Accurate information on the cause of death is obtained from expert teams based on pathological or forensic expertise. Reliable information can be obtained from physicians in hospital settings if the deceased person has been treated in such an institution and has previously been diagnosed with an illness (intrahospital mortality). Intrahospital mortality analysis provides reliable data that can be used in the planning of a bed fund, the amount of medication purchased, the purchase of equipment, the organization and creation of highly specialized medical teams (resuscitation team), the number of resuscitation procedures, the number of pathologists required for autopsy procedures, etc. The aim of the study was to determine the total number of deaths, to identify the most common causes of death and 10 leading diagnoses of deceased patients at the Internal Medicine Clinic, University Clinical Center Tuzla (UKC) during one calendar year (2011). Material and methodes: Archive material (case histories and reports of deceased patients of the Internal Medicine Clinic) were used. Results: During this period, 6 488 patients were treated at the Internal Medicine Clinic and 451 patients died. According to the analyzed data, the most common diagnoses and causes of death at the Internal Medicine Clinic were: cerebrovascular incidents 104 (20.84%), cardiogenic shock in 24 (5.31%), heart failure 59 (10.86%), hepatic coma with cirrhosis of the liver 25 (5.33%), sudden cardiac death 30 (6.53%), respiratory failure 15 (3.32%), myocardial infarction 41 (9.99%), multiorgan failure 18 (4.00%) , pulmonary edema 14 (3.10%), sepsis 6 (1.38%), pulmonary emboli 17 (3.82%), valvular heart disease 9 (1.92%), cardiorespiratory arrest 9 (1.92%) , malignant abdominal neoplasms in 23 (5.28%), pancreatitis 2 (0.44%), hematemesis 8 (1.76%), diabetes mellitus 4 (0.88%), lung tumor 1 (0.22%), chronic renal insufficiency 12(2.54%), suicidal intoxication 4 (0.88%), ileus 4 (0.88%), cachexia 3 (0.66%), restrictive cardiomyopathy 2 (0.44%), mesenteric thrombosis arteries 2 (0.44%), disseminated lupus erythematosus 2 (0.44%), coffee vein thrombosis inferior 2 (0.44%), and 1 (0.22%) died of an aneurysm aortic abdominalis, ventricular septal defect, amyloidosis, disseminated intravascular coagulation, systemic sclerosis, rheumatoid arthritis and breast tumors. Conclusion: During the analyzed period, 6488 patients were treated at the Internal Medicine Clinic and a total of 451 patients died. The most common cause of death in hospitalized patients is cardiovascular disease (n = 208; 41.68% of deaths), with cerebrovascular disease (n = 104; 20.84% of deaths) totaling 312 (62.25%) of deaths from cardio and cerebrovascular disease.

Background: Cardiovascular diseases are the greatest cause of morbidity and mortality in patients with chronic renal insufficiency. Prevalence rate of heart failure in patients with terminal renal insufficiency treated with dialysis ranges from 18% to 45%. Prevalence rate of symptomatic heart failure in the general population of European countries is estimated to be about 4%. Diastolic dysfunction is a cause of heart failure in 33-50% of cases. In the general population, it is considered that 30-40% of patients suffering from primary diastolic cardiac dysfunction due to disorders in relaxation or ventricular extensibility. Echocardiography is a sensitive non-invasive method for detecting disorders of systolic and diastolic function of the left ventricle. Aim: Evaluate the systolic and diastolic left ventricular function in patients in dialysis. Determine the incidence rate of systolic and diastolic left ventricular dysfunction in patients on dialysis. Patients and Methods: A prospective study was conducted that included 50 patients who were treated with chronic dialysis (hemodialysis and continuous ambulatory peritoneal hemodialysis). All the patients underwent ultrasound examination of the heart on the ultrasonic unit Vivid 3 Vingmed Tehnology. Left ventricular systolic function was evaluated on the basis of ejection fraction (EF), which we detected in M-mode according to Teichholz method. Evaluation of diastolic function the left heart chambers is done on the basis of Doppler echocardiographic transmitral flow. Results: The study included 50 patients: 22 males (44%) and 28 women (56%). 35 patients (70%) were treated with hemodialysis, and 15 patients (30%), continuous ambulatory peritoneal dialysis (CAPD). The average age of the patients was 47.33 ±12.74 years. The average duration of dialysis treatment was 42.6 ±17.2 months. Preserved systolic function of the left ventricle was recorded in 83% subjects. Weakened systolic function of the left ventricle was recorded in 17% subjects with average ejection fraction (EF 40%). Diastolic dysfunction of the heart’s left ventricle was verified in 20.4% of patients. All the patients with diastolic dysfunction of the left heart chambers had preserved systolic function of the heart’s left ventricle (regular ejection fraction). Conclusion: The incidence of systolic and diastolic dysfunction of the heart’s the left ventricle in patients on dialysis is high.

