One of the most common causes of acute pain in the lower abdomen is appendicitis and covers almost two thirds of the total number of hospitalized patients. The survey included all patients who have pain in lower abdomen and came to the review at the Polyclinic Doboj-South and General Hospital Tesanj during 24 working hours. The sample consisted of 101 patients hospitalized at the General Hospital Tesanj with the clinical picture dominated by acute pain in the lower abdomen. Taken into account are all relevant clinical parameters necessary for establishing rapid etiological diagnosis of acute lower abdominal pain. So we can say that appendicitis has the following characteristics: pain is gradual, increasing in duration from 8 to 16 h, localized in the lower right quadrant, or begins in the epigastrium and is descending into the lower right quadrant and spreading in a large percentage of proximal dorsal and then the inner part of the thigh. Accompanied by nausea, vomiting, with a statistically significant increase in leukocyte levels over 10000 and pathological findings in urine. The difference between rectal and axillary temperature was statistically significant. Palpatory positive painful in Mc Burney spot. Patients are usually younger than 30 years.

The treatment of patient with relapse of bleeding after application of minimally invasive treatment of hemorrhoidal disease such as elastic band ligation, cryosurgical treatment Hemorrhoidal Arterial Ligation (HAL) can be presented as serious clinical problem in patients with concomitant diseases that can be contraindication for radical surgical treatment. We compared the Simple Digital Method and standard above mentioned minimally invasive ambulatory treatment. We used special proctoscope with Doppler Flowmeter in order to identify all branches of hemorrhoidal artery in the anal canal creating graphical presentation using specially adapted software. HAL method is then used to perform ligation of hemorrhoidal artery branches. The elastic ligatures (called gummiligatures) are then applied to the piles in which most prominent flow was registered using Doppler Flowmeter. Antibiotic prophylaxis and sedation was administered preoperatively. Special computer program registered all steps. Hemorrhoidal ointments and paracetamol were used after surgical procedure. Average number of identified hemorrhoid arteries branches was six, and total duration of the procedure was in average 28 min. We compared patient treatment with our method and standard methods. In tested group we noticed significantly fewer complications (after eight days the number of complications 11% vs. 74%, p<0.001, after 15 days 3% vs. 11%: p=0.101). One year after procedure, the treatment was successful in 91.4%, or 32 out of 35 patients according to proctoscopy and Doppler Flowmeter exam. There were three patients with relapse of symptoms. In 77% of patients hat were treated with rubber bands ligation relapse occurred. Our method is significantly more successful in comparison to classical methods of ambulatory treatment and can be alternative to radical surgical treatment.

Introduction: A medical record is a dataset of a patient which enables his/her health protection in the present and the future, based on registered past events, their evaluation and planning. In other words, a medical record is a very important component of an efficient administration and planning of a patient’s health care, especially in hospital settings. Medical records must be standardized to accomplish everything mentioned above. Due to the large number of technologies, applications and standards, which are used in the processing of information in health care, standardization is very hard to achieve. Patients and methods: 1194 patients were hospitalized at the surgical ward during a period of five months. The data about the patients was entered in a database. In order to assess the minimal data set that is necessary to adequately analyze data in the future, a database was created with all relevant questions about the anamnesis, diagnostic tests and surgical procedures. Results: It is possible to analyze data about the most frequent diagnoses at a surgical department using collected data. It is possible to assume the prevalence of the diagnosis, complication rate, duration of symptoms, postoperative pain level and several other important attributes that are not available otherwise. Discussion and conclusion: The minimal data set included routinely in hospital medical records can provide more thorough analysis of patients diagnosis, therapy, diagnostic procedures, complication rate etc. This can improve the quality of service and provide important data for the hospital management that can be used in planning and hospital management.

