Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study.

BACKGROUND: Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. METHODS: The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007-2015; period 2: 2016-20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. RESULTS: Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. CONCLUSION: Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.

The importance of sentinel lymph node diagnostic biopsy from the lateral neck compartment in the surgical treatment of papillary thyroid cance.

OBJECTIVES: The aim of our study is to determine whether mapping the lymphatic drainage and diagnostic excision of lymph nodes from lateral neck compartment is able to detect ultrasound unknown metastases in this compartment early and thus favorably affect the prognosis of patients with papillary thyroid cancer (PTC). BACKGROUND: Lymph node involvement in the lateral neck compartment is seen in 30-60 % of patients with PTC at the time of diagnosis and affects the prognosis of patients in terms of disease recurrence. METHODS: From June 2012 to December 2016, 154 patients with no evidence of lateral nodal involvement on imaging studies were treated with total thyroidectomy and central comparment neck dissection. A volume of 0.2 ml of Patent Blue dye was applied in the upper half of the thyroid gland with subsequent exposure of lymphatic drainage in the lateral compartment and 2-3 sentinel lymph nodes (SLN) were removed for frozen section (Group 1). In case of metastatic involvement, a lateral comparment neck dissection was performed. The reference groups were composed of a set of patients without detected lymphatic drainage (Group 2) and a set of patients who underwent lateral compartment neck dissection for preoperatively detected metastases in the lymph nodes (Group 3). The biochemical, structural and overall persistence of the disease at the time of administration of adjuvant radioiodine ablation was evaluated. RESULTS: The SLN identification rate was 95.45 %. In Group 1, a total of 32 patients had a positive SLN. Out of these, 24 patients had positive SLNs based on the analysis of frozen section, while in 8 patients, the positive diagnosis was confirmed through definitive histology. The comparison of data from the entire follow-up period in all three groups of patients revealed statistically significant differences in persistence of disease, namely in favor of Group 1. The percentage of reoperations for persistence and recurrence of disease was significantly lowest in Group 1 (2.04 %) compared to Groups 2 and 3 (6.94 % and 45.45 % respectively). CONCLUSION: The method is safe and sensitive for detecting unknown lymph node metastases in the lateral neck compartment, and may facilitate a decision to perform accurate surgical treatment of patients with PTC (Tab. 4, Fig. 2, Ref. 38).

Preoperative nutritional support for patients undergoing elective colorectal cancer surgery - does it really work?

AIMS: This study aimed to evaluate the effect of preoperative administration of oral nutritional supplements (ONS) on the self-sufficiency, physical status, and nutritional status of patients undergoing elective colorectal resections. METHODS: This prospective randomized clinical trial was conducted in a single institution. Patients scheduled to undergo colorectal cancer surgery were randomized to either ONS twice per day for 7 days before surgery or no ONS. RESULTS: We enrolled 120 patients in the study. The two study groups had comparable hospital stay times and comparable numbers of postoperative complications. Laboratory parameter (albumin and prealbumin) values declined in the postoperative period, but differences between study groups were not significant. The groups had comparable arm circumference measurements, muscle mass and fat proportions, and water weights. Patient self-sufficiency in the postoperative period was comparable between groups (P=0.313). Lower limb force declined after surgery, but differences between the groups were not significant (P=0.579). CONCLUSION: Preoperative administration of ONS to patients undergoing elective colorectal surgery did not reduce postoperative morbidity or enhance recovery. Moreover, patient self-sufficiency, physical status, and nutritional status were not influenced by preoperative ONS. Patients should be properly selected for malnourishment before providing nutritional support to manage costs efficiently. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03930888).

Radical gastrectomy with D2 lymph node dissection after neoadjuvant therapy.

