AIM To analyze a change of level of nautriuretic peptide (NT pro- BNP) caused by stress distension of myocardial wall in cases of acute myocardial infarction (AIM), as a possible predictor of early heart failure. METHODS Patients with myocardial infarction were followed up. Standard clinical and laboratory examination, including NT pro- BNP, and other laboratory analyses, were performed on the day of admission, the next day and on the eighth day of hospitalization. Statistical analyses included variance for repeated measurement (ANOVA), factorial multivariate analysis and test of multiple correlations. RESULTS The most important predictors of early heart failure in acute myocardial infarction were age, diastolic blood pressure, creatin kinase (CK) on admission, larger field of infarction zone and so on. Multiple correlations showed statistically significant correlation of age, diastolic pressure and larger zone of myocardial infarction with an increase of NT pro-BNP concentration. The activity of CK on the day after admission was higher than on admission (p=0.02) and myocard-binding CK (CK-MB) the next day after admission was higher than on admission (p=0.016). A statistically significant increase was found on the next day for NT pro-BNP in comparison with the value on admission (p=0.0049), but the level of activity of CK was markedly decreased on the eighth hospital day. CONCLUSION The significant increase of the concentration of NT pro-BNP during myocardial infarction is an important predictor of early heart failure, therefore, in case of a significant increase of NT pro-BNP in the early phase of the infraction a therapy that could prevent clinically relevant heart failure should be administered .

BACKGROUND: Pulmonary embolism (PE) is many times life treating disease, and the diagnosis should be achieved as soon as possible. Presence of fever may be or not present at the start of PE. Haemoculture should be performed any time if PE is linked with fever. It is very important to check out any symptom and sign of PE. D-dimmer may only exclude the diagnosis, but for this purpose it is very important. AIM: To analyze the most important predictors for clinical course and outcome of septic or no septic PE: METHODS: Patients with PE treated in Department of Pulmology in General Hospital Tesanj. PE was considered if Geneve score was five points or more. For any patient CT scan of the chest, chest X-ray at admission, and 4th, 7th and 14th day of hospitalization. Lactat-dechidrogenase, Creatin-kinase, CRP, D-dimmer, ECG and blood gas analyzes were performed, so. RESULTS: During one year of follow up 36 patients were considered for PE, according to Geneve score, among them 11 with septic embolie. In patients with no septic PE no changes on control Chest X-ray were seen, but in any of septic ones X-ray appearance showed progression. Other parameters were nearly the same, with moderate higher level of CRP in PE. The gold standard for diagnosis of PE rest double scintigrafic imaging of the lung, with ventilation and perfusion phase. D-dimmer is very useful parameter to exclude if PE is not occurred. CONCLUSION: The most important parameter to distinguish septic or no septic PE was dynamic changes of chest X-ray appearance with substantial more progression in septic than in non septic ones.

Molecular regulatory mechanisms of lung cancer initiation and progression are poorly understood. Role of micro RNA (miRNA) 19a in lung cancer is still controversial, as well. Treatments of non-small-cell lung cancer (NSCLC), particularly of the squamous subtype are limited. However increasing evidence point many molecular markers as potential prognostic and therapeutic tools. Purpose of this study was to evaluate differences in miR-19a, as well as miR-126 and let-7b expression profiles between NSCLC tumor tissue and healthy lung tissue. Also, the purpose was to evaluate the relationship of miR-19a, miR-126 and let-7b expression to survival outcomes in NSCLC patients but to evaluate the differences of their prognostic values between squamous and adenocarcinoma subtypes. 50 non-small lung cancer patients (32 squamous and 18 adenocarcinoma) and 45 healthy individuals were included. miRNA expression was detected by quantitative real-time polymerase chain reaction. Microvascular density was immunohistochemicaly quantified by factor VIII-related antigen. One- and two-years survival outcomes were observed. Expression of anti-angiogenic miR-19a, miR-126 and let-7b were significantly lower in tumour tissue compared to control lung tissue. Low miRNAs expression correlated with worse progression-free survival in both squamous and adenocarcinoma of the lung. Poor overall survivals were associated with low miRNAs expression only in the squamous lung cancer. Besides miR-126 and let-7b, our observations confirm also anti-angiogenic role of miR-19a in NSCLC patients and suggest the potential new target therapy in squamous lung cancer.

BACKGROUND: Effectiveness of SIT was well documented in many cases and published data. Selection of patients for SIT should be very serious and must include skin test and total and specific IgE measurement. How outcome of SIT correlate with changes of IgE, skin reactivity and overall symptoms reduction is aim of this study. MATERIAL AND METHODS: Skin testing, total and specific IgE measurements were performed before and after each year of treatment. Skin test assessment was performed according to recommendation of Manual of Laboratory immunology. IgE ws performed using ELISA method. Clinical outcome was assessed using AQLQ questionnaire. RESULTS: During five years period 58 asthmatic subjects with home dust and dermathophagoides allergy were treated by SIT. Bseline total IgE was 488,5 IU/ml (SD 78,9), mean specific IgE against dermatophagoides pteronissimus was 36,5 IU/ml (SD 15,2). Subcutaneous tests showed 15-20 mm weal in 43, and more than 21 mm in 15 cases. After 5 years mean total IgE was 227 IU/ml (SD 9,2) and mean specific IgE was 28,2 IU/ml (SD 8,9). Skin tests showed decrease diameter of weal. In 49 out of all patients clinical outcome were very well, and in 9 satisfied (according to AQLQ questionnaire). Using test of correlation, by linear regression, better correlation was shown between of skin testing and AQLQ than in total or specific IgE. So, in vivo skin tests were better predictor for success of SIT, than measurement of IgE. CONCLUSION: Results of skin tests in diagnostic assessment of allergy in asthmatic patients were better predictor of successful outcome of SIT than laboratory measurement of total and specific IgE.

