e20020 Background: Melanoma is a malignant tumor of melanocytes of skin. The histopathological variants of malignant melanoma include the common type (lentigo maligna (5%), superficial spreading melanoma (65%), nodular melanoma (15%), acrolentiginous melanoma (5%). The signet ring cell melanoma is a rare form melanoma, being seen in some 0.5% of melanomas. AIM OF WORK That showed young women with signet ring cell melanoma is a rare form melanoma. METHODS We describe a 39-year-old patient with a primary signet-ring cell melanoma of the skin located on the left upper quadrant of abdominal wall. RESULTS Diagnosis the tumour of skin was in department of surgery and histhopatology in General hospital in Bijeljini in December of the 2007. We performed clinical and histhopatologic examination. Physical examination revealed a well circumscribed and firm mass measuring 150x 100x 80 mm of the skin located on the upper quadrant of abdominal wall and solid mass in pelvis. Because of high suspect melanoma in patient performed surgical excision of skin tumor. Pathohysthology diagnosis was: Melanoma nodularis achromaticum. Immunohistochemistry showed positive reaction of the tumor cells for S-100, HMB-45 protein and vimentin, confirming their melanocytic differentiation. Tumor cells were negative for cytokeratins, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA). After immunohistochemistry analysis definitive pathohystology was: Signet ring cell melanoma. The signet-ring cell melanoma disclosed an invasion to Clark Level V and tumor thickness Breslow level III. Tumor from pelvis was appertain uterus and histopathologic diagnosis is a leomyoma. CONCLUSIONS Signet-ring cell melanoma is a rare morphologic variant of melanoma. Its recognition is important for differentiation from other tumors featuring signet ring cells. No significant financial relationships to disclose.

In 2007, Routledge published Theory for Performance Studies as part of its Theory 4 series, listing Philip Auslander as author. When, in August, The Chronicle of Higher Education revealed that much of the book was lifted word-for-word from the template for the series, Theory for Religious Studies by Timothy K. Beal and William E. Deal, TDR editor Richard Schechner convened via email and phone conversations a TDR Forum, asking leaders in the field to respond to the book and the series. Schechner and other respondents address issues of plagiarism, corporate takeovers of academic publishing, and the dumbing down of performance studies, asking why a notable scholar such as Auslander would undertake such an egregious piece of scholarship. Deal and Beal answer some questions put to them by Schechner, and Routledge's Claire L'Enfant and Talia Rodgers offer their perspectives.

Sažetak. Ekstenzivna hirurgija karcinoma jednjaka je najkomplikovaniji dio digestivne hirurgije i uglavnom je rezervisana za specijalizovane centre. Cilj rada bio je da se evaluiraju početna iskustva u ovoj zahtijevnoj hirurškoj problematici u Klinici za opštu i abdominalnu hirurgiju Kliničkog centra Banja Luka u petogodišnjem periodu. U periodu od 1. januara 2004. do 31. decembra 2008. godine operisan je 81 pacijent, od kojih je 61 (75,31%) imao palijativnu operaciju, a 20 operacija je urađeno s ciljem da se postigne eradikacija bolesti (R0 nivo) (25% stopa resektabilnosti). U grupi operisanih s ciljem eradikacije dominirali su muškarci (15 muškaraca i 5 žena), a većina oboljelih bila je starija od 50 godina (od 43 do 82 godine). Najčešća lokalizacija tumora bio je srednji i donji torakalni jednjak. Za supstituciju je u većini slučajeva korišćen želudac (oko 85%). Put transpozicije grafta bio je najčešće retrosternalni (za vratne anastomoze). Visoka supraaortalna intratorakalna anastomoza bila je najčešća opcija za rekonstrukciju tumora distalnog jednjaka (Ivor-Lewis) (65%). Stopa smrtnosti bila je 10%. Rani morbiditet, kod oko 60% operisanih, uglavnom su činile plućne komplikacije u vidu upala, atelektaza, izliva, pneumotoraksa. Prosječno vrijeme bolničkog liječenja bilo je 18 dana (od 15 do 25). Do trenutka objavljivanja rezultata, živih je pet pacijenata od kojih dvoje živi pet godina nakon operacije i nemaju znakova relapsa bolesti. Kod ostalih operisanih, prosječna dužina preživljavanja je 37 mjeseci (od 18 do 42) i svi su umrli od recidiva bolesti. Patohistološki nalazi pokazuju da prevladava skvamocelularni karcinom (60%), a ostatak su adenokarcinomi. Početna iskustva pokazuju stopu smrtnosti i prosječno preživljavanje koji su prihvatljivi i slični rezultatima drugih koji se rutinski bave ovom vrstom hirurgije.

