UNLABELLED The news in understanding intrahepatal anatomy, such as radiology contemporary technology making easier segmental and bisegmental access to hepatal resection. This access comprises resection of isolated anatomical segments or a sector of liver which is depends of magnitude of intrahepatal pathological process. After segmental or bisegmental resection of liver, patients were analysed in the period from 15 and 30 days after the operation. Analysis of patients from this period comprise: localisation of tumour in relation on segments, liver test and follow up, technique of resection, intraoperative stream, the period of operation, blood follow up through v. portae, blood loss and quantitative and qualitative analysis of postoperative complications. RESULTS between January 2000 and March 2005, sixty two subject were analysed that have been operated on our clinic (segmental or bisegmental resection), because of the metastatic process of liver and hepatocellular carcinoma of liver (HCC). Hospital mortality was 2.1%, with most often mortality in patients with HCC and cirrhosis of liver. High of morbidity from this period were 19,8%. Need for transfusion of blood (fresh erythrocytes) were 1,2 +/- 0,5 U. Patients with HCC had more needs from blood transfusions contrary patients without HCC; 2,9 +/- 1,4 contrary 0,7 +/- 0,28 U (p<0,05). Recidivism of malignant process in hepatal margin were 2,7%. CONCLUSION Segmental hepatal resection is very accurate technique which makes possible complete resection of tumour and in the same time preservation of healthy liver parenchyma. Segmental hepatal resection is especially useful for patients with HCC and patients with recidivism or progress of primary process.

Celiac disease is intolerance to gluten that classically produces chronic diarrhea with a picture of malabsorption and a total villous atrophy. These elements regress completely in a sequential way under a prolonged gluten-free diet. We describe a case of a 35-year-old woman affected by celiac disease who presented atypically, with features including hypoproteinaemia (38g/L) with dominant hypoalbuminaemia (12g/L), weight loss, strong psychoneurotic component and amenorrhoea. These manifestations for the first time were diagnosed as irritable bowel disease and after immunology diagnostic as celiac disease. Current research on celiac disease has pointed out the biologically significant role of antigliadin antibodies IgG and IgA and antibodies to tissue transglutaminase (tTg).

Low HDL cholesterol (HDL-C) level and smoking are known risk factors for coronary heart disease. The effect of cigarette smoking on HDL-C level was analysed in this study, with aim to determine whether smoking causes lowering its level. Study included 105 participants, aged 30-70 years, from Family Medicine Teaching Center of Dom zdravlja Tuzla. Smoking status was analysed and HDL-C level was measured after fasting for at least 12 hours in all participants. The greater number of smokers had HDL-C level < 1.03 mmol/L than non-smokers (P = 0.04). The greater number of non-smokers had HDL-C level > or = 1.54 mmol/L comparing with smokers (P = 0.001). Smokers had significantly lower mean HDL-C level than non-smokers (P = 0.003). Results suggest that cigarette smoking adversely affects HDL-C by lowering its level, which further increases the risk for developing coronary heart disease.

UNLABELLED: Prolonged forms of HAV infection are atypical forms of diseases which occur in up to 24% cases. In clinical mean those forms of disease are described as relapses (recidivisms) and recrudescence. During the three-year multi-centric study we have explored prolonged forms of HAV infection, on two geographically separated and epidemiologically different regions, from every aspect. The purpose of this study, in clinical biochemical sense, was to explore all clinical forms of this disease and determine its biochemical characteristics. This research involved 60 patients with prolonged HAV infection (PTHA) and 30 patients with conventional hepatitis A. During conventional HAV-infection the disease ends in 4 to 8 weeks. Markers of HAV, HBV and HCV infection were determined using ELISA method. Antigen HAV in stool was determined using method of reversed immuno-electro-osmopforesis. Circulating immune complexes was determined photometrical in the sediment poliethylenglicole on rollers length of 450 nm. Research has shown that the PTHA manifests in three clinical forms: recrudescence, relapse and "prolonged hepatitis A from the beginning". All forms of PTHA were often significantly icteric with a clearly shown clinical pictures (p<0.05). Every new disease episode (relapse and/or recrudescence) is in average of smaller intensity than the initial infection. CONCLUSIONS: Clinically clear PTHA infection manifests through recrudescence in 66,8 % of cases, through relapse in 26,6 % of cases and "prolonged hepatitis A from the beginning" in 6,6 % of cases. Recrudescence appears significantly often one time rather than two or more times (p<0.001). Relapse never appeared:after recrudescence, and it was not noted more than once. "Prolonged forms of disease from the beginning" could represent relapse/recrudescence whose initial disease phase remained sub clinic. Average duration of PTHA is five times longer than in the control group. Men tend to fall ill from PTHA twice as much as woman.

