Morphological aspects of myocardial bridges.

Although some myocardial bridges can be asymptomatic, their presence often causes coronary disease either through direct compression of the "tunnel" segment or through stimulation and accelerated development of atherosclerosis in the segment proximally to the myocardial bridge. The studied material contained 30 human hearts received from the Department of Anatomy. The hearts were preserved 3 to 5 days in 10% formalin solution. Thereafter, the fatty tissue was removed and arterial blood vessels prepared by careful dissection with special reference to the presence of the myocardial bridges. Length and thickness of the bridges were measured by the precise electronic caliper. The angle between the myocardial bridge fibre axis and other axis of the crossed blood vessel was measured by a goniometer. The presence of the bridges was confirmed in 53.33% of the researched material, most frequently (43.33%) above the anterior interventricular branch. The mean length of the bridges was 14.64 ± 9.03 mm and the mean thickness was 1.23 ± 1.32 mm. Myocardial bridge fibres pass over the descending blood vessel at the angle of 10-90 degrees. The results obtained on a limited sample suggest that the muscular index of myocardial bridge is the highest for bridges located on RIA, but that the difference is not significant in relation to bridges located on other branches. The results obtained suggest that bridges located on other branches, not only those on RIA, could have a great contractive power and, consequently, a great compressive force, which would be exerted on the wall of a crossed blood vessel.

Blood vessels distribution in body and tail of pancreas- a comparative study of age related variation.

Arterial vascularization of the pancreas has been investigated, as well as variation in vascularization of this organ with regard to the existence of age differences. Aim of the investigation was to establish differences, if any, in newborns pancreas vascularization since diseases invading this organ in newborns have increased recently at this particular age. Injection-corrosion method was used on pancreas arteries and their variations. Twenty-four human pancreas specimens were used for this purpose consisting of 24 cadaver organs aged between 45 and 65, and 12 pancreases of still-born babies. Comparison of the findings has shown that there was no difference in the number, ramification pattern and arterial course between the two experimental groups of organs; all possible blood vessel variations were most probably the result of developmental processes which occur during early stages of intrauterine development.

Investigation of vascularization of human pancreas using method of selective arteriography with insight into significance to a surgical approach for this organ.

This study explored arterial vascularisation of celiac trunk and superior mesenteric artery using method of selective arteriography in series of arteriogram which were done in 39 patients of Institute for Radiology. There were no pathological findings in a single case at pancreas or duodenum. Arteries which arise for vascularization of pancreas had a common spot of arising, flow and ramification. Pancreatic duodenal arteries arcade, which supply blood to the duodenum and the body of the pancreas, were shown in arteriogram. The branches which provide blood supply to the body and the tail of the pancreas were found. There was one case where lower pancreatic artery arose from gastroduodenal artery and in one case a direct anastomosis for celiac trunk and superior mesenteric arteries, better known as Tandler's anastomosis.

[Acute mesenteric vascular occlusion, 4 year experiance in Sarajevo Clinical Centar of University (2004-2007)]. / Akutna mezenterijalna vaskularna okluzija--iskustva sa Klinike za abdominalnu hirurgiju KCU Sarajevo od 2004. do 2007. godine.

