Received: 22 Jul. 2017 Accepted: 20 Oct. 2017

Introduction: Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate. Aims: To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists. Methods: We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1st 2015 and October 31st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis). Results: 1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012). Conclusion: We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.

There are different kinds of foreign bodies that people aspirate. It depends on diet and the customs of the community. Almost the largest percent of accidental deaths in children under the age of 5 goes consists of Foreign Body Aspiration (FBA)1. However, a number of adults live with FBA, and foreign body can remain undetected for a long period of time2. A spoon in the bronchus has rarely been described as a FB, and never as a weapon of suicide so far. As an FB, spoon is always taken through oral route, and located in different parts of the digestive tract. When a large foreign body is aspirated, the result can be acute respiratory distress and, sometimes, even death. Also, foreign body aspiration can mimic other illnesses, causing some difficulties in diagnosis, e.g. astma3. The mortality can be reduced if a foreign body is diagnosed and removed early. Otherwise, the complications are serious and sometimes fatal4.

Introduction: Surgical and medical treatments of nasal obstruction are a common parts of otolaryngologist practice. The definitive treatment of deviated nasal septum is septoplasty. Aim: In this study was to evaluate the values of subjective parameters, and active anterior rhinomanometry parameters prior and three months after the septoplasty. Patients and Methods: We analyzed the subjective parameters (“NOSE” scale), the active anterior rhinomanometry parameters according to International Committee on Standardization of Rhinomanometry, on 40 patients. Thirty healthy adult volunteers participated belonged to the control group. None of the patients or healthy volunteers had previous history of nasal surgery or active rhinological disease. Results: The post-operative improvement in symptoms of nasal obstruction obtained in 92,5% patients and improvement parameters of the active anterior rhinomanometry in 42,5% patients. Conclusion: The correlation between the findings with rhinomanometry and subjective sensation of nasal patency remains uncertain. There still seems to be only a limited argument for the use of rhinomanometry for quantifying surgical results. Three months postoperative findings are very early results to interpret the permanent effects.

OBJECTIVES This study aims to report our experience in the management of foreign body (FB) impaction in esophagus in the Ear-Nose-Throat Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina. PATIENTS AND METHODS Seventy-one patients (44 males, 27 females; mean age 32.99±28.57 years; range 1 to 81 years) who admitted to our clinic between January 2003 and December 2013 with a history of a FB in esophagus were retrospectively analyzed including head and neck examination. All patients were performed rigid esophagoscopy under general anesthesia. RESULTS A total of 32 FBs were detected in children (23 males, 9 females; mean age 4.6 years; range 1 to 11, mod 1) with coins being the most common (56.31%). A total of 39 FBs were detected in adults (21 males, 18 females; mean age 56.2 years; range 16 to 81) with bones and food being the most common (43.6%). Foreign bodies impacted in the upper esophageal sphincter in 87.5% of children and in 66.7% of adults. The duration of localization of FBs in esophagus was between one hour and six months. All procedures were performed without complications; the FBs were completely extracted without the requirement to repeat the procedure. CONCLUSION Our study results suggest that use of rigid endoscope is reliable in removing FBs in the esophagus.

ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion.

ABSTRACT Introduction: Lung cancer is most common cause of cancer-related mortality worldwide. Non-small-cell lung carcinoma (NSCLC) is disease with very low 5-year relative survival rate. For patients with non-small cell lung cancer, roles of current treatments are to prolong survival time and to improve quality of life. Aim: The aim of the work was to compare values of Glasgow Prognostic Score (GPS) before application of the chemotherapy medication with response to chemotherapy and toxic side effects associated with chemotherapy in patients treated with cisplatin-etopozid (PE) and cisplatin-gemcitabin (PG) in stages IIIb and IV of NSCLC. Testing role of Glasgow Prognostic Score as a possible predictor of response to therapy and toxic side effects of chemotherapeutic protocol was another aim of this work. Patients and methods: This prospective study included 60 patients in stages IIIb or IV of NSCLC, with ECOG ≤ 2. The patients were divided in two groups. First group contained 30 patients treated with chemotherapeutic protocol using cisplatin-etopozid (PE), and the same number of patients in the second group were treated with cisplatin-gemcitabin (PG). Results: Glasgow Prognostic Score (GPS) evaluation before the chemotherapy inclusion showed values of 1 (43.30:53.30), then 2 (40.00:36.70) and the lowest 0 (16.70:10.00) which supports the pathological values of GPS in developed lung cancer, i.e. most patients had pathological GPS value in both protocols (83.30:90.00). Monitoring of toxic side effects and response to chemotherapy was done after each cycle of treatment. Discussion: Results of this study revealed importance of GPS in selection of patients for treatment with chemotherapy. Patients with lower values of GPS treated using PE chemotherapeutic protocol had weaker response to therapy. Conclusion: Coefficient of correlation for therapy response in both chemotherapeutic protocol, compared with values of GPS before treatment, were not statistically significant, therefore GPS cannot be considered as a predictor of therapeutic on chemotherapy.

