Introduction: This study highlights the importance of transitioning to a modern approach to outpatient surgery, analyzing the safety and feasibility of this treatment model in patients undergoing hemithyroidectomy or total thyroidectomy, with a focus on postoperative complications.

Materials and Methods: Data were collected from the medical records of 626 patients over a five-year period, from 2011 to 2015, at the Surgery Clinic of the "Dr Dragiša Mišović – Dedinje" in Belgrade. This period allowed for a reliable analysis of the safety and feasibility of outpatientthyroid surgery.

Results: A total of 97 hemithyroidectomies and 529 total thyroidectomies were performed. The average age of hemithyroidectomy patients was 51.24 years, and for total thyroidectomy patients, it was 54.88 years. The most common substrates were benign tumors (over 50%) for hemithyroidectomies and multinodular goiters (almost 50%) for total thyroidectomies. The average hospital stay was 1 day for hemithyroidectomies and 1.48 days for total thyroidectomies. Complications included postoperative bleeding (0.57%), subcutaneous hematoma (1.32%), subcutaneous seroma (2.08%), temporary hypocalcemia or hypoparathyroidism (18.9%), permanent hypocalcemia or hypoparathyroidism (0.76%), temporary vocal cord paralysis (2.65%), permanent vocal cord paralysis (1.89%), bilateral vocal cord paralysis (0.19%), and mortality (0%).

Conclusion: The study confirmed the feasibility and safety of outpatient thyroid surgery, with minimal complications and short hospital stays, especially for hemithyroidectomy, but careful postoperative monitoring is required for patients undergoing total thyroidectomy. 

Introduction: Paraneoplastic pemphigus is an autoimmune bullous and erosive mucocutaneous syndrome associated with malignancy. First of all, it is associated with lymphoproliferative disorders, but also with solid tumors.

Case report: We present a 73-year-old female patient who developed polymorphic lesions on the skin and mucous membranes after treatment of nonHodgkin's lymphoma. Disseminated pale erythematous macules, exudative papules and plaques, papulovesicles, pustules, targetoid lesions and bullae are present on the skin, mostly with a flaccid roof, some with a hypopyon. Oral mucosal changes included erosions and ulcerations covered by fibrin deposits. Histopathological examination of several biopsies revealed the presence of interface dermatitis, eosinophils, necrotic keratinocytes, as well as intraepidermal cracks with acantholytic cells, dominated by eosinophils. Direct immunofluorescence microscopy of the perilesional skin showed fluorescent intraepidermal reticular IgG deposits, as well as segmental linear IgG deposits along the basement membrane zone. Indirect immunofluorescence microscopy revealed circulating IgG autoantibodies binding to monkey esophagus and rat bladder at a titer of 1:320. Initially, he was treated with systemic corticosteroid therapy, then, in consultation with a hematologist, rituximab therapy was indicated (375 mg/m2, 4 doses once a week). The patient died after the 2nd dose of rituximab.

Conclusion: Considering the different clinical, histopathological and immunological features, paraneoplastic pemphigus presents a challenge for the clinician. Knowledge of different clinical presentations, as well as individualization of therapy with a multidisciplinary approach, are of crucial importance. 

 Ruptura potkožne tetive ekstenzora policis longusa (EPL) je jedna od najčešćih povreda tetiva ekstenzora šake. Ova vrsta povrede može biti posledica
 trauma ručnog zgloba. Češće se javlja kao posledica degenerativne ili inflamatorne bolesti. Ponekad se to dešava bez predisponirajućeg stanja, zbog
 kontinuiranih pokreta savijanja i opružanja palca šake.
 Ruptura tetive EPL-a se obično dešava u predelu Listerove kvrge gde su trenja najveća. Kontinuirano ponavljanje mikrotrauma može da uzrokuje
 rupturu. Engkvist i Lundborg [1] su postavili hipotezu o patogenezi mehanizama ove povrede.  Smatrali su da nakon trauma ili zapaljenja formiran
 hematom unutar omotača tetive dovodi do povećanja pritiska u neelastičnom prostoru. Povećanje pritiska može izazvati promene u snabdevanju krvi i
 može dovesti do nekroze i rupture struktura tetiva. Nakon prekida kontinuiteta tetive EPL-a, retrakcija proksimalnog okrajka je praćena
 degenerativnim procesima koji ugrožavaju direktnu suturu.
 Predloženi su mnogi tretmani, artrodeza interfalangealnog (IP) zgloba palca ili transpozicija tetive ekstenzor indicis proprius (EIP) koju je razvio
 Mensch 1925. god. [1].
 Transpozicija tetive šake je hirurška procedura која uključuje repozicioniranje funkcionalne tetive како bi se obnovila funkcija oštećene tetive šake.
 Ova operacija ima za cilj da vrati pokret, funkciju i snagu šake.
 U ovom radu prenosimo naše iskustvo u lečenja traumatske rupture tetive EPL-a metodom transpozicije tetive EIP-a. Opisujemo operativnu tehniku
 transfera tetive EIP-a na tetivu EPL.
 Ključne reči: trasnpozicija tetive, ekstenzor policis longus, ekstenzor indicis proprius, funkcija.

