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: Dementia is a clinical diagnosis based on deficits of intellectual function, usually memory. Primarily neurodegenerative diseases are characterized by progressive neuronal damages and its synapsis. Early-onset Alzheimer disease 18 occurs in someone younger than 65. FDG-PET/CTis a quantitative tomographic technique also calleda biomarker of neuronal activity.

Case outline: A female of 54, mother, 12 years of education, an accountant, was sent to FDG-PET/CT brain scan because of loss of memory, social withdrawal, apathy, behavior changes, troubles with paying bills, speaking difficulties with no structural imaging abnormalities. PET scan reviled glucose hypometabolism in parietal lobes, left posterior cingulum, parietotemporal regions, the left parietooccipital region, left insula and temporal lobes. A male of 43, father, army corporal, 12 years of education, was sent to metabolic hybrid imaging because suspected dementia. He expressed progressive behavior decline, in a year time. The patient wasn't cooperative, could not concentrate and confabulated a lot. Forgetfulness, decline in voluntary dynamics and apathy dominated the clinical presentation. Structural imaging showed supratentorial, right precentral gyri solitary lesion and cortical bilateral hypocampal atrophy. FDG scan reviled distinctively diminished glucose metabolism posteriorly in parietal and temporal lobes, both posterior cingulum. SPM analysis confirmed the visually observed pattern of hypometabolism in both patients.

Conclusion: Depression is an important consideration in the differential diagnosis of AD. Early detection of AD through molecular imaging techniques will assist the choice of medications to slow the progression of the disease and optimize patient care.

Introduction: Asphyxiation by aspiration- inhalation of foreign bodies is a form of violent mechanical asphyxia and can occur at any age, most commonly in children and the elderly. In children up to third age choking is a significant cause of morbidity and mortality. Mortality due to aspiration of foreign bodies is higher in children because of the relatively narrow airways and less developed protective mechanisms. The size, type, shape and place of obstruction with foreign body leads to the diversity of clinical picture.

Case report. We present the case of a 15 month-old girl, who was found by her mother in her house in a village, lying down, cyanotic, collapsed, without breathing. Autopsy showed that the cause of death was acute respiratory obstruction with impacted grains of corn in two places, on the larynx entrance and in the right bronchus.

Conclusion. The diagnosis of death by asphyxiation due to aspiration of foreign bodies is set at autopsy, when the place of airway occlusion is found. If a foreign body was removed during providing assistance, the diagnosis would be made based on medical records or history data of persons who were provided assistance. In cases of sudden deaths of young children, in order to clarify pathophysiological mechanism and mode of death in each case, a pathologist should always keep in mind the possibility of aspiration of foreign bodies, and in accordance with this, carefully apply appropriate autopsy techniques to locate the place of obstruction, with special regard to local finding in airways.

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.

Introduction: Elastic fibers are constituents of the dermal extracellular matrix, determining the histoarchitecture of the
dermal connective tissue. Organization and density of elastic fibers change as skin ages. The aim of this paper was to determine the similarities and differences between the photo-aging and the physiological aging of skin by examining organization and quantifying the elastic fibers in the dermis during aging. The material included samples of photoexposed and photoprotected skin, obtained from 90 cadavers aged 0-82 years. The samples were classified into five age groups: newborns, young age, middle age, mature age and the oldest age. Skin samples were stained using the Halmi modification of Aldehyd fucshin staining method, as well as Alcian blue staining (the Spicer method). Volume density (VD) of the elastic fibers was measured using Image J program.

Results: In the skin of newborns and young age group (neck and abdomen) elastic fibers appeared to form a network structure. In the photoexposed skin of the mature age and the oldest group, elastic fibers showed tendency to fragment, while the elastic material exhibited tendency to accumulate. VD of elastic network in the skin of the neck in the middle, mature and the oldest age group was greater than VD of abdominal skin of the respective age groups (3.66±0.28%, 5.61±0.22%, 6.24±0.21% respectively). Age-related statistically significant increase in VD of the elastic network in the skin of the neck, as well as a statistically significant reduction of elastic network VD in the abdominal skin, has been observed (middle age - oldest).

Conclusion: Correlation of the organization and quantity of elastic fibers with age exhibits different pattern in photoexposed compared to photoprotected skin. A quantitative evaluation of the volume density of elastic fibers correlates with clinically visible signs of photo-aging, primarily with solar elastosis.

Introduction: Glaucoma diagnosis is based on consideration of several factors, such as increased intraocular pressure (IOP), damage to the optical disc, and associated visual field loss. Evaluation of the integrity of the corneal endothelium and monitoring of the corneal thickness is indispensable during the preoperative preparation for phacoemulsification. These data are of great importance for later treatment and monitoring of early and late postoperative complications.

Objective: The aim of this study was to determine the central corneal thickness immediately before and after cataract surgery in patients with primary glaucoma (open and closed angle), comparing them with patients who do not have diagnosed glaucoma. Materials and methods: A prospective study covered a total of 159 subjects who performed cataract surgery by the method of phacoemulsification with the implantation of the intraocular lens in the posterior chamber at the Clinic for Eye Diseases at the Clinical Center of Serbia in Belgrade in 2017 and 2018. Pre-operative patients are classified into two groups. The first group with a primary glaucoma consisted of 71 respondents, with an open angle 41 with glaucoma, and a closed angle glaucoma 30. The second group consisted of people who did not have a diagnosed glaucoma, 88 of them. The central corneal thickness was measured using an ultrasound pachymeter. The measurements were made before the operation, 24 hours, 10 and 30 days after the operation, trying to get all done at the same time of day.

Results: Between patients without glaucoma (BG), primary open-angle glaucoma (POAG) and primary glaucoma of closed angle (PACG), there is a statistically significant difference in median age (χ2 = 10.102; DF = 2; p = 0, 006). Among the observed groups there were statistically significant differences in the values measured preoperatively (χ2 = 10.265; DF = 2; p = 0.006). Among the observed groups, there was no statistically significant difference in the values measured in the first postoperative day (χ2 = 4.364; DF = 2; p = 0.099), nor in the 10th postoperative day (χ2 = 3.250; DF = 2; p = 0.197); 30 days after surgery (χ2 = 1.427; DF = 2; p = 0.490). In each of the groups individually, the appearance of oedema or a very statistically significant difference in the first and tenth postoperative day. Statistically significant difference was present 30 days after surgery, but far less compared to early postoperative period.

Conclusion: Based on the values obtained in this prospective study, we estimate that monitoring of corneal thickness has a mandatory place in the observation of patients after cataract surgery. We found that there is no difference in preoperative measurement only between groups without glaucoma and open angle glaucoma. Measurements performed in the first, tenth, thirtieth day do not differ in groups, but edema restitutin in the 30-th day was observed in all observed groups.