To establish Advisory Board which has tasks to found the learning outcomes to educate professionally competent physicians for the needs of the public health care system. Methods of achieving this based purely on duration of study are fallible and give little information as to how graduates will perform in the workplace. To establish faculty curricula advisory board we conducted a stakeholder’s principles and stakeholder analysis. The stakeholder analysis is a method of determining the most appropriate actions to be taken. During the workshops the structure of advisory board were extensively discussed and debated. Advisory board will consist of a maximum of five persons from a group of internal and five persons from a group of external stakeholders. A Curricula Medical Advisory Board officer will be appointed in university. This Board will be the advisory body for the Faculty’s Academic Council, the Dean and the Faculty Commission for education, where applicable. A great deal of work has already been done to define stakeholders, interrelations between stakeholders, Curricula medical advisory board structure and objectives for each B and H medical faculty to develop curriculum-level outcomes/competences for medical education. Following curricula evaluation and stakeholder analysis the advisory board will oversee implementation of changes and monitor progress of the institutions progress towards fulfillment of agreed aims and objectives.

BACKGROUND/AIM The aim of this study was to establish Gastrointestinal Life Quality Index scores of patients before and after laparoscopic and open cholecystectomy comparing scores after both operations. SETTINGS AND DESIGN The 120 patients were involved in this prospective study, 51 male and 69 female, 59 of patients were underwent by laparoscopic method and rest of them, 61, by open method on Surgery Clinic on Clinical university center in Tuzla in period from February 2006 to October 2006, chosen by consecutive method. This study evaluates patients life quality according to score of Gastrointestinal Life Quality Index. METHODS Patients have been tested two weeks before the operation and in two, five and ten weeks of post-operative period. Except from Gastrointestinal Life Quality Index total score, established scores,a parts of life quality are: symptoms, physical function, emotional and mental status and also social activities. STATISTICAL ANALYSIS USED For analysis of achieved results, SPSS (Statistical Package for Social Sciences, V 10.01) program with statistical parameters was used: average values and standard deviation. Out of statistical tests, we used Chi-square test and Student t-test. Values p < 0,05 have been accepted as statisticaly significant. RESULTS The results of the study confirm a working hypothesis that patients life quality after two and five weeks of postoperative period is significantly better (p < 0.05) in laparoscopic method group versus open method group. Also, in domains Gastrointestinal Life Quality Index symptoms, physical function, emotional and menthal status and social activities results are significantly better (p < 0.05) in the laparoscopic cholecystectomy group than in open method cholecystectomy group. Ten weeks of post-operative period, results showed that these two groups have no difference in life quality in total score, also in domain score. CONCLUSION This comparative study between laparoscopic and open cholecystectomy according to patients life quality aspects confirms advantages of laparoscopic technique in comparison to open cholecystectomy method.

Introduction: Hemostasis is a very important mechanism, whose changes may cause various complications. In the course of surgical interventions some changes in the system of coagulation occur. Laparoscopic cholecystectomy is the method of choice in the treatment of gall-bladder calculosis. In the course of the procedure, the parameters of hemostasis change, and this leads to the possible appearance of thromboembolic complications. The aim of the study was to reveal the changes in the system of coagulation in patients treated by laparoscopic cholecystectomy. Patients and methods: The study included a total of 60 patients, divided into two groups, who were treated either by the classical or the laparoscopic method. The parameters of primary and secondary hemostasis were determined for the patients of both groups at the Polyclinic for Transfusiology, UCC Tuzla, before and during the operation and 24 hours and on the 5th day after the surgery. Results: The changes were more expressed in the group of the patients treated by laparoscopic cholecystectomy. A very important result was the increased value of D-dimer measured on the 5th day after the operation in the patients operated by laparoscopic cholecystectomy, whose value was 2.5 times higher in relation to the preoperative value (263.5 µg/l, so it was beyond the limits of the reference values). Conclusion: Our results suggest that there is increased fibrinolytic activity after laparoscop ic cholecystectomy, which demands more detailed and complete study on thromboembolism prophylaxis.

