AIM To examine two modalities of surgical treatment of diabetic foot based on two different approaches, classical and multidisciplinary. METHODS A retrospective-prospective study including 120 consecutive patients with diabetic foot treated in the Department of Surgery, General Hospital Tešanj in the period 1999-2006. Since 2003 a new multidisciplinary approach to the treatment of diabetic foot based on a more conservative approach has been introduced. Two groups of patients were analyzed according to two treatment approaches: the first group included patients treated with classical method (in the period 1999-2002), and the second group included patients treated with multidisciplinary approach (in period 2003- 2006). An age distribution, gender, local changes in the extremities, results of microbiological analysis of wound swabs, and modalities of surgical treatment of diabetic foot were analyzed. RESULTS Duration of the disease (p=0.24), the level of blood glucose (p=0.52) and glycosylated hemoglobin (p=0.10) had no statistically significant effect to the outcome of the treatment of diabetic foot, while the level of hematocrit (p less than 0.006), fibrinogen (p less than 0.003), cholesterol (p less than 0.000001), and the absence of a pulse in the peripheral arteries (p less than 0.000002), and the outcome of surgical treatment of diabetic foot had the influence to the outcome of the treatment of diabetic foot with statistical significance. CONCLUSION Aggressive and appropriate medical and surgical treatment according to a grade of disease could improve the outcome and reduce the morbidity and mortality of diabetic foot. The results of this study showed the importance of proper diabetes treatment, prevention of complications and a multidisciplinary approach to the treatment of diabetic foot.

Objective – To analyze the clinical and histological characteristics, as well as to evaluate the results of surgical treatment of pediatric neuroepithelial tumors. Patients and methods – A retrospective study was conducted, including 40 pediatric patients surgically treated at the Clinic of Neurosurgery, University Clinical Hospital Tuzla in the period 2002-2012. During the study we formed groups and the analysis was conducted by age, gender, clinical signs, histopathologic types and type of surgical treatment. The results are presented in tables and expressed by relative values. Results – Neuroepithlial tumors are more common in male patients. There was no statistically significant difference in distribution of neuroepithelial tumors (I‡2=0.400; p=0.527) related to supratentorial and infratentorial localization. Infratentorial neuroepithelial tumors are most common at a younger age (F=6.516; p=0.015). Increased intracranial pressure and seizures are the most common initial presentation of neuroepithelial tumors (I‡2=0.022; p=0.882). There was no statistically significant difference between types of surgical resection and localization of the tumor. Usually we performed total resection (I‡2=0.246; p=0.620). There was a statistically significant difference in tumor grade regarding supratentorial and infratentorial localizations (p=0.013). Infratentorial tumors are higher grade (I‡2=5.495; p=0.019). Conclusion – The most common initial presentations of neuroepithelial tumors are increased intracranial pressure and seizures. Infratentorial tumors are higher grade. The most common initial treatment of neuroepithelial tumors is radical surgical resection.

In this paper we presented a patient with a very rare form of pancreatic tumour. The disease began with very non-specific abdominal pain, loss of appetite, and vomiting, mostly mucus. Proximal endoscopy was performed which revealed hiatal hernia and ulcer in the duodenum. Computed tomography of the abdomen showed a tumour formation in the tail of the pancreas, which was surgically removed. Histopathological verification confirmed that it was a solid pseudopapillary tumour of the pancreas. The patient is on regular oncological control.

Laparoscopic cholecystectomy introduced in the late eighties has now become the gold standard and has taken the place of conventional cholecystectomy. Bile duct injury during cholecystectomy is an iatrogenic, but rare catastrophe associated with significant morbidity and mortality. The incidence of bile duct injuries during laparoscopic cholecystectomy is 0.1-0.42%. We have presented a patient who underwent laparoscopic cholecystectomy which got complicated with bile duct injury grade four. The complication was recognized three weeks later. A remediation of complications was performed in a reference center with full involvement of the primary surgeon.

The primary goal in craniopharyngioma treatment is a gross total neurosurgical resection. This paper presents a case with good outcome following a gross total removal of giant juvenile craniopharyngioma. There is a strong relationship between surgical experience in treating these lesions and the probability of total tumor resection without significant morbidity and mortality. The discussion on usefulness of stereotactic instillation of radioactive Yttrium-90 in the tumor cyst and bilateral fronto-orbital microsurgical approach utilized in 12-year-old male patient was conducted. A detailed description of the operative procedure was provided with comparison to other approaches commonly used for giant craniopharingioma. The long term (9 years) and intensive follow up showed good outcome without tumor recurrence. The patient has been receiving lifelong hormones substitution.

Carcinoma of unknown origin is defined as the absence of primary tumor and biopsy proved the existence of metastatic changes. The incidence is about 3% of all cancers. We present a case of a patient who underwent surgery for left breast mammography verified pathological lymphonodes on the left breast and on the left axillary region. Histopathological analysis of excised tissue showed the absence of malignant disease in the breast. A complete diagnostic evaluation also did not confirm the primary lesion. We done fluorodeoxyglucosa positron emission tomography, which had set suspicion of primary breast cancer, but biopsy and pathological reverification were not confirmed. The patient spent six cycles of chemotherapy for cancer of unknown origin. After a year and six months because of sudden right side hemiparesis were performed Computed Tomography and Magnetic Resonance imaging of the head, which indicated that it was a metastatic brain tumour. After metastasectomy, histopathological finding was finally proved to be a metastasis of breast adenocarcinomas. The patient had irradiation of the cranium, and began chemotherapy protocol for breast cancer. In this case, insufficient diagnosis did not affect in the proper therapeutic approach.

