The Impact of Unilateral and Bilateral Eversion Carotid Endarterectomy on Postoperative Hemodynamic Parameters.

BACKGROUND: Carotid endarterectomy (CEA) is an effective and safe treatment of stenosed carotid arteries, and is a preventive operation with well-defined indications. It is associated with a loss of the baroreceptor reflex and postoperatively increased hemodynamic parameters. OBJECTIVE: The aim of the study was to confirm the sensitivity of baroreceptors and the impact on arterial pressure and heart rate in unilateral and bilateral eversion carotid endarterectomies. METHODS: A retrospective study was conducted with 30 patients treated with E-CEA in local anesthesia at the Clinic for cardiovascular surgery from December 2019 to May 2021, due to stenosis of the carotid arteries. Patients were divided into two groups: 15 patients in group A (patients with unilateral E-CEA; 15 patients in group B: patients with bilateral E-CEA). RESULTS: Out of the total of 30 patients included in the research, 15 patients in groups A and B respectively, there were no statistically significant differences in regards to gender (p= 0,245) and preoperative risk factors: smoking (p=0,449); hypertension (p=0,388); diabetes (p= 0,714); hyperlipidemia (p=0.388), coronary disease (p=0.461) and symptomatic stenosis of the carotid arteries (p=0.449). Noted were the statistically significant differences in values of systolic and diastolic pressure on the 3rd postoperative days in patients with bilateral E-CEA (p=0,001; p=0,001), a statistically significant difference in the heart rate was not found in the analyzed groups in the postoperative period (p=0,225; p=0,994). CONCLUSION: This study identified statistically significant differences in values of systolic and diastolic pressure in the early postoperative period. In his period, early detection and correction of these hemodynamic disorders are needed.

Endovascular or open surgical treatment of high-risk patients with infrainguinal peripheral arterial disease and critical limb ischemia.

Aim To determine preferable type of treatment in our clinical circumstances by following two groups of patients with critical limb ischemia (CLI), who were treated endovascularly and surgically. Methods Research was carried out in the form of a prospective study of 80 patients with CLI and Trans-Atlantic Inter-Society Consensus (TASC) C or D type of arterial disease, with American Society of Anesthesiology (ASA) class III risk, who were randomly divided in two groups as per the treatment they received, surgical and endovascular. Patients were followed during 28 months using clinical examination and Duplex Ultrasound (DUS) in accordance with prescheduled control visits. Results There was a statistical difference between surgical and endovascular group in two years patency (82.5% vs. 55%; p=0.022) but it did not result in the difference in amputation free survival (AFS) (95% vs. 85%; p=0.171) or two-year freedom from major adverse limb events (MALE) (87.5 vs. 77.5; p=0.254). Also, there was no difference in the overall survival of patients (100% vs. 97.5%; p=0.317). Conclusion Initial endovascular treatment is a preferred form of the treatment for selected patient population.

Bowel Dilatation on Initial Plane Abdominal Radiography May Help to Assess the Severity of Necrotizing Enterocolitis in Preterm Infants.

BACKGROUND: Necrotizing enterocolitis (NEC) is the most common life-threatening gastrointestinal emergency associated with prematurity. Timely diagnosis and adequate treatment are crucial to reduce the morbidity and mortality of the affected infants. The aim of this study was to evaluate the diagnostic yield of bowel dilatation on plane abdominal radiography (AR) in the early diagnosis and NEC severity in preterm infants. METHODS: We retrospectively reviewed initial ARs of 50 preterm infants with NEC ≥ stage II admitted to the neonatal intensive care unit (NICU) in a tertiary-care hospital. The largest bowel loops diameters (AD), the latero-lateral diameters of the peduncle of the first lumbar vertebra (L1), and the distance of the upper edge of the first lumbar vertebra and the lower edge of the second one, including the disc space (L1-L2), were measured. All anteroposterior ARs were done in a supine projection on the day of onset of the initial symptoms of NEC. RESULTS: Preterm infants with surgical NEC showed a statistically significant increase in the AD/L1 ratio (p < 0.001) and AD/L1-L2 ratio (p < 0.001) compared with preterm infants with medical NEC. We found no significant association between the site of the most distended bowel loop and the severity of NEC (p > 0.05). CONCLUSION: Bowel loop distension on initial AR may serve as an additional diagnostic tool in the early diagnosis and severity of stages II/III NEC. Further prospective clinical studies should validate the results from this study.

