Systemic Inflammatory Response Syndrome in Surgical Patients.

OBJECTIVE: To determine the incidence of systemic inflammatory response of the organism in surgical patients and its impact on the outcome of treatment. METHODS: A prospective study was conducted on 60 patients undergoing abdominal surgical procedures, between January 2014 and December 2015 in the Surgery Clinic at the University Clinical Center Tuzla. Two groups of thirty were formed by the method of consecutive sampling. The first group consisted of subjects who were prepared for elective abdominal surgery (laparoscopic cholecystectomy), and the second group subjects underwent an emergency surgery due to acute abdomen (laparoscopic cholecystectomy). RESULTS: The body temperature difference was statistically significant between the two investigated groups in all stages (c2: t0=3,486; t1=3,098; t2=2,453, t: t0=-11,210; t1=-7,360; t2=-4,927, p < 0,05). Non-elective surgery group had a statistical significant difference of the heart rate at all stages (c2: t0=3,873; t1=3,357; t2=3,227, t: t0=-16,524; t1=-10,407; t2=-9,842, p < 0,05). There is a statistically significant difference in the pCO2 values in all stages between groups (c2: t0=2,582; t1=1,678; t2=1,162, t: t0=4,323; t1=2,653; t2=2,229, p < 0,05). The SIRS score has a good positive correlation with the length of treatment, while the correlation with the outcome of treatment has no statistical significance. CONCLUSION: Inflammation scores monitoring in surgical patients is important for the surgical treatment success analysis. By modifying the therapy and influencing the inflammatory response, the results of treatment are improved.

The Discrepancy Between Subjective and Objective Findings After Septoplasty.

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.

Impact of Comorbidity on Early Outcome of Patients with Subarachnoid Hemorrhage Caused by Cerebral Aneurysm Rupture.

BACKGROUND: One of the complications aneurysms subarachnoid hemorrhage is the development of vasospasm, which is the leading cause of disability and death from ruptured cerebral aneurysm. AIM: To evaluate the significance of previous comorbidities on early outcome of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm in the prevention of vasospasm. PATIENTS AND METHODS: The study had prospective character in which included 50 patients, whose diagnosed with SAH caused by the rupture of a brain aneurysm in the period from 2011to 2013. Two groups of patients were formed. Group I: patients in addition to the standard initial treatment and "3H therapy" administered nimodipine at a dose of 15-30 mg / kg bw / h (3-10 ml) for the duration of the initial treatment. Group II: patients in addition to the standard initial treatment and "3H therapy" administered with MgSO4 at a dose of 12 grams in 500 ml of 0.9% NaCl / 24 h during the initial treatment. RESULTS: Two-thirds of the patients (68%) from both groups had a good outcome measured with values according to GOS scales, GOS IV and V. The poorer outcome, GOS III had 20% patients, the GOS II was at 2% and GOS I within 10% of patients. If we analyze the impact of comorbidity on the outcome, it shows that there is a significant relationship between the presence of comorbidity and outcomes. The patients without comorbidity (83.30%) had a good outcome (GOS IV and V), the same outcome was observed (59.4%) with comorbidities, which has a statistically significant difference (p = 0.04). Patients without diabetes (32%) had a good outcome (GOS IV and V), while the percentage of patients with diabetes less frequent (2%) with a good outcome, a statistically significant difference (p = 0.009). CONCLUSION: The outcome of treatment 30 days after the subarachnoid hemorrhage analyzed values WFNS and GOS, is not dependent on the method of prevention and treatment of vasospasm. Most concomitant diseases in patients with SAH which, requiring additional treatment measures are arterial hypertension and diabetes mellitus. The best predictors in the initial treatment of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm has the presence of comorbidity, which has statistical significance.

Foreign body impaction in esophagus: experiences at Ear-Nose-Throat Clinic in Tuzla, 2003-2013.

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.

Complications Related to Insertion and Use of Central Venous Catheters (CVC).

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 1(st) January 2011- 31(st) 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.

Assessment of depth of anesthesia: PRST score versus bispectral index.

