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Uvod: Dehiscencija kolo-rektalne anastomoze (DKRA) je najteža komplikacija u hirurgiji karcinoma rektuma (KR) i direktno utiče na rane postoperativne ishode, prognozu i stopu preživljavanja. Cilj: ispitati povezanost godišnjeg volumena procedure hirurga i ranih postoperativnih ishoda i analizirati odnos uticajnih faktora rizika za nastanak DKRA u kontekstu iskustva hirurga. Materijal i metode: Retrospektivna,klinička studija jednog centra sa kohortom od 546 bolesnika oba pola sa KR. Kod svih je učinjena klasična (otvorena) prednja resekcija rektuma sa kreiranjem kolo-rektalne anastomoze (KRA) šavnom ili stepler tehnikom, u 10-godišnjem periodu. Bolesnici su podeljeni u tri grupe, shodno godišnjem volumenu procedura 18. ordinirajućih hirurga u kolorektalnoj hirurgiji. Analizirano je sedam ranih postoperativnih ishoda, kao i druga 22 faktora rizika (nezavisne, zavisne i „zbunjujuće“ varijable) od značaja za ishode operativnog lečenja i objašnjenje razlika između grupa hirurških volumena i njihovog uticaja na rane ishode lečenja. Sve operacije su izvedene u Klinici za opštu i abdominalnu hirurgiju KC Banja Luka (RS). Rezultati: Većina hirurga (77,7%) pripadala je grupi sa niskim i srednjim volumenom procedura. DKRA je nastala kod 53 (9,7%) bolesnika sa statistički značajnom razlikom između grupa hirurških volumena. Intrahospitalna smrtnost iznosila je 4,8% (26/546), bez statistički značajne razlike između grupa. Dužina hospitalizacije (> 8 dana, 65,4%) bila je u signifikantnoj korelaciji sa učestalošću DKRA. Grupa hirurga sa visokim volumenom imala je signifikantno bolje rezultate u četiri ranih ishoda. Zaključak: Signifikantni faktori rizika za nastanak DKRA su: T3 N1-2 M0 stadijum KR, nivo anastomoze do 12sm od analnog ruba, Charlson-ov indeks komorbiditeta ≥3, znatan fekalni sadržaj u kolonu (82,5%), preoperativna radioterapija, intraoperativni gubitak krvi >200ml., intraoperativna fekalna kontaminacija (30,8%), protektivna stoma (62,5%) i niski godišnji volumen procedura hirurga. Ovi faktori rizika obeležavaju posebnu „high-risk“grupu bolesnika sa KR, predisponiranu za nastanak DKRA. Visoki godišnji volumen hirurga je najvažniji prediktor uspešnih ranih ishoda u lečenju bolesnikasa KR. Introduction: Dehiscence of the colorectal anastomosis (AD) is the most severe complication of rectum cancer surgery which directly influences early postoperative outcome, prognosis and survival rate. Aim. To examine the connection between the annualvolume of the surgeon and early postoperative outcomes, as well as to analyze risk factors for the development of AD in the context of the surgeon individual experience. Method: Retrospective study performed in a single center, with a cohort of 546 patients of both sexeswith rectal cancer (RC), over a 10-year period.In all patients a classical (open) anterior resection of the rectum with a colorectal anastomosis (CRA), created viasuture or stapler,was performed. Patients were divided into three groups, according to the annual volume of their attending surgeon. Seven early postoperative outcomes were analyzed, as well as 22 other risk factors (independent, dependent, and “confusing” variables) of significance for surgical outcome. The risk factors were analyzed to explain the difference between the groups of surgeons and their influence on the outcomes. All surgeries were performed in the Clinic for general and abdominal surgery, Banja Luka (Republic of Srpska). Results: The majority of surgeons (77.7%) belonged to the low and medium annual volume groups. AD developed in 53 (9.7%) patients, with significant difference between the annual volume groups. The in-hospital death rate was4.8% (26/546), without significant difference between the groups. The length of stay in the hospital (> 8 days in 65.4%) was in significant correlation with the incidence of AD. The high annual volume surgeon group was associated with significantly better results in four of the outcomes. Conclusion: Risk factors for the development of AD were: T3N1-2M0 stadium of RC, anastomosis level up to 12 cm from the anal edge, Charlson comorbidity index of ≥3, significant fecal load of colon (82.5%), preoperative radiotherapy, intraoperative blood loss of more than 200 ml, intraoperative fecal contamination (30.8%), protective stoma (62.5%) and low annual volume of surgeons. These factors mark the particular high risk group of patients with RC predisposed to develop AD. The high annual volume surgeon was the most important predictor of success of the RC surgery.