AIM: The aim of this paper was to evaluate the success of the treatment of patients hospitalised with the diagnosis of Acute Mesenteric Vascular Occlusion (AMT). This research took place in the Clinical Centre University of Sarajevo during the period 2004-2007. A patient with the vascular disease in the bowels had a serious medical and surgical issue from the vascular and abdominal aspect. Issues that came with the vascular illness problem are prominent when referring to acute vascular disease that almost certainly isn't discovered on time. Less than 10% of cases were discovered before the appearance of reperfusion changes on bowels, so that they have chance to be treated by vascular surgeon with direct vascular approach on the blood vessels. The treatment of patients with acute vascular lesions needs to be confronted in the abdominal surgical manner of spare resection of the bowels in the terminal period of ischemia, and conservative treatment in the manner infusion of vasoactive substance; systematic use of anticoagulant therapy and postoperative profilactic therapy; vascular surgical therapy and repeated relaparotomy. The prognosis is poor. Death rate is from 24 to 45% in the worlds and in BiH it is over 60%. METHODS: In total, 47 patients were treated with this diagnosis. Conservative therapy had 9 patients, and 38 are surgical treated. The average age was 65.82 years old. The youngest being 36, and the oldest 87. The death rate in total was 61.78%. In the group of those who chose not to be operated their death rate was 100%. Death rate of those who did operate is 52.88%. DISCUSSION: To increase the number of patients who survive AMT it is necessary to improve the early diagnosis and to be aware of the pathology and early involvement of vascular surgery needs to be enabled. In the therapy that combine surgical-conservative therapeutically treatment of abdominal surgery should be applied where necessary. Spare resection of the bowels, systematic use of anticoagulant therapy, agresiv vasoactiv therapy and second look relaparotomy are stromgly recomended.

Stress, memory and Bosnian war veterans.

The aim of this study was to analyze cognitive dysfunction in PTSD. The testing included 79 Bosnian Army veterans, who participated in Bosnian war from 1992 to 1995. Out of 79 tested war veterans, 45 of developed PTSD while 34 did not. The veterans without PTSD where included in the control group. All the war veterans were of the same education level (secondary education) and between 30 and 50 years of age. Rivermead Behavioral Memory Test - RBMT was applied to all the subjects. The test was originally developed for the purpose of everyday memory problems identification. Clear goal of the 10 RBMT subtests is simulation of everyday life situations. PTSD group achieved significantly lower results than the control group. Results of the total score showed highly significant difference between PTSD and control group. Value of the t-test is t=10,056 with significance level of p<0,001. The same conclusion stands for any RBMT subtest. Numerous psychological studies on PTSD patients show more prominent psychological deficit in war veterans. Our study clearly confirms that finding.

Injection pressure as a marker of intraneural injection in procedures of peripheral nerves blockade.

The blockade of peripheral nerves carries a certain risk of unwanted complications, which can follow after unintentional intraneural injection of a local anesthetic. Up till today, the research of measuring injection pressure has been based on animal models, even though the histological structure of periphery nerve is different for animal and human population, so the application pressure which presages intraneural injection in human population is still unknown. As material in performing this study there have been used 12 Wistar rats and 12 delivered stillborns. After bilateral access to the median nerve, we applied 3 ml of 2% lidocaine with epinephrine, with the help of automatic syringe charger. The needle was at first placed perineural on one side, and then intraneural on the other side of both examination groups. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program BioBench. All perineural injections resulted with the pressure < or = 27.92 kPa, while the majority of intraneural injections were combined with the injection pressure > or = 69.8 kPa. The difference between intraneural and perineural injection pressures for the two different examination groups (rats and delivered stillborns) was not statistically significant (P>0.05). As prevention from intraneural injections today are in use two methods: the method of causing paresthesia or the method of using the peripheral nerve stimulator. However the nerve injury can still occur, independent from the technique used. If our results are used in clinical practice on human population, than the high injection pressure could be the marker of intraneural lodging of a needle.

The role of collateral circulation in preserving myocardial function.

The coronary collateral circulation is an alternative source of blood supply to the myocardium jeopardized by the failure of the original stenotic or occluded vessel to provide adequate blood flow to this region. One hundred coronary angiograms and left ventriculograms of patients with coronary artery disease from the Cardiology Department of University Clinics Centre in Sarajevo were reviewed. The role of collateral circulation in preserving myocardial function was assessed by comparing regional left ventricular contractility in 34 instances of total arterial occlusion and adequate colateral circulation with that in 34 instances of total arterial occlusion and inadequate collateral circulation. Among the group with adequate collaterals, regional left ventricular contraction was normal in 41%, hypokinetic in 53% and akinetic or dyskinetic in only 5%. Among the group with inadequate collaterals, regional contraction was normal in 9%, hypokinetic in 20 % and akinetic or dyskinetic in 70%. These data indicate that collateral circulation plays an important role in preserving myocardial contractility in patients with coronary artery disease.