AIM To compare a benefit of chemiotherapeutic protocols docetaxel with Tarceva molecular therapy in advanced or metastatic non-small cell lung cancer (NSCLC). Primary endpoint-OS (overall survival), toxicity, secondary endpoint-quality of life. PATIENTS AND METHODS In this retrospective and -prospective study a total of 63 patients (two groups--30+33 patients) were analysed and treated for advanced or metastatic NSCLC during the period 2008-2010. One group was treated with molecular therapy Tarceva oral, and the other group was treated with chemiotherapy docetaxel monotherapy every three weeks. The chemotherapy was administered intravenously. Monitoring parameters included overall survival and toxicity. RESULTS Statistical differencet was registered in histology type, total toxicity and total survival. Adenocarcinom occured as a more often pathohistologic type in both groups of patients (Tarceva 57, 6% vs. Docetaxel 83, 3%). The chemiotherapeutic protocol, Docetaxel monotherapy, demonstrated higher total toxicity than Tarceva molecular therapy (hematological toxicity grade II 69.0% Docetaxel vs. 12.5% Tarceva). Tarceva molecular therapy demonstrated longer overall survival (OS) than Docetaxel (Tarceva 26, 4 months vs. Docetaxel 15, 5 months). CONCLUSION In this investigation of two groups of patients the molecular therapy Tarceva was showed better efficiency and toxicity profile. Preferred regimen could be molecular therapy Tarceva.

AIM To investigate a potential difference in postoperative morphological changes of two-level lumbar disc surgery as compared to one level surgery. METHODS The standard lateral radiographs of lumbar spine obtained preoperatively and postoperatively were used in the study . The morphological study included 60 adult patients of both sexes who had undergone the surgery in the period 2002-2006. The first group comprised patients operated on one level (L4/L5 and L5/ S1), and the second included patients operated on two levels (L3/ L4/L5; L4/L5/S1 and L5/S1/S2). Using lateral radiographs, after digitalization, the height of intervertebral disc space (HD), angle between vertebral bodies (A) and translation (T) were measured. RESULTS Comparing preoperative and postoperative values, statistically significant difference has been found for HD in the first group and HD and A in the second group. In neither groups there was statistically significant difference for T, which is one of radiological signs of segmental instability. The comparison of postoperative values for both groups has not shown any statistically significant difference. CONCLUSIONS The standard lumbar discectomy on two levels has not shown more pronounced morphological changes or changes suggesting an increased risk of segmental instability as compared to one level discectomy.

We have presented a case of rare dorsally sequestrated lumbar disc herniation manifesting as cauda equina syndrome. The patient was admitted to the Neurological Department of Canton Hospital Zenica due to urinary retention and weakness in both lower extremities. Magnetic resonance imaging showed a compressing mass located in the dorsal extradural space at the L2-L3 level. An extruded intervertebral disc was found intraoperatively. The decompression was followed by good recovery.

INTRODUCTION This study was aimed at comparing the efficiency and tolerability of two reference protocols Cisplatin and Etoposide and Cisplatin and Vinorelbine in advanced Non-Small Cell Lung Cancer. MATERIAL AND METHODS A total of 60 patients (two groups consisting of 30 patients) were treated for advanced Non-Small Cell Lung Cancer during the period from January to December 2005 according to the reference protocols (Cisplatin 100 mg/m2 D1; Vinorelbine 30 mg/m2 D1, D8 on 4 weeks) and (Cisplatin 100 mg/m D1; Etoposide 100 mg/m2 D1, D3, D5 on 4 weeks) at the Department of Oncology of KBC "Bezanijska kosa". All patients were analysed for tumour response, progression free survival as well as for toxicity. X2 test, Kaplan Meiers curves and Log rank test were used for statistical analysis. RESULTS Although the recorded response rates were a bit lower than in previously published trials, they were not significantly different p = 0.485. No statistically significant difference was recorded in either progression free survival or overall survival. The chemotherapeutical Cisplatin/Etoposide protocol proved to be more toxic both in hematologic (3% vs. 10%) and total toxicities (p = 0.047). CONCLUSION Our study proved both protocols to have equivalent efficacy. However, the Cisplatin, Vinorelbine protocol could be recommended because of its less expressed toxic effects.

Spontaneous regression of herniated nucleus pulposus occurs when intervertebral disc herniation loses its volume partly or totally without surgical interventions. Cases of spontaneous regression of large extruded lumbar disc are rare. We presented a patient with large lumbar disc extrusion documented by Magnetic Resonance Imaging, but not found intraoperatively four months after performing diagnostic. Postoperatively he felt well for two months when the pain reappeared. Control Magnetic Resonance of lumbar spine showed complete resolution of extruded disc fragment comparing with the initial Magnetic Resonance Imaging.

The study presents a rare case of organised chronic epidural haematoma that imitated a meningioma. A patient was admitted to the Department of Neurology of the Cantonal Hospital Zenica due to loss of consciousness and right hemiparesis. Non-contrast Computed Tomography (CT) scan had shown an expansive intracranial process in the left parietal region which was radiologically diagnosed as a meningioma. During the operation a linear skull fracture and organised chronic epidural haematoma were found.