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Approximately 5 to 10% of patients in the emergency department have altered mental status, which is considered as a significant sign of the illness. Elderly patients and patients with concomitant medical conditions, especially those affecting the central nervous system, have an increased risk. Because altered mental status is a symptom of various conditions and diseases, differential diagnosis is challenging for physicians. Using the fundamental emergency care principles of emergency medicine and the ABCDE approach, the cause of the altered mental status can be suspected during the patient’s first encounter. Initial stabilization and clinical assessment are prioritized to direct the physician towards more target therapy of the underlying cause. These clinical guidelines aim to facilitate and enhance the recognition and initial management of patients with altered mental status. [ABSTRACT FROM AUTHOR]

Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose. [ABSTRACT FROM AUTHOR]

Hipničke glavobolje (glavobolje koje se javljaju tijekom spavanja) prema Međunarodnoj klasifikaciji glavobolja – 3. izdanje ubrajaju se u primarne glavobolje. Za razliku od ostalih primarnih glavobolja poput migrene, tenzijske i trigeminalne autonomne glavobolje, u kliničkoj praksi često su neprepoznate ili je postavljena pogrešna dijagnoza. Kornjačina glavobolja se javlja nakon jutarnjeg buđenja te ponovnog usnivanja i buđenja. Javlja se kod osoba koje običavaju tijekom spavanja prekriti glavu pokrivačem (odatle potječe analogija s kornjačinim uvlačenjem i izvlačenjem glave ispod oklopa). Iako je u literaturi opisana prije hipničke glavobolje i smatra se njezinim rijetkim podtipom, do danas nije uvrštena u Međunarodnu klasifikaciju glavobolja. U ovom radu prikazujemo pacijenta s dugogodišnjom hipničkom i epizodičnom kornjačinom glavoboljom. Brojne diferencijalnodijagnostičke dileme s kojima smo se susretali zahtijevale su dodatnu kliničku i neuroradiološku obradu. Utvrđivanje vrste glavobolje temelji se na detaljnoj anamnezi i striktnoj primjeni dijagnostičkih kriterija Međunarodne klasifikacije glavobolja. Važnost ispravne dijagnoze značajna je i s terapijskog aspekta jer se farmakoterapija i preventivno liječenje hipničke i kornjačine glavobolje razlikuje od terapije ostalih primarnih glavobolja. S obzirom na to da su u Međunarodnu klasifikaciju glavobolja uvrštena i izuzetno rijetka stanja poput numularne glavobolje i sindroma pekućih usta, mišljenja smo da kornjačina glavobolja zaslužuje uvrštenje u istu.

Introduction. Inflammatory myofibroblastic tumors predominantly manifest in the lungs of children and young adults, with tracheal localization being very rare. Genetic alternations involving the anaplastic lymphoma kinase gene are identified in 50 to 70% of cases. A conclusive diagnosis relies on biopsy and histopathological analysis. Surgical resection stands as the primary treatment modality. Case Report. We present a case involving a 3-year-old boy with an inflammatory myofibroblastic tumor who had experienced recurrent wheezing attributed to respiratory infections since the age of eight months. Long-term therapy with budesonide and montelukast was initiated, which effectively managed his wheezing until the age of 3 years. Subsequently, despite ongoing medication, he began experiencing severe bronchial obstructions every month, necessitating repeated hospital admissions. At the age of 3 years and 8 months, he was admitted to our hospital due to persistent wheezing, prompting a bronchoscopy. During the procedure, a tumor-like mass was identified in the lower part of the trachea. Bronchoscopic removal of the tumor was performed, followed by cauterization of the remaining tumor tissue. Histopathological examination confirmed the presence of an inflammatory myofibroblastic tumor. Conclusion. Inflammatory myofibroblastic tumors are uncommon neoplasms associated with a borderline risk of malignancy. Given that the symptoms can resemble those of common childhood respiratory conditions, it is crucial to consider this diagnosis in cases of persisting wheezing despite standard therapy. In such instances, performing a bronchoscopy is necessary for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Introduction/Aim. Lentigo maligna (LM) represents an in situ melanoma that develops on chronically photo-damaged skin. Clinical diagnosis of LM is often difficult, even for experienced dermatologists. The aim of the study was to analyze the clinical and dermoscopic features of patients with pathohistologically verified lentigo maligna (LM) and to determine a possible influence of anatomical topography, age and gender in the dermoscopic features of LM. Patients and methods. This retrospective study included 32 patients with 32 LM changes in total, diagnosed between 2017 and 2020. Clinical data recorded from each patient included the following: demographic features (age, gender), anatomic localization (facial or extrafacial) and clinical size (< 10 mm or > 10 mm). Facial area was subdivided into eight topographical sites, while extrafacial localization involved any location outside the face region. All dermoscopic images were analyzed for the presence of dermoscopic features previously described as LM. Results. In the total of 32 patients, there were 19 males and 13 females. The patients' age ranged from 34 to 80 years (median age 60.1 ± 10.4 years). Significant female predominance was observed for localization on the cheeks (p = 0.018). Localization on the nose was significantly associated with patients older than 65 (p = 0.039). The most frequent dermoscopic features were asymmetric pigmented follicular openings in 23 (71.9%) cases, gray color in 22 (68.8%) and pigmented rhomboidal structures in 15 (46.9%) cases. In relation to age and specific dermoscopic features, gray color (p = 0.035) and white scar-like areas (p = 0.012) were significantly higher in patients older than 65, while pigmented rhomboidal structures (p = 0.041) were significantly associated with younger patients. Conclusion. The observed differences in the frequency of clinical and dermoscopic features of LM have significant importance in everyday clinical practice and can assist clinicians in the early diagnosis of this malignant tumor. [ABSTRACT FROM AUTHOR]