[The effect of myocardial bridging on the incidence of coronary arteriosclerosis]. / Uticaj miokardnih mostova na nastanak koronarne arterioskleroze.

In this paper we dissected 50 human hearts obtained from the Department for Anatomy and Department of Forensic Medicine and Pathology, Faculty of Medicne, Sarajevo. Our interest was to show frequency of myocardial bridging on human heart coronary artery branches, their localisation and dimensions. Cross sections of coronary arteries segments in area of bridges, proximal and distal to it, were taken out from hearts on which dissection method showed presence of myocardial bridging of the coronary artery branches. Cuts were made 5microm-tick and coloured by Hematoxylin-eosine, Elastica Van Giesson, and Ladewig after having been fitted into paraffin wax. Preparations were behold mocroscopically and flow direction of myocardial bridge muscle fibres was followed regarding the artery wall, and it was analysed artery wall structure in the myocardial bridge area, proximal and distal to the bridge. Myocardial bridges werw found in 42% examined cases, and with the most frequent localisation on ramus interventricularis anterior (34%). Atherosclerotic change in the artery segments proximal to the myocardial bridge was detected by the histolopathological method and its intensity depended on the myocardial bridge length and years of age. In the area of the myocardial bridge, besided insignificant diffuse intima, there were not any other histopathological changes that would indicate an atherosclerotic process.

[The importance of Willis ring as valvular mechanism in cerebral circulation in patients with different degree of internal carotid artery occlusion]. / Znacaj Willisovog prstena kao valvularnog mehanizma cerebralne cirkulacije kod pacijenata sa razlicitim stepenom okluzije unutrasnje karotidne arterije.

Cerebrovascular deseases , cerebral vessels deseases, represents one of the greatest problems of humankind. The reasons are not just the high incidence and relatively high prevalence of letal outcomes in the acute faze of the desease, but also high level of disfunctionality caused by this disease in numerous patients who survived cerebrovascular insult and haemorraghe The onset, course and outcome of cerebrovascular diseases depends among other things on the possibility o f colateral brain circulation establishment. Willis ring onthe base of the brain is the most important anastomosis between circulation in both carotid arteries and basilar artery. First precondition for Willis ring t o function as valvular mechanisam is its intact configuration. But, it is found in almost half of th e subjectsincluded in the study that certain anatomical abnormalities in the Willis ring structure exist. Presence of these abnormalities favors onset of vascular diseases since they unables colateral circulation establishment. Studies till now have shown that all components of Willis ring do not contribute equally in colateral function among obstructive diseases.

Angiography analysis of variations of the posterior segment of the circle of willis.

Cerebral-vascular diseases present one of the leading problems of the modern mankind. They are followed by the risk of high mortality rate, and as such cause high level of disability with people who survive cerebral-vascular incident (stroke, apoplexy). Researches done so far proved that beginning, course and result of the cerebral-vascular diseases depend immensely of the possibility to establish collateral blood circulation and first of all on so called tertian level that is actually the circle of Willis. The circle of Willis, thanks to communicating segments, provide detour way to procure parts of the brain which, due to insufficiency, do not get enough quantity of blood. In this particular study by the analysis of 150 MRI patient's angiographies of the circle of Willis that had been processed at the Radiology Institute of the Clinic Center of University in Sarajevo, we tried to present the most common variations of the posterior segment of the circle of Willis with patients who did not have signs of the cerebral-vascular diseases. The analysis included two target groups (above 60 years old and younger than 34 years old) and both genders. By the analysis of the angiographies of the circle of Willis we reached following results: complete posterior configuration of the circle of Willis has been found with all patients in 54% of cases, but in some slightly higher percentage complete posterior configuration is noted with younger category of patients compared to elderly patients, and in some higher percentage with female compared to male patients. Out of variations that damage the posterior segment of the circle of Willis the first one, according to the frequency of occurring, is the variation of the type of unilateral fetal sort of posterior cerebral artery, and then the variation marked as unilateral aplasia or hypoplasia of the posterior communicating artery.

