Uvod: Primarni medijastinalni B krupnoćelijski limfom je redak, visoko agresivan oblik non Hodgkinovog limfoma i javlja se u 5-7 % svih difuznih velikoćelijskih B limfoma i 2% svih non Hodgkinovih limfoma. Vodi poreklo od medularnih ćelija timusa i ima sopstvenu histogenezu. Tipično obolevaju mlade žene u trećoj i četvrtoj dekadi života. Sindrom gornje šuplje vene je prisutan u više od 50% slučajeva, sa otokom lica, ruku, dubokim venskim trombozama, dispnejom, disfagijom, bolom u grudima, glavoboljom i kašljem. Dijagnoza se postavlja patohistološkom i imunohistohemjskom analizom hirurškog bioptata dobijenog medijastinoskopijom. Blagovremena terapija ciklusima monoklonskih antitela i polihemioterapijom omogućava stabilan relaps bolesti. Prikaz bolesnika: Pacijentkinja, stara 37 godina, javlja se prvi put na pregled kod svog izabranog lekara jer je već u nekoliko navrata posećivala Službu hitne medicinske pomoći zbog kašlja, osećaja da je nešto davi, nedostatka vazduha, pritiska i bolova u glavi kao i otečenosti vrata i lica. Započeta detaljna dijagnostika. Radiološki utvrđen tumor medijastinuma, kompjuterizovana tomografija potvrdila i poslata na referentni Institut gde je videoasistiranom torakoskopskom hirurgijom i patohistološkom analizom dijagnostikovan PMBCL CSII AM+. Ordinirano šest ciklusa rituksimab, ciklofosfamid, doksorubicin, vinkristin i prednizolon terapijskog protokola koje je podnela sa očekivanim neželjenim dejstvima. Kontrolna pozitronska emisiona tomografija utvrdila da se tumorska masa u potpunosti povukla. U remisiji je dve godine, dobro se oseća i javlja se na redovne kontrolne preglede. Zaključak: Na izabranom lekaru je velika odgovornost u prepoznavanju ranih simptoma maligne bolesti što ubrzava postavljanje konačne dijagnoze i blagovremeni početak lečenja.

Introduction: Primary mediastinal large B cell lymphoma is a rare highly aggressive form of non-Hodgkin lymphoma and occurs in 5-7% of all diffuse large B lymphoma and 2% of all non-Hodgkin lymphomas. Originates from thymic medullary cells and has its own histogenesis. Typically affects young women in the third and fourth decade of life. Superior vena cava syndrome is present in more than 50% of cases, with swelling of face, hands, deep venous thrombosis, dyspnea, dysphagia, chest pain, headache and cough. Diagnosis is made by histopathological analysis and immunohistochemical surgical biopsy specimens obtained mediastinoscopy. Timely treatment with cycles of monoclonal antibody and chemotherapy is requirement to relapse and stable state.

Case outline: Patient, 37 years old, came for the first time for review at General practice because she has been repeatedly visited emergency service due to coughing, feeling that something is strangling, the lack of air pressure and pain in the head and swelling of face and neck. Started detailed diagnostics. Radiologically determined mediastinal tumor, computed tomography confirmed it and sent to the referral Institute where video-assisted thoracic surgery and patho histology diagnosed PMBCL CSII AM +. Administered six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone therapy protocols submitted by the expected side effects. Control positron emission tomography found that the tumor mass completely withdrawn. In remission for two years, have a good feeling and occurs at regular checkups.

Conclusion: General practice has a big responsibility in recognizing early symptoms of malignant disease that accelerates
the diagnosis and timely start of treatment.

Epidemiological characteristics of acute stroke certify the great importance of such disease, which takes the measures of a mass incontagious illness, because it represents one of leading causes of death and invalidity in the world. Contemporary knowledge about the complexity of cerebral infarct has been significantly increased thanks to new imaging methods, which allows correction of clinicaly stated diagnose. The aim of our research was to determine clinical manifestation signs of supratentorial infarcts and their presence compared to anatomic localisations of lesions. 60 patients were clinicaly tested, and a computerised tomografy of brain followed, which disclosed anatomic localisation of lesions. Results have shown that the maniestation of supratentorial infarct in the AMC zone has the most neurological signs, from conscious state disorders, graver pyramid deficit, speaking disorder to hemihypesthesia and hemianopsys. Lighter neurological deficit is found in infarcts which affect AAC and APC zones, which brings to a conclusion that knowing the clinical state and without applying neuroradiological methods can imply to localisation of supratentorial infarcts.

