A 37-year-old male presented in March 2007 with facial oedema. Quincke oedema was suspected and the patient was treated with parenteral corticosteroids and antihistamines. In spite of the therapy, his condition deteriorated. He developed breathing difficulties and cyanosis of his earlobes. Blood gas analysis showed mild hypoxemia and hypocapnia. A thoracic computed tomography (CT) scan showed collateral circulation and a large mass in the right atrium, extending into and obstructing the superior vena cava. The patient was referred urgently to the Cardiosurgery Department, where the tumour was partially resected. It was 50 · 50 · 40 mm in size, weighed 46 g and was covered with an incomplete thin, fibrous, elastic, solid light-brown to greenish membrane. It contained two dark-brown thrombotic masses, 30 · 15 · 10 mm and 25 · 18 · 8 mm in size. Microscopy of the tumour showed blastlike cells with round, irregular or elongated nuclei, finely granulated chromatin, large nucleoli and scanty basophilic cytoplasm. Mitotic and apoptotic indexes were high. There were numerous macrophages involved in phagocytosis of apoptotic debris, creating a 'starry sky' appearance. Immunohistochemical analysis showed cells clearly positive for CD45, CD34, CD117 and myeloperoxidase. Cells were negative for epithelial membrane antigen, cytokeratin, vimentin, S100, neurone-specific enolase, chromogranin A, synaptophysin, desmin, Myo D1, CD99, terminal deoxynucleotidyl transferase, CD15, CD68, lysozyme, CD31, CD79a, CD20, CD10, CD1a, CD3, CD4, CD5, CD7, CD8, CD43, CD45RO, CD56, CD57, CD30 and ALK-1. Proliferative activity was high (up to 40% of cells were Ki67+). A diagnosis of extramedullary myeloblast proliferation without maturation (myeloid sarcoma) was made.The patient was then admitted to our institute for further tests. Morphology and flow cytometry did not show any leukaemic infiltration of the bone marrow. Repeated CT scanning showed the right atrium to be completely filled with a solid, avascular tumour mass, with irregular contours, measuring 44 · 67 · 82 mm (top left), that did not spread into the right ventricle or left side of the heart (top right). There was a well-developed collateral circulation (bottom) between the inferior vena cava and the jugular vein. Combination chemotherapy with daunorubicin and cytarabine was commenced.

Cardiac involvement by non-Hodgkin's lymphoma is not uncommon, however rarely diagnosed during life due to nonspecific clinical presentation. We report a case of secondary cardiac lymphoma in patient who presented with new-onset atrial fibrillation. Cardiac lymphoma was in a form of bulky right atrial mass, infiltrating the atrial septum and cavo-atrial junction with concomitant mild pericardial effusion. In the present case, we illustrate complementary role of transthoracic, transesophageal echocardiography and multislice CT scan with three-dimensional reconstruction, in detection and evaluation of secondary cardiac tumor. Usefulness of echocardiography to follow up the effects of chemotherapy is also shown.

The most frequent benign gallbladder polyps are cholesterol polyps. Next in frequency were adenomas, which may have malignant potential. The aim of this study was to assess the possibility of ultrasonography in the diagnosis and differential diagnosis of cholesterol polyps compared to adenomas. Patients were examined during the period from October 2006. to December 2008. In Department of Ultrasound, Clinic for Gastroenterology and Hepatology, Belgrade. The group of 54 patients analyzed consisted of 30 women (56%) and 24 men (44%). Most (59%) had solitary polyps. In 92.6% of patients the size of polyps was below 10 mm. 74% of respondents were over 50 years. Ultrasonography is the method of choice and gold standard in diagnosis of gallbladder polyps. Based on echoic properties cholesterol polyps can not be distinguished from adenomas. Malignant alteration of polyps also could not be detected. Appropriate ultrasonographic characteristics such as size of polyps, appearance of a broad base that sits on the wall, concomitant lithiasis findings and patient age may be indicative for malignancy.

Objective : Symptomatic, anatomic and urodynamic results of a composite transobturatory tension-free sling with an absorbable middle part, in patients with stress urinary incontinence (SUI), were studied. Methods : A prospective study in 40 women with SUI was performed. Symptoms, urodynamics and anatomical improvements were evaluated separately. Surgery was performed with the transobturatory approach. Results : All patients had both clinically and urodynamically confirmed SUI. Clinical outcome was favorable in 36/40 (90%) patients, after 1 year. Operation improved the position of the bladder neck (2.8 cm and 1.4 cm below the pubic bone, respectively) and significantly decreased mobility of the bladder neck during abdominal straining (3.3 cm and 1.7 cm, respectively). Both symptoms and quality of life were significantly improved 1 month after the surgery. Postoperative maximum flow was lower than the preoperative one but with borderline significance (25.8 and 23.7 mL/s; P = 0.05). Pressure flow study showed unobstructed voiding both preoperatively and postoperatively. Detrusor pressure at the maximum flow was increased (20, 4 and 22, 8 cmH 2 O, respectively) but not significantly. Conclusion : Our results confirmed a high objective cure rate, improvement of symptoms and quality of life, and at the same time, corrected position of the bladder neck and unobstructed voiding.

Takayasu arteritis (TA) is an idiopathic chronic granulomatous vasculitis that affects aorta, its main branches and occasionally pulmonary arteries. It is more common in Asian persons, affecting predominantly young women. Clinical presentation is nonspecific at the beginning of the disease, while in the ischemic disease’s stage it depends on the territories affected. We present the case of a 26-year-old woman who was diagnosed as having TA. Multiple vascular abnormalities of aorta and its branches and severely reduced left ventricular function were present at the time of diagnosis. Immunosuppressive treatment consisting of prednisone and azathyoprine along with conventional heart failure therapy significantly improved her cardiac function