Impact of risk factors, early rehabilitation and management of lymphedema associated with breast cancer: a retrospective study of breast Cancer survivors over 5 years.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a potentially disabling and often irreversible consequence of breast cancer treatment, caused by the mechanical incompetence of the lymphatic system, resulting in reduced drainage capacity and functional overload due to an excessive volume of interstitial fluid surpassing the system's transport capacity in the arm. We wanted to determine the impact and explore the differences in independent risk factors for the occurrence of BCRL; incidence of BCRL over a five-year period at the Institute of Oncology Vojvodina in Sremska Kamenica and to answer the research question regarding the influence of the prehabilitation program on the overall incidence of BCRL during the observed five-year period. METHODS: From 2014 to 2018, a retrospective study was conducted at the Institute of Oncology of Vojvodina in Sremska Kamenica, analyzing female patients who had undergone breast cancer surgery. RESULTS: The study included 150 breast cancer patients who developed secondary lymphedema following surgery with the mean age of 59.2 ± 11.3 years. Fluctuations in hospitalization rates were observed over the five-year period, with the highest number of admissions in 2014 (24.0%) and a decline in 2018 (14.0%). The most common surgical procedure performed was left quadrantectomy (24.0%), followed by right quadrantectomy (20.0%) and left amputation (15.3%). The mean number of removed lymph nodes was 15.2 ± 6.1, with no statistically significant association between the number of removed lymph nodes and the manifestation of secondary lymphedema. The severity of secondary lymphedema varied based on patient age, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Patients who underwent radical surgery were more likely to experience severe lymphedema compared to those who had conservative surgery, although this difference was not statistically significant. CONCLUSION: In our study, the type of surgery, elapsed time since surgery, and the number of removed lymph nodes were not influencing factors for the occurrence of BCRL. However, concerning its severity, a greater number of systemic therapy modalities combined with radiotherapy were associated with a more frequent occurrence of mild and moderate BCRL. Also, the severity of BCRL varied among different age groups, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Ultimately, improving the quality of life for individuals affected by secondary lymphedema remains a crucial goal in the field of oncology.

The Role of Resilience in the Relationship between Sociodemographic, Clinical Characteristics, and Social Support among Breast Cancer Patients in Serbia.

BACKGROUND: The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. METHODS: This cross-sectional descriptive-analytical study was conducted from March to August 2023 at the "Dr. Radivoj Simonovic" General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales-for assessing social support-and the Connor-Davidson Resilience Scale-for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients' sociodemographic and clinical characteristics and levels of social support. RESULTS: The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support. CONCLUSION: This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other.

Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience.

Aim This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery (MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG). Methods This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients with indication for surgical revascularization. Results Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28). Conclusion Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.

Cervical Cancer Prevention Knowledge (Cckp-64) among Female Students in Novi Sad, Serbia during COVID-19 Pandemic.

Cervical cancer is a significant global health concern affecting young women, with over 500,000 new cases reported annually. This questionnaire-based study aimed to evaluate the knowledge of cervical cancer prevention among female students at the University of Novi Sad during the COVID-19 pandemic using the Cervical Cancer Knowledge Prevention-64 (CCKP-64) tool. The study sample consisted of 402 predominantly 20-22-year-old female students from either social or technical science faculties in urban environments. Results revealed that out of the 402 female students involved in the study, most had a good general knowledge of primary prevention of cervical cancer, with a correct answer rate ranging from 29.9 to 80.6%. On the contrary, only 63.4% of female students have heard about the vaccine against cervical cancer; 52.0% know that the vaccine exists in Serbia; and 31.8% know where to get vaccinated. Only a small proportion of students (9.7%) have encountered cervical cancer among their relatives/friends and think that the disease could affect them in the future (25.4%). Older students (>26 years) generally (p < 0.05) had better knowledge regarding distressing symptoms of cervical cancer, cytological examination and secondary prevention; however, it was also noted that a significant percentage of this age group reported not having received vaccinations (53.0%, p = 0.001). This study underscores the need for increased awareness and education about the HPV vaccine and secondary prevention among young women in Serbia. Future research should investigate knowledge and attitudes toward cervical cancer prevention in diverse populations to develop effective interventions and strategies. These findings have implications for public health policies in Serbia to promote cervical cancer prevention among young women.

