Analysis and Forecast of Birth Related Indicators in Selected Balkan and Eastern European Countries.

Background: Health indicators are often used for a variety of purposes, including program management, resource allocation, monitoring of country progress, performance-based payment, and global reporting. Real progress in health towards the United Nations Millennium Development Goals and other national health priorities is vitally dependent on stronger health systems. We aimed to analyse the progress of "birth related indicators" of selected countries of Balkan and Eastern Europe and to forecast their values in the future. Methods: This research report article represents a descriptive data analysis of selected health indicators, extracted from European Health for All database (HFA-DB) and EuroStat. Indicators of interest were analysed for 17 countries in observational period from 1990 to 2019. The data were analysed using a linear trend estimate and median operation and interquartile range 25th-75th percentile were used for better comparison of each country. Forecasting analysis to year 2025 was performed by combining Excel analysis and SPSS program. Results: Number of all live births to mothers aged under 20 is decreasing in almost all examined countries, while live births to mother over 35 is mostly increasing. Total fertility rate is also mainly decreasing in almost all countries of interest for our investigation, as well as the crude birth rate. Estimated infant mortality per 1000 live births is decreasing in all observed countries. Conclusion: Population aging is becoming more pronounced, while current birth-related indicators have negative tendencies; this problem will obviously continue over time.

Exploring Perforated Jejunal GIST: A Rare Case Report and Review of Molecular and Clinical Literature.

This case report details a rare instance of a perforated jejunal gastrointestinal stromal tumor (GIST) in a 76-year-old female patient. The patient presented with acute abdominal pain and distension without any changes in bowel habits or episodes of nausea and vomiting. Initial diagnostics, including abdominal plain radiography and ultrasonography, were inconclusive; however, a computed tomography (CT) scan revealed pneumoperitoneum and an irregular fluid collection suggestive of small intestine perforations. Surgical intervention uncovered a 35 mm jejunal GIST with a 10 mm perforation. Histopathological examination confirmed a mixed cell type GIST with high malignancy potential, further substantiated by immunohistochemistry markers CD117, DOG1, and vimentin. Molecular analysis illuminated the role of key oncogenes, primarily KIT and PDGFRA mutations, emphasizing the importance of molecular diagnostics in GIST management. Despite the severity of the presentation, the patient's postoperative recovery was favorable, highlighting the effectiveness of prompt surgical and multidisciplinary approaches in managing complex GIST cases.

The Emerging Roles of the Adaptive Immune Response in Acute Pancreatitis.

Acute pancreatitis (AP) is an abrupt, variable inflammatory condition of the pancreas, potentially escalating to severe systemic inflammation, rampant pancreatic necrosis, and multi-organ failure. Its complex pathogenesis involves an intricate immune response, with different T cell subsets (Th1, Th2, Th9, Th17, Th22, TFH, Treg, and CD8+ T cells) and B cells playing pivotal roles. Early T cell activation initiates the AP development, triggering cytokines associated with the Th1 response, which stimulate macrophages and neutrophils. Other T cell phenotypes contribute to AP's pathogenesis, and the balance between pro-inflammatory and anti-inflammatory cytokines influences its progression. Regulatory T and B cells are crucial for moderating the inflammatory response and promoting immune tolerance. B cells further contribute through antibody production, antigen presentation, and cytokine secretion. Understanding these immune cells' roles in AP could aid in developing new immunotherapies to enhance patient outcomes. However, further research is required to define these cells' precise roles in AP and their potential as therapeutic targets.

IMPLEMENTATION OF THE NATIONWIDE ELECTRONIC HEALTH RECORD SYSTEM IN SERBIA: CHALLENGES, LESSONS LEARNED, AND EARLY OUTCOMES.

