Introduction: Multiple sclerosis (MS) is a chronic, autoimmune and progressive multifocal demyelinating disease of the central nervous system. The aim of this study was to evaluate rehabilitation of patients with multiple sclerosis using BI (Barthel index) and EDDS (Expanded Disability Status Scale).Methods: A clinical observational study was made at the clinic for physical medicine and rehabilitation in Sarajevo. We analyzed 49 patients with MS in relation of gender, age and level of disability at admission and discharge, patient disability were estimated using EDDS scale. The ability of patients in their activities of daily living were also analyzed according to the BI at admission and discharge.Results: Of the total number of patients (n=49) there were 15 men and 34 women. The average age of female patient was 42.38±13.48 and male patient 46.06±9.56. EDDS values were significantly different at the beginning and at the end of the therapy (p=0.001) as was the value of BI (p=0.001).Conclusion: MS patients, after the rehabilitation in hospital conditions show significant recovery and a reduced level of disability; they show higher independence in activities but rehabilitation demands individual approach and adjustment with what patients are currently capable of achieving.

Introduction: Clostridium difficile is the cause of the post antibiotic colitis. This anaerobe, sporogenous, gram-positive bacteria is most often recognized as the cause of the nosocomial diarrhea. The aim of this work is to show the impact of the infection Clostridium difficile on the result of rehabilitation of the patients that have been treated in the rehabilitation facility.Methods: 448 patients treated at the Clinic for physical medicine and rehabilitation of the Clinical Center University of Sarajevo were included in the study. Gender, age, Barthel index, length of hospitalization, and values of the albumin in the serum were documented. Kolmogorov-Smirnov test, Mann-Whitney U test and One Sample Wilcoxon Signed Rank test were used for data analysis.Results: There were 57% female and 43% of male patients. The average age was 67.5 years for women and 52 years for men. Barthel index at admission was 4.0 and at discharge raised to 8.0 (p=0.047). The length of the hospitalization for patients without infection was shorter (28.8 days) compared to patients with infection (43 days) (p=0.015). Values of the albumin in the blood at patients with confirmed Clostridium difficile infection were significantly lower than referent values (p = 0.016).Conclusion: Patients with Clostridium difficile infection had longer period of the rehabilitation and the results were less favorable.

ABSTRACT Aim: The aim of this study is to evaluate the results of rehabilitation, to determine the prevalence of major risk factors in cerebrovascular accident and their consequences, as well as to propose measures and procedures that will affect the better rehabilitation. Methods: The survey analyzed: age, sex, duration of rehabilitation, activities in daily life through the Barthel index at admission and at discharge, presence of risk factors HTA and DM. The study included a total of 116 patients, the majority of patients are older than 61 years. We had 49% of male patients and 51% of female patients and they spent 31-40 days at the rehabilitation. Results: The most common risk factor is HTA (83%) and diabetes (33%). Most of the patients at admission had a BI from 0 to 4 (32.7%), and at discharge BI in the range 17-20 (36.2%). Statistical analysis shows that there is a statistically significant correlation between the BI at admission, BI at discharge and risk factors of HTA and diabetes mellitus. Conclusions: the rehabilitation results in most patients is good results of rehabilitation. The most important risk factors in patients are HTA, DM and directly affect on results of rehabilitation. For the better results we should have energetic fight against risk factors for HTA and DM through primary and secondary prevention and patient education about early detection and treatment of these risk factors.

