Introduction: Gastrointestinal bleeding represents a serious clinical challenge due to the complexity of diagnosis and the therapeutic options required for effective management. Small bowel bleeding, although relatively rare, poses a significant diagnostic dilemma due to the difficulty in identifying the source and the variability of causes, which differ depending on the patient's age. In the elderly population, vascular malformations are the most common causes, whereas in younger patients, the etiology can be broader, including inflammatory diseases, tumors, and congenital abnormalities. The aim of this study was to investigate the clinical characteristics and outcomes of patients with hemodynamic instability due to small bowel bleeding, with a particular focus on the application of predictive scores (GBS and CRS). Materials and Methods: This retrospective observational study, conducted from January 2023 to January 2024, included 24 hemodynamically unstable patients with diagnosed small bowel bleeding. All patients were assessed using the Glasgow Blatchford Score (GBS) and Clinical Rockall Score (CRS) to evaluate risk and predict clinical outcomes. Demographic data, clinical and diagnostic information were analyzed, with comparative analyses of preoperative, intraoperative, and histopathological findings. Results: The mean age of the patients was 69.8 years, and 79.2% presented with hematochezia. All patients had GBS > 15 and CRS > 6. Conservative treatment was effective in 62.5% of patients, while 37.5% required surgical intervention. The mortality rate was 12.5%. Statistically significant positive correlations were found between GBS and mortality (r = +0.76, p < 0.05) and between GBS and surgical intervention (r = +0.32, p < 0.05). The most common causes of bleeding were vascular lesions, although the source of bleeding was unidentified in 11 patients. Conclusion: Small bowel bleeding remains a major challenge for clinicians, requiring a multidisciplinary approach to diagnosis and treatment. The use of predictive scores such as GBS and CRS aids in assessing severity, guiding decision-making, and planning further treatment.

Introduction: Colorectal cancer (CRC) is among the most common malignancies, with a rising global incidence. Synchronous tumors refer to the presence of multiple tumors simultaneously in different segments of the colon or rectum, while metachronous tumors occur during follow-up after initial treatment. These tumors are often undetected during standard diagnostic procedures, making intraoperative exploration and postoperative monitoring crucial for timely diagnosis and successful treatment. Case Report: A 63-year-old patient was admitted for sideropenic anemia and weight loss. Colonoscopy revealed a tumor in the cecum, confirmed as adenocarcinoma. During surgery, two additional tumor lesions were discovered in the ascending and transverse colon. Following an extended right hemicolectomy and adjuvant chemotherapy according to the FOLFOX protocol, the patient remained disease-free until May 2023, when a metachronous tumor in the rectum was detected. The lesion was removed via transanal excision, and histopathological findings indicated intramucosal carcinoma. Continuous follow-up until November 2024 showed no disease progression. Conclusion: Intraoperative exploration enabled the identification of previously undetected synchronous tumors, influencing the extent of surgery and the postoperative treatment plan. Regular monitoring, including colonoscopy and radiological methods, is essential for the early detection of metachronous tumors and achieving optimal outcomes. This case highlights the importance of a multidisciplinary approach in managing patients with synchronous and metachronous CRC.

Introduction: Chronic limb ischemia (CLI) and diabetic foot significantly impact patients’ quality of life, with high rates of amputation and mortality. Angiosome-oriented revascularization represents an anatomically precise approach, targeting the artery that directly supplies the lesion area. Direct revascularization (DR) is increasingly considered superior to indirect revascularization (IR) due to potentially better wound healing and limb salvage outcomes. Methods: A narrative literature review was conducted using PubMed, Cochrane Library, and Google Scholar, with the keywords: angiosome, critical limb ischemia, diabetic foot, direct revascularization, endovascular, bypass surgery. Studies published between 2020 and 2025 were included, focusing on systematic reviews, meta-analyses, and prospective cohort and clinical studies. In addition to clinical studies, anatomical data on the distribution of foot and lower leg angiosomes were analyzed, including a table illustrating the correlation between wound location and target artery. Results: Six main angiosomes of the lower limb were identified, each corresponding to a specific artery. DR was associated with higher rates of wound healing and limb preservation, reducing the risk of amputation by 20–30% compared to IR. Optimal candidates for DR are those with localized lesions, patent distal target arteries, and adequate microcirculation. DR is less effective or technically unfeasible in patients with diffuse microvascular disease, multisegment occlusions, poor distal vessels, or active severe infections. Advanced technologies such as hyperspectral imaging and indocyanine green (ICG) mapping improve intraoperative perfusion assessment. Conclusion: Angiosome-oriented revascularization is a logical and anatomically grounded approach for treating CLI and diabetic foot. When feasible, DR of the target artery provides better clinical outcomes than IR. Success requires precise diagnostics, patient selection, and multidisciplinary collaboration. Further randomized studies are needed to define optimal application algorithms for this concept.

