Kratak sadržaj Uvod. Uspješnost izvođenja vaskularnih rekonstrukcija, naročito velikih abdominalnih i torakalnih krvnih sudova, nije promijenila stavove većine onkoloških hirurga koji smatraju da je tumorska invazija vaskularnih struk-tura relativna kontraindikacija za uklanjanje tumora. Cilj rada je pokazati da operacije retroperitonealnih tumora koji su u koliziji sa velikim krvnim sudovima imaju prihvatljiv perioperativni morbiditet i mortalitet u ranom postoperativnom toku i zadovoljavajuće udaljene rezultate. Metode. Rad predstavlja prospektivnu studiju koja obuhvata 46 bolesnika (31 muškarac) starosti između 29 i 84 godina (prosječna starost 58 godina) kod kojih je urađena resekcija i rekonstrukcija visceralnih krvnih sudova retroperitoneuma, tokom hirurške resekcije primarnih i sekundarnih tumora retroperitoneuma. Glavni rezultati mjerenja u ovoj studiji su rani (<30 dana) morbiditet i mortalitet, kasni (>30 dana) vaskularni morbiditet i mortalitet, primarna prohodnost vaskularne rekonstrukcije i preživljavanje. Rezultati. Resekcija donje šuplje vene sa rekonstrukcijom PTFE graftom izvedena је kod 4 bolesnika, а aortna resekcija sa rekonstrukcijom graftom kod 2 bolesnika. Rekonstrukcija portne vene bila je izvedena tokom resekcije neoplazmi pankreasa i neoplazme jetre u 3 bolesnika. Resekcija i rekonstruk-cija gornje mezenterične arterije kod 2 bolesnika, zajedničke ilijačne arterije kod 2, zajedničke ilijačne vene u 3 bolesnika. Lijenalna, femoralna i donja mezenterična arterija rekonstruisane su kod 3 bolesnika. Tridesetodnevni mortalitet bio je 8,7% (4 bolesnika). Opšti tridesetodnevni morbiditet bio je 17,39%, dok rani vaskularni morbiditet uključuje krvarenje na arterijskoj ili venskoj anastomozi kod 2 bolesnika i ranu trombozu vaskularnog grafta kod 2 bolesnika. Primarna prohodnost vaskularne rekonstrukcije za 12 mjeseci bila je 80%, a preživljavanje 56,5%. Tokom perioda praćenja 26 bolesnika je bilo živo, bez recidiva osnovne bolesti. Kumulativna stopa preživljavanja bila je 64,3% i 48,2% za 1 i 3 godine. Zaključak. Istovremene rekonstruktivne vaskularne procedure dozvoljavaju resekciju tumora koji zahvataju vaskularne strukture sa prihvatljivim ranim i kasnim morbiditetom i mortalitetom. Ključne riječi: retroperitonealni tumor, tumorska invazija, krvni sudovi, vaskularna rekonstrukcija Adresa autora: Doc. dr Radmil Marić Studentska 7 b 73300 Foča rmaricr@yahoo.com

&lt;p&gt;&lt;strong&gt;Introduction.&lt;/strong&gt; Inadequate postoperative analgesia can affect the functioning of almost all organ systems and significantly increase morbidity and mortality. The aim of study was to analyze and assess response of patient&amp;rsquo;s painful sensations caused by surgical intervention in early stage of acute postoperative pain. &lt;strong&gt;Methods.&lt;/strong&gt; This paper presents a prospective study that follows the reaction of the patient 24 hours postoperatively after different surgical procedures. The only criterion for patient&amp;rsquo;s inclusion in the study was the need for elective surgical intervention. As a source of data used were medical records with complete medical documentation. &lt;strong&gt;Results.&lt;/strong&gt; The study included 126 patients. The group is divided into three subgroups: I - gallbladder surgery, II - resection of the stomach and intestines, III - surgery of hernia abdominal wall. The same analgesics are ordained postoperative: noraminofenazon, and ketoprofen. The severity of pain and testing treatment effect was carried out peacefully, at regular intervals by the appropriate scale for the assessment of the strength and quality of pain. &lt;strong&gt;Conclusion.&lt;/strong&gt; At the time of the need for analgesic patients on a scale of pain showed a value of 6,84 to 7,14 (VAS - visual analog scale). Homeostatic values of variables in the early postoperative period, it remained within normal values. Administration of analgesics &amp;ldquo;at the request&amp;rdquo; of the patient not achieved satisfactory analgesia, because the first postoperative day the patients will have a severe pain (VAS - 7).&lt;/p&gt;