Aim: To study the influence of C-reactive protein (CRP) level in the blood, fibrinogen level and general inflammatory syndrome as the predictors of development of secondary fibrosis in patients with pulmonary tuberculosis (TB). Methods: Concentration of CRP, fibrinogen level was measured using immunoturbidimetric methodIncluding criteria was presentation of TB process in both lungs, as the sign of widespread TB process. Results: We examined 85 patients treated in one year. Mean CRP level was 22,6 mg/mL, range 5-245 mg/mL; normal level (up to 8 mg/mL) was measured in 23,4% patients, medium level (9-20 mg/mL) was measured in 31,3% patients, high level (21-50 mg/mL) were measured in 26,2% patients, and in 23,7% patients CRP were higher than 50 mg/mL. Average fibrinogen level in whole group was 6,9 g/L (SD 5,8). Normal level of fibrinogen (up to 4 g/L) were measured in 6,4% of patients; 4,1-1,0 g/L were measured in 24,6% patients, 10,1-20 g/L were measured in 31,1% patient and level more than 20 g/L were measured in 37,9% patients. Using statistic method of partial correlation statistical significane at level p<0,05 was shown between them. Correlation of CRP and fibrinogen level with appearance of fibrosis on X-ray of the lung was shown. Thereafter, closer correlation was shown with fibrinogen and fibrosis than with CRP and fibrosis. Conclusion: Predicted value of CRP and fibrinogen for pulmonary fibrosis was shown in TB patients. So, attenuation of fibrosis development, possible with antifibroblastic activity of pentoxyphyllin, should be taken in consideration, for prevention of widespread development of lung fibrosis in these patients.

Objective: The primary goal of this study was to determine the difference of abundance of CD4+, CD8+ and CD56+ bronchoalveolar fluid’s lymphocytes and their subpopulations between cancerous lung and healthy lung from the same patient. Methods: Mini-bronchoalveolar lavage was taken from 55 patients from lung with cancer and healthy lung. After laboratory processing and addition of CD4, CD8, CD27, CD28 and CD56 antibody, the material was analyzed by flow cytometer. Results from lung with cancer were compared to the ones from the healthy lung. The examined patients were the test and the control group at the same time. Results: CD27+28+ forms of CD4+ and CD8+ lymphocytes are more activated in the cancerous lung compared to healthy lung, while the CD27-28- forms are less activated in diseased lung. CD4+ forms of CD56+ lymphocytes are more activated in cancerous lung compared to the health lung, while the CD8+ forms are less activated in diseased lung. Conclusion: Immature helper and cytotoxic T lymphocyte response, as well as regulatory NK and NKT cell response are more activated in cancerous lung compared to the health lung of the same patient.

AIM To determinate the difference of abundance of CD4+, CD8+ and CD56+ bronchoalveolar fluid's lymphocytes and their subpopulations between non- and small cell lung cancer. Also, the differences of abundance of examined lymphocytes were compared between main clinical stages of lung cancer. METHODS Mini-bronchoalveolar lavate was taken from lungs of 55 patients with cancer. After laboratory processing and adding CD3, CD4, CD8, CD27, CD28 and CD56 antibody, the material was analysed by flow cytometer. Results of Mini-BAL for non- and small cell lung cancer were compared, as well as the different clinical stages of the disease. RESULTS Immature and regulatory forms of lymphocytes are more activated, while mature and activated forms are less activated in small cell lung cancer compared to non small type. With an increase of the clinical stage of disease, immunological reaction of T lymphocytes is better expressed because of increasing of abundance of immature and regulatory forms of different subpopulations of lymphocytes. CONCLUSION All components of local CD4+ and CD8+ T lymphocyte, as well as NK and NKT cells response were more activated in lungs with small cell lung cancer, and these reactions were more expressed with an increase in the clinical stage.

