Medical Research

HYPERTHERMIC INTRATHORACIC CHEMOTHERAPY (HITHOC) - A TERTIARY ONCOLOGICAL CENTER EXPERIENCE

Fri, 28 Nov 2025 00:00:00 +0100

Introduction: This study aimed to present our experience with HITHOC in the field of multimodality treatment of heterogeneous, potentially resectable, chemotherapy-sensitive pleural malignancies—primary and metastatic—limited to the unilateral thoracic inlet.

Methods: The research included all patients who underwent a HITHOC procedure with CRS at the Institute for Oncology and Radiology of Serbia from January 2018 to December 2024. The indications for procedure were: resectable chemo-sensitive primary or residual/recurrent thoracic malignancies confined to one side of the thorax, and various metastatic diseases restricted to the unilateral thoracic inlet with achieved local disease control. HITHOC was performed with cisplatin (100 mg/m2 in 1000 ml of 5 % glucose, gradually heated to 42 °C) perfusion lasting 90 minutes.

Results: Eleven patients were included in the study, with a mean age of 48.27 ± 18.37 years. The most common tumor pathology was thymoma, followed by malignant pleural tumors. Other tumor pathologies included ovarian cancer, Ewing's sarcoma, alveolar rhabdomyosarcoma, and lung cancer. Average follow-up was 41,73 (median: 35; range: 2-72) months. The overall survival rate was 64%.

Conclusion: HITHOC procedure can be regarded as a safe, feasible, and effective approach for well-selected patients. It could be beneficial not only for its current indications, but also for chemosensitive pleural malignancies, both primary and metastatic, limited to the unilateral thoracic inlet.

SCAPHOCEPHALY: A RETROSPECTIVE SERIES EXAMINING TREATMENT STRATEGIES AND LONG-TERM FOLLOW-UP

Mon, 01 Sep 2025 00:00:00 +0200

Introduction

Scaphocephaly, the most common form of craniosynostosis, is caused by the premature fusion of the sagittal suture, resulting in an elongated skull shape and constrained cranial growth.

Material and methods

This retrospective study included all consecutive patients with sagittal synostosis who were operated on at the Clinic of Neurosurgery, UCCS, in the 20-year period. Detailed patient data were obtained from medical records and neuroradiological diagnostics. The follow-up period for these patients ranged from 6 to 20 years. The acquired data were thoroughly statistically analyzed.

Results

There were 93 children with a clear male preponderance. In the majority of children, there were no perinatal complications, and the majority of mothers didn’t have any chronic illnesses. Three types of surgical treatment were used, with an almost equal distribution. The mean blood loss during surgery varied across the three operative techniques, with the lowest blood loss observed using the TSEO technique. Successful treatment was observed in only 57.1% patients who underwent strip-suturectomy, 96.6% patients treated with the π procedure, and all patients treated with the TSEO technique. Statistical analysis revealed a significantly higher success rate of the TSEO and π procedure compared to strip-suturectomy. Cranial index remained dolichocephalic in 6/28 children treated with strip-suturectomy alone, while in all cases treated with TSEO and π procedure, cranial index normalized. The majority of operated children had no complications.

Conclusion

Successful treatment of scaphocephaly requires a case-specific approach that extends beyond the surgical procedure itself. This series emphasizes the need for individualized treatment plans and a multidisciplinary approach throughout the surgical process.

EFFECTS OF NMDA RECEPTOR ANTAGONISTS ON ACUTE POSTOPERATIVE PAIN

Maja Z Stojanovic, Predrag Stevanovic, Sonja Vuckovic, Katarina Savic Vujovic — Mon, 25 Aug 2025 00:00:00 +0200

Introduction/Aim of the paper: Pain represents a multifactorial process with detrimental effects on the entire organism. This randomized, open-label pilot study investigated the effect of preemptive administration of ketamine and magnesium-sulfate on the intensity of postoperative
pain after laparoscopic colon tumor resection.

Methods: Sixty patients were randomized into the ketamine-magnesium (KM) and the control (C) groups. After the introduction to anesthesia, patients in the KM group received an i.v. bolus dose of 0.5 mg/kg ketamine, followed by a continuous infusion of 0.6 mg/kg/h lasting until the end of surgery. After a bolus dose of ketamine, they received magnesium-sulfate 20 mg/kg in an intravenous infusion (5-10 minutes). Group C received only 0.9% NaCl infusion. After the
patients were awakened (0h), the pain intensity was compared (0- 46h) between the two groups.

