Introduction: Pulmonary arteriovenous malformation (PAVM) is a rare cardiovascular anomaly and represents direct communications between the branches of pulmonary artery and pulmonary veins, without an intervening pulmonary bed. The incidence of PAVM is 2–3 per 100,000 population. The male to female ratio varies from 1:1.5 to 1.8. A clinical manifestation may be from asymptomatic to severe hypoxia. Case presentation: A ten years old boy was admitted to a regional hospital because the mother noticed that the boy was slower in the game at the teacher noticed that the boy was slower and could not lift his eyes up of clinical and laboratory examinations have been shown polycythemia, and cyanosis, bat-like appearance of the fingers and polycythemia, RTG chest and CT have claimed AV malformation of the lower left lobes with the feeding artery Neurologic symptoms may be the presenting symptoms in up to 40% of patients. The patient was successfully treated with left lower lobectomy. Early post-operative recovery has been successful. Later checkups showed better blood saturation with oxygen, the same polycythemia, and a better clinical condition. Discussion and Conclusion: If the etiology of the hypoxemia often remains unclear pulmonary AVM should be considered. The diagnosis needs to be confirmed with a CT scan that should identify the food artery. If the AV malformation occupies large part of the lobe, a reasonable treatment options should be lobectomy. Longterm follow up, including chest CT examinations every 1 to 2 years, is recommended.

Hydatide disease is endemic in sheep and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Bosnia and Herzegovina. Retrospective appraisal of the pressentation, approach to surgical treatment and outcome of hydatid disease in children at the Clinic for Pediatric Surgery and Clinic for Thoracic Surgery University of Sarajevo Clinics Centre in period between 2000-2008. We surgically treated 72 patients (57 male, 15 female) with a diagnosis of pulmonary hydatid disease with average age of 10.36 +/- 4.28 (range 4 to 18) years. Chest radiographs, computer tomograms and ultrasonography were the main methods of diagnosis. The basic principle of surgery was to preserve lung parenchyme as much as possible. Clinical assessment of the symptoms, plain and lateral chest X-rays and computed tomograms led to the correct diagnosis in 100% (72/72) of patients. Solitary lung cysts were found in 79.17% (57/72) patients. While the remaining were multiple cysts in one or more lobes of one or both lungs. Intact cysts were found in 48 (52.17%) and rupture cysts in 44 (47.83%) cases. Lung preserving surgical intervention were done in all of the patients. There was no mortality. Recurrent hydatid cysts were observed in 2.78% (2/72) patients. Lung preserving surgical interventions are the treatment of choice for pulmonary hydatid cysts in children. Radical surgical procedures such as segmentectomy, lobectomy and pneumonectomy should be avoided as much as possible in children.

927AbstractThe solitary fibrous tumors (STF) are mesen-himal neoplasm. In 2002, WHO classified STF in two groups: benign and malignant. Patohistologi-cal classification is based on three characteristics: more then 4 mitosis in 10 high power fields, pleo-morfismus, and necrosis are malignant signs. Sur-gical en block resection is basic treatment tech-nique. Adjuvant treatment in malignant form, by literature, is not very effective. Surgical treatment is first line of treatment even in case of recidive. Neo-adjuvant treatment suggested for mali-gnant form of this tumor is limited because it is impossible preoperatively to determine definitive patohistological diagnosis. It is due to insufficient amount of tissue example, provided by punction biopsy under CT.In this paper we will show STF operated at 1997 year, and recidive after nine years which was successfully extracted.Key words: The solitary fibrous tumors, thora-cotomy, recidiveSažetakSolitarni fibrozni tumor (SFT) je neoplazma mezenhimalnog porijekla koja se na osnovu WHO (World Health organization) klasifikacije iz 2002 god dijeli na benignu i malignu formu. PHD veri-fikacija se vodi trima karakteristikama- vise od 4 mitoze u 10 vidnih polja, izražena celularnost (pleomorfizam) te nekroze su karakteristike ma-lignih formi.Radikalna hirurska resekcija en block je osnov-ni vid lijecenja.Adjuvantna terapija kod malignih formi ne sma-tra se u literaturi jako uspijesnom-hirurska resekcija na prvom mjestu cak i kod recidiva ovog tumora.Neoadjuvantna terapija koja je bila predložena za maligne forme bila je limitirana nemogucnoscu postavljenjanja preoperativne dijagnoze jer trans-torakalna biopsija pod kontrolom CT-a u vecini slucajeva nije dala dovoljno materijala za adek-vatnu PH verifikaciju.U ovom radu prikazacemo SFT operisan 1997 godine, te recidiv tumora devet godina poslije, koji je uspijesno hirurski uklonjen.Kljucne rijeci: Solitarni fibrozni tumor, tora-kotomija, recidiv