Magnetic resonance and magnetic resonance angiography is a non-invasive diagnostic method that is a feasible and reduces the possibility of risk catheterization angiography (IADSA). The patient is not exposed to radiation and iodine intravenous contrast media, which is especially dangerous in patients with renal failure and allergies to iodine.. In the period since 1998 until 2006 there were 102 patients with cerebral aneurysms were diagnosed, 60 (58.8%) female and 42 (41.2%) males, age from 12 to 76 years, average age was 49.41 years The largest number of patients, 83 patients (81.4%) with the diagnosis of aneurysms, had non traumatic intracranial bleeding either subarchnoidal bleeding or intracerebral hematoma. Sixteen patients (15.6%) had occasional headaches, 2 patients had brain tumors, and their aneurysms were diagnosed accidentally. All patients were reviewed at the CT scan, and then they made magnetic resonance with magnetic angiography. There were no aneurysms smaller than 3 mm. the size of 14 aneurysms was 3-5mm, 12 is a differentiated using MIP reconstruction and only 6 using 3D TOF tomograms, while the common processing of MIP and 3D TOF we differentiated 13 aneurysms, and one aneurysm of MCA that is 3mm of size. For evaluation of the presence of aneurysms and its localizations is of great importance evaluation of 3D TOF tomograms that together with MIP reconstruction gives a sensitivity of 99%. MR angiography demonstrated as inadequate for characterization of aneurysms’ morphology in comparison to DSA, and according to an MR angiography cannot be used in planning of the aneurysms embolisation treatment. In monitoring of patients after the endovascular treatment of aneurysms MRI with MR angiography is shown to be a method of choice.

BACKGROUND Laparoscopic appendectomy (LA) has recently become a standard procedure in the treatment of acute appendicitis, as it has been shown to be advantageous over open appendectomy. Since laparoscopic appendectomy was recently introduced in Bosnia and Herzegovina, we evaluated the practice of this procedure in the treatment of acute appendicitis. METHODS An audit was carried out through a written questionnaire sent to 16 different medical hospitals in Bosnia and Herzegovina. The questionnaire examined the use of laparoscopic appendectomy since the period of its introduction to the end of 2007, including operative time, hospital stay, morbidity and mortality rates, conversion rate and the reasons for the conversion and laparoscopic technique. RESULTS The response rate from the questionnaire was 37.5%, but only three institutions (18.75%) perform LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 5 years. In period from inception of LA to the end of 2007, 243 appendectomies were done by laparoscopic approach. Correct diagnosis were made in 229/243 cases. Mean hospital stay was 2.2 +/- 0.4 days. Postoperative complications were observed in 13/243 patients. The most frequent complications were intrabdominal abscess (4/13), wound infection (4/13) and intrabdominal bleeding (2/13). Nine conversions from LA into open procedure were done, two due to technical reasons (equipment malfunction), two due to mesoappendix bleeding and five due to periapendicular block or retrocecal position. Conversions and postoperative complications were observed only at the start of the introduction of this procedure. CONCLUSION Only three institutions in Bosnia and Herzegovina, with small surgical teams, routinely perform laparoscopic appendectomy. Thus, there is a need for systemic education of surgical teams across the country. Laparoscopic appendectomy could be the first operation in the acquisition of laparoscopic skills.

One of the most common events in Surgical Ward is admission of patients with biliary tract disease. To evaluate such patients, it is necessary to create appropriate database and define attributes that will be analyzed. The patients should be divided in groups for analysis and data processing. There were 219 patients included in the study. All patients were selected on the basis of ICD-10 codes and then divided into categories according to the code. In order to assess selected patients, the database was created with all relevant questions about anamnesis, diagnostic tests and surgical procedures. The data about patients was entered into the database. It is possible to analyze data about the most frequent disorders of biliary tract. The most common entity was chronic cholecystitis with calculus and most common procedure was laparoscopic cholecystectomy. The other important attributes are also assessed. ICD-10 classification can be used as a basis for aggregation of data of the patients with biliary tract disease. Some of the codes are more frequent than others and some are rarely used.

Extensive and fast advancements in biomedical sciences created a significant delay in receiving relevant and updated information in medical practice - physicians use old techniques and treat patients incorrectly. Bosnia and Herzegovina signed the Bologna Declaration on 18 September 2003, and in the light of this new approach to university education, and the process of joining The European Union, the authors set the following aims: to determine the current level of knowledge among medical students at the Medical Faculty of the University of Sarajevo, to determine the level of knowledge among medical students before their enrolment at the faculty, and to find out students opinion on their needs for further education. Students also left their suggestions on what should be changed in the curriculum. 203 students were included in the survey and results show that they demand more practical work, direct contact with patients and presentation of interesting clinical cases. Many of them use the internet as professional education means. Professional papers are rarely used. At present, the availability of learning material is insufficient at the faculty library.

