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Volume 53, Issue 4, 2025

Online ISSN: 2560-3310

ISSN: 0350-8773

Volume 53 , Issue 4, (2025)

Published: 30.06.2025.

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30.06.2025.

Professional paper

FEOHROMOCITOM – TUMOR SA MNOGO LICA


 Feohromocitom je redak tumor srži nadbubrežne žlezde, sa incidencom od 0,8 do 2,3 novo-otkrivena slučaja na million stanovnika godišnje, u opštoj
 populaciji. Može se javiti u svakom uzrastu i okolnostima, uključujući novorođenčad, trudnice i dr.. ali je češći kod žena u životnom dobu između 20 i
 50 godina.
 
Dijagnoza se bazira na tipičnim simptomima, laboratorijskim analizama i lokalizacionim pretragama - ultrazvuk, kompjuterizovana tomografija (CT),
 nuklearna magnetna rezonanca (NMR), scintigrafija (MIBG). Preporučuje se i genetski skrining kod sumnje na hereditarnu formu. U 0,1-1% slučajeva
 dijagnozu postavljaju kardiolozi jer podaci ukazuju da svaku novo-nastalu hipertenziju treba evaluirati u pravcu moguće feohromocitomom
 indukovane hipertenzije. Biohemijska potvrda dijagnoze feohromocitoma se bazira na prisustvu povišenih vrednosti kateholamina i/ili njihovih
 metabolite u plazmi ili u urinu. Savremene preporuke polaze od stanovišta da bi  inicijalni skrining feohromocitoma trebalo da uključuje i merenje
 frakcioniranog metanefrina u urini i/ili plazmi. Nakon biohemijske potvrde, mora biti sprovedena lokalizacija tumora. U većini slučajeva
 feohromocitom se može identifikovati pomoću CT-a, ali je NMR bolji izbor za ekstraandrenalne lokalizacije i male tumore. Ako se sumnja na
 paragangliom, multiple tumore ili metastaze, scintigrafija pomoću I-MIBG daje visoku specifičnost i senzitivnost u njihovoj detekciji.   
Hipertenzija se tipično prezentuje kao hipertenzivna kriza, indukovana stresom, fizičkim naporom, naglim pokretima i sl.. Ali, oko 10-20% pacijenata
 ima umerenu hipertenziju, bez hipertenzivnih kriza. Osim paroksizmalne hipertenzije, klasični simptomi, kao što su glavobolja, bledilo, palpitacije,
 anksioznost se javljaju samo kod 50% slučajeva. Oko 5% pacijenata sa feohromocitomom su asimptomatski, što može odložiti dijagnoszu. Zato se za
 ovaj tumor kaže da ima mnogo lica.
 U literaturi se za feohromocitom vezuje pravilo 10%, što znači da u 10% slučajeva može biti: ekstraadrenalna lokalizacija, bilateralan, bez
 hipertenzije, nasledan, maligan, u dečjem uzrastu. Međutim, razvoj sofisticiranih dijagnostičkih metoda dovodi ovo pravilo u pitanje. Hereditarne
 forme imaju veću incidencu bilateralnih tumora (20-50%), ekstra-adrenalna lokalizacija se javlja u više od 20% slučajeva i rizik od maligniteta raste i
 do 40%, prema nekim izvorima.
 Preoperativna priprema ima dva glavna cilja:kontrolu krvnog pritiska i restauraciju volumena krvi do normalnih vrednosti, primenom alfa-blokatora u
 inicijalnom tretmanu
 Intraoperativno pred anesteziologom su dva najznačajnija problema: hipertenzija (tokom indukcije u anesteziju i resekcije tumora) i hipotenzija
 nakon devaskularizacije i ekstirpacije tumora. Takođe, mogu se javiti srčane aritmije kao veliki problem, naročito kod epinefrin-sekretujućih tumora.
 U cilju uspešnog tretiranja ovih hemodinamskih poremećaja, neophodno je preoperativno uspostaviti invazivni monitoring krvnog i centralnog venskog
 pritiska. Antihipertenzivi i antiaritmici moraju biti momentalno dostupni za primenu. Zbog mogućih dramatičnih hemodinamskih poremećaja,
 feohromocitom je nazvan još i “anesteziološka noćna mora

Nevena Kalezić

15.02.2025.

Original scientific paper

RECOMMENDATIONS FOR THE APPROACH TO PATIENTS WITH DISORDERS OF THYRIOD GLAND FUNCTION IN THE DENTAL OFFICE

Thyroid hormones, thyroxine and triiodothyronine, affect the work of all organs and organ systems. Whether they are in excess or in deficit, they lead to significant disturbances in the homeostasis of the organism, changing first of all the metabolic processes and leading to significant clinical manifestations, primarily in the cardiovascular, but also in other organ systems. The imbalance of thyroid hormones also has oralmanifestations, which are often the reason why patients visit the dentist. However, what worries dentists the most is the possibility of acute decompensation of hyper or hypothyroidism, with the appearance of thyrotoxic storm or myxedema coma, which are life-threatening conditions. Therefore, a valid pre-procedural evaluation and preparation of patients with thyroid hormone function disorders for pre-planned dental interventions is of great importance. During dental procedures, it is necessary to adhere to recommendations regarding the choice of local anesthetics, hemostasis, drug interactions, the possibility of infection and minimizing stress, all in order to avoid acute decompensation of thyroid imbalance.

Radomir Mitić, Nina Dimitrijević Jovanović, Hristina Ugrinović, Jelena Vulović, Milena Šibalić, Nevena Kalezić

01.12.2021.

Professional paper

Importance of postoperative pain and possibilities of prevention and treatment

The paper presents the importance of acute postoperative pain, the risk factors for its occurrence and intensity, instruments for its measurement and assessment, as well as the possibilities of prevention and treatment. The fact that post-surgical pain represents not only a subjective unpleasant experience for the patient, but also a factor that significantly contributes to complications and unfavorable outcomes of surgical treatment is well known. Despite that, postoperative pain can be seen very often. To successfully prevent and relieve pain, it is necessary to establish a possible cause-and-effect relationship between the occurrence and intensity of postoperative pain, type of surgical intervention, anesthesia technique, demographic characteristics of patients, comorbidities, chronic therapy, and family and socioeconomic factors. Besides the application of recommendations from the current guidelines and protocols for the prevention and treatment of post-surgical pain to achieve positive treatment outcomes, an individual approach to each patient and the application of multimodal analgesia techniques that include the use of different classes of analgesics, co-analgesics, and non-pharmacological measures, based on modern ERAS-protocols aimed at accelerated recovery after surgical intervention should also be employed.

Anka Tošković, Marina Stojanović, Ksenija Jovanović, Jovan Jozić, Milan Jovanović, Nevena Kalezić

01.12.2019.

Professional paper

Incidence of ectopic thyroid tissue in the adrenal gland

Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.

Matija Buzejić, Božidar Odalović, Goran Zorić, Branislav Rovčanin, Nikola Slijepčević, Katarina Taušanović, Milan Jovanović, Duška Vučen, Boban Stepanović, Nevena Kalezić, Anka Tošković, Ivan Paunović, Vladan Živaljević

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