Objectives: Many countries around the world have recognized the need for using an electronic health record (EHR) system. However, there is limited literature that could serve as a guide during a lengthy and challenging process of planning, development, and implementation of the e-Health system. Since the EHR system was recently introduced in Serbia, the purpose of this communication is to describe our experience and lessons learned along the way. Methods: The key personnel involved in the implementation of the EHR system in Serbia that began in 2015 conducted in 2019 a retrospective narrative review of the process and early outcomes. Results: An incremental approach in the planning, development, and implementation of the nationwide EHR system was taken. The process was split into phases with the gradual introduction of different regions of the country. The gradual shift from the existing to a new workflow for the prospective users was also implemented. The significant milestones were the achievement of quick legislative changes, the hiring of a professional team of experts in the field, the provision of timely and appropriate information and training to prospective users, the close collaboration between the implementation team and the Ministry of Health and mutual understanding of the aims and expectations, and the flexibility in accepting the evolving nature of the process, goals, and the system model. Conclusions: A successful implementation of the nationwide EHR system is feasible providing careful planning, the assembly of a multi-disciplinary team, the use of a stepwise approach, the early and continued involvement of the intended users, and the willingness to make adjustments along the way. The end-result sets the stage for the reform of the health care system itself.

An overview of antiviral strategies for coronavirus 2 (SARS-CoV-2) infection with special reference to antimalarial drugs chloroquine and hydroxychloroquine.

At present, neither specific antiviral drugs, nor vaccine is recommended for coronavirus disease 2019 (COVID-19) treatment. In this review we discuss the drugs suggested as therapy for COVID-19 infection, with a focus on chloroquine and hydroxychloroquine. The list of drugs used for COVID-19 treatment includes a combination of lopinavir and ritonavir, remdesivir, favipiravir, alpha-interferon, ribavirin, atazanavir, umifenovir, and tocilizumab. As their efficacy and safety are under investigation, none of the regulatory agencies approved them for the treatment of COVID-19 infection. Although chloroquine and hydroxychloroquine possess antiviral and immunomodulatory effects, in practice benefit of their use for COVID-19 treatment is controversial. Several studies investigating hydroxychloroquine were stopped and the French national medicines regulator suspended its use in clinical trials because of safety concerns. The results from the double-blind, randomised clinical trials, including large number of participants, will add better insight into the role of these two drugs as already available and affordable, antimalarial therapy. The ethical issue on emergency use of chloroquine and hydroxychloroquine in the settings of COVID-19 should be carefully managed, with adherence to the "monitored emergency use of unregistered and experimental interventions" (MEURI) framework or be ethically approved as a trial, as stated by the WHO. Potential shortage of chloroquine/hydroxychloroquine on the market can be overbridged with regular prescriptions by medical doctors and national drug agency should ensure sufficient quantities of these drugs for standard indications.

Gross Domestic Product and Health Expenditure Growth in Balkan and East European Countries-Three-Decade Horizon.

Background: Dynamics of health care has changed over time along with development of the countries themselves. The aim of the study is to compare macroeconomic and health expenditure indicators of interest, such as total health expenditure (THE) as percentage of global domestic product, global domestic product per capita in US$, and private households' out-of-pocket payments of Balkan and Eastern European countries on health, as well as to assess their progress over the observed period. Methods: This research report represents a descriptive data analysis of indicators extracted from the European Health for All database. The data were analyzed using a linear trend and regression analysis to estimate the timeline changes. Results: Greece and Slovenia have the largest median values of global domestic product per capita throughout the whole period, and the largest increment trend was in Lithuania. Median value in out-of-pocket payment of THE was the highest in Albania and Ukraine, while the largest decrease in trend was noticed in Albania and Bosnia and Herzegovina. Bosnia and Herzegovina and Greece had the largest median value of THE as percentage of Gross Domestic Product (GDP) in the observed period, while regression trend analysis showed that Serbia had the largest increase. Most of the countries showed a significant correlation between observed indicators. Conclusion: Trends in the economy must be constantly monitored due to the fact that the population is aging and non-communicable diseases are multiplying, which requires innovations in medical treatment and pharmaceutical development.

A Correlation Study of the Colorectal Cancer Statistics and Economic Indicators in Selected Balkan Countries.