Objective. Violence against healthcare workers is a significant global problem and is prevalent in both developed and underdeveloped countries. In the Republika Srpska, there is also a problem of violence against health workers and it occurs in the public and private health sector. Most attacks come from patients or their family members who have a mental illness or have harmful behavioral habits such as alcohol or drug abuse. Aim of the work is to examine the prevalence of violence at work against family medicine doctors, the most common forms of violence, the consequences of violence on the professional work of doctors, as well as prevention measures. Methods. The research was conducted in 16 health institutions in the Republika Srpska in the period from January to December 2018 according to the type of cross-sectional study on a randomized sample of 287 respondents, doctors who worked in the service of family medicine. The research instrument was a specially created questionnaire that was created for this research, and the obtained data were statistically processed in the program package SPSS 19. Results. Doctors of both sexes participated in the research, and the majority of respondents were women, 77,8% of them, while 22,2% were men. The majority of respondents are employed in public health care, 97,11% of them. Of the total number of doctors surveyed, 84,48% of them experienced violence at work during their working life. The analysis of the representation of certain types of violence showed that the most common form of violence is verbal violence in the percentage of 40,7%. A total of 73,62% of respondents believe that violence at work affects further professional work. Conclusion. Violence at work against family medicine doctors in Republika Srpska is significant. The most common forms of violence are verbal violence and rude or disrespectful behavior, and as the most important prevention measures, family medicine doctors point out a lower workload with the number of examinations, the introduction of stricter criminal liability for offenders and the introduction of the status of an official.

Introduction. Postoperative cognitive dysfunction (POCD) is very common in patients who are treated in intensive care units or in the surgery department after surgery. This increasingly present complication complicates and calls into question the recovery of the operated patient. We assumed that POCD was associated with blood loss in patients undergoing colorectal cancer surgery. Methods. Our study included 60 patients older than 50 years who underwent elective open surgery for colon cancer. The same protocol was performed for each patient: preoperative preparation and anesthesia. All patients completed three psychometric tests (mini mental test - MMT, information test and Hooper test) the day before surgery, one day after surgery and the seventh day after surgery. Results. Cognitive status examined on the basis of the MMT score showed a statistically significant difference in the number of received blood transfusions after surgery on the first day (p = 0.016) and the total number of received blood transfusions (p = 0.026). Cognitive status examined by the information test showed a statistically significant difference (p = 0.025) in the number of received blood transfusions after surgery on the first day. In patients whose cognitive status was examined by the Hooper test, a high statistically significant difference was observed in the number of received blood transfusions after surgery on the first day (p = 0.001). Cognitive status measured on the basis of MMT score showed that there was a statistically significant difference in the average values of the amount of blood given by transfusion after surgery (p = 0.019). Conclusion. There was a statistically significant cognitive dysfunction in patients who had greater blood loss during surgery and the first day after surgery and who received more blood transfusions (more than 600 ml) during and after surgery. The introduction of psychometric tests in the assessment of cognitive functions as well as the choice of surgery may be important factors in the prevention of POCD.

Introduction. The World Health Organization (WHO) defines burnout syndrome as a condition caused by chronic stress at work, which may be associated with the onset and worsening of psychosomatic illnesses and the quality of life of sufferers. The aim of the work was to determine the prevalence of burnout syndrome in the population of people with leading, chronic, massive, non-communicable diseases, type 2 diabetes and arterial hypertension, while assessing the impact of this syndrome on the quality of life of the subjects. Methods. The research was conducted as a cross-sectional study from March 2019 until October 2019 on a randomized sample of 92 patients with type 2 diabetes and 99 patients with hypertension from two Health Centres in East Sarajevo. A special criterion for inclusion in the research was that the respondents were employed and that their age did not exceed 65 years. The research instrument was a general questionnaire, the WHO questionnaire on burnout syndrome, as well as the WHO SF-36 questionnaire on the quality of life, and statistical data processing was done in the SPSS program version 19.0. The significance of the difference was tested by the ch2 test, and the existence of burnout syndrome was defined according to the WHO questionnaire. Results. In subjects with diabetes, burnout syndrome was present in 52.8% (mildly expressed in 15.2% of the subjects, candidate for burnout syndrome in 19.6% of the subjects, burnout syndrome was present in 17.4%, while in one subject burnout syndrome that endangers health was found) and in subjects with hypertension, burnout syndrome was found in 32% of the subjects. Burnout syndrome was more present in subjects with diabetes than in subjects with hypertension. The difference was statistically significant (ch2 = 8.42; p = 0.003). Subjects with diabetes were significantly more depressed and discouraged than subjects in the group with hypertension (ch2 = 16.14; p < 0.01). The subjects with diabetes had significantly more difficulty in performing their job than those with hypertension during the past four weeks (ch2 = 13.098; p = 0.011). Conclusion. There is a significant frequency of burnout syndrome in patients with diabetes, but also in patients with hypertension. The existence of cause-and-effect relationships significantly affects the quality of life of patients and their ability to work.