Introduction. Nodular melanoma is an aggressive subtype of cutaneous melanoma characterized by rapid vertical growth, increased Breslow thickness at diagnosis, and early metastatic potential. Its atypical clinical presentation may mimic other skin tumors, leading to delayed recognition. Case Report. A 78-yearold patient presented with a giant, ulcerated, whitish, cauliflower-like tumor on the back, measuring 16 × 11 × 5 cm and attached by a narrow stalk. The initial clinical impression favored cutaneous squamous cell carcinoma. Radical excision with a 2.5 cm safety margin was performed. Histopathological examination confirmed nodular melanoma with Breslow thickness > 10 mm, Clark level IV, ulceration, satellitosis, and perivascular and intravascular invasion. Sentinel lymph node biopsy was recommended but declined. The patient did not return for follow-up, and the clinical outcome remains unknown. Discussion. This case highlights several diagnostic challenges. Giant nodular melanomas (> 10 cm) are rare, and minimal pigmentation may contribute to misdiagnosis. The tumor exhibited multiple highrisk features associated with nodal and distant metastasis. Early biopsy and accurate differential diagnosis are essential, as exophytic or atypical lesions may resemble non-melanocytic tumors. Conclusion. Atypical presentations of nodular melanoma require heightened clinical vigilance. Early recognition, appropriate surgical management, and adherence to staging protocols are essential for optimal outcomes.
Introduction. Chronic obstructive pulmonary disease is frequently accompanied by exacerbations that significantly worsen patients’ clinical status. Although infections are the most common trigger, atypical, recurrent, or treatment-resistant exacerbations may indicate other underlying pathologies, including lung carcinoma. Early recognition of malignancy in patients with chronic obstructive pulmonary disease is crucial for timely initiation of therapy and improved outcomes. Case Reports. We present two patients with established chronic obstructive pulmonary disease in whom worsening respiratory symptoms were initially interpreted as exacerbations of the underlying disease. In the first case, chest computed tomography and bronchoscopy revealed a well-differentiated squamous cell carcinoma (stage IIIB), while in the second case histopathological analysis confirmed lung adenocarcinoma (stage IIIA). In both cases, the absence of response to standard therapy and the atypical clinical course raised suspicion of malignancy. Conclusion. Lung carcinoma in patients with chronic obstructive pulmonary disease patients may clinically manifest as an apparent exacerbation of the primary disease, potentially leading to diagnostic delay. Any atypical, frequent, or therapy-refractory exacerbation should prompt further diagnostic evaluation, particularly radiological assessment. Recognition of clinical “red flags,” such as unexplained weight loss, hemoptysis, new-onset chest pain, or radiological changes not attributable to infection, is essential for early cancer detection and improved prognosis. Early implementation of radiological diagnostics, supported by a multidisciplinary approach, represents a key component of successful patient management.
Introduction. Infertility represents a major global health challenge with profound medical, psychological, and social consequences. Despite substantial advances in assisted reproductive techniques, the success rates of in vitro fertilization remain limited, largely due to subjectivity in embryo selection and variability in ovarian stimulation management. Application of artificial intelligence in embryo selection. Artificial intelligence systems enable the analysis of large and complex datasets, including morphological and morphokinetic embryo characteristics derived from static imaging and continuous developmental monitoring. These approaches enhance the standardization of embryo quality assessment and reduce interobserver variability; however, their performance remains constrained by the quality of training data and the incomplete representation of biological determinants of implantation. Role of artificial intelligence in ovarian stimulation management. Algorithms integrating clinical, hormonal, and ultrasonographic parameters facilitate individualized gonadotropin dosing, more accurate determination of final oocyte maturation timing, and reduction of ovarian hyperstimulation risk. Existing studies demonstrate a high level of concordance between algorithm-based recommendations and expert clinical decision-making. Future directions. Further advancements are anticipated through the development of multimodal models integrating morphological, clinical, and genetic data, alongside the implementation of explainable systems to enhance transparency and clinical trust. Conclusion. Currently, artificial intelligence serves primarily as a decision-support tool rather than a substitute for clinical expertise. Its routine clinical implementation requires robust prospective validation and regulatory approval.
