Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.

It has been reported in recent years that elevated thyroglobulin antibody (TgAb) values can be associated with thyroid malignancy. The aim of this study is to determine whether serum TgAb have a predictive role in thyroid cancer in patients with thyroid nodules. The crossed study included 100 patients with scintigraphic cold thyroid nodules divided in two groups. Demographic data, TgAb levels and final histopathological findings were recorded. The first group consisted of 50 patients with histopathological verified malignant nodules and the second group of 50 patients with histopathological verified benign nodules. TgAb were estimated by the radio-immunity assay (RIA) method. The median of TgAb in the group with benign nodules were 14.3 (10-32) IU / mL and in the group with malignant nodules 42.9 (13-156) IU / mL. TgAb values were significantly higher in patients with malignant nodules (p = 0.02 The increase in values of TgAb by 1 IU / mL increased the risk for malignancy by 0.7%. The cut-off for TgAb of > 35 IU / mL discriminates between diagnosis of the malignant and benign thyroid nodule. TgAb of > 35 IU / mL, with a sensitivity of 56% and a specificity of 78%, was found to be a limit value for predicting malignant thyroid lesion. TgAb serum values were predictor of malignant thyroid lesion and their preoperative measurement in combination with other risk factors could assist in preoperative diagnosis in patients with cytological indeterminant thyroid nodules.

Objectives Endemic nephropathy (EN) is a chronic tubulointerstitial renal disease associated with increased incidence of upper urinary tract urothelial cancer (UTUC) occurring predominantly in geographically limited areas in villages along big Danube river. Based on results obtained by the research it is confirmed that aristolochic acid is causative agent of endemic nephropathy (EN). Aim The aim of this study was to determine characteristics of UTUC in two endemic areas and analyze trends in 5-year period. Methods This study included all patients with UTUC with or without synchronous/metachronous urothelial cancer in urinary bladder, from Croatian and Bosnian EN and non-EN regions. We analyzed archival data bases from all patients with UTUC who were admitted and operated in Department for surgery and urology, General Hospital Josip Bencevic Slavonski Brod in the time period between 2005 and 2010. Analyzed groups of patients were divided and compared as EN group (that includes patients from Croatian and Bosnian EN region) and non-EN group (that includes patients from Croatian and Bosnian non-EN region). All surgical specimens were processed according to standardized pathological procedures. Results Comparing patients basic characteristics from Croatian and Bosnian EN region there was no significant difference in gender (females were more frequently affected in both EN regions, p=0.99) or age (p=0.43) of patients. We found higher blood levels of urea and creatinine in group of patients from Croatian EN region when compared with group of patients from Bosnian EN region but the difference was not statistically significant (p=0.79 and p=0.44, respectively). In patients from Croatian EN group Hemoglobin levels were significantly lower than levels from Bosnian EN region patients, p=0.0049. In group of patients from Bosnian EN region ureteral tumors were more frequently observed than in Croatian group of patients, when compared with renal pelvis tumors but the difference was not statistically significant (p=0.258). Conclusion Our data showed some differences in tumor localization between to investigated, relatively nearly situated, EN regions in Croatia and Bosnia. Statistically significant difference in hemoglobin levels between Croatian and Bosnian EN regions that should be further analyzed to give some reasonable explanation.

Objectives: Each surgical patient is preoperatively, intraoperatively and postoperatively exposed to stress. The aim of this study was to determine the existence of preoperative anxiety, and to determine its impact on hemodynamic parameters (blood pressure, heart rate) in patients and dose of anesthetics during induction of anesthesia. Methods: A prospective clinical study conducted at the Department of Anesthesiology and Reanimation and Surgery Clinic of University Clinical Center Tuzla (UCC) in the period May 2012. to January 2015. The 80 patients were analyzed which were planned for and done an elective cholecystectomy surgery or herniectomy surgical intervention. Preoperative anxiety was measured with the help of Spielberg test and evaluation of depth of anesthesia was performed with BIS monitoring. Results: The results showed that all patients had some degree of preoperative manifest anxiety. Average values of mean arterial pressure, preoperatively and after the induction of general anesthesia, differed for 15,4 mm/Hg, but were not observed significant association between Spielberg score and differences in blood pressure. Preoperative anxiety is a significant predictor of administered dose of anesthetic. Each additional score on Spielberg scale reduces the dose of anesthetic for 0,304 mg/kgTT. Conclusion: Adequate assessment of preoperative anxiety and undertaking of certain steps to reduce it can assist in accurately determining the required dosage of anesthetic for the introduction of general anesthesia.

