Introduction: Preoperative carbohydrate oral (CHO) drinks attenuate the surgical stress response; however, the effects of CHO supplementation on the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory and immunology-based predictor remain unclear. This study evaluated the effects of preoperative CHO loading on NLR values and complications following open colorectal surgery compared with a conventional fasting protocol. Methods: Sixty eligible participants having planned for routine and open colorectal cancer surgery from May 2020 to January 2022 were prospectively and randomly allocated to either the control (fasting) group, whose members discontinued oral intake beginning the midnight before surgery, or the intervention (CHO) group, whose members consumed a CHO solution the night before surgery and 2 h prior to anaesthesia. NLR was assessed at 06:00 h before surgery (baseline) and at 06:00 h on postoperative days 1, 3, and 5. The incidence and severity of postoperative complications were assessed by Clavien-Dindo Classification up to postoperative day 30. All data were analysed using descriptive statistics. Results: Postoperative NLR and delta NLR values were significantly higher in controls (p < 0.001; p < 0.001). Control group participants also demonstrated grade IV (n = 5; 16.7%, p < 0.01) and grade V (n = 1; 3.3%, p < 0.313) postoperative complications. There were no major postoperative complications in the CHO group. Conclusion: Preoperative CHO consumption reduced postoperative NLR values and the incidence and severity of postoperative complications following open colorectal surgery, compared with a preoperative fasting protocol. Preoperative carbohydrate loading may improve recovery following colorectal cancer surgery.

Aim To compare hospital costs of acute limb ischemia treatment in two periods of time and to show evidence of long-term repercussions on reducing costs during successful treatment. Methods Retrospective analysis of data obtained from 100 patients' medical history in the period 2000-2016 at the Clinic of Vascular Surgery Sarajevo: group A - 60 patients with acute limb ischemia in the period 2005-2016 and group B - 40 patients with acute limb ischemia (ALI) in the period 2000-2005. From 2000 to 2005 conservative treatment method was used, invasive diagnostic and surgical procedures were often delayed for a shorter or longer period of time. During the period from 2005 to 2016, the management model and safe practice included emergency diagnostic procedures, colour-Doppler, arteriography, emergency surgery (embolectomy by Fogharty and if necessary, vascular by-pass). Results Better health service for the patients with acute limb ischemia was offered in the period 2005-2016, which relied on proven medical treatment trends. The largest share of the total costs of each patient included costs of hospital bed with significant difference between the period 2005-2016 and 2000-2005, mean of 1398.71 KM and 2480.45KM, respectively (p<0.0001), indicating rationalization of time that patients spend at the Vascular Clinic. Conclusion This trend of money/fund savings is an example of good practice, effectiveness and efficiency in the treatment of ALI and as such was used in patients with other vascular diseases.

1. Withington ET. Medical history from the earliest times: A popular history of the art of healing. London: The Scientific Press 1894; 14-23. 2. “Imhotep” Egyptpast. Dostupno na: http://www. egyptpast.com/pyramids/imhotep.html. 3. Lambert T. A brief history of medicine. Dostupno na: http://www.localhistories.org/medicine.html. 4. Renouard PV. History of Medicine: From it’s origin to the 19th century. New York: Cincinnati, Moore, Wistach, Keys and Co 1856; 26. 5. Bible, Old Testament, Genesis 50:2. 6. Prioreschi P. A History of Medicine : Primitive and Ancient Medicine. London: Edwin Mellen Press1991; 297. 7. Garrison FH. An introduction to the history of medicine. Philadelphia and London: W.B. Saunders Company 1922; 50-1. 8. Dunglison R. History of Medicine from the earliest ages to the commencement of the nineteenth century. Philadelphia: Lindsay and Blakiston 1872. 9. Baas JH. Outlines of the history of medicine and the medical profession. New York: J.H. Vail &co 1889. 10. Hamilton W. The history of medicine, surgery, and anatomy, from the creation of the world to the commencement of the nineteenth century.London: Henry Colburn and Richard Bentley 1831; 13. 11. Renouard PV. History of Medicine: From it’s origin to the 19th century. Cincinnati: Moore, Wistach, Keys and Co 1856; 17. 12. Baas JH. Outlines of the history of medicine and the medical profession New York: J.H. Vail &co 1889: 14-7. 13. Sigerist HE. A History of Medicine: Primitive and Archaic Medicine. New York: Oxford University Press 1951; 326. 14. Homer. The Odyssey 4; 227–32. 15. Homer. The Iliad 5; 401. 16. Sigerist H.E. A History of Medicine: Primitive and Archaic Medicine. New York: Oxford University Press 1951; 42-82. 17. Egypt-Gods, Dostupno na: http://ancienthistory.about. com/od/egyptmyth/a/071809EgyptianGodsTable.htm. 18. Wilder A. History of Medicine 1901, Maine: New England Eclectic Publishing 1901. 19. Osler W. Evolution of Modern Medicine. New Haven: Yale University Press 13-15. 20. Sandwich FM. The medical diseases of Egypt. London; 1905. 21. Hickey TM., O’Connell E. The Hearst Medical Papyrus. Berkeley: Bancroft Library 2003. 22. Selin H. Encyclopedia of the History of Science, Technology and Medicine in Western Cultures. Springer 2008. 23. Smith G. E. The Papyrus Ebers . London: The Garden City Press 1930. 24. Jackson M. Asthma: A biography. New York: Oxford University Press 2009; 39.

