Vojnosanitetski pregled

The association of metabolic syndrome with the characteristics of colorectal adenomas

Thu, 27 Nov 2025 12:02:50 +0100

Background/Aim. Metabolic syndrome (MetS) is associated with an increased risk of developing colorectal cancer (CRC). However, data on its relationship with colorectal adenomas (CRA), the primary precancerous lesions, remain unclear and limited in certain regions. The aim of this study was to examine the characteristics and distribution of CRA in patients with and without MetS. Methods. A cross-sectional study was conducted, including 80 patients with CRA, of whom 40 had MetS (MetS group), and 40 did not meet the criteria for MetS (control group). Demographic data, risk factors for CRC (smoking, alcohol consumption, and family history of CRC), protective factors (use of acetylsalicylic acid and nonsteroidal anti-inflammatory drugs, physical activity), and polyp characteristics (size, number, localization, and degree of advancement) were collected and compared between the two groups. The diagnosis of CRA was established by histological examination of polyp specimens retrieved during colonoscopy. The diagnosis of MetS was made if three or more of the following criteria were present: increased waist circumference (≥ 94 cm for males, or ≥ 80 cm for females); hypertriglyceridemia (≥ 1.7 mmol/L); reduced high-density lipoprotein cholesterol levels (< 1.0 mmol/L for males, or < 1.3 mmol/L for females); arterial hypertension (systolic blood pressure ≥ 130 mmHg, and/or diastolic blood pressure ≥ 85 mmHg); fasting hyperglycaemia (≥ 5.6 mmol/L). Results. The average age of the patients was 61 years. Males and females were equally present in both groups, as were all the common risk factors for CRA. There were no differences between the groups regarding adenoma size, number of detected adenomas, localization of adenomas, and the degree of histological advancement of the adenoma. Conclusion. No significant association was found between the presence of MetS and the characteristics and distribution of CRA in our study. Further studies with larger samples and biomarker analyses are needed to better understand the potential role of MetS-related factors in colorectal carcinogenesis.

Urodynamic diagnosis of subvesical obstruction – significance of bladder outlet obstruction index and bladder contractility index

Thu, 27 Nov 2025 12:05:03 +0100

Background/Aim. The bladder outlet obstruction (BOO) index (BOOI) is used during urodynamic testing to diagnose BOO. The bladder contractility index (BCI) is a urodynamic parameter used inconsistently. The aim of this study was to examine the correlation between BOOI and BCI. Methods. A retrospective study was conducted from 2021 to 2023, including 176 male patients. Using the t-test, analysis of variance, and correlation analysis, BOOI and BCI were analyzed. Results. High BOOI values (40–80) and weaker bladder contractility (BCI < 100), as potential causes of lower urinary tract symptoms (LUTS), can coexist in 11.37% of cases. A high BCI value (> 150) is associated with a significant number of patients (7.39%) with high BOOI values (> 40), acting as a compensatory mechanism that masks the true causes of LUTS. Patient groups with BCI < 100 and > 150 show an inverse correlation with BOOI, as expected. Values of BOOI 20–39 and BCI 101–149 can be considered a “gray zone”. The correlation between P_detQ_max and Q_max was not statistically significant (r = -0.2006), making BOO a factor that can influence this relationship. Additionally, the intraurethral catheter positioned during urodynamic testing can significantly affect this correlation. As expected, a negative correlation can be observed between Q_max and BOOI (r = -0.44841, p < 0.001), while BCI and Q_max have a positive linear correlation (R² = 0.2255, p < 0.001). The correlation between the two observed indices, BOOI and BCI, shows a positive linear correlation, presenting a physiological mechanism for BOO compensation (R² = 0.3292, p < 0.001). Conclusion. In combination with BCI, BOOI is sufficient for establishing a definitive diagnosis in the analyzed patient groups. It is recommended that BOOI, BCI, and Q_max always be used in combination. Q_max, as a measure mostly valued on uroflow, may be insufficient for diagnosis in unequivocal clinical cases.

Impact of surgical timing on early functional and cognitive recovery after aneurysmal subarachnoid hemorrhage: the role of early rehabilitation

Thu, 27 Nov 2025 12:14:20 +0100

Background/Aim. Aneurysmal subarachnoid hemorrhage (aSAH) is a critical condition with significant functional and cognitive consequences. The optimal timing for surgical intervention remains controversial, particularly regarding early recovery. The aim of this study was to evaluate early functional and cognitive recovery in patients treated with early vs. delayed surgery, all of whom participated in a standardized early rehabilitation program. Methods. This prospective single-center cohort study included 114 patients who underwent surgery for ruptured intracranial aneurysms between November 2022 and November 2023. Patients were divided into two groups: the early surgery group, where the surgery was performed within three days after aneurysm rupture, and the delayed surgery group, where the surgery was performed more than three days after rupture. Functional status was assessed using the Functional Independence Measure (FIM) scale, and cognitive status was assessed using the Mini-Mental State Examination (MMSE). Both tests were administered at the start and end of the early rehabilitation program. Descriptive and inferential statistical methods (Wilcoxon signed-rank test, split-plot analysis of variance) were used for data analysis. Results. A statistically significant improvement in both functional and cognitive scores was achieved in both groups during the early rehabilitation program (p < 0.001). The greatest improvement was achieved in the FIM motor subscale. At discharge, the early surgery group achieved significantly higher FIM motor and total scores compared to the delayed surgery group (p = 0.024, p = 0.037, respectively). No statistically significant differences were found between the groups in MMSE or FIM cognitive scores. The severity of hemorrhage significantly affected changes in MMSE and FIM scores. Age, length of hospital stay, and the time period until rehabilitation initiation did not significantly influence patient recovery. Conclusion. Early surgical intervention for aSAH, combined with a standardized rehabilitation program, is associated with better early motor functional recovery compared to delayed surgery. Individualized rehabilitation strategies may be needed for patients who underwent delayed surgery.