Dizziness is one of the most common symptoms that patients complain about to their doctors. It can be said that around one third of the entire human population experiences dizziness during their lifetime, and hence its great public health significance. It is not a single disease, however: in the case of dizziness, it is rather a syndrome, which involves hundreds of different causes. It may seem scary to a clinician, but we might realize subsequent to an in-depth analysis that ten dizziness causes are most common, while the remaining ones might be classified as rare diseases, according to the current definition. Consequently, they should not be ignored in a differential-diagnostic process. Actually, any disease that affects < 5:10.000 people is considered rare. It can be said that rare diseases are infrequent, but the patients suffering from them are numerous. Five to eight thousand different rare diseases affect 6-8% of the European Union (EU) population--that is, between 27 and 36 million people. In this article, we have paid attention to those rare vestibular disorders that are significant for quotidian diagnostics, especially with regard to a differential-diagnostic excogitation method. In spite of their major differential-diagnostic importance, some of these disorders are still not included in the ORPHA list of rare entities. On the other hand, the well-known and established disorders, or those that are completely insignificant for everyday medical practice, are enlisted due to their enormously low frequency. [ABSTRACT FROM AUTHOR]

Introduction. Synovial sarcoma is a rare malignant tumor most often localized on the lower limbs near large joints. Histopathology findings is the gold standard for making the diagnosis. However, due to the similarity with other tumors, the findings can be misinterpreted and the correct diagnosis often delayed, and the treatment is inadequate in the early stages of the disease inadequate. Case Report. A 15-year-old female patient came for an examination due to subcutaneous lesion in her hand. The lesion was excised on three occasions due to recurrence, and each time the histopathology findings showed a dermatofibroma. After five years, the patient returned due to the changes under the scar and unpleasant sensations. A surgical excision was performed when dermatofibroma was verified. Two years later, the patient developed necrosis of the entire finger. The finger was amputated, and synovial sarcoma was verified. The patient underwent 25 cycles of radiotherapy. In the following year and a half, the tumor developed metastases, first locoregional and then distant, in the region of the left shoulder joint and the left lung. Conclusion. The histopathological similarity of this tumor with other benign changes indicates the need for further evaluation and differentiation of the pathohistological characteristics from tumors with similar characteristics. Early detection of this type of tumor enables a more favorable course and outcome of the treatment of these patients. Initial radical surgical treatment of this type of tumor is necessary due to the aggressiveness they show and the high frequency of local recurrence. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Leiomyoma is a mesenchymal benign tumor that seldom manifests in the kidney. Typically, these tumors are small, asymptomatic, and often detected accidentally. Differentiating leiomyomas radiologically from other renal neoplasms, particularly renal cell carcinomas, poses a considerable challenge before surgical intervention. Moreover, the conclusive diagnosis of leiomyomas can only be established through histopathological and immunohistochemical evaluation following surgical intervention. Case Report. We present a case of a 44-year-old woman who was diagnosed with right kidney leiomyoma accidentally during a computed tomography examination following exploratory curettage by a gynecologist. An enhanced computed tomography scan revealed a 10 mm tumor located on the upper pole of the right kidney, extending beyond its boundaries. The imaging differential diagnosis was renal cell carcinoma of the right kidney. A laparoscopic partial nephrectomy was performed. Macroscopically, the tumor appeared subcapsular, well-defined, with a firm consistency and a tan-white whorled cut surface. The histological characteristics and the supporting immunohistochemical profile confirmed the diagnosis of renal leiomyoma. The postoperative course was uneventful, and the patient was discharged on the 3rd postoperative day. Conclusion. Leiomyomas are rare kidney tumors. A conclusive diagnosis is established through histopathological findings. The pre-operative differentiation of leiomyomas radiologically from other renal neoplasms, particularly renal cell carcinomas, poses a considerable challenge in radiological assessment. [ABSTRACT FROM AUTHOR]