AIM To examine the effects of sonotherapy on the activities of daily living or as well as the reduction of pain in gonarthrosis. METHODS A retrospective- prospective clinical study included 63 patients, 47 to 86 years old with a verified diagnosis of gonarthrosis. Subjects were divided into two groups. The first group included 26 patients treated with kinesitherapy in combination with electrotherapy; the second group included 37 patients treated with kinesitherapy combined with sonotherapy. The age, sex, activities of daily living by Barthel Index and the intensity of pain by visual pain scale (VAS) was analyzed at admission and discharge of the patients. RESULTS Both groups were matched for age, sex, and Barthel index values at admission and discharge. There was no statically significant difference between the groups according to demogrfphic characteristics. Visual pain scale at admission was almost identical in both groups; VAS at discharge waa lower in the group treated with kinesiotherapy and sonotherapy. Visual pain scale at discharge was lower in both groups than at admission, but without statisticay difference (p more than 0.05). CONCLUSION Sonotherapy and electrotherapy improved the activities of patien's' lives. Both types of therapy, in combination with kinesitherapy, led to a decrease of pain in patients with gonarthrosis.

Many malignancies in elderly population are firstly presented by spine metastases. Taking into account the complexity of metastatic diseases, it is very important to complete tumor staging and determine its pathohistology. In this paper, we present a group of patients on which a percutaneous biopsy of tumor at the Department of orthopedics and traumatology in Sarajevo was made. Including factors were: X-ray, CT or MRI diagnosed spine metastasis of thoracic or lumbar spine of unknown origin. Needle biopsy in local anesthesia was performed on 25 patients in total, and on 21 of them, we confirmed histological metastatic disease (84%). Other four patients had inadequate material for analysis and we had to repeat the procedure. Spine surgery was indicated in 8 of 25 patients (32%). Metastatic disease advanced to the rest of them (68%) and they were only indicated with chemo/radio-therapy (low Tomitta score and short life expectancy). Despite the presence of many metastases, the most symptomatic are spinal metastases. Therefore, other specialists expect orthopedic-trauma spine surgeons to be leaders of the team, although it should be oncologists. Percutaneous spine biopsy allows the acceleration of diagnostic procedure, and, as soon as possible, the beginning of definite therapy.

INTRODUCTION Liver is made up of functionally indipendent parts or segments, and segmentation is based on course and ramification of blood vessels and bile ducts whereby each segment represents separate territory of the liver. Most severe complication is a postoperative liver insufficiency that demands complex treatment, is followed by high mortality and demans specific treatment including liver transpaltation. MATERIALS AND METHODS Study was designed as retrospective and included patients who underwent liver resection at Clinic for abdominal surgery of Clinical Centre University Of Sarajevo (CCUS) during period 2010-2012. The study included 44 patients at the Clinic of abdominal surgery. RESULTS There were 6 (13.6%) hepatocellulare carcinomas, also 6 (13.6%) echinococcus cysts, the rest (72.8%) were different liver tumors. In the study group, following complication have been percepted; biliary leak (defined as the level of bilirubine in drainage fluid exceeding 5.0 mg/dl (> 85 micromol/l) more than 7 days), postoperative hipoalbuminemia, the need for reintervention as well as letal outcome. Complications were percepted in 7 patients (15.9%). In patient with no complication the lenght of hospitalization was 8-12 days while in thoose with complications hospitalization was prolonged to max 25 days. CONCLUSION Majority of resections have beed done due to metastatic tumors, slightly lower number due to primary tumor (hepatocellulare carcinoma). Postoperative complications correlated with older age, comorbidity and higher blood loss during operation. One of the most often complications in our casuistics was biliary leak.

Since its foundation in 1992, the Croatian Medical Journal (CMJ) has followed the strict standards of quality in the scientific publishing. However, the Journal has been aware that its specific position demands more than just following the already established rules. From the very beginning, the Journal declared an “author-helpful policy,” stating that “journal editors should have a major role in training authors in science communication, especially in smaller and developing scientific communities. Journal authors usually send scientifically acceptable but poorly prepared articles and it is a pity to lose valid data because of their poor presentation.” (1,2). In brief, the editors and editorial staff of the CMJ have been well aware that the skills of scientific reporting and publishing in our academic community are not developed and that valuable research results and valid data are being lost because of poor presentation. To be perfectly honest, ten years ago this statement looked like a nice promise, one of the many we in academic medicine learnt not to take too seriously.