Introduction. Open surgical carotid artery revascularization remains the gold standard for the treatment of carotid atherosclerotic disease. The aim of this study was to analyze atherosclerotic risk factors in patients undergoing open surgical carotid revascularization and to evaluate intraprocedural factors associated with periprocedural complications. Material and Methods. This retrospective study included 125 patients treated at the University Clinical Center of Vojvodina between 2023 and 2024. Data were collected from medical records at the Clinic for Vascular and Endovascular Surgery. Results. Patients were categorized as asymptomatic (n = 89) and symptomatic (n = 36). The study population consisted of 63% men and 37% women. An incomplete Circle of Willis was observed in 24% of patients (16% in the asymptomatic group and 44% in the symptomatic group), demonstrating a significant association with disease stage (p = 0.001). Unstable plaques were detected in 15% of asymptomatic and 36.1% of symptomatic patients (p = 0.023). An incomplete Circle of Willis was significantly associated with the occurrence of hyperperfusion syndrome (p = 0.012) and intraoperative hypertension (p < 0.001). Conclusion. Age, cardiac comorbidities, plaque morphology, and completeness of the Circle of Willis are associated with the clinical stage of extracranial cerebrovascular disease. Intraoperatively, hemodynamic instability, carotid plaque length, clamp duration, and total procedure time were associated with an increased risk of procedural complications.
Introduction. Wound infection after groin incision remains a frequent complication in vascular surgery, yet long-term singlecenter data on temporal trends, severity distribution, and pathogen shifts are scarce in southeastern Europe. This study describes the 15-year epidemiology of groin wound infection following femoral vascular procedures and examines changes in incidence, wound depth classification, and methicillin-resistant Staphylococcus aureus prevalence. Material and Methods. All consecutive groin incisions for femoral arterial access performed at a single tertiary vascular center between January 2010 and December 2024 were reviewed. Wound infection was diagnosed within 90 days using standardized surveillance criteria. Annual rates were calculated and tested for temporal trend. Culture results were analyzed by five-year period. Results. Among 8,742 groin incisions, 846 (9.7%) developed a wound infection: 490 superficial (57.9%), 245 deep (29%), and 111 organ/space (13.1%). Annual rates fluctuated between 8.2% and 11.5% without a significant directional trend (p = 0.284). The highest unadjusted rate was observed after infrainguinal bypass (13%). Of 724 culture-positive episodes, the methicillin-resistant Staphylococcus aureus proportion rose across three predefined five-year periods, from 8.7% in 2010-2014 to 13.8% in 2015-2019 and 21% in 2020-2024 (p for trend < 0.001), while gram-negative isolates remained relatively stable at 23-26%. Conclusion. Groin wound infection affected approximately one out of ten femoral vascular procedures over 15 years with no measurable decline across the observation period. The steady rise in methicillin-resistant Staphylococcus aureus supports institutional review of empirical prophylaxis protocols at centers with similar resistance profiles.