Characteristics of violent deaths in the autopsy material of the Pathology and Forensic Medicine Institute of the Military Medical Academy in Belgrade

Nadica Marinković, Nataša Perković Vukčević, Ivan Aleksić — Thu, 27 Nov 2025 12:15:28 +0100

Background/Aim. Violent death is caused by external factors. The aim of this study was to determine certain characteristics of violent deaths in the autopsy material of the Pathology and Forensic Medicine Institute of the Military Medical Academy in Belgrade, Serbia. Methods. A retrospective study of autopsy reports from forensic autopsies performed from 2010 until 2019 at the Pathology and Forensic Medicine Institute identified certain characteristics of violent death. Results. Out of 2,763 forensic autopsies performed during that period, violent death was established in 43.68% of the deceased. The majority of those who died violently were men (73.73%). Violent death was most common in people aged 21–40 years (34.96%). The most dominant cause of violent death was mechanical injuries, followed by chemical and asphyxiation injuries, while physical injuries were the rarest. In 59.32% of violent death cases, toxicological analysis of blood and urine samples showed individual or combined presence of alcohol, drugs, and illegal substances. Conclusion. The presented results may be significant for taking measures that will prevent and reduce the number of violent deaths.

Peritumoral infiltration of CD3 lymphocytes makes a difference in prostate cancer

Thu, 27 Nov 2025 12:16:45 +0100

Background/Aim. Prostate cancer (PC) is the second most common malignancy in men, and the fifth leading cause of cancer death. The most important prognostic parameters are tumor, node, and metastasis (TNM) status, initial prostate-specific antigen (PSA), Gleason score, and grade group. However, these parameters are insufficient for accurate prediction of the course of the disease. The aim of this study was to examine the prognostic and predictive value of CD3⁺ T lymphocyte infiltration, including the CD8⁺ T-cell subset, in PC tissue across various disease stages. Methods. A prospective cohort study included 90 newly diagnosed patients with PC, divided into three groups [30 with medium/high-risk localized disease (Group A), 30 with locally advanced disease (Group B), and 30 with metastatic disease (Group C)]. The patients were followed for 120 months (10 years). The difference in the density of CD3⁺ and CD8⁺ T lymphocytes was analyzed in the tumor tissue (TT) and at the invasive margin (IM). The influence of infiltration of CD3⁺ T and CD8⁺ T lymphocytes on progression-free survival (PFS) and overall survival (OS) in patients with PC was analyzed. Lymphocytic infiltration was quantified at the area of greatest density using an optical Leica microscope at ×200 magnification and photographed with a Leica camera. The field of view was 0.226377 mm². Lymphocytes were then manually counted with the aid of commercially available software Aperio 12.0. Correlations with clinical parameters, PFS, and OS were analyzed using receiver operating characteristic (ROC) curves, Kaplan-Meier survival analysis, and correlation coefficients. Results. High peritumoral infiltration of CD3⁺ lymphocytes was an independent predictor of shorter PFS and OS (log-rank p < 0.001). CD3⁺ IM infiltration correlated significantly with initial PSA, nadir PSA, and perineural invasion (p < 0.05), while there was no correlation with Gleason score, International Society of Urological Pathology (ISUP) grade, or age. Thresholds of CD3⁺ IM predictive of cancer-specific mortality [area under the curve (AUC) = 0.681, p = 0.0017], OS (AUC = 0.634, p = 0.0173), and PFS (AUC = 0.657, p = 0.0062) were identified using ROC analysis. No significant prognostic value was found for CD3⁺T lymphocyte infiltration in the TT, nor for CD8⁺ T lymphocyte infiltration in either TT or at the IM. Conclusion. CD3⁺ T lymphocyte infiltration at IM is a significant prognostic and predictive biomarker in PC, indicating tumor aggressiveness and potential influence on treatment response. These findings support the integration of immune profiling into routine histopathological evaluation to refine risk stratification and guide personalized treatment strategies in patients with PC.

Initially disseminated pediatric high-grade midline glioma without H3 K27M alteration – a case report and literature review

Thu, 27 Nov 2025 12:20:18 +0100

Introduction. Pediatric high-grade gliomas (HGGs) constitute an extremely heterogeneous group of highly aggressive brain tumors. While leptomeningeal dissemination is commonly observed in patients through the course of the disease, cases with initial dissemination are rare. Case report. This paper reports the case of a 12-year-old boy diagnosed with an initially disseminated HGGs with midline localization. Despite surgical intervention and a multidisciplinary treatment approach involving craniospinal radiotherapy and chemotherapy, the patient experienced rapid neurological deterioration and disease progression, and ultimately succumbed to the disease 13 months after diagnosis. In contrast to the vast majority of similar pediatric cases documented in the literature, our patient exhibited an absence of H3 K27M alteration. To our knowledge, this is a unique presentation of a midline HGG with leptomeningeal cranial and spinal dissemination at diagnosis without the expected molecular pattern typically associated with such cases. Conclusion. This case highlights that, whether disseminated or not, pediatric HGGs have similarly poor survival outcomes with no effective treatments. It also underscores the widespread challenge of incomplete molecular profiling in these tumors. This emphasizes the urgent need for a comprehensive molecular analysis of these tumors worldwide to advance diagnosis and guide the development of personalized therapy.