Introduction. Pityriasis lichenoides et varioliformis acuta is a rare inflammatory skin disease of unknown etiology and its diagnosis is sometimes established by eliminating diseases that are considered in the differential diagnosis. Given the lack of randomized clinical trials, recommendations for therapy remain based on case reports and case series. Case Report. We present a 63-year-old female patient with generalized skin lesions including, papules, papulonecrotic lesions, and atrophic scars accompanied by a subjective feeling of itching that occurred 2 months before admission. The histopathological findings showed a mixed perivascular inflammatory cellular infiltrate and capillary blood vessels with thickened walls in the superficial part of the dermis as signs of vasculitis. The infiltrate was dominated by lymphocytes, neutrophils were admixed, but there were no signs of cellular atypia, which supported the clinical diagnosis of pityriasis lichenoides et varioliformis acuta. Therapy with systemic corticosteroids and doxycycline was applied, which led to the resolution of lesions. Conclusion. The authors would like to bring to the readers’ attention a rare skin disease, pityriasis lichenoides et varioliformis acuta, point to papulonecrotic tuberculids in differential diagnosis due to similar clinical presentation, remind them of the dilemmas that may arise in case of the described lymphocytic vasculitis based on the findings of histopathological analysis, and highlight the effectiveness of doxycycline and prednisone in the therapy. [ABSTRACT FROM AUTHOR]

Introduction. Among infectious diseases, tuberculosis ranks first in terms of morbidity and mortality. It mainly affects the lungs, but it can affect any organ in the body. Case Report. A 29-year old female patient, bacillus Calmette-Guerin vaccinated, human immunodeficiency virus-negative, non-smoker, active athlete, presented with magnetic resonance imaging of the spine indicating vertebral body collapse of Th10 with signs of intraosseous infiltration, extraosseous prevertebral, and extracorporeal spread into the spinal canal. Corpectomy of Th10 and Th11 with an anterior fusion of Th9-12 was performed by neurosurgical intervention. Histopathological examination of the vertebral body confirmed a necrotic granulomatous inflammation. No acid-fast bacilli were seen by Ziehl-Neelsen staining, while Mycobacterium tuberculosis culture was positive. Chest X-ray and computed tomography were normal, induced sputum smear microscopy was negative for Mycobacterium tuberculosis. The antituberculosis therapy lasted for 12 months. Conclusion. Spinal tuberculosis is a differential diagnostic problem in relation to pyogenic infections and metastatic bone tumors. [ABSTRACT FROM AUTHOR]

Introduction. Calcifying fibrous tumor is a rare benign neoplasm of soft tissue origin. The tumor is commonly found in young adults. In most cases it is an incidental finding, because patients do not have obvious symptoms. This tumor may appear in different anatomical locations mimicking other stromal lesions. The diagnosis is made based on pathohistological characteristics and an appropriate immunohistochemical profile. The treatment is surgical, and the prognosis is good. Case Report. A 19-year-old female patient was admitted for abdominal surgery presenting with abdominal pain and pressure. Abdominal ultrasonography and multislice computed tomography of the abdomen showed a tumor mass in the right hemiabdomen. The patient underwent surgical treatment and the tumor was completely removed. Macroscopic analysis showed that the tumor was encapsulated and had a smooth surface. Microscopically, the tumor consisted of bundles of partially hyalinized collagen fibers with calcifications in the form of psammoma bodies that were permeated with mononuclear inflammatory infiltrates. Conclusion. Given the higher incidence of other mesenchymal tumors in the abdomen, due to its rare occurrence, calcifying fibrous tumor presents a diagnostic challenge. [ABSTRACT FROM AUTHOR]