Introduction. During pregnancy, approximately 1-2% of patients undergo non-obstetric surgical interventions. Pregnant women are considered at increased risk in the perioperative period, due to anatomical and physiological changes that occur during gravidity. Anatomical and physiological changes. Changes in the respiratory tract are especially pronounced towards the end of pregnancy. These changes include swelling of the oropharyngeal tissues and reduced caliber of the glottis, which can lead to difficulty during ventilation and intubation. Perioperative anesthesiological considerations. Carefully titrating anesthetics is essential, as drug requirements are usually reduced during pregnancy. Medications and toxicity. Drugs administered during pregnancy may have a harmful effect on the fetus depending on dosage, method of administration and time of exposure. Despite years of animal experiments and observational studies in humans, no anesthetic has been shown to be clearly dangerous to the human fetus. Fetal monitoring. Accurate interpretation of fetal heart rate patterns and understanding of the effects of anesthetics enable effective monitoring of fetal well-being and informed decision-making regarding intraoperative care for the safety of both mother and fetus. Non-obstetric surgical conditions. Appendicitis and cholecystitis are the two most common surgical conditions that require treatment during pregnancy. Other more common conditions are chronic inflammatory bowel diseases and pancreatitis. Traumatic injuries of pregnant patients are a special topic. Conclusion. Comprehensive preoperative preparation should performed before every surgical intervention. Pregnant women should never be denied an emergency indicated surgical procedure, regardless of the current trimester of pregnancy.
Introduction. Symptomatic non-ruptured abdominal aortic aneurysm represents an intermediate clinical entity between elective aneurysms and ruptured disease. This study aimed to compare perioperative outcomes and the incidence of acute kidney injury incidence between patients undergoing open surgical repair for symptomatic versus asymptomatic abdominal aortic aneurysms. Material and Methods. This retrospective cohort study included 178 patients who underwent open surgical repair for infrarenal abdominal aortic aneurysm between January 2021 and January 2023. Patients were classified as symptomatic (n = 60) if they presented with abdominal or back pain, limb ischemia without rupture, and as asymptomatic (n = 118) if treated electively. Demographic characteristic, comorbidities, intraoperative parameters, and postoperative outcomes were analyzed. Results. Symptomatic patients had a significantly larger mean aneurysm diameter compared with asymptomatic patients (74.5 vs. 64.2 mm; p < 0.001). Overall postoperative complications occurred more frequently in symptomatic patients (28.3% vs. 9.3%; p = 0.001), particularly cardiac complications (10% vs. 2.5%; p = 0.032). The length of hospital stay was significantly longer in the symptomatic group (10.1 vs. 8.4 days; p = 0.004). The incidence of postoperative acute kidney injury did not differ significantly between groups (31.7% vs. 27.1%; p = 0.53). However, preoperative chronic kidney disease and anemia were strong predictors of postoperative acute kidney injury. Thirty-day mortality was higher in symptomatic patients (8.3% vs. 3.4%) although the difference did not reach statistical significance (p = 0.40). Conclusion. Symptomatic nonruptured abdominal aortic aneurysm is associated with larger aneurysm size, higher complication rates, and prolonged hospitalization. Nevertheless, open surgical repair can be performed with acceptable outcomes in specialized centers.
Introduction. Gastrointestinal endoscopic procedures are increasingly performed in pediatric populations; however, data on postprocedural pain and its determinants remain limited. Adequate sedation and effective pain management are essential for ensuring patient comfort and optimizing procedural outcomes. This study is aimed to evaluate intensity of postprocedural pain following gastrointestinal endoscopic procedures in children and to identify factors associated with increased pain perception. Material and Methods. This prospective clinical study included pediatric patients undergoing elective endoscopic procedures at the Pediatric Clinic in Novi Sad between May and July 2025. Pain intensity was assesses 30 minutes after the procedure using age-appropriate validated scales: the Numerical Rating Scale for children aged ≥9 years, the Wong-Baker Faces Pain Rating Scale, and the Face, Legs, Activity, Cry, Consolability scale for younger children. Patient demographics, procedural characteristics (type and duration), and overall satisfaction were analyzed. Statistical analysis was performed using SPSS version 23. Results. A total of 39 patients were included (16 boys and 23 girls). The most frequently performed procedure was combined esophagogastroduodenoscopy and colonoscopy (61.5%). The mean pain score was 2.69 (SD = 1.73), ranging from 0 to 6. Female patients reported higher pain scores (mean = 3.08) compared to males (mean = 2.12), with the difference approaching statistical significance (p = 0.086). No statistically significant associations were observed between pain intensity and age, type or duration of the procedure, or prior endoscopic experience. The mean satisfaction score was 4.64 (SD = 0.58), with significantly higher satisfaction reported among younger patients (p = 0.03). Conclusion. Identification of individual risk factors for postprocedural pain may facilitate optimization of sedation protocols and support more patient-centered approach in pediatric endoscopy.