OBJECTIVES: This study focuses on the evaluation of the effectiveness of radical gastrectomy with D2 node dissection after neoadjuvant therapy in the patients with gastric cancer. Gastric cancer is a widespread type of cancer, and it is the third leading cause of death in the cancer patients. Metastases most often occur in the lymph nodes and therefore, in addition to gastrectomy, lymph node dissection is often performed in the patients. We are distinguishing between D1, 2 and 3 dissections. As with other cancers, the effectiveness of neoadjuvant therapy is being considered, which aims to improve the patient's prognosis and thus the 5-year survival rate. METHODS: Within the study, we evaluated a group of the patients diagnosed with gastric cancer (n = 41). The average age of the patients was 62.3 years (20-72 years). 68.3 % (n = 28) patients underwent neoadjuvant therapy before surgery, the remaining 31.7 % (n = 13) underwent only radical gastrectomy with D2 lymphadenectomy. In all the cases, an open operational approach was implemented. CONCLUSION: Lymphadenopathy was found in 85.4 % of the patients. Complications occurred in both groups, but in the group with neoadjuvant therapy their share was lower (14.3 % vs 23.1 %), while in the group without neoadjuvant treatment the proportion of duodenal leaks was higher, as well as the number of reoperations. In total, an average of 30 ± 8 lymph nodes were harvested. A lower number of T3-4 cases was found in the neoadjuvant group (17.9 % vs 61.6 %), confirming that the tumour size was significantly smaller in the neoadjuvant group than in the group, who did not undergo it and underwent only surgical treatment. Relapse was found in 29.3 % of the patients after neoadjuvant treatment and in 38.5 % of the patients without neoadjuvant treatment. Also, mortality due to relapse was higher in the group without neoadjuvant treatment (30.8 % vs 21.7 %). The average survival was 25 months (Tab. 3, Fig. 3, Ref. 60).

Coincidence of splenic vein aneurysm and haemorrhagic cyst of the pancreas.

Pseudoaneurysm of the splenic vein is a rare entity which is associated with pancreatitis in 52 % cases. Pseudocysts of the pancreas create approximately 70 % of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen. This is caused by perforation of the pseudoaneurysm of the splenic vein. Enzymatic damage of the splenic vein´s wall is the cause of pseudoaneurysm. The clinical condition varies. It can be asymptomatic or bring about haemodynamic instability. The diagnostic process of pseudoaneurysm of the splenic vein is difficult. This case study introduces a case of a 50­year­old man with the anamnesis of recurrent pancreatitis caused by alcoholism. He had abdominal pain and was diagnosed with a pseudocyst of the pancreas. Abdominal CT showed an extensive capsulated collection in the left subphrenic space, 23cm in diameter, with serosanguineous content and coagulations. The CT visualised the mass effect on the surrounding tissues and a complete deformation of the spleen. Between the collection and partially oppressed tail of the pancreas there was a venous pseudoaneurysm, 3.5cm in diameter. Considering its localization, it most probably originated from the splenic vein. Surgery was done. We did distal resection of the pancreas with a complete removal of the pseudocyst and spleen (Fig. 7, Ref. 11). Keywords: splenic vein, pseudoaneurysm, pancreatitis, pancreatic pseudocysts.

Predictive model using hemoglobin, albumin, fibrinogen, and neutrophil-to-lymphocyte ratio to distinguish patients with colorectal cancer from those with benign adenoma.

