Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.

Introduction: Cardiovascular diseases (CVD) are leading factor in global mortality and morbidity. It is the cause of 1/3 of total annual mortality, while coronary heart disease (CHD), as one of the CVD entities, is responsible for 85% of deaths worldwide. The aim of the study is to show the importance of the first phase of cardiac rehabilitation (CR) in patients who are going on cardiac surgery, as well as the impact on respiratory function, the occurrence of pulmonary complications and the length of hospitalization. Methods: A sample of 18 patients was included in the randomized observer study. First phase of CR was carried out according to a predefined protocol. We used arterial blood gases (ABG) to evaluate the respiratory function, "two-minute walk test" (2MWT) to assess the functional capacity Data taken from medical documentation are the duration of mechanical ventilation (MV), the length of stay in the ICU, occurrence of the postoperative pulmonary complications and duration of total hospitalization. Results: The test sample consisted of 12 men (60.58 ± 8.33) and 6 women (66.00 ± 6.51). The mean value of CR was 6.15 ± 3.98 days and MV 19,67±11,23 hours. There were no pulmonary complications in 61,11% patients. Using ABG, a statistically significant difference was found in PO2 after extubating and at the last day in ICU (p = 0.01). 2MWT preoperatively significantly correlated with the examined on the last day of hospitalization (r = 0.648 p-value <0.001) well as the length of postoperative hospitalization and duration of mechanical ventilation (r = 0.708 p-value <0.001). Conclusion: The study showed that first phase of cardiac rehabilitation may positively affect the improvement of functional capacity.

Introduction: The most common causes of renal artery disease are stenosis, as a consequence of atherosclerosis and fibromuscular dysplasia. Computed tomographic (CT) angiography is a non-invasive method, which enables visualization of vascular structures and walls of blood vessels, as well as morphology of the renal parenchyma. Objective: To determine the importance of CT angiography in detecting the cause and degree of renal arterial disease. Methods: A total of 45 patients were included in the cross-sectional study conducted from March 2017 to March 2019 in the KBC DR Dragiša Mišović-Dedinje, Belgrade, Serbia. Criteria for inclusion were suspicion of secondary arterial hypertension, patients in preparation for kidney transplantation and in the follow-up period after transplantation, as well as patients with suspected traumatic lesions. We analyzed the causes of the disease, the morphology of the blood vessel wall, the percentage of stenosis, and the renal parenchyma. Results: The most common causes of renal arterial disease are atherosclerosis, which was found in 33 (73%) patients, renal artery aneurysm was found in 5 (11%) subjects, fibromuscular dysplasia in 4 (8.9%) and trauma in 1 (2) , 3%) of the patient. There were 10 (22.2%) patients with a significant (average 80 ± 14.5%) degree of stenosis. The sensitivity of CT angiography in the detection of atherosclerotic changes in the renal arteries was 87.9%, while the sensitivity of CT angiography in the detection of fibromuscular dysplasia was 75%. A statistically significant correlation was found between atherosclerotic stenosis of the renal arteries and a positive CTA finding (p = 0.0002). Conclusion: CT angiography is an important method of visualization and quantification of pathological changes in the renal arteries.

Bruxism is a parafunctional activity of the masticatory system, which is characterized by clenching or scraping of teeth. This condition is often accompanied by a change in the shape and size of the teeth, as well as the function of the stomatognathic system. Bruxism can occur during sleep and in the waking state. The etiology is multifactorial and all causes can be divided into peripheral and central. The clinical signs and symptoms of bruxism are primarily characterized by temporomandibular disorders, the appearance of bruxofacets and changes in the hard dental tissues, supporting apparatus of the teeth and masticatory muscles, as well as headaches. The diagnosis of bruxism is made on the basis of anamnesis and clinical signs and symptoms, while electromyography and polysomnographic analysis are used in scientific researches. Therapy is aimed at controlling etiological factors and reducing symptoms. Occlusal splints are the most commonly used in the treatment of bruxism. Medications are used in situations when other methods, including psychotherapy, do not give positive results. Given the multifactorial etiology, the therapeutic approach must be multidisciplinary. The approach to the patient must be individual in order to treat as effectively as possible.

Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.

Prostate cancer (CP) is the most common malignancy in men in America, while it is the second most common in Europe. It is responsible for about 10% of cancer deaths in the same population. It is clinically manifested in various forms, from slow-growing to aggressive forms with pronounced metastatic potential. Diagnosis is made by a well-defined algorithm, which begins with the determination of serum prostate specific antigen values and ends with prostate biopsy as the "gold standard". Pathohistological diagnostic criterias are based on architectural, cytoplasmic, nuclear and characteristics of intraluminal structures, as well as periacinar cleftings, which are deffined as helpfull diagnostic criteria of undoubted importance. Prognostic and predictive parameters are classified into three categories. Some of them are an integral part of routine pathohistologicat report, while others are considered as the diagnostic process progresses. Modern knowledge introduces biomarkers into the everyday practice of personalized medicine, especially when is necessary to treat prostate cancer patients.

The new pandemic, caused by the corona viral disease 2019 (Covid-19), has brought with it a series of restrictive measures that have drastically altered people's way of life and which restrict freedom of movement, behavior and social engagement. At the time of pandemia, almost all aspects of each individual lifestyle have been impaired, especially in members of vulnerable groups, particularly women in postpartum women. Acute psychological reactions to a pandemia may include insomnia, fear of infection, anxiety, frustration, panic attacks, loneliness, but also depressive episodes. Non-psychotic postpartum mood and anxiety disorders can occur as an inability to adapt to stressful life situations. A comprehensive understanding of the impact of the pandemia on the mental health of women in the postpartum period is needed, in order to devise adequate approaches to recovery from such a major disaster as the Covid-19 pandemic.