Minimally invasive mini-thoracotomy access as a surgical method in state-of-the-art treatment of single-vessel coronary heart disease.

Aim To compare outcomes of two different surgical techniques of coronary artery bypass grafting (CABG) for treating isolated left anterior descending (LAD) coronary artery disease by full median sternotomy technique vs. minimally invasive approach via left anterior mini-thoracotomy. Methods This retrospective, observational study, which included 61 elective patients, was conducted at the Clinic for Cardiovascular Surgery of the Clinical Centre of the University of Sarajevo in the period from June 2019 to January 2022. Patients were divided in two groups according to the operative technique used, the sternotomy CABG group of 30 patients where the access considered full median sternotomy, and the minimally invasive CABG group where left anterior mini-thoracotomy was performed. The groups were compared by previously defined primary and secondary clinical postoperative outcomes. Results Out of 61 patients, the majority was males, 50 (82%). The analysis of the outcomes of the minimally invasive CABG surgery showed significantly shorter operative times (p=0.001), less postoperative drainage (p=0.001) and transfusion requirements, shorter mechanical ventilation duration (p=0.0001), low major adverse cardiac and cerebrovascular events rates, as well as shorter Intensive Care Unit stay days with mean of 3.3±1.442 days (p=0.025), but no total hospital stay days with mean of 6.7±1.832 days (p=0.075) compared to sternotomy CABG group. Conclusion Minimally invasive approach for CABG surgery in treating isolated single vessel LAD disease, together with the fasttrack protocol, offers a reasonable alternative to full median sternotomy, leading to faster patients' overall recovery and improving the quality of life.

ABO groups as a risk factor for myocardial infarction in the population of Bosnia and Herzegovina.

Aim To investigate the association of ABO blood types and appearance of myocardial infarction (MI) among the population in Bosnia and Herzegovina. Methods This was a cross sectional study conducted at the Department for Cardiovascular Surgery at the Clinical Centre of the University of Sarajevo from January 1st to December 31st 2019. Patients were divided into two groups, defined by their blood type, A (N=91) and non-A (N=109). ABO blood groups were determined using standard agglutination techniques. Information regarding history of MI was taken from their medical documentation during the preparation for surgery. Results In total 200 patients were involved in this study. The study sample consisted of 151 (74.5%) males and 49 (25.5%) females. Mean age was 62.98 ± 7.73. Various risk factors associated with myocardial infarction were tobacco 92 (46.0%) and alcohol 54 (27.0%) consumption, obesity 77 (38.5%), diabetes mellitus 47 (23.5%) and hypertension 91 (45.3%). Being A blood type (OR=3.308; 95% Cl 1.317-8.311; p=0.011) and being male and having hypertension (OR=3.086; 95% Cl 1.262-7.545; p=0.013) significantly increased the risk for the development of MI among young adults. Patients with A blood type were significantly younger [median 58.0 vs. 63.0; U = 2738.5; p =0.027] when they developed MI compared to non-A blood type. Conclusion The age of myocardial infarction occurrence in the population of Bosnia and Herzegovina is lower in patients with blood group A compared to non-A blood types.

Video-assisted thoracoscopic lobectomy for congenital cystic adenomatoid malformations.

Aim The aim was to show rare cases of congenital cystic adenomatoid malformation (CCAM) and the manner of its surgical treatment with video-assisted thoracoscopic surgery (VATS). Methods Two male and one female child, 7, 4 and 3 years of age were treated for symptoms of cough and high temperature in district hospitals. In all three children laboratory blood tests and chest radiography were done. Auscultatory findings showed the presence of pneumonia. Children were treated with appropriate doses of antibiotics. After the rehabilitation of inflammation, they were sent to the University Clinical Center Sarajevo, where video-assisted thoracoscopic lobectomy (VATS) was indicated after computerized tomography (CT). Results Chest CT scan pointed to the CCAM and pulmonary sequestration (PS) changes to the lungs. This has required surgery lobectomy of an affected part of the lungs. In two children with PS, the aberrant systemic artery came from the most proximal part of aorta abdominals, the third patient did not have an anomalous artery. Conclusion VATS lobectomy is an alternative to the traditional thoracotomy for the treatment of CCAM and PS, however, it should be investigated in the future for its safety and effectiveness.