UNLABELLED: Assessment of depth of anesthesia is the basis in anesthesiologists work because the occurrence of awareness during general anesthesia is important due to stress, which is caused in the patient at that moment, and due to complications that may arise later. There are subjective and objective methods used to estimate the depth of anesthesia. The aim of this study was to assess the depth of anesthesia based on clinical parameters and on the basis bispectral index, and determine the part of bispectral monitoring in support to clinical assessment. MATERIAL AND METHODS: Sixty patients divided into two groups were analyzed in a prospective study. In first group (group 1), the depth of anesthesia was assessed by PRST score, and in the second group (group 2) was assessed by bispectral monitoring with determination PRST score concurrently. In both groups PRST score was assessed in four periods, while bispectral monitoring is used continuously. For analysis were used the BIS index values from the equivalent periods as PRST scores. PRST score value 0-3, and BIS index 40-60 were considered as adequate depth of anesthesia. The results showed that in our study were not waking patients during the surgery. In the group where the depth of anesthesia assessed clinically, we had a few of respondents (13%) for whom at some point were present indicators of light anesthesia. Postoperative interview excluded the possibility of intraoperative awareness. In the second group of patients and objective and clinical assessment indicated at all times to adequate depth of anesthesia. CONCLUSION: The use of BIS monitoring with clinical assessment allows anesthesiologists precise decision-making in balancing and dosage of anesthetics and other drugs, as well as treatment in certain situations.

APACHE II scoring system is superior in the prediction of the outcome in critically ill patients with perforative peritonitis.

BACKGROUND: There are several scoring systems used in the prediction of outcome in critically ill patients. This study was undertaken to evaluate APACHE II, SAPS I, Sepsis score, MOF, TISS-28 and MPI scoring systems in prediction of the outcome in patients with perforative peritonitis. PATIENTS AND METHODS: The prospective study of 145 patients of both sexes with perforative peritonitis was performed. The main outcome of study was peritonitis-related death. Variables necessary for calculation of the scoring systems were recorded at the initial admission to the hospital and the third and seventh day of hospitalization, except Mannheim Peritonitis Index, which was calculated during the first 24 hours after hospitalization. Cut-off points were specified and all values greater than cut-off points were taken to predict death. Sensitivity and specificity are graphically shown for the different values of cut-off points and represented with the receiver-operating characteristic curve. The difference in the area below the curve between scoring systems was statistically compared. RESULTS: The area under the curve for the first postoperative day was 0.87 for TISS-28 score, 0.86 for APACHE II score, 0.83 for MOF and SAPS I, 0.72 for MPI and 0.70 for Sepsis score. This demonstrated that TISS-28 and APACHE II are significantly better than other systems (p < 0.01). In addition, this discriminatory ability remained on the third and seventh postoperative day as well. The highest rate of correlation between the observed and the expected mortality rate for the first (Kendall's tau correlation 0.964) and the third day (Kendall's scorrelation 0.810) was in APACHE II system. CONCLUSION: APACHE II is superior in prediction of the outcome to other tested scoring systems.

Frequency of the central venous catheter colonization in surgical intensive care unit.

UNLABELLED: The use of central venous catheters (CVC) carries a risk from local and systemic infectious complications, with prevalence of 6% in patients in Intensive care unit. Microorganisms colonizing the CVC usually originate from patient's or staff member's skin, but the source can also be a contaminated infusion solution or hematogenous dissemination from a distant focus. The infective agents often show increased resistance to antibiotics, which is an additional therapeutic problem. There is no knowledge of the frequency of the colonization of CVC by microorganisms in hospitals in Bosnia and Herzegovina, neither of the types of microorganisms which usually colonize CVC, nor their sensitivity to antimicrobial agents. METHODS: During the period 2004-2008, the analysis of 188 CVC samples was performed in patients in ICU at which the doubt for CVC connected infection was present. The microorganism identification was performed by standard microbiological antibiotics sensitivity methods. RESULTS: Out of 188 checked samples, 101 (54%) had positive cultures and 87 (46%) were sterile. Out of 101 positive microbiological cultures, in 33 (32.67%) the gram-positive bacteria had been found, gram-negative in 62 (61.37%) and Candida albicans in 6 (5.94%) cultures. Gram-ne-gative bacteria were 93.55% sensitive to imipenem, and Gram-positive bacteria were sensitive to vancomycin. CONCLUSION: Gram-negative bacilli and Coagulase-negative staphylococci are the most frequent micro-organisms which colonize the CVC. The increase of bacteria antibiotics resistance represents a big problem. All those facts leads to the need for bigger control and supervision over the CVC implantation, its proper maintenance and rational use.