Introduction. “Grey zone Lymphoma’’ is associated with various entities. The last published classification of lymphoproliferative neoplasms includes mediastinal grey zone lymphoma. Precise diagnostic criteria are insufficient and establishing a diagnosis is as complex as deciding on treatment options. In this article pathologist and hematologist discuss issues on this topic through case presentation and literature review. Clinical characteristics. It presents in the younger population usually with a mediastinal mass, sometimes large, with compressive symptoms. Pathologic characteristics. Some cases can’t be classified neither as Hodgkin nor Primary mediastinal B-cell lymphoma. Morphology resembles Hodgkin, but with a positive immunophenotype for primary mediastinal or diffuse large B-cell lymphoma, and vice versa. Case report. We presented a case of a 33-year-old male with cervical lymphadenomegaly, B symptoms and clinical deterioration during the diagnostic period. After the first biopsy, differential diagnosis was Epstein-Barr virus-associated lymphoproliferative disorder or classical Hodgkin lymphoma. The second biopsy confirms Epstein-Barr virus-positive diffuse large B-cell lymphoma. The World Health Organization Classification of lymphoproliferative neoplasms – clinical perspective. The term “grey zone lymphoma” is associated with overlapping diagnosis or uncertainty in diagnosis in more clinical settings than the ones provided in the 5th World Health Organization Classification. Discussion. For now, chemotherapeutic regimen (rituximab-cyclophos phamide, doxorubicin, vincristine, prednisone) stays the standard first line therapy for diffuse large B-cell lymphoma regardless of the EpsteinBarr virus status. Mediastinal grey zone lymphoma treatment varies: chemotherapeutic regimen (rituximab-cyclophos phamide, doxorubicin, vincristine, prednisone) was linked with better outcomes than chemotherapeutic regimen (adriablastin, bleomycin, vinblastine, dacarbazine) +/-R, but for some patients chemotherapeutic regimen (dose adjusted-etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) might be beneficial. Conclusion. Grey zone lymphoma is a rare hematologic malignancy that needs extensive sampling for correct diagnosis and is still subject to inter-observer variability [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Inflammatory myofibroblastic tumor is a mesenchymal neoplasm with an aggressive potential and a tendency for recurrence. It is known to occur in a variety of locations, including the female genital tract. The objective of this study was to provide an overview of the clinical, histopathological, immunohistochemical and molecular features of the inflammatory myofibroblastic tumor, emphasizing potential diagnostic pitfalls in the female genital tract. Case Report. The diagnosis of an inflammatory myofibroblastic tumor of the right ovary with extension to the right parametrium and peritoneal adipose tissue was made in a 74-year-old patient after a detailed laboratory testing, computed tomography and histopathological examination. Conclusion. This case report presents an unusual experience of specialists in everyday practice, with a successful combination of skills in gynecological surgery and pathology. Inflammatory myofibroblastic tumor is a diagnostic challenge that needs to be considered in the differential diagnosis of tumors of both the ovary and the entire female genital tract. [ABSTRACT FROM AUTHOR]

Introduction. Neuroendocrine neoplasms are rare heterogeneous malignancies that may occur in almost any organ in the body. These neoplasms are associated with a wide range of clinical and pathophysiological manifestations. Case Report. A 67-year-old female patient, non-smoker with a history of rheumatoid arthritis and osteoporosis, visited her general practitioner complaining of back pain, heart palpitations, and change in stool consistency. Physical examination revealed multiple subcutaneous nodules in the neck and chest area that were painful to touch. Due to suspected hyperthyroidism, she was referred to an endocrinologist. The ultrasound of the thyroid gland showed multiple cysts in the right lobe and a nodule in the left lobe of the thyroid gland. Laboratory tests showed elevated calcitonin and carbohydrate antigen levels. Based on the assumption that medullary thyroid carcinoma was the most likely diagnosis, she was referred to the Nuclear Medicine Department of the Oncology Institute of Vojvodina. A fine-needle aspiration biopsy of the left thyroid nodule was done and thyroid malignancy was excluded. By histopathological analysis of the enlarged right chest lymph node and a skin lump on the left loin, a lung cancer with neuroendocrine morphology with positive neuroendocrine markers was diagnosed. Computed tomography revealed a tumor infiltrating the left hilum with metastases. Conclusion. Skin metastases of neuroendocrine neoplasms are rare and may occur in any part of the human body. They may develop before the primary tumor is recognized and are associated with disseminated malignancy. Diagnosis and treatment are important to control the disease and improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute abdominal pain is one of the most common causes to visit a medical doctor regardless of the child's age. The child's history and a clinical examination are the clue factors in decision, whether laboratory examinations or imaging procedures are necessary. In child with acute abdominal pain the main role of imaging is to differentiate between acute abdomen which requires surgical management and acute abdominal pain which needs conservative treatment. In children a differential diagnosis of acute abdominal pain is age related. Ultrasound (US) examination of abdomen is the first line imaging modality in children with acute abdominal pain. US can visualize the direct cause of abdominal pain, and diagnose the exact nature of the pathology in many emergency situations. US findings often have an impact on a treatment and on a decision about the best modality for further imaging. Plain abdominal radiography is a method of choice only when the bowel perforation, ileus or bowel obstruction (particularly in neonatal period), as well as foreign body ingestion are suspected. Contrast examinations of gastrointestinal tract have a significant role in small children with suspected congenital anomalies, most commonly to rule out malrotation. Magnetic resonance imaging is rarely an option in children with acute abdominal pain. [ABSTRACT FROM AUTHOR]