Colorectal cancer (CRC) is associated with inflammation, activation of coagulation, and mild anemia. Hematological parameters reflecting ongoing cancer may have the potency to be effective for early diagnostics of CRC. The aim of this study was to examine the validity and relationship between some biochemical and hematological parameters for the early diagnosis of CRC. We designed a prospective observational cohort study to analyze whether these laboratory markers have the potency to distinguish benign tumors from malignant before planned surgery. The clinical data were collected from 208 patients with suspected benign or malignant colorectal tumors who were eligible for elective surgery between September 2018 and January 2020. Blood samples were collected one day before surgery, examined parameters included: complete blood count, hemoglobin (HGB) concentration, albumin (ALB), C-reactive protein (CRP), interleukin-6 (IL-6), and fibrinogen (FG). Absolute neutrophil and lymphocyte counts were used for the calculation of the neutrophil-to-lymphocyte ratio (NLR). The diagnosis was confirmed by histopathological examination. The 197 patients were divided into the group of benign (B group = 52 patients) or malignant tumors (CRC group = 145 patients). ROC curves and cut-off values of NLR, HGB, FG, and ALB concentration, serum CRP and IL-6 levels. In the cohort of 197 adult patients submitted for the elective colorectal surgery, the complete blood samples drawn one day before surgery showed significant differences between patients with benign tumors and colorectal carcinoma: HGB (mean 139.9 g/l vs. 129.9; p<0.001), FG (mean 3.36 g/l vs. 3.94 g/l; p<0.001), ALB (mean 43.4 g/l vs. 41.1 g/l; p=0.001), NLR (mean 2.73 vs. 3.88; p=0.016), respectively. CRP (mean 2.9 mg/l vs. 4.4 mg/l; p=0.011), thrombocyte count (mean 235×109/l vs. 265×109/l; p<0.029). Differences in IL-6 concentrations were not significant (2.9 pg/ml vs. 4.15 pg/ml; p=0.052). Using multivariable logistic regression analysis, four valid parameters (HGB, FG, ALB, and NLR) were suitable for the construction of a diagnostic predictive model for the identification of CRC. In conclusion, a panel of routinely examined blood parameters like HGB, FG, ALB, and NLR has the potency to distinguish patients with benign tumors from malignant by applying a diagnostic predictive model for early laboratory detection of CRC.

Pretreatment Levels of Chromogranin A and Neuron-specific Enolase in Patients With Gastroenteropancreatic Neuroendocrine Neoplasia.

BACKGROUND/AIM: Chromogranin A (CgA) and neuron-specific enolase (NSE) are applied in the diagnosis of neuroendocrine neoplasms (NENs), especially non-functional ones. The aim of this study was to investigate the predictive values of CgA and NSE in long-term survival. PATIENTS AND METHODS: Our retrospective analysis included 65 patients with histologically verified gastroenteropancreatic NEN between 2005 and 2019. We performed bivariate and multivariable analyses to evaluate the relationship between CgA and NSE values before histological assessment and overall survival. Distribution of time-to-event was analyzed using Kaplan-Meier survival curves and modelled by Cox regression models. RESULTS: Elevated NSE levels prior to histology were significantly associated with worse survival (HR=1.13, p=0.004) and were associated with low-differentiated NENs (rs=0.321, p=0.0338). CgA was associated with well-differentiated tumors (rs=0.233), but not significantly. CONCLUSION: Pretreatment serum levels of NSE can serve as a valuable additional predictor of long-term survival in patients with NEN.

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis.

BACKGROUND: Closure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure. METHODS: This was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler). RESULTS: In total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was-104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072). CONCLUSIONS: The present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 ( http://www.clinicaltrials.gov ).

The role of subtotal and total gastrectomy in the treatment of gastric cancer.

The optimal procedure for the lower third gastric adenocarcinoma is still an open question. We performed an analysis of the long-term survival of patients after subtotal (SG) or total gastrectomy (TG) on 164 enrolled patients. Bivariate and multivariable analyses were performed in order to identify characteristics associated with long-term survival. Survival was significantly affected by the number of positive lymph nodes (LN). Patients who have undergone TG had a higher number of total removed LN. The adjusted hazard ratio for the TG group suggests a partial superiority of TG over SG for patients with curative intent. Our data support the importance of extended LN dissection.

Diagnostic ipsilateral central neck dissection may reduce undertreatment of initially low-risk papillary thyroid cancer.

