Introduction: to evaluate the frequency and significance of immunohistochemistry-based molecular subtypes of breast cancer and investigate their association with traditional pathological features for breast cancer among Bosnian women. Materials and methods: this study included 100 female patients with primary invasive breast cancer. Immunohistochemical analyses for estrogen receptor (ER), progesterone receptor (PR), HER-2 and Ki-67 were performed to define four biological subtypes: luminal A, luminal B, HER-2-positive and triple-negative. Results: the frequency of luminal A, luminal B, HER2-positive and triple-negative subtypes of breast cancer was 44%, 39%, 11% and 6%, respectively. Molecular subtypes of breast cancer among Bosnian women showed to be independent of traditional pathological features (p>0.05). Ki-67 showed significant di erence regarding luminal B tumor type, where high (≥14%) Ki-67 score was predominantly represented in 36 (92.3%) cases (p<0.001). Conclusion: immunohistochemistry-based molecular subtypes of breast cancer in Bosnian women somehow vary in pathological features, i.e. luminal A subtype in this sample comprised mostly ductal histological type, moderate di erentiation with the involvement of lymph nodes, known as worse prognostic factors, although with no statistical significance.

Methods and patients: A retrospective study was conducted in the period from January to the December 2015 and as a source of data we used medical records. The study included 60 patients with active rehabilitation that starts four to six weeks postsurgery, hospitalized at the Clinic for Physical Medicine and Rehabilitation, University Clinical Center of Sarajevo (UKCS). Outcome measures were: back and leg pain, neurological deficits (leg weakness, numbness and loss of normal bowel and bladder functions) and the length of stay in hospital (LOS).

Kronicna bubrežna bolest (HBB) je važan javno-zdravstveni problem (1). Prema definiciji KDIGO (Kidney Disease: Improving Global Outcomes) HBB je definirana kao strukturno ili funkcionalno ostecenje bubrega, koje traje >3 mjeseca, s posljedicama za zdravlje i klasificirana je na osnovi uzroka, kategorije glomerularne filtracije i kategorije albuminurije (2). HBB ima nekoliko stadija, a posljednji, terminalni stadij ili end-stage of renal disease (ESRD) odgovara uremiji s glomerularnom filtracijom 90 dana se također povecala i u 2011. godini iznosila 123,1 (3). Također, i u drugim zemljama koje vode renalni registar, zabilježen je porast incidencije i prevalencije pacijenata s ESRD. U svijetu je, u odnosu na modalitet tretmana zamjene bubrežne funkcije u razdoblju 2001.-2010. godina, bila najzastupljenija HD (68,5-69,2 %), zatim transplantacija bubrega (22,5-23,1 %), te peritonejska dijaliza (8,3-8,5 %) (4). U Bosni i Hercegovini u razdoblju 2006.-2011., HD je najucestalija metoda zamjene bubrežne funkcije s ucestaloscu UCINAK INTRADIJALIZNOG PROGRAMA VJEŽBANJA NA KVALITETU ŽIVOTA I FIZICKE MOGUCNOSTI U HEMODIJALIZIRANIH PACIJENATA

AIM To determine the effect of a 16-week intradialytic exercise program consisting of 30 minutes of exercise during the first two hours of dialysis with three times a week frequency, on the quality of life (QoL), level of depression/anxiety and physical perfor- mance in hemodialysis (HD) patients. METHODS The clinical, longitudinal, prospective study with one-group repeated measures design was conducted during a 16-week period. A convenience sample of 52 HD patients, who had been on HD for a minimum of 6 months, were included. QoL, level of depression and anxiety (questionnaires: SF-36, Back Depression Inventory (BDI) and Back Anxiety Inventory (BAI)) and physical performance (modifying Visual Analogue Scale (VAS) and Manual Muscle Testing (MMT)) were assessed at baseline and after 4-month exercise program. RESULTS The following scales of SF-36 questionnaire were improved after 16-week exercise program: role functioning/emotional (P=0.01 8), energy/fatigue (P = 0.002) and social functi- oning (P = 0.030). Level of depression and anxiety were significantly decreased in males (P = 0.007 and P = 0.022, respectively) and females (P = 0.001 and P = 0.000, respectively). VAS scale and MMT were significantly increased in males (P = 0.000 and P = 0.001, respectively) and females (P = 0.01 9 and P = 0.001, respectively) after 16-week exercise program. CONCLUSION Exercise program improves some aspects of QoL and physical performance, and decreases the level of depression and anxiety in HD patients.

INTRODUCTION Mortality after hip fracture remains high in spite of the progress of medicine. Due to the trend toward longer life, the problem of hip fracture is getting more significant. The aim of this study is to determine the effects of surgical treatment in patients with high risk of hip fracture on mortality reduction. METHODS In the retrospective-prospective study, 66 patients aged 65-92 with a hip fracture and a high cardiac risk have been analyzed. The risk estimation was based on the Lee index. The patients with three or more risk factors were considered high-risk. The first group consisted of surgically treated patients with a hip fracture and at high cardiac risk, and in the second group were conservatively treated patients with a hip fracture and high cardiac risk. RESULTS In the group of conservatively treated patients, 75% were women and in operatively treated group 67.6%. Patient in both group are similar in relation to the participation of risk factor. A difference has been noticed in terms of renal insufficiency (RI). There was 18.8% conservatively treated patient with RI and 2.9% in operatively treated group. CONCLUSION Patients with hip fracture and at high cardiac risk have lower mortality when treated surgically.