Results: The Mann-Whitney test implied significantly (p<0.05) lower visual analog scale (VAS) scores, in KM group at 0, 1, 2, 10, 22 and 30 hours after the surgery, and no statistical significance (p>0.05) for VAS scores after 6, 14, 18, 38 and 46 hours, compared to C group. Ketamine and magnesium-sulfate significantly (p<0.05) reduced the postoperative consumption of analgesics, increased the sedation level at 0h postoperatively, and increased the overall patient satisfaction with the treatment.

Conclusion: Preemptive administration of ketamine and magnesium-sulfate combination has beneficial effect on postoperative pain after laparoscopic colon tumor resection.

PROGNOSTIC SIGNIFICANCE OF INDEXED STROKE VOLUME IN ASYMPTOMATIC PATIENTS WITH MODERATE TO SEVERE AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Fri, 05 Dec 2025 00:00:00 +0100

Introduction and aim: Whether and when to intervene in asymptomatic patients with moderate to severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) has not yet been determined. In patients with AS, low flow through the aortic valve is defined as indexed stroke volume (SVi) ≤35ml/m². The aim of our work was to determine the relationship between SVi and all-cause mortality, as well as the prognostic significance of low SVi in asymptomatic patients with moderate to severe AS, high mean gradient across (P_mean) the aortic valve and preserved LVEF.

Methods: The study included 121 asymptomatic patients (69 men, mean age 66±11 years) with moderate-to-severe AS (aortic valve area ≤1.5cm²), high P_mean across the aortic valve and preserved LVEF. The median follow-up was 38 months (IQR 35-42 months).

Results: Ten patients (8%) died during the follow-up. All-cause mortality was significantly higher in the group of AS-patients with SVi ≤35ml/m² compared with those with SVi >35ml/m² (15% vs. 4%, p<0.045). The cumulative incidence of all-cause mortality was significantly higher in the group of AS-patients with SVi ≤35ml/m² compared with those with SVi >35ml/m² (log-rank p-value 0.035). After adjustment for outcome predictors, SVi was found to be the most significant predictor of all-cause mortality in the mid-term follow-up (adjusted-HR: 0.870; 95%CI: 0.801–0.945; p=0.001).

Conclusion: The left ventricular SVi is an important predictor of all-cause mortality in asymptomatic patients with moderate-to-severe AS, high P_mean across the aortic valve, and preserved LVEF.

NEURODEVELOPMENTAL DISORDERS IN CHILDREN WITH 22q11.2 DELETION SYNDROME AND RECOMMENDATIONS FOR PEDIATRIC FOLLOW UP

Goran Cuturilo, Zorana Pavlovic, Danijela Drakulic — Mon, 25 Aug 2025 00:00:00 +0200

Summary

Neurodevelopmental disorders are the most prevalent chronic diagnoses in pediatric primary care, with rising incidence and significant impact on cognitive, motor, social, and communication functioning. 22q11.2 deletion syndrome (22q11.2 DS)—the most common human microdeletion syndrome—presents with a broad spectrum of somatic and neurodevelopmental abnormalities. Nearly all individuals with 22q11.2 DS show neurodevelopmental difficulties, including delays in motor and speech milestones, cognitive impairments, and behavioral challenges. The disorder affects approximately 1 in 2,500 newborns and is also associated with congenital heart defects, palatal anomalies, hypocalcemia, and immunodeficiency. Neurodevelopmental manifestations typically begin in infancy with delayed motor and speech development and progress into school age with difficulties in learning, attention, and peer interaction. Intellectual disabilities are common, with a distribution skewed toward lower IQ scores. Children often exhibit a verbal-performance IQ discrepancy and may experience further cognitive decline in adolescence or adulthood. Over 40% of affected individuals meet criteria for autism spectrum disorder, attention-deficit/hyperactivity disorder, or both. They also have increased risks for psychiatric conditions such as anxiety, depression, and schizophrenia. Pediatricians, as primary care providers, play a critical role in early identification and long-term monitoring. Recommendations include routine developmental assessments, early interventions (e.g., speech and occupational therapy), and regular IQ and adaptive functioning evaluations, especially during educational transitions. Early diagnosis and individualized, multidisciplinary approaches are essential to improve developmental outcomes and quality of life in children with 22q11.2 DS.

