 35 cm from the anal verge. Intraoperatively, a cystic calcified tumor of the mesosigmoid was found causing extraluminal obstruction of the left colon. The tumor was extirpated and a partial resection of the adherent great omentum was performed. The histopathological examination revealed a benign cystic teratoma. Conclusion. Considering the fact that mesenteric teratomas are extremely rare tumors, it is difficult to designate a general conclusion for an adequate treatment of patients suffering from them. Complete surgical excision is indicated in order to establish a correct histopathological diagnosis and to relieve the patients of symptoms.

Introduction. Colonic lipomas are relatively common but they rarely progress to complete acute obstruction. Case Outline. We report a case of a 67-year-old woman with acute intestinal obstruction caused by a large pedunculated lipoma of the ileocecal valve. Preoperatively, the patient presented acutely with clinical and radiographic signs of small intestine ileus. A right hemicolectomy with subsequent terminolateral ileocolostomy was performed. The histopathological examination revealed a benign lipoma of the ileocecal valve which telescoped into the cecum and caused ileocolonic intussusception. The postoperative course was uneventful and the patient was free of symptoms during a 12-month follow-up period. Conclusion. Since these benign tumors are frequently revealed by laparotomy and the definitive diagnosis is made on the basis of histopathological examination, we can conclude that extensive resections of the large intestine are justified in cases with acute clinical presentation.

Aim: In this study we want to point out the existence and significance of skip metastasis of rectosimoid cancer. Material and methods: Seventy patinents with verified rectosigmoidal adenocarcinoma, treated in 5- years period, are included in this study. Diagnose was made upon physical examination, barium enema, rectosigmoidoscopy with positive biopsy and finding of isolated lymph node metastasis. Results: Skip metastasis were found within 6 patients (8.6%); 4 of them were males and 2 females, with average age 67 years. Overall, 13 metastasis were isolated; one patient had them 3 and five patinets had 2 skip metastasis. Conclusion: Radical lymphadenectomy of patinets with rectosimoidal cancer requires dissection of lymph nodes along inferior mesenteric artery and its legation on origin, as much as dissection of paraaortal and paracaval lymph nodes.

Postoperativna hipokalcemija je najčešća komplikacija nakon totalne tiroidektomije koja nastaje kao rezultat nenamerne ekstirpacije, manipulacije ili devaskularizacije paratiroidnih žlezda tokom operacije. U cilju predviđanja toga koji će pacijent razviti hipokalcemiju određivali smo vrednosti ranog postoperativnog parathormona radi pravovremenog započinjanja supstitucione terapije prepraratima kalcijuma i vitamina D, kao i radi određivanja termina otpusta pacijenta sa odeljenja u sklopu koncepta jednodnevne hirurgije. U okviru ove retrospektivne studije analizirali smo sve pacijente operisane totalnom tiroidektomijom na Klinici za hirurgiju u KBC „Dragiša Mišović-Dedinje” u Beogradu od početka 2011. do kraja 2018. godine., pri čemu smo započeli sa određivanjem ranog postoperativnog parathormona 2013. godine. Obrađivani su sledeći podaci: period boravka pacijenata u bolnici, broj pacijenata povratnika na stacionarno lečenje zbog hipokalcemije, vrednosti ranog postoperativnog parathormona i vrednosti serumskog kalcijuma nakon 24 sata. Iz studije su isključeni pacijenti sa sinhronim operacijama paratiroidnih žlezda, sa reoperacijama i sa udruženom disekcijom vrata. Od 960 pacijenata operisanih zbog oboljenja štitaste žlezde tokom navedenog perioda, 80% je ispunjavalo navedene kriterijume. U periodu od 2013. do 2018. godine nije bilo pacijenata povratnika na stacionarno lečenje zbog hipokalcemije. Vrednosti parathormona manje od 3pg/ml nađene su kod 18% pacijenata kod kojih je hipokalcemija zabeležena 24, 48 ili 72 sata nakon operacije. Određivanjem vrednosti ranog postoperativnog parathormona (između samog završetka operacije i do 6 sati nakon toga) moguća je adekvatna procena rizika za razvoj hipoparatiroidizma (a samim tim i hipokalcemije) i blagovremeno uključivanje supstitucione terapije kalcijumom i vitaminom D, što može skratiti postoperativno vreme boravka pacijenta na hirurškom odeljenju. [ABSTRACT FROM AUTHOR]