AIM To analyze usefulness of measurement amino-terminal pro-B type natriuretic peptide of (NT pro-BNP) as the one of parameters of water overload in patients with chronic kidney diseases. METHODS A total number of 277 patients with chronic kidney diseases (CKD) were followed up in the period often years between January 2000 and July 2010. Patients with creatinine clearance of 60 ml/min or less were included in the study. Changes of creatinine clearance, and in last five years changes of NT pro-BNP were followed. Water overload was analyzed using chest x-ray in relation with concentration of NT pro-BNP in the blood. RESULTS Decrease of clearance of creatinine ranged from average 54.7 ml/min in the first year to 14.6 ml/min in the fifth year of the monitoring. Average NT pro-BNP level in patients without any sign of water overload was 94 pg/ml (SD 21), mean value in those with Kerley lines was 231 pg/ml/L (SD 64), in those with clear signs of water overload but without pleural effusion it was 525 pg/ml (SD 223), and in those with water retention including pleural effusion it was 1606 pg/ml (SD 1134). Using test of multiple correlation a statistically significant correlation between X-ray signs of water overload and NT pro-BNP concentration was shown, p < 0.05. CONCLUSION Measurement of NT pro-BNP was increased in the beginning of water overload in patients with CKD. Increased value of NT pro-BNP may be found earlier than any other signs of water overload. NT pro-BNP was a useful parameter in estimation of water overload in these patients.

BACKGROUND Pain in the lower abdomen is one of the leading reasons that lead the patient in surgery. Although appendicitis is the most common cause in about two thirds of patients the other causes must be taken into account. OBJECTIVES To determine the probabilities which could determine what is an etiological cause of pain. MATERIALS AND METHODS comprised 102 patients hospitalized in general hospital Tesanj because the clinical symptoms dominated by acute pain in the lower abdomen. The study was retrospective prospective clinical study. All data were collected in a special database and statistically analyzed. RESULTS Of all the causes of abdominal pain in the lower abdomen the most common is appendicitis with a total of 62 patients, of which slightly more male patients (36) compared to female patients (26) or (57% male and 43% female patients). If we analyze the time elapsed from pain onset to patient visit of physician we can say that patient with more intense pain will visit physician sooner. Colic and intense pain is a characteristic of colon cancer (15 patients) and Crohn's disease. Dull pain is characteristic of omentum cyst, diverticulitis, and intestinal obstruction and was seen in one fifth of patients with colorectal cancer and one third of patients with acute appendicitis. Palpatory positive pain in Mc Burney's point distinguishes appendicitis from other causes in most cases. DISCUSSION The decision-making in the treatment of abdominal pain is depending of nature of pain, intensity, spreading, and sensitivity to palpation and localization of pain that usually indicates the place where the sick organ transmits the inflammatory process to the parietal peritoneum. Other symptoms that accompany pain and laboratory tests can be of crucial importance.

Acute appendicitis is one of the most common causes of acute lower abdominal pain. However, there are other diseases that can cause pain and mimic acute appendicitis. Some of these conditions are treated surgically; however, some of them should be treated conservatively. Therefore, the treatment of diseases associated with a number of decisions made by doctors and patients. The decision making is divided into three levels. At the first level, the patient and his family are to decide that patient should go to visit physician. At the second level is a physician in primary health care, who decides whether a patient deserves conservative or operative treatment. If he think that it is necessary to forward patient to the hospital, the other specialist: surgeons, urologists and gastroenterologists are involved in the decision making process. At the third level are decisions about the future treatment of the patient. The patient can be sent to home treatment, control exam could be appointed, patient cold be operated or observed. For decision making process physicians use information collected from patient’s history, physical examination of patients, laboratory tests and radiological examinations.

One of the most common causes of acute pain in the lower abdomen is appendicitis and covers almost two thirds of the total number of hospitalized patients. The survey included all patients who have pain in lower abdomen and came to the review at the Polyclinic Doboj-South and General Hospital Tesanj during 24 working hours. The sample consisted of 101 patients hospitalized at the General Hospital Tesanj with the clinical picture dominated by acute pain in the lower abdomen. Taken into account are all relevant clinical parameters necessary for establishing rapid etiological diagnosis of acute lower abdominal pain. So we can say that appendicitis has the following characteristics: pain is gradual, increasing in duration from 8 to 16 h, localized in the lower right quadrant, or begins in the epigastrium and is descending into the lower right quadrant and spreading in a large percentage of proximal dorsal and then the inner part of the thigh. Accompanied by nausea, vomiting, with a statistically significant increase in leukocyte levels over 10000 and pathological findings in urine. The difference between rectal and axillary temperature was statistically significant. Palpatory positive painful in Mc Burney spot. Patients are usually younger than 30 years.

Gall disease and gall tract diseases, except anamnesis characteristics, physical examination and biochemical findings, require application of modern visual technology which with its high sensitivity and specificity allows quick, accurate and verifiable diagnosis and favorable outcome of disease, a false positive and false negative findings are reduced to a very low percentage. Data from the literature shows the sensitivity of Transabdominal ultrasound (TUS) up to 90% and specificity from 20 to 85%, while CT shows sensitivity up to 87% and specificity up to 90%. In our research, which included 366 patients with gall and gall tract pathology and 147 of them were treated surgically, shows TUS sensitivity up to 87.5%, but the low specificity of 28.5%, mainly caused by a large number of patients with gall tract pathology. CT shows high sensitivity of 100% and 100% specificity, which diverge from data from the literature because CT was done after TUS and with the selection of diagnostically complicated cases. In all these complicated cases surgical findings have confirmed CT diagnosis. From this we can conclude that the application of image technology allows fast and accurate diagnostic and treatment of gall and gall tracts.