This text originated from the initiative “Promoting Student Learning in Large Classes,” which was launched at the University of Minnesota, Twin Cities, during the winter of 2004. This was one of many attempts made by large universities across the country to address the problem of overcrowded classrooms. This particular initiative, sponsored by the Archibald Bush Foundation, was distinguished by its simple and very efficient structure. Instead of individual instructors, it asked for teams. The call for proposals stipulated that each team should consist of a lecturer, a graduate assistant, and an undergraduate student. Their task was to study, as it were, the process of learning that took place in the class, identify the problems, and report them in the large gathering of teams that occurred monthly. With the help of counselors from the initiative, the teams would then try to address the problems they identified. The projected length of the initiative was three years, and the courses it included were introductory lecture classes and mid-level survey courses.

From his rise to power in the mid-'80s to his trial 20 years later, Miloevi was the focus of powerful social theatricalities. As a public performance, Miloevi's trial is inseparable from the mass meetings he organized in Serbia between 1987 and 1989; the political drama of the breakdown of Yugoslavia's federal government; the intense struggles against the opposition fought in the streets; the wars taking place in Slovenia, Croatia, Bosnia, and Kosovo; and finally his own funeral.

Objectives: To evaluate if the open MR is proper to use in the gynecology diagnoses. Methods: The examinations have been conducted with use of an open magnetic resonance imaging device Siemens Concerto 0.23 T, with phased-array coil, using multiplanar sequences (axial, coronal and sagittal oblique), T1-weighted (before and after administration of paramagnetic agent) and T2-weighted. In one of the patients vaginal gel was used. Twenty-three patients have been evaluated, five of them suspected of ovarian cancer, one suspicion of adenomyosis/myomatosis and, two post operatory or suspicion of cervical cancer, two suspicions of endometriosis, two other pelvic tumors, one pelvic malformation, three ovarian cists, seven with other pathologies. Results: The acquired images presented enough quality for diagnosis. Conclusion: All scientific studies found on gynecologic MRI have being carried out with high-field strength magnets, therefore with a closed bore magnet, which makes it difficult to carry out the examination in obese patients and especially in claustrophobic ones. We conclude that open MR can be used for diagnosis in patients with a limiting condition for the use of high-field MR.

INTRODUCTION Understanding the lawful implementations of surgical procedures, such as hysterectomy, raises practical questions concerning legal relations between a doctor and his patient, and consequences of this relationship, which may be legally relevant. The modern legal theory and practice consider doctors and patients to be partners. CONSENT AND INFORMATION Medical practitioners performing surgical procedures are obliged to obtain informed consent. They are also required to inform their patients about indications, course of the operative procedure, postoperative treatment, possible complications during and after the procedure, and quality of life after the operation. Informed conversation should take into account the age, mental status and patient's intellectual abilities. Legal consequences ofsurgical procedures Malpractice litigation mostly concers medical error and negligence. Medical errors should not be confused with ineffective outcome, or complicated postoperative course. Even if the surgical procedure was followed correctly and uneventful outcome took place, there might be some problems. CONCLUSION A patient has a right to receive complete information from a physician about the specific nature of a proposed treatment. A physician has an obligation to elucidate and justify, treatment he proposes. Certain codification of all operative procedures may facilitate this task. Codification instructions about procedures, in this case hysterectomy, must include indications for a certain type of hysterectomy (subtotal, total, radical), as well as for the operative technique (abdominal, vaginal, laparoscopic). Patient information brochures should be available in print, and include information about indications and potential risks associated with the proposed surgical procedure. In this way, it is possible to prevent the inconveniences which may arise from insufficient knowledge and information about surgical procedures.