Colorectal cancer (CRC) is one of the most commonly diagnosed malignant neoplasms. The aim of the study was to evaluate and correlate most important epidemiological and economic indicators of CRC in 11 selected Balkan countries. The number of new CRC cases was 56,960, and the highest 5-year CRC prevalence was in Slovenia, Croatia, and Greece. Age-standardized CRC incidence rates were highest in Slovenia, Serbia, and Croatia, and age-standardized mortality rates were highest in Croatia, Serbia, and Bulgaria. Current Health Expenditure as % of Gross Domestic Product was the highest in Bosnia and Herzegovina and Serbia. The GDP per capita levels have shown positive correlation with the CRC incidence rate and prevalence. Absolute numbers of new and death-related CRC cases and 5-year prevalence in absolute numbers have shown strong positive correlation with GDP in million current US$. It has been shown that various economic indicators can be linked to the rate of incidence and prevalence of the CRC patients in the selected Balkan countries. Therefore, economic factors can influence the epidemiology of CRC, and heavy CRC burden in the Balkan region may be one of the indexes of the economic development.

Vocal Cord Paralysis as the First Sign of Spontaneous Carotid Dissection in a Patient With Extracranial Internal Carotid Artery Aneurysm.

INTRODUCTION: Spontaneous dissection of supra-aortic arteries is an exceptionally rare cause of vocal cord dysfunction. We are reporting a case of spontaneous carotid dissection and internal carotid artery aneurysm presenting as vocal cord paralysis. CASE REPORT: A 44-year-old female was admitted with hoarseness and swallowing disorders. Diagnostic imaging revealed dissection and obliteration of the right internal carotid artery (ICA) 23 mm from the carotid bifurcation. Electromyography revealed unilateral paralysis/paresis of the right vocal cord. Genetic analyses for thrombophilia, methylenetetrahydrofolate reductase, and plasminogen activator inhibitor 1 were found to be at high risk. The patient was discharged after 5 days without any neurological findings, and control angiography revealed complete restitution of the flow in the right ICA one month later. However, a fusiform aneurysm of the distal part of the extracranial right ICA was detected and excluded with endovascular procedure. CONCLUSION: Connective tissue systemic disorders and even mild trauma could initiate the dissection process of neck arteries. Precise diagnosis might be difficult even for an experienced neurologist, however, the final outcome is favorable.

Analysis of malignancy predictors for oxyphile thyroid tumors.

PURPOSE: In contrast to other thyroid carcinomas it is difficult to establish a correct preoperative diagnosis for oxyphile carcinoma of the thyroid. In this study we looked for predictive malignancy factors in order to enable surgeons to choose operative treatment and to perform an adequate operation for each patient with an oxyphile neoplasm of the thyroid. METHODS: In this retrospective study we have analyzed the medical files of all patients with oxyphile tumors of the thyroid operated between 1999 and 2008 in our institution. A total of 256 patients were included and divided into oxyphile adenomas (142) and carcinomas (114) on the basis of their definite histopathological diagnosis. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. RESULTS: Univariate analysis showed that male gender, thyroglobulin concentrations ≥300 ng/ml and tumor diameter >30 mm were significantly more frequent in patients with oxyphile carcinoma compared to patients with oxyphile adenoma, while coexisting Hashimoto thyreoiditis and positive AntiTPO antibodies appeared significantly less frequent in the carcinoma group. All variables with a p value <0.1 in the univariate test were subjected to multivariate regression analysis in which elevated preoperative thyroglobulin concentrations (≥300 ng/ml) was shown as the only independent predictive factor for oxyphile thyroid carcinomas (OR=5.88, 95% CI 2.78-12.05, p=0.001). CONCLUSIONS: Preoperative thyroglobulin concentration is an independent predictor of malignancy for oxyphile thyroid carcinomas.

Burnout of Formal Caregivers of Children with Cerebral Palsy.