Assesment of Carotid Stenosis with CT Angiography and Color Doppler Ultrasonography.

INTRODUCTION: Color Doppler and CT angiography are diagnostic methods commonly used to determine the degree of carotid stenosis. AIM: To evaluate how the degree of carotid stenosis determined by the Color Doppler correlates with the degree of stenosis determined by the CT angiography. MATERIAL AND METHODS: The study was designed as a retrospective study. It included 42 patients with carotid stenosis. From medical records we collected anamnestic data (gender, age and risk factors - hypertension, hyperlipidemia, diabetes, smoking and obesity) and the results regarding the degree of carotid stenosis determined by Color Doppler and CT angiography. RESULTS: Out of the total number of patients (n=42), 73.8% were males and 26.2% were females. Average age of examined patients was 65.24±8.61. Most frequent risk factor of atherosclerosis was hypertension, followed by hyperlipidemia and smoking. NASCET grading distinguishes: first (0-29%), second (30-69%) and third (70-99%) degree of carotid stenosis. According to the Color Doppler evaluation findings, the second degree had 8 patients and 34 patients had the third degree of carotid stenosis. CT angiography have shown that 35 patients had third degree carotid stenosis, while 7 patients had the second degree carotid stenosis. In only one case results of evaluated methods differed regarding assessment of carotid stenosis. We have found that there is a significant positive correlation of the degree of carotid stenosis determined by the Color Doppler with the degree of stenosis determined by CT angiography (p=0.0002). Risk factors of atherosclerosis did not have a significant correlation with the degree of carotid stenosis (p>0.05). CONCLUSION: The degree of carotid stenosis estimated by the Color Doppler positively correlates with the degree of stenosis estimated by CT angiography.

Correlation of Atherosclerotic Risk Factors with the Size of Abdominal Aortic Aneurysm (AAA).

INTRODUCTION: Abdominal aortic aneurysm represents a local pathological dilatation of the abdominal aorta. It is caused by structural weakness of aortic wall but there are many other risk factors that may positively correlate with incidence of AAA like hypertension, smoking, male gender, older age, family history etc. AIM: The purpose of the study was to evaluate the correlation of atherosclerotic risk factors and the size of aortic aneurysm in patients that were admitted for the surgical treatment at the Clinic for cardiovascular surgery in Sarajevo during period 2016-2019. METHODS: The study was designed as a retrospective study with one group of patients that was conducted at the Clinical Center of the University of Sarajevo at the Clinic for Cardiovascular Surgery. It included 150 patients, 126 males and 24 females, all of them with infrarenal localization of AAA. From medical records we have collected relevant anamnestic data (age, gender, positive family history, diabetes mellitus, hypertension, hyperlipidemia, smoking, alcohol consumption and obesity). The size of aneurysm was determined by both ultrasound and CT arteriography. The data are processed in the Statistical Package for Social Sciences Ver. 22.0. The results are tabulated or graphically showed, and level of statistical significance was set at p <0.05. RESULTS: Total amount of 129 of patients (86%) had hypertension, 57.3% (n=86) of them were smokers, 18.7% (n = 28) were former smokers, and 24% (n = 36) were non-smokers Blood lipid level analysis have shown that 44% (n = 66) of patients were normolipemic, while elevated blood lipid levels were found in 56% (n = 84) of patients. Diabetes mellitus was present in 17.3% (n = 26) of patients, 2.7% (n = 4) of them had an insulin-dependent form, while 14.7% (n = 22) of the analyzed patients had insulin independent DM. Almost half of total number of patients (46%, n = 69) were obese. 19.3% (n = 29) of patients consumed alcohol while the 80.7% (n = 121) denied alcohol consumption. Ratio of males in comparison to females was 5:1. The average age in males was 69.79 ± 8.16 years and 72.13 ± 9.11 years in females. Significant statistical correlation of AAA size and risk of atherosclerosis factor has not been established. We have found that there is a significant positive correlation between size of aneurysm and risk of rupture (p= 0,000<0,05). CONCLUSION: Although risk factors of atherosclerosis were present, statistically positive correlation was not confirmed between the size of AAA and analyzed risk factors.

Perioperative results eversion carotid endarterectomy in bilateral symptomatic stenosis.