The goal of rehabilitation is to reduce consequence of injury or disease and to rise social ability and indenpedence for sick persons. In our work we have shown patients treated on The Clinical for Anesthesia and Intensive care from first January to thirty one June 2006. In the same time patients had hospital treatment and rehabilitation. All the patients were analyzed according to gender, age, the etiology of illness, the duration of rehabilitation and rehabilitation outcome at the time of their admission and at the time of their dismissal assumed by ET test. During six months we treated and rehabilitated 140 patients on The Clinic for Anesthesia and Intesive Care. We had 51% men and 49% women. When we analyzed the age we have seen that until 20 years we had 6.7% patients, 21-30 years 6% patients, 31-40 years 7.5% patients, 41-50 years had 20%, 51-60 years 23.3% patients, 61-70 years 24% patients, 71-80 years 9.2% patients and more than 81 years only 3.3% patients. Most of the examinees had acute cholecystitis 15.8% and ileus 12.5% patients. When we analyzed time for rehabilitation the most examinees 24.5% had only 2 days treatment. More than 15 days treatment had only 12.5% patients. All examinees had kinezitherapy. The rehabilitation outcomes demonstrated by ET- test showed increase from 90-120 at time of admission with 36% patients to the interval 160-200 with 30% at the time of discharge. This results showed excellent results of early rehabilitation after injuries or operative treatments. Therefore we can conclude that rehabilitation has to start as soon as possible after injuries or disease. It is the way how to prevent late complications and make the rehabilitation more successful, complete and shorter.

INTRODUCTION In this report we present our experience in "post war" environment in our institution. Any king of pelvic surgery is challenging and impacts significantly on limb and visceral function. Any surgeon has to ask a question "is heroic surgery justifiable". We aim to asses functional, oncologic and surgical outcomes following pelvis tumor resections. MATERIALS AND METHODS Between 1998-2005, 7 patients (mean age 48.2 years) underwent pelvic tumor resections. All of them were primary malignant tumors. We did not identify secondary tumors and benign tumors in our series. Bone tumors were 3 osteosarcomas and 4 chondrosarcomas. Tumors involved the ilium, acetabulum, pubic bones, sacrum or a combination of these. No patient had metastases at presentation. RESULTS All 7 patients underwent hindquarter amputations. Surgical margins were marginal (4), wide (2), and radical (1). There was 1 intraoperative death, 2 local recurrences and 2 metastases. Death from disease occurred at a mean of 12.4 months with mean follow-up of 24 (1-72) months. Emotional acceptance was surprisingly high. Pelvic resections are complex. Functional outcome is significantly affected by surgery. Disease control is similar to limb tumors. Emotional acceptance of surgery in survivors was surprisingly high. CONCLUSION Major pelvic resection for malignancy appears justified.

Carcinoma pancreas takes fourth place based on the representation of carcinoma digestive methodology. Morbidity is about 16% of total morbidity carcinoma digestive system. Early discovery is relatively tough and resection in comparison to discovered cases amounts only 2-5% cases, and in the last period it increased from 10-15%. According to the data of different authors, localization of tumor in the head of pancreas is between 70% and 84% cases. Two times is more often on the male individuals. When we are talking about contraindications of cephalic duodenopankreatectomy in each case absolute contraindication is considered present of liver metastasis and carcinoma peritoneuma. Most of the authors, mainly, present general contraindications such as: resection of lazier, ascit and general condition of patient. Contraindication for the operation is extended ikterus with albminima below 30 g/l. This type of exam shows serious damage of the function of liver. Elison and sur in 1984 noticed that preoperative bilijarna decompresy can decrease postoperative mortality up to 30%, which refers to all operations as well as palliative and radical. Older patients (above 70 years) with pre-comatose or comatose conditions and the patients with the size of the tumor of head pancreas above 1.5 cm, as well as patients with infiltration of veins mesenteric or ports are considered inoperative since resection of large blood veins as well as total pankreatektomia is not prolonging life of patient. Mortality on the cephalic duodenopankreatectomy is oscillating and in the literature data it is found from 10%, and above 30% and in high specialized institutions about 5% or even 0%. According to the statement of the clinic Mayo in 89 cases surviving above five years has been less then 5% and average survival was 1.03 years. Hower is mentioning that five year survival in USD amounts about three pro mile. In our subject we have analyzed operated cases in one year. For the whole year it was operated 14 patients. Considering the number of citizens which are treated at KCUS, it is higher number from the statistics found in the literature. Only one patient had bilirubin, which was within normal limits, while all other patients were operated with increased value of bilirubin. Albumins below 30 g/l were present on the four patients. Ten patients had the size of tumor above 2 cm. One patient after post operation died which amounts to 7, 14% cases and coincides with the facts from the literature. In the conclusion indication for the radical operative treatment of tumor of head pancreas are expanding and operative mortality is decreasing.