BACKGROUND: Burnout syndrome is under-researched within caregivers (CGs) of children with cerebral palsy. The primary aim was to determine the burnout level of formal CGs of children with cerebral palsy (G1) and to compare it with a control group (G2) of professional pediatric nurses, and second, to correlate the level of depression and anxiety with the burnout level. METHOD: In a total sample of 60 CGs, the Maslach Burnout Inventory Human Services Survey (MBI-HSS), consisting of three structural units - emotional exhaustion (MBIEE) subscale, depersonalization (MBI-DP) subscale and personal accomplishment (MBI-PA) subscale - was used to measure burnout. The Beck Anxiety Inventory (BAI) was used for the assessment of anxiety, and the Beck Depression Inventory (BDI) for depression. RESULTS: A significant difference was shown on the MBI-EE subscale and on the BDI test (p<0.05), in both cases higher scores were obtained by G1. High burnout was observed in all subscales, on the MBI-EE subscale registered 50% of CGs in G1, and 17% in control G2. Correlation of the MBI-EE subscale with BDI and BAI tests was highly significant (p<0.01). CONCLUSIONS: These findings indicate the need for future research aimed at formulating preventive strategies for caregivers' mental health. Better care for caregivers would provide them with better professional satisfaction, and consequently would lead to better care for patients.

Anorectal melanoma and seborrheic dermatitis ­ A case report.

Introduction: Anorectal melanoma (ARM) is a rare and aggressive neoplasm with predisposition for early infiltration, distant spread, and unfavorable prognosis. It has been speculated that Malassezia yeasts could possibly have an impact on skin carcinogenesis and development of melanoma, especially in patients with seborrheic dermatitis (SD), due to production of aryl hydrocarbon receptor (AhR) agonists. Case Outline: A 52-year-old man with intensive SD complained of a four-month-long rectal bleeding, tenesmus, pain, and difficulty during defecation. On examination, a rectal tumor was detected and histopathology of tumor tissue revealed ARM with positive protein S100, melanoma antigen HMB45 and melan-A expression. After the diagnosis was established, abdominoperineal resection of the anus and rectum was performed, since the tumor was large, obstructive, and the anal sphincter was invaded. Conclusion: Because of the possible impact of intensive SD to the cross-link between Malassezia yeasts AhR agonists and skin carcinogenesis, we discussed on this matter and reviewed the literature data regarding ARM. In addition to "pathogenic" and "non-pathogenic" Malassezia subtypes based on AhR agonist production, future studies on Malassezia metabolites, their carcinogenic effect in the skin and development of melanoma are needed. If the cross-link between Malassezia AhR agonists and skin carcinogenesis exists, timely prevention of ARM could be done with Malassezia eradication, especially in patients with severe SD.

Benign cystic teratoma of the mesosigmoid ­ Report of a case.

Introduction: Extragonadal intraperitoneal teratomas are very rare, especially those arising from mesentery and mesocolon. In the contemporary literature only 22 cases of such tumors have been published and described. Case Outline: We report a case of a 52-year-old woman with a benign cystic teratoma of the mesosigmoid. The patient presented with mild clinical signs of intestinal obstruction. Computerized tomography of the pelvis and abdomen showed a large 9.7 × 8.9 × 9.4 cm calcified tumor in the lower part of the left hemiabdomen. Extraluminal obstruction was verified by colonoscopy at 35 cm from the anal verge. Intraoperatively, a cystic calcified tumor of the mesosigmoid was found causing extraluminal obstruction of the left colon. The tumor was extirpated and a partial resection of the adherent great omentum was performed. The histopathological examination revealed a benign cystic teratoma. Conclusion: Considering the fact that mesenteric teratomas are extremely rare tumors, it is difficult to designate a general conclusion for an adequate treatment of patients suffering from them. Complete surgical excision is indicated in order to establish a correct histopathological diagnosis and to relieve the patients of symptoms.

In vitro protease inhibition and cytotoxicity of Aspergillus fumigatus biomolecules secreted under long-term aerated conditions.

