Introduction: Until recently, gastric cancer represented the most common visceral neoplasm. In Japan, the prevalence of disease is 58.4 per 100,000 inhabitants for men and 29.9 for women. Here, the incidence is lower. Gastrectomy is the most common surgical method of treating carcinomas of the stomach. Aim of the Study: To determine which method of reconstruction after gastrectomy improves the quality of life optimally. Patients and Methods: We analyzed 221 patient operated on for gastric cancer at the Surgical Clinic of the University Clinical Center in Banja Luka, and the subject of a detailed analysis of the 111 patients who were operated with the intention of achieving curability. Results: Reflux esophagitis is dominant modality in reconstruction wth omega loop (p <0.05). Analyzing GIQLI, we found dominant modality GIQLI II in the total gastrectomy and reconstruction options RY, while predominantly GIQLI III was registered in HLR reservoir reconstruction method (p <0.01). And two hours after the ingestion of a meal labeled with a radioisotope Tc99m in artificial gastric reservoir (HLR) showed signs of radioactivity (about 10% amount). “H0 performance” (AJCC / UICC) was the most frequently recorded in subtotal gastrectomy, while there was significant appearance of “H1” and “H2” modalities with the total gastrectomy statistically. In RY reconstruction, statistically significant was participation modalities “H1”, while “H1” performance (AJCC / UICC) was the dominant modality at the HLR options reconstruction with statistically significant frequency of occurrence (p <0.01). Conclusion: The results of the assessment of quality of life are comparable with the results of other statistical series. They confirm antireflux component Roux en Y reconstructions and its intestinoplications and highlight the advantage of the nutritional components loop modifications (creation pouch-a).

Introduction: Testicular tumors account for approximately 1% of all malignancies in men, but the age of patients and its increasing incidence make this malignancy one of the leading oncological problems. In spite of the fact that the testicles are organs accessible for self-examination and the accessibility of ultrasound examination as the method of choice in diagnostics, these tumors are often detected in an advanced stage of the disease. Aim of the Study: The aim of this study is to evaluate the occurrence of advanced disease at the time of diagnosis of testicular germ cell tumors, through retrospective analysis. Patients and Methods: Our study examines patients with testicular germ cell tumor (seminomatous and non-seminomatous) according to numerous parameters - anamnesis with special emphasis on risk factors, clinical examination, laboratory analyses with tumor markers, and diagnostic imaging examinations (thorax, abdomen and pelvis CT scan). Before the specific treatment, spermiogram and semen cryopreservation were done for most patients, while in some cases additional diagnostics (MRI of the endocranium, skeletal scintigraphy) was indicated as well. Results: During the observation period, 132 patients with testicular germ cell tumor were treated and observed, of which 58 patients (44%) with seminomatous tumor type and 74 patients (56%) with non-seminomatous tumors. Of the total number of patients, at the time of disease diagnosis, there were 41 patients (31%) with N1- N3 status of retroperitoneal lymph nodes and 17 patients (12.8%) with M1a-M1b metastatic status. Conclusion: A large number of newly detected testicular tumors are diagnosed in an advanced stage of the disease. It is necessary to raise awareness of the general population about this malignancy, emphasise the importance of self-examination in younger men, and promote the possibility of routine ultrasound examinations with the aim of early detection of the disease.

Background The purpose of this study is to establish whether the lymph node metastases of the papillary thyroid carcinoma are a significant factor in recurrence of the disease by analyzing the time until recurrence of the disease and frequency of recurrence of the disease. Methods From 1 January 1995 until 30 June 2017, 102 patients were treated at the Public Health Institute Hospital “Sveti Vracevi” in Bijeljina for PTC. In all patients, surgery of the thyroid gland and/or lymph nodes of the neck was performed. Total thyroidectomy (TT) was performed in 20 patients and near-total thyroidectomy leaving <1 g thyroid tissue adjacent to the recurrent laryngeal nerve in 7 patients. TT and lymph nodes dissection were performed in 71 patients. Palliative surgery and biopsy due to locally advanced disease were performed in 3 patients. Results In our study, 102 patients with PTC were analyzed. 82 patients experienced pure PTC (80.4%), the other 20 patients (19.6%) experienced other variants of PTC. 24 patients (23.5%) experienced multi centric or bilateral tumors. 71 patients (69.6%) experienced histologically verified metastases in the lymph nodes of the neck. 7 patients (6.8%) experienced distant metastases. 20 patients underwent total thyroidectomy (TT), and 7 near-total thyroidectomy. Total thyroidectomy + dissection of central and lower jugular lymph nodes with frozen section histopathology verification was performed in 71 patients (69.6%). Out of these 71 patients, in 50 patients (70.4%) metastases were verified in the lower jugular lymph nodes. A modified lymph node dissection (MRND) was also performed in these patients. Conclusion Lymph node metastases of the papillary thyroid carcinoma are a plausible prognostic factor. They are important for recurrence of the disease, but not for survival.

Introduction Duplicated ureter or Duplex Collecting System is a congenital condition in which the ureteric bud, the embryological origin of the ureter, arises twice, resulting in two ureters draining a single kidney. This congenital anomaly is rare, and even rarer when the duplex system with ectopic ureter is present. This type of congenital anomaly is even more rarely diagnosed and surgically treated in adulthood. Case report This case report presents a case of a 32-year-old male, who had a duplex collecting system with two ureters on the left side. Ectopic ureter, draining the upper pole of the left kidney, opened into the posterior urethra. In our patient, taking into account the clinical perspective, the renal tissue damaging of the upper pole which was not functional, partial nephrectomy and ureterectomy was successfully performed.