Uvod/cilj: High-mobility group box 1 (HMGB1) prptein ima različite ćelijske funkcije, sa značajnpm ulogom u arhitekturi hromatina i regulaciji transkripcije. Takođe, HMGB1 ima različite efekte na imunski sistem i deluje kap prp-inflamatprni citpkin, pojačavajući urođeni i stečeni imunski odgovor, te učestvuje u patpgenezi različitih bolesti, od sepse do autoimunskih bolesti i kancera. Ova studija je pročavala pojedinačne nukleptidne polimprfizme (single nucleotide polymorphisms- SNP) na pozicijama rs2249825 [C/T], rs4540927 [G/A], rs19299606 [C/T], rs17074615 [A/C], rs1412125 [T/C], rs1060348 [C/T], rs1045411 [G/A], rs3742305 [G/C] u genu za high-mobility group box 1 (HMGB1) protein u grupi kritično obolelih pacijenata sa sepspm i traumom. Metode: klinička opservacipna analitička studija preseka. Studija je sprovedena na 119 kritično obolelih pacijenata sa sepspm i traumpm. Genotipizacija za citpkin sa HMGB1 za 8 polimprfizma (SNPs) je vršena kpristeći Taq-Man SNP Genotyping Assays, Applied Biosystems. Statistička obrada podataka je vršena preko SPSS 20.0 software (IBM Corp., Armonk, NY, USA). Udruženost između kategorija je vršena preko hi-kvadrat testa ( chi-square test). Količnik šanse -Odds ratios (OR) sa intervalom poverenja od 95% (95% confidence intervals- CI) je izračunat preko multiple logističke regresije (multiple logistic regression analysis) u cilju procene relativnog rizika u zavisnosti od mortaliteta, godina, pola i bakterijskog uzročnika infecije korišćene kao kovarijante u multiploj logističkpj regresiji. P vrednost < .05 je smatrana značajnom. Rezultati: U analizi polimorfizma (SNP), 5 njih su pokazali klinički značajnost u genu za highmobility group box 1 (HMGB1) protein na pozicijama rs2249825 [C/T], rs1412125 [T/C], rs1060348 [C/T], rs1045411 [G/A] i rs3742305 [G/C] kod kritično obolelih pacijenata sa sepspm i traumom. Tri polimorfizma u genu za high-mobility group box 1 (HMGB1) protein na pozicijama rs2249825[C/T], rs1045411 [G/A] and rs3742305 [G/C] su udruženi sa uzročnikpm bakterijskih infekcija, prema nalazu iz hempkulture. Jedan polimorfizam na poziciji rs1060348 [C/T] je udružen sa osnovnom bolešću (peritpnitis, pankreatitis) koja je dovela do sepse. Zaključci Ova studija je proučavala pojedinačne nukleptidne polimprfizme (single nucleotide polymorphisms- SNP) u genu za high-mobility group box 1 (HMGB1) citpkin u grupi kritično obolelih pacijenata sa sepspm i traumpm. Nije upočena povezanost između pojedinačhih polimorfima i ishoda bolesti. Neki pd proučavanih polimprfizma su pokazali udruženost sa bakterijskim uzročnikpm infekcije (prema nalazu hempkultura) i osnovne bolesti (peritonitis, pankreatitis) koja dovodi do sepse. Background/Aim: High-mobility group box 1 (HMGB1) protein has diverse cellular functions, with important role in chromatin architecture and transcriptional regulation. HMGB1 has diverse effects on immunity acting as a pro-inflammatory cytokine, enhancing both innate and adaptive immune response that contribute to the pathogenesis of various disorders, from sepsis and autoimmunity to cancer. This study examined the single nucleotide polymorphisms (SNP) at position rs2249825 [C/T], rs4540927 [G/A], rs19299606 [C/T], rs17074615 [A/C], rs1412125 [T/C], rs1060348 [C/T], rs1045411 [G/A], rs3742305 [G/C] in high-mobility group box 1 (HMGB1) gene in critically ill patients with sepsis and trauma. Methods: Clinical prospective observational analytical cross-sectional study. The study was conducted on 119 critically ill patients with sepsis and trauma. HMGB1 genotypes for 8 SNPs were assessed using Taq-Man SNP Genotyping Assays, Applied Biosystems. Statistical analysis was performed with the SPSS 20.0 software (IBM Corp., Armonk, NY, USA). The association between categorical variables was estimated by the chi-square test. Odds ratios (OR) with 95% confidence intervals (CI) were calculated by multiple logistic regression analysis to estimate relative risk of mortality, age, sex ratio and type of bacteria were used as covariances of multiple logistic regression. P values < .05 were considered significant. Results: In analyzing the polymorphisms, five single nucleotide polymorphisms (SNP) in high-mobility group box 1 (HMGB1) gene have clinical significance at position rs2249825 [C/T], rs1412125 [T/C], rs1060348 [C/T], rs1045411 [G/A] and rs3742305 [G/C] in critically ill patients with sepsis and trauma. No association between SNP and outcome in our study. Three single nucleotide polymorphisms (SNP) in high-mobility group box 1 (HMGB1) gene at position rs2249825[C/T], rs1045411 [G/A] and rs3742305 [G/C] associated with type of bacteria according to the findings of blood culture. One single nucleotide polymorphisms (SNP) at position rs1060348 [C/T] is associated with the basic disease (peritonitis, pancreatitis) which led to sepsis. Conclusion: This study examined the single nucleotide polymorphisms (SNP) in high-mobility group box 1 (HMGB1) gene in critically ill patients with sepsis and trauma. No association between SNP and outcome. Some of the studied SNP showed association with type of bacteria (according to the findings of blood culture) and the basic disease (peritonitis, pancreatitis) which led to sepsis.