INTRODUCTION: Carotid endarterectomy (CEA) is a standard treatment for the prevention of stroke and death in patients with significant stenosis of the internal carotid artery. Eversion endarterectomy is warranted in patients with symptoms of cerebral ischemia and the degree of stenosis of 70-99%. The same is suitable for treating a symptomatic carotid artery stenosis with contralateral stenosis (50-70%). PURPOSE: The aim of this study was to evaluate perioperative complications (ICV, TIA, MI, mortality) in patients treated with carotid eversion endarterectomy with unilateral and bilateral symptomatic stenosis (with bilateral stenosis treated with ACI stenosis ≥70%). PATIENTS AND METHODS: The study included 139 patients with symptomatic carotid artery stenosis at the Department of Vascular Surgery of the University Clinical Center of Sarajevo in the period from January 2012 to December 2014 year. Given the involvement of ACI stenosis patients were divided into two groups. Group A consisted of 74 patients with bilateral stenosis (surgically treated with ACI stenosis ≥70%, while the degree of stenosis opposite ACI was from 50-70%), and group B of 65 patients with unilateral stenosis ≥70%. RESULTS: Of the 139 patients included in the study, in the group A was 74, of which 46 male (62.2%) and 28 female (37.8%), while in group B were 42 male (64.6%) and 23 female (35.4%) (p = 0.90). The subjects in group A were slightly older 65.9 (± 7.8) compared to group B 64.2 (± 7.7) (p = 0.17). Analysis of risk factors indicating a higher number in Group A compared to group B, but the difference was not statistically significant: 34 smokers (45.9%) versus 36 (55.4%); p = 0:34), patients with hypertension (63 (85.1%) against the 52 (80.0%); p = 0.56), with statin therapy (62 (83.8%) versus 52 (80.0%); p = 0.72), diabetes (18 (24.3%) versus 18 (27.7%); p = 0.79) and with a heart disease (18 (24.3%) versus 7 (10.8%); p = 0.06). Analysis of the frequency of perioperative complications between the groups was not statistically significant: ICV (2/74 versus 3/65; p = 1.00), TIA (2/74 versus 3/65; p = 0.88), one death was recorded in group A, while myocardial infarction (MI) we had in either group. CONCLUSION: In this study, no statistically about significant differences in the number of perioperative complications (from 0 to 30 days) between the two groups. With this risk is acceptable to perform carotid endarterectomy in a patient in the opposite ACI stenosis of 50-70%.

Epidemiological aspects of atherosclerosis in patients treated for acute atherothrombosis of extremity arteries.

INTRODUCTION: Risk factors for development of extremity artery atherosclerosis are the same as for coronary and cerebrovascular atherosclerosis namely, diabetes mellitus, hyperlipidemia, arterial hypertension, age and smoking. Atherosclerosis is polyarterial disease that clinically manifests itself most frequently in the form coronary, cerebrovascular or peripheral arterial disease (PAD). All of them have common, ominous and final pathologic step - atherosclerotic plaque rupture that might eventually lead to atherothrombosis and signs of ischemia. There are few studies of risk factor for peripheral artery disease (PAD). AIM OF STUDY: To identify prevalence of known risk factors for atherosclerosis in patients treated for acute atherothrombosis of extremity arteries. PATIENTS AND METHODS: Eighty patient were analyzed with regard to the prevalence of five risk factors for atherosclerosis (diabetes mellitus, smoking, hypertension, hyperlipidemia and age). 80 patients were divided into two groups (Group A and B) depending on country i.e. hospital where they received treatment for acute atherothrombosis of extremity artery. Group A consisted of patients treated at Clinic for vascular surgery in Sarajevo, while patients in Group B were treated in Trollhattan in Sweden at NAL hospital. This study was clinical, comparative, retrospective-prospective. RESULTS: In group A, 20% of patients had diabetes mellitus while in group B prevalence of diabetics was lower (12,5%) but difference was not statistically significant p>0.05. Sixty percent of patients (60%) in group A were smokers. In Sweden, habit of smoking is not as common as in Balkan countries and consequently only 22,5% of patients were smokers in Group l, difference was statistically significant, p<0.05. In patients assigned to group A, 42.5% of them had diagnosis of hypertension while in Group B, 35% of patients were hypertensive. Difference was not statistically significant, p>0.05. 37.5% of patients in group A and 20% of patients in group B had hyperlipidemia. Difference was not statistically significant, p>0.05. In Group A mean age of patients was 67.85 years while mean age in Group B was 73.63. Age difference was statistically significant, p<0.05. CONCLUSION: Prevalence of risk factors of atherosclerosis in peripheral artery disease were evaluated in this study. Significant difference in prevalence of two risk factors were determined namely, smoking and mean age of occurrence of atherothrombosis. Quiting smoking and adopting healthier life habits may lead to reduction of prevalence PAD in younger patients in Bosnia and Herzegovina.