BACKGROUND Isolated sternal fractures (ISF) are uncommon injuries and after exclusion of other concomitant injuries, ISF can be classified as harmless injuries, and can be treated on outpatient basis. OBJECTIVE Based on literature and own experience to make a simple algorithm in the diagnosis and treatment of ISF. PATIENTS AND METHODS Retrospective analysis of medical records of patients who were admitted with ISF to the Clinic for Thoracic Surgery of UCC Sarajevo between January 2000 and January 2010. RESULTS A review included 49 patients with ISF. The average age was 52.67 +/- 12.42 (range 21 to 81) years. Age group between 41 and 61 years was significantly more prone to ISF. Male/female ratio was 2.2:1 (34/15). The major cause of the injury, seen in 77.6% (38/49) cases, was an involvement in road traffic accidents (RTAs). Statistically, there is a significant difference (chi2 = 6.74; p = 0.009) in the frequency of occurrence ISF between drivers [55.1% (27/38)] and passengers [22.4% (11/39)]. Of the remaining eleven patients, four ISF were caused by falls at home, and seven by direct violence to the chest either in sport or in a fight. The sternal view radiography was diagnostic in all patients In most patients [83.7% (41/49)] the enzymatic values were elevated. ECGs were recorded in all cases, of which only 12.2% (6/49) had an abnormality. The average duration of hospitalization was 3.57 +/- 2.01 (range 1 to 7) days. It should be noted that 34.7% of patients were discharged in less than 24h and 73.5% were discharged in under 48h. Commonly used analgesic, metamizol, was applied in 98.0% (48/49) of cases. The combination of tramadol and metamizol was given in 63.3% (32/49) of patients. CONCLUSION Established results support the view that patients with ISF and no abnormality in ECG and cardiac enzymes during the early hours after injury are expected to have a benign course and can be discharged home within the first 24 to 48 hours. Proposed algorithm can be of assistance In making such decisions.

UNLABELLED Para pneumonic effusions are often complications of bacterial pneumonia, occurring in 5-50% patients and in 15% cases it can progress into pleural empyema. Pleural empyema treatment includes drainage of pus, re-expansion of lung by using appropriate antibiotics. Surgical treatment covers implementation of certain thoracic drainage modifications, use of VATS techniques and thoracotomy with pleura decortications. PATIENTS Research has involved 100 patients with diagnosis and treatment of para pneumonic and meta pneumonic pleural empyema. RESULTS Based on previously defined phase of pleural empyema it was determined which surgical procedures have been used in definitive treatment of pleural empyema. In case of 31,17% (24/77) patients it has been found that pre-clinical treatment lasted 31 days and longer, and 49,35% (38/77) patients have been admitted at Clinic after 11 to 30 days of pre-clinic treatment. Only in 19.48% (15/77) patients pre-clinic treatment lasted up to 10 days. 79% (79/100) patients were in third phase of disease, 19% (19/100) patients were in second phase and 2% (2/100) patients were in first stage of disease. Among patients with first stage of disease 1 patient was subject to pleural drainage and 1 was subject to decortications. Among patients with second phase of disease 10 patients were subject to pleural drainage and 9 to decortications. Among patients with third phase of disease 20 patients were subject to pleural drainage and 49 to decortications, 4 patients were subject to pleural drainage with rib resection, and 2 were subject to combination of thoracoscopy and drainage, while in case of 4 patients it was necessary to perform additional drainage. CONCLUSIONS Pleural drainage is first procedure in surgical treatment of pleural empyema, but very often it is not definitive measure of treatment of patients with third phase of disease. Definitive treatment of empyema in third phase is decortications of pleura carried out on 62% patients with this phase of disease. Efficiency of treatment determined on basis of mortality level is satisfactory.