Cavernous transformation of the portal vein occurs with long-standing portal vein thrombosis (PVT) because of the development and dilatation of multiple small vessels in and around the recanalising main portal vein. Thrombosis and occlusion of the portal vein leads to portal hypertension with enlarged spleen and the development of porto-systemic collaterals. The main clinical presentation is gastroesophageal variceal bleeding and hematologic abnormalities due to splenomegaly (hyperspleenismus-pancytopenia). We described the young patient with splenomegaly and extensive cavernous transformation of portal vein. The patient had thrombosis portal vein in early childhood and massive bleeding from large oesophageal varices at age 13. Full clinical evaluation is required because of abdominal pain. The liver is histologicaly and functionally normal. Diagnosis of cavernous transformation of the portal vein is confirmed by abdominal ultrasography, color Doppler ultrasonography and CT angiography. Oesophagogastroscopy reveals almost complete reduction of oesophageal varices, but confirms portal gastropathy as a source of patient's complaints. Natural course of PVT in this patient shows possibility of full reduction of oesophageal varices, but still the presence of different consequences of portal hypertension.

HDL-cholesterol is the independent negative risk factor for coronary hearth disease. Level by =1,54 mmol/l is appropriate, while level by < 1,03 mmol/l is associated with elevated risk for coronary hearth disease. Beside other factors, lifestyle has important influence on HDL-cholesterol level. Inadequate diet, obesity, smoking cigarettes, physical inactivity and excessive alcohol consumption result in lowering its level. Life-style modification (healthy diet, lowering weight in obese patients, smoking cessation, moderate alcohol consumption and regular physical activity) will have a positive effect on the HDL-cholesterol level, as on the other risk factors for cardiovascular diseases, which will improve community health.

Acute pancreatitis occur after autodigestion of pancreatic tissue with pancreatic enzymes followed by necrosis and secondary infection. Two most common causes are biliary stones and alcoholism. Other causes are rare. Computerised tomography and abdominal ultrasonography are of basic diagnostic value. In early phase of pancreatitis ultrasound of biliary three is important. Urgent intervention with stone extraction can prevent severe forms of pancreatitis. Chronic pancreatitis with its etiology is related to alcohol consumption (70-80%). Other causes are common to acute pancreatitis. Long lasting papillar obstruction could cause chronic inflammatory changes on pancreas. Natural course of disease reduce tissue of gland significantly with maldigestion and malabsorption symptoms. Most common tumor of pancreas is ductal adenocarcinoma with increasing incidence of 10/100,000 per year. Risk factors are: smoking, diabetes mellitus, 65% of cancers are in the head of gland. Treatment is surgical but rarely in early phase that allows radical resectability. Endoscopic palliation is placing of biliary stents. Biliodigestive anastomoses are performed surgically.

The most frequent causes of the stenosis are as follows: Schatzki rings, structures as the complications of GERB', postcorrosive and postoperative at nosis. The Balloon dilatation is one from the therapeutic procedures of stenosis of the esophagus. By the clinic research is included 12 patients with the stenoses of the esophagus of the various cause. It is used the balloon dilatator (Olympus) of the diameter 16 and 18 mm, and the analysis 40 mm. In 11 patients the balloon dilatation was successful and led to the walking of the esophagus for endoscope. Only in one patient the dilatation was unsuccesful, because was applied two years after the occurrence of the stenosis caused by the corrosive esophagisitis. It is concluded that the balloon dilatation of the therapeutic procedures of the choice in stenosis of the esophagus.

The objective of this study to consolidate the correlation between BMI with the values of ALT and AST of the healthy adolescents in age of 18, 19 and 20 years. To the group of 237 examinees of the healthy adolescents is determined BMI, and is measured the activity of ALT and AST. In the sample of the examinees we had 22% examinees had the increased BMI > or = 25. The examinees who had the increased BMI (> or = 25), had the significant increased values ALT, and only mildly increased values AST in relation to the upper referent values. On the basis of the simple linear regression was confirmed the positive correlation between the of body mass indexes and activities ALT i AST.