The fatality rate of invasive aspergillosis (IA) is still very high, especially in prolonged and untreated pulmonary cases. Aspergillus fumigatus is the main causative agent of IA and investigation of its metabolites could provide valuable insight into virulence factor(s) associated with this organism. We evaluated the A. fumigatus culture filtrate (CF) products generated during short- and long-term aerated and non-aerated conditions and tested for (i) inhibition of cysteine or serine proteases and (ii) cytotoxicity. In addition, the mathematical model was determined using response surface methodology (RSM) to estimate the influence of different fermentation conditions on A. fumigatus CF characteristics, predict enzyme inhibition and make possible correlations with in vivo conditions. Biosynthesis of A. fumigatus low molecular weight proteinaceous products (from 6.4 to 15.4 kDa) was observed after 6 days of growth under aerated and alkaline conditions. Also, only these CFs showed significant reduction in cell lines survival (Caco-2 and WISH 35.6% and 54.6%, respectively). Obtained results provide solid starting point for further studies that would include: (i) detailed chemical characterization of A. fumigatus CF, (ii) activity relationships and in vivo correlation with pathogenicity of prolonged pulmonary IA and (iii) possible use of biomolecules as diagnostic or therapeutic markers.

Age as a prognostic factor in anaplastic thyroid cancer.

Background. Anaplastic thyroid cancer (ATC) is one of the tumors with the shortest survival in human medicine. Aim. The aim was to determine the importance of age in survival of patients with ATC. Material and Methods. We analyzed the data on 150 patients diagnosed with ATC in the period from 1995 to 2006. The Kaplan-Meier method and log-rank test were used to determine overall survival. Prognostic factors were identified by univariate and multivariate Cox regression analysis. Results. The youngest patient was 35 years old and the oldest was 89 years old. According to univariate regression analysis, age was significantly associated with longer survival in patients with ATC. In multivariate regression analysis, patients age, presence of longstanding goiter, whether surgical treatment is carried out or not, type of surgery, tumor multicentricity, presence of distant metastases, histologically proven preexistent papillary carcinoma, radioiodine therapy, and postoperative radiotherapy were included. According to multivariate analysis, besides surgery (P = 0.000, OR = 0.43, 95% CI = 0.29-0.63), only patients age (P = 0.023, OR = 0.68, 95% CI = 0.49-0.95) was independent prognostic factor of favorable survival in patients with ATC. Conclusion. Age is a factor that was independently associated with survival time in ATC. Anaplastic thyroid cancer has the best prognosis in patients younger than 50 years.

A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production.

BACKGROUND: Seborrheic dermatitis (SD) and Parkinson's disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD. METHODS: This case-control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated. RESULTS: The most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667).The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro. CONCLUSION: From this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data lead to conclusion that local skin performance of PD patient's characterized with increased sebum excretion ratio play a role in SD by stimulation of yeasts replication and enzyme production.

Pedunculated obstructive lipoma of the ileocecal valve: a case report.

INTRODUCTION: Colonic lipomas are relatively common but they rarely progress to complete acute obstruction. CASE OUTLINE: We report a case of a 67-year-old woman with acute intestinal obstruction caused by a large pedunculated lipoma of the ileocecal valve. Preoperatively, the patient presented acutely with clinical and radiographic signs of small intestine ileus. A right hemicolectomy with subsequent terminolateral ileocolostomy was performed.The histopathological examination revealed a benign lipoma of the ileocecal valve which telescoped into the cecum and caused ileocolonic intussusception. The postoperative course was uneventful and the patient was free of symptoms during a 12-month follow-up period. CONCLUSION: Since these benign tumors are frequently revealed by laparotomy and the definitive diagnosis is made on the basis of histopathological examination, we can conclude that extensive resections of the large intestine are justified in cases with acute clinical presentation.

[Treatment of colorectal liver metastases with a combination of liver resection and radiofrequency ablation].