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.

Introduction: Life satisfaction involves cognitive component that allows evaluation of the life and accomplishments of life, and emotional component that includes an evaluation of emotions and mood that followed these accomplishments. Goal: To examine the life satisfaction of young people who attend secondary school, examine the level of satisfaction with life according to sex, to academic achievement, the presence of siblings and to examine the relationship between levels of life satisfaction and risk-taking behaviors. Results and Discussion: The results showed that there was no relationship between life satisfaction and preferences of delinquency, as well as life satisfaction and achieved academic success. The results confirmed the relationship between life satisfaction and sex as well as the relationship between life satisfaction and the presence of siblings in the family.

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.

Introduction: The intention of this work is to research whether the link between the barometer pressure and the cerebrovascular insult (CVI) exists. The stroke is the first cause of non-traumatic disability and third illness by mortality in the majority of available relevant literature. Goals: Goal of the sudy was to research all the cases of the patients who suffered from the acute stroke in the Canton of Sarajevo and those who were treated in the pre-hospital phase by Emergency Medical Institute staff and their working diagnosis was established as CVI ac. Material and methods: The criteria in the research were established for inclusion and exclusion of cases. The days with and without CVI cases were compared with the meteorological data obtained from the Hydro-meteorological Institute of Federation of Bosnia and Herzegovina . Since the approval was requested and obtained from the Hydro-meteorological Institute, all the meteorological data could be compared. The meteorological data comprise the barometer pressure measuring every day at 7 h, 14 h and 21 h. Results and discussion: In the retrospective study, there will be followed, during three years (2004, 2005 and 2006), the cases of the patients who suffered from the stroke, and, the emergency medical care was offered to them by the side of the Emergency Medical Institute of Canton of Sarajevo staff. All the cases in the Canton of Sarajevo were followed regardless of the place of incidence: whether the help was offered in Institute’s outpatient departments, patient’s flat or at public place. Due to the extensiveness of data (in the analysis comprising three years, there was the total of 1930 cases), the test of normal distribution was used. Since it was about the pre-hospital research, the acute stroke was looked at generally without division by types. The certain diagnostics by types can only be established in the hospital. Conclusion: The results in the research indicate that the extreme values of barometer pressure, regardless of their being increased ones or decreased ones, influence the increase of CVI incidence, while by comparing the average values in the days with CVI and without CVI, they did not have any influence on the CVI incidence.

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.

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.

The study presents a case of endometrial cancer in a breast cancer patient treated with tamoxifen. The disease occured with elevated values of CA 125 and CA 15_3 tumour markers without any other signs. Additional diagnostic analyses were performed showing a "de novo" endometrial cancer rather than metastatic breast cancer. The patient underwent surgery and radiotherapy. Thereafter, the values of tumour markers were in the reference values.