Introduction. Hypertensive ischemic leg ulcer, also known as Martorell ulcer, is not very rare, but an under-recognized type of leg ulcer. It has specific clinical and histopathological characteristics. It occurs almost exclusively in patients with arterial hypertension. It is more common in women and in patients with type 2 diabetes. It is localized particularly in the laterodorsal distal third of the lower leg. This ulcer is extremely painful. Its clinical features may very much resemble pyoderma gangrenosum. Case Report. We are presenting a case of a 40-year-old obese male, who suffered from arterial hypertension during the past 26 years. His ulcer appeared spontaneously on the lateral aspect of the right lower leg and progressed gradually. From the very onset, the ulcer was extremely painful. At first, it was diagnosed as pyoderma gangrenosum and treated with systemic corticosteroids and immunosuppressants. Since the response to therapy was not satisfactory, the histopathology was revised and the diagnosis of hypertensive ischemic leg ulcer was made. After initial wound debridement and local negative pressure therapy, split-thickness skin grafting was performed. The pain disappeared right away almost completely and complete epithelization was achieved two weeks after skin grafting. Conclusion. It is important to consider Martorell ulcer in hypertensive patients with extremely painful ulcers of the lower leg. In order to establish the appropriate diagnosis, it is essential to take a deep skin biopsy and correlate the finding with a specific histopathological picture. It is the only way not to confuse hypertensive ischemic leg ulcer with pyoderma gangrenosum, since the management of the two conditions is completely different. [ABSTRACT FROM AUTHOR]

Introduction. Accessory breast is a congenital anomaly where ectopic breast tissue is found at any place other than the normal location. It is an extra tissue or a fully developed breast with a nipple. The incidence of this malformation is 0.4–6%. It is believed that this congenital malformation is associated with incomplete regression of the primitive milk streak during embryonic development. The diagnosis and treatment of accessory breasts is very important, because an ectopic breast tissue can undergo various pathological changes, as well as the normal breast tissue. Case Report. The authors present a 45-year-old female patient who was referred to a surgeon by a general practitioner with a diagnosis of lipomas in both axillary regions. After clinical examination and additional imaging diagnostic procedures (ultrasound and mammography) accessory breasts were suspected. The patient underwent surgery and the accessory tissue was resected. The histopathological examination confirmed the clinical diagnosis of ectopic breasts without any pathological processes. Conclusion. Accessory breast is a rare congenital malformation and its early diagnosis and surgical removal should prevent development of different pathological processes, including breast cancer. [ABSTRACT FROM AUTHOR]

The periosteum is a thin fibrous tissue in a form of fibro-vascular membrane which covers the outer surface of bones. On conventional radiography normal periosteum is completely invisible. The periosteum can be visualized when it is elevated by underlying pathology. Periosteal reaction can be unilateral or bilateral, or localized and generalized. Depends on how fast it takes periosteum to react, it can be divided into aggressive and non-aggressive. The role of computed tomography as superior method vs. nuclear magnetic resonance, ultrasonography or scintigraphy, has been noticed a long time ago. [ABSTRACT FROM AUTHOR]

Introduction. Kaposi sarcoma is a rare soft tissue tumor that may form masses in the skin, lymph nodes, mucosa and many other organs. It has a strong male predilection and is usually seen in the older population. It is caused by human herpes virus 8. Risk factors include compromised immune system, typically seen in patients with human immunodeficiency virus infection or organ transplant recipients. Case Report. We report a 66-year-old Caucasian woman with no previous history of human immunodeficiency virus infection, immunosuppressive therapy or organ transplantation. She was referred to a plastic surgeon by a dermatologist due to a suspected dermatofibroma presenting with one solitary, firm nodule on the dorsal aspect of the foot that she reported to have occurred a year before. A surgery was scheduled in 6 months, as the tumor was assessed as benign. After excisional biopsy and histological evaluation without immunohistochemical staining, that was not available, a diagnosis of benign myofibroblastic tumor was made. Later on, a new similar tumor on the hand appeared and the diagnosis was changed into a malignant tumor. Further pathological examination, using immunohistochemical staining, confirmed Kaposi sarcoma. The malignant cells showed positive immunostaining for CD34, CD31, D2-40, WT1, bcl-2, and human herpes virus 8, but they were CD99 negative. Conclusion. Nonspecific clinical presentation and absence of risk factors may mislead the doctors, delay the biopsy and thus delay adequate treatment. In the same time, histological similarities with other disorders and tumors may be challenging for pathologists and lead to wrong diagnosis. [ABSTRACT FROM AUTHOR]

Introduction. Electrocardiography is an initial non-invasive diagnostic algorithm for ST elevation acute myocardial infarction. Specific electrocardiographic phenomenon is described, when the occlusion of the proximal segment of the right coronary artery or the isolated occlusion of its ventricular branch is presented with ST elevation in the precordial leads. Case Report. A 78-year-old woman was admitted as an emergency due to chest pain and electrocardiographically recorded concave elevation in leads V1 - V3. She was diagnosed with ST elevation myocardial infarction of the anterior region and sent to catheterization laboratory for emergency coronary angiography. It showed an occlusion of the proximal-medial right coronary artery. Behind the occlusion, the right coronary artery, posterior descending artery and posterior lateral artery, a hetero-collateral circulation was seen. Two drug-eluting stents were implanted into the proximal segment of the right coronary artery. Discussion. The phenomenon of acute myocardial infarction caused by occlusion of the proximal right coronary artery and/or ventricular branches of the right coronary artery, presenting with ST segment elevation in the precordial leads, is a consequence of several anatomical variations: occlusion of nondominant right coronary artery, isolated occlusion of the ventricular branch of the right coronary artery, and the occlusion of the right coronary artery proximal to the ventricular branch with hetero collateral circulation on the periphery of the right coronary artery, like in our case. Electrocardiographic characteristic pointing to the occlusion of the proximal right coronary artery and/or ventricular branches of the right coronary artery is higher ST elevation in the lead V1 than in the other leads, followed by the absence of Q wave development. This ST elevation is concave. Conclusion. It is necessary to emphasize the significance of differential diagnosis of culprit lesion in patients with chest pain and elevation of the ST segment in the precordial leads having in mind further different thera peutic algorithms. Patients with right ventricular myo cardial infarction need to maintain an adequate "preload" and avoid vasodilators in order to maintain the right ventricular stroke volume. [ABSTRACT FROM AUTHOR]