Sveži prelomi u ortopedskoj hirurgiji i traumatologiji, dovode do hemodinamske nestabilnosti celokupnog organizma. Kod otvorenih preloma, stepen
 hemodinamske nestabilnosti organizma je značajno veći. Prioritet u lečenju svežih preloma ima DAMAGE CONTROL IN ORTHOPEDIC (DCO). DCO je
 invazivna procedura koja ima ulogu kako u stabilizaciji preloma, tako i u kontroli krvarenja. Prelomi dugih kostiju kao i prelom karlice su apsolutna
 indikacija za DCO. Slobodno možemo reći da ova procedura prestavlja prioritet u lečenju svežih preloma. Procedura je individualizovana u zavisnosti
 od težine povrede kao i  hemodinamskog statusa povređenog pacijenta. U ortopedskoj hirurgiji i traumatologiji kao standardna procedura u DCO
 koristi se spoljašnji fiksator po Mitkoviću. Ortopedski hirurzi moraju biti jako prisebni i obazrivi kod pregledapacijenata sa politraumom i da
 prepoznaju tkzv. trougao smrti. Trougao smrti čine: acidoza, hipotermija i koagulopatija. Svaka karika je medjusobno povezana jedna sa drugom
 dovode do ireverzibilnih promena u organizmu što za posledicu ima smrtni ishod. DCO se sprovodi u tri faze: 1) podrazumeva kontrolu kvarenja,
 smanjenje kontaminacija bakterijama, kao i privremenu fiksaciju preloma. Sve ovo je neophodno uraditi u roku od 1-2h.; 2)  obuhvata stabilizaciju
 vitalnih parametara u JIN-e kao i reanimacija pacijenta ordiniranjem neophodne terapije, krvi i krvnih derivata.; 3) podrazumeva definitivna metoda
 lečenja u smislu nastavka lečenja preloma spoljasnjim fiksatorom ili konverzija u neku drugu metodu lečenja.

Introduction: Nummular headache is a type of primary headache of chronic character, with a large number of described varieties in the clinical picture, and therefore the differential diagnostic consideration must include a large number of disorders related to changes in epicranial structures. Certain dermatological disorders can also include pain in a limited area of the scalp with itching, burning or burning sensation, such as Lichen Planopilaris. Case report: This is a report of a patient who was initially diagnosed with Lichen planopilaris, but after determining the parameters of the distinction and the necessary additional diagnostic procedures, a diagnosis of Nummular headache was made. Conclusion: In this presentation, we have presented another important differential diagnostic item and we believe that the work is a small contribution to everyday practice, but also to further research.

Introduction. Hypothyroidism can be accompanied by various neuropsychiatric manifestations ranging from mild depression and anxiety to psychosis. Objective. The study aimed to determine the presence of depression in patients with hypothyroidism (clinical and subclinical). Methods. The survey was conducted over twenty-four months, from 01. 07. 2017. to 01. 07. 2019., at the Health Center Krupa na Uni. The cross-sectional study included 160 persons, two groups of 80 persons each. The first group included those with newly diagnosed hypothyroidism, while the control group consisted of people with neat, thyroid function. In addition to the general questionnaire, the study used Beck's Depression Inventory and laboratory analyzes (enzymatic assays to determine thyroid stimulating hormone and thyroxine). The chi-square test was used in the statistical analysis. Results. The first group consisted of 62 (38.7%) subjects with subclinical hypothyroidism and 18 (11.3%) with clinical hypothyroidism, 51 (63.7%) women and 29 (36.3%) men with a mean age of 52±6.9 years. The control group consisted of 42 (52.5%) women and 38 (47.5%) men, with a mean age of 51±4.3 years. Mild depression was verified in 50 (31.2%), moderately severe in 43 (26.9%), and severe depression in 3 (1.9%). The study found the existence of statistically significantly moderate-severe depression in participants with subclinical hypothyroidism (p<0.05). Conclusion. The results of our study indicate a statistically significantly presence of moderately severe depression in patients with subclinical hypothyroidism. Early detection and adequate therapeutic intervention of thyroid gland disorders in patients with depression. Our findings favor the need for early and routine screening for hypothyroidism and depression.

IIntroduction: Fractures of the lower leg are frequent fractures of long bones that are of great importance in traumatology. The role of external fixation (SF) as a type of surgical treatment is significant and widely applied. There are 3 methods of using SF to treat tibial fractures: SF as primary and definitive treatment, SF combined with internal fixation, and conversion of SF to internal fixation. Objective: To show the possibilities of SF as a definitive way of treating lower leg fractures. Methods: In our paper, we analyzed 254 lower leg fractures treated with SF according to Mitković M20, which were treated at the Department of Orthopedics and Traumatology of CHC Kosovska Mitrovica. This series included 172 men or 68% of the total number of patients, and 83 or 32% women. Results: The average age of patients treated with this method is between the third and fourth decades of life. Falling on the leg with twisting of the table or the entire lower part of the leg is the most common type and cause of injuries in 69%. A closed lower leg fracture was diagnosed in 220 patients (A AO 59.%, B AO 26% and C AO 15%). Adequate position of the bone fragments was achieved by the closed reposition method in 190 (%), the average healing time was 18.4 weeks. In 93% of patients, we achieved bone union. Conclusion: The simple placement technique, the simplicity of the instrumentation, the wide range of indications where SF can be used, have led to the fact that it is a type of surgical treatment of great importance for lower leg fractures in small areas.