Outcome of endovenous laser ablation of varicose veins.

INTRODUCTION: In Bosnia and Herzegovina according to available data, treatment of incompetent superficial lower extremity varicose veins by endovenous laser ablation (EVLA) has been introduced two years ago and so far no paper has been published regarding results of EVLA treatment of patients from our country. We wanted to present our results with EVLA treatment. AIM OF STUDY: to evaluate and compare primary posttreatment outcomes of endovenous laser ablation (EVLA) with classical surgical method of varicose vein treatment. PATIENTS AND METHODS: The study was clinical and prospective. It was carried out at Clinic for vascular surgery in Sarajevo where fifty-eight (58) patients received surgical treatment for varicose veins and in Aesthetic Surgery Center "Nasa mala klinika" in Sarajevo were sixty-one (61) patients with varicose veins were treated by endovenous laser ablation. Total 119 patients (limbs) with pathologic reflux only in great saphenous vein were evaluated between 1st of January 2013 and 31st of April 2014. Following primary outcome endpoints were evaluated smean day of return to normal everyday activities, patient subjective quantification of pain during first seven days after intervention, incidence of deep venous thrombosis (DVT), incidence of wound bleeding requiring surgical intervention, incidence of peri-saphenous vein hematoma and infection rate. RESULTS: Mean of return to normal activities (expressed in days after intervention); EVLA vs. stripping (surgery) =1.21vs12.24, T test 13,619; p=0, 000, p<0,05. T test was used for comparing Mean value of visual pain analog scale for the first 7 days between groups, for all seven days pain was significantly higher in surgical group of patients as compared to EVLA group; p<0,05. Incidence of hematoma greater than 1% of total body surface area was significantly higher in patients receiving surgical treatment; Pearson Chi Square=23,830, p<0,05; odds ratio:10,453. Incidences of infection, deep venous thrombosis and posttreatment bleeding were not statistically different between analyzed groups; EVLA vs Surgery (Pearson Chi Square =3,237; p>0,05; Pearson Chi Square=2,139, p>0,05, Pearson Chi Square=2,139, p>0,05, respectively.). CONCLUSION: EVLA offers better patient recovery in terms of significantly lower post treatment pain, faster return to everyday activities and lower incidence of bruising (hematomas).

Distal vein patch as a form of autologus modification for infragenicular prosthetic bypass.

INTRODUCTION: Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not available autologus vein. Literature suggest that in these situations, prosthetic graft with some form of modification of distal anastomosis with autogenic tissue is valuable adjunctive. Frequently used modifications are Miller's cuff, Taylor's patch and St. Mary's boot. Recently, there are reports on "Distal vein patch" as a form of autologus modification which, due to its simplicity and patency rate, attracted attention. The aim of this study was to evaluate benefits of this novel modification by comparing its patencies with other autologus modification of distal anastomosis. PATIENTS AND METHODS: Study was performed on 60 patients, diabetics, with critical limb ischemia (CLI). Patients were divided in two groups: Group with distal vein patch modification; and group with some other form modification - control group. Patients were followed at least 22 months. We examined patency of grafts by physical examination or using Color Doppler. For statistical purposes we used KIaplan Meier analysis and curve. Significance was determined by Mann-Whitney, Fisher's exact, Pearsons chi square or Student T test as appropriate. P value less than 0,05 was considered significant. RESULTS: Groups were fairly matched relative to demographics, risk factors, operative intervention and distal anastomosis site. There was not statistical difference in two year primary patency between distal vein patch and control group--50% vs 53% respectivly (X2 = 0,08; p = 0,773). Also, there was not statistically significant difference in extremity survival (77% vs 77%) and patient survival between groups (89% vs 93%; X2 = 2,458; p = 0,117). CONCLUSION: This study proved equivalent patencies of infragenicular prosthetic bypasses performed using distal vein patch technique as with any other modification of distal anastomosis.