UNLABELLED Anatomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. THE AIM of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). MATERIAL AND METHODS The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. RESULTS AND DISCUSSION Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form ofv. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. CONCLUSION The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.

Background. Disorder of hemostasis in hemodialysis patients is focused in two directions, towards the development of thrombosis and bleeding. Both complications make it difficult to treat and are life-threatening for the patient.  Monitoring of hemostatic parameters, it is possible to detect the first changes in the coagulation system and correct the factors that lead to changes and thus prevent or stop the further development of complications. Aim. To determine the hemostatic and dialysis parameters and their influence on the occurrence and development of complications. Patients and methods. From a total of 175 patients, 46 had signs of hemorrhagic syndrome and 16 of them had thrombosis. Parameters of primary and secondary hemostasis were determined and vascular access of ultrasound was examined. Results. In the patients with thrombosis D-dimer level was significantly higher and amounted to 4.18 mg / l, while AT III levels were decreased for 54%. Elevated level of APTT was significant for the patients who had bleeding. In 86% of patients with thrombosis, ultrasound findings correlated with findings of D-dimer. Both complications were more pronounced in the older age group above 46 years. Conclusion. Hemorrhagic syndrome is a frequent complication of thrombosis. The level of D-dimer is directly correlated with ultrasound detection of thrombotic formation. Elevated levels of APTT was in direct correlation with bleeding. The development of complica-tions are affected by other factors, such as: age, access type, type of dialysis membrane, the blood flow. Frequent control of hemostatic parameters is essential for early detection of complications. In the event of changes in coagulation system, type and dose of anticoagulant should be corrected and introducing additional oral anticoagulants should be considered.

Endothelin 1 (ET-1) is vasoactive peptide that acts via ET-A receptors coupling inducing vascular smooth muscle cell proliferation and contraction. ET-1 is involved in the development and maintenance of hypertension. Aim of this study was to determine the contribution of Ras farnesyl transferase, mitogen activated protein kinase (MAP kinase) and cytochrome P¬450 (CYP450) metabolites to ET-1 induced hypertension. ET-1 (5 pmol/kg per minute) was chronically infused into to the jugular vein by use of mini-osmotic pump for 9 days in male Sprague-Dawley rats. Mean arterial blood pressure (MABP) in ET-1-treated rats was 154±2 mm Hg (hypertensive rats) compared with 98±3 mm Hg in control (normotensive) rats. Infusion of Ras farnesyl transferase inhibitor FPTIII (138 ng/min), MAP kinase inhibitor PD-98059 (694 ng/min) and CYP450 inhibitor 17-ODYA (189 ng/min) significantly attenuated MABP to 115±2.5 mm Hg, 109±3 mm Hg and 118±1.5 mm Hg, respectively. These results suggest that CYP-450 metabolites and Ras/MAP kinase pathway contribute to the development of ET-1 induced hypertension. Further investigation has to be done to confirm whether activation of RAS/MAP kinase pathway by arachidonic acid metabolites plays an important role in the development of ET-1 induced hypertension.

BACKGROUND: Heart failure is a common disease that requires frequent and long hospitalizations, the active participation of health workers and family members in the care of such patients, and it leads to reduction of physical activity and lifestyle changes with the patient, which significantly affects the quality of life of patients with heart failure. OBJECTIVE: To determine the quality of life of patients with heart failure in relation to severity of the clinical features. RESPONDENTS AND METHODOLOGY: Analysis of life quality was performed for 120 patients suffering from heart failure, both genders, all age groups in relation to severity of the clinical features. Patients were divided into 4 groups according to NYHA classification of heart failure. The control group consisted of 10 subjects who do not suffer from heart failure. Assessment of quality of life was performed using the SF-36 questionnaire which consists of 8 segments classified in the dimension of physical and mental health. RESULTS: Study group consisted of 130 participants with heart failure had 66 (51%) of male, and other were females, divided into 4 NYHA groups, where every group had 30 subjects (23.1%), and one control group of 10 subjects (7.7%). The analysis of gender and age distribution within the groups found no statistically significant difference (X2=1.70; df=4; p=0.79), (ANOVA; F=0.74; p=0.57). The values of SF-36 score expressed as the median in the control and 4 NYHA groups were decreasing as the functional class progressed. The Spearman Correlation Coefficient showed that there is a strong negative correlation between the scores of SF 36 (total, segments and dimensions) and heart failure expressed through the NYHA classes. CONCLUSION: Quality of life in patients with heart failure was exacerbated and associated with severity of the clinical features.