Traumatic rupture of the major intrathoracic airway following blunt thoracic trauma is a potentially lethal injury which can be repaired successfully if the diagnosis is made early. Early repair of the bronchus will ensure a good anatomic result and almost complete return of pulmonary function. This article describes the situation in a patient with complete transversal and partial longitudinal rupture of the bronchus intermedius after car accidents. Bronchus injury was repaired primarily with uneventful recovery.

Lymphangioleiomyomatosis (LAM) is extreme rare diffuse lung disease of unknown cause seen almost exclusively in women of child-bearing age and rarely postmenopausal which indicates the involvement of hormones-estrogens. It results from proliferation of the cells having a smooth muscle cell phenotype (LAM cells) in the lung, and very often in the kidney and axial lymphatics and lymph nodes or any combination. It may occur sporadically or in association with the neurocutaneous syndrome--tuberous sclerosis. LAM cell proliferation may obstruct bronchioles, lymph vessels and venules that lead to airflow obstruction, formation of lung cysts, bullas and pneumothoraces, chylothorax, chylous ascites, hemosiderosis and hemoptysis. Approxymately 400 cases of LAM have been reported so far, most of them in USA. The average survival is about 8.5 years. There is no specific therapy. There are attempts with progesterone, lung transplantation, Doxycicline besides the symptomatic therapy. A new drug Rapamycin is tested. We are reporting 43-year old woman admitted in the Clinic for pulmonary diseases and TB "Podhrastovi" because of progressive dyspnea and suspect lung diffuse fibrosis, after the surgical treatment of spontaneous pneumothorax. The diagnosis of lung lymphangiomyomatosis was established by chest X ray, computerized chest tomography (CT), pathohistological findings of open lung biopsy. The treatment with progesterone is underway with other symptomatic therapy.

BACKGROUND Hydatide disease is endemic in sheep and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Bosnia and Herzegovina. OBJECTIVE Retrospective appraisal of the presentation, approach to surgical treatment and outcome of hydatid disease in children at the Clinic for Thoracic Surgery UCC Sarajevo between January 2000 and January 2007. PATIENTS AND METHODS We surgically treated 58 patients (48 male, 10 female) with a diagnosis of pulmonary hydatid disease with average age of 11,36 +/- 3,78 (range 4 to 15) years. Chest radiographs, computed tomograms and ultrasonography were the main methods of diagnosis. The basic principle of surgery was to preserve lung parenchyme as much as possible. RESULTS Clinical assessment of the symptoms, plain and lateral chest X-rays and computed tomograms led to the correct diagnosis in 100,0% (58/58) of patients. Solitary lung cyst was found in 68,97% (40/58) patients while the remaining 31,03% (18/58) were multiple cysts in one or more lobes of one or both lungs. Intact cysts were found in 51,35% (38/74) and ruptured cysts in 48,65% (36/74) cases. Lung preserving surgical interventions were done in all of the patients. Postoperative complications were seen in 5,17% (3/58) patients. There was no mortality. Recurrent hydatid cysts were observed in 3,45% (2/58) patients. CONCLUSION Lung preserving surgical interventions are the treatment of choice for pulmonary hydatid cysts in children. Radical surgical procedures such as segmentectomy, lobectomy and pneumonectomy should be avoided as much as possible.