Uvod/Cilj: Acido-bazni poremećaji su uobičajeni kod kritično obolelih pacijenata. Fizičko-hemijski pristup koji je opisao Stewart a modifikovao Figge i sar., omogućava precizan način kvantifikovanja metaboličke acidoze i pruža uvid u njene glavne mehanizme, kao i doprinos neizmerenih anjona metaboličkoj acidozi. Ova studija ima za cilj da utvrdi: 1) da li su konvencionalne acido-bazne varijable povezane sa mortalitetom kritično obolelih pacijenata u jedinici intenzivne nege; 2) da li su SID/SIG bolji prediktori mortaliteta od konvencionalnih acido-baznih varijabli; 3) odrediti sve značajne prediktivne faktore acido-bazne ravnoteže za 28-dnevni mortalitet u Jedinici intenzivne nege. Metode: retrospektivna opservaciona analitička studija. Pacijenti: 142 odrasla pacijenta na mehaničkoj ventilaciji, preživeli (n=68) i umrli (n=74). Vrednosti SIDapp, SIDeff i SIG su izračunavani pomoću Stewart’s-Figge kvantitativnog biofizičkog metoda. U ovoj studiji korišćene su deskriptivne i analitičke statističke metode (T test, Mann-Whitney U test, Hi-kvadrat test, binarna logistička regresija, ROC krive, kalibracija). Rezultati: Univarijantna analiza ukazuje da su statistički značajni prediktori: starost, Na, APACHE II, Cl, albumin, SIG, SIDapp, SIDeff i AG. AG predstavlja model sa lošom kalibracijom, odnosno model sa malom prediktivnom moći. APACHE II ima p vrednost veću od 0,05, ali je blizu istog pa se i on može smatrati potencijalno sumnjivim za predikciju ishoda. SIDeff i SIG predstavljaju modele sa dobrom kalibracijom. ROC analiza ukazuje da APACHE II, Cl, albumin, SIDeff, SIG i AG imaju najveću površinu ispod krive. Kreiranjem logističkih modela metodom kalibracije pronašli smo da ishod zavisi od SIG i APACHE II skora.Zaključak: Neizmereni anjoni omogućavaju predikciju mortaliteta kritično obolelih pacijenata na mehaničkoj ventilaciji, za razliku od tradicionalnih acido-baznih varijabli koje nisu precizni prediktori 28-dnevnog preživljavanja. Background/Aim: Acid-base disorders are common within patients who are critically ill. Physico-chemical approach described by Stewart and modified by Figge et al. gives precise quantification method of metabolic acidosis and gives insight into its main mechanisms, as well as influence of unmeasured anion on metabolic acidosis. Objective of this study is to determine the following: 1) whether conventional acid-base variables are connected with survival rate of critically ill patients at Intensive care unit; 2) whether SID/SIG is better predictor of mortality rate comparing to conventional acid-base variables; 3) determine all significant predictable parameters for 28-day mortality rate at Intensive care unit. Methods: retrospective observational analytic type of study. Patients: 142 adult requiring mechanical ventilation, survivors (n=68) and nonsurvivors (n=74). SIDapp, SIDeff and SIG values were calculated with Stewart- Figge’s quantitative- biophysical method. Descriptive and analytical statistical methods were used in the study (T test, Mann-Whitney U test, Hi-square test, binary logistic regression, ROC curves, calibration).Results: Univariance analysis shows that the following predictors are statistically significant: age, Na, APACHE II, Cl, albumin, SIG, SID app, SIDeff, and AG. AG represents a model with imprecise calibration, i.e. a model with little predictive power. APACHE II has p value more than 0.05 if it is near it, and therefore it can be considered potentially unreliable for outcome prediction. SIDeff and SIG represent models with well-defined calibration. ROC analysis results show that APACHE II, Cl, albumin, SIDeff, SIG i AG have the largest area bellow the curve. By creation of logistic models with calibration methods, we found that outcome depends on SIG and APACHE II score. Conclusion: Unmeasured anions provide prediction of mortality of critically ill patients on mechanical ventilation, unlike the traditional acid-base variables who are not accurate predictors of 28-day mortality rate.