UNLABELLED The adolescent idiopathic scoliosis - AIS over 40 degrees measured by Cobb, are treated by surgery. Most frequently are used corrective spondylodesis by Harrington (with hooks), by Luqe (with wires), anterior spondylodesis (with transcorporal screws). In last two decades, the posterior corrective spondylodesis by transpedicular screws is popularized. Aim of this work is to present advantages and disadvantages of posterior corrective spondylodesis of scoliosis. METHODOLOGY Twenty-three patients have been included in this study, average age of 15 y. (10-32), and mostly female gender. The dynamic and quality of postoperative flow after posterior corrective spondylodesis have been analyzed at the AIS patients on the Dept. of orthopedics and traumatology, Clinical centre University of Sarajevo during last three years. RESULTS The length of postoperative hospitalization in the analyzed group was 7 days, compared with results achieved by other methods. Faster recovery, returning to life activities, final esthetic and functional result were superior, and there was no need for revision surgery. CONCLUSION of this work is that posterior corrective spondylodesis by transpedicular screws at the AIS patients is method of choice, if all requirements of correct performing of that method are met.

UNLABELLED Pancreatic tumor is one with the worst prognosis of all cancers, and the tenth most frequent cancer in Europe, making the 3% of all cancers affecting both sexes. Most patients seek treatment when the disease is in its advanced stage and the level for possible resectability is low. Late presentation of the disease is responsible for the short survival period of 6 months and a five-year survival of 0.4 to 5% of patients. At the Clinic for Surgery in Tuzla during period from January 1st 1996, to January 1st 2011, a total of 127 resection surgeries were performed due to malignant tumors. The goal of this study was to show that adequate assessment of operability, proper surgical strategy and modern techniques of creating anastomoses reduces morbidity and mortality, results in fewer postoperative complications and contributes to better surgical results. In our study sample the most common place of tumor location was the head of pancreas, in 69 (59.7%) patients. Men develop this type of cancer more often than women in the ratio of 2:1, while the median age of patients was 62 years. We faced postoperative complications in 37 (29.1%) patients, pancreatic fistula being the most prevalent complication, occurring in 16 (12.6%) patients. Overall early and late postoperative mortality was observed in 12 (9.8%) patients. CONCLUSION Patients with chronic and hereditary pancreatitis are at a higher risk for developing pancreatic cancer and should be screened for the purpose of early diagnosis. The staging of pancreatic cancer has improved, with the accuracy of 85-90%. Postoperative complications, morbidity, and mortality are significantly reduced (p < 0.05) if the standardized operational procedure is applied and if modern techniques are used to create pancreaticojejunal anastomosis as the anastomosis carrying the highest risk.