Comparison of transperitoneal and retroperitoneal approach in aorto iliac occlusive disease.

INTRODUCTION: Despite the fact that the transperitoneal approach (TP) is most widely accepted approach to the aortic surgery because it is simple, fast, and provides good exposure of the abdominal cavity and vascular structures, lately have been increasingly advocated as an alternative retroperitoneal (RP) approach in order to avoid entering peritoneal sac, achieving lower physiological trauma and faster establishment of gastrointestinal function. OBJECTIVE: The aim of this study was to compare the basic peri and postoperative results of TP and RP approaches in the surgical treatment of AIOD. PATIENTS AND METHODS: The study included 114 patients with aortoiliac occlusive disease (AIOD) that underwent surgical treatment at the Department of Vascular Surgery, Clinical Center University of Sarajevo from January 2010 until December 2012 year. In view of the surgical technique used subjects were divided into two groups. Group A consisted of 57 patients on who had been used RP approach, and group B 57 subjects with TP used approach. RESULTS: In patients from group A were observed significantly lower values: the length of operation (201.66 +/- 43.9 minute vs. 267.36 +/- 47.57 min, p < 0.001), amount of postoperative drainage (56.14 +/- 55.5 ml versus 130.71 +/- 92.34 ml, p < 0.001), length of stay in the intensive care unit (ICU) (1.10 +/- 0.36 days versus 2.46 +/- 1.25 days, p < 0.001), time required for the restoration of gastrointestinal motility (4.38 +/- 5.59 versus 1.05 days +/- 1.19 days, p < 0.001), length of hospitalization (9.26 +/- 1, 95 +/- 11 days versus 1.96 days, p < 0.001), costs of hospitalization (2394.98 +/- BAM 346.67 versus 2933.72 +/- 428.10 BAM, p < 0.001). Analysis of the incidence of postoperative complications (8 vs. 7 complication complications, p > 0.05) and mortality (3 versus 3, p > 0.05) showed no statistically significant difference between the analyzed groups. CONCLUSION: RP approach in vascular reconstructive surgery in AIOD offers better postoperative results when compared to TP approach.

Outcome comparison of two surgical methods used for the treatment of acute thrombosis of arteriovenous fistulas: thrombectomy versus de novo creation of arteriovenous fistula.

The aim of this study was to evaluate efficacy of two surgical methods used for the treatment of acute arteriovenous fistula (AVF) thrombosis. Twenty two out of twenty five patients that were admitted at the Clinic for vascular surgery in Sarajevo received successful surgical treatment for the salvage of acutely thromboses AVF from 2007-2009. They were included in retrospective, descriptive clinical study. Based on the type of surgical procedures performed, 22 patients were divided into two groups. The first group included 10 patients and they had successful thrombectomy of thromboses AVF while 12 patients in second group underwent de novo creation of AVF using blood vessels already exploited for construction of thromboses AVF. Patency rate of salvaged AVF in analyzed groups was compared one month and 6 months after intervention. In the postoperative follow up there was no statistically significant difference in patency rate of salvaged AVF between analyzed groups after one month, (80% vs 100%, Fisher exact test value =2,520, p= 0.195). Patency rate of salvaged AVF after six months of the follow up was significantly better in group that received de novo construction of AVF when compared to thrombectomy group (25% vs. 91%, Fisher exact test value = 1,062, p=0.002). De novo construction of AVF in case of acutely thrombosed AVF offered better patency rate of salvaged AVF when compared to surgical thrombectomy in the follow up period of six months.

Evaluation of medical and surgical management of critical extremity ischemia caused by atherothrombosis.

