Introduction: Syndrome of difficulties in breathing has an important position in pathology of childhood. It is manifested as in diseases of respiratory tract so in series of diseases and pathological conditions linked to other organs and systems. Patients and Methods: Patient with difficulties in breathing develops clinical presentation of respiratory distress, which is characterized with many different clinical symptoms and signs. Acute respiratory failure with discrepancy between utility of oxygen and produces of carbon dioxide is the last point of respiratory distress, so the primary care of clinician is quickly recognition of abnormal blood gasses values. Early identification and appropriate treatment of incoming respiratory failure is essential for good prognosis and decreasing long term complications. The aim of this paper was to analyze retrospectively histories of diseases of children treated at the Department of Intensive care Pediatrics clinic in Tuzla and to establish type and frequency of diseases characterized with syndrome of difficult breathing, frequency of non-respiratory diseases in etiology of this syndrome, and to estimate correlation of clinical findings in admission with pulse oximetry and blood gases findings. Analysis was based on population of patients treated at the Department of Intensive care unit Pediatrics clinic in Tuzla with recorded, clinically manifested syndrome of difficult breathing. Patient selection was performed consecutively from January 1st till 31st December 2006. All selected patients were from Tuzla Canton. Source of data for this investigation was Admission protocol for Pediatric Clinics and Intensive care unit protocol and personal histories of children treated at the Intensive care unit of Pediatric Clinics January 1st till 31st December 2006. Method of work was retrospective study which analyzed anamnestic data, clinical and laboratory findings, therapeutical procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. Results: The results of investigation demonstrated that in anlized period (from January 1st till 31st December 2006) in Pediatric Clinic, Tuzla a total number of 3932 children were treated, out of them 767 (19.5%) children were treated at the Department of Intensive care unit. Syndrome of difficulties in breathing was recorded in 608 patients (79.3%). The biggest number of children in this group were treated for syndrome of broncho-obstruction, total of 332 children (54.6%). Other large group was neurological disorders: convulsions and epilepsy, total number of 125 patients (20.6%). Out of total number of patients 11 (1.8%) suffered from complete failure of breathing and required mechanical ventilation support. Out of this number 10 of them were chronic ill patients. The most common causal factor for respiratory insufficiency in strict meaning of this word and endangering respiratory arrest was epileptic attack and recidivated pneumonia. Discussion: Clinical findings, pulse oximetry and blood gases analysis were in correlation and in favor of hypoxemic type of respiratory insufficiency. Results of gas analysis for group of neurological disorders and poisoning spoke in favor of acute hypercapnic respiratory insufficiency. Clinical parameters for dyspnea were absent and finding of pulse oximetry monitored isolated for these disorders demonstrated partly unreliable.

The study was designed to determine pre-, intra-and postoperative serum cortisol and prolactin (PRL) concentrations in patients subjected to low abdominal surgery under total intravenous anesthesia (TIVA) with propofol-fentanyl, and under general balanced anesthesia with isoflurane-fentanyl. The prospective study included 50 patients of both sexes, aged between 35 and 60 years, subjected to elective low abdominal surgery. Patients were randomly divided into two groups: an experimental group, consisting of 25 ASA I/II (American Society of Anesthesiologists I/II classification) patients treated under TIVA with propofol-fentanyl, and a control group consisting of 25 ASA I/II patients treated under balanced anesthesia with isoflurane-fentanyl. The length of the surgery and the degree of the surgical trauma did not differ significantly between the two anesthesia groups. Blood samples for cortisol and PRL measurements were drawn at exact time points: 30 minutes before the beginning of the surgery (T0), 30 minutes after the beginning of the surgery (T1), at the end of the surgery (T2), 2 hours after the surgery (T3), and 24 hours after the surgery (T4). Serum levels of cortisol and PRL were measured using commercially available kits. The results were evaluated with the nonparametric Mann-Whitney test. The serum concentration of cortisol measured at T1 time point in patients treated under TIVA was significantly lower (p=0.04) than that in patients treated under general balanced anesthesia. The average circulating levels of PRL measured at T1, T2 and T3 time points in patients treated under TIVA were significantly lower (p=0.003; p=0.002; p<0.05; respectively) than those in patients treated under balanced anesthesia. The results obtained suggest that the endocrine stress response developed in response to surgery is probably attenuated in patients treated under TIVA with propofol-fentanyl and, thus, that these patients are less stressed in comparison to patients treated under general balanced anesthesia with isoflurane-fentanyl.

INTRODUCTION The prevalence of broncho-obstruction in children is in permanent increase at any age and in global. According to many studies, about 50% of children have at least one episode of broncho-obstruction in the first six years of life. Risk factors for broncho-obstruction in children include not only intrinsic, but a lot of extrinsic factors which could accelerate beginning of early symptoms. Globally, there is increase in first hospitalization with broncho-obstruction and many authors described decrease in rehospitalizations, thanks to therapy improvements. There is evidence of seasonal distribution of children treated for broncho-obstruction. Depending on country and author, different periods of year are related to increased number of patients, which could be explained by seasonal agents. Many studies described geographic variation in incidence and prevalence of respiratory diseases, which could also be explained by seasonal agents. PURPOSE The aim of this paper is to establish frequency of broncho-obstructive syndrome, comparing the age, gender, place of inhabitance and seasonal agents in children treated at the Department of Intensive care at the Pediatrics Clinic in Tuzla trough analysis of their personal histories, clinical, radiography and laboratory findings. METHODS Analysis was based on population of patients treated at the Department for Intensive care of Pediatrics Clinic in Tuzla with broncho-obstructive syndrome, from January 1st to 31st December 2006. All selected patients were from Tuzla Canton. Source of the data for research were Admission protocol for Pediatric Clinics, Intensive care unit protocol and personal histories of children treated. Method of work was retrospective study which analyzed anamnesis' data, clinical, radiography and laboratory findings, therapeutic procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. RESULTS AND DISCUSSION Total number of 767 children were treated during the investigated period at the Intensive care unit. Out of this number 332 children (43,3%) were treated for syndrome of broncho-obstruction. The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was most common at nursing age (40,0%) and 76,5% patients were under age of five. Boys dominated at all age groups except for repeated admissions of school age where this relation was equal. Spatial distribution demonstrated that the highest number of children treated for broncho-obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Season distribution demonstrated that the highest numbers of children were treated in December, and lowest in July and August. Number of treated children was statistically significant higher during winter months. Broncho-obstructive syndrome in 67,5% patients was with radiography confirmed pneumonia and in 13,8% with lung athelectasis. The most common isolated agents were Staphylococcus, Klebsiella and Pseudomonas. CONCLUSION The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was found in 67,5% patients with radiography confirmed pneumonia.