Although small papillary thyroid cancer (PTC) patients are considered as low-risk population, approximately 5-20% of these patients relapse after surgery. The objective of this single-center retrospective study was to identify risk factors, which could help to distinguish patients who would need additional treatment after surgery. A total of 268 patients (39 men, 229 women, median age 49 years) underwent surgery between 2007-2015, and fulfilled inclusion criteria: tumor size ≤20 mm, absence of metastatic lymph nodes (LN) in the lateral neck compartment (LC), and absence of local invasion. Total thyroidectomy was performed in 252 cases, in 221 cases with central neck compartment (CC) dissection. The outcome - a more aggressive disease - was defined as the presence of metastases in the LNLC or in distant organs found during follow-up. A median follow-up was 117 months. Overall, 41 patients experienced the outcome with a median time-to-event of 18 months. Male gender (OR=2.2, p=0.049), extra-thyroidal extension ETE (OR=2.61, p=0.015), and metastases in LNCC (OR=4.21, p<0.001) were associated with worse outcome. Multivariable analysis and stratification according to ETE revealed an effect modification with a higher effect of the positive LNCC on the outcome among patients without ETE than in those with ETE. Our findings advocate placing greater emphasis on the role of LNCC metastases in the absence of ETE. In clinically node-negative tumors intraoperative examination of CC on the side of the tumor followed by CC dissection if metastatic lymphadenopathy is present could play an important role in the stratification of patients with small-size PTC.

Acute appendicitis: Clinical anatomy of the new palpation sign.

INTRODUCTION: Currently, diagnosis of acute appendicitis (AA) is challenging. Here, we aim to propose using the new palpation sign to diagnose AA and establish the effectiveness of clinical examination using a proprietary diagnostic palpation procedure. MATERIALS AND METHODS: We retrospectively analyzed 2,883 patients of all ages who were examined for suspected AA, of whom 532 patients required surgical intervention, using the new palpation sign. Patients were divided into three age categories. Based on the correlation between clinical data and histological findings, clinical examination finding was defined as false negative, false positive, and positive. Pearson correlation analysis was performed to assess the correlation between patients' sex and age distribution and clinical and histological findings. RESULTS: There was a strong correlation (r > .95) for distribution of total number of examined patients (distributed in groups by sex and age) versus false-positive clinical findings, total number of examined patients (distributed in groups by sex and age) versus positive clinical findings, and total number of examined patients (distributed in groups by age) versus histology in phlegmonous and gangrenous appendicitis. Correlations (r = .94 and .90) were observed for distribution of total number of examined patients (distributed in groups by age) versus negative histological findings and Byron's obliterating appendicopathy. Pearson's chi-squared test showed no significant difference between expected and observed frequencies of both clinical and histologic findings. CONCLUSIONS: The new palpation sign can be used to diagnose early and later stage appendicitis, especially in children and young women, and is very effective in indicating surgery for AA.

Collision of a neuroendocrine tumor and ductal adenocarcinoma of the pancreas: a rare case report.

Despite the increased incidence of pancreatic cancer, reported data of collision pancreatic tumors are very rare, limited just to sporadic cases. There are only two described cases of the collision pancreatic tumor consisting of neuroendocrine and pancreatic ductal adenocarcinoma in the literature. Currently, we are presenting a case of a young female patient with pancreatic ductal adenocarcinoma surrounding a smaller focal lesion of the well-differentiated neuroendocrine pancreatic tumor. The patient underwent proximal pancreaticoduodenectomy with uneventful postoperative course. Histogenesis of these colliding tumors remains unclear. However, there are several proposed theories. Surgical resection could be the treatment of choice of resectable cases; however, preoperative diagnosis is virtually impossible.

Applications of magnetoliposomes with encapsulated doxorubicin for integrated chemotherapy and hyperthermia of rat C6 glioma.