Istraživanje je sprovedeno na specifičnoj populaciji pacijenata koja se najčešće podvrgava operacijama zamene zgloba kuka. Zbog prisutnih komorbiditeta, važno je prevenirati postoperativni bol kao faktor koji doprinosi razvoju postoperativnih komplikacija. Osnovni cilj je bio da se ispita uticaj D tipa ličnosti, anksioznosti i depresivnosti na pojavu jakog postoperativnog bola. Takođe je jedan od ciljeva istraživanja bio da se ispita uticaj faktora vezanih za operaciju na jak postoperativni bol kao i uticaj jakog postoperativnog na pojavu hroničnog bola.U studiju je uključeno 90 pacijenata koji su ulazili u studijsku ili kontrolnu grupu zavisno od jačine bola na numeričkoj rejting skali (NRS) od ≥ 5. Nakon operacije u spinalnoj anesteziji, postoperativni bol je tretiran ketorolakom ili morfinom ako je bio ˃ 5 na NRS. Pacijenti D tipa su praćeni i u odnosu na potrošnju morfina, ocenu i zadovoljstvo terapijom bola u odnosu na one koji nisu imali karakteristike D tipa. Nakon tri meseca pacijenti su intervjuisani u vezi sa postojanjem hroničnog postoperativnog bola. Subanalizom se došlo do zaključka da D tip, kao i kombinacija D tipa ličnosti i anksioznosti odnosno depresivnosti, daje još veću verovatnoću za jak postoperativni bol. Isto tako u ovom istraživanju, ženski pol i jak preoperativni bol su se pokazali bitnim. S druge strane, faktori rizika vezani za operaciju nisu bili od značaja. D tip ličnosti se može detektovati testom koji je jednostavan u uslovima anesteziološke kliničke prakse. Psihološka priprema ove grupe pacijenata i podrška okoline su bitni za bolji postoperativni ishod. This study has been conducted on a specific group of patients that most frequently undergo the operation of hip joint replacement. Due to present comorbidities, it is important to prevent post-operative pain as a factor which contributes to the development of post-operative complications. The main objective has been the analysis of the impact of type D personality, anxiety and depression on the occurrence of strong post-operative pain. Also, one more objective of this research has been the analysis of the effect of factors related to operation on strong post-operative pain as well as the effect of strong post-operative pain on the occurrence of chronic pain. The study included 90 patients within the study and control groups depending on the intensity of pain on numerical rating scale (NRS) from > 5. After the operatin in spinal anesthesia, post-operative pain was treated with ketorolac and morphine if the intensity of pain was > 5 on NRS. Type D personality patients were also observed in relation to consumption of morphine, evaluation and satisfaction with the treatment of pain comparing to those not having the characteristics of type D personality. Three months later the patients were interviewed about the existence of chronic post-operative pain. By subanalysis the following conclusion has been reached : type D personality as well as the combination of type D personality and anxiety or depression, enhance the possibility of the occurrence of strong post-operative pain. Also, female gender and strong post-operative pain proved to play an important role. On the other hand, risk factors in relation to operation have not been taken into consideration. Type D personality can be detected by a test which is simple in the conditions of anaesthetic clinical practice. Psychological preparation of this group of patients and supportive surrounding are important factors for better post-operative outcome.