Detection of neurovascular structures using injection pressure in blockade of brachial plexus in rat.

In the last few decades there has been a great development of regional anesthesia; all the postulates are defined and all the techniques of usage are perfected. However, like any other medical procedure, the block of brachial plexus carries a risk of certain unwanted complications, like possible intraneural and intravascular injections. The reason for great discrepancy between the injury of brachial plexus and other periphery nerves while performing the nerve blockade is the frequent usage of this block, but also the specific proximity of neurovascular structures in axilla. The purpose of this work is to determine the values of pressures which appear in para-neural, intraneural and intravascular injection applications of local anesthetic, and to compare those values in order to avoid cases of intraneural and intravascular injections in clinical practice with consequential complications. In experimental study there have been used 12 Wistar rats of both genders. After anesthesia with ether and mid-humoral access to the neurovascular structures in axilla, the injection of 2% lidocaine with epinephrine was performed with the help of automatic syringe charge. The needle was at first placed para-neural, and then also intraneural and intravascular. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program. All para-neural injections resulted with the pressure between 13,96-27,92 kPa. The majority of intraneural injections were combined with the injection pressure greater than 69,8 kPa, while the intravascular injections were combined with injection pressure less than 6,98 kPa. Based on the available data it can be noticed that so far none of the methods of prevention from unwanted complications of regional anesthesia can insure the avoidance of intraneural and intravascular injection of local anesthetic. Based on our research it is obvious that the measuring of pressure during the nerve blockade is very important in order to decrease the risk of neurological and possible systematic complications. It is also clear that a small, mobile, and financially quite available apparatus for pressure measurement can help in differentiation between para-neural, intraneural and intravascular injection. Avoiding high injection pressure prevents from lodging the needle into intraneural space, while avoiding a very low injection pressure prevents from lodging the needle into intravascular space followed by consequential complications. The usage of this apparatus can find its application in other blockades of periphery nerves, and in other branches of medicine as well.

Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs.

BACKGROUND: Unintentional intraneural injection of local anesthetics may cause mechanical injury and pressure ischemia of the nerve fascicles. One study in small animals showed that intraneural injection may be associated with higher injection pressures. However, the pressure heralding an intraneural injection and the clinical consequences of such injections remain controversial. Our hypothesis is that an intraneural injection is associated with higher pressures and an increase in the risk of neurologic injury as compared with perineural injection. METHODS: Seven dogs of mixed breed (15-18 kg) were studied. After general endotracheal anesthesia, the sciatic nerves were exposed bilaterally. Under direct microscopic guidance, a 25-gauge needle was placed either perineurally (into the epineurium) or intraneurally (within the perineurium), and 4 mL of lidocaine 2% (1:250,000 epinephrine) was injected by using an automated infusion pump (4 mL/min). Injection pressure data were acquired by using an in-line manometer coupled to a computer via an analog digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. On the 7th day, the dogs were killed, the sciatic nerves were excised, and histologic examination was performed by pathologists blinded to the purpose of the study. RESULTS: Whereas all perineural injections resulted in pressures < or =4 psi, the majority of intraneural injections were associated with high pressures (25-45 psi) at the beginning of the injection. Normal motor function returned 3 hours after all injections associated with low injection pressures (< or =11 psi), whereas persistent motor deficits were observed in all 4 animals having high injection pressures (> or =25 psi). Histologic examination showed destruction of neural architecture and degeneration of axons in all 4 sciatic nerves receiving high-pressure injections. CONCLUSIONS: High injection pressures at the onset of injection may indicate an intraneural needle placement and lead to severe fascicular injury and persistent neurologic deficits. If these results are applicable to clinical practice, avoiding excessive injection pressure during nerve block administration may help to reduce the risk of neurologic injury.