Copyright of Acta Facultatis Medicae Naissensis is the property of Nis University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. A proliferation-inducing ligand is a membrane binding protein that represents one of the main survival factors for immature, naive and activated B-cells, and is involved in the global immune response. The objective of this study was to determine whether plasma levels of a proliferation-inducing ligand may be used to assess the proliferation of B-lymphocytes in patients with bacterial infections, B-cell malignancies and autoimmune inflammatory disorders. Material and Methods. The study included 91 patients divided into three groups and 30 blood donors assigned to the control group. Group 1 included 34 patients with bacterial infections confirmed by microbiology and/or radiology diagnostic tests; group 2 included 32 patients with B-cell malignancies; and group 3 included 25 patients with autoimmune inflammatory diseases. All plasma samples were assayed for a proliferation-inducing ligand using enzyme-linked immunosorbent assay. The differences between groups were examined by one-way analysis of variance test and post hoc analysis. Results. One way analysis of variance test showed a statistically significant difference in concentrations of a proliferation-inducing ligand in the examined groups. The highest mean value of a proliferation-inducing ligand was found in patients with established bacterial infections (x® = 8,294 ng/ml). Post hoc analysis showed that a proliferation-inducing ligand levels in the plasma samples of patients with bacterial infections were significantly higher than in healthy controls, and patients with hematological and autoimmune diseases, respectively. Conclusion. B-cell proliferation was increased in patients with bacterial infections in regard to patients with other disorders. Therefore, a proliferationinducing ligand can be used to differentiate bacterial infections from other inflammatory disorders and may be helpful in decision making whether to start antibiotic treatment or not. [ABSTRACT FROM AUTHOR]

Endometriosis is defined as a functional endometrial tissue outside the uterine cavity. The ectopic endometrial tissue has been identified after gynecologic laparoscopy or laparotomy procedures in the skin, subcutaneous tissues, abdominal and pelvic wall musculature, and it represents amayor cause of acute or chronic recurrent abdominal or pelvic pain resembling the menstrual cycle. The frequency of abdominal wall endometriosis is approximately 1% of all women who had a cesarean delivery. A 39-year-old patient with a history of one prior Cesarean section, presented with continuous cyclical focal pain at the left part of cesarean scar site for the past 16 months, 23 months after Cesarean section. The patient underwent a mini laparotomy, when endometrioma was completely removed surgically. The PH diagnosis of endometriosis was based on the presence of all elements of the endometrial mucosa (glands, stroma and signs of fresh and old hemorrhage) in an inadequate place (anterior abdominal wall). Endometriosis is difficult to diagnose and it is often mistaken for other conditions such as a suture granuloma, incisional hernia, primary or metastatic cancer. Endometriosis can be prevented only with good surgical techniques and clinical practice as well as the proper care during primary surgery. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal / Medicinski Časopis is the property of Serbian Medical Society, Section Kragujevac and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Lymphomas are a group of neoplasms of the lymphatic and reticuloendothelial system. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma, depending on the immunohistological characteristics of malignant lymphocytes. B-cell lymphomas are more frequent than T-cell lymphomas. In this case report we present a male patient with diffuse large B-cell lymphoma localized in the maxilla. Case Report. A 59-year-old man presented with a painless swelling in the right posterior region of the maxilla. A solid tumor was found in the right posterior maxillary region by intraoral examination, firstly suspected as a dental infection. Since the symptoms did not improve a month after the first dental treatment, he was referred for further diagnostic evaluation. The established diagnosis was diffuse large B-cell lymphoma. The patient received standard therapy for diffuse large B-cell lymphoma - rituximab-cyclophosphamide, hydroxydaunomycin, oncovin, prednisolone, six cycles and regression of the oral lesion was noticed. Conclusion. Lymphoma of the oral cavity usually presents as a swelling and may mimic odontogenic infection. Dentists should be aware of this possibility especially if the swelling is painless and if the initial treatment has failed. [ABSTRACT FROM AUTHOR]