Implementation of IMRT offers possibility to escalate radiation therapy dose without increased acute and late toxicity. The aim of this study is to compare acute and late genitourinary and gastrointestinal toxicity in patients treated with IMRT and 3DCRT technique. This study included 35 patients in study group a treated with IMRT technique, and 35 patients in study group B treated with 3DCRT technique. Patients were selected and referred to radical radiotherapy treatment prostate cancer. Acute genitourinary and gastrointestinal toxicity was evaluated during radiotherapy treatment according to recommendation of RTOG group. Late gastrointestinal and genitourinary toxicity was evaluated during regular control exams after radical radiotherapy treatment for six months. Based on the results χ2 test there was no statistical significant difference (p>0,05) between study group a i B in terms of acute gastrointestinal and genitourinary despite escalated radiotherapy dose in study group B treated with IMRT technique. Based on the results χ2 test there was no statistical significant difference (p>0, 05) between study group a i B in terms of late gastrointestinal and genitourinary toxicity. Intensity modulated radiation therapy is optimal technique in the radical treatment prostate cancer. This technique allows clinical benefit compared with 3D conformal radiotherapy-escalation of radiotherapy dose without increased toxicity in patients treated with IMRT technique.

Background: Gastric cancer, by the definition of World Health Organization (WHO), is a malignant epithelial tumor of mucosa of the stomach with glandular differentiation. Objective of this Scientific paper was to maintain the relation of expression of HER2 protein and hystological type of cancer according to Lauren in gastric cancer. Methods: In this research, archival samples of tissues of gastric cancer are used from 60 patients that have been obtained after subttotal or total Gastrectomy with a regional lymphadenectomy of lymph nodes. The most representative tissue samples of gastric cancer tissues are selected by the standard hematoxylin-eosin staining method which are cut again by using a microtome and treated by immunohistochemistrical technique with antibody on the HER2 according to the protocol of the producer and then evaluated by light-microscopic and again evaluated by a modified system of scoring the HER2 positivity of surgical resections. In the data processing, descriptive statistics and nonparametric test of significance respectively. Chi square test and one sample T-test, and also correlation tests respectively Pearson test of correlation. Results: Statistical analysis of expression of HER2 protein according to hystological type of gastric cancer done by chi-square test, does not show significant relation between these two variables (x 2 =4,900). Analysis by using one sample T-test does not show statistical significance (t=1.1880), and analysis by using Pearson test of correlation shows negative correlation that is not statistically significant (r= -0.029) between these two tested parameters. Conclusions: Expression of HER2 protein by using an univariate statistical method according to Pearson has shown a negligible negative correlation without statistical significance according to histological type by Lauren.

Implementation of IMRT with 4DCT simulation offers possibility to correlate the respiratory movements and position of tumor volume during radiotherapy treatment. The aim of this study is to quantify movements of primary tumor during IMRT treatment in three axes-Z-superoinferiorSI, X-mediolateral ML, Y -anteroposterior AP.This study included 15 patients with lung carcinomareferred to radical radiotherapy. Contouring of GTV was done in the phases FBGTV FB, phase 0-GTV0, phase 50GTV 50, and phase MIP-GTV MIP. Comparison was done with GTV FB as basic value. Evaluation was done in three axis-SI, AP, ML. The movements of GTV in relation to X axis were in the range 0.02-0.47 cm, in relation to Y axis in the range from 0.01-0.56 cm, and according to the Z axis in the range of 0.00-0.79 cm. Based on the results of t-test there was a statistically significant difference (p<0.05) related to X axis between the upper and lower lobe. There was no statistically significant difference (p>0.05) between the upper, lower and middle lobes related to Y and Z axis. The test results which were obtained after the 4D CT simulation and planning of IMRT treatment show the importance of high-quality and precise radiation therapy treatment.

Background: The study used data from medical and counselling of patients who were diagnosed with hormone-dependent breast cancer. Aim: The objective of the paper is to identify within a group of patients diagnosed with hormone sensitive breast cancer and those who have received adjuvant tamoxifen, and then to isolate the patients with whom the therapeutic effect of tamoxifen stopped (resistance to tamoxifen). Methods: The study analyzed 153 patients in the period from 2005 to 2011, at the Public Health Institution Hospital, Sveti Vracevi" in Bijeljina. Resistance to tamoxifen was developed by 60 patients (39.2%) and 93 patients (60.8%) did not develop resistance to it. Results: More common emergence of resistance is in the premenopausal group of patients (p<0.001). Statistically significant difference in frequency of resistance to tamoxifen was observed in the group of patients with ER-/PrR+ status of steroid receptors (p<0.001). In relation to HER-2 status of diagnosed cancer, a statistically significant difference in frequency of resistance emergence during tamoxifen therapy in patients with HER2-positive status (p<0.001) was observed. We found that there is a statistically significant difference between patients with metastatic in lymph nodes compared to patients who had no metastases in lymph nodes (X 2 =39.494; p<0.001). Conclusions: The analysis of menopausal status of patients, status of ER/PgR receptors status, HER-2 status of diagnosed cancer and status of lymph nodes trying to sort out the parameters on the basis of which a group of patients who can be expected to develop resistance to tamoxifen could be differentiated.