The aim of this study was to determine a frequency and a type of early and late surgical complications in kidney transplantation, their impact on renal graft survival among 80 patients, 54 (67.5%) males and 26 (32.5%) females who had undergone a living and cadaveric kidney transplant at the Surgery Center in Tuzla in the period from 15.09.1999 until 31.12.2008. The subjects were divided into two groups according to donor age, younger and older than 55. A significantly higher incidence of early rather than late surgical complications was observed in an experimental group (p=0.001, and p=0.77, respectively). There was a statistically significant difference in the length of graft survival (p=0.004) and the number of deaths (p=0.038). Older age of kidney graft donor had an impact on the occurrence of early surgical complications and no influence on the occurrence of late surgical complications. Fatal outcome after kidney transplantation was significantly higher in patients who received grafts of elderly people.

Acute pancreatitis is a rare but life-threatening complication in patients with transplanted kidney. The incidence of acute pancreatitis after kidney transplantation ranges from 2% to 7%, with mortality rate between 50 and 100%. We report a case of a female patient aged 46 years, developing an interstitial acute pancreatitis 8 years following a renal transplantation. The specific aethiological factor was not clearly established, although possibility of biliary pancreatitis with spontaneous stone elimination and/or medication-induced pancreatitis remains the strongest. Every patient after renal transplantation with an acute onset of abdominal pain should be promptly evaluated for presence of pancreatitis with a careful application of the most appropriate diagnostic procedure for each individual patient.

INTRODUCTION Kidney transplantation assures considerably better quality of life than the treatment of end-stage renal disease patients with dialysis. GOAL Authors intended to present results of kidney transplantations that were performed for over 13 years in UCC Tuzla. EXAMINEES AND METHODS Total of 100 transplantations have been done over 13 years. The gender and age structure have been presented, as well as number of transplantations per year, type of transplantation (living related donor, living unrelated donor, deceased donor), number and percentage of donors and results of transplantations expressed as survival of both the patient and transplanted kidney/ renal graft. We also wanted to presented other important events such as dates of introduction of certain drugs, dates of first cadaver transplantation, transplantation with desensitization protocols and dates of first living unrelated (spousal/emotional) transplantation. RESULTS The survival of patients and renal grafts were demonstrated by Kaplan-Meier curve, and obtained results were fully in range of results recommended in other literature and by other authors. One-year survival of graft is 94%, with five-year survival being 75%. One-year survival of patients is 95%, and five-year survival of patients was 84%. DISCUSSION Our results have been compared to those from other studies, gaining suggestions for transplantation improvement. CONCLUSION Among all modifications of renal replacement therapy transplantation is by far the method of choice because, its well known advantages aside, it also has an economical advantage over chronic treatment with dialysis and it should therefore become interesting to healthcare systems.

Cardiovascular disease is the most frequent cause of morbidity and mortality after renal transplantation and remains a significant barrier to improve long-term outcomes.Although transplantation improves life expectancy compared with dialysis, survival remains well below general population estimates. Approximately 50% of patients die with a functioning transplant, with approximately 50% of these deaths from cardiovascular disease or stroke.[3] Cardiovascular death rates underestimate the full impact of this disease process given the large number of nonfatal events, including acute myocardial infarction, cardiac arrhythmias, heart failure, and stroke, that affect quality of life.