Analysis of the Blood Consumption for Surgical Programs.

INTRODUCTION: Transfusion is an activity that assures sufficient supply of blood and blood components to treat the sick and injured. In transfusion departments is necessary to timely provide adequate amounts of blood and blood products for various surgical procedures. MATERIAL AND METHODS: To determine the total amount of preoperative requirements (BT/AB and BT/AB/MT) for blood and blood products in surgical departments of General Hospital "Prim. Dr. Abdulah Nakas" in the period from June 1, 2014 - December 31, 2014 and analyze the requirements for blood in relation to surgical procedures, surgical discipline, period, age and gender of patients. To determine the maximum consumption levels surgeries. RESULTS: The total amount of preoperative requirements for blood and blood products in surgical departments amounted to 927. Almost the same number of requests with a slightly higher percentage was in December and October and the lowest in June. The average age of patients was 52.2±20.1 years with the youngest patient aged 9 and the oldest at the age of 97 years. Women were more prevalent with 686 or 74% of the time compared to men. The largest number of requests for surgery elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement 98 (10.6%). Maximum consumption for surgical operations Hysterectomy totalis abdominals 15 doses of blood. CONCLUSION: The largest number of requests were for elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement with 98 (10.6%). Maximum consumed doses had gynecology surgery at Hysterectomy totalis abdominals 15 doses of blood, then orthopedics surgery at Primary hip prosthesis 11 doses.

THE MANAGEMENT OF TRANSFUSION SERVICES, ANALYSIS AND ASSESSMENT.

INTRODUCTION: The hospital blood bank (HBB) need to timely provide adequate amounts of blood and blood products for surgeries. For various surgical programs are performed assessments of the average number of blood doses needed for surgery. By using two types of requisitions BT/AB (blood type/antibody) and BT/AB/MT (blood type/antibody/match test) for pretransfusion immunohaematological testing in General Hospital "Prim. Dr. Abdulah Nakas" is achieved more rational consumption of blood and blood derivatives and financial savings through reduced number of matching tests (MT). GOAL: To determine the total amount of pre-operative requisitions (BT/AB and BT/AB/MT) for blood and blood products at surgical departments of the General Hospital "Prim. Dr. Abdulah Nakas" in the period from June 1, 2014 - December 31, 2014 and analyze the consumption/return of blood in reserve in relation to the surgical disciplines, the total number of savings in MT. Conduct assessments MSBOS (Maximum Surgical Blood Ordering Schedule). RESULTS: The total amount of preoperative requisitions for blood and blood products in surgical wards was 927 requests from which 623 demands or 67.2% is tested by BT/MT, while 304 or 32.8% was tested by BT/AB/MT. Transfused in total was 617 units of blood and blood products, 275 units were not transfused. Probability of transfusions for surgery was 51.3, the highest in the case of surgical intensive care 70.4 and the lowest for the department of general surgery 37.2%. Assessment of indicators of efficient resource management indicates they are the best at the delivery ward 0.89, while a total for surgical wards is 0.69. In total for surgery on the average were required 2.1 units of blood. By using two types of requisitions for pretransfusion immunohaematological testing (BT/AB and CG/AB/MT) is achieved more rational use of MT. In 623 requests for BT/AB only 61 MT were performed. Average of blood units issued in accordance with these requirements is 0.08 and the savings in the number of MT amounts to 562.

Contrast Media Injector Technology - Renal Safety During Coronarography.