AIM: To assess efficacy of surgical and medical (conservative) treatment of acute exacerbation of chronic extremity ischemia by evaluating their early therapeutic outcomes in terms of mortality, extremity amputation and reamputation rate, limb salvage rate and length of hospitalization period. PATIENTS AND METHODS: Patients were divided into two groups based on method used for the treatment of critical ischemia. Group A consisted of 40 patients that were subjected to surgical treatment of critical extremity ischemia during period 2004-2009. All patients were subjected to thrombectomy in local anesthesia (2% lidocaine) as initial step of treatment protocol. Urgent Seldinger angiography was performed for all patients that have undergone thrombectomy regardless of successfulness of thrombectomy. Based on angiography findings decision was made about further definitive treatment. It consisted of either using antiaggregating drugs (acetyl salicylic acid; 150 mg/day) if no significant postthrombectomy stenotic lesion was found or subjecting patients to further surgical revascularization in the form of bypass were significant stenosis or occlusion was identified. Group B consisted of 40 patients; all of them received conventional heparin anticoagulation therapy supplemented with vasoactive infusion treatment (Pentoxyohylline 300 mg/day) during period 1998-2004. On the third day of hospitalization oral anticoagulation (Sintrom) was included in the therapy protocol using dosage 2-8 mg/day in order to achieve INR 2-4, once therapeutic INR was obtained heparin was withdrawn. Study was clinical, designed as retrospective prospective and was conducted at the Clinic for vascular surgery in Sarajevo. RESULTS: Mean age in group A was 66,5 years and in group B it was 65,78 years. Lenght of hospital stay in group A was 13,78 days while in group B it was 34,25 days (P value < 0,001). Limb salvage rate was 70% in group A and 17,5% in group B (P value < 0,001). In group A, nine amputations were performed (22,5%) while in group B we had to perform 38 amputations (95%), P value < 0,001. Only one reamputation was performed in group A (2,5% of patients) while in group B ten reamputations were performed (25% of patients). Mortality rate between groups was not statistically significant (P value < 0,077). CONCLUSION: Surgical thrombectomy as introduction to definitive treatment of critical limb ischemia caused by atherothrombosis gives statistically superior results in comparison to conservative treatment.

Acute renal failure and ureteral leak after open surgery aortoiliac aneurysm repair.

We present a case of 52 year old male with an acute renal failure that took place 4 days after open transabdominal surgery repair of infrarenal abdominal aneurysm along with aneurysm of left common iliac artery and dilatation of left external iliac artery. Patient was subjected to 13 hemodialysis treatments that resulted in satisfactory recovery of renal function. One month after aneurysm repair he developed the right ureteral leak, consequently urinoma and acute renal failure once again. We suppose that ureteral leak was related to segmental ischemic necrosis of right ureter but not to traction or other iatrogenic ureteral injury. Percutaneous nephrostomy and insertion of ureteral stent was resulted in complete recovery of renal function.

Comparative analysis of diagnostic evaluation of abdominal aortic aneurysm: CT angiography versus Seldinger angiography.

INTRODUCTION: Preoperative evaluation of patients with aneurysm of abdominal aorta includes CT angiography. Stenotic changes of iliac arteries greater than 50% imply consideration of aorto-femoral reconstruction in order to avoid upcoming occlusion of iliac arteries in the near future. AIM: Comparison of detection of arterial stenotic changes between CT and Seldinger angiographies that are > or = 50% in aorto-iliaco femoral region. METHODS AND PATIENTS: This is a retrospective descriptive study that included 73 patients diagnosed with AAA from 2006-2008. Both CT and Seldinger angiography were performed on 43 patients, while 30 patients were evaluated only with CT angiography. RESULTS: out of 43 patients that were evaluated with both CT and Seldinger angiography, 30 of them were males and 13 were females. Stenotic changes > or = 50% detected by CT are as follows: aortic bifurcation -9.3% of patients, common iliac artery-11.62% of patients, internal iliac artery -46.51% of patients, external iliac artery 25.58% of patients and 4.6% of patients in case od common femoral artery. Seldinger angiography detected stenotic changes > or = 50% as follows: aortic bifurcation -16.27% of patients, common iliac artery -16.27% of patients, internal iliac artery -60.46% of patients, external iliac artery 32.55% of patients and 9.3% of stenotic changes at the level of common femoral artery. CONCLUSION: Seldinger angiography detected more stenotic changes of iliac artery segment in comparison to CT angiography and in that aspect every suspicion of potential stenotic change in iliac artery segment should be additionally evaluated by Seldinger angiogram in case of patients with AAA.

Why historians of medicine called Ibn al-Nafis second Avicenna?