Objective – Teratomas with sacrococcygeal, mediastinal and gonadal locations are the most frequently occurring pediatric germ cell tumors. Cervicofacial and intracranial locations are rare. Approximately 20% of giant cervical teratoma causes airway compression. We report a congenital cervical teratoma with partial airway compression diagnosed post-natally in a preterm infant. Case report – A 27 year old mother delivered a male infant at 35 weeks gestation after her first uneventful pregnancy. The newborn had a notable anterior neck mass measuring 4x5 cm. The alpha fetoprotein level was elevated at 317.5 ng/ml and I²-HCG was less than 1.2 mI U/ml. An MRI scan showed a 24x53x27 mm prelaryngeal and paratracheal solid-cystic mass compressing and shifting the larynx and trachea to the right. The tumor was approached via a wide collar incision. It did not communicate with the oesophagus, trachea or thyroid gland and did not infiltrate the surrounding tissues. It was completely excised. Pathological examination revealed an immature teratoma. The recovery was uneventful. Conclusion – Teratoma in infancy may present in an unusual cervical location. Not only giant tumors may compress the airway.

Malignant tumors of the thyroid gland account for about 1% of thenewly diagnosed malignant tumors each year, and their incidence inwomen is twice the incidence in men. According to the WHO classification (2004) thyroid tumors are divided into: carcinoma of the thyroid,adenoma and similar tumors, and other thyroid tumors whichinclude: teratomas, angiosarcomas, paragangliomas and others, as wellas primary lymphomas and plasmacytomas. Primary thyroid lymphomasare defi ned as lymphomas which originate in the thyroid gland.Th is study presents the case of a 68-year-old patient with a thyroidlymphoma, which caused compression of the airways. In the patientpresented there was reduced activity of the thyroid gland. Th e dominantsymptoms were: breathing diffi culties, hoarse voice and the enlargementof the thyroid. An ultrasound examination was performedbefore surgery on the neck, which showed a multinodular thyroid,with compromised and compressed trachea to the right and rear. Anemergency surgical procedure was performed to reduce the tumor.Pathohistological diagnosis confi rmed diff use large B cell lymphoma.Th e aim of the study was to present a patient with a thyroid lymphoma,who had previously not had any immunological changes to the gland,that is, she had not had any chronic lymphocyte thyroiditis, but due tothe compressive syndrome it was necessary to perform an emergencysurgical procedure to reduce the tumor.

INTRODUCTION AND AIM The aim of this study was to quantitatively evaluate serum concentration of alpha 1-antitrypsin (A1AT) in patients undergoing surgery of head and neck malignant tumors. PATIENTS AND METHODS Fifty patients undergoing surgery because of head and neck tumors in the years 2007-2008 were analyzed. Serial determinations were performed in all patients in three times: preoperative day--A1AT1; first postoperative day--A1AT2, and thirtieth postoperative day--A1AT3. Concentrations of A1AT were determined by nephelometry method. RESULTS The patients' age varied from 39 to 86 years, 46 male and 4 females. Serum values of A1AT in patients with stage III and IV are statistically significant elevated after operation (and after one month), but in patients with lower stages (I and II) there were not. In patients with laryngeal malignancies recorded statistical significant elevation of serum values of A1AT postoperatively (and after one month). Other tumor locations did not recorded the same results. CONCLUSION The above results suggest that measurements of A1AT may have an ancillary role in the diagnosis and monitoring of head and neck tumors.

Background: The most comon patohistologi-cal finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. Objective: To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Methods: Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoid-ectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. Results: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chisquare test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. Conclusion: The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.