UNLABELLED Assessment of depth of anesthesia is the basis in anesthesiologists work because the occurrence of awareness during general anesthesia is important due to stress, which is caused in the patient at that moment, and due to complications that may arise later. There are subjective and objective methods used to estimate the depth of anesthesia. The aim of this study was to assess the depth of anesthesia based on clinical parameters and on the basis bispectral index, and determine the part of bispectral monitoring in support to clinical assessment. MATERIAL AND METHODS Sixty patients divided into two groups were analyzed in a prospective study. In first group (group 1), the depth of anesthesia was assessed by PRST score, and in the second group (group 2) was assessed by bispectral monitoring with determination PRST score concurrently. In both groups PRST score was assessed in four periods, while bispectral monitoring is used continuously. For analysis were used the BIS index values from the equivalent periods as PRST scores. PRST score value 0-3, and BIS index 40-60 were considered as adequate depth of anesthesia. The results showed that in our study were not waking patients during the surgery. In the group where the depth of anesthesia assessed clinically, we had a few of respondents (13%) for whom at some point were present indicators of light anesthesia. Postoperative interview excluded the possibility of intraoperative awareness. In the second group of patients and objective and clinical assessment indicated at all times to adequate depth of anesthesia. CONCLUSION The use of BIS monitoring with clinical assessment allows anesthesiologists precise decision-making in balancing and dosage of anesthetics and other drugs, as well as treatment in certain situations.

Introduction: sudden cardiac death (SCD) is an unexpected natural death due to cardiac causes in a short time period in a person with or without preexisting heart disease. Incidence of SCD in general population is 1/1000 inhabitants. Aims: to determine the incidence of SCD at a territory of Zivinice municipality. Patients and methods: this study is a prospective examination of SCD by using the data from death certificates, data received from interviews with competent physicians, witnesses and family members. Definition and criteria of SCD by European Society of Cardiologist and American Heart Association from 2001 and use of International Classification of Diseases, version 10, were applied to determine the number of SCD. Results: sudden cardiac death is the single most frequent cause of death in inhabitants of the Živinice municipality. The incidence of SCD at the municipal Živinice was 1 .4 cases per 1000 inhabitants per year. Mean age was 66.3 (±12,6) years; in average, men were 7.2 years younger than women. The risk for SCD was 1.24-fold higher in men than in women. Correlation between the age and numbers of SCD was high (r=0.89; p<0.005). The most frequent risk factors were age, family history of SCD and/or cardiovascular disease and inadequate physical activity; leading conventional risk factor was hypertension. Witnesses of sudden cardiac death were present in 58.0% cases. None of the persons with out-of-hospital SCD received adequate first aid from bystanders. Conclusion: Sudden cardiac death is the single most frequent cause of death among inhabitants of Zivinice municipality; proportion of SCD within all other causes of death was 22.3%. Incidence of SCD however, is not significantly higher when compared to industrialized countries. A risk for sudden cardiac death is significantly higher and directly depends on the presence and number of risk factors.

Technical systems for endoscopy diagnostics are suitable for application of computer technology. Endoscopic methods can make use of hardware-software packages for the digitalization of images, after which it is possible to store and subsequently analyze, as well as transfer pictures to the local information and communication systems. After installation of these packages follow up of the examination is on the computer monitor, and the examination of patient receives the additional quality and speed. Endoscopic methods enable provision of following functions: Entering basic demographic data about patients, Following use of material, invoice production, etc. Recording video in real time, Review of existing material, image analysis, sequences, Image processing and printing preparation, Creation of own interface, or appearance of doctor’s reports, Data back-up from the software, recording on CD or DVD media,Conversion into any format and recording of data directly on CD or DVD, Easy access to previous patients examinations, Statistical data analysis. analysis and interpretation as basis for writing scientific and professional articles, Networking possibilities with other users. Special advantages for users of these methods are: Safer work for doctors and patients, Application of teleeducation system in process of knowledge transfer to the large number of participants (video conferences, workshops with transfer of “live” image and immediate analysis and comments) Functional dynamic analysis, Possibility for additional consultation or teleconsultation with other experts, Possibility to send image on distance using internet. Imaging views from endoscope, radiological (CT, MRI) or ultrasound obtained during the examination of the patients can be stored on appropriate media. In radiology and gastroenterology used are Pacs / Ris (System for archiving and communicating through images/ Radiology information system) systems. It is a system for work with images, and their purpose is to exclude use of films and start digital data processing. With this project, it is possible to transfer complete series of recordings with modalities such as CT, MRI, and diascopy, endoscopy ultrasound, to a system for archiving and communications, and after that all doctors who are in the network can view the images, give their opinions and seek the opinions of colleagues. This kind of software allows the processing and postprocesing (analysis) of recordings with the help of appropriate tools–zoom, filtering, invert, three-dimensional reconstruction, etc., all with the goal of more accurate diagnosis when viewing recordings. Such analysis is particularly important in the preparation or during the surgeries, and three-dimensional reconstruction of the liver is particularly important in preparation for transplantation. Network access is possible from any networked computer. With this software it is possible to seek via Internet the opinion of radiologists or gastroenterologist from

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.

Most attacks of acute pancreatitis are self limiting, and the patients recover completely within days or weeks. In a few cases, however, the course is severe, with development of organ failure (single or multiple) and local complications such as necrosis, abscesses, and pseudocist. Between 01.01.2001-01.06.2004, 286 cases of acute pancreatitis were treated in our clinic. The purpose of this study is to represent indication for operative treatment of acute pancreatitis and its complications, according to the Atlanta classification. According to our date, the most frequent cause are changes on biliary tract. Of these 286 patients, 247 suffered from a mild or moderate type of acute pancreatitis and responded fully to medical treatment (215 patients) or to biliary tract surgery (32 patients). The hospital mortality of this group of patients was 2.4%. Surgery was indicated when the patients developed signs of an acute abdomen (9 patients), pancreatic pseudocyst (7 patients), progressiv icterus (2 patients), infection of pancreatic necrosis (10 patients), and pancreatic abscess (7 patients). Four patients with pancreatic necrosis were stable, and they had conservative treatment. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. The hospital mortality of patients with severe acute pancreatitis was 28.2%. Multiple organ failure was the predominant cause of death.

Occurrences of arrhythmias during the acute myocardial infarction is explained with local ischaemia, but mechanism of later occurrences is unclear. Our study had for the aim to examine relationship between postinfarction left ventricle dilatation and appearance of arrhythhmias, and to show drug effects on remodelling. Patients who developed progressive left ventricle dilatation had higher mortality then patients without changes of left ventricle volume, and mortality is due of sudden cardiac death. Drugs who had preventive effects or reverse remodelling can help in prevention of malignant arrhythhmias and sudden cardiac death. It is showed that ACE inhibitors, beta-blockers and aldosterone antagonists had preventive effects on left ventricle remodelling. The combined therapy with ACE inhibitors, beta-blockers and aldosterone antagonists is showed as the most-effective in prevention of remodelling, appearaance of arrhythhmias and sudden cardiac death.