Introduction: It is estimated that the prevalence of primary hyperparathyroidism in patients over 40 years is about 1 % (men 0.4 %, women 1.6 %). Despite developments in diagnosis today, the highest percentage of patients with hyperparathyroidism remains undetected, and it is estimated that only 10% of cases are diagnosed and treated. In 90% of patients, the cause of hyperparathyroidism is one pathologycally changed parathyroid gland. Aim of the Study: To estimate the efficiency and reliability of a conservative approach in surgical treatment, previously diagnosed with primary hyperparathyroidism, in comparison to a traditional neck exploration showing all four parathyroid glands. Patients and Methods: In the study, we analyzed the results of 71 patients at the University Clinical Center of the Republic of Srpska in the period from 2008 to 2017. The diagnosis of primary hyperparathyroidism was set based on the ultrasonography and scintigraphy of parathyroid glands, neck CT scan, clinical pictures and laboratory findings. The surgery included short cervical incision of 2 cm and 4 cm, placed 2 cm above the jugulum with unilateral neck exploration and extirpation of modified parathyroid gland. Results: In the research were used classification methods, structural-functional analysis, synthesis, comparisons, abstractions, concretisations and simpler statistical method with the use of descriptive statistics to prove the hypothesis set, out of which tables, grafs, and summaries were used. 71 patients diagnosed with primary hyperparathyroidism were operated. The youngest patient was 28-year-old and the oldest 79-year-old. On the basis of the PH findings, targeted parathyroidectomy procedure was successful in 94.3% cases. Conclusion: The goal of the surgical approach, with unilateral neck exploration, allows successful identification of pathologically modified parathyroid gland and efficient treatment of primary hyperparathyroidism.

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Background Pleural effusion refractory to diuretic treatment is frequent in advanced heart failure. Therapeutic thoracentesis (TT) is a time-honored practice, recently made simpler and safer by guidance with lung ultrasound. Purpose In order to elucidate safety of lung ultrasound-driven TT in refractory heart failure, we compared incidence of pneumothorax requiring surgical drainage in patients undergoing TT with or without lung ultrasound. Methods and results In a single-centre retrospective analysis we recruited 373 patients with heart failure with reduced ejection fraction (26 ± 12%), New York Heart Association class ≥3, and pleural effusion ≥ moderate at lung ultrasound. They underwent overall 493 TT. Evacuated pleural fluid by passive drainage was 1030 ± 534 mL. The maximal interpleural space was 73.6 ± 15.6 mm before, and 12.4 ± 3.1 mm after TT (p < .001). Two groups of TT were identified ex-post: 462 guided by lung ultrasound (Group 1); 31 without ultrasound guidance (Group 2), performed by cardiologist/pneumologist lacking access to ultrasound machine or expertise in lung ultrasound). The rate of complications (pneumothorax) was 0/462 in Group 1 and 3/31 in Group 2 (0 vs 10%, p < 0.001) Conclusion Lung ultrasound-driven TT of pleural effusion in decompensated heart failure patients is feasible and safe when performed by cardiologists guided by lung ultrasound. A blind TT without ultrasound guidance is associated with higher rate of pneumothorax, and should be avoided.

Introduction: Malignant cells invasion of lymphatic drainage represents the basic precondition of metastasis and the disease progress. The invasion of tumor depends on its pathomorphologic characteristics, out of which one of the most significant role is the type. Aim of the Study: Descriptive analysis of operated patients, estimation of frequency and representativeness of the stated types of NSCLC in the monitored group, analysis of malignant cells of lung cancer in lymphatic drainage on the basis of the type of primary tumor. Patients and Methods: The study included 331 patients, who underwent the surgery during which the malignant infiltration was removed, in addition to the dissection of lymph nodes drainage. Results: Out of the total number of operated patients, 257 of them were male gender, while 74 were female gender, with the average age of 63.52 years (21-80). The relation of gender structure of the patients in relation to gender was statistically significant (p=0.00). The ratio between squamous cell carcinoma to adenocarcinoma was 182:140, while the other types of tumor were insignificant. Statistically, there was no significant difference in the frequency of two most common types of lung cancer (χ 2 test= 3.02; p=0.09). There was no statistically significant connection between the type of tumor and N1 metastasis (χ 2 =1.55; p=0.46), as well as in the ratio between the type of tumor and malignant infiltration of lymph nodes, level N2 (χ 2 =2.33; p=0.32). Conclusion: There is no connection between the type of lung cancer and invasion of levels N1 and N2 of lymph nodes.

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