Aim: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. Patients and methods: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). Results: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21(25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found.

ABSTRACT The study is designed to evaluate the influence of remifentanil/propofol anesthesia on ventilator-associated pneumonia (VAP) occurrence and respiratory support (RS) time after major cardiac surgery. Material and methods: In retrospective-prospective study we investigated the respiratory support time and VAP occurrence in group of 47 patients with remifentanil/propofol and 35 patients with fentanil/midazolam anesthesia after major cardiac surgery in period June 2009–December 2011. Groups are divided in subgroups depending of who underwent cardiac surgery with or without cardiopulmonary by pass (CPB). Results: The time of respiratory support (RS) was the shortest in remifentanil group without CPB (R/Off 63min ± 44.3 vs R/On 94min ± 49.2 p=0,22), but was longer in fentanil group (F/Off 142 min ± 102.2 vs F/On 212 min ± 102.2 p=0.0014). The duration of RS of ON pump remifentanil group was shorter than in ON pump fentanil group (R/On 94 min vs F/On 212 min p=0.0011). The time of RS of OFF pump remifentanil group was lower than in Off pump entangle group (R/Off 63min ± 44,3 vs F/Off 142min ± 102.2 p=0,021) with statistically significance. Ventilator–associated pneumonia was detected in 7 patients (8.5 %). Six patients (17.1%) were from entangle group and one patient (2.1%) from remifentanil group. The most common isolates were Pseudomonas aeruginosa in all patients and both Pseudomonas aeruginosa and Klebsiella pneumonia in one patient. Conclusion: The remifentanil anesthesia regimen in cardiac surgery decreases length of respiratory support duration and can prevent development of VAP. The role of remifentanil anesthesia in preventing VAP, as one of the most important risk factor of in-hospital mortality after cardiac surgery is still incompletely understood and should be investigated further.

72 544x376 Normal 0 21 false false false BS-CYRL-BA X-NONE X-NONE The occurrence of hypocalcemia is an important and frequent complication of thyroidectomy that occurs in up to 75% of all surgeries. The value of serial measurement of serum calcium in postoperative period has a questionable validity. We aimed to evaluate the value of serial calcium measurements and other clinical and biochemical factors as predictors for occurrence of hypocalcaemia. We prospectively evaluated 50 patients subjected to thyroid surgery due to various indications during the year 2011. Predictive values of serial calcium measurements were evaluated by using Receiver Operating Characteristics (ROC) analysis. We recruited 50 patients with average age (SD) of 49.32 (12.15) years, spanning from 18 to 72 years. There were 38 (76%) female patients with women to men ratio of 3.17 to 1. There were 13 (26%) patients with the occurrence of hypocalcemia, out of which the most had temporary hypocalcemia (11; 22%). when comparing malignancy (8/17; 47.1%) vs. other reasons for surgery (5/33;15.15%), there were proportionally more patients with hypocalcaemia, among patients referred for surgery due to thyroid malignancy (X 2 =4.39; df=1; p=0.036). We compared predictive value of each particular calcium measurement for prediction of occurrence of hypocalcaemia and there was no statistical difference between AUROCs. A detailed ROC analysis for calcium measurement on day 2 was performed with the best performing threshold value of calcium of 1.95 with sensitivity of 70%, specificity of 97% and positive and negative predictive value of 90%. Serial measurement of calcium in postoperative period after thyroid surgery is not necessary and that measurement on second day after surgery is sufficient for predicting the occurrence of hypocalcaemia. Values of calcium measured 6 hours after the surgery may be used as an early and less precise predictor for occurrence of hypocalcaemia.

AIMS Determination of degree of liver function damadge after nonpentrative and penetrative injury as well as degree of postoperative recovery of liver function after surgical procedure of penetrative and non-penetrative injury. METHODS 60 patients were analised by retrospective-prospective study after surgery performed on University-Clinical Centre Tuzla in period from March 2008 to June 2011, out of which 30 of them were surgicaly treated for non-penetrative and 30 for penetrative liver injury. All patients were determined for values of total billirubine, direct billirubine, albumins, aspartat aminotransferasis (AST), alanin aminotransferasis (ALT) in preoperative period and in two weeks of postoperative recovery. In statistical data processing T-test of independent variables was used along with methods of descriptive statistical analysis. the difference on level p < 0,05 is statisticaly significant. RESULTS Significant difference of values in direct billirubine, total proteins, albumins, AST, ALT was found by analysis of paremeters in liver function in preoperative period and among values in total and direct billirubine, total proterins, albumins, AST, ALT on 7th and 15th postoperative day among tested groups. CONCLUSION Liver function damaged is larger after non-pentrative liver trauma in comparing to penetrative one. Liver function recovery is longer after surgical procedure of penetrative liver injury in comparing to non-pentrative liver injury.