Chronic obstructive pulmonary disease (COPD) significantly reduces quality of life and is one of the main causes of chronic morbidity and mortality worldwide. Acute exacerbation of COPD (AECOPD) is a life-threatening condition that causes rapid deterioration of respiratory symptoms (worsening of dyspnea, cough and/or abundant sputum production) requiring urgent treatment. This review article examines the evidence underlying supplemental oxygen therapy and ventilator support during exacerbations of COPD. In the introduction, we discuss the epidemiology and pathophysiology of hypercapnic respiratory failure, and then we explain that the key to achieving appropriate levels of oxygenation is using controlled low-flow oxygen therapy. In patients with risk of hypercapnia a target oxygen saturation (SaO ) range of 88%–92% 2 is now generally accepted unless hypercapnia is disproved by gas analysis of arterial blood. However, if the partial pressure of carbon dioxide in arterial blood (PaCO ) is normal, oxygen therapy may target the usual saturation range of 94%–98%. 2 Many COPD patients may have a lower stable SaO , such that chasing this target (94%-98%) is not usually necessary unless 2 the patient is unwell. Further, we review current recommendations for ventilatory support in patients with AEHOBP. Noninvasive ventilation has assumed an important role in managing patients with acute respiratory failure. The use of invasive ventilation is the last remaining option, associated with a poor outcome.

Cilj ove studije je bio da definišemo faktore koji bi mogli da poboljšaju ishod reanimacije pacijenata koji su doživeli vanbolnički akutni zastoj srca poštujući "Utstein" model sakupljanja podataka. U dvogodišnjoj prospektivnoj studiji ispitano je 200 pacijenata koji su doživeli vanbolnički akutni zastoj srca i faktori koji su povezani sa preživljavanjem. 78% pacijenata je doživelo akutni zastoj srca kardijalne etiologije, 65% u kućnim uslovima, 3,7% je reanimirano od strane spasilaca, 36% je zatečeno u ventrikularnoj fibrilaciji (VF) ili ventrikularnoj tahikardiji (VT) bez pulsa, 64% u asistoliji/električnoj aktivnosti bez pulsa (PEA), 52% pacijenata je intubirano na mestu nastanka akutnog zastoja srca i preživljavanje do otpusta iz bolnice je bilo značajno veće u ovoj grupi pacijenata. Prosečno vreme stizanja do pacijenata bilo je 6,6 minuta. 66,7% pacijenata je defibrilirano nakon 4 i više minuta. 131 (65,5%) pacijent je proglašen mrtvim na terenu, 69 pacijenata je transportovano u bolnicu. 53 (76,8%) pacijenta iz grupe transportovanih je umrlo za vreme transporta ili na odeljenju reanimacije, 7 je umrlo nakon prijema u bolncu a 9 je preživelo do otpusta iz bolnice. Multivarijantnom logističkom regresijom je utvrđeno da su varijable značajno povezane sa preživljavanjem: starosno doba, endotrahealna intbacija na terenu i vreme stizanja do pacijenta. Uspeh reanimacije bio je značajno veći kod mlađih pacijenata, kod onih intubiranih na terenu i kod onih kod kojih je ekipa hitne medicinske pomoći stigla u kraćem vremenskom intervalu.

Introduction: antibiotic prophylaxis in surgical patients is defined as the use of antibiotics to prevented infection of the operating field. Applies in cases where the infection is not clinically manifested. The aim of this paper is to demonstrate the importance of the prophylactic use of antibiotics in the prevention of postoperative infection for patient's inguinal hernia. Materials and methods: The making of the material used Surgical Clinic KBC Pristina in Gracanica, which is part of the "preventive use of antibiotics in surgical patients, through follow-up prospective study of 200 patients. The first group (study group-Group I) consisted of 100 patients with inguinal hernia, in which we apply the prophylactic use of antibiotics. Study group was divided into two subgroups: (Group IA), 50 patients with inguinal hernia in which the solution methods with installation of mesh. (Group IB), 50 patients with inguinal hernia where the tension applied in the treatment methods of treatment. In the second group of patients (control group-Group II) with the same number of patients in the postoperative tre- atment are therapeutic dose used antibiotics. Research results: In our study, the prophylactic purposes, we used compound II generation cephalosporine cefuroxime (Nilacef), which are given in intravenous bolus, the induction of anesthesia, in a dose of 1.5 grams. In 100 patients examined groups, we used prophylactic cefuroxime 100 ampoules (Nilacefa) of 1.5 grams, whi- le the treatment of 100 patients in the control group used for therapeutic purpose 894 ampoules of different antibiotics. Pos- toperative wound infection in patients with prophylactic application of antibiotics are not recorded, while we were in the gro- up where the applied dose of antibiotics therapeutics wound infection noted in two (2%) patients. The average number of days of treatment the study group, the postoperative period was 2.81 days, while patients with a therapeutic dose of antibiotics the average number of days was 5.28. Cost of treatment cefuroksim 50 patients, the prophylactic use amounted to 32,460RSD, while the cost of antibiotics applied in the postoperative treatment of the control group, in which we applied the therapeutic dose antibiotic treatment, was 253,961.52 RSD, which is 7.8 times more expensive. Conclusion: The prophylac- tic application of antibiotics reduced the non-critical use of antibiotics, the incidence of infection of the operating field, mor- bidity and mortality due to postoperative infection, the frequency of resistance to antibiotics, antibiotics to minimize the ef- fect of Bacterian normal flora of the patient, changes in the defense system of the patient, and thus the cost of hospital treat- ment of surgical patients.