Presentation of variations in the anterior part of the circle of Willis as a result of MRI-angiography method.

As it is well known the beginning, the course and the result of the cerebral-vasculare disease depends on, among other stuff, the possibility of establishment of the brain collateral circulation. The Willis's artery circle based on brain is the most important anastomoses between the blood circulation of the both, carotid and basilar artery. However, in almost half of the cases of the examined circle of Willis, certain deviations from the normal anatomy configuration have been identified that immensely facilitate occurance of vascular diseases, because it makes difficult establishment of collateral blood circulation. In this particular study, 150 MRI patient's angiographics had been analyzed that were processed at the Radiology Institute of the Clinic Center of the University of Sarajevo. The morphologic variations of the circle of Willis were analyzed on these angiographics and those were patients who did not have any signs of cerebral-vasculare diseases. We have tried to determine which variations are the most commonly occuring in the front segment of the circle of Willis with two target groups (older -- above 60 years old and younger- up to 34 years old) and including both genders. The method of the MR angiography in two projections enabled good visualisation of all components of the circle of Willis and based on their analysis we have achieved the following results. The complete front configuration of the circle of Willis had been found with all patients in 76,7% of the cases. We noted slightly higher percentage of the anterior configuration with younger category of patients compared to older patients, and with males compared to females. Out of the variations that damage the anterior segment of the circle of Willis, the first one, according to the frequency of occuring, is the variation of the type of hypoplasia or aplasia of Al segment of the anterior cerebral artery, and then the variation marked as duplication or multiplication of the anterior communicating artery.

[Angiographic imaging of supernumerary kidney arteries by nonselective angiography]. / Angiografski prikaz prekobrojnih arterija bubrega metodom neselektivne angiografije.

In this paper was examined the occurrence frequently more of one kidney artery of the aortic origin. The examinations were performed on the 213 angiograms of the kidney artery by the method of the unselective renal angiography per Seldinger, in both sexes, of the various life ages. On the analyzed angiograms was the presence of these arteries in 25.82% of cases. They were more often at the right side in 49.09%, than on the left side in 36.36%, while their both side presence was found in 14.55%. Although are these arteries more frequently in male persons, a though the sex cannot be statistically significant the parameter for the determination the frequency of their occurrence. In the relation to the backbone column the level of the exit of this arteries from the aorta is the greatest number of cases between the trunk of the first and third loins vertebra (L1-L3) and all were directed according to the medial edge of the corresponding kidney. According the place of the entrance in the kidney can be differed three types of these arteries: the artery, and upper and low polar artery. On the analyzed angiograms most often were found the hilar and lower polar artery, while the upper polar artery was present in only seven cases of the total number of the analyzed angiograms. We consider that the recognition of the supernumerary arteries of the kidney there is both anatomically and the significance in the surgical and radiological practice and their best identification achieves by the application of the angiographic radiology methods.

Contribution to the knowledge of position, flow and arterial distribution of cerebral blood vessels in foetuses 4 to 9 months of age.

We studied cerebral blood vessels in 25 fetuses of gestational age 16-36 weeks and in 10 cadavers of still-born babies by injection-corrosive method. In the early fetal life, arteries are thin with the straight flow, which is directly connected with the brain development. Progressive changes are observed in all the three cerebral arteries in 28-week old fetus, which straight flow becomes more and more tortuous. As in the 32nd week the brain develops faster and gyri and sulci are being formed, the arteries assume wavy flow and number of their rami increases. In a still-born baby, arteries are of rather bigger caliber; they branch abundantly; and due to their relatively broad cerebral sulci, it can be said that their flow is partly tortuous. Our results show evidently that position, flow and relation of cerebral arteries change concurrently with the brain development and appearance of cerebral gyri and sulci.

Study of the changes in the position and the pattern of changes of the brain arteries in fetuses and full-term stillborns.

