Introduction Gastrooesophageal reflux disease (GERD) could be one of the causes of chest pain with or without Helicobacter pylori (HP) infection. Aim To evaluate origin of chest pain and to correlate positive history of chest pain and gastrointestinal system diseases. Subjects and Methods During 01.01.2005. to 01.01.2008., 352 patients age 4 to 18 years, from Cardiology and Gastroenterology department of Paediatric clinic of CCU Sarajevo with history of chest pain were investigated. The evaluation was done by protocol: history, physical examination, ELISE test on HP, oesophagogastroduodenoscopy (EGDS) with biopsy and histological examination, Holter ECG, echocardiography, psychogenic assessment and laboratory parameters. Results From 352 investigated patients with chest pain, 80 (22.7%) were ELISE HP and EGDS biopsy positive, 64% pts were females. Patients were divided in groups: I: age 4–11 years (with in 21.2% positive findings), II: age 11–15 years (HP+ in 56.2%), and group III age 15–18 years with in 22.6% positive HP findings. Laboratory parameters were normal. Psychogenic findings were positive in 12.5% pts. By ECG Holter in 3.6% a premature extrasystole were detected. Patients with HP infection were treated according therapeutic protocol with proton pump inhibitors plus two antibiotics for 4 weeks. During follow up post therapy period of six months, there were no subjective or clinical signs of chest pain in 52.5% patients. Conclusion The cause of chest pain in this study, in presence of HP infection was detected in statistically significantly higher percentage in older groups of patients. With appropriate therapeutic treatment, chest pain symptoms were solved.

Objective Dog bites can cause a spectrum of injuries, from lacerations to avulsions and crush injuries. In recent years, it has become more and more apparent that dog bites are a serious and often underestimated public health problem in Bosnia and Herzegovina. Methods The standard medical treatment of dog bites at our department consists of meticulous wound cleaning and closure of gaping wounds. Surgical closure was indicated when a firm wound closure without a suture was not possible. Childrens’ charts were analysed for personal data, type of injury and clinical course. Results Children who were younger than 4 years sustained significantly more attacks by small dogs compared with older children. The incidence was highest in 3-year-old patients and decreased with increasing age. A seasonal fluctuation was detected: a majority of the children were injured in the summer months and peak incidence occurred during July. Complications occurred in 13% of children. Discussion In agreement with previous publications, our data showed that the most common area targeted by dogs was hands and legs, reflecting the closer proximity of the child’s head to the attacking dog. Unfortunately, three of the children included in this report died. Conclusions Children who are younger than 12 years represent the high-risk group for dog attacks. Parents and children should be educated regarding behaviour around animals—dogs, especially those that are unfamiliar to the child. Encourage local leash laws and reporting of bites, and educate the public about responsible dog selection, ownership, and training.

Juvenile chronic arthritis (JCA) is a disease or a group of diseases with chronic nonsuportive connective tissue inflammation. Depending of the onset of the disease and its course in the first six months there are three major types: systemic, poliyarticular and pauciarticular disease. Indicators of bad prognosis were: systemic form with signs of inflammation in the first six months, poliarticular onset and course, RF positivity, positive ANA and eye involvement. In the period from 1996 to 2002 at the Cardiology-Rheumatology Department in Sarajevo Pediatric Clinic 63 patients were addmited. Out of this 49 (78%) were new cases JCA was more frequent among school age girls 35 (57%). Systemic--onset JCA 9 patients (14%), polyarticular onset 19 patients (30%), pauciarticular onset 35 (55%). 15 (23.8%) was RF (rheumatoid factor) negative, 4 (6.3%) RF positive. Pauciarticular forms type 1 were 20 (31.7%), type II were 15 (23.8%). In 11 (17.5%) patients laboratory tests and clinical signs indicated poor prognosis. All patients with indicators of poor prognosis needed more aggressive therapy. Although JCA is the most frequent rheumatic disease and the leading cause of invalidity, and one of the most frequent chronic disease in children, we still do not know enough. The optimal treatment is still a challenge especially onset of JCA with poor prognosis.

