Introduction: Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma, which in most cases is treated conservatively. It remains an open question frequency when the injuries of the heart and pericardium are not timely diagnosed and surgically treated. Aim: To demonstrate the importance of well-timed surgical treatment of blunt chest trauma, when coupled with cardiac and pericardial injuries. Methods: At the Thoracic Surgery Clinic of the University Clinical Centre Banja Luka, Bosnia and Herzego vina, during period of 10 years (01.01. 2008 – 31.01.2018.), the total of 66 patients were treated for urgent thoracotomy due to clinically and radiologically unclear findings after blunt chest trauma. In general, diagnostic examinations, apart from laboratory analysis, included radiological imaging and Multi Slice Computed Tomography (MSCT) of the chest, followed by an ultrasound of the heart in cases when sternum was injured or when pericardial tamponade was suspected. Results presented in the study where obtained from the retrospective analysis of patients data. This work presents a retrospective observational cross-sectional study, which results in the assessment of the correctness of a particular diagnostic test. Statistical methods used: descriptive statistics, counting measures (frequencies and percentages), central tendency measures (arithmetic mean), variability measures (standard deviation). Results: Sixty six patients were treated with urgent thoracotomy after a blunt trauma of the chest due to the unclear clinical and radiological finding. In the case of 11 patients (10 men and 1 woman), presenting 16.6% of the total sample, pericardial and cardiac injuries were detected and treated intraoperatively. Further, in the case of the one patient, pericardiotomy and suturing of the right heart chamber where performed, with the creation of a pericardial window. Transthoracic echocardiogram was not used as the primary screening module, but rather as a diagnostic test for patients who had unexplained hypotension and arrhythmia. Radiographs of the chest showed cardiomegaly with or without epicardial fat pad sign suggesting a pericardial effusion. Conclusion: Blunt cardiac and pericardial injuries represent a serious therapeutic problem, which, if not treated properly, result in a high mortality rate. Echocardiography is the primary diagnostic method for initial detection of pericardial effusion. Pericardial fluid first accumulates posterior to the heart, when the patient is examined in the supine position. As the effusion increases, it extends laterally and with large effusions the echo-free space expands to surround the entire heart. The size of the effusion may be graded as small ( echo free spaces in diastole <10 mm, corresponding to approxymately 300 ml), moderate (10-20 mm, corresponding to 500 ml), and large ( >20 mm, corresponding to >700 ml). When the ability of the pericardium to stretch is exceeded by rapid or massive accumulation of fluid, any additional fluid causes the pressure with the pericardial sac. Early recognition, pericardiotomy with pericardial window creation and/or ventricular rupture suture remain the “gold standard” in the treatment of blunt cardiac and pericardial injuries.

Molecular pathology of lung adenocarcinoma, it is probably better defined as compared to other tumor types, due to its frequency, and surgical accessibility of its success in the identification of clinically important mutations in this type of cancer. EGFR (eng. Epidermal Growth Factor Receptor) mutations have been clinically most relevant mutations in lung cell carcinoma, as well as significant predictors for the therapy target chemotherapeutics. The transmembrane glycoprotein from the group of epidermal growth factor receptor is present in 10% to 15% of cases of advanced non-small cell lung cancer. The study included 29 patients in the period from Маѕ 2012 to December 2016 in the Department of Pulmonary Diseases University Clinical Centre RS implemented diagnostic and therapeutic treatment of NSCLC. All patients cytology and/or histologically confirmed adenocarcinoma of the lung, and in the Department of Pathology, University Clinical Centre RS spent additional molecular testing of existing material. The study confirms the dominance of the cited literature were adenocarcinomas and more frequent incidence in the female population and in the category of nonsmokers. The study shows that the mean duration as well as the median survival longer than one year. Kontakt osoba: Lora Novaković Lacković Original Research Respiratio

Despite being known for 5000 years, after the records of imperial Chinese doctors, cannabinoids as a subject of scientific research experienced its rise after 1964, when delta nine tetrahydrocannabinol (Δ 9 THC) by Israeli scientists was identified. This was followed by the discovery of endogenous ligand / endocannabinoids, as well as receptors CB1 and CB2. In a broader sense, endocannabinoids act as neuromodulators and immunomodulators. They are included in the various physiological processes such as: the occurrence of pain, cognition, memory formation and neuroplasticity, physical activity, respiratory processes, appetite regulation, control and heart rate, nausea and emesis, intraocular pressure, inflammatory and immune processes (antigen recognition).