Keywords: 22q11.2 deletion syndrome, DiGeorge syndrome, neurodevelopmental
disorders

EPIDEMIOLOGY OF ISCHEMIC HEART DISEASE

Isidora Vujcic, Jadranka Maksimovic, Sandra Sipetic Grujicic — Mon, 01 Sep 2025 00:00:00 +0200

Ischemic heart disease (IHD), or coronary artery disease, ranks as the primary global cause of mortality and disability.

This narrative review summarizes the epidemiology of IHD, focusing on global distribution, risk factors, and prevention.

A literature search was conducted using PubMed, Scopus, and Google Scholar databases to identify relevant studies from the past decade.

In 2019, IHD affected 197.2 million individuals, resulting in 9.1 million deaths, and 182.0 million disability-adjusted life years (DALYs) worldwide. While age-standardized mortality rates, DALYs, and prevalence have declined, the number of reported cases continues to rise. The highest prevalence was reported in Central and Eastern Europe and Central Asia, while the lowest was in South Asia. Modifiable and non-modifiable risk factors influence IHD. The main causal risk factors, such as hypertension, dyslipidemia, diabetes, smoking, and age, are independently associated with IHD development.

Environmental factors (air pollution, noise exposure, and climate change) further increase the risk of IHD. The emerging concept of the exposome emphasizes that the cumulative and combined influence of environmental risk factors plays a crucial role in the development of IHD.

IHD can be prevented from developing through primordial (targeting social determinants like urbanization, poverty, illiteracy, living conditions) and primary prevention (management of risk factors through lifestyle interventions, pharmacotherapies).

IHD is a growing global health and economic challenge, disproportionately affecting low-income regions, as a result of population aging, limited access to healthcare, and the presence of numerous risk factors that require appropriate prevention and treatment.

SURGICAL SIGNIFICANCE OF ANATOMICAL VARIATIONS OF THE PARATHYROID GLANDS

Fri, 07 Nov 2025 00:00:00 +0100

A solid understanding of the surgical anatomy of the parathyroid glands is based on a thorough knowledge of their embryonic development. Anatomical variations in the number, morphology, vascularization, and localization of the parathyroid glands present a challenge during surgical exploration of the neck, both in the treatment of hyperparathyroidism (HPT) and in thyroid surgery. In about 2.3% of patients undergoing thyroidectomy, incidental parathyroidectomy occurs. Our review aims to highlight the incidence of anatomical variations in the localization, number, morphology, and vascularization of the parathyroid glands, as well as their significance in the surgical treatment of parathyroid gland functional disorders. A good understanding of embryologic development and neck anatomy is essential for parathyroid surgery. Contemporary imaging diagnostic modalities used in parathyroid surgery do not have the same sensitivity and specificity as in other surgical fields, and they significantly increase treatment costs. The success of surgical treatment largely depends on the surgeon's knowledge and experience.

If parathyroid glands are not found in their usual locations, an extensive bilateral neck exploration must be performed. Meanwhile, parathyroid adenomas located in the mediastinum below the aortic arch require a specialized diagnostic and surgical approach. Measurement of intraoperative PTH (ioPTH) levels increases the success rate of surgical interventions.

CASE REPORT OF SEVERE CYTOMEGALOVIRUS INFECTION IN PREGNANCY: PREVENTION AND TREATMENT OPTIONS

Wed, 31 Dec 2025 00:00:00 +0100

Introduction: Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. It can be the cause of serious clinical manifestations, leading to permanent disability in infected children. Unlike most other TORCH infections, both primary and non-primary CMV infection can affect fetus.

Patient Review: We present a case of congenital CMV infection that was diagnosed after the onset of severe fetal anomalies in the third trimester. The patient was referred to our hospital in 35. weeks of pregnancy complicated by severe intrauterine growth restriction and fetal brain anomalies seen on the ultrasound and magnetic resonance imaging (MRI): simplified gyration and a highly suspected band heterotopia (differential diagnosis: lissencephaly), dilated temporal and occipital horns of lateral ventricles with intraventricular septations, vermian hypoplasia, zones of t2 hyperintense lesions. Serology testing revealed positive results for CMV-specific IgM antibodies and a positive result for CMV-specific IgG antibodies with high avidity (91,7%). After performing the amniocentesis (PCR), we got positive result for CMV. The patient was informed about the poor prognosis of the congenital CMV infection with those findings on the fetal brain. She opted for the termination of pregnancy.

Conclusion: Given that this is the most common congenital infection, it is necessary to continually raise awareness among pregnant women about primary prevention methods. In the meantime, efforts should focus on research aimed at timely detection and treatment, to prevent severe forms of congenital infection.