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B. Prnjavorac, K. Abduzaimović, E. Ajanović, Muhamed Clanjak, Merlina Kalajdžija, B. Rakić, S. Redzepović

In the paper are stated the data of ten years observations of the occurrences of the seroconversion in the patients at the dyalized treatment in the dyalized center in Tesanj. The seropositiveness to B and C hepatitis was 16.5%, what is the usual percentage for the local population. The serconversion to the positive C hepatitis occurred in one patient, and that in the first year of the dialyzed treatment, what remains the possibility the dyalizis began in the period of the incubation. The separation of the seropositive apparati for the dyalisisi from the rest made the sufficient organizational measure by the dyalized center.

B. Prnjavorac, E. Ajanović, B. Rakić, S. Kahvić

Analyses of creatinema in the cases of global respiratory failure was performed in this paper. The patients with global respiratory failure treated in General Hospital in TeSanj have been followed. For all patients laboratory analyses have been performed on the admimtion and in the time of clinical status improvement, including creatinin level, K, Na, Hb, Htc, and blood gas analyses with mesurement of pO2 pCO2 pH, BE, saturation of the blood with oxgen, BE and HCO3-. Creatinine level have been considered in coleration of body mass index, and general nutritional status. The dinamic source of creatinine level in the blood have been followed, in relation of parameters of respiratory status. The statistical significance in relation of creatinine level with the respiratory status was registrated. With the improvement of respiratory status and laboratory analyses related to respiratory status, decrease of creatinin level was registrated. Because of that the therapy given to the patients with respiratory failure could influence on potassium level, the relation of creatinnemia and potassium level in the blood wasn't considered. The high creatinin level couldn't be explained with the initial renal failure, but as the sign of metbolic adaptation to hypoxemic and hypoxyc situation on the body. The registration of high creatinine level in the situations of global respiratory failure could be the guidelines for the choice of the antibiotics for these patients, mostly for potentially nephrotoxic antibiotics, like aminoglicosides, and theirs combinations. The decision and evaluation of benefit and toxicity of antibiotics for these situations could be easier.

E. Mesic, A. Halilbasić, S. Rašić, E. Leto, D. Poljak, Ž. Stipančić, F. Bahtic, B. Prnjavorac

INTRODUCTION In BiH there are no summary data about chronic dialysis patients (CDP). With this study we tray to make first step to establish B&H system for collecting necessary data. METHODS This is a retrospective study for 1999 years. We collect data with question form which have been distributed to dialysis centers (DC) in BiH. RESULTS We got answer from 6 (37.5%) DC: Tuzla, Sarajevo, Bihac, Odzak, Travnik and Tesanj. Totally number of CDP was 533, 256 female (48%) and 277 male (52%), and 79% of them are between 26-65 yrs. Leading primary renal diseases were: glomerulonephritis 22%, pyelonephritis 16%, endemic nephropathy 11%, unknown ESRD 10%, polycystic renal disease 9% and diabetes 9%. Peritoneal dialysis have ben performed in 10 patients only, and bicarbonat HD in 46% of CDP. Half of the patients had serum haemoglobin lower than 7 mmol/1 and only 12% received erythropoietin. 17% of the patients had coronary disease, and 7% peripheral vascular disease. We registered 43 (8%) HBsAg, but 294 (55%) antiHCV positive patients. 52% of the CDP have been vaccinated against B hepatitis. Last year died 76 patients (14.26%), mostly caused by coronary diseases (21%), cardial failure (20%), cerebrovascular accidents (15%) and sepsis (11%). 53% of patients are on dialysis between 1-5 yrs. CONCLUSION In this study participated 6 DC only, but we think that data we collect are good basis for establishing B&H system for registration and follow-up of the ESRD patients.

B. Prnjavorac, E. Ajanović, I. Masic, B. Rakić-Prnjavorac, K. Kahvić, S. Kahvić, M. Smailbegović

The data in computing programs could make two types of problems, functioning of medical equipment and analyses of medical datas. The first one is not use limiting problem. The troubles could be performed in calculation of pregnancy dates but the final calculation in up to medical practitioners. The former situation, analyses of medical datas, could be limited without complete and correct datas, mainly in analyses of life expectancy tables, and related fields.

B. Prnjavorac, E. Ajanović, I. Masic, B. Rakić-Prnjavorac, K. Kahvić, S. Kahvić, M. Smailbegović

Use of medical information in everyday practice has been described in this paper. Importance of systematic collection, analysis and use, including correct "data management" is noticed. Information system is formed of every noted information, not only in computing form. Use of databases allows us connection to many information, but rational use should allow us to select only these in number an quality which are necessary for decision making.