Development of computer networks and introduction and application of new technologies in all aspects of human activity needs to be followed by universities in their transformation on how to approach scientific, research, and education teaching curricula. Development and increased use of distance learning (DL) over the past decade have clearly shown the potential and efficiency of information technology applied in education. Use of information technology in medical education is where medical informatics takes its place as important scientific discipline which ensures benefit from IT in teaching and learning process involved. Definition of telemedicine as "use of technologies based on health care delivered on distance" covers areas such as electronic health, tele-health (eHealth), telematics, but also tele-education. Web based medical education today is offered in different forms--from online lectures, online exams, web based continuous education programs, use of electronic libraries, online medical and scientific databases etc. Department of Medical Informatics of Medical Faculty of University of Sarajevo has taken many steps to introduce distance learning in medical curricula--from organising professional--scientific events (congresses, workshop etc), organizing first tele-exam at the faculty and among first at the university, to offering online lectures and online education material at the Department's website (www.unsa-medinfo.org). Distance learning in medical education, as well as telemedicine, significantly influence health care in general and are shaping the future model of medical practice. Basic computer and networks skills must be a part of all future medical curricula. The impact of technical equipment on patient-doctor relationship must be taken into account, and doctors have to be trained and prepared for diagnosing or consulting patients by use of IT. Telemedicine requires special approach in certain medical fields--tele-consultation, tele-surgery, tele-radiology and other specific telemedicine applications should be introduced to the curricula. Telemedicine and distance learning are best suited for medical education and doctor-to-doctor consultation--first contact between doctor and a patient should stay face-to-face when possible. In this paper, we present the results of the project Introduction and Implementation of Distance Learning at the Medical Faculty of University of Sarajevo and compare it with the following expected outcomes: development and integration of information technology in medical education; creation of flexible infrastructure which will enable access to e-learning to all students and teaching staff; improvement of digital literacy of academic population; ensuring high educational standards to students and teaching staff; helping medical staffto develop "life-long learning" approach in work and education.

CONFLICT OF INTEREST: NONE DECLARED Introduction The International classification of diseases (ICD) is the most important classification in medicine. It is used by all medical professionals. Concept The basic concept of ICD is founded on the standardization of the nomenclature for the names of diseases and their basic systematization in the hierarchically structured category. Advantages and disadvantages The health care provider institutions such as hospitals are subjects that should facilitate implementation of medical applications that follows the patient medical condition and facts connected with him. The definitive diagnosis that can be coded using ICD can be achieved after several visits of patient and rarely during the first visit. Conclusion The ICD classification is one of the oldest and most important classifications in medicine. In the scope of ICD are all fields of medicine. It is used in statistical purpose and as a coding system in medical databases.

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.

The appendicitis is one of the most common entities that could be met at surgical department. Chronic pelvic pain of right iliac fossa is common and it causes disability and distress and results in significant costs to health services. Often, investigation by laparoscopy reveals no obvious cause for pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, the vascular hypothesis where pain is thought to arise from dilated pelvic veins in which blood flow is markedly reduced and altered spinal cord and brain processing of stimuli in women with chronic pelvic pain. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. We aimed to identify and review treatments for chronic pelvic pain related to appendicitis. Frequently ultrasound and CT scan cannot confirm the diagnosis of chronic appendicitis due to non significant swelling of vermiform appendix. The study excludes patients with a diagnosis of pelvic congestion syndrome, those with pain known to be caused by gynecological disorders or irritable bowel syndrome. Detailed history, clinical examination, and serological and radiological investigations failed to reveal the cause of the pain in all cases. We presumed that pain is caused by chronic appendicitis with appendicolithiasis and that removal of appendix will result in symptom relief. We performed study with 75 patients treated by laparoscopic appendectomy. Duration of symptoms ranged from 3 to 48 months, with a mean of 13.1 months. All patients included in this study had right iliac fossa pain lasting more than three months. We performed radiological contrast studies to verify appendicolithiasis of irregularity of appendicular wall. Patient with mild symptoms were excluded, only patients that have symptoms that cause disability were operated. We compared pain according to localization, duration and character. We evaluated the pain one month after operation and compared its characteristics with preoperative pain. There is strong evidence that postoperative pain is significantly lower in operated patients and most of them are without any symptoms after operation.