We present a case of 71 year old man operated in our clinic for ruptured abdominal aneurysm complicated with aorto-caval fistula, which was revealed during the surgery and successfully repaired by direct sutures within the aorta. This is the first record of the aorto-caval fistula that was so far noticed in our clinic. Urgent surgery and repair of the defect conneting aorta and vena cava by direct sutures within the aorta followed by ruptured aneurysm repair with tube graft is only way of treatment. Despite its infrequent occurrence, aorto-caval fistula should always be considered in any case of ruptured abdominal aneurysm.

INTRODUCTION Post-transplantation hypertension is one of the most important factors with negative influence on survival of a graft and a patient. The objective of this study was to evaluate the influence of donor's age on hypertension and the outcome in living-related transplantation of the kidney. METHODS The research included 52 recipients of the graft, 30 women and 22 men who received living-related kidney graft in the time period of 1999 to 2004. In the while control group consisted of recipients of graft who's donors were younger than 55. Age and sex of the donor, glomerular filtration rate of the donated kidney, dialysis treatment, kidney disease and number of months after transplantation were monitored. Blood pressure was measured once a day and average monthly value was assessed. Creatinine clearance was evaluated once in six months period. Functional kidney graft after 60 months was considered the one with serum creatinine < or = micromol/l. Statistical analysis included t test, Fisher's exact test, chi-square test, Kaplan - Meier curve and multivariate logistic regression. RESULTS Experimental group included 23 examinees who received grafts from donors 55 years old and above (18 men and 5 women, average age 34.86 +/- 6.54, who have been treated for 35.33 +/- 37.59 months) while control group included 29 examinees (16 men and 13 women, average age 31.69 +/- 10.5, who have been treated for 21.03 +/- 25.59 months). Average age of the donors in the experimental group was 62.43 +/- 4.10 and 45.31 +/- 5.24 in control group. Mean creatinine clearance of the donated kidneys was 47.87 +/- 10.5 ml/min in experimental group and 51.19 +/- 10.1 ml/min in the control (p = 0.005). Sixty months after transplantation graft was functional in 32.69% recipients of the experimental group and in 82.75% recipients of the control group. The average systolic blood pressure in test group was 146 +/- 20 mm Hg, and in the control 129 +/- 16 mm Hg (p < 0.001). Average diastolic blood pressure was 90 +/- 11 mm Hg in experimental group, and 83 +/- 10 mm Hg in the control (p < 0.03). CONCLUSIONS Age of the donor has significant influence on long-term survival of the kidney graft in the living-related transplantation. Survival of the graft in examinees without hypertension is significantly longer. Treatment of post-transplantation hypertension is one of the most important tasks in the treatment of patients with transplanted kidney.