Introduction: Merkel cell carcinoma (MCC) is a rare, very aggressive neuroectodermal tumor of the skin typically located on sun-exposed areas and frequently found in Caucasian men between 70 and 80 years of age. Case Report: We present a case of a 86-year-old woman who was referred to our Skin Cancer Unit with a red and well defined nodule located on her left commissure of the mouth, that grew during a couple of months and was completely asymptomatic. Dermoscopic examination revealed a reddish background with linear and arborizing irregular vessels, some out of focus vessels and whitish areas. The lesion was excised, histological examination showed that the tumor was hypercellular and composed of round epithelial elements with large nuclei and scant cytoplasm suggestive of MCC. Immunohistochemical stains confirmed a diffuse positivity with cytokeratin (CK) 2 chromogranin, and synaptophysin; CK7 and thyroid transcription factor-1 (TTF-1) were negative. Sentinel lymph node biopsy was done, resulting negative for neoplastic cells, and computed tomography (CT) of the chest, abdomen and pelvis showed no distant metastasis. Adjuvant radiotherapy on the tumor site and on homolateral neck lymph nodes was also done. Conclusion: Merkel cell carcinoma presents as an asymptomatic, rapidly growing nonpigmented nodule without specific characteristics. Dermoscopic features may help to distinguish MCC from other similar tumors: linear irregular vessels, milky pink areas, architectural disorders and structureless areas, even if not specific, when present are strongly suggestive of MCC. Wide excision with 2 cm margins with adjuvant radiotherapy is the treatment of choice in high-risk primary tumors, while sentinel lymph node biopsy and computed tomography scans are necessary for early diagnosis of metastatic disease. [ABSTRACT FROM AUTHOR]

Introducion. This type of hepatocellular carcinoma is characterized by fever and persistent leukocytosis. Case report. This is a report of a patient with a long term fever accompanied by persistent leukocytosis. Abdominal ultrasonography revealed a focal lesion in the left hepatic lobe, whereas, computed tomography/ magnetic resonance imaging findings were consistent with a liver abscess. The patient received therapy for liver abscess, without improvement. He underwent left lobe segmentectomy 3, with histological features of hepatocellular carcinoma (pseudoglandular type). Conclusion. In patients with focal hepatic lesions accompanied with raised temeparature and persistent leukocytosis, without adequate therapeutic response, this clinicopathological type of hepatocellular carcinoma should be considered. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to present a diagnostic procedure in a case of residual melanoma of the finger. Case report: We received a dome shaped, skin specimen from a forty-four year old man. The skin sample was taken from the fourth finger of his right hand and it was 1 cm in diameter. The skin coloured lesion was serially sectioned and submitted for histopathologic analysis. Microscopic examination showed that it was melanocytic lesion and considering it had no epidermal component, additional molecular analyses were needed to exclude a clear cell sarcoma. A diagnosis of residual melanoma was made, from subsequently received clinical data, however there was no accompanying histopathological analysis from the first excision. Conclusion: A histopathological diagnosis, in general, as well as in the case of melanoma may be difficult due to the lack of clinical data. Contemporary histopathological diagnostics has a good support tools for establishing an accurate diagnosis, which governs the further diagnostic and therapeutic patient's protocol. However, clinical dermatological examination of doubtful pigmented lesions, complemented by histopathologic diagnostics is a crucial step important for timely diagnosis in order to avoid delay in the therapy which is important for patient's disease outcome. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Veterinary Medicine / Arhiv Veterinarske Medicine is the property of Scientific Veterinary Institute Novi Sad and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pityriasis rubra pilaris (PRP) is an idiopathic inflammatory hyperproliferative chronic dermatosis characterized by: perifollicular coalescing papules with central keratotic acuminate plugs gradually submerged in sheets of erythema; perifollicular erythema with islands of unaffected skin; palmoplantar keratoderma; diffuse desquamation which typically spreads from the head down to the feet. The cause of the condition is unknown, but possible etiological factors include: vitamin A deficiency, trauma, infections, autoimmune mechanisms, and malignancies. Taking into account different age of onset, clinical course, morphology and prognosis, there are six different types of the disease: two in adults (classical and atypical); three in children (classical, circumscribed and atypical); one in individuals infected with human immunodeficiency virus. This paper presents two male patients with clinical symptoms of classical PRP, 53 and 69 years of age at the onset of the disease, with rapid generalized involvement, typical erythematous perifollicular papules, islands of unaffected skin, palmoplantar hyperkeratosis with a waxy appearance and nail changes. The diagnosis was based on clinical findings and histopathologic analysis. Apart from topical therapy with emollients, corticosteroids and keratolytics, they received systemic retinoids and corticosteroids, which resulted in improvement of skin lesions. It is extremely important to consider the possible triggering factors, establish the diagnosis as soon as possible and begin proper treatment. [ABSTRACT FROM AUTHOR]

