Background/Aim. Surgeon-specific experience as measured by procedure volume can have a significant impact on survival of patients with rectal cancer (RC). The aim of this study was to determine whether an individual surgeon-specific volume of procedure influences early postoperative outcomes as well as to determine the strength of different groups of annual surgeon volume (ASV), as a predictor of outcomes in patients after RC resection up to 30 days postoperatively. Methods. This retrospective observational single center study involved a cohort of 546 patients of both sexes, operated for a 10-year period due to RC. Patients were divided into three groups, according to the annual volume of RC procedures of a surgeon who operated them. Seven outcomes were analyzed: the incidence of colorectal anastomotic dehiscence (CRAD), operative time, intraoperative blood loss, hospital stay, in-hospital death, the status of the circumferential resection margin (CRM) and the total mesorectal excision (TME) with number of lymph nodes, as well as some risk factors (several independent, dependent and ?confusing? variables) of importance for the outcome, to explain the difference. The strength of each group of surgeons and their effect on early outcome of treatment were determined. Results. The majority of surgeons (77.7%) belonged to the low and medium ASV, which performed a slightly higher number of surgeries (281) than the high volume group. The high-volume surgeon group was associated with significantly better results in four outcomes (CRAD, operating time, CRM, TME and number of lymph nodes). Conclusion. In our surgical institution, the high volume surgeon remains an important predictor of success of the RC surgery.

Introduction: Gastrectomy is one of the most common surgical methods for the treatment of gastric cancer, which basically destroys the mechanism and digestion chemistry. Reconstruction after gastrectomy attempts to optimize the antireflux and nutritive component of the postgastrectomic syndrome.Objective: To determine which reconstructive method after gastrectomy has the optimal synthesis of antireflux and nutritional components.Patients and Methods: 111 patients were treated for gastric malignancies at the Surgical Clinic of the University Clinical Center in Banja Luka, which were operated with the intention of achieving curability.Results: Based on Fisher’s exact probability test there is no statistically significant difference (p> 0.05) in mortality compared to the restoration of digestive continuity after gastrectomy. Reflux oesophagitis is the dominant modality of morbidity in omega-loop reconstruction (p <0.05). There is no statistically significant difference (p> 0.05) in late dumping syndrome in patients relative to individual gastric substitution options. In the Hunt-Lawrence-Rodino pouch reconstruction option, there is no statistically significant difference (p> 0.05) in the participation of individual modalities of meal quantity in relation to the condition before the disease or the modality of the nutritional status. .Conclusion: The results indicate the antireflux component of reconstruction Roux en Y and the advantage of the nutritive component in the loop modification (the creation of the Hunt-Lawrence-Rodino pouch).

Introduction: Bone formation marker osteocalcin (OC) and bone resorption marker C-terminal telopeptide of type 1 collagen (CTX) can be used to detect or to monitor the early responses of the skeleton to physical activity. Literature suggests that it is likely that higher body mass index (BMI) has positive effect on bones and can postpone onset of osteoporosis. Aim of the Study: The aim of this study is to: 1. Determine the effect of aerobic physical acitivity on OC and CTX in young women 2. Investigate correlation of OC, CTX and BMI in young women engaged into structured aerobic excercise Material and methods: Study included 64 healthy young women, aged 19 to 25 years, devided into two groups: intervention group (n=32) and control group (n=32). The study duration was six weeks with follow-up period of four weeks. The intervention group underwent structured aerobic physical activity program for six weeks, but the control group did not receive such program. Level of OC, CTX and BMI were measured at baseline, after 6-week aerobic program, and after 4-week follow up (only intervention group). Results: There was significant increase of OC level after 6-week aerobic program, while level of CTX did not changed. OC level was at its maximum immediately after finishing the program in the participants with normal BMI (p<0.001). There was no statistically significant interaction of BMI and CTX level. Conclusion: Aerobic physical activity increases level of osteocalcin, suggesting that it has positive influence on bone formation in young women, primarily in women with normal BMI.