OBJECTIVE The purpose of this study was to assess the risk factors for adhesive small bowel obstruction (SBO) following colectomy for colorectal cancer. PATIENTS AND METHODS In this retrospective study we analyzed 284 patients who underwent surgery for colorectal cancer at the Department of Surgery University Clinical Center Tuzla in the period from 1st January 2009 until 31st December 2014. All patients underwent open colectomy. The length of follow up was from 6 months to 6 years (median follow up 3 years and 6 months). The study included all patients who underwent surgery due to colon cancer. The study excluded patients with postoperative small bowel obstruction after colon cancer surgery with different comorbidities. RESULTS In the analyzed sample of 284 patients, a small bowel obstruction occurred in 13.7% patients after surgery for colon cancer. The highest correlation of risk factors and the occurrence of postoperative small bowel obstruction after colectomy for colorectal cancer in multivariate regression analysis was found to be for Tumor-Node-Metastasis ≥3 (or =3.680), and postoperative complications (or =30.683). CONCLUSIONS Postoperative SBO have many causes, but in this study the highest risk factors were the Tumor-Node-Metastasis ≥3, and postoperative complications.

Introduction: Gastric cancer is the second most important neoplasm in the world. Surgical resection is the treatment of choice for gastric cancer, and recognized by the International Union against Cancer (International Union Against Cancer – UICC) TNM classification of the parameters of the tumor and lymph node. Prognostic factors related to characteristics of the tumor by histopathologic findings have an impact on the planning of the operation. According to the results of most studies it is possible to predict survival and recurrence based on histological type and TNM classification of tumors on the one hand and the surgical procedure on the other. Aim: The aim of the research was to analyze prognostic factors that influenced the frequency of recurrence in gastric surgery patients. Patients and methods: The five year study covered a population of 100 treated patients of adenocarcinoma of the stomach at the Department of Surgery, University Clinical Center Tuzla. The first group were characteristics of tumors in patients with gastric adenocarcinoma. Lymphadenectomy and splenectomy, types of surgery were the second group of prognostic factors. Results: Histological type and TNM stage of tumor as prognostic factors had a significant impact on local tumor recurrence. The type of surgery had no statistically significant value for tumor recurrence (p = 0.7520). Conclusion: Statistical analysis of prognostic factors related to histopathologic characteristics of tumors and the type of surgery gave the results that had an impact on recurrence in gastric surgery patients. The most important prognostic factors were TNM stage of tumor and histological type of tumor that influenced the incidence of recurrence.

Aim: The aim of this study was to determine the influence of specific prognostic factors on the survival time of patients who have been operated on in Tuzla Canton in Bosnia and Herzegovina. Method: Retrospective - prospective five-year study that was performed in University Clinical Center in Tuzla, the Department of Surgery, included 100 patients treated from adenocarcinoma in the period 01.01.2010 - 31.12.2015. Data about type of gastric resection, lymphadenectomy and splenectomy, were obtained from operational noteand formed a first group of prognostic factors.The second group included pathological characteristics of the tumor, including size, location, its histological type, Borrmann’s classification, differentiation, characteristics of resection lines, number of metastatic lymph nodes, peritoneal dissemination, and distance metastases. Data obtained from the Institute of Pathology, University Clinical Center in Tuzla. Results: Tumors located in the antrum (p<0.0446) were the most valuable for prognoses. Subtotal gastrectomy had the best statistical value (p< 0.036). In 79% cases where splenectomy was not performed, the survival time was longer making splenectomy a significant prognostic factor (p<0.0013). Conclusion: Factors that influencedsurvival time, as a measure of relative risk, include tumor size, its location, the TNM stage, and the type of operation. A longer survival time 12 - 15 months was present where subtotal gastrectomy was performed without splenectomy on patients with a tumor in the antrum. With tumor< 5 cm, at stage T3 and T4, and where other types of operations were performed, the average survival time was 7 - 8 months.