We studied cerebral blood vessels in 20 fetuses of the gestation age between 16-36 weeks, and in 5 full-term stillborn cadavers by the method of dissection. One portion of the brain samples were processed by filling the blood vessels with 10% solution of formalin, whereas in the other group we used Mixobar and injected it through carotid artery to demonstrate brain arteries. In early fetal life the arteries are thin and have a straightforward pattern, which is in a direct correlation with the development of the brain. In brain arteries of a 28-week old fetus we observed progressive changes at all three brain arteries that began to assume more curved pattern. Since a significant increase in the brain growth and formation of the gyruses and sulcuses of the brain occurs in the 32nd week, the arteries also assume a wavier pattern, and the number of its branches increases. In full-term stillborns, the arteries are much larger in caliber, they branch abundantly, and due to relatively wide brain sulcuses we may also conclude that their pattern is partially tortuous. From our results it is evident that there are changes in the position, pattern and relationship of brain arteries that are parallel with the brain development and formation gyruses and sulcuses of the brain.

Changes in blood vessels in fetuses 4 to 9 months intrauterine life old by postmortem angiography method.

We monitored changes in caliber, position and branching of blood vessels in fetuses of 4 - 9 months of intrauterine life. By precise dissection we prepared starting parts of common carotid artery and internal jugular vein in 40 cadaver fetuses. The vessels were injected with Telebrix and subjected to postmortem angiography at the Institute of Radiology Clinics Center in Sarajevo. Thereafter, arteries obtained were compared and analyzed. In preparations of few months old fetal material we observed arteries of fairly straight course, low caliber and with no observable ramification. When preparations of more mature stillborn infants were examined, we detected arteries of undulating course, more expressed ramification and higher caliber. In stillborn babies, all three arteries are of high caliber with rich branching. Considering that in this phase of brain development sulcuses are relatively wide, we can say that course of arteries is partially tortuous. Analysis of venous vessels shows good distinction of venous sinuses and subarachnoidal cisterns. We can conclude with great certainty that the changes occur in position, caliber and relationship among vessels in fetus during the period of brain sulci and gyri formation.

Significance of establishing collateral circulation by leptomeningeal anastomoses in the occlusion of arteriae cerebri mediae.

We have investigated establishment of collateral circulation in patients with cerebral circulation disorder. Thirty angiograms of patients treated at Neurological Department of Hospital Centre in Sarajevo suffering from arteriae cerebri mediae occlusion were used for this study. Cerebral anastomoses that included connections between arteriae cerebri anterior and arteriae cerebri mediae over leptomeningeal anastomoses occurred in some patients suffering from occlusion of this arteriae. It was concluded that the majority of anastomoses existed between big leptomeningeal branches of postcommunicant segment of a. cerebri anterior and branches of cerebri mediae. These collaterals are of great significance as their functional ability is sometimes of a high degree in cases of occlusion of one or the other artery. It can be concluded that anastomosing of the blood vessels increases their volume in the whole and therefore more blood can be provided, although physiological factors should not be neglected, as functional effectiveness of collateral circulation in postocclusive states depends also on the state of the whole cerebrovascular system, then on the speed of creation of occlusion (thrombosis or embolism), systemic arterial pressure, volume and viscosity of the blood.

The significance of the extracranial-intracranial anastomoses of carotid system in occlusion of internal carotid artery.

The existence of collateral circulation in patients with impaired intracranial circulation was studied. We analysed angiograms of 35 patients of the Neurology Clinic of Clinical Centre in Sarajevo with occlusion of internal carotid artery. In majority cases collateral circulation was not established. In patients with occlusion of internal carotid artery, extracranial-intracranial anastomoses were established in some cases, with results of surviving and patients recovery. Collateral circulation based on blood vessels which are formed in the early stages of fetal life. Some embryonal arteries undergo an involution process, while the other part of blood vessels stay unfunctional during life, until cerebrovascular disease appearence, when it comes to their activation. Establishing of the collateral circulation in post-occlusiv status depend on great number of factors: number of anastomoses, their calibre,velocity of occlusion and complete vascular status of patients.