Introduction: It is estimated that an average of 1,308 people die in traffic accidents in the world every day. Traffic accidents are caused by factors of the road, vehicles and the human factor, which occur alone or in combination with other factors in over 90% of cases. Material and methods: The retrospective systematic research included all cases of traffic trauma that were brought to the admission surgical outpatient clinic in the Clinical Hospital Center Kosovska Mitrovica in the period from January 2020 to December 2022. Results: In the observed period, 126 patients were registered. The age of the respondents differs statistically according to gender (p=0.030), and the highest frequency is male (81.8%) in the working population (18-59 years). The age of the subjects showed no statistical association with the types of injuries in traffic trauma (p=0.151). Friday and Saturday are the days with the highest risk (25.3% of injuries), and Sunday is the day with the least number of injuries (3.6%). The lowest number of injuries was recorded from January to May (n=12, 9.5%), and the highest was in the period August to October (n=54, 42.9%). A male patient, 20 years old, an alcoholic, required urgent surgical treatment (splenectomy) due to abdominal injuries. Alcoholism and the age of the subjects did not show statistical significance (p=0.495), and 24.6% of patients had a diagnosis of alcoholism. The age of the subjects showed a statistical association with hospitalization (p=0.004), male gender and age between 18-59 years. Only 2 patients required transport to a highly specialized facility. The fatal outcome showed a statistically significant correlation with the age of the respondent (p=0.016), there was only one patient (between 12-18 hours), a female, 85 years old as a passenger of a motor vehicle. Conclusion: The results of our study indicate a statistically significantly more frequent injury and hospitalization of male patients, that Friday and Saturday are the days of greatest risk and that the fatal outcome occurs in extremely elderly patients. Our findings favour the need to raise public awareness through the media, public actions and forums.

Supracondylar fractures are the most common elbow injuries in children and are associated with prolonged morbidity due to possible complications that can lead to deformity. The decision on the treatment method is made based on Gartland's classification (I, II, III and IV types) and the treatment can be non-operative (I and II type) and operative (III and IV type). When it comes to the percutaneous method, the main dilemma for its implementation is related to pinning from the medial side of the elbow because there is a high possibility of injury to the n. ulnaris which, according to data from the literature, occurs in some 15% of cases. The aim of treatment is pain relief and maintenance of the patient's functional status. The case presented in this paper represents a patient with whom the clinician is most likely to encounter and shows the clinical assessment of the patient's condition, the way of deciding on the treatment method and the outcome of the treatment undertaken. Agirl, 8 years old, was injured when she fell while playing. At the Department of Orthopedic Surgery and Traumatology, Clinical Hospital Center Kosovska Mitrovica, the patient was clinically and radiographically examined, and the injury was defined as a supracondylar fracture type III according to Gartland. After adequate preoperative preparation under general anesthesia, without the use of a drape - Turniquet, with the use of a C-bow, repositioning is performed and after obtaining a satisfactory position of the fragments, they are fixed percutaneously with 3 Kirschner needles, two medially and one laterally. The patient was discharged 3 days after admission with controls performed for 7 days. The Kirschner pins were removed on the 5th week after the operation and physical treatment was started, after which the movements of flexion and extension as well as pronation and supination were fully restored. Similar results are found in the literature. This information can be helpful in advising parents about what to expect after their child's injury. Also, they represent evidence of good clinical practice for orthopedic doctors and physiotherapists.

Introduction: Ellis-van Creveld syndrome is a rare genetic disorder characterized by short limb dwarfism, additional fingers and/or toes (polydactyly), abnormal development of fingernails and, in over half of the cases, congenital heart defects. Motor development and intelligence are normal. This disorder is inherited as an autosomal recessive condition. Some boys with this condition have been described with undescended testicles (cryptorchidism) or an abnormally located opening of the urine canal in the penis (epispadias). Abnormalities in the chest wall, spine and respiratory system have also been reported. Case report: The boy, aged two (2) years and eight (8) months, lives with parents and two brothers, in good living conditions. From the perinatal anamnesis, we can see that it is the third child from the third monitored pregnancy, delivered naturally at 39.gestational weeks, with normal birth parameters (3980/51/36), Apgar score 9. Immediately after birth, has been spotted complete postaxial polydactyly on both hands and postaxial poly-syndactyly (3,4,5,6) on the left foot, and ultrasound of the hips in early infancy indicated their unusual morphology and delayed bone maturation, which led to further medical investigation and treatment. Conclusion: Ellis-van Creveld syndrome is an extremely rare disease (this is the first registered case in our country). On the basis of this case, we want to express the importance of early diagnosis in order to improve the prognosis of the disease, and necessity of careful monitoring of these patients.