INTRODUCTION Evaluation of neurogenic urination dysfunction by urodynamic examination in patients with spinal cord lesions is essential for ensuring the effective emptying of the bladder and the prevention of urological complications. GOAL To establish the relation between urodynamic findings with the development of complications of the upper urinary tract (UUT) in patients with spinal cord lesions. MATERIALS AND METHODS This is a retrospective study involving 42 patients with spinal cord lesions in which are analyzed complications of UUT incurred in an average 4-year period. It also included urodynamic examination of 41 patients (one patient with definitely placed catheter) and the results are compared with the found UUT complications. Among urodynamic parameters were compared the values of bladder compliance (C), maximum detrusor pressure in the filling phase (Pdet.max) and detrusor activity. RESULTS UUT complications: nephrolithiasis 24%, ureteropieloectasia 21%, chronic pyelonephritis 10% and hydronephrosis in 5% of patients. In 26 (64%) patients were found low compliance (C < 20 ml/cmH2O), and preserved in 15 (36%) patients. Pdet.max. was significantly lower in patients with preserved compliance (p < 0.01). According detrusor activity was found 22 (54%) hyper reflex and 19 (46%) areflexic bladders. In the group with areflexic bladder, UUT complications has 7 (37%), in group of hyper reflex bladder 10 (45%) patients. In areflexic bladder with UUT complications was found significantly lower levels of compliance (p < 0.01) than in the group without complications. CONCLUSION In our sample of patients with spinal cord lesions was demonstrated the impact of low compliance to the occurrence of UUT complications. It is also in case of the areflexic bladder found significant difference in compliance between the groups with and without UUT complications. Maintaining bladder compliance and low values if intracystic filling pressure the most important tasks in maintaining vesico-sfincteral balance, and thus prevention of urological complications in patients with spinal cord lesions.

CONFLICT OF INTEREST: NONE DECLARED Neck pain syndrome is described as: Pain in the neck affects at least once in a lifetime every second person, and also 10 % of adult population suffers from chronic pain in this area. It is more often among women. A constant increase of incidence in the industrialized countries is noticed. It is also the leading cause of referral to physical rehabilitation. It is causing huge financial costs in the health care system. There is no consensus regarding Neck pain syndrome management, but many therapeutic modalities are applied: a) to isolate (or manage) rare, but potentially dangerous states that can cause neck pain; b) identify and treat each co morbid state and risk factors; c) provide resources and information’s, especially about regarding use computers in dayly practice. Physical and manual treatments can be: a) physical therapy can assist to achieve early mobilization and return to daily activities; b) active physical therapy , mobilization, manipulation and exercises can assure short time relief of neck pain; c) home based exercises, as shown by this research, can significantly prolong the pain free period, in case of patients with the chronic syndrome; d) Medications, combined with the exercise program and ergonomic improvements can be effective solution for the chronic or recurrent neck pain. Intensive treatments in Neck pain syndrome are: a) Surgical and other intensive treatment (rarely indicated); b) invasive treatments includes and percutaneous radiofrequent neurotomy and cervical epidural analgesis.

GOALS The goals of the research were: a) to identify possible serious and specific causes of neck pain; b) to identify psychological and social barriers for recovery; c) to determine the degree of dysfunction caused by nonspecific neck pain; d) reduce pain; e) improve functioning and reduce disablement; f) prevent recurrences and development of chronic forms. ATTENDEES AND METHODS: As a sample for this research we selected patients with the verified neck pain syndrome, 120 of them in total which we divided into two groups with 60 patients. One group is treated with the classic rehabilitation method and the other cohort underwent active exercises during a six months period. For testing we used WAD scale and NDI questionnaires, which are approved all around the world and described in available literature. RESULTS In the time period from January 3rd until December 31st 2006 there was a total of 6163 specialist evaluations, first or control ones. During the same time period physical rehabilitation started 516 patients with the neck pain syndrome from which: 426 women (82.3%) and 90 men (17.7%). Majority of patients axial neck pain was diagnosed or not complicated neck pain syndrome (G 54.2), but for the patient in Center for physical rehabilitation much more frequent is cervical brachial compared to the reference data. In baseline, demographic and clinical data for the 120 respondents did not have significant statistical deviations. Average patient's age is 47 years, with very low variation coefficient. Variation coefficient; V(A) = 13 % (very low) V(B) = 13% (very low). Also within baseline, the pain (VAS) and self estimated functionality impairment (NDI), was also similar for both groups. All respondents N = 120 had the initial evaluation of functioning status 3. After 6 months reevaluation we gave significant differences in clinical state levels of the patients from the training (A) and the control group (B). If we analyze the relationship between frequencies, we can conclude that the patients--but not all, which exercised in their homes, have better functional status and reduced pain, and 10% of them did not have any problems. But, also 15% of patients that did not exercise within home program have improvement in clinical status, which can be explained with the usual, spontaneous remission of the neck pain syndrome. DISCUSSION AND CONCLUSION According to the results of the conducted research, continuous and long lasting exercised to strengthen the neck muscled with the home exercise program are efficient in the treatment of patients suffering from neck pain syndrome. Ten percent of the patients that exercised did not feel the subjective problems, which 60% of them had significant reduction of pain, reduction in use of analgesics and anti rheumatic medications, with improvement in local and general functioning status as well as daily activities in life and work, and that is statistically highly significant advantage compared to the patients that did not exercise. Work in the department of physical and family medicine, organized at the local community level, provides good basis for the scientific research and possibility to implement prevention programs, with necessary interdisciplinary and cooperation between teams. The perspectives are the following: In general, evidence degree for a neck pain is quite low. Determination of guidelines for better systematization of therapy is important prerequisite for the future efficacy researches of various concepts.