Background: To prove the frequency of thrombocytosis in patients with cancer, and the importance of anticoagulant therapy. Thrombocytosis represents an elevated platelet count of more than 350,000/mm 3 which is one of the risk factors for venous thromboembolism. Methods: This study has analyzed 146 patients who were hospitalized at the Oncology Clinic of the University Clinical Centre, Banja Luka and the Day Oncology Hospital “S.tetik”, Banja Luka in the period between 2009 and 2014. These were patients with breast tumor, gastrointestinal or gynecological malignancies. Thrombocytosis was detected in 38 patients in the moment of diagnosing. All examinees were analyzed by sex, age, primary site of tumor, presence of comorbidity, relevant laboratory analyses, clinical stage of the disease (metastatic or localized disease). Results: In the observed sample of 146 patients, thrombocytosis was detected in 38 patients in the moment of diagnosing the disease (26%). Through the follow-up, DVT (deep venous thrombosis) was found in 13 patients (34.2%) and anticoagulant therapy was administered. Out of patients who were not on anticoagulant therapy because they had no thrombotic manifestations (25 patients, 65.8%), 2 ended up experiencing the development of a clinical presentation of massive pulmonary embolism with fatal outcome. Conclusions: The occurrence of thromboembolism significantly increases morbidity and mortality, as well as the total cost of treating cancer patients. Regardless of the fact that cancer patients are at a high risk of thromboembolic events, thromboembolic prophylaxis has not been adopted as a standard therapeutic modality because of potential bleeding.

Treatment results of 200 injured with the lesions of 282 magistral blood vessels were analyzed. All were combat injuries, and the majority was caused by the fragments of explosive device. The mechanisms of such the injuries produced large defects of soft tissues as well as the high level of the wound contamination, which aggravated reconstructive procedures and increased the risk of infection. In the majority of cases anatomic reconstruction of the artery was performed, and the ligature was used only in the case of graft infection and in the injuries of one artery of the lower leg or the forearm. The majority of injuries was solved by lateral suture or patch plastic, since postoperative constriction caused by those methods did not cause greater hemodynamic disorders due to the size of venous lumen. The duration of ischemic interval was of the utmost importance for the favorable final result of the treatment, as well as the adequate debridement of the wound, good soft-tissue cover of the reconstructed blood vessel and precise atraumatic technique. Total percentage of amputations was 14.5%, and all were involving the lower extremities, and were mostly caused by popliteal artery lesion. Language: sr

Treatment results of 200 injured with the lesions of 282 magistral blood vessels were analyzed. All were combat injuries, and the majority was caused by the fragments of explosive device. The mechanisms of such the injuries produced large defects of soft tissues as well as the high level of the wound contamination, which aggravated reconstructive procedures and increased the risk of infection. In the majority of cases anatomic reconstruction of the artery was performed, and the ligature was used only in the case of graft infection and in the injuries of one artery of the lower leg or the forearm. The majority of injuries was solved by lateral suture or patch plastic, since postoperative constriction caused by those methods did not cause greater hemodynamic disorders due to the size of venous lumen. The duration of ischemic interval was of the utmost importance for the favorable final result of the treatment, as well as the adequate debridement of the wound, good soft-tissue cover of the reconstructed blood vessel and precise atraumatic technique. Total percentage of amputations was 14.5%, and all were involving the lower extremities, and were mostly caused by popliteal artery lesion.

Segmental portal hypertension is a rare pathologic condition, which produce gastric bleeding. Spleen vein thrombosis is more often caused by pancreatic disease (inflammations, tumors). Diagnosis is difficult to perform. Initial treatment is conservative. After successful conservative treatment early surgery should be planned. Unsuccessful conservative treatment indicates surgery. Splenectomy absolutely eliminates risk from rebleeding. Prognosis of these patients depends from etiology of pancreatic disease. We present a 46 old woman who successfully operated in our Department of Surgery due to massive upper gastrointestinal bleeding caused by isolated portal hypertension.

Segmental portal hypertension is a rare pathologic condition, which produce gastric bleeding. Spleen vein thrombosis is more often caused by pancreatic disease (inflammations, tumors). Diagnosis is difficult to perform. Initial treatment is conservative. After successful conservative treatment early surgery should be planed. Unsuccessful conservative treatment indicates surgery. Splenectomy absolutely eliminates risk from rebleeding. Prog­nosis of these patients depends from etiology of pancreatic disease. We present a 46 old woman who successfully operated in our Department of Surgery due to massive upper gastrointestinal bleeding caused by isolated portal hypertension.