Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

IntroductionThe finding that long noncoding RNAs (lncRNAs) originating from tumor cells could be found in general circulation has prompted the idea to use lncRNAs as noninvasive diagnostic biomarkers of particular diseases. In this study we explored the expression pattern of circulating GAS5 (growth arrest-specific transcript 5) lncRNA in non-small cell lung cancer (NSCLC) patients and its association with clinicopathological characteristics.Material and methodsExpression pattern of circulating GAS5 was analyzed in 58 plasma samples of NSCLC patients, and 15 healthy controls. Quantitative assessment was performed using the real-time PCR method and TaqMan chemistry.ResultsCirculating GAS5 expression level in NSCLC patients was not significantly decreased compared to control samples (p = 0.081). Statistically significant difference in GAS5 expression was found in relation to TNM stage of the tumor (p < 0.001), decreasing with progression of the tumor stage. Lower GAS5 expression was detected in patients with larger tumors (p = 0.006), and in patients with lymph node metastasis (p = 0.001). Receiver operating characteristic curve analysis was used to evaluate the diagnostic potential of circulating GAS5 expression, showing the highest predictive power in distinguishing between stage III/IV patients and control samples (AUC = 0.8; sensitivity 53%, specificity 93%), and also for separating patients between TNM stage I/II and stage III/IV (AUC = 0.82; sensitivity 73%, specificity 79%).ConclusionsOur study suggests that decreased expression of circulating GAS5 is closely related to the tumor size and TNM stage. Therefore the measurement of GAS5 expression level in plasma could be a promising noninvasive diagnostic molecular biomarker in NSCLC patients.

Introduction Simultaneous bilateral spontaneous pneumothorax (SBSP) is a potentially life-threatening state that may imitate many lung diseases. The aim of this report was to describe the presentation and highlight potential difficulties in diagnosis and management of patients with SBSP. Case outline A 23-year-old female patient was urgently assessed because of a progressive two-day-long dyspnoea with associated bilateral chest pain. Lung auscultation revealed equally diminished breath sounds on both sides. During the initial examination, there was evidence of symptomatic deterioration with bilateral pleuritic chest pain, increased dyspnoea, and agitation. The patient was found to have type II respiratory failure with the following biochemical parameters: pH 7.34, PaCO 2 6.3 kPa, and PaO 2 7.9 kPa. A chest radiograph confirmed bilateral partial pneumothoraces of approximately 30%. Both left-and right-sided thoracostomies with large-bore chest drain insertions were performed emergently, followed by partial resolutions of pneumothoraces. CT of the chest demonstrated residual pneumothoraces bilaterally with multiple apical bullae. In the further course, the patient subsequently underwent video-assisted thoracoscopic surgery with bilateral apicoectomies, bullectomies, and pleural abrasion. Her chest drains were removed three days after surgery and a post-treatment chest radiograph demonstrated resolution of the pneumothoraces. She was discharged without complications. Conclusion Using clinical presentation, diagnostic algorithm and therapeutic management applied in the case of our patient, we emphasized a few mandatory steps in establishing the diagnosis of SBSP and further treatment.

Introduction/Objective The aim of the study is to analyze the treatment of spontaneous pneumothorax (PSP) through our 10-year experience. Methods The study included 67 patients with PSP treated with video-assisted thoracoscopic surgery (VATS) or with thoracic drainage (TD) in the Clinic for Chest Surgery at the Military Medical Academy in Belgrade, Serbia in the 2008-2017 period. Results PSP patients with VATS were younger (33.2 ± 16.4 vs. 45.5 ± 21.5 years, p = 0.010), and both groups consisted mainly of males (69.2% vs. 78%). VATS-treated patients were hospitalized shorter and wore drains (p < 0.001, p < 0.002). Recurrence after treatment was more common after TD (61% vs. 3.8%) and in most cases it was treated with VATS (92%). The incidence of intraoperative complications is similar between groups (p = 0.599, p = 0.636, p = 0.311, p = 0.388, p = 0.388, respectively). Pain was more common in TD (p < 0.001). The early complications in the group of patients treated with TD occurred more often (p < 0.001, p < 0.001), without significant difference in the incidence of pleura infections and intercostal blockade between groups (p = 0.388, p = 0.388, respectively). Patients treated for PSP with the VATS method came to the control follow-up later, compared to patients treated with TD (p < 0.001). Conclusion VATS proved to be efficient, which was reflected in the optimal duration of surgery, length of hospitalization, tolerable postoperative pain and satisfactory cosmetic effect, and postsurgical relapse in only one case.

Introduction. The aim of this manuscript was to report a case series of three patients diagnosed with multiple primary synchronous cancers (MPSC) in the lungs who were treated multidisciplinary at a single-center institution. Outline of cases. Three male patients were referred to the Clinic for Chest Surgery, at the Military Medical Academy in Belgrade, Serbia for planned surgical treatment of previously detected lung cancers. During subsequent diagnostic procedures, second primary synchronous tumors were detected in all presented cases. All patients underwent surgical resection and chemotherapy or a combination of chemo- and radio- therapy. Two of three patients died with an average survival period of 32 months. One patient is still alive, with current disease-free interval of 21 months. Conclusion. MPSC is a rare condition. The final diagnosis should be based on clinical, radiological, histopathological, and genetic analyses. Treatment modalities of MPSC depend on the clinical staging of the disease, patient?s general medical condition, and general assessment of tumor operability and resectability.

lečenje bolesnika, osmišljavanje i pisanje rada Aleksandar Nikolić-lečenje bolesnika, saradnja pri pisanju rada Vlado Cvijanović-lečenje bolesnika, saradnja pri pisanju rada Aleksandar Ristanović-korekcije jezika, saradnja pri pisanju rada Nataša Vešovićkorekcije jezika, pronalaženje literature Dejan Stojković-tehničko ureĎivanje rada, pronalaženje literature Vanja Kostovski-pisanje apstrakta Ljubinko Đenićprevod na engleski jezik Stevan Čičićprevod na engleski jezik 3

Introduction Dirofilariasis is a zoonosis caused by nematodes from the genus Dirofilaria, which is a parasite in dogs and other canids, and humans get infected by a mosquito bite. In Europe, the number of patients outside the endemic area is increasing. So far, more than 2,850 cases of human dirofilariasis have been reported worldwide. In the last 20 years, we have had only two confirmed cases in our institution. The disease is manifested in a cutaneous, visceral, and ocular form. From the initial infection, the first symptoms can take several years to manifest. The diagnosis can be confirmed histologically, morphologically, and/or by molecular techniques. The treatment includes surgical removal of the parasite and antiparasitic therapy. Case outline The paper presents two cases of Dirophilaria repens infection. The first patient had a migratory nodular facial skin change for several years. After the skin induration incision in the zygomatic region, a 7-cm-long worm was extracted, later identified as Dirophilaria repens. The pathohistological finding of the extirpated change showed that it was a granuloma inflammation. The second case was a patient with a persistent cough and hemoptysis, with a morphologically verified nodular change in the pulmonary parenchyma. The pathohistological finding of the extirpated change showed a chronic granulomatous inflammation and the presence of parasites. The treatment of both patients resulted in a complete recovery without complications. Conclusion In case of subcutaneous nodules or unclear lung changes, dirofilariasis should be considered. Video-assisted thoracoscopic surgery is the leading diagnostic surgical procedure concerning dirofilariasis, and a significant therapeutic modality.

No abstract