INTRODUCTION: Radiofrequency ablation is a new invasive procedure that is being increasingly used in the treatment of colorectal liver metastases. Resection as the only potential cure for colorectal liver metastases is limited by the size and the itrahepatic localization of lesions. Radiofrequency ablation may extend the limitations of classic surgery. In this work we analyzed the combination of surgical liver resection and radiofrequency ablation of liver metastases. MATERIAL AND METHODS: This study included 11 patients with colorectal metastases. Colon resection and radiofrequency ablation have been performed in five (5) patients, three (3) patients underwent liver resection and radiofrequency ablation, and in three (3) patients colon resection, liver resection and radiofrequency ablation were performed. RESULTS: In our study group, there were 6 (54.54%) men and 5 (45.45%) women aged 55 to 66 years and 52 to 67 years of age, respectively. During operations, we treated 30 liver metastases, 2.72 metastses per patient. There were from 2 to 4 ablation metastases. The diameter of colorectal metastases was between 11 mm and 44 mm. Most of ablation metastases (12 or 40%) were between 2.1 cm and 3 cm in diameter. Only 10% of ablation metastases were over 40 mm in diameter. DISCUSSION: The majority of patients with metastatic colorectal hepatic tumors are not candidates for surgical resection, due to tumor size, location and multifocality. However, we can treat advanced colorectal cancers and colorectal liver metastases with a combination of liver resection and radiofreqency ablation. In this way we can operate and give a chance to patients with multifocal metastases and metastases with a diametar over 40 mm. CONCLUSION: A combination of liver resection and radiofrequency ablation in treatment of advanced colorectal cancers with liver metastases is a good treatment modality which increases the number of operabile cases.

[Multiorgan resection in patients with gastric cancer]. / Vrednost multiorganske resekcije kod bolesnika sa karcinomom zeluca.

INTRODUCTION: Multiorgan resection for a malignancy is a very complicated procedure, but there is always the question: does it work? In everyday clinical practice gastric cancer in phases III and IV is rather frequent. Unfortunately, our patients are under the age of 55 years. D2 lymphadenectomy is not as extensive as D2 +/ or D3, so one must ask himself if multiorgan resection is worth the risk MATERIAL AND METHODS: We evaluated two groups of patients: group I consisted of 34 patients who underwent total or subtotal gastrectomy, systematic lymphadenectomy and resection of one or more organs; group II (control) consisted of 167 patients who underwent total or subtotal gastrectomy and systematic lymphadenectomy. These two groups of patients were analzyed in regard to: Bormann's classification, histopathologic type, early mortality, early postoperative complications, lymph node dissection and long-term survival. RESULTS: According to Bormann's classification the most common type of carcinoma in both groups was ulcerovegetativ tumor (70.6% in I and 58% in II). In the first group of patients a great number of patients had poorly differentiated adenocarcinomas (47%), while in the second group the most common histologic type was well differentiated intestinal carcinoma (28%). Patients with multiorgan resections had higher rates of early postoperative mortality and morbiditiy (mortality--14.7% and complications--26.5%) than patients in control group (mortality--4.8% and complications--11.4%). The most frequent causes of postopertive mortality and morbidity were anastomotic leakage and wound infections in both groups. Metastatic lymph node invelvement was higher in the first group (41%), than in the second (28%). Long-term survival was best in the control group (38.5 months). Patients with multiorgan resection had better survival (25.4 months) than inoperable cases (only 5 months). DISCUSSION: Patients undergoing multiorgan resection usually have advanced gastric cancer with tumor infiltration in surrounding structures. Only these cases are absolute indications for this radical operation, because patients have better chances for survival. CONCLUSION: Multiorgan resections are extensive procedures with high rates of postoperative mortality and morbidity, but represent the only way for better survival of patients with advanced gastric cancer.

[Skip metastases in rectosigmoid carcinoma]. / "Skip metastaze" kod karcinoma rektosigme.

AIM: In this study we want to point out the existence and significance of skip metastasis of rectosimoid cancer. MATERIAL AND METHODS: Seventy patients with verified rectosigmoidal adenocarcinoma, treated in 5-years period, are included in this study. Diagnose was made upon physical examination, barium enema, rectosigmoidoscopy with positive biopsy and finding of isolated lymph node metastasis. RESULTS: Skip metastasis were found within 6 patients (8.6%); 4 of them were males and 2 females, with average age 67 years. Overall, 13 metastasis were isolated; one patient had them 3 and five patients had 2 skip metastasis. CONCLUSION: Radical lymphadenectomy of patients with rectosimoidal cancer requires dissection of lymph nodes along inferior mesenteric artery and its ligation on origin, as much as dissection of paraaortal and paracaval lymph nodes.