Introduction. Gastrointestinal stromal tumors are the most common mesenchymal tumors of the digestive tract. Leiomyosarcomas of the gastrointestinal tract are rare mesenchymal neoplasms which grossly and histologically resemble gastrointestinal stromal tumors. They may be differentiated from gastrointestinal stromal tumors by using immunohistochemistry and they are typically positive for α smooth muscle actin and desmin and negative for c-kit, CD34 and DOG1.1. They often express calponin and h-caldesmon. Case Report. We present a case of a 59-year-old male with anemia, weight loss, intermittent abdominal pain and right abdominal mass. Colonoscopy revealed an exophytic ulcerated neoplastic mass in the ascending colon and abdominal computed tomography scan showed an ill-defined heterogeneous tumor mass which surrounded almost the whole ascending colon. The patient underwent right hemicolectomy and partial resection of ileum. Histopathological examination revealed a leiomyosarcoma composed of atypical spindle cells positive for α smooth muscle actin, desmin and vimentin, and negative for c-kit, CD34, S100 and neuron specific enolase. The patient is alive 8 months after the operation, undergoing chemotherapy. Conclusion. We have concluded that the multimodal approach comprising chemotherapy and complete surgical resection controls the leiomyosarcomas. [ABSTRACT FROM AUTHOR]

Introduction. The systems of energy in surgery are applied in order to achieve better and more effective performing of procedures. Whereas various energy sources, including electricity, ultrasound, laser and argon gas, may be used, the fundamental principle involves tissue necrosis and hemostasis by heating. Electro Surgery. Electro Surgery is a surgical technique by which surgical procedures are performed by focused heating of the tissue using devices based on high-frequency currents. It represents one of the most frequently used energy systems in laparoscopy. Ultrasound Energy. The basic principle of operation of the ultrasound surgical instruments is the usage of low-frequency mechanic vibrations (ultrasound energy within the range of 20-60 kHz) for cutting and coagulation of tissue. Laser. Laser is the abbreviation for Light Amplification by Stimulated Emission of Radiation, aimed at increasing light by stimulated emission of radiation and it is the name of the instrument which generates coherent beam of light. Argon Plasma Coagulation. It has been in use since 1991 for endoscopic hemostasis. It uses highfrequency electric current and ionized gas argon. The successful application of devices depends on the type of surgical procedure, training of the surgeon and his knowledge about the device. Surgeons do not agree on the choice of device which would be optimal for a certain procedure. Conclusion. The whole team in the operating room must have the basic knowledge of the way an energy system works so as to provide a safe and effective treatment of patients. The advantages and shortcomings of different systems of energy have to be taken into account while we use a special mode. [ABSTRACT FROM AUTHOR]

The article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP). The authors analyze the diagnostic errors, present literature review, and their own observations. The clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2%) patients, 6 (26%) patients received treatment for toxic exanthema, and only 2 (8.8%) patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Keratosis lichenoides chronica represents a distinct entity, a rare disease of unknown etiology and pathogenesis, with clinical manifestations which, although typical, require extensive differential diagnosis. The course of the disease is chronic, progressive, and it is resistant to various treatment options, so despite variations in the clinical picture it is really easier to diagnose than to treat. This is a case report of a male patient in whom the diagnosis of keratosis lichenoides chronica was based on typical clinical picture, repeated biopsies and histopathological findings, course of the disease and poor response to any therapy. [ABSTRACT FROM AUTHOR]

Introduction. Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential diagnosis and the efficacy of rehabilitation treatment. Case report. A 25-year old male patient sought medical help complaining of the pain along the distal third of tibia. The pain was present on palpation of the distal two-thirds of the lateral and medial tibial border over the length of 9 cm and on muscle manual testing of foot flexors. The patient underwent physical and exercise treatment for three weeks. The recovery was monitored by visual analogue scale, which measured the lower leg pain, pain on palpation and manual muscle testing. In addition, the patient himself assessed his ability to resume sport activities on the 5-point Likert scale. The final evaluation and measurements showed his complete functional recovery. Conclusion. The results obtained in this case show the importance of accurate clinical diagnosis and rehabilitation for medial tibial stress syndrome [ABSTRACT FROM AUTHOR]

Melasma is a common cosmetic problem and its severity ranges from minor pigmentation during pregnancy that resolves spontaneously, to a chronic, troublesome, disfiguring condition. Today, there are various treatment modalities for melasma, providing a different success rate. The need for an effective treatment for melasma is becoming more and more significant probably due to the current lifestyles with increased UV exposure, broad use of hormones for contraception and hormone replacement therapy, as well as increasing esthetic demands. The mainstay of treatment is regular use of sunscreens along with topical medications suppressing melanogenesis. This review summarizes recent progress in understanding the pathophysiology of melasma and implications for new treatment strategies. [ABSTRACT FROM AUTHOR]

Copyright of Acta Stomatologica Naissi is the property of Clinic of Stomatology Nis and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)