INTRODUCTION Accurate information about the cause of death is given by expert teams based on pathological or forensic expertise. Reliable information can be obtained from doctors from clinical-hospital institutions if the deceased person was treated in such an institution and with previously diagnosed disease (hospital mortality). Analysis of hospital mortality provides a lot of data that can be used in planning the hospital beds capacities, the amount of drug procurement, purchasing equipment, organization and creation of highly specialized medical teams (medical team for resuscitation), the number of reanimation techniques, the number of pathologists who are required for autopsy procedures, etc. GOAL was to determine the total number of deaths, the most common causes of death and the 10 leading diagnoses of deceased patients at the Clinic for Internal Medicine of Clinical Center in Tuzla during 2008. MATERIAL AND METHODS We used the material from the archive (medical records and reports on deceased patients, delivered by physicians working at the Clinic for Internal Medicine of Clinical Center in Tuzla). RESULTS During 2008 at the Clinic for Internal Medicine 368 patients died. According to the analyzed data leading cause of death and leading diagnosis as cause of death at the Clinic for Internal Medicine in 2008 were as follows: cardiogenic shock in 73 (19.84%), cerebrovascular stroke in 46 (12.50%), coma due to stroke in 32 (8.70%), coma not classified as cerebral in 25 (6.79%) (metabolic 13 (3.53%) and hepatic 12 (3.26%), cardiomyopathy in 22 (5.98%), malignant neoplasm of the abdomen in 17 (4.62%), respiratory insufficiency in 17 (4.62%), acute myocardial infarction and myocardial infarction with rupture in 17 (4.62%), pulmonary edema in 16 (4.35%), and cardiorespiratory arrest in 13 (3.53%) deaths. CONCLUSION During 2008 at the Clinic for Internal Medicine of Clinical Center in Tuzla died a total of 368 patients. The most common cause of death of patients at the Clinic for Internal Medicine of Clinical Center in Tuzla are cardiovascular disease (n = 175; 47.55% of deaths), in second place was cerebrovascular disease (n = 76; 20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascular and cerebrovascular disease.

INTRODUCTION Post-transplantational hypertension is one of the most important factors which has negative influence on survival of a graft and a patient. The objective of this study was to evaluate the influence of donor's age on hypertension and the outcome in living-related transplantation of the kidney. METHODS The research included 52 recipients of the graft, 30 women and 22 men who received living-related kidney graft in 5 years period. In experimental group there were recipients of grafts who's donors were 55 and older, and in control group recipients of graft who's donors were younger than 55. Age and sex of the donor, glomerular filtration rate of the donated kidney, previous dialysis treatment, kidney disease and number of months after transplantation were monitored. Blood pressure was measured once a day and average monthly value was assessed. Creatinine clearance was valuated once in six months. Functional kidney graft after 60 months was considered the one with serum creatinine < or = 150 micromol/l. Statistical analysis included t-test, Fisher's exact test, chi-square test, Kaplan- Meier curve and multivariant logistic regresion. RESULTS Experimental group included 23 examinees who received grafts from donors 55 years old and above (18 men and 5 women, average age 34.86 +/- 6.54, who have been treated for 35.33 +/- 37.59 months), and control group of 29 examinees from donors younger than 55 (16 men and 13 women, average age 31.69 +/- 10.5, who have been treated for 21.03 +/- 25.59 months). Average age of the donors in experimental group was 62.43 +/- 4.10 and 45.31 +/- 5.24 in control group. Mean creatinine clearance of the donated kidneys was 47.87+/- 10.5 ml/min in experimental group and 51.19 +/- 10.1 ml/min in the control (p = 0.005). Sixty months after transplantation graft was functional in 32.69% recipients of the experimental group and in 82.75% recipients of the control group. The average systolic blood pressure in experimental group was 146 +/- 20.00 mmHg, and in the control group 129 +/- 16.00 mmHg (p < 0.001). Average diastolic blood pressure was 90 +/- 11.00 mmHg in experimental group, and 83 +/- 10.00 mmHg in the control (p < 0.03). CONCLUSIONS Donor age has significant influence on long-term survival of the kidney graft in the living-related transplantation. Survival of the graft in examinees without hypertension is significantly longer. Treatment of post-transplatational hypertension is one of the most important tasks in the treatment of patients with transplanted kidney.

Several criteria are necessary to meet in order to have the diagnosis of Balkan endemic nephropathy established. One of them is tubular proteinuria type that may be found, but not in the early stage of the disease. Beta 2 microglobulin may be found in the early stage, but its determination is rather cumbersome and not suitable for a daily routine. Therefore, urinary albumin/creatinine ratio was determined in 8 patients (all females, aged 58,37±4,37 years) from the town of aamac region (Bosnia and Herzegovina) as a measure of albumin excretion in order to establish useful marker in the early stage of the disease. Increased urinary albumin/creatinine ratio, was found in 50% of BEN patients. According to these preliminary results, microalbuminuria could be used as the reliable marker for the early detection of BEN.