Sažetak. Cilj rada bio je da se analiziraju rani rezultati operativnog liječenja bolesnika sa metastazama kolorektalnog karcinoma u jetri. Studijom su obuhvaćena 453 bolesnika operisana na Klinici za opštu i abdominalnu hirurgiju Kliničkog centra u Banjoj Luci u periodu od 01. aprila 2004. do 31. marta 2009. Metastaze u jetri imalo je 108 (23,84%) bolesnika. Kod 49 (45,37%) bolesnika one su bile sinhrone, a kod 59 (54,63%) metahrone. Kod 39 (36,11%) bolesnika postavljena je indikacija za hirurško liječenje, a kod 27 (25%) urađena je uspješna resekcija jetre. U grupi uspješno operisanih bilo je 14 (51,85%) žena, prosječne starosti 60,4 (46-75) godine i 13 (48,15%) muškaraca, prosječne starosti 66,8 (57-75) godina. Kod 16 (59,26%) bolesnika korišćena je desna subkostalna laparotomijska incizija, a kod 11 (40,74%) pristup po Makuchiju. Kod 6 (22,22%) bolesnika je urađena segmentektomija, kod 3 (11,11%) bisegmentektomija, kod 4 (14,81%) lijeva hepatektomija, kod 2 (7,41%) desna hepatektomija i kod 12 (44,44%) atipična resekcija jetre. Prosječno je operacija trajala 138 (75-265) minuta. Kod 15 (55,56%) opsežnih resekcija korišćena je tehnika hepatične vaskularne izolacije (kod 6 selektivno klemovanje portne trijade za resektovani lobus i kod 9 bolesnika intermitentno klemovanje hepatoduodenalnog ligamenta po Pringleu). Prosječno vrijeme hepatične vaskularne izolacije iznosilo je 30 minuta. Od ukupnog broja operisanih 16 (59,26%) bolesnika dobili su transfuziju krvi (u prosjeku 450 mL). Prosječna hospitalizacija je trajala 9,3 dana. Komplikacije su se javile kod 5 (18,52%) bolesnika, a nijedan bolesnik nije podlegao intraoperativno i postoperativno. Anatomske resekcije jetre sa selektivnom vaskularnom hepatičnom ekskluzijom i uz upotrebu harmoničnog skalpela ili uređaja za tkivno spajanje jesu uspješne i pouzdane metode sa minimalnim intrai postoperativnim komplikacijama.

Sažetak. Ekstenzivna hirurgija karcinoma jednjaka je najkomplikovaniji dio digestivne hirurgije i uglavnom je rezervisana za specijalizovane centre. Cilj rada bio je da se evaluiraju početna iskustva u ovoj zahtijevnoj hirurškoj problematici u Klinici za opštu i abdominalnu hirurgiju Kliničkog centra Banja Luka u petogodišnjem periodu. U periodu od 1. januara 2004. do 31. decembra 2008. godine operisan je 81 pacijent, od kojih je 61 (75,31%) imao palijativnu operaciju, a 20 operacija je urađeno s ciljem da se postigne eradikacija bolesti (R0 nivo) (25% stopa resektabilnosti). U grupi operisanih s ciljem eradikacije dominirali su muškarci (15 muškaraca i 5 žena), a većina oboljelih bila je starija od 50 godina (od 43 do 82 godine). Najčešća lokalizacija tumora bio je srednji i donji torakalni jednjak. Za supstituciju je u većini slučajeva korišćen želudac (oko 85%). Put transpozicije grafta bio je najčešće retrosternalni (za vratne anastomoze). Visoka supraaortalna intratorakalna anastomoza bila je najčešća opcija za rekonstrukciju tumora distalnog jednjaka (Ivor-Lewis) (65%). Stopa smrtnosti bila je 10%. Rani morbiditet, kod oko 60% operisanih, uglavnom su činile plućne komplikacije u vidu upala, atelektaza, izliva, pneumotoraksa. Prosječno vrijeme bolničkog liječenja bilo je 18 dana (od 15 do 25). Do trenutka objavljivanja rezultata, živih je pet pacijenata od kojih dvoje živi pet godina nakon operacije i nemaju znakova relapsa bolesti. Kod ostalih operisanih, prosječna dužina preživljavanja je 37 mjeseci (od 18 do 42) i svi su umrli od recidiva bolesti. Patohistološki nalazi pokazuju da prevladava skvamocelularni karcinom (60%), a ostatak su adenokarcinomi. Početna iskustva pokazuju stopu smrtnosti i prosječno preživljavanje koji su prihvatljivi i slični rezultatima drugih koji se rutinski bave ovom vrstom hirurgije.

