The Military Medical Academy of the University of Defence (Serbian: Војномедицинска академија, romanized: Vojnomedicinska akademija; abbr. VMA), is a military hospital center in the Banjica neighborhood of Belgrade, Serbia.Founded in 1844, it is a part of the Serbian Armed Forces and is generally intended to serve the officers and soldiers, although it is open for civilians as well. It is known for its high standard in medical practice and is generally considered to be the best medical institution in the country.
Introduction: Mixed germ cell tumor (MGCT) is most common in younger patients and is localized primarily to the gonads. After reviewing the literature, we concluded that there are only a few cases of mediastinal MGCT - primary mediastinal MGCT accounts for about 10-15% of all mediastinal malignancies and up to 3% of all MGCT. Mediastinal MGCT with more than three pathological components, such as yolk sac tumor, teratoma, and embryonal carcinoma, has not been reported previously in the reviewed literature. Our patient had two more components (carcinoma and seminoma). Case report: The patient was a 40-year-old male who presented with chest pain and fever; chest CT showed a giant mass in the right pleural space, with a maximal diameter of 120 mm. Bronchoscopic findings were normal, and bronchial biopsies were negative. A combined open and VATS approach was used, which revealed NSCLC. The patient underwent chemotherapy, but the next CT scan of the thorax showed progression. Decision was made to perform surgical treatment - salvage pneumonectomy with "coliseum" approach. Intraoperatively, it was verified that the tumor origins were in the mediastinum, so the whole tumor was removed. The whole right lung was in atelectasis, but was not infiltrated by tumor - full reexpansion of the right lung was established during the surgery. The patient tolerated surgery well. Definitive PH finding showed that it was a mixed malignant germinative tumor. Urology findings and the postoperative full-body CT showed no signs of residual or recurrent tumor. Conclusion: The patient was initially misdiagnosed and treated with chemotherapy after the conclusion that he was not a candidate for surgical treatment. Primarily planned salvage surgery for this young patient ended as radical surgery and without the need for pneumonectomy.
Excimer laser pulses using the LASIK method ablate the corneal stroma, achieving its remodeling to the desired optical characteristics. Besides correcting ametropia, it is desirable to minimize the induction of higher-order optical aberrations (HOA), as they affect the occurrence of glare and halos in night vision conditions. Fractional clearance (FC) represents the ratio of the treated optical zone (OZ) to the pupil diameter in scotopic lighting conditions. This study aims to examine the relationship between the enlargement of the treated OZ diameter and the increase in FC index on postoperative HOA levels. A prospective study included 37 subjects (74 eyes) with myopia treated with the LASIK method. The eye with a higher residual stromal bed value was treated with an OZ diameter of 7.0 mm, and the other eye of the same patient with an OZ diameter of 6.5 mm. After 6 months, an objective evaluation of optical outcomes was performed using an Analyzer device. The mean FC value in the group of eyes treated with OZ 6.5 mm is 2.138 (SD 0.30), and in the group treated with OZ 7.0 mm is 2.325 (SD 0.37), statistically significant (t=3.64; p<0.001). A smaller induction of all measured HOA was found when a wider OZ of 7.0 mm was treated, with the statistically significant reduction observed in spherical aberration induction. The increase in FC index is proportional to the enlargement of the treated OZ diameter. With an increase in FC value, the level of all HOA decreases after the LASIK procedure, with the most significant reduction observed in spherical aberration induction. Enlargement of OZ to 7.0 mm, when corneal structural characteristics allow it, improves postoperative optical outcomes.
Introduction/Objective: Radiotherapy for breast cancer can rarely lead to radiation-induced osteosarcoma (RIOS), a highly aggressive malignancy. This article aims to present the specificity of the surgical treatment applied and the level of aggressiveness of this rare malignant tumor. Case report: A 63-year-old female patient was admitted to the Chest Surgery Department of the Military Medical Academy due to a large exulcerated sternal mass releasing a purulent secretion, initially misdiagnosed as recurrent breast carcinoma 15 years post-treatment, and anemia. Biopsy confirmed high-grade osteosarcoma following prior radiotherapy. After metastasis was ruled out, the patient received neoadjuvant chemotherapy and underwent radical resection of the sarcoma, sternum, anterior III-VII ribs, and adjacent soft tissues. Chest wall reconstruction was achieved using titanium bars, clips, and a latissimus dorsi myocutaneous flap. Upon local recurrence, further resection of the manubrium and anterior II ribs, with soft tissues, was performed. A year after the initial operation, a suspicious subcutaneous mass in the left pectoral region was excised for histopathological analysis. Conclusion: RIOS of the chest wall exhibits a more aggressive course and worse prognosis than sporadic chest wall sarcomas, with higher rates of recurrence despite wide resection, as demonstrated in this case. Reconstruction with titanium bars and clips, after extensive anterior chest wall resection, provides a rigid and feasible alternative for restoring stability. This case underscores the importance of recognizing RIOS as a rare but serious late complication of breast cancer radiotherapy and highlights the complexity and specificity of surgical management and reconstruction for optimal outcomes.