Introduction: Postpartum depression negatively affects a woman's quality of life and the development of a relationship with her child, which can have far-reaching consequences on the cognitive, behavioral and emotional development of the child. Etiology includes genetic predisposition, sudden hormonal changes, and sociodemographic factors. Case report: A 28-year-old patient, married, mother of a one-month-old boy. She graduated from the High school of economics, unemployed. She appears in the family medicine clinic due to chronic fatigue and bad mood, at the insistence of her husband, who thinks that she needs professional help. She grew up in a harmonious family. He gets along well with his wife, there are no existential problems. It denies previous illnesses. Neat appearance, inconspicuous posture and behavior, psychomotor diskette slowed down, more sparse spontaneous verbalization, slightly compromised volitional instinctual dynamisms, lowered basic mood. In the laboratory findings, hypothyroidism with elevated thyroid peroxidase antibody and antithyreoglobulin antibodies is detected. The thyroid ultrasound verifies the right lobe of 46x14x15mm, the left lobe of 48x13x12mm, inhomogeneous and easily hypoechoic structure. The Edinburgh Postnatal Depression Scale indicates the presence of depression (total score 18). The patient is referred for a consultative examination by a psychiatrist and a nuclear medicine specialist. Psychiatrist indicates the introduction of Sertralin 50 mg tablets (1x1/2 for the first seven days, then 1x1) and Bromasepam tablets 1,5 mg (2x1/2), nuclear specialist Levotiroskin sodium tablets 50 mcg (1x1/2 for 5 days and 1x1 for 2 days). After six months, withdrawal of the symptoms of the disease and exclusion of therapy by a psychiatrist. Conclusion: Autoimmune thyroid disease is a significant and often unrecognized cause of postpartum depression. Early detection and timely therapeutic intervention of these have a significant role in the prevention and successful treatment of postpartum depression.

Introduction: The process of recording a patient includes a procedure with several separate segments during work that together provide the imaging to be obtained for adequate radiological analysis. Throughout the process, it is possible to experience errors that create artifacts on X-rays which ultimately results in an inadequate recording that is not for valid analysis. Aim: Determine the total number of radiological films that are not for valid analysis. Sort out and analyze errors in radiographs according to the work process. Provide recommendations for improving the quality in the process of recording the patient. Material and methods: A prospective study was conducted at the Radiology Clinic of the Clinical Hospital Center Pristina-Gracanica, for two calendar years. All films that are not for valid analysis were considered. The radiological procedure of patient imaging was broken down into logical segments so that possible errors could be observed. We have summarized the causes of the artifacts in five appropriate groups (errors made by the recording technique, during the acquisition of the image, caused by the object of recording, during the processing of films in an automated machine and improper handling of films). Results: The total amount of used X-ray films is 32600 pieces, of which 242 (0.74%) were errors and artifacts. The most common format of a film with an error or artifact was 30x40 cm. A frequency of errors according to the cause of the occurrence is classified into appropriate groups. The largest number was in a group 1 - 155 (64.04%), in a group 2 - 3 (1.24%), in a group 3 - 13 (5.37%), in a group 4 - 67 (27.69%), and in a group 5 - 4 (1.66%). Conclusion: In the proper systematization of all observed errors and artifacts of X-ray film, it allows us to realise the place of error during the whole process of recording and processing of the film. We hereby wish to propose their elimination and improve the quality of the radiology department.

Introduction. Jarisch-Herxheimer reaction implies trembling, headache, temperature, rash, meningitis, respiratory problems, liver, kidney and heart dysfunction during antibiotic treatment of Lyme disease. Case outline. A 47-year-old patient in May 2016 had circular redness on the thigh, fatigue, myalgia, nausea and headache. Borrelia Burgdorferi IgM antibodies were positive. She took doxycycline 200 mg/day, four weeks. Western blot IgM and IgG were positive as well. Retreated with Azithromycin, 500 mg/day, three weeks. Next year, there was a sleep and memory disorder, fatigue, dizziness, right leg paresthesia and burning in the soles, muscle weakness, decreased sensitivity and right foot hyperreflexia. Electromyography showed axonal degeneration of the peroneus and the tibialis. Pleocytosis (5 leucocytes/mm³) and intrathecal IgG were found. Magnetic resonance of the head in order. Neuroborreliosis was diagnosed and treatment included ceftriaxone, 2 grams/day, three weeks. After the second dose, trembling, myalgia, headache, nausea, flushed nose, dizziness and nausea started. Temperature 37.8°C. No changes on the skin. The antibiotic was not interrupted, symptomatic therapy was administered, and after two days the symptoms stopped. Neurological disorders have not completely disappeared. Titre antibodies still present. Conclusion. Jarisch-Herxheimer reaction occurs in 7.0-30.0% of patients treated for Lyme disease. Causes are multifactorial. Spirochetes release toxins, hypersensitivity is present, phagocytes destroy agents, complements and cytokines are activated. It is often not recognized. Tremor, fever, myalgia and skin rashes are present before the antibiotic, and the worsening is attributed to the underlying disease or allergy. Doctors should expect it during the treatment of spirochete-related diseases and provide appropriate care.