AIM: This study sought to assess whether the volume and osmolarity of contrast media (CM) influences the occurrence of contrast induced nephropathy (CIN) following coronarography procedure. CIN can be defined as an increase in the serum concentration of creatinine greater than a 25% from baseline during the period of 12 to 48 hours after the administration of radiocontrast media. MATERIAL AND METHODS: We examined 100 patients without diabetes with serum creatinine concentration from 45 mmol/l to 141 mmol/l and 100 patients with diabetes with serum creatinine concentration from 46 mmol/l to 161 mmol/l who underwent coronary angiography. During procedure they received iso-osmolar contrast medium, Visipaque 320 (iodixanol-320), for group without diabetes from 40 to 340 ml and for group with diabetes from 49 to 310 ml. RESULTS: CIN occurred in 27 (13,5%) of the 200 study patients. There was a trend toward higher prevalence of CIN (16% vs.11%, p = 0.086) in the diabetic group compared with the non-diabetic group. Patient with diabetes received less contrast media, they are younger but number patients with CIN are higher. CONCLUSION: Increasing contrast media dose is associated with the occurrence of CIN following coronarography. But, another risk factors like diabetes mellitus, old age, male sex and preexisting kidney disease have influence of developing CIN after coronarography.

Analysis of Cystic Fibrosis in Federation of Bosnia and Herzegovina.

AIM: The aim of this study is to present the first total number of tested children in the Federation of Bosnia and Herzegovina and the number of children with positive sweat test. During the study we determined the number of ill children, the median age of children with cystic fibrosis, date of initial diagnosis, an average amount of chloride in the sweat. MATERIAL AND METHODS: The study was a retrospective, conducted at the Department of Pulmonology Pediatric Clinic of University Clinical Center of Sarajevo. RESULTS: In the period from March 2003 to December 2014, we have tested 625 children. 351 child were from Sarajevo Canton and 272 children from other cantons. Female children were more affected then male children, in the ratio of 1: 1,105. An average age of female children was 4.19±4.26 years, and the male 2.15±3.11 years. The median concentration of chloride in the sweat measured by sweat test was for male children 103.05±21.29 mmol/L, and for the female children 96.05±28.85 mmol/L. CONCLUSION: Most of children in Federation of Bosnia and Herzegovina have ∆F508 gene mutation. In the post-war period we started to use a sweat test. Male children tend to live longer than female children with CF.

V-type mini sternotomy in aortic valve replacement.

As patients and their physicians become more demanding, the desire to make the procedures "minimally invasive" is growing constantly. In short, "minimally invasive" is a code phrase for life saving procedures which in same time disrupt our quality of life the least. Its goals include reducing incision size, decreasing surgical trauma and pain, and improving cosmesits, patient satisfaction, and recovery times. However, the most important goal of minimally invasive aortic valve surgery must be to maintain or improve the efficacy and safety of conventional aortic valve surgery. In this report we would like to present operative technique of minimally invasive aortic valve replacement (MIAVR) we use in our hospital.

Atrial fibrillation and coronary bypass surgery - what can be risk factors for its' appearance?

The main goal of our study was to evaluate possible perioperative risk factors for occurrence of atrial fibrillation in the postoperative period in patients after CABG operations. The study included 140 patients after CABG, divided into two groups - Group I - 64 patients with new onset of POAF and Group II - 76 patients without postoperative atrial fibrillation occurrence. In both groups possible risk factors for atrial fibrillation onset (preoperative and postoperative) were analyzed.Results showed that we can predict new onset of atrial fibrillation after CABG if the following preoperative factors are present - low ejection fraction (less than 40%), LAd > 40mm, higher body mass index (BMI over 30), presence of COPD and older age. Important perioperative factors for onset of atrial fibrillation in our study were longer extracorporeal circulation, increased dose/number of inotropic drugs, blood transfusion and elevated WBC count postoperatively.

[Staphylococcus pneumonia--complications]. / Stafilokokna pneumonija--komplikacije.