Introduction. Robotic-assisted gait training is a high-technology rehabilitation intervention that has gained increasing popularity over the past two decades. However, limited research has explored how the parents of children with cerebral palsy perceive this intervention. The aim of this study was to examine parents? perspectives on robotic-assisted gait training with regard to the child?s experience, its effects on impairments, and functional activities. Material and Methods. A total of 24 participants, including 23 mothers of children with cerebral palsy, completed an online cross-sectional survey distributed via SurveyMonkey. The survey was administered two months after completion of 20 sessions of robotic-assisted gait training. Results. All parents (100%) reported that robotic-assisted training was an enjoyable experience for their child and highly valued the quality of communication between the therapist and the child. Parents observed improvements in self-confidence (79.17%), muscle endurance (79.16%), muscle flexibility (66.66%), and reduced muscle tightness (78.26%). Additionally, improvements were noted in standing posture (54.07%), the ability to walk longer distances (62.50%), functional activities in daily life (66.66%), and participation levels (75%). Conclusion. Parents perceived robotic-assisted gait training as an engaging intervention that positively influences physical health, self-confidence, and happiness. Improvements in motor activities, participation in daily life, and quality of life were observed following 20 sessions of robotic-assisted gait training.
Introduction. Gallbladder perforation is a rare but potentially lifethreatening complication of acute cholecystitis, with reported mortality rates exceeding 50%. Owing to its frequently non-specific symptoms, early diagnosis is essential. Radiological imaging - particularly contrast-enhanced computed tomography and ultrasonography - plays a key role in identifying perforation. Case Report. We present the case of a 62-year-old patient with Niemeier Type II gallbladder perforation. At admission, prominent clinical or laboratory indicators of acute disease were absent. Initial management included broad-spectrum antibiotics and supportive therapy. Although percutaneous drainage was considered, the procedure was deemed unfeasible due to the close proximity of the abscess to the hepatic flexure of the colon. Consequently, an open cholecystectomy with abscessotomy was performed two weeks after symptom onset. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day for continued outpatient care. Conclusion. While surgical intervention is mandatory in cases of generalized biliary peritonitis, the optimal treatment strategy for localized gallbladder perforations remains debated. Current literature emphasizes the advantages of open cholecystectomy despite longer hospitalization, whereas delayed surgical intervention may be beneficial in carefully selected patients.
Introduction. Single-chamber and dual-chamber pacemakers are used for the treatment of bradycardia. Dual-chamber pacemakers more closely replicate physiological cardiac function by preserving atrioventricular synchrony, whereas single-chamber pacemakers are less complex, more cost-effective, and easier to implant. Clinical trials comparing these two pacing modalities have reported inconsistent results, largely depending on the studied population and study design. The AQUAREL questionnaire is a disease-specific instrument designed to assess life quality of life in patients with pacemakers. The aim of this study was to compare the quality of life of patients with single-chamber and dual-chamber pacemakers using the AQUAREL questionnaire. Material and Methods. After providing informed consent, 80 patients treated at the Institute for Cardiovascular Diseases of Vojvodina completed the AQUAREL questionnaire. Inclusion criteria were age ?60 years and implantation of either a single or dual-chamber pacemaker. These criteria were met by 69 patients, including 33 with single-chamber and 36 with dual-chamber pacemakers. Data were obtained from the Institute?s digital medical record. Statistical analysis was performed using standard methods. Results. The mean age of the patients was 76 years; 42 participants (63.77%) were male, and 92.75% had at least one comorbidity. Analysis of AQUAREL questionnaire scores revealed no statistically significant differences in overall quality of life between patients with single-chamber and dual-chamber pacemakers. Conclusion. Although patients with dual-chamber pacemakers reported fewer severe symptoms compared with those with single-chamber pacemakers, the difference was not statistically significant. Overall, no significant difference in quality of life was observed between patients according to pacemaker type.