At the end of IX and beginning of the X century begins development and renaissance of the medicine called Arabic, and which main representatives were: Ali at-Taberi, Ahmed at-Taberi, Ar-Razi (Rhazes), Ali ibn al-Abbas al-Magusi (Haly), ibn al-Baitar, ibn al-Qasim al-Zahrawi (Abulcasis), ibn Sina (Avicenna), ibn al-Haitam (Alhazen), ibn Abi al-Ala Zuhr (Avenzor), ibn Rushd (Averroes) and ibn al-Nafis. Doctors Taberi, Magusi and Razi were born as Persians. Each of the listed great doctors of the Arab medicine in their own way made legacy to the medical science and profession, and left lasting impression in the history of medicine. Majority of them is well known in the West well and have their place in the text-books as donors of significant medical treasure, without which medicine would probably, especially the one at the Middle dark century, be pale and prosaic, insufficiently studied and misunderstood, etc. Abdullah ibn Sina (Avicenna) remained unsurpassed in the series of above listed. Close to him can only come Alauddin ibn al-Nafis, who will in mid-XII century rebut some of the theories made by Avicenna and all his predecessors, from which he collected material for his big al-Kanun fit-tibb (Cannon of medicine). Cannon will be commended for centuries and fulfilled with new knowledge. One of the numerous and perhaps the best comments-Excerpts is from Nafis-Mugaz al-Quanun, article published as a reprint in War Sarajevo under the siege during 1995 in Bosnian language, translated from Arabic by the professor Sacir Sikiric and chief physician Hamdija Karamehmedovic in 1961. Today, at least 740 years since professor from Cairo and director of the Hospital A-Mansuri in Cairo Alauddin ibn Nefis (1210-1288), in his paper about pulse described small (pulmonary) blood circulatory system and coronary circulation. At the most popular search engines very often we can find its name, especially in English language. Majority of quotes about al-Nafis are on Arabic or Turkish language, although Ibn Nafis discovery is of world wide importance. Author of this article is among rare ones who in some of the indexed magazines emphasized of that event, and on that debated also some authors from Great Britain and USA in the respectable magazine Annals of Internal medicine. Citations in majority mentioning other two "describers" or "discoverers" of pulmonary blood circulation, Miguel de Servet (1511-1553), physician and theologian, and William Harvey (1578-1657), which in his paper "An Anatomical Exercise on the Motion of the Hearth and Blood in Animals" published in 1628 described blood circulatory system. Ibn Nafis is due to its scientific work called "Second Avicenna". Some of his papers, during centuries were translated into Latin, and some published as a reprint in Arabic language. Significance of Nafis epochal discovery is the fact that it is solely based on deductive impressions, because his description of the small circulation is not occurred by in vitro observation on corps during section. It is known that he did not pay attention to the Galen theories about blood circulation. His prophecy sentence say: "If I don't know that my work will not last up to ten thousand years after me, I would not write them" Sapient sat. Searching the newest data about all three authors: Alauddin ibn Nafis (1210-1288), Michael Servetus (1511-1533) and William Harvey (1628) in the prestige Wikipedia I manage to link several most relevant facts, based on which we can in more details explain to whom from these three authors the glory and the right to call them self first describer of the pulmonary and cardiac circulation belongs. About Servetus and Harvey there is much more data than on ibn Nafis, about which on Google there are mainly references in Arabic and Turkish language, and my four references on Bosnian, with the abstracts in English. Probably the language barrier was one of the key reasons that we know so little about Nafis and so little is written, although respectable professor Fuat Sezgin from Frankfurt in 1997 published comprehensive monograph about this great physician, scientist and explorer, in which papers we can clearly recognize detailed description of the pulmonary and cardiac circulation. Also, I personally published separate monographs about this scientist, and which can be found on www. avicenapublisher.org.

[Hydatid cysts as a cause of acute artery occlusion]. / Hidatidna cista kao uzrocnik akutne arterijske okluzije.

This is a case report of 7 years old boy who presented to us with acute onset of pain and coldness in left leg that appeared during a game and started 3 hours prior to admission in our hospital. Developmental and past medical histories were nonspecific. Physical examination revealed absence of all pulsations in left lower extremity in addition to presence of paralysis of left peroneal nerve. Complete diagnostic investigation was carried out including Seldinger angiography and occlusion of left external iliac artery was confirmed. Embolectomy was performed and hydatid cyst that caused arterial obstruction has been removed from left external iliac and common femoral artery. Follow up examination after 7 days confirmed presence of palpable pedal pulsation with slight lingering paresis of left peroneal nerve that improved with physical rehabilitation exercises. The aim is to present an extremely rare case of primary arterial echinococcosis and to stress upon necessity of including it into differential diagnosis of acute arterial occlusion in regions where this illness is endemic.