In this work is presented the structure of the morbidity of the patients treated at the Cardiohematology department of the Pediatric Clinic in Sarajevo. It were followed four the most frequent groups of the diseases. The results show the trend of the increasing of the number of the hospitalized children with the congenital anomalies of the heart and juvenile chronic arthritis, with the decrease of the number of the ill become by streptococcal infections of the upper respiratory tract and the rheumatic illness. It is increased the number of the hospitalized children is the result of the beginning of the cardiosurgical way of the taking care of these patients. The decreased of the number of the ill become is the consequence of the improvement of the healthcare protection at the primary level with the continuity of the further trend of the decrease of the number of the patients ill become from acute rheumatic disease.

During April 1997 to October 2000, 65 children (61.5% female and 38.5% male) have been operated at KCU Sarajevo at the Hospital for Cardiac surgery. Diagnostic procedures, preoperative and postoperative treatment have been carried out at Pediatric hospital, Clinical center University of Sarajevo. The average age of establishing the diagnosis was 20 months and 4.5 years was the average age of surgical treatment. The most frequent defects were: Atrial septal defect 27.69%, Tetralogy of Fallot 16.92%, Patent ductus arteriosus 16.92%, Coarctatation of the aorta 7.69%, combination of more simple defects 7.69%, Atrioventricular septal defects 6.15%, Ventricular septal defect 4.61%, Pulmonary stenosis 4.61%, Anomalous pulmonary venous connection 4.61% and the other complex defects 3.07%. Among all cases 10.76% were associated with some of the syndromes. In 86.13% of cases total correction have been performed and palliative in 13.84% of cases. Death rate was 10.76%, and postoperative complications 21.53%. Catheterizations was performed on 14 patients (21.53%), and three of them had therapeutic interventional cardiac catheterization (coil, umbrella, balloon dilatation). The average timing of: preoperative procedures was 3.5 days, postoperative following 7.5 days and intensive care 2.2 days.

UNLABELLED During August 1996 to August 1998 at the Paediatric Clinic in Sarajevo, 8 patients (pts) have been diagnosed to have a Transposition of the Great Arteries (TGA), age 10 hrs to 31 days. First Group (n = 4) had a simple TGA and in II Group in 3 pts TGA was associated with double inlet left ventricle (DILV) and subpulmonary artery stenosis and in 1 with double outlet right ventricle (DORV) and subpulmonary artery stenosis. Anatomical correction of TGA-arterial switch has been performed in Group I, mean age 15.5 days (7-18). In Group II palliative correction has been completed in: atrioseptectomy (1/4), pulmonary artery banding (3/4), right Blalock-Tausing modified shunt and also partial correction: Glenn anastomosis, mean age 4.7 months. Pts have been followed from 3 to 19 months postoperatively. All pts are well, except 1 pt who died following the arterial switch (mortality rate 12.5%). The aim of this study is to evaluate left ventricle (LV) function pre and postoperatively with electrocardiographic monitoring. Electrocardiographically there was no significant rhythm disorders. Using M mode echocardiography techniques, LV function was measured including internal dimensions of the LV as well as a wall thickness and than compared with the others comparable to the age and body weight. LV function in pts post anatomical correction has returned to normal values faster, with statistically significant difference of p = 0.02, than in pts post palliative-partial correction. CONCLUSION Echocardiographically LV function in pts with TGA post arterial switch returned faster to normal values than in pts following the palliative-partial correction.

Children's occult infections are characterised presenting pathogenic bacteries in blood of children in age 3 to 36 months, but they are good general aspect and orderly immunologic status and they don't have signs of focal infection. Manifestation of occult infections determined: age of child, increasing bodies temperature, testsphysical observance and clinical-biochemistry tests. Prevalence of manifestation occult infections is 3-8%, but they manifest ni a form occult bacteremia, occult pneumonia nad occult urinary infection. Methodic, systematic admission and adequate clinical-biochemical monitoring, we minimise sequeles of occult infections. Risk of serious sequeles at occult infections is importantly decreasing by epidemiological changes that it rises by using vaccination against Haemophilus influenzae and Streptococcus pneumoniae is leading ethiological source. Many contraversal opinions are presented in glance of therapeutic strategy at children's occult infection. Future of solutions at many hesitations ni context diagnosis and therapy of occult infections is established in using recent detectional tests /pneumococcus PCR, plasmas tumor reaction, interleukin lâ/ and preventive intervetions activities /conjugated pneumococcus vaccination/.