In the period between March 1, 2003 to June 1, 2003 at the Clinic of Orthopaedic Surgery and Traumatology, we treated 174 patients with injured or diseased extremities. An average age was 46,95 years (27-81). We treated 33 patients (18,9%) nonoperatively and 141 patients (81,1%) operatively. Preoperative and postoperative thromboembolic profilaxis (TEP) with low molecular heparin was registered in 50 patients (28,9%). In the first 10 days, 12 (9,2%) patients without TEP had signs of thromboembolism, 2 patients died in the first 10 days with the signs of thromboembolism. In the control group, in the period between March 1, 2005 to June 1, 2005 at the Clinic of Orthopaedic Surgery and Traumatology, we treated 162 patients with injured or diseased extremities. The average age was 47,2 years (17-82). We treated 29 patients nonoperatively (17,9%) and 133 patients (82,1%) operatively. All patients had preoperative and postoperative thromboembolic profilaxis (TEP) with low molecular heparin. In the first 10 days, 5 (3%) patients had signs of thromboembolism. None of the patients from control group died. Our results showed that TEP in orthopaedic surgery and traumatology is necessary.

Background: Breast carcinoma recurrence appears in 5%-30% of cases, after the completion of breast cancer treatment. Recurrence appears on thoracic wall (chest wall), on the skin, on the breast tissue remaining after the surgery, equal sided axillary lymph nodes, supraclavicular lymph nodes or on the internal mammary lymph nodes. Recurrence often stays undetected by clinical examination, while it can be detected by ultrasound and punctured under ultrasound control. Cytological confirmation of malignant cells represents a signal to commence a specific recurrence treatment. Methods: Aspiration puncture under ultrasound control has been performed within 128 patients. Only 38 patients, out of 128, did not have distant metastasis at the moment of recurrence detection, so the recurrence was sur- gically removed and was subjected to the histopathological analysis. The results of definite histopathological analysis were compared to the clinical results and cytological results, which had been obtained preoperatively. Results: 31 patients, out of above mentioned 38 patients, have had breast carcinoma recurrence, while 7 patients have had benign tumor lesion. Clinical diagnoses were correct in 47.4% of cases, and incor- rect for 52.6%. False positive finding result happened in 7.89% cases and false negative finding result happened in 39.47% cases. Ultrasound diagnoses were correct for 86.84% of patients and incorrect for 13.16% of patients. Cytological analysis of material obtained by aspiration puncture under ultrasound control produced correct diagnoses for 86.84% of patients. 13.16% of patients had inconsistent cyto- logical and histopathological findings result. Cytological analysis has detected malignant cells for 5.26%, but the recurrence was not histopathologically confirmed, which points that the results were falsely positive. Falsely negative results were confirmed for 7.89%. Conclusion: Clinical examination was reliable for 52.6% of patients examined. Cytological analysis of material obtained by ultrasound-controlled puncture was reliable for 86.84% of patients examined. Aspiration puncture followed by cytological analysis gave falsely negative result for 7.89% of patients examined, while clinical examination gave falsely negative result for 39.47% of patients examined. Aspiration puncture gave falsely positive result for 5.26%, and clinical examination gave falsely positive result for 7.89%. Aspiration puncture is simple, easy to perform, without damaging effect for the patient or the medical personnel, it is not expensive and it is significantly more reliable than clinical examination itself for detection of breast carcinoma recurrence.

INTRODUCTION Medical law is a scientific discipline which has not been affirmed in our country, but at law schools in many developed countries it has gained the status of a separate scientific discipline and today it is studied with multidisciplinary cooperation of Schools of Medicine, Schools of Dentistry and Schools of Pharmacy. Generally speaking, medical law concerns the rights and duties of the medical profession. ETHICS AND LEGAL QUESTIONS OF MEDICAL LAW The progress of scientific research and of new technology used in diagnostics and treatment, opens new fields in terms of responsibility. Most European countries have legal institutions in the field of health care. These include laws and legal acts, as well as codification of professional norms. LAW CONCERNING PHYSISIANS Apart from the national law, there is also an international law concerning physisians. The World Health Organization and the World Association of Medical Doctors brought the following declarations: Declaration on Promotion of Patients' Rights, the Revised Lisbon Declaration on Patients' Rights, the Revised Helsinki Declaration on Biomedical Research Involving Human Subjects and the Council of Europe's Convention on Human Rights and Biomedicine. CONCLUSION There is no national order of physicians in Serbia and Montenegro, because chambers of physicians with legal authority and mandatory membership have not been formed. The foundation of Chambers of Physicians of Vojvodina and Montenegro is the first step to goal achieving.