Introduction. Anterior cruciate ligament injuries predominantly affect young, physically active, and working-age population. The objective of anterior cruciate ligament reconstruction extends beyond restoring knee stability and mechanical function; it also aims to improve the patient?s overall quality of life. Material and Methods. A total of 307 patients diagnosed with anterior cruciate ligament injury were included in the study. This investigation builds upon our previous research, expanding the analysis to a larger patient cohort. Group A consisted of 187 patients with isolated anterior cruciate ligament rupture, while Group B included 120 patients with combined injuries: 70 with inner meniscus injuries, 24 with outer meniscus injuries, and 26 with injuries to both menisci. Results and Discussion. Analysis of the Knee Injury and Osteoarthritis Outcome Score revealed statistically significant differences across multiple parameters, including pain intensity, activities of daily living, sports and recreational function, and perceived quality of life. In all these domains, patients in Group A achieved better outcomes compared to those in Group B. Female patients demonstrated higher quality-of-life scores related to activities of daily living compared to male patients, which may be attributed to greater postoperative engagement in such activities. Conclusion. Although statistically significant differences were observed in several functional and quality-of-life domains, the overall findings did not demonstrate detectable clear advantage in quality of life for patients with isolated anterior cruciate ligament injuries compared to those with concomitant meniscal lesions following anterior cruciate ligament reconstruction.
Introduction. Acute myeloid leukemia and chronic myeloid leukemia are malignant blood cell disorders characterized by increased angiogenesis. This study aimed to evaluate blood vessel density in bone marrow tissue of patients with acute and chronic myeloid leukemia and to determine whether there is a statistically significant difference compared to a control group. Material and Methods. This retrospective study included 90 bone marrow biopsy samples, categorized into three groups: control, acute myeloid leukemia, and chronic myeloid leukemia. Pathohistological diagnoses were retrieved from the records of the Center for Pathology and Histology of the Clinical Center of Vojvodina. Samples were processed using standard histological and immunohistochemical techniques, examined microscopically, and photographed. Blood vessel density was quantified using ImageJ program, analyzing five microphotographs per sample, with results expressed as percentages. The mean value was calculated for each subject. Data were analyzed statistically and presented numerically, graphically, and in tables. Results. The mean blood vessel density was 1.85% (?}0.56%) in the control group, 3.72 (?}1.67%) in the acute myeloid leukemia group, and 5.42% (?}2.28%) in the chronic myeloid leukemia group. A statistically significant difference in blood vessel density was observed among the groups. Conclusion. The statistically significant difference in blood vessel density between the groups underscores the role of angiogenesis in the pathogenesis of these malignancies and suggests its potential relevance in diagnosis and therapeutic strategies.
Introduction. Inherited epidermolysis bullosa comprises a heterogeneous group of genetic disorders characterized by skin fragility, resulting in blisters, erosions, and scaring of the skin and mucous membranes following minimal mechanical trauma. Patients with inherited epidermolysis bullosa are at increased risk of developing aggressive cutaneous squamous cell carcinoma, most commonly arising on the extremities. Case Report. We report a case of a 21-year-old female with inherited epidermolysis bullosa who presented with a progressively enlarging tumor on the right lower leg, appearing as a small crusted lesion. Physical examination revealed a firm, elevated lesion measuring approximately 10 cm in greatest diameter, covered with crusts. The patient had previously undergone two surgical excisions the same site for confirmed cutaneous squamous cell carcinoma. Radiological evaluation demonstrated no evidence of bone invasion, while ultrasonography identified a single enlarged lymph node in the right inguinal region. Partial biopsy of the lesion confirmed cutaneous squamous cell carcinoma, and lymph node biopsy revealed reactive lymphadenitis without metastatic involvement. Considering the presence of typical lesions throughout the body, the patient?s inability to achieve verticalization, limited reconstructive options, and repeated recurrence of aggressive carcinoma, limb amputation was considered the most appropriate therapeutic approach. Conclusion. In patients with inherited epidermolysis bullosa who develop recurrent cutaneous squamous cell carcinoma, particularly after multiple local recurrences and in the absence of feasible reconstructive options, amputation may represent an unavoidable yet life-preserving treatment strategy, even in the setting of localized disease.