We admitted 70 years old woman with signs of acute abdomen and severe hemorrhagic shock. The urgent laparatomy was done. We found necrosis of the right liver lobe with signs of diffuse hepatic disease. We removed necrotic liver tissue and applied perihepatic package in order to stop bleeding. Patient was sent to ICU. Six days after first operation operative removal of hepatic package was done and cholecystectomy due to gangrene of gallbladder. Patohistology revealed miliary tuberculosis of liver with necrosis. Laboratory findings showed severe hypoalbuminemia, leucopenia and anemia. Tenth day after first operation, patient developed ARDS that could not be treated successfully, so patient died next day.

INTRODUCTION The medical informatics as the separate medical discipline very quickly gets developed, both in Bosnia and Herzegovina. In our country, the medical informatics is a separate subject for the last ten years, regarding to the Medical curriculum at the biomedical faculties in Bosnia and Herzegovina is in accordance with the project of the education related to Bologna declaration and the project EURO MEDICINA. This year the Chair of the Medical Informatics of the Medical Faculty in Sarajevo celebrates ten years of its existence. WORK METHOD By the descriptive method of the research which included the questionnaire of about 400 students of the biomedical faculties, we established the attitudes and we took into consideration opinions of the students of these faculties about the validity of the contents of the subject of the medical informatics, the availability of the adoption of the material by the theoretical and practical performance of the teaching process and the suggestions and recommendations of the students about the contents that have to be throwned out from the curriculum and the teaching material that needs to be included. WORK RESULTS The research was performed using the separate questionnaire pattern data carriers with the defined characteristics for the quality assessment of the performed course. The total attitude of the assessed students speaks about dominantly expressed satisfaction with the majority of the parameters that are important for assessment of the quality and the tuition contents that was evaluated during the questionnaire. The results are shown in the tables and graphs, and they are describing the program of the tuition and the contents of the methodical units, and the system of the examination for the students using the method of "multiple choice". CONCLUSION The education in the field of the medical informatics is based at the concept which is used in the developed countries of the world, and according the recommendations of the working groups of the European and world association of the medical informatics. The theoretical and practical teaching and training performance in the wholeness is performed by use of the computer equipment, and the final knowledge check of the students also is performed using the Data Base Management System MSAccess specifically designed to cover full teaching and training material by using questions set in the data base which encircled nearly 1500 questions combinations.

Expert systems are the software systems developed by the application of the various intelligence, which could successfully compete to peoples-experts, and have the consultant function with the characteristics of the explanations and the advices in some specific domain. These are, in essence, the intelligent information systems, which consists several thousands of the rules from the definite problem field and which are capable to explain their decisions. The knowledge systems are lesser software systems, also developed by means of the technique of the artificial intelligence which are usually less successful in some field of knowledge of the experts. In the paper are presented the basic characteristics three most often applied expert systems in gastroenterology: Quick Medical Reference (QMR), HEPAT, ILIAD.

Ethics, especially medical ethics, is of a great importance in medical informatics field ethical principles have great importance in confidentiality, security, and access to patient records. This is not as simple problem as it looks in the first sight, and--in that context--it is significant that many jurisdictions have drafted laws in this regard. As medical informatics has been developed, this ethical problem is becoming very important for medical informatics. Many efforts to make fundamental principles "according to which data protection and access to official information could be reconciled" are made. The principles described in this paper are independent of any process, as they are based on ethical principles. It avoids any kind of conflict or misunderstandings. They can be a base for making of an ethical code for informatics in health care delivery. These principles are independent of any particular "laws", and they can serve as to establish uniformity of standards in medical informatics.