Background: In hernia inguinal regions that are usually on the front wall of the belly may appear epigastric, umbilical and postoperative (incision-ventrale) hernia. Incision (postoperative-ventral) hernia is the kind of hernia that occurs in the area before surgical incision made through the entire thickness of the abdominal wall. Purpose: The aim of this paper is to indicate the frequency incision, epigastric and umbilical hernia, and the validity of some methods used in surgical treatment. Materials and methods: The making of the material used Surgical Clinic KBC Pristina in Gracanica. This prospective study we included 107 (3.43%) patients with hernia abdominal front wall, which were operated in the Surgical Clinic from 2003- 2009th year. Results and discussion: the anterior abdominal wall hernia, are recorded in 48 (44.86%) male patients and in 59 (55.14%) female patients. Age is of great influence on the frequency of anterior abdominal wall hernia, because we have the largest number of hernia 45 (43.14%) recorded in patients older than 61 years. Free hernia we found in 68 (63.55%) and hernia incarcerate of 39 (36.45%) patients. Incision (postoperative) we found a hernia in 44 (41.12%), umbilical in 36 (33.65%) and epigastric of 27 (25.23%) patients. Postoperative hernia is most often occurring after longitudinal laparotomia. We have them registered in 19 (43.18%) patients with infraumbilical, in 10 (22.72%) with supraumbilical, in five (11.36%) with subcostal, with four (9.09%) with transrectal, at two (4.55%) with pararectal laparotomia, in two (4,55%) patients after lumbotomia made with two (4,55%) after Phanensthil incision. The treatment of the anterior abdominal wall hernia in 72 (67.21%) patients, we used prolen net, while in 35 (32.79%) patients made plastic abdominal wall. Drainage was used in 62 (57.94%) operated patients. In 78 (72.90%) patients applied the prophylactic dose of antibiotics, while in 29 (27.10%) patients applied therapeutic dose. The length of treatment of patients who applied prophylactic dose of antibiotics was 2.48 days and length of treatment of patients with therapeutic dose applied was 4.82 days. Prospective studies of patients in the postoperative complications are recorded in four (3.74%) patients. We had wound infection in two (1.87%) and recidive hernia in two (1.87%) patients. Conclusion: This surgical method, when it comes to herniotomia, a direct comparison with the number of postoperative recurrence. Implantation of mesh has found its place and it is a revelation in the resolution of abdominal wall hernia.

Ahernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are often enclosed in the thin membrane that naturally lines the inside of the cavity. Although the term hernia can be used for bulges in other areas, it most often is used to describe hernias of the lower torso (abdominal wall hernias). Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated). If the hernia sac contents have their blood supply cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency. Aims of the paper were: 1. to reveal the prevalence of inguinal region hernias (IRH) among all patients being admitted to emergency ward of Surgery Clinic at Gracanica during 2006 and 2. to show treatment efficacy of each surgical methods used. Material and method: Clinical
Center Pristine, Surgery Clinic at Gracanica patients' medical records were analyzed. Prevalence of IRH was monitored during the time frame of 1 year (2006). Basic statistical methods were applied for data analyzing. Results and discussion: During the time observed, 504 patients underwent surgical treatment. Among them, 162 patients (32,14%) were operated on inguinal region hernias. IRHs were more prevalent in males - 146 cases (90,12%) in comparison to 16 cases in females
(9,88%). During the certain time period, IRHs were more prevalent in adults 101 cases (62,35%) than in children 61 cases (37,65%). The vast majority of all operated hernias, belong to group of inguinal hernias 156 cases (96,30%). At the same time, there were only 6 cases (3,70%) of femoral hernias. This observation is in concordance with the data published worldwide inguinal hernias make up 75% of all abdominal wall hernias and occur up to 25 times more often in men than women.
The study, also, revealed incarcerated hernia (part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia) in 6 patients (3,70%) while recurrent hernia was found in 3 patients (1,85%). The most frequently used surgical approaches were: i) Ferrary method in 54 patients (33,33%; ii) Lichtenstein method in 42 patients (25,93%), and iii) Bassini method in 35 patients (22,22%). Postoperative complications were noted in 3 patients (1,85%). Conclusion: Based on the results obtained, one may conclude that efficacy of surgical method used in treatment of IRH is in indirect relation with the number of postoperative recidives the higher the number of hernia recurrences, the lower the efficacy of surgical method is