SUMMARY – The purpose of the study was to assess the level of serum malondialdehyde (MDA) concentration and its association with the stage and histopathologic sizes of colorectal cancer (CRC). One hundred and two patients having undergone surgical treatment of CRC between January 2014 and December 2015 were included in this cross-sectional study. The patients were divided into four groups (stage I-IV) according to the TNM classification. Control group included 30 subjects with no signs of malignancy and inflammatory diseases. In each patient, preoperative blood samples were obtained for determination of MDA concentration by ELISA immunoassay. Serum levels of MDA were progressively increased in patients with CRC, reaching the highest value in the fourth stage of CRC. Serum concentrations of MDA were significantly higher in pT4 group as compared with pT3 and pT2 groups of CRC patients (p<0.01). Significantly higher levels of MDA were found in the N1 and N2 groups of CRC patients as compared with N0 group, as well as in patients with metastatic disease as compared with those without metastasis (p<0.001). In conclusion, the progression of CRC is associated with a significant increase in serum MDA levels.

Background Tumor development and growth are driven in many cases by inflammatory cells, which can produce cytokines and other factors that can stimulate the development of the malignant process. The aim of this study was to evaluate interleukin-6 (IL-6), C-reactive protein (CRP), matrix metalloproteinase-9 (MMP-9), serum levels in patients with colorectal cancer (CRC), and their association with the stage of CRC. Methods IL-6, MMP-9, and CRP serum levels were measured in 75 patients with CRC just before surgical treatment, as well as in 20 healthy individuals as controls. Surgically obtained tissue material was subjected to pathological analysis. Results Significant increase in CRP and IL-6 serum concentration is associated with increasing stage of CRC (p <0.05), where MMP-9 serum level was significantly higher in stages III and IV compared to the stage II CRC. Significant correlation was found between IL-6 and MMP-9 serum levels (rho=0.478; p <0.001) as well as between IL-6 and CRP serum levels (rho=0.720; p <0.001) and between MMP-9 and CRP serum levels (rho=0.379; p <0.001). Serum levels of MMP-9 and CRP have been shown to be independent predictors of the CRC stage. Conclusion Combined quantification of IL-6, MMP-9, and CRP serum levels seems to be a reliable index of inflammation-related processes during colorectal carcinogenesis.

Aim To determine the serum levels of matrix metalloproteinase 9 (MMP-9) concentration and their association with the stage and histopathologic sizes of colorectal cancer (CRC). Methods One hundred and two patients with clinically diagnosed and histologically confirmed colorectal cancer ready for surgical treatment were included in the study. In each patient, preoperative peripheral venous blood samples were taken for determination of the concentration of MMP-9 using ELISA immunoassay test. Resected tumour specimens were studied pathologically according to the criteria of the TNM classification. All patients were divided into groups according to the TNM classification. The control group presented 30 subjects of the appropriate age and gender with no family history of cancer, clinical signs of malignancy or inflammatory bowel disease. Results The serum levels of MMP-9 were progressively increased in patients with CRC reaching the highest value in the fourth stage of CRC. It was also confirmed that the serum concentrations of MMP-9 were significantly higher in patients with pericolonic lymph nodes involvement compared to the patients with no involvement of lymph nodes, 456.4 (445.9-464.7) ng/mL vs. 438.4 (418.4-447.8) ng/mL (p<0.001). Significantly higher serum levels of MMP-9 were found in the patients with metastatic CRC, 458.5 (452.0-468.1) ng/mL compared with the CRC patients without metastasis, 445.8 (436.9-456.5) ng/mL (p<0.001). Conclusion It was confirmed that serum concentration of MMP-9 presented the significant independent risk factors for the progression of CRC.