There is substantial evidence regarding enhanced antitumor cytotoxicity of selected chemotherapeutic agents by appropriate heat exposure (40-44°C). Based upon these results, the integration of hyperthermia as an additional treatment modality given simultaneously with systemic chemotherapy is currently of considerable interest. Hyperthermia can be induced by alternating magnetic field and magnetic nanoparticles. Thus, we have used thermosensitive magnetoliposomes that contained superparamagnetic iron oxide nanoparticles and doxorubicin for in vitro and in vivo therapy of rat glioma C6. The results showed that magnetoliposomes can be specifically heated to 43°C (phase transition temperature of a used lipid composition) in a few minutes, and during this, the encapsulated doxorubicin is released in a controllable manner. The in vitro experiments showed that the cell viability decreased to 79.2% after heat treatment alone and to 47.4% for doxorubicin-loaded magnetoliposomes without application of alternating magnetic field, while the combined treatment resulted in 17.3% cell viability. Also, in vivo results demonstrated that magnetic drug targeting has a strong antiglioma effect with a tumor volume growth inhibition and complete regression. Such targeted delivery and controlled release of anticancer agents would provide clinical advantages compared with currently available methods.

Application of cationized magnetoferritin for magnetic field-assisted delivery of short interfering RNA in vitro.

Cationized magnetoferritin is used for development of a simple, efficient, and fast delivery of short interference RNA into cells using combination of magnetophoresis for pre-concentration of siRNA-magnetoferritin complex on the surface of plated cells with subsequent application of nanosecond laser pulses producing stress waves in transfection chamber, which permeabilize cell membrane for the facilitated delivery of siRNA into the cell interior. As has been quantified using siRNA inducing cell death assay, by combination of these two physical factors we have obtained high efficiency for tested three different human carcinoma cells. Proposed method of gene silencing based on cationized magnetoferritin is a versatile and easily accessible platform with many possible applications in gene therapy.

Application of Albumin-embedded Magnetic Nanoheaters for Release of Etoposide in Integrated Chemotherapy and Hyperthermia of U87-MG Glioma Cells.

BACKGROUND/AIM: Malignant gliomas remain refractory to several therapeutic approaches and the requirement for novel treatment modalities is critical to combat this disease. Etoposide is a topoisomerase-II inhibitor, which promotes DNA damage and apoptosis of cancer cells. In this study, we prepared albumin with embedded magnetic nanoparticles and etoposide for in vitro evaluation of combined hyperthermia and chemotherapy. MATERIAL AND METHODS: Magnetic nanoparticles were prepared by a modified co-precipitation method in the presence of human serum albumin and etoposide. A cellular proliferation assay was used to determine the effects of these nanostructures on the viability of U87 glioma cells in an alternating magnetic field. RESULTS: The in vitro experiments showed that cell viability decreased to 59.4% after heat treatment alone and to 53.8% on that with free etoposide, while combined treatment resulted in 7.8% cell viability. CONCLUSION: Integrating hyperthermia and chemotherapy using albumin co-embedded magnetic nanoheaters and etoposide may represent a promising therapeutic option for glioblastoma.

Fibrinogen Levels Are Associated with Lymph Node Involvement and Overall Survival in Gastric Cancer Patients.

BACKGROUND/AIM: Combination of perioperative chemotherapy with gastrectomy with D2 lymphadenectomy improves long-term survival in patients with gastric cancer. The aim of this study was to investigate the predictive value of preoperative levels of CRP, albumin, fibrinogen, neutrophil-to-lymphocyte ratio and routinely used tumor markers (CEA, CA 19-9, CA 72-4) for lymph node involvement. MATERIALS AND METHODS: This retrospective study was conducted in 136 patients who underwent surgery between 2007 and 2015. Bivariable and multivariable analyses were performed in order to identify important characteristics associated with the risk of lymph node involvement. Kaplan-Meier survival curves and log-rank tests were used to compare overall survival. RESULTS: Lymph node involvement was significantly affected by preoperative fibrinogen (p=0.008) and albumin (p=0.023). Poor clinical condition, T and N staging and fibrinogen level above 3.5 g/l were significantly associated with worse overall survival. CONCLUSION: Preoperative fibrinogen and albumin levels are significantly associated with lymphoid metastases in patients with gastric cancer.

Influence of naturally occurring antioxidants on magnetic nanoparticles: risks, benefits, and possible therapeutic applications.