The paper presents the case of a 4-year-old child who was admitted with the diagnosis Dg: Pleuropneumonia lat. sin, while in the further course as a suspicion due to progressive flow as staphylococcus pneumonia. The illness is complex in terms of treatment. The diagnosis was set based on the history of illness, its clinical course, laboratory findings, radiology tests. The boy was hospitalized in January in current year with symptoms (coughing, vomiting and fever) that have been lingering for the past two days. The boy has been treated with a ternary antibiotic therapy (cephalosporin of third generation parenterally with aminoglycosides, plus anti-staphylococcus therapy). In laboratory findings Sedimentation rate increased 88/134 WBC 75 thousands. Radiologically extended pleuropneumonia on the left side. In sputum staphylococcus aureus was isolated. In the further course of hospitalization, due to the development of progressive form of staphylococcus pneumoniae with a fever of up to 39 degrees, pale aspect and dyspnoic patient with anemia and with complications in the form of cysts, ruptures and pneumothorax, with a thoracic drainage performed. In the further course, the cysts were gradually absorbed, while the thoracic drain was grafted. Clinically, the child was looking better. We continued the anti-staphylococcus therapy (stanicide), to which the child reacted well clinically and radiologically. Auscultatory breathing on the left side was audible. The last follow-up and the last rtg pulmo et cor 6 months after the outbreak of illness with a complete regression of the foregoing changes.

Application of EuroSCORE in "Heart center Sarajevo".

Our aim was to evaluate risk stratification model, European System for Cardiac Risk Evaluation (logistic EuroSCORE) for patients treated in clinical hospital. EuroSCORE is useful to separate patients into risk groups so that the mortality and morbidity risk can be compared. From 1st January 2006 to 31st July 2006 the total of 124 adults have been operated and were classified according to the EuroSCORE algorithm. We have compared correlation of the predicted mortality and observed mortality (as death within the 30 days following the operation) and frequency of postoperative complications. All patients were divided into three risk groups. The low risk group had 30 patients with 0 death (0%) and 1 morbidity (3,33%). The medium risk group had 59 patients with 0 death (0%) and 4 morbidity (6,77%). The high risk group had 35 patients with 2 death (5,71%) and 5 morbidity (14,28%). Mortality in our clinic is much less than predicted mortality and we can be satisfied with our results. Incidence of complications after cardiac surgery is between 25 and 40% (STS database). Our results are within that range. We recommend logistic version of EuroSCORE as good and simple method to predict postoperative prognosis.

[Pancreas and laparoscopy]. / Pankreas i laparoskopija.

UNLABELLED: Number of studies were performed about pneumoperitoneum effect formed during laparoscopic surgery to the function of thoraco-abdomininal organs. However, studies about influence of pneumoperitoneum to the pancreas function are very rare. This is just what this study is about. Two groups of patients are included in the study: examined group of about 30 patients who had holecistectomy performed by laparoscopic surgery technique, and the control group (30 patients) who had holecistectomy performed by the laparotomic technique. Activity of the pancreas amylases was controlled 2, 6, 24, 48 and 72 hours, for the patients from both groups, before and after the surgery. CONCLUSION: After statistic analysis of gained data it was not possible to prove that pneumoperitoneum with a pressure of 15 mmHg has influence to the excretory pancreas function.

[Influence of CO2 pneumoperitoneum on liver function]. / Utjecaj CO2 pneumoperitoneuma na jetrenu funkciju.

CO2 pneumoperitoneum is an insuflication of CO2 into abdominal cavity in order to enable visulation of organs, and easier manipulation with instruments during laparoscopic surgery. Pressure that is being used is between 12 to 20 mmHg, but it is usually 14 mmHG, and it is higher than a pressure in the port system, which is between 7 to 10 mmHG. This causes changes in activity of AST, ALT and bilirubin during the laparoscopic surgery. In this research we have had two groups of 30 patients that had laparoscopic holecystectomy (researched group) and laparoscopic (control group) surgical technique. We have had compared values of activity for AST, ALT and bilirubin before and after the surgeries (after 6, 24, 48 and 72 hours). We concluded that changes of activity for AST, ALT and bilirubin during laparoscopic surgery are more outstanding with higher degree of significance than what happened during laparotomic surgery. Changes are of transitory nature and after 72 hours they return to the preoperative values.

[Treatment of Pseudomonas aeruginosa in cystic fibrosis in a child]. / Tretman pseudomonas aeruginosa kod oboljele djece sa cisticnom fibrozom.