In 25 patients, 13 boys and 12 girls, median age 5.5 years, in 1990-2000, surgical reparation of their heart defects were performed. Median age of diagnostic Tetralogy of Fallot was 3.2 months, range 1 day-2 years. Anoxic spells were present in three patients. Ten patients (median age 3 years, range 3 months-10 years) initially palliated with a modified Blalock-Taussig shunt, underwent a reparation at a median of 4.5 years after palliation. Median follow up was 4.2 years, range 3 months-10 years. The 30-day mortality rate was 16%. Mean right ventricular outflow tract gradient on echocardiography was 20.20 +/- 4.78, and mean oxygen saturation was 96% +/- 1.3. Two patients had non significant residual ventricular septal defect with left to right shunt, 7 right ventricular enlargement and almost all mild pulmonary regurgitation. Also two patients had Blalock-Taussig shunt's thrombosis. Before surgical reparation, one boy showed pulmonary valve's endocarditis. Complete atrioventricular block has been developed on one girl. No patient required reintervention during follow up and there was no late mortality. Almost all of our patients were asymptomatic, had normal activity, regularly exercised and some of them participated in school sport programs. Complete correction of Tetralogy of Fallot showed good results with normal life expectancy for the patients.

Cardiovascular diseases cause death in 40% patients on the chronic haemodialysis program. Our aim was to assess the heart changes in these patients by echocardiography. We have tested 40 patients, but 34 of them accomplished criteria for this study. There were 19 (55.88%) females and 15 (44.12%) males. The average age was 44 years and average duration of haemodialysis treatment was 4.72 years. The research was made with ultrasound device TOSHIBA SSH 65 A SONOLAYER and transducers 3.5 and 2.75 MHz. Twenty patients (58.82%) have had pathological echocardiogram. Ten patients (29.42%) have had conditionally normal echocardiogram while four patients (11.76%) have had completely normal echocardiogram. In patients with pathological echocardiogram, some of the left ventricle hypertrophy forms dominated. Echocardiography is a useful method in morphologic and functional cardiac assessment at the last stage renal disease patients on the chronic haemodialysis program. Using the aforementioned method we are able to select the patients who need intensive cardiac care.

The aim of the study is to evaluate choice, efficacy and safety of transcatheter therapy in patients (pts) with congenital heart disease which has been performed in Europe on pts from the Paediatric Clinic of Sarajevo. From January 1996 to August 1998 out of 20 transcatheter therapeutic interventions, 5 have been done in pts whose congenital heart lesions: ductus arteriosus persistence (DAP), atrial septal defect (ASD), pulmonary artery valve stenosis (PS), aortic valve stenosis (AS), were diagnosed in first year of life. Pts were followed 11 months post interventions (the longest period of follow-up 19 months). All pts are well and asymptomatic. DAP closure has been done using "coil" devices in 2 pts (in Italy and Monaco) age 5 and 7.5 years. Duct diameter was 3.5 mm and 4 mm with percent of success within 24 hrs of 100%. With PW Doppler no residual ductual shunt has been proven. Transcatheter closure of ASD type secundum diameter 9 mm, using the "amplatz" device has been performed in Germany. No residual shunt has been proven by echocardiography. Balloon pulmonary valvuloplasty successfully was done in 1 pt in Austria age 3/12 with normal flow of right ventricle outflow tract post intervention. Balloon aortic valvuloplasty was performed in Sweden in neonate with decrease of pressure gradient of AS for 70%. Using Pencil Doppler, 8/12 post intervention in that pt restenosis occurred. The therapeutic catheterizational technique has been successful in alternating surgical approach to resolve congenital heart disease. With further development of catheter systems, techniques and longer periods of follow-up, possibilities of simpler, faster, safer and more efficient solvation of cardiac lesions will brightening up the future of paediatric interventional catheterisation.

A case of congenital heart disease (single ventricle) has been reported in nine and half years old child. This congenital heart disease is uncommon, but its diagnosis and treatment are complex. Complete noninvasive and invasive diagnostic procedure has been performed with this child. This congenital heart disease is proclaimed as inoperable because pulmonary hypertension has been developed.

This article presented the analysis of structure of morbidity of cardiorheumatological diseases at Pediatric's Clinic Sarajevo, before and during the war. The results showed that number of acquired heart diseases has not decreased, with permanent presence of streptococci.