We have studied interaction of well known antioxidant L-ascorbic acid with magnetic nanoparticles containing insoluble Fe(III) in their core. In analogy with ferritin, mobilization of iron in the form of water soluble Fe(II) was observed, especially pronounced at higher temperatures. In the presence of hydrogen peroxide cytotoxic hydroxyl radicals are produced. These results suggest possible harmful effects of widely used magnetic nanoparticles as a MRI contrast agents in combination with overload of organism with ascorbic acid in some specific conditions, like fever of patient. On the other hand combination of magnetic nanoparticles and ascorbic acid may be used for a cancer therapy using alternating magnetic field for the release of Fe(II) via Néel relaxation of magnetic moment of used nanoparticles. We have further found that lipoic acid is an efficient antioxidant scavenging hydroxyl radicals produced by Fenton reaction from Fe(II).

Sertoli-Leydig cell tumor of the ovary--morphological and immunohistochemical analysis.

Sertoli-Leydig cell tumor is a rare and usually unilateral tumor of the ovary occurring in women's reproductive age. Only about 10% of these patients are over 50 years of age. One third of these patients are suffering from signs of virilisation. This work summarizes the morphological and immunohistochemical characteristics of this tumor in a 56-year old woman with clinical signs of virilisation.

Occurrence of erectile dysfunction, testosterone deficiency syndrome and metabolic syndrome in patients with abdominal obesity. Where is a sufficient level of testosterone?

AIM: The aim of this study was to determine the prevalence of erectile dysfunction (ED), testosterone deficiency syndrome (TDS), and metabolic syndrome in patients with abdominal obesity (AO) and the prevalence of morbidity at different levels of testosterone (TST). BACKGROUND: Male sex hormones play an important role in ED and variety of TDS and may have influence on the development of metabolic syndrome. The number of men with AO which constitutes a serious health risk is continuously growing. Currently, there are different views that TST levels are already insufficient, and the patient should benefit from treatment. OBJECTIVES: This study examined the association between ED, testosterone level and metabolic syndrome in men with AO. DESIGN, SETTING, AND PARTICIPANTS: The study was carried out in an outpatient urology center of Urology Clinic and Obesity Center of the Clinic of Internal Medicine. There were 167 participants­men with AO which were examined as part of preventive examination. METHODS: Hormonal, a complete urological and internal evaluation was carried out in every patient. RESULTS AND LIMITATIONS: We found some degree of ED in 73% (122/167) in men with AO. The TST levels below 14 nmol/l had of these 122 patients 84 patients (68.9%) and 49 patients (40.2%) below 10 nmol/l. In this group of patients, we found 103/167 patients (61.7%) with metabolic syndrome. When we compared TST level and morbidity, we found significantly more patients with diabetes mellitus (DM), hypertension and dyslipidemia in group with TST below 10 nmol/l. We also found difference in the levels of HDL cholesterol and triglycerides in the group of patients with TST 10­14 and over 14 nmol/l. CONCLUSION: Patients over 40 years of age with AO and ED should also be examined for TDS and metabolic syndrome. In this group of patients we found that 113/167 patients (67.6%) had total TST below 14 nmol/l, and sufficient level of TST seems to be above this level.

Fetus in fetu from newborn's mediastinum: case report and a review of literature.

Fetus in fetu is a rare congenital anomaly, when the malformed monozygotic twin is found within the body of a living child or sometimes in an adult. We report a case of fetus in fetu diagnosed during the early third trimester of pregnancy, in the medial and inferior portions of anterior mediastinum of the dominant twin. The diagnosis was suspected by prenatal ultrasound and fetal magnetic resonance imaging. It was postnatally confirmed by CT and RTG, surgically removed after birth and histologically examined. Histologically we found well-developed organs and tissues derived from all germ layers. To our knowledge, we describe the fourth case of fetus in fetu located in the thorax, and the second case located in the anterior mediastinum. This case highlights the usefulness of prenatal ultrasound and MRI in the diagnosis of mediastinal masses, and the usefulness of complete histological examination for confirmation of diagnosis of fetus in fetu. We also reviewed the possible embryologic backgrounds of this congenital anomaly.