Zoran Hadziahmetovic1, Narcisa Vavra – Hadziahmetovic2 Clinic for Emergency medicine, Clinical center of Sarajevo University, Bosnia and Herzegovina1, Clinic for Physical medicine and rehabilitation, Clinical center of Sarajevo University, Bosnia and Herzegovina2 tor of the arm where infraspinatus shoes more power in outer rotation of the shoulder compared to teres minor. Kineziologically they represent anatomical and functional system. With its tone they act as active links of the shoulder joint because they assure the contact between humerus head with cavitas glenoidalis scapulae. If we observe only lateral shoulder rotators (mm. infraspinatus and teres minor) they participates in moves of horizontal adduction of the upper arm; upper fibers of m.infraspinatus in flexion of upper arm, and lover in adduction. Outer rotation of the forearm is according to muscle power weaker movement compared to the inner rotation. Injuries of the RC can be expressed in form of partial or complete rupture or asymptomatic as subacromial impingement syndrome which is expressed with the characteristic signs which involves subacromial pain, crepitating and impossibility to elevate limb. Prevalence of RC increases with age: so that the patients without RC rupture are at the average age of 19 years, and with the unilateral rupture 59 year, and with bilateral rupture at 68 years (1). Main cause of impingement is repeated touching (collision) of humerus head with lower surface of the frontal part of acromion and coracocromial ligament. Most often involved tendons are one of supraspinatus and infraspinatus. But similar symptoms can be caused by other important anatomic structures such as subacromial burs and tendon of the biceps long head. Clinical tests which are specific for determining impingement and RC lesion are functional tests; Neer, hawkins – Kennedy and adductive (drop arm) tests which determines the degree of limitations for active adduction of the upper arm. Painful adduction, subacromial painful arch in range from 30 0 to 120 o (involved structures of the subacromial joint) goes in favor of partial rupture and painful impossible initial adduction of the upper arm to complete rupture. Noticeable is the disorder of the humoroscapular rhythm. Verification of the muscle strength weakness should be evaluated by the group test for the lateral rotators of the shoulder which is performed and evalu148-152

INTRODUCTION In the paper, the authors presents medical meaning of whiplash neck injury (WNI) according right time diagnosis and management. PATIENTS AND METHODS The aim was to estimate the functional answer according diagnosis and therapeutical modalities. 35 patients were treated in Clinical center University of Sarajevo in period 2004/2008. They were divided in two groups--G1 with 18 patients and G2 with 12 patients. G1 group is treated by soft cervical collar and analgetics, G2 by physiotherapeutic modalities. First check was 6 months after injury and treatment beginning. RESULTS Immediately after a whiplash accident all patients have back pain in the cervical spine. Two of them have paresthesia in the upper extremity, headaches have 7 of them, spasm of paravertebral muscles has 1, spasm of art. carotis 1, laceration of the longus colli muscles, accompanied by hemorrhage and edema 1. CONCLUSION The authors did 6 weeks follow- up after treatment of patients and 77% of them had no problems, 23% patients lost symptoms of WNI after 2 - 6 months. They come back to everyday activities in period 1 - 3 months except 2 of them who needed 6 months. Presented values clinical parameters indicate that there is no statistically significant difference in finale results between groups, G1 and G2 (p > 0.05).

Kinesitherapy (KT) is field of rehabilitation that uses the movement in order to cure patient. Knowledge about movement, condition and method of act of movement determine the final effect of this kind of treatment. Nevertheless, the role of patient is active and the positive effect can be achieved only if patient understand his role in process of therapy. The role of patient is frequently forgotten and the results of this research are valuable in assessment of patients' role in treatment.

One of the complications caused by spinal lesion is osteoporosis which development is induced by lesion itself, and its mechanism is not explained enough. Risk factor of this kind of osteoporosis is fracture which management is difficult and is cause of further complications which aggravate already damaged quality of life of patients with spinal cord injury, and demand additional health insurance expenses. Importance of prevention and treatment of spinal cord injury induced osteoporosis is enlightened by case report.