INTRODUCTION Endoscopic ultrasonography (EUS) is a well-established method of evaluating patients with gastrointestinal diseases, especially malignancies. EUS is like other similar endoscopy techniques, based on high frequency ultrasonography. This high level technology allows examination of tissue to almost microscopic level, not only in digestive system but its surrounding structures. OBJECTIVE The aim of this study was to determine the contribution of endoscopic experience, based on the number of endosopic ultrasonography examination performed in the three years period, to obtain 80% diagnostic accuracy with staging of the disease in order to achieve a 30-60% change rate in treatment decisions which is accepted standard. RESULTS First group with 210 patients was examined in the first year of work; 325 examined in the second year of work and 295 in the third year. DIAGNOSTIC Accuracy in the first year of work, were 45% (p<0.001 for the choledocholithiasis; p=0.197 for the pancreatic cancer; p=0.195 for LN detection in the gastric cancer). In the second year of work diagnostic accuracy were 78%/p=0.550 for the choledocholithiasis; p=0.228 for the pancreatic cancer; p=0.503 for LN detection in the gastric cancer/. Diagnostic accuracy in the third year of work were 81%/p<0.001 for the choledocholithiasis; p=0.018 for the pancreatic carcinoma; p=0.042 LN detection in the gastric cancer/. CONCLUSION Application of Endoscopic ultrasonography in diagnostics, based on number of EUS examination performed, after three years of work, achieved 80% diagnostic accuracy, compared to standard imaging methods and results of surgery in staging of the disease. EUS results made a change in treatment decisions in 30-60% of patients which is world standard and completely justify use of endoscopic ultrasonography in clinical practice.

OBJECTIVE To evaluate the influence of the laparoscopic tehnique in healing of hernia from the perspectives of time to full recovery, return to work and complications. TYPE OF STUDIES: Randomized, prospectiv study. All relevant factors, should be important to evaluate operative method. Laparoscopic operative treatment has several advantages over classical operative techniques. Main advantage is less tissue damage and consequently less possibility of postoperative complications. Furthermore, period of rehabilitation for patient is shorter, with less pain and shorter period for recovering. PATIENTS AND METHODS A group of 60 qualified patients was formed with non complicated inguinal hernia. Patients of both gender, aged 19-68, were preoperatively examined. Intraoperative wounds during operation were defined as an intraoperative complications. In postoperative course complications were divided on immediate, early and late postoperative. Patients were re-examined during hospitalization, in the periods of one month, six month, one year and two years after operation. RESULTS We had no intraoperative complications. Two immediate complications were observed scrotal swelling and hematoma. Two early postoperative complications were also noted a general disuric complication and purulent wound inflammation. As well we have noted only one late complication; pain in inguinal region. We had two relapsing hernias. Duration of hospital treatment was 1-7 days with average of 2,5 days for examined group. Overall absence was 10 day and patients were back to job under full physical activities. CONCLUSION In non complicated inguinal hernia, laparoscopic tehnique have less complications than classic methods, shoter time to full recovery and to return to work.