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Introduction. Despite the high incidence of hemorrhoidal disease and the widespread use of numerous topical preparations, there is still a lack of information regarding their efficacy. Therefore, the aim of this study was to assess the efficacy and tolerability of a new topical medical preparation containing sodium hyaluronate, calendula extract, hamamelis extract and mentha piperita essential oil as major components. Material and Methods. This prospective double-blind randomized clinical study included 49 patients with a diagnosis of hemorrhoidal disease. The patients were randomly assigned to two groups: Avaricon® group that included patients who applied 0.20% Avaricon® Hemor and a placebo group who applied placebo during 2 weeks. The effects of Avaricon® Hemor on the symptoms of hemorrhoidal disease, its safety, tolerability as well as compliance and adherence of study patients were analyzed. Results. Our results showed that Avaricon® Hemor was significantly superior to placebo in controlling most symptoms of hemorrhoidal disease. Conclusion. The tested medical agent showed to be effective with good tolerability and safety profile indicating its possible use in various therapeutic protocols in the management of hemorrhoidal disease. [ABSTRACT FROM AUTHOR]

Introduction: Radiofrequency ablation is a new invasive procedure that is being increasingly used in the treatment of colorectal liver metastases. Resection as the only potential cure for colorectal liver metastases is limited by the size and the itrahepatic localization of lesions. Radiofrequency ablation may extend the limitations of classic surgery. In this work we analyzed the combination of surgical liver resection and radiofrequency ablation of liver metastases., Material and Methods: This study included 11 patients with colorectal metastases. Colon resection and radiofrequency ablation have been performed in five (5) patients, three (3) patients underwent liver resection and radiofrequency ablation, and in three (3) patients colon resection, liver resection and radiofrequency ablation were performed., Results: In our study group, there were 6 (54.54%) men and 5 (45.45%) women aged 55 to 66 years and 52 to 67 years of age, respectively. During operations, we treated 30 liver metastases, 2.72 metastses per patient. There were from 2 to 4 ablation metastases. The diameter of colorectal metastases was between 11 mm and 44 mm. Most of ablation metastases (12 or 40%) were between 2.1 cm and 3 cm in diameter. Only 10% of ablation metastases were over 40 mm in diameter., Discussion: The majority of patients with metastatic colorectal hepatic tumors are not candidates for surgical resection, due to tumor size, location and multifocality. However, we can treat advanced colorectal cancers and colorectal liver metastases with a combination of liver resection and radiofreqency ablation. In this way we can operate and give a chance to patients with multifocal metastases and metastases with a diametar over 40 mm., Conclusion: A combination of liver resection and radiofrequency ablation in treatment of advanced colorectal cancers with liver metastases is a good treatment modality which increases the number of operabile cases.

Introduction: Multiorgan resection for a malignancy is a very complicated procedure, but there is always the question: does it work? In everyday clinical practice gastric cancer in phases III and IV is rather frequent. Unfortunately, our patients are under the age of 55 years. D2 lymphadenectomy is not as extensive as D2 +/ or D3, so one must ask himself if multiorgan resection is worth the risk, Material and Methods: We evaluated two groups of patients: group I consisted of 34 patients who underwent total or subtotal gastrectomy, systematic lymphadenectomy and resection of one or more organs; group II (control) consisted of 167 patients who underwent total or subtotal gastrectomy and systematic lymphadenectomy. These two groups of patients were analzyed in regard to: Bormann's classification, histopathologic type, early mortality, early postoperative complications, lymph node dissection and long-term survival., Results: According to Bormann's classification the most common type of carcinoma in both groups was ulcerovegetativ tumor (70.6% in I and 58% in II). In the first group of patients a great number of patients had poorly differentiated adenocarcinomas (47%), while in the second group the most common histologic type was well differentiated intestinal carcinoma (28%). Patients with multiorgan resections had higher rates of early postoperative mortality and morbiditiy (mortality--14.7% and complications--26.5%) than patients in control group (mortality--4.8% and complications--11.4%). The most frequent causes of postopertive mortality and morbidity were anastomotic leakage and wound infections in both groups. Metastatic lymph node invelvement was higher in the first group (41%), than in the second (28%). Long-term survival was best in the control group (38.5 months). Patients with multiorgan resection had better survival (25.4 months) than inoperable cases (only 5 months)., Discussion: Patients undergoing multiorgan resection usually have advanced gastric cancer with tumor infiltration in surrounding structures. Only these cases are absolute indications for this radical operation, because patients have better chances for survival., Conclusion: Multiorgan resections are extensive procedures with high rates of postoperative mortality and morbidity, but represent the only way for better survival of patients with advanced gastric cancer.

Introduction: Small bowel neoplasms are relatively rare, considering digestive system neoplasms. The aim of this case report was to point to clinical manifestations, significance and treatment patterns of small bowel lymphomas., Material and Methods: This is a case report of a sixty-eight year old patient who had undergone surgical treatment due to clinical and radiological findings of small bowel obstruction., Results: Histological findings revealed a malignant lymphoma. Primary small intestine lymphomas are treated by radiochemotherapy followed by surgical treatment (partial resection).