Objectives: The percentage of patients with difficult and prolonged healing of the wound is still high, while the immediate complications such as wound dehiscence occurs in up to 3 % of all treated patients in abdominal surgery. The aim of study was to analyze the risk factors and comorbidities in the group patients undergoing laparotomy and associated with early postoperative wound dehiscence. Methods: The retrospective study included all patients treated surgically at Clinic of General and Abdominal surgery, Clinical Center of the University of Sarajevo in the period from January 1, 2013 until January 1, 2016, with clinically verified surgical wound dehiscence. Results: The results showed statistically proportion of male patients (70%) compared to female (30%). The largest number of respondents were in age group 71-80. Surgical wound infection was evident in 61% of patients, malignant staining in 52%, hypoproteinemia was found in 50% of patients, anemia in 43%, peritonitis in 36% and diabetes in 14% of respondents. Of the total respondents with surgical wound dehiscence, 30 (68%) had comorbidities present. By analyzing the prevalence of comorbidity and risk factors recorded in relation to comorbidity, it was noted that hypertension is most often associated with hypoproteinemia (X2=4.399; p=0.036), wound infection (X2=4.112; p=0.043) and malignant diseases (X2=4.016; p=0.045). The frequency of the anemia, peritonitis and diabetes in the sample was not different in relation to the comorbidity conditions (p >0.05). Conclusions: The risk factors occurrence of surgical wound dehiscence in our study were identified as hypoproteinemia, malignant disease, anemia and peritonitis. The highest incidence of dehiscence was in patients operated on in medical emergencies, and in patients with malignant disease.

Objectives : The surgical treatment of hydatid cyst varies from simple puncture and aspiration to radical resections and total cystectomy. The aim of this study was to evaluate and compare outcome of different surgical treatments of liver hydatid cysts in our center. Methods : This retrospective study included 33 patients who were operated for hydatid liver disease between 2010 and 2015. During that period radical surgery (pericystectomy or hepatic resection) was performed in 15 patients, while 18 patients underwent conservative surgery, including endocystectomy and drainage procedures. Data collection included demographic variables, diagnostic methods, surgical procedures, and morbidity and recurrence rates. The diagnosis was in the most cases set by ultrasound evaluation and CT scanning. Results : The mean age of patients who underwent surgical treatment was 47.09±13.57 years, with 45.5% of men. The majority of respondents had hydatid cysts classified as CE2 (60.6%). More patients had hydatid cyst localized in the right lobe of the liver (48.5%). Multiple cysts (2-4) had 36.4% of patients. Length of hospitalization was significantly shorter in the group treated with radical surgical procedure in comparison with conservative surgery (9.67±3.39 vs. 14.44±6.68 days, p=0.01). The overall rate of recurrence was 3% and observed only in the conservative surgery group (5.6%). Conclusion : Radical surgery (pericystectomy or hepatic resection) and conservative surgery (endocystectomy and drainage procedures) are safe treatments for hydatid cysts of the liver. Radical surgery of liver hydatid cyst can be performed with lower rate of recurrence. Keywords : hydatid cyst, surgery treatment

Objectives: The association of inflammatory reactions with almost all types of cancer supports the concept that inflammation is a critical component of tumor progression. The present study aimed to evaluate the relationship of serum markers of chronic inflammation with the stage of and histopathological size of colorectal carcinoma (CRC). Methods: This cross-sectional study included 90 patients of both sexes, mean age 66.2 (range 47-78) years, with clinically and histologically confirmed CRC, who were admitted to the Clinic for abdominal surgery UCCS for surgical treatment of CRC. The patients according to the stage of disease were divided into three groups (stage II–IV). The control group consisted of 30 subjects with no signs of malignancy and acute inflammatory diseases. Staging of CRC was done according to the TNM classification. In each patient, the preoperative blood samples were taken for determination of the parameters of inflammation: the erythrocyte sedimentation rate, white blood cells, C-reactive protein (CRP), fibrinogen and alpha 2 globulins. Results: It was confirmed that increasing markers of inflammation followed increasing stages of colorectal cancer, depth of tumor invasion and the occurrence of metastatic disease. CRP is a biomarker that consistently and significantly increases from the second to the fourth stage of colorectal cancer (7.2 (2.3-14.6) mg/L vs. 21.85 (12.3-41) mg/L vs. 38.6 (21.5-79) mg/L; p<0.01) and significantly correlates positively with the stage of CRC (r= 0.783, p<0.001), and the tumor size (r=0.249, p<0.05). Conclusion: The study results point to an increase in the degree of chronic inflammation throughout the progression of colorectal cancer. The most consistent marker of chronic inflammation that accompanies the progression of colorectal carcinoma is CRP.

