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).ResultsThe 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.ConclusionInflammation 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.

Introduction:This research was to follow characteristics of breakthrough pain caused by cancer (BTcP) and other most common sympthoms (ESAS) at patients in advanced stage of cancer disease in palliative care.Patients and methods:Prospective study included 433 patients which were treated in Palliative Care Centre in UKC Tuzla, Bosnia and Herzegovina. Group 1 was consisted of 353 patients whose basal cancer pain of intensity 4-7 NRS was treated weak opiates (basal analgetic- fixed combination of tramadol/paracetamol (37.5 mg/325 mg) in initial dose 3x1tbl for pain intensity 4, to 4x2tbl (for pain intensity 7). In Group 2 (80 patients) basal pain of intensity 8-10 was treated strong opiates as basal analgetic (oral morphine and transdermal fentanil). If the previous day were 2 or more breakthrough pain that required ‘’rescue dose’’ of analgetics (tramadol 50-100 mg orally in group 1 ie. Oral morphine 8-12 mg in the group 2), the dose of basal analgetic was increased.Results:The total number of reported breakthrough pain in all 433 patients for 10 days of treatment was 3 369 (0.78 BTcP /per patient/day), where at Group 1 patients showed significantly lower BTcP (0.56 BTcP/patient/day). The average intensity of BTcP was 5.91 where in the Group1 was 4.51 while in the Group 2 8.04. 582 (17.28%) was rated grade 7, of which 539 were successfully coupled by strong and 43 (7.39%) successfully coupled by weak opiates. From 556 BTcP who were rated with 8, 540 of them were coupled strong and only 16 successfully coupled by weak opiates. 1967 (58.39 %) of breakthrough pain has occured in the evening hours (18-06 h), while 1402 (41.62%) BTCP occured during day hours (06-18h). Most (1290 or 38.29%) of breakthrough pain lasted less than 10 minutes, 882 (26.18%) between 16 and 20 minutes, 752 (22.32%) between 11 and 15 minutes, 407 (12.8%) between 21 and 30 minutes and 38 (1.13%) lasted longer than 20 minutes.Conclusion:Duriong our study, we noted a relatively large number of breakthrough pain with lower intensity (3-6) in patients treated with weak opiates, which are also adversely affected patients satisfaction with pain treatment and required additional doses of analgetics. In the small percentage is possible the breakthrough pain of stronger intensity (7-8) treat by maximum doses of weak opiates.

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. e present study included  patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters:  hour urine output, creatinine clearance (Cr Cl) and glomerular fi ltration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to  years, and Group II encountered recipients who received renal graft from donors older than  years. Our goal was to determine whether donor age over  years signifi cantly diminishes renal graft function in fi rst seven post transplant days. No statistically signifi cant diff erence was found between Group I and II regarding  hour urine output. From second to fi fth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than  years (±,  vs. , ±, ). On the fi fth, sixth and seventh post operative day GFR was signifi cantly higher in patients who received renal graft from donors age up to  years (p<, ). Our data showed no signifi cant diff erence in observed variables between the two groups, thus indicating that utilization of renal grafts from donors' age >  years is acceptable and may considerably expand the donor pool.

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All conventional immunosuppressive tree drugs-protocols are based on Cyclosporine; consisting of low doses of Cyclosporine (CsA), Azathioprine (AZA) or Mycophenolate Mofetil (MMF) and Prednisolone. AZA has been used in clinical transplantation for more than  years and was the fi rst immunosuppressive agent to achieve widespread use in organ transplantation. MMF was introduced in clinical practice in  after several clinical trials proved that it was more effi cient than AZA for prevention of acute rejection episodes. Our aim was to evaluate infl uence of AZA and MMF on renal graft function in early post-transplant stage. Study recruited  patients who underwent kidney transplantation in University Clinical Centre Tuzla. All patients received CsA and corticosteroid-based immunosuppression, as a part of triple immunosuppressive regiment,  patients received AZA and  MMF. In order to assess renal graft function, following parameters were evaluated: glomerular fi ltration rate GFR (ml/min) creatinine clearance (CrCl) (ml/min),  h urine output (ml/day), and from the serum potassium, sodium, urea and creatinine (mmol/dm). Signifi cantly higher average values of  hour urine output were recorded during fi rst seven postoperative days in patients receiving MMF compared to those treated with AZA. Serum creatinine values showed statistically signifi cant decrease, starting with the second postoperative day, in MMF vs. AZA group (,±, vs. ,±,; p<,). GFR was signifi cantly higher in MMF compared to the AZA group of patients. On the fi rst post-transplant day CrCl was higher in AZA group (,± vs. ,±,; p=,), next six days situation is reversed CrCl is signifi cantly higher in the MMF group (,± vs. , ±,  p=,). MMF vs. AZA therapy was associated with protective eff ect against worsening of renal function in fi rst seven post-transplant days.