B. Prnjavorac, E. Ajanović, I. Masic, B. Rakić-Prnjavorac, K. Kahvić, S. Kahvić, M. Smailbegović

Inhibitors of angiotensin converting enzyme (ACE inhibitors) have been introduced more than fifteen years ago into the treatment of hypertension, congestive heart failure, myocardial infarction and diabetic nephropathy. The therapeutic success is related to their action in reduction of plasma and tissue angiotensin II concentrations and potentiation of endogenous kinins. They are able to improve myocardium metabolic status, prevent cardiac hypertrophy, limit myocardial infarct size, and thus prevent heart failure. Since 1987 ACE inhibitors are introduced in the clinical practice in our clinic. We introduced the therapy with lisinopril (Lopril), in 70% of patients among 2855 patients that were admitted in Coronary Care Unit in 1997 and 1998. Lisinopril was introduced as soon as the patient was admitted, together with fibrinolitic, Heparin and Aspirin therapy. Since that time we noticed decrease in postinfarction heart failure in comparison to previous years. We recommend permanent therapy with a small doses of ACE inhibitors in patients with heart infarction.

E. Ajanović, B. Prnjavorac, K. Kahvić, J. Denjalić, M. Salihagić

This paper is a review of the patients with pulmonary thromboembolism hospitalized at General hospital in Teanj starting from the first case recorded in 1980 till now and 172 patients were subjects of this study. Thromboembolism was a direct cause of death in 43.7% (75 patients). Clinical and laboratory records, etiology, chest radiography, ECG data of 89 patients hospitalised and treated in the last five years were analyzed in detail. The most frequent symptoms were dyspnea and tachypnea, often accompanied with other symptoms (84.2%), chest pain (65.2%), cough (52.4%), tachycardia (40.5%), hemoptysis (25.8%). At 74% of patients with pulmonary thromboembolism a significant simultaneous increase of all examined enzymes, except CPK was found. Pulmonary insufficiency (global or partial) was found at 75% of patients. According to our results, in 57.2% of the subjects the pathologic changes on Radiography (infiltrates of the lung, with or without affection of the pleura and changed position of diaphragm) were found, and 70.9% had changes on the ECG.

B. Prnjavorac, E. Ajanović, D. Binakaj, S. Rozajac, H. Djogić, S. Hasukić, A. Denjalić, H. Škiljo

Case record of patients with lung abscess treated by postural drainage is presented in this paper. In young man with multiple explosive injuries lung abscess was formed two months after injury. A postural drainage with parenteral application of antibiotics has been performed. The expectoration was painful. At the seventh day there was no temperature, ESR was described at the tenth day. The general status was becoming better. At the seventeenth day patient was discharged from Hospital. Rig imaging was shown nearly completely resolution of lung abscess. Postural drainage was effective because of favorable localisation of abscess near the large bronchus and basely part of the lung.

The functional parameters Raw, Rrs, FEV1, RV, FEF25 and FEF50 have been examined in 1000 patients with bronchial obstruction. Measurement of airway resistance is the precise examination for bronchial obstruction. For the routine clinical examination the interruptional measurement of Rrs is sufficient (correlation test + 0.56). Resistance may be measured indirectly by dynamic pulmonary volume testing (correlation FEV1: Raw = -0.55; FEF50: Raw = -0.63).

Observations of the diagnostic procedures of 397 patients treated due to the pleural effusion have been presented. Some of the methods were very differential. Pleural effusions were not only an etiological problem but sometimes the morphological identification is very difficult because of the atypical view of the radiologic appearance. X-ray examinations of the effusion in many projections enables differentiation from other cases. In cases where clinical and X-ray examinations cannot be performed different procedures like transthoracic tap and explorative thoracotomy should be performed.

E. Ajanović, B. Prnjavorac, M. Ajanović, K. Kahvić, M. Alicehajić

A case of specific tuberculous pericarditis is described. A short clinical and etiological classification of pericarditis is given. There are so many new forms of pericarditis today, like autoimmune, postirradiation, drug induced, etc. Specific tuberculous pericarditis is rarely registered today. One must intend to specify TB pericarditis almost if pericardial effusion is present. Pericardial punction is of much help in the diagnosis and treatment of pericardial effusion. Steroid therapy is very important in prevention of forming pericardial adhesions.

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