, ABSTRACT Introduction: Traumatic flail chest is segment of the chest wall, which is caused by multiple fractures or by separation of bone structures (at least three sequential broken ribs or separated into two fracture lines). These injuries are mainly seen in polytrauma patients. Aim of the Study: Our aim is to show the therapeutic benefits of surgical treatment (operative stabilization) of the flail chest. Patients and Methods: We retrospectively analyzed patients who underwent surgery at the Clinic of Thoracic Surgery, University Clinical Centre of the Republic of Srpska, Banja Luka, in the period from 01. 12. 1997 - 04. 06. 2016. Results: 50 patients with traumatic flail chest with average age of 47.42 years were surgically treated in the twenty-year period at the Clinic of Thoracic Surgery, University Clinical Centre of the Republic of Srpska, Banja Luka. The average length of a hospital stay was 15 days. Survival rate in the operated group was 91.43%. Conclusion: If conservative measures such as internal stabilization, the use of analgesics, antibiotics, oxygen therapy and airway toilet does not lead to stabilization of respiratory function, surgical chest wall stabilization is necessary.

Introduction: Spinal column represents a strong and flexible body axis. It is consisted of vertebrae which are connected by the intervertebral disk and solid fibrous joints. Aim of the Study: To ascertain whether or not and to what extent foraminotomy affects the final outcome of lumbar herniated disc surgery. Patients and Methods: This retrospective study analyzed 71 patients who were operated at the Clinic of Neurosurgery in Banja Luka, in the period from 2009 to 2016. Extirpation of disc was performed in 41 respondents, while in 30 patients, a nerve root was further alleviated, along with the extirpation of disc. All patients were operated under the same conditions. Results: There was no statistically significant difference in the age of women and men who underwent classical discectomy and foraminotomy. There was a statistically significant difference in the disc protrusion and extrusion in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was no statistically significant difference in diagnosis in respondents who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was statistically significant difference in the severity of pain in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was a statistically significant difference in clinical recovery, where the findings were in favor of the respondents who underwent foraminotomy, compared to the respondents who did not. Discussion: The treatment of this syndrome is complex, multidisciplinary and with problematic success, and in cases when the operation is performed, the results are not as good as in the primary operation. Conclusion: The results of this study show that the patients who underwent foraminotomy during the operation of prolapsed lumbar disc have a clinically better result.

Sažetak. Ekstenzivna hirurgija karcinoma jednjaka je najkomplikovaniji dio digestivne hirurgije i uglavnom je rezervisana za specijalizovane centre. Cilj rada bio je da se evaluiraju početna iskustva u ovoj zahtijevnoj hirurškoj problematici u Klinici za opštu i abdominalnu hirurgiju Kliničkog centra Banja Luka u petogodišnjem periodu. U periodu od 1. januara 2004. do 31. decembra 2008. godine operisan je 81 pacijent, od kojih je 61 (75,31%) imao palijativnu operaciju, a 20 operacija je urađeno s ciljem da se postigne eradikacija bolesti (R0 nivo) (25% stopa resektabilnosti). U grupi operisanih s ciljem eradikacije dominirali su muškarci (15 muškaraca i 5 žena), a većina oboljelih bila je starija od 50 godina (od 43 do 82 godine). Najčešća lokalizacija tumora bio je srednji i donji torakalni jednjak. Za supstituciju je u većini slučajeva korišćen želudac (oko 85%). Put transpozicije grafta bio je najčešće retrosternalni (za vratne anastomoze). Visoka supraaortalna intratorakalna anastomoza bila je najčešća opcija za rekonstrukciju tumora distalnog jednjaka (Ivor-Lewis) (65%). Stopa smrtnosti bila je 10%. Rani morbiditet, kod oko 60% operisanih, uglavnom su činile plućne komplikacije u vidu upala, atelektaza, izliva, pneumotoraksa. Prosječno vrijeme bolničkog liječenja bilo je 18 dana (od 15 do 25). Do trenutka objavljivanja rezultata, živih je pet pacijenata od kojih dvoje živi pet godina nakon operacije i nemaju znakova relapsa bolesti. Kod ostalih operisanih, prosječna dužina preživljavanja je 37 mjeseci (od 18 do 42) i svi su umrli od recidiva bolesti. Patohistološki nalazi pokazuju da prevladava skvamocelularni karcinom (60%), a ostatak su adenokarcinomi. Početna iskustva pokazuju stopu smrtnosti i prosječno preživljavanje koji su prihvatljivi i slični rezultatima drugih koji se rutinski bave ovom vrstom hirurgije.