Endothelins (ETs) are a family of three peptides (ET-1, ET-2, ET-3) that are implicated in the physiological control of vascular smooth muscle cell (VSMC) and myocardial contractility and growth. ET-1 is vasoactive peptide that acts via ET-A receptors coupling inducing vascular smooth muscle cell contraction. ET-1 is involved in the development and maintenance of hypertension. Aim of this study was to investigate whether ET-1 can induce vascular smooth muscle cell proliferation through arachidonic acid (AA) metabolites formed via cytochrome P¬450 (CYP-450). VSMC proliferation was measured by [3H]thymidine incorporation in cultured cells treated by ET-1 (10 to l00 nmol/L) in presence of different inhibitors of CYP-450 (17-ODYA 5 μmol/L), lipoxygenase (LO) (baicalein 20 μmol/L) and cyclooxygenase (COX) (indomethacin 5 μmol/L). ET-1 (10 to 100 nmol/L) induced VSMC proliferation and this effect was attenuated by CYP-450 inhibitor (17-ODYA) and lipoxygenase (LO) inhibitor (baicalein) but not by cyclooxygenase (COX) inhibitor (indomethacin). CYP-450 and LO metabolites of AA, 20-hydroxyeicosatetraenoic acid (HETE) and 12-HETE increased [3H]thymidine incorporation in VSMC. Inhibitors of MAP kinase (PD-98059 50 μmol/L) and cPLA2 (MAFP 50 μmol/L) attenuated ET-1 as well as 20-HETE induced VSMC proliferation. These results suggest AA metabolites via CYP-450 mediates ET-1 induce VSMC proliferation.

Aim: The prognostic value of circulating antibodies to oxidized low-density lipoprotein (anti-oxLDL) in patients with coronary heart disease is not completely clear. We aimed to investigate the association between levels of anti-oxLDL in three groups of patients with different grades of severity of coronary heart disease. Patients and methods: The study included 101 patients classified into three groups: one (N=35) with acute myocardial infarction (AMI), a group (N=35) with angiographicallly proven coronary artery disease (APCAD), and a group without angiographicallly proven coronary artery disease (N=31) designated as a control group. Levels of IgG anti-oxLDL antibodies were meausured by enzyme-linked immunosorbent assay. Results: Mean anti-oxLDL value was significantly higher in patients with AMI than in patients with APCAS (1342.1±581.5 mIU/ml vs. 553.0±183.3 mIU/ml, p<0.001), as well as compared with control group (1342.1±581.5 mIU/ml vs. 246.5±114.3, p<0.001). Similarly, significant difference in anti-oxLDL levels was found between the patients with APCAS and control group (p<0.001). Conclusions: The present study showed that elevated levels of anti-oxLDL are positively related with a severity of coronary artery disease. Hence, elevated levels of anti-oxLDL may identify patients with unstable coronary heart disease. Oxidized LDL in circulating plasma could serve as a marker of cardiovascular events.

Background and Purpose: Investigations of the larynxes in thyrty infants during the first year of life of both sexes, randomized trial, were performed by morphological and histologic analysis. Morphometric parameters of the larynx as: length (anterolateral parameter), width (transverse parameter) and thickness (anteroposterior parameter) were determined. These parameters determine the size and shape of the larynx. The repciprocal relation parameters which determinate size of the larynx in infants and the body length are in high correlation. Therefore, the equation for calculating the size of the larynx out of the body heght was founded. Histologic characteristics of the laryngeal cartilage are constant. They indicate evident changes, that are the basis for approximate determination of a child’s age. Materials and Methods: The organs of the infants were taken from pathoanatomical autopsies. None had changes in the respiratory system. The major methods of the investigatio were anatomical macrodissection, morphological and histologic analysis and statistics. Results: The average body length in infants was 540 ± 20 mm (54 ± 2cm) and the average larynx length was 11.9± 0.3 mm. There was a correlation between these parameters p ‹ 0.01 (r = 0.75). The average value of the width of the larynx in infants was 17.7 ± 0.5 mm. The width of the larynx was in correlation with the body length p ‹ 0.01 (r = 0.79). The average value of the thickness of the larynx was 12.6 ± 0.4 mm. This parameter was correlated with the body length p < 0.01 (r = 0.82). Histological analyses results of our investigation, cartilage of the larynx in infants, show that hyalin structure is the result of age changes. Conclusion: Quantitative anatomical knowledge on the larynx in the pediatric population are necessary for the clinical orientation, particularly for choosing a suitable endotracheal tube. Size of the larynx in prematures, neonates and small children, constantly follows the external body dimensions, particularly the body height, that is confirmed by the correlation factor in its highest value. They indicate evident changes, that are the basis for approximate determination of a child’s age. Hyalin structure is in correlation to the children’s age.