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Faruk Konjhodžić

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The first brain operation in Bosnia and Herzegovina was performed in the Muslim Charity Hospital (Vakufska Bolnica – Vakuf Hospital) in Sarajevo in 1891. In fact, three brain operations were performed in that hospital. All of the three patients operated on had sustained head injuries several months prior to the operation, and subsequently, they suffered from epileptic fits caused by bone fragments in the brain. The operation consisted of craniotomy, removal of the bone fragments, and closure of the dura matter. The epileptic fits ceased in all patients following the operation. The above indicated operations were performed by Dr. Carlo Bayer. The hospital was founded in 1866, and it is generally considered the first modern hospital in Bosnia and Herzegovina

Early posttraumatic epilepsies (EPTE) are epileptic attacks that appear in first seven days after brain injury, with incidence of 3-5%. Predictors for development of EPTE are: impressive skull fracture with rupture of dura, intracranial haemorrhage, neurogical deficit (brain contusion), and posttraumatic amnesia longer than 24 hours. It is more common in children than in adolescents and adults. It carries four times increased risk for development of late posttraumatic epilepsy. Aspects of pharmacological prophylaxis was often considered, but scientifically neglected, without clear standings regarding controversial data in literature. Patients with severe head injury, hospitalised at Neurosurgical Hospital and Pediatric Hospital, Clinical Centre University of Sarajevo, in period from 6th of April 1992 till 1st of July 1994, were included in study. Prophylaxis of EPTE was carried out with phenobarbital (2-3 mg/kg) or phenytoin (3 mg/kg) parenterally. Decision was made upon clinical findings. CT scan was done in 13.5% patients, and in 31.9% patients serum concentrations of antiepileptic drugs were monitored. 310 patients aged 0-18 years (105 patients 0-10 years, and 205 patients 11-18 years) were investigated. Predictors of EPTE presented were posttraumatic amnesia longer than 24 hours in 90.6%, neurogical deficit in 86.45%, impressive skull fracture with rupture of dura in 81.3% and intracranial haemorrhage in 40.6%. Only two boys developed EPTE in first 24 hours after injury. This study has showed that use of antiepileptic drugs can decrease incidence of EPTE. However, problem remains, management of injured patients is still highly individualised, based on different experiences of doctors that treat patient, and without clear guidelines.

The authors presented work of Muslim Charitable Hospital in Sarajevo, which was established in the year of 1866 and the reason why Lands Hospital was also established in the same city. They presented the latter and the first five years of its functioning too. They also presented six figures, which undoubtfully argued that Land Hospital was not builder for domestic inhabitants already for medical purposes of occupational troops and all those, which was coming with them. But domestic inhabitants very soon occupied almost all beds in new hospital, because hospital was established allotted and sanitary occasions in Bosnia and Herzegovina irrespective of many community hospitals were not finished and ended with the Muslim Charitable Hospital, because of its small capacity and arising of necessities of inhabitants.

Islam has initiated fast development of health system worldwide, as well as in Bosnia. That progress is, primarily, a result of faith that is not only a religion, but also a philosophy of life in general. Islam prefers studying and science, and it brings many precise statements on hygiene in all aspects of human life. Naturally, that resulted in many laws, institutions and activities in all aspects of health system. That has happened 800 years before sanitary inspection in Europe was established. Author made a question: Why and how public health has developed in islamic countries so many years earlier than European science began to deal with it? God's will, that had illuminated mind of an alphabetic shepherd, illuminated man's mind. So, islamic rules have posed the direction to be followed.

The article presents an overview of 14 months of operational experience in prehospital cardiopulmonary resuscitation and the data collected during this period from the RMS Centre, Sarajevo. Between June 1996 and August 1997, the EMS teams dispatched from EMS Centre resuscitated 106 cases of non-traumatic respiratory and cardiac arrest. The data includes analyses of the reasons for this vital stoppage, employing standard measures for classifying each case. From the total number of cases studied, 18 patients were successfully resuscitated (16.98%), and with spontaneous respiration and circulation, were transported to the emergency room, but only six patients were released from the hospital after definite treatment (5.66%). The conclusions drawn from the study indicate that CPR is the most critical factor in the successful prehospital resuscitation of cardiac arrest victims, and that educated non-professionals can play an important role in life-saving during the critical period prior to the arrival of EMS providers. More work on this topic (i.e. Community education and information) is clearly needed in order to better understand the practical implications of this assertion.

In the pleiad of the great names from the Golden Age of the Arabian medicine: at-Taberi, ar-Razi, al-Magusi, al-Baitar, al-Zahrawi, ibn-Sina, ibn-Haitam, ibn-Zuhr, ibn-Rushd, ibn-Nefis the important place belongs to the physicians-practitioners--many of the applied methods by the Arabian doctors were forerunners of the contemporary diagnostic or therapeutical methods. Later the methods were modernized by the great surgeons Ambroise Pare, Agnew, Hunter, Warren, Billroth, Mayo et al. No doubts, the methods and instruments of that time were primitive and the possibilities for research work, difficult. Because of this reason a respect should be given to those great man in the history of medicine.

In the course of the past 100 years of the Regional Hospital, the Clinical Centre now experienced a number of organizational, functional and technological changes. There 6 striking periods: 1. Period of the Regional Hospital in Sarajevo, 1894-1918; 2. General State Hospital, 1919-1940; 3. World War 2, 1941-1945; 4. Clinical Hospital of the Medical Faculty in Sarajevo, 1946-1974; 5. University Medical Centre in Sarajevo, 1974-1992; 6. Clinical Centre of University in Sarajevo, since 1992 to the present days. From the modest building like pavilions, the Regional Hospital in Sarajevo became a modern Clinical Centre, 40 units, Institute of Research Work and the developed secondary and terciary health protection, except cardiosurgery. The Clinical Centre and its staff are the true heroes of the war, who succeed in the past two years to extend over a million of helps, nearly 20,000 surgical operations, over 1,5 million of diagnostic treatments, more than 100,000 psychotherapeutical treatments, more than 3,000 deliveries, etc. All that was performed in the extra-ordinary difficult circumstances, without electricity, the damaged equipment, reduced medical staff and shortage of the medical materials and drugs. The Clinical Centre was awarded by the UN for humanity and human rights, 1983 and the Humanist of the Year in B&H in 1993.

K. Custović, F. Konjhodžić, K. Arnautović

A series of 129 cases of spontaneous intracerebral hematomas of ganglio-basal and thalamic localization was studied. Out of the number, twenty were thalamic hematomas. Only hematomas of hypertensive and unknown etiology were analysed. In all patients included in the study, the diagnosis was established using clinical methods and confirmed using radiological methods. Thalamic hemorrhages were treated conservatively, while those of ganglio-basal localization were treated both conservatively and surgically, depending on localization and initial clinical picture. The results of the treatment and quality of life in survivors were directly dependent upon the clinical and radiological parameters.

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