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.

The aim of this study is to determine the relationship between food contaminated with heavy metals and growing number of stomach adenocarcinoma patients in Tuzla Canton after flooding of the river Spreča catchment area. The scope of work is retrospective and prospective five-year study (2010-2015) of 1,000 patients, who had stomach adenocarcinoma surgery in the department of surgery, University Clinical Centre Tuzla, and answered questions about diet. The patients were predominantly male, aged 60 to 70 (1.5: 1). The data on heavy metal contamination in farmlands in the river catchment area were provided by the Federal Department of Agropedology. The malignity was reported to the department of public health in Tuzla Canton. The results showed an increase in number of patients with stomach adenocarcinoma in the industrially developed municipalities who consumed vegetables contaminated with heavy metals after the floods. The smallest number of patients who underwent stomach adenocarcinoma surgery comes from the municipalities situated out of the flood plain, where farmland was not contaminated. It is concluded that most of the patients having stomach adenocarcinoma came from the municipalities with contaminated agricultural soil. The diet included vegetables, meat, and dairy products.

A 47 year old man was admitted to hospital with abdominal pain, constipation and extreme abdominal distension. The patient did not have a regular bowel movement for the last two years of his life. He had been using laxatives, enema and went through manual removal of fecal impaction for the last 20 years of his life. At the age of 1, he underwent anal atresia surgery and Hirschsprung's disease (HD) was diagnosed at that time. The abdominal CT scan revealed massive fecal material in dilated colon and visible compressions of nearby structures. Medical consilium decided that the patient should undergo surgery, subtotal colectomy and unipolar colostomy. During the operation 21 kg feces was removed. The quality of life of patient improved significantly. Colostomy gave better results than treatment with laxatives for 20 years.

Background: The frequency of severe chest injuries are increased. Their high morbidity is followed by systemic inflammatory response. The efficacy of pharmacological blockade of the response could prevent complications after chest injures. Aim: The aim of the study was to show an inflammatory response level, its prognostic significant and length of hospital stay after chest injures opiate analgesia treatment. Methods: Sixty patients from Department of Thoracic Surgery with severe chest injures were included in the prospective study. With respect of non opiate or opiate analgesia treatment, the patients were divided in two groups consisted of 30 patients. As a inflammatory markers, serum values of leukocytes, neutrophils, C-reactive protein (CRP) and fibrinogen in three measurements: at the time of admission, 24hours and 48 hours after admission, were followed. Results: Statistically significant differences were found between the examined groups in mean serum values of neutrophils (p=0.026 and p=0.03) in the second and the third measurement, CRP (p=0.05 and 0.25) in the second and the third measurement and leukocytes in the third measurement (p=0.016). 6 patients in group I and 3 in group II had initial stage of pneumonia, 13 patients in group I and 6 in group II had atelectasis and 7 patients from group I and 4 from group II had pleural effusion. The rate of complications was lower in group of patient who were under opiate analgesia treatment but without significant difference. The length of hospital stay for the patients in group I was 7.3±1.15 days and for the patients in group II it was 6.1±0.87 days with statistically significant difference p=0.017. Conclusion: The opiate analgesia in patients with severe chest injures reduced level of early inflammatory response, rate of intra hospital complications and length of hospital stay.

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.

Mucionous appendiceal neoplasms are rare entity with different prognostic value. Surgery offers the optimal treatment for mucionus neoplasms in patient with no metastatic disease. We present the case of patient with mucinous appendicel neoplasm that had prior been undergone to hysterectomy and adnexectomy. Considering the intraoperative finding and no signs of perforation or metastatic disease appendiceal resection with the resection margin high on appendiceal basis was performed. No further oncological treatment was necessary

Mucionous appendiceal neoplasms are rare entity with different prognostic value. Surgery offers the optimal treatment for mucionus neoplasms in patient with no metastatic disease. We present the case of patient with mucinous appendicel neoplasm that had prior been undergone to hysterectomy and adnexectomy. Considering the intraoperative finding and no signs of perforation or metastatic disease appendiceal resection with the resection margin high on appendiceal basis was performed. No further oncological treatment was necessary.

UNLABELLED Pancreatic tumor is one with the worst prognosis of all cancers, and the tenth most frequent cancer in Europe, making the 3% of all cancers affecting both sexes. Most patients seek treatment when the disease is in its advanced stage and the level for possible resectability is low. Late presentation of the disease is responsible for the short survival period of 6 months and a five-year survival of 0.4 to 5% of patients. At the Clinic for Surgery in Tuzla during period from January 1st 1996, to January 1st 2011, a total of 127 resection surgeries were performed due to malignant tumors. The goal of this study was to show that adequate assessment of operability, proper surgical strategy and modern techniques of creating anastomoses reduces morbidity and mortality, results in fewer postoperative complications and contributes to better surgical results. In our study sample the most common place of tumor location was the head of pancreas, in 69 (59.7%) patients. Men develop this type of cancer more often than women in the ratio of 2:1, while the median age of patients was 62 years. We faced postoperative complications in 37 (29.1%) patients, pancreatic fistula being the most prevalent complication, occurring in 16 (12.6%) patients. Overall early and late postoperative mortality was observed in 12 (9.8%) patients. CONCLUSION Patients with chronic and hereditary pancreatitis are at a higher risk for developing pancreatic cancer and should be screened for the purpose of early diagnosis. The staging of pancreatic cancer has improved, with the accuracy of 85-90%. Postoperative complications, morbidity, and mortality are significantly reduced (p < 0.05) if the standardized operational procedure is applied and if modern techniques are used to create pancreaticojejunal anastomosis as the anastomosis carrying the highest risk.