BACKGROUND Metallic foreign bodies in the lung could be recognized using radiography. Non-metallic foreign bodies make difficultes because they are not as dense as metals. The aim of this report was to present the case of non-metallic foreign bodies in the lung. CASE REPORT A soldier of the Federation Army of Bosnia and Hertzegovina, injured in the explosion in 1998 was presented. The soldier was subjected to thoracic drainage and surgery tretment of the wound. After one year, the pulmologist treated him with tuberculostatics because of hemoptysis and pulmonary infiltration shown by a radiogram. This therapy had no effects, and the pulmologist presented this case to the thoracic surgeon who made thoracotomy removing a piece of wood (13 x 2 x 0.7 cm), 20 different-size pieces of wood, and a piece of textile from the lung. CONCLUSION Patients with penetrating explosive lung injuries without metallic foreign bodies shown by a radiogram, with complications as hemoptisis, lung abscess, bronchiectasis, obstruction of the bronchus, chronic pneumonia should be subjected to thoracotomy for removing suspected foreign bodies without resecting the lung.

Background. Metallic foreign bodies in the lung could be recognized using radiography. Non-metallic foreign bodies make difficulties because they are not as dense as metals. The aim of this report was to present the case of nonmetallic foreign bodies in the lung. Case report. A soldier of the Federation Army of Bosnia and Hertzegovina, injured in the explosion in 1998 was presented. The soldier was subjected to thoracic drainage and surgery tretment of the wound. After one year, the pulmologist treated him with tuberculostatics because of hemoptysis and pulmonary infiltration shown by a radiogram. This therapy had no effects, and the pulmologist presented this case to the thoracic surgeon who made thoracotomy removing a piece of wood (13 × 2 × 0.7 cm), 20 different-size pieces of wood, and a piece of textile from the lung. Conclusion. Patients with penetrating explosive lung injuries without metallic foreign bodies shown by a radiogram, with complications as hemoptisis, lung abscess, bronchiectasis, obstruction of the bronchus, chronic pneumonia should be subjected to thoracotomy for removing suspected foreign bodies without resecting the lung.

Anaplastic large cell lymphoma (ALCL) is a rare non-Hodgkin, T-cell lymphoma, representing only 2-3% of all lymphoid neoplasm's in adults according to World Health Organization (WHO). CD30 antigen-positive, large neoplastic cells characterize ALCL. We present here a 46-year-old male with pulmonary ALCL previously diagnosed with Hodgkin disease. Microscopically, atypical bi-and multinucleated cells with frequent mitoses were present. The neoplastic cells were large and had clear cytoplasm, large vesicular nuclei, and prominent nucleoli. Immunophenotypic analysis revealed LCA, vimentin and CD30 positivity. ALK immunostaining was negative. Immunohistochemical profile was consistent with ALK negative ALCL. The progression of Hodgkin lymphoma to aggressive non-Hodgkin lymphoma (ALCL in this case) is well known entity. After the diagnosis was established, our patient immediately had been referred to the Department of Hematology in order to get appropriate chemotherapy, necessary in such cases.

OBJECTIVE Descriptive-analytic appraisal of validity of surgical approach to diagnosis and therapy in solitary pulmonary nodules (SPNSs). TASK: to establish justification of surgical removing of SPNs which etiology is unclear after complete previous clinical investigation. PATIENTS AND METHODS In the period between 1 January 1999 and 1 January 2004, included in this investigation were all patients with SPN of unclear origin who were referred to the Clinic for Thoracic Surgery-UCC Sarajevo after complete previous clinical investigation. RESULTS We operated 60 patients with proved SPN. The malignancy was found in 44/60 (73,3%) patients. There were established following types of malignancy carcinoma planocellulare in 54,5%, adeno carcinoma in 36,5% carcinoma bronchioloalveolare in 4,5% and tumor carcinoides in 4, % patients. We did following types of operation atypical (wedge) resection in 20 (33,3%), lobectomy in 36 (60,0%) and pneumonectomy in 4 (6,7%) patients. There were neither intra- operative complications nor intra operative mortality. Postoperative morbidity include: pleural emphysema in 1 (1,65%) and stress ulcers in 1 (1,65%) patients. There was not early postoperative mortality (until 30 days after operation). CONCLUSION The malignancy was the most frequent cause of the SPNs. Operative and postoperative morbidity and mortality are relatively negligible. High percentage of the malignancy in SPNs, negligible operative and post operative morbidity and mortality justify aggressive surgical approach to diagnosis and therapy in SPNs and point out to the necessity for early removing of this kind of pulmonary lesion.