Topiramate is the new antiepileptic drug, which is related with high efficiency in the reduction seazures, and also whit high prevalention of cognitive adverse events. Purpose of study is to define the relationship between efficiency topiramate in control of epileptic seizure and the apperance of cognitive adverse events. In the prospective stady we followed 40 adult patients with refractory epilepsy, which treatment took place on the Institute of neurology Clinical center of Serbia. The efficacy of treatment was estimated as the ratio of the total number of seizures during the last two months before the introduction of topiramate (on basic antiepileptic therapy) and during the last two months on stable (200mg/day) dose of topiramate.All patients are neuropsychological tested twice. First time before the start of therapy with topiramate, and next time two months after the achieving of stable dose. We used neuropsychological tests for evaluation attention, concentration, visual and verbal memory, speech, executive functions, divergent opinion and visual construction abilities. Patients with good success of topiramate in control of the seizures had worse scores on cognitive measurements than patients in whom topiramate was not demonstrated efficacy in treating epileptic seizures. Our findings indicate that the appearance of cognitive adverse events of topiramate possible in patients with reduction of seizure after the introduction of drug. This suggests that the same mechanism topiramat achieve a positive therapeutic effect and adverse effect on cognition in people with epilepsy.

One of leading causes of death in the world is stroke, more often it strikes population under the age of 65, and those who survive it are left with a maximum degree of invalidity. Supratentorial infarcts are the most common form of ACM, occuring as a consequence of blood vessel occlusion, which irrigation zone is above tentorium, and it appears in 80% of infarcts. Diagnosing of such infarcts is based on clinical and neuroradiological parameters, and computed tomografy is called "gold standard". Therefor, our goal was to introduce a CT parameters, which follow complications of supratentorial infarcts and have predictional character. A prospective study followed the state of 60 patients with supratentorial infarcts of brain, performed CT diagnostics, established infarct complication parameters and their effects on clinical state and diseases outcome. Large tentorial infarcts in ACM vascularisation zone, mass-effects and mediosagital structure motions are significant predictors of infarct ill outcome when it comes to surviving and functional recovery. 

Patients with epilepsy more often than healthy individual have cognitive disorders, what may be the result of different factors, among which significant place occupy the treatment with antiepileptic drugs. Topiramate is the new antiepileptic drug, which is related with high efficiency in the reduction seazures, and also whit high prevalention of cognitive adverse events. Purpose of our study is to clarify the role of depression in developing cognitive adverse events during therapy with topiramate in patients with refractory epilepsy. In the prospective stady we followed 40 adult patients with refractory epilepsy, which treatement took place on the Institute of neurology Clinical center of Serbia. All patients are neuropsychological tested twice. First time before the start of therapy with topiramate on basic antiepileptic therapy, and next time two months after the achieving of stable dose of 200mg/day. We used neuropsychological tests for evaluation attention, concentration, visual and verbal memory, speech, executive functions, divergent opinion and visual construction abilities. For estimate degree of depression we used Hamilton's scale of depression. Patients with the depressive manifestation had lower scores on cognitive tests in comparition to patients without the depression, before and after introductions topiramate. More the score of depression was larger, the scores of neuropsychological tests have been worse. Depression has bad influence on the cognitive functioning and her presence in the patients with epilepsy increases the risk from development of cognitive adverse events of topiramate.

Besides big improvement of diagnostic, therapeutic and preventive procedures vascular disease generally and vascular disease of brain remain of biggest importance in total morbidity and mortality. This examination included patients in Urgent Surgery Center “Simonida” Gracanica. In article is represent relationship between brain and heart dysfunctions and it is obvious that cerebral disturbances can cause heart disturbances and also it can be in opposite direction. Well, based on this is very important to make fast and correct orientation: CARDIOCEREBRAL or CEREBROCARDIALSYNDROME. In diagnostic procedure and therapeutic treatment is necessary cooperation between cardiologist and neurologist because in most of these cases we have cardiocerebral or cerebrocardial syndrome. Better treatment patients with brain stroke claim teamwork different specialist.