UNLABELLED Obesity is one excess of body fat frequently resulting in a significant impairment of health. Lack of physical activity is one possible cause for obesity. GOAL To exam relation between obesity and physical activity. MATERIAL AND METHODS A sample with 154 randomized chosen patients make 48 (31.2%) men, and 106 (68.8%) women, 30-80 years old. Obesity is defined by bodymass index (BMI) over 30. Physical activity is defined by the modified scheme of Hanson and Ainsworth. RESULTS Obesity was presented with 106 patients (68.84%). Lack of physical activity was present with 134 patients (87.01%). Physical activity was presented with 20 patients (16.91%), with 5 patients (25%) who are obese, and 15 patients (75%) who are no obese. CONCLUSION Lack of physical activity plays role in creation of the obesity.

The subject of the family medicine on the medical faculties in Bosnia and Herzegovina existed from recently as a separate curiculum of the medical study. Until recently the contents of this discipline interpreted within the subject of the social medicine or the object of the primary healthcare protection, and programs of teaching were based mainly on Anglosaxon experiences. The fact is that some teachers of the medical faculty in Sarajevo had their own visions and programs of the family medicine which by years were tested in the units of the family healthcare protection in Sarajevo, Mostar, and Banja Luka, about what was published in our and foreign literature. New approach from the family medicine should be based on as follows: greater use of the standardized procedures for the improvement of the communication skills; revised educational procedure of all the participants 6 interdisciplinaryilly in the education of the family medicine; improvement of knowledge about methodlogy and the principles of the research; improvement of the techniques and knowledge about the maipulatin of the medical informations; development of the skills of the continued studying through the total working aga; to the development of the capability of the critical estimation of the own work important; by the defining of the important educational goals in the curriculum of the urgent medicine; to the development and use of the methods feed-back informations from the students; to the modernizing of the methods of the evaluation of the educational process-adopted knowledge and the attitudes and the carrying out of the practice of the patients, and the ethic values in that process. In this work the authors consider the stated experiences in the education from the subject family medicine at our faculties realting to the foreign, and suggest that new concept of the education on the basis of these experiences in the practice.

Primary gastritis, duodenitis, peptic ulcer of stomach and duodenum are no longer considered to be disorders of the balance of secretion of acid and immune responses of the gastric mucose but it is thought to be caused by Helicobacter pylori infection. One of the most important factor causign the malignant gastric diseases such as carcinoma and non-Hodgkins MALT Lymphoma is an early infection by this spiral gram-negative bacterium. We performed byopsi of the gastric mucose in 80 of our patients. Endoscopic and histological results showed that 74 patients had gastritis 6 others had normal results. The highest incidence of disease was found in children of 11 to 14 years of age because 67.4% were girls and 22.4% were boys of this age. Ethiological analysis of patients with gastritis showed that Helicobacter pylori was isolated in bioptic material of 46 patients while results of other 28 patients were negative.

With the aim to evaluate the influence of gastric resection on the morphological and functional conditions of the liver and the eventual appearance of gallstones, 50 randomized patients with a resection of the stomach were clinically analysed at different period of time, together with 50 patients suffering from peptic ulcer. All patients underwent a liver biopsy, 26% of the patients with gastric resection and 20% of the patients with peptic ulcer showed pathological findings of the liver, which statistically is not a significant difference. The most frequent pathologic change in both groups was a persistent hepatitis, while gallstones rarely occurred. Further, a presence in the past of viral hepatitis and alcoholism in both groups has been analysed as possible factors for the mentioned changes in the liver. Hbs Antigen detection has also been drawn as important. People with gastric resection belong to the jeopardized groups of the population with a great risk-factor related to previous frequent blood transfusion and other medical procedures. Patients who underwent a gastric resection, were analysed for the influence of the time period, following operation, on proved lesions of the liver, which were also observed in relation to dumping syndrome, malnutrition and other postresection syndromes. The authors point out the importance of making an early detection of the lesions of the liver, during surgery, with the aim to prevent the development of severe chronic inflammation.