UNLABELLED Pleural effusion is acumulation of liquid in pleural space, wich caused primary of pleural diseases or secundary of systemic diseases. PROBLEM Pleural effusion are the most frequently caused by malignancy and make worse poor condition of patients with malignancy. Pleural punction is insufficient metod for treatmen of malignancy pleural effusion. The best modefor treatment is pleurodesis using Doxicyclin. PATIENTS AND METHODS There are embrased all patient hospitalized in thoracis surgery department of KCU Sarajevo in period may 1999. - septembar 2002. whole medicaly treatet in procedure of chemical pleurodesis because of malignant pleural effusion. Examinee group of patients are medicaly treatet in procedure of chemical pleurodesis. Control group of patients are medicaly treatet by pleural punction because of malignanacy pleural effusion, same diseases in both group of patients. The results are present textualy, numberly and graphic printing. RESULTS Procedure of chemical pleurodesis obtained in mostly patients obliteration of pleural space, and prevent reaccumulation of pleural effusion. Procedure of chemical pleurodesis make quality of life better, complications are rare, mortality conect with procedure is not exist.

A case of sarcoma Ewing hemithorax lst sin has been reported in an 8-year-old girl. The girl was admitted in our hospital with referral diagnosis Pleuropneumonia exudativa left side. The girl was sent from Nova Bila with the foregoing diagnosis. The difficulties started in early April this year with high body temperature, pains in the left side of the chest. After a detailed anamnesis, clinical picture of the girl and radiological examinations/ chest x ray, CT scan of the chest and operative findings/ sarcoma Ewing diagnosis was confirmed. The disease is very rare, while diagnostics and course are complex. The girl was admitted at the Pulmology Department of the Pediatric Clinic on 16.03.2005. At the Department, the girl was medically treated with three antibiotics: cephalosporins of third generation, ceftriaxon (Longacef), aminoglycoside Amikacin and antistaphyloccoc therapy (Orbenin). Due to a dull sound on percussion and weaker auscultatory breathing on the left, and radiological shading of the left chest, a CT of the thorax was performed. It showed expansive changes of the left chest. Also performed was a pleural punction of the left chest, after which around 500 ml sero-hemorrhagic content was taken out and sent for patohistology analysis. After a pre-operative preparation, the operation was performed on 28.03.2005, which is when a fat-like tumorous mass was found completely filling up the pleural cavum and by its weight exerting pressure on the lungs. In the projection of VI and VII rib, the described mass infiltrates the thoracic wall. The tumor extirpation "in toto" was performed and sent for patohistology analysis, ex tempore. Also performed was a pleuropectomy in the projection of the wall infiltration, as well as a partial resection of the VII rib. Also performed was a decortication of the visceral pleurae. The post-operative course has been passing normally and with good pleuropulmonary findings, with the wound healing per primum. Patohistology results: sarcoma Ewing hemithorax lat. sin. The girl continued her cytostatic therapy in Zagreb following the operation.

Extralobar pulmonary squestration is a rare anomaly of abnormal pulmonary tissue without any communication to the bronchial tree and that receives blood supply from anomalous systemic arteries. We presented a case of massive hemothorax caused by bleeding inside extralobar pulmonary sequestration in an 34-year young man on anti-coagulation therapy because of built-in mechanic aortic valve. Surgical treatment was decortication and sequestrectomy after ligature of the aberrant vessels. We reviewed the literature on this topic and did not found any report about similar case.