Introduction: Laparoscopic cholecystectomy (LC) is a method of choice for chronic gallbladder calculus. Surgeon’s experience and sophistication of the work method itself have brought a number of advantages in comparison to open cholecystectomy (OC). Particularly, the advantage corresponds to decreased immune response of the organism on surgical stress. The aim of this study was to define the level of surgical stress through immune response of the organism on stress. Patients and Methods: One hundred patients were involved in the study, 50 of whom were treated by LC method and the other 50 by open method. The patients were of middle age group, between 47 and 57 years of age, mostly female. C-reactive protein was studied as one of the parameters of the organism’s immune response during LC and OC, and also a number of leucocytes, erythrocytes, haemoglobin and hematocrit after LC and OC procedures. C-reactive protein is a biochemical marker, as an organism’s response to stress and the aim of this study is to confirm the CRP values during surgical treatment of chronic calculus of the gallbladder through different surgical methods: conventional or open surgery and laparoscopic surgery which is considered less invasive. Number and frequency of intra-operative and post-operative complications during laparoscopic and open cholecystectomy were also compared. The erythrocytes, haemoglobin and hematocrit and leucocytes, were also determined in both groups of patients with the aim to confirm the hypothesis that the laparoscopic cholecystectomy is a less invasive method compared to the classic or open method. Results and Discussion: The results have confirmed the hypothesis that the laparoscopic cholecystectomy surgical method is less invasive and showed that the value of CRP is much less in post-operative period after LC than OC. In this way, decreased immunological response of the organism on the surgical laparoscopic procedure were confirmed in this study. Decreased value of leucocytes was determined in laparoscopic technique in the post-operative period in comparison to open technique. The number of erythrocytes, hematocrots and haemoglobin were not significantly different in the post-operative period during LC and OC. Complications such as bleeding, bile leakage, subphrenic abscess, post-operative pancreatitis, post-operative wound infection, hernias of post-operative sections and keloid were present more in OC than in LC. Conclusion: Inflammation of early protective homeostatic immune response on post-operative wound characterises the production of C-reactive protein as one of the activities of cellular and humoral mechanisms. This comparative study between laparoscopic and open cholecystectomy in light of immune response of the organism to stress, number and type of intra-operative and post-operative complications, confirmed advantages of laporascopic technique in comparison to open method.

Resectional surgery on rectum, finishing with continued colo-rectal anastomosis by the classical manual technique, were burdened by a great number of post surgery complications of dehiscentio over 60%. If we take into reconsideration a high number of mortality 5-20% then we have valid reasons for developing modern and safer methods of surgical intervention of these patients. Two groups of 60 patients each, have been analyzed. They have been operated at the Surgical clinic University Clinical Center Tuzla because of rectum malignancy. The first group of patients where the colo-rectal anastomosis was manually operated was done between 1995-1998. In the second group of the patients being operated, colorectal continuity was done by stapler. The patients were operated in time period 2001-2002. The medium evaluation time was 20 months, for each group. All the patients were operated in elective programme, after endoscopic treatment and ph diagnosis done. The patients from the both analyzed groups were operated by the same surgeons. Preoperational procedure and postoperational observation was fullfilled according to the unified protocol. The patients with their colo-rectal continuity having been by stapler had a shorter surgery time, and less transfusion of blood. They had less ureter lesion. Also they have got a shorter hospitalization time with less number of anastomotic complications. Dehiscenc as well as bleeding. The patients with colorectal anastomosis made manually had more repeated surgeries. The patients from the manual group of the surgeries had more anastomotic relapses. The difference in the number of post operational strictures in both analyzed groups was not noticed. The patients with stapler colorectal anastomosis had no mortality. The manual group had one lethal case. The important thing that is noticed is a larger number of stapler colorectal anastomosis, not because of the illnes incidence increase but decrease of abdominoperineal rectum amputation. The patients have been safely operated from the oncologic point of wiev. They have continuing anastomosis which was not burdened with a larger number of morbidity and mortality. This was possible to do by improving surgical strategy and technique and introduction of stapler in every day surgical practice.

The purpose of this thesis was to investigate international specialisation and trade patterns in the Romanian automotive industry. This was done in view of the Romanian EU accession in 2007, both in relation to the original 15 EU members and in the global context. The two measures used are Balassa’s Revealed Comparative Advantage measurements and the Grubel-Lloyd measure for Intra-Industry Trade. The results of our findings show that Romania has comparative advantage in the production of parts and components, especially in relation to EU15, but not in finished vehicles. We did however find positive indicators that could lead to a comparative advantage in the production of finished vehicles after accession. Where trade patterns are concerned we found that the levels of Intra-Industry Trade were higher in products that showed comparative advantage. We also looked at product fragmentation and found an increased degree of product fragmentation related to a higher level of Multinational Corporation involvement and an increased inflow of Foreign Direct Investments.