INTRODUCTION Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. OBJECTIVE To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. MATERIAL AND METHODS The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. RESULTS AND DISCUSSION After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. CONCLUSION The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

Polytrauma is defined as injury that have affected at least two different organ systems or organs, with at least one of them is life-threatening. It as a sum of severe anatomical and functional impairments, whose evolution is difficult to predict and often questionable outcomes. According to statistics obtained from MTOS (Major Trauma Outcome Study) and TARN (Trauma Audit Research Network) totals up to 10% of all hospitalized injuries. Accompanied by a high mortality rate, especially in the population of young and middle-aged, which in the levels of the organization of our health service is 25-35%. The causes of polytrauma are numerous, and the most common consequence of road accidents, falls, violent crimes with the actions and use of weapons, natural disasters, wars, mining accidents etc. The mortality rate in polytrauma depends on many factors related to all levels of care polytraumatised person in the organization of the health system. According to data from the NTDB ACS for 2004. mortality rate in polytrauma was 18,04% (with ISS value 16-24, mortality rate was 6,21%, and with ISS value >24 mortality rate was 33,05%). TARN data it has about 17,7%. The aim of our study is to make the quantification of polytrauma in a five-year period (2000. to 2004.) taken care of at the Clinical Center University of Sarajevo, to process data received by multiple scoring for each individual patient and to calculate and display total mortality rate in the sample with the comparison of results from the MTOS and TARN baseline norms.

Carcinoma pancreas takes fourth place based on the representation of carcinoma digestive methodology. Morbidity is about 16% of total morbidity carcinoma digestive system. Early discovery is relatively tough and resection in comparison to discovered cases amounts only 2-5% cases, and in the last period it increased from 10-15%. According to the data of different authors, localization of tumor in the head of pancreas is between 70% and 84% cases. Two times is more often on the male individuals. When we are talking about contraindications of cephalic duodenopankreatectomy in each case absolute contraindication is considered present of liver metastasis and carcinoma peritoneuma. Most of the authors, mainly, present general contraindications such as: resection of lazier, ascit and general condition of patient. Contraindication for the operation is extended ikterus with albminima below 30 g/l. This type of exam shows serious damage of the function of liver. Elison and sur in 1984 noticed that preoperative bilijarna decompresy can decrease postoperative mortality up to 30%, which refers to all operations as well as palliative and radical. Older patients (above 70 years) with pre-comatose or comatose conditions and the patients with the size of the tumor of head pancreas above 1.5 cm, as well as patients with infiltration of veins mesenteric or ports are considered inoperative since resection of large blood veins as well as total pankreatektomia is not prolonging life of patient. Mortality on the cephalic duodenopankreatectomy is oscillating and in the literature data it is found from 10%, and above 30% and in high specialized institutions about 5% or even 0%. According to the statement of the clinic Mayo in 89 cases surviving above five years has been less then 5% and average survival was 1.03 years. Hower is mentioning that five year survival in USD amounts about three pro mile. In our subject we have analyzed operated cases in one year. For the whole year it was operated 14 patients. Considering the number of citizens which are treated at KCUS, it is higher number from the statistics found in the literature. Only one patient had bilirubin, which was within normal limits, while all other patients were operated with increased value of bilirubin. Albumins below 30 g/l were present on the four patients. Ten patients had the size of tumor above 2 cm. One patient after post operation died which amounts to 7, 14% cases and coincides with the facts from the literature. In the conclusion indication for the radical operative treatment of tumor of head pancreas are expanding and operative mortality is decreasing.

Operations malignity on the colon and rectum belong into a group of risky operational treatment, which has a high percentage of early postoperational complications in comparison to the other operational treatments in digestive surgery. To determine the precentage of the postoperational complication of the resectional treatment on the colon and rectum, obtained results compare with the experience of the other authors. Analysed 439 patients operated from malignity on the colon and rectum in five year period (1998-2002). Bleeding after the postoperation had 8 patients (1.82%). Dehiscentio anastomosis has been evident in 21 patient (4.78%). Interintestinal apscess has been evident in 4 patients (0.91%). The infection of operational would of the 45 patients has been (10.25%). Dehiscentia of the operational wound of 10 patients has been (2.27%). Ileus in early postoperational stage has been evident in 16 patients (3.64%). The Total number of reoperation based on the analysed complications has been evident in 50 patients (11.38%). As e conclusion we can see that ours results coincides with the experience of the other authors.