The report deals with the case of a 10-year-old girl with chronic cystic fibrosis. She has been repeatedly treated at the hospital. She has been hospitalized due to respiratory deterioration. Cystic fibrosis is a rare disease, inherited autosomaly recessively, but is very complex in terms of diagnostic and treatment. Fibrosis is the formation of scar tissue due to injury or long term inflammation. The diagnosis is confirmed based on a clinical picture of the child, measure of Chloride in the sweat, chest X-ray, CT thorax, laboratory findings--genetic confirmation CFTR genes. The diagnosis is originally set when she was 4 years old. She is now admitted due to a deterioration of the main disease. Five days before the admission, the girl had a higher bodily temperature, cough and difficult breathing. Due to the deteriorated general condition and the respiratory insufficiency and respiratory acidosis in blood gas analysis, the girl was intubated and put on the complete mechanical ventilation (IPPV). Since the girl is a chronic patient with bronchiectasie chronic walls of bronchi changes full of the mucus, who is not responding to conservative treatment (antibiotics), therapeutic and diagnostic flexible bronchoscopy had to be performed, resulting in a gram-negative bacteri Pseudomonas aeruginosa--a typical bacteri for chronically sick C. F. patient. Pseudomonas aeruginosa is typically acquired in early childhood. This bacteria is giving progressive lung disease and often aggravates morbidity and mortality. So the main thing as a respiratory management is prevention of lung infection with this bacteria. A Pseudomonas therapy was prescribed according to the sensitive antibiogram, (Garamycin). Antibiotics are crucial to treating cystic fibrosis lung infections. Therapy with an amynoglicoside in combination with a B-lactam or a quinolone antibiotic is standard. It is a difficult to deliver a high doses at these antibiotics via the iv. route without significant systemic adverse events (otoxicity and nephrotoxicity). A reformulation of the aminoglycoside antibiotic tobramicin or garamycin therapy is solution for inhalation. To be well established infections the suppression of Pseudomonas aeruginosa has been shown to lead to decreasing same bacteria and benefits lung function from antibiotic therapy in a way that can be maintained over extended period. During bronchoscopy was given locally on changes mucous pulmozyme (to destroy a very hard mucous) and garamycin. So, after taking out a lot of mucus, it was later continued spontaneously. Control chest x ray and blood gas analysis are now very improved.

[Sarcoma Ewing left hemithorax]. / Sarcoma Ewing lijeve strane grudnog kosa.

A case of sarcoma Ewing hemithorax lst sin has been reported in an 8-year-old girl. The girl was admitted in our hospital with referral diagnosis Pleuropneumonia exudativa left side. The girl was sent from Nova Bila with the foregoing diagnosis. The difficulties started in early April this year with high body temperature, pains in the left side of the chest. After a detailed anamnesis, clinical picture of the girl and radiological examinations/ chest x ray, CT scan of the chest and operative findings/ sarcoma Ewing diagnosis was confirmed. The disease is very rare, while diagnostics and course are complex. The girl was admitted at the Pulmology Department of the Pediatric Clinic on 16.03.2005. At the Department, the girl was medically treated with three antibiotics: cephalosporins of third generation, ceftriaxon (Longacef), aminoglycoside Amikacin and antistaphyloccoc therapy (Orbenin). Due to a dull sound on percussion and weaker auscultatory breathing on the left, and radiological shading of the left chest, a CT of the thorax was performed. It showed expansive changes of the left chest. Also performed was a pleural punction of the left chest, after which around 500 ml sero-hemorrhagic content was taken out and sent for patohistology analysis. After a pre-operative preparation, the operation was performed on 28.03.2005, which is when a fat-like tumorous mass was found completely filling up the pleural cavum and by its weight exerting pressure on the lungs. In the projection of VI and VII rib, the described mass infiltrates the thoracic wall. The tumor extirpation "in toto" was performed and sent for patohistology analysis, ex tempore. Also performed was a pleuropectomy in the projection of the wall infiltration, as well as a partial resection of the VII rib. Also performed was a decortication of the visceral pleurae. The post-operative course has been passing normally and with good pleuropulmonary findings, with the wound healing per primum. Patohistology results: sarcoma Ewing hemithorax lat. sin. The girl continued her cytostatic therapy in Zagreb following the operation.