Introduction. Surgical repair of inguinal hernias is among the most commonly performed procedures in general surgery. Despite the high volume of operations performed annually, urological complications following this procedure remain underreported. Testicular torsion is one of the most frequent causes of an acute scrotum; however, it is rarely considered a postoperative complication, which may delay diagnosis and subsequently increase the risk of testicular loss. Case Report. We present the case of a 47-year-old male who was admitted to the Emergency Department with scrotal pain occurring three days after an elective right-sided inguinal hernia repair. Physical examination and scrotal color Doppler ultrasonography were performed, after which urgent surgical exploration was indicated. Intraoperatively, a 360o intravaginal torsion of the right spermatic cord was identified, with no restoration of blood flow following detorsion. Based on intraoperative findings, a right-sided orchiectomy was performed. The diagnosis was subsequently confirmed by histopathological examination. Conclusion. Although postoperative symptoms may be nonspecific and misleading, clinicians should maintain a high level of suspicion for possible urological complications after inguinal hernia repairs. Delayed recognition can significantly impact a patient?s quality of life and may result in considerable medico-legal consequences. Early identification and prompt management are thereof essential.
Introduction. Open surgical decompression is considered the most efficient treatment for carpal tunnel syndrome and is associated with excellent outcomes in approximately 70-90% of cases. This study aimed to determine whether a correlation exists between potential predictors of postoperative outcomes and patient satisfaction following surgical procedure. Material and Methods. This retrospective study utilized data collected from the database of the University Clinical Center of Vojvodina and supplemented by telephone interview. Four categories of potential predictors were analyzed: patient-related factors, comorbidityrelated factors, clinical findings, and other relevant factors. Results. A statistically significant positive correlation was identified between patient gender and postoperative satisfaction scores. Additionally, pain intensity, nocturnal pain, and postoperative complications demonstrated statistically significant negative correlations with satisfaction scores. Conclusion. Understanding predictors of surgical outcomes can assist patients in making informed decision regarding treatment and in setting realistic expectations about functional recovery following carpal tunnel decompression.
Introduction. Solitary rectal ulcer syndrome typically presents as painful or difficult defecation and rectal bleeding. The aim of this case report is to highlight how misinterpretation of histopathological findings following colonoscopy can lead to unnecessary and potentially mutilating surgical interventions. Case Report. A 58-year-old man was diagnosed with rectal cancer based on histopathological findings obtained after colonoscopy and supported by pelvic magnetic resonance imaging. A transanal excision of the suspected tumor mass was performed. However, definitive histopathological analysis of the surgical specimen revealed features consistent with solitary rectal ulcer syndrome. Subsequent revision of the initial colonoscopic biopsy by an experienced colorectal pathologist confirmed the diagnosis of solitary rectal ulcer syndrome. Follow-up colonoscopy performed three months postoperatively showed no evidence of tumors, ulcerations or polyps in the colon. Conclusion. Careful integration of clinical presentation, endoscopic findings, imaging, and expert histopathological evaluation is essential to avoid misdiagnosis and overtreatment. In suspected cases of solitary rectal ulcer syndrome, biopsy specimens should be reviewed by pathologists experienced in colorectal pathology do prevent unnecessary radical surgical procedures.