In this paper we examine the effects of L-aspartate, L-glutamate, and beta-N-oxalylamino-L-alanine (Lathyrus toxin) on Retzius nerve cells of the leech Haemopis sanguisuga. The goal was to compare the electrophysiological effects of endogenous vs. exogenous amino acids, known as potent neurotoxins, through the mechanism ofexcitotoxicity. We used classical intracellular recordings on Retzius nerve cells in isolated ganglia of the leech, and plotted dose-response curves to compare potencies. Our results show that Lathyrus toxin is more than 200 times more potent in depolarizing the membrane potential on our model than L-aspartate and L-glutamate, which are approximately equipotent.

Introduction: Gastric MALT lymphoma accounts aproximately 7% of all gastric tumors. Women are mostly affected by this disease (mean age 60 years). The aim of this study was to determine the incidence of gastric MALT lymphoma in the Endoscopy Unit of the Department of Gastroenterology Of University Clinical Center Tuzla, the degree of histological malignancy and correlation with the Helycobacter pylori infection and then to evaluate the effectiveness of triple-antibiotic therapy (protonic pump inhibitors and antacides) in treatment of these cases. Patients and methods: All the patiens in the study were performed with gastroscopy and mucosal tissue biopsy in the Endoscopy Unit of the Department of Gastroenterology of UKC Tuzla. PHD and IHH analysis of the given material were performed in the Patology Department of UKC Tuzla. The blood analyses on H. Pylori were done in the Department of Microbiology of UKC Tuzla. Results: 112 patients with gastric tumors were involved in this study, 91 of whom suffered from malignant tumors, six of them had MALT lymphoma (five of them had confirmed H. pylori infection, four had histologically confirmed low-grade tumors and two was categorised as high grade malignancies). Histological lesions were classified according to the actual Ann Arbor classification. Patients with high malignancy risk underwent the operative procedures, and then were treated by polychemiotherapy (CHOP protocole, VI-VIII cikluses). All the patients with confirmed H. pylori infection were treated with antibiotics for 2-4 months, after which complete eradication was accomplished in all cases. Patients histologicaly diagnosed with low grade malignancy showed complete histological regression. In addition to that, after triple antibiotic therapy none of the patients presented with the disease transformation into another histological form. Discussion and Conclusion: The results of this study prooved high incidence in use of triple antibiotic therapy in treatment of patients who suffer from MALT lymphoma with confirmed H. pylori infection. Besides, it is very important to emphasise the fact that patients had no side-effects during polychemiotherapy which was used to treat all the patients regardless of their histological type and malignancy degree of MALT lymphoma.

Introduction: Laparoscopic appendectomy becomes a usual method in the treatment of acute appendicitis, although its advantage over open appendectomy has been proven. In Bosnia and Herzegovina, a few medical centers are introducing laparoscopic appendectomy as a method of treatment of acute appendicitis. In this study we want to compare different methods of treatment of acute appendicitis. Patients and Methods: During 20 months we have analyzed 498 patients operated due to acute appendicitis. We followed the duration of operation, total hospitalization stay, complications of surgical procedure and reasons of conversion in patients operated by laparoscopic approach. Results: The duration of operation was 96 minutes in the group operated by open approach and 107 minutes in the group operated by laparoscopic approach. Total hospitalization stay was 3.9. days in the group operated by open approach and 2.3. days in the group operated by laparoscopic approach. The most frequent complication in the group operated by open approach was infection of the operative wound (56/452) and ileus (5/452), and in the group operated by laparosocopic approach ileus (1/46) was the most frequent complication. Conclusion: The patients operated by laparoscopic approach have fewer risk of wound infection, and the hospital stay is shorter. With the increase of surgeon’s experience this method of treatment of acute appendicitis will become a method of choice.