Introduction: Voice dysfunction represents a significant postoperative complication following total thyroidectomy, particularly in patients whose profession depends on their voice (singers, lecturers). The main causes include injury to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN), as well as vocal cord trauma during intubation or the occurrence of postoperative edema. Methods: A systematic search of PubMed and Cochrane databases was conducted for studies published between 2014 and 2025. Included studies comprised randomized controlled trials, meta-analyses, systematic reviews, and relevant clinical guidelines. Data were analyzed regarding the incidence of voice dysfunction, mechanisms of nerve injury, surgical and anesthetic risk factors, prevention strategies, and postoperative management, including the use of intraoperative neuromonitoring (IONM). Results and Discussion: Recurrent laryngeal nerve paresis leads to dysphonia and reduced phonatory power, whereas superior laryngeal nerve injury decreases the high-frequency vocal range and vocal endurance. The risk is increased in reoperations, large retrosternal goiters, and invasive tumors. The use of IONM reduces the risk of permanent RLN injury, although its reliability may be compromised by improper use of neuromuscular blockers or anesthetic protocols. Anesthetic factors, including improper intubation, excessive cuff pressure, and multiple intubation attempts, significantly contribute to voice changes. Prevention includes careful anesthetic management, precise intubation technique, and coordinated work between surgeons and anesthesiologists. Early postoperative evaluation, fiberendoscopic examination, acoustic analysis, and speech therapy contribute to preserving vocal cord function. Conclusion: Voice dysfunction following total thyroidectomy arises from both surgical and anesthetic factors. Prevention of complications requires a multidisciplinary approach, coordination between surgeons and anesthesiologists, and the use of intraoperative neuromonitoring. Therapy and rehabilitation, including otolaryngological assessment and speech therapy, aim to preserve and restore vocal function.

Introduction: Pseudoaneurysm (PSA) is defined as a defect in the arterial wall at the puncture site, leading to an extraluminal blood collection surrounded by fibrous tissue, and represents the most common vascular complication after coronary angiography. The aim of this study was to identify risk factors for PSA development after coronary interventions and to define criteria for surgical treatment. Materials and Methods: A retrospective analysis was conducted on 32 patients treated at CHC Zemun over a ten-year period (2012–2022). During the observed period, 16,787 coronary procedures were performed (10,498 coronary angiographies, 6,289 PCIs). The study group included 17 patients with PSA, and 15 patients in the control group with a hematoma that did not progress to PSA. Demographic data, comorbidities, laboratory parameters, therapy, smoking habits, procedural details, and PSA characteristics were recorded, with comparison between surgically and conservatively treated patients. Results: The mean time to PSA diagnosis was 3.29 ± 4.7 days, whereas hematomas were diagnosed within 24 hours. No significant differences in sex or age were observed between groups. More than half of the patients had hypertension, hyperlipidemia, and chronic cardiac or renal diseases. Low hemoglobin, thrombocytopenia, and INR >3 were identified as independent risk factors. Most interventions were performed via the right femoral artery, with PSA most commonly located in the common femoral artery. Median PSA diameter was 44 mm in surgically treated patients and 19 mm in conservatively treated patients. No deaths occurred; the most common postoperative complication was residual hematoma. Conclusion: The first 72 hours after intervention represent the most critical period for PSA detection. PSA diameter is a key factor in therapy selection, lesions >2 cm and complicated ones require surgical intervention, while smaller lesions can be treated conservatively. Timely diagnosis and treatment improve outcomes, and our findings may help optimize patient monitoring protocols and early surgical intervention selection.

The development of colposcopy and the Papanicolaou (Pap) test marked a turning point in the prevention and early detection of one of the most aggressive gynecological cancers—cervical carcinoma. Hans Hinselmann (1884–1959) first used the colposcope in March 1924 and published his research, along with a description of the instrument, in 1925. This year is considered the beginning of the colposcopic era. Using his device, Hinselmann was able to identify early stages of cervical cancer and describe epithelial changes he termed “precancerous lesions.” He emphasized the importance of systematic prevention and advocated for the establishment of centers dedicated to early cervical cancer detection. Although a persistent and methodical researcher, Hinselmann crossed ethical boundaries under the Nazi regime, participating in forced sterilization programs of women from 1935 onward. After World War II, he spent three years in prison (1946–1949), was removed from clinical work, and later incriminated for his involvement. Following his sentence, he was allowed to practice privately until his retirement in 1949. Hinselmann died in 1959 in Goethehaus. In Serbia, the first article on the importance of colposcopy in gynecological diagnostics was published by Berislav Berić in 1954. Štucinova and Mladen Broćić were pioneers in introducing colposcopy in the country. The Section for Colposcopy and Cervical Pathology was established on September 26, 1995, in Brezovica, marking the institutionalization of this field in Serbia. With the adoption of a new Statute on November 12, 2006, the Section evolved into the Serbian Association for Colposcopy and Cervical Pathology.